Progresson the Road to the Future

Progress
on the Road to the Future
NURSING ANNUAL REPORT 2013
1
MEDSTAR WASHINGTON HOSPITAL CENTER
OUR
Goal
▶ TA K E
1, 8 0 0 N U R S E S and a few hundred patient care technicians, unit clerks,
paramedics and dispatchers working on 54 different units in 14 separate shifts around
the clock…and then move them all in one unified direction.
That’s the goal of Roadmap to the Future, the Department of Nursing’s Strategic
Plan. Developed collaboratively with the input of hundreds of nurses, Roadmap
empowers the nursing staff to drive improvements in the delivery of care at MedStar
Washington Hospital Center. The Roadmap was distributed in November 2012, and
outlines specific goals in such vital areas as safety, patient satisfaction and professional
development. It will be updated yearly.
This year’s Annual Report, Progress on the Road to the
Future, shows that planning that involves all the players
works. It pays tribute to the enormous energy, dedication
and caring that the entire Department of Nursing puts
into both patient care and the new Strategic Plan. All the
accomplishments here were staff-driven, and relate to the
goals in the Strategic Plan.
On some measures, such as voluntary nurse turnover
rates, we have improved so much that we are now doing
better than the national average. On other measures, like
professional development, we are just beginning new programs that will support and
encourage those who want to grow their career here.
Enjoy this story of a dynamic year in a department with thoughtful ideas, amazing
energy and the Strategic Plan to get us where we are going. The most exciting part?
We’re just getting started.
Susan Eckert, RN, MSN
SENIOR VICE PRESIDENT & CHIEF NURSING EXECUTIVE
2013 Nursing Annual Report
2
Goal
▶ ▶ TO E S TA BLISH A N EFFEC TI V E LE A DER SHIP TE A M
200
At the end of fiscal year 2013, there are 1,803 clinical nurses at MedStar Washington
Hospital Center. They work in 32 inpatient units and 22 additional patient care
areas. There are also more than 150 unit clerks, 276 patient care technicians and
various other associates in the Department
of Nursing. They work 24/7 in a series of 14
TO G E T H E R , T H E S E N I O R N U R S I N G
shifts per week.
D I R EC TO R S H AV E M O R E T H A N 2 0 0
A stellar leadership team is vital to thoughtfully run these units with a constant focus on
quality and safety. One of the first goals of the
2013–2015 Strategic Plan: create a core of senior nursing directors with the experience
and expertise to support every associate in providing excellent patient care.
YE ARS OF NURSING E XPERIENCE
In FY2013, two new senior nursing directors — Jane McGee as head of Medical/
Surgical Services and Janis Donnelly as head of Nursing Quality, Safety and
Education­ — joined the nursing leadership council. In addition, Rosemarie Paradis
was appointed vice president of Nursing Excellence. Collectively, the team brings nine
masters of nursing degrees, three MBAs, and five certifications to the leadership table.
But most importantly, they have all spent years as nursing clinicians. They know what
works and what doesn’t, from the bedside to the boardroom. They can work with all
nurses to move the Department of Nursing forward on the road to the future.
▶ ALL ABOUT EXCELLENCE
Senior Nursing Leadership Team: FRONT ROW, (L–R): Rosemarie
Paradis, vice president Nursing Excellence, Susan Eckert, senior
vice president and chief nursing executive, Tonya Washington,
vice president, Nursing Operations. BACK ROW (L–R): Jane McGee
(Medical/Surgical), Ariam Gebrehiwot (Ambulatory Care),
Barry Garner (Critical Care), Janis Donnelly (Quality, Safety
and Education) and Ann Marie Madden (Nursing Operations,
MedStar Heart Institute).
3
MEDSTAR WASHINGTON HOSPITAL CENTER
ROSEMARIE PARADIS served 23 years in
the military, first as a hospital corpsman
and then as a career officer in the Navy
Nurse Corps. She followed with a stint
at the Veterans Health Administration
and the Navy Bureau of Medicine and
Surgery headquarters, then she moved
to Riyadh, Saudi Arabia to take on the
Assistant Chief of Nursing Affairs role
at the King Faisal Specialist Hospital
and Research Centre, a 936-bed tertiary care facility. For someone who
likes such adventure, what’s next? For
Paradis, it was MedStar Washington
Hospital Center. In her role as vice
president of Nursing Excellence, which
she began in FY13, Paradis works with
all nurses at the Hospital Center, ensuring they have the tools and resources
they need to deliver high quality and
safe patient-first care—and excellence
in Nursing.
