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2024 SANFORD BISMARCK

NURSING REPORT

Table of Contents Organizational Overview A message from the Chief Nursing Officer of Bismarck ..........................................................................4 Our Mission, Vision and Values .......................................................................................................................... 7 About Sanford Health ............................................................................................................................................ 8 Sanford Bismarck in 2024..................................................................................................................................... 9 Culture......................................................................................................................................................................... 10 Structural Empowerment Shared Governance ...............................................................................................................................................12 Professional Development.................................................................................................................................. 14 Commitment to Community Involvement ....................................................................................................17 Nurse Residency Program...................................................................................................................................18 Exemplary Professional Practice Professional Practice Model ............................................................................................................................. 20 Culture of Safety.....................................................................................................................................................22 Accountability, Competence and Autonomy .............................................................................................25 Awards & Recognition Annual APP Awards .............................................................................................................................................26 DAISY Nurse Leader .............................................................................................................................................26 DAISY Team Award ..............................................................................................................................................26 DAISY Award for Extraordinary Nurses .......................................................................................................27 Sanford Bismarck Nursing Award Winners .................................................................................................28 Transformational Leadership Advocacy and Influence .....................................................................................................................................32 Visibility, Accessibility and Communication ...............................................................................................33 New Knowledge, Innovations and Improvements Research ................................................................................................................................................................... 34 Evidence-Based Practice ....................................................................................................................................36 Innovation .................................................................................................................................................................38

2024 NURSING REPORT

ORGANIZATIONAL OVERVIEW A message from the Chief Nursing Officer Each year in preparation for the annual nursing report, I take the opportunity to reflect on the prior year and the invaluable contributions of our nursing teams. Working together, we achieved so much in 2024, and I’m grateful for the chance to share an overview of our efforts and accomplishments. High-quality and compassionate care has always been our focus, and last year was no exception. 2024 marked the first full year of the Zen Den, a space dedicated to helping nurses recharge and focus on their own well-being. We also launched Bismarck’s first Wellness Committee, which kicked off in December with a holiday social. Supporting our nurses and providing outlets for personal wellness is just one way we can show our gratitude for the care they provide to patients every day. Additionally, a record number of our student nursing interns chose to stay at Sanford, transitioning into professional nursing roles following their experience. These interns represent the bright future of nursing; their decision to launch careers with us reflects the strength of our programs and the supportive environment we have created. Our collaboration with Bismarck Public Schools on back-to-school immunization efforts is another example of how we’re making a difference in our communities. This initiative highlights the broader role we play in supporting wellness beyond the walls of our facilities. Last year, we also saw our largest turnout for Soaring to Excellence, an annual awards event dedicated to celebrating and recognizing the exceptional work of our nurses. It’s a chance to highlight their contributions, share their inspiring stories, and acknowledge the difference they make in the lives of those we serve, their families and each other. In 2025, we’re excited to open 36 more beds, bring in mobility devices and explore technological innovations to help support patient care. We’re also continuing to build initiatives that meet the needs of our patients and staff, including the recently enhanced Ethics Committee and the highly successful Behavioral Emergency Response Team. Lastly, our bedside report process is improving both patient care and experience, and our international nursing program is growing with plans to expand into ambulatory spaces. Despite workforce headwinds and other challenges facing health care, we’re firmly committed to supporting our teams and continuing to recruit top-quality nurses to join us. The culture we’ve built together is something special and speaks volumes about what it means to be a Sanford Health nurse. We look forward to another year of growth, innovation and unmatched excellence. Gratefully,

Wendy Kopp Wendy Kopp, PhD, MSN, RN, CENP Chief Nursing Officer, Sanford Bismarck Medical Center and Clinics

ORGANIZATIONAL OVERVIEW

2024 NURSING REPORT

ORGANIZATIONAL OVERVIEW

OURour MISSION mission To care, comfort and cure.

OURour VISION vision

To be the premier rural health system in the United States.

OURour VALUES values

Service Doing our best every day to uphold and care for others.

Courage Having the strength to persevere, problem solve and take action.

Humility Respecting others and knowing there is more to learn.

Stewardship Safeguarding the resources that have been entrusted to us.

Family Honoring the commitment we have to each other through it all.

2024 NURSING REPORT

About Sanford Health Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization serves 2.4 million patients and more than 425,000 health plan members across the upper Midwest including South Dakota, North Dakota, Minnesota, Wyoming, Iowa, Wisconsin and the Upper Peninsula of Michigan. The integrated nonprofit health system includes 56 hospitals, more than 270 clinic locations, 144 senior care communities, 4,500 physicians and advanced practice providers, nearly 1,000 active clinical trials and studies, and nine world clinic locations around the globe.

