Newsletter. Mission. Vision. Pride. Message from Sheila Sheila Antrum, Chief Nursing and Patient Care Services Officer

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1 Newsletter DEPARTMENT OF NURSING Mission. Vision. Pride Edition IV NOVEMBER 2012 Message from Sheila Sheila Antrum, Chief Nursing and Patient Care Services Officer Dear Colleagues, ongratulations to all of the staff at UCSF Medical Center and UCSF Benioff Children s Hospital for achieving the American Nurses Credentialing Center (ANCC) Magnet designation! Magnet designation recognizes the great work performed not only by our nurses, but by all of our staff, management, and providers, and is a true testament to your hard work and commitment. The Magnet Recognition Program recognizes healthcare organizations both nationally and internationally for their outstanding quality patient care, nursing excellence and innovations in professional practice. Achieving Magnet status underscores the fact that UCSF is a world-class organization, as less than 7 percent of hospitals in the United States and abroad have received this designation to date. As we look forward, we will focus on sustaining and continually improving our outcomes and the many positive changes we have made. I am very proud of all of you and sincerely thank you for achieving this major nursing milestone and recognition. V Sincerely, Sheila Antrum, RN, BSN, MHSA, NEA-BC Chief Nursing Officer/Executive Director, Patient Care Services, UCSF Medical Center IN THIS ISSUE 2 5 North Clinical Practice Council Making a Difference 3 UCSF Nurses Celebrate at Magnet Conference 3 Spotlight on UCSF Home Health Care 4 Clinical Quality Council Co-sponsors Quality Event 5 Educational Options for Associate Degree Nurses Evidence-Based Practice Fellows T r a n s f o r m a t i o n a l L e a d e r s h i p Magnet Site Visit RN Escorts Perspectives By: Jody Mechanic, RN, MS, Director, Professional Nursing Practice, Magnet Program Director and Pam Worobel-Luk, RN, MSN Awesome - amazing! were the words repeated daily by the direct care nurses escorting our Magnet Appraisers throughout the four-day site visit in July. The appraisers also echoed these same words of high praise. The fourteen escorts, with representatives from the Magnet Unit Champions, Staff Advisory Council, Unit Councils and Apex Superusers, did an outstanding job escorting our Magnet Appraisers. Four escorts, David Hoey, CNII 8 Long, Michele Nomura, CNRN, CNIII 8/11 NICU, Katharine Hansen, CNII 15 ICN, and Amanda Mangan, CNIII 6L recount their experiences and share their perspectives: Describe your experience as an escort - DH: It was an incredible opportunity to visit various units and departments that I do not usually get to see in my day to day role. Amazing things are being done by the nurses at UCSF. For example, the ACC Pediatric Hemodialysis unit was one of the stand out units with regards to the phenomenal work and services they provide their patients and families. It was an honor to represent the Nursing Department when I was initially asked, and that was only solidified throughout the week by the passion, professionalism, enthusiasm, knowledge and leadership demonstrated by our nurses as we visited the units. MN: Having the honor to serve as a UCSF Magnet escort was an amazing experience and definitely a highlight of my nursing career. It was so inspirational to visit various units and hear about all of the amazing work nurses are doing for patients and families. It was nice getting to know the Magnet appraisers and also my fellow Magnet escort colleagues from other units. KH: My week with the Magnet appraisers was, as we continue to be reminded, a journey. I went into the week with nerves, excitement, and questions. I came out with enhanced excitement in UCSF, unexpected knowledge gained, and new friends. I was privy to a lot of information that I never would have been exposed to without this experience. I met nurses from all areas, each with a different story. It is quite amazing just what nurses at UC do and have done. AM: The Magnet site visit rekindled my fire for nursing. I had the privilege to see my fellow nurses shine and be proud of all the little things we forget others see and appreciate. continued on page 2... U N I V E R S I T Y O F C A L I F O R N I A S A N F R A N C I S C O MVP Department of Nursing Newsletter 1

