There are plenty of lists that rank hospitals based on outcomes, awards and having top docs, but those good things don't always trickle down enough to make working as a nurse in the facility a positive experience. In the ADVANCE Readers' Choice survey, we asked nurses to rank hospitals based on elements that would make a difference to them: quality of care, organizational culture, communication, professional development and retention efforts.

By Amy Lillard

Consistency, Collaboration & Care

Readers' Choice for Organizational Culture

When asked about the organizational culture at their hospitals, nurses from the centers honored in the ADVANCE 2008 Readers' Choice Survey spoke of shared accountability, consistent goals and mission, respect, responsibility and significant opportunities for nurses to give their input into hospital governance. It all adds up to hospitals where nurses find a supportive environment that enables them to provide the best patient care.

For one honoree, a unique organizational culture of support and responsibility derives from the needs of a unique patient population. At Children's Memorial Hospital in Chicago, treating the specialized needs of children requires the best from nurses.

"Working with children is extremely rewarding," said Alisa Abraham, RN, clinical nurse manager. "We can give these children a chance to live out a life they probably wouldn't be able to otherwise. It takes a special person to work with children, and a special organizational culture to provide the best environment for patients and nurses. Children's Memorial has it."

To offer the best patient care, Children's

Memorial promotes a culture of openness between nurses, physicians and other staff. Only by powerful, productive relationships between all can patients and families benefit.

"From the top down, we always know everyone here is dedicated to the kids," said Roseann Greene, RN, spina bifida nurse coordinator. "We all have the same mission and goals, and that's children first. In my clinic, to advance the care of spina bifida, the nurses, neuro-surgeons, urologists, orthopedists and everyone else are all working together on this common cause. It's refreshing, because it makes it easier to do our jobs, take care of the children and make it easier for families."

Removing Boundaries

Other hospitals named tops in this category also thrive on the consistency of goals throughout their organizations, resulting in good give and take and a lack of boundaries that can inhibit patient care. At Advocate Illinois Masonic Medical Center in Chicago, the culture is one where first names reign and all are committed to a positive and productive atmosphere.

"We have shared goals and shared respect, no matter if we're speaking with other nurses, top administrators or cafeteria workers," said Kimberlee Bermont, RN. "We know how important everyone one of us is to our goal of superior patient care."

Another essential ingredient of a supportive and constructive culture is the ability for nurses to share in the governance of the organization. Each hospital named in this category provides nurses with opportunities ranging from committee leadership to town hall meetings.

At Saint Francis Hospital in Evanston, IL, nursing representatives from all parts of the organization meet on a monthly basis for committees ranging from professional development, advisory councils, RN-MD collaboration and more. Nurses are encouraged to actively participate in these councils, discussing specific cases and issues on unit floors that need solutions, or greater organizational issues. The councils also allow nurses a forum to request equipment, share different approaches to scheduling and staffing, and determine best practices.

"The nurses have a real impact on leadership at the hospital through this model," said Angelique Richard, PhD, RN, vice president of patient care services. "Nurses at all levels have a voice here and set the pace for nursing practice at the hospital."

St. Mary Medical Center in Hobart, IN, builds on this notion of ensuring nurses have a voice, highlighting monthly staff meetings and town hall meetings as a chance for nurses to be heard. At town hall meetings especially, hospital updates are provided and future plans revealed, and nurses can test moderators with queries, issues and other day-to-day needs. Answers to questions from these meetings and others are posted on the hospital intranet for all to review and internalize.

At Loyola University Medical Center, Maywood, IL, a strong environment leads to engaged nurses providing the highest quality of care.

"Our chief nurse, Paula Hindle, MSN, MBA, RN, is working with many nurse leaders to influence the organizational culture so both ambulatory and hospital nurses participate is shared decision-making regarding their practice," said Deborah A. Jasovsky PhD, RN, NEA-BC, associate chief nurse executive and Magnet Program director. "Their responses to the professional development programs from our education department and Marcella Niehoff School of Nursing help explain why the nurses believe we provide quality care to our patients."

All About the Patients

Overall, hospitals with the most powerful organizational cultures give nurses the power to cross typical division lines, taking control of their jobs and their centers to provide the best patient care possible.

"Ultimately, we're all involved in the care of patients," said Abraham at Children's Memorial. "One of our biggest missions is to holistically serve our patients, involving families and our entire staff in their treatment. That means there are no strict boundary lines between physicians, nurses and other caregivers. We're here for the same purpose, and we support each other to keep these children top of mind. It provides for a well-rounded culture and complete care."

