. '
HOSPITAL BEST 
PRACTICES
NURSE 
RECRUITMENT AND 
RETENTION 
YICIS.
" !o"

-Jt-
""Ja 
OFFICE OF INSPECTOR GENERAL 
OFFICE OF ANALYSIS AN 
INSPECTIONS 
NOVEMBER 1988  . '
OFFICE OF INSPECTOR GENERAL

The mission of the Ofce of Inspeto 
Genera (OIG) is to
prmote the effciency, effective-
(nefsSs )an.d  integrty of pro  in the Unite States Deparnt of 
It dos  Health and Huma Serces
th by developing method to 
Created by statute in 1976, the Inspetor Generdae kteete pasn db optrhv ent Sfrued,t awa ste and
 abuse. 
fuly and curntly inored about progrs  the  and the Congrss 
or maagement problems and reommends cor
retive action. The OIG peors 
its mision by conductig 
tions with approxitely 1,200 sta strtegicaly  audittsh, ineve sctigoatuionns atnrd .i n
spe
located arund 
OFFICE OF ANALYSIS AND INSPECTIONS

Th repo 
is pruced by the Ofce of Analysis and Inspons 
major offes with  Of  (OAI, one of the

the OIG. The other two 
tigations. The OAl conducts  ar the  of Audit andte Ofce of 
determe prgr  insptions which ar tyicay shan-te stues Inves
effectiveness, effciency and vuerbilty  designed to 
to frud or 
abuse. 
THIS REPORT

Entitled "Hosita  Prtis 
Best  in Nur Rectmnt 
conduCt to descbe tehnques use  aatntd  Reacntion," ths intion 
was

by hospitas to  and reta nurs. 
The repo was prpar unde the dition of AI 
E. Shpiegelm, 
Gener Ofce of  Regional Insptor
Analysis an Insptions, 
followig Ofce of Anysis an Insptions Rsetgai:o n Parcipatg in 
ths prject were the 
Ltr
Joy Qu, 
Region m,  ProjeCt 
Eileen 
Sil Region
Debo 
Haey, 
Regi IX 
gart 
Shell, Regk V 
Heua 
Mata Zita,  . '
HOSPITAL BEST PRACTICES 
NURSE 
RECRUITMENT AND 
RETENTION 
Richard P. Kusserow 
INSPECTOR GENERAL 
OAI.03-801121 
NOVEMBER 1988  ........................................... ... ..... ....... .................
................................................................................................................ ....... ..................... . . '
TABLE OF CONTENTS 
OVERVIEW.. ................. 

BRAUNER PSYCHIATRIC HOSPITAL............................................................ .

Atlanta, Georgia

EVANSTON HOSPITAL ............ ..... .... 

Evanston, ilinois

HER MANN HOSPITAL.................................................................. ............................ 
Houston, Texas 
I NG HAM ME DICAL CENTER....................................................................................

Lansing, Michigan 
KAISER-PERMAN ENTE HOSPITAL SYSTE M .. 
Northern Caliornia  ........................................... no..

CRAWFORD W. LONG HOSPITAL........................................................................... 10 
Atlanta, Georgia 
METHODIST HOSPITAL .......... ............ 

..................................................................... 12

Gary, Indiana 
NEW ENGLAND MEDICAL CENTR 
....................................................................... 14

Boston, Massachusetts 
ORLANDO GENERAL HOSPITAL............................................................................ 16 
Orlando, Florida 
MEDICAL CENTER AT PRINCETON 
Princeton, New Jersey  ............................ 17 
S1: LUKE'S EPISCOPAL HOSPITAL...... ........... ......................... .............................. 20

Houston, Texas 
SEQUOIA HOSPITAL.................................. ....... ................... ......... ....... 

.................... 22

Menlo Park, Caliornia 
WASHINGTON HOSPITAL CENTER 
........................................................................ 24
Washington, D.
 OVERVIEW

PURPOSE 
The pwpses of ths inspetion we 
to (I) descbe tehniques use by
retan nures, and (2) determe  hospitas to 
mang thugh  the extent to which nures  attct and
parcipate in hospita 
reprsentation on hospita governing  decision 
presents our findigs on hospita nure recruitment  boes and key cottes. This report
nurse Parcipation in  and retention techniques. Findings on 
decision mang ar 
contaned  in a  separte repon.

BACKGROUNp 
Nurse Retention Problems 
Even though the supply of registe nurs (Rs)  ti 
are experiencing the most severe RN  is at an al  high of 2 
workig, and of  shortge in recent history. Eighty percenmit lolfi nR,N hso saprietals
these 68 percent 
cause sicker patients  ar employed in hospitas. Hospitas
reuir highly sophisticated  nee more nurses be-
choosing to wor in  car. At the same time, more nurses are
other health car settngs. ACCorg to Amer 
(AH) sureys, 
hospita RN vacancies 
more than doubled  Hospita Association
percent by December 1987.  frm 4.4 pent 
in 1983 to 11.3
Many factors contrbute to the 

limite advancement 
 curnt nuring shortge. They include
 saar 
oppottties, chagig  Compression and
patients and shorr  work scheduls, frstron  cag 
stays, lack of  in  for sicker
care decisions and fewer students roepgtinnigt fioorn n anud rreispnt,g lac k cof aautronromsy .inmang 
patieO! 
HHS Nursing Commission 
In December 1987
, Heath and Human Servces  Seta 
(HS) 
ftcioioanlr  Cpto lam.m Tshsieon S toe Scttday' st hCeO nmumr sssihoOnr ogne N aunrsdi npgr ios vhi ehai  withO at irse Bpoo waennd a pcpoorintitevde a  ascp-e
Admnistrtor of the Heath Ca Financing  by Calyne K. Davis, PhD.
itiated at the Commssion  Admnitrtion. Ths
s reuest.  inSpetion was in-
METHODOLOGY 
We asked State Nures 
Associations in nine States 
which had develope  arund the countr to identify 
strategies to  nurs.  hospitals
bas on  reruit and retan 
their reommndations.  Eleven hospitas were 
telephone surey.  Two adtional hospitas we identied dug  selected
Between June and September 1988, we visite Our ear I ier
the Distrct of Columbia to 
obta ilormtion  13 hospitas in 9 States and

hospitas raged in size frm 89 to over 800  about reibnent and retetion strtegies. The 
be. As it tued 
out, al were in urban area,  . '
and most had achieved substatial reuctions in their nurse turover and vacancy rates since
implementig their strtegies. 
We also identified elements that these hospitas had in common. 
Earlier this year, durng a telephone surey for the another inspetion
, we also took the time to
ask chief executive offcers (CEOs) and chief nursing officers (CNOs) at a nationwide 
ru  radom
sample of 93 'Urban and  hospitas what they were doing to deal with the 
nurse shonage.
We wante to gain additional perspetive on the 
strategies and 
tehniques used by hospitals to
recruit and retan nurses. 
FINDINGS 
The best practices hospitas visited 
shar commn elements which may account for the suc

cess of their nure 
reitment and retention strategies. These elements include:

Management commitment to nursing and nurses. 
Strng suppon frm the chief executive 
offcer and governing boy.

