Editorial Board

T H E
Editorial Board
THE MOSES H. CONE MEMORIAL HOSPITAL
SYSTEMWIDE
Nicole Baltazar-Holbert, RN, MSN
Assistant Director, Departments 2500, 2600, 6500
Lisa Boland, RN, MSN, CHCR
Manager, Nursing Outreach and Retention,
Setting the Pace Editor
Ashley Jarrell, RN, BSN, BA
Department 2300, Surgical Intensive Care
WESLEY LONG HOSPITAL
Maura Barber, RN, BSN, Copy Editor
3West, Oncology
WOMEN’S HOSPITAL
Beth Smith, RN, MSN, NE-BC
Director, Mother Baby Unit, Central Nursery,
Lactation and Perinatal Education
ANNIE PENN HOSPITAL
Debbie Green, RN, DNP, CENP
Vice President, Nursing and Patient Services
BEHAVIORAL HEALTH HOSPITAL
Akeysha McMurren, RN, MSN
Administrative Coordinator
SPECIALTY AREAS
JC Cooper, RN, BSN, CTRN, EMT
CareLink
Lelia Moore, RN, BSN, FCN
Coordinator, Congregational Nurse Program
AT LARGE
Belinda Hammond, RN, MSN, CEN, CCRN
Clinical Nurse Educator-Critical Care
Danyel Johnson, RN, MSN
Clinical Nurse Educator-Medical Surgical;
Research Council Representative
P U L S E
O F
N U R S I N G
AT
C O N E
H E A LT H
conehealth.com
Winter 2013 • Vol. 10 No. 1
Ruthie Waters, RN, MSN
Relationship Based Care Coordinator
Melody Bullock, RN, BSN, BS, MS, CRNI
Relief Nurse, Pediatrics
SUPPORT SERVICES
Peggy Wynn, MLIS
Librarian, Wesley Long Hospital
EDITORS
Co-Editor, Nursing Practice
Thresa Haithcock, RN, DNP, APRN-BC
Co-Editor, Nursing Education
Peggy Hewitt, RN, MSN
Department 2000
Co-Editor, Nursing Research
Nancy Summerell, RN, MSN
Clinical Orientation Nurse, ED Academy
Editor-in-Chief
Sarah Lackey, RN, MSN, CCNS
Magnet Program Coordinator, Trainee
Rapid Response Team, Relief
Ann Finch, RN, MSN, PMHCNS
Read Nursing Beat online. Go to the intranet home page and click on the Nursing Beat logo.
NURSING BEAT
MISSION STATEMENT
To communicate and celebrate the
dynamic power of nursing innovations
and enduring values.
1200 North Elm Street, Greensboro, NC 27401
conehealth.com/nursing
When Current Practice Is Not Best Practice:
Using the Iowa Model to Change Practice
page 3
CONE HEALTH
CONE HEALTH
Message from the CNO
We serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care.
This time of year, as I sip on
my hot chocolate and
wish for snow, (Wait a
minute! I’m from New
Jersey – I never want
leadership; structural empowerment; exemplary professional practice; new knowledge, innovations and improvements using evidenced-based practice and research; and
From the Editor
empirical outcomes that contribute to the well-being of
our patients, our work environment and our community.
to see snow again!)
I think back on 2012
In October, we will hold our second nursing research sympo-
and all of our won-
sium. Dr. Linda Akin, our keynote speaker, is a professor at
derful accomplish-
the University of Pennsylvania and is one of the most well-
ments. Because of
known investigators and speakers on nurse-patient ratios,
all of your hard work
nursing educational levels and the nurse work environment.
and efforts, we had a
very successful year in
nursing.
Currently, we have more than 233 nurses attending school
to advance their degrees. Our dream in 2013 is that even
more nurses take advantage of our REACH scholarship
Some examples include our
program and return to school to advance their education.
systemwide Cone HealthLink Go Live;
a successful Joint Commission survey; our nursing re-
Whatever changes 2013 brings to the healthcare industry, I
search symposium held at the Koury Convention Center;
know the Cone Health nursing staff will be prepared to lead
23 nurses being named to the Great 100; our Emergency
the way by constantly searching for a better way to provide
Department, Medical/Surgical and Critical Care Nursing
care to our patients, our families and our communities.
Academies; our new Professional Nurse Advancement
Program (PNAP); our new DermaTherapy linen rollout; and
As always, thank you for all you do!
countless nurses participating in research, publishing and
Respectfully,
presenting across the country.
2013 promises to be just as exciting for us. This year we
Theresa Brodrick, RN, PhD, CNS, CNA
will seek Magnet re-designation, an honor Cone Health
MAGNET
nurses have enjoyed since 2005. Many of you will be asked
to share your stories and examples of transformational
INSIDE THIS ISSUE
2
3
5
6
7
7
8
2
Message from Theresa Brodrick
When Current Practice is Not Best Practice
NICU Creates the “Bubble” to Fight Infection
Care Delivery Model: What’s That?
Marjorie Simpson Award
Humpty Dumpty Award
Changing the Culture of Nursing, One Idea at a Time
TRANSFORMATIONAL LEADERSHIP
10
12
13
14
16
19
Destination RN: Cone Health’s High-Flying
Nurse Extern Program
2012 Press Ganey National Client Conference
The House That Cone Health Nurses Built
Meeting Acute Mental Health Needs
Setting the Pace
From the Editor
I had the privilege of work-
cal/Telemetry at the problem list flip chart, markers in hand.
ing with the Rapid Response
My camera let me into places I might not have been able to
Team at The Moses H. Cone
go without a good reason. The command center was par-
Memorial Hospital on Sun-
ticularly impressive. Six of our leaders, surrounded by charts
day, Nov. 4, the day Cone
and electronic monitors, communicated continuously with
HealthLink went live at Moses
command centers in the other facilities. They were going
Cone Hospital, Wesley Long
through items one by one, listening, asking questions, giving
Hospital, Cone Health Behavioral Health Hospital and Cone
feedback. It reminded me of movie clips of NASA control
Health Cancer Center. The bridge to the new system actu-
rooms because of the quiet, the gravity and the focus that
ally occurred about 3 a.m. At 7 a.m. when the day shift folks
was weighty in the room.
walked in, we did not know how it was going to be - we just
knew we had to walk in and do it.
