Dartmouth Hitchcock Nursing Year in Review 2013

2013DARTMOUTH-HITCHCOCK NURSING | A YEAR IN REVIEW

NURSING YEAR IN REVIEW // 2013

Dear Colleagues,

This special edition of Dartmouth-Hitchcock Nursing serves as our 2013 Nursing Year in Review. This letter as your chief nursing officer is one of the final items I am completing as I prepare to leave for retirement. It gives me a chance to reflect one last time upon the accomplishments and commitments of Dartmouth-Hitchcock (D-H) nurses. Reading about our 2013 accomplishments will be a great way for our new leader to learn about our nursing community.

The 2013 Dartmouth-Hitchcock Nursing: A Year in Review again highlights our accomplishments as directed by the nursing strategic plan and in alignment with the components of our Professional Practice Model (PPM) for Nursing at D-H. As we have described many times, D-H has a clear vision and direction for the future: improving the health of the population, providing value-based care and moving to new reimbursement models. Our nursing strategic plan was developed and has been revised to align with our organizational vision and strategy. The PPM provides the framework to approach the nursing strategic plan in a systematic way using the D-H philosophy and values for nursing as the guideposts. These documents provide us with focus for the work

ahead of us as a professional nursing community and supports creating a sustainable health system to improve the lives of the people and communities we serve. They also incorporate our nursing mission and two high-level goals: a healthy care environment and a healthy work environment.

As I review the list of items included in this review, I feel great pride and gratitude for our accomplishments. Aligned with the intention of the D-H Value Institute, we have educated our nursing leaders and unit-based council chairs as Yellowbelts, thereby increasing our capacity to make improvements in the care of our patients and our work environment. In keeping with our Shared Governance motto, “Every Nurse a Leader,” this review highlights the role of direct care staff in the design of our new inpatient units, the selection of an evidence-based practice implementation model and the transformative work of Team Care, an interprofessional collaborative effort to improve the experience of our patients. The outcomes and progress of these various items are astounding and, due to the efforts of so many of you, focused on making things better.

In reflecting on my career as a nurse, I appreciate most the countless opportunities I have had to learn and grow. Many of you know I often make the statement “If the door opens, walk through it.” This phrase is meant to convey my own experience that many of the opportunities I have had through my nursing career were unexpected and, quite frankly, often out of my comfort zone. Over this past year, I have observed many of you reach outside of your comfort zone and grab unexpected opportunities that came your way; opportunities to learn and grow and to make things better for our patients and families—to create an environment in which our patients and families can heal, the pinnacle/peak in our PPM schematic and the ultimate goal for nursing practice at D-H. That is, after all, our stated mission.

My sincere thanks for everything you have done to make it a reality,

Linda

Linda J. von Reyn Chief Nursing Officer (April 2009 to March 2014)

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Throughout Dartmouth-Hitchcock (D-H), we advance population health by forging partnerships. Our D-H Nursing Professional Practice Model, designed to reflect the landscape of the mountains in our region, guides us to "Reach the peak by building relationships."

The features in our 2013 Dartmouth-Hitchcock Nursing: A Year in Review describe initiatives that nurture relationships that are fundamental to achieving the healthiest population possible. Building relationships with self, relationships with colleagues and relationships with patients and families are prerequisites for engaging patients, families and health professionals as partners in a sustainable health system.

We are building relationships with self by investing our energy in improving our practice and our processes. In what must be the largest Yellowbelt training ever orchestrated by our Value Institute, more than 70 nursing leaders learned the improvement science that helps us start taking care of tomorrow's patients today.

Working with our colleagues from many disciplines to reduce readmissions from heart failure, we witness the power of relationships and collaboration to affect meaningful benefits for patients for whom enjoying the best care means staying out of the hospital.

Our Team Care initiative is bringing it all together, shining the light of our culture of caring on the complex environment of inpatient care. We look forward to the future of Team Care with a deep focus on improving communication and clinical quality in alignment with the Partnership for Patients/Hospital Engagement Network program.

The movement toward population health and value-based care is driving innovation in the community care setting—after all, most care delivery and self-care happens right in the home. One of our most proactive and meaningful initiatives is helping our senior citizens stay well and independent at home, while also advancing our expertise and capacity to deliver accountable care at the regional level.

I am grateful to Linda von Reyn, PhD, RN, for her gra-cious leadership and legacy of encouraging emerging leaders to reach for new opportunities. Beginning in 2013, I have been honored to serve on the D-H Board of Governors, and I look forward to continued oppor-tunities for us to work together to improve the lives of the people and communities we serve.

Cheryl L. Abbott, MSN, CNRNNeurosciences/ENT Staff Nurse Executive Chair

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Professional Practice ModelIn its simplest form, a model is a visual representation of a set of relationships. A Nursing Professional Practice Model conveys the values and core characteristics of nursing in a given organization. Nursing at Dartmouth-Hitchcock (D-H) has many elements that normally appear in the Professional Practice Model (PPM), including our nursing mission, our commitment to patient- and family-centered care, our philosophy of nursing, an identified nursing theorist and strong Shared Governance structures. What Nursing at D-H lacked was a picture that reflected all these values and could provide a common foundation for Nursing at D-H.

As part of the development of the revised nursing strategic plan in 2012, one of the goals was to develop and implement an agreed upon PPM. The Magnet Ambassadors were a key group involved in this chartered work, as they provide broad nursing representation from across the organization. The team began by understanding and defining professional practice models to develop shared

and common terminology. They next reviewed models from other organizations, and then worked with Communications and Marketing to develop a schematic for D-H. This information was shared along the way with the unit-based councils, nursing leadership teams and the house-wide Coordinating Council to provide feedback and facilitate dialogue. Every nurse in the organization received a brochure with the new design and a high-level description of each of the elements. A deeper analysis of aligning nursing work with each element of the model began at the annual Shared Governance retreat in November 2013. This same presentation also occurred as part of Nursing Professional Practice Grand Rounds in December 2013.

The Magnet Ambassadors are currently working with peers at the unit level with large dry erase posters to begin to align the work at the unit level with our new PPM. This is meant to be a positive experience, with nurses reflecting on the work they have been involved in and are most proud of and

Paula Johnson, BSN, MPA, DA, RN

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identifying where it best fits within the model—to begin to bring the model to life in each individual practice setting. In addition, the model is being rolled out on the Intranet and the Internet so that people both internally and externally can identify what it means to be a nurse at D-H. As we continue to develop new relationships and partnerships, having a common foundation for nursing becomes increasingly important.

The stories highlighted in this year in review align with the different components of the new model, and I hope will inspire you to reflect with pride on the work being done to advance nursing at D-H.

Paula Johnson, BSN, MPA, DA, RN Clinical Program Coordinator, Magnet and Retention

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PATIENT & FAMILY CENTERED CARE

RELATIONSHIP BASED CARE

RESPECT& DIGNITY

INFORMATIONSHARING PARTICIPATION COLLABORATION

create anenvironmentin whichPATIENTS & FAMILIEScan HEAL

OVERVIEW

Left to right: Jill Toth, BSN, RN; Janice Chapman, BSN, RN; and Paula Johnson, BSN, MPA, DA, RN

D-H Nursing Professional Practice Model

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Managing Pain, Pleasing Patients Pain. For many, and perhaps even most patients, pain plays a major role in how they define their hospital experience. The hospital staff’s management of a patient's pain, then, can also define a patient’s perception of their care.

“Yet pain, so elemental to the human sense of wellness, is very difficult to manage,” says Kate Bryant, BSN, RN, staff nurse in the 3 West inpatient surgical unit at Dartmouth-Hitchcock Medical Center (DHMC). “It’s really challenging. Basically, pain is whatever the patient says it is. And one patient’s ‘2’ can be another patient’s ‘8’,” she adds, referring to the standard 10-point pain scale, where “0” is no pain at all and “10” is “excruciating pain.” The problem of pain management is especially apparent in 3 West, which issues more narcotic pain medications than any other unit at DHMC.

Patients completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) upon discharge consistently gave DHMC scores in the low 60s on average for pain management—not bad, but not great either. With the Affordable Care Act placing more emphasis than ever on HCAHPS scores, Bryant and nurse colleagues on 3 West as well as 2 and 4 West resolved to develop and implement a plan to improve our scores.

