NURSING - Sentara Healthcare · 2019-08-07 · Rebecca Winters, OR, CNOR Savannah Southard, OR,...

NURSING ANNUAL REPORT 2018SENTAR A RMH MEDIC AL CENTER

Eugene Dovis, RN

2018 NUR SING ANNUAL REPORT | 1

TABLE OF CONTENTSMessage from our CNE ......................................................................................................3

2018 Year in Review ............................................................................................................4 Transformational Leadership ............................................................................................5 Nursing Strategic Plan ...............................................................................................5 Magnet Redesignation ...............................................................................................6

Structural Empowerment...................................................................................................7 Professional Development ........................................................................................7 Advancing Education Degrees .................................................................................7 Specialty Certification ................................................................................................8 Clinical Ladder Program ............................................................................................9 Reward/Recognition ................................................................................................11 Nursing Education Symposium ..............................................................................18 Nurses Week .............................................................................................................19 Community Involvement ..........................................................................................20

Exemplary Professional Practice ...................................................................................22 Professional Practice Model ..................................................................................22 Shared Governance .................................................................................................22 Nurse Residency Program ......................................................................................24

New Knowledge, Improvements, Innovations .............................................................26 Evidence-Based Practice/Nursing Research/Quality Improvement ...............26 Dissemination of Scholarly Work ...........................................................................30

Empirical Outcomes..........................................................................................................32 Falls with Injury .........................................................................................................32 HAPIs Stage II & Above ...........................................................................................33 CLABSI ........................................................................................................................33 CAUTI ..........................................................................................................................34 Clinical PI Goals ........................................................................................................35 Patient Satisfaction ..................................................................................................36 RN Turnover ...............................................................................................................36

Sentara’s Nursing Mission, Vision, Philosophy ...........................................................37

2 | 2018 NUR SING ANNUAL REPORT

L to R: Erin Neff, RN, Liza Gunter, RN, Amber Showalter, RN


A MESSAGE FROM OUR CNEDear Colleagues,

Welcome to Sentara RMH Medical Center’s 2018 Nursing Annual Report. As your Chief Nurse Executive, it is my pleasure to present to you a summary of our many accomplishments over the past year. I am proud of our nursing team and want to thank you for your hard work and dedication. Sentara RMH nurses are commited to providing exceptional care to our patients and their families, and you will see evidence of this commitment throughout this report. Our nurses, in collaboration with our interprofessional partners, have continued to make quality and safety of patient care a priority. Our Shared Governance structure remains strong at the unit, hospital, and system level, and nurses on these councils continue to focus on improving patient outcomes in alignment with our strategic goals. These teams make clinical excellence, quality, and evidence-based practices a priority. This past year, Sentara RMH submitted a comprehensive document in October to the American Nurses Credentialing Center (ANCC) to be redesignated as a Magnet® hospital. We received our initial Magnet® designation in 2014. Our Nursing Excellence Champions chose the theme of “Reaching New Heights of Excellence” for our redesignation journey. It has been exciting to see our clinical nurses develop professionally as we work together to improve the quality of care for our patients and improve our work environment. I would like to thank all of our nurses and recognize their dedication to their profession and to Sentara RMH. Your passion for high quality patient care has provided a positive impact on our community. I appreciate and respect each of you, and I continue to be honored with the opportunity to be a part of our accomplishments. Our journey to Reaching New Heights of Excellence continues as we work together to provide excellent care for our community. Respectfully,

Donna S. Hahn, DNP, RN, NEA-BCVice President Acute Care Services/Chief Nursing Executive


2018 YEAR IN REVIEW

764 Registered Nurses

120 New RNs Hired79 New Grads Started NRP in 2018

68% BSN or Higher Degree

24% Certified Nurses

355 Page Magnet Document Submitted 10/1/18

20,716 Patient Admissions

166 Average Daily Census

1,865 Babies Born

11,976 Surgical Cases

69,697 ED Visits

Organizational Goal

OG 1Clinical Quality & Safety – Achieve better health for our members and patients

OG 2Customer Centricity – Provide an exceptional desired experience

Nursing Goals (Objectives)

NG 1.1Achieve Clinical Performance Improvement (CPI)

NG 1.2Decrease care variation applying evidence based practice to achieve nurse sensitive goals

NG 2.1Ensure Care delivery is based on unique needs and desires of patients and families

Metrics (Outcomes)

NG 1.1.1Achieve 3 of 4 hospital division CPI 2018 goals; 5 of 6 corporate division CPI 2018 goals

NG 1.2.1Meet 3 of 4 System nurse sensitive clinical indicator goals- CLABSI, Falls with Injury, Hospital Acquired Pressure Injury, CAUTI

NG 1.2.2Meet VTE and Vaccine goals

NG 1.2.3Ensure frontline clinical staff practice under evidence based care guidelines

NG 2.1.1Meet Customer Satisfaction Goal

NG 2.1.2Assess implications for nursing of the digital application

NG 2.1.3Partner with VPMAs for work on specialized, diverse patient population initiatives including communication, Opioid addiction epidemic, and pain management.


TRANSFORMATIONAL LEADERSHIPTransformational Nurse Leaders create a culture of nursing excellence to lead people where they need to be in order to meet the many demands of the changing national healthcare landscape. Unlike yesterday’s leadership requirement for stabilization and growth, today’s leaders must transform their organization’s values, beliefs, and behaviors. This requires vision, influence, clinical knowledge, and a strong expertise relating to professional nursing practice.

NURSING STRATEGIC PLANOur 2017+ nursing strategic plan was created in support of the 2017 Sentara Healthcare Strategic Plan. The plan ended at the end of 2018. We will have a new strategic plan for 2019-2021.

L TO R: Shawn Craddock, Patra Reed, Tammy Joseph, Sabrina Shiflett, Donna Hahn, Lesley Cook, Jenay Mason, Faye Satterly, Marcus Almarode. Missing from photo: Tena Bibb.


Organizational Goal

OG 3Growth & Innovation – Grow existing and new markets

Nursing Goals (Objectives)

NG 3.1Expand nursing capacity utilizing innovative staff retention and cost reduction methods

Metrics (Outcomes)

NG 3.1.1Improve retention of new RN graduates over 2017

NG 3.1.2Improve overall RN retention by 1% over 2017 baseline of 14.4%

NG 3.1.3Improve retention of APRNs in Medical Group (baseline- NPs = 6.8%, CRNAs = 4.4%, 2017 - 1Q18)

NG 3.1.4Improve retention of LPNs in long term care over 2017 baseline of 22.1%

NG 3.1.5Reduce overall system turnover of support staff reporting to nursing by 3%

NG 3.1.6Will reduce RN purchased labor over 2017

NG 3.1.7Collaborate on cost of care initiatives with VPMAs to include LOS.

NG 3.1.8Partner with Materials Management to reduce costs by $500,000.

NG 3.1.9Improve nursing workforce professional practice development

MAGNET® REDESIGNATIONSentara RMH received initial Magnet® designation from the American Nurses Credentialing Center (ANCC) in December 2014. Magnet is the highest award that an organization can receive for nursing excellence. Organizations must reapply every four years for redesignation. Sentara RMH submitted documents for redesignation in October 2018. We will have a site visit in 2019. Our Nursing Excellence Champions chose the theme of “Reaching New Heights of Excellence” for our redesignation journey.

M AG N E T


STRUCTURAL EMPOWERMENT Our nurses have actively engaged in opportunities to learn and teach others and have developed their professional practice, knowledge, and skills by obtaining certifications, returning to school to advance their nursing degrees, and climbing the clinical ladder.

PROFESSIONAL DEVELOPMENTADVANCING EDUCATION DEGREESAt the end of 2018, 68.3% of registered nurses at Sentara RMH Medical Center held a BSN or higher degree. This percentage has steadily increased over the past several years. Sentara continues to offer nurses numerous options and many opportunities to fund their education including tuition assistance and reduced tuition at participating colleges. The Institute for Nursing Excellence and Innovation established by the RMH Foundation also supports Sentara RMH nurses working to obtain their Bachelor of Science in Nursing (BSN) degree through scholarship support, which is made possible by the Foundation and generous donors. In 2018, we had 26 RNs receive a scholarship to help them pay for their BSN program.

