editors cone health nurse executives the pulse … dynamic power of . nursing innovations and ......
TRANSCRIPT
conehealth.com Fall 2013 • Vol. 10 No. 3
T H E P U L S E O F N U R S I N G A T C O N E H E A L T H
1200 North Elm Street, Greensboro, NC 27401conehealth.com/nursing
Lisa Boland, RN, MSN, NEA-BCManager, Nursing Outreach and Retention,
Setting the Pace Editor
Sarah Clark, RN, MSN, CCRNSimulation Coordinator
Belinda Hammond, RN, MSN, CEN, CCRNClinical Nurse Educator-Critical Care
SUPPORT SERVICESPeggy Wynn, MLIS
Librarian, Wesley Long Hospital
Co-Editor Thresa Haithcock, RN, DNP, APRN-BC
Clinical Nurse Specialist
Co-EditorNancy Summerell, RN, MSN
Clinical Orientation Educator, ED Academy
Editor-in-ChiefSarah Lackey, RN, MSN, CCNS
Magnet Program Coordinator, TraineeRapid Response Team, Relief
MARKETING SUPPORTDeborah Humphrey, MA
Director of Communications
DESIGNERMary Jo Helms, CreativeMode
Editors
Theresa Brodrick, PhD, RN, CNS, CNA Executive Vice President & Chief Nursing Officer
Anne Brown, RN, MSN, PCCN Director, Nursing/Patient ServicesWesley Long Hospital
Dennis Campbell, RN, MS, BSN, NEA-BC Executive Director, Quality Excellence
LaVern Delaney, RN, MSN, MHA/MBA Director, Nursing/Patient ServicesICU Service, Moses Cone Hospital
Debbie Grant, RN, MSN, CENP VP Nursing/Patient Services, Moses Cone Hospital
Debbie Green, RN, DNP, CENP Vice President Nursing/Patient Services Annie Penn Hospital and Behavioral Health Hospital and Interim President Behavioral Health Hospital
Cheryl Hausner, RN, MSN, MSED Director, Nursing Practice and Education
Karin Henderson, RN, MSN, CENP Executive DirectorOrganizational Integration
Joan LoPresti, RN, MS, BSN, NEA-BC Director, Nursing/Patient Services, MedSurg Service, Moses Cone Hospital
Sue Pedaline, RNC, DNP, MS VP Nursing/Patient Services, Women’s Hospital
Annette Smith, RN, MSN VP Nursing/Patient Services, Wesley Long Hospital
Cheryl Somers, RN, MSN, NEA-BC Executive Director, Emergency Services
Youland Williams, RN, MSN, NEA-BC Executive Director, NursingOncology Services
Cone Health Nurse Executives
Maturing in Nursing page 3
Nursing BeatMISSION STATEMENT
To communicate and celebrate
the dynamic power of
nursing innovations and
enduring values.
Message from the CNO: Preparation for Unprecedented Change
CONE HEALTH
MAGNETTRANSFORMATIONAL LEADERSHIP
2 19
Two weeks ago I had the fortune of
having an all-day work commit-
ment canceled. I was so happy
that I had “free time.” I came to
work in scrubs and spent the day
at MedCenter High Point (MCHP)
in their cancer center and their
emergency department (ED) after
stopping by the MCHP pharmacy to
say hello. What an amazing experience
to see such well-oiled teams providing incredible care. What
was even more impressive was the fact that each of these
departments could not say enough unsolicited, positive
things about the other departments in the building. Each
group wanted me to know how they supported each other
while always putting our patients first. It was truly inspira-
tional to get to spend the afternoon with these groups of
care providers.
So why am I sharing this? In the midst of unprecedented
change for Cone Health not one of these employees has
lost sight of our values and our patients. I met Scott, RN,
from CareLink who was transferring a patient from MCHP.
Although he was handling more change than many other
departments in our system, his professionalism and empa-
thy for his patient were unwavering. His actions made me
incredibly proud to be a nurse and even more proud to be
a Cone Health nurse. Over and over again in this organiza-
tion I have experienced that same professionalism, commit-
ment and caring for our patients and families in the midst of
change and uncertainty.
I wish I were a fortune teller and could predict our future in
healthcare--then I could answer so many of your questions.
But I’m not. What I can say is this: Stay flexible, learn different
roles and acquire as much education as you can. I have always
said that the more education you have, the more flexible you
become and the more opportunities will open for you.
To that end, I am so very excited about our new partner-
ship with the University of North Carolina at Greensboro
(UNCG). Today I signed an educational contract with the
UNCG School of Nursing to place their RN to BSN curriculum
on The Moses H. Cone Memorial Hospital campus (in the
Black Box) by spring 2014. In addition, Alamance Regional
Medical Center, Cone Health’s Burlington campus, has been
successful in getting Winston Salem State University to place
its RN to BSN curriculum on its campus in the spring of 2014.
I am committed to making it as easy as possible for you to
return to school, both for you and for our patients. Please
take advantage of these opportunities as we face all of these
unknowns together.
I feel so very fortunate to work with all of you, and I
appreciate each and every one of you for all that you do!
Respectfully,
Theresa Brodrick, PhD, RN, CNS, CNA
The next step for Magnet: Site VisitWe mailed the Magnet application on
July 30. Right now the appraisers have
this massive record of our work sitting
in their laps, and they are evaluating
everything that makes up our nursing
practice at Cone Health. They are not
only reading our words, but also look-
ing into the evidence we supplied to
prove that what we said is true.
Once they read the application, they
may ask for clarification. This may mean
requests for further evidence or to completely rewrite an item.
Marjorie Jenkins, the Magnet Program Director, says they always
ask for something. We will have a prescribed time period to
supply what the appraisers request and then they will evaluate
again.
The next real test of our Magnet worthiness will be the site
visit. The goal of the appraisers’ visits will be to verify, amplify
and clarify the contents of the written document and the
presence of excellence in nursing throughout the organization.
Your Magnet Champion will have a summary of the document
to work from; the whole Magnet application will be available
through the Magnet website and it will have an index.
The appraisers will be here for three to four days. Here are some
of the things they will do:
• Randomly select nurses for group meetings.
• Randomly review personnel files of direct-care nurses and
leaders.
• Visit with members of the community and area schools of
nursing.
• Review metrics: budget, nurse sensitive indicators, nurse and
patient satisfaction data.
• Review advocacy department files for reports related to
nurses and nursing.
They will meet with our Chief Nursing Officer every day of the
visit. Direct-care nurses will serve as escorts and timekeepers
for the appraisers. Attendance will be taken at every
meeting. Appraisers will visit most nursing departments and
departments that work closely with nurses. They like to visit
randomly selected patients and families (permission to do so
must be obtained by direct-care nursing staff).
Appraisers may review nursing documentation, unit schedules,
outcomes data, care plans, patient education materials, meeting
minutes and Internet search capabilities accessible by nurses.
There will be times scheduled for drop-in meetings where staff
can talk with appraisers.
How can you prepare? • Soak up your Champion and RN4s education.
• Create bulletin boards showcasing nursing on your
department using the Magnet components and the
Professional Practice Model so that you have something to
reference when the appraisers are on your department.
• Appraisers do not want to see planned presentations, so
don’t plan anything. Just know your stuff.
• Make sure your documentation is clean and in order, including
meeting minutes.
• Know what your scores are—nurse sensitive indicators, nurse
and patient satisfaction data.
I know that nursing in this organization is excellent. Let’s get out
there and show the appraisers. I am looking forward to working
with you as we take the next Magnet step.
Sarah Lackey, RN, MSN, CCNS, Editor-in-Chief
Magnet Program Coordinator, Trainee
Rapid Response Team, Relief
CONE HEALTH
INSIDE THIS ISSUE3 Maturing in Nursing
4 h.i.c.c.u.p.s.
5 Culture Change: Nursing Style
6 Falls... What Are We Going To Do?
8 Annie Penn Has Left the Building
9 A New Gold Standard for Inpatient Care
10 We Welcome Burlington Campus Nurses
13 The Great 100 Nurses in North Carolina
14 Setting the Pace
18 Telling the Story: Measures of Magnet
19 The next step for Magnet: Site Visit
We serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care.
From the Editor
Maturing in Nursing
318
The spark of interestIn 2011 I attended a chapter meeting of the Association of periOperative Registered Nurses where I heard Dr. Susan Letvak, Assistant Professor of Nursing at the University of North Carolina at Greensboro, speak on “The Greying of the Nursing Workforce,” based on her research on the mature nurse. As she presented what mature nurses bring to nursing and what challenges we face in nursing as they retire, I thought of all the nurses in surgical services at Annie Penn Hospital where I work. More than half of us will be eligible to retire within the next 10 to 15 years.
