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Compiled by | Jordan Colwell, MHA, BSN, RN Contact | Jordan Colwell, MHA, BSN, RN P 308.630.1450 E Jordan.Colwell@rwmc.net 4021 Avenue B Scottsbluff, NE 69361
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Table of Contents A Note From The Editor
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Diabetes Prevention Program
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A Message from Shirley
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Breakfast with Shirley
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Professional Development
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Safety Sense
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Skin Care Note
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Shared Governance Report
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Welcome to this edition of the Magnetic Times!
F. Jordan Colwell F. JORDAN COLWELL, MHA, BSN, RN Survey Preparedness/Magnet Coordinator
It is hard to believe that the holiday season is here and we will be celebrating another new year. What makes 2013 significant (and a year to remember) is that we all received word that we will be cutting major portions from our operating budget. Any news source this past year has repeatedly covered the new Affordable Care Act insurance law. As this year comes to a close, there are still many uncertainties of where the law will take us as well as what health care will look like in the future. With these uncertainties, I have noticed that co-workers are tense and stressed. This time of year, we are supposed to be sharing time with our loved ones, being thankful for what we have, and preparing our New Year’s resolutions. In 2014, I challenge everyone to focus on the one thing we can control; our attitude. As Keith Harrell says in his article, “We can choose an inner dialogue of self-encouragement and selfmotivation, or we can choose one of self-defeat and self-pity. It’s a power we all have.” (p. 2) Mr. Harrell’s quote has made me reflect on my own life and how I choose to respond to information that I have not been fond of. After reflection, the important fact that I took away is that in life, we will hear negative information but we get to choose what we fixate on each day. Mr. Harrell states, “Your mind is a computer that can be programmed. You can choose whether the software installed is productive or unproductive. Your inner dialogue
is the software that programs your attitude, which determines how you present yourself to the world around you.” (p. 2) In the article, Mr. Harrell goes on to list 10 strategies on how to improve one’s attitude. Out of the 10 strategies, I picked two that each of us can relate to. The first strategy is the use of enthusiasm. This important word means that as a person, you can use it to move forward or suppress it to stay where you’re at. Enthusiasm enables you to speak up, commit, and find determination in your every-day work life (Harrell, 2013). The second strategy is the use of exercise. Regular exercise can provide positive feedback for all of us and make us feel that we are doing something important for ourselves. In closing, I wish you all a happy New Year and remember, with our attitudes, we can change whatever comes our way. Yours in health,
Jordan Colwell
Reference
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Harrell, K. (2013). Why your attitude is everything. Retrieved from www.success.com/article/why-your-attitude-is-everything
“We are what we repeatedly do. Excellence, therefore, is not an act but a habit.” —Aristotle
Shirley Knodel SHIRLE Y KNODEL, MS, RN Chief Nursing Officer VP of Patient Care
As we come to the close of 2013 and look forward to what the New Year will bring, it seems appropriate to spend some time focusing on how to prepare for ongoing challenges in the health care industry. In my readings, I came across an article recently published in Forbes Magazine titled, “Mentally Strong People: The 13 Things They Avoid.” The editor makes the point that while physical strength and health are important, mental strength can mean even more. The editor tapped into Amy Moran, a licensed clinical social worker and writer who compiled a list of the 13 things mentally strong people avoid: 1. Waste time feeling sorry for themselves 2. Give away their power 3. Shy away from change
4. Waste energy on things they can’t control 5. Worry about pleasing others 6. Fear taking calculated risks 7. Dwell on the past 8. Make the same mistakes over and over 9. Resent other people’s success 10. Give up after failure 11. Fear alone time 12. Feel the world owes them anything 13. Expect immediate results It seems to me that we need to approach the New Year by keeping our focus not on the above 13 things, but rather on doing our best to take steps forward with the information available to us at this time while keeping our patients as our central purpose. For the full article please go to: http://onforb.es/18ffXHu
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Jackie Delatour, RN, CCRN
I’m from Harrison, Neb. I was born in Lewellen, Neb. and have lived on a ranch my entire life. I came to work at Regional West Medical Center after the Crawford hospital closed.
