The Highest Level of Care
Angelica Tellgren, RN, learned the magnitude of being a nurse at The Nebraska Medical Center in a very unlikely place.
While waiting in line at a local Walgreens to pay for a prescription, Tellgren realized she was short on cash and without her credit card. As she apologized and told the pharmacist she would have to return, an elderly woman behind her insisted on paying the difference saying, “The doctors and nurses at The Nebraska Medical Center have saved my life many times, this is the least I can do.”
That brief encounter was one that will always be powerfully engraved in Tellgren’s memory. It now serves as a daily reminder of the important role of the nurse and the significant impact she can have on the lives of others.
“This incident made me really proud to be a nurse at The Nebraska Medical Center,” says Tellgren. “It’s made me want to come back to work and try even harder every day to live up to that higher standard and to strive to be an excellent nurse.”
Nursing care excellence at The Nebraska Medical Center has been recognized in many new and uncharted places over the last few years.
In a recent validation of nursing excellence, The Nebraska Medical Center has been named one of the 2009 top 100 hospitals for nurses to work for by Nursing Professionals magazine. The Nebraska Medical Center placed 43rd in the ranking among a pool of more than 5,200 hospitals across the country. Hospitals are selected based on a survey that is sent to 25,000 randomly selected hospital nurses throughout the country that measures their job satisfaction.
According to Rosanna Morris, RN, senior vice president of patient care services and chief nursing officer (CNO), there are several factors that make The Nebraska Medical Center an attractive place to work. The first of these is the academic environment, which is conducive to innovation and provides a strong foundation in research. Other key components include the hospital’s close relationship with the University of Nebraska Medical Center (UNMC) and Clarkson Colleges of Nursing; a collegial and respectful relationship between the doctors and nurses; and a robust nurse governance system.
Nursing excellence has been a resounding theme that Morris has been able to affirm since she took the helm as CNO at The Nebraska Medical Center in early 2008. “Before I came here, I continually heard about the high level of professionalism, expertise, competency and ability to collaborate with medical staff,” she says. “What has been wonderful is that over the last year, I’ve been able to validate those perceptions.”
Morris says the role of nursing at The Nebraska Medical Center is held in high esteem and respect. “Nurses are the advocate and coordinator of care,” she says. “Our training and expertise are critical because we serve as the filter to ensure that the care being delivered is safe and appropriate and exceeds the needs of our patients.”
The commitment to nursing begins from the top down with the board of directors and CEO down to the medical staff, says Glenn Fosdick, FACHE, president and CEO of The Nebraska Medical Center. Fosdick has elevated nursing’s role in this institution by making it a c-suite position that reports directly to the CEO. “I look at the role of the CNO and CMO (chief medical officer) as my clinical advisors,” says Fosdick. “Whenever we have to make decisions that affect clinical care, I want the CNO and CMO to be a part of those decisions.”
The quality of nursing care has been a significant factor in helping The Nebraska Medical Center secure, for the fourth consecutive year, the J.D. Power and Associates Distinguished Hospital award. This distinction acknowledges a strong commitment by the medical center to provide “an outstanding inpatient experience.” J.D. Power surveyed patients after discharge from the hospital about their perceptions of the hospital stay, focusing on five key areas: speed and efficiency, dignity and respect, comfort, information and communication, and emotional support. According to the survey, patients gave The Nebraska Medical Center particularly high marks in the areas related to nurses’ concern about patients’ pain, comfort and overall well-being.
Many polls have shown that patients’ experiences are directly related to the care they receive from nurses. The nurse, who spends a significant amount of time at the bedside, plays an important role in supporting patient care and understanding the needs of the patient and family, notes Morris.
“Nurses form the basis and infrastructure from which care is provided,” she says. “This care is provided in partnership with multiple disciplines and under the guidance of our medical staff. When patients get to the point where they need more sophisticated interventions and observations in an acute care environment like The Nebraska Medical Center, the role of nursing is absolutely fundamental.”
The Nebraska Medical Center’s strong focus on continuous quality improvement as well as high nursing satisfaction are important factors that have contributed to a high level of quality care, says Morris.
Nursing satisfaction is at an all-time high. In the most recent survey, 90 percent of nurses responded. “Normally, a 30 percent response rate is considered good,” says Morris. “This implies that our nurses are interested, they’re engaged and they know their voices are going to be heard. When you have a high level of satisfaction among your nurses, patient satisfaction scores also tend to rise.”