Goal
▶ INCR E A SED NUR SING R E TENTION A N D ENGAGEMENT
900
NURSES (50 PERCENT OF THE
N U R S I N G S TA FF ) H AV E B E E N
H E R E LO N G E R T H A N FI V E Y E A R S
In FY13, nurse turnover rates were high nationwide. In fact, the Bureau of Labor
Statistics estimates a 26 percent growth in the demand for nurses through the next
seven years, the highest growth in demand of any career in the U.S.
Driven partly by these national trends and by the fact that nurses with experience
at any institution increase the quality and safety of patient care, one of the key
goals in the Department of Nursing Strategic Plan is to reduce turnover rates and
improve nurse engagement. Key tactics implemented in FY13 to reduce turnover:
▶WHO
WE ARE
The Department of Nursing strives
for diversity to reflect the impressive
breadth of backgrounds in the 450,000
inpatients and outpatients treated
annually. Our nurses hail from both
the local area and as far away as
Mongolia, Afghanistan and Venezuela.
Gender
GENDER
MALE
9%
ՔՔCreation of a Nurse Engagement Team, to develop specific programs for nurse
on-boarding and retention
91%
ՔՔImplementation of a shadow program to allow nurses to understand and
experience practice across units
FEMALE
Ethnicity
ՔՔDevelopment of nurse “bridge” programs to provide in-house training in new
specialties and other professional development programs
As a result, voluntary nurse turnover rates at the Hospital Center dropped below
13 percent for the first time in more than four years. The national average ranges
from 14 percent (KPMG) to 14.7 percent (2013 NSI Nursing Solutions Survey).
ETHNICIT Y
0.6% NATIVE AMERICAN/
ALASKAN NATIVE
35.6% WHITE
18.2% ASIAN
E M P LOY E E E N G AG E M E N T: 2 013 DATA V E R S U S 2 010 DATA
CATEGORIES
IMPROVEMENT
SINCE 2010
FAVORABLE SCORES 2013
Leadership & Direction
55
65
17
58
12
Performance Management
75
11
Supervision
74
9
Career Development & Training
70
Patient First
25
50
LESS THAN 1 YEAR
7
40
0
19.9%
31.3%
10+ YEARS
8
63
Total Rewards
Length of Service
LENGTH OF SERVICE
9
65
Engagement
43.5% BLACK
2.2% HISPANIC
19
Communication
Teamwork
0.1%
HAWAIIAN OR
PACIFIC ISLANDER
4
75
0
20
13.6 %
1– 2 YEARS
9.2%
9.1%
2– 3 YEARS
7– 10 YEARS
31.3%
10+ YEARS
19.9%
LESS THAN 1 YEAR
5.5%
8.1%
5– 7 YEARS
3.3%
3– 4 YEARS
4– 5 YEARS
2013 Nursing Annual Report
4
▶ AG E N C Y
NURSE TRENDS
108
N U R S E S H AV E
BEEN HERE MORE
THAN 30 YEARS
Agency (temporary) nurses play a vital role, filling in gaps in staffing. Yet, one of the
targets of the Strategic Plan is to replace agency nurses as much as possible with staff
nurses, both full-time unit-based nurses and nurses from the Hospital Center’s float
pool. Staff nurses say they prefer working with other staff nurses, because it enhances
the overall quality of care, by ensuring that patients are cared for by nursing staff that
understand the Hospital Center systems and resources. It also enhances collegiality.
▶ SO FAR SO GOOD
Nurse DEE STOEHR started at MedStar
Washington Hospital Center working in
the hematology lab when she was 18. She
graduated from the School of Nursing
here in 1963. She met her husband here,
had her two children here … and in FY13,
Dee celebrated her 50th anniversary in the
Emergency Department.
In FY13, Resources Management staff reviewed processes and worked with nursing
leadership to identify staffing requirements, to better predict turnover and anticipate
future staffing needs. This information led to changes in hiring decisions that
minimized vacancies requiring the use of contract agency staff. This, coupled with a
shift to using per diem staff to cover vacant shifts, led to a 61 percent decrease in the
use of contract agency staff.
NUMBER OF CONTRACT NURSES
The Nursing Float Pool also was revamped. An additional assistant nursing director
(AND) was hired to manage the patient care technician (PCT) and unit clerk float
pool, which allowed for more coaching and mentoring of both the support and
professional nursing associates.
Additional PCTs were hired to work
AG E N C Y N U R S E U S E
in the float pool and received a
50
comprehensive orientation. Current
DEPARTMENT OF
NURSING
PCTs were provided with a newly revised
40
annual skills update.
30
20
OVERSIGHT
AREAS
10
0
FY12
FY13
▶ I FOUND WHERE I WAS MEANT TO BE
Keeping nurses who come to MedStar Washington Hospital Center as travel or agency nurses is
strategically beneficial to both parties. Travelers get to “try out” the environment first and commit
only when they feel comfortable. The Hospital Center hires a nurse who is already versed in the
systems and culture.