Nursing deparent commtment to the intrnsic value of nuring.

Strong nursing leadrship.

Strtegic planing.

Commtment to patient car.

Decentrized decision mag.

Nurses involved in decision mang.

Prblem identification and solution.

Commtment to education.

Employee recognition. 
Competitive 
salars and benefits. 
The opinions of CEOs and CNOs contacted in our telephone 
surey parlel 
Higher pay, incras reitment  these findings.
effort and educational benefits were the tehniques cited
most fruently. Urban hospitas also mentioned a varety 
of other approaches, includig
flexitime, 
grter autonomy in patient car, affiliation with nursing schools, 
incrasing nurse
membership on commttees and improving relations between medcal and nursing 
provision of child  stas. The 
car servces was generaly limited to 
lare urban hospitas. 
This repon highlights a few of the best practices 
sen durng our hospita visits and provides
contacts for readers who would like more infonnation on 
parcular techniques or approaches, 
The hospitas are presented in 
alphabetical order.  . '
BRAUNER PSYCHIATRIC INSTITUTE 
Smyrna, Georgia

Background,  Founded in 1910, Brauner Psychiatrc Institute was the fIrst psychiatrc hospital 
in Georgia. Tody it is 
one of thee psychiatrc facilties in the for-
profIt Brauner Hospital Sys
tem, occupying 32 acres in a campuslie settng nonhwest of 
Atlanta. Brauner offers 
and outpatient psychiatrc and  inpatient
substace abuse treatmnt program for 
adolescents and adults.
Its 89-bed inpatient acute psychiatrc care facilty also 
provides State certfied educational ser
vices for adolescents. 
Twenty-one percent of Brauner 
s nurses have baccalaurate 
degrs and 
masters prepard. The nur tuover rate, 12 percent in 1986, decased 1t0o  p5e rpceernctent for the
first 6 months of 1988. Durng the same 
crts  period, the vacancy rate drppe 
cent. The CNO  from 15 to 2 per
this improvement to Brauner 
s system of decentrize nuring

management

Decentralized Management: 
 Brauner s nursing deparent is 
headed by an Associate Ad

ministrator who has 
decentrize management to the unit level. The CNO' 
s management

philosophy is summarze in Brauner s curnt 
nursing brochur: 
Nurses ar valued members of our progressive 
multidisciplinar team and their
ideas, independent judgment and accountabilty 
ar encourged and rewarded in a
professional annosphere of mutual 
trst and parcipatory management. 
Staf RNs manage nuring units, 
serve on multidisciplinar commttees (quality assurance
safety, planning), and co-lead patient councils. 
Nures are encouraged to excel and to be crea

tive. In the words of the CNO, "
there is always a positive 
performce expectation.

Nursing Council:  Although she represents nuring on the hospita' 
s executive maagement

team, and regularly attends meetigs of the Boar of 
Trustees and key commtts, 
recognized that there was no nure representation at the Brauner Hospita System cotrhpeo rCaNre 0 

level. She established a Nursing Council to discuss nuring issues system-wide and make
presentations to 
corprate management. The Council has ben positively viewed at the cor
porate level and enhances the pro-nursing 
envionment thoughout the hospita 
system. 
MDanaigsenmenety Di nCeyo Strypler: a
tion to  Four year ago, the CNO hir maagement consultants from the
trn sta in parcipatory management techniques. The theme which
has evolved frm this trning is that each employee can make an 
imponat contrbution
the success of the crbe the atmsphere at Brauner as a "
each of us contrbute day.  carg, supportve famly," to which
" This attitude also applies to operational concerns, such as staff.
ing, patients ' progress and interpersonal relationships.  . '
Brauner s Employee of the Month program recognizes employees who embody the 
carng and
supportve philosophy which now penneates the 
nuring deparment. Rewards 
include a
Mickey Mouse watch, a cash 
git, picture publication in the employee newsletter and private

parkig for one month.

Nursing staffalso enjoy yearly outings and seasonal softball 
games, in which all hospital staff
are invited to 
tae par. Brauner makes their swimmng pol available for use by 
staf and
their famlies, and sponsors a 
Grad Slam Tennis Tourament for employees. 
In conjunction with the Atlanta Hawks, Brauner has established a pro-
Hugs Not Drugs: 

education anti-dg campaign called "H4gs Not Drgs." Now in its second year, the program
includes recorded "rap" messages by members of the professional basketball team. 
The anti-drg message is brought to local schools by a 
multidisciplinar team with financial 
suppon frm hospital admnistrtion. Employees view ths progr as a positive example of
the collegial atmsphere at Brauner. In the words of a 
sta nure, "  s al of us working
together that maes Brauner a hospital to be proud of. " 
Contact for more informatn: 
Brauner Psychiatrc Institute 
3180 Atlanta Street, S. 
Smyra, Georgia 30080

Cherr E. Spencer-Stak, MN, RN, CNAA

Associate Admistrator

(404) 4  0081  , '
EVANSTON HOSPITAL

Evanston, Illnois

Background.:  With 450 beds, Evanston Hospita is par of a two-hospita system in suburban
Chicago affIliated with Nortwestern University School of Medcine. 
Last year, nure recruit
ment included about 60 percent experienced nurses, with the remainder being new graduates. 
Half of the nursing 
sta have diplomas or associate 
degres, 43 percent have baccalaureate
degrees and 7 percent are masters 
prepar. The hospita has a tota of 664 budgeted staff RN
positions. 
Severa year ago, nuring 
Peer Reviw: 
 adistration saw a nee to revise the perfonlance
review system. The problem was that supervisors 
were not able to observe all 
staf behavior
and were relying on second hand data to evaluate performance. They established a peer 
review system that is now used thughout the hospita. 
Sta 
responsibility is the basis for the 
per review system: al staf review and ar reviewed
by their peers. Each person is reviewed by two reviewers -- one chosen by the head nurse and 
one chosen by the person being reviewed. One reviewer is at the same level as the reviewee, 
while the second is on a speial 
management admnistrtive 
career trck. The reviewee meets
with the reviewers before meeting with the head 
nure, who retans deision authority 
promotions and pay rases. The head nurse 
also faciltates the enti proess by providing
guidace to reviewers and advising them on how to discuss issues with the reviewee. 
Marketing To High School Students:  The local high school offers a health car coure in
which students rotate though dierent aras of health car delivery, 
includig nursing ser
vices at Evanston. Whe at the hospita, students are supervise by a unit preeptor. 
Nursing sta have also inti ted a program to educate high school counsellors about the profes-
SIon. 
Continuing Educaton:  While the hospital provides no paid educational leave, scholarships 
of $2 00 
per year for 2 years are available to cover 
relate expenses such as travel and
babysittg. 
Contact/or more in/ormatn 
Evanston Hospita 
2650 Ridge Avenue 
Evanston, llinois 60201

Suzanne Durburg, RN, MS

Associate Chaian

Deparent of Nursing

(312) 492-6409  , " , '
HERMANN HOSPITAL

Houston, Texas

Bf1kground:  Established in 1925, Hermann Hospita is 
no ta suppon. With 908  nonprfi  nonsectaan
licensed and 550 stafed  , and receives
cal Center complex. Hermann is the 
 bes, it is located in HOuston 
primar  s Texas Medi
teaching facilty for the University of

Medical School. Nursing serices a
 r decnlr  th  Texas
CNO and 38 nuring  with  line 
units operate by 32 nure  dictors reponing
managers.  tn the
Fifty-five peent of the nursing sta have assoiate degrs
uates, 30 percent have  , 10 pecen, 
baccalaw-ate  ar diploma grd.
has 944 budgeted RN 
 degrs and 5 percent 
sta nurse positions, and a stable vacaanrc yma rsatteer os f p1r0e ppaerrecde.n tH.
 ermann
nurse-patient ratios in crtical care are 1:2 with medcal surgical units 
Prsent 
rangig from 
1:5 to 1:8.

