Dartmouth Hitchcock Medical Center Emergency Department

Lebanon, New Hampshire

The emergency department team at Dartmouth Hitchcock Medical Center focused on nurse satisfaction shifting. By focusing on developing interprofessional relationships, the culture shifted to highlighting what was working well in an effort to replicate the positives and not focus on negatives. A positive culture reduced turnover rate, increased staff satisfaction, engagement, patient experiences and outcomes. The team’s practice area council developed a code of conduct, which set foundational expectations for everyone. The culture shifted to one that emphasizes assuming positive intent and being kind, resulting in a 16 percent turnover rate, down from 20 percent in 2024, and an increased interprofessional relationship Press Ganey score from 3.71 to 3.97 in 2025.

Dartmouth Hitchcock also developed a behavioral emergency response team with a focused effort to reduce patient and staff injury with early de-escalation. The BERT team consists of an ED RN, psychiatric ED RN, security and a provider who is called urgently to address escalating behaviors. The changes have resulted in decreased workplace violence injuries and patient restraints. The BERT team approach, which allows for early interventions through trauma-informed care, emphasizes the compassionate aspects of nursing care for psychiatric patients and contributed to staff satisfaction.