2013 Nursing Annual Report
Transcription
2013 Nursing Annual Report
grow heal change and advance Seton Nursing 2013 DEAR FELLOW NURSES: Nursing is always challenging work. During the past year, at hospitals across the nation, sweeping changes at the federal and state levels created a “new normal” for health care that is focused on delivering better patient outcomes at a lower cost. Consumers and payers alike are demanding not only high-quality health care, but also value for their money. In response, Seton nurses experienced growth, change, advancement and healing—the four themes of this year’s Nursing Annual Report. Growth has been a defining feature for Seton for the past decade. In 2013 we opened a new wing and began offering new services at Dell Children’s Medical Center; opened new clinics with our ambulatory partners; and increased the number of approaches designed to improve care for fragile, chronically ill patients. Seton nurses are members of interdisciplinary teams engaged in clinical integration efforts like the new Pre-operative Optimization Assessment Clinic at Seton Medical Center Austin. Change is being implemented at the unit level through the exciting Clinical Scene Investigators program. Other changes are being implemented through Nursing Congress, Seton’s shared governance model. Using evidencebased best practices, nurses are helping to improve patient outcomes and satisfaction, while reducing hospital readmissions—a key performance measure used to evaluate hospitals in the new health care environment. Advancement is a hallmark of Seton nursing. Our nurses continue to take advantage of tuition reimbursement and flexible scheduling to return to school, advance their know-how and advance practice. Many of our nurses benefit from the generosity of fellow nurses and other community donors who support the popular Seton Nurse Scholarship Endowment. Seton nurses are also making strides as scholars, conducting groundbreaking research, publishing in prestigious nursing journals and speaking at national conferences. Healing is the heart of nursing and something that we can look forward to doing together in the coming year. This year’s annual report focuses on the power of holistic care and the importance of taking time to understand what our patients—and we ourselves—need to heal. The important role that nurses play as healers cannot be overstated. Whether it be a nurse navigator providing emotional support to a young cancer survivor or a direct care nurse calming an anxious patient before a procedure, we touch lives in ways unlike any other profession. As Seton’s Senior Vice President of Nursing, I am committed to engaging you and your colleagues in decisions that make practicing your profession at Seton Healthcare Family as gratifying as possible. You have stepped up to recent challenges and have continued to provide exceptional care to every patient, every day. For that and everything else you do for our community, I thank you. As we look to the future I am optimistic. Because of you and your dedication to your patients and profession, I believe that WE CAN do great things. Sincerely, Yvonne VanDyke, MSN, RN RWJF Executive Nurse Fellow Senior Vice President, Nursing and Clinical Education Center we can Seton Nursing 2013 (from left): Diane Krause, MSN, RN, Senior Director of Nursing, Seton Medical Center Hays; Debra Hernandez, MHA, BSN, RN, FACHE, CENP, Chief Nursing Officer, Seton Medical Center Austin and University Medical Center Brackenridge; Christine Laflamme, MSN, MBA-HCM, RN, Senior Director of Nursing, Seton Smithville Regional Hospital and Towers Nursing Home; Susan Grice, DNSc, MSN, RN, NEA-BC, Chief Nursing Officer, Seton Shoal Creek Hospital; Magdalena Belury, MSN, RN, NE-BC, Senior Director of Nursing, Seton Southwest Hospital; Margaret Butler, MBA, BSN, RN, NEA-BC, CNOR, Senior Director of Nursing, Seton Northwest Hospital; Deb Brown, MHA, BSN, RN, Vice President, Patient Care Services, and Chief Operating Officer, Dell Children’s Medical Center; Melanie Fox, MSN, RN, NEA-BC, Chief Nursing Officer, Seton Medical Center Williamson; Yvonne VanDyke, MSN, RN, Senior Vice President of Nursing and Clinical Education Center, Seton Healthcare Family (insets): Karen Litterer, MSN, RN, NEA-BC, Senior Director of Nursing, Seton Highland Lakes Hospital; Robbie Rabe, MSN, BSN, RN, Senior Director of Nursing, Seton Edgar B. Davis Hospital nship-Based C o i t are la e O I S N I V R Relationship-Based Care is a professional practice model with six dimensions for transforming care delivery in ways that honor relationships with patients, families and colleagues. Quality Outcomes Teamwork PATIENT & FAMILY Stewardship MISSION VALUES Transformational Leadership Primary Care Team t CA P ro LLS fess T O A C TI O N i o n a l P r a c ti c de Se on l Professional Nursing Practice eM o grow1 heal5 change9 advance13 inspire17 award18 work19 “Everyone wants to live on top of the mountain, but all the happiness and growth occurs while you’re climbing it.” Andy Rooney 1 grow grow Zachery and his parents Mary Beth and Ronnie Seton is growing in terms of both its impact on the community’s health and in its ability to better serve the region’s booming population. In 2013 Seton celebrated the opening of a new bed tower at Dell Children’s Medical Center with new services, including an expanded Epilepsy Monitoring Unit. Seton also continued to introduce innovative services like the Pre-operative Optimization Assessment Clinic at Seton Medical Center Austin, which is led by an interdisciplinary team of nurses, physicians and other professionals. DELL CHILDREN’S MEDICAL CENTER’S EXPANDED EPILEPSY MONITORING UNIT: EXPERT CARING AROUND THE CLOCK Dell Children’s Medical Center opened its new bed tower in April 2013, adding 72 patient beds, the first inpatient pediatric rehabilitation center in Central Texas and an expanded Epilepsy Monitoring Unit (EMU) that can serve the growing number of patients seeking care in Austin. “It’s great to have more beds,” said Kyla Carlson, RN, who works in the unit and has played an important role in training the EMU nursing staff. “It was always a struggle to make sure we could accommodate all of our patients— now we can.” The EMU rooms are equipped with video cameras connected to a state-of-the-art monitoring room where (EEG) technicians monitor patients around the clock. The new unit also has a sensory playroom that patients can visit if their wires can be removed. The playroom was specially designed with a padded floor, interactive lights and other sensory experiences that children can enjoy in a calming environment. Teresa Ontiveros, MSN, RN, started working at the Dell Children’s Medical Center EMU in 2010. “The new EMU is amazing,” she said. “Our program is nationally recognized and we have patients from all over the country.” Teresa especially enjoys the close-knit culture in the EMU and the opportunity to build trust with the families she serves. She recalls fondly a young teen named Zachery who suddenly developed seizures after a serious case of H1N1 and was admitted to the EMU for observation. During one of her shifts, Zachery had a seizure and the team sprang into action, following established protocols. “When I was charting after the event, the mom came over to me crying,” Teresa recalled. “She thanked me for being such a calming force in the room during her son’s seizure and for performing such an outstanding assessment. That made me feel great.” Teresa developed a special kinship with Zachery and was happy to learn that he was a candidate for a brain grid and eventually resection surgery that successfully controlled his seizure activity. “The surgery helped him go back to the life that he had before the illness,” Teresa explained. 