Matching Patent Census 10 

the Nurs 
aware that there were not enough  Resource: Ealier ths year the CNQ beam 
acutely
the hospital. She informed the hosstpaifta n'urses to provide quality car to all patients admitted to
s other executive offcers and the
staffing combined with increasing patient acuity can  BOar that shon 
faction and strss, and le to burout  rendreeudc e qualty of care, cause job dissatis
She 
to the avaiable nursing sta.  that the number of
bes be matched

The BOar agrd 
to match the 
patint acuity to existig nure resourcs. In
CNO  this change enables us to manage the work environment instead of thethe words of the 
managing us. 
envirnment 
The nursing Staf were positive about this 
Boar 
level policy change
tagible evidence that nursing issues  , as it prvided them with
toward improving the work envionmeanrt  aimnpdo an amle.a Tsuherb lceh 
ange was seen as a significant step
commtment to quality patient  demonstration of the hospital'

car. 
Research Staff 
Positin:  Hermann performs medcal 
clients, including other area hospitals, the University ofr eTseexaarsh a fnodr  tah ew Uid.e
  
rage of external
vice, as well as internally for 
sta  S. Public Health Ser
physicians and the 
nuring depanent. In

dinate researh, the hospita established a research 

an effon to COOr

researher.  position fIled by a doctoral prepared 
nurse 
The nurse researcher reviews the proposed Protocol with the 
sesses clinical safety, patient rights issues afected nurse manager
, who as-
, stafing requirements and 
monitor the studies. A nursing Protocol is
the unit s ability to 
managers provide in-servce education prioderv etloop eidn aintd inaurtsiiongn o.r dSertsa afrfe  wrtten.

thoughout the process, pancularly on feasibilty and quality  feeback is solicited 
review proess enables them to conl1l and  assurce. Sta 
believe thaI the
maage their work envirnment,
ing an opponunity for collaborative interaction with a 
as well as pro- .d. 
multidisciplinar team.
 , '
Flexibility through Job Sharng:  Hermann encourages job flexibilty. One type of flexible
scheduling is job  tie 
sharng, where two nures shar one full-
position. The nures divide
their hour, salar, and 
benefits in accordace with their 
personal and professional needs. This
option is avaiable to new graduates as well 
as to experienced nures. 
ProfessioTUIPractice Unit:  In an effon to addrss problems 
tween different units, a professional practice progr  associated with "floati" be
which does not alow 
floatig has been
pilote successfully in the Pediatrc Crtical Care 
rotate "on call" duty on their  Unit. Tshet aengt i nuring sta have agreed
tie off to ensur adequate  24 hours a day, 7 days a
week. Nures are salared 
and the number of hours worked is dependent on patient census and 
acuity. 
Petformnce Plus 
Program:  Performance Plus is an individualze orientation program for
RNs and LVNs. It begins with an assessment of a new employee 
sonal and decision makng  prepar  s clinical, technical, interper
skils. Masters  clinical instrctors then 
ize progrs  design individual
using a simulated clinical laboratory along with self-
learing packets, 
tapes/videos and slide presentations. 
progr 
The  is mandatory for new employees, and is also 
mae available to experienced staf
who wish to acquire, updte or practice both fundaenta and sophisticated nursing skills. The
progr 
CNO believes ths 
has streamned the orientation program 
whie enhancing 
professional competency of sta.  the
Contact for more informatn: 
Hermn 
Hospital 
Texas Medical Center 
6411 Fannin 
Houston, Texas 77030-1501 
Carol Ann Cavour, RN, MS, CNAA 
Vice Prsident for Nursing Afais 
(713) 797-4011  INGHAM MEDICAL CENTER 
Lansing, Michigan 
Background:  Ingham Medcal Cente is a non-
though it is self suppog, 
membe of  prfit hospita in Lasing, Michigan. Al
the govering boy
ar selecte by the 
couniy.
Ingham is hudgeted for 365 RNs. About 35 
pent 
masters prpar.  have 
The RN to patient  bahelor degres and 
surgical unirs. Ingham  rati vares /Tm 1:1 in intensive  3 pecent
IS-IS pecent for the  s RNy vaeca.n cy and tuOver rates have  car to 1:4 in medical
Michigan Slate  pat 3  One reon for this may berem at he hospSilatbale'  at 6 pen, and 
Univerity (MSU), as nurse mar  s prximity to
employed until their spouses complete their studies. to MSU Stunrs 
tend to reman 
The cwrnt 
CNO cam to Ingham abut IO ye 
eight Vice Prsidents, she also serves on 
 ago as Vice Prsident for Nuring.
the Executive Commttee.  One of 
The CNO' s magement phiosophy is 
thugh grate  based on enhancing the profeSSionalsm of
maagement responsibilty. Eah  nurs
hea 
pmrasneangteirg ( PthMe) u nwiht obu dhgaes th toi tghe  and fig authortym, aaonr  iusn rite sisp onsible fboyr a patient car 
PC'  gOVerg boy.  preparg and
Cosistent with the CNO'
sional sn aur renscionurgge ds tot areg.a r  themselves  as lead rather th as sUpesophilo soophyf,  the
the profes. 
Enhtleed Pro!essi1lism thrugh M tlagemelt 

hospital decision makng.
has  involved  the adoption of a  Respons:  Ingham 
sees of methods to enhance sta nurs Overl  strtegy
' respnsibilty in
Commillee 
Partieipotion:  Intiate a dead 
the hospita'  ago, RNs now 
s professional practice reprsent their
, quality assurance, infection control colleagues on
management and ethcs/professional 
stadas  , risk
commttees. 
Enhnced S'4 Nure 
slaff nures an assoRespo nsibility:  adsThtirs porrc e involves the relationship between
nuring 
respnsible to a  (ANAs). Each RN on 
prmar ANA for plannig patient ca  ever shif,
the sam  whether or not that ANA works
sht as the RN. Since no 
chare nures
nigh, shif, eah  durg 
ar on duty 
has develope witRhN  ihs eperr sAonaNllyA 
.  responsible for the patient  ca wthiteh einv ethnei gp laann dshe 
The CNO has 
alo worked on eliminatig 