I knew Annie Penn Hospital would not close its doors when we retire, but think of all the knowledge and experience leaving in a short period of time. Experts predict a nursing shortage in 2020, so what could be done? I could not wait to contact Dr. Letvak and tell her my interest in the work she was doing.
A research project beginsI contacted Dr. Letvak the next day. Research says the needs of the mature nurse are different from those of younger nurses. Retaining older nurses in the workforce is crucial not only because it is expensive to recruit and train new nurses, but also because their experience is critical to patient care. Determining the needs of the mature nurse could assist in retaining mature nurses. I wanted to do research on the mature nurses at Cone Health. Dr. Letvak was willing to help in any way she could and agreed to serve as the principal investigator. I was about to learn how to conduct a research study.
Development and institutional approval To examine mature nurses at Cone Health we chose to replicate a research study Dr. Letvak had developed to study this topic in other hospitals. We titled our research project “Identifying the Needs of the Mature Nurse Workforce.” The purpose was to identify demographics, characteristics and needs of the mature nurse workforce at Cone Health. Among the data to collect was how long the respondents planned on staying in their jobs at Cone
Health, job satisfaction and a checklist ranking strategies that would be important to mature nurses.
The first step in the approval process was a presentation to the Nursing Research Council for their recommendations and approval. I have to admit I was a little nervous but settled when I saw how interested and enthusiastic the members of the council were about the topic. Dr. Letvak served as the principal investigator and assisted with completion of the application for Institutional Review Board approval.
Data collection, analysis and resultsIn February 2012, 1,446 nurses (age 40 or older) at Cone Health were invited to participate in an online survey. Age selection was based on the federal government’s definition of age 40 as being an older worker. The survey consisted of 20 questions and a comments section.
Of the 1,446 nurses invited to participate, 547 (38 percent) responded. Responses came from nurses in all types of positions—from physicians’ offices to administration. More than 70 percent of those who responded were direct-care nurses, while more than half had more
than 26 years of nursing. Think of all the knowledge and experience represented!
Retirement in the next 10 years is in the plans of 45 percent of those surveyed. This figure correlated with current research and the prediction that we will be facing a national nursing shortage by 2020. An important comment to note was that many would prefer to retire gradually.
The top four themes in the survey responses were related to recognition, education, flexible scheduling, and salary and benefits. Many felt that their experience was not valued or recognized. There was a split on formal education with many requesting classes be held on-site and others wishing to see less emphasis placed on
By Betty Ashley, RNFA, CNOR
CONE HEALTH CONE HEALTH
On the cover: More than half of Operative Services nurses at Annie Penn Hospital will be eligible to retire in the next 10-15 years.
Here is their story:
Background: The patient was incoming
from Rockingham County by ambulance.
She was actively having a heart attack
and needed an emergent cardiac cath-
eterization but we could not get her stable
enough in the emergency department (ED). She kept coding.
We knew this patient—we had been following her for more
than a year in the Heart Failure Clinic. She had just been put on
the heart transplant list.
Who, what, when: • The interdisciplinary team provided high quality CPR for
more than 30 minutes.
• The patient’s family was asked if they would like to stay
during resuscitative efforts; they did and were coached by
the staff.
• Department 2900 nurses came to the ED and assisted with
placement of an intra-aortic balloon pump. The patient was
stabilized and taken to the cath lab; the hypothermia
protocol was invoked.
• After the event was over, the lead physician sought out team
members to thank them personally for doing effective CPR.
Participants included nurses from ED, 2900 and IV team;
physicians from ED and Cardiology; emergency medical
technicians; nursing secretaries; a chaplain; a patient advocate;
Radiology; Respiratory Therapy; and cath lab personnel.
Results and significance: • Anoxic brain injury was avoided. Within 48 hours of
presenting to the ED, the patient was fully awake and
transferred to Duke University Medical Center.
• The lead physician sought out team members to thank them
for their efforts.
• The family expressed appreciation for being included in
patient care.
• The patient received a heart transplant within one week of
this event. She was eventually discharged and went back to
her life.
This story demonstrates many of the Magnet components:
Transformational leadership: the leadership within the team
and the vision that established the S-T segment Elevation
Myocardial Infarction (STEMI) protocols and team.
Structural empowerment: the protocols of STEMI,
hypothermia, CPR and other training of the personnel
involved.
Exemplary professional practice: the Professional Practice
Model components of interdisciplinary collaboration, evidence-
based practice, caring, competence and celebration; and the
Relationship Based Care components of care for colleagues
and care for patients and families.
Empirical outcomes: feedback from family and a successful
outcome for the patient.
CONGRATULATIONS to this dynamic team. What is YOUR
Measure of Magnet story?
TELLING THE STORY: Measures of MagnetThe Moses H. Cone Memorial Hospital
Emergency Department (ED) received the Measure of Magnet award for August.
MAGNETEMPIRICAL OUTCOMES
MAGNETEXEMPLARY PROFESSIONAL PRACTICE
Continued on page 4
Current literature
sources predict a
nursing shortage by
2020. 45% of Cone
Health mature nurse
survey respondents
plan to retire in the
next 10 years.
4 17
CONE HEALTH
Setting the PaceCONE HEALTH
I talk with hundreds of patients every month and hear in their own
words and voices the impact our care makes on their lives. Most of
the feedback they provide is overwhelmingly positive. I often process
these comments when I am working in the garden.
The growing season was quite challenging this year, and pests and
unprecedented rainfall ruined the bountiful harvest I typically enjoy. I
was thinking about my patient conversations one day as I pulled up
my sad, fruitless tomato plants. It occurred to me that I had witnessed
a trend with many patient comments. Often they tell me how much
better their recent hospital experience was than the previous one. This
has become my favorite thing to hear. They see a difference in our
culture; there is a noticeable improvement in the way we interact and
communicate with them and their families. They tell me they believe
we really do care about them during their time of need. Some even
tell me that we are like friends to them, and they did not want to leave.
Although patient satisfaction data clearly validates this feedback as
an accurate representation of our culture, nothing confirms it more for
me than hearing it directly from our patients.
That same day in the garden I had an unexpected discovery. Thriving
behind a screen of tall weeds, hidden and forgotten, was a robust,
heavily laden pepper plant. I have never had success with growing
peppers. Yet here, in the midst of this disaster of a garden, was a plant
full of big, beautiful peppers that had survived the worst gardening
year in my memory. Something had grown after all, in spite of the rain,
the pests and my own weaknesses as a gardener. It was especially
gratifying. My disappointment and frustration turned to inspiration.
In the midst of our hectic and demanding workplace, our
communication of caring is thriving, just like that pepper plant. Our
patients see, hear and feel the difference. That only happens because
of the individual efforts caregivers make to establish and maintain
authentic and meaningful relationships with our patients and families.
Despite the challenges and changes we are facing in our work, we are
making a difference where it matters most: with those who are in our
care this very moment.
I look forward to hearing more stories of how you guide patients
through their experience of illness and hospitalization with your caring
and compassionate healing.
h.i.c.c.u.p.s.By Laine Tousey, RN
Highly Involved Compassionate Caring Uniting People Skills
Maturing Nursing Continued from page 3
obtaining a degree. Other educational needs identified were computer classes and generational classes. With increasing patient acuity and expectations, many mature nurses feel they cannot keep up the pace. Many stated they cannot continue working 12-hour shifts. Suggested solutions included job sharing, creative job roles and part-time or flexible shifts. Lastly, the main issue in terms of salary and benefits is the glass ceiling for long-term employees—maxing out in the pay grade.
Implications for nursing at Cone HealthOf those mature nurses responding, 64 percent plan to leave their current practice role in the next 11 years and 60 percent plan to leave Cone Health within the next 11 years. Still, the overwhelming majority of respondents are satisfied with their current work environment and the quality of care they provide, and would recommend Cone Health to other nurses.
Dissemination: spreading the wordWhat started out as a spark of interest grew into an amazing journey. I had no idea this project was going to be such a hot topic. I received emails from mature nurses with ideas, suggestions and frustrations, which I passed on to the Nursing Excellence/Retention Committee to keep this topic alive. In August 2012 I was invited to join the committee.
In September 2012 I was honored to be a podium presenter at Cone Health’s Nursing Research and Evidence Based Practice Symposium, Building Blocks for Quality Care: Making the Pieces Fit. In April 2013 I presented at Grand Rounds, the surgical services staff meeting at Annie Penn Hospital and the Annie Penn Nursing Symposium. Surgical services staff at Women’s Hospital invited me to present in August 2013.