SENTARA RMH RN EDUCATION 6-YEAR TREND


2015 2016 2017 2018Percent Certified Nurses, Overall 17% 18% 20% 24%Organization Goal (%) 18% 19% 21%

17%18%

20%

24%

0%

5%

10%

15%

20%

25%

% Certified

Year

SRMH Professional Nursing Certification, 2015-2018

Melinda Smith, Endo RN to BSNAlicia Wenger, FBP RN to BSNLauren Braithwaite, FBP RN to BSNMary Lam ,ICM RN to BSNSusan Justice, MG MSNAshley Miller, OR RN to BSNTracey O’Neal ,OR RN to BSNTiffany Rothe, PCU RN to BSNAnastasia Shulgan, Peds RN to BSNDonna Lucas Periop, RN to BSNCarlissa Lam, Quality DNPLeora- Leigh Pedersen, Surgical Services RN to BSNSavannah Southard, Surgical Services RN to BSNDawn Whetzel, Treatment Center RN to BSN

SPECIALTY CERTIFICATION Sentara RMH participates in several programs that assist nurses to achieve their certification goals. Programs such as ANCC’s Success Pays™ and AACN’s Certification discount programs have enabled many nurses to sit for board certification in their nursing specialty without any outlying cost. We continue to increase the number of certified nurses at SRMH each year.

Kudos to the Education Department for having 100% certified nurses and to 4 East for having the highest increase of certified nurses in 2018.

L TO R: 4E nurses, Hilary Breeden, Katie Rohrer, Amy Steele, Amanda Green, Tanya Bradford

Below is a list of nurses who advanced their education degree in 2018. Congratulations! Amy Bayne, 3W RN to BSNJulie Cunningham, 3W RN to BSNKristi Eckard, 3W RN to BSNScott Beckler, 3W MSNAmanda Green, 4E RN to BSNAmy Steele, 4E RN to BSNEmma-Rose Kline, 4E RN to BSNHilary Breeden, 4E RN to BSNKatie Rohrer, 4E RN to BSNTanya Bradford, 4E RN to BSNValerie Simmers, 4E RN to BSNCarolyn Simmons, 5W RN to BSNHeather Lambert, 5W RN to BSNHeidi Miller, 5W RN to BSNApril Simmons, BHU RN to BSNEmily Joiner, BHU RN to BSNCindy Wheelbarger, Cancer Center RN to BSNValerie Matthews, CCU RN to MSNJessica Dove, ED RN to BSNEugene Dovis, Education RN to BSNJenny Hoten, Education MSNJill Delawder, Education DNPLisa Stroupe- Kephart ,Education MSNJulie Cook, Endo RN to BSN

Donna Morgan, 3 West, Med-SurgRebecca Hawkins, 3 West, Med/SurgAmanda Green, 4 East, Med-SurgAmy Steele, 4 East, Med-SurgCindy Campbell, 4 East, Med-SurgHilary Breeden, 4 East, Med-SurgJames Russell, 4 East, Med-SurgNawar Altuma, 4 East, Med-SurgShelby Shultz, 4 East, Med-SurgTanya Bradford, 4 East, Med-SurgClaudia Accord, 4 West, Med-SurgBrittney Villeda, 5 West, Med-SurgElizabeth Alderfer, 5 West, Cardiac VascularHeather Staton, 5 West, Med-SurgMatt Coleman, 5 West, Med-SurgAngela Hensley, BHU, Psychiatric & Mental HealthCarol Sacra, Cancer Ctr, OCN Sheila Baugher, Cancer Ctr, OCN Yvonne Jarrells, Cancer Ctr, OCN Bethany Alexander, Care Management, Case ManagementCeci Weaver, Cath Lab, Cardiac VascularBrittney George, CCU, CCRN

Christy Crawford, CCU, CCRNTyler Thompson, CCU, CCRNCarolyn Book, ED, Cert Flight RNCayla Wilson, ED, EMT-BasicMollie Jones, ED, CENBecky McCutcheon, Education, C-EFMJeannine Rennick, Education, CWCNJennifer Hoten, Education, Med-SurgSuzanne Jenkins, Education, Med-SurgBridgette Clark, FBP, C-EFMFaythe Silveira, FBP, C-EFMJennifer Baugher, FBP, C-EFMMelissa Lambert, FBP, C-EFM Tanya Shenk, FBP, EFMApril Eavers, H&V, Cardiac Vascular Nurse,

CCRPJane McTier, H&V, Cardiac VascularBeverly Eye, Nursing Admin, Nursing

Professional DevelopmentKara Monger, OR, CNORKeli Feldmeier, OR, CNORMaria Snyder, OR, CNORRebecca Winters, OR, CNORSavannah Southard, OR, CNOR

Ashley Miller, OR, CNORMary Beth Tysinger, PACU, CPANShelley Lenker, PACU, CPANErin Neff, PCU, PCCNJessica Thomas, PCU, PCCNLeslie Harris, Peds, Pediatric Nsg, RN-BCMargaret Furr, Peds, Med-SurgJennifer Lough, Phys Prac, Cert OH RN SpecMalinda Whitfield, Phys Prac, Adult Psych &

Mental Health NPSusan Holsinger, Phys Prac, CCCTMSusan Justice, Phys Prac, CNLWendy Lucas, Physician Practice, CCCTMSharyn Tieszen, Same Day Surgery, Cert

Amb Perianesthes


The Education Department

We would like to commend the following nurses who obtained a new certification in 2018. Congratulations on your successful testing!

CLINICAL LADDER PROGRAMSentara RMH continues to have a strong Clinical Ladder Program, which is coordinated by the Shared Governance Education and Professional Development Council. Listed below are the annual statistics for RNs achieving clinical ladder levels III through V since the inception of the program in 2006.

Clinical Ladder 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Advancement Levels: III 70 45 63 65 86 110 102 105 115 122 136 117 119 IV 15 24 22 26 36 46 55 70 65 65 62 58 67 V 0 0 4 7 9 11 14 21 16 24 26 30 43 Total 85 69 89 98 131 167 171 196 196 211 224 205 229


LEVEL III Johnson, Whitney 3 WestJones, Alexis 3 WestNorris, Patty 3 WestWalden, Heather 3 WestAltuma, Nawar 4 EastBlosser, Jennifer 4 EastBottenfield, Lisa 4 EastCampbell, Cynthia 4 EastChvanov, David 4 EastCollier, Kayla 4 EastGarnett, Megan 4 EastGoss, Susan 4 EastGrandstaff, Colleen 4 EastHassler, Beth 4 EastKline, Emma-Rose 4 East Price, Lisa 4 East Shugan, Tim 4 East Simmers, Valerie 4 East Armstrong, Kylie 4 West Knicely, Lois 4 West McWilliams, Corey 4 West Miller, Kathryn 4 West Smith, Tamerau 4 West Taylor, Gloria 4 West Viola, Charlene 4 West Rodriguez, Yeney 5 West Suslaev, Olga 5 West Miller, Heidi 5 West Rhodes, Angela AIC Cashatt, Annette BHU Hensley, Angela BHUJoiner, Emily BHUSimmons, April BHUCummings, Tricia Cancer CtrMyers, Ashley Cancer CtrRhodes, Jody Cancer CtrRathbun, April cath labBennett, Brittany CCUBrown, Stacy CCUMoyer, Renee CCUTate, Tiffany CCUClemmer, Charles EDDennis, Kimberly EDGabriana, Materna EDGriffin, Jessica EDJohnson, Tammy EDKauffman, Sarah ED