The goal of any pain management plan, says Bryant, “is to keep pain always in control.”

B R I N G I N G I N T H E Y E L L O W B E LT

The result was a quality improvement Yellowbelt project that not only found ways to improve pain management in all these inpatient units, but also pro-vided new ways for nurses to connect with patients.

The Six Sigma methodology was developed back in 1986 by Motorola, the electronics company, as a way

to improve, quality and consistency of manufactured products. Today, the methodology and its hierarchy of staff expertise—Yellowbelts, Greenbelts, Black-belts—are used in many business sectors, including health care. At D-H, the Value Institute has com-bined Lean techniques with the Six Sigma method-ology to establish a standard framework for quality improvement efforts throughout the organization.

As part of the Nursing Strategic Plan to increase expertise in process improvement, 68 nursing staff and leaders were trained in Six Sigma methodology at the Yellowbelt level, including Bryant and her team mem-bers. Following the training session during the sum-mer of 2013, the team, which included 2 West Nurse Manager Angela Price, BSN, RN; staff nurse Courtney Peterson, MEd, RN; Unit Supervisors Ericka Bergeron, BSN, RN, and Kimberly Hardin, RN; and 3 West Nurse Manager Nancy Karon, BSN, RN, ONC, first identified their goal: an average HCAHPS score of 71 or better related to how patients perceive their pain manage-ment at D-H. After discussion and a staff survey, the Yellowbelt team decided that focusing on staff nurse education would yield the best results.

Staff education included distribution of five “Pain Tips of the Week” during a five-week period, men-toring on the floor by charge nurses and a review of monthly HCAHPS scores. The scores were also posted on Quality Boards on the unit.

Perhaps mostly importantly, the team, with input from staff, developed a Patient Daily Goal Sheet to be used by patients and nurses to establish pain-management goals, e.g., "'I want my pain not to exceed 2 today.' The Goal Sheet became a way for patients and nurses to connect," says Bryant. “We found that a lot of patients didn’t understand the pain medication regimen they were on. Some were on regular pain meds, others on an as-needed basis. The Goal Sheet gave us a way to talk about it and clear up any misunderstandings.”

The Goal Sheet proved to be a great success—with one drawback: “It’s another piece of paper floating in the patient’s room.” So the Goal Sheet’s informa-

MANAGING PAIN, PLEASING PATIENTS - ACCOUNTABIL ITY

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tion was transferred to the white board hanging in each patient’s room. It is updated daily in consul-tation with physicians, nurses and the patient and patient’s support group.

O B TA I N I N G A “ P A I N H I S T O R Y ”

The Yellowbelt team also surveyed 15 patients to learn what was most important to them about managing their pain. They discovered the impor-tance of obtaining a “pain history” when a patient is admitted to the unit, which Bryant points out is different than a medical history. “You find out how each patient has handled their pain in the past, what has worked and what hasn’t with medica-tions or other non-pharmacological methods. It’s an essential tool to help come up with an effective new pain-management strategy.” The pain history also helped create a dialogue between patient and nurse. “It gave us a chance to tell the patient, ‘We are here as your advocate. We are partners in your pain management,’” she says.

Team Care—D-H’s interdisciplinary, relationship-based care initiative that uses rounding interven-tions to bring the patient and patient’s family into partnership with providers and hospital staff—“is a big part of this,” she adds. “Purposeful Rounding, the Nurse Knowledge Exchange at the bedside, Interdisciplinary Rounding—they all address pain in one way or another.” Managing pain moved to the center of discussions rather than being regarded as an unavoidable byproduct of medical treatment.

The Yellowbelt team tried to be realistic about its goals. “We didn’t want to set the bar too high, because we didn’t want to fail,” she admits. But after two months, HCAHPS scores for pain management for the three inpatients units par-ticipating in the Yellowbelt project climbed past the original goal of 71. Not content to merely succeed, Bryant says successes indentified by the project have been integrated into ongoing opera-tions and team members hope to see scores higher than ever. ●

D-H NURSING PROFESSIONAL PRACTICE MODEL: ACCOUNTABILITY

The Professional Prac-tice Model element of Accountability reflects the responsibility of the nurse to provide high-quality, evidence-based care, but also to identify and implement oppor-tunities for continuous improvement. The Yel-lowbelt training provides a standardized approach to this improvement pro-cess, providing training and tools to implement an improvement project with small tests of change.

Kate Bryant, BSN, RN, center; and Keith Garland, RN, right

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Where Design Meets Nursing’s Mission: Creating a Healing Environment“Patient-centered” at Dartmouth-Hitchcock doesn’t apply only to patient care. Ultimately, even the design of a patient room is a key element of the patient experience and of the D-H Nursing Mission, which is to create an environment in which families and patients can heal. Nurses play an active role in creating this environment, whether through identifying unique needs of patients and families or in the creation of healing spaces. The new Intensive Care Unit (ICU) and Medical Specialties Unit at Dartmouth-Hitchcock Medical Center (DHMC) show how thoughtful, careful design can meet nursing’s mission and satisfy multiple needs in the process.

Just like patients and doctors, nurses, too, “want an efficient design and the latest technology,” says Steve Thomas, MSN, RN, CCRN, a nurse manager who was deeply involved in the design of the new units. “As nurse manager, I attended literally hundreds of pre-planning meetings with all the stakeholders who interface with the ICU. We had weekly meetings with our architectural firm, built a mock-up of a room and had nurses visit the mock-up and provide feedback.”

The fundamental problem the new ICU was designed to solve is a simple enough problem: create more beds at DHMC. But, in addition, the new unit had to improve patient care for present and future patients as well as working conditions for staff.

“The new unit allows patients to receive the best of what medicine can offer while at the same time recognizing that some of what patients need can’t be provided by drugs and devices or even the hospital staff,” says Jeff Munson, MD, MSCE, one of the ICU providers who was involved in the project from the beginning. “D-H recognizes the vital role each patient's family and friends can play in illness and health, and every effort has been made to allow our patients’ loved ones to be more involved in the care."

“We designed the rooms to have a defined nurse area, patient area and family area,” adds Thomas. "There is plenty of room for everyone.”

WHERE DESIGN MEETS NURSING'S MISSION - NURSING MISSION

"D-H recognizes the vital role each patient's family and friends can play in illness and health, and every effort has been made to allow our patients' loved ones to be more involved in the care." -Jeff Munson, MD, MSCE

Left to right: Marie Christine, Fahrner, RN; Jen Clark, RN; and Lori Wild, RN


A D R E A M C O M E T R U E

From a nursing perspective, the new ICU is a dream come true. Patient rooms, all of which are single and private, are laid out with a “nursing zone” and a corresponding family space to separate visitors from nursing/clinical duties without creating a physical barrier. Clinicians, nurses and family are out of each other’s way but not so distant to prevent a collaborative relationship. Monitoring equipment is mounted on booms and patient lifts descend from the ceiling. A clinician’s computer is located beside every patient bed.

“The orientation of the bed in each room is more natural and allows patients to see outside. This

is critical to reducing the rate of delirium in our patients,” says Munson. “Each room also includes a large family space with a pull-out couch and a bathroom with a shower." This arrangement allows visitors to remain with their loved ones throughout their hospitalization.

Deanna Orfanidis, MS, RN, nursing administrative director for Inpatient Care in Critical Care and Surgical Specialties, who was also involved in the design of the new ICU, notes that “a lot of thought went into the color scheme and the way the architecture works to facilitate efficiency in delivering care to patients. Aesthetically, the new ICU is really pleasing.”

“The rooms are large enough to allow the full

Nursing staff demonstrate new ICU technology.

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spectrum of critical care, which often includes multiple providers as well as several pieces of equipment such as dialysis machines and ventilators. The new rooms also give nurses the ability to complete their electronic documentation without leaving the bedside," describes Munson.

This ability comes into play especially with Team Care, D-H’s interdisciplinary, relationship-based care initiative that uses rounding interventions to bring the patient and patient’s family into partnership with providers and hospital staff. One of the key interventions is the Nurse Knowledge Exchange at the bedside during a shift change. With the ability to document information electronically at the bedside, it’s easy for the off-going nurse and the on-coming nurse to include the patient in the conversation.

