My name is Russ Schroeder and

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1 Volume 1 Issue 1 September 2016 CONTENTS Transformational Leadership 1 Letter from the CNO Relationship Based Care Nursing PERK Program Structural Empowerment 3 Shared Governance Celebrating Nurses Week Professional Practice 5 Think Like a Nurse Charge Nurse Conference Innovation and Improvement 6 Nurse Certification Delayed Bathing Pressure Mapping Evidence-Based Practice Nurse Preceptor Program Letter From The CNO My name is Russ Schroeder and it s my pleasure to join you as your interim Chief Nursing Officer. It is also my pleasure to present the inaugural issue of Nursing Matters, St. Anthony s nursing newsletter. The purpose of this newsletter is to create a formal dialogue among nursing colleagues about innovation in professional practice and to celebrate the great work that happens here at St. Anthony s. Please send me, or any of the nursing leadership team, any topics of interest that you would like to see featured in future issues. Furthermore, if you feel that a Russ Schroeder, MS, BSN, RN Interim Chief Nursing Officer certain department, team, or caregiver deserves recognition for elevating professional practice, please let us know so we can spotlight them in this newsletter. In my short time here I can honestly say that I am impressed with the nursing care being provided here. I want to thank everyone for the warm welcome I have received. I m looking forward to meeting more of you and working with you. Russ Schroeder, MS, BSN, RN, Interim Chief Nursing Officer

2 Transformational Leadership Relationship-Based Care at St. Anthony s Medical Center In 2015, St. Anthony s Medical Center adopted Relationship-Based Care (RBC) as our Professional Practice Model of care. The implementation of RBC has been a hospital-wide effort to build on St. Anthony s guiding principles (own patient safety, be nice, work hard, and accommodate) by focusing on individual employees and their relationships with their patients, co-workers and self. Relationship-Based Care is supported by evidence to improve the patients experience and satisfaction, and also to improve the employees experience and satisfaction. When those two important aspects of health care improve, patient outcomes and hospital quality improve as well. To execute RBC, St. Anthony s has utilized Shared Governance as the decision-making model, which relies on the problem-solving skills and teamwork of front-line caregivers to promote evidence-based, best practice. Using RBC guidelines while supporting employees to put them into action, with a special emphasis on developing relationships, provides a strong foundation for nurses and all caregivers. It s about me and my team, how I m interacting with people and how I m feeling, so I can give the best care to my patients stated Carol Ellis, MSN, RN, NEA-BC, Vice President of Nursing at St. Anthony s. Departments that have or will enter into the RBC journey, known as a wave, attend training and are assigned a St. Anthony s RBC leader who provides guidance and support. To date, three waves have been implemented, with the majority of nursing units and support departments participating. Staff members have been encouraged to reflect on processes within their unit and select initiatives based on identified areas of opportunity unique to their department. The teams that have been involved so far are highly motivated. They have faced bumps in the road, but they have been able to overcome them. Managers are involved as well, and when employees encounter barriers, the manager can step in and help with those. The managers have learned a lot about their teams through RBC, and having the opportunity to engage in the improvement of patient and employee satisfaction has been rewarding. According to Carol, Relationship-Based Care has opened up a way of thinking that is whole: It s not pieces or parts, it s everything we do. This is what relationshipbased care is all about. What is the best for the patient, how can I ensure that it is the best workflow for me and my co-workers, and how do we make that happen? This is an exciting time for St. Anthony s, our patients, our employees and our community! Carol Ellis, MSN, RN, NEA-BC, Vice President, Nursing SOME CHANGES THAT HAVE RESULTED FROM RBC: Designation of Dedicated Break Spaces Patient Care Acuity Boards Compassion Fatigue Recognition Healthy Interpersonal Relationships A Shift in Focusing on What is Most Important to the Patient Carol Ellis, MSN, RN, NEA-BC Vice President, Nursing Nursing P.E.R.K. Clinical Ladder Program Nursing P.E.R.K. Recipients at the 2015 Award Ceremony. The Nursing P.E.R.K. Program at St. Anthony s Medical Center was initiated in July The program is designed to recognize and reward excellence in clinical practice, leadership, professional growth, and active engagement within the organization. Nurses have the opportunity to enroll annually in the year-long program which promotes Patient care of the highest quality; Engagement, recruitment, and retention of staff; Recognition and reward for performance; and Knowledge and competence at the bedside. The program consists of three levels, with eligibility requirements and reward compensation increasing with each. To date, 14 RNs have successfully completed the program, resulting in a total payout of nearly $30,000. Several additional portfolios from the 2015 fiscal year are currently in review. Awards are expected in September Karla Herrington, MSN, RN, Department of Professional Practice & Staff Development 2 St. Anthony s Medical Center