Lam, Heather EDPalmer, Tina EDSimmons, Jaimie EDWright, Kylan EDAguiar, Shaina FBPAnsley, Deborah FBPArbaugh, Madelyn FBPBailey, Allison FBPBaldwin, Rebecca FBPBennison, Rachel FBPCrosby, Rebecca FBPDove, Amanda L FBPEberly, Sonya FBPEvans, Megan FBPFairweather, Sarah FBPHummel, Glenda FBPLester, Rachel FBPL’Heureux, Jody FBPLough, Rachel FBPMartin, Mariah FBPMartin, McKenzie FBPMcDaniel, Jennifer FBPMills, Emily FBPMorris, Daniela FBPRoby, Kimbery FBPRunion, Kacey FBPShowalter, Chelsea FBPSly, Alisha FBPSpitler, Sherrie FBPVeglia, Michelle FBPZirkle, Kelly FBPBreneman, Angela H&VCummings, Miranda H&VDeaver, Lindsay H&VEavers, April H&VLong, Kristine K H&VMonroe, Melinda H&VShowalter, Amber H&VThomas, Lauren ImagingJerlinski, Sharon Mod SedMills, Catherine Mod SedPitsenbarger, Kathleen Mod SedAlbrite, Kathy Mod-SedDepoy, Gina Mod-SedCowan, Pajaree(Omi) ORFierro, Caitlin ORLacek, Karen ORLeap, Kristin OR

Moore, Maria ORSmallwood, Sarah ORSnyder, Maria ORSouthard, Savannah ORFisher, Joyce PACUHill, Kelsey PACUWilliams, Leesa PACUHawkins, Deanna PASSLowery, Anne PASSMcIntyre, Linda PASSSaylor, Debra PASSDeVore, Brittany PCUFarrell, Michelle PCUGunter, Liza PCUHuffman, Holly PCUJackson, Mari PCUMahwood, Avin PCUMoyer, Samuel PCUPortillo, Brittany PCUHamberger, Jessica PedsBaldwin, Sharon A PeriOPDepoy, Louann PeriOPLucas, Donna PeriOPZiccardy, Paul TxCenter ____________________

LEVEL IV Alderfer, Elizabeth 5 WestBills, Ariel 4 EastBradford, Tanya 4 EastGeary, Maria 4 EastGreen, Amanda 4 EastRohrer, Katie 4 EastRussell, James 4 EastAcord, Claudia 4 WestHershberger, Brian 4 WestPeters, Jessica 4 WestBurgoyne, Heather 5 WestDiffenderfer, Ashley 5 WestTyler, Liana 5 WestBow, Charlotte Cancer CtrDye, Laurie Cancer CtrLowry, Carol Cancer CtrShank, Lisa Cancer CtrGardner, Erin CCUWinters, Rebecca CTORHarmon, Carla EDLeatherland, Cerrianne ED

Miller, Sheila R EDSumner, Michael EDYoung, Kathy Jill EDClarke, Bridgette FBPCunningham, Jennifer FBPGingerich, Sara FBPPrice, Megan FBPPropst, Marilyn FBPPultz, Jessica FBPSizer-Lewis, Melissa FBPSychev, Oksana FBPWhiteley, Kimberly FBPFrench, Courtney H&VGodshall, Sara H&VHess, Amy H&VPugh, Barbara H&VThomas, Helen “Ann” H&VDirks, Penny ImagingFindley, Stephanie ImagingLeighton, Marsha ImagingSimmons, Phaedra ImagingWilhelm, Elisabeth ImagingDean, Kim Mod SedFeldmeier, Kelinda ORMacMillan, Kathy ORMiller, Ashley ORPeric, Jerica ORPropst, Dawn ORLenker, Shelley PACUBradley, Linda PASSWebb, Stephanie PASSBowman, Rebecca S PCURogers, Krista PCUBeeker, Erin PedsBondurant, Gina PedsMcDonald, Deborah Peri-OpPence, Rebecca Peri-OpWill, Charlotte Peri-OpBontrager, Debra Pt EdClark, Susan Pt EdDovis, Eugene Pt EdRoy, Margaret Pt EdBrewer, April Tx CtrChilds, Elizabeth Tx CtrRhodes, Laura TxCenterWhetzel, Dawn TxCenter

LEVEL VBreeden, Hilary 4 EastRawley, Melissa 4 East Spicer, Amy 4 East Steele, Amy 4 East Stoneberger, Staci 4 East Coleman, Matt (Christopher) 5 West Ritchie, Samantha 5 West Sandoval, Brooke 5 west Simmons, Carolyn 5 west Miller Roadcap, Cynthia care manager Roes, Laura Cath Lab Snow, Anne Cath Lab Haviland, Jennifer CCU Leontie, Samantha CCU Mason, Chris CCUThompson, Tyler CCUQuach, Brenda CCU Hoops, Brenda EDGriffin, Melissa EDNeher, Paula EDFoltz, Rebecca ERGaddis, Linda FBPKenney, Diana FBPLambert, Melissa R FBPMohler, Darla FBPShenk, Tanya FBPSilveira, Faythe FBPSmith, Julie M FBPWilson, Chasity FBPEdwards, Jessica H&VMartin, Gloria H&VRhodes, Salinda H&VSmith, Nancy J H&VWeaver, Ceci H&VMcTier, Jane HVCNeff, Erin PCUThomas, Jessica PCUFurr, Margaret PedsHarris, Leslie PedsBlock, Amy Peri-OpFoltz, Doris Peri-OpPierantoni, Julie Pt EdCaricofe, Krystal Tx Ctr

2018 CLINICAL LADDER RECIPIENTS Congratulations to all who maintained or advanced on the clinical ladder in 2018.

L TO R: Jamie Martin, Julie Pierantoni, RN,Jennifer Blosser, RN, Liza Gunter, RN, Brittany Devore, RN, Leesa Williams, RN(not pictured: Maria Geary, RN, Donna Blank, RN)

RECOGNITION/REWARDSEach year, Sentara RMH nurses are recognized for their contributions to nursing excellence in many different ways. Below are just a few examples of nurses that were recognized in 2018.

NURSES WEEK AWARDS Our annual “Excellence in Nursing Practice” award winners were announced during Nurses Week 2018. These nurse professionals were nominated by their peers for exemplifying excellence in nursing and being committed to improving health every day. We commend them for excellence in mentoring, leadership and service.

The 2018 Excellence in Nursing Practice Award winners were:

• Beginning Practitioner of the Year: Brittany Devore, RN, PCU• Preceptor of the Year: Leesa Williams, RN, PACU• Nurse of Distinction: Maria Geary, RN, 4E• Nurse Excellence in Patient Centered Care: Donna Blank, RN, Same Day Surgery• Exemplary Clinical Practice: Jennifer Blosser, RN, 4E• Transformational Leader: Liza Gunter, RN, PCU• Excellence in New Knowledge and EBP: Julie Pierantoni, RN, Pt Education • Support Staff Excellence in Patient Centered Care: Jamie Martin, NCP, PCU



2018 PATIENT SAFETY CHAMPIONSEach year during National Patient Safety Awareness Week, we recognize four team members who have been nominated by their peers as persons who help shape our culture of safety at Sentara RMH. In addition, we also present the annual Victoria Morris Patient Safety Award to a team member who exemplifies the type of passion, dedication and commitment to patient safety that was evident in the work of Victoria “Tori” Morris, RN, who served as the hospital’s Patient Safety Officer and Patient Safety Coordinator for the last five years of her life. Three of the five safety champions in 2018 were nursing team members. Congratulations to our safety champion winners; thank you for the work you do to support our culture of safety.

