ANNUAL NURSING REPORT 2013
Table of Contents Letter from the CNO 1 Demographic Information 2 Our Nursing Philosophy 3 Transformational Leadership 4 2014-2016 Nursing Strategic Plan 2009- Strategic Goals and Accomplishments Leadership-Advocated Resources CNO s role in Big Sky Medical Center Development Chats with the Chief : Summary and Description Structural Empowerment 11 Shared Decision Making Professional Development Clinical Advancement Ladder Mentorship Program Nurse Residency Program and Preceptor Workshop Community Outreach Exemplary Professional Practice 19 Professional Nursing Defined Interdisciplinary Collaboration to Improve Patient Outcomes Improving Care Delivery and Patient Satisfaction Providing Family Centered Care New Knowledge, Innovation and Improvement 24 Quality Management National Safety Summit Nurse-Led Research Innovative Strategies Awards and Recognition 27 CNOR-Strong Designation National Certifications in 2013 Daisy Awards Accolades Organization Awards Summation 32
Dear nursing colleagues, patients, families, and community members, I have the distinct privilege of introducing you to the 2013 Annual Nursing Report for Bozeman Deaconess Health Services. This first annual report is dedicated to the more than 500 LPNs, RNs and APRNs at BDHS who are committed to caring for our patients and their families. The numerous accomplishments highlighted in the pages of this report are impressive, leading us to the affirmation that nursing plays a key role in providing an excellent patient experience. The commitment, engagement and leadership demonstrated by the nurses at BDHS in their care of patients and their families are unparalleled. Many times every week, I am privileged to read the expressions of gratitude from patient and families whose lives have been positively and dramatically impacted by the nurses who have cared for them. We are living in an era filled with dramatic, rapid changes in the way healthcare is provided and how it is reimbursed. In this changing environment, the one constant will always be the patient s need for excellence in care and experience. Now, more than ever before, the nurses role is essential to providing safe, quality, effective and efficient care to our patients. BDHS nurses have proven their ability to adapt to the changing environment while continuing to maintain their commitment to the patient and their family. I am extremely proud to have the opportunity to partner with BDHS nursing professionals. My commitment to each of you is continual leadership to reach higher levels of excellence while providing an environment of professional growth and development, and opportunities for shared decision making. Thank you to each member of our nursing team. May you celebrate our nursing accomplishments as you review this report. Vickie Groeneweg, MSN, RN, MBA Chief Nursing Officer 1
Demographic Information Bozeman Deaconess Hospital is a Joint Commission certified, licensed Level III trauma center located in Gallatin County. The 86-bed facility serves southwest Montana, including Gallatin, Madison and Park counties. Bozeman Deaconess Health Group is a multi-specialty group providing patients access to a variety of primary care and specialty physicians and healthcare professionals. Together we make up Bozeman Deaconess Health Services, where our caring staff ensures that care is integrated and specialized to meet the evolving needs of our community. Bozeman Deaconess Health Services has 1560 employees. Registered Nurses (RNs) comprise 27% of employees at our organization. Direct Care Positions: 277 RNs in our Hospital 84 RNs in our Health Group Indirect Care Positions: 57 RNs in our Health Services 418 RNs total at our organization Licensed Practical Nurses Direct Care Positions: 12 in our Health Group 2 in our Hospital 14 LPNs total in the organization Advanced Practice Registered Nurses Direct Care Positions: 2 in our outpatient procedural areas 11 in our Health Group 13 APRNs total at Bozeman Deaconess Health Services Direct Care RN Demographics Age and Experience Educational Preparation Employment Status Mean unit RN age is 42 years 23% with five or fewer years practice experience 54% with greater than ten years practice experience 5% report Masters or Doctorate education level 68% report Baccalaureate education level 25% report Associate education level 2% report Diploma education level 99% report receiving education in the U.S. 58% full time 33% part time 9% casual call 2
Our Nursing Philosophy At Bozeman Deaconess Health Services, we are committed to a Culture of Excellence. Additionally, Deaconess Hospital :: Hillcrest Living mission, :: vision, and Bozeman Deaconess Group webozeman are committed to Bozeman Deaconess HealthSenior Services values in anhealth effort to meet our goal to be an organization of excellence that challenges all of us to be the best that we can be. We believe nursing at Bozeman Deaconess Health Services is an essential profession, promoting commitment to a Culture of Excellence. Mission. To improve community health and quality of life. Vision. Our Values: What we believe. To be a leading integrated health system, ranked in the top 10% in the nation by 2016. S Service: We believe service excellence is critical to our mission P People: We believe people are our most important resource I Integrity: We believe relationships are built on honesty and trust R Respect: We believe each person is unique and worthy of respect I Improvement: We believe continuous improvement of quality and safety is key to our success T Teamwork: We believe teamwork and communication are essential in achieving excellence 3
Transformational Leadership 2014-2016 Nursing Strategic Plan This plan provides our entire division with an inspirational guide for achieving our ultimate goal of nursing and patient care excellence. Our strategic planning process involves all levels of nurses from the direct care RN all the way to the CNO. Magnet Component Transformational Leadership GOAL Strategy Date Develop strong risk-taking leaders who model and articulate nursing excellence in dayto-day operations All Nurse Managers with National Certification Establish Nursing Manager Core Competencies based on ANA s Scope and Standards for Nurse Administrators All Nursing Leaders involved in National Professional Organizations Establish Tuition Reimbursement program Develop and implement Nursing Leader Academy All Nursing Leaders will have a succession plan CNO will participate in credentialing of all APRNs ANA s Scope and Standards of Nurse Administrators implemented as basis for job description and evaluation CNO has relationship shown both structural and operational in all areas in which nursing is practiced 2015 2014 3rd Quarter 2015 2014 4th Quarter Develop 2014 Implement 2015 2014-3rd Quarter 2014 3rd Quarter 2014 3rd Quarter 2014 4th Quarter Structural Empowerment Create a structural framework for the development, implementation and sustainability of patient care excellence Establish RN-Physician Council to develop and sustain patient care collaboration Establish Patient-RN Council to improve the delivery of patient care 75% of RNs participating in professional organizations Establish and sustain BSN level education at >80% for all direct care RNs Develop and implement required ANCC Policies Establish participation by APRNs in Shared Governance Implementation of self evaluation and peer evaluation into staff annual performance evaluation Establish Nurse Manager Leadership at the MSN educational level 2014 4th Quarter 2015 2014: 25%; 2015: 50%; 2016: 75% 2014: Establish; 2015/16: Sustain 2014 3rd Quarter 2014 4th Quarter 2014 4th Quarter 2020 4
