NURSING Elevating Nursing. Transforming Care.

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1 NURSING ANNUAL 2014 REPORT Elevating Nursing. Transforming Care.

2 A MESSAGE FROM THE CHIEF NURSING OFFICER TABLE OF CONTENTS A Message from the Chief Nursing Officer 1 Nursing Professional Practice Model 2-3 Transformational Leadership 4-5 Shared Governance 6-7 Relationship-Based Care 8-9 Evidence-Based Practice and Research Innovation Professional Development Career Advancement and Recognition Quality and Safety Nursing Excellence Award Recipients 19 It is with great pride I present the 2014 Reading Hospital and Health System Nursing Annual Report, which reflects our continued work to elevate nursing and transform patient care. Our 2014 annual report honors the women and men who chose this rewarding profession and have made a difference in the lives of those we care for and our community. One of our nurses, Ainsley Hartman, BSN, BA, RN, N3S Oncology Unit, put into words the honor and challenge that is our profession: Every day I am fortunate to be a nurse, the person to whom someone surrenders their well-being, their very life. These patients are veterans, daughters, businessmen, teachers, doctors, and sometimes, nurses themselves. They have loved ones and bucket lists unfinished; their bodies humbled by cancer and other terminal illnesses. As a nurse we often leave a little bit of ourselves at the bedside. I have learned to consider it a blessing to be such an integral part of my patients lives and in many cases their last few moments on earth. We are indeed fortunate that our work makes such a difference in the lives of others. That work, while rewarding, is challenging. We are presented every day with difficult circumstances both in patient care and our practice. Our work is guided by our professional practice model. It is our true north, or the compass that guides us through the most difficult circumstances that life can present. This year we celebrated many achievements, including the kickoff of the formal Journey to Magnet Excellence and submission of our application to the American Nurses Credentialing Center Magnet Recognition Program. We evolved and expanded shared governance to include a Staffing Committee, Ambulatory Nursing Council, and PCA Council to strengthen the voice and engagement of nursing staff in improving care and practice. Unitbased nursing teams began redesigning care delivery to strengthen the nurse-patient therapeutic relationship, colleague collaboration, and continuity of care. The percent of BSN prepared and specialty certified nurses continued to increase at an impressive rate. We introduced the clinical nurse specialist role to provide clinical leadership for both unit and organizational improvement of nursing quality indicators. The unit-based clinical leadership model was expanded and we made strides in decreasing falls with injury and hospital acquired pressure ulcers and infection, and improving nurses communication with nurses. It is an incredibly exciting time for nursing! Nurses at all levels are conducting research and evidence-based practice improvements related to nurse-physician communication and collaboration, reduction of hospital-acquired infection, nurse residency and preceptor program effectiveness. Technology innovations, especially EPIC optimization and GetWellNetwork, have been implemented with clinical nurse input to improve care and patient engagement. This has been a year of continued growth, change, and improvement made by clinical nurses and nurse leaders committed to our core purpose of advancing health and transforming lives and our vision to achieve excellence in a patient-first environment. It is this commitment that inspires us to be our best and provide the best care for those we serve. Sincerely, Mary Agnew MS, RN, NEA-BC Vice President & Chief Nursing Officer Commitment to our core purpose and vision for nursing inspires us to be our best. We are transforming and advancing the care of patients and our profession. Mary Agnew, MS, RN, NEA-BC discusses the honor and challenge of healthcare and how nurses and their colleagues are making a difference in the lives of those throughout our community. 1

3 NURSING PROFESSIONAL PRACTICE MODEL KEY PRIORITIES ORGANIZATIONAL NURSING Operational Excellence Journey to Magnet Excellence Unit-Based Clinical Leadership Nursing Quality Indicator Improvement Research/EBP/Innovation Skill Development Leadership Development Patient Experience GetWellNetwork NICHE Program Relationship-Based Care Delivery System Care Delivery Redesign Caring Practices Bedside Shift Report Meaningful Rounding Patient Goal of the Day/Encounter READING HOSPITAL NURSING PROFESSIONAL No Pass Zone AIDET Shift Huddle Care Team Rounds PRACTICE MODEL Commitment to Co-Workers Employee Engagement Shared Governance Nursing Communication Strategy Unit Engagement and Retention Plan The Reading Hospital Nursing Professional Practice Model, commitment to providing excellent, compassionate care Just as the north star and a compass provide direction Professional Development Initiatives (BSN, Certification) True North, is the framework for bringing to life nursing s vision of achieving excellence in a patient-first environment. The components are the guiding principles for nursing practice. to patients, their families, and our community. Nursing practice is anchored by the mission, vision, values, and standards that distinguish Reading Health System and its goals for Advancing for navigating one s journey, so does Reading Hospital s True North provide direction for navigating the Journey to Nursing Excellence. Clinical Integration Market Expansion Nursing Professional Practice Model integration across Reading Health System Service Line Development Support At the core, is the unwavering Health, Transforming Lives. 2 3