2 Optimization clinic patients are going home half a day sooner on average than their counterparts who did not visit the clinic (2.47 days compared to 2.91 days). Kathy Kaut, MSN, RN, ANP-BC SETON OPTIMIZATION CLINIC: GIVING ORTHOPEDIC SURGERY PATIENTS A LEG UP Rehabilitation is a standard in most post-operative care, but what can be done to give patients the best possible results before they even step foot into an operating room? It’s called “pre-hab” and is being offered at Seton’s new Pre-operative Optimization Assessment Clinic (POAC) at Seton Medical Center Austin. The clinic, which was created by Drs. Shelby Carter, Randall Schultz and Carol Wratten, along with Josie Moszynski, MHA, BSN, RN, acute care director, employs an interdisciplinary team of nurses, social, rehab and case workers. “A multilayer clinic offers multilayer benefits,” Josie said. “Patients who are better prepared for surgery are less anxious, at lower risk for complications, mobilize earlier and return to work and sports faster.” 3 During a three-hour preoperative visit, Kathy Kaut, MSN, RN, ANP-BC, meets with patients to assess their risks for surgery. During the preoperative visit patients also: • meet with the anesthesiologist, case manager and physical therapist, • conduct blood work and other labs, and • attend a one-hour class, led by a nurse on what to expect and how to prepare before, during and after surgery. Within 72 hours of hospital discharge, Seton’s nurse navigators follow up with their patients to inquire about their wounds, ability to eat, access to drinks and medications and pain level. At this point nurses have an opportunity to intervene, if needed, and manage the readmission process—potentially avoiding an ER visit. Currently five orthopedic surgeons are referring their total knee replacement patients to the clinic, which has already seen more than 200 patients. One of those patients was (continued) SCHOOL NURSES: EXTENDING BEYOND THE WALLS OF THE SCHOOL Kristen Pokky, RN Patricia, who had a total left knee replacement with Dr. Shelby Carter in October. Before the procedure he referred her to the POAC. “I was impressed with the clinic staff,” Patricia said. “Kathy, the nurse practitioner, was professional, personable and thorough. She obviously had a lot of experience with patient care and what is involved with surgery. She was very helpful and knowledgeable.” After surgery Patricia spent two nights at Seton Medical Center Austin. She had rehab during her stay, which was part of her POAC treatment, and found the experience “very beneficial.” She added, “It is important to get up and get moving. The rehab during my hospital stay helped me with my balance, mobility and my confidence.” The Seton Healthcare Family provides school nurses across the Austin Independent School District (AISD), delivering compassionate care and support that help local youth grow into healthy, self-sufficient adults. Kristen Pokky, RN, works at an AISD high school where one of the students is a paraplegic. Because his home did not have a ramp, he had to rely on family members to carry him in and out. When his mother was deported and other family members moved out, the student became a prisoner in his own home. Kristen worked tirelessly to locate a resource to build a ramp for this student. She connected with the Austin Fire Department and together they made a plan, which resulted in a ramp being built for the student so that he could become more independent. “This is only one example of how Kristen has touched the lives of the students on her campus,” explained Laura Cotton, BSN, RN, NCSN, a clinical manager with Children’s/AISD Student Health Services. “She views her job as a privilege and an honor to help these young people.” At several months post-surgery, Patricia is doing well. She has regained nearly all of her range of motion and has been discharged from outpatient physical therapy. More important, she is pain-free and staying active—biking, walking the dogs and volunteering at her church. When asked if she would recommend the POAC, Patricia responded with a resounding yes. “I would recommend the optimization clinic because of the team’s thoroughness in preparing a person for surgery.” Overall, Patricia’s stay at Seton Medical Center Austin was a positive experience. “I was very pleased with the nursing care that I had at Seton. They were there whenever I needed them and acted like they really cared about how I was doing.” 4 “Healing yourself is connected with healing others.” Yoko Ono 5 heal heal Maria Marek, MTS, BA, RN, and Charlotte, a patient A love for healing and connecting with others is the reason why Seton nurses get up and go to work each day, despite the challenges that may confront them. In line with Seton nursing’s professional practice model of Relationship-Based Care, Seton nurses provide holistic care—attending to physical, spiritual and emotional needs. Whether the patient is a young cancer survivor or a mentally challenged adult, Seton nurses are on hand to motivate, calm and reassure. ONCOLOGY NURSE NAVIGATORS: EMPOWERING AND INSPIRING CANCER SURVIVORS Clinical nurse navigator Maria Marek, MTS, BA, RN, works with adolescent and young adult cancer survivors who have completed treatment and are in surveillance or follow-up care. Her job involves helping young survivors understand their cancer diagnoses (including the possible late effects of their cancer treatment) and develop survivorship plans. “One of the first patients I met was introduced to me by the chaplain at the Shivers Cancer Center as she waited for her appointment with the oncologist,” Maria said. “Her name was Charlotte and I could still very clearly see the scar on her head from surgery for a brain tumor.” In the waiting room, Charlotte opened up to Maria about her physical symptoms—fatigue, tingling and numbness—and also her emotional state of mind. The young woman was lonely and depressed and felt terribly isolated because she did not know any other young adults like herself. “I asked how I could help her most,” Maria recalled. “She told me that more than anything she just wanted to meet someone like herself with the same diagnosis.” When Charlotte mentioned hearing about a cancer summit for young adults, Maria quickly sprang into action and found an upcoming conference of young adult cancer survivors in Las Vegas. She even secured a donation of frequent flier miles to help Charlotte with some of the travel costs. To raise the rest of the money for the trip, Charlotte sold chocolate-covered strawberries for Valentine’s Day using social media to get the word out. At the conference Charlotte met many young adults with her same cancer diagnosis, including conference organizer Matt Zachary. “Going to this event has pushed me to get busy living my ‘new normal’ life,” Charlotte said in a thank you letter to the frequent flier miles donor. “I would have never made it to that conference if Maria had not pushed me and offered her help,” Charlotte said. “That event changed my outlook on life.” Today Charlotte is an active member of Seton’s steering group for the Young & Strong Fight Club, a Facebook group that helps survivors meet. “Charlotte’s courage and energy for life has inspired me and many others,” Maria said. “She has helped shape what I do and how I listen as a nurse navigator.” 