2010 Nursing Annual Report
Nursing: The Hands That Heal
Dear Colleague: The year of 2010 brought many changes, challenges and accomplishments for St. Patrick Hospital nurses. I look back and marvel at the progress we made; it was a truly great, exciting year. It is with pleasure and pride that I write this introduction to our very first annual report. I feel honored to serve the nurses and the staff who help us deliver excellent patient care. I also feel privileged to work with an incredibly talented and committed team of nurse leaders, which is unfailingly committed to serving our patients and the greater Missoula community.
Among the highlights from 2010: • We developed and adopted a new Professional Practice Model, updated our strategic plan to reflect the decision to pursue Magnet and commenced direct-care nurse peer review. Each of these changes will challenge us to be more professional, team-based and accountable. • We highlighted and learned about evidence-based practice and have committed to continue to expand our knowledge in our daily care of patients. In addition, we have encouraged each other to pursue additional formal education. • Among our highly recognized programs this past year was the reverification as a Level II Trauma Center by the American College of Surgeons, as well as designation as a Regional Trauma Center by the State of Montana. In addition, our FirstStep program was accredited as a Child Advocacy Center in 2010. I am proud of the leadership nurses have taken in these achievements. • We continued to focus on patient safety and satisfaction, as well as employee satisfaction, because we know that when staff members have a direct voice in decisions that impact their work, they provide excellent care to patients. Along these lines, in the last year I had the pleasure to watch direct care nurses make decisions that, just a few short years ago, would have been made by formal nursing leaders. This may be one of our most exciting accomplishments of all. As we work through 2011, I feel great pride in our nursing team and optimism for the future of St. Patrick Hospital. The opportunities I have to assist all of our nurses to expand their view of their workplace, their profession and their approach to patient care make me look forward to my work every single day.
Joyce Dombrouski, Chief Nursing Officer
Providence nurses embrace their heritage of compassion, courage and leading-edge care as a steadfast, sacred presence in protecting and easing the way for those in need.
Table of Contents Who We Are................................................................................ 2 Nursing Education........................................................................ 3 Opportunities for Nurses .............................................................. 4 Awards........................................................................................ 5 Our Nursing Approach .............................................................. 6-7 Our Governance ....................................................................... 8-9 Our Work ............................................................................. 10-12 Honoring Our Nurses ..................................................................13 Our Success ...........................................................................14-15 Journey to Magnet.................................................................16-19 Looking to the Future................................................................. 20
Cover Photo: Amy Van Cleave, RN, 5S Dana Cramer, RN, 4S Sara Keller, RN, 5S Sarah Husbyn, RN, OR Cindy Knutsen, RN, NBMI This Page: Kathy Inman-Miller, RN, CVL
Who We Are Nurses at St. Patrick Hospital are reflective of our community of Missoula. They are diverse, eclectic, well-educated, spirited and full of heart. Four hundred and fifty Registered Nurses, 25 Licensed Practical Nurses, 50 Certified Nurses
Assistants and many support staff all help to deliver the excellent care the community and region have come to expect. Through hard work and wrestling with the challenges of healthcare, we take pride in our excellent outcomes. Because many
of us have worked at St. Pat’s a long time, we value the friendships we make among nurses and other staff. This kind of support helps us to deliver compassionate care to the patients and families of Western Montana who need our help.
RNs Jan Hansen, Gina Martin and Sara Lahey review records.
Nurse Satisfaction: Nurses at St. Pat’s report their satisfaction with these measures as follows, compared to the nurses in Providence as a whole.
Nurse Tenure: The average number of years of RN tenure in 2010 at St. Patrick Hospital was 8.91 years.
70
82% 73%
78%
67%
MODERATE
60 50 40 30
LOW
20 10
19.93
20
17.96
16.93
16.91
15 12.32 10
8.74 7.21
5
PERCENTAGE OF RN TENURE
80% 77%
SATISFACTION LEVELS
80
HIGH
25 90
0
0 My job makes good use of my talents and abilitites
Participation in decision making
St. Patrick Hospital Nurses
Teamwork
<1 year
1-2 years
3-5 years
6-10 years
11-15 years
16-20 years
> 20 years
Providence Nurses
2010 N U RS IN G A N N UA L R E P O R T
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Nursing Education Staying educated in the fast-moving world of the nursing profession is a challenge. Yet, opportunities abound. • T he recently started Great Nurses Great Falls program provides a convenient and affordable way for nurses with their Associate’s Degree to earn a Bachelor of Science Degree in Nursing through a combination of distance learning and locally facilitated program hosted at St. Patrick Hospital. Along with the scholarship provided by the Hospital, all the nurse has left to pay for is his or her books.