4 TRANSFORMATIONAL LEADERSHIP EVERY NURSE IS A LEADER The Unit-Based Clinical Leadership Model expansion to 8 units is reducing length of stay and readmission Clinical Nurse Specialist model is providing masters-prepared clinical leadership for nursing quality improvement The LEAD program was redesigned and is engaging clinical nurses in applying leadership skills to clinical practice Nurses at all levels transform nursing practice and care to achieve excellent outcomes as confirmed by Paulette Glenn, BSN, RN IV, CMSRN, R3E Core Facilitator and recipient of the 2014 Excellence in Clinical Practice Award: Nurses are leading changes in practice, such as huddles and bedside shift report, to improve communication, safety, and the patient experience. Nurses are engaged in achieving health system goals for managing population health and clinical integration Emergency nurses and physicians presented brain attack best practices at the International Stroke Conference 2014 Stormy Bernhart, RN, CRRN, Acute Rehabilitation Unit, and Erin Marinchak, MSN, RN, ACNS-BC, CCRN, CPHQ, Clinical Nurse Specialist, Surgical Division, co-lead the Fall Resource Nurse Team and interdisciplinary efforts that are reducing falls with injury rate. Robin Riegner, RN, CCM, Manager, Population Health Management, counsels a patient on wellness promotion. Jennifer Seaman, RN, E3, discusses changes in core facilitator orientation with Melissa Armstrong, MS, RN, GCNS-BC, CMSRN, Clinical Practice Educator, Medical Division. 4 5

5 Staffing Committee Co-Leader Lowell Fina, PhD, RN III, CEN, Cardiovascular Division, explains that through shared governance, every nurse has a voice in improving care and practice: Clinical nurses collaborate with nurse leaders to assure high quality care providers and adequate resources to meet patient needs. SHARED GOVERNANCE EVERY NURSE HAS A VOICE The Staffing Committee sub-team of Operations Council is standardizing scheduling policies and practices Newly chartered PCA Council defined PCA role and PCA involvement in organizational council work Ambulatory Council is addressing practice issues specific to nurses working in outpatient and same day procedural areas Brooke Raifsndyer, RN, ED, advocated for better management of caregiver stress. Here she and Chaplain Tim Sadler discuss how the new ED Critical Incident Stress Management (CISM) program is supporting distressed staff members. RN Peer Review Team redesigned process and tools based on best practices, which will be piloted in 2015 Shared Governance Effectiveness Survey guided a focused nursing communication strategy for councils and leaders Concerned ED nurses prompted a CISM team that partners nurses and chaplains in addressing post-traumatic stress Beverly Guest, RN, Clinical Quality Coordinator, Reading Health Physician Network, and Melissa Reinard, BSN, RN, Cancer Infusion Center, plan education programs during an Ambulatory Council web-based meeting. Patient Care Assistant leaders of the PCA council, recorder Elizabeth Burkey, E2, co-chair Robbie Smith, Cardiovascular Services, and chair Jessica Wolgemuth, N5W, work with facilitator Ronnie Ursin, DNP, MBA, RN, NEA-BC, Medical Division Director, to update the PCA job description to include support for nursing quality improvement. 6 7

6 RELATIONSHIP-BASED CARE EVERY NURSE IS A HEALER Nurses Improving Care for Health System Elders (NICHE) program is underway to improve safety and quality of geriatric care RN Bedside Shift Report is engaging patients and families in planning care and improving communication with nurses Meaningful Rounding and No Pass Zone are improving patient safety and responsiveness of all staff to patient needs Stacy Greblick, RN III, RNC, CCRN, NICU RBC Council Chair, is a passionate advocate for Relationship-Based Care (RBC), the nursing care delivery model: We are strengthening colleague relationships and redesigning care delivery for greater continuity and improved therapeutic nurse/patient relationships. Wendy Lundregan, MSN, RN, OCN, Medical Division Nurse Specialist and NICHE Program Coordinator, consults with Geriatric Resource Nurse, Christina Patch, RN, E2, regarding polypharmacy issues that impact optimal care of geriatric patients. Psychiatric Nurse Liaison consultation with acute care staff is addressing the unique needs of medical-surgical patients with behavioral health issues Shift huddles are strengthening care team communication, teamwork, and focus on patient safety and quality SICU staff role modeled excellent community relationships by donating 1037 pounds of food for Greater Berks Food Bank Float Pool PCA, Tom McIntyre, a member of the Meaningful Rounding team, mobilizes a patient; rounds include mobilization and positioning, toileting, pain management, and environmental safety checks. Lisa Naugle, MSN, RN-BC, Psychiatric Nurse Liaison, customizes plan of care with Lauren Levengood, RN, C3, to reduce physical restraint and improve patient safety. 8 9