6 HOLISTIC CARE PILOT PROGRAM: PROVIDING PEACE TO PATIENTS AND THEIR CAREGIVERS To learn more about how holistic care could be formally integrated with direct care nursing, long-time Seton associate and energy healer Aluvia Astrid developed the Holistic Care Nursing Pilot Project. Over the course of 11 weeks, 53 nurses from seven different nursing units received extensive training in six holistic mindbody-spirit healing modalities: Healing Presence, Mindful Listening, Guided Imagery, Massage, Energy-based Touch, Breathwork and Suggestion Therapy. The basic question guiding the pilot project was: “If nurses were formally trained in holistic intervention techniques, would they use them and, if so, which ones?” Nurses were asked to track their usage of the various modalities and share their stories about how holistic interventions helped their patients cope with pain, distress, anxiety and other challenges. One of those nurses was Juanita Martinez, BSN, RN, who works at University Medical Center Brackenridge on the ninth floor. Juanita recalls a patient who was extremely anxious about her plan of care. Even though the patient’s pain was well-controlled with medications and her primary physician had just been in to see her, she continued asking for her doctors and wanted to know what was happening next. “Moments earlier, the patient mentioned to me that she missed her garden,” Juanita recalled. “I then practiced breathwork and guided imagery with her. I asked her to imagine that she was in her garden, wearing a large sun hat “We heal ourselves first and then offer our healing presence to others.” Aluvia Astrid 7 Aluvia Astrid, long-time Seton associate and energy healer, along with Juanita Martinez, BSN, RN and that she was seeing new buds sprout from her newly planted flowers. We went through the exercise for only a few minutes, but the benefit was profound.” The holistic intervention had an amazing impact on the patient, putting her at ease and allowing her to process information clearly from that point forward. “Not only was practicing breathwork and guided imagery a benefit to my patient, but it was also of great benefit to me as her primary nurse,” Juanita added. “It was very rewarding to connect with her and be of help to her in a time of need.” Juanita has helped lead an effort to provide holistic care training to University Medical Center Brackenridge clinical assistants. “Our goal is to change the mindset of clinical assistants and empower them,” she explained. “We want clinical assistants to feel comfortable trying holistic care techniques like guided imagery and breathwork with patients who may benefit from these proven interventions.” Holistic care is an evidence-based therapeutic approach that works with traditional medicine to foster healing. Central to holistic care are respect and attention to a person’s physical, mental, emotional and spiritual needs. Holistic care is an important component of Seton’s professional practice model, Relationship-Based Care, and nursing philosophy. QUICK THINKING CALMS AGITATED PATIENT Gaddiel Vilela is a Seton Premier Staffing nurse who floats regularly to Seton Medical Center Austin Endoscopy. One day Gaddiel was assigned a mentally challenged 29-year-old patient who was extremely anxious and refused to be taken downstairs for a procedure. The patient clung tightly to her stuffed animal, curled up in the bed and defiantly exclaimed “No!” as the direct care nurse tried coaxing and pleading for her to move to the stretcher. Noting that the patient had a large picture of Justin Bieber beside her bed, Gaddiel pulled out his phone, punched a few keys and started playing a Justin Bieber song. Within seconds, the patient looked up, started smiling and agreed without hesitation to get onto the stretcher. With the music still playing on his phone, Gaddiel easily transported her to Endoscopy where she cooperated with her caregivers. Gaddiel’s creative quick thinking and intervention demonstrates holistic, Relationship-Based Care. By placing the patient at the center of care, Gaddiel and his fellow caregivers were able to build trust and promote healing. Gaddiel Vilela, RN 8 ”Coming together is a beginning; keeping together is progress; working together is success.” Henry Ford 9 change Laura Kane, BSN, CPN, Chair, and John Villasana, BSN, CCRN, Vice-Chair John: Awareness of shared governance is nearly universal, but engagement is much smaller. Since every unit has its own idiosyncrasies, it is essential to find innovative ways for engagement. Nurses must come together and talk about their professional practice for their voices and clinical expertise to be heard about patient care and the work environment. Every single person has an opportunity to be involved. Question: Why does Nursing Congress exist? Laura: Nurses are professionals who must use independent thought and judgment in providing care. Nursing Congress relies on a democratic component to empower nurses to have input and vote on issues as a group. Their vote affects the care provided through policies, procedures, orders and other practices. Nurses need to establish who they are, what they do and the effect they have on patient outcomes and the work environment. Policy changes are not mandated. Every single person has an opportunity to be involved. Every nurse is encouraged to provide written feedback, evidence and opinions through the Seton intranet. change The U.S. health care system is changing—and so is Seton. One of the guiding forces of change at Seton is Nursing Congress, a key element of the network’s shared-governance structure that empowers direct care nurses and gives them a voice in guiding the change occurring at both the network and unit level. Other forces of change at Seton are the Clinical Scene Investigator (CSI) teams who use evidence-based practice to promote positive changes in their units at six hospitals. NURSING CONGRESS: GIVING DIRECT CARE NURSES A VOICE Interview with Laura Kane, BSN, RN, CPN, Chair, and John Villasana, BSN, RN, CCRN, Vice-Chair Question: What do you think staff nurses know about Nursing Congress? Laura: I think nurses don’t fully understand the importance of Nursing Congress unless they participate. As part of the residency program, new RN residents attend a Nursing Congress meeting. They are always just wide-eyed and amazed at the opportunity for participation by frontline nurses in our practice. The more we can expose direct care nurses to a meeting, the more nurses will understand that they can participate and have choices and input into guiding their nursing practice. Nurses can be involved from wherever they are. John: We have great leaders, but nurses are the ones who are at the bedside of the patient. To provide the best care, our input needs to be recognized and valued; I think shared governance does that. For instance, patient care policies should be evidence-based, which means using the top existing scientific evidence, the clinician’s knowledge and taking into consideration the patient’s wishes, preferences and values. Who better than the frontline nurse to drive and decide on the patient care policies? It is an opportunity to continually improve how we do things. Congress exists so that experts at the bedside can provide, at the very least, a filter to make sure