Learning Support

Readers' Choice for Professional Development

Professional development can be as simple as effective orientation programs and tuition reimbursement for degreed programs. But it takes a progressive and committed hospital to go further, supporting independent continuing education, encouraging and rewarding certification, promoting nursing leadership of education offerings and even presenting opportunities for nursing research. The hospitals recognized in our Readers' Choice Survey for Professional Development do just that.

Take Central DuPage Hospital, in Winfield, IL. Nurses organize and lead a tremendous docket of on-site professional development options, including topical seminars, "Lunch and Learn" sessions, technical demonstrations and more. The nurses have internalized the message about the importance of professional development from the administration.

"The opportunities for nurses to be heard and determine the course of our professional development are extremely beneficial," said Susan Bosman, RN, staff nurse in the IMCU. "It comes from our leadership, who promote the idea of continuing education here and out in the community, and who support our efforts. As nurses, we're encouraged to run meetings, share what we've learned in our units and creatively think about what we can do better."

Central DuPage also focuses on career advancement and recognition of nursing achievement as a part of their professional development activities. Their RISE program, referring to "RNs in Search of Excellence," rewards nurses for their achievements in leadership, clinical expertise, advocacy and more. With award ceremonies and publicity, as well as monetary bonuses and raises, nurses are encouraged to reach for the pinnacles of their care areas.

In addition to on-site classes and nurse-led seminars, Central DuPage also offers generous tuition reimbursement and flexible scheduling for schooling. Those who seek certification have the option of in-unit courses or off-site work, with accommodation made for time and expenses.

There for Each Other

Another essential component of empowering nurses in their education and careers is an atmosphere of support when peers embark on professional development.

"In some hospitals, nursing staff could be unhappy about needing to cover for nurses who take time away for education," said Kimberlee Bermont, RN, at Advocate Illinois Masonic Medical Center in Chicago. "Here, everyone understands because everyone is working on something. Even senior nurses are still continually asking questions and doing research. We're all on a journey, all trying to improve knowledge and supporting each other in the process."

At Saint Francis Hospital in Evanston, IL, that support is shown in a successful in-hospital certification prep program. The hospital offers a 12-week on-site course to prepare nurses for the exam and then holds the exam on-site, addressing some of the fears and variables that can negatively contribute to poor performance. As a result, 50 percent of Saint Francis nurses are certified in their clinical area of expertise, compared to 27 percent nationally. After passing the exam, nurses are rewarded with bonuses.

"Being a nurse for 30 years, I thought I knew it all," said Angie Pojas, MS, RN, TNS, ECRN, emergency department team leader, "but in my board preparation classes, I learned quickly that wasn't the case. I was challenged, but also given a confidence and feeling of comfort. I also know our doctors value the nurses who take the class and feel we are an asset to them."

An additional unique aspect of hospitals that value professional development for nurses is the mingling of nurse and physician. At Saint Francis, a professional series of lectures is held by the physicians on a regular basis, offering talks on specific clinical areas and relying on nurse participation. Additionally, nursing grand rounds provide nurses the opportunity to present a case or subject in their expertise to other nurses and physicians. Doctors enthusiastically support the nursing professional development opportunities and the chance to improve patient care through interaction.

The benefits of robust professional development programs are real and recognized by top hospitals.

"These education opportunities allow nurses to connect the dots, to see how being a part of a practice group or quality group directly impacts patient care," Bosman said. "If nurses have the ideas for best practices, for example, and have the means to present it to others, we can see better patient care. It's exciting to be a part of that."

Without Boundaries

Readers' Choice for Communication

Effective communication for nurses is multilayered. It's about offering the appropriate tools for intrahospital communication, as well as the ability to communicate good news beyond the hospital gates. It's about providing the best processes for communicating to administration, physicians and other nurses, and effectively setting forth procedures for reporting successes and errors.

But beyond all this, hospitals with exemplary communication also must ensure nurses feel respected, supported and informed. The five hospitals selected for Readers' Choice honors in communication create an environment where nurses can stay informed clinically and administratively. They create a system of ongoing feedback and appraisal, as well as a network of nurses and physicians who communicate clearly and respectfully. They provide a sense to the surrounding community that this hospital is the place to rely on, in sickness and in health.

An Open Door

One characteristic of communication excellence these hospitals show, an aspect often overlooked in traditional communication efforts, is ensuring management and administration are consistently accessible to nurses. At Saint Francis Hospital in Evanston, IL, nurses feel comfortable identifying issues and bringing them to team leaders on the floor and physicians.