ORGANIZATIONAL OVERVIEW

The integrated nonprofit health system includes: • 56 medical centers • 270 clinic locations • 144 senior care locations • 132 skilled nursing and rehab facilities • 195,593 Sanford Health Plan members • 42,775 employees • 2,931 physicians and advanced practice providers and 8,291 registered nurses delivering care in more than 80 specialty areas • Centers of Excellence: – Cancer – Children’s – Heart – Orthopedics and Sports Medicine – Women’s Health Each year, Sanford Health provides: • 5.8 million outpatient and clinic visits • 80,880 admissions • 143,217 surgeries and procedures • 9,541 births • 224,223 emergency department visits

Sanford Bismarck in 2024 • 13,979 admissions • 622,324 outpatient visits • 38,382 emergency department visits • 1,628 births 2024 NURSING REPORT

Culture At Sanford Health, we believe quality health care should be available close to home for everyone, everywhere. From our roots in the Midwest, we are proud to set the standard for delivering world-class care. By building on the talents, experiences and beliefs of our employees, we aim to improve the lives of patients and residents throughout the communities we serve. Through our shared commitment, we can become the nation’s most-connected, widestreaching health care system, shrinking the distance between every patient and their best, healthiest life. Sanford Bismarck Wellness Committee By Nick Hillman, BSN, RN The Sanford Bismarck Wellness Committee is a newly founded committee whose mission is to foster a holistic approach the overall health and well-being of all Sanford Bismarck employees. The committee empowers employees to lead healthier, joy-filled lives. By providing resources, support and opportunities for physical, mental, spiritual and emotional wellness, we aim to create a positive community that enhances our team’s personal and professional lives. Our kickoff holiday social took place in December of 2024. Staff enjoyed refreshments, pet therapy and pampering with massages, facials and hair tinsel.

ORGANIZATIONAL OVERVIEW

Zen Den By Jessica Kindseth, MSN, RN, CNML, COHPM Prolonged exposure to workplace stress can result in compassion fatigue and job dissatisfaction. To combat this negative impact, Wendy Kopp, the chief nursing officer at Sanford Bismarck, led an initiative to dedicate a space that’s accessible 24/7 and provides a serene environment for frontline staff to step away from their busy workspaces. The tranquil atmosphere of the Zen Den gives employees an opportunity to relax and re-energize. Massage chairs, art supplies, yoga equipment, written materials and aromatherapy are just some of the tools available to support our staff’s well-being. Scheduled wellness events have also been hosted in the space, including facials, acupuncture and Reiki treatments during National Nurse’s Week. The Zen Den is located on the first floor of the medical center and was made possible through generous gifts to the Sanford Health Foundation of Bismarck.

2024 NURSING REPORT

STRUCTURAL EMPOWERMENT Shared Governance Senate Retreat Written By Lindsey John, BSN, RN In 2024, the Nursing Senate retreat was held at the Bavendick Stateroom on the Bismarck State College campus. The theme was “Nourishing Knowledge, Collaboration and Teamwork,” with an emphasis on interdisciplinary collaboration to promote excellence in care delivery. Senators had the opportunity to learn from keynote speaker, Rose Sherman, Ed.D, RN, NEA-BC, FAAN, a nationally known author and leader coach, as she touched on communication and collaboration, and strategies for leading high-performance teams at all levels. Staff also had the opportunity to experience new culinary offerings, do crafts, network and try wellness activities like Pilates.

STRUCTURAL EMPOWERMENT

Annual Meeting By Lori Gustafson, BSN, RN, CPAN As the chair of the Nursing Senate of Sanford Bismarck, I had the chance to attend the 2024 Sanford Enterprise Annual Meeting along with chair elect, Angela Wald, BSN, RN. The meeting took place at the beautiful Sanford Pentagon in Sioux Falls. Administrators, doctors and other health care providers heard from Bill Gassen and the many speakers that provided insight into the future of the industry. We learned about what Sanford Health offers, challenges of hospital systems and changes to anticipate. During the meeting, there were opportunities to attend specialty sessions. In one session, we heard about provider retention and burnout, and providers had an opportunity to voice concerns. Every attendee could talk with enterprise leaders about various subjects, like legal issues, laws governing health care or more local concerns. Throughout these two days, I could feel that Sanford cared about every employee and wanted to communicate the way to approach uncertainties together. We all had time to ask questions or offer comments as we collaborated with our peers and leaders. We have a voice, and our leaders want us to use them to help make Sanford Health a great organization that provides great care to our communities.

