Shared governance keeps ED nurses, patients happy
Ranking in 95th percentile or higher for 10 years
Garnering patient satisfaction scores in the 95th percentile is impressive, but doing it for 10 consecutive years really makes people sit up and take notice.
That's exactly what's happened with the ED at Southwestern Vermont Medical Center (SVMC) in Bennington. The department is one of 12 winners of the newly created Summit Awards, presented by Press Ganey Associates of South Bend, IN, to departments rated in the top 5% of the nation in terms of satisfaction for the last three years. A total of 925 EDs were surveyed.
As a matter of fact, says Sheila Ritoch, RN, director of critical care services, the department has been in the 95th percentile since 1997 and, in 2000, it hit the 99th percentile. It ranked in the 98th percentile for 2006. She gives much of the credit to the shared governance model of nursing in the department. "The nursing staff have a say over what our practices are," Ritoch explains. "For example, they sit in on all interviews for potential candidates who have applied for positions." Southwestern Vermont is a magnet hospital, which is a gold seal of approval given by the American Nurses Association to facilities that pass a rigorous survey.
Attracting the best RNs
When you are a magnet hospital, one benefit is that you are able to attract and keep the best nurses, says Daniel Perregaux, MD, the ED medical director.
During the interview process, Ritoch and the nursing staff evaluate not only nursing skills, but attitude and communication skills. "We try to focus on someone who has a good sense of humor and a positive attitude," she says.
Nurses also sit on the policy and procedures committee, Ritoch says. "Any changes that are coming down, any equipment buying, anything that is going to impact their practice, we discuss and talk about the best way to implement it," she says.
How does this translate into improved patient satisfaction? "When nurses feel they are heard and have control over their practice, it gives you a satisfied nurse with a positive attitude," Ritoch explains. "There isn't a single nurse here who does not have their focus on the patient."
The nurses in the ED realize that patient perception is reality, says Ritoch. "If the patient feels unhappy, they know there's something we could have done better," she says.
Making it better
When patients do express dissatisfaction, the nursing staff have the ability to give them a coupon they can use in the hospital gift shop. They often go beyond the call of duty to make an unhappy patient happy again.
"One time a little boy broke his arm, and the paramedics had to cut his 'Hard Rock Café' T-shirt off," Ritoch recalls. "He was heartbroken, so the staff took it upon themselves to go out and get him a new T-shirt." On other occasions, she says, they have purchased coupons for groceries.
When complaints reach her desk, Ritoch sends a note to the nurse to discuss the matter. "Our approach is: What can we do to change perception the next time?" she says.
Another key to higher satisfaction levels has been a change in the staffing patterns, which came in the wake of studies on turnaround time to discharge, she says. "We looked at what our busiest times were and tried to adjust staffing between 10 a.m. and 10 p.m.," she says. "We start with one number of RNs at 6 o'clock, add more at 8, and then at 10, so we always have the right amount for the quantity of patients."
The staffing model for physicians and physician assistants (PAs) has changed in recent years as well, says Perregaux. "One local hospital closed, and the volume came to us; we responded by increasing our PA staffing over the years," he reports. "This way, we can see patients quickly and make sure they get the care they need."
Ritoch says a remodeling of the ED also has contributed to patient satisfaction. "We installed TVs and phones in all the rooms," she says.
New protocols help
Perregaux is convinced that his active CME program and updated protocols also benefit patient satisfaction.
"We have a very aggressive program for maintaining airway certification. We've started work on triage protocols to facilitate care for pneumonia and sepsis, and we have had long-standing stroke and cardiac care protocols," he says. "This enables us to rapidly initiate care, and even if the patient is really ill and unaware, the family sees what we are doing and takes notice."
Administrative support is critical, he adds. "I've worked at various facilities across the country, and without reservation, this facility's administrative interaction with the medical side is remarkable and dramatic," he says. "We feel our opinions and observations are being heard, and that extends very directly to patient care."
Sources
For more information on the shared governance approach to nursing, contact:
- Daniel Perregaux, MD, Emergency Department Medical Director; and Sheila Ritoch, RN, Director of Critical Care Services, Southwestern Vermont Medical Center, 100 Hospital Drive, Bennington, VT 05201. Phone: (802) 442-6361.
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