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Our journey along the Pathway to Excellence®

By: Wade Tyrrell, MSN, RN

A rural community hospital shares its story of designation and re-designation. 


  • Pathway to Excellence® is an evolving process that roadmaps opportunities to enhance nursing recruitment and retention, nursing autonomy and satisfaction, interdisciplinary collaboration, strategic focus, team engagement, ownership and accountability, well-being, and community awareness/presence.
  • From an administrative viewpoint, Pathway to Excellence is a significant investment of time, money, effort, and emotion that provides an immense return.

What began at Sterling Regional MedCenter as a vision to enhance the nursing culture and innovate nursing beyond its historical foundation has become a reality that exceeds the expectations of everyone involved. The organization’s 9-year journey along the American Nurses Credentialing Center Pathway to Excellence® may serve as a guide to other organizations ready to take this step.

About our organization

Sterling Regional MedCenter is a 25-bed, prospective-payment, non-profit, Level III trauma designated, rural referral acute care hospital on the northeastern plains of Colorado. Our scope of care compares with that of a suburban community hospital and includes full-scale emergency and trauma services; full-scale digital imaging, nuclear medicine, and PET/CT; full-scale perioperative services; the David Walsh Cancer Center (a comprehensive program with medical and radiation oncology); a full range of rehabilitation therapies; a family birthing center; an 18-bed medical surgical unit; an intensive care unit; a hospitalist program; and full range of support services.

Sterling, a member of Phoenix-based Banner Health, was the first hospital to accept Banner Health leadership’s 2020 challenge for every hospital in the system to achieve either Pathway to Excellence or Magnet® designation. Sterling received its first Pathway to Excellence designation in late 2013.

The process

Sterling’s journey began in early 2011 when the organization experienced a great deal of change in leadership and scope as well as nursing turnover. The work environment was stressed because of nurse anger and doubt as a result of these changes. A visionary group of frontline nurses and nurse leaders took the opportunity to make positive change by enhancing the role of nursing and energizing the nursing culture. The biggest decision group members faced was how to accomplish and sustain these results. Through literature searches and networking, they discovered the Pathway to Excellence framework and formed the inaugural Pathway to Excellence Committee. Initially, the members experienced some uncertainty, but as they moved deeper into the process, they became more sure that what they were embarking on would change the organization’s future.

Through ongoing planning and breakout sessions with our nursing team, the Pathway to Excellence framework became the road map for change and innovation. Clear communication prompted engagement and helped the committee gain nursing support. Newsletters, all-RN meetings, committee members visiting unit staff meetings to provide updates, and team building exercises to promote Pathway to Excellence standards and elements of performance reinforced our progress and ongoing momentum.

As the strategy to build and implement the various performance elements of the framework continued, frontline nurses saw gradual changes and had the opportunity to participate in the process, have their voices heard, become an integral part of decision-making, integrate education and innovation, and witness improved processes and outcomes. Although the committee remained the driving force, the nurses were the deciding force that made Sterling a Pathway to Excellence organization.

When interviewing for the chief nursing officer (CNO) role in late 2013, I remember sensing an energy I hadn’t experienced elsewhere. I wasn’t sure if it was the rural setting or the size of the organization. While meeting with various groups and team members, I learned about the decision to seek Pathway to Excellence designation and the positive effects the process had on nursing and the organization.

Three years later, I had the opportunity to witness the process from the beginning when Sterling sought redesignation. The focus, drive, and hard work behind the effort remains a part of our culture today.

Ongoing journey

From an administrative viewpoint, Pathway to Excellence requires a significant investment of money, hard work, and emotional energy. However, it results in immense returns. Pathway to Excellence isn’t a one-and-done designation. Rather, this evolving process roadmaps opportunities to enhance nurse recruitment and retention, nurse autonomy and satisfaction, interprofessional collaboration, strategic focus, team engagement, ownership and accountability, well-being, and community awareness and presence.

The submission of the document for our first re-designation in late 2016 represented many hours of focus, intensity, angst, celebration, growth, and achievement. At times, this redesignation felt easier than the original submission, but then we realized that wasn’t the case. Rather, we were better prepared; we had grown with the Pathway to Excellence experience. Although the standards and elements of performance had not changed, the Pathway to Excellence framework provided us with the opportunity to demonstrate the growth and advancement of our nursing culture since our initial designation.

When submitting our first redesignation document, we compared it to the previous one from 2013. It was an emotional and humbling experience. We were impressed by our growth, talent, achievements, and outcomes. Each day, as we awaited redesignation document review, we shared one element of performance with our nursing team to increase their awareness of the document’s content and recognize the growth and success we’d achieved together.

As work began on our second redesignation, new standards and elements of performance that focused on staff well-being and community interaction and contribution required stronger nursing inclusion in new areas. As our hospital grew in scope and service, it became more difficult to maintain nursing team participation in the redesignation process. Using open and transparent communication, the Pathway to Excellence Committee and nursing leaders kept team members well informed about our pro­gress, which added depth and substance to our established program.