That was the case for SYDNEY AMADO in FY13. She received her nursing degree from Virginia
Commonweath University, then spent three and a half years living and working in Richmond. “We
were the only trauma center for miles around, so it kept us busy,” she says. When the self-described
“military brat” got restless, she signed on as a travel nurse. She confesses she really wanted to end
up in Boston —“my favorite city”— but did stints at Yale, Johns Hopkins, Santa Barbara and Stanford
University hospitals before landing in the MedSTAR Trauma Unit last winter. “I came here to be near
family for a while, and I ended up loving this unit. I had never worked in trauma bays before. Plus,
the staff is awesome,” she says. When her three month contract expired, “I signed up. It’s hard to
explain, but I felt like I had found where I was meant to be.”
5
MEDSTAR WASHINGTON HOSPITAL CENTER
Dee Stoehr—
50 years at the
Hospital Center
Former traveler
Sydney Amado.
Goal
▶ INCR E A SED PROFE SSION A LISM A N D PROFE SSION A L DE V ELOPMENT
403
R N C E R T I FI C AT I O N
R EC E I V E D $1.7 M I L L I O N I N
TUITION REIMBURSEMENT
Healthcare is constantly evolving, and the Strategic Plan includes goals to develop
and grow the expertise and skills of our nursing associates so they remain on the
cutting edge.
It begins with a policy of hiring nurses who have completed their Bachelor of
Science in Nursing and continues by helping nurses, patient care technicians and
others go back to school to complete their undergraduate degree or advanced
degrees. In FY13, 403 nursing associates received more than $1.7 million in tuition
reimbursement to further their formal education.
40%
30%
20%
10%
0%
N U R S I N G A S S O C I AT E S
% CERTIFICATION
% PROFESSIONAL
ORGANIZATION
MEMBERSHIP
It continues with additional training and education. In FY13, about $70,000 was
allocated to 167 nurses to attend continuing nursing education conferences.
Those who want mid-career skills development can participate in “bridge” programs,
which provide intensive 18-month on-the-job training in numerous specialties.
2013 Nursing Annual Report
6
81
%
81
60%
40%
0%
ՔՔDuring FY13, Nursing Education provided 206 courses, and supported each
nurse in completing his or her annual competency requirements.
17
8
3
DIPLOMA
AD
81 P E R C E N T I N O N E Y E A R
ՔՔA total 146 nurses moved into one of nine bridge programs (Operating
Room, PeriAnesthesia, Emergency Department, Cardiac Catheterization Lab,
Electrophysiology Lab, Critical Care, Progressive Care, Women’s and Infants’
Services, Neonatal Intensive Care) for intensive 18-month work-based specialty
training.
100%
20%
I N C R E A S E D FR O M 67 P E R C E N T TO
ՔՔAll 455 new nurses in FY13 were provided with extensive orientation.
R N D EG R E E S
80%
P E R C E N T O F S TA FF W I T H B S N D EG R E E S
BSN
MSN
0.4
DNP/PhD
ՔՔTraining in new specialties and other professional development programs
As a result, voluntary nurse turnover rates at the Hospital Center dropped below 13
percent for the first time in more than four years. The national average ranges from
14 percent (KPMG) to 14.7 percent (2013 NSI Nursing Solutions Survey).
▶ TAKING IT TO HEART
Several nurses working on the Cardiac Intermediate Care Unit
(IMC), are studying to become Certified Heart Failure Nurses
(CHFN). They will use their expertise to care for the increasing
number of patients who are admitted with the diagnosis of
heart failure and who require advanced cardiac therapies
such as inotropic drug infusions, ultrafiltration or ventricular
assist devices.
During the last year, the Cardiac IMC multidisciplinary team
developed evidence-based admission and discharge criteria
and specific treatment protocols for the heart failure population.
Special emphasis on patient education improves the patient’s
ability to manage his or her therapy and devices once she or he
has have been discharged.
Staffing has been increased and staff has been provided
with additional education to meet the needs of the complex
advanced heart failure patient. As a result, up to 11 patients
needing advanced therapies can now be cared for on the unit,
with the goal of increasing that number to 15.
Members of the Cardiac IMC multidisciplinary team
Goal
▶ ENH A NCED PATIENT C A R E
91,000
M E D S TA R WA S H I N G TO N H O S P I TA L C E N T E R
E M E R G E N C Y D E PA R T M E N T T R E AT S 91, 0 0 0
PAT I E N T S P E R Y E A R — A B O U T 2 5 0 P E R DAY.