2 S T R U C T U R A L E M P O W E R M E N T By: Suzanne Tay-Kelley, RN, MS, CNIII 5 North 5 North Clinical Practice Council Making a Difference Vickie Thun, CN IV 5 NORTH- SURGICAL ONCOLOGY MZ Nurses at Mount Zion s 5 North Surgery-Oncology unit have made things much easier for their patients emerging from the Operating Room and recovering in the following days: colorful easy-to-follow roadmaps. These are patientcentered clinical pathways for care and teaching. Led by unit Clinical Practice Council co-chairs and Vickie Thun CN IV and Colette Jappy, CN III a workgroup implemented single-sheet pathways for ileostomy and tracheostomy patients and their families, outlining care and education goals on successive post-op days. CN IIs Sarah Egan, Katie Matza, and James Merriman helped create the documents over several months in conjunction with the colorectal and head and neck surgery teams. The pastel sheets guide patients, families, and nurses alike on daily expectations and progressive independence, avoiding near-discharge rushes to complete the teaching process. Patients need to learn new skills during a stressful and difficult time, noted Vickie. Starting on post-op day one and re-enforcing daily will allow them to gain the necessary knowledge and skills... for discharge. For example, the Ileostomy Clinical Pathway is laid out from post-op days 0 (surgery date) to 5, with each day focusing on specific skills and activities that build upon each other, Colette said. By the time patients go home, they should have practiced sufficiently to be able to empty and change their ileostomy bags independently. From teaching apprehensive patients how to strip and empty their Jackson-Pratt drains, to bedside supply checklists, the sheets promote better outcomes through consistency of care provided by all nurses working with 5N s complex patient population. Now a template is in place that can be used for other surgeries, and work has already begun on a guide for prostatectomy patients. It s overwhelming at first, said Katie, referring to learning drain management. She developed the JP drain care section of the Tracheostomy Pathway. This helps nurses do it step-by-step It was cool to get the word out, and we re getting good feedback from the doctors, she said. It s nice to make a difference. continued from page 1: we forget others see and appreciate. The most important part of your experience was DH: It was such a fantastic opportunity to see all the little pieces of the Nursing jig saw; all the many incredible projects and initiatives on each individual unit coming together to create an overall excellence in nursing. The unit based councils may feel they are only making a small difference, but we got to see the big picture, how these small advances in nursing practice all combine to enhance nursing as a whole throughout UCSF. MN: The most important part was having the opportunity to listen to a room full of physicians, many being attending physicians, during one of the breakfast sessions. Every single physician had a personal and positive story to share about the difference we make as nurses. They view UCSF nurses as intelligent, inquisitive, and a major part of the multidisciplinary team. They respect our hard work and value our opinions. KH: The best part of the week was my time spent at the open forum meals. People weren't necessarily talking about a certain topic or area, but it was a time for them to simply share their story. When working on one unit, we all tend to focus on just that, our area. What we aren't exposed to is what else goes on in all other units - we are a huge organization. AM: I was in a breakfast session with doctors from all over the organization. Each doctor recounted the importance of the nurse's role in their practice. I wish we had taped the session for all nurses to hear. I felt proud to be a member of the UCSF nursing team. How will you apply the experience to your practice DH: I will move forward always looking to improve my practice with the realization and attitude that we can always improve how we provide our care. We heard over and over that our Magnet experience is a journey, and I am excited to start at my own unit level and identify our next challenges, as we continue to move forward as a profession. One of the big take home messages is there is no change too small or too great; we have the resources available so we should tackle the issues that matter to us most. MN: At the end of the site visit, it was really nice when Mark Laret stopped by to tell us he was really proud. I have always been happy to work at UCSF but this experience makes me even more proud to be a UCSF nurse! KH: I have a bigger view of UCSF today than I did before. UCSF is full of smart, energetic and unique people. There are so many projects other nurses have done that give answers to those questions many of us have. I am inspired to continue to ask and research questions I have on my own unit. We all contribute to this institution and should be proud of the work we do, no matter how big or small it may seem. MVP Department of Nursing Newsletter 2