7 EBP Intern Angela Yoder, BSN, RN IV, CCRN-CMC, PCCN, MICU, initiated evidenced-based Chlorhexidine bathing as a standard of practice and continues to champion evidencebased practice improvement. The EBP Internship provides nurses guided instruction to review research and identify and implement evidence-based best practices. EVIDENCE-BASED PRACTICE AND RESEARCH EVERY NURSE IS A SCIENTIST EBP Interns examined evidence related to alarm fatigue, trauma, family presence, patient education, communication, and sexual assault R3S CIWA Task Force is piloting an evidencebased Alcohol Withdrawal Protocol to improve patient assessment and safety Nurse Perceptions of Clinical Deterioration study examined Modified Early Warning Score (MEWS) effectiveness Perceptions of Hope Engendering Behaviors Study validated work of RBC to maintain patients hope and dignity Nurse-Physician Communication and Collaboration Study is guiding focused improvement in interprofessional teamwork The RN Residency Study completed its 6th cohort; study findings prompted MATT simulation inclusion in Residency curriculum Andrea Fischer, MSN, RN, CMSRN, Clinical Practice Educator, educates new nurse, Mary Rus, RN, N3W, on use of MEWS to assess clinical deterioration. R3S CIWA task force members, Paul Little, DO, and Alan Hyneman, RN, discuss progress in implementing the CIWA Alcohol Withdrawal Protocol. Director of Nursing Research, Debra H. Stavarski, PhD, RN, and Walter Bohnenblust, MD, discuss RN-MD Collaboration study findings and strategies to improve communication, such as care team photos on assignment and whiteboards

8 INNOVATION EVERY NURSE IS AN INNOVATOR GetWellNetwork patient engagement technology is improving the patient experience, education, and communication with nurses Nurses at all levels participated in optimizing Reading HealthConnect to better support risk screening and protocol documentation Job Appreciation at The SurgiCenter at Spring Ridge partners colleagues to walk in each other s shoes and improve teamwork As a Systems Analyst, Kelly Sue Flynn, BSN, RN-BC, uses her clinical expertise to engage nurses with information technology teams to implement new technologies that enhance patient care. Nurses use technology innovations, such as GetWellNetwork, to better engage patients and families in their care. On World Stroke Day, E1 stroke nurses took community health education and screening to the heart of the City of Reading Designing new products, such as an IV pole drainage bag hook, is one way in which nurses are innovating to improve outcomes Mary C. Day, MSN, RN, ACNS-BC, Clinical Nurse Specialist, Surgical Division, demonstrates to Nathan Ray, RN, R3E, how to use the IV pole urinary drainage bag hook that she designed to facilitate mobilization and prevent infection. Adopt a Class, an innovative twist to United Way Stuff the Bus, is building strong relationships with community schools Spring Ridge SurgiCenter OR nurse Barry Schaeffer, RN, CNOR, demonstrates the equipment he uses to Mary Jones, front desk receptionist, during Job Appreciation shadowing. Pediatric Nurse, Amanda Taylor, RN, educates her patient and his mother in how to use GetWellNetwork

9 MICU interns Zebadiah Sheamon, BSN, RN, and Cassondra Good, BSN, RN, simulate defibrillation during the first six months of their three-year internship. Rodrigo Ugalde, BSN, RN IV, CRRN, Acute Rehabilitation Unit, advanced from LPN to RN, RN to BSN, and is now enrolled in an MSN program. Nurses are supported to achieve specialty certification, advance academically, and in their ongoing development of clinical and leadership skills. PROFESSIONAL DEVELOPMENT EVERY NURSE IS A LIFELONG LEARNER AND EDUCATOR Over 90% of our nursing units continue to outperform national benchmarks for specialty certification This year, 1350 certified nurses and their colleagues were recognized for their commitment to excellence Enhanced education assistance increased clinical BSN percent from 35% to 41% in 2014, and increased BSN enrollment The Cedar Crest College MSN partnership graduated the first cohort of nurse leaders, who focused project work on outcome improvement Periop 101, an intensive immersion orientation, is facilitating the transition of new nurses to specialty practice The new Critical Care Transitional Fellowship Program transitions graduate nurses into Intensive Care through experiential learning Patrice Sadler, RN, CGRN, Endoscopy Suite, was the first nurse in her department to become certified; since then 100% of nurses in the Endoscopy Suite now hold specialty certification. Periop 101 intern, Andrew Addison, RN, enjoys hands-on learning with preceptor Kasie Moll, RN, BSN, CNOR, RNFA, and Tara Lantz, RN, 2014 Periop 101 graduate

