Taking Oncology Nurses' Roles Into Consideration When Determining Hospital Rankings

This year’s depiction of “the best” hospitals generated by the U.S. News & World Report garnered significant attention after its release. Institutions that made the coveted list were quick to buy up media advertisement space to widely market their rankings. However, on social media, I saw numerous physician commentaries stating that the criteria used for the rankings were flawed. This made me curious about what variables were used to identify “the best” of this year’s hospital rankings when nursing is taken into consideration.

The hospitals were categorized within the categories of outcomes and patient experience, and process and outcomes. Some examples included discharge to home, availability of technology, presence of intensivists, patient volume, patient experience, presence of select patient specialty offerings (i.e., fertility clinic, hospice, pain management, palliative care, translators, wound management) and the expert opinion by physicians. There were only 2 criteria that addressed the quality of nursing: staffing and Magnet status.

After looking in detail at the criteria, this ranking methodology is indeed flawed. Why? Because it does not reflect the robust nature of nursing excellence that is required to be “the best” hospital in any category, and most certainly within the nurse-intensive nature of cancer care. The isolated use of nursing positions (i.e., staffing) does not reflect the quality of nursing care required to render optimum patient care. You may think, well Magnet status is taken into consideration, but that is a sign of practice excellence. Only 1 point is given to hospitals holding this prominent recognition, while all other criteria are judged on a wide spectrum with their own factors taken into consideration. Furthermore, even the top hospital is only given an “above average” for its nursing staffing while scoring “very high” or “excellent” in every other category.

Irrespective of the number of intensivists and the latest technologies, without nurses, no hospital can function. All cancer therapies and supportive care interventions require the expertise of oncology nurses to assess, treat, monitor, support, teach, and counsel patients and their caregivers in ways that physicians or other members of a patient’s care team cannot. It is timely that nurses speak up about their absence within the criteria used to measure “the best” when rankings like this are not taking crucial aspects of a patient’s care into perspective.