3 U C S F N u r s e s C e l e b r a t e a t M a g n e t C o n f e r e n c e By: Rowena Henry, RN, CN III, 12 GCRC UCSF magnet conference attendees pose for a picture before the designation ceremony. A very upbeat contingency of UCSF Medical Center nurses headed to Los Angeles for the ANCC National Magnet Conference October Our eighty-five proud RNs and colleagues were among the 7000 celebrating newly designated Magnet facilities, attending classes, networking, sharing information, and being acknowledged by keynote speakers. Cued from this year s theme in LA, Reaching for the Stars, our group stylishly dressed for the announcement ceremony in black and white, replete with top hats decorated in San Francisco traditions, including the bridge, the Giants, Alcatraz, and tie-dye. When the Medical Center s name was called last but not least - there were no doubts about our identity as we boisterously cheered our way towards the stage with a definite air of accomplishment. We enjoyed a wonderfully rich opportunity getting to know nurses from other UCSF units and services, comparing notes, and developing lasting professional bonds. Our nurses talked to colleagues from across the country and learned about their clinical work. Innovative, creative thinking was evident on the posters displaying best practices at Magnet hospitals. We came away with a new perspective affirming our care is equally excellent and should be shared at the 2013 Magnet conference! Spotlight on UCSF Home Health Care By: Laura Franklin, RN, MS, CNS, Home Health Care Transitions of care. It s one of the latest health care buzz phrases for those in between times where change can mean increased risk for a patient with a new diagnosis or illness. UCSF Home Healthcare agency (HHC) bridges this gap with its interdisciplinary team of clinicians who visit these patients in their homes after an illness, accident, or surgery requiring additional follow-up and monitoring. Clinic patients are also referred when their needs and care can be managed at home rather than in an inpatient setting. Clinicians in patients homes operate with an almost unparalleled level of autonomy, but still need support, consultation, and ongoing education to provide excellent care. HHC has clinical managers with extensive experience and has recently added a clinical nurse specialist to resource and focus on staff education. The agency sees about 2300 patients annually in San Francisco and parts of Marin and San Mateo Counties. The population ranges from new moms with newborns, to pediatrics with complex long term care, Laura Franklin, RN, MS, CNS geriatric patients with both chronic issues and new acute illness, and to post-transplant patients learning to manage large regimens of medications and self-care. Most services revolve around teaching the patient and caregiver to become independent in their own care. Clinical services include skilled nursing; home health aide; physical, occupational, speech, and nutrition therapies; and social work. Clinicians provide wound care, medication teaching, risk assessment, functional rehab, infusion therapy, community services and care planning, and short term help with bathing and personal care. UCSF s HHC clinicians utilize modern technology to enhance care. Small laptops enable in-home documentation and access to medical records. Blackberry cell phones are essential for taking pictures to send visual updates to physicians or colleagues. Finger stick tests are available to check coagulation. The agency plans to convert from its separate EHR to APeX in the near future. Like the rest of the Medical Center, HHC tracks many types of patient outcomes including satisfaction. We are most proud of our lower rate of hospital readmissions than the national average. This is important because one of our main benefits to the continuum of care is to help patients stay out of the hospital and remain safely in the community. Home health care is an old concept which is gaining new vitality in the current climate, as policy-makers and think tanks realize again how important it is to keep patients in their home and out of higher levels of care. It provides patients a better quality of life and makes financial sense for our health care system. MVP Department of Nursing Newsletter 3

