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AUG U S T 201 2

Written by | Jordan Colwell, BSN, BSHS, RN Contact | Jordan Colwell, BSN, BSHS, RN P 308.630.1450 E Jordan.Colwell@rwmc.net 4021 Avenue B Scottsbluff NE 69361

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Table of Contents Letter from the Editor

Calendar of Events

A Message from Shirley

Service Excellence

Skin Care Note

Breakfast with Shirley

Professional Development

Shared Governance Reports

Clinical Coordinator Corner

Tear off Reference Algorithm

Special News Article

Special Article

Infection Control Corner

Photos 30

Safety Sense

Position Update

F. Jordan Colwell F. JORDAN COLWELL, BSN, BSHS, RN Survey Preparedness/Magnet Coordinator

Welcome to the June/July/August edition of the Magnetic Times. Many of you might know me from being a Night House Supervisor, but due to an unexpected back injury and surgery, I am unable to go back to my supervisor role at this time. I have been working in this position since May 2012 and I am grateful that Shirley Knodel, Susan Backer, and Sarah Shannon had the confidence in me to work at this capacity. Being a staff nurse and supervisor, I had no idea what went on behind the scenes at the hospital. The Joint Commission requirements have really opened my eyes as to how a hospital is run and why we do some of the things we do. One thing that hasn’t changed is that the patient is still the number one priority, and as long as we keep our staff and patients safe, we will meet the biggest requirements with any survey. This fall you will be seeing staff from the Joint Commission team come around and visit with you while you’re working. These visits are not intended to be negative in nature; all the staff will be doing is making sure that you’re prepared for the survey. This survey can happen at any time from now until January 2014. Many of you are probably asking where Avis Rogers went. Avis decided to retire in April so she could spend more

time with her family. She will be relocating and is looking forward to the change. She sends her best to all staff and will miss everyone! Since I will be taking over the Joint Commission (survey preparedness) and the Magnet Journey, Susan Backer is the new Patient Safety Officer and Clinical Nurse Specialist. Susan has an extreme passion for patient safety and loves guiding us on the safety journey. She also has a Master’s degree and is a licensed Clinical Nurse Specialist. Susan will be working on programs such as the new electronic care plan program and Horizons Expert Plan (HEP). Susan and I are both located in the Restorative Care Unit. Please stop by and say hi. If you have questions, please do not hesitate to call or email either of us. Thanks for all you do here at RWMC and I hope you enjoy my first publication of the Magnetic Times! Yours in Health,

F. Jordan Colwell

I am going to reproduce for you below an excerpt from the weekly update to the BICC, Pediatrics, and NICU staff by their assistant director, Erika Carmody, BSN, RN. Erika took this from the book, Moss, T., Helldorfer, M., and Selberg, J. (2011), Healing with Heart- Inspirations for Health Care Professionals, Mass Communications: Holding to our Caring Convictions during tight financial times.

Shirley Knodel SHIRLE Y KNODEL, MS RN Chief Nursing Office VP of patient care

It’s not uncommon for messages to come down from senior management announcing a new phase of belt tightening. Anyone who has worked in our field for any length of time has experienced the constant balancing act that health care organizations face in treating the uninsured or underinsured in our community while still coming up with the financial resources to pay for staff, maintenance of equipment, growth, as well as the operational costs associated with running a topnotch facility. Unfortunately, when we have to function during a time of financial constraint, we operate with an attitude of scarcity-mixed with a little fear and anxiety associated with the loss of jobs. Employees who are challenged to do the same job with even fewer resources than before are placed in an uncomfortable situation.

When these times arise, working harder is not an option because we’re already tapped out. The mere suggestion that we work harder is a turn-off and increases stress. We can better serve ourselves and our patients if we can resist this bunker mentality and instead, look for ways to work differently. Continuing a tradition of caring does not always mean using up a lot of money. There are ways to continue to care for our patients even during a period of tight budgets. As important as money is, all of the resources in the world will not guarantee quality care. All of us have known colleagues who have reached into their own pockets or gone beyond their job description to help others in need. Here’s an example of how one of our own showed compassion, generosity. and innovative thinking ► Continued to page 7

Summer Weather By Rachelle Noe, RN

Please remember that as summertime continues to warm us up, to use lots of sunscreen!

► Continued from page 6

toward one of his patients. One morning, we were discharging a homeless man from the hospital. He had no shoes. A nurse on the floor who was arranging for the patient’s discharge took off his own new Nikes and gave them to the patient. “I’ve got another pair in my locker.” We only found out later that not only did this nurse literally take the shoes off his own feet to give to this homeless man, but he did so knowing that he would be sacrificing his new pair for the older, worn out shoes in his locker. This nurse’s behavior is typical. Every day of the year in different ways, employees and physicians go out of their way for patients, usually unnoticed. The behavior of the nurse giving away his shoes is one more hint that we can find an opportunity to genuinely care at any moment

in any place within an organization. What we need is simply an appreciation of others and a generous spirit. As St. Francis of Assisi reminds us, “It is in giving that we receive.” I will do my part to spend my organization’s money and resources wisely. I will also look for ways to work differently, smartly, and with awareness. I will find unique ways to give.

Reapplication of cream is the most important part and one that is often forgotten after entering water or perspiring. Keep hydrated by drinking lots of water!

“Whatever a profession is or does depends on the contribution and commitment made by its members. How a profession is perceived by others depends on the perception generated by members of the profession who represent its interests to the public it serves.” —Porter O’Grady, T. (2013) Leadership in nursing practice. Burlington, MA., Jones and Bartlett Learning

Sue Schoeneman, MSN, RN Oncology My degree is a Master of Science in Nursing from the University of Nebraska Medical Center. I will be boarding soon for my Advanced Practice Nursing certification and plan to provide care as a Nurse Practitioner. My special interest has been Oncology. I hope to continue in the Oncology area and plan to certify as an Advanced Oncology Certified Nurse Practitioner.