L TO R: Billy Carney, RN, Unit Coordinator in PACU; Josie Martin, NCP, 4 West; Jimmy Ford, Protection Services—recipient of the 2018 Victoria Morris Patient Safety Award; Jill Young, RN, Unit Coordinator, ED; and not pictured, Marti Reel, Pharmacist, Outpatient Pharmacy

ACE (ALWAYS COMMITTED TO EXCELLENCE) WINNERSThe Sentara Always Committed to Excellence (ACE) Award is given twice a year to two outstanding staff members in each Sentara division who are nominated by their peers for always exhibiting excellence in their adherence to all five Sentara Commitment to patients, visitors, physicians and coworkers. Each winner receives a $500 prize (minus standard deductions) and an ACE Award pin.

Brittany Porcillo, RN, PCU

WOW WINNERSSubmitted WOWs are reviewed quarterly by our Sentara RMH Patient Family Advisory Council (10 community members) and they select one quarterly winner. It’s very hard to pick just one because there are many deserving staff members. One person is selected to receive the award and they receive a WOW Moment Award Certificate, 2 movie tickets, a WOW lapel pin, and a dedicated WOW parking spot for 90 days. These employees exhibit behaviors that demonstrate they are living our Sentara Commitments.

1ST QUARTER WINNER, 2ND QUARTER WINNER, 3RD QUARTER WINNER, Pamela Miller, RN Emmarie Clem, RN Carol Lowry, BSN, RN, OCN PACU 5 West Cancer Center


SENTARA RMH BRINGS HOME 2018 RUNNER-UP “POPULATION HEALTH” HQI AWARDThe Continuum Case Management team received the runner-up Health Quality Innovator (HQI) Award for population health at the annual HQI awards ceremony in Richmond. HQI recognizes healthcare organizations that are using evidence-based approaches to quality improvement to deliver better care, better population health and lower healthcare costs. Awards were provided in the areas of collaboration, data-driven care, patient-centered care, population health and rural health.

FROM LEFT: Gina Sprouse, Mim Yoder, Cindy Harlow, Stephanie Davis, Stephanie Lam, Laura Watson, Vicky Heishman and Patra Reed

VIRGINIA NURSES ASSOCIATION (VNA) GALA AWARDS The annual VNA Gala recognizes nurses across Virginia for their outstanding leadership, professional practice and community impact. The following nursing staff was nominated for awards at the VNA Gala:

Virginia Magnet Consortium Award Nominees:

• Kara Smoker, BSN, RN, CNML (Nursing Leadership)• Jenny Hoten, MSN, RN, CMSRN (Nursing Educator)

Virginia Nurses Association Forty under Forty Award Nominees:

• Stephanie Armstrong, BSN, RN• Tyler Thompson, BSN, RN, CCRN (Honorable Mention) FROM LEFT:

Jenny Hoten, MSN, RN, CMSRN, and Donna S. Hahn, DNP, RN, NEA-BC

L to R: Stephanie, Jenny, Kara, Tyler


SENTARA SYSTEM INTEGRATED CARE MANAGEMENT RN OF THE YEARLaura Watson, BSN, RN-BC, CHFN, CCCTM was named the 2018 Sentara System Integrated Care Management (ICM) RN of the Year at Sentara’s National Case Management Week Celebration in October. Each year the ICM Practice Forum chooses a RN and Social Worker of the Year and a Novice RN and Social Worker of the Year from nominations from all 12 hospitals and all ambulatory settings employing Integrated Care Managers.

Laura was presented the award by Karen Eckert, VP of Integrated Care Management and Genemarie McGee, Sentara CVP and CNE. “In grateful appreciation for your dedication to partner with a program surrounding the CHF patient that will assist with helping patients have a better quality of life, reduce admissions, and have the resources they need.”


CERTIFIED NURSES DAYCertified Nurses Day is celebrated on March 19th, the birthday of Margreta “Greta” Madden Syles, EdD, RN, FAAN (1903-2005). Known as the “Mother of Nurse Credentialing,” Styles was a visionary scholar with an international impact on the nursing profession. The thousands of certified nurses in the U.S. today and the growing role of certification in contributing to better patient outcomes are a lasting testament to her legacy. Sentara RMH celebrates our certified nurses annually on March 19th, Certified Nurses Day. Below is a picture of the certified nurses who were able to attend the celebration in 2018.


DAISYThe DAISY program was implemented at Sentara RMH in 2016 as another way to recognize our nurses for the exceptional care they provide to their patients. The DAISY Award is an international program developed to recognize nurses for their exceptional care. It is an acronym for Diseases Attacking the Immune System. The DAISY Foundation was formed in 1999 by the family of J. Patrick Barnes who died at age 33 of complications of ITP. The nursing care Patrick received when hospitalized profoundly touched his family.

Sentara RMH continued this recognition program for nurses in 2018. Anyone can nominate an RN for the DAISY award. The Nursing Excellence Champions Council (made up of staff nurse representatives from most units in the hospital), reads blinded nominations and votes quarterly on their top choices based on the DAISY criteria.

The 2018 DAISY winners are listed below:

• Connie Clem, RN• Maria Geary, RN• Avin Mahmood, RN• Kevin Grauer, RN • Allison Bailey, RN• LeAnn Kendall, RN• Krista Rogers, RN• Olga Suslaev, RN• Jacque Early, RN• Jessica Peters, RN• Erin Beeker, RN• Kelly Zirkle, RN


L TO R: Connie Clem, RNMaria Geary, RNAvin Mahmood, RNKevin Grauer, RN

L TO R: Allison Bailey, RNLeAnn Kendall, RNKrista Rogers, RNOlga Suslaev, RN

L TO R: Jacque Early, RNJessica Peters, RNErin Beeker, RNKelly Zirkle, RN


TEAM DAISYWe also added the Team DAISY award in 2018. This award is designed to honor collaboration by two or more people, led by a nurse, who identify and meet patient and/or patient family needs by going above and beyond the traditional role of Nursing. Our first annual DAISY Team Award was presented in June to the PACU Team.

PACU team members

NURSING EDUCATION SYMPOSIUMOn September 14th, the Sentara RMH Staff Development Education team hosted their 2nd annual Nursing Symposium, “Empowering the Caregiver” and, needless to say, it was a hit! The day began with a presentation from Wendy Brown about generational differences and how to best understand their “style”. Robin Martin (from Chaplaincy Services) talked about meaningful conversations. There was an opportunity to talk with a panel of professional organization members; specifically, on how to join, why to get involved and the benefit it provides personally and professionally. Throughout the day, staff were able to talk with nursing school representatives and view nursing research posters done by their peers.

Erin Williams, who is a nationally certified counselor, a licensed professional counselor and works on the Behavioral Health Unit, charmed the audience with her comical and honest discussion on caring for the mental health patient population. The Emergency Department’s Carolyn Book and Paula Neher gave an inspiring talk on how nurses need to learn, first and foremost, to care for themselves. Lastly, there was Ron Culberson; his presentation was on “If Not Now, When? Making the Most of Your Life, Your Relationships, and Your Work.” The theme for the day was super heroes.


NURSES WEEK 2018During Nurses Week 2018, there were a variety of activities for nursing staff; a few of those activities included breakfast served by the nursing leadership team, a cake walk, a unit block party where each unit displayed posters with information about their department, door prizes, and a fun photo booth.


COMMUNITY INVOLVEMENT Our mission at Sentara RMH is to improve health every day. Community healthcare outreach is one way we fulfill our mission by continually trying to improve upon our services, expanding the continuum of care, educating individuals about their health, fostering a culture of learning among our skilled professionals, and reaching out to individuals in need.

1. County Fair: Each year, Sentara RMH has a large presence at the Rockingham County Fair, which occurs in mid-August. Nearly 100 staff members volunteer throughout the week to greet fair goers, provide free bottles of water, and provide free health screenings, such as blood pressure checks, cholesterol screenings, and blood sugar screenings. In 2018, clinical nurses performed 1,100 free blood pressure screenings and 245 free blood glucose tests during the week at the fair.