2024 NURSING REPORT

Professional Development Celebrating Certification - Certified Nurses Day By Lindsey John, BSN, RN Each year, March 19 marks Certified Nurse’s Day, a day to honor and recognize all nurses who contribute to improved patient outcomes through national board certification in their specialty. This year, based on certified nurses’ preferences, recognition was provided at the unit level and they received a gift certificate to the Sanford Store to celebrate accomplishments in certification. In 2024, we recognized and celebrated 344 certified nurses, including advanced practice providers, in the Bismarck Region. We continue to support gaining and maintaining certification, via free continuing education unit offerings, certification review courses and support through the entire certification process. Certification exam fees are covered by the organization, and certified nurses receive a bonus upon certification and recertification. Inpatient Annual Education By Mckayla Snell, MSN, RN The 2024 Inpatient Annual Education sessions were held on April 9, 19, and May 15 at the Bismarck State College campus. A total of 660 registered nurses from all inpatient units attended. The education sessions offered American Nurses Credentialing Center contact hours and included three large group discussions and five specialized breakout sessions. During the large group discussions, attendees participated and reported growth in the following sessions: • A well-being activity • Best practices for bedside reporting • A Culture of Safety panel discussion The breakout sessions focused on key topics, including: • Professional development • Infection prevention • Managing urgent situations • Vascular access • Surgical and catheterization lab checklists

STRUCTURAL EMPOWERMENT

Student Nurse Internship Program By Mckayla Snell, MSN, RN In 2024, Bismarck welcomed 47 nursing students into our 10-week summer internship program. This program helps nursing students expand their clinical skills and knowledge under the guidance of experienced nurse preceptors. These Sanford Student Nurse Internship Program (SSNIP) interns were assigned to both inpatient and ambulatory settings. New in 2024: • Dual or split internship experiences, allowing students to split their time between two departments. These split experiences included inpatient-inpatient and inpatient-ambulatory options. • Preceptor Gratitude Awards recognized preceptors for their exceptional contributions to the program. Seven awards were presented, each based on key categories within the Preceptor Program. Congratulations to our distinguished preceptors: Joy GiCiro, Cassidy Purintun, Sadie Lauf, Marie Eloisa Mendoza, Megan Voit, Kylie Tucker and Ashton Iszler This year our SSNIP end-of-program celebration was attended by interns, preceptors and leaders and closed out the year with food, an opportunity to connect with department leader and ask questions about different care areas and our preceptor awards ceremony.

2024 NURSING REPORT

2024 Internationally Educated Nurse Orientation By Adam Grimsley, BSN, RN, CCRN In 2024, the Leadership, Education and Development (LEAD) Center facilitated the orientation of 43 international nurses, with 10 additional nurses recruited independently of Connetics. Our Internationally Educated Nurse (IEN) program is renowned for exceeding the standards of similar programs, ensuring that nurses are well-prepared professionally, socially and personally. One notable initiative was the IEN Fiesta. We identified the need for community building and organized a picnic and potluck at Sertoma Park, featuring games for children and karaoke. This event welcomed all current IENs in Bismarck, alongside Sanford leadership, and attracted over 80 participants. We also host regular gatherings for these nurses, providing a platform to share information, discuss challenges and achievements on the job, and foster community. Recently, we introduced a segment where leadership attends, allowing them to engage with staff on a personal level and address any issues directly. These fellowships often feature potluck meals, encouraging participants to bring dishes from their home countries. In 2024, we also welcomed a PRN team member specializing in IEN education. As a former IEN herself, she offers invaluable insights and relatability, greatly enhancing the training experience.

STRUCTURAL EMPOWERMENT

Commitment to Community Involvement Safe Kids Bismarck-Mandan Community Engagement By Alyssa Preszler, BSN, RN, CEN, CPST Safe Kids Worldwide is a nonprofit organization dedicated to preventing childhood injuries through education, community involvement, safety device distribution, and more through local coalitions. Safe Kids Bismarck-Mandan is a local coalition led by Sanford Health where I work as the injury prevention coordinator and the pediatric emergency care coordinator. Each summer, Safe Kids Bismarck-Mandan and Sanford host Kids Safety Day, a large, outdoor fair designed to educate children and their caregivers on all aspects of safety in childhood in a fun and hands-on environment. Each event involves the participation of over 20 different community organizations, a food truck, bounce houses, face painting and more. We’ve hosted the event for the last 3 years and have had more than 750 attendees each year. In addition to Kids Safety Day, I work with Bismarck Burleigh Public Health and the Bismarck Police Department, host “bike bus” events for local elementary schools. At these events, kids arrive to a designated spot where our team can ensure children have helmets and are wearing them properly. Once everyone is ready, adults lead the kids on bike ride to their school. We try to host two to three events each fall and spring, rotating between different elementary schools. Our goal is to highlight the fun and health benefits of biking to school while also teaching kids how to be safe while riding their bikes.

