Sunday, March 25, 2001

Respect for nurses drives success at St. Elizabeth

Good pay and chance for input result in low turnover

By Tim Bonfield
The Cincinnati Enquirer

        Most Tristate hospitals have been struggling to hire nurses.

        The problem is so severe that hospitals have diverted record numbers of life squads elsewhere five of the past six months.

[photo] Tracei Schack (right), a registered nurse, drops by to show her newborn to fellow nurses.
(Patrick Reddy photos)
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        One exception is the St. Elizabeth Medical Center group in Northern Kentucky.

        Unlike their big competitors north of the Ohio River, St. Elizabeth's three hospitals in Covington, Edgewood and Williamstown are not desperate for nurses. They are not facing financial crises. And they are not sending life squads someplace else every other day.

        St. Elizabeth has been adding beds and services while other hospital groups have endured closings and deep cutbacks. Along the way, St. Elizabeth is quietly developing a reputation for low cost and high quality, especially in cardiac services.

        “The key to all this has been the nurses,” said Joe Gross, St. Elizabeth president and chief executive. “Our product is patient care, and the biggest raw material in that product is our nursing employees.”

    A survey for the Greater Cincinnati Health Council conducted in December and January measured job satisfaction views of 269 randomly selected hospital nurses:
• 77 percent were somewhat or very satisfied with their jobs
   • 59 percent said excessive patient-to-staff ratios or intensity of workload would be most likely to make nurses quit
   • 52 percent would not recommend nursing as a career to friends and relatives
   Of those who would not recommend nursing as a career, reasons included:
• 25 percent citing inadequate pay and benefits
   • 21 percent citing intensity of workload
   • 20 percent citing lack of professional respect
   When asked: What one change would most increase their likelihood to stay on the job?
• 47 percent said provide adequate staffing
   • 24 percent said increase pay and benefits
   • 10 percent said professional respect and recognition
   • 8 percent said improved communication and better management
   Source: Greater Cincinnati Health Council
    Founded: 1861 in Covington.
    Locations: Covington, Edgewood, Williamstown.
    Affiliations: Catholic Healthcare Partners, Archdiocese of Covington.
    Employment: About 3,200, making it Northern Kentucky's third-largest employer.
    Patient volume: More than 23,000 inpatient admissions per year, 92,000 emergency visits and 250,000 outpatient visits per year.
    Awards: June 2000: HCIA-Sachs rated its heart services among the top 100 in the country; April 2000: rated its cardiac program among the top 3 percent nationwide, including five-star ratings in specific surgeries and treatment of heart attack; Fall 2000: Data Advantage Corp. ranked it among the nation's 100 lowest-cost providers for 20 of the 50 highest volume services provided by hospitals; April 1999: St. Elizabeth featured in a front-page Wall Street Journal article; August 1999: St. Elizabeth Medical Center named the nation's 20th “Baby-Friendly” hospital by an affiliate of UNICEF.
        No hospital, not even at St. Elizabeth, is having a rosy time. But its confrontation with economic troubles offers insight into issues facing hospitals today.

        Among the signs of success at St. Elizabeth:

        • With a $5.6 million profit on operations, St. Elizabeth was the only big hospital group in the Tristate that made money in 2000. It earned enough to give nurses a 6.5 percent raise this year and all employees a bonus averaging $500. Cincinnati's biggest hospital groups — the Health Alliance of Greater Cincinnati, TriHealth and Mercy Health Partners — have reported losses and closings in recent years. Mercy Hospital in Hamilton is the latest, expected to close by June 1.

        • St. Elizabeth has about half the nurse vacancies other Tristate hospitals face. The average nurse has worked there more than 10 years.

        • The hospital group hasn't gone on diversion at all in 2001. Hospitals go on diversion when they are swamped, directing life squads to take all but the most unstable patients someplace else. Through February, Jewish Hospital declared 41 diversions; Christ Hospital, 26; Good Samaritan and Bethesda North, 15 each; and University Hospital, 13.

        • St. Elizabeth has collected several industry awards since 1999, including a ranking among the nation's 100 lowest-cost hospitals and among the nation's top 100 hospitals for cardiac care.