I am pleased that we will be accomplishing one need—recognition—in this issue of Nursing Beat. I want to thank every mature nurse for his or her years of nursing, and I wish we could highlight every one of them.
Outcomes• Department 4700 CAUTI rates have decreased to zero, and this rate has been held for seven months. Foley device days continue to decrease. Hospital-acquired infection rates have been at zero for almost 12 months.• Falls have decreased to zero for 42 days at the time of this writing.• Patient satisfaction scores climbed to the 17th percentile out of the single digits, and then into the 38th percentile. • Previous years’ participation in staff engagement scores had always been less than 50 percent. This year it was 98 percent.
What made the difference?Holding staff accountable and emphasizing the importance of individual accountability helped to establish teamwork. “We had to have positive momentum, and there were some people holding us back,” says Monette Mobalo, Department Director.
Hiring new staff, including several new graduates, helped to adjust ratios. With positive energy and better workflow, there was much less negativity and more engagement. Staff had more ownership of the outcomes and more pride in their work.
Keeping it goingTeamwork is now bubbling up all over the place. New projects are taking hold:• Nurse Tech weekly IV audits• Development of RNs as academy coaches• Streamlining the orientation/onboarding process to include weekly goals and the development of new employees
Staff and leadership understand the importance of information and celebration. A bulletin board kept in the staff common area presents vital and ongoing information (see photo). Every achievement is celebrated no matter how big or small. Ice cream, potluck dinners and even a chocolate fountain (to celebrate the 38th percentile for patient satisfaction), as well as food catered to all shifts, help to include everyone in the celebration.
Most importantly, Department 4700 staff members have crafted their own vision for the department: “To become a leading heart failure de-partment in the Triad.” Along with it, they have identified their collab-orative core value: integrity and their philosophy: “One team, one goal. No exceptions, No excuses. For every patient, every time.”
Staff members who have been on the department for more than two years notice the change in its culture. Everyone is noticeably happy and willing to do more, for the sake of the patient and for one another. Working as a unified group with a sharp focus on patients has pulled together everyone who works with patients on Department 4700—everyone. Culture change, nursing style.
Culture Change: Nursing Style continued from page 5Stroke Certified Registered Nurse• Susan Ashcraft, RN, MSN, ACNS-BC, SCRN, Clinical Nursing Support• Greg Calone, RN, BSN, CCRN, SCRN, Neuro ICU, Moses Cone Hospital
ADVANCING IN EDUCATION
MSN • Jackie Mieczkowski, RN, MSN, ANP University of North Carolina at Chapel Hill, May 2013
MHA• Angela Daye, RN, BSN, MHA, Pfeiffer University, August 2013
BSN • Kathleen Brooks, RN, BSN, Chamberlain College of Nursing, April 2013• Christina Canipe, RN, BSN, University of North Carolina at Greensboro, May 2013• Lori Doss, RN, BSN, University of North Carolina at Greensboro, May 2013• Katalina Eubanks, RN, BSN, University of North Carolina at Greensboro, May 2013• Shantelle Greene, RN, BSN, University of North Carolina at Greensboro, May 2013• Dana Herndon, RN, BSN, University of North Carolina at Greensboro, May 2013• Katie Hyatt, RN, BSN, University of North Carolina at Greensboro, May 2013• Thaih Rcom, RN, BSN, Winston-Salem State University, May 2013• Jessica Serva, RN, BSN, RC-MNN Ohio University, June 2013• Janice Smith, RN, BSN, University of North Carolina at Greensboro, August 2013• Jason Upham, RN, BSN, CEN, University of North Carolina at Greensboro, April 2013
BS• Olivia Blue, EMT, BS in Biology, Minor in Psychology, High Point University, May 2013
Associate Degree in Nursing • Susan Coe, RN, ADN, Alamance Community College, May 2013• Jessica Corona, RN, ADN, Guilford Technical Community College, May 2013• Francis Dudley, RN, ADN, Guilford Technical Community College, May 2013• Alaina Nease, RN, ADN, Guilford Technical Community College, May 2013• Juliet Williams, RN, ADN Davidson Community College, May 2013
Associate Degree in Medical Office Administration• Wanda Booth, NS/MT Rockingham Community College, May 2013
5
Culture Change: Nursing StyleThe challengesDepartment 4700, the Moses H. Cone Memorial Hospital was in a difficult state. Rapid turnover in management had left the department with poor morale and limited staff engagement. Poor performance on nurse sensitive indicators made things worse:
• Hospital-acquired infections were at an all-time high.• Methycillin Resistant Staph Aureas (MRSA) rates were elevated.• C. diff ran regularly through the department.• Catheter-acquired urinary tract infections (CAUTI) rates were high.• Falls were high, with some patients having sustained injury.• Weights and intake/output measures were not consistent.
The department had a poor reputation for clinical precision. Heart failure patients have to have careful fluid management. Without regular weights and intake/output measures, there was no way to accurately make decisions for medication adjustment and other treatments. Top decile performance had to include accurate intake/output measures and documentation.
Something had to be doneStaff and leaders of Department 4700 knew something had to be done. Nursing practice had to improve. Using the Shared Governance Council structure, they made these changes:
• Process standards were changed to measure Foley catheter output every four hours.• All ambulatory patients were to be weighed on the standard scale, not the bed scale, and as soon as possible.• Staff members were educated one-on-one to the new process, and commitment was expected.
Practice changes to protocols were not enough. Three staff engagement activities were designed and implemented by the Council:
• Mandatory team-building retreats. Here a new program called Acknowledging Patients’ Participation Lengthens Life Expectancy (APPLE) was born. It happened when patients and their needs were considered first. Everyone was involved in this program.• Peer recognition. A Drop in Your Bucket program was implemented. This program encourages staff to post notes on a bulletin board to show appreciation to one another. Notes are counted monthly and prizes given.• Rookie of the Month Award. This program recognizes new nurses. It uses WOW cards, a term coined by a patient.
RegroupDespite the efforts of the entire department, the results of these efforts were not great. Several staff members were lost to other departments. Patient acuity and volumes were high. Consistent
short staffing and high patient ratios led to frustration and disengage-ment.
CAUTI rates by 2012 were the highest in the health network. Patient satisfaction scores were in the single digits.
Staff and leadership regrouped with the Council. They decided to attack the CAUTI problem first. They made the problem a focus of everyone on the department. Here’s what they did:
• Developed an audit system where nurse secretary/monitor techs perform daily device audits. Audits include physically visualizing the device and making sure it is secured, the bag is dated and located lower than the patient.• A CAUTI Champion was selected—an Nurse Secretary Monitor Tech (NSMT) took on the catheter project as her own.• NSMTs were encouraged and empowered to question nurses about any catheter that had been in more than 48 hours.• Nurses were encouraged and empowered to discontinue catheters per protocol guidelines that had already been established.• NSMTs and nurses were encouraged to ask physicians questions about catheters in place more than 48 hours and to make suggestions for alternatives.
The results? Foley device days began to decrease.
The frequency of falls was another stubborn problem. The new falls bundle helped with this effort. The falls champion made sure the mandatory education for all staff was completed. High-risk fall patients were rounded on more frequently, video rooms were used for monitoring and patients were discussed in huddles. The results? Falls began to decrease.
As they experienced successes, the staff became more focused on the accuracy of weights and intake/output measures, even engaging the physicians in honoring the strict intake/output protocols.
Staff continued to ask each other what could be done to improve patient satisfaction. Physicians were reminded of the “AIDET” tool’s effectiveness for patient engagement.