2. International Festival: The hospital has a booth set up at the Festival each year where we offer blood pressure screenings, diabetes screenings, and information on cultural diversity programs such as our Diversity in Healthcare Scholarship and interpretation/communication services. The International Festival is a free day of family fun that celebrates the many cultures that make up our community. It features international foods, music, dance, activities for all ages, a multi-language area, Teen Spacefest and a World Bazaar featuring traditional folk art. Attendance numbers are usually around 7,000-8,000 people and the event is accessible to individuals with diversified mobility and older adults.

3. Blue Ridge AACN donated gifts to children at Christmas to the Section 8 Housing Authority in Harrisonburg in December. The Blue Ridge AACN in cooperation with the SRMH Critical Care Unit chose 20 children from the Angel Tree to buy Christmas gifts for in December. This is the third year and they continue to increase the number of kids they provide for! They chose this particular project because the families in Section 8 Housing have to apply for this and have certain criteria like paying their bills on time for the entire year and being employed in order to qualify. The CCU nurses felt that this was a way to help out those who are really trying to help themselves and just need a little nudge.

4. Family Fair: In 2018, approximately 300 people attended the annual Family Fair which is designed to provide outreach and education to families in our community. The fair features both the Family Birthplace and Pediatric units by showcasing the services that both units have to offer. Other Sentara RMH departments and community agencies are featured as well during the fair. Numerous educational exhibits are available

for families, and fun activities are featured, such as face painting, door prizes, car seat safety checks, unveiling of the 2017 baby collage, the empathy belly, and refreshments.

RIGHT: Stacy Brown RN CCU, Erin Gardner BSN, RN CCU, Amber Pence Housing-Family Self Sufficiency Program Coordinator Harrisonburg Redevelopment and Housing Authority and not pictured Chris Mason BSN, RN CCU


5. Camp RMH: For the past several years, Sentara RMH has offered a week-long camp in June for middle school students interested in healthcare. The campers get to participate in various hands-on activities that give them an idea of different healthcare careers.

6. Heart Chase, Valley 4th Run and Matters of the Heart: The Heart and Vascular/Cardiac Cath team participated in these community events in 2018. Heart Chase is a good-cause community adventure game organized by the American Heart Association. It’s a fun and frenzied pursuit of hidden rewards and healthy lives. The Valley 4th Run is the only chip timed race in the Shenandoah Valley that lets you pick your distance (1.5 mile, 5K, or 10K) and your charity. Our team supported Big Brothers/Big Sisters and the Downtown Renaissance initiative. Matters of the Heart is a public heart health seminar that provides free blood pressure screenings and presentations about various heart health topics.

ABOVE:Camp RMH

RIGHT: Matters of the Heart

Seminar

LEFT:Family Fair

ABOVE: Heart Chase

LEFT: Valley 4th Run


THE SENTARA PROFESSIONAL PRACTICE MODEL The Sentara Professional Practice Model (PPM) is a graphic depiction of how nursing is practiced at Sentara RMH. The PPM is a schematic representation of the values, organizational structures, and processes that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality outcomes for our patients, families, and community.

SHARED GOVERNANCESentara RMH has had a shared governance structure in place for over a decade. This structure continues to be fundamental to maintaining and further developing our clinical practice standards, professional development, and evidence-based practice and nursing research. Through the shared governance structure at Sentara RMH, nurses have participated and led many efforts to improve our patients’ experiences and outcomes. We continue to have four very active hospital shared governance councils, and also have nurse participation on councils and forums at the system level. In 2018, the Education and Professional Development Council was chaired by Samantha Ritchie, MSN, RN-BC, Professional Practice & Safety Council was chaired by Jerica Peric, BSN, RN, Evidence-based Practice and Nursing Research Council was chaired by Tyler Thompson, BSN, RN, CCRN, and the Nursing Excellence Champions Council by Brenda Hoops, RN, CEN, SANE.

EXEMPLARY PROFESSIONAL PRACTICE

Relationship

Create acaring

compassionaterelationship

with thepatient/family

Team

Collaboratewith the

healthcareteam to use

evidence-basedpractice in

providing care

To Create An Environment

of Health and Healing

Coordination

Assess, manage,coordinate &

evaluatethe care and education of

patient/familyalong the

healthcarecontinuum

Nursing Vision

Nursing Scope of Practice

Nursing Foundation

Care DeliverySystem

Patient-Centered CareRelationship-Based Care

A Culture of Safety and Accountability


HOSPITAL COUNCIL ACCOMPLISHMENTS IN 2018

The Education and Professional Development Council recognized our certified nurses on Certified Nurses Day, revised the clinical ladder program and reviewed 231 portfolios, established nursing certification and education goals for the organization, recognized staff who had advanced their education degrees, featured monthly Lunch and Learn sessions on topics identified in the nursing learner needs assessment, promoted specialty certification, monitored usage of SmarTIGR for patient education, developed the TIGR of the month award for the unit that showed the most TIGR videos, implemented a visual reminder (a magnet placed on the white boards) to use the TIGR system, worked on a professional development pathways document, and provided education on consenting patients.

The Professional Practice & Safety Council reviewed several Sentara RMH nursing policies and procedures (24 were archived, 26 were edited, and 7 were kept with no revisions), created a new inpatient transfer checklist, piloted a system medication teaching tool to help patients better understand side effect, and saw positive results, piloted a process to prevent contamination of medications in isolation rooms and developed a job aid, created an SBAR and sent out on how to properly document that a patient has an insulin pump so Pharmacy is notified, made recommendations for KVO rate policy, and monitored nurse sensitive quality indicators (falls, HAPIs, CAUTIs, CLABSIs, etc.).

The Nursing Excellence Champions Council voted on DAISY nominations received quarterly and recognized 12 nurses with the DAISY award, added a Team DAISY award which was presented to PACU, voted on Nursing Excellence nominations for 8 categories, which were presented during Nurses Week, promoted Healing Touch sessions for staff on the units and reviewed evaluations monthly, reviewed unit dashboards monthly, reviewed patient and RN satisfaction results, developed Magnet Redesignation Theme: “Reaching New Heights of Excellence”, reviewed and made recommendations on the revision of the Sentara Nursing PPM, recommended displaying DAISY wall in hallway above steps from cafeteria, reviewed role in Magnet redesignation journey, rounded on nursing units with cart to educate staff about Magnet document submission and redesignation timeline, and discussed strategies for combating clinician burnout.

The Evidence-Based Practice and Nursing Research Council approved eight new nursing research studies, closed six nursing research projects, and renewed three nursing research projects from 2017; approved 18 evidence-based (EBP) projects - 14 were from the Nurse Residency Program (NRP), held one EBP Mentorship workshop; offered monthly educational opportunities, supported the NRP residents, conducted literature review on KVO IV rates for the Professional Practice & Safety Council, and put out a call for posters for Nurses Week and the Education Symposium.


Cohorts 4, 5, and 6

NURSE RESIDENCY PROGRAM By Beverly Eye, BSN, RN-BCNurse Residency Program Coordinator

Sentara Hospitals, in collaboration with Vizient and the American Association of Colleges of Nursing (AACN), launched the Vizient/AACN Nurse Residency Program™ in the first quarter of 2016. This nurse residency program is a one-year program, includes an evidence-based curriculum, has become the gold standard, and is well published. The Vizient/AACN Nurse Residency Program™ boasts a 92% new nurse retention rate in 2018 verses the 71 – 74% that is reported nationally.

As of January 1, 2019, Sentara RMH Medical Center has initiated nine nurse residency cohorts comprised of over 180 new nurses. Graduates of the program include 102 residents with 30 evidence-based practice (EBP) projects presented at graduation. Several EBP projects have been recommended and/or implemented into practice. In addition, many of our residents have moved on to leadership roles including unit leadership and Shared Governance Council involvement, have acquired a nurse specialty certification, and are involved with the Nurse Residency Program (NRP) in facilitator and EBP project mentor roles.