D E S I G N I N G F O R R E S P O N S I V E N E S S

The new Medical Specialties Unit on 2 East, which opened last summer, is using a new nurse call system, called NaviCare®, which enhances staff coordination. Together with relocated equipment and supplies, the call system allows staff to work more efficiently, according to Melissa Golightly, BSN, RN, who serves as nurse manager for the 60-bed Medical Specialties Unit on 1 East, 2 East and 3 East.

NaviCare® is an example of how technology can combine with design and the nursing mission to improve patient care. “It interacts with our beds and links to badges that each nursing staff member wears,” says Golightly. Using graphical touch screens that are located in each patient room and throughout the Medical Specialties Unit, nursing staff are able to quickly locate colleagues and request help when they need it. Unit support assistants are also able to answer patient call lights, helping to keep the workflow efficient. A favorite feature among nursing staff is auto canceling. “That means that the system automatically cancels the call lights when a nurse walks into a room,” she comments. “That seems like a small detail, but for the nurses it was huge. Before, staff had to go to the back wall of the room and reach over equipment to turn it off manually.”

As with the new ICU, the changes introduced in the new Medical Specialties Unit came about with the

full engagement of the nursing staff. “They came up with the idea to feature artwork to promote a healing environment. Now we have some really nice photos and paintings, done by our own staff members, displayed around the unit,” she says.

A C O O R D I N AT E D E F F O R T

“When you think about any of these projects, you’re planning for the future. The challenge, though, is being visionary,” comments Orfanidis. “You have to ask: What will the patient population be in the future and how will health care be delivered in a hospital setting?"

“Preparing to open a new unit makes one truly appreciate how many people are absolutely necessary to make state-of-the art intensive care possible,” comments Munson. “These projects have required the coordinated effort of representatives from virtually every part of the hospital." ●

"When you think about any of these projects, you're planning for the future. The challenge, though, is being visionary. You have to ask: What will the patient population be in the future and how will health care be delivered in a hospital setting?" -Deanna Orfanidis, MS, RN

WHERE DESIGN MEETS NURSING'S MISSION - NURSING MISSION

Left to right: Jessica Nordman, RN; Melinda Deneau, LNA; and Melissa Golightly, BSN, RN

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Selecting a Model for Evidence-Based Practice at Dartmouth-Hitchcock

In the fall of 2013, staff nurses on Dartmouth-Hitchcock’s (D-H) inpatient Hematology-Oncology Unit questioned a proposed change in nursing practice.

The D-H Blood Bank had just changed the policy that cancer patients would no longer automatically be given the pre-medications Tylenol and Benadryl before receiving blood and platelet transfusions. The nurses were concerned about changing this long-held practice, which helps prevent a reaction with the transfusions.

R E S E A R C H I N G T H E L I T E R AT U R E

A small group of the nurses, together with a clinical specialist and a nurse practitioner, formed a team to examine the clinical question using an evidence-based practice framework. Their goal was to conduct a critical review of the current literature to determine if the proposed change was the best practice and best for patients.

After researching the literature and pulling together a detailed summary of studies done on the topic, they reconvened to discuss their findings. “I was there for the meeting,” says Susan DiStasio, DNP, ANP-C, APRN, AOCNP, administrative director of Nursing at the Dartmouth-Hitchcock Norris Cotton Cancer Center. “As they went through each article, it became clear that the evidence consistently showed no difference in reactions with the pre-medications. The group was stunned.”

The group made several recommendations that resulted in changes in their care process and in the orientation of new nurses. They did presentations at their staff meeting and for the ambulatory nurses in the Infusion Suite. “It was a very empowering experience for them,” says DiStasio.

E X P A N D I N G E V I D E N C E - B A S E D C A R E

The story from 1 West serves as “a great example of the critical role evidence-based practice plays in ensuring that patients receive care that is of the highest safety and quality,” says Mary Jo Slattery, MSN, RN, clinical program coordinator for Nursing Research.

“Within our Nursing Strategic Plan, and through a capstone project that Susan did for her doctoral program, there was clear recognition that we needed a structure, a framework for expanding the use of evidence-based practice here,” says Slattery. One way to expand the framework for evidence-based practice

SELECTING A MODEL FOR EVIDENCE-BASED PRACTICE AT DARTMOUTH-HITCHCOCK

Susan Distasio, DNP, ANP-C, APRN, AOCNP

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is through the implementation of a model. An evidence-based practice (EBP) model provides a standardized approach to answering clinical questions or in developing an evidence-based practice project.

As members of the Shared Governance Research Council, Slattery and DiStasio helped lead efforts over the past year to select and implement an EBP model—one that melds clinical expertise, research evidence and patient values and can be integrated across the D-H system.

Slattery and librarian Heather Blunt pulled together the majority of the literature for the Research Council to review. “The group selected five models to evaluate, so that we had two reviewers per model,” says Slattery. “We developed criteria that we took from the literature, ranked

them and narrowed the list to three for more in-depth review. Kim Maynard, our chair, and I then made a recommendation to the Coordinating Council, and they supported it fully.”

A N E W E V I D E N C E - B A S E D P R A C T I C E M O D E L F O R D - H

The Research Council chose the Iowa Model of Evidence-Based Practice to Promote Quality as the best fit for the organization.

“Some of its strengths are that it’s well-established, it’s very consistent with our culture of quality improvement and it’s more practical and easier to use than the other models we looked at,” says Slattery. “It also emphasizes the importance of forming teams and working collaboratively to solve problems.”

“In addition," says DiStasio, "we liked how, once you identify your clinical question, it asks how your project fits into the strategic plan for the organization. This really helps you to prioritize what you’re doing,” she says. “And if you evaluate the literature and you don’t find enough evidence to make a change in practice, it asks you to consider conducting your own research.”

Next steps include establishing a team and timeline for implementation. "We’ll have a larger group, which will be part of a research committee, with a wide range of people from leadership to staff nurses,” says Slattery.

“Our goal is to start slowly and gradually expand the number of projects as we go along, so we can build on the new knowledge and excitement that is generated,” adds DiStasio. “The biggest part will be getting people to participate in the projects. We want every nurse to have an experience like the nurses did on 1 West.” ●

D-H NURSING PROFESSIONAL PRACTICE MODEL: SHARED GOVERNANCE

The Nursing Professional Practice Model (PPM) at D-H includes an element focusing on shared gover-nance. Shared governance provides a structure and forum for shared dialogue and shared leadership to address priorities for nursing and to develop and implement the nurs-ing strategic plan. One of the elements of the nursing strategic plan includes a goal to iden-tify and implement an evidence based practice (EBP) model for nursing; a standardized approach to answering clinical ques-tions or to develop an evidence based practice project. In examining the PPM schematic, it was identified that the correct group to lead this initia-tive was the Research Council, part of the shared governance struc-ture at D-H. This story highlights the benefits of the use of an EBP model, as well as the structure and process used at D-H for the selection of an agreed upon EBP model for full implementation.

Mary Jo Slattery, MS, RN

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PROFESSIONAL

DEVELOPMENT

D-H NURSING PROFESSIONAL PRACTICE MODEL: PROFESSIONAL DEVELOPMENT

Professional development is one of the key components of the Nursing Professional Practice Model (PPM) at D-H. Professional develop-ment is guided in part by the American Nurses Associa-tion (ANA) Code of Ethics for Nursing, which includes a commitment to the advancement of the nursing profession, promotion of the nursing profession, account-ability and responsibility for practice, and a commit-ment to becoming a lifelong learner. Each individual has accountability and responsi-bility for their own profes-sional development, and D-H provides numerous resources to support each individual’s goals. The Professional Development element also aligns with the Institute of Medicine (IOM) Future of Nursing recommendations, which include recommenda-tions for nurses to practice at the fullest extent of their licensure and training, to in-crease the number of nurses with a baccalaureate degree to 80 percent by 2020, to double the number of doc-torate-prepared nurses by 2020, and to prepare nurses to become full partners at decisional tables to influ-ence health care reform and policy. The framework for professional development at D-H and the resulting nurs-ing strategic plan goals pro-vide the best launch pad for these changes to occur. D-H nurses are among the very best in the industry; provid-ing the right framework, tools and resources will position D-H nurses to be recognized leaders in the advancement of the profession.