3 Structural Empowerment Shared Governance at St. Anthony s Nurses need to feel empowered; we have the ability to influence what changes are made to our nursing practice and the care we give at the bedside, explained Alyssa Lehr, SICU RN, Chair of the Nurse Practice Council. For change to happen there has to be a team with the motivation and desire to improve outcomes. Shared Governance is not a new concept at St. Anthony s Medical Center, but participation over time has dwindled. In the past, being a part of shared governance was an extra, added responsibility for nurses who wanted to get involved; but nursing has grown as a profession and taking ownership of your practice is now the obligation for all nurses. Whether you are a part of a hospitalwide council or a member of your unit-based council, the responsibility of improving standards of care to benefit patient outcomes is the goal of nursing every single day. In accordance with the implementation of Relationship-Based Care (RBC), it was clear that this was the opportunity to make a change to support the revitalization of Shared Governance at St. Anthony s. The implementation of RBC has empowered nursing divisions to reinvigorate their unit councils, with goals of identifying opportunities for and executing improvement of collegial relationships, patient and family relationships, and practice standards. Each council is unique in their mission and vision, but all have the same goal of promoting staff satisfaction and improving patient safety. Karen Wray, explained, As nurses, we see our patients at their worst. Being the chair of the Quality Council, our members are empowered to identify issues and to seek ways we can elevate our standards to provide the best care for our patients we are entrusted with each day. Shared Governance promotes change, team work, and professional accountability to improve not only the care provided to our patients at St. Anthony s, but also to support the morale of all staff working to meet their needs. NURSE RESEARCH COUNCIL The Nurse Research Council utilizes nurses as the forefront to create an evidence-based practice culture at St. Anthony s Medical Center. The council aims to promote nursing as a scientific career and encourages others to carry out clinical inquiry and creative thinking. As a brand new council, there is abundant opportunity, and through guidance by a PhD prepared mentor, Jenny Broeder, Interim Dean at Webster University, the council members are discovering the possibilities of how nursing research can impact patient care at St. Anthony s. The council meets on the second Tuesday of every month from 8:30-10:00 AM. NURSE PRACTICE COUNCIL The Nurse Practice Council strengthens the voice of the nursing staff at St. Anthony s to provide insight, promote change, and to make decisions to create a united and inviting work environment for all frontline staff. Some of the major accomplishments this year include the recruitment of members from each nursing division; development of a subcommittee to improve handoff communication between nursing units, including the Emergency Department and Hyland Behavioral Health; and enhanced incentives for the nursing staff holiday rotation. The Nurse Practice Council meets on the 4th Wednesday of every month from 12:00-1:30 PM. NURSE QUALITY COUNCIL The Nurse Quality Council promotes the quality of nursing care to ensure the efforts to elevate patient safety and evidence-based standards of care are effective, efficient, and equitable. Nursing Quality Indicator data serves as the foundation for the council s purpose of identifying hospital-wide patient safety and quality issues, along with solutions to improve the outcomes of patient care. The council meets on the first Tuesday of every month from 8:00-9:30 AM. NURSE TECHNOLOGY COUNCIL The Nurse Technology Council s mission is to streamline the nursing documentation process and to improve workflow for nursing staff within the electronic medical record (EMR). The Technology Council was instrumental in creating the Patient Overview screen, aka Patient Story, which was implemented in January 2016 to streamline the bedside report process. The council s mission is vital to not only improving nursing workflow, but also in meeting requirements that influence reimbursement and reflect the care each patient receives within the organization. The Technology Council meets on the 4th Wednesday of every month from 2:00-3:00 PM. ADVANCE PRACTICE PROVIDER COUNCIL The mission of the Advanced Practice Provider Council is to unify the voices of the Advance Practice Nurse, Clinical Nurse Specialist and Physician Assistant in order to provide evidence-based, cost-effective, patient-centered care throughout our facilities and the community. The council aims to promote the role of the advanced practice nurse as a mentor to direct care nurses, along with improving collegiality with all members of the healthcare team. The council holds open meetings scheduled on a month-to-month basis. Kelly Russell, MSN, RN, CMSRN, Department of Professional Practice & Staff Development Nursing Matters 3

