Celebrating Magnet Excellence Nursing Annual Report 2010

Transcription

1 Celebrating Magnet Excellence Nursing Annual Report 2010

2 Northwestern Memorial Framework for Nursing Practice* This pictorial representation guides our nurses as they provide care to patients, collaborate within multidisciplinary teams and contribute to the profession of nursing. Each circle depicts an essential component of nursing practice at Northwestern Memorial. All components intersect at the center, illustrating our commitment to our Patients First mission and patient centered care. * Based on the work of nursing theorist Virginia Henderson Northwestern Memorial Nurse Advocate Autonomous Collaborative Compassionate Dynamic Knowledgeable Professional Patients First INDEX Nursing Excellence Shared Leadership Continuous Learning Professional Contribution Patient Care Team Integrity Teamwork Safe and Effective Care Innovation 2 Workforce Supply and Performance 6 Leadership 9 Healthy Practice Environment 11 Research and Evidence-Based Practice 12 The Northwestern Plan for Advancing Nursing Excellence This table highlights how the goals of the Division of Nursing at Northwestern Memorial align with the strategic goals of Northwestern Medicine, the shared vision that joins Northwestern University Feinberg School of Medicine and Northwestern Memorial HealthCare. By aligning our strengths and resources to encourage innovation and discovery, we strive to become one of the country s top academic medical centers. Northwestern Medicine Goals Deliver Exceptional Care Nursing Goals Innovation Advance Science and Knowledge Research and Evidence-Based Practice Develop People, Culture and Resources Workforce Supply and Performance Healthy Practice Environment Leadership

3 Dear Colleagues: Fiscal year 2010 was a remarkable year of accomplishment for Nursing at Northwestern Memorial Hospital. We advanced our Plan for Nursing Excellence across five areas of strategic focus: Innovation; Research and Evidence-Based Practice; Workforce Supply and Performance; Healthy Practice Environment; and Leadership. The capstone to this year was achieving Magnet redesignation in December. This important milestone reminded us once again that Northwestern Memorial s commitments to our Patients First mission, teamwork, and safe and effective care really do make a difference. Our 2010 Nursing Annual Report highlights the accomplishments of Northwestern Memorial nurses in each of our five strategy areas. Within Innovation, we expanded our Patient Centered Care Model to Surgical Services, the Emergency Department and procedural areas. In addition, we further embedded the model on inpatient units by focusing on the core tenets of anticipating care, coordinating care and engaging patients and families in care planning. The result was continued improvements in our nurse-sensitive quality indicators, including the lowest fall and pressure ulcer prevalence rates achieved to date. Within Research and Evidence-Based Practice, we initiated 11 new nursing research studies and increased the number of nurses presenting at conferences. Our nurses also received national recognition for their work, including poster awards at national conferences and book and journal publications. In the area of Workforce Supply and Performance, our efforts to advance the professional practice environment resulted in recognition as a national leader for our certification outcomes and a partnership with Chamberlain College of Nursing to support our nurses in pursuing BSN and MSN degrees. We supported our goals for Healthy Practice Environment by further decreasing nursing needle stick injuries and advancing our Take-a-Break Program. In addition, we continued to advance our Leadership goals by adding the Nursing Finance Committee to our shared leadership committee structure. Thanks to all of our nurses for your ongoing care and compassion for our patients. The achievements outlined in this report provide all of us with many reasons to celebrate nursing excellence at Northwestern Memorial. Sincerely, Michelle A. Janney, RN, PhD, NEA-BC Senior Vice President and Wood-Prince Family Chief Nurse Executive Northwestern Memorial Hospital

