Naval Hospital Bremerton has proven that a small military treatment facility can contend with larger, well known civilian hospitals for a prestigious award using certification as a standard to positively impact patient-centered care and safety.

NHB was recognized by the Competency and Credentialing Institute (CCI) with 2015 Honorable Mention distinction for the True North Award on March 17. St. Clare Hospital in nearby Lakewood, Washington, was top winner.

CCI developed the True North Award as a means to recognize those facilities whose True North principles guide their nursing staff to be lifelong learners, models of competent practice, and advocates for excellence.

"Congratulations to Naval Hospital Bremerton on being named runner up for the CCI True North Award. There were a record number of applications this year. Being one of the top performers among this stellar group of facilities is a significant accomplishment," said Shannon Carter, CCI Executive Director and Chief Executive Officer.

The award nationally recognizes that NHB advocates for specialty nursing certification and promotes a culture of safety, which helped contribute to the 2014 DOD Patient Safety Award being awarded to the command for the second consecutive year.

"I was shocked when I got the call from Jim Stobinski, CCI director of credentialing and education while I was on leave. We had submitted it just within deadline and was wondering if I had left something out. I was so proud of my team and their efforts," said Cmdr. Annie Case, Perioperative (Main Operating Room) Department head.

Stobinski attests that NHB's recognition was no fluke and came against stiff competition from across the U.S.

"The first year we had 14 hospitals and this year we had 30, and those 30 were some of the biggest well-known names in the country with the best operating rooms. NHB as a small hospital up against hospitals with 30 to 40 operating rooms and we initially thought that they can't compete against that. But NHB has such a good culture that they proved they can compete," said Stobinski.

Ashley Henson, CCI communication head explained that health organizations that apply for the True North Award are often among the most well-respected care providers in the United States. Being selected as the winner or receiving the Honorable Mention distinction means that a facility has stood out in their unique approach to encouraging their nurses to become CNOR (Certified Nurses Operating Room) and supporting them as they strive to deliver the best care to their patients.

Henson also acknowledged that NHB received the Honorable Mention distinction because of its high rate of certification among perioperative nurses. Furthermore, NHB's focus on rewarding and recognizing CNOR certified was among the best. Finally, NHB received letters of support displayed a genuine and authentic intention to deliver the best patient care possible through challenging nurses to obtain the CNOR certification and validate their specialized knowledge.

When asked what such recognition means for the command, Main OR nurses and especially for the patients, Case shared a published quote from Stobinski in his recent article, "Nurses who participate in the certification process, which is seldom a requirement for employment, are active participants in a process that requires these nurses to exceed the requirements of most employers. It is this willingness to go beyond requirements and to stay current in their practice that holds promise for improvements in patient safety."

"Although Navy Medicine's Incentive Special Pay for Specialty Nurses does help to monetarily promote certification, it does put the carrot on the stick to employees that if they would like a retention bonus, then certification is mandated. As I stated to the other operating room department heads around the Navy, this award is achievable by many commands if they have a traditional Certification Nurse's Day celebration already - as we do here at NHB - and an active public affairs officer to highlight the department. We are not unique to being able to apply and answer each requirement with supporting documentation," explained Case, also citing that positive feedback from the Joint Commission and the recent Navy Medicine West Assist Visit on how well NHB's Sterile Processing Department is performing were all beneficial highlights to share with the CCI in applying for award consideration.

The Certified Nurse Operating Room nurses recognized as contributors to the award along with Case are Lt. Cmdr. Chris Keith; Lt. Cmdr. Lacy Gee; Lt. Cmdr. Jennifer McKinney; Lt. Cmdr. James Buchanan; Lt. Cmdr. Steve Sarro; Lt. Cmdr. Stu Ewy, Lt. Cmdr. Darlene Lao (currently deployed), Lt. Travis Carr, and Lt. Tim Boring.

"CCI is most proud to honor and recognize perioperative nurses who also serve our country. Your nurses display excellence in the OR suite and across the world as they selflessly care for their patients and protect our citizens each and every day. NHB's team in an inspiration in character and professionalism to the Board and staff of CCI, as well as the perioperative nursing community," said Henson.