Allison McHugh, BSN, MHS, RN, NE-BC; left, and Sonal Kumar, PhD

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PROFESSIONAL DEVELOPMENT

Professional Development

N U R S I N G L E A D E R S H I P D E V E LO P M E N T

“Strong nursing leadership is needed more than ever in times of great change,” says Allison McHugh, BSN, MHS, RN, NE-BC, nursing administrative director for Medical Specialties, Neurosciences and Cardiovascular services. That’s why the Nursing Leadership Development Series was launched in 2013. McHugh, along with Debra Hastings, PhD, RN-BC, CNOR, director, Continuing Nursing Education; and Sonal Kumar, PhD, senior strategic plannning specialist, developed the program, which uses experiential learning methods to allow nurses to learn, practice and apply leadership skills.

During the six-month program, participants spend time in the Patient Safety Training Center to test the learning in their day-to-day work. “It will prepare participants for AONE (American Organization of Nurse Executives) and Clinical Nurse Manager/Leader certification, which is great for personal advancement and important for Dartmouth-Hitchcock (D-H) Magnet designation,” says McHugh.

Believing that leadership is a core competency for health care professionals, the Geisel School of Medicine offers a summer course called “The Science and Practice of Leading Yourself,” directed by the Dean of the Geisel School of Medicine, Wiley “Chip” Souba, MD, ScD, MBA. The focus is on effective leadership. Nurses, physicians, administrators and others take part in the course, providing what Hastings calls “truly interprofessional education and learning.”

C E R T I F I C AT I O N S

“Certification is one of the many opportunities for professional development,” says McHugh. With the focus of health care shifting to continuum of care, population heath and disease management, nurses need to become increasingly certified and specialized to acquire the set of skills required for their clinical responsibilities.

D-H offers a vast array of preparatory courses to help nurses become certified in a specialty. “We have well over 200 different certifications,” says McHugh, “from wound specialist to nurse executive. Most of the time you have to go someplace else and pay for the preparatory course, but D-H offers free prep courses to employees.“

Under an ongoing collaborative, D-H and The Dartmouth Institute for Health Policy and Clinical Practice (TDI) are offering a new certificate program this year: “The Linda von Reyn Value-Based Care Scholars program.” It’s been named in honor of D-H’s recently retired chief nursing officer, who exemplifies the critical skills that are needed as health care transitions to value-based care. “It is a team-based, interprofessional program,” says Hastings. “Six nurses are paired with residents from their department, and together they work on a project that benefits that patient population.” The “von Reyn scholars” will earn a TDI Certificate in the Fundamentals of Value-Based Care.

Debra Hastings, PhD, RN-BC, CNOR

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A D V A N C I N G A C A D E M I C E D U C AT I O N

D-H has a long-standing history of encouraging and supporting nurses to pursue advanced educational opportunities, and there are several teams across D-H working on the achievement of this goal.

“We want nurses to practice the highest level of their profession," says McHugh. “Our goal here, which is part of the D-H nursing strategic plan, is that 80 percent of our bedside nurses will have a bachelor’s degree in nursing by 2020. We estimate 50 percent of D-H nurses currently have a baccalaureate education.”

Nurses enrolled in baccalaureate nursing programs receive advanced training in quality improvement and evidence-based practice, preparing them to function effectively in an increasingly complex environment. The literature reveals that those patients who are cared for by a baccalaureate-prepared nurse experi-ence better outcomes. The Iowa Model report also includes findings that nurses with a BSN degree are more likely to go on to pursue graduate degrees in nursing, helping to create the pipeline for nursing fac-ulty and to continue to increase the knowledge base of nursing through PhD-prepared nursing researchers.

There are many programs available to those interested in pursuing or advancing a nursing degree. Hastings and her colleague Paula Johnson, BSN, MPA, DA, RN, clinical program coordinator of Magnet and retention in the Office of Professional Nursing, hold monthly educational forums that often lead to one-on-one ses-sions. “I feel like I have traveled a long path to advance my education and progress in my career,” says Hast-ings, “so if I can help someone in their personal quest, I’m happy to support them in meeting their goals. In fact, I very much enjoy this aspect of my work.”

S C H O L A R S H I P S A N D G R A N T S

Tuition reimbursement is available at D-H and there are scholarship and grant opportunities as well. There are several scholarships that support nurses to at-tend a national or international conference in their specialty, to gain and share the latest knowledge and to maintain continuing education credits needed to support certification in a specialty. In addition, the Varnum Auxiliary Nursing Scholarship is available

annually for those enrolled in nursing programs. Be-ginning in 2001, the Auxiliary has provided an average of $40,000 each year to support those enrolled in nursing degree programs

“Each spring we enter ‘scholarship application season’ as we prepare to provide scholarships to D-H nurses during National Nurses Week. Each year, we aspire to increase the number of nurses who apply for these scholarships,” explains McHugh. That’s where Hast-ings’ team comes in. They look to put nurses in touch with those opportunities. Hastings says specialty organizations are often overlooked as a resource. Ad-ditional sources of funding include Sigma Theta Tau, International Honor Society of Nursing, particularly for degrees beyond the baccalaureate level, and other nursing-based organizations.

W H Y P R O F E S S I O N A L D E V E L O P M E N T

“You can become a nurse,” says McHugh, “but it’s not an end when you graduate. There’s so much more you can do, so much more you can learn about your profession or that you can learn about your practice.” “Everything is changing in health care,” says Hastings. “It is important to build on what we learn in our basic nursing education programs. Nursing is a profession that demands life-long learning. We need to keep ad-vancing our education and broadening our knowledge base in order to provide nursing excellence at the point of care. We need to continue our education for our licensure—we need it for our certification. ●


17



Meghan PoperowitzMeghan Poperowitz, BSN, RN-BC credits a freak bike accident for her second career as a nurse.

“I remember opening my eyes to a cartire next to my unhelmeted head,” she says. While suffering only two fractures in her pinkie finger, her interaction with the health care system proved life-changing. After volunteering on a medical unit in a Philadelphia hospital, Poperowitz decided she wanted to be a nurse. She quit her job and went back to school for her second bachelor’s degree.

It was Dartmouth-Hitchcock’s robust residency program that drew her to New Hampshire three years ago. Now a staff nurse on the Medical Specialties unit, her interests lie in geriatrics and palliative care. “In Girl Scouts, we always volunteered at nursing homes,” says Poperowitz. "I used to adore hanging out with seniors. I really enjoy working with that population.”

Through courses offered at D-H, she’s become certified in geriatric nursing and is preparing to become certified in palliative care. Last year, she participated in AgeWISE, a six-month residency program that focuses on geropalliative care. While earning contact hours and continuing education credits, she was able to integrate the new learning into her clinical setting. “I became an unofficial leader on the floor,” she says. “Co-workers began to seek me out as a resource. I was able to support my fellow nurses by helping them navigate difficult end-of-life care conversations. That kind of in-depth training just isn’t given in nursing school.”

She goes to Nursing Grand Rounds, attends geriatric

boot camps—one-hour lunch learning sessions—and would love to take a leadership course. “The educational offerings are robust”, says Poperowitz. “You can pretty much have any opportunity you want. You just have to put yourself out there and be aware of what’s happening around you. I read all the emails, the nursing newsletters and check the continuing education website regularly.”

Poperowitz is now looking at a Master’s program and, eventually, to becoming a nurse practitioner.

Just last month, she sat down with Debra Hastings, PhD, RN, CNOR, director of Continuing Nursing Education, to discuss future steps. ●

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D-H’s new Nursing Professional Practice Model (PPM) provides the framework for approaching the nursing strategic plan. The main goal of the strategic plan—to improve population and patient health—will be made possible by optimizing the role of the professional nurse. ElevateHealth, an innovative provider/insurer collaboration, is informed, in part, by professional nurses who also play a critical role in its operation.