render the necssar car in  the "  hour mentaity. 
necssa  " Rather, RNs 
but also that the nurse is not the  time. Ths mes  ovare reexp ected 
quir S hour. The focus is setrxcptley te to be there a fuS hourno t  if otnlhy e pthaatii nnto c ar dos nios tpaid 
prfessional: on the patient rather than on the clock.  Nurses ar also responsible for decisions on such matters as capital equipment for patient care, 
They are expeted to reach consensus on the most cost efficient and patient effective equip
ment purchases, and to make recommendations to hospita 
maagement. 
Ingham recently expanded the seven-step floor nurse career 
Yearly Step Increases: 

progrssion to nine steps. For advancement to the ninth step, RNs must demonstrate a 
high level of accomplishment in such activities as: 
collaboration with other health professionals to benefit the patient; 
service on hospital commttees; 
parcipation in professional organizations; and 
contrbutig to the development of unit goals. 
Development of these additional steps is expected not only to deal with the problem of wage 
and advancement compression for staff nurses but also to foster 
grater professionalism. A
nurse at Step Nine can 
ear more than a supervisor and be considere for management posi
tions even without prior formal management experience. 
Contact for more informaton: 
Ingham Medical Center 
401 W. Grenlawn Strt 
Lansing, Michigan 48910-2819

Dorothea Milbradt, RN, MSN

Vice President for Nursing

(517) 334-2349  , -
KAISER. PERMANENTE HOSPITAL SYSTEM

Northern California

Background:  The Kaiser Foundation Health Plan 
staed durig World War II to provide
health care for Kaiser-Pennanente s Caifornia employees. The system is divided
cally and the nonhern regional offce monitors 14  geographi
medcal centers and 26 clinics thoughout
nortern Calfornia. 
The system employs approximately 6,00 sta nurs 
in the nonhern ara. 
Most of the hospi
tas are long-established community 
facilties and four are teaching hospitals. The RN vacan
cy rate for the fIrst quarer 
of 1988 was 5.4 percent
, down from the 1987 rate of 7. 
Turover stoo at  1 percent.
7 percent in 1987. 
Kaiser has piloted a varety 
of program in hospitals thoughout the system. 
Boosting Nursing School Enrollment: 
 In a cooperative effon with the University of San 
Fracisco (USF), associate degr 
nures can reeive BSN degrees by completing a specially
talored 15-month program. Tuition for this progr 
is one-third less than the regular rate be
cause Kaiser staf serve as instrctors and Kaiser provides the  progr
strctued to enable nures to continue working while attendingc lassrom. The 
classes 2 days per week. Stu-
dents complete the clinical work in their own hospitas. 
They ar expecte to work 
facility at least 1 year before acceptace to the progr.  in a Kaiser 
Joint Practice Committees:  The Kaiser Hospita in Sacramento, Caifornia has initiated

several joint practice commttees to give physicians and nurses an opponunity to "

sues together.  tackle is
" Commttees on peatrcs, 
medcine/surgery meet monthly to discuss obstetrcs, intensive car, diabetes, hospice and

problems and issues in a collegial environment.
While most physician members ar volunteers, nurs ar 
selected by 
parcipation is also included in the trning  pers. Nurse commttee
budget. As expressed by the CNO, "
to involve nurses is money well spent.  money spent 
Paired Care: 
 The Sacraento facilty is piloting  paid car 
model on one medicalsurgical

unit of the day shift. The hospita has paied 
summer intern nursing students who have com

pleted a semester of clinical 
trning with three RNs to assist in rendering bedside
RNs review and assess the interns car. The 
' basic nursing skils. 
Reduced LIers of  Sacrento facilty, 
Management:  In the  seven clinical coordinators
(equivalent to head nurses), along with a few 
assistat clinical coordinators for intensive care
and the night shift, are the only management layer between the CNO and 
arves at the hospita by 6:30 a.m. daly, primaly to be accessible to the sntigah tR Ns. The eNO
maintans high visibilty by makg  sta. She
rounds of several units each day and rotates services
thrughout the week. Durng 
oriemation for new staf, the CNO emphasizes her open door
policy so the nurses wil realize she is always 
accessible. The CNO feels that "
staf nurses
 have a lot of autonomy. They have to mae some goo decisions...and should not be afraid to 
call the physicians ditly when necessar. 
In a new program simiar to the Federal Health 
Forgivable Loan Program: 
 Prfessions Nurs
ing Loans of the 1960s, students can apply for loans after completing half of their nursing 
trning. After grduation, students work at Kaiser for a specified number of years. 
progrs ar 
Most new hospital  developed by multidisciplinar team of physicians, nurses, 
human resources sta and admnistrtors. These working groups have existed in the Kaiser 
regional settng for years to "advise, lobby and negotiate" for improvements in health car 
delivery and maintaning goo sta. 
Contact for more informatn: 
Kaiser Foundation Health Plan, Inc. 
Nonhern Calfornia Region 
1950 Franin Street, 4th Floor

Oakand, Californa 94612-2291

Kathn L. Bray, RN, MBA

(415) 987-2964  , -
CRAWFORD W. LONG HOSPITAL 
Atlanta, Georgia 
Background:  The Crwford W. Long 
(CWL) Hospita of Emory University is a 503
acute car facilty 
located in Atlanta
, Georgia. Over 75 percent of its nursing  bed 
BSN degrs. Oprating at incrasg levels of capacity  sta have RN or
was 6.6 percent and the tuover  pent  sice 1986, the 1987 vacancy rate
rate was 8.5 
since 1976 when the RN  These statisrics have improved Steadily
tuover 
rate was 85 percent. 
In an effor to idntify factos contrburing to the 
unacceptable level of tuover
ducted thee sureys: 
, the CNQ 
Con-
Telephone inteiews 
with nurs who 
inadequate orientation and supervision ahsa dt hreeisr imgnaeidn. r eHasaol no ffo trh lee arevsinpogn. dents idenrified
Curnt nuring  as 
Staf were 
primaly  wby they stayed at CW. 
interested in patient  Seventy-eight pecent were
car and patient focuse 
issues. 
Curent staf were asked to identiy the job 
Parient  factors they considered most

car was the numbe one  importnt.