I graduated from Saint Elizabeth School of Nursing in Lincoln, Neb. Before that I attended UNL for one year. Sadly, I was a member of the last graduation class when the new Saint Elizabeth Hospital was built and the Franciscan nuns decided to close the school.
Erin Hill, BSN, RN, CEN I am from Cody, Neb., and I went to nursing school in Scottsbluff and raised my kids here so I settled down here and fell in love. So now I have two families here.
I went to the University of Nebraska Medical Center and received my BSN and part of my MSN. I received my CEN in November.
I went into nursing because my dad insisted that I go to college. What I really wanted to be was a race car driver.
I went into nursing because, ever since having children of my own, I have loved babies and children and wanted to be able to help them. I moved to the Emergency Department because I love learning and I felt I had so much more to learn, and the Emergency Room would provide me with many learning opportunities—so far it has.
As for spare time, I don’t ever have any. Like I always say, “I’m never busy, just always doing something.” But should I have spare time, I would choose to be with my family! I enjoy my grandchildren, traveling, and cooking.
I love spending time with my family as well as traveling. I like the outdoors and have jet skis. I also have a jeep that I like to go four wheeling with. And don’t forget gambling.
As for advice to new grads, “You have chosen the perfect profession for raising a family.” I worked part-time/full-time while raising four children and never once did I miss any of their activities. Nursing gives you so much flexibility for family and working.
Ask questions. Never be afraid to ask questions. There are no stupid questions. The new nurses that make me nervous are the ones that don’t ask questions. If the nurse you’re asking gives you a bad time, just ask someone else and explain with a nice smile to the first nurse that you have a curious mind.
I have been blessed with a wonderful nursing career and made many friends that have been both patients and coworkers.
Always expand your knowledge—no matter how much you know you can always learn more. Expand your horizons. These days, many nurses are looking for employment elsewhere, when sometimes they just need reenergized. Take time to stop and smell the roses and really think about the difference you could make in someone’s life. And to the nurses—you have been around the block a couple of times. Take time with the younglings and remember they will be caring for you one day and you want them to be knowledgeable and compassionate to you, so be the same to them.
When I retire, I hope to pursue my career as a race car driver.
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2013 Nurse Resident Graduation
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By Rachelle Noe, BSN, RN, CWOCN Wound Care Nurse
Ostomy Cares Regional West Medical Center has all of the necessary supplies needed to care for your ostomy patient. ALL supplies are located in the Stockroom, Ext. 1616. Note: 2W has limited supplies in the south hall supply Pyxis. Ostomy Supplies Ostomy Appliances: Colostomy/Ileostomy • 2½” flat, one piece, lock-n-roll (budded stoma) • 4” two-piece, flat, lock-n-roll (budded stoma) • 1½ and 2” convex one piece, lock-n-roll (flush/retracted stoma) • Sterile two piece, flat…applied after surgery Additional ostomy supplies in the stockroom • Barrier rings • Stoma powder • Belt (can only be used on our convex appliances as it loop/hooks in place) • Paste • Lubricant/deodorant Urostomy Appliances/Supplies • 2 ½ flat, one piece (budded stoma) • Convex 1 ½”, one piece (flat/retracted stoma) • Adaptors and urine drainage bedside bags
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Additional supplies needed for an ostomy bag change: • Skin prep • Scissors • Sharpie and transparency OR pre-cut stencil • Washcloths and linen bag • Trash bag • Gloves Additional Information • The wound/ostomy nurses do the post-op teaching on new ostomy patients, teach an additional family member or caregiver, and order each patient a starter kit through Hollister. The Rx for their supplies is given to them at this time. • Where to find the procedure for ostomy cares and an ostomy supply list with pictures: • Located on the Regional West Medical Center Intranet www.rwmc.net>Employee Resources>Ostomy. • If your patient has a specific appliance he or she uses that Regional West doesn’t supply, they may bring in their own supplies or have a family member bring their supplies in for them.