Colleen Kennedy, MSN, RN Cardiac Rehabilitation My degree is a Master of Science in Nursing Education. I would like to one day teach nursing education at a nursing school. For new nurses, make sure you keep organized and ask for help when you need it. Nurses should continue to increase their visibility and awareness of nursing’s influence among the professional medical community.

Jina L. Nemnich, MSN, ACNP-BC My degree is a Master of Science in Nursing, Acute Care Nurse Practitioner. I chose to pursue a master’s degree simply because I felt the need to expand my knowledge base and become a more effective nurse. I started out by taking Master’s level courses in Pathophysiology, Pharmacology, and Statistics. These classes were fun and exciting because I could bring my new knowledge to the bedside and apply it. I also found encouragement and inspiration by knowing that previous RWMC nurses such as Jennifer Axt, APRN; Patty Brisco, APRN; Beth Clemens, APRN; Kevin Harriger, APRN; and Ron Strachan APRN had successfully obtained their degrees while raising

families. With the support of my family, coworkers, and RWMC I applied to the MSN program through UNMC and made the decision to become an Acute Care Nurse Practitioner based upon my passion for critical care. I have accepted a position working with Dr. Massey in the Ear Nose and Throat–Head & Neck Surgery clinic. I am very excited for this next chapter in my life! I enjoy spending time outdoors with my family (husband Geoff, sons Creighton 5, Carver 4) while camping, boating, hunting, and fishing. I also enjoy maintaining and developing the website I created to tutor student nurses and in my free time I love to decorate cakes for weddings and special events.

S P E C I A LT Y C E R T I F I C AT I O N S Roxie Shaul, RN Certified Ambulatory Peri-anesthesia Nursing (CAPA), works in Outpatient Surgery

Erin Holcomb, MSN, APRN I have an MSN in the Family Nurse Practitioner track. I chose the degree in order to give myself an opportunity to experience the options within the advanced nursing role. My first goal was to become a nursing instructor and that is still likely to happen. As I went further into my program, I became more and more interested in the options within the practitioner role. My interests are mainly the emergency room and/or walk-in facilities. I like managing the acute illnesses

and injuries and seeing a large number of patients in a single shift. I am currently working as a Nurse Practitioner at Quick Care Medical Services but plan to return to the hospital setting in the future, preferably in the emergency room. My long-term goals include traveling to larger hospitals in Colorado as well as working in critical access hospitals. Iâ€™d like to experience all ranges in services and accessibility. I would also like to be an instructor at a nursing college and teach pathophysiology or assessment (my favorite courses).

To be honest, I went into nursing because I was in love with my boyfriend (now husband). The nursing school here seemed to be a good option at the time. I grew up and graduated from Banner County High School. I then graduated from West Nebraska General Hospital School of Nursing. My first job was in Houston, TX on a medical floor. We then moved back to the area and I worked in NICU for 11 years. In 1996, I transferred to Outpatient Surgery. I enjoy the hands-on care and getting to know the patients. Many of them come back weekly for infusions and are like family. I hope at the end of the day, Iâ€™ve somehow made their admission with us a good experience. I have several hobbies, but the ones I like the most are to run and cycle, as well as gardening, and collecting/refinishing antiques. My most favorite time is spending each and every moment with my family.

Linda Fowler, RN Certified Emergency Nurse, ICU/PCU Clinical Coordinator I always wanted to be a nurse. I can’t remember the specifics as to why I made that decision. I know that caring for people and being there in time of crisis and ill health was a lot of my decision. I suspect that part of it was the fact that the nurses I knew and read about were knowledgeable, respected, and independent thinkers. I was raised in Gering, Nebraska. I am a graduate of West Nebraska School of Nursing. I earned my BSN at University of Nebraska Medical Center, and CCRN in 1981 (yes I know–if I give the year, half of the people I work with will remind me they were not born then).

I have spent my entire career in critical care. I started as a TA in the emergency room. When I added emergency services to my responsibilities, I immediately started thinking certification. I waited until I met the practice requirements for certification. I believe that certification is important. It challenges you to learn more about your specialty. It validates your knowledge and practice of a nursing field or specialty. I like caring and educating patients, families, and co-workers. I love putting complex pictures together so it makes sense.

Professional Development S P E C I A LT Y C E R T I F I CAT I O N S

Billie Harris, RN Certified Medical-Surgical Nurse 2nd West Staff Nurse I graduated early from Northglenn High school in Denver, Colorado and at seventeen I joined the US Navy. In the Navy, I worked as a Training Petty Officer for the Auxiliary Division (aircraft elevators, oxygen/nitrogen generation, and air conditioning/ refrigeration) and the Reactor Dept. (maintenance and operation of main propulsion). When I got out of the Navy, I became a commercial truck driver and then a licensed general contractor in the Denver area. Then after the birth of our first child, my wife and I had a discussion about who would stay home with the baby. I apparently lost that conversation and found myself going from working two jobs to being a house husband. It was during this time I decided I should go back to school with my GI bill that I had earned in the Navy. I

wasn’t quite sure what I wanted to do. So, I went to the local university and had a personality test given by the psychology dept. and they said I should be a nurse. I said they should get in touch with the mathematics dept. because they don’t know how to add up their own test. I had never done anything like nursing, or medical, or not involving grease, mud, and sweat. However, I do have a sister who is a nurse and she thought I had the right personality for nursing and that I should give it a shot. So I went and got my CNA license and loved it. I really enjoyed all the personal interaction and hearing patient’s stories and getting to help them. I also loved the challenge of learning something different and technical, and that we are always learning something new. From there I got my LPN, then ADN, and finally ► Continued to page 11

Pam Zitterkopf, RN Certified Clinical Health Coach, Cardiac Rehabilitation I chose nursing because I enjoy taking care of people. I really care

constantly busy. My patients are what I like the most, I do all I can to

about people and I enjoy helping them to get better. I knew back

help them and educate them to improve their health. I was part of

when I was in junior high that I wanted to be a nurse. Being around

the very first RWMC group that got certified in PALS at Poudre Valley

people has always been a joy for me. When you are a nurse, you see

Hospital.

people at their worst times and being kind and understanding can ► Continued from page 10

be very rewarding.