policies make sense. Question: What do you hope to achieve? Laura: Shared governance has been recognized by Magnet® and Pathway to Excellence® as an essential ingredient for an excellent work environment and improving patient outcomes. Seton is well known nationally for our shared governance structure and often receives groups from across the country to learn more. Nursing Congress goals this year are to: 1) increase interaction and discussion, 2) increase attendance, 3) remove participation barriers and 4) utilize innovative approaches to patient care using evidence and best practices. John: As vice-chair, my primary role is to support Laura. I am concerned about the future of shared governance. I know that we have major fiscal challenges, but I want to make sure that nursing is part of the solution. I would like to see Nursing Congress take on some sort of stewardship role. For example, while I was chair of the acute care council, we worked with materials management about linen usage. Through this project, the acute care council was able to put processes into place that saved more than $1 million by reducing linen usage. If shared governance routinely did a stewardship project every year, then we can pay for ourselves. That would ensure that Nursing Congress could always survive. That’s my big dream. We will need the support of the organization to make that happen. Laura and John: We are thankful to Dr. Joyce Batcheller for her vision. She founded shared governance and left the legacy with us to continue to change and evolve so that professional nurses can do what they do best— take care of patients by blending the best of art and science. “Nurses are professionals. We are the ones who are at the bedside of the patient and in order to provide the best care, our input needs to be recognized and valued. I think shared governance does that.” Laura Kane, BSN, RN, CPN 10 CSI profiles Clinical Scene Investigator Program: Implementing Change on the Front Lines of Nursing Nursing practice plays an essential role in health care quality and managing overall health care costs. Six innovative teams of Seton ICU/ IMC nurses applied for and received $50,000 in grant funding from the American Academy of Critical Care Nursing’s (AACN) Clinical Scene Investigators (CSI) program to be divided among the teams. This 16-month training program arms staff nurses with the knowledge and support necessary to become leaders who guide their peers in creating unit-based change that is easily scaled hospitalwide. Dell Children’s Medical Center Project Coach: Vickie Simpson, MSN, BA, RN, CCRN, CPN, CPHQ Team Members: Roxy Cantu, RN; Jennifer Knox, BSN, RN, CCRN; Shannon Head, BSN, RN; Gavin Longway, BSN, RN Project: Got Skin? Decreasing Incidence of Device-Related Pressure Ulcers in the Pediatric ICU at DCMC. Synopsis: The Dell Children’s Medical Center’s CSI team’s primary goal is to decrease the incidence of device-related pressure ulcers in the Pediatric ICU with a focus on early prevention. Additionally, the team anticipates improved patient satisfaction, reduced patient length of stay and decreased supply costs. The team’s catchy tagline “Got Skin?: #Take the Pressure Off” is displayed on t-shirts, tote bags, pens and other items that were distributed at a lively kickoff event. The team gathered baseline data through surveys of clinical staff and families and developed tools such as a skin caddy and handouts for families to encourage them to be integral members of the team to prevent device-related pressure ulcers. The team also introduced Wednesday Skin Day and plans to educate all new hires about the “Got Skin” initiative during orientation and competencies. (from left): Jennifer Knox, BSN, RN, CCRN; Vickie Simpson, MSN, BA RN, CCRN, CPN, CPHQ; Gavin Longway, BSN, RN; Shannon Head, BSN, RN; Roxy Cantu, RN University Medical Center Brackenridge Project Coach and Lead: Jonathan Hecht, MSN, RN, ACNS-BC; Taya Murray, MSN, RN Team Members: Caroline Burger, MSN, RN; Arianne Pichon, BSN, RN, CCRN; Luisa Silva, BS, RN; Monica Wilson, BSN, RN, CCRN Project: Reducing Central Line-Associated Bloodstream Infections in the IMC/ICU. Synopsis: The University Medical Center Brackenridge CSI team’s primary focus is preventing central line-associated blood stream infections, or CLASBSIs, in the ICU with evidence-based interventions directed toward central line maintenance. It is essential that central line insertion techniques are in line with best-practice recommendations in both the ICU and emergency department (ED) setting, not only because of patient safety, but also because the Centers for Disease Control and Prevention estimates that the average cost of a central line-associated bloodstream infection is $16,550. The CSI team created “The Scrub Club,” an infection prevention marketing and education campaign to achieve its goals in the critical care and EDs. The team used evidence-based practice to develop a game plan and promoted the interdisciplinary effort with a special logo, t-shirts, traveling display boards and widespread use of posters, stickers and other tools. (from left): Monica Wilson, BSN, RN, CCRN; Arianne Pichon, BSN, RN, CCRN; Caroline Burger, MSN, RN; Luisa Silva, BS, RN Seton Medical Center Austin Project Coach and Lead: Phyllis Barron, MSN, MSHP, RN, FNPC, CCRN; Frances Simpson, MSN, RN, ACNS Team Members: Casey Clapp BSN, RN, CHPN, CCRN; Beth Cotten BSN, RN, CCRN; Lyn Jay MSN, RN, ACNP, CCRN; Travis VanDinh, BSN, RN Project: Bridging the Gap: Improving Care Through Understanding, Improving PatientFamily Communication, Satisfaction and Pain Management. Synopsis: The Seton Medical Center Austin CSI team’s goal is to partner with the Palliative Care Team to implement the best practices set out by the Centers for Advance Palliative Care and the National Institutes of Health called “Improving Palliative Care in the ICU” (IPAI-ICU). For some critically ill patients, ICU treatment is more burdensome than beneficial or is inconsistent with the patient’s and family’s values, goals and preferences. It is also difficult for some patients and family members to participate in the plan of care. The CSI team anticipates the implementation of the IPAI-ICU bundle will: 1) improve symptom management, 2) improve patient/family satisfaction, 3) decrease ICU length of stay and 4) decrease the use of non-beneficial treatments without increasing ICU mortality. The Seton Medical Center Austin team is utilizing the CSI grant to pilot three aspects of the IPAI-ICU Care and Communication Bundle: 1) identifying surrogate decision-makers, 2) presenting a family brochure and 3) facilitating an interdisciplinary family meeting. Marketing and education activities included an ice cream social, t-shirts with the “Bridge the Gap” logo, trifold poster, handouts and extensive training sessions led by palliative care medical staff. 