10 CAREER ADVANCEMENT AND RECOGNITION EVERY NURSE IS RECOGNIZED Eighty-eight nurses were honored at the annual awards gala for successfully challenging to RN III, IV, and V levels The 2014 Nursing Excellence Awards recognized over 100 nurse and interprofessional colleague nominees The Nursing Awards Gala attendance exceeded 625 the highest attendance to date by nurses and physician colleagues The Unit Professional Excellence Award was presented to E2 for high engagement in workplace and outcome improvement Alan Howard, MSN, MDiv, RN V, CEN, Emergency Department, is recognized through the Career Advancement Program for his masters degree, certification, years of experience, and leadership of the ED Research/EBP Committee. Nurses have the opportunity to advance while working at the bedside and are encouraged and recognized for their contributions to clinical and professional excellence. The Rising Star award recognized clinical support staff enrolled in RN programs, for their contributions to care and academic excellence The 2014 Rising Star Award recipient Allison Bossler, transitioned from PCA, Acute Rehabilitation Unit, to graduate nurse, R3S, and continues to exemplify compassion, caring, and commitment to excellence. Crystal Geissler, BSN, RNC-OB, Labor and Delivery, is a role model RN IV, who coaches colleagues to challenge in the career advancement program

11 QUALITY AND SAFETY Elizabeth Kowalick, BSN, RN, IV, Cardiovascular Services, helps to achieve quality outcomes such as Door to Balloon times that consistently outperform national benchmarks. Fall with Injury Rate Linear (Fall with Injury Rate) Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 EVERY NURSE MAKES A DIFFERENCE Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 FALL WITH INJURY RATE Nursing staff is improving nursesensitive quality outcomes, including falls with injuries, communication with nurses, and hospital-acquired pressure ulcers. CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION (CLABSI) RATE Q Q Q Q4 Outperformed national median benchmark 3 of 4 quarters CLABSI rate Target 2014 NURSING EXCELLENCE AWARD RECIPIENTS Excellence in Clinical Practice: RN Paulette Glenn, BSN, RN IV, CMSRN, R3E Medical Surgical Unit Excellence in Clinical Practice: APN Diana Blair, CRNP, Acute Rehabilitation Unit Excellence in Clinical Practice: LPN Sheila Faust, LPN, Family Health Care Center Excellence in Clinical Support Rosalind McNally-Walling, Emergency Department Excellence in Mentoring/Teaching Marcia Cook-Love, MSN, APRN, BC, FNP, Faculty, School of Health Sciences Linda DeLong, MS, RN, PMHCNS-BC, Faculty, School of Health Sciences Spirit of Caring Women s Health Center Rising Star Allison Bossler, PCA, Brain Injury Unit (now RN, R3S) Excellence in EBP Leadership and Innovation Debra Stavarski, PhD, RN, Director Nursing Research Innovation Award Perioperative Services RN IV Journal Club Adjusted Mean Score by discharge date Question: Staff treated you with respect Friendliness/Courtesy of the nurses Jan 14 - Mar 14 Apr 14 - Jun 14 Jul 14 - Sep 14 Oct 14 - Dec 14 PATIENT EXPERIENCE: INPATIENT Excellence in Staff Leadership Heather Kulaga, BSN, RN, CMSRN, C3 Surgical Unit Excellence in Administrative Practice Kimberly Swenson, BSN, RNC-MNN, Nurse Manager, Mother Baby Unit Excellence in Patient-First Environment Christina Studlack, RN III, CAPA, C1 Cardiac Unit Excellence in Nursing Quality and Safety Ariana Pilat, BSN, RN IV, CCRN, Surgical Intensive Care Unit Interdisciplinary Collaboration Award Colleen Sauls, MA, Social Worker, Children s Health Center Support Services Department, Mark McNash, Vice President Physician Collaboration Award Leonard D Addesi, MD Unit Professional Excellence E2 Medical Unit 18 19

12 Reading Health System PO Box Reading, PA

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