What makes a great working environment for nurses? According to nurse leaders at the five hospitals that made ADVANCE's Readers' Choice Honor Roll, the answer is multifaceted.

First, you need an empowered nursing staff. They should be supported by leaders who value the work nurses do, support their professional development, communicate clearly and consistently, and reward them for excellence.

Quality of Care

Suellyn Ellerbe, MN, RN, NEA-BC, executive vice president of clinical operations/chief nursing officer at Saint Clare's Health System, Denville, NJ, firmly believes quality starts at the bedside.

"Feedback from physicians, patients, families and others is the dedication of the nursing staff is extraordinary," she said. "Despite changes in philosophy, management and fiscal situations over the years, our nurses have stayed very focused on quality of care."

Dianne A.M. Aroh, MSN, RN, NEA-BC, executive vice president of patient care services/chief nursing officer at Hackensack University Medical Center, Hackensack, NJ, agreed.

"It's very shortsighted when healthcare organizations look only at the bottom line and make hasty decisions that erode the base of their operations," she said. "We believe the higher the quality of care, the stronger the organization.

"We made a significant investment within our organization by funding positions for performance improvement advisers who focus on helping our staff nurses understand our quality data, learn how to interpret that data, and identify how nursing practice impacts quality care."

Nurses at Mount Sinai Medical Center, New York, NY, focused heavily on quality as they achieved Magnet re-designation this year.

"Most of [those] standards do reflect quality, whether they address nurse satisfaction, work environment or quality itself," said Carol Porter, DNP, RN, senior vice president/chief nursing officer.

By focusing on patients, nurses at NewYork-Presbyterian Hospital provide great care.

"Our success starts with the vision of our board of trustees and senior leadership; we work hard to clearly articulate our vision and values throughout the institution so every single employee understands what is at the core of everything we do," said Wilhelmina Manzano, MA, RN, NEA-BC, senior vice president/chief nursing officer at NewYork-Presbyterian Hospital.

Organizational Culture

Great hospitals value their nurses.

"We focus very heavily on nurses participating in initiatives related to nursing practice, quality, performance improvement, cultural competency and recruitment/retention," said Susan Bowar-Ferres, PhD, RN, NEA-BC, senior vice president/chief nursing officer at NYU Langone Medical Center, New York, NY. "Departmentwide and specialty-specific councils provide a wide choice of participation and engagement for staff."

Ellerbe shared a similar message. "From the top down, you see people at Saint Clare's valuing what happens between the caregiver and the patient.

"Where the rubber meets the road, the focus is on the frontline caregivers and the patients they serve," she added.

At NewYork-Presbyterian, senior leaders have created a caring, supportive environment for staff.

"We are highly driven as an organization, and we expect our staff to give their best in putting patients first, doing the right thing the first time, all the time," Manzano said.

Porter characterized Mount Sinai's culture as inclusive, interactive and based on trust.

"You can't always do everything people want, but if there's trust, they will come back and ask you why," she noted. "High ratings on our NDNQI [National Database of Nursing Quality Indicators] RN Survey reflect that trust."