2012 Nursing Annual Report Models of Nursing Excellence

2012 Nursing Annual Report Models of Nursing Excellence

Foundations of Excellence. The Mission, Vision and Values of SJH, together with an intense focus on the exemplary expectations of the ANCC Magnet Model and a fully matured Professional Practice Model inform and direct each and every endeavor undertaken by the SJH Nursing Department. We are pleased to share our 2012 Annual Nursing Report as an exemplar of the achievements and accomplishments of both SJH and our extraordinary nurses. Mission: To provide high quality health services that improve the lives of all we serve Vision: South Jersey Healthcare is the region s leading network of health care providers, delivering the full continuum of primary, acute and advanced care services. Values: Quality, Partnership, Empowerment, Integrity, Stewardship and Compassion From Our Cover SJH Regional Medical Center Vineland, NJ SJH Elmer Hospital Elmer, NJ Bridgeton Health Center Bridgeton, NJ The SJH Nursing Executive Team (Left to Right) Janet Davies, RN, MSN, CCNS VP Patient Care Services, Elmer Hospital Elizabeth Sheridan, RN, BSN, MA, NEA-BC, FACHE Chief Nursing Executive, South Jersey Healthcare Chief Operating Officer, Regional Medical Center Anne McCartney, RN, MSN, CNM, NEA-BC VP Patient Care Services, Regional Medical Center

Transformational Leadership Transformational Leaders at all levels embody the shared Mission, Vision and Values of the organization, influence change and advocate for excellence. Leading The Patient Centered Care Experience An exemplary patient experience is second only to exceptional patient outcomes at SJH. Under the visionary leadership of Elizabeth Sheridan, RN, BSN, MA, NEA-BC, FACHE (CNO, SJH and COO, RMC) SJH has implemented numerous system level improvements including a transition to electronic documentation, an RN-Nurse Aide model of care and most recently the incorporation of a Room Service Model for meal delivery. The move to Room Service required a complete restructuring of the Food and Nutrition Services department, overseen by Ms. Sheridan in her role as COO. In addition, numerous nursing practice changes were required to incorporate the new process in care routines. In her role as CNO, Ms. Sheridan empowered nurses at all levels to participate in numerous work-outs and analysis to ensure a safe and successful roll out. As a result, patient satisfaction scores have continued to steadily increase since the implementation of Room Service at the RMC with plans to expand the service to Elmer Hospital in 2013. Nursing Leaders Transforming Practice Nurse Manager Chris Roller, RN-BC also recognizes the unique needs a specialty patient population represents. The frail elderly patients admitted to the 1 East Unit often present with multiple complex physical and psychosocial needs. Seeing this as an opportunity rather than a challenge Chris led the 1 East UBPC in re-designing their geriatric focused NICHE (Nurse Improving the Care of Healthsystem Elders) Rounds to directly focus on their patient s specific needs. As a result, rates of a number hospital related complications common to geriatric patients have been decreased one east. In fact in the last two years, 1 East Unit has had only one episode of restraints, two episodes of CAUTI and two episodes of HAPU. In addition, LOS on the unit has decreased from 5.7 to 4.3 days. Leadership from the Bedside NICU Staff Nurse Wendy Kelley, RN-C, BSN plays an active role SJH s Safe Sleep initiatives. When Wendy discovered grant funds were available from the CJ Foundation for SIDS, she immediately recognized an opportunity to improve Safe Sleep Education at SJH. In December, 2012 Wendy Kelley and the SJH Safe Sleep Team received notification that their proposal for a novel conference Providing Culturally Competent Safe Sleep Education was funded in full. This conference, designed to help health care providers deliver life saving Safe Sleep Education to the diverse population served by SJH in the most effective manner is scheduled for October, 2013. The conference education will also serve as the basis for nursing research study measuring the effectiveness of culturally competent safe sleep education.