▶A
S E A M L E S S PAT I E N T E X P E R I E N C E
In FY13, a special team of nurses began working with a variety of Performance
Improvement consultants to optimize patient “throughput”— the flow of time
and information for patients in the hospital — as well as improving the patient’s
experience while here. The goal: to ensure that patients receive care that is
efficient and of the highest quality in a comfortable environment.
The FY13 projects focused on:
ՔՔEnsuring beds are available for
postoperative patients
ՔՔImproving the efficiency of bed
assignments
ՔՔImproving bed turnover and
availability
ՔՔStandardizing the discharge process
ՔՔDecreasing transport time for
discharges
ՔՔEnsuring needed equipment is
available for discharge
Ongoing quality monitoring validated
the success of the project. The average
length of stay has trended down, and is
now below the target of 5.5 days. Overall
patient satisfaction with the hospital has
improved to above a target of 70 percent.
The number of Emergency Department
boarding hours has decreased signifiwcantly from a baseline (FY13 thru
February) of 6,560 to 3,014 in June.
2013 Nursing Annual Report
8
Nurses on 2H learned to use
the pupilometer to detect
subtle changes in a patient’s
condition.
▶ TA K E
O N E U N I T, S H A K E W E L L …
For the 49 nurses on unit 2H, FY13 brought a lot of changes. Originally serving as
a general surgical/medical ICU, the second floor ICU made a radical change this
year: all nurses were retrained so the ICU could become dedicated to neurologic
patients. This meant all nurses and patient care technicians went through eight
hours of training, during which they learned to care for patients with strokes,
brain tumors, traumatic brain injury and spinal cord injuries. Among the new
skills: how to use a pupilometer to detect subtle changes in a patient’s condition
and how to categorize a patient on the National Institutes of Health Stroke Scale.
They also learned advanced neuroassessment skills to identify subtle changes in
patient condition.
The advanced training paid off: since the change in service line, neurosurgery
volumes have accounted for almost half of all patient admissions to 2H. The
training teaches earlier interventions for changing conditions, which results
in better patient outcomes. The transition may have been challenging, but it
apparently wasn’t that bad: since the changeover, staff engagement scores have
gone up 6 points.
9
MEDSTAR WASHINGTON HOSPITAL CENTER
Jani North-Saale, 2H Nursing Director, says
“It is very exciting to work with a group of
nurses who are so dedicated to expanding their practice, and for us to be able to
provide expert care to such a dynamic and
challenging group of patients.”
Goal
▶ FOCUS ON QUALIT Y AN D SA FE T Y
▶ Q UA L I T Y
I N I T I AT I V E S
Safety in the hospital environment requires rigorous attention and continuous review.
In FY13, several Department of Nursing safety initiatives led to improvements.
FA L L P R E V E N T I O N
Using evidence-based interventions for
their specific patient population, unit
leaders and staff targeted opportunities
for improvement. Two nursing units,
3NW and 4F, exceeded their target of a
25 percent reduction in falls. Among the
interventions used:
ՔՔDiscussing fall assessment scores during
daily huddles with the staff
A N N UA L FA L L R AT E
3.5
2.9
3.0
2.9
Fall Rate
70
LESS
FALLS
111
LESS
FALLS
2.6
2.5
2.1
2.0
1.5
2.0
Target
FY2009
FY2010
FY2011
FY2012
FY2013
ՔՔRenewed emphasis on the use of bed alarms and response to alarms
ՔՔHourly rounding to support toileting and ensuring personal items are within reach
ՔՔImproved staff awareness of patients on fall precautions by using visual aids, such
as magnetic yellow stars on the assignment board and yellow socks for high-risk
patients
As a result, the FY13 annual fall rate was reduced to 2.0 falls/1,000 patient days.
P R E S S U R E U LC E R S
An interdisciplinary project piloted The National Pressure Ulcer Advisory Panel
& Wound Ostomy Continence Nursing Society recommendations for liquid
nutritional supplementation for patients at risk for pressure ulcers. The pilot units,
1C and 3NW, engaged in two six-week trials, with each interval evaluated for
enrollment adherence, and nurse and patient satisfaction. The results were positive
and the program is recommended for hospital-wide implementation in FY14.
Such pressure ulcer prevention efforts have succeeded in decreasing the rate of
pressure ulcers by 35.5 percent during the last year, or 50 fewer patients developing
a hospital-acquired pressure ulcer.
CO R E M E A S U R E S
Nursing core measures are a set of evidence-based care processes endorsed
by the National Quality Forum to improve the quality of care through the
implementation of standardized performance measure systems.
F Y 13 C O R E M E A S U R E C O M P L I A N C E
MedStar Washington Hospital
Center was awarded the 2013
Delmarva Award for Medicare
Excellence.