Mimi Emerson, MS, RN, care coordinator for ElevateHealth and D-H Wellness Plus, explains nursing’s role in program development and delivery.

What is ElevateHealth?ElevateHealth is a new approach to collaboration between providers and Harvard Pilgrim Health Care to deliver the best, most efficient health care to subscribers. It’s an insurance product that is available to employers with two to 50 employees and in-cludes more than 400 primary care physicians, 2,600 specialists and the inpatient facilities of Dartmouth-Hitchcock Medical Center, Elliott Hospital System, Cheshire Medical Center, New London Hospital and Southern New Hampshire Medical Center.

ElevateHealth focuses on a care management approach that brings clinical and utilization information together for the benefit of individual patients and overall population health.

How will information sharing translate to better health?By marrying clinical notes and claims information, we shed new light on individual and population health. Physicians see where patients are having trouble: What is sending them to primary care, specialists

or the hospital? Are they getting or following pre-ventative care? Population data informs physicians of important patterns: Are people seeing treatment outside the local network? Are they seeking care in the Emergency Department instead of through their primary care provider?

ElevateHealth is described as being a “collaborative and innovative partnership.” Why is it important to deliver care this new way?There is general recognition that the health care pic-ture has become fragmented. Physicians and insurers don’t have a complete picture of what’s happening to the patient.

In addition, as we learn more about the way health care is being delivered, we understand that the quantity of resources and the quality of resources aren’t always aligned. We’re trying to increase quality by sharing information between the insurer and providers, then utilizing care coordination to bring the right resources to patients.

What was your role in ElevateHealth’s development and planning? I’ve been a care manager in the D-H Wellness Plus program for six years. Care coordination is a big part of ElevateHealth, so I was asked to lend my expertise to the development of the product.

I and other nurses from Elliot Health System and Harvard Pilgrim Health Care are on the ground doing the work of care management and coordination. As a member of the committee that outlined this feature of ElevateHealth’s care delivery model, I was able to share my knowledge and experience.

What does a care coordinator do?Care coordinators make sure there’s a connection be-tween the patient and primary care provider, special-ty care providers and additional resources as needed. For example, if a patient is hospitalized, I’ll reach

ELEVATEHEALTH IMPROVING PATIENT AND POPULATION HEALTH

ElevateHealth:

19


ELEVATEHEALTH: IMPROVING PATIENT AND POPULATION HEALTH

out to see why and what’s happening. If there’s not a strong connection between the patient and his or hers physician, I’ll get engaged. It’s especially impor-tant to check in with people when they’re discharged from the hospital.

We also help patients who are dealing with chronic disease. We might hear from the insurer that a patient doesn’t seem to be doing well. We can reach out and understand what’s going on and offer information or help the patient find the right resourc-es. Most importantly, we can help that patient clarify what he or she needs and wants and organize his or her care around that. And we can make sure that the primary care physician has the information needed to support the patient.

What are the biggest challenges faced by this new delivery system?Figuring out how to share information appropriately is a big challenge. While adhering strictly to privacy rules and regulations, we also need to make sure that providers and care coordinators have the information necessary to help patients. Most patients are very receptive to a proactive call that asks how they’re doing or checks in on an issue. Others wonder how a care coordinator got their information. It’s an educa-tion process.

How is ElevateHealth working? The program has been operational since December 2013, and the subscriber base is small but growing. We are encouraged by the wide array of employers who have made this product available to their employees, and anticipate that this trend will fuel a strong mem-bership in future years. Our actual measures of success are still being developed, and it will take some time to really know how the program is doing from that vantage point. As a new program, we have the flex-ibility to adapt as we grow, responding in real time to our customers’ needs, and providing the most relevant, helpful “array” of services available.

What have you learned through your involvement in ElevateHealth?People often see insurance on one side of health care and providers on the other. It’s very new to see pro-viders and insurers working together. As I’ve gotten to know people who work for Harvard Pilgrim Health Care, I understand that we have the same goals. This is in part about saving money, but more, importantly, it’s about using resources to the patient’s and popula-tion’s benefit.

Improving Patient and Population Health

Mimi Emerson, MS, RN

20 Team Care, Dartmouth-Hitchcock’s innovative interdisciplinary care initiative, is building the future of inpatient care delivery. A relationship-based care (RBC) model, Team Care focuses on three key relationships: the relationship with self, with others and with patients and families. Team Care’s focus on integrating key behaviors, or “interventions,” into daily work reinforces the importance of these connections and the building of relationships that result in improved communication to achieve better outcomes and experiences for patients and families.

TEAM CARE AND RELATIONSHIP-BASED CARE

The four key interventions to improve outcomes for all inpatients at D-H under the Team Care initiative include:

1. Purposeful Rounding: To improve patient experience and care outcomes

2. Interdisciplinary Patient Care Rounds: Creating a daily plan of care and daily goals

3. Nurse Knowledge Exchange (NKE): Nurse-to-Nurse report at the bedside

4. Leadership Rounding for Outcomes: Identified as the single best way to support implementing needed change efficiently, but in a manner responsive to issues identified by patients and staff

Team Care and Relationship-Based Care

Implemented with a launch in the fall of 2013, the initiative is already beginning to fundamentally and positively reshape the patient experience and im-prove outcomes at D-H. To understand the impact of these interventions, practices and processes are mea-sured and the data are collected on a weekly basis.

“The differences are real and early results can be seen in the data we’ve collected so far,” says Pam Brown, BSN, MS, RN, director of Nursing Quality and Safety and improvement advisor to Team Care’s Advisory team. “Some of the results are really powerful.”


From left to right: Members of the Team Care Advisory Team, Johanna Beliveau, MBA, RN; Diane Andrews, MHCDS, RN;

Steve Surgeoner, MD; and Pam Brown, BSN, MS, RN.

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R E S U LT S T O D AT E

Team Care’s results to date are indeed impressive. First, a growing majority of inpatient units now have highly engaged nursing and physician co-leader pairs who are determining priorities and implementation of Team Care initiatives within their areas. “These co-leader pairings are a linchpin of Team Care. Over time, we all know that new initiatives will be added to our priorities. These co-leader pairings across the inpatient areas are precisely how we will diffuse best practice for today’s hot topics, and also for future initiatives.” says Steve Surgenor, MD, associate chief officer for Quality and Value.

Second, patients are seeing their primary nurse much

more quickly following the implementation of NKE. The average time until a nurse sees their first patient following a shift change has dropped in some units from more than 25 minutes to less than five minutes. The percentage of patients now experiencing NKE at their bedside has averaged between 85 percent and 95 percent since the beginning of December. And the percentage of patients responding “always” to survey questions regarding effective communications with nurses, doctors and hospital staff has improved from a low of 60 percent in September to a high of 83 percent in December, as measured in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. “The interventions that have been tested are taking hold,” says Brown. “They are very much becoming the way we do things here.”

L E A D E R S H I P R O U N D I N GSafety Rounds are an integral component of Team Care and an essential part in helping to initiate culture change. These rounds provide an opportunity for leaders to engage with staff and learn about real-life issues of quality and safety. Sam Casella, MD, associate director for Quality and Safety, at CHaD, left, leads Safety Rounds on the Pediatric Adolescent unit. Joined by Johanna Beliveau, MBA, RN, administrative director and Team Care Collaborative co-chair, center, Sara Chaffee, MD, medical director, far right; and Buffy Meliment, BSN, RN, unit nurse manager (not shown); talk with Kim Derryberry, RN, about recent issues with chemotherapy administration, where communication and hand-off (two elements of the Team Care Collaborative) are emphasized as critical to safe practice.


22


T H E N U R S I N G P E R S P E C T I V E

From a nursing perspective, Team Care emphasizes and values communication, especially with the patient and the patient’s support network. Team Care’s patient-centered approach can be seen in the Purposeful Rounding posters on display in several of the inpatient units at Dartmouth-Hitchcock Medical Center (DHMC). These posters remind nurses what ROUNDS stands for: (R) ARe you comfortable? (O) Do you need to be moved to the Other side of the bed? (U) Do you need to Use the bathroom? (N) Do you Need anything? (D) Would you like the Door open or closed? And (S) Make a Safety check of lines and cords in the room.