We completed some major projects last fall: People Excellence Celebrations, Cone HealthLink, Joint Commission, end-
I have to tell you, I have never been so proud of the place I
of-fiscal-year activities, the holidays. In January, we turn our
work. As I walked the halls that day, I saw more heads bent
thoughts to the next adventure – our Magnet redesignation.
together focusing on common problems than I ever have be-
Magnet is not something separate and apart from what we
fore. There was laughter but also hard work. There was gra-
already do or different from what we already are. The Magnet
cious accommodation for mistakes and a struggling together
application just pulls it all together in one place. The site visit
for accuracy; there was a sense of triumph alongside a subtle
lets the appraisers see for themselves what we have done.
underlying sense of unease. We wanted to get it right; we did
For the most part, writing the application and getting ready
not want to mess up. We wanted to learn quickly and well so
for the site visit is a way to celebrate our hard work and ac-
we could get on with the real work of our day.
complishments. It will be an opportunity to demonstrate the
amazing Cone Health spirit I saw that Sunday in November
Our leaders came in to cheer us on. There was food every-
as we launched the largest phase of Cone HealthLink.
where – apples, oranges, health food bars, pizza, sodas,
sandwiches. How welcome was that sweet taste of a Nature’s
Congratulations to everyone for integrating one of the most
Own bar in the middle of mental gymnastics. Stories from
innovative electronic medical record systems into practice in
rounding leaders, support staff and employees were varied
such an amazing way. It is a pleasure and an inspiration to
in their degree of catastrophe. The teamwork prevailed. We
work in this organization.
did not falter. We soldiered on, taking one problem at a time,
climbing up that mountain.
I brought my camera to work that day. I got some great
shots, some with rather amusing captions – Dr. Buccini in his
Superman tie; Ed White, RN, in the Emergency Department
in an “oh my” gesture; the staff of Department 5500-Medi-
Sarah Lackey, RN, MSN, CCNS, Editor-in-Chief
Magnet Program Coordinator, Trainee
Rapid Response Team, Relief
[email protected]
19
CONE HEALTH
THE MOSES H. CONE MEMORIAL HOSPITAL
Setting the Pace
Shannon Love, RN, PCCN, Department 3300-Intermediate Care Unit,
Moses Cone Hospital
Carol Mead, RN, PCCN, Women’s
Nursing Unit, Women’s Hospital
Nurse Executive Certification
Master of Science in Nursing
Mona Easter, RN, BSN, MBA, NE-BC,
Department 300 and ICU, Annie Penn
Hospital
Julie O’Neal, RN, MSN, CEN, Clinical
Nursing Support
University of North Carolina at
Greensboro, December 2012
Master of Health Administration
Tina Miller, RN, BSN, PCCN, Intermediate Care/Urology, Wesley Long Hospital
Waqiah Ellis, RN, MSN, NE-BC, Department 2000-Heart Unit, Moses
Cone Hospital
Donna Owens, RN, BSN, PCCN, Department 4700-Congestive Heart Failure/Telemetry, Moses Cone Hospital
Kameka Totten, RN, BSN, MBA/MHA,
NE-BC, 5 East Medical Unit and Flexible Resources, Wesley Long Hospital
Chris Ralph, RN, BSN, PCCN, Department 3700-Progressive Care Unit,
Moses Cone Hospital
Nurse Executive Advanced Certification
Kim Sachs, RN, PCCN, Medical/Surgical ICU, Women’s Hospital
Gretchen Stevens, RN, PCCN, Flexible
Resources, Wesley Long Hospital
Jessica Sutter, RN, PCCN, Department
2000-Heart Unit, Moses Cone Hospital
Farrah Tarpley, RN, BSN, PCCN, Department 3700-Progressive Care Unit,
Moses Cone Hospital
Jill Tsoutis, RN, PCCN, Department
3700-Progressive Care Unit, Moses
Cone Hospital
Kelli Willard, RN, PCCN, Department
3700-Progressive Care Unit, Moses
Cone Hospital
Allen Worley, RN, BSN, MSN, PCCN,
Department 3300-Intermediate Care
Unit, Moses Cone Hospital
Janet Worrell, RN, PCCN, Department
3700-Progressive Care Unit, Moses
Cone Hospital
Anne T. Brown, RN, MSN, PCCN, NEABC, Nursing Administration, Wesley
Long Hospital
Joan LoPresti, RN, BSN, MS, NEA-BC,
Nursing Administration, Moses Cone
Hospital
Annette Smith, RN, MSN, NEA-BC,
Nursing Administration, Wesley Long
Hospital
Ruthie Waters, RN, MSN, NEA-BC,
Relationship Based Care, Systemwide
Nursing Practice
Peace Dormon, RN, BSN, Flexible Resources, Wesley Long Hospital
Pfeiffer University, August 2012
Angela Moore, RN, BSN, Quality Informatics
Pfeiffer University, August 2012
Cheryl Poteat, RN, BSN, Palliative
Care, Wesley Long Hospital
Pfeiffer University, August 2012
Bachelor of Science in Nursing
Sue Ellen Grounds, RN, BSN, Palliative
Care, Wesley Long Hospital
Western Governor’s University, October 2012
Margaret Steelman, RN, BSN, Quality
Informatics
Winston-Salem State University, December 2012
Using the Iowa Model to Change Practice
By Allyson Daniels Kirkman, BSN, RN III, and Danyel Johnson, MSN, RN, CNN
Pressure ulcers. Sentinel event. Evidence-based practice
(EBP) project. All of these words may sound intimidating, but they became a harsh reality for the Department
6700-Medical/Renal nursing staff at The Moses H. Cone
Memorial Hospital.
Pressure ulcers adversely compound healthcare costs,
length of stay and patient satisfaction1. Experiencing a
sentinel event and finding two pressure ulcers during a
Pressure Ulcer Prevalence (PUP) survey in late 2011 required
an evidence-based practice project to change practice and
transform these negative patient outcomes.
