Strengthening Nursing Fundamentals to Improve Patient Experience with Sadie Durham, DNP, RN

Summary

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Podcast Summary

Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode Title: Strengthening Nursing Fundamentals to Improve Patient Experience
Guest: Dr. Sadie Durham, DNP, RN, Chief Nursing Officer, Ascension St. Vincent's Clay County, Middleburg, FL
Host: Mackenzie Bean, Associate Vice President & Managing Editor, Becker's Hospital Review
Date: February 17, 2026
Episode Theme:
This episode discusses how refocusing on foundational nursing practices—specifically, bedside shift reporting and hourly rounding—led to dramatic improvements in patient experience metrics at Ascension St. Vincent's Clay County. Dr. Sadie Durham shares how her team identified the need to return to nursing fundamentals, the steps they took to standardize these practices, and the sustained impact on patient satisfaction and staff engagement.

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Key Discussion Points & Insights

1. Recognizing the Problem and the Decision to Refocus (00:36 - 02:34)

• Context: In 2024, the hospital experienced a notable decline in patient experience scores, spurring leadership to investigate root causes.
• Initial Approach: The team analyzed patient comments about long wait times, communication gaps, and inconsistent care.
• Diagnosis: They recognized lapses in basic nursing practices—bedside shift reporting and hourly rounding—rather than the absence of new technological tools.
• Quote (Sadie Durham, 01:09):

  "We saw a significant decline in our patient experience scores ... What we determined was, in just our general assessment, is there were some key fundamental nursing things that we just weren’t doing or we weren’t doing consistently. And those things were bedside shift reporting and hourly rounding."

2. Leadership Philosophy and Patient-Centered Care (02:34 - 03:25)

• Philosophy: Dr. Durham sees her core responsibility as ensuring safe, high-quality care with the patient at the center of every decision.
• Intentionality over Innovation: Rather than chasing new initiatives, she championed getting “back to the basics.”
• Quote (Sadie Durham, 02:34):

  "Ultimately, it’s always to ensure that we’re giving our patients the best care possible ... It’s really important for us to engage our patients, to listen to their voice, and really to ensure that they have a great experience."

3. Implementing Change: Overcoming Barriers and Educating Staff (03:42 - 05:39)

• Understanding Barriers: Leadership engaged bedside nurses directly to understand why fundamentals weren't being followed, using their feedback to shape the approach.
• Building a Team: Charge nurses were recruited as “champions” to advocate for and model these practices among their peers.
• Education and Validation: A comprehensive training program was rolled out to all staff, focusing on both the “how” and the “why.” Leaders then validated adoption with real-time observation and feedback.
• Onboarding All Staff: Emphasis on universal participation—veterans and newcomers alike.
• Quote (Sadie Durham, 03:42):

  "We needed people. We needed cheerleaders for the cause, essentially. So we pulled in our charge nurses ... and we did training with them, talked to them about what their perceived barriers were."

4. Early Results and Cultural Change (05:39 - 06:49)

• Unexpected Wins:
  • Noteworthy changes in staff behavior: nurses were present in patient rooms during shift changes, even on weekends.
  • Sustained adherence to the new procedures, indicating true culture change rather than temporary compliance.
• Quote (Sadie Durham, 05:57):

  "...One of the measures of true success is going on a floor on a weekend when there are no nursing managers, when there are no directors walking around, and seeing that at 7 am the floor is clear because the staff are in the rooms doing bedside shift reporting."

5. Sustaining Progress through Empowered Frontline Leaders (06:49 - 07:56)

• Sustained Progress: The key to ongoing compliance was ensuring that charge nurses not only promoted, but also consistently modeled the desired behaviors.
• Accountability: Frontline leaders set the tone and expectations for their teams, preventing regression to previous habits.
• Quote (Sadie Durham, 07:04):

  "...If you don’t have charge nurses that hold the teams accountable and model the behavior, then the staff will say, ‘okay, we don’t have to do it because our charge nurse isn’t doing so.’"

6. Impact: Improved Net Promoter Score (NPS) and Staff-Patient Connection (07:56 - 09:18)

• Measurable Results:
  • Net Promoter Score rose by about 40 points within six to eight weeks after program implementation.
  • Increased staff awareness of how consistent, simple practices drive patient feedback.
• Patient-Focused Benefits: Enhanced team responsiveness and communication recognized directly by patients.
• Quote (Sadie Durham, 08:09):

  "...We saw almost, I would say within about six to eight weeks of rolling it out and everyone being trained ... we saw immediate increases in our scores in those points."

7. Advice for Nurse Leaders Facing Similar Challenges (09:18 - 11:01)

• Return to Basics: Leaders should first ensure the fundamentals are being done well before seeking entirely new solutions.
• Importance of Standardization: Success relies on consistent expectations across departments and validation by leaders at every level.
• Fundamental Principles: Reinforces that basic nursing care is the driving force behind quality improvement and patient experience.
• Quote (Sadie Durham, 09:39):

  "We don't always have to look to new technology, always need significant financial investment. Sometimes it’s just as simple as going back to our basic practices and ensuring that we’re executing them."

