Delivering quality and innovation in care is the American Nurses Association (ANA) theme for Nurses Week 2013. People do not always think of government as being the source of innovation. My organization is owned and operated by the County of Santa Clara, in the heart of Silicon Valley where innovation is in the air, where people expect you to be creative.

The Santa Clara Health and Hospital System is focusing on health promotion to reduce the burden of care on the population we serve. We expect an increased need for primary care in 2014 as the newly insured want to gain better access to care and hopefully reduce the need for more expensive care in the ED. As a county hospital, we are the local safety net provider, caring for the underinsured and uninsured, as well as the insured as an innovative center for spinal cord rehabilitation, a level I trauma center and a level III NICU we see the full spectrum of patients.

As a unique health system that includes the Public Health Department and Mental Health Agency, we are working on models of care to better integrate services. We are taking a unique approach to the Partnership for Patients initiative by focusing on reducing readmissions for behavioral health patients who have had a recent hospitalization for a physical medical condition. The nurses in the Valley Homeless Clinic work closely with this population and are focusing on one patient at a time to keep them out of the ED. So far we have significantly changed the behavior of two patients. That may not seem like much, but when you consider the amount of nursing time that goes into seeing the same patient in the ED at least every few days, you realize that patient would be better served elsewhere and that bed better occupied by someone who is acutely ill.

The good news for Nurses Week 2013 is we are going live with a new electronic medical record (EMR) system for computerized physician order entry (CPOE) and clinical documentation. While we have some automation, having a fully integrated record for inpatient, ambulatory and behavioral health will make a tremendous difference in enabling a more thorough history and assessment for nursing, as well as our interdisciplinary colleagues.

We are delighted as an academic center to finally have full CPOE and clinical documentation. For many people this may not seem so remarkable; however, in mid-2012 only 20 percent of U.S. hospitals attested to Stage 1 Meaningful Use (30 percent of patients had at least one medication ordered electronically).

As a public entity we are fortunate that our board has invested to ensure that the residents of this county have the benefit of the best information technology (as we see it around us every day) to enable safe, timely, efficient care to ensure efficacy and equity. This is a time to reflect on what nurses bring to the table, and nurses were crucial in the success of the development and implementation of the new system. As their chief nursing officer, it is a great way for us to celebrate Nurses Week as we are very proud of their practice and accomplishments.


Trudy Johnson, MA, RN, NEA-BC
Chief Nursing Officer
Santa Clara Valley Medical Center
San Jose, CA