Allyson Daniels, with staff of 6700.
The process of developing the EBP project began with
exploring the Iowa Model, the framework adopted by Cone
Health to guide the integration of research into practice.
Step Three: Reviewing the evidence. A literature review
The six steps of the Iowa Model direct the implementation
revealed clinical practice guidelines and best practice in-
of the project to ensure the desired outcome is met.
terventions specific to skin care. These were compared to
ADVANCING IN EDUCATION
Marie Trogden, RN, BSN, Department
5500-Medical/Telemetry, Moses Cone
Hospital
Winston-Salem State University, December 2012
Step One: Identifying triggers and formulating a burning
nite disparity between best practice and current practice
Doctor of Philosophy in Nursing
Associate Degree in Nursing
question. PUP results, a sentinel event and inaccurate skin
existed.
Bonnie Gibbs, RN, General Surgery,
Wesley Long Hospital
Forsyth Technical Community College,
May 2012
documentation were identifiable triggers. There also was a
Oncology Nurse Certification
Regina Baldwin, RN, ONC, 3 East Oncology, Wesley Long Hospital
Crystal Dodson, RN, MSN, PhD, Inpatient Diabetes Program
University of North Carolina at Chapel
Hill, December 2012
Submit “Setting the Pace” items for our spring 2013 edition to [email protected]
no later than Friday, March 1, 2013.
Requirements for submissions:
• All submissions require: Employee Name, Campus, Department, Highest Degree Earned, National Certification(s) held at that time.
• Category assignment: Publication, Presentation, Poster, Promotion, Certification or Graduation.
• Graduations will also include: Degree Earned, Name of School and Date of Graduation.
• Publications will also include: Title of Article; Title of Publication/Book, Volume number (Issue Number); Date (month and year); Page range.
• Presentations (At the Podium) and Posters (On Display) will also include: Title of Presentation/Poster; Location (Name of Event/
Conference/Forum); Date of Event (month and year).
Correction from the Fall 2012 Issue of Nursing Beat:
Tina Miller, RN, BSN, PCCN, 4th Floor Urology/Intermediate Care at Wesley Long Hospital, received her PCCN certification. Our apologies for this error.
18
When Current Practice Is Not Best Practice:
the current nursing practices in the department. A defi-
knowledge deficit among nurses concerning wound identi-
Step Four: Changing practice. All nursing staff were re-
fication, staging of pressure ulcers and the required docu-
quired to complete the National Database of Nursing Qual-
mentation. A burning question developed: Will implement-
ity Indicators (NDNQI) Pressure Ulcer Training Modules,
ing a skin care competency increase nurses’ knowledge of
attend a mandatory class led by the Skin Savers and com-
skin and wounds, improve documentation, and decrease
plete skin care competencies created by the team. Peer
the incidence of pressure ulcers among patients?
education empowers staff and leads to the compliance
and integration of evidence-based prevention strategies
Step Two: Forming a Team. Skin Savers - which consisted
into practice and improves patient care outcomes (2). Ad-
of nurses, nurse techs, wound, ostomy, continence nurses
ditional practice changes included using the Cone Health
and a clinical nurse educator - was organized. Serving as
Skin Care Nursing Protocol, body maps to facilitate nurse
the project leaders, the Department 6700 RN IIIs guided
tech to nurse communication, and mirrors for improving
and supported the team and staff throughout the duration
skin assessments.
of the project.
On the cover: Allyson Daniels and Angelina Leonar practice
proper wound measurement on a simulated wound.
Continued on page 4
MAGNET
EMPIRICAL OUTCOMES
3
THE MOSES H. CONE MEMORIAL HOSPITAL
CONE HEALTH
Setting the Pace
When Current Practice Is Not Best Practice, Continued
“We have come a long way
and still have a long way to
go, but the most rewarding
accomplishment throughout this process is seeing
the positive impact our
practice change has had on
our patients. How exciting!”
Step Five: Evaluate the practice change. After several weeks, the
team evaluated the changes in practice. Complete and accurate
skin documentation increased from 61 to 85 percent, documentation of admission and transfer skin assessments improved
prevention interventions rose from 20 to 60 percent. Ultimately,
the PUP rate declined to zero.
Susan Geubtner, RN, BSN, PCCN,
Emergency Department, Wesley Long
Hospital
Step Six: Dissemination. Sharing the results of this EBP project
RN Care Coordinator
has been phenomenal. The Skin Savers poster titled “The Pressure Is On: Skin Savers to the Rescue” has won first place in the
the Nursing Leadership Excellence Award at the North Carolina
Organization of Nursing Leaders 2012 Conference. This project
was accepted as a poster presentation at the 2011 Southeastern
Region WOC Nurses Society Conference and the 2013 Annual
Preventive
Pressure Ulcer Prevalence
“We have come a long way and still have a long way to go, but
the most rewarding accomplishment throughout this process is
seeing the positive impact our practice change has had on our
6.7%
patients. How exciting!” says Allyson Daniels Kirkman, RN III,
BSN, Department 6700.
References
1Fife, C., Yankowsky, K., & Ayello, E. (2011). Legal issues in the care of pressure
ulcer patients: Key concepts for healthcare providers-A consensus paper from the
International Expert Wound Care Advisory Panel. Journal of Wound, Ostomy &
Continence Nursing, 2011 Jul-Aug (4S): Supplement: S11.
2Keller, R., Frank-Bader, M., Beltran, K., Ascalon, M., & Bowar-Ferres, S. L. (2011).
Peer education: An innovative approach for integrating standards into practice.
