annual nursing report 2013

ANNUAL NURSING REPORT 2013
Table of Contents
Letter from the CNO1
Demographic Information2
Our Nursing Philosophy3
Transformational Leadership4
2014-2016 Nursing Strategic Plan
2009-2012 Strategic Goals and Accomplishments
Leadership-Advocated Resources
CNO’s role in Big Sky Medical Center Development
“Chats with the Chief”: Summary and Description
Structural Empowerment11
Shared Decision Making
Professional Development
Clinical Advancement Ladder
Mentorship Program
Nurse Residency Program and Preceptor Workshop
Community Outreach
Exemplary Professional Practice19
Professional Nursing Defined
Interdisciplinary Collaboration to Improve Patient Outcomes
Improving Care Delivery and Patient Satisfaction
Providing Family Centered Care
New Knowledge, Innovation and Improvement24
Quality Management
National Safety Summit
Nurse-Led Research
Innovative Strategies
Awards and Recognition27
CNOR-Strong Designation
National Certifications in 2013
Daisy Awards
Accolades
Organization Awards
Summation32
mbers,
ts, families, and community me
Dear nursing colleagues, patien
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n making. Thank you to
opportunities for shared decisio
team. May you celebrate
each member of our nursing
as you review this report.
our nursing accomplishments
MBA
Vickie Groeneweg, MSN, RN,
Chief Nursing Officer
1
Demographic Information
Bozeman Deaconess Hospital is a Joint Commission certified, licensed Level III trauma center located
in Gallatin County. The 86-bed facility serves southwest Montana, including Gallatin, Madison and
Park counties. Bozeman Deaconess Health Group is a multi-specialty group providing patients access
to a variety of primary care and specialty physicians and healthcare professionals. Together we make
up Bozeman Deaconess Health Services, where our caring staff ensures that care is integrated and
specialized to meet the evolving needs of our community.
Bozeman Deaconess Health Services has 1560 employees. Registered Nurses (RNs) comprise 27% of
employees at our organization.
Direct Care Positions:
277 RNs in our Hospital
84 RNs in our Health Group
Indirect Care Positions:
57 RNs in our Health Services
418 RNs total at our organization
Licensed Practical Nurses
Direct Care Positions:
12 in our Health Group
2 in our Hospital
14 LPNs total in the organization
Advanced Practice Registered Nurses
Direct Care Positions:
2 in our outpatient procedural areas
11 in our Health Group
13 APRNs total at Bozeman Deaconess Health Services
Direct Care RN Demographics
Age and Experience Mean unit RN age is 42 years
23% with five or fewer years’ practice experience
54% with greater than ten years’ practice experience
Educational Preparation 5% report Masters or Doctorate education level
68% report Baccalaureate education level
25% report Associate education level
2% report Diploma education level
99% report receiving education in the U.S.
Employment Status 58% full time
33% part time
9% casual call
2
Our Nursing Philosophy
At Bozeman Deaconess Health Services, we are committed to a Culture of Excellence. Additionally,
Deaconess Hospital
::
Hillcrest
Living mission,
:: vision, and
Bozeman
Deaconess
Group
weBozeman
are committed
to Bozeman Deaconess
HealthSenior
Services’
values
in anHealth
effort
to
meet our goal to be an organization of excellence that challenges all of us to be the best that we can
be. We believe nursing at Bozeman Deaconess Health Services is an essential profession, promoting
commitment to a Culture of Excellence.
Mission. To improve community health and quality of life.
Vision.
Our Values:
What we believe.
To be a leading integrated health system, ranked in
the top 10% in the nation by 2016.
S
Service: We believe service excellence is critical to our mission
P
People: We believe people are our most important resource
I
Integrity: We believe relationships are built on honesty and trust
R
Respect: We believe each person is unique and worthy of respect
I
Improvement: We believe continuous improvement of quality and safety is key to our success
T
Teamwork: We believe teamwork and communication are essential in achieving excellence
3
Transformational Leadership
2014-2016 Nursing Strategic Plan
This plan provides our entire division with an inspirational guide for achieving our ultimate goal of
nursing and patient care excellence. Our strategic planning process involves all levels of nurses from
the direct care RN all the way to the CNO.
Magnet
Component
Transformational
Leadership
GOAL
Develop strong
risk-taking leaders
who model and
articulate nursing
excellence in dayto-day operations
Strategy
•
•
•
•
•
•
•
•
•
Structural
Empowerment
Create a structural
framework for
the development,
implementation
and sustainability
of patient care
excellence
•
•
•
•
•
•
•
•
All Nurse Managers with National Certification
Establish Nursing Manager Core Competencies
based on ANA’s Scope and Standards for Nurse
Administrators
All Nursing Leaders involved in National Professional
Organizations
Establish Tuition Reimbursement program
Develop and implement Nursing Leader Academy
All Nursing Leaders will have a succession plan
CNO will participate in credentialing of all APRNs
ANA’s Scope and Standards of Nurse Administrators
implemented as basis for job description and
evaluation
CNO has relationship shown both structural and
operational in all areas in which nursing is practiced
Date
2015
2014 – 3rd Quarter
2015
2014 – 4th Quarter
Develop 2014
Implement 2015
2014 - 3rd Quarter
2014 – 3rd Quarter
2014 – 3rd Quarter
2014 – 4th Quarter
Establish RN-Physician Council to develop and sustain 2014 – 4th Quarter
patient care collaboration
Establish Patient-RN Council to improve the delivery of 2015
patient care
75% of RNs participating in professional organizations 2014: 25%; 2015:
50%; 2016: 75%
Establish and sustain BSN level education at >80% for 2014: Establish;
all direct care RNs
2015/16: Sustain
Develop and implement required ANCC Policies
2014 – 3rd Quarter
Establish participation by APRNs in Shared Governance 2014 – 4th Quarter
Implementation of self evaluation and peer evaluation 2014 – 4th Quarter
into staff annual performance evaluation
Establish Nurse Manager Leadership at the MSN
2020
educational level
4
Transformational Leadership
Exemplary
Professional
Practice
Attract, develop
and retain
competent,
compassionate
nursing
professionals
committed to
excellence in
nursing practice
•
•
•
•
•
Increase RN Certifications to 50%
Extend Certification pay to RNs in BDHG
RN Satisfaction Scores in 75th percentile as measured
by NDNQI
Develop and implement clinical continuing education
plan
Develop and implement Nursing Professional Ethics
Council
2016
2015
2014 – 4th Quarter
2015
2014
2014: 1 project
2015: 2 projects
2016: 2 projects
2015
New Knowledge, Create an
Innovation and
environment
Improvement
conducive to the
improvement
of nursing
practice through
knowledge and
innovation.
•
•
•
•
Develop and implement Nursing Grand Rounds
Establish Journal Club
Develop and implement BDHS IRB
Support RN Lead research projects yearly
•
Develop and implement Nursing Research Residency
Program
Empirical
Outcomes
•
Achieve top 10th percentile in all Nurse Sensitive
Indicators as measured by NDNQI
Achieve top 75% for all HCAHPs components by 2016
Achieve 5 of 8 consecutive quarters of required data
above national benchmark
Formalize Community impact plan for BDHS Nurses
Create a culture
of superior clinical
performance
•
•
•
Professional Advisory Council
5
2016
2014 – 4th Quarter
2014 – 4th Quarter
2016
2015
2015 – 1st Quarter
2014 – 4th Quarter
Transformational Leadership
2009-2012 Strategic Goals and Accomplishments
Our strategic goals and accomplishments are a direct result of all levels of nurses working together
and collaborating with other disciplines to improve patient care and drive excellence.
