The Appleton unit's results have exceeded expectations. Length of stay and cost of care per stay on this unit have both fallen 20%. Nursing productivity increased, which enabled the hospital to increase patient throughput and care for more patients. Patient satisfaction went up 30% to the 90th percentile, and staff satisfaction is very high, Hetherington says. The healthcare system will roll the collaborative care model out to all acute-care units over the next four years.
New nursing roles
Few CEOs know as much about what keeps nurses happy as Chilton Memorial Hospital President and CEO Deborah Zastocki. Not because she's a long-time hospital administrator and an experienced nurse (which she is), but because she's spent the past few years surveying nurses and nurse managers to determine what will make them happy—and keep them happy.
"Before you start making changes, you really need to ask people who are in the role currently and, even more importantly, you need to start asking the questions of people who might be in your potential leadership groups. What's important to the group that's in charge now may not be what's important to the group that's potentially coming up," Zastocki says.
Zastocki's interest in this area is two-fold. As the leader of a 256-staffed-bed community hospital in Pompton Plains, NJ, she wants to do all she can to keep good workers on board. But nursing satisfaction and healthcare in the future was also the topic of her recently completed doctoral dissertation. As part of her research, Zastocki surveyed nurse managers throughout New Jersey.
Her research showed that most nurses were less interested in the dollar signs attached to a job and more interested in the opportunities an organization offers. Of primary importance was a work-life balance—something that's not always found in traditional nursing leadership positions.
Nurse managers told Zastocki that they wanted flexibility—involvement in decision-making and the ability to make lateral moves across departments—opportunities that Chilton already offers or plans to offer in the future. Zastocki also plans to hire more clerical people to help with the administrative tasks that overwhelm many nurse leaders.
Like ThedaCare, Chilton is increasing staff involvement, hoping it will attract and keep good employees. Recently, the hospital created the RN First Assist (RNFA) Program to help better staff the operating room. The OR is not typically an area in which new nurses want to work, says Zastocki, because college nursing programs don't spend a lot of time teaching about it and it's perceived as less desirable than other units.
To educate nurses about the OR, Chilton offers internal training through a six- to eight-month mentorship program in which nurses learn OR skills and how to handle different types of surgeries. Those who want to expand their knowledge beyond the program can then participate in RNFA training.
RNFAs are more involved in the surgical process than typical RNs. They can participate in suturing and other more complex tasks, assist surgeons on scheduled and unscheduled cases, and work closely with the doctor on each case. The program has been successful, Zastocki says, by providing horizontal growth opportunities for nurses and solving Chilton's OR staffing needs.
A retreat for all
New employees at the 141-staffed-bed Griffin Hospital in Derby, CT, become engaged almost the minute they walk through the door. While most organizations have some sort of employee orientation and training, few send every employee to an off-site, overnight retreat like Griffin does.
The retreat is a two-day overnight stay at a local convent conference center, says Bill Powanda, Griffin vice president. "Every employee at Griffin is considered a caregiver, so every employee goes—from security to housekeeping to business staff to nurses," he says.
The retreat was designed in 1992 to re-create the patient hospital experience for employees, but the added benefit has been empowered and loyal staff, Powanda says.