"In our surgery department, we have a morning lineup every day where we can discuss issues and concerns," said Sheila Hogan, RN. "Our managers have an open-door policy and also come on the floor throughout the day. This allows us to resolve a lot of issues and improve the processes in our unit, and gives us the opportunity to discuss issues affecting patient care."

Coming Together

The best communication efforts by hospitals also ensure nurses from throughout disparate units have the chance to regularly come together, share experiences and collaborate toward the greater hospital mission. Saint Francis uses its extensive professional development opportunities to accomplish this.

"The whole idea at Saint Francis is that classes, town hall meetings and councils have nurses representing all different units, mixing up the staff," said Lydia Dacenko-Grawe, RN. "I've worked at places where nurses only know people from their own units. But here we're meeting regularly with nurses from different floors and units in collaboration. It gives us the occasion to acknowledge expertise in other areas and learn from each other."

At St. Mary Medical Center in Hobart, IN, town hall meetings serve as both professional development and communication expansion.

"Nurses and physicians are all invited to our town hall meetings, encouraging us to interact," said Kristen Stok, RN, ASN. "We learn what's happening in our hospital, what new additions and procedures we have, and any hospital staff recognition. We can ask questions of the leader and each other, and always feel valued for our input. We also have a hospital newsletter that communicates the town hall news and other updates."

The potential to learn from other units and other nurses is a hallmark of excellent hospital communication, as these centers know. By offering opportunities to participate in councils and professional development courses incorporating all hospital staff, for example, hospitals can truly work from best practices.

"In our clinical professional councils, we set aside time at each meeting where all units can talk to each other," said Kimberlee Bermont, RN, Advocate Illinois Masonic Medical Center in Chicago. "If one nurse or unit has a problem, they can solicit advice and learn what other units do. That has been a fabulous experience for everyone. There is that definite need to understand other practices, and at Masonic we have the opportunity and venue provided to us. It gives us the chance to work together to provide the best patient care possible."

Communication is more than simply conversing toward specific ends, as evidenced by our top hospitals. Only by ensuring hospital communication opens up opportunities, offers the potential to improve patient care, and establishes a culture of cooperation can a hospital truly create an ideal environment for working nurses.

Vote of Confidence

Readers' Choice for Retention Efforts

Nurses feel comfortable and satisfied with their hospitals for many reasons. Hospitals that offer a competitive salary and benefits, schedule flexibility and education opportunities show their nursing employees they value their time and efforts. But there's more.

The Readers' Choice honorees for retention efforts have unique approaches to showing nurses their appreciation and esteem. Whether it's growth opportunities, rewards and recognition, or accommodation for nursing education and development, the best hospitals retain their nursing workforce by demonstrating how much they value every single nurse.

Support System

At Northwest Community Hospital in Arlington Heights, IL, classes needed to effectively perform nursing jobs are offered on-site, and the hospital actively encourages development through advanced degrees. But beyond all the professional opportunities and shared-governance options, retention is really about support.

"Bragging about Northwest Community is something I love to do, and that's because our hospital has confidence in us as nurses," said Susan Pritscher, RN, ED manager. "We have so many mentors and so many cheerleaders. They prepare us to do the best we can for our patients and to feel on top of our game. We're encouraged to take on new standards, new challenges and new technology because of the support we always have."

Another telling sign of a hospital's potent retention efforts is the welcome given to older nurses, valuing the expertise and experience they bring.

"We'll sit in a meeting or committee and have more than 100 years of longevity in the room," Pritscher said. "We even have a 25+ Year club. Nursing is a very challenging job and to have an environment that supports you long into your career is invaluable."

At Central DuPage Hospital in Winfield, IL, retention is a matter of continually challenging its nurses, as well as developing skills and practice in collaboration

"Nursing is highly valued at Central DuPage Hospital," said Susan Bosman, RN, staff nurse in the IMCU. "What makes this such a unique environment are the interactions we have. As a student nurse instructor, I'm always pointing out to my students how nurses are collaborating on cases, how they're avoiding finger pointing on outcomes that are unexpected, and just moving forward, solving the problems together. It's a terrific feeling to impart this caring and respect to our students."

Leslie Becker, RN, staff nurse and chairman of the Professional Practice Council at MacNeal Hospital, Berwyn, IL, believes her facility excels in retention efforts through engaging nurses within and beyond the hospital's walls.

"MacNeal Hospital has a strong shared governance structure that encourages and supports staff nurse involvement," she noted. "The hospital offers clinical advancement to those nurses who remain in direct patient care and contribute to the activities, council work and the community."