response, followed by 
working relationships.  aduate stafftng and congenial 
Analysis clearly indicate that nures 
were 
late to beide nuring. However focuse on parient 
car and their concerns were re-
dit  , the only opponiries for car 
leaving 
patient care.  advancement reuired 
As a result of the sureys, CW adted a 
prgrs,  prmar 
riont a  implemente a Pretorship  nurg prace  mol,  imprved ornta

der  fore. The tak for coduCt 2  progr, and establshed a I6-mebe car 
interviewed sta on al shift,  year of reseh into other available prgrs lad
and assessed available 
of action. The CNO served as a consultant to 
 resours befor 
reCommnding a 
the task force.
 Course 
PTwrog-Trra.c k Career  In 1980, CWL pilOted the Nursing Caeer Advancement
Lar: 
The fOllowing yea, a dual-track
 car lar 
provides for carr advancement in both pa,t ifeivnet -cleavree la nd  was implemente It

admstration. 
Every nure wa expete to apply for a carr lad 
salares would be 
 posirion. One inducemnt was 
remained active durernugc etdh ea tnrda nnseitairolny  fr3o0m0  rae ceived salares incrases.
 that no
The tak force
ing car to one wber prmorions  system which promoted away 
frm beside 
wer bas on  nurs
managerial areas. They provided workshops and binethearvaicoterd  cwoimthp eetmepncloey ees
in either clinical or
the transition. 
as neeed to aid  , "
year experience. The continuity of care provided by RNs and nure practitioners is credited
with creatig an envirnment which is conducive to sta retention. 
Another element of ths carr ladder is that advanced degrees are not reuir to progress
thugh 
the five steps. However, the hospital does provide 
scholarhips for nures wishing to 
pursue advanced degres. 
The CNO crets the carr ladder with retention of a highly skilled nuring staff 
with an 
average tenur of 5 to 7 years, able to provide quality car to acutely il patients within today 
cost-contanment envinment. The CWL employs no nur reiter; positions are filled by
employees ' recommndations or responses to local advertsing. 
The nursing deparent s dedcation to patient care is fuer demonstrated by their invened
organizational chan which features the patient and famly at the very top. 
Neonatal Nurse Practitiner  Eight year ago, CW pioneere 
Program:  the neonatal perina
ta nurse practitioner program in the State of Georgia, to provide 24-hour coverage in a high 
risk service ara. The relationship among sta nurses on this unit is both collaborative and 
collegial. There ar no RN vacancies, and the average sta RN has at least 5 
year ex
perience. The contiuity of care provided by RNs and nurse practitioners is credted with 
creating an envirnment which is conducive to sta retention. 
Contact for more informatn: 
Crawford Long Hospital of Emory University 
550 Peachtree Stret, N.

Atlanta, GA 30365 
Katherine Pope, RN, BSN 
Assistat Admistrator for Nuring 
(404) 892-411  , '
METHODIST HOSPITAL 
Gary Indiana 
Background:  Methodst Hospita is a 60 be 
and Menillvile, Indiana. It spoosor a famly 
two-hospita sYStem with 
camuses in Gar 
teching/traiing site for nurng, dieta,  practi residency prgr 
and serves as a
pMreothgord,s t is afliated with Indiana Univeprhiytys iNcaoln twheerspty ,in Phaacy, and social Wor.
clincal elective courses the aras of nuring 
, and nuring 
researh. Eighty  school extern 
phavre epdaiplorm.as   or assoate degrS, 
 19 percent have  pent of the nursing staf
bacalurtes and 
percent ar maters 
Five nur clical 
levels employe at ths hospita 
and Parcipation in  ar bas on sk
educational and reseh  , me spia 
rather than to fonnal prjects
activitis. Pay scales ar 
educatin. Methodst has 691  tied to 
and tuover rates for the  budgeted  cliical level
fit half of 1988 we 8.  pent  sta nurse positions. Vacancy
and 15 pent.
Collaboraon wilh Local 
ses, Methodst has  Uni"",.iI: To matan a 
entere into a Varety of COntinuig  of wel-educate nur-
Nursing School.  collabortive  supply 
ventus with 
the Inana 
University 
Stunt Exern 

Program: 
hextier ns ha ben so successESftublli shed in 
 1975, the hospta'  progr of hig 
Student
into petment  tht  last  ye, 80 pettnt of thei 
senior externs 
imo the hospital at an peovietni oenasr.li eTrh set apgreo ogfr atmhe ihra esd nuocwation. Were 
ben expanded to brg students 
Level I 
extes, new nuring 
students with no 
to suppon professional  coure wor complete
objective is to prvide esaltya  efoxrp oa sfuewr  thoo ur of non-patient car duties,.  aThr ehired 
the  hospital  philosophy and culture. 
extes, 
Level n 
students with at 

bed and breakast leat  one semeste of coure work,
" duties, such as feeng  ar assigned 
patients. 
Level m extes
, in their 
patient  fial year of nuring Stdies, Provide
car under RN supervision.  SOme dict 
W ork -S

Clinical Electives: 

Students expeence in  A joint work -Study cliical
 electve coure prvides

ha-torecruit aras such 
units. The hospita pays tuition and  as the operating 
clinical prepto  provides a smal stipend. SturdOeOnmts  awnodr nke wuritohl
ogical

and 
ar taught by staff nurse 
response, this clinical elective program may be eexxppaendrte. dD tuoe th teo  neonata 
the extrmely positive
medcalsurgical and oncology 

nits.  . '
ProjeclOverlap:  This is a joint project, now in the planning stages, aimed at recruiting 
bright high school students into nursing. High school students 
to take university level science courses,  wil have an opponuniry 
earing both 
their coure work.  high school and college credirfor 
Contact for more infonnatn: 
Methodst Hospital

60 Grat Stret

Gar, Indiana 46402

Sherr M. Burger, RN, MA

Vice President of Patient Car 
Services

(219) 886-4795  NEW ENGLAND MEDICAL CENTER

Boston, Massachusetts

Background:  A 469-bed acute car facilty in Boston, Massachusetts, the New England Medi
cal Center serves as a diagnostic and refen-al center for multiple 
medcal and surgical' 
ties and is the primar  special
teaching facilty for Tufts University School of Medcine.

is known for specific expenise in cardiology, cardiac- The Center

thoracic surgery, oncology, onhopedics
and neonatology. With an RN complement of just over
60, the 
durig 1986 and 1987 and stands at 4 percent for the  nure vacancy rate was zero
turover rate is 12 percent  fist 9 months of 1988. This year s RN 
Nursing Case Management: 
 The Nursing Case Management advanced professional practice
model was implemented 2  crted 
year ago, and is  with attrcting nurses to the 
ter. The approach is more than a nursing model; it is also a philosophy of nursingM aenddi cpaalt ieCnent 
care. 
Nursing case management is the application of 
trditional maagement skils at 
level by the  the individual
primar car giver to achieve positive outcomes economically and 
within a specifc period of  effciently
tie. Fundaental to this system is the belief that the case manage
ment role is best filled by the 
cliician who relates diectly to the 
patient and famly. Care is
provided by a formal nursing 
grup practice, and is coordnated by the nurse case manager in
collaboration with the physician. 
Development of the nursing case management 
moel involved a complete 
rexamnation of
the nursing role in the hospita setting. Hospita maagement 
recognized that nurses were no

longer satisfied to function in the shadow of the medcal profession and that they wanted to

parcipate in decisions on patient care and the 
restrcturng of 
delivery systems. They felt

that responding to the CUIent nurse 
shortge required a reformulation of the
that recruitmnt and  nurse role and 
retention strategies would fall shon if this was not done.
As a professional practice model, 
nuring case maagement 
and unique contrbution as collaborative 
 acknowledges nures' valuable

members of the health car team. It 
many of the complex issues facing  also responds to

admnistrtors, maagers, and 
clinicians as they develop
strategies to achieve quality 
car in a cost effective manner. 
Managed car reuires 
a skilled cliicianmaager who is cOmmtted to both the patient and
Nurs 
the institution.  have traditionally not ben 
skilled in management, nor have they been
given the information
, tols or authority to manage 
manager is the priar  car beyond their own shifts. The case
nurse responsible for developing individual patient care

