Nurse Retention Report
Does nursing at your hospital matter?
Hospitals exist to provide nursing services. If patients did not need 24/7 nursing care, they would be in an outpatient setting. Since the main reason patients are hospitalized is for nursing care, we must strengthen its delivery to improve patient care, reduce errors and improve patient satisfaction.
| Nursing excellence | Ratings review--Meta critic of hospitals | also measure retention for nurse managers |
| Autonomy | What causes moral distress? Intersex surgeries, nurses forced to intubate old people, give away free formula | care coordinators and our piece |
| Seats at the table | alarm fatigue our piece | |
Nurses week celebrations |
Fully embracing the value of nursing, treating nurses with respect and like respected professionals so to bring out their true value to patient care and the hospital's concerns to prevent errors
These changes don't necessarily involve spending more money
| Hiring, firing and supervising | ||
| A | Entirely a nursing decision (no physician involvement) | |
| B | ||
| C | ||
| D | Technically a nursing decision, but nurse managers are weak and buckle under pressure from physicians. Nurses get fired or disciplined for displeasing a physician, even if they are doing right by the patient | |
| F | Physician involvement in nurse hiring, firing or supervising | |
| Ethics comittee representation of nursing | ||
| A | At least half of the ethics committee is composed of nurses. The ethics committee is readily available 24/7 for any disagreement, no matter how slight. | |
| B | ||
| C | ||
| D | ||
| F | There are no nurses on the ethics committee | |
| Nurses in control of the hospital, which is a nursing institution | ||
| A | >50% nurses on board of trustees CEO is a nurse CNO reports to the CEO Nurses providing nursing care, All RN institutions. Nursing assistants assis the nurses, not the patients |
|
| B | ||
| C | ||
| D | The CEO is a non-nurse, non-physician. | |
| F | CNO reports to the CMO. |
|
| Seats at the policy making table | ||
| A | Nurses make up at least half of 100% of policy-making bodies | |
| B | Nurses make up at least half of >50% of policy-making bodies | |
| C | Nurses have seats on 100% of policy-making bodies, but make up fewer than 50% of the members of these bodies | |
| D | ||
| F | Nurses have seats on fewer than 25% of policy-making bodies | |
| Do physicians have firing authority over nurses? | ||
| A | ||
| B | ||
| C | ||
| D | Physicians are able to eject nurses from the OR or other patient rooms | |
| F | ||
| Space 10 | ||
| A | ||
| B | ||
| C | ||
| D | ||
| F | ||
Promoting nursing to the community
| Public relations representation for nursing | ||
| A | Half of the PR staff devoted solely to nursing | |
| B | ||
| C | ||
| D | 1 PR staff devoted solely to nursing | |
| F | Zero PR staff devoted solely to nursing | |
| Website representation for nursing | ||
| A | Nursing is touted to patients as being of prime benefit. All nurses appear on the website with biographies, photos and contact information | |
| B | ||
| C | ||
| D | ||
| F | Magnet status is hidden | |
Respect
| Hall of Fame | ||
| A | No nurses among the honored and respected founders and leaders at the hospital. Photos on the walls only of non-nurses | |
| B | ||
| C | ||
| D | ||
| F | ||
| Nurses week celebrations | ||
| A | Designed to increase understanding and respect of nursing | |
| B | ||
| C | ||
| D | Cups of coffee | |
| F | Flowers, hearts, angels, teddy bears |
|
| Marginalization: Parking policy | ||
| A | Everyone who parks at the hospital is charged the same amount | |
| B | ||
| C | ||
| D | Everyone who parks at the hospital is charged the same amount. Patients and family members get a discount. | |
| F | Nurses the only ones charged for parking |
|
Patient care and experience
| Patient autonomy | ||
| A | Staff clearly know that patients are in charge of their care. There is no use of the phrase "doctor's orders," since it implies physicians are in charge of patients. | |
| B | ||
| C | ||
| D | ||
| F | ||
Environment
Noise A All health workers wear soft shoes, visitors are advised to wear soft shoes upon entry and through the website B C D F Staff allowed to wear loud shoes, automatic paper towel dispensers or hand dryers used, staff talks loudly at anytime, especially night
Family support system
| Visitors | ||
| A | Each patient has a private room in every setting in which they are lying down. Patients decide who they want to visit them Visiting hours are 24/7 Each room has space for at least 2 visitors to sleep |
|
| B | ||
| C | ||
| D | ||
| F | 30% or more patients share a room Staff or anyone besides the patient in control of who may visit the patient, who may not Visit hours are limited |
|
| Privacy and relaxation: Private rooms | ||
| A | Each patient has a private room in every setting in which they are lying down. Patients are not kept waiting in the hallway at any time. |
|
| B | ||
| C | Only shared space is in emergency and recovery | |
| D | 10% or more patients share a room | |
| F | 30% or more patients share a room |
|
| Music | ||
| A | Patients have access to music they control in every setting, especially surgery and invasive procedures | |