Continued on page 17
By Donna Owen and Monette Mobalo
MOSES H. CONE MEMORIAL HOSPITAL
MAGNETEXEMPLARY PROFESSIONAL PRACTICE
CONE HEALTH
Setting the Pace, Continued• Theresa Davis, RN, Pediatrics, Moses Cone Hospital• Vincent DiMattia, RN, BSN, Operative Services, Moses Cone Hospital• Cybil Eckelmann, RN, BSN, Pediatrics, Moses Cone Hospital• Ginger Fountain, RN, Operating Room, Women’s Hospital • Patricia Freeze, RN, CNOR, Neuro Operative Room, Moses Cone Hospital• Gayle Gambaccini, RN, BSN, Internal Medicine Center, Moses Cone Hospital• Martha Hamby, RN, BSN, Emergency Department, Wesley Long Hospital• Myrtle Hardin, RN, BSN, OCN, Cone Health Cancer Center• Connie Harris, RN, SANE-A, Maternity Admissions, Women’s Hospital• Sharon Hitchcock, RN, BSN, Operative Services, Moses Cone Hospital• China Hollis, RN, BSN, OCN, 3 East Oncology, Wesley Long Hospital• Margaret Iorio, RN IBCLC, Lactation, Women’s Hospital• Kristi Johnson, RN, Emergency Department, Moses Cone Hospital• Heather Koran, RN, BSN, RNC-OB, Birthing Suites, Women’s Hospital• Shannon Love, RN, BSN, PCCN, Department 3300, Moses Cone Hospital• Christopher McKeown, RN, BSN, Department 2100, Moses Cone Hospital• Janice Myers, RN, BSN, OCN, Cone Health Cancer Center• Debra New, RN, Operative Services, Women’s Hospital• Philomena Obasogie-Asidi, RN, BSN, Department 3000, Moses Cone Hospital• Paul O’Neal, RN, BSN, CTRN, CareLink Mobile Critical Care Transport • Kim Osborne, RN, BSN, OCN, 3 East Oncology, Wesley Long Hospital• Misty Rich, RN, BSN, Mother/Baby, Women’s Hospital• Bettie Rutherford, RN, Mother/Baby, Women’s Hospital• Carole Schiller, RN, Department 3300, Moses Cone Hospital• Dana Smith, RN, BSN, CPAN, Moses Cone Surgery Center• Jamie Tracy, RN, OCN, 3 East Oncology, Wesley Long Hospital• Heather Tripp, RN, BSN, ONC, Department 5 North, Moses Cone Hospital• Tamara Washington, RN, BSN, Department 2000, Moses Cone Hospital• Jennifer Welch, RN, BSN, CNOR, Operative Services, Moses Cone Hospital• Chalondra Yelverton, RN, Operative Services, Moses Cone Hospital• Judy Young, RN, BSN, CEN, Emergency Department, Annie Penn Hospital• Karen Young, RN, BSN, CMSRN, Department 5100, Moses Cone Hospital
Registered Nurse 4 • Lisa Brewer, RN, BSN, RNC-OB, Antenatal, Women’s Hospital• Tara Dark, RN, BSN, CMSRN, Intermediate/Urology, Wesley Long Hospital• Deborah Sharpe, RN, BSN, RN-BC, CRRN, Inpatient Rehab, Moses Cone Hospital• Anita Sowder, RN, BSN, RN-OB, Labor & Delivery, Women’s Hospital• Donna Wear, RN, BSN, RNC-LRN, Mother/Baby, Women’s Hospital
GROWING IN PRACTICE
Advanced Diabetes Management • Crissy Dodson, RN, MSN, PhD, BC-ADM, Inpatient Diabetes Department Certified Diabetes Educators• Gina Davis, RN, BSN, CDE, Inpatient Diabetes Department• Kendra Martin, RN, BSN, CDE, Inpatient Diabetes Department Certified Forensic Nurse Examiner• Angelia Cox, RN, CareLink Mobile Critical Care Transport Certified Medical Surgical Registered Nurse• Lisa Covington, RN, BSN, CMSRN, Unit 300, Annie Penn Hospital Certified Neuro Registered Nurse• Jessica Jarvis, RN, CBIS, CNRN, Department 3100, Neuro ICU, Moses Cone Hospital Certified Nurse Operating Room• Holly Protzek, RN, CNOR, Operating Room, Annie Penn Hospital Critical Care Registered Nurse• Lourdes Elder, RN, CCRN, ICU-SD, Wesley Long Hospital• Jennifer Fuquay, RN, CCRN, ICU-SD, Wesley Long Hospital• Korey Hickling, RN, BSN, CCRN, Department 2300 Surgical ICU, Moses Cone Hospital• Hans Johnson RN, CCRN, ICU-SD, Wesley Long Hospital• Velina Killmeyer-Peretin, RN, BSN, CCRN, ICU-SD, Wesley Long Hospital• Queeneth Mbemena RN, BSN, CCRN, ICU/SD, Wesley Long Hospital • Chris McKeown, RN, BSN, CCRN, 2100 Medical Surgical ICU, Moses Cone Hospital • Michael Nanney, RN, RRT, CPAN, CCRN, PACU, Wesley Long Hospital• Lauren Nester RN, CCRN, ICU-SD, Wesley Long Hospital• Tvedt Woods RN, CCRN, ICU-SD, Wesley Long Hospital
Inpatient Obstetric Nursing Certification• Tanya Stalling, RN, MSN, RNC-OB, Administration, Women’s Hospital Nurse Executive Certification• Jean Reinert, RN, MSN, NE-BC, Staff Education Oncology Nurse Certification• Erica Sica, RN, BSN, OCN, Medical Oncology, Cone Health Cancer Center Progressive Care Certified Nurse• Abla Afatsawo, RN, PCCN, Department 2600, Moses Cone Hospital• Leslie Anderson, RN, PCCN, Intermediate/Urology, Wesley Long Hospital• Deanna Dillon, RN, BSN, PCCN, Department 3300, Moses Cone Hospital • Stephanie Flippin, RN, BSN, PCCN, Department 2000, Moses Cone Hospital• Peggy Hewitt, RN, PCCN, Department 2000, Moses Cone Hospital• Lacey Hitt, RN, BSN, PCCN, Department 3300, Moses Cone Hospital • Tim Irby, RN, PCCN, Department 3300, Moses Cone Hospital • Jennifer Johnson, RN, BSN, PCCN, Administrative Coordinator, Moses Cone Hospital• Monica Lane, RN, BSN, PCCN, Department 2600, Moses Cone Hospital• Susie Milner, RN, BSN, PCCN, Admission Nurse, Moses Cone Hospital• Ashley Smith, RN, PCCN, Department 3700, Moses Cone Hospital• Tracey Snider RN, PCCN, Intermediate/ Urology, Wesley Long Hospital • Tasha Upham, RN, PCCN, Department 4700, Moses Cone Hospital • Maggie Vaughn, RN, PCCN, Department 3300, Moses Cone Hospital • Shannon Willis, RN, BSN, PCCN, Department 3700, Moses Cone Hospital• Matt York, RN, PCCN, Department 3300, Moses Cone Hospital • Mildred Zafra, RN, BSN, PCCN, Department 3700, Moses Cone Hospital
Nationally Certified Brain Injury Specialist • Shelli Coggins, RN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital• Jessica Jarvis, RN, BSN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital• Heather Klenk, RN, BSN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital• Devon Lofters, RN, BSN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital• Amy Lomax, RN, BSN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital• Megan Powell, RN, BSN, NCBIS, Department 3100, Neuro ICU, Moses Cone Hospital
16
F
CONE HEALTH
6
Falls are a concern for almost every health system. The literature
is overflowing with commentary, research, evidence-based
initiatives, case studies and opinions related to falls. Whether
the information on the subject is focused on prevention, risk
scales, risk for injury, risk factors, specialty areas, inpatient or
outpatient and/or all of the above, the point is that falls are a
widespread patient quality and safety concern.
With the plethora of information about falls available and our
common sense from practice, we all know falls are costly. They
are costly not merely from a monetary standpoint, but from
the sequela associated with falls. Those costs are the result of
higher mortality, decreased mobility, readmissions, increased
length of stay, and fear and/or decreased quality of life for
those who experience a fall.
Cone Health solutionsWhat has Cone Health done to effectively decrease the number
of falls and more importantly, falls with injury? To reference the
literature, there is no “magic bullet” to prevent falls. However,
at Cone Health, there are must-haves we use in our bundle for
fall prevention. If falls are prevented, it is reasonable to discern
injuries will be prevented.
Falls include a lot of individual factors. Whereas you can
have a central line bundle, a fall prevention bundle is not so
straightforward. Our bundle has a three-pronged approach. We
have clinical, education and leadership components. We also
use the Johns Hopkins fall risk assessment tool along with our
clinical bundle.
Education BundleOverall: Teach Back and Ask Me 3
• Quarterly Computer Based Learning education for
nursing and non-nursing staff; Computer Based Learning
for Nurse Techs. - Hourly rounding with environmental rounding.
- Patient safety plan.
- Interventions in Cone HealthLink (clinical bundle
chart—the must-haves).
- ABCS (age, bones, coagulopathy, surgery).
• Round on all high-risk patients every shift to ensure red socks,
yellow armband and bed alarm set.
Response after fall• Assist patient with safe patient handling equipment.
• Leadership notified (department director or designee).
• Never Event Fall Huddle.
- leadership must be present.
- huddle conducted at the bedside.
• Provider notified.