Pneumonia
Blood Culture in ED prior to initial antibiotics
99%
Heart Failure
Discharge instructions
99%
SCIP
Urinary catheter removal by day 2
95%
Timely VTE prophylaxis
98%
Cardiac surgical patients with controlled 0600 blood sugar
Immunization
Influenza vaccination
97%
Pneumococcal vaccination
96%
Stroke
Discharge instructions
93%
VTE
Discharge instructions
99%
2013 Nursing Annual Report
10
▶ S M O OT H E R
O P E R ATO R
BEVERLY JAMES says she is an operating room nurse “to the core.” She helped open the first
floor OR at the Hospital Center in 2006. She assisted in almost every kind of surgery during the
past 12 years. “I can’t think of anything I’d rather do,” she says.
Then she was asked to become control desk manager for the third floor OR, managing the
flow of patients in an operating arena where more than 40 procedures per day are the norm.
“Everyone here is about patient first, advocating for patients,” she says. “Everyone was willing
to ask, ‘What can we do differently?’”
These days patients spend no time in the waiting room, but are taken back immediately and
interviewed to see if they have completed all their pre-operative instructions and whether
anything (such as difficulty inserting an IV) will be an issue. Other changes include more
immediate patient contact with anesthesiologists and surgeons and better communications
procedures. The result: on a day in FY13 when there were 65 procedures, “We totally rocked it.
There were no delays,” James says proudly. “Everyone has the same goal: we value our patients
and want the best for them. It’s corny, but it’s true.”
11 MEDSTAR WASHINGTON HOSPITAL CENTER
Beverly James—
operating room
nurse “to the core”
Goal
▶ IMPROV ED PATIENT SATISFAC TION
2,500
H O U R LY R O U N D I N G L E A D S
TO M O R E T H A N 2 , 5 0 0 PAT I E N T
I N T E R AC T I O N S P E R M O N T H
Sheila Smith— “You are lucky to have her on board”
of systems, circumstances and inner
workings of the hospital was apparent
from our first meeting. The bottom line
is that I feel very fortunate to have been
introduced to this fine professional. You
are lucky to have her
on board.”
H O U R LY R O U N D I N G
Hourly rounding on patients is an
important evidence-based practice that
increases both patient satisfaction and
ensures the patient’s safety. In FY13,
hourly rounding became a central part
of the Strategic Plan’s target of improved
patient satisfaction.
Associates were provided additional
education, scripting and bedside
validation. A new nurse/patient call system
was fully implemented, improving contact
between nurses and their patients.
Nurse leaders increased their daily
rounding, using a high tech/high touch
approach. The goals:
N U R S E N AV I G ATO R S
Thanks to feedback from patients who desired coordination
of care and an identified point of contact, the highly
successful Nurse Navigator program of the Surgical
Oncology practice expanded to the Medical Oncology
practice in MedStar Washington Hospital Center’s
Washington Cancer Institute during FY13.
Research shows that navigators increase access to patient
care and positively impact patient outcomes. Six oncology
nurse navigators, who assist the patient through the complex
medical system from diagnosis through survivorship, were
added to Medical Oncology.
In addition to helping the patient overcome barriers to
care, the navigators ensure the patient is referred to Cancer
Support Services and also serve as a patient advocate. If the
patient experiences problems during his or her treatment,
the navigator can provide support by performing telephone
triage and guidance. The navigator becomes a partner for the
patient and family throughout the treatment process.
Patient Randy Martin was clearly impressed. “Sheila Smith
is a wonderful, upbeat person,” he says of his navigator. “A
rare find today. Her experience and complete knowledge
ՔՔImproved communication
ՔՔClarified expectations
ՔՔIssue management
ՔՔService recovery
ՔՔRecognizing and rewarding excellent nurse performance
Nurse leaders are using iPads® to track their interactions and
collect data that can be used to improve overall performance
on the nursing unit.
DISCHARGE CALL S
Making sure patients receive excellent care across the
continuum is crucial to optimal outcomes. At MedStar
Washington Hospital Center this includes the post-discharge
period. Discharge calls are made to all inpatients within 48
hours of discharge to ensure that patients understand their
discharge instructions, comply with medications and have
made follow-up appointments and plans. If any problems
are identified, the nurse leader uses an algorithm to ensure
that the patient receives the appropriate intervention. During
FY13, the hospital converted to the Studer Patient Call
Manager System for discharge calls.
2013 Nursing Annual Report
12
Goal:
▶ IMPROV ED CO M M UNIC ATIONS
54
C H I E F N U R S I N G E X EC U T I V E S U E EC K E R T
V I S I T S A L L 5 4 I N PAT I E N T U N I T S AT L E A S T
O N C E A Y E A R F O R A M I N I TOW N H A L L
Communications in a hospital the size of MedStar Washington
Hospital Center can be daunting. The Department of Nursing
continually strives to upgrade communications among and for
nurses. In FY13, the system included:
ՔՔHuddles: A the beginning, middle and at hand-off on each
shift, nurses “huddle” (hold a brief meeting) to discuss
issues, alert colleagues to potential problems and hear
important notifications.