GOAL
1. Create a structural
framework for the
development of patient
care excellence
2. Develop strong, risktaking leaders who
model and articulate
nursing excellence in
day-to-day operations
Strategy
1. Develop a Magnet Steering Committee
Date
Completion
2009
1/2009
2. Establish Magnet Leadership Councils:
2009
Leadership, Quality, Recruitment and Retention,
Professional Growth and Development, Research
3/2009
3. Develop a Professional Model of Nursing
Practice
2009
5/2009
4. Develop Mission, Vision, Values for Patient
Services
2009
5/2009
5. Develop organizational chart for Patient Services
2009
12/2009
6. Conduct Gap Assessment for Patient Care
Services
2009
12/2009
7. Formulate a 3-year Strategic Plan for Patient
Services
2009
9/2009
8. Develop Nursing Dashboard with Clinical and
Operational Metrics
2009
12/2009
9. Develop and implement Shared Governance
2010
6/2010
10.Form collaborative partnership with local
bargaining unit for Magnet Project
2009-2011
6/2010
11.Develop Patient Services communication plan
2010
In progress
12.Reorganization of Nursing and Patient Care
Services reporting to CEO
2011
2012
1. Provide access to a national periodical database
for utilization to implement evidence-based
practice
2009
2009: CINAHL
2011: Added
Nurse Reference
Center
2. Implement formal nurse leader continuing
education, i.e. Nurse Managers Academy
2012
CARRY OVER
3. Establish nursing manager core competencies
based on ANA Standards for Nursing
Administrators
2012
CARRY OVER
4. Implement staffing ratios benchmarked to the
NDNQI survey findings
2010: 10th
Percentile
2011: 25th
Percentile
2013: 50th
Percentile
12/2010:
Assessed with
return of NDNQI
data
5. Develop Competency based evaluation process
2010
11/10/2010
6
Transformational Leadership
3. Create a culture
of superior clinical
performance
6. Nursing Leaders to NDNQI and Magnet national 2010-2011conferences
2012
2010: 5 Nurse
Managers +
CNO
7. Develop Clinical Ladder
2012
2011
8. Nursing Leaders involved in national professional 2012
organizations (100%)
CARRY OVER
9. Develop Succession Plan
2012
In progress
10.Collaborate with MSU for online Nursing
education (advanced degrees)
2012
CARRY OVER
11.Develop tuition reimbursement program for
patient care leaders
2014
CARRY OVER
12.Require/encourage patient care leaders
educational advancement; MSN required of
nursing managers
2015
CARRY OVER
1. Engage in the National Database of Nurse
Quality Indicators
2009
9/2009
2. Establish nursing research partnership between
BDH Patient Services and MSU School of
Nursing
2009-2010
8/2009
3. Evaluate and change nursing processes
according to evidence-based practice
2010-20112012
In Progress
4. Establish a Nursing Peer Review committee
2009
9/2009
5. Maintain real-time Joint Commission readiness
2009-20102011-2012
In progress
6. Identify and initiate unit-based quality projects
which result in change of practice
2009-20102011-2012
10/2010: CQI
Training of UBC
Chairs, projects
initiated
7. Identify, display and communicate quality
metrics to department and staff
2011
In progress
8. Implement NUR, eMAR and Bedside Medication
Verification
2009
3/2009 and
8/2009
9. Provide access to a national periodical database
for implementation of EBP
2009
9/2009
10.Identify and develop clinical centers of
excellence—Pain, Ortho, Cardiac and Stroke
2011-20122013
CARRY OVER
11.Establish unit-based practice and quality councils 2010
in all patient care areas
6/2010
12.Score > 90% in all Nurse Sensitive Indicators
2010-20112012 ongoing
In progress
13.Develop Medical Library
2013
2013
7
Transformational Leadership
4. Create a relationship
driven, patient- and
family-focused
organization with
emphasis on an
excellent patient
experience
1. Score >90% in the HCAHPs Inpatient Patient
Satisfaction Survey (all domains)
2010: 75%
2011: 90%
2. Evaluate patient care areas to determine
environmental improvements needed
to enhance patient and family centered,
relationship-based care
2010
In progress
11/2010
3. Develop and implement plan to improve patient 2010-2011care environment to enhance patient and family 2012
centered care
5. Attract, develop, engage 1. Define Professional Nurse at Bozeman
and retain competent,
Deaconess Health Services
compassionate nursing
2. Develop/foster physician/nurse partnerships
professionals
(Based on 2009 Physician Survey)
6. Utilize technology
for nursing care
delivery to streamline
processes, improve
communication,
handoffs and discharge
and engage in patient
care
Q1-3 2010: 74%
2009
10/2009
2010-20112012
Ongoing
3. Investigate/research recruitment/retention best
practices
2010
In progress
4. Develop and implement formalized reward and
recognition plan for nursing
2010-2011
6/2012
5. Develop recruitment/retention plan
2011
In progress
6. Implement Clinical Ladder
2012
2012
7. Support and encourage RN certification in area
of practice
2012
Ongoing
8. Transform nursing practice from task orientation
to professional nursing practice
2010-20112012
Ongoing
9. Implement unit-based self-scheduling
2012
CARRY OVER
10.Develop competency based orientation and
evaluations
2012
CARRY OVER
11.Enhance and formalize on-site continuing
education
2011-2012
11/2010
12.Introduce mandatory continuing education
requirements
2011
2011
13.Establish tuition reimbursement program
2014
10/2010:
Montana BON
1. Implement electronic nursing documentation
2009
1/2009
2. Implement eMAR and Bedside Medication
Verification
2009
3/2009
3. Replace Nurse Call Light System
2012
2012
4. Implement software to optimize gathering of
nursing operational metrics
2013-14
CARRY OVER
8
Transformational Leadership
7. Utilize technology for
nursing care delivery to
streamline processes,
improve communication, handoffs and
discharge and engage
in patient care
1. Reduce Serious Safety Events by 80%
1. 2010-2011
1. In progress
2. Implement STAR program
2. 2010
2. 10/2010
3. Implement SBAR communication tool
3. 2010
3. 10/2010
4. Improve reporting on “Near Miss” safety events
4. 20102011-2012
4. In progress
5. Improve processes identified in “Near Miss”
reporting
5. Ongoing
5. In progress
Leadership-Advocated Resources
Recognizing better ways to provide care and comfort to patients and advocating for those resources
is part of nursing at Bozeman Deaconess. To that end, our Chief Nursing Officer and Nursing Managers successfully advocated for $1.7 million in 2013 to purchase new hospital beds for all rooms, and
to replace the existing call-light system, which integrates call lights, alarms, room-to-room communications and an employee tracking system with central monitoring. These equipment purchases represent a great investment in patient safety and satisfaction, and staff satisfaction.
9
Transformational Leadership
CNO’s Role in Big Sky Medical Center Development
Vickie Groeneweg, MSN, RN, MBA
Chief Nursing Officer
Our Chief Nursing Officer not only influences organization-wide
change surrounding nursing practice, she also influences change
beyond the scope of nursing. Vickie Groeneweg, MSN, RN, MBA, has
been involved in the strategic planning of the new medical facility
being built in Big Sky.
Our Chief Nursing Officer:
1. Participated with senior leadership in strategic planning for advancing into the Big Sky market.
2. Reviewed and conferred with senior leadership on FTE’s to staff Big Sky Medical Center.
3. Participated with senior leadership and
the architectural firm to design the
Medical Center.