Similar to previous designations, all-RN meetings, staff meetings, team huddles, CNO and staff time sessions, emails, leadership rounding, and nursing events helped to maintain awareness, momentum, and enthusiasm.

We received our second designation in 2017 and are currently awaiting our third designation.

Voices from the journey

Sterling Regional MedCenter nurses share their thoughts about the or­ganization’s Pathway to Excellence® journey.

“We all learned to do things differently—and better! Over time, from those initial meetings until now, we have created and nurtured a positive work environment, greater staff engagement, greater staff retention, nursing participation on interdisciplinary teams, improved patient safety and quality outcomes, and greater job satisfaction.”

—Nancy Zwirn, RN, a founding member of the Pathway to Excellence Committee (now retired and serving as a volunteer)

“Pathway to Excellence has positively impacted nursing by allowing our staff to gain an appreciation for the elements that were already being provided to us that we viewed as ‘normal.’ It has given nursing better awareness that we can be change agents and participate in decisions that impact us, whenever possible. Personally, it has been amazing to watch the changes that have occurred and to be a part of building nursing’s impact on our future.”

—Elizabeth Kuntz, BSN, RN, who was an emergency department RN when the journey started and is now a senior RN house manager

“The Pathway program empowers nurses to participate in decision-making within their environment. Since becoming a Pathway to Excellence designated facility, our nursing culture continues to grow and improve—nurses are at the heart of the hiring process, the orientation process, and obviously the retention of our nurses. As an RN, it is very important to me that nurses participate in the creation of policies and procedures that directly affect the way we provide care. Pathway to Excellence has done an excellent job in creating the opportunity for us to do just that, and to voice our opinions and concerns about everything that affects us, our coworkers, and our patients. It was the platform our hospital needed to move nursing forward and create a safe, proactive culture in our workplace.”

—Emily Hidalgo, BSN, RN, CMSRN, who joined Sterling as a new graduate over 5 years ago and is now a member of the Pathway to Excellence Committee and the Daisy Award Committee

Pathway to Excellence outcomes

Our journey to Pathway to Excellence have resulted in several achievements. Our voluntary nursing turnover rate has remained at zero for 5 of the 6 years of our designation. We’ve seen year-over-year improvement in our individual unit-based National Database of Nursing Quality Indicators, and we achieved the highest overall nursing Practice Environment Score of all 28 Banner Health acute care facilities during the 2018 and 2019 surveys. Nursing engagement and leadership effectiveness scores have demonstrated year-over-year increases in our annual VOICE® Survey (our system’s employee satisfaction survey). In our 2019 survey, we achieved the highest score within Banner Health for “great place to receive care”—a significant improvement over previous years.

More than half of our nurses are cross-trained in more than one care area, and we’ve efficiently expanded our service lines to add additional nursing team members. Within the community, we’ve created activities to support awareness, well-being, safety, and preparedness. In addition, for the past 4 consecutive years, we’ve achieved “Top 100 Rural and Community Hospital” status by the Chartis Group, LLC. This status indicates top performance in managing risk, achieving higher quality, securing better outcomes, increasing patient satisfaction, and operating at a lower cost. (See Adapting to a pandemic.)

Adapting to a pandemic

Sterling Regional MedCenter was first affected by the COVID-19 pandemic in mid-March 2020, far ahead of most of the other Banner Health hospitals. We encountered many challenges, including restricted points of access, team screening, drastically decreased patient volumes in ambulatory care and the emergency department, and a complete shutdown of elective surgery. As nursing leaders worked to balance operations with the workforce, we had to sharply reduce hours or furlough many of our highly valued team members.

To support each other, Sterling nurses

  • retrained to provide care in our acute respiratory unit and other areas
  • flexed hours using paid time off to help those who couldn’t take paid time off
  • provided childcare assistance for those whose children no longer had day care because of a state public health order.

These and other actions demonstrate Pathway to Excellence at its best—accountability, autonomy, collaboration, education, energy, focus, resilience, strength, support, and community.

We’ve purposefully kept our nursing organizational chart flat with only a single line of leadership

between team members and the senior operations team. This helps to support the Pathway to Excellence framework and ensure close communication, collaboration, knowledge-sharing, strategic planning, transparency, support, a culture of safety, and exceptional outcomes.

Looking ahead

The foundation the Pathway to Excellence process has provided continues to strengthen us, and we’re confident it will continue to for many years to come. I’ve been asked by many of my peers if we could have achieved our growth and success without the Pathway to Excellence framework as our partner. My quick response is, “Not as quickly, not as successfully, and definitely not as sustainably.”

Wade Tyrrell is chief executive officer/chief nursing officer at Sterling Regional MedCenter in Sterling, Colorado.

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