2010 RN Education and Certification Levels: Missoula is fortunate to have two BSN and two ADN programs nearby. We enjoy a high percentage of BSN-prepared nurses and an equally high percentage of nationally recognized nursing certifications among our staff. 61 Certified
253 412
62 BSN or higher
•A nnual scholarships from the St. Patrick Foundation help dozens of employees and their children obtain more education.
254 412 0
100 Percent
200
300
# Nurses per category
400
500
Total Direct Care Nurses
•H uman Resources provided tuition reimbursement to 56 employees in 2010, helping to defray the cost of tuition for formal education. •N urse managers work to provide flexible scheduling as needed for nurses to be able to take the time to attend school. • I n 2010 The Learning Center, with support from Nursing Administration, added Nursing Reference Center (NRC) to the clinical toolbox for staff. NRC is a database offers nurses, students and hospital librarians the best available and most recent clinical evidence from thousands of full-text documents. In addition, NRC offers over 600 free courses approved for nursing continuing education hours. • T he Learning Center at St. Patrick Hospital is the largest Medical Library in the state. It is a full-service 5
medical library providing literature searching, document delivery, interlibrary loan and a variety of book and electronic collections. It houses 475 print journals and an additional 45 electronic subscriptions. The Library licenses online resources such as UpToDate, the Cochrane Library and Nursing Reference Center for use by all staff and shares purchase of additional journal databases with hospital libraries across the Northwest for improved access and reduced cost. The librarians provide assistance to clinicians, students and community members to access the research and information they need.
• I n 2010 The American Heart Association updated recommended guidelines for basic life support, advanced cardiac life support and pediatric advanced life support certifications. The Learning Center maintains the most current study materials and coordinates the training for St. Patrick clinical staff.
2010 N U RSI N G A N NUAL REPOR T
Opportunities for Nurses Many roles and opportunities exist for nurses at St. Patrick Hospital:
Inpatient Direct Care Specialties
Outpatient Direct Care Specialties
Inpatient Rehabilitation Facility Neurobehavioral Medicine (Psychiatric Care) Intensive Care Unit Telemetry Unit Ortho-Neuro Nursing Unit Oncology Unit Pediatric Unit Pre-operative Nursing Unit Surgical Unit Post-operative Care Unit
Surgical Services Radiology Nursing Emergency Department Life Flight Wound Care Services Support Specialties Education Infection Control Quality Assurance International Heart Institute
Eric Trevelline, MD Stephanie Lohman, RN, Endo
Amy Lindstrom, RN, ICU
“I love the challenge of my job and the exceptional diversity the operating room provides for me.” – Leslie Zahn, RN, OR 2010 N U RS IN G A N N UA L R E P O R T
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2010 Awards 2010 Energy Star Award for the Providence Center The Providence Center received the ENERGY STAR award—meaning it meets strict energy performance standards set by the EPA and uses less energy, is less expensive to operate and causes fewer greenhouse gas and are emissions than its peers. The EPA rating system accounts for differences in operating conditions, regional weather data and other important considerations.
National Children’s Alliance Accreditation First Step Resource Center – a Children’s Advocacy Center at St. Patrick Hospital – was awarded accreditation by National Children’s Alliance (NCA) following an extensive application and site review process. As the accrediting agency for Children’s Advocacy Centers, NCA awards accreditation to centers responding to allegations of child abuse in ways that are effective and efficient and put the needs of child victims of abuse first. Accreditation is the highest level of membership with NCA and denotes excellence in service provision.
Silver Medal of HonorLife Center Northwest St. Patrick Hospital received the Medal of Honor for excellence in organ transplantation practices based on the national data established comparing number of eligible deaths and actual donors. This is due to the educational efforts of staff about organ donation after cardiac death, brain death and neurological death.