I have always enjoyed cardiac and behavioral health care the most. I have done some employee educational things, like

my BSN from the University of Northern Colorado. I have worked in Oncology, Acute Rehab, and am currently work on the 2nd West Post Surgical unit. I serve on the Kids Care team and am involved in several committees and precepting here at the hospital. I enjoy being involved as part of a team and teaching others. I am also a bit of a book worm and love reading nursing journals about the latest and greatest topics.

Here is my education history: I was first an LPN

Zoll AED Monitoring. Patient education has always been

after high school, then I went to the diploma

interesting for me, the more education the better equipped

school of nursing. When the BSN program

patients will be to manage their health. I have done special

started in Scottsbluff through UNMC, I went on

education for my work area, like the aortic balloon pump,

to study for my BSN and graduated in 1992.

12 lead EKG and clinical health coach.

What keeps me busy these days are my three destructive and wonderful children Lance 11, Mike 9, and crabby Abby 2. The boys are always involved in sports and I like taking them camping, rock climbing, biking, skiing, basically anything outdoors.

After having a family, I went back to get my MA in counseling. Currently I am studying for my MSN as a Nurse Educator.

To the new nurses, always keep your head up, even in the tough times. I always keep the motto in mind “and this too shall pass.” Enjoy seeing your patients get better

I have worked at RWMC for the past 34 years in various areas. I

even if you don’t get recognized for the hard work you did to take

started on the surgical floor, which was 4th floor back then. Then I

care of them. Nurses do a lot of heroic things, I can not count the

went to ICU/CCU after getting my RN. During that time I worked and

number of lives I have saved in my career but I know in my heart that

floated to ER, NICU, and surgery. In 1991, I went to Pre-Admit testing

I was there and they are alive today because of what I did. You are

and learned to do pre- anesthesia assessments. I later transferred

making a difference and in the end you are the one who made the

to work on Behavioral Health Unit and then went to Cardiac/

difference, so pat yourself on the back, you did it and you did it well!!

Pulmonary Rehab, where I currently work. I like the continual learning. Nurses never quit learning over their career as the field of medicine is ever changing. It is never a boring career, there are always changes along the way and I keep

P R O F E S S I O N A L D E V E L O P M E N T > S P EC I A LT Y C E R T I F I C AT I O N S

Stephen Matthews, RN Certified Critical Care Nursing Manager of ICU /PCU I was always fascinated by the healthcare profession growing up and my studies took me into nursing. I attended Columbus High school and then went to Chadron State College where I received a Bachelor’s degree in Human Biology. After my studies at Chadron State, I went to Creighton University and earned a Bachelor’s degree in Nursing. I hope to start my Master of Science in Nursing program this fall. I worked for 3.5 years in the ICU and three years as House Supervisor at Bergan Mercy Medical Center, Omaha. After that, I worked for one year as a Critical Care Director at St. Helena Hospital in California. I came to Regional West in January 2012. I enjoy helping patients and families through their time of need and that is the main reason I went into this profession. When I am not at work, I enjoy sailing, hiking, and of course the honey-do list!

Michelle (Shelly) Meisner, RN Outcome Assessment Information Set Certified Nurse, Home Care Staff Nurse I first became interested in nursing when I was a CandyStriper for West Nebraska General Hospital in the 1970’s, helping in the gift shop and on the Pediatric floor. I graduated from West Nebraska General Hospital in 1983. I am currently taking online classes working towards my BSN through Chamberlain University. I have worked at Regional West since 1983, including Pediatrics, Surgery, Platte Valley Pediatrics, Acute Rehab Unit, Utilization Review, and Home Care. I feel that taking a nationally standardized, exam that evaluates a clinician’s knowledge allows me to help Home Care clinicians promote and demonstrate their commitment to accurate assessment of patients, which allows consistent application of the guidelines provided by the Centers for Medicare & Medicaid (CMS). This

allows me to demonstrate and establish my expertise and commitment to OASIS data accuracy. What I like most about nursing is that there are always new challenges and I enjoy helping people. My advice to a new graduate would be to find an area of nursing that you are passionate about, find a mentor that will help you grow professionally and personally, and then dream big. We have many, talented role models here at Regional West and together we can make a difference in our community! The things I enjoy doing outside of work include: traveling, spending time with family and friends, gardening, crafts, and working my Beauti-Control Spa business.

Cheng Wei-Kow, RN

Michelle Keener, RN

Certified Emergency Nurse, ICU/PCU/ER Staff Nurse

Certified Ambulatory Peri-anesthesia Nursing (CAPA), Outpatient Surgery

I initially went into nursing school because my mother thought that it would be a good career choice for me (I think my mother always wanted to be a nurse herself because my sister got convinced into nursing school too). I am from Taiwan and attended Taipei Municipal Chung-Shan Girlâ€™s Senior High School. After I graduated from high school, I attended Kaohsiung Medical University School of Nursing. I had to decide a major when I entered the college so I took my motherâ€™s advice, but had doubts until my junior year. When I started clinicals with patients, it was there that I knew that nursing was going to be for me because of the impact I had on their lives. I worked in Taiwan for a couple of years after

graduation, and have experience in postpartum, medical-surgical and oncology. I moved to the U.S. in 2005, and moved to Colorado in 2006 and started working in Julesburg, Colorado and couple of other small hospitals. I did ER/OB/medsurg, completed my paramedic education in 2011 and came to work at RWMC in ICU. I am also cross-trained in ED and work parttime for Valley Ambulance as a paramedic. The thing I like the most about nursing is that there is a variety and with variety comes new challenges that continue to test my abilities both intellectually and mentally. In my spare time, I love to read, cook, and scrapbook.