Reduce your risk of developing type 2 diabetes through National Diabetes Prevention Program By Joanne Krieg, Marketing and Public Relations Department Are you concerned about your risk for type 2 diabetes? Are you ready to take steps to reduce your risk? If so, the Diabetes Care Center at Regional West Physicians Clinic is ready to help you change your life – and your diabetes risk in 2014. The Diabetes Care Center is offering a free lifestyle change program for people at risk for developing type 2 diabetes. The year-long program, which begins in January, is part of the National Diabetes Prevention Program, sponsored by the Centers for Disease Control and Prevention (CDC). The program helps participants learn new ways to incorporate healthy eating and physical activity into their daily lives under the guidance of a trained lifestyle coach. According to the CDC, lifestyle changes can reduce the risk of developing type 2 diabetes by 58 percent. The class will be led by the Regional West Physicians Clinic Diabetes Education staff.
five to seven percent of their starting body weight over the course of the program, and do at least 150 minutes of physical activity each week. The program teaches skills and provides tools to make a change for life. Participants learn strategies to add healthy eating and moderate physical activity into daily living, as well as techniques to handle stress and strategies to overcome barriers to a healthy lifestyle. To qualify for this free diabetes prevention program, a person must have prediabetes, a body mass index of 24 or higher, have had diagnosed gestational diabetes with a past pregnancy, or been told by a health care provider that they are at risk for developing type 2 diabetes. To enroll in the National Diabetes Prevention Program or to learn more about it, please call the Diabetes Care Center at Regional West Physicians Clinic, 308.630.2100.
The National Diabetes Prevention Program involves weekly meetings for 16 weeks, then monthly meetings for the remainder of the year. Participants set two primary goals: lose
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Attending: Spring Sherrell, Connie Morrill, Michelle Powell, Lori Lopez, Leonard Knorr, Laura Wright, Shannon Hultengren, Alice Fillingham, Shirley Knodel
November 26 A nurse expressed what a patient said regarding their worry for what is going to happen in the hospital. Shirley explained that nationwide, health care is uncertain right now. Regional West has worked hard to not fill some positions because we have in-house applicants to take them. We have to get leaner. Shirley asked the group if our nurse residency program was adequate or does the nursing administration need to take another look at it. The directors and Shirley have been working on cost containment issues. Shirley expressed the importance of good customer service and how we need to recruit our patients back to using our facility instead of going to Colorado. Shirley shared with the staff that the Regional West Physicians Clinic-Family Practice is currently using a VHA consultant to help with access issues there. She believes that this will help get more patients seen during the day. Shirley asked everyone in the room to be ambassadors to our hospital to get patients to come and see us.
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One nurse expressed a concern regarding staffing issues and if we will go back to our old practice model. Shirley stated that the rumor of going back to old practices is not true. She mentioned that computer systems in the future will do more for us and now we need to redevelop our unit secretaries to utilize them more since they are not inputting orders since the new CPO began being used. A nurse had a question regarding RCI insurance and asked if she had a procedure done here, would they every consider giving people a discount if they have not yet met their deductible. Shirley explained that if you stay within network here at the hospital, you do get a discount. She will review the new offerings and send them out to this group. One nurse explained that she is happy with her new Plan D and once you meet your deductible, RCI pays the whole bill. Shirley explained that she has discussed RCI insurance with other colleagues and we are unique because Regional West Medical Center pays a certain amount each month to match people’s HSA plan D.
A nurse asked why other employers don’t offer the HSA. Jordan will work with Human Resources to get an answer to this question. A nurse asked if the clinical ladder would be going away. Shirley explained that it would not go away, but it needs to revisited annually.
One nurse asked about the call light system and the staff emergency buttons. She is concerned because since the new updates on the call light system and the bed alarms are not loud enough. Shirley will be working on this to see what we can do to make sure the emergency call light button and exit beds are loud and can be changed.
One nurse asked about the concern of having 2E changed to Pediatrics. Shirley explained that she and the directors have listened to the concerns and are still working on where to place Pediatrics. They are still brainstorming and there is no decision as yet.
A nurse asked how The Joint Commission survey and the DHHS survey went this past year. Shirley explained the process and let the staff know that Jordan Colwell will be getting communication out to all staff. Overall we did a great job of providing great care.
Shirley mentioned that we need to continue utilizing supplies in an efficient manner as well as stopping stockpiling linen, since it is measured by the pound.
A nurse expressed concern about the cleanliness of the elevators used for patient care. Another nurse expressed appreciation of the new floors laid in some of the elevators. Shirley will work with Environmental Service to see if we can look at the elevators.