Transformational Leadership Exemplary Professional Practice Attract, develop and retain competent, compassionate nursing professionals committed to excellence in nursing practice Increase RN Certifications to 50% Extend Certification pay to RNs in BDHG RN Satisfaction Scores in 75th percentile as measured by NDNQI Develop and implement clinical continuing education plan Develop and implement Nursing Professional Ethics Council 2016 2015 2016 2014 4th Quarter 2014 4th Quarter New Knowledge, Innovation and Improvement Create an environment conducive to the improvement of nursing practice through knowledge and innovation. Develop and implement Nursing Grand Rounds Establish Journal Club Develop and implement BDHS IRB Support RN Lead research projects yearly Develop and implement Nursing Research Residency Program 2014 4th Quarter 2015 2014 2014: 1 project 2015: 2 projects 2016: 2 projects 2015 Empirical Outcomes Create a culture of superior clinical performance Achieve top 10th percentile in all Nurse Sensitive Indicators as measured by NDNQI Achieve top 75% for all HCAHPs components by 2016 Achieve 5 of 8 consecutive quarters of required data above national benchmark Formalize Community impact plan for BDHS Nurses 2016 2015 2015 1st Quarter 2014 4th Quarter Professional Advisory Council 5
Transformational Leadership 2009- Strategic Goals and Accomplishments Our strategic goals and accomplishments are a direct result of all levels of nurses working together and collaborating with other disciplines to improve patient care and drive excellence. GOAL Strategy Date Completion 1. Create a structural framework for the development of patient care excellence 1. Develop a Magnet Steering Committee 2. Establish Magnet Leadership Councils: Leadership, Quality, Recruitment and Retention, Professional Growth and Development, Research 3. Develop a Professional Model of Nursing Practice 4. Develop Mission, Vision, Values for Patient Services 5. Develop organizational chart for Patient Services 6. Conduct Gap Assessment for Patient Care Services 7. Formulate a 3-year Strategic Plan for Patient Services 8. Develop Nursing Dashboard with Clinical and Operational Metrics 9. Develop and implement Shared Governance 10. Form collaborative partnership with local bargaining unit for Magnet Project 11. Develop Patient Services communication plan 12. Reorganization of Nursing and Patient Care Services reporting to CEO 2009 2009 2009 2009 2009 2009 2009 2009 2010 2009-2011 2010 2011 1/2009 3/2009 5/2009 5/2009 12/2009 12/2009 9/2009 12/2009 6/2010 6/2010 In progress 2. Develop strong, risktaking leaders who model and articulate nursing excellence in day-to-day operations 1. Provide access to a national periodical database for utilization to implement evidence-based practice 2. Implement formal nurse leader continuing education, i.e. Nurse Managers Academy 2009 2009: CINAHL 2011: Added Nurse Reference Center CARRY OVER 3. Establish nursing manager core competencies based on ANA Standards for Nursing Administrators CARRY OVER 4. Implement staffing ratios benchmarked to the NDNQI survey findings 2010: 10th Percentile 2011: 25th Percentile 2013: 50th Percentile 12/2010: Assessed with return of NDNQI data 5. Develop Competency based evaluation process 2010 11/10/2010 6
Transformational Leadership 6. Nursing Leaders to NDNQI and Magnet national conferences 2010-2011- 2010: 5 Nurse Managers + CNO 7. Develop Clinical Ladder 2011 8. Nursing Leaders involved in national professional organizations (100%) CARRY OVER 9. Develop Succession Plan In progress 10. Collaborate with MSU for online Nursing education (advanced degrees) CARRY OVER 11. Develop tuition reimbursement program for patient care leaders 2014 CARRY OVER 12. Require/encourage patient care leaders educational advancement; MSN required of nursing managers 2015 CARRY OVER 3. Create a culture of superior clinical performance 1. Engage in the National Database of Nurse Quality Indicators 2. Establish nursing research partnership between BDH Patient Services and MSU School of Nursing 2009 2009-2010 9/2009 8/2009 3. Evaluate and change nursing processes according to evidence-based practice 2010-2011- In Progress 4. Establish a Nursing Peer Review committee 2009 9/2009 5. Maintain real-time Joint Commission readiness 2009-2010- 2011- In progress 6. Identify and initiate unit-based quality projects which result in change of practice 2009-2010- 2011-10/2010: CQI Training of UBC Chairs, projects initiated 7. Identify, display and communicate quality metrics to department and staff 2011 In progress 8. Implement NUR, emar and Bedside Medication Verification 2009 3/2009 and 8/2009 9. Provide access to a national periodical database for implementation of EBP 2009 9/2009 10. Identify and develop clinical centers of excellence Pain, Ortho, Cardiac and Stroke 2011-- 2013 CARRY OVER 11. Establish unit-based practice and quality councils in all patient care areas 2010 6/2010 12. Score > 90% in all Nurse Sensitive Indicators 2010-2011- ongoing In progress 13. Develop Medical Library 2013 2013 7
Transformational Leadership 4. Create a relationship driven, patient- and family-focused organization with emphasis on an excellent patient experience 1. Score >90% in the HCAHPs Inpatient Patient Satisfaction Survey (all domains) 2. Evaluate patient care areas to determine environmental improvements needed to enhance patient and family centered, relationship-based care 3. Develop and implement plan to improve patient care environment to enhance patient and family centered care 2010: 75% 2011: 90% 2010 2010-2011- Q1-3 2010: 74% In progress 11/2010 5. Attract, develop, engage and retain competent, compassionate nursing professionals 1. Define Professional Nurse at Bozeman Deaconess Health Services 2. Develop/foster physician/nurse partnerships (Based on 2009 Physician Survey) 2009 2010-2011- 10/2009 Ongoing 3. Investigate/research recruitment/retention best practices 2010 In progress 4. Develop and implement formalized reward and recognition plan for nursing 2010-2011 6/ 5. Develop recruitment/retention plan 2011 In progress 6. Implement Clinical Ladder 7. Support and encourage RN certification in area of practice Ongoing 8. Transform nursing practice from task orientation to professional nursing practice 2010-2011- Ongoing 9. Implement unit-based self-scheduling CARRY OVER 10. Develop competency based orientation and evaluations CARRY OVER 11. Enhance and formalize on-site continuing education 2011-11/2010 12. Introduce mandatory continuing education requirements 2011 2011 13. Establish tuition reimbursement program 2014 10/2010: Montana BON 6. Utilize technology for nursing care delivery to streamline processes, improve communication, handoffs and discharge and engage in patient care 1. Implement electronic nursing documentation 2. Implement emar and Bedside Medication Verification 3. Replace Nurse Call Light System 4. Implement software to optimize gathering of nursing operational metrics 2009 2009 2013-14 1/2009 3/2009 CARRY OVER 8
Transformational Leadership 7. Utilize technology for nursing care delivery to streamline processes, improve communication, handoffs and discharge and engage in patient care 1. Reduce Serious Safety Events by 80% 2. Implement STAR program 3. Implement SBAR communication tool 4. Improve reporting on Near Miss safety events 5. Improve processes identified in Near Miss reporting 1. 2010-2011 2. 2010 3. 2010 4. 2010-2011- 5. Ongoing 1. In progress 2. 10/2010 3. 10/2010 4. In progress 5. In progress Leadership-Advocated Resources Recognizing better ways to provide care and comfort to patients and advocating for those resources is part of nursing at Bozeman Deaconess. To that end, our Chief Nursing Officer and Nursing Managers successfully advocated for $1.7 million in 2013 to purchase new hospital beds for all rooms, and to replace the existing call-light system, which integrates call lights, alarms, room-to-room communications and an employee tracking system with central monitoring. These equipment purchases represent a great investment in patient safety and satisfaction, and staff satisfaction. 9