Benefits of the Nurse Residency Program are numerous. We have observed improvement in our 1st year new graduate nurse retention rates since the implementation of the Nurse Residency Program. Our residents confirm that participating in the NRP seminars has provided an environment for enhancing their critical thinking and prioritization skills due to the use of case studies, focused discussions, and simulation opportunities. Residents also benefit from


the interactions with curriculum experts on a variety of topics related to leadership, quality outcomes, and professional development. Our residents are also fortunate to have experienced EBP mentors assisting with project development at each seminar.

During Tales from the Beside/Clinical Reflection sessions, residents are provided a safe and confidential place to share success stories, best practices, case studies, and difficult situations with an experienced clinician. This particular component of the seminar is rated as the most beneficial by the majority of nurse residents.

The Sentara RMH Nurse Residency Program is one of the largest in the system in terms of the number of residents. The success of our Program is due to engaged residents, supportive managers and schedulers, dedicated facilitators, EBP mentors, educators, preceptors, and content experts. We continue to update our Program based on feedback from our residents, the Nurse Residency Team, and the review of best practice strategies from a variety of sources.

For additional information about our Nurse Residency Program contact Beverly Eye at [email protected] or 540-689-6227.

REFLECTIONS FROM A RESIDENT FROM COHORT 5, EMMARIE CLEM, RN

“The nurse residency program was truly a blessing to me during my first year of Nursing. It provided me with a place to meet, share and confide with fellow first year nurses working at Sentara RMH. These monthly meetings not only helped me connect with fellow 1st year nurses but it also helped me realize I wasn’t alone in my feelings, experiences and self-doubt. The nurse residency program also provided me with knowledge, skills, and resources I needed as a new nurse. I am so very grateful that Sentara RMH has a nurse residency program that has been helping new nurses for years now. I believe the nurse residency program greatly impacted my job satisfaction and retention. This is a wonderful place to work not only because it offers a wonderful nurse residency program, but because everyone you meet makes you feel so welcome, valued, respected, and part of a team. Thank you.”

Emmarie Clem, RN

PCU residents


In 2018, nurses piloted and implemented several new practices that were evidence-based to improve patient outcomes. A few examples of these are provided below.

• INSULIN BUNDLE: The insulin bundle process was initially piloted on 5 West and then implemented across all inpatient units in December. The Medication Safety Committee developed this new process due to an increase in reported insulin errors at Sentara RMH. The most common cause of these errors was related to the timing of insulin administration. The insulin bundle coordinates point of care (POC) glucose levels, insulin administration, and meal tray delivery times to improve the timing and thus safety of mealtime insulin. All three steps are carried out by the nurse. The nurse performs Insulin Bundle Rounds as the meal trays are delivered to the floor by Food Services staff. NCPs also are important to the success of this process as they pre-round prior to insulin rounds to ensure that the other needs of patients are met so that the insulin bundle process is not delayed. We have had impressive results with the insulin bundle process. A snapshot of insulin administrations showed an average of 5.6 minutes from POC glucose to insulin administration time. This is an 85% decrease in time from baseline. This improvement in time between POC glucose and insulin administration is helping us to improve the safety of our patients.

NEW KNOWLEDGE, IMPROVEMENTS, INNOVATIONS

• GLUCOMMANDER: In May 2018, Sentara RMH implemented Glucommander™, an evidence-based practice that calculates personalized insulin dose recommendations by analyzing a patient’s response to insulin and trends in blood glucose over time. This new practice, which is based on evidence allows for better management of glucoses (meals, insulin sensitivity, organ dysfunction, trending) and decreases hypo and hyperglycemic events.

• NITROUS OXIDE ON FBP: Family Birthplace started offering nitrous oxide as an option for pain control to women in labor.This is becoming a common practice across the US and we are the 3rd hospital in the state of VA and the 1st in the Sentara System to offer this option. It is much like the gas given at the dentist office, but it is mixed with oxygen so the patient gets a low dose and it is safe for baby. About 10% of our patients utilize the gas for pain control (180 per year) so it has proven to be a great option for some patients. This new practice was presented and approved by Medical Executive Committee in February 2018. The RMH Foundation supported the equipment purchase for this patient care initiative.

• STROKE STRETCHER: The American Stroke Association developed “12 Key Best Practice Strategies” for decreasing door-to-intervention times in ischemic stroke patients. One of these key strategies is to transfer patients directly to the CT scanner. The Emergency Department (ED) began using a stroke stretcher in March 2018 to streamline


the door-to-CT process. When EMS reports they have a patient with stroke-like symptoms, they are assigned to the stroke stretcher. On arrival at the ED, the stroke team meets the patient at the stretcher, performs a quick assessment, and takes the patient directly to the CT scanner. In the first week and a half, we saw the median door-to-CTA completion drop by 10 minutes.

• CARE DELIVERY MODEL PILOT ON 4 EAST: This pilot explored partnership models of care delivery supporting relationship based care and retention of nurses while improving select patient and nurse outcomes. Formal focus groups with staff nurses guided implementation of literature findings. Care provided to patients did not change; structure in which care was being provided did change. Unit based shared governance councils designed new assignment guidelines and operational components supporting the model. Evaluation of the new model looked at several factors: patient satisfaction, nurse satisfaction, RN turnover and retention, nurse sensitive clinical indicators, nurse care hours per patient day, and patient mobility interventions. Nurse satisfaction statistically increased. No statistically significant difference in patient satisfaction or clinical outcomes with exception of mobility interventions. Operational care components all improved through the use of mid-shift huddles, proactive meal breaks, and a buddy system.

• CRITICAL CARE PAIN OBSERVATION TOOL (CPOT): The inability to verbally report pain due to mechanical ventilation, sedation, or loss of consciousness does not negate that a patient is experiencing pain and makes accurate assessment by bedside clinicians difficult. When a patient is unable to self-report pain, the next step is to use a valid and reliable pain assessment tool. Sentara RMH was one of three Sentara ICUs to pilot the critical care pain observation tool (CPOT). After a successful pilot, the Critical Care Nurse Practice Forum approved implementation across all ICUs as an available tool for assessing pain in non-verbal adult critically ill patients.

• TRANSITION UNIT: On February 5, 2018, Sentara RMH opened a transition unit on 2 West-A for patients in the Emergency Department who are being admitted but there are no available beds on an inpatient unit. The primary mission of the Transition Unit (TU) is to provide safe, effective and hospital-focused care to patients who are leaving the ED and waiting for transition to their hospital room. The use of the Transition Unit helped to improve treat and admit times from the ED.

• CAUTI CHAMPIONS: Catheter-Associated Urinary Tract Infection (CAUTI) is a serious, life-threatening and preventable complication of an indwelling urinary catheter. In 2018, Sentara Healthcare renewed emphasis on a Life-Cycle Approach to CAUTI Prevention. The CAUTI Taskforce developed a define, design, and implement (DDI) phase I and Phase II resolution. To support and sustain these initiatives, phase II involved implementation of a CAUTI champion program to train and engage frontline content experts for each unit. Jill Delawder, Critical Care Clinical Nurse Specialist, led a sub-team

LEFT: 4E staff


of the CAUTI Taskforce to develop the champion program. The sub-team identified a site lead for every facility that was also a member of the CAUTI taskforce. Each site then identified a co-lead. Managers identified 1-2 staff members for each unit to become CAUTI champions. CAUTI Champions assist in closing practice gaps, reinforce evidence-based practices, assist in attainment of CAUTI goals, utilize approved tools and resources to provide peer coaching, and assist in the analysis of unit based CAUTIs. CAUTI Champions attended a 4-hour instructor led training that occurred from July through September 2018 for designated RNs or LPNs in ED, ICU, IMC, Medical-surgical and OR (women’s-health optional). Champions will attend quarterly training. We hope that the CAUTI champions will help with sustainability through audit, peer coaching, and expert consultation.

In 2018, we had several staff that was involved in nursing research, evidence-based practice (EBP) projects, and quality improvement (QI) projects. Provided below is the list of these projects.