The case manager is accountable for meeting those  Outcomes,

Outcomes within (1) an appropriate length
of stay, (2) limited resources and (3) established 
stadas.  , " 
, -
stadaze 
Cae managers use  plans of care that have 
ben jointly developed by nursing and
medcine for given mecal case tys. The plans are highly detaled and provide an explicit
stadad by which to continuously monitor patient 
progrss. Case managers 
breviated versions of  also use ab
cas maagement plans known as crtical pathways. 
The crtical path
way shows the key incidents, e.
g., tests, tratments, discharge planning, that must occur in a
timely fashion to achieve an appropriate length of stay. 
Accordig to the CNO, nuring case 
management has elevated 
nuring to a 
authority within the institution, while clearly defining and translating into acptuoasilt piornac otifce the

profession s goals of collaboration and accountabilty.

Initial data suggest that this model has: (1) 
promote nures
' professional development and

satisfaction, (2) met or reuced lengt of stay timelines, (3) achieved expected clinical out

comes, (4) promoted collabOrative practice, 

coordiated car and 
utilized appropriate or reuced resources.  continuity of car, and (5)

In an effon to shar this model 
as widely as possible, Medcal Center sta 
tas thoughout the U.S. and in England, publish a quarrly  consult with hospi
newsletter entitled 
The Center for  Definition-
Nuring Cae Management,
" hold workshops and author publications. 
Contact for more infonnatn: 
New England Medcal Center 
750 Washington Strt, 
Box 861

Boston, Massachusetts 02188 
Phylls Hoopman, RN
, MSN

Dirctor, Surgical Nuring

(617) 956-5572  , "
ORLANDO GENERAL HOSPITAL

Orlando, Florida

Bflkground:  Orlando General Hospita is a not-
license be. It  for-profit community hospita with 197
employs about 180 RNs, of whom 20 
Last year, the overa tuover  percnt wor on a pan-tie 
rate for nures thughout  basis.
the hospital was about 18 
percnt.
The hospita's obstetrcs and gyneclogy (OBIGYN unit 

fac a 
May OBIGYN nures wer resigng out of  fr  Pancularly serious prblem.

wher they felt ineXpeence and inaduate.f rstrriona ppeb eing "flte" to other unts
morivato. Reitmnt  Money  to be only a tempor 
of new OBIGYN nur 
of expensive prvate agency  spealists was prvig dificult
nurs was incring.  , and the use
obstetrcs nures  In an attmpt to adss 
researched and established a professional practice unit.  ths problem
, the 
ProfessilU Pro/i 
in the nuring unit,  Unit (PPUo): pte Base on the concpts of autoomy and self-
responsible for the tthye  PPU  as a coletely separte enrity.  governance 
and qualty of  Eah nure is penally
an 
as a whole. Nures make  car given  the success and 
prucrivity of 
decisions on care, scheduling and budget. 
the unit 
Key elements of the PPU include the following: 
Sta 
Self-scheduling:  schedule their own work hours using
majorty vote. Flxible  gudelies detened
frm trrional  4-y, lO-hour shifts prde 
stag  oprima COverge. Shifts var
schedules by  hourly between 5:00 an 
m., and 8:00 and 10:00 p.  8:00 a.m., 1:00 and 3:00
Nur 
over 
. Salaried Staff 
 receve no 
savigs of $100,00 by elimiating  or "on ca" pay. The unt eSttes annual
increasing nurse salares.  pol and agency nures and overtme pay, while 
Decision by Committee: 
 Commttees known as " 
operarions: educarion quality cirles" make desions on 
Each cirle consists of,  tpher  review, budget, quaity assurance, stafing and schedulinugn.j,
months. Every nurse parcipatot efsiv, e nurs who rotate between cOmmttes every
some in two 
cirles simultaeously. 
Regular Staff Meetings: 
 Nurses are 
meetings held every month.  reuired to attend at least one of the two staff
Thee to five 
physicians  nurses also pancipate in the monthly
meetig. Communicarion between nures 

since this practice staed.  and physicians ha imprved

Self Performance Appraisals: 
 Nures 
evaluate their own perfonnance and their self
assessments 
ar reviewed by 
peers.  THE MEDICAL CENTER AT PRINCETON

Princeton
, New Jersey

Background:  The Medcal Center at Prnceton (MCP) is a 440
be compfex located in Prn
ceton, New Jersey. The acute car facilty has 270 beds, the skilled nursing rehabilitation unit
has 90 beds, and the psychiatrc unit has 80 beds. 
When the present CNO assumed her position in 1980, the nurse 
were 38 percent and 18 percent respetively. After  turover and vacancy rates 
soliciting 
situation, she sought and received Board approval of her  sta feeback and analyzing the
several significant actions:  pro-nuring philosophy, and for 
improved nursing salar and 
benefits strctue; 
decentralized nursing management; 
establishment of clinical career 
laders; 
implementation of a closed unit 
stafmg system; 
creation of a hospital-
based nursing 
pol; and

adoption of a patient 
centere car model.

The success of these measurs was reflecte in the 
1982 vacancy and tuover rates of 15 and
2 percent. These rates remained stable until 
Januar 
1987, when competing facilties began of
fering large salar increass, bonus packages and bounties 

nurses accepte positions at these hospitals. The remandert ofo autntdc tt haermeas enlvuerse sw. oMrkanngy d MouCbPle
shifts, 
to many weekends and floating to units with insufficient personnel.
Turover rose 
27 percent and the vacancy rate reached 19 percent in 1987. 
Importance of Board Support: 
 The CNO's first step was to seek Boar 
cent acoss the board salar incrase for nures, to  th  approval for a 20 per
year in order to mainta party. May boar  be granted in  steps thughout the
members ar CEOs frm neighboring Fonune
500 companes. Their 
business expertse enabled them to recognize that they "

hospital without nures.  can t run the

" They approved the salar increase. 
New Ways to Deliver Patnt 
The CNO also sought 
dissatisfaction. Thee areas  Care:  sta input on the reasons for their
were identified: schedules, salar/benefits and nuring/non-nurs
ing functions. As a result of 
reoIIendations made by subcommnees established to addrss
these concerns, a number of actions have been taken:  , "
Creative Work Schedules 
 -A weekend premium pay pilot program has been instituted
which has allowed staf more weekends 

off.

Salary/Benefit  - Staf have received two raises and an increase in base salares. 
Nursing/Non-
Nursing Functions: 
 Within the priar 
all functions they were performng, and then distinguisnhuedrs binegtw meoedne tlh, onsuer wesh iicdhe nmtiufisetd be

perfonned by an RN and those which could be delegated. This exercise led to a 
complete 
rethinng and analysis of delivering
quality.  car economically without 
sacrificing 
The result was a new 
car moel which 
clearly identifies patient
car 
responsible staf person. Tasks 
were incorprate  functions and the
orientation was provided. Professional  into job descrptions and in 
nuring  service
suppon personnel whose positions had been 
 sta ar no longer being substituted for
elimiated to cut 
costs.