| B | ||
| C | ||
| D | ||
| F | No music in hospital, music forbidden in any setting, or muzak or smooth jazz piped in | |
| Family members at your side | ||
| A | Family members allowed at your side 24/7 with made beds and chairs for at least 2 | |
| B | ||
| C | ||
| D | ||
| F | ||
| Access to health information, and the latest research | ||
| A | Wifi, sites with latest research | |
| B | ||
| C | ||
| D | Written material with latest research, no wifi | |
| F | No wifi, no written materials | |
Improving Recruitment, Retention and Reimbursement by Strengthening and Promoting Nursng at Your Hospital
Are you read for ACA, CMS compare--don't lose your reimbursement. If you're not measuring nursing quality timeliness and effective care, statins, stroke education, discharge instructions. Voluntary at first, later will be tied to reimbursement. Are nurses trained on EMR, mandate for reimbursement, why not email, patient status, where family could submit information
Environment of hospital, bring it back to Nightingale
Medicare
Recruitment and retention is one of the
http://www.beyondintractability.org/bksum/fisher-beyondreason
Hospital Compare by Medicare http://1.usa.gov/1DuqYSm
Patients who reported that:
Nurses communicated well
Physicians communicated well
Received as soon as they wanted
Pain well controlled
Medicines explained before giving it to them
Clean bathrooms
Quiet rooms
They were given information about what to do during their recovery at home
They understood their care when they left the hospital
Hospital acquired infections
Death rate
Readmissions
Access to holistic providers beyond the usual, massage therapy, QiGong, Reiki...
Independent reimbursement for nurses
Falls and trauma, with 7,954 HAC-associated live discharges in FY 2009 and the first 10 months of FY 2010.
Deep vein thrombosis or pulmonary embolism (DVT/PE) following certain orthopedic procedures, with 4,195 HAC-associated live discharges in FY 2009 and the first 10 months of FY 2010.
Vascular catheter-associated infection with 5,167 HAC-associated live discharges in FY 2009 and the first 10 months of FY 2010.
Nurses should consider creating or enhancing websites to explain nursing, including the sites of their employers and professional groups. Websites are now the public face of an organization. Nursing schools often profile their faculty, letting the public know about professors’ credentials and interests. But it is still rare to find much about nurses on hospital websites, as we explained in chapter 10 in discussing the Truth’s 2012 analysis of the sites of leading U.S. hospitals.
Few websites highlight nursing care or the people who deliver it in any detail, much less the detail devoted to physicians. And site sections that do describe nursing seem to be aimed mostly at nurses themselves. For example, we have seen no websites that advertise a hospital’s Magnet status as a draw to patients—we have only seen it used as a nursing recruitment tool.
Massachusetts General Hospital’s site (www.massgeneral.org) does list the credentials of a small number of nursing leaders in some detail and it describes the work of many nursing teams, units, and programs. However, the descriptions appear with those of other non-physician professions under “Patient Care Services.” They appear to be directed at nurses rather than patients. And they are brief and bland, paling in comparison to the extensive, high-production-value promotion of the hospital’s medical departments, which boast about the qualifications and care of physicians. The site also has a page with links to information about the hospital’s Magnet Recognition, but little effort to make it comprehensible to anyone outside nursing; it’s hard to imagine a lay person spending time there.
Make sure that your institution’s website conveys to the public the key role nurses play in patient care. To develop a website, ask media relations professionals for help. You might profile each nursing service and individual nurses. The public should be able to learn who is doing the nursing, including the nurses’ educational background and credentials, as well as contact information so families and the public can get answers to their questions. Include headshots and contact information for each nurse, not just the top executives. What innovations have your nurses played a role in? Have their achievements been in the news or recognized by nursing groups? Explain how your institution is working to improve nursing care. Consider including photos, audio, and video. Be sure it is easy to get to the nursing material from the site’s main page. It may be more effective to integrate information about nursing in the site areas that promote the institution’s health field-specific institutes, centers, and departments—you know, where the sites tend to boast about their great physicians and suggest the physicians are doing or directing everything that matters—rather than in site areas labeled “nursing” or “patient care services,” where, let’s face it, members of the public are less likely to go. Some sites have a “Find a Physician” link from the main page. Consider adding a “Find a Nurse” link right next to it, so visitors can contact any nurse in the hospital.
