Healthy work environment: Medical center program thrives as nurse staffing elsewhere suffers

p>In late March UC Davis Medical Center Associate Director Carol Robinson and several nurses were interviewed by Time magazine.

Last week, the medical center hosted Hamako Kitsumata, Japan's deputy director of the Ministry of Health, Labor and Welfare. Katsumata and a colleague peppered Robinson, who is in charge of nursing services, and her staff with questions about patient care, staffing and education programs.

And soon, the medical center's nursing practices will be featured in two prominent nursing journals.

The schedule has kept Robinson on her toes, but she's glad to see the medical center get exposure.

"The publicity is good. We've being seeing nurses calling from everywhere trying to get on," Robinson said. "It's good to help us fight the nursing shortage."

Nationwide, hospitals have closed patient beds and canceled surgeries because of a lack of nurses on staff. The shortage has been attributed to the stress and working conditions of the typical nursing job, along with a declining enrollment in nursing schools.

Across California in December, about 20 percent of nursing posts in hospitals were vacant, said Jan Emerson, spokeswoman for the California Healthcare Association. So far, however, the medical center has been able to keep its 1,400 or so nurses on the job at a far higher rate than its peers across the state.

Low job vacancy rates

From January through March, the medical center's nurse-vacancy rate was 8.08 percent, Robinson said. And unlike at many hospitals, only nurses employed by UC Davis work there. The medical center does not use a nursing agency to fill empty spots. Instead, it pulls from its per-diem pool.

Emerson said she's not surprised to hear the figures. "UC Davis Medical Center is in a better sitation overall than most hospitals because … of their unique programs," she said.

The medical center is one of fewer than 30 hospitals in the country certified as a magnet hospital by the American Nursing Credentialing Center. The certification is given to hospitals that show strong nurse leadership, a commitment to improving patient care and a recognition of the cultural diversity of its patients and staff.

An enthusiastic, fulfilled staff

The medical center includes programs like Center for Nursing Research, which examines patient care and professional issues. At the center, Margaret Hodge, a clinical nurse scientist, helps staff nurses develop their own studies and works on her own research into factors affecting cognitive functions of nurses working 12-hour shifts. "Having nurses who are enthusiastic about research, read the latest research findings and who conduct their own research - all of those things benefit the nurses and the patients," she said.

With very few exceptions, patient care at the hospital is provided by only registered nurses. Only a few licensed vocational nurses, hired years ago, remain on staff.

That makes UC Davis a fulfilling place to work, said Bree Cox, a pediatric nurse who recently joined the medical center staff.

"You get to do everything with patients, from giving them IV medications to bathing them," she said.

High-quality patient care

The medical center reports fewer patient falls, fewer medication errors and fewer pressure sores on patients than many other hospitals because of the skills of its nurses, Robinson said. "We get superior patient outcomes be-cause we have highly qualified staff," she said.

Primary-care nursing is perhaps Davis' most visible program of excellence, Robinson said. Under the nursing model, patients are each assigned a primary nurse, responsible for developing a plan of care for the child and acting as a family advocate. Each time the child is re-admitted to the hospital, he or she is ideally assigned the same nurse. When the nurse is not on duty, a team of associate nurses carry out the care prescribed by the primary nurse.

The model allows nurse Ellen Kissinger to know initimately the needs of patients like 10-year-old Nehemiah Lawsha. He has stayed at the hospital on numerous occasions over the past few years, seeking treatment for the blood disease sickle cell anemia.

"I know that he doesn't tell me when he is in pain. You have to know by visual (clues)," Kissinger said. "And if he's sleeping a lot, I know that's not him."

Nehemiah's mother, Triscina Lawsha, says she appreciates the continuity of care primary nursing provides. "(Kissinger) knows my son. It helps that I don't have to say things over and over again," Lawsha said. "Sometimes if he's really sick, I don't want to do that."

Future nurses badly needed

Despite kudos from patients and familes and national and international acclaim, UC Davis nursing isn't resting on its laurels. The average age of a California nurse is 47 years old, according to the state Healthcare Association. Many of the students in nursing schools now are older students exploring a second career. The medical center and its peers need to find ways to encourage younger students to enter the physically and mentally demanding profession, she said.

To entice them, Robinson tells students about the opportunities nursing provides not only in patient care but also in research, management and teaching.

"It's a very diverse profession," she said. "We try to promote that."

Media Resources

Amy Agronis, Dateline, (530) 752-1932,

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