Code Lavender, escape rooms, professional development and flexible scheduling are just some of the nurse initiatives top hospitals are implementing to create an excellent nurse workplace.
In August, Nurse Journal, a career and education resource website, ranked 15 hospitals as the top for nurses to work at. They determined the top 15 hospitals by using rankings from CMS, the American Nurses Credentialing Center Magnet Recognition Program, and the Hospital Consumer Assessment of Healthcare Providers and Systems Patient Survey as well as the following criteria: patient satisfaction scores, safe staffing levels, hospital safety measures, nursing career opportunities, benefits, workplace environment and ratings from nurse reviewers.
Here, six leaders break down their goals for nurses that improve patient care and work culture:
Margarita Baggett, MSN, RN. Chief Clinical Officer for UC San Diego Health: As a top ranked hospital, there is a strong emphasis throughout nursing to foster a sense of belonging and ensure all team members feel safe and are encouraged to speak. This ties into the strategic foundation at UC San Diego Health to break down structural racism and develop strategies related to training on diversity, equity and inclusion and to implement action plans. All nurse leaders go through multiple education events over the year to learn about the implications of racism on teams and patients and how to break down these harmful structures.
In nursing, the aim is to outperform the previous year when it comes to nurse sensitive indicators. Reducing harm to patients through monitoring and implementing action plans to improve NSIs is a large part of the nursing strategic plan. NSIs are specific patient outcomes, influenced by nursing care, such as prevention of falls, pressure injuries and certain infections. Using our Daily Engagement System, all units are asked to identify the greatest area for improvement and target efforts toward reducing those risks to patients. Data is available to measure outcomes over time and DES is used to report progress toward goals, escalate barriers and allocate resources. To help improve patient experience, inpatient nursing is working on quietness at night projects at the unit level and partnering with the Experience Transformation Department to identify root causes and determine evidence-based interventions. Quietness projects were identified as an opportunity for improvement across the inpatient units using experience data. Lastly, nursing has implemented exit interviews to better understand why nurses leave the organization to quickly address barriers to nurse retention.
Dina Dent, DNP, RN. Vice President and Chief Nursing Officer at Inova Health System (Falls Church, Va.): Some of the key goals within our nursing enterprise include:
- Encouraging RNs to practice at the top of their licenses, to empower them with the autonomy and resources they need to provide the best care possible while advancing their nursing careers.
- Promoting nursing career growth through Inova 's ADVANCE Clinical Ladder Program. Just last month we graduated our first-ever RN5 nurses, who lead by their example and will help mentor our next generation of great nurses.
- Enhancing our sharded government structure to ensure that every nurse's voice is heard.
- Streamlining documentation house-wide and piloting virtual nursing on several of our units, to diminish the administrative burden and allow nurses to spend more time at the bedside.
- Continue to decrease our dependency on agency nursing. At Inova Fairfax, we are down 19% on our use of agency nursing compared to 2022, a savings of about $14.8 million.
- Continue to decrease our nursing turnover rates. In December 2019 our nursing turnover rate was 17.2%, as of August 2023 we are now at 14.32%.
Brandee Fetherman, MSN, RN. Chief Nursing Officer at Morristown (N.J.) Medical Center: We are actively engaged and continuously enhancing our patient experience initiatives. We celebrate "Extraordinary Caring" monthly by celebrating exceptional patient care stories at our leadership meeting. It is the best part of the meeting, and we often bring back the patients or family members to share their stories.
Professional development opportunities for our nurses is a key component to enhancing the patient care we provide. They also continue to provide support and encouragement for our nursing professionals to reach for higher competencies as part of their ongoing professional and career development.
In addition, we are fortunate to have Atlantic Health System's Institute for Bioskills Training and Innovation that offers a wide variety of simulation training and education exercises, both in the lab as well as in the hospital setting. We have also developed creative ways to collaborate and learn together, such as escape rooms which were really fun, and other new and different ways of learning to bring out the best in the entire team.
Ryannon Frederick, MSN, RN. Chief Nursing Officer at Mayo Clinic (Rochester, Minn.): The priorities we've established for our nursing colleagues fall into three areas: transforming the practice, supporting the workforce and accelerating nursing research.
- In practice transformation, we want our nurses' work environment to change significantly. We want to decrease the documentation burden so nurses can focus on hands-on patient care. These transformations include testing tools that incorporate automation and artificial intelligence, improving communication and introducing new care delivery models such as virtual care.
- For our workforce, we are creating an environment that is superior for the nurse and supports retention. Our diverse front-line nursing staff recently shared that they don't see diversity reflected in leaders, making it harder to recognize a pathway to grow in their skills and careers. We took their feedback to heart and are working toward diversity in leadership that reflects the diversity of our staff and communities. In addition, we just began a mentorship program for diverse staff to connect with a leader who will help them develop in the trajectory they want to grow professionally. We continue to grow and improve our professional governance models so nursing staff feel empowered and equipped with training, change and career opportunities.
- In support of nursing research, we're building the base of scientific evidence around the care our staff provides and the challenges our staff, patients and their families face. The most exciting part is developing teams of direct care nurses and nurse scientists to solve clinical problems they see and experience at the bedside. We're also growing the number of nurse scientists through educational scholarships and an internal professional development program.
Joye Gingrich, BSN, RN. Chief Nursing Officer and Vice President of Patient Care Services at UPMC Harrisburg (Pa.): Nursing goals for the year are focused on quality of life, well-being and professional development. We want to ensure nurses are aware of professional growth and development opportunities and support them to pursue.
The transition of graduate nurses into professional practice can be both exciting and challenging, so UPMC's My Nursing Residency is an extensive program designed to support new nurses during the transition from student to nursing practice. The UPMC My Nursing Career Ladder offers more opportunities and accelerated growth, plus greater compensation, which is more attainable for nurses.
Flexible scheduling is another key priority. UPMC Harrisburg offers a web-based scheduling solution that allows nurses to have greater influence over their schedule. Weekend and night programs provide additional compensation to reward nurses interested in working off-shift.
Mary Beth Thoburn, BSN, RN. Chief Nursing Officer of Cleveland Clinic Fairview Hospital: We spend a great deal of time focusing on a culture of safety and high reliability. All nurses participate in online learning followed by team discussions on speaking up. Specific tools for improving communication are reviewed and discussed. This initiative is inclusive of nurse-patient communication, as well as caregiver-to-caregiver communication.
Attending to the emotional needs of our caregivers is a priority for our entire organization. To that end, we have implemented Code Lavender to support a team that has endured a particularly stressful patient or caregiver event. The code is supported by our spiritual care colleagues who bring a basket of snacks, inspirational messages and aromatherapy tools to the team. They hold a brief huddle to acknowledge the event, allow for the team to express their thoughts and then provide support for the next several days.
Our Emerge Stronger program provides peer-to-peer support to those experiencing emotional distress. Peer mentors are trained to provide support to other caregivers. This is a short-term relationship to encourage nurses to share their experiences and feelings with a trusted peer. Finally, we have a nurse ethicist on our team who provides clinical consults as well as education to nurses on moral distress. We continue to explore flexible scheduling options to support work and life integration and enhanced job satisfaction. Our clinical goals are determined by our teams as they review nurse driven patient outcomes. Benchmarking with other healthcare organizations allows us to measure our performance and collaborate with others to share best practices.