ՔՔWeekly leadership meetings.
ՔՔ“Mini town halls,” where Chief Nursing Executive Susan
Eckert and other nurse leaders visit a department and talk
with clinical nurses about issues that need to be addressed.
Direct contact with senior leadership provides a forum for
feedback. If a meeting results in a call for action, a followup town hall is scheduled a few weeks later.
ՔՔSpecial nurse-only email lists, such as the
MedConnect Minute, that informed nurses on
procedures and notifications about the electronic
medical records system training and launch.
ՔՔMedStar Washington Hospital Center Facebook
page, which celebrates news and events and profiles
nurses.
ՔՔA blog communicating important messages both internally
and to the community at large about noteworthy events at
MedStar Washington Hospital Center.
CO M M U N I T Y S E R V I C E
The Nurses Embrace eXcellence Together (NEXT)
Committee, composed of 21 Hospital Center nurses,
organized multiple community outreach projects during
FY13. They conducted a health fair during Nurses Week. A
Warm and Fuzzy collection of hats, gloves, and other warm
winter items was held to benefit the Community for Creative
Non-Violence. One hundred backpacks with school supplies
were donated to Marshall Elementary School. The committee
also developed and conducted an “anti-bullying” in-service
for nursing associates.
ՔՔWritten communications including electronic newsletters
such as the weekly Nurse Leader Bulletin and bi-weekly
Center eNurse, print publications such as the quarterly
Center Nurse and hospital-wide publications such as
CenterFocus and CenterScope.
Nurses from the Neonatal Intensive Care
Unit at the Hospital Center walked for March of
Dimes in March of FY13, raising enough to be
placed in the top ten of all fundraising facilities.
ABOVE:
13 MEDSTAR WASHINGTON HOSPITAL CENTER
Goal
▶ IMPROVED INTEGR ATION WITH UNIT CLERKS AND PATIENT CARE TECHNICIANS
425
NURSING SKILL MIX
7%
UNIT CLERKS
13%
PATIENT CARE
TECHNICIANS
80%
REGISTERED
NURSES
U N I T C L E R K S A N D PAT I E N T C A R E
T EC H N I C I A N S W O R K AT M E D S TA R
WA S H I N G TO N H O S P I TA L C E N T E R
The 425 unit clerks and patient care technicians are vital partners for nurses
to provide stellar patient care. The Strategic Plan targets improvements in the
integration of these associates in the overall functioning of the Department of
Nursing.
U N I T C L E R K R EO R I E N TAT I O N
Twenty four unit clerks have been hired during FY13, and the unit clerk float pool
has been increased by 11 to improve coverage on all units. The float pool was
reorganized with a dedicated manager for the clerical staff.
With the implementation of a new electronic medical records system, the unit
clerk role is being redefined by the Clerical Role Post MedConnect II Committee,
which includes two unit clerk representatives. Once the work of the committee is
complete, an education program and new unit clerk orientation will be developed.
PAT I E N T C A R E T EC H N I C I A N E D U C AT I O N C L A S S E S
The Strategic Plan called for developing on-going education for patient care
technicians in FY13.
With help from Nursing Education and several PCTs, a series of classes provided
updates on patient safety issues, including falls prevention and CAUTI and
CLABSI prevention. Other issues addressed included PCT safety and nurse/
PCT communication, delegation, the use of Maxi
slides, proper technique for urinary catheter care and
discontinuation, CHG baths, and the proper activation
of bed and chair alarms.
To express appreciation to the PCTs for the work they
do, a video titled, “On All Levels, We Appreciate Our
PCTs” was produced to begin each class, highlighting
the value of the PCT role in the Hospital Center. It
includes the chief nursing executive giving opening
remarks and nurses and unit leadership sharing their
experiences. The video also highlights Gwendolyn
Jackson PCT, 5NW. Gwendolyn was on the PCT
on-going education committee and was instrumental
in curriculum development. Her passion for patient
care was evident in her committee work, in her video
comments, and when she shared her thoughts in class.
Gwendolyn Jackson, PCT— instrumental in curriculum
development
2013 Nursing Annual Report
14
Goal ▶ ELEC TRONIC MEDIC A L R ECOR DS IMPLEMENTATION
16,000
N U R S I N G I N F O R M AT I C S P R OV I D E D M O R E T H A N
16 , 0 0 0 H O U R S O F T R A I N I N G F O R 1, 8 0 0 A S S O C I AT E S
I N T H E D E PA R T M E N T O F N U R S I N G
A huge task for FY13: prepare to launch MedConnect II, the electronic medical
records system that would cover all inpatient units at MedStar Washington Hospital
Center. This meant system training for every nurse and unit clerk.