4 E X E M P L A R Y P R A C T I C E P R O F E S S I O N A L By: Pam Worobel-Luk, RN, MSN Clinical Quality Council Co-sponsors Quality Event Disseminating outcomes of initiatives throughout large hospitals is challenging. The Quality Celebration event, held October 19th, helped raise awareness by highlighting multiple improvements in clinical care delivered at UCSF Medical Center. This second annual symposium was collaboratively sponsored by Nursing s Clinical Quality Council and the Medical Center s Patient Safety and Quality Services. Over 125 staff members attended. A combination of strategies was used to communicate quality improvements. Keynote and short rapid fire educational sessions included topics on: national health reform and the future of QI; the UCSF delivery system reform program (DSRIP); sepsis prevention; value based purchasing links to HCAHPS; and the sustainability model. Thirty-two posters of recent and sustained quality initiatives completed by groups throughout the Medical Center were on display. In addition to Nursing and physicians, Nutrition & Food Services, Pharmacy, and the Clinical Lab submitted posters. Event attendees voted on these projects which culminated in eight recognition awards. Here are the posters submitted by nurses. Most initiatives involved multiple nurses. Red font denotes some of the winners - the vote count was tight! INITIATIVE SUBMITTER (S) Normothermia Upon Arrival in 15 ICN Cynthia Jensen, CNIV & Kim Johnston, PCM Accessing Tricky Pediatric Veins - 6 PCRC Jeanne Addis, PCM VAP Prevention in the Pediatric ICU Shelley Diane, CNS HAPU Prevention in Pediatrics Shelley Diane, CNS HAPU Prevention in 10 ICC Cass Piper, CNS Jesse Abilla, CNIII 9/13 ICU, explains his poster to Noraliza Salazar, Nurse Educator, at the October Quality Event. Glucose Control in Cardiac Surgery Patients - Jacqueline Hall, CNII & Etsuko Nakatsuka, 10 CVT CNII Mannitol IV Extravasation Prevention on Vivien Ma-Wong, CNIII & William Gersten, 8L-8S CNII Gay Capistrano, CNII & Cassandra Peri-op DVT & PE Prevention on 8L-8S Recchioni, CNIII Partner with Me Program Patients with Carla Graf, CNS Dementia Out of Bed Day Zero 12L Ortho Surgery Olga Sukhenko, CNIII, EBP Fellow Patients Feeding Tube Patient Education 5E/W Meghan Gebauer, CNIII, EBP Fellow Folks with Strokes ED Stroke Team Tina Quon, CNS Falls Prevention in Neuro ICU Laura Braehmer, CNIII VAP Prevention in Neuro ICU Princess Dy, AN1 HAPU Prevention in Neuro ICU Kelly Wood, CNIII RN Certification in 9/13 ICU Jeselle Abilla, CNIII BCMA Simulation Training Craig Johnson, Informatics & Adam Cooper, Educator Med Administration Accuracy Program Mary Moore, Nursing PI Lab Collections Questionable Prevention Twyla Szeto, Educator & Pauline Chin, Educator M V P D e p a r t m e n t o f Posters on Display at the October Quality Celebration Event. Nu r s i n g Ne w s l e t t e r 4

5 E X E M P L A R Y P R O F E S S I O N A L P R A C T I C E By: Arcyl De La Cruz, RN, CN III, 9 Long Educational Options for Associate Degree Nurses Janice Elzinger, CNIII 9/13 ICU, epitomizes the Medical Center s mission to provide the best care possible. Continued professional development, including educational advancement, affords UCSF nurses support for improving and implementing practices which maintain our excellent level of patient care. Magnet designation has been achieved; but Janice s educational journey has only begun she plans to return to school to earn her BSN degree. As an Appraiser escort during the Magnet site visit, her eyes were opened to the multitude of opportunities nursing offers, such as leadership, research, and education. She is now even considering obtaining a master s degree. Janice originally started out in a non-nursing track at Grand Valley State University in Michigan. Two fateful experiences steered her into pursuing a nursing career. A job caring for elderly residents in an assisted living facility was enjoyable and inspiring. At the same time, Janice s biology professor helped her realize her passion was health care. Then, because of timing, she transferred into and graduated from the ADN program at Grand Rapids Community College, and began her professional career as a med-surg nurse. A travel nurse assignment in 2001 at CPMC fortuitously brought Janice to San Francisco. There she met Sharon Rimando, CNIII, who also worked at UCSF and encouraged her to apply to the 2002 Critical Care Training Program. Janice has worked her way up to CNIII in 9/13 ICU since completing the program a decade ago. She plans on staying at the Medical Center indefinitely and continuing her education. There are several local BSN options for Janice, and other nurses like her. The Associate Degree in Nursing to Master of Science Pathway program, offered by UCSF School of Nursing (SON), is at the top of Janice s list. This program partners with John F. Kennedy University or Golden Gate University. Pathway nurses, upon completion of a bachelor degree in any of these two university s programs, which takes months, are eligible to attend UCSF s SON master s program. The Pathway will allow Janice to focus her bachelor preparation on her interest in