EBP Project Title

Improving team function during Cardiac/Respiratory Arrest in the ED

Improving communication regarding wait times in the ED

Use of a mobility aid for early mobilization of high acuity patients

Best practices for new nurse retention

Assist in decreasing COPD patient readmissions

Comfort Care Resources for Patients

Anxiety and Post-Surgical Pain Management

Management of ETOH detox patients

Perioperative patient warming

Extended Recovery Surgical Patients and Readmission

Phenobarbital vs Benzodiazepines or Alcohol Detox Patients

Alcohol/drug withdrawal interventions Assaults on Nursing Staff

Primary Investigator(s)

Danielle Powers, RN; Sarah Kauffman, RN; Holli Parker, RN

Magdalene Dada, RN; Jessica Dove, RN; Cara Owens, RN;Becky Grogg, RN

Mariah Martin, RN; Brittany DeVore, RN; Kelly Lam, RN;Kristen Fearing, RN

Emmarie Clem, RN; JoAnn Tucker, RN; Josh Stewart, RN

Alexandra Litwiller, RN; Whitney Johnson, RN; Kevin Parks, RNJessica Batac, RN

Nicole Moody, RN; Tanya Bennett, RN; Jami Strawderman, RNAllison Ruhman, RN

Katie Hackenbracht, RN; Marissa Thompson, RN; Amy Carlison, RN

Bethannie Parks, RN; Elizabeth Hassler, RN; Amanda Pyles, RNAriel Bills, RN; Annette Cashatt, RN

Melanie Graves, RN; Angelina Moore- Miller, RN; Sarah Fairweather, RN; Olivia Driver, RN

Aidan Newcity, RN; Kamar Kiser, RN; Kayla Collier, RN

Tessa Dean, RN; Melissa Rhinehart, RN; Hollie Michael, RN

Jonathan McMullan, RN; Justine Paladino, RN; Jaleh Nault, RN

Ashley Andrews, RN; Jacqueline Stevenson, RN; Kimberly Heatwole, RN; Mariah Foltz, RN


Social Media/HIPPA Best Practices

The Role of Discharge Navigator in the Reduction of 30 Day Readmissions

Fight the Foley

Comparison of Readmissions Rates

Promoting Patient Self-Advocacy

Haley Stonebraker, RN; Krystina Poindexter, RN; Veronica Deltoro, RN; Dylan Polley, RN; Brittany Turner, RN

Debbie Kile, DNP, RN, NE-BC; Karen Weeks, MSN, RN

Jill Delawder, DNP, RN,ACCNS-AG, CCRN-CSC

Debbie Kile, DNP, RN, NE-BC

Brandi Burkhart, MSN, RN

Primary Investigator(s)

Valerie Matthews, MS, RNJill Delawder, DNP, RN,ACCNS-AG, CCRN-CSC

Lisa Stroupe-Kephart, MSN, RN, CCRN, CNL

Susan Justice, MSN, RN, CNL

Carlissa Lam, DNP, RN, CCNS, CEN, CPEN

Julie Pierantoni, MSN, RN, CDE

Scott Beckler, BSN, RN


Susannah Lepley; Kathie Zimbro, PhD, RN

Nursing Research Study Title

Implementation of the Critical Care Pain Observation Tool

Failure to Rescue Quality Improvement Initiatives to Improve out-of-CCU Cardiac & Respiratory Arrest Occurrences & Decrease Patient Mortality

Tobacco Cessation for Vascular Patients

Implementation of a Crisis Intervention Team Assessment Center to Decrease Emergency Department Length of Stay for Behavioral Health Patients

Type 2 Diabetes Stigmatization in the Shenandoah Valley of Virginia

Walk Together: Increasing Inpatient Ambulation

The Benefits of a Community-Based Diabetes Program on HgbA1c Levels: A Program Evaluation

Women Rise: Empowering Women to Manage Pain

L TO R: 3W staff, 4W staff, 5W staff


2018 Poster Presentations

DISSEMINATION OF SCHOLARLY WORKAs a Magnet organization, we conscientiously integrate evidence-based practice and research into our clinical practice. We also seek to add to the body of knowledge so that others may learn from us. We were quite busy in 2018 sharing our nursing best practices at local, regional, state, and national events. Kudos to all listed below who disseminated their scholarly work through poster or podium presentation and publications.

Title of Poster/Abstract

“Ischemic Stroke: Transport of the Alteplase Patient”

“Ischemic Stroke: Transport of the Alteplase Patient”

Strategic Goal Alignment with Evidence-Based Practice Projects

Strategic Goal Alignment with Evidence-Based Practice Projects

Systemwide Evaluation of the Efficacy of the Vizient/AACN Nurse Residency Program™

The Use of Education and Cognitive Behavioral Techniques in Managing Nurse-to-Nurse Incivility

Using Community Health Workers in Collaboration with Nurse Case Managers in Effecting Change in Quality of Life for Heart Failure Patients

Using Community Health Workers in Collaboration with Nurse Case Managers in Effecting Change in Quality of Life for Heart Failure Patients


A Multi-site Project to Compare the Predictive Accuracy of the Cubbin-Jackson and Braden Skin Risk Tool in Critical Care Patients

A Multidisciplinary Code Sepsis Team to Improve Sepsis Bundle Compliance in the Emergency Department


Community Based Diabetes Prevention and Self-Management Education







Researchers / Authors

Michael Sumner, BSN, RN

Michael Sumner, BSN, RN

Joanne Williams-Reed, DNP, RN-BC, CNS; Lesley Cook, MSN, RN, NE-BC, Susan Winslow, DNP, RN, NEA-BC

Joanne Williams-Reed, DNP, RN-BC, CNS; Lesley Cook, MSN, RN, NE-BC, Susan Winslow, DNP, RN, NEA-BC

Lesley Cook, MSN, RN, NE-BC; Joanne Williams-Reed, DNP, RN-BC, CNS;

Deborah B. Kile, DNP, RN, NE-BC;

Patra H. Reed DNP, RN, CNML, CCCTM; Donna S. Hahn DNP, RN, NEA-BC

Patra H. Reed DNP, RN, CNML, CCCTM; Donna S. Hahn DNP, RN, NEA-BC

Deborah B. Kile, DNP, RN, NE-BC

Jill Delawder MSN, RN, ACCNS-AG, CCRN-CSC; Samantha Leontie BSN, RN, CCRN

Jill Delawder MSN, RN, ACCNS-AG, CCRN-CSC









Where presented National (N) Regional (R) Local (L)

(N) Vizient national conference

(R) Sentara Stroke Symposium

(N) Vizient NRP Conference at Savannah, GA

(R) NLA at Sentara

(R) NLA at Sentara

(R) Sentara Nursing Leaderhip Symposium

(R) NLA at Sentara

(R) Virginia Doctors of Nursing Practice Conference

(R) Virginia Doctor of Nursing Practice Conference

(N) Doctors of Nursing Practice Conference in Palm Springs, CA

(L) SRMH Nursing Symposium Harrisonburg, VA



(R) Virginia Nurses Association Conference, Richmond, VA

(L) Critical Care Trauma Symposium Norfolk, VA

(L) Critical Care Trauma Symposium Norfolk, VA

(R) VONEL, Williamsburg, VA

(R) VONEL, Williamsburg, VA

(R) Sentara Nursing Unit Coordinator Conference

Date

March 2018

March-18

Mar-18

Jun-18

Jun-18

Jun-18

Jun-18

Jul-18

Jul-18

Sep-18

Sep-18

Sep-18

Sep-18

Sep-18

Oct-18

Oct-18

Oct-18

Oct-18

Nov-18


2018 Podium Presentations Title of Presentation / PowerPoint


Education and the Use of Cognitive Behavioral Techniques in Managing Nurse-to-Nurse Incivility

Education and the Use of Cognitive Behavioral Techniques in Managing Nurse-to-Nurse Incivility


University-to- Community Partnerships that Support Health Advocacy in the Shenandoah Valley





Julie Pierantoni, MSN, RN


Date & Place Presented: National (N) Regional (R) Local (L)

September 2018; (N) Doctors of Nursing Practice Conference; Palm Springs, CA

September 2018: VNA Fall Conference; Richmond VA

December 2018: VNA webinar; Harrisonburg VA

September 2018: VNA Conference, Richmond, VA

November 2018; (L) JMU’s National Conference on Engagement

2018 PublicationsTitle of Publication

Community Health Worker Program Cuts Costs, Admissions for Heart Failure Patients

The Effectiveness of Education and Cognitive Rehearsal in Managing Nurse-to-Nurse Incivility: A Pilot Study


Patra H. Reed, DNP, RN, CNML, CCCTM

Deborah Kile, DNP,RN, NE-BC

Journal / Month / Pages

Hospital Case Management/ May 2018/Vol. 26, No. 5; p. 61-72

Journal of Nursing Management, 2018;00:1–10.