According to Nancy Karon, BSN, RN, nurse manager on 3 West, the NKE, especially, makes patients more engaged with their recovery; family and support sys-tem members feel informed and included; and there’s been a noticeable improvement in staff morale.

“We see ourselves as a team,” she says. “Everybody has a responsibility for a patient.” This sense of responsibility encourages nurses to sharpen their ob-servations, to notice even slight changes in a patient’s appearance or behavior. “We’re paying attention to the patient’s condition earlier and earlier,” she adds. “That’s going to improve their care.”

Other Team Care data show improvements in nurse communications, doctor communications and in the amount of time that patients receive help after asking for it. Last summer, the percentage of patients who said they would recommend D-H to others—a key indicator of patient experience and satisfaction—was in the high 70s; the percentage is now in the high 80s. When surveyed, patients were asked, “Is the staff doing everything they could to help you with your pain?” More than 80 percent answered "yes."

A N E V O L U T I O N

Team Care evolved from the work of 10 frontline improvement teams who participated in the national Partnership for Patients initiative last year. This national initiative aims to improve quality, safety and health outcomes across the U.S. by reducing 10 com-mon sources of preventable harm in the hospital set-ting. While the RBC model has proven successful in several large health care organizations, Eric Lansigan, MD, the medical director on the Medical Hematol-ogy/Oncology inpatient unit, who has been working closely with Nurse Manager Virginia Bayliss, still calls Team Care “a huge cultural shift.”

In January 2013, after months of work to share and learn from the best hospitals in the nation, the frontline improvement teams presented their recom-mendations for practice changes that would make D-H safer and improve the patient experience. Team Care began to take shape following those presenta-tions. Based on previous experience with the model, Team Care co-chair Johanna Beliveau, MBA, RN, approached the sponsors, Linda von Reyn, PhD, RN, chief nursing officer; and George Blike, MD, chief quality and value officer; with a proposal for the Team Care Collaborative. "I have seen this model produce truly fantastic results and that is what we need now, for our patients and our staff," she says.

Team Care is being implemented through an “all teach, all learn” methodology known as a break-through series collaborative. Learning sessions are conducted every two to three months where nurses, physicians and allied health providers share experi-ences and compare notes, while also learning from experts in the field. Learning Session I, held in Oc-tober 2013, introduced the concept of relationship-


Left to right: Lynn McRae, MA, RN; Sarah Paige BSN, RN; Cheryl Abbott, MSN, CNRN; and Deborah King, LNA

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D-H NURSING PROFESSIONAL PRACTICE MODEL: CARE DELIVERY

The Care Delivery component of the D-H Nursing Professional Practice Model (PPM) highlights the roles, systems and approach in the delivery of care to our patients, families and community. The care delivery system at D-H is interdisciplinary in nature, with the nurse at the center, providing care coordination as part of their role.

THE TEAM CARE GRAPHIC:

A Venn diagram-style visual aid depicting the interconnection of Self, Colleagues and Patient/Family is showing up throughout DHMC on posters and flyers. “The graphic is the program in a nutshell—it’s all about collaboration and relationships,” says Surgenor. “It’s a great reminder that Team Care is, in fact, Dartmouth-Hitchcock Care.”

based care and presented the experiences of some early Team Care adopters. Learning Session II, in February 2014, focused on building teams and us-ing teamwork to conduct effective interdisciplin-ary rounding. A third Learning Session was held in May of 2014.

The learning sessions provide an opportunity for teams to talk about issues and work out kinks in a non-judgmental, non-hierarchical environment. At Learning Session II, it was soon clear that the “ideal state” of interdisciplinary rounding is a mov-ing target and is different for each unit. But that is the nature of Team Care: it’s a dynamic initiative that thrives on adaptability.

L I V I N G U P T O A M I S S I O N

“Team Care is about improving quality in a number of ways through team work and thoughtful col-laboration,” says Surgenor. “We have learned that one of the best ways to reduce unwanted com-plications and, at the same time, to improve the patient experience is to engage the expertise of a variety of relevant caregivers who come together

as a patient care team, including the attending physician, nurses, physical therapists and every-one in between. A unique challenge for academic medical centers like DHMC is that many learners join the team, which most of us find very reward-ing, but also makes Team Care more complicated. And the patient and his or her family is the most critical member of the team. While the work is challenging, it is also enormously rewarding, he emphasizes. Team Care is at the very heart of a patient-centered culture of caring, he says. “Team Care’s defining quality and value is greater col-laboration by clear roles and responsibilities for the benefit of the patient as well as communication and teamwork among staff.”

Nancy Karon agrees. “What it’s really all about” for nursing, she says, “is living up to D-H’s mission of being patient-centered. This is where it happens. You get in the room with the patient, you talk to them and include them in the treatment plan of the day, you write the information on the white board in the room, you go back to check on them and they know when to expect you, you talk to family members who are in the room—you can really assess what’s going on with a patient.” ●

Left to right: Matt Truland, RN; Kate Bryant, BSN, RN; Aurora Gleason, LNA; and Rhonda Tracey, RNSelf

Colleagues Patient/ Family

TEAM CARE

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AMERICAN ASSOCIATION OF HEART FAILURE NURSES

Certified Heart Failure NurseSherry Duveneck, MSN, RN, CHFN

AMERICAN ASSOCIATION OF NEUROSCIENCE NURSING

Certified Neuroscience NurseWanda Handel, MSN, RN, CNRN

AMERICAN ASSOCIATION OF PERIOPERATIVE REGISTERED NURSES

Certified Operating Room NurseCeline Crete, RN, CNOR

AMERICAN HOLISTIC NURSES CREDENTIALING CORPORATION

Certified Health and Wellness Nurse CoachRita Severinghaus, BSN, MA, HWNC-BC

AMERICAN NURSES CREDENTIALING CENTER

Certified Medical-Surgical NurseJennifer Berry, BSN, RN-BC

Certified Family Nurse PractitionerBrianna Seaver, APRN, FNP-BC

Certification in Gerontological NursingMeghan Poperowitz, BSN, RN-BC

COMMISSION FOR CASE MANAGER CERTIFICATION

Teryl Zimmermann Desrochers, RN, CCM

Carol McShane, RN, CCM

INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS

Certified Lactation CounselorAdrienne Domenicucci, RN, CLC

MEDICAL-SURGICAL NURSING CERTIFICATION BOARD

Certified Medical Surgical NurseSusan Loskutoff, RN-BC

NATIONAL ASSOCIATION OF HEALTH COACHES

Certified Health CoachDenise Biron, MS, RN, COHN, CHC

NATIONAL BOARD FOR CERTIFICATION OF HOSPICE AND PALLIATIVE NURSES

Certified Hospice and Palliative NurseCharlene Forcier, RN, CHPN

NATIONAL CERTIFICATION CORPORATION

Neonatal Intensive Care NursingJenny Morrow, BSN, RNC-NIC

ONCOLOGY NURSING CERTIFICATION CORPORATION

Oncology Certified NurseLinda Kirouac, RN, OCN

Christi-Lynn Martin, BSN, RN, OCN

Kathleen Pieroni, RN, OCN

Carley Starr, RN, OCN

ADULT ONCOLOGY CERTIFIED NURSE PRACTITIONER

Melissa Davis, APRN, AOCNP

WOUND, OSTOMY AND CONTINENCE NURSING CERTIFICATION BOARD

Certified Wound Care Nurse

Kate Roche, RN, CWCN

EDUCATION UPDATES

Sydney Allen, BSN, RN, OR, completed a Bachelor’s Degree of Science in Nursing from Franklin Pierce University.

Theresa Banks, MSN, RN, OPN, completed a Master’s Degree of Science in Nursing Education from the University of Phoenix.

Wanda Handel, MSN, RN, CNRN, Neurosciences/ENT, completed a Master’s Degree of Science in Nursing from the University of Alabama at Birmingham.

Catherine Holub-Smith, DNP, RN, Pediatrics, completed a Doctorate in Nursing Practice Degree from Northeastern University.

Rachelle Kleber, BSN, RNC-NIC, ICN, completed a Bachelor’s Degree of Science in Nursing from Excelsior College.