Transformational Leadership CNO s Role in Big Sky Medical Center Development Vickie Groeneweg, MSN, RN, MBA Chief Nursing Officer Our Chief Nursing Officer not only influences organization-wide change surrounding nursing practice, she also influences change beyond the scope of nursing. Vickie Groeneweg, MSN, RN, MBA, has been involved in the strategic planning of the new medical facility being built in Big Sky. Our Chief Nursing Officer: 1. Participated with senior leadership in strategic planning for advancing into the Big Sky market. 2. Reviewed and conferred with senior leadership on FTE s to staff Big Sky Medical Center. 3. Participated with senior leadership and the architectural firm to design the Medical Center. 4. Provided direct input into the design and furnishing of the Emergency Department and patient rooms. 5. Provided oversight of the clinical function of the Medical Center for inpatient and ambulatory care. For more information on Big Sky Medical Center visit: bigskymedicalcenter.com. Big Sky Medical Center Chats with the Chief: Summary and Description Chats with the Chief have provided a forum for the Chief Nursing Officer to directly communicate important nursing issues to members of the Department of Nursing. For each Chat, twelve one-hour sessions provide opportunity for all nursing staff to attend. In 2013, three Chats were held. January, 2013 May, 2013 October, 2013 Direction of Nursing in 2013 was the theme with 112 nursing professionals attending. What Piece Will You Be in Our Journey to Excellence focused on the meaning of excellence and how it is measured. There were 105 nursing professionals attending. Professional Nursing: Florence, If You Could See Us Now focused on nursing as a profession and the responsibility nurses have as professionals. 128 members of the Department of Nursing attended. 10
Structural Empowerment Shared Decision Making We believe all levels of nurses chief nursing officer, managers, and direct care staff hold the authority, accountability, and professional responsibility to govern their practice. That is why we created the first Shared Governance structure in 2008, and have continued to function very well within our Shared Governance model throughout 2013. The structure we ve built incorporates a network of eight Leadership Councils and nine Unit Based Councils that facilitate the nurses ability to govern nursing practice at Bozeman Deaconess Health Services. Our Shared Governance structure was formalized by adopting organization-tailored by-laws. Currently, our Councils are functioning under our by-laws to effectively promote autonomous practice governance. Our Shared Governance structure has inspired Nutrition Services, Respiratory Services, and Pharmacy Services to develop shared-decision-making councils of their own. Leadership Council Evidence-Based Practice Chair: Lynnora Jetter, RN, CEN Accomplishments Initiated Critical Thinking project Policies and Procedures: Reviewing outdated policies Ensuring EBP is included Switching to Lippincott Online Leading Nurses in EBP Updated Care Plans to meet state requirements Research Chair: Sandi Burgard, MSN, RN Offered Guided Discovery Workshop series Mentored nurse-led research Developed and proposed Institutional Review Board (IRB) policy at BDHS 11
Structural Empowerment Nurse Informatics Chair: Amanda Dewit, BSN, RN Designed layout of Nursing webpage for BDHS website Created Nursing Informatics SharePoint tab Mentored Colleagues in use of Excel to compile data and create graphs Offered education courses on the use of Excel Conducted Nursing Informatics Learning Needs Assessment Assisting with adoption of a new electronic health record (EPIC) Professional Growth and Development Chair: Heather Egstad, BSN, RN Modified Clinical Advancement Ladder 2013 criteria to meet nursing needs Introduced Clinical Advancement Ladder to Health Group RNs Developing Nurse Residency Program Recruitment and Retention Chair: Christine Benbow, BSN, RN Coordinated three Daisy Awards to recognize exceptional nurses Hosted founders of the National Daisy Award Ensured high participation rates in the NDNQI RN Satisfaction Survey Created reward baskets and delivered to departments with 100% participation in NDNQI RN Satisfaction Survey Models of Care Chair: Carrie Waddell, BSN, RN Offered continuing education on Professional Practice Model Sent RNs to RBC Leadership Conference Redesigning the PPM and CDS Nursing Peer Review Chair: Kaylee Davies, BSN, RN, ONC Reviewed multiple cases to determine if standard of care was breeched Created plan to reduce nurse anxiety and fear with council appearances Determined changes to practice that improve patient care Quality and Safety Chair: Barb Johnson, RN, BSN Received education to become Performance Improvement Mentors for colleagues Initiating plans for incorporating Safe Patient Handling and Mobility standards Unit Based Council Bozeman Deaconess Health Group Chair: Amber Dubay, BSN, RN Accomplishments Created Community Resource phone list for the organization Developed medication titration process and charting procedure Incorporated hypertension worksheets throughout practices Initiated Nurses Prevent Failure Performance Improvement Project Wound Clinic Chair: Crystal Marx, BSN, RNC, CWCA Designed daily Safety Huddle morning practice Initiated Performance Improvement project on Provider Wait Time Initiated Hemoglobin A1C Performance Improvement project Working with other units on reducing hospital acquired pressure ulcers Hosted Bozeman Wound Conference 12
Structural Empowerment Surgical Floor Chair: Amanda Tempero, BSN, RN, ONC Initiated Quiet Please Performance Improvement project Organized Aide and Unit Clerk Appreciation Celebration Initiated Bedside Reporting framework Worked with ER to improve patient admission process Initiated Performance Improvement Project on decreasing noise Developed Mentor Program for new graduates Medical Floor Chair: Rye Cech, BSN, RNC Instituted Bedside Reporting Initiated Unit acuity system to help with patient assignments Improving Direct Admittance process Creating hallway bulletin board Initiated Performance Improvement on starting IV antibiotics Started Safety Huddle practice in the mornings Used team building strategies: celebrations, Facebook page, softball team Surgical Services Chair: Michelle Elder, RN Implemented Handoff throughout Surgical Services using a standardized green sheet Initiates better staff communication throughout surgical services Emergency Department Chair: Jason Buchovecky, BSN, RN Improving department communication: UBC bulletin board, emails, posting meeting minutes, direct people to SharePoint Initiated Performance Improvement Projects: hand washing, allergy banding, specimen labeling Developed department Vision Statement Planned Emergency Nurses Week Celebration Coordinated Certification Review course at BDHS Improving ED throughput, collaborating with other units Endoscopy Chair: Stacey Rugheimer, MSN, RN Initiated Teambuilding project Improving communication between GI clinic and Endoscopy to reduce errors Intensive Care Unit Chair: Susie Frederickson, BSN, RN Implemented Infection control project on C.Diff Improving communication between UBC and staff through Buddy System Initiated Performance Improvement project on reducing noise at night Monitored Sedation Vacation documentation and practice Initiated bedside reporting Assisted with Sepsis SIM Family Birth Center Chair: Heidi Godwin, BSN, RN Instituted Bedside Reporting Initiated Performance Improvement project on patient satisfaction: courtesy and respect Reducing patient interruptions project Initiated project on improving patient satisfaction: cleanliness of room 13