Journal of Nursing Care Quality, 26 (2), 120-7
Lorinda Shaw, RNC-MNN, BSN, Nursing Administration, Women’s Hospital
Certified Inpatient Obstetrics Nurse
Medical-Surgical Certification
Heather Koran, RNC-OB, BSN, Labor
and Delivery, Women’s Hospital
Jakeema Bryant-McLaughlin, RN,
BSN, CMS, 5 East Medical Unit, Wesley
Long Hospital
Ashley Tuttle, RNC-OB, BSN, Labor
and Delivery, Women’s Hospital
Certified Nephrology Nurse
Danyel Johnson, RN, MSN, CNN, Clinical Nursing Support
Tom Bailey, RN, BSN, CNRN, Department 3100-Neuroscience ICU, Moses
Cone Hospital
Cone Health Medical Group Clinical
Performance Manager
Robert Slaughter, RN, MSN, Cone
Health Physician Services Quality and
Safety Department
Kristie Payne, RN, MSN, Cone Health
Physician Services Quality and Safety
Department
sustain quality nursing care.
Bonnie Brown, RN, CEN, Emergency
Department, Annie Penn Hospital
Raney Gagnon, RN, BSN, RNC-OB,
Labor and Delivery, Women’s Hospital
Subsequent PUP surveys have warranted a need for continued
skin education will be the next steps in the unrelenting quest to
Maternal Newborn Nursing
Certified Neuroscience Registered
Nurse
Triad HealthCare Network Quality Performance Manager
EBP project. Further auditing, accountability and continuing
Certified Emergency Nurse
Christy Wicker, RN, BSN, RNC-OB,
Labor and Delivery, Women’s Hospital
American Nurses Association Nursing Quality Conference.
efforts in maintaining the practice changes established in this
%
Karin Henderson, RN, MSN, CENP,
CCRN, CS, GNP, Strategic Planning
and Development
Assistant Director
Health Evidence-Based Practice and Research Symposium, and
Skin and Wound Documentation
in the Medical Record
Executive Director of Organization
Integration
from 81 to 90 percent, and the documentation of pressure ulcer
2012 Cone Health Nursing Research Day, third place at the Cone
- Allyson Daniels, RN, BSN
GROWING IN LEADERSHIP
Registered Nurse III
Delia A. Turner, RN, BS, CCRN, Department 2100, Moses Cone Hospital
GROWING IN PRACTICE
Advanced Practice Certification Exam
for Wound Care
Dawn Engles, RN, MSN, CCNS,
CWOCN, Inpatient Wound and Ostomy Center
Ambulatory Care Nursing
Theresa Crabtree, RN-BC, BSN, Urgent Care Center
Certified Clinical Nurse Specialist
Dawn Engles, RN, MSN, CCNS,
CWOCN, Inpatient Wound and Ostomy Center
Sarah Lackey, RN, MSN, CCNS, Nursing Administration
Certified Nurse Manager and Leader
Sandra Kuider, RN, MSN, Emergency
Department, Annie Penn Hospital
Critical Care Registered Nurse
Brittany Deitz, RN, BSN, CCRN, Department 2900-Coronary Intensive
Care/Step-Down Unit, Moses Cone
Hospital
Kyle Duncan, RN, BSN, PCCN, CCRN,
Department 2300-Surgical Intensive
Care, Moses Cone Hospital
Catie Duszlak, RN, BSN, CCRN, Department 2100-Medical-Surgical Intensive Care, Moses Cone Hospital
Hans Johnson, RN, BSN, CCRN, Intensive Care/Step-Down, Wesley Long
Hospital
Kristin Mullins, RN, BSN, CCRN, Department 2900-Coronary Intensive
Care/Step-Down Unit, Moses Cone
Hospital
Emily Newsom, RN, BSN, CCRN,
Department 2300-Surgical Intensive
Care, Moses Cone Hospital
Kate Saftner, RN, BSN, CCRN, Department 2300-Surgical Intensive Care,
Moses Cone Hospital
Brooke Simpson, RN, CEN, CCRN,
CareLink Mobile Critical Care
Tvedt Woods, RN, BSN, CCRN, Intensive
Care/Step-Down, Wesley Long Hospital
Heather Bullins, RN-BC, BSN, CMS,
5 East Medical Unit, Wesley Long
Hospital
Chasity Hearn, RN-BC, BSN, CMS, 5
East Medical Unit and Flexible Resources, Wesley Long Hospital
Melinda Kallam, RN-BC, BSN, CMS,
Flexible Resources, Wesley Long
Hospital
Progressive Care Certified Nurse
Karen Ambrose, RN, PCCN, Flexible
Resources, Wesley Long Hospital
Katie Bloodworth, RN, PCCN, Department 3700-Cardiac Progressive Care
Unit, Moses Cone Hospital
Sherry Bolen, RN, PCCN, Women’s
Nursing Unit, Women’s Hospital
Amber Carter, RN, BSN, PCCN, Department 3700-Cardiac Progressive
Care Unit, Moses Cone Hospital
Eva Cooke, RN, BSN, PCCN, Intermediate Care/Urology, Wesley Long Hospital
Linda Curran, RN, PCCN, Department
2600-Step-Down, Moses Cone Hospital
Dana Dark, RN, PCCN, Intermediate
Care Urology, Wesley Long Hospital
Tymeeka Davis, RN, BSN, PCCN,
Department 2000-Heart Unit, Moses
Cone Hospital
Pam Garman, RN, BSN, PCCN, Intermediate Care/Urology, Wesley Long Hospital
Paige Grady, RN, PCCN, Adult ICU,
Women’s Hospital
Christina Hall, RN, PCCN, Department
3700-Progressive Care Unit, Moses
Cone Hospital
Kathy Heater, RN, PCCN, Intermediate
Care/Urology, Wesley Long Hospital
Janet Humphreys, RN, PCCN, Department 3700-Progressive Care Unit,
Moses Cone Hospital
Continued on page 18
4
17
CONE HEALTH
WOMEN’S HOSPITAL
Setting the Pace
IN PRINT
Theresa M. Davis, RN, MSN
Connie Barden, RN, MSN, CCRN-E, CCNS
Carol Olff, RN, MSN, CCRN-E, NEA-BC
Mary Pat Aust, RN, MS
Maureen A. Seckel, APN, ACNS-BC, CCNS,
CCRN
Crystal L. Jenkins, RN, MHI
Wendy Deibertm, RN, BSN
Phyllis Griffin, RN, BSN, MSN
Pat Herr, RN, BSN
Carrie Hawkins, RN, BSN, MSN, CCRN
Mary McCarthy, RN, BSN
Co-author: “Professional Accountability in the Tele-ICU.” Critical Care
Nursing Quarterly; October/December
2012, 35(4), 353-356.