Structural Empowerment SJH supports a vibrant, well educated environment which fosters clinical, academic and professional nursing excellence. Nurses at all levels are empowered patient advocates. Academic Excellence In 2012 more than two hundred SJH nurses took advantage of SJH s tuition assitance policy as well as their many partnership with local and on line colleges and universities. As a result SJH nurses are bringing the exceptional knowledge associated with advanced degree attainment to our patients bedsides in record numbers. By the end of 2012, more than 80 SJH direct care nurses have earned a new Bachelor s Degree or higher in nursing, representing an increase of more than 42% over 2011 numbers. 300 250 200 150 100 50 0 # Direct Care Nurses with BSN or Higher 2011 2012 PIV Infection Reduction According to the Centers for Disease Control, thousands of Central Line Associated Blood Stream Infections (CLABSI) occur annual in American hospitals. The diligence of SJH Physicians, Nurses and Staff has resulted in CLABSI rates that are consistently less than national benchmarks. However, in accordance with SJH s commitment to continual quality improvement, SJH has turned its focus to infections related to Peripheral IV sites (PIV). This endeavor included the development of a PIV Task Force, a complete policy review and update, intensive re-education, the addition of an informatics alert to clinical documentation systems and the creation of PIV rounds. As a result of these interdisciplinary efforts, PIV related BSI incidence decreased from a high of 4 infections/quarter to less than 4 infections across the entire year of 2012. 200 150 100 50 0 PRIDE Participants 2011 2012 Clinical Excellence The recent Institute of Medicine Future of Nursing report recommended nurses commit to lifelong learning. SJH recognizes the exceptional commitment to both professional excellence and lifelong learning that nursing specialty certification represents. To support our nurses in their pursuit of professional development, the SJH Professional Ladder (the PRIDE Program) proudly offers pre-payment for nursing certification exam fees and allows nurses to use a portion of their tuition reimbursement funds to attend national conferences and maintain their certification. As a result, PRIDE participation has nearly doubled and nearly 20% of SJH direct care nurses are nationally certified.

Exemplary Professional Practice The SJH Professional Practice Model lays the foundation for excellence in nursing care, remarkable patient outcomes and an exceptional work environment. The SJH PPM The SJH PPM underwent a substantial modification in 2012. Based on the recommendations of the Professional Development Council and the Nursing Executive Council, the model has evolved from the four basic tenets set forth by Hoffart & Woods to include the numerous and varied aspects of professional nursing practice at SJH. The new 2012 model includes the following areas: SJH Mission, Vision and Values; Professional Nursing Values; Interdisciplinary Collaboration, Keys to Success; Reward and Recognition; Professional Development; Shared Governance; Care Delivery Models Engaged in Excellence A collaborative environment which empower nursing excellence and nursing autonomy results in an exemplary work environment. Despite a rapidly changing economic and healthcare environment, SJH nurses continue to report Employee Engagement scores that exceed national norms for both RNs and healthcare workers in general. In 2012 SJH nurses reported satisfaction scores that exceeded national norms in each of the ten domains measured.

Exemplary Professional Practice Workplace Safety The first step in creating a healthy work environment is creating a safe work environment. SJH s Work Place Violence committee serves as a venue for nurses at all levels to work with the leaders of ancillary departments and the Security Staff to enhance work place safety measures. In addition to physical enhancements such as an increased security presence and additional card swipe locks, SJH has also invested in providing work place violence prevention training and non-violent crisis prevention training to nurses and staff in high risk areas. As a result, Work Place Violence incidence have decreased dramatically through out the past year. End of Life Care The American population is both aging and suffering from more and more severe chronic diseases. As these conditions persist the need for comprehensive Palliative Care is urgent. SJH offers a complete Palliative Care Program that offers SJH providers and inpatients access to the latest evidence based interventions to improve quality of life and diminish suffering. The SJH Palliative Care program is unique in its utilization of Advance Practice Nurses and Nurse Case Managers as the core of the interdisciplinary team. In 2012, SJH added a second APN to the Palliative Care Program thus increasing the access patients and providers have to this vital service. As a result, readmission rates in the palliative care population have decreased by more than 30%. Excluding an outlier case in July, 2012 the SJH Palliative Care Program has also decreased the amount of time that Palliative Care patients remain in the hospital from nearly five days to less than three days. Avoiding Critical Complications SJH Patient Outcomes routinely meet or exceed ANCC Magnet Standards for the required indicators of Falls and Hospital Acquired Pressure Ulcers as well as other voluntary indicators such as restraint usage and catheter associated urinary tract infection. Complications commonly seen in critically ill patients such as Ventilator Associated Pneumonias and Central Line Associated Blood Stream Infections represent an more challenging opportunity to improve patient care. The interdisciplinary, nurse-led SJH VAP and CLABSI team routinely use the Evidence Based Practice process to ensure that our standards of care incorporate the best practices and protocols available. In 2012 SJH was pleased to add Dr. Edward Grey to our Critical Care Team. If an incident should occur the teams use Root Cause Analyses and the DMAIC performance improvement process to ensure that the quality of care is continually improved. As a result, CLABSI rates at SJH have continued to decrease and only one episode of VAP has occurred at SJH in the last two years.