4. Provided direct input into the design
and furnishing of the Emergency Department and patient rooms.
5. Provided oversight of the clinical function of the Medical Center for inpatient and ambulatory care.
For more information on Big Sky Medical
Center visit: bigskymedicalcenter.com.
Big Sky Medical Center
Chats with the Chief: Summary and Description
Chats with the Chief have provided a forum for the Chief Nursing Officer to directly communicate
important nursing issues to members of the Department of Nursing. For each Chat, twelve one-hour
sessions provide opportunity for all nursing staff to attend. In 2013, three Chats were held.
January, 2013
“Direction of Nursing in 2013” was the theme with 112 nursing professionals
attending.
May, 2013
“What ‘Piece’ Will You Be in Our Journey to Excellence” focused on the
meaning of excellence and how it is measured. There were 105 nursing
professionals attending.
October, 2013
“Professional Nursing: Florence, If You Could See Us Now” focused on
nursing as a profession and the responsibility nurses have as
professionals. 128 members of the Department of Nursing attended.
10
Structural Empowerment
Shared Decision Making
We believe all levels of nurses—chief
nursing officer, managers, and direct care staff—hold the authority,
accountability, and professional
responsibility to govern their practice. That is why we created the
first Shared Governance structure
in 2008, and have continued
to function very well within
our Shared Governance model
throughout 2013.
The structure we’ve built incorporates a network of eight Leadership Councils and nine Unit Based
Councils that facilitate the nurses’
ability to govern nursing practice at
Bozeman Deaconess Health Services.
Our Shared Governance structure was
formalized by adopting organization-tailored
by-laws. Currently, our Councils are functioning
under our by-laws to effectively promote autonomous practice governance.
Our Shared Governance structure has inspired Nutrition Services, Respiratory Services, and Pharmacy
Services to develop shared-decision-making councils of their own.
Leadership Council
Accomplishments
Evidence-Based Practice
Chair: Lynnora Jetter, RN, CEN
Initiated Critical Thinking project
Policies and Procedures:
Reviewing outdated policies
Ensuring EBP is included
Switching to Lippincott Online
Leading Nurses in EBP
Updated Care Plans to meet state requirements
Research
Chair: Sandi Burgard, MSN, RN
Offered Guided Discovery Workshop series
Mentored nurse-led research
Developed and proposed Institutional Review Board (IRB) policy at BDHS
11
Structural Empowerment
Nurse Informatics
Chair: Amanda Dewit, BSN, RN
Designed layout of Nursing webpage for BDHS website
Created Nursing Informatics SharePoint tab
Mentored Colleagues in use of Excel to compile data and create graphs
Offered education courses on the use of Excel
Conducted Nursing Informatics Learning Needs Assessment
Assisting with adoption of a new electronic health record (EPIC)
Professional Growth and
Development
Chair: Heather Egstad, BSN, RN
Modified Clinical Advancement Ladder 2013 criteria to meet nursing needs
Introduced Clinical Advancement Ladder to Health Group RNs
Developing Nurse Residency Program
Recruitment and Retention
Chair: Christine Benbow, BSN, RN
Coordinated three Daisy Awards to recognize exceptional nurses
Hosted founders of the National Daisy Award
Ensured high participation rates in the NDNQI RN Satisfaction Survey
Created reward baskets and delivered to departments with 100% participation in NDNQI RN Satisfaction Survey
Models of Care
Chair: Carrie Waddell, BSN, RN
Offered continuing education on Professional Practice Model
Sent RNs to RBC Leadership Conference
Redesigning the PPM and CDS
Nursing Peer Review
Chair: Kaylee Davies, BSN, RN, ONC
Reviewed multiple cases to determine if standard of care was breeched
Created plan to reduce nurse anxiety and fear with council appearances
Determined changes to practice that improve patient care
Quality and Safety
Chair: Barb Johnson, RN, BSN
Received education to become Performance Improvement Mentors for colleagues
Initiating plans for incorporating Safe Patient Handling and Mobility standards
Unit Based Council
Accomplishments
Bozeman Deaconess Health Group
Chair: Amber Dubay, BSN, RN
Created Community Resource phone list for the organization
Developed medication titration process and charting procedure
Incorporated hypertension worksheets throughout practices
Initiated “Nurses Prevent Failure” Performance Improvement Project
Wound Clinic
Chair: Crystal Marx, BSN, RNC, CWCA
Designed daily Safety Huddle morning practice
Initiated Performance Improvement project on Provider Wait Time
Initiated Hemoglobin A1C Performance Improvement project
Working with other units on reducing hospital acquired pressure ulcers
Hosted Bozeman Wound Conference
12
Structural Empowerment
Surgical Floor
Chair: Amanda Tempero, BSN, RN, ONC
Initiated Quiet Please Performance Improvement project
Organized Aide and Unit Clerk Appreciation Celebration
Initiated Bedside Reporting framework
Worked with ER to improve patient admission process
Initiated Performance Improvement Project on decreasing noise
Developed Mentor Program for new graduates
Medical Floor
Chair: Rye Cech, BSN, RNC
Instituted Bedside Reporting
Initiated Unit acuity system to help with patient assignments
Improving Direct Admittance process
Creating hallway bulletin board
Initiated Performance Improvement on starting IV antibiotics
Started Safety Huddle practice in the mornings
Used team building strategies: celebrations, Facebook page, softball team
Surgical Services
Chair: Michelle Elder, RN
Implemented Handoff throughout Surgical Services using a standardized
green sheet
Initiates better staff communication throughout surgical services
Emergency Department
Chair: Jason Buchovecky, BSN, RN
Improving department communication: UBC bulletin board, emails, posting
meeting minutes, direct people to SharePoint
Initiated Performance Improvement Projects: hand washing, allergy banding,
specimen labeling
Developed department Vision Statement
Planned Emergency Nurses Week Celebration
Coordinated Certification Review course at BDHS
Improving ED throughput, collaborating with other units
Endoscopy
Chair: Stacey Rugheimer, MSN, RN
Initiated Teambuilding project
Improving communication between GI clinic and Endoscopy to reduce errors
Intensive Care Unit
Chair: Susie Frederickson, BSN, RN
Implemented Infection control project on C.Diff
Improving communication between UBC and staff through “Buddy System”
Initiated Performance Improvement project on reducing noise at night
Monitored Sedation Vacation documentation and practice
Initiated bedside reporting
Assisted with Sepsis SIM
Family Birth Center
Chair: Heidi Godwin, BSN, RN
Instituted Bedside Reporting
Initiated Performance Improvement project on patient satisfaction: courtesy
and respect
Reducing patient interruptions project
Initiated project on improving patient satisfaction: cleanliness of room
13
Structural Empowerment
Professional Development
The Education Department is an approved provider for continuing education through the Montana
Nurses Association and the American Nurses Association. To provide multiple opportunities for professional development, the Education Department and educators planned for, coordinated and/or
presented multiple continuing nursing education offerings in 2013.