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Care Delivery Innovation Funding of Providence Health & Services This Innovation Funding Award will be used to implement Better Choices, Better Health in the Western Montana Service Area. These Stanford SelfManagement workshops are for people with chronic conditions and illnesses. They are facilitated by trained lay persons within the community who also have chronic conditions.
Care Delivery Innovation Funding of Providence Health & Services The Care Delivery Innovation Council of Providence Health & Services Washington/Montana Region set aside $500,000 to teams needing seed money to conduct projects that would support the vision of Providence and test new models of care. Funding was awarded to St. Patrick Hospital and the Western Montana Service Area for advance care planning.
Environmental Leadership Circle Award St. Patrick Hospital was inducted in to the Environmental Leadership Circle through Practice Greenhealth, one of only three hospitals in the nation that were inducted in 2010. Practice Greenhealth is a non-profit group helping hospitals and healthcare facilities to operate with fewer environmental impacts. To be considered, facilities must meet the criteria for the Mercury-Free Award, recycle at least 25% of their total waste, lead the health care sector in innovation and sustainability, and be leaders in their community.
Outcomes Excellence Award The Cardiac Rehabilitation Program at St. Patrick Hospital received the Outcomes Excellence 2010 Award from the Regional Cardiac Rehabilitation Montana Outcomes Project. Of the 10 quality indicators evaluated, the Cardiac Rehab Program exceeded the regional mean more often than any of all large or interventional hospitals from 12 states tracking and reporting a uniform set of quality indicators. This is the third consecutive year that Cardiac Rehab has received this award.
Diabetes Care Services Accreditation St. Patrick Hospital Diabetes Care received accreditation from the American Association of Diabetes Educators in 2010 signifying their compliance with the National Standards for Diabetes Self-Management Education (DSME). The overall objectives of DSME are to help patients make informed decisions, use appropriate self-care behaviors, solve problems, collaborate with the healthcare team to improve clinical outcomes, health and quality of life.
Honorable Mention as a Bicycle-Friendly Business St. Patrick Hospital received an Honorable Mention as a Bicycle Friendly Business from the League of American Bicyclists which recognizes employer efforts to encourage a more bicycle-friendly atmosphere for employees and customers.
2010 N U RSI N G A N NUAL REPOR T
Our Nursing Approach
St. Patrick Hospital Professional Practice Model
Living Our Mission To our patients: To our staff: As nurses, we believe:
We promise to know you, hear you, engage you in your care, keep you informed, find time for you, learn from you, teach you and heal you. We promise to know you, hear you, engage you in patient care, keep you informed, find time for you, learn from you, teach you, support and empower you. • We can make a difference in the lives of our patients and their families by delivering compassionate, equitable nursing care. • Our role is to embrace the needs of the poor, vulnerable and disenfranchised in our local as well as global communities. • Our care system is dedicated to providing the appropriate level of care throughout the continuum of our patients needs.
Honoring Our Heritage As nurses, we believe:
• We are inspired by the courage and compassion of Mother Joseph of the Sacred Heart and the other Sisters of Providence displayed when, in 1873, they began a ministry of education and healing from a simple dwelling in the Missoula Valley. • We honor the Sisters call to respond to the needs of the poor and vulnerable with the same extraordinary vision, creativity, skill and pioneering spirit that marked their work in the late 1800s. • We are committed to continuing the legacy of caring that is founded on compassion, faith, and empathy as was taught by the Sisters at the St. Patrick Hospital School of Nursing established in 1906.
As nurses, we believe:
• We are leaders in healthcare, and therefore we provide and support the partnerships that align our organization with regional entities to provide coordinated care honoring cultural diversity. • Our role is to work with patients and members of our community to determine the most appropriate care in the most appropriate setting. • We provide a healing environment that addresses the mind, body and spirit of our patients across the continuum through our integrated care processes. • We provide education to the public both independently and in partnership with our community organizations to positively impact the health of our community.
As nurses, we believe:
• Utilizing evidence to support and strengthen our practice is essential to achieving the quality of care we seek to provide to our patients. • Our profession has as its foundation the essentials of research, evaluation and translation of evidence into our clinical and operational processes. • Integrating evidence-based practice and research innovations into our profession enables us to provide high-quality, efficient care that improves our patient outcomes.