2024 NURSING REPORT

Nurse Residency Program By Laurie Vanderpan, MSN, RN, NRP Coordinator – Bismarck region The Nurse Residency Program (NRP) in Bismarck continues to make noteworthy progress in enhancing the self-confidence and competence of new graduate nurses, encouraging them to lead effectively at the point-of-care. The 2024 statistical data from our NRP dashboard confirms that the program has successfully met its goals and achieved a notable 93.8% retention rate over the past two years. The NRP fosters a positive environment, offering immediate support for the challenges new nurses face in the hospital setting. In addition to providing valuable feedback, the program has expanded its guest speaker panel to cover a wider range of topics relevant to acute care nurses. Recent additions included discussions on Sanford’s Ethics Committee, the Joint Commission, and professional pitch etiquette. The program has also focused on enhancing its evidence-based curriculum, with subject matter experts helping groups in pitch development for projects and forming PICOT questions. A key component of the program is the emphasis on well-being. Each seminar connects new graduates with experts such as a dietitian, a sleep specialist, financial advisors, spiritual counselors and mental health professionals. These sessions provide valuable insights into maintaining personal well-being, helping nurses access the latest resources available to them. We are excited to share that the NRP is finishing on a high note. Our request for reaccreditation by the Practice Transition Accreditation Program has been approved, and we are scheduled for a virtual surveyor visit in the coming weeks. This achievement would mark an important three-year milestone in our ongoing commitment to excellence.

STRUCTURAL EMPOWERMENT

Nurse residents in Cohort 16, September 2024 “Professional Development Day”

Nurse residents in Cohort 15. May 2024, “In-depth Team Reflection with Jenga game”

Nurse residents in Cohort 14, January 2024 “Stress release with plastic balls”

2024 NURSING REPORT

EXEMPLARY PROFESSIONAL PRACTICE Professional Practice Model Enhancing Emergency Services in the Ambulatory Setting By Lindsey John, BSN, RN The Bismarck Code Blue Committee, in collaboration with ambulatory leaders and nurses, identified a gap in resources surrounding emergent situations in the ambulatory setting. For many years, teams operated under the premise of “scoop and run” to the emergency department when patients or visitors experienced rapid response events or code blues. Teams conducted extensive literature reviews revealing that new research suggests optimal outcomes evolve from urgent management or stabilization on the scene prior to transfer to the emergency department. As a result, teams consisting of intensivists, anesthesiologists, critical care nurses, respiratory care teams, nursing practice, bed management, ambulatory nurses and leaders came together to develop the Ambulatory Code Blue and Rapid Response Teams. Nurses helped develop Simulation in Motion training and education for the ambulatory frontline staff, as well as the code and rapid teams, to prepare for the management of these emergency situations. Nursing Simulation By Kara Vollrath MSN, RN The simulation team and the trauma team participated in two city-wide emergency drills. These large-scale emergency exercises are designed to test response plans in a crisis. The drill brought together multiple agencies to simulate a real disaster scenario, ensuring coordinated efforts in emergency rescue operations and public safety. The first drill was a school mass shooting, and the second drill was a plane crash with burn victims. The simulation team started making and preparing the moulage burns weeks before the drill, ensuring a realistic appearance for the victims. The simulation and trauma team members applied the moulage to each victim, assisted the victims in understanding their injuries and the appropriate actions and responses needed to portray them accurately.

EXEMPLARY PROFESSIONAL PRACTICE

2024 NURSING REPORT

Culture of Safety Elopement Intervention Committee By Sean Forster BSN, RN Elopement is often considered a psych, obstetrics or pediatric unit concern. Over the years, the industry has worked to protect these vulnerable populations leading to vast improvements in environmental security. However, we now find ourselves identifying a new at-risk population, and elopement is no longer isolated on those three units. As medical complexity has increased, so has the risk of patients being safe to leave their therapeutic medical treatment settings. Through case review and population trends, we have identified that we have elopement risk patients all throughout the facility. These patients could pose a risk to themselves or others if they elope. Upon reviewing elopement events and staff concerns, a multi-disciplinary Elopement Prevention Committee was formed in the winter of 2023. This committee included team members from risk management, quality improvement and regulatory compliance, as well as hospital leadership, medical staff leadership and nursing experts. Through our committee, we identified four elopement categories: • General staff concerns of elopement risk • Provider-justified lack of capacity • Legal emergency detention process • Legal court commitment process We reviewed all the workflows leading to each decision and identified gaps that could lead to elevated elopement risk. With this information, we created one workflow for the hospital to follow. Our goal was to make the workflow simple to follow. All the protocol triggers should flow into one elopement prevention precaution, especially since it could be initiated by four different triggers. We also wanted a clear way to communicate the risk and mitigation interventions to all disciplines throughout the hospital and care team. The committee developed a new elopement precautions policy, pulling and building upon best practices from other Sanford facilities and adding our own individualized patient care and staff priorities. This policy included a definition of each elopement trigger and a new nursing-driven panel to allow nursing staff to initiate focused interventions to help mitigate elopement risk. The panel was built into hospital policy, as well as into a OneChart workflow. We chose to include it in OneChart so all clinical team members could see the elopement precaution flag on the patient dashboard, as well as interventions put in place to support the safety of both patients and staff.

