Nursing News

Nurses Play Key Role in Nation's Top 100 Hospitals

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By Amanda Sounart, associate editor

The 15th annual 100 Top Hospitals list was released this week by Thomson Healthcare, revealing some new additions to the list as well as some long-time recipients. These hospitals are recognized as "national benchmarks for success" in both patient care and financial growth.

The hospitals on the list have been reviewed and ranked based on eight clinical and financial factors that have been determined to show the hospital's overall success. These measures include risk-adjusted mortality, risk-adjusted complications, patient safety composite, average core measures scores, severity-adjusted average length of stay, expense per adjusted discharge, profit from operations, and cash-to-debt ratio. One of the largest contributing factors to the success of these hospitals is their nursing staff.

"These are hospitals that have to be performing well across the board," said Jean Chenoweth, senior vice president in the Center for Healthcare Improvement at Thomson Healthcare. "We measure quality in terms of outcome, of cost of care and efficiency of care, all of which nurses influence. Nursing is a true contributor to saving lives, reducing costs and geting patients better sooner. "

In order to discover the key to being a top performing hospital, Thomson Healthcare has done several studies on the recipients and discovered that they often have several factors in common, including the relationship between the nursing staff and hospital administration.

"A very high proportion of the 100 Top Hospitals are Magnet hospitals," noted Chenoweth. "The executives at these hospitals have always looked at nursing as a key component to success. They were typically earlier than others in making nurses members of the leadership team. They are significantly more likely to have shared governances."

While nurses at these hospitals are included in leadership, a common theme among these hospitals is to have the majority of the nurses at the bedside caring for the patients.

"The 100 Top Hospitals have a lower number of RNs in administration and a higher number of them in direct patient care," said Chenoweth. "They don't overload in nursing administration. They also have a higher RN to LVN ratio."

While dedicated and experienced nurses are contributing factors to good outcomes, the 100 Top Hospitals ensure that their staff is working together harmoniously, which leads to a positive work environment.

"In all of the 100 Top Hospitals it takes a total team effort," added Chenoweth. "Typically when difficulties arise between nursing and administration or administration and the board, these hospitals act quickly to correct the situation. When there is turmoil, performance declines. You can't be setting the benchmarks for the nation and have discord. Every single nurse, manager, housekeeper, physician and board member has to be working for the same goal."

All of the data collected for the 100 Top Hospitals was gathered from public information from the previous year. Hospitals have no say as to whether or not they make the list, making it a true indicator of where the hospitals stand. There is no nominating or sponsorships involved in the process.

"We create this list every year to better reflect what a well managed hospital looks like and what its characteristics are," Chenoweth noted. "We also don't sell these reports to consumers. We deliberately set the prices for a hospital to reach. We don't do this because we're selling magazines or advertising. We do it because we're trying to encourage performance improvement."

To read more about the 100 Top Hospitals, visit

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