As nurses, we believe:
• We must continually advance our knowledge and expertise in the field of nursing as it coincides with our goals of providing excellent care and improving patient outcomes. • In a system for rewarding nurses, through compensation and other non-monetary forms of recognition, who seek additional clinical expertise or advanced credentialing. • We are mentors who share our enthusiasm about professional nursing within the organization and the community. • Advanced practice nursing roles are essential in our organization as they support and enhance nursing care throughout the organization and the community.
Reaching Our Community
Seeking Evidence of Our Practice
Embracing New Knowledge
Shared Governance
“The decision-making process that places authority, responsibility, and accountability for patient care with the practicing nurse.” (AONE Leadership Series 1996).
As nurses, we believe:
• The role of Shared Governance in our organization allows all staff opportunities for formal, collaborative and coordinated problem solving within the practice of nursing. • The principles of Shared Governance are attractive to nurses from all levels because of the compelling, valued activities and experiences they provide. • Shared Governance functions as a method to communicate decisions and strategies to the nurse at the bedside. • The model continually evolves through a review of implemented changes and by seeking input from the staff nurses as to its success in relation to their daily work.
2010 N U RS IN G A N N UA L R E P O R T
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St. Patrick Hospital Care Delivery Model Providence Health System Mission Statement As people of Providence, we reveal God’s love for all, Especially the poor and vulnerable, through our compassionate service.
Introduction Patients and families are partners in the delivery of care at St. Patrick Hospital. The St. Patrick Hospital care delivery model is a blend of Dr. Jean Watson’s Human Caring Theory and the AACN Synergy Model. Watson’s theory reflects mindful, in-the moment, committed caring. It serves as a reminder that nursing practice is a deeper knowledge, understanding of and compassion for self and others. The Synergy theory emphasizes matching patients’ characteristics and nurses’ competencies to yield synergies resulting in optimal outcomes for the patient.
Utilizing the Nursing Process As a leader and integrator of care, the nurse has the responsibility, authority and the accountability for assessing, planning, coordinating, and implementing the plan of care and to evaluate the patient needs to optimize outcomes.
Communicate the Plan of Care Ongoing conversations between the patient, family and care givers allow the patient the opportunity to define an optimal level of wellness. Discussions about care and outcomes that matter most to the patient and family help to cultivate trusting and caring relationships.
Coordinate Care The nurse acknowledges the expertise of all team members and coordinates the contributions across the continuum of care, assisting patients and families to meet their goals.
Foster Patient and Team Relationships The nurse creates an atmosphere that fosters an intentional relationship with the patient and family, actively involving them in the decision making process. Through this relationship, the team is mindful of the uniqueness of the patient, recognizing that every encounter is an opportunity to nurture and heal the patient.
Involve Community Resources The nurse facilitates and coordinates care across the continuum. The interdisciplinary team assesses the need for additional care and identifies community re-sources to best serve the needs of the patient. The team proactively partners with community wide services to optimize the health of the population we serve.
Incorporate Evidence Based Practice We have a sustainable care delivery system that is so outstanding that we would entrust the lives and well-being of our own loved ones to it with no hesitation. We have accomplished this by creating an Evidence Based Practice culture among all disciplines. Through the integration of best research, clinical expertise and patient values we proactively and systematically make decisions to improve outcomes.
Promote Professional Excellence The organization supports and encourages education and career advancement allowing nurses the opportunity to practice within their desired specialty. We encourage autonomy by creating a platform for nurses to develop the knowledge and tools to navigate the intricacies of care delivery. Our Learning Center mission is to inspire excellent patient care, staff development and community well-being through learning and innovation.
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2010 N U RSI N G A N NUAL REPOR T
Shared Governance Work in 2010
Nursing Shared Governance Advisory Council
Fulcrum and communication center for process and progress
Professional Development Council Education, nursing recognition, planning
Unit Based Councils
Clinical Operations
Group of staff on each unit who address clinical and practice issues on that unit.