Total Number of RN
Participants for the Year
Total Number of Contact
Hours Offered per Activity
PAIN RESOURCE UPDATE
27
4.00
EVIDENCE-BASED PRACTICE
37
2.25
ACLS NEW PROVIDER
4
10.42
RELATIONSHIP-BASED CARE
16
11.75
ACLS NEW PROVIDER
4
10.42
PEARS PROVIDER
6
6.33
PALS NEW PROVIDER
6
13.92
CHEMOTHERAPY/BIOTHERAPY
9
6.75
PROGRESSIVE CARE UNIT
12
6.75
ACLS NEW PROVIDER
6
10.42
FETAL & INFANT LOSS
6
2.00
ACLS NEW PROVIDER
7
10.42
PEARS PROVIDER
9
6.33
PALS NEW PROVIDER
6
13.92
RELATIONSHIP-BASED CARE
16
11.75
ACLS NEW PROVIDER
5
10.42
CINAHL
7
1.00
PRECEPTOR WORKSHOP
12
4.25
ACLS NEW PROVIDER
4
10.42
PALS NEW PROVIDER
3
13.92
ACLS NEW PROVIDER
7
10.42
PRECEPTOR WORKSHOP
18
4.25
STABLE
16
7.25
PALS NEW PROVIDER
9
13.92
CHEMOTHERAPY/BIOTHERAPY
6
5.75
ACLS NEW PROVIDER
5
10.42
ACLS NEW PROVIDER
10
10.42
SEPSIS WORKSHOP
18
2.10
CAN'T BREATHE, CAN'T FUNCTION
0
0.00
PEARS PROVIDER
8
6.33
SEPSIS WORKSHOP
27
2.10
PROGRESSIVE CARE UNIT
12
6.75
WOUND CARE CONFERENCE
44
6.25
ACLS NEW PROVIDER
8
10.42
PAIN RESOURCE UPDATE
20
4.50
SURGICAL CARE CONFERENCE
37
6.25
Total Number of Offerings
Total RN Participants
Total Contact Hours Offered
36
447
274.57
Activity Title
14
Structural Empowerment
Clinical Advancement Ladder
The Clinical Advancement Ladder was designed,
implemented and is maintained by the Professional Growth and Development Council, which
is comprised of direct-care nurses, educators,
and managers. It was created by nurses for
nurses, to promote growth and advance professional nursing practice.
In 2013, the Division of Nursing recognized 22
Registered Nurses in the completion of a portfolio to achieve Clinical Nurse I or II.
In 2014, we have 81 nurses intending to complete a portfolio submission and achieve recognition on the Ladder. That’s 22% of our Registered
Nurses striving to grow and develop professionally to advance nursing practice, which will ultimately result in the improvement of patient care.
CONGRATULATIONS 2013 CLINICAL
ADVANCEMENT LADDER NURSES!
Clinical Nurse I: Michelle Elder; Lynnora Jetter;
Audrey Higley; Stacey Rugheimer; Lynn Gray;
Shannon Gaines; Annemarie Bodner; Theresa
Hollowell; Lisa Riggin; Stewart Chumbley; Melissa Harrigan; Becky Pierce
Clinical Nurse II: Jamie Swandal; Lauren Vinson;
Allison Armitage; Heidi Godwin; Katy Osterloth;
Kimberly Todd; Rye Cech; Kaylee Davies; Cortney Harrison; Crystal Marx
Clinical Nurse I Exemplar:
Becky Pierce, BSN, RN, a direct-care nurse on
the Medical Unit, completed and submitted a
portfolio to achieve Clinical Nurse I recognition. Becky has been practicing for more than
20 years as a Registered Nurse and has been at
Bozeman Deaconess Health Services for 12 of
those years. To achieve recognition on the Ladder, Becky assisted the Gallatin County Health
Dept. with an annual vision screening at a local
elementary school. She stated that “volunteering
to assist with the school’s vision screening engages me to be involved in the school and part
of the community.” Beyond community service,
Becky precepted newly graduated nurses, participated as a member of the Recruitment and
Retention Council, was a team leader on the
Medical Unit, served as a wingman to her colleagues, and became certified in the protection
of human subjects in
research studies.
We’re proud to have
Becky practice at this
organization and
commend her efforts
to advance professional nursing practice and improve
patient care delivery.
Becky Pierce BSN, RN
Medical Floor
The Clinical Advancement Ladder is a structure
that “supports a lifelong learning culture that
includes professional collaboration and the promotion
of role development, academic achievement, and
career advancement (ANCC, 2013).”
The Clinical Advancement Ladder is a guide that helps nurses formally “support organization
goals, advance the nursing profession and enhance professional development (ANCC, 2013).”
—The Commission on Magnet Recognition, (2013). 2014 Magnet Application Manual. Silver Spring, MD:
American Nurses Credentialing Center.
15
Structural Empowerment
Clinical Nurse II Exemplar:
also was proud that she “achieved a personal goal
of getting a grant proposal funded” to keep this
conference affordable.
Heidi Godwin, BSN, RN, CLC, a direct-care nurse
in the Family Birth Center, completed and submitted a portfolio to achieve Clinical Nurse II recognition. Heidi has been a practicing Registered Nurse
for nearly five years, all at Bozeman Deaconess
Health Services. Heidi exemplifies the Clinical
Nurse II. She volunteered 60 hours of community service to the Rocky Mountain Childbirth
Conference, a non-profit dedicated to delivering
an annual low cost, high-quality conference on
childbirth-related issues for nurses in Montana.
Through this experience, Heidi stated that she has
become “...inspired to be a leader. This experience has brought many positive attributes to my
career, from simple things like effectively running
a meeting, to borrowing ideas on how to effectively enhance teamwork, to utilizing an interconnected pool of experts to design research.” She
We’re very proud of the initiative Heidi took and
the leadership she demonstrated through this
service. Heidi also precepted new nurses, chaired
her Unit Based Council, became certified in the
protection of human subjects in research, worked
as a Certified Lactation Consultant, completed 65
continuing education credits and was a member
of the Association of Women’s Health, Obstetrics,
and Neonatal Nurses. Because of Heidi, nurses
around the state have access to education regarding evidence-based maternal-newborn care and
practices. She is improving maternal-newborn
care beyond the Gallatin Valley, which will improve the health and quality of life for many
generations.
Mentorship Program
The Surgical Unit Based Council at Bozeman
Deaconess Hospital implemented a mentoring
program for nurses in June 2013, which continues
offering collegial assistance to new nurses once
they have completed their 10-week orientation. In
the program’s first six months, nine pairs of mentors/mentees were initiated. In most cases, the
mentored nurse requested that their preceptor
continue as their mentor.
Mentors and mentees, who are required to meet
at least once every six weeks, together decide
how often and when they meet. Several pairs
meet monthly for breakfast to discuss questions
and issues that have occurred, while others schedule competency testing at the same time so they
can meet afterwards. Mentors are always just a
text or phone call away, as well.
The program is geared to helping recently hired
nurses become better caregivers. The goals are
to increase their confidence in their skills, which
helps increase job satisfaction, length of tenure
and willingness to pick up extra shifts. Having a
specific person of whom they can ask questions
reduces the likelihood of errors and improves
overall patient safety. The Unit Based Council will
evaluate the program in mid-2014, and make
changes with input from the current participants.
The program is expected to be expanded to other
nursing departments in the near future.
The mentors are available to answer questions
about clinical aspects of the job, hospital policies
and more, or when the new nurse simply needs
to express concerns or frustrations. The informality of the program, requiring minimal paperwork,
provides a simplified way for the new nurses to
ask questions and feel connected, vastly increasing their sense of comfort and confidence while
also giving the mentor a chance to perform a
“purposeful check-in” in person.
16
Structural Empowerment
Mentor/Mentee Exemplar:
discussions. Their conversations often cover the
emotional side of nursing, such as dealing with
difficult patients whether from behavior issues or
a bad diagnosis. The two plan to continue meeting after the formal program ends.