4 INNOVATION Celebrating Magnet Excellence At Northwestern Memorial, we work together to ensure quality in all stages of care. Our attentiveness to patient needs and commitment to improving the health of the community are part of what makes us a national leader in providing exceptional patient care. These efforts are recognized with Magnet status, the gold standard for nursing excellence and quality patient care. The American Nurses Credentialing Center (ANCC) first awarded Northwestern Memorial the four-year Magnet designation in We earned Magnet redesignation in 2010 an accomplishment achieved by only three percent of hospitals nationwide. Magnet redesignation reflects the caliber of our nursing workforce as a team dedicated to advancing our Patients First mission and demonstrating each day that excellence matters in everything we do. While this designation is a nursing credential, it was very evident to the appraisers and the commissioners that the strong, multidisciplinary work of the entire Magnet team led to the successful outcome. At the end of the day, this team effort benefits the patients you serve. KAREN DRENKARD, MD, DIRECTOR, MAGNET RECOGNITION PROGRAM In evaluating Northwestern Memorial for Magnet redesignation, the ANCC noted our organizational strengths of interdisciplinary collaboration, teamwork, innovation, transparency, quality and engagement of physicians, employees and the community. These key markers of success help distinguish Northwestern Memorial as a destination of choice for exceptional patient care. Other attributes that contribute to our Magnet status are that: n Our nurses stand out in national comparisons on education with more than twice as many having earned the Bachelor of Science in Nursing or higher degrees. n We have nearly twice as many nurses credentialed in their specialty compared Magnet hospitals report higher patient and family satisfaction as well as fewer patient falls, fewer medication errors and lower mortality. Magnet appraisers recognized our organizationwide excellence and have identified a number of best practices in programs, processes and outcomes that set Northwestern Memorial nurses apart. These best practices include changes to our Patient Centered Care Model to enhance patient satisfaction and quality of care hospitalwide; providing resources to increase professional certifications and improve patient outcomes; and a new Peer Review program to foster a culture of continuous learning, safety and accountability. to the national average. n Our nurses work as partners with physicians to improve care and contribute to research, leadership, process improvement, quality and safety. By demonstrating continued excellence in transformational leadership; structural empowerment; exemplary professional practice; new knowledge; innovation and improvements; and empirical outcomes, Northwestern Memorial nurses exemplify our commitment to our Patients First mission. 2

5 N U R S I N G A N N U A L R E P O R T INNOVATION Patient Centered Care Model Phase 2 Building on our commitment to providing exceptional patient and family centered care, we expanded our Patient Centered Care Model (PCCM) in fiscal year The PCCM was first introduced to the inpatient units in fiscal year 2009 and has now been implemented in Surgical Services, the Emergency Department and procedural areas such as Radiology and the Cardiac Catheterization Lab. The enhanced model guides daily practice in all areas. we also seek to increase the involvement of patients and families, optimize the amount of time nurses spend interacting with patients and work to assess and reduce missed care. In addition, we are working to implement a standardized, hospitalwide process for coordinating, communicating and documenting a patient centered, interdisciplinary plan of care. The success of the PCCM is anchored in practices such as proactive hourly rounds and safety huddles. Teams of nurses in both inpatient and procedural areas have adapted key aspects of the model, such as rounding within their individual units or departments to ensure that we are effectively anticipating and coordinating the care needs of all patients. With the new implementation of the PCCM, Surgical Services has seen a positive correlation between that and an increase in our patient satisfaction scores. The staff is enthusiastic about the changes and there are consistent expectations for everyone. JIMM PLAZA, RN, BSN, MBA, EDUCATION COORDINATOR FOR PRENTICE SURGICAL SERVICES, OLSON AMBULATORY SURGERY CENTER, PRE-OP CLINIC The PCCM continues to focus on the three guiding principles of anticipating care, coordinating care and engaging patients and families in care planning. We are measuring the impact of the PCCM through monitoring of outcome indicators such as patient satisfaction, falls, urinary tract infections and core measures. While we outperform national benchmarks on all nurse sensitive indicators, a goal for the next phase of the model is to achieve sustained top-decile performance in key patient care quality and satisfaction indicators. Shaun Hamberlin, RN, staff nurse, uses best practices from the model to care for Radiology patients. To do this, we are using our area-based quality improvement committees to monitor and analyze these quality indicators. Through the expanded model, FROM THE PATIENT S PERSPECTIVE If I have a question, they answer willingly and knowingly. They make my visitors feel welcome, too. Laurie Teitelbaum, patient, Surgical Services, Prentice Women s Hospital, photographed with Jimm Plaza, RN, BSN, MBA (left), education coordinator for Prentice Surgical Services, Olson Ambulatory Surgery Center, Pre-Op Clinic, and Rita Govert, RN, BSN (right), Prentice Surgical Services 3