With the guidance of the Clinical Informatics team, 22 clinical nurses became
“trainers”— system experts who then spent three months as the leaders in this
effort. They first prepared 350 nurses to be “super-users” for their units, then led
more than 1,800 associates through a minimum of eight hours of class each to
learn how to use MedConnect II.
In preparation for MedConnect II, a hospital-wide hardware assessment led to
upgrades like additional desktop computers, WOWs (Workstations on Wheels),
recessed hallway computers, tablets and new models of handheld scanners,
the MC75s.
MedConnect II will enhance patient safety with such upgrades as Computerized
Prescriber Order Entry (CPOE) for patient care orders, which will decrease
transcription errors, legibility issues and delays in order entry. Double checks and
provider rationale requirements, standardized order sets, automated medication
reconciliation as well as evidence-based plans of care also are available in the system.
Kenneth Kilemi started as a PCT, is now an
RN on 2NE and was one of 22 MC2 trainers.
“I wanted to be in the middle of it all,” says
the three-year Hospital Center veteran.
“Around the corner, after we get past the
newness, people will love this.”
AU TO M AT E D Q UA L I T Y A N D
R EG U L ATO R Y M O N I TO R I N G
MedStar Washington Hospital Center
has been a beta site for the Seer (Zeta)
system. The system allows for clinical
quality monitoring data and regulatory
tracers to be entered into a program
that allows for real time results. Pressure
ulcer, pain, plan of care and fall audit
data are being entered into the system
by clinical nurses who view on a
dashboard how their unit is doing. This
allows for immediate corrective actions
and ensures improved compliance and
unit regulatory readiness.
15 MEDSTAR WASHINGTON HOSPITAL CENTER
Goal
▶ INCR E A SED AC A DEMIC R E SE A RCH
25
%
N U R S I N G AC A D E M I C
RESE ARCH INCRE ASED
2 5 P E R C E N T I N F Y13
The Strategic Plan includes increased support for nursing research.
UHC NURSE RESIDENCY PROGR AM
Lilian Njoki (pictured below) collaborated with
fellow nurse residents Kristina Mobley, Ellie
Lomax, Maria Huddleston, Jonathan Whitman
and Jennie Bisset to research whether headlamps
were better for patient rest than turning on the
lights when they visited rooms at night.
In August 2012, 105 first-year nurses entered the University HealthSystem
Consortium (UHC)/Association of American Colleges of Nursing (AACN) Nurse
Residency program at the Hospital Center. New residency classes enter quarterly.
In its first year, the program grew to 126 new residents.
A key feature of the UHC residency is that each new nurse designs and completes
an evidence-based research project on his or her unit. In FY13, residents from unit
2C presented their abstract at the national UHC conference held in San Diego,
Calif., and 138 nurses completed 32 research projects, including noise reduction
studies and the use of headlamps to minimize patient disruption during nighttime rounds.
C E N T E R F O R E XC E L L E N C E I N N U R S I N G
The Center for Excellence in Nursing (CEN) at MedStar Washington Hospital
Center was created to help nurses keep pace with innovation, and advance the
practice of nursing through innovative projects, research and staff development.
CEN is funded through grants, philanthropic donations and by nurses who give
generously through payroll deductions. In FY13, CEN provided numerous awards
supporting education and research. It also purchased a high fidelity simulation
mannequin to provide real-life scenarios to nurses in a safe environment. CEN
will conduct research to demonstrate the efficacy of this technology in developing
critical thinking skills in registered nurses.
P R AC T I C E C H A N G E R E S E A R C H
A randomized controlled trial on Mother-Baby units 5D and 5F looked at whether
parental involvement can change a parent’s perception of overall care. In the
trial, nurse associates completed newborn pulse oximetry screening either in
the nursery, which is the usual practice, or at the mother’s bedside, a practice
change. It measured if mothers were more knowledgeable and satisfied when
screening occurred at the bedside. The RN team, including Elizabeth Bradshaw,
Lucy Wilcox, Preneta Richmond, Alease Young, Maria Floyd and Pat McCartney,
identified specific benefits of bedside screening and shared these tips with others
on the units.
2013 Nursing Annual Report
16
17 MEDSTAR WASHINGTON HOSPITAL CENTER
Goal
▶ INCR E A SED NUR SE SA FE T Y
21
%
N E W L I F T EQ U I P M E N T I S C R E D I T E D W I T H A
21 P E R C E N T D EC R E A S E I N S TA FF I N J U R I E S
A S S O C I AT E D W I T H PAT I E N T H A N D L I N G .