I chose to go into nursing because I always knew that I wanted to do something in healthcare and because of all the career options that are available to nurses. I graduated from Gering High School and I attended the University of Nebraska-College of Nursing in Scottsbluff. When I completed nursing school, I worked on 3rd floor for one year and then transferred to Outpatient Surgery where I have worked for the last six and a half years. The one thing that I like the most about nursing are the challenges I can face as well as the variety of patients that we see everyday. Since I have three young children, they are my special interest right now and I love having quality family time. When I do get to have time to myself, I love to scrapbook.

Tina Delgado, RN Certified Medical-Surgical Nurse Pre-admit Testing Staff Nurse (Not pictured, information unavailable)

Early Identification and Treatment of Sepsis Linda Fowler LINDA FOWLER, RN, CCRN, CEN Clinical Coordinator-ICU/PCU

epsis is nothing new in the ICU. We see it at least every week and frequently every day. Therefore, it is no surprise that it is called “a complex clinical syndrome that is challenging to diagnose and treat.” In 2000, there were more than 750,000 cases a year and mortality ranged from 28 to 50 percent. In 2008, the Society of Critical Care Medicine with the International Sepsis Forum set forth guidelines for the care of this syndrome. The goal was early identification of SIRS (systemic inflammatory response syndrome), early identification of sepsis, and standardized goal-directed therapies to treat sepsis. In

2010, AACN published a practice alert on initial recognition and resuscitation of sepsis. Multiple studies have been done that show we can improve the survival and outcome for patients with sepsis by working together and developing a plan for organized, systematic, goal-directed care. Some facilities have decreased mortality as much as 25 percent. We are working with Dr. Scheppers to develop a sepsis protocol. As we move forward, we will involve additional physicians, nurses, and departments. I read a very brief paper on an approach to patient identification and physician ► Continued to page 15

“A complex clinical syndrome that is challenging to diagnose and treat.”

► Continued from page 14

notification using an SBAR approach (Nanette, Kent, and Willa Fields—March JEN 2012). It makes sense and potentially will help identify patients early. It uses a one, two, three, or ABC approach so that each patient is screened by nursing. We know that sepsis is not always the first diagnosis that is made or the admitting diagnosis from the emergency room. Sometimes we see it on a rapid response call, it may be the patient who transfers down, or the patient assigned to you today in the ICU/PCU who just doesn’t seem to be doing as well.

▪ Cardiovascular–SBP < 90 ▪ CNS–altered level of consciousness or altered metal status ▪ Renal–drop in urine output < 0.5ml / kg / hr for more than 2 hours and Cr increase >0.5mg/dL above baseline If yes–SBAR S: Initial screen for sepsis is positive B: SIRS criteria met + a known or suspected infection + signs of organ dysfunction

In each of the situations above we can take the time to look at three subsets of data.

A: Complete vital signs and any other data your have to share

1. Screen for systemic inflammatory response syndrome (two of the following)

R: Please come evaluate the patient or Request lactate, ABGs, labs or Request fluids or pressors if hypotensive

▪ Heart rate > 90 beats/min ▪ Temperature > 100.4°F or < 96.8°F ▪ Respiratory rate > 20 breaths/min or PaCO2 < 32 mm Hg ▪ WBC count > 12,000/mm3 or < 4000 or a left shift of bands >10% If you do not have two of the above–stop here. 2. Look for infection ▪ Suspected or documented infection ▪ Antibiotic therapy ordered–not for prophylaxis ▪ If one is present–move on to look for signs of organ dysfunction, which is a change from baseline. 3. Organ dysfunction (the full list is longer, but these are easy)

This basic screen and SBAR approach may help to indentify patients we may have missed or not identified in the first six-hour window. It fits right in with the culture of safety and safety tools we are building. Question: Your new pneumonia vs. chest pain admit arrived three hours ago. He is now confused and trying to climb out of bed. He re-orients easily but attempts to get up every 15 min. His wife is upset because he is never like this. You note that his current vitals are HR 118, rr 24, bp 96/50, temp 100.6 and SpO2 is 88 on 3 liters. You just turned the oxygen up from 2 liters.

JENonline.org / edwards lab card Click to vist the web page. Check out the tear of reference page on page 25.

What is the SIRS criteria? What Infection criteria is met? Is there end organ dysfunction? Does this patient screen as possible sepsis?

▪ Respiratory–Dropping SpO2 < 90%

Extended Shifts and Fatigue Nursing, a complex and demanding occupation, requires abundant physical energy and sharpness of mind. Sleep deprivation is a threat to the energy requirements of the job. Chronic sleep loss can result in health problems, mood alterations, and impaired memory and judgment. The cumulative effect of sleep deprivation from working consecutive extended hour shifts is a significant safety concern.