New Knowledge Innovations and Improvements Nursing Research and culture of inquiry thrive at SJH. SJH nurses continuously seek out and facilitate the most innovative and effective evidence based best practices. When this knowledge is not available, they are supported in conducting original nursing research studies to add to nursing knowledge and the existing evidence base. New Knowledge In Action Nurses working in the 2 East unit of Elmer Hospital are familiar with emerging evidence and new knowledge in support of holistic and integrative strategies to support patient care. The 2 East UBPC anecdotally noticed an increase in the number of patient receiving prescription sleep aides. In addition, patient satisfaction with quietness and the hospital environment were less than optimal. As a result they undertook a literature search to identify the best evidence based practices to promote sleep in a more holistic manner. In addition to a number of environmental improvements, the UBPC developed a Bedtime Bundle. The Bedtime Bundle consists of a menu of interventions patients can select from including MP3 players with a musical selection of their choice, herbal tea, aromatherapy diffusers and eye masks. Since the implementation of the Bedtime Bundle patient satisfaction scores have improved in both areas (Hospital Environment by 16.6% and Quietness by 27.9%). More importantly, the use of ambient on the unit (measured in mg/pt day) has decreased by more than 50% from a high of 0.39 to a low of 0.13. Innovation in Critical Care... In 2012 SJH Nurses led an interdisciplinary initiative to improve the care of SJH s most critically ill patients. Based on American Heart Association recommendations, SJH has recently implemented a Therapeutic Hypothermia After Cardiac Arrest protocol in an effort to improve patient recovery and preserve function after cardiac arrest. SJH nursing leaders Janet Davies, RN, MSN, CCNS (VP of Patient Care Services, Elmer Hospital), Michele Zucconi, RN, MSN, CCRN (Administrative Director, Cardiac Care Center) and Sherry Remy, RN, MSN, CEN (Director of Nursing, Emergency Services) worked collaboratively with SJH s Emergency and Critical Care physicians to create and implement a comprehensive protocol covering care from arrival in the Emergency Department through discharge to home. To date more than a dozen patients have benefitted from the TH Protocol including most recently a young patient in their twenties who, despite multiple cardiac arrests, left the hospital for home with no functional deficits. 2012 Nursing Research Highlights Impact of an Interdisciplinary Patient Education Intervention on Diabetes Self Care Outcomes Cardiac Acute PI: Carol Copsey, RN-BC, MSN Will Implementation Of An Evidence Based Practice Protocol And Guidelines Result In Early Identification Of Delirium In South Jersey Healthcare Patients. 1East PI: Chris Roller, RN-BC The Researcher Is In. The SJH Nursing Research Council serves as a venue through which nurses at all educational and experience levels find the support they need to develop and accomplish novel nursing research studies. Recently the council recognized an opportunity to further individualize the mentoring and support available to researchers of all kinds. In 2012 the Master s prepared nurses of the SJH Nursing Research Council began offering Research Office Hours to allow for one on one support to prospective nurse researchers. The Council currently supports ten office hours each week across all shifts and all three campuses. To date the Research Office Hours program has offered support to more than a dozen prospective researchers including nurses, physicians, residents and pharmacists.

2012 Models of Excellence South Jersey Healthcare, our community and the nursing profession have recognized the excellence of the SJH Nurses and the work that they do. 2012 Awards and Honors Michele Zucconi, MSN, RN, CCRN American Association of Critical Care Nurses Circle of Excellence Nurse.Com/Nursing Spectrum National Nurse of the Year: Patient & Staff Management March of Dimes Nurse of the Year: Critical Care Roseanne DeFrancisco, RN, MSN ONE New Jersey Nursing Mentorship Award Dawn Goffredo, RNC-OB, MSN March of Dimes Nurse of the Year Leadership Robin Taylor, RN-C, BSN March of Dime Nurse of the Year Women s Health Sharon Grusemeyer, RN, BSN, CPHQ Mary Matyas, RN, APN-C Mary Bonini, RN, BSN March of Dimes Nurse of the Year Finalists Sharon Slavic, RN, MSN, MBA American Association of Critical Care Nurses Nurses in Washington Internship Scholarship Winner Acute Care of Elders (ACE) Unit Designation RMC 1 East Chris Roller, RN-C (Nurse Manager) & Terri Spoltore, RN, MSN, CCRN (Administrative Director) New Jersey IOM Future of Nursing Action Coalition Elizabeth Sheridan, RN, BSN, MA, NEA-BC, FACHE Chair Pillar V SJH Hosted South Jersey Action Coalition Forum May 29, 2012 New Jersey Council of Magnet Organizations Anne McCartney, RN, MSN, CNM, NEA-BC (Transformational Leadership) Janet Davies, RN, MSN, CCNS (Education & Outreach) Terri Spoltore, RN, MSN, CCRN (Structural Empowerment) Sami Abate, MSHS, RN, CCRN (New Knowledge & Innovations) Michele Zucconi, RN, MSN, CCRN (Exemplary Professional Practice) Congratulations 2012 SJH Nurses of the Year