• Family notified.
• Safety Zone Portal (our incident reporting system).
• Progress note completed by nursing.
Leadership Bundle1. Never Event Fall Huddle immediately after fall at patient’s
bedside with patient and family input. Leadership to conduct
environmental check at patient’s bedside.
a. Interview patient and family if present.
b. Must attach evidence of rounds with Never
Event Fall Huddle.
2. Complete Leadership Fall Bundle drill down, in follow-
up section of Safety Zone Portal , within 48 hours of fall.
Department Director arranges drill down within 48 hours.
3. Site vice president of nursing (VPN) review completed Safety
Zone Portal within 72 hours of fall.
4. If Safety Zone Portal not complete, site VPN to follow-
up with department director.
5. Falls agenda item at every department-level meeting.
Continued on page 7
FALLS…What are we going to do?By Thresa Haithcock, RN, DNP, ACNS-BC
Clinical Fall Bundle: Interventions Universal Moderate High
Patient safety plan
Hourly rounding
Door open if unsupervised
Minimum 2-hour toileting
Yellow arm band/red socks
Supervise/assist bedside sitting
Bed alarm For score > 10
Remain with patient when toileting
Move to room with best visual access
MAGNETEMPIRICAL OUTCOMES
Susan Ashcraft, RN, MSN, ACNS-BCHeather Klenk, RN, BSNDenise Wolfe, RN, CNRN.Heather Pitts, RD, LDN Megan Powell, RN, BSNJessica Jarvis, RN, BSNDevon Lofters, RN, BSN“Ventilator-Associated Pneumonia in the Trauma Patient: An Accident Prevented by Thinking Outside the Bundle.” National Teaching Institute and Critical Care Exposition, Boston, May 18-23, 2013.
Cynthia Wrenn, RN, CNOR, RNFAElisa Haynes, RN, BSN, CPAN Ashley Olson, RN, BSN“What’s for Dinner? Research!!! The Bed-side Nurse’s Perspective on Research.” Association of Operating Room Nurses (AORN) National Congress, San Diego, March 2-7, 2013.
Susan Ashcraft, RN, MSN, ACNS-BCLinda Coon, RN, BSN, MSACindy Bussey, RN, BSN, CNRNJamie Cargal, RN, BSN, CNRNAshley Allred, RN“Patient Transfer Check-Off Decreases Fall Rate on Stroke Unit.” The International Stroke Conference, Honolulu, Feb. 6-8, 2013.
Heather Tripp, RN, BSN“Orthopedic Core Curriculum.” National Association of Orthopedic Nurses (NAON) 33rd Annual Congress, San Antonio, May 18-21, 2013.
Laurie McNichol, MSN, RN, GNP, CWOCNLaura E. Edsberg, PhD Jennifer T. Wyffels, PhD“Proteomic Evolution of a Deep Tissue Injury (DTI).” National Pressure Ulcer Advisory Panels 13th National Biennial Conference, Houston, February 2013.
ACCOLADES
Eva Hyde, RN, MSN, CNS, ONC Was elected as president of the Southeast-125 Triad Chapter of NC, National Association of Orthopaedic Nurses.
Julie O’Neal, RN, MSN, CEN Received the University of North Carolina at Greensboro School of Nursing, Sigma Theta Tau International, Gamma Zeta Chapter “Master of Science in Nursing Award for Excellence.” This honor is awarded to one graduate student nominated by School of Nursing faculty.
Sandra Kueider, RN, BSN, MSHCA, and Susan Owens, RN, BSN Were selected as SILVER Touchstone Award winners for the 2013 Carolina Health Systems Quality and Service Sharing Day.
Maryellen Paton, MSN, RN, CNS, CCRN, and Terri Wyatt, RN, BSN, MBA Project titled “Knot So Fast: Promoting Quality Care by Reducing Nonviolent Restraint Utilization” was selected as a SILVER Touchstone Award winner for the 2013 Carolina Health Systems Quality and Service Sharing Day.
Jennifer L. Zinn, MSN, RN, CNS-BC, and Larry “Rock” Sumner, BS, CFPS Project titled “Empowering Staff When Disaster Strikes: Fire Safety in the Operating Room” was selected as a BRONZE Touchstone Award winner for the 2013 Carolina Health Systems Quality and Service Sharing Day.
Jennifer L. Zinn, MSN, RN, CNS-BC, and Vangela Swofford, BNS, RN, CSSBB Project titled “Transforming Surgical Quality with Inter-Professional Collaboration” was selected as a BRONZE Touchstone Award winner for the 2013 Carolina Health Systems Quality and Service Sharing Day.
Diane Celano, RN, Department 5500 Completed the Geriatric Resource Nurse Core Curriculum offered by NICHE. She is our first official GRN. She completed the entire program for 20 contact hours.
Karin Henderson, RN, MSN, CENP, Executive Director of Organizational Integration Was appointed to the National Center for Health Care Leadership Advisory Council on Mergers and Acquisitions this summer.
Kimberly Lynn, RN, MSN, CCM Was selected from among 400 graduate submissions at The University of Phoenix to speak at the graduation ceremony held in Charlotte.
Beverly Harrelson, RN, MSN, CPAN Was elected to serve a two-year term as Certi-fied Post Anesthesia Nurse (CPAN) chair of the National Exam Construct Commit-tee for The American Board of Perianes-thesia Nursing Certification (ABPANC).
Debbie Green, RN, DNP, CENP was accepted into the Robert Wood Johnson Foundation Executive Nurse Fellows Program.
Growing in Leadership
Director• Gretta Frierson, RN, BSN, MBA/MHA, Clinical Support Services, Moses Cone Hospital• Nicole Baltazar-Holbert, RN, MSN, 5 North Orthopedics and Spine Center, Moses Cone Hospital• Marjorie Jenkins, PhD, RN, BSN, MBA, NEA-BC, Director Nursing Research
Manager• Gina Lurz, RN, BSN, Clinical Nurse Manager, LeBauer Cardiology• Stephen Coward, RN, BSN, MHA/MBA, Employer Health Services Manager, Employer Health Administration
Assistant Clinical Director• Geronda Pulliam, RN, MS, BSN, CCM, THN, Care Management
Assistant Director• Allena Day, RN, BSN, RN-BC, Department 4 North/Neuro, Moses Cone Hospital• Yonkai Ramzah, RN, BSN, MHA, Department 5 North Orthopedics, Moses Cone Hospital• Lindsay Draper, RN, BSN, RN-BC, Department 5500 Medical/Telemetry, Moses Cone Hospital• Jamie Wilkinson-Cargal, RN, BSN, CNRN, CBN, Women’s Nursing Unit and Adult ICU, Women’s Hospital• Kate Clark RN, BSN, CEN, Emergency Department, Moses Cone Hospital• Jason Upham, RN, BSN, CEN, Emergency Department, Moses Cone Hospital• Monica Lane, RN, BSN, PCCN, Department 2600, Moses Cone Hospital• Melanie Mitchell, RN, BSN, Emergency Department, Wesley Long Hospital• Traci Hampton, RN, BSN, Emergency Department, Wesley Long Hospital• Tonica Johnson, RN, BSN, MSN, CCRN, NP-C, Department 2100, Moses Cone Hospital
Title Changes from CNE to CNS • Jenny Clapp, Women’s Health• Danyel Johnson, Medical-Surgical • Candace Matthews, Pediatrics• Denise Rhew, Emergency Department
Registered Nurse 3 • Nerissa Abordo, RN, BSN, CMSRN, Department 6500, Moses Cone Hospital• Debra Anderson, RN, OCN, 3 East Oncology, Wesley Long Hospital• Robin Bass, RN, CRNI, Cone Health Cancer Center• Carla Bethune, RN, BSN, CNOR, Operative Services, Moses Cone Hospital• Beth Bradt, RN, MSN, Department 3300, Moses Cone Hospital• Bonnie Brown, RN, BSN, CEN, Emergency Department, Annie Penn Hospital• Nancy Caddy, RN, BSN, RN-BC, Pediatrics, Moses Cone Hospital• Kellie Capes, RN, BSN, PCCN, Intermediate/Urology, Wesley Long Hospital• Kate Clark, RN, BSN, CEN, Emergency Department, Moses Cone Hospital• Victoria Cox-Ingram, RN, BSN, Department 2100, Moses Cone Hospital• Linda Curran, RN, BSN, PCCN, Department 2600, Moses Cone Hospital• Debra Dallas, RN, BSN, CNOR, Operative Services, Annie Penn Hospital• Shareen Davenport, RN, BSN, Operative Services, Wesley Long Hospital.