One nurse expressed a concern about not getting laundry back once it was cleaned. She recommended having Regional West relook at doing our own laundry instead of sending it out. One nurse expressed concern about employees throwing away linen instead of putting it in the dirty holder. She asked if there could be different containers that are color coded so people could recognize them easier. She also asked if it was possible to have a different container since the one on her unit is hard to put linen in. One nurse explained that the bags on the unit are different colors and change frequently so it is hard to keep track of what bags to use when. Shirley stated that she will pursue this with Environmental Services and nursing leadership. A nurse expressed a concern about nighttime charge nurses being shared or having them take patient loads. Another nurse stated that this would work only if staffing is efficient. Shirley shared with the group that the hospital is having a hard time recruiting certified nursing assistants. She asked the group if possibly having unit secretaries cross train to become certified nursing assistants will help raise the wage level for the certified nursing assistants. Shirley asked the group to start making lists on how they would want the unit secretaries to be utilized in the future.
Responses (to questions in the Breakfast with Shirley section) from Eric Vardell, Regional West Health Services Compensation and Benefits Manager. 1.) Co-workers (and their families) on our insurance do get a ‘discount’ on services and pharmacy billed through our insurance, even before they meet their deductible. We should always make sure that the person scheduling us for a procedure, office visit, or pharmacy charge gets a copy of our current insurance card and sends the bill to RCI, even if we know that we have not met our deductible. RCI will then send the provider back a notice of the (reduced) amount that can be billed, based on the “Usual and Customary” schedules. The provider then bills us for this reduced amount. This is the amount we pay the provider. Some will attempt what’s called “balance billing” for all of some part of the difference; but this is rare for medical, and only occasional for dental or other services. 2.) I try to remind people that Regional West is paying for the parts of their bill that they don’t have to pay, not RCI. RCI is a wholly owned subsidiary of Regional West Health Services, and only administers the design and billing of our plan. Regional West pays approx. 84 percent of our bills, which is approximately $20 to 22 million per year. ► Continued to page 12
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3.) Some employers do offer an HSA match. a. By federal law, the HSA is only legally available if the employee is enrolled in a qualifying high deductible Plan, like our 2013 Plan D, and our 2014 health insurance. b. High Deductible plans (HDHPs) are becoming more common, so people are seeing them more often, and then hearing about HSAs more often. Approx half of all US employers who offer insurance will offer an HDHP in 2014, and approximately one-fourth will offer an HDHP as their only plan in 2014. This HDHP-only rate is growing at about 25 percent per year, so expect to see more and hear more about HSAs as time goes on. c. Other employers offer higher HSA match rates than we do; but in those cases the insurance premiums are higher to offset the total spending by the employer. We choose to keep the cost of insurance much lower, rather than increase the cost of the insurance and offer higher HSA matching. This allows more people to afford the insurance.
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Susan Backer SUSAN BACKER, MSN, APRN‑CNS, ACNS‑BC Patient Safety Officer/CNS
With the holiday season upon us it is a good time to reflect back on 2013. It has been a successful year as we have seen our SSER decrease from 0.86 in the 4th quarter of 2012 to 0.55 at the end of the 3rd quarter 2013. This is a 77.27 percent decrease from a baseline of 2.42. So far in the 4th quarter of this year, the SSER jumped to approximately 0.75. Even though we will not meet our year-end goal of 0.25, we continue to see a steady decrease in serious safety events. Good work, everyone. The Safety Coaches program continues to grow and mature. Dylan Cardiff, Safety Coordinator, and Christa Pelster, Environmental Services Office Coordinator, are very active in helping me lead this group. They are dedicated to safety at Regional West Health Services and their expert help is greatly appreciated. There are currently about 75 active safety coaches. This group of dedicated front line workers provides education to staff, coach, and cross-monitor peers, and role model the safety behaviors. Thank them for their commitment to patient safety.