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Notable Quotes & Memorable Moments

• On simplicity and leadership:

  "Sometimes it’s just as simple as going back to our basic practices and ensuring that we’re executing them."
  — Sadie Durham, 09:39

• On visible behavior change:

  "Seeing that at 7am the floor is clear because the staff are in the rooms doing bedside shift reporting ... that was an immediate shift."
  — Sadie Durham, 05:57

• On the patient as the center:

  "It’s really important for us to engage our patients, to listen to their voice and really to ensure that they have a great experience."
  — Sadie Durham, 02:34

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Timestamps for Key Segments

• 00:36: Discovering decline in patient experience and identifying fundamental issues.
• 02:34: Dr. Durham’s nursing leadership philosophy and decision-making.
• 03:42: Engaging frontline nurses, addressing barriers, and building buy-in.
• 05:39: Observing early positive cultural shifts post-implementation.
• 06:49: The importance of frontline leaders in sustaining change.
• 07:56: NPS improvement and linking results to practice changes.
• 09:18: Advice to peers and the case for focusing on fundamentals.

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Conclusion

This episode underscores that returning to and rigorously applying nursing fundamentals—specifically bedside shift reporting and hourly rounding—can drive significant improvements in both patient experience and internal culture. Dr. Sadie Durham’s story highlights the power of clarity, staff engagement, and strong frontline leadership, offering listeners a practical, replicable path to quality improvement in healthcare environments.

Transcript

[A]

Hello, everyone. Welcome to the Becker's Healthcare Podcast. I'm Mackenzie Bean, associate Vice president and managing editor of Becker's Hospital Review. And today I am so thrilled to be joined by Dr. Sadie Durham, who is the Chief Nursing officer at Ascension St. Vincent's Clay county in Middleburg, Florida. Dr. Durham, thank you so much for joining us on the podcast today. How are you doing?

[B]

I am doing well, Mackenzie. Thank you so much for just having me. I'm excited about the opportunity to share the progress that we've made as it relates to our patient experience score. Yeah, well, we're.

[A]

We're so excited to have you, and let's jump in and start talking about that. As I understand it, back in 2014, you really identified an opportunity to refocus on fundamental nursing practices, and, as you said, has led to some pretty significant improvements in patient experience. So maybe you could just start there. Looking back, you know, what really motivated the effort to refocus on nursing fundamentals for your team?

[B]

So it was. That's a good question. It was back in 2024, and what we recognized is we just. We saw a significant decline in our patient experience scores, and we really couldn't figure out why at the time. Of course, we're looking at the comments. We see wait times, we see communication, we see all of these. So brought the team together, the frontline nursing leaders and their director and said, hey, guys, let's figure out what's happening. Let's figure out what's going on. And what we determined was, in just our general assessment is there were some key fundamental nursing things that we just had weren't doing or we weren't doing consistently. And those things were bedside shift reporting and hourly rounding. So instead of employing something new or adding something new to the mix, essentially, we just said, let's go back to the basics. You know, let's go back to the fundamentals, and let's redeploy that. So that's really where it started at working. Yeah.

[A]

And I think, you know, we're in a moment where you constantly see healthcare pushing towards new tools or technologies and innovations. But like you said, you made a very intentional decision to focus on those foundational nursing behaviors. Can you talk to me a little bit more about that decision? And how do you think that aligns with your own philosophy as a nurse leader?

[B]

You know, when I think about my personal philosophy as a nurse leader, ultimately, it's always to ensure that we're giving our patients the best care possible, care that's safe and care that's of quality. Right? And in doing that, it's. It's really important for us to engage our patients to listen to their voice and really to ensure that they do have a great experience. And I think in ensuring that, we're keeping our patients at the center, that's the core, right? So that's really where it came from, is making sure that they're at the center of that care, and we're doing the best that we can to ensure that, A, again, their experience is great, and then B, that is in alignment with the care that we provide to them.

[A]

So you've identified the opportunities to standardize and refocus on bedside shift reporting hourly rounding, a lot of those fundamentals. Can you talk us through? Where did you go from there? Once you identified that opportunity, how did you take the next steps to implement it? And what did that really look like in practice?