Hailey Young, BSN, RN, says there can be a lot of
adjustment anxiety as a newly graduated nurse,
so it’s important to have a colleague you can
speak with comfortably about professional issues. Young, who has worked at BDH for a year,
was delighted to be able to participate in the
Surgical Unit’s mentorship program, with her
preceptor Megan Litle, BSN, RN, continuing as
Young’s mentor. The relationship provides Young
an opportunity to discuss difficult situations, get
work-related questions answered, or simply voice
frustrations to a colleague without discomfort,
and gives Litle the same opportunities in return.
Young and Litle recommend the program for all
new nurses, pointing to the success of their own
connection. Having started work in a large group
of new graduates, Young said the mentorship
program also made them a better team because it
required the new nurses to branch out and build
relationships with other nurses.
Litle and Young say their similarities have led to a
friendship based on trust. “It was nice that I could
choose my own mentor,” Young said. “It doesn’t
take a lot of effort.” That, said Litle, “means it was
a good match.”
Working the night shift together, they can touch
base on the job when the need arises, and go out
for coffee about once a month for more in-depth
Nurse Residency Program and Preceptor Workshop
The Institute of Medicine (IOM) collaborated
with the Robert Wood Johnson Foundation
(RWJF) to create a Report on the Future of Nursing. This report contained a number of recommendations, including one regarding health care
organizations’ need to support nurses’ completion of a transition-to-practice program.
selves and the nurse
being precepted.
Additionally, to help
new nurses safely
and successfully transition to independent practice, the
Sandi Burgard, MSN, RN
Professional Growth
Education
and Development
Council collaborated with Sandi to establish our
first-ever Nurse Residency Program. The Nurse
Residency Program was designed in 2013 and is
being implemented in 2014 to include monthly
interactive educational activities for new graduate nurses throughout the organization.
The Education Department manager, Sandi
Burgard, MSN, RN, and the clinical nurse educators developed a Preceptor Workshop and
hosted two sessions in June and August. The
Preceptor Workshop provides strategies for
being an effective preceptor to nurses throughout the organization. Educating and equipping
preceptors with invaluable tools helps meet the
recommendation made by the IOM and RWJF
to successfully transition new nurses into the
workforce. Thirty participants gained an understanding of the skills needed to be an effective
preceptor and learned practice strategies to improve the precepting experience for both them-
The Nurse Residency Program and the Preceptor Workshop together will significantly impact
the quality and safety of patient care delivery
through the effective transition of new nurses
into actual clinical practice.
17
Structural Empowerment
Community Outreach
Community Care Connect (CCC), a mobile
outreach program, is a partnership among Bozeman Deaconess Health Services, Gallatin CityCounty Health Department, Gallatin County
Food Bank, Community Health Partners and the
local Human Resource Development Council.
This mobile outreach is offered via a bus that
has been remodeled to provide on-site health
screenings, immunizations and information. On
June 25, 2013, the CCC vehicle was featured
in the Bozeman Daily Chronicle because of the
program’s significant efforts to connect the
community to much needed health screenings
and other services.
CCC coordinator and registrar from Bozeman
Deaconess Health Services. The staff provides
free health screenings such as breast exams,
blood pressure checks and body-mass indexing,
blood draws for glucose levels, cholesterol, complete blood count and comprehensive metabolic
panel, as well as medication counseling and
providing referrals to low-cost and free clinics if
more medical care is indicated.
Our nurses also provide many of the same
screenings and services at the Health Screening
days held annually in Bozeman and Big Sky, at
several community trade fairs each year including Babes in Bozeman and the Women’s Expo,
and provide medical care at community athletic
events such as the annual “3-on-3” three-day
street basketball tournament.
Health screenings are provided through CCC
free of charge to all, particularly the uninsured or
underinsured population in our tri-county area. It
travels hundreds of miles to rural towns like West
Yellowstone, Manhattan, Belgrade and Three
Forks, as well as offering services in the Bozeman
community. Members of the healthcare team
staffing the vehicle include phlebotomists, nurse
practitioners, pharmacists, registered nurses,
Our nurses are dedicated to positively impacting
the health of the community and have
demonstrated that by offering their services
through community outreach. Nurses who
worked at Bozeman Deaconess-sponsored
events in 2013 include: Loretta Bendz, Amy
Braaksma, Nicky Buck, Kristen Cotton, Judy
Douglas, Allison Duffy, Tara Faris, Lynda Gullett,
Melissa Harrigan, BreAnn Hebel, Shandi Hertz,
Audrey Higley, Theresa Hollowell, Jocelin
Jenkins, Shannon Lester, Marjorie Martin,
Crystal Marx, Kathryn Nass, Joni Oswald,
Rebekah Pierce, Hannah Pulaski, Tracy Reamy,
Lisa Riggin, Cathy Rogers, Amanda Salzer, Janet
Smith, Lisa Sorensen, Judy Sorg, Lisbeth Stump,
Jaimie Swandal, Lindsey Taylor, Kimberly Todd,
Nita Wade.
18
Exemplary Professional Practice
Professional Nursing Defined
Definition of Professional Nursing
Using multiple caring theories from Jean
Watson, Kristen Swanson, Madeline Leiniger,
and Sharon Dingman, we believe there can be
no curing without caring. Establishing caring,
therapeutic relationships with the patient and
family, with our colleagues, and with ourselves
will fully allow us as nurses to provide a healing environment and deliver excellent patient
care (Koloroutis, 2004).
Professional nursing at Bozeman Deaconess
Health Services is practiced through patientcentered caring relationships, utilizing clinical
judgment and advocacy in the care of individuals, families, communities and populations, to
promote, improve, maintain, or recover health;
to cope with health problems; and to achieve
the best possible quality of life, whatever the
disease or disability, from the beginning of life
all the way through a dignified death.
Evaluating the Models of Care
The Models of Care Council, comprised of
direct-care nurses, managers, and educators
from various departments, are evaluating and
modifying the existing Professional Practice
Model to establish a new and improved model
that best fits nursing at Bozeman Deaconess.
This model will serve to provide the Division
of Nursing with a common identity and guidance on practicing as professional nurses.
Theoretical Beliefs
Patient and Family Centered Care is built
upon the belief that care should be designed
to meet the unique needs of each individual
patient and family. The care provider conveys
an unwavering respect and personal concern
for the patient, strives to understand what is
most important to each patient and family,
safeguards their dignity and well-being, and
actively engages them in all aspects of care.
Interdisciplinary Collaboration to Improve Patient Outcomes
Collaboration between professions and disciplines directly correlates to better, safer patient
care. To ensure our staff is equipped with the
tools they need to collaborate effectively, we’ve
been careful to include all disciplines when running simulations.
Simulation I
Noelle gave birth seven times in January, and
hemorrhaged two hours later after each birth,
but survived all seven times. Noelle, of course, is
not human; she is a simulation mannequin used
at Bozeman Deaconess Health Services to train
nurses and other providers in safety issues and
safety processes.
More than 90 people, divided into seven teams
with physicians, nurses, technicians and support
staff participated in the simulations caring for a
19
Exemplary Professional Practice
postpartum hemorrhage patient. They included
obstetricians, family practitioners, anesthesiologists and certified nurse midwives with privileges
at Bozeman Deaconess.
BDHS staff members spent six months designing
the simulation which was enlightening for both
ER and ICU nurses, as staff learned how situations are handled in other hospital departments.