15
If falls are prevented, it is reasonable that injuries will be prevented.
Setting the Pace, Continued
7
MAGNETNEW KNOWLEDGE, INNOVATIONS
AND IMPROVEMENTS
CONE HEALTH
Setting the PaceCONE HEALTH
What we have listed is not the inclusiveness of our efforts, nor is it what we started with. We had to start somewhere and have modified our bundle along the way. Our Stop All Fall Events (SAFE) team has made tremendous strides and continues to be fully invested in making a difference for our staff in order to help our patients.
Our resultsBeing fully transparent, here are our falls numbers for the whole health system. We went live with our bundle around March 2013, but there was much information and talk about the whole pro-cess prior to that. What is remarkable is that we have also had a significant decrease in falls with injury. We are publicly reported related to our falls data and according to VHA, a company that offers analytics in health care, we are one of the health systems with the most improved rates among our peers.
We have learned that it is difficult to stay positive and keep mo-mentum. We have developed a patient safety plan, advocated for gait belt usage by nurses and nurse assistants, and imple-mented many other initiatives.
We continue to highlight our recognition plan. The Humpty Dumpty Award goes to the department with the most de-crease in total number of falls for a quarter compared to the previous one. For example, our Quarter 3 Humpty Dumpty went to Department 4000. Steven E. Marshall, RN, BSN, CCRN, Nursing Manager, Inpatient Rehab 4000/4100 at the Moses H. Cone Memorial Hospital, attributes the department’s success to “increased rounding and making sure that the safety plan is updated and that everyone is utilizing the interventions listed.” Upon presenting the Humpty Dumpty, the staff members were engaged and excited to receive the award.
Recognizing extended successWe just began the Red Slipper Award. This will recognize de-partments who have had consistent success in preventing falls. Here are the details:
Falls Prevention Recognition – Red Slipper Award
Purpose: To recognize inpatient departments for their fall prevention
efforts
Effective: Quarter 4 (current days with no falls through the end of third
quarter—2013)
Guidelines:• Departments who have gone a “long stretch of days”
as indicated below (>30, 60, 90 or 120 days) will receive
recognition for achieving this anytime during the quarter.
• The criteria below are suggestions only and are done at the
discretion of the department director.
• The department leaders will be responsible for acknowledging
the days without falls as they occur (not waiting until the end
of the quarter).
• Submit via email information related to numbers of
consecutive days with no falls. A certificate will be prepared
by the SAFE team and presented to the department(s) at
Nursing Leadership Council.
• Only those departments who have gone 30+, 60+, 90+, 120+
or more consecutive days during the quarter without a fall are
the departments who should submit their information.
The SAFE team is open to any and all suggestions, comments
and/or questions. Please email Thresa at
Grand Rounds and Falls SummitFalls preventions will be presented in November’s Nursing
Grand Rounds. We are also in the planning stages for another
Falls Summit tentatively scheduled for January 2014. Keep an
eye out for advertisements of these events and remember to
submit your ideas and your recognitions to the SAFE team.
14
IN PRINT
Laurie McNichol, RN, MSN, GNP, CWOCNMikel Gray, Phd, RN, CUNP, CCCN, FAANJan Colwell, RN, MS, CWOCN, FAANDorothy Doughty, RN, MSN, CWOCN, FAANMargaret Goldberg, RN, MSN, CWOCNJo Hoeflok, RN, BSN, MA, ET CGN(C)Andrea Manson, RN, BSN, ETSamara Rao, RN, BScN, CETN(C)“Peristomal Moisture-Associated Skin Damage in Adults with Fecal Ostomies: A Comprehensive Review and Consensus.” Journal of Wound Ostomy Continence Nurse; July/August 2013, 40(4), 389-399.
Laurie McNichol, RN, MSN, GNP, CWOCN Carolyn Lund, RN, MS, FAANTheodore Rosen, MDMikel Gray, PhD, RN, CUNP, CCCN, FAAN“Medical Adhesives and Patient Safety: State of the Science: Consensus Statements for the Assessment, Prevention, and Treatment of Adhesive-Related Skin Injuries.” Journal of Wound, Ostomy and Continence Nurse; July/August 2013, 40(4), 365-380.
LaVern W. Delaney, RN, MSN, MBA “From Turmoil to Success: Facilitating the Future of Nursing.” Nurse Leader; August 2013, 62-64.
Lelia Moore, RN, BSN, FCNAlyson J. Breisch, RN, MSN, FCNPam Spach Hurley, RN, BSN, FCN“Faith Community Nursing: Innovative Practice in Faith-Based Settings.” Tar Heel Nurse; July, August/September 2013, 12,16.
Melissa Morgan, BSN, RN, CICTeresa Hopkins, BSN, RN, MHA, CWS Kim Helsabeck, BSMT, MSPH “Impact of a Multi-Hospital Intervention Utilizing Screening, Hand Hygiene Education and Pulsed Xenon Ultraviolet (PX-UV) on the Rate of Hospital Associated Methicillin Resistant Staphylococcus Aureus.” The Journal of Infection Prevention published online before print, June 5, 2013.
Jennifer L. Zinn, RN, MSN, CNS-BC Jeanne B. Jenkins, PhD, RN, MBABeverly Harrelson, RN, MSN, CPANCynthia Wrenn, RN, CNOR, RNFAElisa Haynes, RN, BSN, CPANNicole Small, RN, BSN, CNOR“Differences in Intraoperative Prep Solutions: A Retrospective Chart Review.” Association of Perioperative Registered Nurses; May 2013, 97(5), 552-558.
Marlienne Goldin, RN, BSN, MPA“Honoring Loss in the Neurosurgical Intensive Care Unit.” Dimensions of Critical Care Nursing. May/June 2013, 32(3), 123-124.
Annette Smith, RN, MSN, NEA-BCLaurie L. McNichol, RN, MSN, GNP, CWOCNMary Anne Amos, RN, MSN, NE-BCGayle Mueller, RN, BSN, MHA/MBA, CCRNTracy Griffin, BSBJoe DavisLora McPhail, RN, BSNTerry G. Montgomery, PhD“A Retrospective, Nonrandomized, Before-and-After Study of the Effect of Linens Constructed of Synthetic Silk-Like Fabric on Pressure Ulcer Incidence.” Ostomy Wound Management, April 2013, 59(4), 28-34.
AT THE PODIUM
Crystal Dodson, PhD, RN, MSNJenny Simpson, RN, MSN, BC-ADM“Critical Care Glycemic Management: Pearls of Success.” American Association of Diabetes Educators, Philadelphia, Aug. 9, 2013.
Betty Ashley, RN, CNOR, RNFA“Identifying the Needs of the Mature Nurse Workforce.” Grand Rounds, Annie Penn Hospital Surgical Services and Annie Penn Research Symposium, Reidsville, April 2013.
Laurie McNichol, RN, MSN, GNP, CWOCN “Medical Adhesives and Patient Safety: Results of a Consensus Conference Focusing on Medical Adhesive Related Skin Injury.” 45th Annual Wound Ostomy and Continence Nurses (WOCN) Society Conference, Seattle, June 2013.
Laurie McNichol, MSN, RN, GNP, CWOCN Lectures: “Medical Adhesives and Patient Safety: Results from a US-Based Consensus Conference” and “Best Practices in Pressure Ulcer Prevention.” 1st International Congress on Skin Damage Prevention Best Practices, SIPIELA-Chile, Santiago, Chile, April 2013.
Lobel Lurie, RN, MACassandra Galloway, RN, MBA/MHA“Destination RN: A Themed Approach to a Nurse Extern Program.” Association for Nursing Professional Development Convention, Dallas, July 17-20, 2013.
Dawn Whitmire, RN, MSN RN-BC, CNORJulie O’Neal, RN, MSN, CEN“Pushing the Limits…Nurturing Nurses with a Portfolio-Based Clinical Ladder.” Association for Nursing Professional Development, Dallas, July 2013.
Pam Smith Tate, RN, BSN, CA “CAM: Complementary/Alternative Medicine.” Annie Penn Rural Nursing Symposium, Reidsville, April 2013.
Marlienne Goldin, RN, BSN, MPA“Self-Care for Researchers.” 2nd Annual Nursing Research and Evidence-Based Practice Research Symposium, Carolinas Medical Center Auditorium, Charlotte, Sept. 27, 2013.
Marlienne Goldin, RN, BSN, MPA“Nurse Caring in the Community.” An Address to the Lillian Wald Ambassadors of the Visiting Nurse Service of NY, Main Office, New York, Sept. 12, 2013.