Jennifer L. Zinn, RN, MSN, CNS-BC, CNOR
Charlotte L. Gugliemi, RN, BSN, MA, CNOR
Patsy P. Davis, RN, BA, CNOR
Clara Moses, RN, BSN, MS
Co-author: “Addressing the Nursing Shortage: The Need for Nurse
Residency Programs.” AORN J; 96(6):
652-657.
Susan Hummel Pedaline, RN, MS, DNP, RNC
Gail Wolf, RN, PhD, FAAN
Linda Dudjak, RN, PhD
Holly Lorenz, RN, MSN
Maribeth McLaughlin, RN, BSN, MPM
Dianxu Ren, MD, PhD
Co-author: “Preparing Exceptional
Leaders.” Nursing Management; September 2012, 38–44.
Jean Reinert, RN, MSN
Andrea Bigelow, RN, MSN
“Overcoming Nursing Faculty Shortages and Bridging the Gap Between
Education and Practice.” Journal for
Nurses in Staff Development; September/October 2012, 28(5), 216-218.
Laurie McNichol, RN, MSN, GNP, CWOCN
C.R. Ratliff, RN, PhD, APRN-BC, CWOCN
Co-author: “Risk assessment, staff
education, and interventions for pressure ulcer prevention programs.” Pressure Ulcers: Prevalence, Incidence and
Implications for the Future; Washington, DC: NPUAP, 2012: 197-226.
16
Laurie McNichol, RN, MSN, GNP, CWOCN
C.R. Ratliff, RN, PhD, APRN-BC, CWOCN
Co-author: “National Pressure Ulcer
Advisory Panel accomplishments over
the past 10 years.” Pressure Ulcers:
Prevalence, Incidence and Implications for the Future; Washington, DC:
NPUAP, 2012: 231-237.
Joseph Coladonato, MD
Annette Smith, RN, MSN
Nancy Watson, RN, BSN, CMSRN
Anne T. Brown, RN, MSN, PCCN
Laurie l. McNichol, RN, MSN, GNP, CWOCN
Amy Clegg, RN, MSN, CWOCN
Tracy Griffin, RN, MSN, CWOCN
“Prospective, Nonrandomized Controlled Trials to Compare the Effect of
a Silk-Like Fabric to Standard Hospital Linens on the rate of Hospitalacquired Pressure Ulcers.” Ostomy
Wound Management, October 2012,
58(10), 14-31.
Eva Hyde, RN, MSN, CNS, ONC
Brenda Murphy, RN, MSN, GNP-BC
“Computerized Clinical Pathways
(Care Plans): Piloting a Strategy to
Enhance Quality Patient Care.” Clinical
Nurse Specialist-Journal for Advanced
Nursing Practice; September/October
2012, 26(5), 277-282.
AT THE PODIUM
Sarah Clark, RN, MSN, CCRN
Belinda Hammond, RN, MSN, CEN, CCRN
“The Top 10 List: Lessons Learned During the First Year of Simulation.” 7th
Annual South Eastern Nursing Staff
Education Symposium, Asheville, Nov.
3, 2012.
Laurie McNichol, RN, MSN, GNP, CWOCN
“Health Economics and Pressure Ulcer
Prevention.” Northeast WOCN Regional Meeting, Princeton, NJ, October
2012.
Joy Berrong, RN, DN, RNC-OB, C-EFM, FNE
“Trauma in Obstetrics.” Piedmont
Chapter Association of Women’s
Health, Obstetric and Neonatal Nurses
(AWHONN) Conference, Women’s
Hospital, Greensboro, October 2012.
ON DISPLAY
Stephanie Cole, RN, BSN
“Magnesium for Neuro Protection
of the Preterm.” Piedmont Chapter
AWHONN Conference, Women’s Hospital, Greensboro, October 2012.
NICU Creates the
“Bubble” to Fight Infection
By Beth Smith, RN, MSN, NE-BC
Becky Zhang, RN, BSN, RNC-OB
Sandra Holleman, RN, BSN, RNC-OB
“Foley Catheter use after an Epidural.”
Piedmont Chapter AWHONN Conference, Women’s Hospital, Greensboro,
October 2012.
The Neonatal Intensive Care Unit (NICU)
at Women’s Hospital excels in quality
as they work to eliminate Central Line
Associated Blood Stream Infections
(CLABSI). For two years, the NICU
Stacey Toben, RN, BSN, CPEN
Jamie Blue-Matthews, RN, BSN, CEN
Denise Rhew, RN, MSN, CEN
“Simply Educate Me... Decreasing
Blood Contamination Rates.” Emergency Nurses Association Annual Conference, San Diego, September 2012.
has participated in a two-year statewide collaborative through the Perinatal Quality Collaborative of North
Carolina (PQCNC) to help reduce the
CLABSI rate across the state. Overall,
statewide CLABSI rates in NICUs have been
ACCOLADES
April Schamberg, RN, BSN
Ann Councilman, RN, BSN, MHA/MBA
Were selected by the American Organization of Nurse Executives (AONE)
to attend the AONE Emerging Nurse
Leader Institute held in November
2012 in Chicago, Illinois.
Emmanuel Castro, RN-C, BSN
Amy Clegg, RN, MSN, NP-C, CWOCN
Dawn Engels, RN, MSN, CCNS, CWON
Jan Goltare, RN-BC
Kimberly Gengler, RN
Danyel Johnson, RN, MSN, CNN
Allyson Kirkman, RN, BSN
Angelina Leonar, RN
Anita Mintz, RN
Beth Passmore, RN
Luz Rosero, RN
Poster Presentation: “The Pressure Is
On: Skin Savers to the Rescue.” North
Carolina Organization of Nurse Leaders Research Day, Raleigh, November
2012. Recipient of the Leadership
Award.
reduced by 68 percent.