Simulations provide an opportunity to practice
CRU, which stands for Cooperative- RespectfulUnified, to create a team framework. It is the
basis of Phase II of Bozeman Deaconess’ safety
culture work. CRU teaches staff to think and
work as a team, allowing them to figure out processes and communication issues they may face
with no cost to a real patient.
About 100 employees participated, including
staff from the ER, ICU, radiology, laboratory,
pharmacy and respiratory services, nurse supervisors, and physicians. Each group “treated” a lifelike mannequin in the ER, where a newly implemented sepsis protocol was initiated and then
transferred the “patient” to an ICU nurse and
critical care physician. One common finding was
staff were hindered by communication barriers,
particularly due to a lack of integration between
the ER and ICU computer systems, making verbal communications crucial.
Safety consultant Craig Clapper, founding partner of Healthcare Performance Improvement,
which helped design the exercise with a team
from Swedish Simulation and Innovation out of
Seattle, said such healthcare simulations provide
three benefits: training on protocols, training of
people as a team, and facilities testing.
Since a key component to sepsis care is the patient’s fluid status, staffers are developing systems
to ensure the ICU is alerted to the amount given
in the ER. The SIM demonstrated the BDHS commitment to teamwork, and was a stellar example
of CRU—closed loop communications, staying
with your wingman, teamwork and clearly identified roles, and clear concise communication—
and how it is implemented at BDHS.
Simulation II
Sepsis is a system-wide infection that can lead to
multi-organ failure if not caught and treated in
time. Bozeman Deaconess Hospital conducted
simulations of patients suffering from sepsis diagnosed in the ER and then transferred to ICU, to
learn where sepsis care can be improved.
20
Exemplary Professional Practice
Improving Care Delivery and Patient Satisfaction
Justin Elder’s story:
Our nurses are dedicated to safe, high quality
nursing care delivery. They find evidence-based
solutions to problems they encounter when caring for patients.
Ensuring that nurses
and medical providers stay up-to-date
on the condition
of each patient
and issues affecting the department
are always imporJustin Elder, RN, BSN
tant components
ICU
in providing high
quality and safe care. Safety Coach Justin Elder,
RN, BSN, saw a way to improve the level of
communication about safety issues and patient
care in the Intensive Care Unit. Many hospital
departments have implemented “morning safety
huddles,” where staff are encouraged to discuss
safety thoughts and concerns for that particular
day. “We already did our version of that informally during the change-of-shift group report,”
Elder said. “I thought we should make it part of
our reporting system so we can get more ICU
RNs involved.”
One program in which we take pride is our Safety Coach program. At Bozeman Deaconess we
have 75 interdisciplinary safety coaches, many of
whom are nurses. Our safety coaches are specifically trained in the science of safety, and spend
countless hours improving practices to ensure
that we reach our goal of zero preventable harm.
Heather Davis’ story:
In caring for children, proper dosing
of medications and
use of correct size
equipment depends
on their weight.
During a medical
trauma, access to
Heather Davis, RN, CNOR
that information can
Surgical Services
be all important in
providing adequate care as quickly and safely as
possible. That’s why Heather Davis, RN, CNOR,
an anesthesia nurse in Bozeman Deaconess
Hospital’s Surgical Services and a Safety Coach,
devised a plan to identify all pediatric patients
with an ankle band indicating the patient’s actual weight in kilograms that is now used hospital wide.
Now, the Charge RN each shift is responsible for
taking a two-minute “time out for safety” during
the group report to discuss any safety concerns
for that shift. Each morning the Charge RN reports the previous day’s concerns to the department manager, who brings them to senior staff
at the morning Safety Huddle.
Crystal Marx’s story:
Crystal Marx, RNC,
BSN, CWCA, Clinical Supervisor in the
Bozeman Deaconess Wound Clinic
and Safety Coach,
realized that when
diabetic patients
While all hospital patients get a wrist band with
a number of identifying factors, the ankle band is
used solely to indicate weight of patients younger than age 15, and is more easily reached in an
emergency situation, according to Patient Safety
Coordinator Kimberli Herring, BSN, RN. “Use
of pediatric weight-based banding will improve
safety and continuity of care,” said Davis.
21
Crystal Marx, RNC, BSN, CWCA
Wound Clinic
Exemplary Professional Practice
Amanda Tempero’s
Story:
Getting a good
night’s rest is an
important part of the
healing process, particularly for surgery
patients at Bozeman
Amanda Tempero RN, BSN
Deaconess Hospital.
Surgical Services
Amanda Tempero,
RN, BSN, coordinated with her colleagues on the
Surgical Unit Based Council to address this issue.
By minimizing interruptions, shutting doors at
night for appropriate patients, decreasing the
call system volume at night, consistently informing patients of noise expectations and providing
sleep masks and ear plugs in all admissions packets, the Surgical Unit exceeded its goal of 60%
patient satisfaction on night noise. In fact, they
reached 66.7% in the second quarter of 2013,
far above the national average of 54.3%.
came into the clinic for care, staff didn’t have a
standardized way to validate their hemoglobin
A1C or blood glucose level.
“We see about 80 diabetic patients a month, but
we weren’t tracking their long-term blood glucose levels,” said Marx. “We had been taking the
patient’s word for what it was, without actually
knowing how long it had been since they had a
reading.”
Working with the Wound Clinic Unit Based
Council, Marx developed a policy to monitor
patients’ hemoglobin A1C levels more closely by
communicating with primary providers and the
Diabetes Center, and created a database to track
this information. Now staff know patients’ actual
levels and how that affects their healing, while
involving the patient more effectively in their
own healthcare.
22
Exemplary Professional Practice
Lactation Counselors Help Moms Find Breastfeeding Success
Bozeman Deaconess Women’s Center lactation
coordinator established new goals to help make
breastfeeding a successful experience for new
mothers and their babies. Lactation counselors
who are also RNs work with patients before and
after their babies are born, providing training
and information on milk production, feeding
cues and adequate nutrition through breast- or
bottle-feeding, during hospital stays, once they
are home and after mothers return to work.
breastfeeding after returning home, and for
more changes when the moms return to work.
Mothers can be seen on an out-patient basis by
the lactation specialists as long as they need or
want the help. Counselors also expanded their
out-patient clinic efforts by working with the
Gallatin Breastfeeding Coalition and helping
sponsor the Baby Bistro at the Bozeman Public
Library. Three Bozeman Deaconess lactation
counselors have earned IBCLC (International
Board Certified Lactation Consultant) status:
Beckie Walters, BSN, RN, IBCLC, RLC, Nancy
Thompson, BSN, RN, IBCLC, RLC, CCE, and
Bernadette Neuman BSN, RN, IBCLC.
With 100 babies born at Bozeman Deaconess
Hospital each month, the counselors offer
assistance to new mothers while they are in
the hospital, help them develop plans for
Beckie Walters, BSN, RN, IBCLC, RLC,
Nancy Thompson, BSN, RN, IBCLC, RLC, CCE
Family Birth Center
23
New Knowledge, Innovation and Improvement
Quality Management
• Tracy Knoedler, BSN, RN, MPH: Infection
Prevention Coordinator
• Kim Herring, BSN, RN: Patient Safety
Coordinator
• Karen Lanz, BSN, RN: Patient Relations
• Carrie Corwin, BSN, RN: Core Measure
Coordinator
Bozeman Deaconess Health Services’ Quality
Department focuses on ensuring that patients
receive highly reliable care from providers and
staff, as well as working collaboratively with others to eliminate preventable harm at BDHS. They
extensively track outcomes data to determine
areas for opportunity and improvement. The
department, staffed primarily by nurses, takes
a 360° view of all issues relating to quality and
safety, and tries to connect other staff, patients
and community members with resources they
need to get answers to their questions. Specific
issues are handled by the following nurses:
• Marie Hamilton, RN: Ambulatory Care
Quality Improvement Coordinator
• Allison Treloar, MN, RN, CNL: Maternal
Newborn Quality Coordinator
• Hollie Raycraft, BSN, RN: Director of
Quality Management
• Rene’ Fredette, BSN, RN: Risk Manager/
Surgical Quality
• Andrea Roberts, BSN, RN: Joint Commission
Accreditation Coordinator/Patient Relations
Quality Department 2013
National Safety Summit
with Craig Clapper, founding partner of Healthcare Performance Improvement (HPI), which
hosted the Summit
and advises BDHS on
its safety initiative.