The patient care areas have started using simulation for educational purposes. Clinical coordinators and a few other dedicated RNs have taken the lead and are doing a fantastic job. This group is currently taking Simulation Education Modules through the National League of Nursing’s Simulation Innovation Research Center. Alicia Kunz, Clinical Nurse Educator in the Education Department and now Nurse Manager in the Emergency Department, formed partnerships with WNCC and UNMC nursing colleges to use their simulation equipment. She arranged education for clinical coordinators on the use of the equipment and led simulation in the Nurse Residency program. Alicia played a pivotal role in the growth and success of this program. Dr. Joe Margheim, Emergency Department physician, has also been a great asset to the simulation program. He brings a special interest and knowledge of simulation manikins from his Education Department residency experience. Three major “in situ” learning simulation experiences were held this past year. The Emergency Department and ICU/PCU ran simulation on sepsis and Surgery did simulation on malignant hyperthermia. Staff and
providers participated. The success of these larger events gave us a great start with working in teams in simulation. Safety behavior training for new hires and new leaders continues with great success. We have a dedicated team of trainers who take turns providing training to new hires the first day of orientation. The trainers are Sylvia Dolberg, Sean McCracken, Dylan Cardiff, Linda Fowler, Karna Kleager, Michelle Powell, Lenna Booth, and myself. They do a great job and I am grateful for their commitment. Safety behavior training for new leaders is scheduled once a quarter. Julie Schaff, Education Department Director, and I lead this training. Julie’s leadership skills and education background are a great asset at Regional West Health Services. I appreciate her partnership in this endeavor. Currently we are conducting a Patient Safety survey. We are using a different survey this year than what we have used in the past. Our new survey is through the Agency for Healthcare Research and Quality (AHRQ) and is titled, “Hospital Survey on Patient Safety Culture.” We are doing the data collection and analysis ourselves, rather than using a vendor, which is a first for us. The AHRQ Patient Safety survey places an emphasis on patient safety issues and on error and event reporting. It also measures seven unit-level aspects of safety culture: 1. Supervisor/Manager expectations and actions promoting safety 2. Organizational learning–continuous improvement 3. Teamwork within units 4. Communication openness 5. Feedback and communication about error 6. Non-punitive response to error 7. Staffing
In addition, the survey measures three hospital-level aspects of safety culture: 1. Hospital management support for patient safety 2. Teamwork across hospital units 3. Hospital handoffs and transitions And finally, there are four outcome variables included: 1. Overall perceptions of safety 2. Frequency of event reporting 3. Patient safety grade (of the hospital unit) 4. Number of events reported For our first survey, we have chosen to survey hospital staff with direct contact or interaction with patients (nurses, unit secretaries, rehab therapists); hospital staff who may not have direct contact or interaction with patients but whose work directly affects patient care (pharmacists, respiratory therapists, Laboratory, Imaging Services); and hospitalemployed physicians who spend most of their work hours in the hospital (Anesthesia, hospitalists, pathologists, intensivists, Emergency Department providers). This surveyed group also includes supervisors, managers, and directors of these areas. The survey is conducted in the month of December, with data analysis occurring in January. Survey results will help guide planning for 2014. Overall, it has been a busy year with much accomplished. As 2013 ends it’s always good to look back, review what we have accomplished, and express appreciation for our blessings. I am thankful for Regional West Health Services and the services we provide to our community of family and friends; the work I am tasked to do, which I enjoy very much; and the people I am privileged to work with—all the dedicated people committed to keeping patients, staff, and the environment safe; and the progress we are making in changing our culture to benefit all of us. Thank you, everyone, and have a blessed holiday season.
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The Quality and Safety Council celebrates the implementation of a successful nursing Peer Review Committee. Attending: Austin Engel, Susan Backer, Lucrecia Spady, Liz Ossian, Michelle Powell, Jeanie Miller, and Jodi Walter.
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Shared Governance Nursing Leadership Report Please help me congratulate the new leaders of Shared Governance for 2014. Coordinating Council Liz Ossian, Chair, and Michelle Powell, Chair-elect Quality and Safety Council Christy Jay, Chair, and Michelle Powell, Chair-elect Professional Practice Council Lenna Booth, Chair, and Nina Palomo, Chair-elect Patient Care and Practice Council Liz Ossian, Chair, and Ellen Otto, Chair-elect Nurse-Finance Council Paul Adams and Amy Holzworth, Co-chairs Night-Shift Council Matt Blaylock, Chair, and Nikki Rotert, Chair-elect
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