11 (from left): Phyllis Barron, MSN, MSHP, RN, FNPC, CCRN; Casey Clapp, BSN, RN, CHPN, CCRN; Lyn Jay, MSN, RN, ACNP, CCRN; Beth Cotten, BSN, RN, CCRN; Travis VanDinh, BSN, RN; Frances Simpson, MSN, RN, ACNS Through the CSI program, Seton nurses will have free access to a wide range of real-world grant project plans, interventions, tools, outcomes and resources that provide answers to common clinical challenges and inspirational ideas for nurses and other leaders across the hospital. Work kicked off in January 2013, with the teams examining issues on their units and formulating plans to make measurable improvements with education and awareness campaigns. Seton CSI teams meet regularly with a CSI coach from the AACN to collaborate on research, evidence-based practice, quality and marketing and education techniques to further their initiatives. All of the teams will present their work to a national audience at the June 2014 AACN Innovation Conference. Seton Northwest Hospital Project Coach and Lead: Nancy Hunter, MSN, RN; Suzanne Hindelang, MSN, RN Team Members: Lisa Brown, BSN, RN; Melissa Emmons, BSN, RN; Caroline Johnson, MSN, RN, CCRN; Jennifer Keily, RN Project: Communication Matters: Improving Hand-Off Communication Between the ER and Critical Care Units at SNW. Synopsis: The Joint Commission Sentinel Event Database shows that 65 percent of sentinel events are related to communication breakdown between the health care team and/or patient and family. The Seton Northwest Hospital CSI team’s goals are to improve hand-off communication between the ED and critical care units to: 1) reduce patient safety events, 2) improve patient and health care team communication satisfaction scores, 3) improve nurse satisfaction/communication during care transitions and 4) increase collaboration between units. The CSI team at Seton Northwest Hospital has already made headway in improving hand-off/care transition communication. Nurses in both units collaborated to develop a new hand-off reporting tool and have displayed posters called “Communication Matters” in both the ER and critical care unit. (from left): Nancy Hunter, MSN, RN; Jennifer Keily, RN; Caroline Johnson, MSN, RN, CCRN; Melissa Emmons, BSN, RN; Lisa Brown, BSN, RN; Suzanne Hindelang, MSN, RN Seton Medical Center Hays Project Coach and Lead: Francesca Damiano Hammond, MSN, RN Team Members: Jamie Beffort, BSN, RN; Tiffany Borromeo, BSN, RN; Christine McIver, BSN, RN; Lindsay Young, BSN, RN Project: I “Mustache” a Question about Medication Education: Educate before You Medicate, a Campaign to Improve Medication-Related Communication HCAHPs Scores. Synopsis: The goal of the Seton Medical Center Hays CSI team was to improve communication with patients regarding medication. The team sought to improve patient communication scores and to reduce readmissions by preparing patients with helpful medication information upon discharge. They included clerks, techs, nurses and clinical assistants in distributing patient discharge folders containing medication handouts, business cards for patient provider team members and scratch paper for note-taking. During Nurses Week the team successfully generated staff, patient and family interest in the project by wearing ”Mustache You a Question” t-shirts and posting the project’s mustache logo around the unit. Weight-based drip information badge tags were provided to staff, who were encouraged to utilize them as reference tools. (from left): Lindsay Young, BSN, RN; Christine McIver, BSN, RN; Jamie Beffort, BSN, RN; Francesca Damiano Hammond, MSN, RN Seton Medical Center Williamson Project Coach and Lead: Lisa Votti, BSN, RN-BC Team Members: Marcia Baricuatro, BSN, RN, CCRN; Soumaly Rattanasvanh, BSN, RN, CCRN; Lisa Thackerson, RN, CNRN; Maricelle Thornton, BSN, RN Project: The Noise Pollution Solution: a Campaign to Increase Hospital Environment, Patient Loyalty and Decrease Length of Stay by Reducing Noise Levels in the ICU at Seton Medical Center Williamson. Synopsis: The Seton Medical Center Williamson CSI team is working to increase patient satisfaction and decrease length of stay by improving sleep among its patients. The team measured the sound levels of common hospital equipment and patient-care devices on the unit. They also educated staff at meetings via handouts and a trifold poster board. Using AACN grant funds, the CSI team purchased eye masks, ear plugs, fans, sound machines and CD/radios for use by patients as a noise pollution (control) solution. (from left): Maricelle Thornton, BSN, RN; Marcia Baricuatro, BSN, RN, CCRN; Soumaly Rattanasvanh, BSN, RN, CCRN; Lisa Thackerson, RN, CNRN; Lisa Votti, BSN, RN-BC 12 “If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” John Quincy Adams advance 13 Seton nurses continue to advance the professional practice of nursing through both their educational endeavors and their groundbreaking research. A growing number of Seton nurses are returning to school to earn a higher degree and advance their skills and scientific knowledge, some with the help of the Seton Nurse Scholarship Endowment. At the same time, Seton nurses, including advanced practice nurses, continue to lead teams conducting innovative research to improve patient care. advance THE SETON NURSE SCHOLARSHIP ENDOWMENT: GOING THE EXTRA MILE To encourage and inspire nurses to further their formal education, the Seton Foundation established the Seton Nurse Scholarship Endowment in 2005. Because of the generosity of Seton associates (who have donated more than $600,000 to the scholarship endowment through the Seton Cares campaign) and individual donors, the Seton Nurse Scholarship Endowment has provided more than 165 scholarships totaling more than $375,000. In Fall 2013 the Seton Foundation announced the names of the 24 Seton nurses who each earned a $3,000 scholarship from the Seton Nurse Scholarship Endowment. Hand-selected by a committee of nurses, past scholarship winners and Seton Nurse Scholarship Endowment donors, the 24 recipients all stand out for their commitment to Seton’s mission and willingness to go the extra mile for their patients and community. Erika Alexander, University Medical Center Brackenridge Jeffery Bothof, Seton Medical Center Austin Todd Brady, University Medical Center Brackenridge Jennifer Burrough, Seton Medical Center Hays Susan Cepeda, Seton Northwest Hospital Vanessa Cuellar, Seton Medical Center Hays Katie Jo Dixon, University Medical Center Brackenridge Staci Eaton, Seton Network Oncology Services/Shivers Teresa Evan, Seton Highland Lakes Hospital Denise George, Seton Edgar B. Davis Hospital Michelle Gillespie, Seton Medical Center Hays Robert Green, University Medical Center Brackenridge Angelique Ibarra, Seton Medical Center Hays Akira Jerome, Seton Highland Lakes Hospital Mary Kalapach, Seton Medical Center Austin Alicia Kellogg, Dell Children’s Medical Center Rosemary Klein-Robbins, Seton Shoal Creek Hospital Madeline Lopez, Dell Children’s Medical Center Trina Mays, Seton Medical Center Austin Julie Miller, Seton Smithville Regional Hospital Amy Mitchhart, University Medical Center Brackenridge Jeannette Rivera, University Medical Center Brackenridge Luc Vezina, Dell Children’s Medical Center Lisa Votti, Seton Medical Center Williamson In keeping with the recommendation from the Institute of Medicine Future of Nursing report, Seton has established the goal for 80 percent of its nurses to have a Bachelor of Science in Nursing by 2020. With the rising cost of education, the Seton Nurse Scholarship Endowment continues to play an important role in helping nurses pay tuition. 