They spoke about
“building collegial
interactive teams,” a
concept called CRU,
or Cooperative-Respectful-Unified, at
Kim Herring, BSN, RN
BDHS.
Patient Safety Coordinator Kim Herring, BSN,
RN, was selected to present the successes of Bozeman Deaconess Health Services’ safety program
at Safety Summit 2013: A Decade of Navigating
Toward Zero Events of Harm. Herring presented
Quality
24
New Knowledge, Innovation and Improvement
HPI cited BDHS and Herring for the outstanding
work done in applying CRU concepts in simulation. “The work—in terms of planning, execution, and developing communication tools for
CRU—is absolutely the best in our client community,” Clapper said.
Now in Phase II, BDHS is promoting CRU to
build teamwork skills among all staff and providers and to become ‘highly reliable.’ “We have to
work toward having every single person practice
safety all the time, and do what they do correctly
every time,” Herring said. “We have to develop
good teamwork skills. And we have to learn to
give people feedback, tell them when they are
contributing
to the cause
of safety and
when they
are not.”
Herring spoke about the safety program at our
hospital, like BDHS’s Great Catch hotline, safety
posters, ‘Who’s Your Wingman’ contest, ‘Safety
Starts With Me’ video, promoting the Five Safety
Habits, and the ratio of 72 safety coaches to 86
beds. She credits BDHS’ success to the “unrelenting commitment of the Board and Administration,” and “saturating” the BDHS community
with the concept of reducing preventable harm.
Nurse-Led Research
Currently our organization conducts many
research studies to identify new and innovative
treatments and practices. Our Cancer Center
is part of the Seattle Cancer Care Alliance and
diligently conducts clinical trial studies in search
of new treatments and cures for cancer. Montana State University, with its main campus also
in Bozeman, also conducts many studies through
our organization, such as methods to improve
patient flow through surgical services. Additionally, the Research Council’s interest in mentoring
nurses to conduct nursing research led to them
providing the Division of Nursing with a six-week
course titled Guided Discovery.
This workshop inspired Kimberly Todd, BSN,
RNC, a nurse in Labor and Delivery, who sought
out a study in progress at Stanford University
regarding probiotic use and the reduction of
Group B strep in pregnant women. Todd asked
to become a satellite site to conduct the already
designed study here at our organization. She
worked with Dr. Aziz, an obstetrician and scientist with Stanford to learn about the study, how
to obtain consent from patients to ensure their
proper protection and carry out a research study
from start to finish. This project is still in progress,
but Todd stated the experience she’s gained as a
result has proven to be invaluable in her quest to
become a nurse scientist.
Dr. Donna Williams, Montana State University
Dean of Graduate Studies and Research for the
College of Nursing, hosted the guided discovery
workshop. She led six nurses through the process of differentiating evidence-based practice
from research, developing a clinical question,
and learning how to answer that clinical question through the research process.
Because Todd was so inspired by the research
process, she decided to also assist an immunology student at Montana State University to collect
cord blood for further testing in an immunologic
study. Todd is a true innovator at heart and is
advancing nursing science and practice not only
locally, but globally.
25
New Knowledge, Innovation and Improvement
Innovative Strategies
Patients at Bozeman Deaconess Health Services
have access to cutting edge treatments, skilled
specialists, caring and supportive clinical staff,
the latest in clinical trials, and a host of support
services. These choices, combined with a serious diagnosis, can leave a patient overwhelmed
and feeling lost. Help is available at Bozeman
Deaconess in charting a course through the vast
array of services and treatment, thanks to its
clinical patient navigators.
navigator can play an integral role in making the
progression through the healthcare system positive, and optimally, seamless. Whether holding a
patient’s hand at the time of a biopsy or answering questions about upcoming procedures, the
patient navigators at Bozeman Deaconess are
available to provide immediate support to the
patient and their family.
Child works directly with patients, reviewing
medical histories, explaining treatment options,
and assisting in determining the optimal testing
procedures. She also assists patients with scheduling additional tests, including diagnostic and
interventional procedures, as well as securing
referrals to appropriate specialists and follow-up
care. In helping coordinate patient’s care, Child
ensures timely service for patients.
Kendall Child,
FNP-C, is a clinical
patient navigator
at Bozeman
Deaconess Hospital,
acting as liaison
between cancer
patients’ primary
Kendall Child, FNP-C
care providers and
Cancer Center
the specialists who
ultimately become involved in their care. The goal
is to ensure patients receive necessary medical
care in a timely manner and to promote effective
and collaborative communication between the
patient and his or her healthcare team.
Calling herself a patient advocate, Child keeps
patients informed, makes sure their questions are
answered and listens to their concerns and fears
while offering compassion and unconditional
support. The goal, said Child, is to provide the
best care possible for every patient as they make
their journey back to wellness.
Confronting cancer is an inherently vulnerable
time for the patient and one in which a patient
26
Awards and Recognition
CNOR-Strong Designation
Bozeman Deaconess Health Services has earned
the CNOR® Strong designation from the Competency & Credentialing Institute (CCI). The
CNOR® Strong designation is given to facilities
in which at least 50% of its OR nursing staff
are CNOR certified. 2013 was the first year CCI
awarded this elite status to selected facilities
nationwide.
Earning individual CNOR certification demonstrates a commitment to providing evidencebased patient- and family-centered care during surgery. Since operating room nurses can
make all the difference to a patient undergoing
surgery, the operating room nursing team has
made this commitment to be strong patient
advocates ensuring patient safety.
CNOR is a definition, not an acronym. CNOR
certification is defined as “the documented
validation of the professional achievement of
identified standards of practice by an individual
registered nurse providing care for patients before, during and after surgery.” It is an objective,
measurable way of acknowledging the achievement of specialty knowledge beyond basic nursing preparation and RN licensure.
Patient safety and positive surgical outcomes are
of utmost importance at Bozeman Deaconess,
and supporting nurses as they exceed expectations to achieve their perioperative nursing
certification reflects Bozeman Deaconess’ commitment to its core values.
National Certifications Achieved in 2013
Julie Belschwender, BSN, RN, CLC,
Family Birth Center
Kathryn Trelfa, BSN, RN, RCIS, Cardiac Services
Heather Walsh, BSN, RN, CNOR, Surgical Services
Kelsey Elkins, BSN, RN, CLC, Family Birth Center
Rhyana Bouton, BSN, RN, ONC, Surgical Unit
Aileen Fennelly, BA, RN, CLC, Family Birth Center
Heidi Godwin, BSN, RN, CLC, Family Birth Center
Kallie Kujawa, MN, RN, CNL,
Nursing Administration
Lindsey Mastel, BSN, RN, CLC,
Family Birth Center
Nancy Thompson, BSN, RN, IBCLC, RLC, CCE,
Family Birth Center
Tammy McKinney, BSN, RN, CLC,
Family Birth Center
Beckie Walters, BSN, RN, IBCLC, RLC,
Family Birth Center
Amanda Salzer, BSN, RN, CGRN, Endoscopy
Hilary Smith, RN, BSN, CAPA,
Perioperative Services
Amanda Tempero, BSN, RN, ONC, Surgical Unit
Emily Rex, RN, BS, BSN, CPAN,
Perioperative Services
Rachel Toleno, BSN, RN, CLC, Family Birth Center
27
Awards and Recognition
Daisy Awards
and the unquestioned spoiling that a grandmother might provide.”