        • St. Elizabeth has been adding services, including a new cancer wing in 2000 and a women's health unit this year in Edgewood. It also recently tripled the size of its emergency department in Williamstown.

        St. Elizabeth has spent years building a culture of respect for nurses, Mr. Gross said.

        “At its best, nursing is no cakewalk,” he said. “It's a demanding profession, emotionally and physically. We try to let nurses do what they like to do: care for the patient and work with their families.”

        Other nurses in the Tristate notice.

        “Nurses are staying there,” said Cheryl Townsend, a nurse at University Hospital. “They seem to have a family atmosphere. They seem to have a close connection between the administration and the nurses that do the work.”

        St. Elizabeth's treatment of nurses is uncommon, said Dr. Linda Aiken, an expert at the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

        Hospitals nationwide are failing to retain nurses, she said, because they no longer offer the pay, the involvement and the institutional support nurses expect. Hospitals are less able to compete for nurses with home-care services and doctors' offices.

        “There are plenty of nurses in the United States at the moment,” Dr. Aiken said. “But they don't feel good or safe about the work they're doing in hospitals.

        “There are some hospitals out there, like St. Elizabeth, that are developing those conditions. But most hospitals are way, way, way behind in terms of modern approaches to managing their workplaces.”

        St. Elizabeth can afford to offer the highest average hourly pay for nurses in the region — $20.89 per hour. And the hospital group involves nurses in many decisions, such as what supplies to buy and how to staff the units.

        Perhaps most important, St. Elizabeth avoided two morale-bursting policies common among Cincinnati hospitals: It does not pay large signing bonuses to new employees. And it does not hire temporary-agency nurses.

        At some hospitals, as many as half the nurses in hard-to-fill shifts are temporary staff, Mr. Gross said.

[photo] Nurse Melanie Ingram and social worker Jim Bishop.
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        “Nurses don't like working with (agency) nurses that get higher pay than they do but don't know the hospital as well,” Mr. Gross said. “They don't like seeing new co-workers getting bonuses they don't get.”

        St. Elizabeth's willingness to close medical units rather than overburden nurses also breeds loyalty, said Jane Swaim, who left University Hospital five years ago to become vice president of nursing at St. Elizabeth.

        “The administration truly supports nursing. I've had (nursing staff) increases every year I've been here,” she said.

        Melanie Ingram, 43, has been a nurse at St. Elizabeth since 1993. She came to the hospital because it offered much higher pay than the hospital near her home in Milan, Ind. She stayed because she feels involved in how the hospital runs.

        “I have a vested interest in seeing that things go well,” Ms. Ingram said.

        At other hospitals, temporary nurses often don't get involved in planning or solving problems, Ms. Ingram said.

        St. Elizabeth's location also has contributed to its growth during difficult times for health care.

[photo] A Rays of Hope pin means an employee contributes to the “Vision” program.
        St. Elizabeth is 140 years old, and is Northern Kentucky's third-largest employer. The area's continuing influx of residents and businesses provides its hospitals with employees, volunteers and financial support.

        The sense of pride at St. Elizabeth can be measured in hard dollars: More than 75 percent of employees give part of their pay to the hospital group's “Vision” program, contributing $1.5 million for various hospital projects.

        St. Elizabeth moved its main hospital from a limited-growth location, Covington, to a fast-growing suburb, Edgewood.

        The greater demand has given the hospital greater leverage with health insurers.

        In contrast, many of Cincinnati's biggest hospitals remain concentrated in older neighborhoods with shrinking populations. Until the mid-1990s, the state blocked them from moving into growing suburbs.

        St. Elizabeth also avoided the waves of hospital consolidations, which led to downsizings, closings and management reorganizations at Health Alliance, TriHealth and Mercy Health.

        St. Elizabeth is not immune to the industry's ills. It still copes with tight reimbursement from insurers and a shrinking pool of nurses. The hospital group has vacant nursing jobs.

        “Lots of days, I think I can't walk one more mile,” Ms. Ingram said. “But the reasons I went into nursing are still there. I always wanted to fix things for other people.”

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