Many people look for general health information on the Internet. Nurses can create websites to educate their patients or communities about health, and in doing so, illustrate nursing expertise. In today’s managed care environment, many patients get home after a hospital visit with little idea how to manage their conditions. They may not understand how to use their crutches, monitor their wounds, test their blood sugar levels, exercise, or avoid foods that put them at risk. Even when hospital nurses manage to give patients this information, patients may forget or simply be overwhelmed. The Internet can be a great way to fill this need and perhaps prevent future hospitalizations. If you do set up an informational website, consider becoming certified by Health on the Net Foundation, an international non-governmental organization that guides consumers to reliable health websites.
Electronic environment
Physical environment
Professional environment
Institutional Environment
Emotional environment?
Committees / Boards
Electronic environment
Website
Electronic health record
Physical environment
Signage
Structure of the floors
Parking spaces
Photos of hospital leaders listed on wall? Do they include nurses?
Professional environment
Is education about nurses included in physician orientation
Do physicians follow nurses in a shadowing program
Are M&Ms just for physicians?
Emotional environment
Decreasing violence and bullying, zero tolerance
People who throw scalpels go to jail
Committees / Boards
Nursing grand rounds
Are nursing committees fully funded and given power to effect change?
Continuing education for nurses--covered by hospital?
Patient satisfaction higher when nurses have a work environment in which they feel vallued
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores and other core measures in value-based purchasing will affect their payments.
"Medicare is very clear about this. Average performers won't break even"
Who matters? If the hospital's public face is that of physicians, and as patients travel through their hospital stay, they will experience a nurse-intensive stay they will be disappointed because they will feel as though they were ripped off, cheated because hospitals are supposed to be about physicians, right? That's
Medicare Surevey of patient experiences
Patients who reported that
they were given information about what to do during their recovery at home
they understood their care when they left the hospital
they would definitely recommend the hospital
who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)Death rate for heart attack patients
Readmissions, complications and death
Website
Nursing leaders on the website held in similar esteem to others?
Magnet on the main page? Is it directed at patients or just used as a nurse recruting tool?
Staff nurses held in as much esteem as staff physicians
Magnet directed at nurses, not patients
No nurses linked from mail, about us, providers pages
Signage
Institutional Environment
Public relations professionals promoting only physicians?
Board of directors, any nurses?
Find a Doctor / Find a Provider
Are nurses important to your institution?
Do they do outreach in terms of health minutes, health education through a website? Are nurses creating these educational materials? Publications that are sent to the local community, do they feature nurses? Is health educational material written by nurses?
Is nursing depicted as gendered? (Getting makeovers for nurses week?)
Is nurses week all about teddy bears and candy, or does it honor real nursing achievement?
Forms / computer / papers
Nurse-friendly language on records, software and to the public?
Electronic health records, do physicians see nursing notes?Medical / health homes
Name of institution a "Hospital" or "Medical center"
Names of committees
Use of the word "resident" and "doctor" are they limited to physician?
Maps internal and external, nursing deparments identified?
Explanation about nursing units, what type they are?
Staffing ratios listed every shift?
Nursing mix, pride in increased education?
Nursing CEUs matter?
Are nurses invited to committees?
Nursing research celebrated?
Do physicians or medical students have nurse shadowing days?
Is there a PR person just for nursing?
Each nurses face and bio appear on the website?
Nursing research and ideas promoted within and to the public?
Physician rounds done with nurses?
Nurses identified as such with badges? Are they pink?
Nursing uniforms look professional?
Artwork
Physician-only dining room
Physicians free food
Online or other videos aimed at the public or at health professionals
The public should be able to learn who is doing the nursing, including the nurses’ educational background and credentials, as well as contact information so families and the public can get answers to their questions. Include headshots and contact information for each nurse, not just the top executives. What innovations have your nurses played a role in? Have their achievements been in the news or recognized by nursing groups?
Explain how your institution is working to improve nursing care. Consider including photos, audio, and video.
Be sure it is easy to get to the nursing material from the site’s main page. It may be more effective to integrate information about nursing in the site areas that promote the institution’s health field-specific institutes, centers, and departments—you know, where the sites tend to boast about their great physicians and suggest the physicians are doing or directing everything that matters—rather than in site areas labeled “nursing” or “patient care services,” where, let’s face it, members of the public are less likely to go.
Some sites have a “Find a Physician” link from the main page. Consider adding a “Find a Nurse” link right next to it, so visitors can contact any nurse in the hospital.
TAN, “Nursing Representation on the Websites and Boards of Directors at the Top 17 Hospitals Ranked by U.S. News and World Report in 2012” (March 2012), http://tinyurl.com/n8hp4kr.
Contact Sandy Summers by email ssummers@truthaboutnursing.org
Office phone 410-323-1100
Cell 443-253-3738
Educate the world that nurses save lives!