Diana Baratta DIANA BARAT TA, MSN, MA, RN Director Medical Surgical Services

The Joint Commission issued a Sentinel Event Alert in December of 2011 stating that the link between worker fatigue and adverse events is well documented and studied. The increased risk of accident after about 12 hours is twice the risk after 8 hours. Nurses working successive 12 hour shifts typically get inadequate sleep between shifts to recover physically or cognitively, irrespective of whether the work is in the day or during the night. Most experience greater sleepiness by their third consecutive 12 hour shift. There is a greater chance of error due to cognitive slowness. Of great concern is that a fatigued worker is more prone to automobile accidents. The National Highway Traffic Safety Administration estimates that 100,000 automobile crashes occur each year as a result of drowsy drivers. A 2011 American Nurses Association Health and Safety Survey found that one in 10 nurses surveyed were involved in an automobile accident that they believed was related to fatigue from shift work. Despite abundant evidence of safety concerns linked to the extended shift, nurses find the compressed work week

satisfying and patients experience greater continuity of care. Recommendations for mitigating the effects of the 12 hour shift include: ▪ Limit the number of consecutive shifts worked to three ▪ Allow time for breaks ▪ Engage in short periods of moderate exercise ▪ Pause and concentrate before starting a nursing task ▪ Use a system of independent double-checks for critical tasks or complex patients ▪ Set up an environment conducive to quality sleep such as darkening the room and turning off all telephones ▪ Take a nap before reporting for a night shift For the safety of our patients and your own well-being, make wise and health conscious choices. Make sleep a priority. Caruso and Hitchcock (2010). Strategies for nurses to prevent sleep-related injuries and errors. Rehabilitation Nursing, 35, 192-197 Dawson (2012). Putting the brakes on drowsy driving. The American Nurse, March/April. Retrieved from www.TheAmericanNurse.org Estryn-Behar, et. al. (2012). Effects of extended work shifts on employee fatigue, health, satisfaction, work/family balance, and patient safety. Work, 41, 4283-4290. Geiger-Brown et. al. (2012). Sleep, sleepiness, fatigue, and performance of 12 hour shifts. Chronobiology International, 29, 211-219.

Infection Prevention

Amanda Sabo AMANDA SABO, BSN, RN Infection Prevention Specialist

Infection Prevention is actively participating in the National Healthcare Safety Network (NHSN) surveillance program through the Centers for Disease Control and Prevention. NHSN offers multiple patient safety modules to report potential Hospital Acquired Infections while patients have been under a facility’s care. Surgical site infections, catheter associated urinary tract infections, central line associated bloodstream infections, multidrug-resistant organisms, clostridium difficle infections, ventilator associated pneumonia, and post-procedure pneumonia comprise a few of the main modules for NHSN. By utilizing a surveillance program, trends can be identified and benchmark goals set. By following the National Patient Safety Goals many of the hospital-acquired infections can be prevented. The most effective prevention tool is hand hygiene. Hand hygiene includes the act of foaming in and out of patient rooms and care areas and practicing good

hand washing technique. Following standard precautions for patient care, for all patients, all of the time, can also decrease the risk of transmitting potentially infective organisms to patients. Following isolation precautions (contact, droplet, and airborne) can prevent spread of communicable disease and multidrug-resistant organisms (MDRO’s). Adhering to standard and isolation precautions and using appropriate personal protective equipment (PPE) also protects the employee from the risk of communicable disease. Infection prevention involves every department as well as the hospital’s physical structure itself. Make sure to report any physical structure concern such as leaking pipes or drains immediately to the Facilities Department. Do not rely on the next person to report it. Time is crucial in addressing such concerns in order to prevent potential infection to our patients.

As you may know, I have recently transitioned from Magnet Coordinator to the Patient Safety Officer. Avis Rogers retired earlier this year and we thank her for all she has done to promote patient safety. Since I have served as the Change Agent for the Safety Culture Initiative that started in late 2009, transitioning into this role just made “sense” (as in Safety Sense). I enjoy my work as the Change Agent so I am very happy to embrace the role of Patient Safety Officer and am excited to deepen my knowledge in this area.

Susan Backer SUSAN BACKER, MSN, APRN‑CNS, ACNS‑BC Patient Safety Officer/CNS

I’d like to recap our accomplishments on the safety journey. In 2010 Margo Ferguson, Avis Rogers, Barb Lundgren, and I worked diligently on a Common Cause Analysis of our past events. Margo worked hard to put together our Serious Safety Event Rate (SSER). In 2011, we educated all leaders on leader safety behaviors and everyone, including physicians, on safety behaviors. We also brought in consultants to provide training on cause

analysis. We now have a much richer cause analysis program with apparent cause analysis, root cause analysis, and common cause analysis. This process helps us identify system problems that need to be fixed. In 2012, we started the Safety Coaches program. Safety coaches are direct care staff who are trained to coach staff in the safety behaviors. We are also revisiting the leader behaviors (tools) and staff behaviors (tools) throughout the year in order to deepen our knowledge and use of these tools. “We have come a long way, baby!!!” as the saying goes. Right now, we are in a period of time on this safety journey that feels tedious and not much fun. But this is the most critical time where we need to be diligent and stay on course. Thank you for working hard to keep patients safe. Together we can make a difference and meet the goal of “zero” events of harm.

2012 Calendar of Events

Date/Time August 16 7 to 8 a.m. August 23 8 a.m. to 3:30 p.m. August 28 8 to 9 a.m. September 20 7 to 8 a.m. September 25 8 to 9 a.m. September 27 8 a.m. to 3:30 p.m. October 18 7 to 8 a.m. October 23 8 to 9 a.m. October 24 2:30 to 3:30 p.m. October 25 8 a.m. to 3:30 p.m.