4 Structural Empowerment Celebrating Nurses Week Nurses Week at St. Anthony s Medical Center was celebrated May 8 May 14. This year s theme, Culture of Safety, It Starts with You, encouraged nurses to focus on themselves. As busy healthcare professionals in charge of delivering the highest quality patient care in St. Louis, it s easy to sometimes forget to care for ourselves, said Carol Ellis, Vice President of Nursing. To this end, a variety of activities offered during the week were both fun and educational, including a professional development day, a series of compassion fatigue seminars, an education fair and yoga classes. There was food too lots. Nurse Managers distributed donuts to weekend shift employees. Popular area food trucks served authentic Cajun and Mexican food. Over 3000 Italian ices were handed out to all hospital employees and an Italian-themed lunch was offered in the cafeteria. In addition, 1200 T-shirts were given out to RNs, NPs and LPNs to celebrate their dedication and commitment to the patients we care for. Multiple pairs of Cardinals baseball tickets were also raffled off throughout the week. But Nurses Week isn t just about giving back to our amazing staff. Every year the Nurses Week Committee runs a concurrent charitable drive for a local non-profit organization; this year s drive was for Lydia s House, an organization that works to end domestic violence by being a place of healing and a voice of hope for abused women and their children. Hundreds of desperately-needed goods and supplies were donated by St. Anthony s employees to directly help local families bridge the gap between emergency shelters and safe, independent living. To all our nursing staff, thank you for a wonderful Nurses Week and for your tireless commitment to serving the greater South County community. Christian Trokey, Executive Assistant to the CNO & VP, Nursing Nurses participating in a Blessing of the Hands by Pastoral Care. Staff visiting the food truck during Nurses Week. Staff visiting the Shared Governance Poster Fair during Nurses Week. Staff enjoying A Night in Italy with an Italian-themed dinner, along with games and other festivities, during Nurses Week. 4 St. Anthony s Medical Center

5 Exemplary Professional Practice Learning How to Think Like a Nurse In March 2016, a group of nurses from St. Anthony s had the privilege of attending the Learning How to Think Like a Nurse conference held at the University of Missouri Columbia, along with nurse preceptors, clinical instructors and educators from around the region. The conference focused on identifying new, more effective ways to teach clinical reasoning skills to new nurses and nursing students. There were several takeaways that I found to be helpful Liz Warden, Telemetry (left) and Liz Weseman, Ortho (right) at the Learning How to Think Like a Nurse conference. Several nurses in leadership roles at St. Anthony s Medical Center had the privilege of attending the Charge Nurse Leadership Development Conference at the Tan-Tar-A Resort at Lake of the Ozarks in May The conference was filled with charge nurses, managers, and other leaders in nursing throughout the Midwest. It was led by Elizabeth Larson, M.S., B.A., R.N., a passionate nurse with an impressive background. The interactive, two-day conference discussed many topics involving the role of the leader on the frontline. Several of these topics included the essential leadership traits of a nurse, communication techniques, conflict resolution, time management, and leadership styles. The speaker incorporated activities to allow charge nurses to work together and learn from one another. Since the role of charge nurse varies greatly by organization, in my own practice as a preceptor, both for new RNs and student nurses completing their clinical rotations at St. Anthony s. One main topic of discussion was what it means to think like a nurse. Clinical judgment is the process by which nurses make their decisions about patient care throughout the day, whether it takes time and effort or comes naturally from years of experience. It is patient-focused and individualized, and includes interpreting patients needs, recognizing and responding to changes in patients situations, deciding how and when to take action, and knowing which assessment data is relevant for each situation. Although clinical judgment develops with experience, there are several things we can do as preceptors to help foster this in our new co-workers. nurses were able to provide helpful ideas and feedback to each other through conversation and interactive activities. To begin the conference, participants were divided into many groups. The assignment for each group was to draw a picture of what a While many new nurses begin their career with a list of tasks they learned in nursing school, developing clinical judgment is more challenging and time consuming. As we learned at the conference, asking questions is one of our most powerful tools during nursing orientation. For instance, instead of just asking your preceptee which patient they re planning to see first, ask them how they arrived at that decision. Instead of pointing out abnormal labs, ask the orientee if there s anything about the lab values that concerns them. It is also helpful for them to hear you thinking your own thought process out loud. Verbalize how you re going through the decision-making process and encourage them to do the same. Starting the habit of thinking out loud early can make a huge difference in developing new nurses from novices to independent critical thinkers. Sandra Trieb, BSN, RN, Medical Oncology/ Neuro Charge Nurse Leadership Development Conference Lindsey Ponder, BSN, RN, Medical Telemetry, and Missy Benoist, BSN, RN, General Surgery, at the Charge Nurse Leadership Development Conference. charge nurse looks like. After completion, the pictures were hung up for everyone to see and compared to one another. While all of the pictures differed in many ways, they all had one thing in common, a big heart drawn in the center of the page. This served as a reminder that sometimes we need to take a step back and remember why we became nurses in the first place. Elizabeth has had much success in the nursing field and said she would not be where she is today without love for the job. She quoted from another speaker, to be successful, the first thing you must do is fall in love with your work. We all have a desire to make a difference, and that is exactly what we do every day. Each of the St. Anthony s nurses who participated was thankful for the opportunity and looks forward to putting the lessons learned into practice. Missy Benoist, BSN, RN, General Surgery Nursing Matters 5