6 INNOVATION Clean Hands Performance: Clean Hands (Inpatient and Emergency Department Performance) support and feedback to improve performance and sustain achievements. Interventions across the organization in fiscal year 2010 included: n Displaying Clean Hands screen savers on all computers in patient care areas organizationwide. n Developing new Clean Hands signage displayed in public areas. 100% n Posting monthly comparison data by discipline and unit via and on 90% 80% the Clean Hands site on the intranet. Adherence (%) 70% 60% 50% 40% 30% 20% n Implementing a new process for weekly audits during which trained observers are assigned to monitor sister units. n Providing weekly performance updates on every unit to nursing leadership and nursing area-based quality committees to highlight performance and address gaps. 10% 0% FY09Q1 FY09Q2 FY09Q3 FY09Q4 FY10Q1 FY10Q2 FY10Q3 FY10Q4 NMH Performance NMH Goal Northwestern Memorial achieved the highest performance to date on adherence to the hand hygiene protocol at 95 percent. We met our goal and advanced the culture of clean hands across the organization. The commitment of our entire hospital has made hand hygiene practices a routine part of providing safe patient care to prevent the spread of infection. We also have engaged patients to become our partners in safety by empowering them to remind their visitors and our staff, if necessary, to clean their hands when they enter and leave patient rooms. Nursing leaders across the organization have played a vital role in building and sustaining our culture of safety, including hand hygiene. A team of nurses led efforts to create a survey for all patient care staff, collaborated with managers and staff to identify barriers to proper hand hygiene and provided continual 4 As part of the goal to advance the culture of clean hands, one intervention included reevaluating the placement of hand gel dispensers and relocating them to reinforce consistent use throughout patient care areas, practiced here by Maryanne Fishman, RN, MS, AOCN, advanced practice nurse in Hematopoietic Stem Cell Transplant.

7 N U R S I N G A N N U A L R E P O R T INNOVATION Falls The falls rate per 1,000 patient days has continued to decline and, by the fourth quarter of fiscal year 2010, reached an all-time low of Performance for the falls prevention protocol remained greater than 95 percent throughout the year. Targeted interventions included: n Developing a new approach to fall prevention that assumes all patients are at increased risk for falls unless proven otherwise. A standardized set of interventions was created for implementation upon admission that can be removed after the nurse evaluates the patient for predefined exemption criteria. n Piloting the new fall prevention plan in five units. n Tailoring education and presentations to all high-risk units by identifying potential causes of falls unique to their environment. n Enhancing the Falls Champion program, in which direct care nurses are educated to serve as unit experts in fall prevention and provide ongoing education and reinforcement to nurses and patient care technicians. Pressure Ulcers The elimination of hospital-acquired pressure ulcers continues to be a major focus. In fiscal year 2010, we outperformed the benchmark for the National Database of Nursing Quality Indicators with a pressure ulcer prevalence rate of 4.7 percent. In addition, performance on the pressure ulcer prevalence protocol was greater than 95 percent. Targeted interventions for fiscal year 2010 included: n Continuing weekly skin assessment rounds on all inpatient nursing units. n Using change of shift safety huddles to identify patients at risk for pressure ulcers. n Leveraging the Enterprise Data Warehouse to monitor daily pressure ulcer prevalence and provide real-time reports of pressure ulcers to nurses at the unit level. n Partnering with Risk Management to ensure that all hospital-acquired stage 3 and stage 4 pressure ulcers have a mini-root cause analysis completed at the unit level and requiring regular reporting of findings to the Pressure Ulcer Oversight Committee and the Nursing Quality and Patient Safety Committee. n Implementing a mini-root cause analysis process to be completed by unit leadership and caregivers following a patient fall. n Creating a post-falls assessment in the electronic medical record to facilitate improved communication on specifics of each fall, enhancing the capability for collective data analysis and working to ensure that information about the fall is available for any future inpatient admission. 25% 20% Hospital-Acquired Pressure Ulcer Prevalence (Lower is better) Falls Rate Per 1,000 Patient Days (Lower is better) Prevalence (%) 15% 10% 4 5% Rate per 1,000 Patient Days FY2009 = 2.74 Falls Rate per 1,000 Patient Days FY2010 = 2.32 Rate per Year 0% FY09Q1 FY09Q2 FY09Q3 FY09Q4 FY10Q1 FY10Q2 FY10Q3 Prevalence Benchmark: National Database of Nursing Quality Indicators Weighted Mean FY10Q4 Benchmark: National Database of Nursing Quality Indicators Weighted Mean 0 FY09Q1 FY09Q2 FY09Q3 FY09Q4 FY10Q1 FY10Q2 FY10Q3 FY10Q4 5