EXEMPLARY PROFESSIONAL PRACTICE

The workflow and policy went into place in the fall of 2024. Prior to that, educational materials were distributed through professional management, nursing senate and education council meetings. We created new yellow folders to organize all current or active legal elopement paperwork. These are disseminated from both the emergency department and 7W psych. While elopement risk will never be 100% mitigated, we have taken substantial steps to improve our understanding of elopement risk, the rationale for the concern and key clinical interventions to put in place to maintain safety for staff, the patients and the community. Our protocol focused specifically on four SAFE skills: • Speaking up for safety • Communicate clearly • Attention to detail • Know why and comply Moving forward we will continue to focus on the questioning attitude SAFE skill as we validate and verify this protocol is leading to positive and sustainable clinical improvement and outcomes.

2024 NURSING REPORT

A Full Year of BERT By Sean Forster BSN, RN The concept of the behavioral emergency response team, or BERT, is not new to health care, nor to Sanford Health, as teams have been successfully implemented across Sanford facilities. Literature supports the implementation of BERT-like resources to support behavioral health in the medical setting. BERT can also help support workplace violence prevention by helping patients and staff work through the tensions people face during medical and acute crises. For this reason, a workgroup of risk management, security and behavioral health professionals launched BERT in Bismarck in September 2023. For a successful implementation and maintenance of a BERT program, we had to align resources, workflows and education prior to the go-live date. The BERT work group focused on addressing real world concerns from our core providers, nurses and CNAs who work with high stress patients and encounter workplace violence. After viewing workflows from other locations, the group felt something critical was missing. Other workflows followed a “one-and-done” approach, meaning the team would only interact with the patient during initial BERT call. Our team believed that true behavioral change, clinical support and therapeutic coping skills are not achieved in one session, so we created a workflow that deviated from the others. It’s also important to note that clinical staff change from shift to shift, so we needed BERT to be as fluid as staffing. As a result, we created our core BERT response to include a minimum of two visits – the initial call and at a minimum of one follow-up the next shift. This allows the rounding BERT nurse and security team member to provide continual support across shifts and during fluctuations in the patient’s mood or circumstances throughout their stay. Following up gave BERT the ability to reinforce behavior expectations and provide therapeutic support to the patient and the staff caring for them. In 2024, we had 173 initial BERT calls and 913 follow-up visits. BERT has brought additional support and resources directly into the hands of the clinical team members and nurses throughout the hospital. With an elevated focus on patient-centered care, therapeutic relationship building and therapeutic boundary setting we have seen an increased awareness of staff workplace violence interventions and mitigation.

EXEMPLARY PROFESSIONAL PRACTICE

Accountability, Competence and Autonomy Charge Nurse Training Academy By Sara Rice, M. Ed. In January 2024, a new training, Charge Nurse Basics, was implemented to support the professional development of charge nurses. The training, which includes topics such as adaptive leadership, emotional intelligence and emergency management, aims to enhance knowledge and skills in the charge nurse role. The course was offered eight times in 2024, with 168 participants. Survey results showed an increase in the average satisfaction rating for the charge nurse role from 6.2 (pre-survey) to 7.5 (post-survey) on a scale from 0 to 10. Nurses also reported improved ability to apply knowledge and skills in the role for all course objectives (scale 0 to 10 where 0 equals not confident and 10 equals very confident). Participant feedback highlighted appreciation for topics related to emergency management, safety, and role expectations, as well as the session’s interactivity and the opportunity to learn from peers. Based on participant feedback, the morning and afternoon session topics were adjusted, and content was revised. Charge nurse training will continue to evolve as we monitor data and learner feedback. Starting in 2025, Charge Nurse Basics will be offered in the summer and fall, with the potential to add more offerings if necessary. Additionally, charge nurse competencies were reviewed and updated to ensure they align with the goal of building confidence in the role. This work was completed by individuals from the Bismarck LEAD Center, inpatient nurse directors and inpatient nurses. Finally, a charge nurse tracking tool was created to provide a centralized list of charge nurses, supporting program evaluation and tracking metrics.

2024 NURSING REPORT

AWARDS & RECOGNITION Annual APP Awards

Rookie of the year

Recipient:

• Hannah Bailey, PMHNP, APRN, CNP

Innovator

Recipient:

• April Berger, FNP, APRN, CNP

APP of the year

Recipient:

• Erin Schwinkendorf, FNP, APRN, CNP

Lifetime Achievement

Recipient:

• Christian Matthews, APRN, CRNA DAISY Nurse Leader The DAISY Nurse Leader Award recognizes nurses who have made an extraordinary contribution to patient care. Honorees can include any nurse leader who has directly influenced patient care, such as nurse managers, directors, supervisors and clinical care leaders.