Structural Empowerment Professional Development The Education Department is an approved provider for continuing education through the Montana Nurses Association and the American Nurses Association. To provide multiple opportunities for professional development, the Education Department and educators planned for, coordinated and/or presented multiple continuing nursing education offerings in 2013. Activity Title Total Number of RN Participants for the Year 14 Total Number of Contact Hours Offered per Activity PAIN RESOURCE UPDATE 27 4.00 EVIDENCE-BASED PRACTICE 37 2.25 ACLS NEW PROVIDER 4 10.42 RELATIONSHIP-BASED CARE 16 11.75 ACLS NEW PROVIDER 4 10.42 PEARS PROVIDER 6 6.33 PALS NEW PROVIDER 6 13.92 CHEMOTHERAPY/BIOTHERAPY 9 6.75 PROGRESSIVE CARE UNIT 12 6.75 ACLS NEW PROVIDER 6 10.42 FETAL & INFANT LOSS 6 2.00 ACLS NEW PROVIDER 7 10.42 PEARS PROVIDER 9 6.33 PALS NEW PROVIDER 6 13.92 RELATIONSHIP-BASED CARE 16 11.75 ACLS NEW PROVIDER 5 10.42 CINAHL 7 1.00 PRECEPTOR WORKSHOP 12 4.25 ACLS NEW PROVIDER 4 10.42 PALS NEW PROVIDER 3 13.92 ACLS NEW PROVIDER 7 10.42 PRECEPTOR WORKSHOP 18 4.25 STABLE 16 7.25 PALS NEW PROVIDER 9 13.92 CHEMOTHERAPY/BIOTHERAPY 6 5.75 ACLS NEW PROVIDER 5 10.42 ACLS NEW PROVIDER 10 10.42 SEPSIS WORKSHOP 18 2.10 CAN'T BREATHE, CAN'T FUNCTION 0 0.00 PEARS PROVIDER 8 6.33 SEPSIS WORKSHOP 27 2.10 PROGRESSIVE CARE UNIT 12 6.75 WOUND CARE CONFERENCE 44 6.25 ACLS NEW PROVIDER 8 10.42 PAIN RESOURCE UPDATE 20 4.50 SURGICAL CARE CONFERENCE 37 6.25 Total Number of Offerings Total RN Participants Total Contact Hours Offered 36 447 274.57
Structural Empowerment Clinical Advancement Ladder The Clinical Advancement Ladder was designed, implemented and is maintained by the Professional Growth and Development Council, which is comprised of direct-care nurses, educators, and managers. It was created by nurses for nurses, to promote growth and advance professional nursing practice. In 2013, the Division of Nursing recognized 22 Registered Nurses in the completion of a portfolio to achieve Clinical Nurse I or II. In 2014, we have 81 nurses intending to complete a portfolio submission and achieve recognition on the Ladder. That s 22% of our Registered Nurses striving to grow and develop professionally to advance nursing practice, which will ultimately result in the improvement of patient care. CONGRATULATIONS 2013 CLINICAL ADVANCEMENT LADDER NURSES! Clinical Nurse I: Michelle Elder; Lynnora Jetter; Audrey Higley; Stacey Rugheimer; Lynn Gray; Shannon Gaines; Annemarie Bodner; Theresa Hollowell; Lisa Riggin; Stewart Chumbley; Melissa Harrigan; Becky Pierce Clinical Nurse II: Jamie Swandal; Lauren Vinson; Allison Armitage; Heidi Godwin; Katy Osterloth; Kimberly Todd; Rye Cech; Kaylee Davies; Cortney Harrison; Crystal Marx Clinical Nurse I Exemplar: Becky Pierce, BSN, RN, a direct-care nurse on the Medical Unit, completed and submitted a portfolio to achieve Clinical Nurse I recognition. Becky has been practicing for more than 20 years as a Registered Nurse and has been at Bozeman Deaconess Health Services for 12 of those years. To achieve recognition on the Ladder, Becky assisted the Gallatin County Health Dept. with an annual vision screening at a local elementary school. She stated that volunteering to assist with the school s vision screening engages me to be involved in the school and part of the community. Beyond community service, Becky precepted newly graduated nurses, participated as a member of the Recruitment and Retention Council, was a team leader on the Medical Unit, served as a wingman to her colleagues, and became certified in the protection of human subjects in research studies. We re proud to have Becky practice at this organization and commend her efforts to advance professional nursing practice and improve patient care delivery. Becky Pierce BSN, RN Medical Floor The Clinical Advancement Ladder is a structure that supports a lifelong learning culture that includes professional collaboration and the promotion of role development, academic achievement, and career advancement (ANCC, 2013). The Clinical Advancement Ladder is a guide that helps nurses formally support organization goals, advance the nursing profession and enhance professional development (ANCC, 2013). The Commission on Magnet Recognition, (2013). 2014 Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center. 15
Structural Empowerment Clinical Nurse II Exemplar: Heidi Godwin, BSN, RN, CLC, a direct-care nurse in the Family Birth Center, completed and submitted a portfolio to achieve Clinical Nurse II recognition. Heidi has been a practicing Registered Nurse for nearly five years, all at Bozeman Deaconess Health Services. Heidi exemplifies the Clinical Nurse II. She volunteered 60 hours of community service to the Rocky Mountain Childbirth Conference, a non-profit dedicated to delivering an annual low cost, high-quality conference on childbirth-related issues for nurses in Montana. Through this experience, Heidi stated that she has become...inspired to be a leader. This experience has brought many positive attributes to my career, from simple things like effectively running a meeting, to borrowing ideas on how to effectively enhance teamwork, to utilizing an interconnected pool of experts to design research. She also was proud that she achieved a personal goal of getting a grant proposal funded to keep this conference affordable. We re very proud of the initiative Heidi took and the leadership she demonstrated through this service. Heidi also precepted new nurses, chaired her Unit Based Council, became certified in the protection of human subjects in research, worked as a Certified Lactation Consultant, completed 65 continuing education credits and was a member of the Association of Women s Health, Obstetrics, and Neonatal Nurses. Because of Heidi, nurses around the state have access to education regarding evidence-based maternal-newborn care and practices. She is improving maternal-newborn care beyond the Gallatin Valley, which will improve the health and quality of life for many generations. Mentorship Program The Surgical Unit Based Council at Bozeman Deaconess Hospital implemented a mentoring program for nurses in June 2013, which continues offering collegial assistance to new nurses once they have completed their 10-week orientation. In the program s first six months, nine pairs of mentors/mentees were initiated. In most cases, the mentored nurse requested that their preceptor continue as their mentor. The mentors are available to answer questions about clinical aspects of the job, hospital policies and more, or when the new nurse simply needs to express concerns or frustrations. The informality of the program, requiring minimal paperwork, provides a simplified way for the new nurses to ask questions and feel connected, vastly increasing their sense of comfort and confidence while also giving the mentor a chance to perform a purposeful check-in in person. Mentors and mentees, who are required to meet at least once every six weeks, together decide how often and when they meet. Several pairs meet monthly for breakfast to discuss questions and issues that have occurred, while others schedule competency testing at the same time so they can meet afterwards. Mentors are always just a text or phone call away, as well. The program is geared to helping recently hired nurses become better caregivers. The goals are to increase their confidence in their skills, which helps increase job satisfaction, length of tenure and willingness to pick up extra shifts. Having a specific person of whom they can ask questions reduces the likelihood of errors and improves overall patient safety. The Unit Based Council will evaluate the program in mid-2014, and make changes with input from the current participants. The program is expected to be expanded to other nursing departments in the near future. 16