8 WORKFORCE SUPPLY AND PERFORMANCE New Education Coordinator Role To support the professional development of our nursing staff and better coordinate educational needs throughout the hospital, we redesigned our staff educator role to create a new education coordinator position. The development of this new role brings a collaborative and coordinated approach to nursing education and our transition-to-practice programs. The new education coordinators are responsible for assessing, directing and coordinating both the formal and informal education of nursing staff at the unit and department levels. They work closely with the NM Academy, the Nursing Education and Professional Development Committee, the Department of Professional Practice and Development and the Hospitalwide Shared Leadership Committees. Since the change, the visibility of the education coordinators across the organization has increased. They serve on various hospital committees and provide consultation on clinical and quality issues for nurses. In addition, they participate in area-based quality committee meetings and coordinate and oversee new employees as they transition into their new roles. Listening to staff is a key aspect of the role, as is participating in symposia and other educational outreach programs. Our education coordinators work to integrate research and evidence-based practice into all education programs. The development of this new role has enabled our education coordinators to collaborate more effectively to advance our mission to bring the best patient care to the bedside. The education coordinator role serves as a great resource in the hospital. We have a voice and people listen. With the redesigned role, I m available to the staff more and they call me about anything they might be unsure about. SHARON LUMPKINS, RN, AN EDUCATION COORDINATOR FOR 14E, 13E AND 13W FEINBERG Under the new model, education coordinators are collaborating across departmental lines, sharing their expertise and working together to more effectively address the education needs of our nursing staff. For example, education coordinators from different units have partnered to educate nurses on a new Ventilator Acquired Pneumonia (VAP) prevention bundle, supplies and equipment. Another effort brought together ICU nurses for the launch of a new electronic documentation system. Georgie Perry, BSN, RNC-NIC (left), and Jonna Burchett, RN, BSN, MSN (right), both postpartum education coordinators in Prentice Women s Hospital, teach new staff nurse Michelle McNees, RN, MSN (middle), proper techniques for infant CPR. 6