Theresa Murray, MSN, RN, OPN, completed a Master’s Degree of Science in Nursing from Norwich University.

Timothy Wheaton, RN, Day Surgery Center, completed an Associate Degree in Nursing from St. Joseph’s School of Nursing, Nashua, NH.

Heather Worster, RN, Day Surgery Center, completed an Associate Degree in Nursing from Manchester Community College.

SCHOLARSHIPS AWARDED

Elsa Frank Hintze Magnet Scholarship for Nursing Excellence

Karen Downing, RN Pediatrics Clinic

Kimberly Derryberry, BSN, RN Inpatient Pediatrics

Lynne Chase, MPH, RN, CEN Emergency Department

The Levine Nursing Continuing Education Award

Jillian Rafter, RN, CEN Emergency Department

Courtney Peterson, RN 4 West Inpatient Surgery

Margaret Provost, BSN, RN Pediatric Intensive Care Unit

Gladys A. Godfrey Scholarship

Ayla Priestley, LNA ICU

Evidence-Based Nursing Practice Award

Stacia Ghafoori, RN, CPON Pediatric Intensive Care Unit

Patient Safety Training Center Innovation in Nursing Education Award

Lisa Davenport, RN, CCRN CVCC

James W. Varnum Auxiliary Scholarship Awards

Kathryn Abraham, BSN, RN Norris Cotton Cancer Center, Office of Clinical Research