Award

Recipient:

Joy Giciro, BSN, RN

DAISY Team Award The DAISY Team Award recognizes that outstanding care is often a collaborative effort from dedicated teammates.

Award

Recipients: • Hannah Swenseth, BSN, RN, CPN • Mallory Waters, BSN, RN • Kayla Wentz, BSN, RN

AWARDS & RECOGNITION

The DAISY Award for Extraordinary Nurses The DAISY Award is a national recognition program that celebrates the extraordinary clinical skill and compassionate care provided by nurses every day. The award was established in 1999 by the family of J. Patrick Barnes, who died at the age of 33 from complications of idiopathic thrombocytopenic purpura. Deeply moved by the care Patrick received during his hospitalization, the family created the DAISY Foundation to honor nurses who go above and beyond. Today, the DAISY Award is presented in more than 3,000 health care facilities across all 50 states and 13 countries. At Sanford Health, patients and families touched by the nursing care they receive can submit a nomination to recognize the nurse’s kindness, care and expertise.

Award

Recipients:

Casey Tanous, RN

Lainie Estenson, BSN, RN

Andrea Grubb, BSN, RN, CAPA

Kristen Johnson, BSN, RN, CPHON

Robert Miller, BSN, RN

Lauren Guggenberger, BSN, RN, RNC-OB

2024 NURSING REPORT

Sanford Bismarck Nursing Award Winners

Star Performance Award

Recipients:

Tayla Gange, BSN, RN

Tammy Dahme, BSN, RN

Justin Sabo, RN

Exemplary Professional Practice Award

Valerie Schuh, BSN, RN, MEDSURG-BC

Barbara Kelly, BSN, RN, PMH-BC

Tracey Goetzfried, BSN, RN, PMH-BC

Michelle Schmidt, BSN, RN, PMH-BC

Structural Empowerment Award Meagan Schrader, BSN, RN

Lindsey John, BSN, RN

Recipients:

AWARDS & RECOGNITION

Recipients:

Transformational Leadership Award

Recipients:

Samantha Wagner, BSN, RN, ONC

Trisha Eckroth, BSN, RN

Florence Nightingale Award

Recipients:

Ryan Tauck, ADN, RN

Judy Muth, DN, RN

New Knowledge, Innovations, and Improvements Award

Recipients:

Karlee Epperson, BSN, RN

Kalcey Schneider, BSN, RN, ONC

2024 NURSING REPORT

AWARDS & RECOGNITION

Distinguished Wisdom Keeper Award

Recipients:

Brenda Schiff-Seehafer, BSN, RN, RNC-NIC

Tammi Randolph, BSN, RN, CNML

Friend of Nursing (Individual) Award

Recipients:

Catherine Hellman, MLT

Peter Kurniali, MD

Friend of Nursing (Department) Award

Recipient:

Air Med Paramedics

Jan Kamphuis Spirit of Nursing Leadership Award

Recipient:

Samantha Richter, MSN, RN, CNML, SCRN

2024 NURSING REPORT

TRANSFORMATIONAL LEADERSHIP Advocacy and Influence Omnicell Medication Cabinet Implementation By Adam Grimsley, BSN, RN, CCRN The LEAD Center played a pivotal role in the implementation of the Omnicell medication cabinet, dedicating over 40 hours to meetings and preparations for extensive training initiatives. Our team was instrumental in organizing and overseeing all training activities related to Omnicell, excluding the training of 43 pharmacists. Greg Fritz from the pharmacy department was the only individual whose contributions may have surpassed ours in supporting this initiative. Although Omnicell personnel conducted training sessions for our 89 super users, they did so under the continuous guidance and supervision of our team. The initial strategy involved these super users subsequently training the entire cohort of 568 end users. However, we soon recognized that this approach added stress to the super users’ day and did not consistently meet the rigorous standards that distinguish our center from others within the organization and nation. In response, four highly motivated and industrious LEAD members swiftly adapted, assuming responsibility for conducting all enduser training sessions with the support of the super users. With less than a 10-minute notice, four of us took on the responsibility of nearly 100 people. Beyond training, we provided comprehensive support to every unit undergoing Omnicell implementation through intentional rounding, informative literature dissemination and cordial communication. Our group’s excellence is not merely a claim but is substantiated by evidence from this and numerous other educational initiatives. Bedside Rounding By Chantel Erickson, BSN, RN In June of 2024, Sanford Bismarck nurses participated in an enterprise-wide bedside report initiative, called ISHAPED, which stands for: • Introductions