6 Innovation and Improvement Nursing Certification Several studies indicate that organizations which support and encourage their nurses to achieve professional certification in their chosen field report increased RN satisfaction and improved patient quality outcomes. Nursing Leadership at St. Anthony s Medical Center (SAMC) has committed to assisting nurses with advance payment of fees required to sit for professional certification exams. Nurses who presently hold a professional certification may also be reimbursed for their recertification fees. Ainsley Breedlove, BSN, RN, CCRN and Lisa Devore, RN with the certification recognition plaque in SICU. In the near future, certification recognition plaques will be displayed in each nursing unit, listing the name of each nurse from that unit who has achieved certification. Nurses who participate in the PERK Clinical Ladder Program receive points for their certification and are recognized and celebrated annually in March on Professional Certification Day through efforts coordinated by the Department of Professional Practice & Staff Development. As certification is a voluntary process, nurses at SAMC who achieve this distinction demonstrate the upmost commitment to their professional development, along with the dedication to providing the best care to every patient, every day. Michelle Jost, MA, BSN, RN, Director of Professional Practice & Staff Development Teresa Readenour, BSN, RN, Family Birth Center, with the delayed newborn bathing patient education board. Delayed Newborn Bathing The Family Birth Center at St. Anthony s Medical Center has benefited from having a strong unit-based council in place for over two years. With the recent integration of Relationship- Based Care (RBC), the council has evolved and shifted focus to leadership within the department, as well as developing and applying research-based, patient-centered practices. The team decided to research practices related to delayed newborn bathing after a staff member presented information about the new recommendation to the unit council. Members then reviewed current World Health Organization (WHO) recommendations and found that according to WHO, delaying the newborn bath for a minimum of eight hours improves stabilization of newborn body temperature and blood glucose levels, in addition to enhancing breastfeeding and maternal-newborn bonding. The council worked for over a three-month period to assemble a delayed bathing protocol, communicate changes in practice to physicians and unit staff, and develop education strategies for patients. The Family Birth Center initiated delayed bathing at the end of May Prior to implementing these new guidelines, babies born at St. Anthony s were bathed approximately one hour after birth. The recent changes have already proven to be successful as the mother is able to have her infant skin-to-skin for a longer period of time after birth, which leads to improved breastfeeding in those first few hours of life. Since the changes were implemented, the council has been tracking patient satisfaction scores related to preparation for discharge. The goal is to see an improvement in those scores over the next three months. Although some staff resisted the proposed changes in practice, members of the council worked with their peers to overcome barriers. The ownership and responsibility for implementing evidencebased nursing practice within the unit has given council members a sense of accomplishment and pride. Not only has the ability to change practice been fulfilling to staff, knowing they are basing practice on current evidence leaves them feeling confident that they are providing the best care to every patient, every day. Carrie Aten, RN, Family Birth Center; Marybeth Hurd, BSN, RN, Family Birth Center; and Julie Long, RN, Nurse Manager, Family Birth Center 6 St. Anthony s Medical Center

7 Innovation and Improvement Debbie Coleman, BSN, RN, CWOCN-CRN with a pressure mapping poster she presented at the 2015 European Pressure Ulcer Advisory Panel (EPUAP) conference in Belgium. Pressure Mapping at SAMC Four times a year, the SWOT (Skin, Wound, Ostomy Team) Department at St Anthony s Medical Center (SAMC) collects and analyzes NDNQI (National Database of Nursing Quality Indicators) data to identify opportunities for improvement in pressure ulcer prevention. Even with advanced support surfaces, combined with turning and repositioning schedules, pressure ulcers continue to develop, affecting 7.4 million people annually worldwide. Research has suggested that repositioning interventions alone do not effectively minimize high tissue pressures and that each patient needs to be repositioned based on individual needs. Unfortunately, caregivers only know if their turning and repositioning techniques are ineffective when damage occurs. With this knowledge, SWOT nurses implemented a month-long trial with a continuous bedside pressure mapping (CBPM) system in the Surgical Intensive Care Unit (SICU). CBPM allows caregivers to monitor whether the surfaces under the patients, as well as turning and repositioning techniques, effectively redistribute pressure. Nurses were able to use images from CBPM to assess areas of high pressure and as a result, redistribute these pressures with microshifts (small adjustments made with the draw-sheet) and airbed adjustments. Individual repositioning techniques based on CBPM resulted in optimal pressure redistributions, along with a consistent reduction in peak pressures by 25%. Following these outcomes, a similar trial was initiated in the Operating Room with the goal of reducing OR-attributed pressure ulcers or injury. St Anthony s Medical Center became the second hospital in the country to utilize mapping technology in the OR. A task force of staff from the OR and the SWOT Department evaluated additional methods of decreasing pressure, including new surfaces, adding waffle cushion under the sacral area, modifying the sacral prevention protocol, and other process changes within the peri-operative phase. These initiatives promoted a reduction in Hospital Acquired Conditions (HAC) stemming from the OR from 61% to 20% over the past year. The information gained from these trials has resulted in an understanding of what is truly going on beneath patients. This new technology is providing the medical community with insight that was previously unavailable. As a result current standards of care in turning and repositioning patients every two hours will likely change stated Debbie Coleman, BSN, RN, CWOCN-CRN of the SWOT Department. Debbie Coleman, BSN, RN, CWOCN-CRN, Skin, Wound, and Ostomy Team Evidence- Based Practice in Nursing Conference This past April, a handful of St. Anthony s nurses had the great opportunity to attend a conference in Columbia, MO that focused on evidencebased practice (EBP), and how and why it is so important to integrate into medical practice. According to the conference s keynote speaker, Susan Stillwell, DNP, RN, CNE, ANEF, FAAN, evidence-based practice is the standard to transforming healthcare, and that healthcare outcomes improve by 28% if EBP principles are followed. Patient care is enhanced by taking into account the best available evidence and nursing expertise, along with the values and preferences of the individuals, families, and communities who are served. EBP changes a medical community s culture from simply carrying out rituals, to promoting a culture of asking questions. According to Einstein, Doing the same thing over again and again and expecting different results is the definition of insanity. This conference brought to light how often medical professionals do things a certain way simply because that s how we ve always done it. It s time to start asking questions and take advantage of our resources to answer these questions. Obviously, there are always obstacles to making widespread change, but as long as there is commitment and dedication, there is always opportunity for improvement. We have a developing Shared Governance program at St. Anthony s, as well as plenty of new nurses joining our team with new ideas and motivation, who will serve as catalysts to becoming an evidence-based practice community. Corey Oberlander, BSN, RN, Medical Oncology/Neuro Nursing Matters 7

8 St. Anthony s Medical Center Kennerly Rd. St. Louis, MO NON-PROFIT US POSTAGE PAID ST. LOUIS, MO PERMIT 121 Nursing Matters Volume 1, Issue 1, September 2016 Nurse Preceptor Program Preceptors play an invaluable role in the successful transition of nurses to new work environments, competency development, job satisfaction, and ultimately, retention of staff. At St. Anthony s Medical Center (SAMC), preceptors serve as education coaches who direct clinical practice and assist with orientation of new nurses and nursing students. The role includes evaluation of educational needs and learning opportunities for nursing staff utilizing staff input, physician feedback, and observed performance through day-to-day, face-to-face guidance. Preceptors are also challenged to serve as role models who support and encourage professionalism, self-awareness, and critical thinking. The Nurse Preceptor Program is designed to provide the tools required for nurses to perform the role of preceptor to the best of his or her ability. New preceptors are encouraged to attend the Missouri Hospital Association (MHA) Preceptor Academy, a full-day workshop offered several times annually throughout the St. Louis area. These academies, which serve as the foundation for preceptor education, provide in-depth training that fosters professional growth and enhances leadership skills of preceptors. In addition, workshops offered at SAMC through the Department of Professional Practice and Staff Development build on the material offered through MHA. Topics are diverse and specific to the nurse population at St. Anthony s. St. Anthony s has about 250 approved nurse preceptors at any given time. Nurses who express an interest in becoming a preceptor must fill out a preceptor application and gain approval from management. Those who have completed the application and who precept St. Anthony s employees are eligible to receive a preceptor differential. Application forms and additional information can be located by visiting the Preceptor Development Program Page on the St. Anthony s Medical Center website at stanthonysmedcenter.com/employees/preceptor-development- Program. Nurses attending the Preceptor Workshop at St. Anthony s in April Karla Herrington, MSN, RN, Department of Professional Practice & Staff Development