The CNQ remains commtt 
mang  to "nursing being able to provi 
the system revolve arund the cargiver complete, high-quality car-
Boa'  , not the 
contiuig suppor  cargivers arund the system.
for nursing has been regnze  " The

ben inuential in  thughout 
improving nure- the hospita, and has
coupled with these specific changes phhayvsei cian relationshps. The
 prnurng 
envinment
alady had a positive impact. During the first half
of 1988, both tuover and vacancies droppe to 
12 percent. 
Contact for more 
informaton: 
Medcal Center at Prnceton

253 Witherspon Street

Prceton
, New Jersy 
08540

Elizabeth L. Buff, RN
, MA .
Vice Prsident for Nursing 
(60) 734-4593
 ST. LUKE'S EPISCOPAL HOSPITAL 
Houston, Texas 
Background:  Sl Luke s Episcopal Hospital is a private, not-for-profit, acute car facility 
cated in the Texas Medcal Center complex in Houston.  lo
Recognize as 
one of 10 major surgi
cal centers in the world, it perfonn 12,00 surgical cases per year. With 949 licensed beds,
St. Luke s provides car in 40 medcal specialties. 
When the CUIent CNO came to St. Luke 
at 66 and 28 percent. The CNO saw this sc risni s1 9a8s 5a,n t hoep pRoNn utnuiotyve fro ra cnhda nvgaec.a ncy rates stoo
listener and faciltator A self-described
, she has 
fostere an envionment that is "focused on 
Both sta and patients ar seen as problem identiers and problem solvers.s Tolhveiirg  opprionbiolenmss a.re
continualy sought thugh an ongoing surey proess initiated by 
the CNO. 
The CNO'  crbilty with sta
, pers and upper maagement has been built on swit im
plementation of recommnded changes. 
She challenges 
to determne what nee  sta not to overstudy a problem, but
to be done, test a solution and, if it fails, 
this technique has ben  tr again. The success of

percent and 8 percent fobr othrnee f iorustt  by dramatic drps in nurse tuover and vacancy rates to 6

hal of 1988. It 
was also from ths proactive envirnment

that nurses were selecte to sta Sl Luke  Super Unit.

s "
The Super Unit is a 47-be 
Super Unit: 
 medcal-surgical unit where solutions to 
sta  problems ar ,
piloted. All  identify problems. A resident maagement 
engineer investigates issues and
quantifies possible solutions. Every step includes input from unit 
are highlighted below: '  sta. Two CUIent projects 
Installation of Additional Telephones: 
 With most of their tie 
spent at the bedside.
nurses found that they often missed calls 
frm 
physicians beause of the time 
reach the nurses ' station. Instalation of  needed to
extr telephones half-way down the halls has
resulted in a 50 percent improvement in the number of calls completed. 
Patient Care Area 
When staf nurses reponed they 
Pharmcist:  were spending too
much tie performg pharaceutical functions, a 
The resident pharist has proven to be a valuablep hreasnoaucricset  tow apsh yassisciigannesd,  ntuor sthees  aunndit.
patients, and nurses 
tie has ben fred up for nursing tasks. In the words of the
pharcy ditor, "
we are no longer just a voice at the other end of the phone. 
Community Outreach Program: 
 This program began in Apri 1987 when a 
help in mang a health presentation at her child'  nurse asked for
stitutionss scho.ol. B y June 1988, the progr 
made 62 visits to schools and health  had
fai and contacted over 20,00 chidren and adults 
263 health topics. It has involved 
Luke s laboratory, dieta and phaIrpaucltyi ddisecpipalriennart st,e ams of nures and other sta from
as well as professionals frm 
other 
1 n  Shared Governance: 
 The theme of St. Luke s shared governance is nurses ' accountability

and responsibilty for patient care. It is based on "promoting professional 
nuring from the

bottom." St. Luke s adopte its the-tiered model of shar governance 2 years ago.

Consisting of unit staff nures, it deals with all issues affecting 
Unit Council: 
 the unit,
g., hirng, budgets, scheduling, peer review. Unit councils are fully operational. 
Clinical Area Council: 
 Stil in the planning phase, its responsibilties cover an entie 
clinical specialty. 
Staff Nurse Council:  This hospita-wide boy includes representatives from all unit 
councils and is co-chaied by an elected staf nurse and the CNO. It addrsses problems
involving more than one clinical ara. All clinical task forces and commttees repon to 
it. 
Nursing Support Servces:  Initialy created to help nures deal with changes in the nuring
deparent, 
the NSS is a confdential service of professional 
and personal suppon for beside 
nurses. Aid is provided in an environment 
where any job relate or personal concern can be 
discussed. 
On the professional side, the NSS clinical nurse specialists consult on pain management, 
bereavement counseling and other clinical specialties, as well as providing in-service 
education specifically tailored to the unit's staf nees. 
On the personal side, NSS offers career counseling, suppon groups, negotiation skills 
and substace abuse programs.

affi 
In the words of the CNO, NSS "acknowledges that nuring is difficult and  its impor
tance to the organzation. 
Contact for more informatn: 
St. Luke s Episcopal Hospita 
Texas Medcal Center 
6720 Benner Strt, P.O. Box 20269 
Houston, Texas 77225-0269 
Karlene Kerfoot, PhD, RN 
Senior Vice Prsident for Nursing 
(713) 791-4080  , '
SEQUOIA HOSPITAL 
Redwood CIty California 
Built in 1950, Sequoia Hospital is 438-
Background:  be not-for-profit acute-care facility lo
cated in Redwoo City, Cafornia. 
Over the past 2 years, extensive renovations have been
complete in the labor and delivery areas, 
binng rooms and extended 
increased bins in the area, the hospita added a level 2  nurery aras. Due to
nurery to car for 
babies with medi
cal problems. A shon stay admssion unit is under 
cardiovascular deparnt  constrction. The hospita is known for its
and provides a varety of speialty 
servces including coronar
bypass surgery, 
coronar researh and invasive cardiac procedurs, sleep 
disorders treatment
and extended car. 
In June 1988, budgeted RN positions 
totaed 534, over twce the number neeed in 
Half of the nuring  198!.
sta have associate degrs, 40 
percent ar diploma nurses. All clinical specialists apnedrc seonmt eh auvnei t baccalaurate degrs and
maagers are 
prepard.  masters
Durg 1980 , the RN tuover was 16 percent. Tody it is less than 3 percent. The RN
vacancy rate for the first 6 months of 1988 was 6 percent and the average 
lengt of RN 
employment now stads at 9.
5 years. The RN to patient ratio vares from
care and carac car  1:1 for the intensive 
units to 1:6 for the medcalsurgical unit. 
The CNO is an Associate Admstrator
, who believes that "nuring has a 
in senior maagement at Sequoia.  strsse  very strng presence
" She  that may changes in the hospita 
sible beause "we have an  ar pos
admistrator who is a real supponer of nuring. 
Nurse Internship Program: 
 The hospita has had an active 
1980. One of its most successful progrs  reitment commttee since
is the nurse internship progr 
early 1987. It is gear  which began in
toward senior nursing students from several area nursing schools who
have at least 1 year of cliical trning. 
Students complete a summr 
orientation and work

pan tie durng the school year. Since Sequoia nurses have a reputation in the community of

trating patients well, students  progr 
ar very reeptive to the  and many accept permanent
employmnt afr gruation. 