Event Nurse/Physician Shared Governance Council

Location

Shared Governance Day

Keith Room

Breakfast with Shirley RSVP to Becky at 1451 or email Nurse/Physician Shared Governance Council Breakfast with Shirley RSVP to Becky at 1451 or email

Goshen Room

Shared Governance Day

Keith Room

Nurse/Physician Shared Governance Council Breakfast with Shirley RSVP to Becky at 1451 or email

SB II

LPN Quarterly Meeting

Sioux Room

Shared Governance Day

Keith Room

SB II

SB II Goshen Room

Goshen Room

Evidence-Based Practice Workshops

Title Session 1: Re-igniting the Spirit of Inquiry Session 1 Repeat Session 2: Searching the Literature Session 2 Repeat Session 3: Evaluating the Evidence Session 3 Repeat

Date/Time September 10 1 to 3 p.m. September 21 1 to 3 p.m. October 9 1 to 3 p.m. October 19 9:30 to 11:30 a.m. November 9 9:30 to 11:30 a.m. November 19 1 to 3 p.m.

Place SB II SB II

Evidence-Based Practice workshops are planned for this fall. Register today on Swank Health. We need a minimum of five people to hold each class. Questions? Please call Susan Backer, ext. 1197.

Harms Center B 120 Harms Center B 120 SB II SB II

The Right Thing to do!

Karla Edwards K ARL A EDWARDS Service Excellence

Picture Dr. Sorensen sitting in a hotel conference room with 20 or 30 other hospital CEOs. A man, short in stature but long in passion bounces around the front of the room sharing his enthusiasm for patient satisfaction. Dr. Sorensen is a smart man. Many call him a visionary. Maybe, because more than twelve years ago at that conference, he could see how important patient satisfaction was going to become and how difficult it was going to be to attain. And he believed the man at the front of the room, Quint Studer (1), had the answer. When he drove back into town after that meeting, it was clear that we had to “do it.” As Dr. Sorensen used to tell every group of eager new employees at orientation, “We do Service Excellence because it’s the RIGHT thing to do.” And that is how Service Excellence came to be at Regional West. Our first step was to form seven teams that began meeting in January 2002. They were: Patient Satisfaction (which was initially divided into inpatient and outpatient), Standards of Behavior, Physician Satisfaction, Measurement, Rewards and Recognition (notice that has now been flipped to Recognition and Rewards to emphasize that recognition is more important to employees than rewards), Service Recovery, and Leadership

Development. Over time, Service Excellence has evolved. Some of the teams have changed names, for example the Patient Satisfaction team is now the Patient Loyalty team, because we want more than satisfied patients, we want loyal patients. The Measurement, Leadership Development, and Standards of Behavior teams were disbanded as they served their purpose. For example, the Standards of Behavior became so ingrained in our culture that it made sense that they be managed by an appropriate department as Leadership Development, which is now a part of the Education Department. In many ways, Service Excellence has become such a part of “who” Regional West is that some employees think we are no longer “doing it.” Dailies are a responsibility of Service Excellence and an example of something ingrained in our culture. The annual Regional West family picnic (mark your calendar for September 15) is a Service Excellence activity, as are the five Break for Excellence lunches, the Star program and banquet, and the Adopt-A-Spot garden project. Myers Briggs and all the training and team building associated with that are coordinated through Service Excellence leadership. ► Continued to page 21

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Customer Service training was designed by Service Excellence in response to patient complaints and was aligned with the Standards of Behavior. All current employees participated in customer service training in 2010 and it continues as a part of New Hire Orientation. I also work one-on-one with employees who need a refresher course on customer service, dealing with difficult people, communicating more appropriately with co-workers, etc. I coordinate the patient satisfaction surveys with the survey company, HealthStreams and distribute the two yearly reports they produce. Kent Anders, Quality Department, pulls together monthly reports, graphs and charts for each department specifically mentioned in the surveys. I run custom reports for many departments, teams and committees and work with them on the implementation of best practice improvements. For example, each month I present a custom patient satisfaction report to nursing managers, make suggestions and assist with improvements. I meet with ED physicians quarterly to share their patient satisfaction scores and tactics for improvement. Two department-specific information boards are making the rounds to explain HCAHPS and Value Based Purchasing. Once every department has had the board, it will start the rounds again with new information.

and out of their vehicles, to find their way, pass along messages between patient and their ride, calm tempers and anxieties, and dance. Yes, dance. Valet Santos Ramirez learned how to fox trot from a 96-year-old visitor to the North Plaza. Yes, Dr. Sorensen may be a visionary. The journey to achieving patient satisfaction is not an easy one, but one that he knew we must take. Service Excellence does still exist and Regional West is determined to give the kind of personalized care that patients rank highly satisfying. The support of Dr. Sorensen, the VPs, Directors, and employees is necessary. The Service Excellence department may be passing out road maps for the journey, but itâ€™s all of us who have to get on board.

(1) Studer began his career in health care in the Chicago area, eventually moving to Baptist Hospital in Pensacola, Florida. He has been wildly successful in improving patient satisfaction in a multitude of health care settings including inpatient and out, large and small, critical access to teaching hospitals. He is now the President and CEO of his own organization, Studer Group, whose mission it is to help other facilities achieve their patient satisfaction goals. Much of what we do here at Regional West is based on Studerâ€™s research and experience.