Structural Empowerment Mentor/Mentee Exemplar: Hailey Young, BSN, RN, says there can be a lot of adjustment anxiety as a newly graduated nurse, so it s important to have a colleague you can speak with comfortably about professional issues. Young, who has worked at BDH for a year, was delighted to be able to participate in the Surgical Unit s mentorship program, with her preceptor Megan Litle, BSN, RN, continuing as Young s mentor. The relationship provides Young an opportunity to discuss difficult situations, get work-related questions answered, or simply voice frustrations to a colleague without discomfort, and gives Litle the same opportunities in return. Working the night shift together, they can touch base on the job when the need arises, and go out for coffee about once a month for more in-depth discussions. Their conversations often cover the emotional side of nursing, such as dealing with difficult patients whether from behavior issues or a bad diagnosis. The two plan to continue meeting after the formal program ends. Young and Litle recommend the program for all new nurses, pointing to the success of their own connection. Having started work in a large group of new graduates, Young said the mentorship program also made them a better team because it required the new nurses to branch out and build relationships with other nurses. Litle and Young say their similarities have led to a friendship based on trust. It was nice that I could choose my own mentor, Young said. It doesn t take a lot of effort. That, said Litle, means it was a good match. Nurse Residency Program and Preceptor Workshop The Institute of Medicine (IOM) collaborated with the Robert Wood Johnson Foundation (RWJF) to create a Report on the Future of Nursing. This report contained a number of recommendations, including one regarding health care organizations need to support nurses completion of a transition-to-practice program. The Education Department manager, Sandi Burgard, MSN, RN, and the clinical nurse educators developed a Preceptor Workshop and hosted two sessions in June and August. The Preceptor Workshop provides strategies for being an effective preceptor to nurses throughout the organization. Educating and equipping preceptors with invaluable tools helps meet the recommendation made by the IOM and RWJF to successfully transition new nurses into the workforce. Thirty participants gained an understanding of the skills needed to be an effective preceptor and learned practice strategies to improve the precepting experience for both themselves and the nurse being precepted. Additionally, to help new nurses safely and successfully transition to independent practice, the Professional Growth and Development Sandi Burgard, MSN, RN Education Council collaborated with Sandi to establish our first-ever Nurse Residency Program. The Nurse Residency Program was designed in 2013 and is being implemented in 2014 to include monthly interactive educational activities for new graduate nurses throughout the organization. The Nurse Residency Program and the Preceptor Workshop together will significantly impact the quality and safety of patient care delivery through the effective transition of new nurses into actual clinical practice. 17
Structural Empowerment Community Outreach Community Care Connect (CCC), a mobile outreach program, is a partnership among Bozeman Deaconess Health Services, Gallatin City- County Health Department, Gallatin County Food Bank, Community Health Partners and the local Human Resource Development Council. This mobile outreach is offered via a bus that has been remodeled to provide on-site health screenings, immunizations and information. On June 25, 2013, the CCC vehicle was featured in the Bozeman Daily Chronicle because of the program s significant efforts to connect the community to much needed health screenings and other services. Health screenings are provided through CCC free of charge to all, particularly the uninsured or underinsured population in our tri-county area. It travels hundreds of miles to rural towns like West Yellowstone, Manhattan, Belgrade and Three Forks, as well as offering services in the Bozeman community. Members of the healthcare team staffing the vehicle include phlebotomists, nurse practitioners, pharmacists, registered nurses, CCC coordinator and registrar from Bozeman Deaconess Health Services. The staff provides free health screenings such as breast exams, blood pressure checks and body-mass indexing, blood draws for glucose levels, cholesterol, complete blood count and comprehensive metabolic panel, as well as medication counseling and providing referrals to low-cost and free clinics if more medical care is indicated. Our nurses also provide many of the same screenings and services at the Health Screening days held annually in Bozeman and Big Sky, at several community trade fairs each year including Babes in Bozeman and the Women s Expo, and provide medical care at community athletic events such as the annual 3-on-3 three-day street basketball tournament. Our nurses are dedicated to positively impacting the health of the community and have demonstrated that by offering their services through community outreach. Nurses who worked at Bozeman Deaconess-sponsored events in 2013 include: Loretta Bendz, Amy Braaksma, Nicky Buck, Kristen Cotton, Judy Douglas, Allison Duffy, Tara Faris, Lynda Gullett, Melissa Harrigan, BreAnn Hebel, Shandi Hertz, Audrey Higley, Theresa Hollowell, Jocelin Jenkins, Shannon Lester, Marjorie Martin, Crystal Marx, Kathryn Nass, Joni Oswald, Rebekah Pierce, Hannah Pulaski, Tracy Reamy, Lisa Riggin, Cathy Rogers, Amanda Salzer, Janet Smith, Lisa Sorensen, Judy Sorg, Lisbeth Stump, Jaimie Swandal, Lindsey Taylor, Kimberly Todd, Nita Wade. 18
Exemplary Professional Practice Professional Nursing Defined Definition of Professional Nursing Professional nursing at Bozeman Deaconess Health Services is practiced through patientcentered caring relationships, utilizing clinical judgment and advocacy in the care of individuals, families, communities and populations, to promote, improve, maintain, or recover health; to cope with health problems; and to achieve the best possible quality of life, whatever the disease or disability, from the beginning of life all the way through a dignified death. Theoretical Beliefs Patient and Family Centered Care is built upon the belief that care should be designed to meet the unique needs of each individual patient and family. The care provider conveys an unwavering respect and personal concern for the patient, strives to understand what is most important to each patient and family, safeguards their dignity and well-being, and actively engages them in all aspects of care. Using multiple caring theories from Jean Watson, Kristen Swanson, Madeline Leiniger, and Sharon Dingman, we believe there can be no curing without caring. Establishing caring, therapeutic relationships with the patient and family, with our colleagues, and with ourselves will fully allow us as nurses to provide a healing environment and deliver excellent patient care (Koloroutis, 2004). Evaluating the Models of Care The Models of Care Council, comprised of direct-care nurses, managers, and educators from various departments, are evaluating and modifying the existing Professional Practice Model to establish a new and improved model that best fits nursing at Bozeman Deaconess. This model will serve to provide the Division of Nursing with a common identity and guidance on practicing as professional nurses. Interdisciplinary Collaboration to Improve Patient Outcomes Collaboration between professions and disciplines directly correlates to better, safer patient care. To ensure our staff is equipped with the tools they need to collaborate effectively, we ve been careful to include all disciplines when running simulations. 19 Simulation I Noelle gave birth seven times in January, and hemorrhaged two hours later after each birth, but survived all seven times. Noelle, of course, is not human; she is a simulation mannequin used at Bozeman Deaconess Health Services to train nurses and other providers in safety issues and safety processes. More than 90 people, divided into seven teams with physicians, nurses, technicians and support staff participated in the simulations caring for a