Through the work of a multidisciplinary team from the NICU, several changes
in practice for the care of infants with central IV lines have been successful in helping reduce the CLABSI rate, according to Susan Jones, RNC-NIC,
NICU Assistant Director. One creative change to practice is the creation of
the “bubble,” the practice of screening off the area around sterile central line
“This has truly
been a team
effort among all
staff to make this
work a success.
We are extremely
proud of all
involved.”
– Susan Jones, RNC-NIC
procedures. Inside the bubble, other practices include using a face mask and
sterile gloves during IV tubing assembly; using a completely closed system
for IV fluid and medication delivery; scrubbing the needleless connectors on
the IV lines with friction for at least 15 seconds and allowing to air dry; and
changing central line dressings only as needed. As of Dec. 1, the NICU has
been 379 days CLABSI free.
In the fall of 2011, the NICU was invited to participate in a national collaborative. Women’s Hospital was one of 91 NICUs from nine states who worked
to reduce their CLABSI rates. Through work on the national level, the NICU
added an additional goal to focus on removal of central lines as soon as the
infant’s condition allowed. The NICU has been invited to participate in the
next phase of the national collaborative. “This has truly been a team effort
among all staff to make this work a success. We are extremely proud of all
involved,” Jones says.
MAGNET
NEW KNOWLEDGE, INNOVATIONS
AND IMPROVEMENTS
5
CONE HEALTH
Care Delivery Model: What’s That?
By Ruthie Waters, RN, MSN, NEA-BC
We made it through the implementation of Cone HealthLink, “One Patient-One Chart.” We also survived an in-
During that stay, the multidisciplinary team assesses the need for further treat-
tense visit from The Joint Commission, and we received
ment based on the patient’s needs. The Assessment Crisis Team (ACT), composed
a reprieve from another visit, for now. I had the privilege
of registered nurses, licensed clinical social workers, licensed professional coun-
of having an active role in both of these very important
selors and chaplains, is responsible for assessment and referral services, orders
events, and I am very proud to say that I work in an or-
for admissions and referrals from medical-surgical units. “It’s a challenging work
ganization where I see caring demonstrated consistently,
day – never dull,” Bartlett says. “We want to contribute to Cone Health and to the
across the board, no matter where you work or what your
community.”
Focus on Patient Safety,
Privacy and Care
• State-of-the-art
camera surveillance
throughout the unit.
role is.
The Behavioral Health Hospital “goes out of its way to include us,” says Jamie
You may be wondering, “What’s next?” Or, being the
Blue-Matthews, RN IV, BSN, CEN, Emergency Department, Wesley Long Hospital.
strong and supportive team players you are, perhaps you
are saying, “Bring it on, I can handle it!”
Staff and Community Response
The reality of mental health care today impacts the staff and the community.
Well, how about this? We are up for Magnet re-designation
Things are not always rosy in the Behavioral Health Emergency Department. On
in a few short months, and we need to have a clear under-
some days, 10 beds are not enough, and the stress can be intense. “I use humor,”
standing of how all that we do comes together to get us to
Smith says. “I encourage the staff so we don’t get bogged down.”
Magnet status.
Blue-Matthews thinks debriefing with the chaplain and “just talking among ourOne of the terms you will need to understand as we pre-
selves” is the best way to deal with the challenges. “It takes a special nurse to do
pare for our visit with the surveyors for Magnet re-designation is “care delivery system.” At Cone Health, our care
team and how leadership manages the department. When
delivery system is Relationship Based Care (RBC).
leadership promotes the therapeutic relationship between
the patient, nurse and all members of the care team, an
A care delivery system is an infrastructure for organizing
environment of caring and healing is established. Staff
and providing care to our patients and families. Plain and
develops and grows, and we meet our mission of caring for
simple, the care delivery system is what guides the way we
our patients/families, our community and each other. That
provide care to our patients every day. The primary focus
is our care delivery system, RBC.
• Secured bedside
emergency equipment.
• Hospital-provided
nutrition.
• Two bathrooms with
showers.
• Policies assuring
patients’ and visitors’
rights.
this job,” Blue-Matthews says. “Emergency nurses think fast and act quickly. Here,
listening can be the best skill.”
According to Deborah Thomas, NT, patients have positive opinions about the facility and care in the Behavioral Health ED. “Thank you for not treating my mother
like a burden, for staying with her” is affirming to hear. Thomas chose to work in
this department and notes, “Every now and then I make a difference.”
• Restraints avoided if
possible.
• Greensboro Police
Department officer
present 24 hours
per day.
in our care delivery system is the relationship between the
nurse and the patient and family.
Look for a CBL coming soon to help connect the care delivery system to other important structures and processes
Other important elements of a care delivery system in-
in nursing at Cone Health. Knowledge of how these drive
clude: staffing and scheduling of patient assignments, how
the actual care we give is important as we seek our third
we communicate with other members of the healthcare
Magnet designation.
“Every now and then I make a difference.”
MAGNET
– Deborah Thomas, NT
EXEMPLARY PROFESSIONAL PRACTICE
6
15
ANNIE PENN HOSPITAL
BEHAVIORAL HEALTH HOSPITAL
Meeting Acute Mental Health Needs
Through Multidisciplinary Collaboration
Humpty Dumpty
Award
By Ann Finch, RN, MSN, PMHCNS
Working to prevent falls
Opened in 2012 as part of the new Wesley Long Hospital Emergency Department, the impressive Behavioral Health Emergency Department is striving to
meet the acute mental health needs of our community’s residents.
The winner of the Humpty Dumpty award goes
to Department 6700-Medical/Renal, Moses Cone
The 10-bed unit’s focus is on safety, stabilization and referral.
“I love it,” says Mike Smith, RN III, a former police officer and emergency
From left to right: Nicole Small, Assistant Director, Surgical
Services, Melanie Bradsher and Wayne Mcfatter, Director of
Surgical, Endoscopy and Radiologic Services.
nurse who now works at the Behavioral Health Emergency Department.
tant.”