Kristin McLamb, RN, MSN, RN-BCSarah Clark RN, MSN, CCRN “Tools for Your Toolbox: Hammering Home Effective Communication Skills.” International Nursing Association for Clinical Simulation 12th Annual International Nursing Simulation/Learning Resource Centers Conference, Las Vegas, June 2013.
Kristin McLamb, RN, MSN, RN-BCSarah Clark MSN, RN, CCRN “There Is No ‘I’ in Team: Building Teamwork Through Inter-Professional Simulation.” International Nursing Association for Clinical Simulation 12th Annual International Nursing Simulation/Learning Resource Centers Conference, Las Vegas, June 2013.
ON DISPLAY
Susan Ashcraft, RN, MSN, ACNS-BCLinda Coon, RN, BSN, MSA Ashley Allred, RNCindy Bussey, RN, BSN, CNRNJamie Cargal, RN, BSN, CNRN“Patient Transfer Check-Off Decreases Fall Rate on Stroke Unit.” International Stroke Conference, Honolulu, Feb. 6-8, 2013.
Susan Ashcraft, RN, MSN, ACNS-BCKatherine Clark, RN, BSN, CENRita Mintmier, RN, BSN, CNRN Debra Britt, RN, BSN, CCRNDenise Rhew, RN, MSN, CEN“The Positive Impact of Role Definition with Communication on Door-to-Needle Times in Acute Stroke Patients Receiv-ing Intravenous Alteplase.” International Stroke Conference, Honolulu, Feb. 6-8, 2013.
Susan Ashcraft, RN, MSN, ACNS-BCKyle Duncan, RN, BSN, CCRNDevon Lofters, RN, BSNDenise Wolfe, RN, CNRN“Reducing Urinary Catheter Device Days and the Impact on Urinary Tract Infection Rates in the Neuro Intensive Care.” National Teaching Institute and Critical Care Exposition, Boston, May 18-23, 2013.
8 13
ANNIE PENN HOSPITAL CONE HEALTH
oday Annie Penn Hospital is more than just a self-contained, community hospital.
While inside the walls we are continually improving technology and skills, providing
our patients with state-of-the-art care delivered by an exceptional staff of caregivers,
outside the walls Community Outreach is working to further the mission of delivering
exceptional health care. Through health fairs, cooking classes, preventive health screen-
ings, physician lectures and education to our community, we extend our Cone Health
values of compassion and caring into the people of our region.
Community Outreach is led by an RN: Stokes Ann Hunt. Her clinical background pro-
vides her with the knowledge and experience to promote healthy living to residents of
Reidsville and the surrounding communities. She is a registered nurse and has a mas-
ter’s degree in health administration.
Hunt coordinates health fairs using Annie Penn Hospital nurses and employees from
other Annie Penn departments at local manufacturing companies, such as Miller Coors,
Unified, Amcor, and Lowe’’s Home Improvement. At these health fairs nurses do blood
pressure screenings, blood glucose screenings, distribute educational literature and
information on breast health. Departments such as surgical services, radiology and
rehabilitation provide education about services offered at Annie Penn Hospital and how
to prevent on-the-job injuries. Health screenings are provided at area street festivals
such as the Downtown Reidsville Festival, Bright Leaf Hoe Down in Yanceyville, Madi-
son Street Festival and others. Hunt notes, “By providing resources to our
community, we often reach populations of patients who do not have
access to healthcare. We help educate and provide referrals as
needed.”
In addition to her role with Community Outreach,
Hunt is also the executive director of the Annie
Penn Hospital Foundation, which was formed in
1990 and has been an integral part of the hospital.
In this role she cultivates donors by organizing
fundraisers that promote the foundation. These
fundraisers not only bring in donations, but also
help educate the community about Annie Penn
Hospital and the foundation. During the past decade
the foundation has given more than $500,000 back
to the hospital and the community.
Annie Penn Has Left the BuildingBy Stokes Ann Hunt, RN, BA, MHA, CPHQ
MAGNETSTRUCTURAL EMPOWERMENTMosaic tile displayed in the serenity garden
Stokes Ann Hunt, RN, BA, MHAExecutive Director of the Annie Penn Hospital Foundation and Director of
Community Outreach
Celebrating Nursing Excellence: The Great 100 Nurses in North Carolina
Looking back to when she received the award, Anita Sherer RN, MSN, PCCN, observed “It was such a
tremendous honor to be named to the Great
100 in 1990. As I have watched many of my
highly respected colleagues and exceptional
nurses from all over the state added to the
Great 100 ranks, that honor has only grown
in magnitude for me. I am so proud to be a
part of this noble profession and consider it a
privilege to serve our patients alongside these
dedicated nurses.”
In the 25-year history of the Great 100 Nurses in North Carolina, 300 Cone
Health nurses have been selected for this honor.
The Great 100 began in 1988 when Heather Thorne, RN, brought together
a group of Registered Nurses from across North Carolina to develop a plan
for selecting and recognizing nurses for outstanding professional ability and
for the contributions to the improvement of the healthcare services in their
communities.
The Great 100, Inc. is a peer recognition organization honoring the nursing
profession in North Carolina by:
• Recognizing the importance of Registered Nurses in diverse practice settings.
• Positively impacting the image of nursing and nursing as a profession.
• Acknowledging 100 North Carolina Nurses annually who demonstrate
excellence in practice and commitment to their profession.
• Contributing funds for scholarships for registered nurse education.
The organization’s mission is to positively impact the image of nursing by
recognizing nursing excellence and providing scholarships for nursing education
in North Carolina.
In the past 25 years, more than 70 Cone Health registered nurses have benefited
from the $510,000 raised in nursing scholarships. Christopher McKeown RN III, BSN, CCRN, 2100, The Moses H. Cone Memorial Hospital, is a 2013 Great
100. “To be recognized by your peers for an award that supports and promotes
professionalism and excellence of nursing practice is an honor. I thank all the
nurses I have learned from throughout my career and those kind enough to
nominate me as a Great 100 Nurse.”
By Nicole Baltazar-Holbert, RN, MSN, and Sarah Clark, RN, MSN
MAGNETEXEMPLARY PROFESSIONAL PRACTICE
Aspiring Great 100 Keanna Johnson, RN3,BSN, Unit 4700, The Moses H. Cone Memorial Hospital and Great 100, 1990, Anita Sherer, RN, MSN, PCCN, system-wide CNS for telemetry units.
“I am proud to be a Great 100 recipient and feel
honored to be part of such an exceptional group of nurses. Great 100 honors
excellence in practice and commitment to the
profession of Nursing and it is my pleasure to be a
part of this legacy.” Beverly Causey, RN, BSN,
Staff Educator I, Staff Education.
Great 100, 2013, Chris McKeowan, RN3, BSN, CCRN, Unit 2100, The Moses H. Cone Memorial Hospital and Great 100, 2012, Robyn Wofford, RN, BSN, PCCN, Care Coordinator 3300.
Pictured at top: Beverly Causey, RN, BSN, Staff Educator I, Staff Education.
T
12 9
ALAMANCE REGIONAL MEDICAL CENTER CONE HEALTH
A New Gold Standard for Inpatient CareThe University of North Carolina
at Greensboro School of Nursing
acknowledged Annette N. Smith
Osborne, RN, BSN, MSN, for her work
in pioneering the innovative fabric that
has revolutionized patients’ comfort
and safety during their stay at Cone
Health.
Osborne, a UNCG alumnus,
headed a team that started testing
DermaTherapy® to determine the
benefits to both the patient and the
organization. Early trials indicated the
therapeutic linen provided a 50 percent
reduction in pressure ulcers and when
combined with other quality initiatives
helped to prevent or significantly
reduce the number of Methycillin
Resistant Staph Aureas (MRSA)
events. In fact, the results from the
three clinical trials led to implementing
DermaTherapy as a new gold standard
in inpatient care throughout Cone
Health’s five hospitals—a first for any
health organization in the world.
Cone Health and Osborne’s leadership
were recognized in the 2013 UNCG
School of Nursing publication UNCG
Nursing in an article titled “SON
Graduate Leads Therapeutic Linens
Project.”
One of the fundraising events has been held for more
than 20 years. Every year, the foundation helps ring in
the Christmas season with “An Enchanted Evening,” held
the first Saturday in December. At this event attendees
enjoy live band music, heavy hors d’oeuvres and festive decorations. The most
unique event the foundation plans is “Guess Who’s Coming to Dinner?” This event
highlights at least four beautiful homes throughout Reidsville and the surrounding
community. Guests do not know where they will be dining until they receive
an invitation to a specific home. This produces an environment that appeals to
many foundation supporters. The newest event is a garden party that encourages
attendees to wear hats for an afternoon event promoting women’s health, as it is
held during National Women’s Health Week in May.
