Members of Rhoads 5 SICU, winners of the Gold Beacon Award
Nurses make up the single largest segment of the health-care work force, providing 95 percent of direct care to hospitalized patients. So it’s not surprising that the higher the quality of a hospital’s nursing staff, the better the patient care.
But how does a consumer determine how good a nursing staff is? Magnet® accreditation -- one of the most respected recognitions of nursing excellence -- is a good place to start. Created by the American Nurses Credentialing Center, the Magnet Recognition Program closely examines a hospital’s nursing practices. Only those hospitals that meet its high standards – currently less than seven percent of U.S. hospitals – receive the recognition of excellence. The Hospital of the University of Pennsylvania is among that elite group. It received Magnet accreditation in 2008 and was recently re-accredited.
Studies show that, for many reasons, Magnet hospitals provide higher-quality care, leading to better patient outcomes, shorter lengths of stay, and higher patient satisfaction. For example, Magnet nurses use evidence-based care, ie, processes that have been proven successful in patient care. And they not only use these processes, they often discover them. As
Victoria Rich, PhD, the chief nurse executive of the University of Pennsylvania Medical Center, noted, “Our focus is on innovation, new knowledge and outcomes. We are using science to take nursing to the next level.”
Interdisciplinary collaboration among all members of the health-care team is crucial in Magnet hospitals, and the nurse’s voice is a vital component. Also, nurses in Magnet hospitals tend to be better educated. As patient needs and care environments have become more complex, nurses need to attain the necessary competencies to deliver high-quality care. At HUP, 88 percent of nurses hold at least a four-year nursing degree and many have pursued advanced degrees as well.
A study by Linda Aiken, PhD, director of Penn’s Center for Health Outcomes and Policy Research, and colleagues showed that hospitals employing higher percentages of nurses with bachelor’s degrees had lower surgical-patient mortality than hospitals with fewer bachelor’s-prepared nurses. The study demonstrated that nursing experience, while an important factor in patient outcomes, is not as critical as nurse educational preparation. And in more recent research, Aiken demonstrated that surgical patients cared for in Magnet-recognized hospitals have significantly lower odds of mortality and failure-to-rescue than those cared for in non-Magnet facilities.
While Magnet is awarded for nursing excellence throughout a hospital, the Beacon Award for Excellence recognizes individual units. According to the American Association of Critical-Care Nurses, which awards the recognition, Beacon units “distinguish themselves by improving every facet of patient care.” Fewer than three percent of this country’s intensive care units have received the Beacon Award. Since 2005, seven of HUP’s critical care units have been awarded Beacon recognition, some more than once. And, most recently, Rhoads 5, its surgical ICU, received a Gold Beacon award, one of only 10 in the entire country.
Patient outcomes are very important for both Magnet and Beacon recognitions, with a focus specifically on “nursing sensitive indicators,” ie, areas where nursing care have a significant impact. For example, nurses are responsible for the overall management of the central – intravenous (IV) – line. They must keep the area around the IV clean, monitor it carefully for any problems, and advocate for its removal as soon as it’s no longer necessary. Without this focused care, a bloodstream infection can develop, which not only uses precious health-care dollars to treat (on average $19,000) but can also lead to sepsis and, possibly, prove fatal. With specific strategies in place, HUP has seen its rates of BSIs plummet over the past several years. Indeed, some units have gone without a single central-line BSI for years!
Inpatient falls, another nursing sensitive indicator, represent a significant patient safety issue. Working with other members of the health-care team, HUP’s nursing staff developed specific initiatives and interventions to lower the number of falls. Since strategies were first put in place in 2010, the number of falls has dropped considerably, and they continue to do so. In the last quarter of 2012 (October to December), HUP’s fall rate was better than 75 percent of academic medical centers, which often treat patients with a high risk for falls.
As Rich noted, “These achievements further solidify HUP as an organization dedicated to providing excellence in nursing services and the highest quality of patient care.”