Exemplary Professional Practice postpartum hemorrhage patient. They included obstetricians, family practitioners, anesthesiologists and certified nurse midwives with privileges at Bozeman Deaconess. Simulations provide an opportunity to practice CRU, which stands for Cooperative- Respectful- Unified, to create a team framework. It is the basis of Phase II of Bozeman Deaconess safety culture work. CRU teaches staff to think and work as a team, allowing them to figure out processes and communication issues they may face with no cost to a real patient. Safety consultant Craig Clapper, founding partner of Healthcare Performance Improvement, which helped design the exercise with a team from Swedish Simulation and Innovation out of Seattle, said such healthcare simulations provide three benefits: training on protocols, training of people as a team, and facilities testing. Simulation II Sepsis is a system-wide infection that can lead to multi-organ failure if not caught and treated in time. Bozeman Deaconess Hospital conducted simulations of patients suffering from sepsis diagnosed in the ER and then transferred to ICU, to learn where sepsis care can be improved. BDHS staff members spent six months designing the simulation which was enlightening for both ER and ICU nurses, as staff learned how situations are handled in other hospital departments. About 100 employees participated, including staff from the ER, ICU, radiology, laboratory, pharmacy and respiratory services, nurse supervisors, and physicians. Each group treated a lifelike mannequin in the ER, where a newly implemented sepsis protocol was initiated and then transferred the patient to an ICU nurse and critical care physician. One common finding was staff were hindered by communication barriers, particularly due to a lack of integration between the ER and ICU computer systems, making verbal communications crucial. Since a key component to sepsis care is the patient s fluid status, staffers are developing systems to ensure the ICU is alerted to the amount given in the ER. The SIM demonstrated the BDHS commitment to teamwork, and was a stellar example of CRU closed loop communications, staying with your wingman, teamwork and clearly identified roles, and clear concise communication and how it is implemented at BDHS. 20
Exemplary Professional Practice Improving Care Delivery and Patient Satisfaction Our nurses are dedicated to safe, high quality nursing care delivery. They find evidence-based solutions to problems they encounter when caring for patients. One program in which we take pride is our Safety Coach program. At Bozeman Deaconess we have 75 interdisciplinary safety coaches, many of whom are nurses. Our safety coaches are specifically trained in the science of safety, and spend countless hours improving practices to ensure that we reach our goal of zero preventable harm. Heather Davis story: Heather Davis, RN, CNOR Surgical Services In caring for children, proper dosing of medications and use of correct size equipment depends on their weight. During a medical trauma, access to that information can be all important in providing adequate care as quickly and safely as possible. That s why Heather Davis, RN, CNOR, an anesthesia nurse in Bozeman Deaconess Hospital s Surgical Services and a Safety Coach, devised a plan to identify all pediatric patients with an ankle band indicating the patient s actual weight in kilograms that is now used hospital wide. While all hospital patients get a wrist band with a number of identifying factors, the ankle band is used solely to indicate weight of patients younger than age 15, and is more easily reached in an emergency situation, according to Patient Safety Coordinator Kimberli Herring, BSN, RN. Use of pediatric weight-based banding will improve safety and continuity of care, said Davis. Justin Elder s story: Justin Elder, RN, BSN ICU Ensuring that nurses and medical providers stay up-to-date on the condition of each patient and issues affecting the department are always important components in providing high quality and safe care. Safety Coach Justin Elder, RN, BSN, saw a way to improve the level of communication about safety issues and patient care in the Intensive Care Unit. Many hospital departments have implemented morning safety huddles, where staff are encouraged to discuss safety thoughts and concerns for that particular day. We already did our version of that informally during the change-of-shift group report, Elder said. I thought we should make it part of our reporting system so we can get more ICU RNs involved. Now, the Charge RN each shift is responsible for taking a two-minute time out for safety during the group report to discuss any safety concerns for that shift. Each morning the Charge RN reports the previous day s concerns to the department manager, who brings them to senior staff at the morning Safety Huddle. Crystal Marx s story: Crystal Marx, RNC, BSN, CWCA, Clinical Supervisor in the Bozeman Deaconess Wound Clinic and Safety Coach, realized that when diabetic patients Crystal Marx, RNC, BSN, CWCA Wound Clinic 21
Exemplary Professional Practice came into the clinic for care, staff didn t have a standardized way to validate their hemoglobin A1C or blood glucose level. We see about 80 diabetic patients a month, but we weren t tracking their long-term blood glucose levels, said Marx. We had been taking the patient s word for what it was, without actually knowing how long it had been since they had a reading. Working with the Wound Clinic Unit Based Council, Marx developed a policy to monitor patients hemoglobin A1C levels more closely by communicating with primary providers and the Diabetes Center, and created a database to track this information. Now staff know patients actual levels and how that affects their healing, while involving the patient more effectively in their own healthcare. Amanda Tempero s Story: Getting a good night s rest is an important part of the healing process, particularly for surgery patients at Bozeman Deaconess Hospital. Amanda Tempero, Amanda Tempero RN, BSN Surgical Services RN, BSN, coordinated with her colleagues on the Surgical Unit Based Council to address this issue. By minimizing interruptions, shutting doors at night for appropriate patients, decreasing the call system volume at night, consistently informing patients of noise expectations and providing sleep masks and ear plugs in all admissions packets, the Surgical Unit exceeded its goal of 60% patient satisfaction on night noise. In fact, they reached 66.7% in the second quarter of 2013, far above the national average of 54.3%. 22
Exemplary Professional Practice Lactation Counselors Help Moms Find Breastfeeding Success Bozeman Deaconess Women s Center lactation coordinator established new goals to help make breastfeeding a successful experience for new mothers and their babies. Lactation counselors who are also RNs work with patients before and after their babies are born, providing training and information on milk production, feeding cues and adequate nutrition through breast- or bottle-feeding, during hospital stays, once they are home and after mothers return to work. With 100 babies born at Bozeman Deaconess Hospital each month, the counselors offer assistance to new mothers while they are in the hospital, help them develop plans for breastfeeding after returning home, and for more changes when the moms return to work. Mothers can be seen on an out-patient basis by the lactation specialists as long as they need or want the help. Counselors also expanded their out-patient clinic efforts by working with the Gallatin Breastfeeding Coalition and helping sponsor the Baby Bistro at the Bozeman Public Library. Three Bozeman Deaconess lactation counselors have earned IBCLC (International Board Certified Lactation Consultant) status: Beckie Walters, BSN, RN, IBCLC, RLC, Nancy Thompson, BSN, RN, IBCLC, RLC, CCE, and Bernadette Neuman BSN, RN, IBCLC. Beckie Walters, BSN, RN, IBCLC, RLC, Nancy Thompson, BSN, RN, IBCLC, RLC, CCE Family Birth Center 23