After spending about eight years at another healthcare institution, Tellgren says she can speak from experience that there is a difference in the nursing experience at The Nebraska Medical Center. “Nurses are more respected here,” says Tellgren. “They are treated as highly respected members of the healthcare team. Everyone seems to be happier here and when nursing satisfaction is higher, I think that contributes to a higher quality of care delivered.”
Quality improvement at The Nebraska Medical Center is a top management priority for which nurses play a critical role. “Nurses traditionally represent the largest population in the hospital and as such, they are an integral part of the clinical setting and can make or break quality and safety,” notes Fosdick.
To help strengthen the nurses’ role in advancing quality, the medical center recently created a new position – director of Nursing Research and Quality-Based Outcomes. The role of this position is to lead nursing research, drive evidence-based practice and quality outcomes.
“Appointing a leader in nursing who is dedicated to quality and who understands what our outcomes are and how we measure ourselves with academic institutions across the United States raises that commitment to quality another notch,” says Morris. “It will allow us to focus within nursing and do even more performance improvement, which provides overall improvement in patient care.”
The Nebraska Medical Center’s focus on quality is paying off. Nursing quality indicators as measured by the National Database of Nursing Quality Indicators (NDNQI) have scored nurses at The Nebraska Medical Center consistently in the top 10 percent in all categories. Scores in a number of quality indicators are surpassing national benchmarks. This includes areas such as wound ulcer prevention, inpatient fall prevention, urinary tract infections and blood stream infections.
The level and complexity of nursing care provided at The Nebraska Medical Center is another factor that sets nursing apart from other hospitals. “As a tertiary care hospital, our nurses care for the sickest and most clinically challenging patients in the region,” says Fosdick. “As such, they are faced with multiple challenges and situations each day and at the same time must deal with patients and families who are undergoing incredible stress. Combine that with the fact that healthcare is continuously changing and The Nebraska Medical Center is at the forefront of change and new technology. This results in nurses who are some of the best and most qualified in the country. If you can work here, there’s no place in the country where you can’t work, because you will be exposed to the sickest, most complex and most advanced technology available anywhere.”
In 2007, The Nebraska Medical Center received one of the highest honors for nursing excellence that a medical center can receive when it was designated a Magnet Hospital by the American Nurses Credentialing Center (ANCC). The Magnet achievement is widely viewed as the “gold standard” in the nursing profession, and it is awarded to a select 4 percent of all hospitals nationwide.
“The components necessary to achieve the Magnet designation require institutions to really function a level above other hospitals – it’s going beyond the norm,” says Morris. “We have solid systems and programs in place to achieve high-end clinical quality, professional growth and development of staff as well as research initiatives.”
A shared governance system is an important component shared by all Magnet hospitals and one which is practiced with great pride and diligence at The Nebraska Medical Center. Each nursing department or unit elects representation to a unit-based council (UBC) that meets monthly to discuss patient care issues. Their ideas or concerns are then brought to a leadership council, comprised of representatives from each of the UBCs, which identify, clarify and respond to issues related to five areas of accountability. These include: nursing practice, performance improvement, research, professional development and management. And finally, the chairs of each of these five councils meet monthly with the CNO to maintain communication and develop strategic direction.
“The art of creating a strong nursing culture which leads to a strong nursing environment is about empowering nurses in daily nursing practice,” says Morris. “Through the shared governance system, our nurses drive nursing practice and protocols. All of our nurse leaders have a seat at the table to provide input into decisions that are being made that affect them and their working environment. This has created an environment of empowerment, engagement and ultimately, strong performance.”
According to Nicole Turille, RN, VNS, chair of the Nursing Practice Council, the shared governance structure has been key to driving nursing excellence, quality and satisfaction. “It gives us all a voice and allows us to have a say in our patients’ care,” she says. “It helps ensure we are giving the most current nursing care possible.”
“The Nebraska Medical Center appreciates and promotes a strong nursing care delivery model,” says Morris. “The hospital ensures that nursing has a seat at every table where decisions are made not only organizationally, but particularly those that impact nursing practice and patient care. Support, recognition and promotion of the value of the nursing profession in this organization is what separates us apart from other organizations.”