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The Impact of Nursing Excellence on 'Pretty Much Everything in Healthcare'

Analysis  |  By Jennifer Thew RN  
   February 28, 2020

There is a strong correlation among nursing excellence and patient loyalty, physician engagement, and clinical outcomes, finds a new Press Ganey report.

Nurses are everywhere. They're at the bedside, in patients' homes, in outpatient clinics, in schools, even in the C-suite and the board room. We know their numbers are many—just over 3.8 million registered nurses nationwide.

Now, thanks to a new Press Ganey 2020 Nursing Special Report: The Far-Reaching Impact of Nursing Excellence, there's data to show nurses have power in those numbers and can produce positive and far-reaching outcomes within a healthcare organization and the healthcare system at large.

For the report, nursing excellence was defined in terms of the five domains that make up the American Nurses Credentialing Center’s Magnet Recognition Program® model:


1. Transformational Leadership

2. Structural Empowerment

3. Exemplary Professional Practice

4. New Knowledge, Innovations, and Improvements

5. Empirical Outcomes

The report's findings showed a strong correlation among nursing excellence and patient loyalty, physician engagement, and clinical outcomes.

For example, when the Press Ganey researchers compared performance on measures of patient experience between Magnet® and non-Magnet hospitals, they saw consistently better performance in Magnet facilities. In an analysis of Press Ganey patient experience scores, "the respective percentages of mean Top Box scores for the global Likelihood to Recommend measure for Magnet and non-Magnet hospitals were 75.0 and 70.9. The Top Box score percentages for Overall Rating were 75.4 and 73.4, respectively," according to the report.

Additionally, the report found that a culture that supports nursing excellence positively influences patients' perceptions of physicians. The study found that compared to non-Magnet hospitals, Magnet hospitals had higher percentages of Top Box scores and higher mean scores for patients’ perceptions of:

  • Physicians' concern for patients' needs
  • How well the physician kept the patient informed
  • Physician skill
  • Physician friendliness and courtesy
  • Physician responsiveness to patient concerns
  • Inpatient admission speed

"It reinforces and affirms what I've known all along: the impact that nursing [has] on pretty much everything in healthcare and healthcare organizations," says Christy Dempsey, DNP, MSN, MBA, CNOR, CENP, FAAN, chief nursing officer at Press Ganey. "But nursing is an evidence-based profession and, certainly, we are an evidence-based company, so we really needed the data to make sure that was, in fact, the case. We found that nursing excellence impacts physician engagement, clinical quality, patient experience, and nurse experience."

In a recent interview with HealthLeaders, Dempsey reflected upon the study's findings and results. The transcript has been edited for clarity and brevity.  

HealthLeaders: Beyond Magnet designation, how do you define nursing excellence?

Christy Dempsey: We did use Magnet as the marker for analysis of nursing excellence. But what we found in terms of the characteristics associated with nursing excellence were developing and advancing strong nurse leaders who advocate for patients [and] also for nurses; an organizational structure that supports shared governance; having nurses at every level making decisions; making sure that you are measuring and looking at the data and establishing those performance benchmarks; promoting autonomy for nurses within that shared governance framework; implementing care models that optimize outcomes that include [things such as] patient experience and workforce engagement in addition to clinical quality outcomes; nurturing the culture of interprofessional [teamwork];  and the ability to grow and develop in the organization and within the profession, all within a framework of high reliability.


HL: If you walked into an organization with a strong presence of nursing excellence, what would that look like on a day-to-day basis?

Dempsey: I think absolutely it boils down to culture, but I think as a patient, you know it when you see it. As a nurse, you know it when you see it. I think a culture of nursing excellence is pervasive throughout an organization and it is tangible because all of those characteristics I talked about previously are in place.

HL: How does nursing excellence influence patients' perceptions of their care?

Dempsey: [When we compared] Magnet organizations to non-Magnet organizations, what we found is that nurses are more satisfied with their work environment [within Magnet organizations]. We have found repeatedly that work environment is critical, and nurses are more likely to stay in their job at a Magnet organization. They feel like they have more opportunities for development and more autonomy to lead care and to practice at the top of their licenses. We know that those things impact the patient experience, the data bears that out.


HL: One of the interesting things from the report is that nursing excellence influenced patient assessment of physicians and physician engagement. Can you talk a little bit about that and what your assessment of this finding is?

Dempsey: Healthcare is a team sport. Clearly, none of us can do it by ourselves. We all went into this business with the goal of helping and healing. When we have a culture that supports those inherent rewards and the fact that we are in a noble profession and that we are able to help and heal, I think collaboration, teamwork, and mutual respect help those inherent rewards outweigh the stress and distress that comes with [working in healthcare].

HL: Besides Magnet designation, what are some other ways that organizations can elevate nursing excellence?

Dempsey: I think nursing excellence is a journey. It doesn't require designation. I think the attributes that we talked about before, the domains for Magnet, all of those can be a part of a journey to nursing excellence that any organization can achieve. So regardless of whether you're going for Magnet designation, every organization should be on the journey in working toward excellence.

HL: What specific actions do you recommend nurse leaders take to boost nursing excellence? Where should they focus their efforts?

Dempsey: The first thing you have to do is make sure you know the current state of the nursing culture, including the safety culture. Again, the work environment is so critical. [You must] understand where you are right now and then define what the nursing professional practice model is going to be.

You need to identify where are you, where you want to be, what the gaps are, and how you are going to address those gaps. You have to have data transparency and a communication plan around that data. It's not enough just to post the data. You have to understand what the data means, what it's telling you, and build stories around that data. It's about making sure that you understand when you're tracking the metrics, the benchmarks, and the outcomes how that translates into a return on investment.

HL: Anything else you want to highlight about the findings?

Dempsey: I think everybody understands that nursing—most certainly acute care organizations as well as across the continuum—is the biggest line item on the budget. But [it is] also the front line of care. [Nurses] spend time with patients, and not only provide clinical care, but also coordinate care and manage the transitions of care throughout the continuum. They communicate, advocate, educate, and comfort. I think that [shows in] the patient's perception of their care experience. [The patient] notices. Those organizations that invest in the journey to nursing excellence, which everybody should be on, are best able to leverage the skill, the compassion, and the true passion [of] nurses.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


Organizations with strong cultures of nursing excellence receive higher 'Likely to Recommend' Top Box scores

Patients' perceptions of physicians are influenced by the presence of nursing excellence.

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