Nursing Excellence Makes a Difference to Patients

Last year I moved from Boston to a suburb just north of Charlotte, NC, and I recently needed to make a decision about which hospital I should visit. In Boston, I had been spoiled for choice, with a multitude of famous, big-name hospitals to choose from. Being new to North Carolina, I was faced with a more difficult choice as I knew nothing about the two big players in town.

I did some research and both places appeared to be outstanding. What made me choose one over the other? It was designated as an ANCC Magnet Recognition Program® facility. If I'm going to be hospitalized, I would rather be in a designated center for nursing excellence. Studies have shown that Magnet Recognition Program (MRP) organizations have better patient outcomes, higher nurse to patient ratios, lower nurse turnover, higher rates of nurses with advanced degrees or professional certifications, and happier nurses, which generally translates to happier and more satisfied patients.

Happier nurses improve satisfaction results, which must be regularly measured and benchmarked at MRP hospitals.

I wanted to know what makes nurses more satisfied at MRP-designated facilities, so I spoke with senior nursing leaders at Massachusetts General Hospital, my old stomping grounds. MRP-designated Mass Gen has also been rated highly in US News & World Report's annual list of America's Best Hospitals. It ranked No. 12 on the list for best nursing care (highest percentage of patients who said their nurses were "always" courteous, listened carefully, and gave clear explanations) and No. 7 for patient satisfaction.

Mass Gen's Chief Nurse and Senior VP for Patient Care, Jeanette Ives Erickson, says the culture of the organization creates an excellent nursing environment and high rates of satisfaction. At Mass Gen, the nursing culture has a unity of purpose, she says.

"What unifies us as a nursing service is the passion for our patients. We are very much a patient- and family-centered organization, and I think that's what helps to establish our unity of purpose," says Erickson.

Erickson notes nurses at the hospital are highly educated and that research and education are valued. Of the almost 4,000 RNs, 75.3% have at least a BSN, 7.2% have an advanced degree, and there are 55 doctoral-prepared nurses.

The organization also empowers its nurses to make decisions. "We have had a collaborative shared governance structure in place since 1997. So we have people who give the care at the table contributing to decision making about how we will take care of patients," says Keith Perleberg, director of nursing quality.

Susan Morash, nursing director, adds that accountability and authority rest with clinicians. "It's a big satisfier for them to know that bedside decision-making is supported and recognized," she says, citing the nursing practice committee, where nurses can decide together whether to make changes to their practice.

As chief nurse, Erickson meets each month with the staff nurse advisory committee that represents each clinical area in the hospital. "It's a wonderful opportunity for them to have dialogue with the chief about the things that are worrying them, such as facilitators and barriers to care delivery. They are not shy about bringing system-related issues, supply-related issues, anything that's on their mind. We solve problems in the moment, and they feel totally empowered," says Erickson.

I asked Erickson about nurse-patient ratios at her organization—a big satisfier for nurses and patients—and her answer shows why the organization's nurses rate it highly.

"At the end of the day, the staff nurses are the ones who are able to make a decision as to whether they need to have more people on duty or less people on duty," says Erickson. "They don't have to get my permission or the nursing director's permission to call someone in for help. They can just go ahead and do it. In my opinion, there is no bigger problem related to patient safety and quality than to have to seek permission when you need assistance to take care of patients. I view all of our nurses as leaders. They are very competent and they can make these decisions about what resources they need in the moment."

All these things set Mass General's nurses apart. "The happiness comes from satisfaction with work," says Morash. "At the end of the day, if you know your patients are getting great care, you're satisfied with your work, and you feel supported and valued, I think that's going to translate into friendliness."

Hospital patients, often scared, sick, and vulnerable, depend upon competent, professional, compassionate nurses. That's what they'll remember when they talk to family and friends, or when you've asked them to rate their experience.