9 N U R S I N G A N N U A L R E P O R T WORKFORCE SUPPLY AND PERFORMANCE New Partnership for BSN and MSN Degrees In collaboration with nursing leadership, Northwestern Memorial changed the hiring standards for nurses. Beginning in fiscal year 2010, we now require a minimum of a Bachelor s of Science in Nursing (BSN) for all new RN hires. This decision was made in light of an increasing body of evidence-based research documenting that BSN education is linked to improved patient outcomes such as fewer pressure ulcers and lower failure to rescue rates. At the same time, we reaffirmed our commitment to nurses who currently hold Associate Degrees in Nursing (ADNs). To support our nurses in advancing their education and ongoing professional development, we entered into an agreement with Chamberlain College of Nursing to offer two BSN options. The first is a hybrid cohort model that offers nurses a combination of onsite and online courses, while the second option offers all courses online. Nurses can choose which of the two options best meet their personal and professional needs. All nurses enrolled in Chamberlain s BSN or Master s of Science in Nursing (MSN) programs receive a 15 percent tuition discount. In addition, as Northwestern Memorial employees, nurses can use their tuition reimbursement benefits to help fund their education. The first hybrid cohort was launched in August of 2010 with 15 students. As of February of 2011, 73 nurses were enrolled in Chamberlain programs 66 in the RN to BSN program and seven in the MSN program. The Chamberlain College of Nursing RN to BSN program is one of the important ways that we are advancing our vision to attract, develop and retain exceptional nurses and provide them with an environment that fosters excellence through continuous learning. Through our commitments to BSN hiring and the continuing education of our current nurses, we anticipate further increasing the number of nurses with BSNs at Northwestern Memorial. The managers are very supportive of our return to school by giving us flexible work schedules and ongoing encouragement, says Michele Bankhead, RN (left), staff nurse in the GI lab. Cornet Berry, RN (middle), staff nurse on 12W Feinberg, and Karen Campbell, RN (right), staff nurse on 12E Feinberg, are excited about the opportunity to advance their education and the flexibility the program offers. I enjoy the ability to take my classes online and not have set days or times scheduled for classes and clinical, Berry says. 80% 70% 60% 50% 40% 30% 20% 10% 0% Educational Preparation of Direct Care Nurses In FY10 the percentage of BSN and MSN prepared nurses increased from 78% to 84%. Our goal is an annual increase of at least 2%. 71% 72% 74% 74% 73% 74% 20% 17% 16% 16% 14% 13% 6% 5% 7% 5% 5% 4% 5% 5% 5% 5% 3% FY05 FY06 FY07 FY08 FY09 FY10 % Diploma % ADN % BSN % MSN 10% 7

10 WORKFORCE SUPPLY AND PERFORMANCE Certification Outcomes Northwestern Memorial continues to support and encourage our nurses to pursue national certification in their areas of specialty. In fiscal year 2010, we identified specialty nursing certification as one of the core tenets of what it means to be a Northwestern Memorial nurse. We also set a goal to increase the number of newly certified nurses by 10 percent. We exceeded our goal, achieving a 12.5 percent increase, or 89 newly certified direct-care nurses. Overall, 44 percent of our direct-care nurses are certified, compared to 28 percent at Magnet hospitals nationally. To support our goal of advancing certification, we offer annual onsite review courses in a number of nursing specialties, including critical care, medical-surgical, cardiac-vascular, emergency, oncology and women s health. The courses are offered as a benefit to our nurses and enable them to earn continuing education hours for attending. In addition, nurses who are full- or part-time employees can use the hospital s tuition reimbursement benefit to cover the cost of taking the exam. Number of Northwestern Memorial Certified Nurses Nurses who provide care at the bedside and expertise through advanced certifications contribute to patient centered discussions during interdisciplinary rounds regarding daily needs. Nursing Demographics in Fiscal Year 2010 Caucasian 67% Asian/Pacific Islander 19% African-American 9% Latino 5% Northwestern Memorial Nursing at a Glance in Fiscal Year Q1GY07 Q2GY07 Q3GY07 Number of Certified Nurses Q4GY07 Q1GY08 Q2GY08 Q3GY08 Q4GY08 Q1GY09 Q2GY09 Q3GY09 Q4GY09 Q1GY10 Q2GY10 Q3GY10 Q4GY10 NMH Goal (10% increase each year) Total Registered Nurses 2,279 Certified Nurses 906 Advanced Practice Nurses 167 Nurses with Associate Degree/Diploma 340 Nurses with Bachelor of Science in Nursing 1,523 Nurses with Master of Science in Nursing 197 Nurses with Doctorate 9 Percentage Female 92 Percentage Male 8 Average Age 38 Average Years of Service 14 RN Vacancy Rate 3.6% RN Voluntary Turnover Rate 7%