Housewide clinical practice concerns, policies
Professional Development
UBC
Operations
Transfer Mobility
Safety issues related to transferring patients, interdisciplinary
Nursing Advisory Council
Transfer Mobility
Research Fellows, disseminating findings, overlap with other research in hospital
Medication and nursing issues
Night Shift
Research
Research
Med Safety
Medication Safety
Super Users
Nightshift Council Interdisciplinary issues that affect night shift
Clinical Documentation Super Users Support and education about documentation-related systems and processes (Meditech Super Users)
2010 N U RS IN G A N N UA L R E P O R T
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Clinical Operations •D eveloped an Evidence-Based Practice Algorithm • F rom change forms: female urinals for post-surgical patients, bedside procedure carts, heighten safety regarding medications based on weight • P olicies and procedures (utilizing EBP): chest tubes, enteral feeding, epidural management, external fixators for orthopedics, blood cultures and bleeding precautions, halo pin care. • R eviewed quality indicators and developed action plan for foley care and documentation.
Clinical Documentation Superuser Council In 2010, the Clinical Documentation Superuser Council (CDSC), previously known as the Meditech Super User Group, assisted in the implementation and education of Bedside Medication Verification (BMV), which went live in February 2010. Throughout the year, the CDSC focused on BMV optimization with an emphasis on patient safety and streamlined workflows. The CDSC combined the critical care and medical-surgical physical assessments. In addition, the CDSC did ongoing maintenance, revisions and cleanup of documentation, education about documentation requirements, and creation of rules in the eMAR and physical assessment that ensure patient safety and compliance with regulatory requirements.
Medication Safety 1. C hanged Pyxis fill process: bar code technology used to verify correct stocking of drugs in Pyxis. 2. BMV implementation and monthly review of med/patient scanning at bedside rates 11
3. Monthly reviews of Hospira pump use and compliance. Nursing education and alteration of drug libraries to ease staff use but maintain patient safety. 4. Medication boxes ordered and installed in all medical-surgical rooms to store multidose items such as inhalers, creams and insulin pens. 5. 4N member, Peggy Martino, did research on time wasted waiting for meds in the pyxis. Change made to stock all tablets and capsules in both Pyxis machines to reduce wait time.
Nightshift Council New in 2010, the Nightshift Council is comprised of a multidisciplinary team of staff to include nursing, pharmacy, radiology, environmental services and sterile processing, all areas that have a 24-hour operation. Gathering ideas and solutions for practice or process issues from the staff who works the night shift was a major goal this year. The first foray into staff-driven decision-making was to address the concern of availability of healthy food for the night shift. This was the number one issue raised by all areas functioning during the night hours. This team worked closely with Food and Nutrition to come up with innovative ideas, which will be implemented in the near future.
Professional Development Council In 2010, The Professional Development Council (PDC) focused on staff/nurse education and Peer Review for nurses. In addition, PDC selected the recipient for the Spirit of Nursing Award, assisted with the “Ticket to Surgery” processes and changes, reviewed and posted the Nursing Bill of Rights and
recommended that all councils include two non-nursing patient care staff. PDC developed and implemented the Peer Review process that was rolled out in November, and participated in the process to bring the Ebsco Nursing Reference materials to St. Pat’s.
Research Council Initiated in September, the Research Council Charter was developed and planning for the remainder of 2010 and all of 2011 completed. The first task was to prepare a mechanism to request and accept research proposals the 2011 fellows. The Council developed the following tools: • Call for applications for nursing research fellows • Evaluation tool for written applications • Evaluation tool for interviews
Transfer Mobility •R ecruited and trained 6 “Expert Trainers” and 26 new Transfer Mobility Coaches (TMC). • Implemented monthly nursing orientation process for new clinical staff. • Created HealthStream module and return demonstration for all clinical staff. Achieved 82% completion rate on HealthStream. • Created communication tool via Vocera “Call Mobility Coach” for all staff to have access to TMC when needed. • Sling reference guide created and available on all units. • Disposable slings available from Stores. • Inventory list completed for all units; equipment location standardized. • Binders created with equipment information. • “How to Use” laminated cards completed and placed on all clinical equipment. 2010 N U RSI N G A N NUAL REPOR T
Shared Governance Work in 2010 Project-Specific Workgroups Communication/Recognition Help improve communication issues that hamper our patient care. Develop communication plan for Magnet roll-out and sharing with hospital staff. Create ways for staff to be recognized for new ideas, effective change suggestions, accomplishments, community involvement, etc. Education Address Magnet criteria for staff and patient education. Also provide education about Magnet itself.