• Plan

• Story

• Error Prevention

• History

• Dialogue

• Assessments Nurses use this acronym as a guide for formatting patient reports. Handoff at the bedside has been proven to improve safety and care of the patient, communication among care team members, and overall patient experience. After implementing ISHAPED, patient experience scores showed a marked improvement, especially in the areas of “nurses explaining things” and “confidence and trust in nurses.” Bedside reporting continues to be a focus of nursing practice at Sanford Bismarck as teams work to improve handoff communication and refine report format. 32

TRANSFORMATIONAL LEADERSHIP

Visibility, Accessibility and Communication Transition Unit PI Project By Erin Christian, BSN, RN ‘Movin’ on Up’ to 7N Transition Unit

Improving Hospital Throughput

Chantel Erickson, BSN, RN, Erin Christian, BSN, RN Bed Management

Background Over the past few years, Sanford Health Bismarck has been faced with record volumes in the Emergency Department and inpatient medical center. Day to day navigation of increasing volumes highlighted the need to improve throughput by utilizing a space to support patients until time of discharge or time of available inpatient bed.

Objective Improve hospital throughput through utilization of 7N Transition Unit within first 6 months of unit being open Monday through Friday during the hours of 0700-1900 to: ▪ Decrease left without being seen occurrences in ED by 5% by 7/5/2024 ▪ Decrease length of stay for Orthopedic joint patients by 30 minutes by 12/31/2023

Metrics

Actions Taken

Outcome Metrics: Tracking left without being seen data and filtering data down to 0700-1900 Monday through Friday.

• Project Charter completed and used PDSA methodology to overcome barriers • Educated leaders, direct care staff, support staff, and providers • Implemented bed request process to decrease phone communication from Bed Management to unit charge nurses • House Supervisor education to screen patients and notify providers • 7N unit staff education on total joint patient care • Patient Experience involvement with shadowing a patient going to Transition unit and developing scripting to support the message nurses give to patients • Met with front line nursing staff for workflow efficiencies

Tracking length of stay for total joint patients. Process Metrics: Tracking daily volume of patients assigned to 7N Transition Unit, with a goal of at least 20 patients being transferred to unit per day Monday through Friday.

Analysis

Next Steps • Create workflows for patients without pending admission orders to transfer to 7N until admission orders are placed by attending provider • Expand days and hours of operation to support facility throughput needs

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10/2021

2024 NURSING REPORT

NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS Research Navigating Nurse Wellness in Rural America By Emily Smith, DNP, RN, CNE The LEAD Center played a pivotal role in the implementation of the Omnicell medication The Sanford Nursing Research Team, which includes Bismarck representatives Emily Smith, DNP, RN, CNE, and Martha Stow, BSN, conducted the Navigating Nurse Wellness in Rural America research study. This multi-site, mixed methods study was conducted to determine the current wellness levels of clinical registered nurses, advanced practice registered nurses and nurse leaders in rural American settings, including the barriers encountered and strategies used to maintain or enhance their wellness. It was key to also determine what interventions these rural nurses recommended in their workplace to promote wellness. Phase 1 of the study used survey questions from the Integrative Health and Wellness Assessment (IHWA V2 2022) with open-ended questions to explore nurses’ wellness. The IHWA V2 2022 measured nurses’ holistic wellness in eight dimensions. The Online Wellness Survey was deployed to 6,989 clinical registered nurses, advanced practice registered nurses and nurse leaders. Significant findings included age, years of experience and role. Barriers of insufficient time, work environment and family responsibilities were identified. Recommendations involved the work environment, stress management and healthy boundaries with suggestions for implementation. Following survey analysis, Phase 2 of the research study consisted of six focus groups tasked with identifying recommended interventions most salient to each nursing role that could be implemented across the health care system. Focus groups reinforced Phase 1 online findings and provided more context and detail to the intervention recommendations for promoting wellness in the work setting. These findings were disseminated throughout Sanford Bismarck. Additionally, the research study was published in the January 2025 issue of The Journal of Nursing Administration.

NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS

2024 NURSING REPORT

Evidence Based Practice HAPI Reduction By Nikki Fischer-Buchholz, BSN, RN, CWON I’ve learned so much as a certified wound ostomy nurse over the last 14 years and have a passion for helping patients in need of this type of care. Over the two and half years I’ve been in Bismarck, I’ve been working on improving patient care through sharing educational resources about skin, wound and ostomy care, distributing this information to current staff, international travel staff and new graduates. I’ve received positive responses from staff and requests for more education from unit managers and directors. About one and a half years ago, I started working more with the quality improvement team. I was also able to get involved in the local and enterprise-wide hospital acquired pressure injury (HAPI) meetings. By working closely with our quality improvement team, we’ve been able to recognize injury trends and work on ways to improve or prevent injuries from happening. When an injury happens to a patient while they’re in our care, we do a root cause analysis on what happened, why it happened and what we could have done to prevent it. When there are multiple patients with the same or similar injuries, we put together HAPI times educational flyers that go out to the units to let them know that these injuries are happening and provide solutions to prevent them. Since we began sending out HAPI times flyers, our pressure injuries have decreased. We’ve also seen a decrease in more common injury types by implementing preventive devices, changing practice and recognizing trends. Some of the changes we made included: • Providing education on the proper use of our new skin care line • Limiting the layers we have under the patient to help prevent moisture associated skin damage • Labeling beds so we can recognize patients quickly • Using preventive devices that help reduce pressure-related injuries for the patients that using CPAP and BIPAP devices • Using seat cushions when necessary There is always going to be room for continued improvement. My goal is to keep learning and improving our best practice as things change. Through prevention and education, our patients can receive great care and great outcomes.

NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS

No Bones About It – We’ll Get You Screened! By Jennifer Hall, BSN, RN, ONC The orthopedics, sports medicine and podiatry quality project received first place at the Sanford Improvement Symposium. Our performance improvement project, “No Bones About It – We’ll Get You Screened!” focused on improving breast and colon cancer screening rates by more than five percent in the orthopedics and podiatry specialty clinics. Our actual improvement rates were higher: Orthopedic clinics Breast cancer screening: 6.8% Colon cancer screening: 6.2% Podiatry clinics Breast cancer screening: 10.6% Colon cancer screening: 8.4% A success story: One of our patients thanked us for getting him in for a colonoscopy. His provider diagnosed him with early colon cancer at age 56. The patient was treated surgically without metastasis.

2024 NURSING REPORT

Innovation Psychiatric Patient Movement PI Project Summary By Sean Forster, BSN, RN This project was driven by ongoing concerns and complaints about delayed patient access and ease of access to psychiatric services and active treatment, both at Sanford Health and throughout North Dakota. We had a broader mission objective of improving access to active treatment and enhancing psychiatric relationships with hospital wide staff and departments. Action taken to achieve our objective included: • Enhancing treatment team discharge plans by identifying follow-up providers to schedule aftercare early. This also helped with identifying and overcoming common psychiatric discharge barriers like delayed safety plans, safe dispositions, aftercare, service connections, court management, clothing and transportation. • Scheduling earlier discharge times and working with OT to close out active treatment plans as well as develop continuation of care post discharge resources. This was all added to new discharge folders for organization. • Working with the emergency department, providers, and charge nurses to flex capacity for admissions so we can take patients before the room is ready or before planned discharges have departed. • Focusing on project actions and identifying new actions that were needed through 7W multidisciplinary clinical huddle team meetings. We also identified barriers or ineffective workflows. As a side note, Amwell telepsychiatry consultation in the emergency room coincided with this project. This further supported psychiatric patient access to the appropriate level of care, which included inpatient, CRU stepdown, outpatient and primary care follow-up. Throughout 2024, Amwell consults led to over half of patients being discharged from the emergency room. They either had their needs met and were sent home, or they were sent to outpatient treatment resources. This project saw a decrease in both emergency room and medical unit throughput times. That shows the value of getting patients into the right therapeutic environment for active treatment and highlights the necessity of reallocating medical and emergency room resources into active operation. Based on our final outcomes, we believe we have overwhelmingly impacted the mission of being the best psychiatric tertiary care facility in our region. We see this demonstrated in a few ways. First, there has been a decrease in psychiatric deflections. There has also been a decrease in psychiatric patient emergency department throughput as compared to the general population. Before, psychiatric patients sat in the emergency department 0.66 hours longer than a general patient. Now they wait 0.64 hours less than a general patient. We also noted a drop in the stay lengths in the medical-surgical unit before transfer. Admit times all shifted up and support the overall balance of patient

NEW KNOWLEDGE, INNOVATIONS, AND IMPROVEMENTS

movement. We also decreased staffing stress by lowering admit numbers and discharges during the 4- and 2-hour windows leading up to shift change. Next steps in our program algorithm include: • Develop staffing and acuity management plans for continuous flex capacity 24-7 • Enhance patient education prior to discharge to improve discharge decision to door times • Expand therapeutic programing to decrease length of stay waiting for active treatment • Expand our relationships with our medical partners by further enhancing a hybrid treatment model that mutually respects medical management with a psychiatric focus to improve overall hospital safety and lead to best practices In Our Education Era By Samantha Wagner, BSN, RN, OCN Historically, most Sanford Bismarck oncology patients received their chemotherapy education from their oncologist at their initial appointment or from a nurse or nurse navigators on the day of their first chemotherapy infusion. Patients stated that anxiety levels are highest during the initial clinic visit with their oncologist as well as their first chemotherapy appointment. Staff noticed that education was not as effective during those appointments, prompting a change in our process in hopes to better prepare the patients for their treatment.

2024 NURSING REPORT

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