Stephanie Berman, RN General Internal Medicine

Teresa Brubaker, BSN, RN Perioperative Services

Maddie Dalgliesh, BSN, RN NSCU

Stephanie Donahue, RN Pulmonary, Manchester

Katherine Doton, MSN, RN Pediatrics Clinic

Nicola Felicetti, RN Care Management

Lise Fex, BSN, RN-BC 2 West

Robyn Galvin, RN Endoscopy, Nashua

Susan Gaston, RN Infectious Disease, Manchester

Aurora Gleason, LNA 3 West

Chad Harrington, LNA Neurosciences

Colleen Harrington, BSN, MEd, RN, CNOR OSC

Veronica Januszewski, RN Primary Care

Claire Ketteler, RN-BC Psychiatry

April Kingsbury, LPN Primary Care

Katrina Masure, BSN, RN ICN

Nichole Moorhead, RN Perioperative Services

Lisa Moulton, RN Pediatric Pulmonary, Cystic Fibrosis Research

Ruth Anne Neborsky, RN Patient Placement

Jennifer Norris, RN, CFRN DHART

Sarah Nugent, RN Operating Room

Ayla Priestley, LNA ICU

Kristen Rhodes, RN Primary Care, Concord

Tracie Ruggles, RN-BC 3 West

Kathleen Schumann, CMA Plymouth Pediatrics

Rachael Smith, BSN, RN 4 West

Jordan Swartout, RN Neurosciences

Sarah Thompson, BSN, RN PICU

Lisa von Braun, MSN, RN, CNL Psychiatry

Melissa Waggoner, RN CHaD Pediatric Gastroenterology

Theresa Ward, RN, CCRN Emergency Department

Jennifer Wasilauskas, RN Perioperative Services


25


Kerry Wulpern, BSN, RN ICCU

OTHER AWARDS

Areté Awards

Doug Alizio, BSN, RN Life Safety

Sydney Allen, BSN, RN Operating Room

Beth Beauchain, BSN, RN 2 West

Molly Bondurant, RN, CFRN DHART

Tina Bowers, RN HSCU

Leslie Burke, BSN, RN ICU

Barbara Carr, BSN, RN PACU

Linda Coutermarsh, RN, CNRN NSCU

Ellen Gilbert, RN Care Management

Laura Heath, BSN, RN PICU

Michelle Isner, BSN, RN ICCU

Nancy Kennedy, RN Radiation Oncology

Brandi LaCroix, LPN Primary Care

Douglas Laidlaw, RN CVCC

Sara McMillan, RN ISCU

Dawn Malinowski, LPN Pediatrics Clinic

Tracy Mauck, BSN Pediatrics

Jacquelyn McDowell, RN 1 West

Jennifer Mellish, BSN, RN, CNOR OSC

Cynthia Morris, BSN, RN, CAPA Same Day Surgery

Renee Ratte, BSN, RN ICN

Tracie Ruggles, RN-BC 3 West

Rachael Smith, BSN, RN 4 West

Jocelyn Verrill, LPN Rheumatology

The Sandra Dickau Award for Patient and Family Centered Care

Deb Cofell, BSN, RN Care Management

The Deirdre Sheets Patient and Family Centered Care Award

Mary Lou Judas, BSN, RN ICN

The Deborah Miller ARNP, CNM, MPH Award for Advanced Practice in Nursing

Danielle Basta, APRN Primary Care

The Barbara Agnew RN Magnet Award for Mentorship

Mildred Sattler, BSN, RN, CCRN Emergency Department

The Marianne Markwell RN Commitment Award for Neuroscience Nursing

Becky Murdough, RN Neurology Clinic

The Rolf Olsen Partnership in Nursing Award

Joanna Celenza ICN

The Donna Crowley Excellence in Nursing Leadership Award

Bridget Mudge, MSN, RN, CNS Pediatrics

The Bakitas Award for New Knowledge, Innovations and Improvements

Ellen Prior, BSN, MS, CCM Care Management

Sue Von Iderstine, RN Vascular Access

DAISY Awards

Dorothy Heinrich, BSN, RN 4 West

Chris Apel-Cram, RN, CCRN ICU

Denise Johnson, LPN Urology

Lauren Clause, RN ICN

Jane Kenyon, RN Birthing Pavilion

Robin Williams, RN PICU Float

Michelle Adamyk, RN Nashua Day Surgery

Yellowbelt TrainingKerstin Alderson, BSN, RN ICU

Virginia Bayliss, BSN, RN MHO

Emily Beaudoin, RN BP

Ericka Bergeron, BSN, RN 3 West

Lise Bernardi, RN Medical Specialties

Tina Bowers, RN HSCU

Kathleen Brochu, BSN, RN OB-GYN

Pamela Brown, BSN, MS, RN OPN

Teresa Brubaker, BSN, RN OR

Kate Bryant, BSN, RN 3 West

Michelle Buck, RN Patient Placement

Deborah Cantlin, BSN, RN GIM

Holly Converse, BSN, RN Same Day Surgery

Mary Coutermarsh, BSN, RN, VA-BC Vascular Access

Amy Curley, MSN, RN, CEN ED

Kimberly Derryberry, BSN, RN Pediatrics

Susan DiStasio, DNP, RN NCCC

Miriam Dowling, MSN, RN, CCRN ICU

Susan Eichholz, BSN, RN, OCN MHO

Maureen Gardella, RN Psychiatry

Margaret Georgia, RN Care Management

Stacia Ghafoori, RN, CPON PICU

Pamela Goodale, RN Flex Unit

Melinda Goodwin, RN Live Well Work Well

Gregory DeMatteo, BSN, RN MHO

Wanda Handel, MSN, RN, CNRN 5 West

Kimberly Hardin, RN 2 West

Jessica Harrington, Nursing Student, INBRE Program Pediatrics

Justin Harris, BSN, RN ICCU

Debra Hastings, PhD, RN-BC OPN

Megan Howe, BSN, RN MHO

Stephen Jameson, RN, CFRN DHART

Christine Judd, RN Flex Unit

Nancy Karon, BSN, RN-BC 3 West

Sarah Lou King, RN, CAPA OSC

Rachelle Kleber, BSN, RNC-NIC ICN

Caron (Heidi) LaCasse, BSN, RN, CNRN 5 West

Cynthia LaClair, RN Wellness Plus

Janet Levasseur, BSN, RN Medical Specialties

Carol Majewski, BSN, MS, RN Perioperative Services

Teresa Malec, RN Flex Unit

Caryn McCoy, MSN, RNC-NIC ICN

Elizabeth McGrath, APRN NCCC

Lynn McRae, RN 5 West

Michael Mehegan, RN, TNCC ED

Tina Mongillo, MSN, RN ISCU

Janice Narey, MSN, RN ICU

Alyssa Olson, BSN, RN MHO

Courtney Peterson, RN 4 West

Jean Picconi, MSN, RN-BC OPN

Barbara Power, RN, CNRN 5 West

Angela Price, BSN, RN-BC 2 West

Ellen Prior, BSN, RN, CCM Care Management

Lori Profota, DNP, RN OPN

Margaret Provost, BSN, RN PICU

Mildred Sattler, BSN, RN, CCRN ED

Jacqueline Stout, BSN, RN ICCU

Jane Taylor, BSN, RN ICU

Cynthia Tebbetts, BSN, RN 5 West

Sarah Thompson, BSN, RN PICU

Moriah Tidwell, BSN, RN, TNCC ED

Jennifer Wasilauskas, RN OR

Lisa Wesinger, RN MHO

Sharon Wiley, RN CGP-Manchester

Lori Wood, RNC-NIC ICN

Mary Wood, MSN, RN, CDE OPN

CERTIFICATIONS


26


Green Belt Training

Karen Pushee, MA, RN CVCC and ICCU

Kyle Madigan, MSN, RN, CEN, CFRN DHART

Pam Brown, BSN, MS, RN OPN

Kerry Mogan, RN Family Medicine, Keene

Susan M. Smith, BSN, RN OR

Black belt Training

Johanna Beliveau, MBA, RN Administrative Director, Maternal Child Health and Psychiatry

Other Awards

Wanda Handel, MSN, RN, CNRN, received the Outstanding Clinical Nurse Specialist Graduate Student Award from the University of Alabama at Birmingham.

Heidi Hayes, RN, received an Advanced Nursing Leadership Certificate from St. Anselm College.

Linda Kirouac, RN, OCN and Kimberly Sleeper, BSN, RN, CPON, received a Certificate in Chemotherapy/Biotherapy from the Oncology Nursing Society.

GRANTS AWARDED

Patricia Borden, BSN, MBA, RN, and Judith Dixon, MSN, RN received an Evidence-Based Research Grant from the American Nephrology Nurses’ Association for the research proposal, “Multidisciplinary CKD Clinic.”

PROFESSIONAL ACTIVITIES

Teryl Zimmermann Desrochers, RN, CCM• Dartmouth-Hitchcock

Representative, Manchester Collaborative for Healthy Living

Paula Johnson, BSN, MPA, DA, RN• Member, New Hampshire

Nurses Association Commission on Continuing Nursing Education

Sheila Johnson, MBA, RN• Member, Board of

Directors, National Alliance on Mental Illness, New Hampshire

• Member, Board of Directors, Riverbend Community Mental Health Center, Concord, NH

• AAACN Care Coordination Transition Management Competencies Phase IV Expert Panel, American Academy of Ambulatory Care Nurses

Ellen Parker, RN• Member at Large, Board

of Directors, New England Nursing Informatics Consortium

Paul O’Kane, MSN, RN• President, Vermont

Nursing Informatics Association, first chapter organization of the American Nursing Informatics Association

Ellen Prior, RN, C-TTS• Primary Prevention

Tobacco Work Group, New Hampshire Comprehensive Cancer Collaborative

• Member, Upper Valley Public Health Advisory Council Executive Committee

Tammy Lambert, MSN, RN• Member, March of Dimes

Board of Governors, New Hampshire Division

Susan M. Smith, BSN, RN, CNOR• Secretary, Association of

Perioperative Registered Nurses, Chapter 3001

Linda Thompson, BSN, RN, CNOR• Treasurer, Board of

Directors, Association of Perioperative Registered Nurses, Chapter 3001

Patricia Tobin, LPN• Director, National

Federation of Licensed Practical Nurses

• Member, American Association of Ambulatory Care Nurses

Maureen Quigley, APRN• Co-Chair, Integrated

Health Education Committee, American Society for Metabolic and Bariatric Surgery

• Member, American Society for Metabolic and Bariatric Surgery Integrated Health Executive Council

PUBLICATIONS

Duveneck, S., Matchem, L., Kaminski, K., Beggs, V., D’anna, S. (2013). Reducing heart failure readmissions continuing care manager. Heart and Lung: The Journal of Acute and Critical Care, 42(6), 6.

Martin, C.L., Szczepiorkowski, Z.M., Dunbar, N. (2013). Complete recovery of neurologic function in a patient with Marburg’s variant of multiple sclerosis who received high dose cyclophosphamide and therapeutic plasma exchange. Journal of Clinical Apheresis, 28(2), 127-128.

McCabe, E. (2013). Breast Disorders. In T.M. Buttaro et al (Ed), 4th Ed. Primary Care: A Collaborative Practice. St. Louis, MO: Elsevier Mosby.

Rosenkranz, K.M., Tsui, E. McCabe, E., Gui, J., Underhill, K., Barth, R. (2013). Increased rates of long term complications after MammoSite brachytherapy compared to whole breast radiation therapy. Journal of the American College of Surgeons, 217(3), 497-502.

Severinghaus, R. (2013). Caring about community, ecology and the lives of women. AHNA Beginnings, 33(5), 14-16.

PRESENTATIONS

Caller, T., Secore, K., Ferguson, R., Jobst, B. Design and Feasibility of a Memory Intervention with Focus on Self-Management for Cognitive Impairment in Epilepsy. American Epilepsy Society. Washington, D.C. (December)

Chase, L. A Qualitative Study to Explore the Role of Nurses in Health Policy Development in the Middle East. Sigma Theta Tau International 24th Nursing Research Congress. Prague, Czech Republic. (July)

Cochrane, E., LaClair, C. Putting Patients in the Driver’s Seat: How Care Coordinators Help COPD Patients Manage their Chronic Illness. Case Management Society of New England. Worcester, MA. (October)

Collette, A. Improved Nurse-to-Nurse Communication and Patient Safety with a Standardized Reporting Tool. Nursing 2014 Symposium. Las Vegas, NV. (March)

Crean, N. Are You Ready for a Site Visit? New Hampshire Immunization Conference. Manchester, NH. (March)

Duveneck, S. Reducing Heart Failure Readmissions at Dartmouth Hitchcock Medical Center. American Association of Heart Failure Nurses 9th Annual Conference. Montreal, Quebec Canada. (June)

Johnson, S. IT/Analytics. Medicare Shared Savings Program Boot Camp, American Medical Group Association. Philadelphia, PA. (May)

Johnson, S. Effective collaboration between hospitals and health plans to enhance quality of care and health outcomes to reduce readmission rates. 2013 Congress on Reducing Hospital Readmissions/World Congress. Las Vegas, NV. (April)

Martin, C.L., Szczepiorkowski, Z.M., Dunbar, N. Complete Recovery of Neurologic Function in a Patient with Marburg’s Variant of Multiple Sclerosis who Received High Dose Cyclophosphamide and Therapeutic Plasma Exchange. American Society for Apheresis Annual Meeting. Denver, CO. (May)

Mudge, B., Skinner, C., McGrath, S., Kasten, D., Jenzen, L., McCarthy, J. SSHHH…It’s Quiet: Reducing Monitor Alarms While Enhancing Patient Safety. National Patient Safety Foundation. New Orleans, LA. (May)

Parker, E. Creating the Role of the Nursing Informatics Preceptor. American Nursing Informatics Association Conference. San Antonio, TX. (April)

Parker, E., O’Kane, P. Creating the Role of the Nursing Preceptor in Informatics. Epic User Group Meeting. Verona, WI. (September)

Secore, K., Caller, T., Rosenbaum, R., Kleen, J., Kaspar, J., Harrington, J., Jobst, B. Transitions in Care: Improving the Hospital Discharge Process for Epilepsy Patients. American Epilepsy Society. Washington, D.C. (December)

Certifications


Cover: From left, Moriah Tidwell, RN; Amy Curley, CNs; and Jill Toth, BSN, RN Inside back cover: Hillary Hudson, RN

Editor Anne Clemens

Design: Erin Higgins

Writers: Steve Bjerklie

Beth Carroll Tim Dean

Karen Kaliski

Photography: Mark Washburn

Dartmouth Hitchcock Nursing Year in Review 2013

Documents

Transcript of Dartmouth Hitchcock Nursing Year in Review 2013