New Knowledge, Innovation and Improvement Quality Management Bozeman Deaconess Health Services Quality Department focuses on ensuring that patients receive highly reliable care from providers and staff, as well as working collaboratively with others to eliminate preventable harm at BDHS. They extensively track outcomes data to determine areas for opportunity and improvement. The department, staffed primarily by nurses, takes a 360 view of all issues relating to quality and safety, and tries to connect other staff, patients and community members with resources they need to get answers to their questions. Specific issues are handled by the following nurses: Hollie Raycraft, BSN, RN: Director of Quality Management Rene Fredette, BSN, RN: Risk Manager/ Surgical Quality Andrea Roberts, BSN, RN: Joint Commission Accreditation Coordinator/Patient Relations Tracy Knoedler, BSN, RN, MPH: Infection Prevention Coordinator Kim Herring, BSN, RN: Patient Safety Coordinator Karen Lanz, BSN, RN: Patient Relations Carrie Corwin, BSN, RN: Core Measure Coordinator Marie Hamilton, RN: Ambulatory Care Quality Improvement Coordinator Allison Treloar, MN, RN, CNL: Maternal Newborn Quality Coordinator Quality Department 2013 National Safety Summit Patient Safety Coordinator Kim Herring, BSN, RN, was selected to present the successes of Bozeman Deaconess Health Services safety program at Safety Summit 2013: A Decade of Navigating Toward Zero Events of Harm. Herring presented with Craig Clapper, founding partner of Healthcare Performance Improvement (HPI), which hosted the Summit and advises BDHS on its safety initiative. They spoke about building collegial interactive teams, a concept called CRU, or Cooperative-Respectful-Unified, at BDHS. Kim Herring, BSN, RN Quality 24
New Knowledge, Innovation and Improvement HPI cited BDHS and Herring for the outstanding work done in applying CRU concepts in simulation. The work in terms of planning, execution, and developing communication tools for CRU is absolutely the best in our client community, Clapper said. Herring spoke about the safety program at our hospital, like BDHS s Great Catch hotline, safety posters, Who s Your Wingman contest, Safety Starts With Me video, promoting the Five Safety Habits, and the ratio of 72 safety coaches to 86 beds. She credits BDHS success to the unrelenting commitment of the Board and Administration, and saturating the BDHS community with the concept of reducing preventable harm. Now in Phase II, BDHS is promoting CRU to build teamwork skills among all staff and providers and to become highly reliable. We have to work toward having every single person practice safety all the time, and do what they do correctly every time, Herring said. We have to develop good teamwork skills. And we have to learn to give people feedback, tell them when they are contributing to the cause of safety and when they are not. Nurse-Led Research Currently our organization conducts many research studies to identify new and innovative treatments and practices. Our Cancer Center is part of the Seattle Cancer Care Alliance and diligently conducts clinical trial studies in search of new treatments and cures for cancer. Montana State University, with its main campus also in Bozeman, also conducts many studies through our organization, such as methods to improve patient flow through surgical services. Additionally, the Research Council s interest in mentoring nurses to conduct nursing research led to them providing the Division of Nursing with a six-week course titled Guided Discovery. Dr. Donna Williams, Montana State University Dean of Graduate Studies and Research for the College of Nursing, hosted the guided discovery workshop. She led six nurses through the process of differentiating evidence-based practice from research, developing a clinical question, and learning how to answer that clinical question through the research process. This workshop inspired Kimberly Todd, BSN, RNC, a nurse in Labor and Delivery, who sought out a study in progress at Stanford University regarding probiotic use and the reduction of Group B strep in pregnant women. Todd asked to become a satellite site to conduct the already designed study here at our organization. She worked with Dr. Aziz, an obstetrician and scientist with Stanford to learn about the study, how to obtain consent from patients to ensure their proper protection and carry out a research study from start to finish. This project is still in progress, but Todd stated the experience she s gained as a result has proven to be invaluable in her quest to become a nurse scientist. Because Todd was so inspired by the research process, she decided to also assist an immunology student at Montana State University to collect cord blood for further testing in an immunologic study. Todd is a true innovator at heart and is advancing nursing science and practice not only locally, but globally. 25
New Knowledge, Innovation and Improvement Innovative Strategies Patients at Bozeman Deaconess Health Services have access to cutting edge treatments, skilled specialists, caring and supportive clinical staff, the latest in clinical trials, and a host of support services. These choices, combined with a serious diagnosis, can leave a patient overwhelmed and feeling lost. Help is available at Bozeman Deaconess in charting a course through the vast array of services and treatment, thanks to its clinical patient navigators. Kendall Child, FNP-C Cancer Center Kendall Child, FNP-C, is a clinical patient navigator at Bozeman Deaconess Hospital, acting as liaison between cancer patients primary care providers and the specialists who ultimately become involved in their care. The goal is to ensure patients receive necessary medical care in a timely manner and to promote effective and collaborative communication between the patient and his or her healthcare team. navigator can play an integral role in making the progression through the healthcare system positive, and optimally, seamless. Whether holding a patient s hand at the time of a biopsy or answering questions about upcoming procedures, the patient navigators at Bozeman Deaconess are available to provide immediate support to the patient and their family. Child works directly with patients, reviewing medical histories, explaining treatment options, and assisting in determining the optimal testing procedures. She also assists patients with scheduling additional tests, including diagnostic and interventional procedures, as well as securing referrals to appropriate specialists and follow-up care. In helping coordinate patient s care, Child ensures timely service for patients. Calling herself a patient advocate, Child keeps patients informed, makes sure their questions are answered and listens to their concerns and fears while offering compassion and unconditional support. The goal, said Child, is to provide the best care possible for every patient as they make their journey back to wellness. Confronting cancer is an inherently vulnerable time for the patient and one in which a patient 26
Awards and Recognition CNOR-Strong Designation Bozeman Deaconess Health Services has earned the CNOR Strong designation from the Competency & Credentialing Institute (CCI). The CNOR Strong designation is given to facilities in which at least 50% of its OR nursing staff are CNOR certified. 2013 was the first year CCI awarded this elite status to selected facilities nationwide. Earning individual CNOR certification demonstrates a commitment to providing evidencebased patient- and family-centered care during surgery. Since operating room nurses can make all the difference to a patient undergoing surgery, the operating room nursing team has made this commitment to be strong patient advocates ensuring patient safety. CNOR is a definition, not an acronym. CNOR certification is defined as the documented validation of the professional achievement of identified standards of practice by an individual registered nurse providing care for patients before, during and after surgery. It is an objective, measurable way of acknowledging the achievement of specialty knowledge beyond basic nursing preparation and RN licensure. Patient safety and positive surgical outcomes are of utmost importance at Bozeman Deaconess, and supporting nurses as they exceed expectations to achieve their perioperative nursing certification reflects Bozeman Deaconess commitment to its core values. National Certifications Achieved in 2013 Julie Belschwender, BSN, RN, CLC, Family Birth Center Kelsey Elkins, BSN, RN, CLC, Family Birth Center Aileen Fennelly, BA, RN, CLC, Family Birth Center Heidi Godwin, BSN, RN, CLC, Family Birth Center Lindsey Mastel, BSN, RN, CLC, Family Birth Center Tammy McKinney, BSN, RN, CLC, Family Birth Center Amanda Salzer, BSN, RN, CGRN, Endoscopy Amanda Tempero, BSN, RN, ONC, Surgical Unit Rachel Toleno, BSN, RN, CLC, Family Birth Center Kathryn Trelfa, BSN, RN, RCIS, Cardiac Services Heather Walsh, BSN, RN, CNOR, Surgical Services Rhyana Bouton, BSN, RN, ONC, Surgical Unit Kallie Kujawa, MN, RN, CNL, Nursing Administration Nancy Thompson, BSN, RN, IBCLC, RLC, CCE, Family Birth Center Beckie Walters, BSN, RN, IBCLC, RLC, Family Birth Center Hilary Smith, RN, BSN, CAPA, Perioperative Services Emily Rex, RN, BS, BSN, CPAN, Perioperative Services 27