[B]

So the first thing that we did is we really needed to figure out why weren't we practicing in this way anymore? Why were we not consistent with bedside shift reporting? Why weren't we grounding on our patients hourly? So really started with just going to our bedside nurses and saying, hey, why aren't we rounding? Why aren't we doing bedside nursing? We really wanted to understand what their perceived barriers were because that would help us to develop our program moving forward and determine how we can mitigate those perceived barriers. And then after that, we decided that we needed some champions, right? We needed people. We needed cheerleaders for the cause, essentially. So we pulled in our charge nurses, and we did training with them, talked to them about what their perceived barriers were. And really we wanted them to be those resources for their peers, to be able to help to disseminate why these practices are so important, not just for the patients, but. But for them as well. And then we came up with an education plan and made sure that we included the how and the why, why these practices were so important. And then once we educated everyone, and I mean, everyone had to go through that education. So it took us a few months to get everyone through. We put the practice into motion, right? And then we had our leaders validate the adoption. So it was more than just saying, hey, go out and do. The leaders would go and they would validate, they would observe, and then they would provide feedback, sometimes in real time, other times immediately after their observation, just to help, to coach and to help the associates feel more comfortable in the process. Because, remember, we had some associates that had experienced bedside shift recording and rounding, and then we had some that this was fairly New because our processes were very inconsistent.

[A]

Mm, that makes sense. So I'm curious, as these practices became more and more consistent, nurses were receiving the feedback. What were some of the positive shifts that you noticed, whether in patient interactions, nurse experience, or of course, in your actual metric?

[B]

So I think the first, I would call it a non anticipated victory is, you know, prior to that when you would go on the floors, everyone's at the nurse's station, Hubbard. But after we implement it, I think one of the measures of true success is going on a floor on a weekend when there are no nursing managers, when there are no directors walking around and seeing that at 7am the floor is clear because the staff are in the rooms doing bedside shift reporting. So I think that was an immediate shift that we saw, which was great because typically what happens when you roll out these new processes? It's great Monday through Friday, but then on the weekend, people settle back into their prior behaviors and performances. Yeah.

[A]

Talk more about that. How have you been able to sustain some of the progress that you've seen and make sure there isn't that slippage back, not just depending on the weekday, but also over time? As I know this was back in 2024 when you first started it.

[B]

I think one of the key pieces, of course your managers are there, but the key piece is ensuring that your frontline leaders, meaning your charge nurses, are modeling the behavior and then helping to reinforce the expectations. That was an opportunity that we identified early on as we were working through the process is if you don't have charge nurses that hold the teams accountable and model the behavior, then the staff will say, okay, we don't have to do it because our charge nurse isn't doing so. I would say that was probably one of the most pivotal pieces, is ensuring that the frontline leaders that are there day to day and spend the most time leading the team, so to speak, are modeling the behaviors and reinforcing the.

[A]

Expectation, really having them serve as their change management champions and setting that example.

[B]

Yes.

[A]

Yeah. And I know I reported a significant increase in the hospital's net promoter score, which I want to make sure we mention. Can you explain that improvement as well, please?

[B]

It was a great improvement. It was about 40 points. So the prior fiscal year, you know, as I mentioned before, we really struggled, right. And we listened to our patients and they said, hey, you guys are taking too long to respond. There are some opportunities in responsiveness, there's opportunities in communication, there's opportunities in care, team connection. And that's how we were able to build it back to those pillars of bedside shift reporting and hourly rounding. But in doing those things, we saw almost, I would say within about six to eight weeks of rolling it out and everyone being trained and probably about 50 to 60% of the staff being validated, we saw immediate increases in our scores in those points. So that was very eye opening and very rewarding. And to share that with the staff so that they can correlate our patients experience with us just doing something as simple as keeping our patients at the center, checking on them every hour and exchanging that, having a good pain handoff in front of our patients within the.

[A]

Center, significant to see such an immediate improvement there. I'm curious for nurse leaders who might be listening to this and also working to strengthen their own patient experience or team connection or other fundamentals, what advice would you have for them based on your own journey here?

[B]

So I think the first thing is very evident is we don't always have to look to new technology, always need significant financial investment. Sometimes it's just as simple as going back to our basic practices and ensuring that we're executing them. I think that when we start different initiatives or when we work on action plans, we come up with all these different tactics and sometimes we don't see progress. I think where sometimes we fail as leaders is we want to throw something new at it instead of looking at the current tactics and determining are we really doing what we said we would do. Another component is that standardization. What we recognized early on is in some of our departments they were doing really well. But when staff spoke to another department, there wasn't that consistent accountability. So from like a director standpoint, a CNO standpoint, there's also going to need to be some validation that all of your leaders are operating in a standard way and making sure that that leadership presence is there because that really matters as well. And then just remember that our fundamentals, they're truly the core of why we do what they do and they do drive quality in patient experience.

[A]

It's such a good reminder that even as health care continues to change, the heart of nursing really remains the same. So, Sadie, thank you so much for joining us on the podcast, sharing your leadership approach in this experience. I think it'll resonate with a lot of listeners. We so appreciate it.

[B]

Thank you. Thank you for having me. Thank you so much.

[A]

Of course. And thank you everyone for listening in as well. We will see you on the podcast next time.