14 Karen Hollis, BSN, RN, CWON; Sharon Demel, MSN, RNC-NIC, CNS; Marcie Moynihan, MSN, RN, CNS; Debbie Vance, MSN, RNC-NIC, RN V NURSING RESEARCH: BREAKING NEW GROUND Debbie Vance is an RN V who works in the NICU at Seton Medical Center Austin. A member of the Seton Healthcare Family since 1999, Debbie returned to school for her Master of Science in Nursing at the urging of her director and is glad she did. “I appreciate the opportunity to use the skills and knowledge I learned earning my master’s degree to improve the care of our smallest patients.” Today Debbie leads a team of nurses (Karen Hollis, BSN, RN, CWON, clinical manager, Wound, Ostomy and Continence Department/Seton Healthcare Family; Sharon Demel, MSN, RN, RNC-NIC, clinical nurse specialist, Neonatal Intensive Care Unit/ Dell Children’s Medical Center; and Marcie Moynihan, MSN, RN, clinical nurse specialist, Neonatal Intensive Care Unit/Seton Medical Center Austin), pioneering research on ways to reduce skin breakdown of infants, especially those born prematurely. Although evidence-based skin assessment tools currently exist for adults and children, until now there has been no valid and reliable assessment tool for infants that could help providers 15 like Debbie decide when to take extra prevention measures to protect a newborn’s fragile skin. So she and her team used an online survey tool and two rounds of Delphi technique with interprofessional providers who routinely care for neonates to gather information. Round one participants were asked, “What do you perceive as risk factors for skin breakdown in neonates?” Responses were categorized into broad themes. In round two, respondents were asked to rank the importance of these themes using a five-point Likert scale. These data resulted in the creation of the Seton Infant Skin Risk Assessment Tool, currently being further validated through retrospective chart review and the Neonatal PReSKIN Risk Intervention Resource Tool. Debbie recently received approval from the Seton Institutional Review Board for the retrospective chart review testing tool. She has also submitted an article to National Association of Neonatal Nurses that will be published in the nursing journal, Advances in Neonatal Care.“Not only is nursing research essential to improving patient care, but it is also part of being a Magnet® hospital,” Debbie explained. “We need to support nurses in their endeavors to do nursing research.” Seton nurses are advancing the professional practice of nursing and improving outcomes by implementing evidence-based practice and conducting nursing research. Listed below are projects led by RN V nurses in 2013. • Evaluation of a Hospital Tracheotomy Education Program to Improve Clinical Effectiveness for Patient and Families. Jan Alexander, DNP, MSN, M. Div, RN V, Dell Children’s Medical Center • Peritoneal Dialysis Competencies: Assessing Systems and Providers and Building Capacity on a Complex Pediatric Short Stay Unit. Anna Rivera, MSN, RN V, Dell Children’s Medical Center • Operational Strategies to Build Skills and Outcomes in a New Complex Pediatric Care Unit: Assessing respiratory unit services and nursing skills. Julie Castro, MSN, RN V Dell Children’s Medical Center • Patient Call Back: Analytics for Patient Cost Accounting and Satisfaction Outcomes, Opportunities for Dissemination and Use. Katy Starnes, MSN, RN V, University Medical Center Brackenridge • Healthcare Team Performance: Selected System Development to Standardize Acute Care Nursing Tools for Quality Care in a Post-Reform Environment. Elaina Diaz, MSN, RN V, University Medical Center Brackenridge • Delphi Survey of Risk Factors for Neonatal Skin Breakdown: Toward Validating a Tool to Engage Best Practices for Interventions and Outcomes. Debbie Vance, MSN, RNC-NIC, RN V, Seton Medical Center Austin, University Medical Center Brackenridge • Obesity Program Effectiveness Improvement: Ambulatory Clinical Systems Strategies. Sandra Lopez, MSN, RN V, Dell Children’s Medical Center • Exploration of the Impact of Psychiatric Education on Quality of Care Issues in the Emergency Department. Elizabeth Wilson, MSN, RN V, Seton Shoal Creek Hospital • Overcrowding in ED: Implementation Impact of UMCBED/DSRIP System. Curk McFall, MSN, RN V, University Medical Center Brackenridge “Nurses are at the front lines of the big changes taking place in health care today. In an environment that grows more complex and specialized every day, increasing the educational requirements of our nurses is a necessity, not an option. The Seton Nurse Scholarship Endowment plays a vital role in helping Seton nurses advance their formal education and ultimately improve the quality of care they provide to our patients.” Yvonne VanDyke, MSN, RN 16 Saluting Joyce Batcheller, DNP, RN, NEA-BC, FAAN Robert Wood Johnson Executive Nurse Fellow Alumna Seton Senior Vice President/System Chief Nursing Officer, 1994 to 2013 The 1990s were a time of extreme turbulence. Managed care had saturated the local market and Hospital Corporation of America/Columbia was coming to the area. Seton needed to build and expand locations to compete and thrive. o succeed, Seton would need a strong leader for nursing. T Joyce Batcheller, who had years of high-level operations experience, was recruited from a Magnet® hospital in Fairfax, Virginia. In 1995 Seton leased the public Brackenridge Hospital, as it was named then. Batcheller knew she had to unify the two nursing cultures that were each a century-old, strong, proud and distinct. Her vision was for the new, larger system to function as one hospital, one where nursing care was standardized using the best, evidence-based practices from both hospitals. Batcheller said: When I first started at Seton, the decision-making seemed to be very top-down, and I knew that things had to change. We needed to engage front-line nurses and build a critical mass of empowered leaders. o learn more about shared governance, I sent a few people T to my former hospital in Fairfax to talk to staff and leaders and attend an actual Nursing Congress meeting. Those individuals came back excited and helped to create Seton’s Nursing Congress and specialty councils. We did not have all of the answers when we started; we had to make it up as we went along. here was always a lot of intentional focus to make sure T we could spread best practices, learn to use evidence-based practice and improve patient outcomes. Several important investments were made over the years and we worked to show the difference those investments were making. uring the long process, we developed a lot of nursing talent D and improved patient outcomes in ways I never could have dreamed of when we first started. So many people today— nurse educators, managers, directors and site CNOs—started as staff nurses and grew up within Seton. S tronger professional relationships among nursing and other disciplines developed, which contributed greatly to improved patient outcomes. These accomplishments have been shared through local and national presentations, publications and many site visits. 