Just as crucial to providing a hospital where nurses want to work are powerful rewards and recognitions for good work, awarded on an organizational and individual basis. At Central DuPage, major celebrations are held when awards are won, incorporating all staff to show off the joint achievement.

At St. Mary Medical Center in Hobart, IN, a number of activities celebrate individual nurses who demonstrate the excellence of care and knowledge the hospital values. On a monthly basis, nominations are accepted for a hospitalwide employee of the month, who then receives an impressive recognition plaque. Each floor also gets in on the act, picking an employee of the month who receives gift certificates and photo recognition at the nurse station. Nurses are routinely surprised with rewards for everyday excellence; spotted doing something exemplary, the nurse may even be recognized in the hospital newsletter as STAR employee of the month. Finally, for nurses who go above and beyond, a fast-track salary option exists, boosting the rate of pay increases to get a nurse up to the median or top levels of pay for that position.

Putting Passion in Place

Retention can be about monetary benefits, plaques and surprising benefits. It can be about extending opportunities for professional development and growth. But overall, retention efforts work best when they emphasize excellence in care and encourage nurses to do their absolute best.

"The great environment at Northwest Community absolutely increases customer service and excellent patient care," Pritscher said. "They provide us with all the tools and the knowledge to give the best care. It really empowers us and encourages our passion in nursing."

Empowering Nurses

Readers' Choice for Quality of Care

Nurses are critical to a hospital's delivery of excellent care. The best hospitals recognize this integral link and work extensively to support and encourage nurses on their journey.

Readers who participated in the Readers' Choice Survey named five hospitals as the best in quality of care for this reason. The honorees consistently provide high-quality care to patients and do that in part by focusing on proper nurse education, staffing, tools, technology and evidence-based methods.

St. Mary Medical Center in Hobart, IN, knows the importance of nurses in providing quality of care to their patients. To ensure nurses know precisely what the hospital needs and empower them to give unfailingly superior patient care, St. Mary's has implemented a systemwide program for nurse interactions.

"We're able to give consistent, comprehensive care through the AIDET system," said Jennifer Walczak, BSN, RN. "First, we Acknowledge the patient and Introduce ourselves, letting them know who we are, what we're going to do and why. We prepare them for the Duration of their treatment and procedures, ensuring the family and patient know what to expect. We Explain what's going on at all times, keeping the patient and family informed and comfortable. Finally, we always Thank patients for choosing St. Mary when they leave. No matter what floor you're on or what unit you're in, every nurse knows this procedure and is able to give a complete experience."

Something New

Another hallmark of dedication to quality of care is forward momentum. Hospitals must be committed to continually updating their procedures, technology and information, all to reflect new evidence and new offerings. At the same time, nurses and other staff must feel confident in taking on new challenges and encouraged to incorporate what's best for patients.

At Central DuPage Hospital in Winfield, IL, this mission is taken to heart.

"We're always in motion at CDH," said Susan Bosman, RN, staff nurse in the IMCU. "We have a very positive attitude that's coming from all levels in the hospital and we consider ourselves pioneers. Nurses know we are able to impact patient outcomes and make a difference because of new education, new technology, new techniques and new best practices."

Central DuPage also knows providing quality of care comes from professional development and education. In addition to building the skills and abilities of nursing staff, the value of professional development extends to building confidence and a sense of security in patients. Knowing a hospital's nursing staff is highly certified and encouraged to take ownership of their careers can go a long way to prove to patients the hospital is the place to rely on. Patients can have a sense they're going to the hospital with the most experts in the area and, therefore, will receive the best care.

Quality of care also can be a direct result of nursing input and research, as nurses at Advocate Illinois Masonic Medical Center in Chicago know.

"We all have the same focus and same goals, and all want to provide the best care," said Kimberlee Bermont, RN. "The hospital really relies on nurses to drive this excellence of care. Through leadership councils, we routinely go over patient satisfaction markers and quality indicators, talk with units about what's working and not, discuss how to approach problems through evidence-based practice and generally focus our work in meaningful ways."

Quality of care comes from hospital efforts and organization, as well as leadership. At Saint Francis Hospital in Evanston, IL, nurses cite the vision of leaders that trickles down to the staff level, laying a foundation for excellence in patient care, organizational culture, communication, professional development and retention. They talk about the high standards to which they're held and the hard work they give as a result.

"Our nurses are a very energized workforce," said Angelique Richard, PhD, RN, vice president of patient care services. "They're here around the clock and devoted to providing the best quality of care. It's a privilege to care for patients, and our nurses never forget that."

Amy Lillard is a frequent contributor to ADVANCE.