Evidence-Based Practice Help to establish EBP as a habit in clinical decision making at St. Pat’s. Create vision, education plan and implementation plan. Leadership Development Address Magnet criteria for staff development, succession planning and effective shared governance leadership.
Professional Practice Model Develop a Professional Practice Model and Nursing Care Delivery Model. Educate staff. Quality Oversee Quality criteria in Magnet. Help create and support the habit that clinical practice changes are driven by quality outcomes.
“As a Level II Trauma Center, we care for a lot of people who have been badly injured. We made it a priority to do what we could to support organ donation. In 2010 we won national recognition for our work with the silver award granted by the Department of Health and Human Services. It took a full team of nurses, physicians, social workers and more, and is very gratifying to know we are helping our patients and families help others”.
– Dawn Rorhbach, RN, ICU “The Multidisciplinary Rounds project was started at SPH to improve communication with all caregivers, focusing on the patient’s goals for the day, goals for the stay, potential discharge needs and planned discharge date. I was one of the 5N staff members involved in this project. Staff feel this brief meeting helps caregivers to improve on the great care we already give to our patients by focusing early on the patient’s plan of care and discharge needs”.
– Lori Grimes, RN, 5N 2010 N U RS IN G A N N UA L R E P O R T
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Workgroups
Work in 2010
Communication/Recognition Nurses Week, developed Positive Connections newsletter, Innovation Awards
Education Identified various examples of how we implement new knowledge and improve patient care through our shared governance structure Reviewed the process for supporting nurses to become certified in their specialty through the provision of study materials at The Learning Center and financial incentive Wrote examples of education structures and processes at St. Patâ&#x20AC;&#x2122;s that will be included in the Magnet document
Evidence-Based Practice
Created Vision Statement
Examined sources of evidence applicable to EBP Hosted EBP conference with 160 attendees and ASU faculty Selected Models (ARCC and Iowa) to serve as framework for our efforts Developed PowerPoint tutorial for staff
Leadership Development Analyzed the leadership sources of evidence for the Magnet document and identified examples that have outcomes that can be captured Divided the sources of evidence and wrote examples for the Magnet document that exemplified nurses in lead roles in the delivery of patient care Supporting the work of this group, two RNs at St. Patâ&#x20AC;&#x2122;s are participating with other Providence organizations to create a nurse leadership curriculum to provide development opportunities for our nurses
Professional Practice Model
Created workgroup Developed Professional Practice Model and Nursing Care Delivery Model. Developed plan for disseminating models, using in PMPs
Quality Conducted Gap Analysis 13
Constructed Nursing Quality Dashboard 2010 N U RSI N G A N NUAL REPOR T
Honoring our Nurses
Spirit of Nursing St. Patrick Hospital wishes to recognize all Spirit of Nursing Award 2010 nominees. Their above and beyond care of patients and peers is an inspiration to us all. CriSTy GrAySoN “Cristy Grayson has been an RN on 4N since 2003. Her knowledge base on cardiothoracic issues is immense, and she readily shares it so others learn and excel. She also has a vast understanding of cultural differences and frequently is assigned patients of different cultures.” “Cristy is a positive, pleasant person who puts her patients at ease with her friendly mannerisms.” “She ambulates her post open heart surgery patients and helps them with their deep breathing and oxygenation by talking with them while they walk and laughing with them; they really love her.”
Lori GriMES
DEB CHAPMAN
“Every day she supports and mentors staff nurses so they can give the care that patients need. She participated in the Admissions Kaizen and asks appropriate questions so that patients are admitted to the correct unit. By helping to negotiate a RN contract that was approved by RNs, she helped ensure a satisfied RN work force that continues to make a difference for all St. Pat’s patients.”
“Deb never fails to make the patient ‘of the moment’ a priority. She has a remarkable way to instill confidence in each person she deals with. She has a positive uplifting persuasion about her and keeps staff and patients smiling and calm. Deb is calm, efficient, articulate and genuine.” “A patient arrived for a PET scan on St. Patrick’s Day. She commented that the balloons were wonderful. Deb had a balloon waiting for the patient after her scan. The woman was so pleased.”
MiCHELLE SAGE
CLESS BroWN
“Michelle always gives 100% to her patients. She is an excellent nurse who cares about her patients and coworkers.”
