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Nursing Care


Nursing care is at the core of a hospital's patient care. Some of the indicators in this section summarize how Norton Healthcare staffs its hospitals. Other indicators assess the working environment provided for nurses. Recognizing the importance of nurses in hospital care, Norton Healthcare has participated in the American Nursing Association’s National Database of Nursing Quality Indicators (NDNQI ®) since early 2006. Our primary goal in becoming participants was to obtain comparative information for use in quality improvement activities. Other sections of this report also have nursing-sensitive indicators. Norton Healthcare performance represents the performance of all the hospitals combined.

RN survey - practice environment scale
Practice Environment Scale. The overall survey assesses our nurses' opinions about the nursing environment in the hospital on a scale from 1 to 4. The overall average is calculated as the average of five subscales: participation, foundations of quality, leadership, staffing, and nurse-physician collaboration. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Intervent ional units. NDNQI® does not permit other organizations to display their national results. More information about NDNQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, all questions high 2.89 2.83 2.80 2.83 3.34 2.95    
Nurse Participation in Hospital Affairs. The participation subscale assesses our nurses' opinions about such things as the hospital's chances for nurse career advancement and participation in hospital decision-making. Average of 9 questions on a scale from 1 to 4. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Interventional units. NDNQI® does not permit other orga nizations to display their national results. More information about NDNQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, participation subscale high 2.83 2.71 2.69 2.83 2.92 2.80    
Nurse Foundations for Quality of Care. The Foundations subscale assesses our nurses' opinions about the hospital's support for nursing quality of care. Average of 10 questions on a scale of 1 to 4. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Interventional units. NDNQI® does not permit other organizations to display their national results. More information abou t NDNQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, foundations subscale high 3.12 2.97 2.98 2.99 3.47 3.12    
Nurse Manager Ability, Leadership, and Support of Nurses. The Leadership subscale assesses our nurses' opinions about the hospital's nurse managers. Average of 5 questions on a scale of 1 to 4. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Interventional units. NDNQI® does not permit other organizations to display their national results. More information about ND NQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, leadership subscale high 2.96 2.94 2.86 2.90 3.36 3.01    
Staffing and Resource Adequacy. The Staffing subscale assesses our nurses' opinions about the hospital's adequacy of staffing and supporting resources. Average of 4 questions on a scale of 1 to 4. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Interventional units. NDNQI® does not permit other organizations to display their national results. More information about NDNQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, staffing subscale high 2.67 2.76 2.50 2.56 3.10 2.71    
Collegial Nurse-Physician Relations. The Nurse-Physician subscale assesses our nurses' opinions about their working relationship and collaboration with physicians. Average of 3 questions on a scale of 1 to 4. The higher the score, the more positive the rating reported. Nurses with direct patient care responsibilities responded anonymously to the National Database of Nursing Quality Indicators (NDNQI®) RN Survey Practice Environment Scale (PES) on a website provided by NDNQI®. We have adjusted the displayed numbers to reflect the hospital's particular mix of nursing units. NDNQI® provides only summary results back to participating hospitals. The survey only includes nurses with direct patient care responsibilities in the Critical Care, Step Down, Medical/Surgical, Neonatal Intensive Care, Psychiatric, Ambulatory Care, Emergency Department, Obstetrics, Perioperative, and Interventional units. NDNQI® does not permit other organizations to display their national results. More infor mation about NDNQI® can be found at www.nursingquality.org.(NQF NS 7) avg. nurse answer 1-4 survey, MD collaboration subscale high 2.89 2.78 2.91 2.97 3.51 3.05    
Miscellaneous
Participation in a Systemic Clinical Database Registry for Nursing Sensitive Care.(CMS) Is the hospital in a clinical database registry for nursing care? high yes yes yes yes yes yes    

The following set of indicators do not have a desired direction.