Probably the most visible Service Excellence piece is the valet service. There are seven valets who cover four locations with hours ranging from 5:30 a.m. to 4 p.m. The highest number of cars parked so far was 38 at the North Plaza on a day when the temperature soared to 104 degrees. The valets do so much more than park vehicles. They assist visitors in

| There was a comment that WNCC students wear two different shades of blue and hunter green scrubs. This was more of an FYI for the colors that they might pick for RWMC. | There was a comment made about the numerous computer issues lately. Shirley remarked that someone from McKesson has been hired to work on these issues but some of the build issues were done wrong on our side so these issues are all being addressed. An RFP (Request for Proposal) has been issued to look at other systems. Shirley continued that it will take a minimum of four years to switch to a new system. There is also a steering team addressing computer issues as well. Employee Breakfast June 26, 2012 Questions, Concerns, etc. Attending: Bobbi Turner, Kelsey Judy, Angie Fry, Sandy Hebbert, Crystal Sterkel, Stephen Matthews | Shirley discussed the scrub research project that is currently ongoing. | Staff has heard about this project and are wondering when to buy new scrubs? Shirley explained that this research group has chosen five colors that the RNs will get to vote on to choose a color. It will probably be three months before anything is trialed here at Regional West Medical Center. | What about wearing a shirt underneath the scrubs? Will this be allowed? Shirley asked that this person contact someone from The Professional Practice Council and ask them this question.

| A process was changed on April 1, trying to streamline patients from Pre-Op to the OR. The comment by this nurse is that this process has created a cluster. The rooms in Pre-Op are too small was also the comment. Shirley explained the process of where the surgery building is at.

| Doctor’s rounding times with pediatrics and birth and infant needs to improve. | Cleaning of rooms on the floors has become a problem. | Asked if IV/PICC team could expand to being on call and on weekends. Shirley will talk with the team as well as the Director of ER/ICU. | NICU nurses are being called to start IVs in ER and they are being exposed so need to have a plan in place.

Employee Breakfast July 24, 2012 Questions, Concerns, etc. | Talked about the enterovirus on pediatrics, birth and infant care, and NICU. Encouraged children less than 15 years of age to not visit the hospital until virus is under control. | Talked about first starts in the morning and what are the solutions to make it work smoother. The process will work smoother after the new facility is built. Will be requesting a report from Karna and Janet regarding this process. Did request ideas from the group which were provided. | Discussed endo at the surgery center and the possibilities of cross training to the unit to pick up hours. | Talked about how two doctors, staff from the surgery center, and outpatient surgery worked together to help a patient have a less invasive procedure than expected. The patient and their family was very thankful!

| Physicians are not using proper PPE when entering patient’s rooms and will not comply with nurse’s request. Shirley will get Dr. Colon involved so he can talk to physicians one-on-one. Was brought up that some family and friends are not being compliant as well and Shirley has suggested that Amanda Sabo create a hand-out to educate them. | Question was asked about the incentive pay and how will staff be retained if cuts are happening. | Question was asked on nurses that top the pay grade and do not get the same pay increase as the lower staff nurses. Shirley explained that the seasoned nurses will get a pay increase but it depends on this year’s market for 1.5 of the year. Shirley assured that the seasoned nurses will go up once the market goes up. | A question was asked regarding the single uniform color and Shirley explained her research project.

Shared Governance Council Updates Care & Practice Council The council continues work on the fall program. Rebecca and Janelle will be presenting a business plan proposal to Shirley Knodel. The council is also in the initial stage of reviewing articles on fatigue related to the 12-hour shifts.

Quality & Safety Council

Austin commented that the council is gathering data for the hand hygiene project. The pilot for this project has been completed—a pilot on 2E, 2W and 3rd floor. The council is now reviewing articles on nursing peer review.

Nurse/Physician Council

Connie commented that the structural changes have been completed on 3rd floor. Physician rounding continues to be an issue in all areas.

Evidenced-Based Practice Council

Janet commented that the proposal for the go-to meeting has been submitted to Steve Hodges.

Professional Practice Council

Shirley remarked that the color of the scrub choices has been chosen by this group and these choices will be voted on by all

By F. Jordan Colwell, BSN, BSHS, RN Survey Preparedness and Magnet Coordinator

After attending a presentation on Magnet Recognition Programs at a 2003 conference, Di Twigg, the executive director of nursing services at Sir Charles Gairdner Hospital (SCGH), returned to work inspired. Should the facility pursue designation by this program run by the American Nurses Credentialing Center (ANCC)? Her nurse colleagues at this 600bed public hospital in Nedlands, Western Australia, needed convincing. After all, the facility was already a member of the Australian Council on Healthcare Standards, which provides a quality framework and external peer review. Would this American program benefit an Australian health care facility? Several presentations later and after examining other quality frameworks, the nurse executives agreed that the Magnet program had the greatest evidence of success. The hospital, a major teaching and research center employing more than 2,000 nurses, had developed a culture and practice environment conducive to the delivery of high-quality patient care. It valued its experienced and dedicated nursing staff and wanted to promote staff retention as a priority for workforce planning. This article tells the story of SCGHâ€™s journey to Magnet designation.

By Susan Clement, BSN, RN

AJN June 2012 Vol. 112, No. 6

Implemented by the ANCC, the Magnet Recognition Program “recognizes health care organizations for quality patient care, nursing excellence, and innovations in professional nursing practice.” The program is well established in the United States as a framework for workforce planning, innovative practice, and quality care. Hospitals that achieve Magnet recognition support a positive practice environment and opportunities for career development; thus, the program provides a strong foundation for nurse recruitment and retention. Most recently the program has attracted international interest as health care organizations search for effective ways to recruit and retain staff and deliver quality patient care. The first hospital to receive Magnet designation outside the United States was Rochdale Infirmanry, in Rochdale, Lancashire, United Kingdom, in 2002. The second was Princess Alexandra Hospital in Brisbane, Australia; where staff turnover improved from 25 to 10 percent in the two years after Magnet recognition in 2005. Its success served as a catalyst for other Australian hospitals to consider the program. Once the SCGH nurse executives reached consensus, the next step was to present the idea to other hospital and nursing staff. Sound evidence and rationale were required to show the benefits of participating in yet another accreditation program. The executive director of nursing services initiated a “Magnet Road Show,” a series of presentations to hospital executives and