11 N U R S I N G A N N U A L R E P O R T LEADERSHIP Shared Leadership Committees Shared Leadership Committee Structure Our Nursing Shared Leadership Committees continued to make important contributions to advancing nursing excellence in fiscal year A highlight of the year was the addition of a Nursing Finance Committee (NFC) to our hospitalwide shared leadership structure. The NFC, chaired by Kelly Marks, RN, BSN, MICU clinical coordinator, is charged with promoting the delivery of safe, effective and cost-efficient patient care by evaluating, implementing and optimizing fiscal responsibility across all areas of nursing. Nursing Education and Professional Development Nursing Research and Evidence- Based Practice Chief Nurse Executive Coordinating Council Hospitalwide Shared Leadership Committees Nursing Best People and Professional Excellence Nursing Technology and Informatics Nursing Quality and Patient Safety Nursing Finance Nursing Professional Practice Our nursing financial processes received national recognition in a recent article in Nursing Economics. In addition, the Magnet appraisers highlighted our financial practices as an exemplar of excellence. MICHELLE A. JANNEY, RN, PHD, NEA-BC, SENIOR VICE PRESIDENT AND WOOD-PRINCE FAMILY CHIEF NURSE EXECUTIVE, NORTHWESTERN MEMORIAL HOSPITAL Departmental Shared Leadership Committees Unit-Based Committees Shared leadership at Northwestern Memorial continues as a dynamic, evolving structure designed to foster nursing excellence through effective horizontal and vertical communication and promotion of autonomy, clinical decision making and accountability for practice among nurses throughout the organization. The work of the NFC was cited among the exemplars of excellence in our 2010 Magnet redesignation report. The goals for the NFC s first year were all accomplished and included: n Educating committee members on financial measures. n Introducing financial concepts to nurses across Northwestern Memorial. n Developing a process for reviewing patient care medical device requests with costs greater than $10,000. n Identifying opportunities to reduce waste. Kristopher Goetz, director of Operations, NFC facilitator, and Kelly Marks, RN, BSN, MICU clinical coordinator, NFC chair, prepare the agenda for an upcoming meeting. 9

12 LEADERSHIP Peer Review The focus of our nursing Peer Review program is to improve patient care, support a culture of continuous learning and ensure best practices. In its first full year, Peer Review already has led to advances in the quality of nursing care and enhanced patient safety. Our goal is to share what we ve learned though peer reviews with all nurses at Northwestern Memorial. The Nursing Quality Peer Review Committee (NQPR) meets monthly to discuss medical errors and adverse events. The 10-member committee is made up of exceptional performers who are direct-care nurses with at least two years of experience and drawn from all departments. Members review cases referred by risk management, the quality department, staff and other members of the interdisciplinary team. We want to reach out to make anyone comfortable in making a referral, in identifying near misses and cases that should be reviewed. The case reviews can lead to improved patient outcomes. Nursing Quality Peer Review Committee members discuss cases and make recommendations on how to advance quality care. ANN SCHRAMM, RN, MSN, DIRECTOR OF WOMEN S HEALTH While nurse committee members may empathize with the pressures and complications that occur on the job, they are charged with stepping back to objectively examine each case. The process is intended to evaluate cases using professional standards of practice. Nurses whose cases are being heard do not attend, though they are interviewed beforehand. share with nursing staff, such as the importance of checking medications to ensure the manufacturer s label and the hospital pharmacy label match. One discussion centered on how fatigue and lack of sleep impacts decision making. The process empowers staff nurses to identify and address gaps in quality care and promote a culture of safety and best practices. The peer review process promotes transparency, increases teamwork, supports creativity and creates sense of ownership among nursing staff. In the past year, the committee has reviewed various cases, including some medical errors and adverse events. The committee identified key issues to 10