business management. San Francisco State University and Cal State East Bay offer the RN to BSN Advanced Placement Option (APO) program. It is designed for ADN nurses to study full or part time while working. The APO-BSN can be completed in 1 to 1.5 years (full time). The University of San Francisco and Dominican University provide another option for the working nurse. USF s ADN to MSN-CNL program and DU s ADN/RN to MSN put the nurse directly into a graduate curriculum. MSN coursework and Clinical Nurse Leader (CNL) competencies can be completed in 2 years. The University of Phoenix also has a RN to BSN program. The Prior Learning Assessment process allows nurses to apply previous academic and work experiences toward college credits. On-line ADN to BSN or MSN programs can be the right fit for many working RNs. Accredited programs are flourishing and employ a variety of teaching methods. Examples are Walden University and Georgetown. See links below for listings of on-line programs. Janice is prepared for the time, effort, and patience necessary to study while working full time; but she feels it will open doors full of opportunity. By developing professionally she can promote positive changes with outcomes to improve care and the environment for our patients and staff. Program Links: Janice Elzinger, CNIII 9/13 ICU UCSF: SFSU: CSUEB: USF: Dominican: Phoenix: On-line ADN to BSN listing: On-line ADN to MSN listing: MVP Department of Nursing Newsletter 5

6 N E W A N D K N O W L E D G E, R E S E A R C H By: Suzanne Tay-Kelley, RN, MS, CNIII 5 North I N N O V A T I O N 2012 Evidence-Based Practice Fellows Seven UCSF direct care nurses were among 28 Evidence-Based Practice Fellows who shared findings from their clinical inquiry projects on June 20. More than 120 attendees heard insights from nurses representing seven Bay Area hospitals at the UCSF Center for Nursing Research & Innovation s 2012 Fellows Celebration event. I laughed, cried, lost data, and still made it through, Meghan Gebauer, CNIII from 5E/W said of her six-month project trialing a tool to help educate patients discharged with newly-placed feeding tubes. It was a reminder of what an incredible impact the individual nurse can have on our practice. The Department of Nursing s EBP program has sponsored 42 nurses since its launch in 2006 and accepts applications each Fall. The EBP fellowship helped me to grow and had a strong influence on my decision to apply to the Master s CNS program at UCSF, noted 11 Long s Jolene Scarella, CNII. She worked on a palliative care project for hematology/oncology patients. I would highly recommend the EBP Fellowship to other nurses as a way to round out their direct care experience. EBP FELLOW PROJECT COACH Angelynn Cowen, CNII, 10 CVT Increasing Patient Awareness of Fall Prevention Through Selfassessment Elise Hazlewood, CNS Meghan Gebauer, CNIII, 5E/W Improving Discharge Teaching for Patients with Newly-placed Feeding Tubes Janice Hull, Educator Courtney Gregory, CNII, PCICU Kathleen Rodriguez, CNII, 10 CVT Improving Breastfeeding Rates in the Pediatric Cardiac ICU Improving RN-PCA Communication Lori Fineman, CNS Elise Hazlewood, CNS Jolene Scarella, CNII, 11L Enhancing Palliative Care in the Heme/Onc Population Through the Lens of the RN Tracy Moran, CNS Olga Sukhenko, CNIII, 12L Improving Early Post-op Ambulation Rates in Ortho Patients Carla Graf, CNS Stephanie Thompson, CNII, AHU Optimizing Flow in Hemodialysis Catheters Heparin vs Citrate Carol Viele, CNS EDITORIAL STAFF Arcyl De La Cruz, RN, CN III, 9 Long Rowena Henry, RN, CN III, 12 GCRC Sandy Ng, RN-BC, MSN, Patient Care Services Clinical Information Coordinator Suzanne Tay-Kelley, RN, CN III, 5 North Ricky Pobre, RN, CN II, 8 South Pam Worobel-Luk, RN, MSN, Nursing Projects ADVISORS: Sheila Antrum, RN, BSN, MHSA, NEA-BC, Chief Nursing Officer/Executive Director, Patient Care Services M V P Jody Mechanic, RN, MS, NE-BC Director of Professional Nursing Practice D e p a r t m e n t o f On October 13, 2012 Dr. Mary M. Sullivan was inducted as a Fellow into the A m e r i c a n Academy of Nursing in Washington DC. The Academy is composed of more than 1,800 nurse leaders in education, management, practice, policy, and research. Selection criteria into the Academy include evidence of significant contributions to nursing and health care and is one of the most prestigious honors in the field of nursing. Once inducted new fellows are eligible to use the credentials FAAN (Fellow of the American Academy of Nursing) after their name. Sugge stion welco s and comm med b y via e ents are mail: U C S F N Newsle u r s ttergro i r.org n g csfme dct Nu r s i n g Ne w s l e t t e r 6

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