Melanie Bradsher receives
Marjorie Simpson Award
Community Need
Toni Bartlett, RN, BSN, MHA, Assistant Director, Assessment Department, Cone
Health Behavioral Health Hospital, has witnessed the increasing demand for
emergency mental health services and Cone Health’s commitment to serve this
Mike Smith, RN III, and
Sheila Lilly, RN II, MSN-MHA,
in the Behavioral Health ED.
population. As a result of North Carolina mental health reform during the last
decade, local mental health departments have been consolidated and privatized
while the number of beds at state mental hospitals has been reduced. An unintentional effect of reform was the increase in the number of patients relying on
emergency departments for care. A census of more than 20 mentally ill patients
“It takes a special
in the Cone Health emergency departments has become common.
Multidisciplinary Collaboration
job. Emergency
nurses and nurse techs who provide care 24 hours daily, seven days a week. The
The Behavioral Health Emergency Department has a dedicated staff of registered
unit sees patients with a variety of diagnoses. Many are depressed and suicidal.
Wesley Long Hospital for a 73 percent reduction.
Congratulations on these successful gains in one
Melanie Bradsher, RN, BSN, CGRN, Endoscopy Specialty Coor-
our patients - keeping them safe and preventing
dinator at Annie Penn Hospital, received the Marjorie Simpson
harm.
Award for professional excellence.
The award was started in 1995 and has been awarded annually
since then by Surgical Services at Annie Penn Hospital. The
criteria for being nominated are:
• Demonstrates integrity, honesty, accountability and functions
within his or her scope of practice
• Displays a commitment to patients, families and colleagues.
nurses think fast
homeless. Smith says the unit stays “about 99 percent full, with an average length
and act quickly;
The nominees can be from any area of Surgical Services (OR,
of stay of two to three days.”
Anesthesia, Short Stay, PACU, Endoscopy, Sterile Processing
Staff of 6700 pose with the Humpty Dumpty Award.
Department) and any job category (nurse, tech, staff, leader, etc.).
here, listening can
14
a 29 percent reduction in falls and to 5 East of
of the most important nursing responsibilities for
Others are homicidal or psychotic while others need detoxification. Some are
– Jamie Blue-Matthews
Inpatient Rehabilitation, Moses Cone Hospital, for
• Member of the surgical services team for at least one year.
nurse to do this
be the best skill.”
For improvements between quarters 3 and 4,
honorable mentions go to Department 4000 -
“There’s a need for psychiatric help. I like meeting emergency medical
needs as well as emergency psychiatric needs. They are equally impor-
Hospital, for an 82 percent reduction in falls.
MAGNET
MAGNET
TRANSFORMATIONAL LEADERSHIP
EXEMPLARY PROFESSIONAL PRACTICE
7
MAGNET
CONE HEALTH
Changing the Culture of Nursing,
One Idea at a Time
By Nicole Baltazar-Holbert, RN, MSN, and
Monette Mabolo, RN, MBA, MSN, CPAN, NEA-BC
“Culture” has been a buzzword at Cone Health recently.
•
Monette Mabolo, RN, MBA, MSN, CPAN, NEA-BC,
We as nurses are faced with the challenge of how to en-
Department Director for 4700, wanted a way to
hance current culture to improve the experience of both
chronicle the good things patients had to say about
patients and staff. Consider the recent experiences of one
the care they received on her unit. Mabolo’s idea led
unit: The Moses H. Cone Memorial Hospital’s Heart Failure
to the creation of a “WOW” card (as in “Wow, I had a
Unit (Department 4700) recently launched several new
great experience”). Some patients fill out their WOW
initiatives that are helping to transform the Unit’s nursing
cards at the hospital, while others take them home
culture while improving patient care in their department.
to mail them back later. One patient recently wrote
about how 4700’s staff “gets it”: putting patients first
•
Unit 4700 recently implemented a fun and effective
with expert care. “The WOW cards have been a great
way to educate heart failure patients. Following the
way for me to see more of the many wonderful things
systemwide People Excellence Symposium, the unit
the staff do for our patients,” Mabolo says. The cards
staff brainstormed ways to develop their own “sig-
are also positive reinforcement for the staff and go on
nature” initiative. Mavis Nyako, RN, proposed send-
display at the nurse’s station. Moreover, several other
ing heart failure patients home with a fresh apple as
units have “borrowed” the WOW card idea as a way
a tangible symbol of healthy lifestyle changes that
to celebrate the good things happening on their own
will be necessary. Nyako also proposed the acronym
units.
Cone Health’s High-Flying
Nurse Extern Program
APPLE: Acknowledging Patient’s Participation Lengthens Life Expectancy. (The APPLE program also helped
to debut the new “ZONE” heart failure educational
tool, which is a stoplight visual to help patients assess
daily weight gain and overall health, guiding patients
when to contact a physician with the hope of reducing hospital readmissions.) Patients also leave with a
thank-you card designed by Assistant Director Lanisha
Hunter, RN, BSN, MHA, and signed by the staff. The
latest patient satisfaction results compiled by Press
Ganey revealed the APPLE initiative has skyrocketed
Unit 4700 to the 90th percentile in patient satisfaction
Recently launched
initiatives are helping to
transform this Department’s
nursing culture while
improving patient care.
concerning discharge teaching.
Illustration by Bill Stork, StorkStuff
8
13
ANNIE PENN HOSPITAL
2012 Press Ganey
National Client Conference
Debbie Green
Mickey Foster
The experts on how to achieve top-decile performance
Additionally, in 2012, Annie Penn Hospital achieved 99th
nationally in employee, physician and patient satisfaction
percentile ranking in employee engagement, making it
shared their secrets with a standing-room-only crowd of
eligible to receive the Press Ganey Distinctive Workplace
healthcare providers recently.
Award in 2013. Hospitals need to achieve 95 percent or
above employee engagement scores for two consecu-
The experts? Cone Health’s own Dr. Debbie Green, Vice
tive years to achieve this award. If successful, Annie Penn
President, Nursing/Patient Services, Annie Penn Hospital,
Hospital would be the only hospital in the state of North
and Mickey Foster, President, Annie Penn Hospital.