Nurse safety, especially workplace injury reduction, received significant attention in
FY13. Two major initiatives to reduce and prevent staff injuries were implemented:
The Sharp Safety Committee and the Safe Patient Handling Program.
Based on the recommendation of several nurse associates in the Sharp Safety
Committee, the hospital piloted a new Safety Glide needle and replaced all
non-safety needles with needles that feature safety devices. The transition was
completed in May 2013. As a result, the total number of sharp injuries declined,
and will continue to be tracked through
the next year. In addition, the committee
will identify and implement prevention
strategies to ensure that the sharp injury rate
continues to decrease.
The Safe Patient Handling Program
earmarked almost $500,000 for the safe
handling of patients in the intensive care
units and burn operating room on 4H
with the installation of ceiling lifts. The 79
new lifts allow nurses to mobilize patients
on their sides with minimal assistance,
lift patients out of bed to chairs, or lift to
accommodate linen changes. The new lift
equipment is credited with a 21 percent
decrease in staff injuries associated with
patient handling.
2013 Nursing Annual Report
18
19 MEDSTAR WASHINGTON HOSPITAL CENTER
▶NURSING
AWA R D S
S A FE T Y S U P E R S TA R AWA R D E E S
F O R F Y13
2 013 E XC E P T I O N A L N U R S E
AWA R D W I N N E R S
Nilocent Antonio, RN
Nursing Leadership, Evelyn Ougo, RN, 1C
Alexis Banner, RN
Premila “Susie” Bartley, RN
Lan Bui, RN
Ashley Costello, RN
Mariyam Durojaiye, RN
Lizollete Ekwopi, RN
Kehinde “Kennie” Fadojutimi, RN
Elise Fellman, RN
Kimberly Foley, RN
Quality of Care, Justinne Cano, RN, 4E
Nursing Management, Alfreda Hicks, RN,
2E/2EIMC
Interdisciplinary Relationships, NICU
Team
Michael Kingan, RN, 2013 Research Poster
Award, George Washington University
Shared Decision-Making, Joan Breece, ANP
Community Service, Barry Garner, RN, &
N.E.X.T Committee
Peer Mentor, Catherine Odhiambo, RN
Wilma Harbin, RN
Nurse Teacher, Karen Batchellar, RN
Brenda Harpe, RN
Nurse Education Professional
Development, Kristina Mckenzie, RN,
Education
Jaime Konieczny, RN
Francesca Leo, RN
Jade Liu, RN
Sherlie Newsome, RN
Teresa Petty, RN
Team Builder, Schauntel Rodgers, RN, 3C
Jenifer Rilloraza, RN
LauraRobertson, RN
Natalie Suttles, RN
Claire Wagner, RN
Heather Watson, RN
Aimee Zepnick, RN
P R E S I D E N T ’ S P E R S O N A L LY
M A K I N G A D I FFE R E N C E AWA R D
Lorelei Reyes-Lumpp, RN
Rita Owens, RN
Anne Veppumthara , RN
Nicole Robayna, RN
Zainab Turay, RN
Pat McCartney, RNC, PhD, FAAN, Award
of Excellence in Practice, Association of
Women’s Health, Obstetric & Neonatal
Nurses
Image of Nursing, Sherri Bell Medoza, RN,
2E
Clinical Expert, Karen (Cheli) Mega, RN,
Critical Care
Latrice Moore, RN
Leslie Smith, Office of President of the DC
ONS Chapter
Andrea Ryan, RN, Cathie Guzzetta, RN,
Raymond DiPhillips, RN, Mihriye Mete,
RN, Ethics & End of Life Specialty Poster
Award, Society of Critical Care Medicine,
and awarded a 2013 Research Poster Award
by the Sigma Theta Tau International
Nursing Society, Phi Epsilon Chapter
Jonathan Griffith, RN
Allison Kopp, RN
E X T E R N A L AWA R D S
C E N T E R F O R E XC E L L E N C E
I N N U R S I N G AWA R D S
R E S E A R C H AWA R D
Susan Serdensky, RN, Paula Sanford,
RN, Rita Owens, RN, Jill Schie, RN, Ivy
Pimental, RN, & Bridgett Henry, RN
Adelaida Dizon-Dauz, RN
L E A D E R S H I P D E V E LO P M E N T
E D U C AT I O N AWA R D
Michael Kingan, RN
Susan Serdensky, RN
Billy Mullins, RN
Jani North-Saale, RN
2E/2EIMC Staff
Jackie Clark, RN
Latrice Moore, RN
Dionne Ross, RN, as the recipient of the
MWHC Board of Directors Leadership
Award
Department of Nursing
110 Irving Street, NW
Washington, DC 20010