to all departments in the facility. The purpose of the presentations was to introduce the principles of the program, describe how these principles were applied in practice, present the evidence for the program in the literature, and highlight the program’s potential benefit to staff, patients, and the organization as a whole. At the conclusion of the road show, the question was posed to the staff: Should SCGH simply adopt the principles of the program or seek formal accreditation? While application costs were discussed, greater emphasis was placed on the cost of not adopting the program. The response was overwhelming: implement the program and seek formal accreditation and recognition. A project manager was appointed, and senior nurses recommended nurses from their units to participate in the effort. Gaining the support and commitment of staff was essential. This was achieved through a marketing plan highlighting the program’s key principles, benefits, and outcomes. Marketing materials also described how the Magnet program complemented the hospital’s existing quality program while providing a dedicated focus on nursing. A slogan, “Magnet, a Hospital Project: A Nursing Award,” communicated the message that the support of the entire staff was vital for participation. Magnet’s champions were appointed on each unit to raise awareness, ► Continued to page 28

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influence change, and discuss questions and concerns with staff. In monthly meetings with the executive director of nursing services, these champions shared their experiences and staff concerns, and brainstormed solutions. For example, when evening staff complained about a lack of meal choices, cafeteria hours were extended, additional sandwich toasters and microwaves were purchased, and healthier meal options were made available in vending machines. Minutes and outcomes from these meetings were emailed to all Magnet champions, published on the hospital internet, and shared with senior nursing staff during regular unit meetings. Coordinating long-distance communication. SCGH in Nedlands, Western Australia, is more than 11,000 miles from ANCC headquarters in Silver Spring, Maryland. Communication was primarily through email and, when necessary, by teleconference although the 12-hour time difference required considerable planning and coordination. A designated ANCC staff member consulted with us, helping us to navigate program criteria and providing further detail and explanation when needed. An application was submitted to the ANCC in October 2006. The application is the first phase of the recognition process and includes a fee and supporting

documents. Attending the National Magnet Conference in October 2007 in Atlanta enhanced our understanding of the scope and impact of the program. The conference highlighted successful strategies and initiatives to address program criteria. We established important relationships with the ANCC staff, other international delegates, and nurses from U.S. Magnet Hospitals. The search for evidence to support our application unveiled a number of innovative programs and practices already in existence. These would form the basis of our application and included graduate program support nurses; clinical coaching roles; nurse-led clinics in a number of clinical specialties including breast cancer, wound management, and incontinence; nurse-led discharge in cardiology; and the introduction of nursing assistant roles to support the RN workforce in high acuity areas. Nursing engagement at both the organizational and community level was also highlighted. We provided evidence of nursing involvement on key hospital decision-making committees; in community and health education programs; and in membership in local, state, and national professional bodies. The reporting requirements, outlined within the Magnet program, compelled us to review and revise the way we collect and report workforce and quality data, placing greater emphasis on benchmarking and outcomes linked to strategic goals. New systems and â–ş Continued to page 29

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processes were implemented to collect and report data that included both hospital and unit-level outcomes. A glossary of terms was provided to clarify differences between American and Australian terminology. For example, what Americans call “scheduling” is known as “rostering” in Australia; likewise American “float staff” are Australian “casuals.” It was also necessary to describe how certain advanced practice roles are defined in Australia; therefore, we included information on education and scope of practice for NPs and clinical nurse specialists. An explanation of Australian health care system, its organizational structures, governance, and financial management was provided. A threepage document outlined the public health system, commonwealth and state responsibilities, and the role of our Medicare system. Education, training, and regulatory requirements were also specified. Distinctions in our nursing education and training, scope of practice, and regulatory requirements were outlined. This included specifics about undergraduate education of RNs and enrolled nurses; legislative and regulatory requirements for practice; and the industrial agreement and enterprise bargaining process, negotiated between the government and the nursing union, to establish nurses’ wages and working conditions. Magnet criteria required the hospital to compare and contrast the ethnicity of its patient population with that of its nursing workforce. While such data is collected for patients as part of the admissions process, no such information was available for nursing staff. To meet this requirement, questions of ethnicity were incorporated into a nursing demographic survey.

In August 2008, our written submission addressing the program criteria was sent to the ANCC for review. It highlighted innovative ongoing programs and opportunities for change as model of care projects incorporating team nursing, and recognized the valuable role of nursing in enhancing patient outcomes. After reviewing our documentation, the ANCC arranged for a site visit in February 2009. Over four days, beginning each morning at 7:15 and ending at 6 p.m., a team of three ANCC surveyors interviewed staff and toured the facility, reviewing the policies, programs, and practices described within the document. Each day began and ended with meetings with Di Twigg, the executive director of nursing services and with me, the Magnet program manager. On April 22, 2009, SCGH was awarded Magnet status. The president of the ANCC Magnet program described our application as “outstanding.” Today, our nursing staff feels valued, and their work has been widely recognized. Our current nurse vacancy rate is 4% and our turnover rate is 8.5%. Our nursing culture has improved from one of reaction to one of consolidation. Overall, staff satisfaction has improved and staff engagement has increased. Of 392 Magnet-designated hospitals, five are now located outside the United States: three in Australia, one in Lebanon, and one in Singapore. The ability of these facilities to successfully adopt the Magnet principles validates the program’s global application. As one of these international sites we now have the opportunity to share our experiences, showcase our successes, and thus help the quality of health care in the global arena.

Joint Commission Lunch and Learn Participants July

Nancy Ross, Susan Backer, LaNell Dancer, Computer HED Meeting.

Shari Rogers and Sara Hessler

Nursing Summer Internship Program

ICU and Staff Code Blue Practice

Nursing PP Team hard at work with Mosby Program.

Coordinating Council Retreat July