13 N U R S I N G A N N U A L R E P O R T HEALTHY PRACTICE ENVIRONMENT Nurse Workforce Development Northwestern Memorial Hospital s Nursing Best People and Professional Excellence Committee is focused on developing and implementing programs and initiatives that promote recruitment and retention and maintain a safe and healthy work environment. Under the leadership of Abby Jones, RN, BSN, CNRN, chair, and Maureen Slade, RN, MSN, APRN, CMHCNS, facilitator, the members have advanced initiatives that help create a healthy work environment. Chicago Cares Highlight As part of Northwestern Memorial s commitment to serving the community, the Nursing Best People and Professional Excellence Committee actively recruited nurses organizationwide to participate in the annual Chicago Cares Serve-a-thon, during which volunteers work to beautify Chicago Public Schools with painting, cleaning and landscaping. These volunteer recruitment efforts contributed to Northwestern Memorial receiving the Chicago Cares Team of the Year Award in fiscal year 2010 for having nearly 600 volunteers, the most for any corporate sponsor. Volunteers from nursing represented a 17 percent increase over the nurses who participated the previous year. Take-a-Break Nurse Work Injuries We continue to make significant progress in decreasing nursing injuries as a result of sharps or needles. Over the past two years, needle stick injuries among nurses have declined by 45 percent. Exposure Rate as a percent of total RNs at Northwestern Memorial 1.80% 1.60% 1.40% 1.20% 1.00% 0.80% 0.60% 0.40% 0.20% 0% Nursing Work-Related Injuries: Blood and Body Fluid Exposures (BBFE) Involving Sharps/Needles F08Q1 F08Q2 Blood and Body Fluid Exposures involving sharps/needles First quarter 2008 Baseline - BBFE-Sharps = 1.08% F08Q3 F08Q4 F09Q1 Nurse Engagement F09Q2 F09Q3 F09Q4 Northwestern Memorial is committed to creating a professional practice environment for nurses that advances shared leadership, participation in decision making, professional development, career advancement and interdisciplinary team collaboration. We assess these parameters through an annual employee engagement survey. In fiscal year 2010, 87 percent of employees participated in the survey. Nursing outperformed the Magnet norm and Northwestern Memorial s overall scores for engagement. F10Q1 F10Q2 F10Q3 F10Q4 100% 90% Nursing Engagement Scores Compared to Northwestern Memorial Overall and Other Magnet Organizations Nursing NMH Overall Magnet Norm 80% 70% 60% 50% 40% 30% Staff nurse Abby Jones, RN, BSN, CNRN (left), staff nurse in the NSICU, prepares for her 30-minute uninterrupted meal break, which is required during each work shift. Taking a break helps improve job satisfaction, says Sara Buenaventura, BSN, CMSRN (right), manager on 14E Medicine and Feinberg Observation Unit. Evidence-based research shows staff who take breaks contribute to a safer work environment. 20% 10% 0% Organizational Effectiveness Recognition/ Career Advancement Supervisory/ Management Coworker Performance/ Cooperation Engagement Grand Mean 11

14 RESEARCH AND EVIDENCE-BASED PRACTICE Nursing Research and Evidence-Based Outcomes During fiscal year 2010, we advanced our research and evidence-based practice outcomes in several key areas. Eleven new research studies were reviewed and approved by the Nursing Research and Evidence-Based Practice Committee. In addition, Northwestern Memorial provided 117 contact hours of research and evidence-based practice education for nurses. This included our Annual Nursing Research Symposium, A New Decade of Discovery: Making a Difference through National Recognition n Kate O Brien, RN, BSN; Margaret Mensing, RN, BSN; and Megan Ethington, RN, BSN: Putting the Patient at the Center of Care: Using Theory in Practice. Best Clinical Poster, 2009 Academy of Medical-Surgical Nurses Annual Convention. n Molly Reagan, RN, BSN; Carol Payson, RN, MSN, NE-BC; Lisa Kwasigroch, RN, MSN, RNFA, CNOR; Paul Langlois, APN, PhD, CCRN, CCNS, CNRN; and Michelle A. Janney, RN, PhD, NEA-BC: Pressure Ulcers: Getting to Zero by Utilizing the Multidisciplinary Grass Roots Approach. Outstanding Poster Award at the 2010 American Organization of Nurse Executives Annual Meeting and Exposition. Publications n Linda Morris, PhD, APN, CCNS, and M. Sherif Afifi, MD: Tracheostomies: The Complete Guide, Springer Publishing n Barbara Holmes Gobel, RN, MS, AOCN, and two professional colleagues: Cancer Nursing: Principles and Practice (7th ed.), Jones and Barlett Publishers n Carol Burke, RNC, APN, MSN: Active vs. Expectant Management of the Third Stage of Labor and Implementation of Protocol (May 2010). Journal of Perinatal & Neonatal Nursing, 24, n Julie Garrett, RN, BSN, CCRN; Heidi Wheeler, RN, MS, ANP-C; Kristopher Goetz, MA; Mary Majewski, RN, MSN; Paul Langlois, RN, PhD, CCRN; Carol Payson, RN, MSN, NE-BC: Implementing an Always Practice to Redefine Skin Care Management (September 2009). Journal of Nursing Administration, 39, Janet Palamone, RN, MSN, APN, CNRN, CCRN, Neuro/Spine Intensive Care Unit (NSICU) education coordinator, discusses her poster presentation on Tap and Twist, a research study on preventing deep vein thrombosis in NSICU patients. Nursing Research Partnerships, which was offered in partnership with Northwestern Lake Forest Hospital and Rehabilitation Institute of Chicago, and attended by more than 100 Chicago area nurses. Northwestern Memorial nurses delivered 66 posters and presentations at conferences in fiscal year 2010, an increase of 10 percent from the previous year. Significant achievements included: Northwestern Memorial Hospital: Nursing Publications, Presentations and Research Studies FY 2007 FY 2008 FY 2009 FY Publications Presentations Research Studies