Hunt’s nursing background has played a key role in facilitating activities that
benefit the hospital and provide services needed by the patients. The foundation
gives back to the hospital by funding grants for equipment and programs and by
helping fill gaps left by the current economic environment of budget shortfalls.
Some recent grants awarded by the foundation are
• GEM car that picks up patients at their vehicles and delivers them to the lobby door.
• Relocation of the hospital Chapel.
• Mosaic artwork in the Serenity Garden.
• Communication boards for the emergency department.
• Cancer nurse navigator.
• Diabetic educator.
• Community walking trail.
• Startup supplies for the Community Outreach Program
Hunt’s nursing background has also been a valuable asset in helping to guide the
foundation’s board of directors in the grant process, helping them to determine
needs that are most beneficial to the hospital and the community.
It became apparent that having a nurse in these roles helps both the hospital and
the community. “Networking within the community provides me with relationships
that continue to grow and support the hospital,” Hunt says. By being purposeful
with her community interactions, she feels this helps build the donor base for the
foundation, which in turn, benefits the endowment that gives back to the hospital.
New Chapel relocated to the lobbyCommunity Outreach nurses at a street festival
MAGNETTRANSFORMATIONAL LEADERSHIP
Continued from page 11
Nursing also contributes to the health of the
community through the diabetes counseling services
and occupational health services provided by the
nurses. At the Cancer Center, synchronization of policies
between outpatient and inpatient cancer services,
overseen and developed by interdisciplinary committees,
allows nurse navigators to bridge between both service
areas. This has resulted in integrated and seamless care
delivery for cancer patients.
Nursing cultureWhen asked about nursing at their facility, nurses and nursing
leaders consistently talk about the community focus. “These
patients are our neighbors; we see them everywhere,” stated
nursing department directors while being interviewed. Through
Knowledge Based Charting, nurses use their developing
knowledge of patients to create timely and transferable
documentation so they can pick up the threads of their
patients’ lives every time they come into the hospital.
Nurses also talk about the community environment within their
ranks. It is not unusual to see departments supporting other
departments. “Simple gestures build bonds,” was one comment
during the interview session. A few examples:
• Cake delivered from one department’s celebration to the
emergency department because the nurses knew the ED was
very busy.
• Charge nurse and secretary on one department gaining
computer clearance to work on orders for another unrelated
department (orthopedics and oncology).
• Helping without being asked.
• Nurses being cross-trained for patients outside their typical
population and accepting this without resistance or hesitation.
• Nurses’ week celebrations, including music, dancing and
nursing leadership serving staff.
• Employee health nurses’ “Drive-By Flu Shots” designed
to reach staff early in the season so direct-care nurses are
protected.
Relationships among professionals at the Burlington campus
are collaborative and supportive. The organization enjoys high
scores on indicators of physician-nurse relationships collabora-
tive clinical practice and Shared Governance exists everywhere.
Carla Foust, RN, Critical Care Unit (CCU), an eight-year employ-
ee of the hospital, describes it this way: “The way we practice is
very interdisciplinary; I have no problems going to anyone in the
hospital to take care of my patients.”
Leaders in the organization are accessible and open to employ-
ees of all levels. When issues arise that significantly impact pa-
tient care and/or employee safety, departments work together
to develop and implement solutions.
Merging with Cone HealthMany of the staff who were part of the merging of the two
regional hospitals that created Alamance Regional still work at
the Burlington campus. They remember what it feels like to go
through the process and are able to verbalize and support other
employees as they face the transitions ahead.
Nursing department directors are enthusiastic about and proud
of the nursing care and the nursing history at the hospital.
“We’ve been through a lot of changes over the years,” they said,
“but lately not so much.” They said they enjoy change and are
ready to embrace what lies ahead as they are exposed to new
ideas and practices through our relationship together.
With genuine interest these nursing leaders listened to informa-
tion about the Cone Health Professional Practice model, the care
delivery system of Relationship Based Care (with which they are
familiar) and the steps ahead to measure and instill Magnet stan-
dards and directives in the organization. Cone Health will benefit
from the rich creativity that the Burlington campus nurses have
already demonstrated in their unique and progressive nursing
solutions. In turn, it is hoped that the ideas and Magnet culture
we can share with them will provide them with the stimulation
and change they seek. The end result is sure to be enriching for
nurses, nursing practice and patient care.
10 11
ALAMANCE REGIONAL MEDICAL CENTER ALAMANCE REGIONAL MEDICAL CENTER
Burlington Campus NursesShared Governance is a familiar practice for nursing at
the Burlington campus, in place since 1991. There are four
organization-wide Shared Governance councils that have
interdisciplinary membership. Department-based councils
are staff driven with leaders functioning only as facilitators.
Each department council determines its own structure
for membership and addresses practice issues related to
that department. The entire Shared Governance structure
underwent revitalization in 2011 to increase participation and
revise bylaws.
Education and community involvementEducation is a value in nursing at the Burlington campus. The
organization supports clinical experiences for a number of
schools of nursing in the area:
• University of North Carolina at Chapel Hill.
• Duke University.
• UNC Greensboro.
• Winston-Salem State University.
• Alamance Community College.
• Rockingham Community College.
There is financial support for tuition assistance for RN to BSN
and BSN to MSN formal education. A Winston-Salem State Uni-
versity RN to BSN cohort group is scheduled to begin classes
on campus in January. The Nettie Harmon Foundation focuses
on funding for continuing education for direct-care nurses,
including reimbursement for certification fees and review
classes. This fund was started by a physician who was inspired
by the effect that educated nurses had on patient outcomes in
his practice. Since its inception many donors have contributed,
and in May 2013, 26 nurses were awarded with funds totaling
$8,000.
Nurses in the organization are integrally involved in community
outreach. RNs give free obstetrical classes, provide education
for all hip and knee replacement prior to surgery, participate
in the March of Dimes and Relay for Life fund-raisers, and hold
reunions for special care nursery graduates, to name a few.
Nurses even organized a voluntary sitting schedule to take
shifts sitting with a dying patient.
Continued on page 12
We Welcome
What Alamance Regional nurses say about their nursing:
- Wonderful teamwork- Caring people- So organized!
- A lot of help everywhere- Nursing staff is really involved with patient care
- I have the best manager!- Great environment and staff
- I like the small community hospital, repeat patients that you know.
- Hometown atmosphere
The Guardian Angel program is a way for patients to honor staff. Patients nominate staff and make a donation. Donations are used to support employees in need. An example of this was when the fund was used to purchase medications for an employee who faced prolonged absence because of illness. Staff members who have been nominated wear a guardian angel pin.
TThe nurses from the Greensboro campus recently wel-
comed the nursing staff of the Burlington campus to the
Cone Health family. A member of the Nursing Beat edito-
rial staff spent an afternoon at Alamance Regional Medical
Center, now called the “Burlington Campus,” talking with
nursing department directors, touring the facility and speak-
ing with nurses.
Before it was fashionableIn the middle 1990s Alamance Regional nurses were quietly
developing nursing best practices that would later be rec-
ognized as progressive initiatives in the nursing profession.
The hospital’s history started in 1985 with the fusion of two
hospitals that had served the region. In 1995, a new hospital
building was constructed. The union of two facilities under
one roof marked the beginnings of sophisticated nursing
practice in this 238-bed community hospital. In order to
effectively merge the two nursing staffs, nurses and nursing
leaders developed the first nursing philosophy for the orga-
nization. They also initiated a shared management structure,
standardized their plans of care based on evidence through
a system called Knowledge Based Care, began using
electronic medical records and introduced interdisciplinary
Shared Governance councils.
One example of how these nurses developed programs that
were ahead of their time is the program for orienting new
graduates that started in 1991. This program began when
nursing leaders in the organization wanted to help more
effectively transition new nurses into practice. The program
was designed with preceptors, support groups, classroom
instruction and methods to confidentially discuss issues. The
program was set up to last a year. At the beginning of the
program a nurse would spend 12 weeks in clinical rotation
before going to the home unit for which she was hired. In-
tensive Care Unit nurses spent time in a residency program.
The hospital added 27 new graduate nurses to the program
in July 2013. The program is continuously evaluated and
elements added. The results? Of the new nurses who have
been hired between July 31, 1988, and July 31, 2011, 47 per-
cent still work for the Burlington campus. Retention rate for
the program participants between July 2012 and July 2013 is
84 percent.