The Daisy Award for Extraordinary Nurses was
established by Mark and Bonnie Barnes in 2000
to honor the compassionate care given by nurses
to their terminally ill son and their entire family.
The Daisy Foundation’s mission is to recognize
extraordinary nurses around the world who
make an enormous difference in the lives of
patients and families by the super-human work
they do every day. In 2013, these Bozeman Deaconess Nurses were nominated by their peers for
the honor, which is awarded quarterly:
•
Rye Cech, BSN, RN, January, Bozeman
Deaconess Hospital medical floor. Cech was
nominated in part based on comments from
a former patient: “She provided the support
of a sister, the concerned care of a mother,
the toughness and practicality of an aunt,
•
Chris Bies, RN, April, Family Birth Center. A
graduate of MSU-Northern, Bies was nominated by her colleagues for her abilities in
orienting new nurses, her compassion and
dedication to patients, and being a role
model for all her colleagues.
•
Pat Armstrong, RNC, July, Pain Resource
Nurse, Bozeman Deaconess Hospital medical
floor. Armstrong was selected for the honor
based on nominations from two patient
families, who cited her confidence, caring,
empathy, being a team player and her personality.
•
Matt Larson, BSN, RN, September, Bozeman
Deaconess Hospital Intensive Care Unit. Larson was nominated by fellow staff for being
“a rock star among nurses, a fearless and
selfless team player and exceptional nurse.”
Larson was further honored by Daisy Award
founders Mark and Bonnie Barnes who attended his presentation.
Daisy Award winners meeting Mark and Bonnie Barnes, founders of The Daisy Award.
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Awards and Recognition
Accolades
Keven Comer,
APRN, FNP-BC,
was named
the Advance
Practice Registered Nurse of
Keven Comer, APRN, FNP-BC
Bridger Internal Medicine
the Year by the
Montana Nurses Association (MNA). She received the award at
the 100th MNA Annual Convention. Comer, a
Family Nurse Practitioner for 16 years, works at
Bozeman Deaconess Bridger Internal Medicine.
Comer also participates in the Community Care
Connect project and is an active member of the
Medical Home Executive Team.
award at the Annual Alumni weekend in September. Groeneweg has worked at Bozeman Deaconess Hospital for 23 years.
Anna Dennis, LPN2, was
selected to
receive the first
ever Montana
State University
Anna Dennis, LPN2
Honorary AlumFamily Birth Center
ni Award. The
2013 award recognizes a non-alumnus whose
extraordinary service has advanced the university and made significant contributions to the
campus, college and community. Dennis, who
earned her LPN degree in 1971 and has been a
full-time post-partum nurse at BDH since 1986,
was nominated by nearly six dozen fellow employees and physicians, half of whom graduated
from the MSU nursing program. She was cited
for continually educating new staff members
and supporting MSU by training and supporting
new nursing students and encouraging them to
further their studies and obtain higher degrees.
Vickie Groeneweg, Chief
Nursing Officer
and Vice President of Patient
Services, was
Vickie Groeneweg, MSN, RN, MBA
Chief Nursing Officer
named Alumni
of the Year by
Crown College, a private college west of Minneapolis, where she graduated with a degree in
elementary education. Groeneweg received this
29
Awards and Recognition
Organization Awards
At Bozeman Deaconess Health Services, our
employees strive to provide safe, high quality
care to every patient. This is especially true of
our nurses. Those efforts were recognized by
top healthcare industry analysts with a slew of
awards in 2013, illustrating BDHS’ system-wide
dedication to clinical quality, patient care and
safety, and providing excellent healthcare to
our community members. The awards not only
clearly demonstrate these are our highest priorities in service to our patients, they also recognize
the commitment by all employees and medical
staff for continuous improvement and validate
BDHS’ efforts to become a ‘high reliability’
healthcare system. Our employees’ hard work
and dedication is a critical component to all of
these achievements.
in heart attack, pneumonia and surgical care.
Bozeman Deaconess achieved cumulative performance of 95% or above across all accountability measures, which represent evidence-based
practices such as giving aspirin at arrival for heart
attack patients or giving antibiotics one hour
before surgery.
Healthgrades
Healthgrades, the
leading online resource to help consumers search, compare and connect
with physicians and
hospitals, presented
Bozeman Deaconess
with the Pulmonary
Care Excellence
Award for 2014, and ranked us among the top
5% for Overall Pulmonary Services. BDHS also
was recognized for clinical excellence in Orthopedic, Pulmonary and Gastrointestinal Care, and
was the only hospital in Montana to receive the
2013 Healthgrades Outstanding Patient Experience Award, ranking in the top 15% in the
nation. Additionally, Healthgrades named BDHS
a Five-Star recipient for Total Knee Replacement
three years in a row (2012–2014), and recognized Bozeman Deaconess for the first time as
a Five-Star recipient for treatment of Chronic
Obstructive Pulmonary Disease, Pneumonia and
GI Bleed for 2014.
The Joint Commission
Bozeman Deaconess Health Services has been
named a Top Performer on Key Quality Measures® by The Joint Commission, the leading accreditor of healthcare organizations in America,
for exemplary performance in using evidencebased clinical processes that are shown to improve care for certain conditions. One of only
1,099 hospitals in the U.S. earning the distinction, BDHS was recognized for its achievements
30
Awards and Recognition
Mountain-Pacific Quality Health
The Leapfrog Group
Bozeman Deaconess Health Services
earned the Quality Achievement
Award from
Mountain-Pacific
Quality Health
for the sixth
year in a row.
BDHS was one of
only three hospitals in
the state to win MountainPacific’s highest award in 2013, a reflection of
Bozeman Deaconess’ results in improving quality
performance, eliminating avoidable patient harm
and delivering exceptional patient experiences.
The Quality Achievement Award recognizes
Montana hospitals for their dedication to preventing surgical infections and ensuring patients
receive high-quality care for heart attack, heart
failure or pneumonia.
Bozeman Deaconess Health Services was honored for the second year in a row with an “A”
in the Fall 2013 update to the Hospital Safety
Score, which rates how well hospitals protect patients from accidents, errors, injuries and infections. Bozeman Deaconess was one of only three
hospitals in Montana to earn this highest grade.
The Hospital Safety Score, administered by
The Leapfrog Group, an independent industry
watchdog, is calculated using publicly available
data on patient injuries, medical and medication
errors, and infections.
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Summation
The Annual Nursing Report is designed to serve
as an historical document recognizing the contributions of nurses at Bozeman Deaconess Health
Services to their patients, the people of this community, and their profession. It demonstrates our
nurses’ commitment to achieving the strategic
priorities of the organization and to providing
quality compassionate care safely at all stages of
each patient’s journey. This report reflects only a
glimpse of the dedicated care our nurses provide
every day.
Evidence Based Practice Council
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bozemandeaconess.org