Because the interns 
ar alady famiar with the hospita when hir 
into permanent positions.
their orientation costs 
ar lower than for other new graduates and the tie reuir 
fully prouctive  to become
employees is  progr 
reuced. The intern  is designed for 15 to 20 students
and is funded thugh 
the regular hospital budget. As expressed by the CNO, it has been "
trmely successful."  ex-
Hospital Nursing Committees: 
 Sequoia has thee nursing commttees which
visible thughout the hospita.  ar highly  Council on Nursing Practice  (formrly the Procedures Commttee): This group of 15 to
20 nures from all clinical specialties update policies, procedures and protocols. The 
commttee works so well that revision of the nursing procedurs manual 
wil be 
completed 1 year earlier than its original deadline. 
Nursing Quality Assurance Council: 
 This is a group of staff nures, with cliniCal 
specialists as advisors, who develop stadads of practice. They conduct a mock 
JCAHO inspection and infonn managers of possible violations that should be corrcted 
before the actual review. They also wrte a "Staying Ready for JCAHO" column for the 
hospita' s monthly nuring newsletter. 
This commttee reviews issues and problems identified 
Nursing Excellence Commttee: 

by nuring staff and develops propose strtegies and solutions. Issues addressed to 
date include (1) accessibilty of admnistrative and nursing managers, (2) marketing the 
hospital in the community and (3) the handling of non-nursing taks. 
Adopt- School Program:
 Several year ago, Sequoia "adopted" an area midde school.
Durg 
National Nures Week, nurses visit the school and meet with students. To expand the 
contact beyond the health car professions, hospital accounting 
sta meet with math students 
to discuss careers in accountig. The students prouce crts for patients and provide the 
entenanment for the annual 
employee appreiation dier durng the holidays. The hospital 
has also staed a junor nurses' club at the school and plans ar underway to conduct student 
tour of the hospital. 
Contact for more informatn: 
Sequoia Hospita 
Whpple and Alamed Avenues

Redwoo City, Calforna 94062

Donna Derner, RN-Employment Speialist

Nurse Recitmnt Cordator

(415) 367-5525  WASHINGTON HOSPITAL CENTER 
Washington, D.

Washington Hospita Center (WC) is an inner city teaching facilty, which ser
Background: 
ves as both a trauma center and a regional health care provider. Upon completion 
o(a new ad
dition, bed capacity wil tota 871. The WHC is the "flagship" facilty of the Medlantic Health 
Care Group. 
The WHC employs five RN s for every auxilar sta 
person. The RN vacancy rate for the
first quarer of 1988 was 7 percent in an ara where the average is 18 percent Over half of the 
nursing sta have bachelors degrees and about 10 percent ar maters prepared. Nurse patient
ratios var from 1: 1.2 in intensive care to 1:5 on the medcaVsurgical units. 
In 1978, WHC nures went on stre for 31 days to protest wages and workg conditions. In 
March 1982, major strtetgirc do wnsizing occur wherein 13 top level executive positions 
were deleted frm the hospita' s organzational strctu. The Deparnt was rerganized
and the executive team  to six. It was in this crsis envinment that the present CNO
accepted the chalenge "to establish a dynamc nuring division -- one that respects, recog
nizes and underscores the value of professional nursing practice. 
The Team Approach to Everything:  The reorganize executive team set about tuing around
a nuring deparent with a "por self-image. " Using an approach where no one team mem-
ber, including the CNO, was overly visible, they completely restrctu 
the nuring depan
ment. Policy and procedur formats 
were modfied commttees were restrctued to include 
sta nures, communication lies were opened, a professional practice modl was imple
mented, and a nuring maagement information system was established. In adtion, 
the nurs
ing focus was shited to a business approach to health car delivery, and the nuring
philosophy was revised. 
The WHC  The executive team believes that the nursing philosophy 
Nursng Philosophy: 
must say what you believe in." It is the underlying basis for all activities which 
ar tageted
towar "always reaching beyond the expeted" level of 
performance and fostering excellence 
in nursinga prra tice. The phiosophy, reprinted below, is displayed proently on al desks 
and work  in the nuring deparnt. 
Nursing at the Washington Hospital Center is 
Distinction in clinical nursing practice through working with each patient and 
famly to maintain or restore the optimum level of health or to face death with dig
nity. 
Distinction in nursing research and education through advancing and support
ing the acquisition of knwledge. 
Distinction in nursing administration through leadership within an atms

phere of collaboration, creativity and positive regard.
 Nursing Product Line: 
 The prouct line was develope to reognize WHC'
expertse and foster nuring  s clinical nursing
s image as a business. Al nuring 
tion on existig nuring proucts or  sta were asked for infonna
those under development 
Four maketable prouct aras
were identied: operations management, consultat services, educational 
cations.  seminar and publi
After developing products in each of these aras, 
WHC fonnally introduced its product line in
October 1986 at the annual meeting of the American Organization of Nurse Executives. Two 
WHC proucts 
ar highlighted below. 
Nursing Connections: 
 Nuring Connections" may be one ofWHC' 
and ambitious projects. It is the  s most innovative
fit scholarly nuring joural published by 

care facilty in the  an acute
countt. The joural promotes collaboration between nurses in a
varety of practice 
settgs and bridges the gap between education and practice. 
Anicles 
ar wrtten by nures, business professionals, lawyers and others interested in 
contrbutig to 
the practice of nuring. 
Team Teaching: 
 Ara universities asked the CNO to teach 
courses at the senior masters level. She accepted on the connduitriionng t haadt nsihset brea tailloonw
 ed to 
involve a l7-member 
multidiscipliar team to teach each course. She believes that,
everyone brings 
strngts and expertse to the effort 
allows "everyone to be  " A collborative environment
recognize. " 
Last year, prouct line activities rase a 
substatial amount for 
the nursing budget. The suc-
cessful marketing and delivery of the 
prouct lie demonstrates 
with nursing while enhancing professional 
 an abilty to blend business

grwth, reognizg nuring as a 
health  leader in the

car delivery system, and creatig an envinment 
conducive to 
qualfied and highly cOmmtted sta.  reruiting and retaining

Nursing FeUowship: 
 Ealy in 1989, the first post 
tems management wi begi  Haar  gruate nuring fellowship in health sys
with the  School of Public Health. 
Contact for more informatn: 
Washigton Hospita Center 
Irg 
110 
Strt, N.W., Room 2A26 
Washigtn, D.
C. 20010

Joyce E. Johnson
, RN, DNSc

Vice Prsident, Division of 
Nuring

(202) 877-6698