17 y 1996 the foundation for Batcheller’s democracy for B nursing, called shared governance, was laid. It allowed and motivated nurses at all levels of the organization and from across all campuses to unite as a profession. Rather than digging in heels to maintain the status quo, nurses rolled up their sleeves and worked together to improve clinical outcomes by enhancing patient care. A top-down nursing structure had been toppled. F ront-line nurses brainstormed to find ways to improve care on unit practice councils. Specialty councils (acute care, behavioral health, critical care, etc.) and a Nursing Congress met to standardize best practices, based on research. Nurse leadership and management support staff participated in shared governance with flexible scheduling. A Clinical Ladder was formed that recognized participation in shared governance and professional development. he teams began to create one innovation after another, T e.g., perinatal safety, rapid response teams, patient care boards. The world noticed. The Institute for Healthcare Improvement and the Robert Wood Johnson Foundation collaborated with Seton Nursing for major projects such as Transforming Care at the Bedside and the Time and Motion nurse efficiency study. Seton nurses have published and presented their innovations across the country and internationally. A record number of Seton nurses are certified in their specialties. Batcheller’s transformational leadership by modeling behaviors and expectations for front-line staff was instrumental in developing Seton Nursing’s culture of excellence. All of this is evidenced by Seton’s four Magnet® and five Pathway to Excellence® designations. Seton nurses are extremely committed to the mission “ and values of the organization, and they truly care about people,” Batcheller said. “They have a lot of pride in the care they provide their patients. Staff nurses have been able to interact with top executives. They are pushed to think differently and speak up and challenge the status quo. It’s all about being a professional.” The nurses at Seton Healthcare Family salute Joyce for her many years of dedicated service, which has positioned us well to meet the future. awards and recognitions Joyce Batcheller, DNP, RN, NEA-BC, FAAN, was selected to serve on the advisory board of the Anita Thigpen Perry School of Nursing at Texas Tech. Vicki Batson, PhD, MSN, RN, CNOR, NEA-BC, was awarded the Surgical Services Nurse of the Year by the Austin Area chapter of AORN, the Association of Perioperative Registered Nurses. Sylvia Danko, BSN, RN, OCN, CBCN, was chosen by the Texas Nurses Association-District 5 as among its “Fabulous 5.” Danko was honored at the TNA annual banquet in May. Lisa Dugger, MSN, ACNS-BC, CDE, received the 2013 Rising Star Alumni Award by The University of Texas at Austin School of Nursing. Seth Gregory, MSN, RN, was selected as a clinical reviewer for the American College of Surgeons National Surgical Quality Improvement Program—Pediatric. Sheila Hale, RN, CRNI, VA-BC, was selected for membership to the Association for Vascular Access Global Strategy Committee. Rita Kluny, BSN, RN, MTh, BC-HN, CHTP (I), HTCP (I), was invited to participate in the 57th United Nations Commission on the Status of Women in March at U.N. headquarters in New York City, which focused on eliminating violence against women and girls. Cindy Manning, RN, CBCN, was chosen by the Texas Nurses Association-District 5 as among its “Fabulous 5.” Manning was honored at the TNA annual banquet in May. Peggy O’Neil, RN, OCN, CBEC, CBCN, was named the Central Texas Oncology Nurse of the Year. Susan Russo, BSN, RN, was elected as a “Favorite Oncology Professional” by Cure Search for Children’s Cancer, a national non-profit foundation. Linda Sifuentes, RN, was recognized by the Area Agency on Aging of the Capital Area for her volunteer service and advocacy for A Matter of Balance, an award-winning, eightsession, evidence-based program for adults older than 60 who have experienced falls, fear falls or who are at risk of falling. Yvonne VanDyke, MSN, RN, was named one of 20 Robert Wood Johnson Foundation Executive Nurse Fellows for 2013. Yvonne VanDyke, MSN, RN, was honored with the Health Initiative Award for education at the 75th anniversary gala of the Beta Psi Omega chapter of Alpha Kappa Alpha sorority, a community service organization. Joni Watson, MSN, RN, MBA, OCN, was selected to serve on the National Oncology Nursing Society’s quality campaign team. Laura Winslett, MSN, RN, CNS-BC, CNRN, CNOR, was given the Austin Advanced Practice Nurses Organization’s APN Excellence Award. Nurses in the Media Toni Inglis, MSN, RN, CNS, FAAN, retired neonatal intensive care staff nurse and editor of Seton NursingNews, writes a monthly opinion column for the editorial page of the Austin American-Statesman. The Smithville Times ran a feature story on February 19 about Seton’s house-call program for the elderly and chronically ill to avoid hospital visits. The story featured Cherrie Pullium, MSN, RN, ACNS-BC, who now provides daily medical services to residents at Towers Nursing Home, a department of Seton Smithville Regional Hospital. Charlie Fox-Simpson, MSN, RN, ACNP-BC, AACC, was profiled in the winter 2013 issue of Texas Tech University Health Science Center’s Pulse. DAISY Award Winners DELL CHILDREN'S MEDICAL CENTER Jen Birkenheiser, BSN, RN Darla Dodge, RN, CCRN Vanessa Hernandez, BSN, RNC-NIC Kindsay Leite, BA, RN Erin Moore, BSN, RN Laura Presley, BSN, RN, CPN Paul Simmons, BN, RN Carissa Stephens, BA, RN, CPN, CCRN Anne Wood, MSN, RN SETON EDGAR B. DAVIS HOSPITAL Cristita Adams Racelis, BSN, RN Denise George, RN SHIVERS CANCER CENTER Cassie Gossett, BSN, RN SETON MEDICAL CENTER AUSTIN Iris Barrera, RN Sharon Burba, BSN, RN Alison Faulconer, RN Chuck Furlong, RN Marcus Gasaway, RN Jennifer Gravett, BSN, RN June Hallidy, BSN, RN Ina Holmes, RN Julie Howell, RN Mim Luetje, BSN, RN-BC, CVRN Susan Muela, RN Kristen Smith, BSN, RN SETON MEDICAL CENTER HAYS Tiffany Borromeo, RN Jessica Fitch, BSN, RN Jacque Goodman, BSN, RN Angelique Ibarra, RN Jennifer Martinez, RN Melissa Minton, RN, CEN Stephanie Riding, RNC-OB Julie Schmiedeke, RN Melissa Vermeulen, RN SETON NORTHWEST HOSPITAL Jay Owens, RN, CCRN, SNW IMC SETON MEDICAL CENTER WILLIAMSON Christy Canion, RN Ajisha Sankar, RN Kathryn Sonoda, BSN, RN UNIVERSITY MEDICAL CENTER BRACKENRIDGE Todd Brady, RN Allison Floyd, RN, CCRN Sandra Hoover, BSN, RN Rachael Love, BSN, RN Laura Milburn, RN-BC Linda Miller, RN Bobby Robinson, BA, RN Katie Scott, RN 18 nursing scholarly works Podium Presentations Gwenn Scott, DNP, RN, FNP-BC, presented “Health literacy in the U.S.” at the 2013 John W. Stormont Conference on South Texas in Victoria, Texas, in February. Joyce Batcheller, DNP, RN, NEA-BC, FAAN, presented “Texas Team: Advancing health through nursing” to an operations meeting of executives of Texas universities and research institutes at the Texas Tech University Health Sciences Center in Lubbock in February. Buffy Allen, MSN, RN, and Yvonne VanDyke, MSN, RN, presented “Simulation: The centerpiece of clinical education at the Seton Healthcare Family” at the third annual Southwestern Academy of Teachers Educational Symposium in Dallas in April. Sheila Hale, RN, CRNI, VA-BC, presented “Equipped for excellence: a theory based orientation plan for vascular access clinicians” at the Infusion Nurses Society National Meeting in Charlotte, NC, in May. Alyssa Monacelli, MSN, RN, and Valerie Vesich, RHIT, CTR, presented “Tumor conference make-over: high technology and multidisciplinary” at the 39th annual educational conference of the National Cancer Registrars Association in San Francisco in June. Alanna Scott, RN, CNOR, presented “Engaging future perioperative nurses: taking the show on the road” at the 60th AORN Congress in San Diego in March. Curk McFall, MSN, RN, presented “Quality of life experienced by military burn survivors” at the 45th annual meeting of the American Burn Association in Palm Springs in April. Karen McCarthy, MSN, RN, ANP, ACHPN, presented “Don’t tell my mother she has cancer” at the annual American Academy of Nurse Practitioners conference in Las Vegas in June. Seth Gregory, MSN, RN, presented “Strengthening NSQIP-P data through multilayered review and subspecialty champions’ involvement” at the