Case notes that perioperative nurses are eligible to take the CNOR exam after spending two full years in an OR setting, and once they have achieved the certification they further bolster the entire Main OR professional competency.

"They help to highlight that the staff are dedicated to ensuring that they stay current with perioperative nursing practice guidelines, which is directly related to supporting patient safety and working as a highly functioning departmental unit," Case said.

According to Case, CNOR impacts Navy Medicine Readiness by directly helping to provide agile, adaptable capabilities to engage locally and globally.

"The CNOR (certification in general) provides monetary compensation to a highly deployable group of personnel and this in turn promotes retention - up to four years on bonus - and also provides stability in the Nurse Corps workforce with less retention and less losses. There are more senior commanders working in the perioperative environment due to Incentive Special Pay for Specialty Nurses guidelines which provides seniority and knowledge retention in a normally very fluid environment due to military Permanent Change (of) Station rotations," said Case, noting that a CNOR also improves Navy Medicine Value by ensuring highest quality care through best healthcare practices, and helps with jointness and interoperability by pursuing the advanced training and skills which assist operational commitments, such NHB perioperative nurses still directly assigned in support of Operative Enduring Freedom in Afghanistan.

Submitting for the True North award had to be encapsulated in three distinct categories of recognition, reward and results.

In regards to recognition, NHB demonstrated how their organization utilized a variety of opportunities to celebrate and recognize the achievement of CNOR certification. NHB has consistently been highly supportive of perioperative nursing certification. Every year on March 19, Naval Hospital Bremerton celebrates Certified Nurses Day, where all certified nurses throughout the hospital are recognized. There's a reception attended by hospital leadership and nurses from all departments.

"Whenever a nurse achieves certification in a varying subspecialty, an email is sent to the Navy Nurse Corps monthly newsletter where it is published and celebrated by the entire Navy Nurse Corps community. Our local director of nursing also congratulates each nurse personally in their respective work areas for their individual achievement. Each individual department makes announcements at their staff meetings as well," said Case.

In demonstrating the reward criteria, NHB showed how their organization transformed thinking, structures and processes to address challenges and remove barriers to certification.

"All nurses are eligible for exam fee reimbursement, and military nurses are eligible for an incentive specialty pay. They become eligible for this additional bonus upon passing the CNOR exam. Here at Naval Hospital Bremerton, nurses are able to study at work and use a regular work day to take the exam. Study guides have been made available, as well as currently certified nurses routinely help the other nurses study for the exam," Case said.

NHB also had to show that there were visible results that validate the impact of activities designed to encourage certification and recertification.

"We are committed to providing expert perioperative nursing care. We have a surgical site infection rate lower than the national average. We also have the highest rate of certified nurses in all hospital departments, currently at 92 percent. There have been zero customer service complaints in the last year, and our operating room consistently receives positive feedback from our patients. During our last Joint Commission inspection, there were zero findings or recommendations related to perioperative nursing care, and our Sterile Processing Unit received several "Bravos" from the inspectors. We also have a 100 percent retention rate, with the only losses being to planned permanent changes of station or retirement for the active duty population of nurses. Each year we provide guidance, mentorship, and assistance in completing the personal package submission requirements for at least two nurses who are interested in applying for the U.S. Navy Perioperative Nurse Training Program, with a near 100 percent selection rate," stated Case.

The CCI website states that the CNOR certification program for perioperative nurses interested in improving and validating their knowledge and skills and providing the highest quality care to their patients. For more than 30 years, perioperative nurses have used the CNOR credential to gain credibility and recognition from colleagues and patients, achieve their personal and professional goals, and enhance their career development.

Perioperative nurses like those who staff NHB's Main OR plan, implement, and evaluate nursing care of the patient in surgery. They assist in preparation of the patient and the environment for surgery, and supervise and evaluate personnel and participate in their instruction and training. They maintain records and reports for accreditation and medico legal protection of the surgical team and the patient, as well as assist in investigation and evaluation of techniques, supplies, and instruments. They also ensure the availability, functional integrity, and economic use of all surgical supplies and equipment.

"As prior Navy and Navy Medicine, Jim and I are very proud of a Navy hospital being honored," said Frances Skupski, CCI Board of Directors president.


For more news from Naval Hospital Bremerton, visit www.navy.mil/.