Total direct patient care hours per patient day, by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) ICU ? 15.61 18.44 15.88 15.53 18.92 16.68    
Number of direct patient care hours in the step down unit provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) StepDown ? 9.85 10.09 10.15 10.16   10.06    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Med-Surg ? 8.35 9.30 8.16 9.48 8.83 8.70    
Number of direct patient care hours in the medical unit provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Medical ?         7.69 7.69    
Number of direct patient care hours in the surgical unit provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Neonatal ICU ?       10.41 11.23 11.01    
Number of direct patient care hours in the moderate acuity unit provided by nursing staff per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by all nursing staff. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Moderate Acuity ?         11.55 11.55    
RN direct patient care hours per patient day, by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) ICU ? 14.57 16.57 13.24 14.26 18.26 15.03    
Number of direct patient care hours in the step down unit provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) StepDown ? 7.22 7.37 6.92 7.11   7.07    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Med-Surg ? 5.20 6.84 5.56 6.16 7.37 5.93    
Number of direct patient care hours in the medical unit provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Medical ?         6.56 6.56    
Number of direct patient care hours in the surgical unit provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Neonatal ICU ?       9.57 10.80 10.48    
Number of direct patient care hours in the moderate acuity unit provided by a registered nurse (RN) per inpatient day. The right nurse-to-patient ratio improves patient care. Includes direct patient care hours worked by RNs. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 6 / ANA) Moderate Acuity ?         9.73 9.73    
Percent of total direct patient care hours supplied by RNs, by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) ICU ? 93.30 89.88 83.40 91.80 96.49 90.13    
Number of direct patient care hours in the step down unit provided by RNs as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) StepDown ? 73.30 73.04 68.17 70.03   70.22    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Med-Surg ? 62.31 73.55 68.20 65.03 83.46 68.13    
Number of direct patient care hours in the medical unit provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Medical ?         85.27 85.27    
Number of direct patient care hours in the surgical unit provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Neonatal ICU ?       91.96 96.21 95.15    
Number of direct patient care hours in the moderate acuity unit provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Moderate Acuity ?         84.25 84.25    
Percent of total direct patient care hours supplied by LPNs, by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) ICU ? 0.09 0 0.03 0.06 0 0.04    
Number of direct patient care hours in the step down unit provided by LPNs as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) StepDown ? 0.55 0 6.91 2.56   3.96    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Med-Surg ? 5.89 0.00 9.86 2.02 1.28 4.44    
Number of direct patient care hours in the medical unit provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Medical ?         0 0    
Number of direct patient care hours in the surgical unit provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by registered nurses (RN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by RNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Neonatal ICU ?       1.43 0 0.36    
Number of direct patient care hours in the moderate acuity unit provided by licensed practical nurses (LPN) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by LPNs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Moderate Acuity ?         0 0    
Percent total direct pat care hrs supplied by UAPs (unlicensed asst personnel), by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) ICU ? 6.61 10.12 16.57 8.15 3.51 9.84    
Number of direct patient care hours in the step down unit provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) StepDown ? 26.15 26.96 24.92 27.42   25.82    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Med-Surg ? 31.80 26.45 21.94 32.95 15.25 27.43    
Number of direct patient care hours in the medical unit provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Medical ?         14.73 14.73    
Number of direct patient care hours in the surgical unit provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Neonatal ICU ?       6.61 3.79 4.49    
Number of direct patient care hours in the moderate acuity provided by unlicensed assistive personnel (UAP) as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. Includes direct patient care hours worked by UAPs (employee and contract). Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Moderate Acuity ?         15.75 15.75    
Percent of direct patient care hours supplied by contract staff, by unit
Number of direct patient care hours in the intensive care unit (ICU) provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps healthcare costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) ICU ? 5.28 1.54 1.87 1.34 0.41 2.25    
Number of direct patient care hours in the step down unit provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) StepDown ? 4.38 1.76 3.26 2.54   3.30    
Number of direct patient care hours in the medical/surgical (Med-Surg) unit provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Med-Surg ? 2.90 1.71 3.91 1.02 2.46 2.49    
Number of direct patient care hours in the medical unit provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Medical ?         0.14 0.14    
Number of direct patient care hours in the surgical unit provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Surgical ?       #   #    
Number of direct patient care hours in the neonatal intensive care unit (NICU) provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps health care costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Neonatal ICU ?       2.90 0.43 1.05    
Number of direct patient care hours in moderate acuity unit provided by contract staff as a percentage of total direct patient care hours. The right nursing skill mix improves patient care and keeps healthcare costs low. NHC has its own clinical agency and these direct patient care hours are reported as contract. Excludes OR, ED, OB, L&D, nursery, SNU, short stay, and psychiatry staff hours.(NQF NS 5 / ANA) Moderate Acuity ?         2.94 2.94    

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