American College of Surgeons National Surgical Quality Improvement Program National Conference in San Diego in July. Karen Hamlett, BSN, RN, presented “Implementing safe sleep practices at Dell Children’s Medical Center” at the Children’s Hospital Association of Texas Pediatric Nursing Conference in Dallas in October. Maria Tappan, MSN, RN-BC, and Elaina Díaz, MSN, RN, CMSRN, presented “Multidisciplinary rounds: engagement through education” at the Association for Nursing Professional Development Annual Convention in Dallas in July. Publications Marianne Mowry, MSN, RN-BC, presented “Using immersion simulation methodology with standardized patients in behavioral health” at the Association for Nursing Professional Development Annual Convention in Dallas in July. Sally Freeman, MSN, RN, NCSN, NEA-BC; Barri Rosenbluth, LCSW; and Laura Cotten, BSN, RN, NCSN, authored “Teen dating abuse: recognition and interventions” in the January issue of NASN School Nurse, Vol. 28, No. 1. Elaina Díaz, MSN, RN, CMSRN, and Maria Tappan, MSN, RN BC, presented “Multidisciplinary rounds: engagement through education” at the Association for Nursing Professional Development Annual Convention in Dallas in July. Deanna Eichler, BA, MSN, RN, authored “Patient screening and callback prevent readmissions: a process improvement project” in the January/February issue of Professional Case Management, Vol. 18, No. 1, pp. 25-31. Jennifer Tiller, MSN, RN, CPNP, CPHON, presented “Acute chest syndrome in sickle cell disease: collaborative initiatives to improve care” and “Hemophilia 101 for the advanced practice nurse: it’s easier than you think” at the Association of Pediatric Hematology/Oncology Nurses 37th Annual Conference and Exhibit in Louisville in September. Joni Watson, MBA, MSN, RN, OCN, authored “Colorectal cancer screening methods at a glance” in the April, May, June issue of Texas Nursing Voice, Vol. 7, No. 2, p. 9. Marilyn Shook, BS, RN, CLNC; Kenna Hamm, LMSW; Sara Gordon, RNC-OB; Becky Roberson, BSN, RNC-NIC; and Rev. Andrea Northcut, MAMFC, MARE, BCC, presented “A Magnet-driven approach to taking the guesswork out of complex perinatal cases” at the 2013 National Magnet Conference in Orlando in October. Saul Benítez Jr., MSN, RN, ACNS-BC, and Ernest Haeusslein, MD, FACC, ABIM, presented “Management of complex CHF in the outpatient setting” at the Seton Heart Institute’s 2013 Cardiology Update for Primary Care in Austin in October. Elaina Díaz, MSN, RN, CMSRN; Buffy Allen, MSN, RN; Maria Tappan, MSN, RN-BC; Marianne Mowry, MSN RN-BC; Judy Kitchens, MHA; Carolyn Jackson, RT; Cleo Hill, CA; and Candie Clark, CA, performed a live, 30-minute simulation for the opening session of the Simulation User Network Conference in San Antonio in October. Vicki Batson, PhD, MSN, RN, CNOR, NEA-BC, presented “Coaching by first line managers and outcomes of professional work satisfaction, job satisfaction and intent to stay” at the Sigma Theta Tau International 42nd Biennial Convention in Indianapolis in November. Susan Shineldecker, BSN, RN, NCSN, presented “Infection Control in the School Setting” at the annual conference of the Texas School Nurses Organization in Dallas in November. Poster Presentations Joni Watson, MBA, MSN, RN, OCN, presented “Eliminating personal and organizational distress when planning and implementing routine psychosocial distress screening” at the Association of Cancer Executives annual meeting in San Antonio in January. Vicki Batson, PhD, MSN, RN, CNOR, NEA-BC, presented “Staff nurse perceptions of first line managers’ coaching behaviors” at the 60th annual Congress of the Association of PeriOperative Registered Nurses in San Diego in March. Patty Cervenka, BSN, RN, CPN, and Dory Collette, RN, CCRN, presented “Improving infection control precautions on a general medicine unit” at the March 2013 Creating Connections Conference in Anaheim, CA. 19 Vickie Simpson, MSN, RN, CCRN, CPN, CPHQ, and Jennifer Ard, BSN, RN, presented “Surgical positioning: preventing pressure ulcers in the operating room” at the March 2013 Creating Connections Conference in Anaheim, CA. Marianne Mowry, MSN, RN-BC, and Mark D. Crump, BSN, RN-BC, authored “Immersion scenarios bridge the education-practice gap for new graduate registered nurses” in the July issue of the Journal of Continuing Education in Nursing, Vol. 44, No. 7, pp. 319-325. Vickie Simpson, MSN, RN, BA, CCRN, CPN, CPHQ; Ann Bailey, MBA, BSN, RNC, CIC; Renee Higgerson, MD; and LeeAnn Christie, MSN, RN, CCRN, authored “Ventilator-associated tracheobronchitis in a mixed medical/surgical pediatric ICU” in the July issue of Chest Journal, Vol. 144, No. 1, pp. 32-38. Patty Adams, BSN, ARM, RN, NCSN, and Susan Shineldecker, BSN, RN, NCSN, authored “Unaccompanied youth: school nurses caring for adolescent minors living without a parent or guardian” in the August issue of NASN School Nurse. Pam Combs, PhD, RN, authored “The Vanishing Caregiver” in the September issue of ISHLT Links, newsletter of the International Society for Heart and Lung Transplantation. Anne Raines, MSN, RN, authored “Nursing implications for patients with hepatoblastoma,” published Oct. 11 in Oncopedia. James Davis, MAHCM, MSN, RN; Joyce Batcheller, DNP, RN, NEA-BC, FAAN; and Patricia Yoder-Wise, EdD, RN, NEA-BC, ANEF, FAAN, authored “Hope for the future: intensifying spirituality in the workplace,” in the October/December issue of Nursing Administration Quarterly, Vol. 37, No. 4, pp. 309-316. Joyce Batcheller, DNP, RN, NEA-BC, FAAN; Ann Hendrich, PhD, RN, FAAN; and Angela Janik, MBA, MSN, RN, authored “The Ascension Health experience: maximizing the chief nursing officer role in a large, multihospital system to advance patient care quality and safety” in the October/December issue of Nursing Administration Quarterly, Vol. 37, No. 4, pp. 277-288. Karen Burkman, MSN, RN, NEA-BC; Diana Sellers, MSN, RN, CPHQ; Cheryl Rowder, PhD, RN, CCRC; and Joyce Batcheller, DNP, RN, NEA-BC, FAAN, authored “An integrated system’s nursing shared-governance model: a system chief nursing officer’s synergistic vehicle for leading a complex health care system” in the October/ December issue of Nursing Administration Quarterly, Vol. 37, No. 4, pp. 353-361. In Memoriam Mark D. Crump, BSN, RN-BC, Seton Shoal Creek Hospital we can SITES Dell Children’s Medical Center of Central Texas 4900 Mueller Boulevard Austin, TX 78723 (512) 324-0000 Seton Northwest Hospital 11113 Research Boulevard Austin, TX 78759 (512) 324-6000 Seton Edgar B. Davis Hospital 130 Hays Street Luling, TX 78648 (830) 875-7000 Seton Shoal Creek Hospital 3501 Mills Avenue Austin, TX 78731 (512) 324-2000 Seton Highland Lakes Hospital 3201 South Water Street Burnet, TX 78611 (512) 715-3000 Seton Smithville Regional Hospital 800 East Highway 71 Smithville, TX 78957 (512) 237-3214 Seton Medical Center Austin 1201 West 38th Street Austin, TX 78705 (512) 324-1000 Seton Southwest Hospital 7900 FM-1826 Austin, TX 78737 (512) 324-9000 Seton Medical Center Hays 6001 Kyle Parkway Kyle, TX 78640 (512) 504-5000 University Medical Center Brackenridge 601 East 15th Street Austin, TX 78701 (512) 324-7000 Seton Medical Center Williamson 201 Seton Parkway Round Rock, TX 78665 (512) 324-4000 Denotes Magnet Designation Denotes Pathway to Excellence Designation S E T O N . N E T / N U R S I N G We appreciate the team (Jill Pendleton, Linda Vochatzer, Nancy Mastronardi, Amy Spiro, and Marc Swendner) for their dedication to the production of the Nursing Annual Report.