Awards and Recognition Daisy Awards and the unquestioned spoiling that a grandmother might provide. The Daisy Award for Extraordinary Nurses was established by Mark and Bonnie Barnes in 2000 to honor the compassionate care given by nurses to their terminally ill son and their entire family. The Daisy Foundation s mission is to recognize extraordinary nurses around the world who make an enormous difference in the lives of patients and families by the super-human work they do every day. In 2013, these Bozeman Deaconess Nurses were nominated by their peers for the honor, which is awarded quarterly: Rye Cech, BSN, RN, January, Bozeman Deaconess Hospital medical floor. Cech was nominated in part based on comments from a former patient: She provided the support of a sister, the concerned care of a mother, the toughness and practicality of an aunt, Chris Bies, RN, April, Family Birth Center. A graduate of MSU-Northern, Bies was nominated by her colleagues for her abilities in orienting new nurses, her compassion and dedication to patients, and being a role model for all her colleagues. Pat Armstrong, RNC, July, Pain Resource Nurse, Bozeman Deaconess Hospital medical floor. Armstrong was selected for the honor based on nominations from two patient families, who cited her confidence, caring, empathy, being a team player and her personality. Matt Larson, BSN, RN, September, Bozeman Deaconess Hospital Intensive Care Unit. Larson was nominated by fellow staff for being a rock star among nurses, a fearless and selfless team player and exceptional nurse. Larson was further honored by Daisy Award founders Mark and Bonnie Barnes who attended his presentation. Daisy Award winners meeting Mark and Bonnie Barnes, founders of The Daisy Award. 28
Awards and Recognition Accolades Keven Comer, APRN, FNP-BC Bridger Internal Medicine Keven Comer, APRN, FNP-BC, was named the Advance Practice Registered Nurse of the Year by the Montana Nurses Association (MNA). She received the award at the 100th MNA Annual Convention. Comer, a Family Nurse Practitioner for 16 years, works at Bozeman Deaconess Bridger Internal Medicine. Comer also participates in the Community Care Connect project and is an active member of the Medical Home Executive Team. Vickie Groeneweg, MSN, RN, MBA Chief Nursing Officer Vickie Groeneweg, Chief Nursing Officer and Vice President of Patient Services, was named Alumni of the Year by Crown College, a private college west of Minneapolis, where she graduated with a degree in elementary education. Groeneweg received this award at the Annual Alumni weekend in September. Groeneweg has worked at Bozeman Deaconess Hospital for 23 years. Anna Dennis, LPN2 Family Birth Center Anna Dennis, LPN2, was selected to receive the first ever Montana State University Honorary Alumni Award. The 2013 award recognizes a non-alumnus whose extraordinary service has advanced the university and made significant contributions to the campus, college and community. Dennis, who earned her LPN degree in 1971 and has been a full-time post-partum nurse at BDH since 1986, was nominated by nearly six dozen fellow employees and physicians, half of whom graduated from the MSU nursing program. She was cited for continually educating new staff members and supporting MSU by training and supporting new nursing students and encouraging them to further their studies and obtain higher degrees. 29
Awards and Recognition Organization Awards At Bozeman Deaconess Health Services, our employees strive to provide safe, high quality care to every patient. This is especially true of our nurses. Those efforts were recognized by top healthcare industry analysts with a slew of awards in 2013, illustrating BDHS system-wide dedication to clinical quality, patient care and safety, and providing excellent healthcare to our community members. The awards not only clearly demonstrate these are our highest priorities in service to our patients, they also recognize the commitment by all employees and medical staff for continuous improvement and validate BDHS efforts to become a high reliability healthcare system. Our employees hard work and dedication is a critical component to all of these achievements. The Joint Commission Bozeman Deaconess Health Services has been named a Top Performer on Key Quality Measures by The Joint Commission, the leading accreditor of healthcare organizations in America, for exemplary performance in using evidencebased clinical processes that are shown to improve care for certain conditions. One of only 1,099 hospitals in the U.S. earning the distinction, BDHS was recognized for its achievements in heart attack, pneumonia and surgical care. Bozeman Deaconess achieved cumulative performance of 95% or above across all accountability measures, which represent evidence-based practices such as giving aspirin at arrival for heart attack patients or giving antibiotics one hour before surgery. Healthgrades Healthgrades, the leading online resource to help consumers search, compare and connect with physicians and hospitals, presented Bozeman Deaconess with the Pulmonary Care Excellence Award for 2014, and ranked us among the top 5% for Overall Pulmonary Services. BDHS also was recognized for clinical excellence in Orthopedic, Pulmonary and Gastrointestinal Care, and was the only hospital in Montana to receive the 2013 Healthgrades Outstanding Patient Experience Award, ranking in the top 15% in the nation. Additionally, Healthgrades named BDHS a Five-Star recipient for Total Knee Replacement three years in a row ( 2014), and recognized Bozeman Deaconess for the first time as a Five-Star recipient for treatment of Chronic Obstructive Pulmonary Disease, Pneumonia and GI Bleed for 2014. 30
Awards and Recognition Mountain-Pacific Quality Health Bozeman Deaconess Health Services earned the Quality Achievement Award from Mountain-Pacific Quality Health for the sixth year in a row. BDHS was one of only three hospitals in the state to win Mountain- Pacific s highest award in 2013, a reflection of Bozeman Deaconess results in improving quality performance, eliminating avoidable patient harm and delivering exceptional patient experiences. The Quality Achievement Award recognizes Montana hospitals for their dedication to preventing surgical infections and ensuring patients receive high-quality care for heart attack, heart failure or pneumonia. The Leapfrog Group Bozeman Deaconess Health Services was honored for the second year in a row with an A in the Fall 2013 update to the Hospital Safety Score, which rates how well hospitals protect patients from accidents, errors, injuries and infections. Bozeman Deaconess was one of only three hospitals in Montana to earn this highest grade. The Hospital Safety Score, administered by The Leapfrog Group, an independent industry watchdog, is calculated using publicly available data on patient injuries, medical and medication errors, and infections. 31
Summation The Annual Nursing Report is designed to serve as an historical document recognizing the contributions of nurses at Bozeman Deaconess Health Services to their patients, the people of this community, and their profession. It demonstrates our nurses commitment to achieving the strategic priorities of the organization and to providing quality compassionate care safely at all stages of each patient s journey. This report reflects only a glimpse of the dedicated care our nurses provide every day. Evidence Based Practice Council 32