Carolina with this honor.
The setting? The annual National Press Ganey Conference
on Nov. 13 in Washington, DC.
Green and Foster told the audience that successful organizations know that one of their most valuable resources for
Press Ganey is a recognized leader in healthcare perfor-
delivering superior care is dedicated employees. True part-
mance improvement and works with more than 10,000
nership between employer and employee is a win-win-win,
healthcare organizations nationwide, setting benchmarks
resulting in quality improvements that benefit patients,
for best practices.
staff and operational outcomes.
Green and Foster’s presentation was titled “Leading for a
Evidence of this partnership is evident in the National Da-
Trifecta: Top Performance in Patient, Employee and Physi-
tabase of Nursing (NDNQI) RN Satisfaction Survey results
cian Satisfaction.” Their remarks focused on how employ-
for 2012, in which Annie Penn Hospital scored at the 90th
ee and physician satisfaction translates into exceptional
percentile nationally in the Practice Environment Score,
4700 also included staff orientation in its cultural
new hires. Owens also created a tracking tool for
quality and patient care.
and all five components of it, which include participation
evolution, by aggressively soliciting feedback from
mandatory first-year education for new RNs. The
in hospital affairs, foundations for quality, nurse manager
new hires to the unit. That feedback led to the
RN IV and lead staff meet with orientees once a
Press Ganey reported that the mean score of Annie Penn
ability, staffing and resources, and nurse:physician re-
creation of a 4700 Orientation Model by Donna
month for the first three months, and then at the
Hospital for the fourth quarter of 2011 reached the 95th
lationships. Additionally, nurses at Annie Penn Hospital
Owens, RN, BSN, PCCN. “Lead” staff for each role
end of the first year. The goal of this strong Ori-
percentile in employee engagement; the 96th percentile
rated their job enjoyment at 5.58 points above the 90th
now collaborate with the Unit’s RN IV to review
entation Model is that is supports experienced as
in physician satisfaction; and the 94th percentile in patient
percentile rating nationally.
orientation materials specific to their job titles and
well as new-to-role employees. It is unique in that
develop the expertise to teach new employees
Lead staff roles were created for RNs, NSMTs, and
with the same knowledge as the unit educator.
Nurse Techs so that they could develop expertise
A Nurse Secretary Monitor Tech (NSMT) serves
specific to their job titles. New hires this fall felt
as the Orientation Materials Coordinator, whose
better acclimated to the unit, Owens says. Another
job is to compile an orientation notebook with
“win” at Cone Health for employee-driven cultural
resource documents specific to 4700 competen-
change!
satisfaction. Only a small number of hospitals nationwide
manage to achieve top-decile performance in all three key
areas.
MAGNET
TRANSFORMATIONAL LEADERSHIP
Clarification
Staff and leadership of 4700 enhance current culture to improve the experience of both patients and staff.
cies, as well as to coordinate welcome gifts for all
On page 10 of the Nursing Beat, Vol. 9 No. 4, Fall 2012, it states: “The PNAP review committee will then schedule a date
for an interview with the committee.” This should read: “Upon approval of your portfolio by the PNAP review committee,
you will be sent an email with information to schedule a time with the committee. RN IIIs will come to pick up their portfolios at their scheduled time. RN IVs will give a brief (10 minute) presentation about their case study or project.”
12
MAGNET
STRUCTURAL EMPOWERMENT
9
CONE HEALTH
“Destination RN”
Cone Health’s High-Flying Nurse Extern Program
Cone Health’s Nurse Extern program, “Destination RN,”
By Cassandra Galloway, RN, MBA\MHA, Jacqueline Clarke, RN, MSN, OCN, Ariella Singer, RN, BSN, and Maura Barber, RN, BSN
• The program has grown from 15 participants to as many
offers BSN nursing students paid externships during the
as 40 per year.
velop “soft” skills such as effective communication, teambuilding and problem-solving.
summer prior to their senior year. “Destination RN,” now in
its fourth year, uses a theme-based approach to support
• Cone Health successfully retains many externs as nurse
the transition from student to the role of practicing nurse.
techs during their senior year of nursing school.
The extern program takes each nursing student on a 10-
Montressa Blount, NT 1+3, who currently works in the flex
pool, affirms the value of being a nurse extern. “It certainly
was a rewarding experience for me. I gained a lot of confi-
week “trip.” Participants “board” a plane and journal about
• Upon graduation, 97 to 100 percent of previous nurse
their experiences. The trip culminates in a celebration at
externs join Cone Health as new graduate nurse
their final destination – the end of the 10 weeks.
employees.
dence for my clinical classes, and I have stayed on at Cone
Health to work during my senior year,” she says.
Interested applicants may apply for an extern position dur-
Cassandra Galloway, RN, MBA\MHA, and Lobel Lurie, RN,
MA, Extern Program Coordinators from the Staff Education office, recently won “Best Practice” for their poster on
“Destination RN,” which was presented at the 2012 Association for Nursing Professional Development national
conference in Boston.
100% of the 2010 Nurse Extern group became Cone
Health nurses and are still employed in the network.
At a time when some other hospitals in the state and
region have curtailed or ended their summer extern offerings, Cone Health’s nurse externship program, which
began more than 20 years ago, continues to flourish. For
example:
The goal of “Destination RN” is to expose the student ex-
ing the November through January period of their junior
tern to patient care in the acute care setting, while working
year of nursing school. For more information, go to cone-
side-by-side with a registered nurse. The extern and nurse
health.com and type “nurse extern” into the search win-
share the same patient assignments, which enables the
dow or contact the Staff Education office.
student to observe and acquire new skills. For example, the
nurse extern must be certified to perform the same tasks
as a current “NT 1+3,” including using sterile technique,
IV care and urinary catheterizations. Externs also attend
weekly meetings with the program coordinators to de-
“It certainly was a rewarding experience
for me. I gained a lot of confidence for my
clinical classes, and I have stayed on at Cone
Health to work during my senior year,”
MAGNET
STRUCTURAL EMPOWERMENT
10
11