15 Northwestern Memorial Recognition and Awards n Magnet Recognition Redesignated with Magnet status, the gold standard for nursing excellence and quality of care. First designated in n America s Best Hospitals Ranked locally as the No. 1 hospital in Chicago with 12 medical specialties recognized nationally in 2010 by U.S. News & World Report. n University HealthSystem Consortium Listed in the top 20 in the University HealthSystem Consortium 2010 Quality and Accountability rankings of academic medical centers. n 100 Best Companies for Working Mothers Named to Working Mother magazine s list for 11 consecutive years. n 100 Top Hospitals Recognized as one of the nation s Top Hospitals for 2010 by Thomson Reuters, an annual study that examines the overall performance of more than 3,000 hospitals nationwide. Susan Brunovsky, RN, BSN, CCRN, CNRN, and Matthew Groth, RN, BSN, CCRN, teach an NSICU patient the foot and ankle range of motion exercises that are part of the Tap and Twist study. Tap and Twist: Preventing Deep Vein Thrombosis Preventing deep vein thrombosis (DVT) is a major focus of hospitals nationally and patients in Neuro/Spine Intensive Care Units (NSICUs) are at particularly high risk for developing this complication. A team of nurses from the NSICU studied whether the addition of nurse-initiated foot and ankle exercises to current prevention measures would further decrease the incidence of DVT among their patient population. The study included 315 adult NSICU patients. Investigators assessed patients histories, lower extremity Doppler (LED) readings, percentage of time patients performed the exercises and documentation of standard DVT measures. Overall, there was no statistically significant difference in DVT rates for patients receiving the foot and ankle range of motion intervention during the study period as compared to the usual nursing practice during the year prior. However, those who developed a DVT had a significantly lower compliance rate with the exercises compared with those who did not develop a DVT (38.7% versus 58.4%, p<0.001). The findings suggest that foot and ankle exercises may have a role in reducing the incidence of DVT. The investigators have presented their findings nationally and have a manuscript under review by a peer-reviewed journal. n Patient Satisfaction Ranked first among Chicago hospitals in Overall Patient Rating by Consumer Reports. n Consumer Choice Sole winner for six consecutive years of the Consumer Choice award in market research of Chicago-area consumers. Named most preferred Chicago-area hospital in the same study for 16 consecutive years. n Most Wired Named 10 times to Hospital & Health Networks magazine s list of the 100 Most Wired hospitals and healthcare systems. n National Quality Health Care Award Sole recipient of the prestigious national quality award in 2005, presented by the National Committee for Quality Health Care. May Northwestern Memorial Hospital Division of Public Relations, Marketing and Physicians Services. For more information about Northwestern Memorial Hospital, please visit nmh.org

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