L TO R: Michael Sumner, Lesley Cook, Julie Pierantoni, Patra Reed, Debbie Kile

Samantha Leontie & Jill DelawderJill Delawder


Members of the Falls Steering Team

EMPIRICAL OUTCOMESSentara RMH nurses take ownership of nurse-sensitive indicators, including Falls with Injury, Hospital Acquired Pressure Injuries (HAPIs), Catheter Associated Urinary Tract Infections (CAUTI), and Central Line Blood Stream Infections (CLABSI). Each year, we set stretch goals to further improve our patient outcomes. Below are the 2018 outcomes.

FALLS WITH INJURYSentara RMH met the falls w/ injury goal in 2018. Our goal for falls with injury was a rate of 0.395–or 21 or less falls with injury. We finished the year with 18 falls with injury, which was a rate of 0.373. This was a decrease from 27 falls with injury (rate of 0.55) in 2017. Thanks to the Falls Steering Team and all of our staff for focusing on fall prevention strategies and keeping our patients safer!

Jan-‐ 18

Feb-‐ 18

Mar -‐18

Apr-‐ 18

May -‐18

June -‐18

Jul-‐ 18

Aug-‐ 18

Sep-‐ 18

Oct-‐ 18

Nov -‐18

Dec-‐ 18

fall w/ injury rate 0.624 0.000 0.471 0.735 0.000 0.245 0.265 0.262 0.985 0.497 0.260 0.000 goal 0.395 0.395 0.395 0.395 0.395 0.395 0.395 0.395 0.395 0.395 0.395 0.395

0

0.2

0.4

0.6

0.8

1

1.2

Falls with Injury Rate

2018 SRMH Falls w/ Injury 2018 SRMH Falls w/ Injury


HOSPITAL ACQUIRED PRESSURE INJURIES (HAPIs) STAGE II & ABOVEWe also met our 2018 goal for HAPIs Stage II & Above. Our goal was a rate of 1.70 or 19 or less Stage II & above HAPIs. We finished the year with 7 Stage II & above HAPIs, which was a rate of 0.64 for the year. This was a decrease from 11 Stage II & above HAPIs (rate of 0.99) in 2017. We were #1 in the Sentara system in 2018! Thanks to the HAPI Team and everyone for focusing on pressure injury prevention strategies and keeping our patients safer.

Jan-‐ 18

Feb-‐ 18

Mar-‐ 18

Apr-‐ 18

May-‐ 18

June-‐ 18 Jul-‐18 Aug-‐

18 Sep-‐ 18

Oct-‐ 18

Nov-‐ 18

Dec-‐ 18

HAPI Stage II & above rate 0.00 2.29 2.04 1.18 0.00 0.00 0.00 1.19 0.00 0.00 0.00 1.09 Goal 1.70 1.70 1.70 1.70 1.70 1.70 1.70 1.70 1.70 1.70 1.70 1.70

0.00

0.50

1.00

1.50

2.00

2.50

3.00

Rate pe r 1,000 Admiss ions

2018 SRMH Stage II & Above HAPIs

HAPI Team

2018 SRMH Stage II & Above HAPIs

CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS (CLABSI)Our goal for 2018 was to achieve two or less CLABSIs. We did not meet our goal. We had five CLABSIs in 2018. However, we do continue to outperform the National Database of Nursing Quality Indicators (NDNQI) benchmark for the majority of our units.

Jan-‐ 18

Feb-‐ 18

Mar-‐ 18

Apr-‐ 18

May -‐18

Jun-‐ 18

Jul-‐ 18

Aug-‐ 18

Sep-‐ 18

Oct-‐ 18

Nov-‐ 18

Dec-‐ 18

CLABSI 0 0 0 0 2 1 0 0 1 0 1 0

0

0.5

1

1.5

2

2.5

Raw # of CLABSIs

2018 SRMH CLABSIs 2018 SRMH CLABSIs

CATHETER ASSOCIATED URINARY TRACT INFECTIONS (CAUTI)Our 2018 goal was to achieve less than seven CAUTIs at SRMH. We did not meet our goal. We ended the year with a total of 15 CAUTIs for the year. However, we do continue to outperform the National Database of Nursing Quality Indicators (NDNQI) benchmark for the majority of our units.

2018 SRMH CAUTIs


TOP TO BOTTOM:ED staff, FBP staff, Perlop staff, Tx Ctr staff


2018 CLINICAL PI GOALSBelow are the 2018 clinical performance improvement (CPI) goals and SRMH’s performance to the goals. We did not meet our goal to achieve 3 of 4 CPI goals.

HOSPITAL READMISSION Less than 14.1% hospital readmission within 30 days

measured Aug – Oct

Green indicates meeting/exceeding goal

Yellow indicates close to meeting goal

Red indicates not meeting goal

GOAL 1 14.5%

INPATIENT MORTALITY Inpatient mortality limit of a 0.80 ratio

measured Sep – Nov

GOAL 2 .57%

TREAT & RELEASED 50% of ED patients Treat & Released within 120 minutes


GOAL 3 28%

TREAT & ADMITTED 40% of ED patients Treat & Admitted within 240 minutes


GOAL 4 37%


PATIENT SATISFACTIONAs shown by the graph below, SRMH met our inpatient HCAHPS 2018 goal. Our goal was 73.5 and our actual score was 74.7. Thank you for all of your hard work in improving our patients’ experience.

RN TURNOVERSRMH’s 2018 overall nursing turnover rate was 10.9%. According to the 2018 National Healthcare Retention & RN Staffing Report, which is one of the largest healthcare retention survey databases, in 2017 the average nursing turnover in hospitals was 16.3%. Meanwhile, Sentara’s aggregate 2018 nursing turnover rate was 14%.

40%

55%

70%

85%

100%

HCAHPS Top Box Rate Sentara RMH - % of responses scoring 9 or 10 of 10

Goal

74.7 72.7 74.4

2018 Goal =73.5

HCAPS Top Box Rate Sentara RMH-% of responses scoring 9 or 10 of 10


SENTARA’S NURSING MISSION STATEMENT: Why We ExistWe improve health every day through nursing excellence.

SENTARA’S NURSING VISION STATEMENT: What We Seek to BeTo create an environment of health and healing.

SENTARA’S PHILOSOPHY OF NURSINGWe Believe:

• The foundation for our work is a culture of safety and accountability;

• Our nursing practice foundations differ between facilities as we respect the culture, history, and diversity of patient populations;

• Our responsibility is to create a caring and compassionate relationship with patient/client/family;

• As nurses, we collaborate with the healthcare team to use evidence-based practice in providing care;

• Nurses assess, manage, coordinate and evaluate the care and education of the patient/family along the continuum of care.

• Our vision is to create an environment of health and healing.

NURSING - Sentara Healthcare · 2019-08-07 · Rebecca Winters, OR, CNOR Savannah Southard, OR,...

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Transcript of NURSING - Sentara Healthcare · 2019-08-07 · Rebecca Winters, OR, CNOR Savannah Southard, OR,...