Box Butte General Hospital

Rural Critical-Access Hospital in Nebraska Supports Nurses with EBSCO Health’s Nursing Reference Center™ Plus

At a Glance

Box Butte General Hospital
Alliance, Nebraska

Institution Type:   Health Care
Related Products:   Point-of-Care Tools


Located in Alliance, Nebraska, Box Butte General Hospital is a rural, critical-access hospital with 25 beds for all patient types and a staff of more than 250 employees providing emergency care and a variety of inpatient and outpatient services. These services include general and orthopedic surgery, medical imaging, dialysis, infusion, rehabilitation and much more.

In 2015, the hospital began subscribing to EBSCO Health’s Nursing Reference Center™ Plus, an evidence-based point-of-care resource designed specifically for nurses that provides quick and easy access to the most current information on diseases, medications, best practices and more. This information supports patient care, patient education, as well as the development of hospital policies and procedures. In addition, Nursing Reference Center Plus’s Continuing Education Modules offer nurses a convenient new way to complete required contact hours.

Our nurses have the information that they need to provide better care. [They] are more informed and better educated than they were before we had Nursing Reference Center Plus.

Kim Tschacher
Clinical Nurse Educator
Box Butte General Hospital


According to Clinical Nurse Educator Kim Tschacher, Box Butte General Hospital had long-used print reference books to support nursing practice, patient education, and the creation of policies and procedures.

“I didn’t feel like it was very sound information,” Tschacher explained, adding that many reference books are updated only every five years or so. “Knowing that the evidence continually changes, I wanted a better product.”

Tschacher began researching evidence-based reference tools and quickly discovered Nursing Reference Center Plus. She reached out to her EBSCO sales representative and arranged for a three-month trial. Tschacher also looked at other point-of-care tools, but none measured up to the EBSCOs product.

Nursing Reference Center Plus was just want we needed,” Tschacher said. “It was a perfect fit for our organization.”


Nursing Reference Center Plus offers a vast collection of point-of-care and professional development resources to nurses, including evidence-based care sheets, patient education handouts, videos, continuing education modules and more.

Tschacher said it’s easy to navigate the content in Nursing Reference Center Plus, which is available on all nursing computers throughout the hospital. Each article includes a hyperlinked table of contents, so users can quickly jump to the section they need.

“Nurses spend so much time hunting for and gathering [information],” Tschacher said, “so if I can save them some time, that’s great.”

The videos in Nursing Reference Center Plus include short overviews of how to perform specific nursing procedures or skills, from inserting a nasogastric feeding tube to cleaning and irrigating wounds. Graphical images assist at the point of care. Tschacher encourages nurses who may need refreshers to view the videos.

The videos came in handy recently when Tschacher had to send home a middle-aged farmer with a central line catheter because he chose to continue antibiotic therapy in his home. “His wife agreed to administer his antibiotics for him for two weeks after his hospital discharge.”

Since home health care was not available in the patient’s area, Tschacher built a competency for him and his wife using Nursing Reference Center Plus. She had them view a few of the videos and assigned them to read articles on the care of a central line. They both watched Tschacher change the central line dressing, the patient’s wife successfully demonstrated the procedure back to Tschacher, and Tschacher sent them home with detailed discharge instructions on caring for a central line.

“They did fine with it,” she said. “Never an infection.” Tschacher credits Nursing Reference Center Plus for making it possible to respect the patient’s wishes while ensuring his health and safety. “That was kind of incredible for me to be able to educate them so easily and to have them understand so well what they needed to do.”

Tschacher praised the quality of Nursing Reference Center Plus’s patient education handouts. Written by an editorial network of nursing experts, writers, editors and researchers, these handouts are highly graphical with color illustrations and are provided in English and Spanish. “The discharge instructions are far easier to read than what we currently have,” Tschacher said.

The content in Nursing Reference Center Plus is also supporting the nursing staff in developing and updating hospital policies and procedures. The tool allows users to create and share folders and set email alerts to notify them whenever a topic is updated with new evidence.

“Today I’m just finishing up a policy on the administration of IVIG (intravenous immunoglobulin),” Tschacher noted. “I’ve used Nursing Reference Center Plus almost exclusively because I can’t find a lot of information on [the topic] anywhere else, in particular for pediatric patients.”

Finally, Nursing Reference Center Plus provides nurses the opportunity to earn Continuing Education Units, or CEUs. Each continuing education module contains course material, an interactive review, a module evaluation and a competency test with a certificate of completion. Nurses create their own account within Nursing Reference Center Plus, which they can link to their nursing license number. All their work is saved within the module and can be submitted for credit at no additional charge.

Tschacher called the CEU modules in Nursing Reference Center Plus “far superior” than what the hospital’s nurses had available to them before. “We have a very pro-active nursing staff here, and we have many nurses going back for higher education,” she said. “I really encourage [them] to use Nursing Reference Center Plus as they progress throughout their education. It’s a really great tool for them.”

Benefits & Results

Accessed more than 10,000 times in its first year, Nursing Reference Center Plus has become the go-to evidence-based resource for the hospital’s nursing staff.

“I love the system and use it for discharge education,” one emergency department nurse said. “The content is simple and to the point.”

Another nurse praised the continuing education component. “It is easy to use, the information is up-to-date, and I like the fact that the system will store my certificates for me.”

Tschacher said nurses in several departments, including the infusion nurse and the hospital’s diabetic educator, use Nursing Reference Center Plus. “There’s enough material in Nursing Reference Center Plus that any department could benefit from [the resource],” she said. “I use it every day.”

In addition, Nursing Reference Center Plus has supported the hospital in maintaining Joint Commission certification. After a recent survey, the hospital was tasked with improving its transportation of instruments from the point of care to where they are cleaned and sterilized. “I used Nursing Reference Center Plus and found all the information I needed,” Tschacher explained. “We developed a plan, we did education, and the deficiency was corrected.”

Finally, Nursing Reference Center Plus has helped in improving overall patient satisfaction, as evidenced by the hospital’s increased HCAHPS scores.

“Our nurses have the information that they need to provide better care,” Tschacher said. “[They] are more informed and better educated than they were before we had Nursing Reference Center Plus. I get excited about it still because I just think it’s the greatest thing.”

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