“Cless cares for every patient as if he or she were his grandparent. He never rushes, and always takes the time to listen and put the patient at ease. He explains everything and has extraordinary patience.“
“She has great initiative in creating better protocols for ways toprevent MRSA contamination in our OR.” “An excellent representative of the caliber of nursing care that all patients would hope to receive.”
“I get more thank you notes from patients that mention Cless by name than any other nurse.”
EiLEEN rouNS
EMiLy JACoBSEN
“Eileen is a very kind and caring individual to patients and their families but also to her coworkers. She is always willing to stop and spend an extra minute or two listening, teaching, mentoring.”
“I have received feedback regarding Emily’s care for a young diabetic patient. Her compassion was exceptional and her ability to educate the family on what to expect helped to ease their concern for their loved one. Emily is a role model for nursing and I appreciate all she does.”
2010 N U RS IN G A N N UA L R E P O R T
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Spirit of Nursing Innovation Awards The innovation awards were started in the 3rd quarter of 2010 to recognize a staff member who had a great idea that led to a helpful change. Winners are chosen by the Advisory Council. 3rd Quarter 2010 Innovation Award Recipient “Just Use It” Program and Trainers St. Patrick Hospital, in partnership with Diligent Services, implemented our Safe Patient Lifting and Handling Program, “Just Use It,” in July 2008. Between November 2008 and March 2009, Diligent Services trained 58 Transfer Mobility Coaches and 469 staff. The implementation contract with Diligent Services ended April 2010. Over the past year, St. Patrick Hospital has decreased the number of OSHArecordable injuries to five. Prior to implementation of the program, we
averaged 32 OSHA-recordable injuries per year from 2004-2006. Diligent Services guarantees a 60% reduction in employee patient handling injuries. St. Patrick Hospital attained a 69% reduction in injuries.
no hesitation to be in the spotlight. Contagious energy is present in the classroom. 4th Quarter 2010 Innovation Award Recipient
In order to sustain our “Just Use It” Program, the Transfer Mobility Shared Governance Council proposed to train “Trainers.” On April 6, Six “Trainers” were trained including Belinda Nowatzke, RN; Mike Neal, PT; Barrett Campbell, HCA; and Betsy Keffler, RN. In turn these new trainers then trained 26 new Transfer Mobility coaches April 6-7. Beginning in May 2010 our Trainers began educating new nursing staff during Nursing Orientation to St. Patrick Hospital Patient Lifting/ Transfer Policy and Procedure (IDPPTC-036) and providing hands-on experience and orientation to the ARJO lift equipment. The Trainers showed enthusiasm, competency and
Marni Richards, Staffing Specialist, has been an instrumental member of Shared Governance and the Magnet Journey. Past membership drives for Shared Governance ran October December, with new members starting in January. In 2009 there were 7 applications, in 2010 there were 10. Marni noticed this and suggested moving the membership drive to the beginning of the year after the holidays, when staff is less busy. This idea was adopted by the councils and a new membership drive began in February 2011. There were 27 applications a simple idea that had a large impact! Thank you Marni for making a suggestion that boosted enrollment and offered an opportunity for staff. Your idea strengthened this successful process that improves patient care.
Betsy Keffler, RN, 4S; Belinda Nowatzke, RN, 4S; Mike Neal, PT. Not pictured: Barrett Campbell, HCA, 4S 15
2010 N U RSI N G A N NUAL REPOR T
Our Success
Evidence of Success is measured in how well we meet out quality goals, Success is measured in how well we meet our asEvidence well as ourofpatient centered clinical outcomes.
quality goals, as well as our patient-centered clinical outcomes.
Patient Falls Preventing patient falls is a primary focus of nursing care. While challenging, our utmost priority is to prevent injury. On two of our busiest floors, nurses fall prevention compares with national benchmarks. Falls with injury are extremely low at St. Patrick Hospital. Surgical Unit (5S) Fall Rate
Telemetry Unit (4N) Fall Rate
8 6.57
8
6.3
6 4.47
6 4
3.89 2.94
2.94
2.3
2.66
3.71
3.64
3.05 4
2.09
3.65
3.58
2.53
2 0.72
2
0 Q1
Q2
St. Patrick Hospital Surgical
Q3
Q4
0
An important nurse-sensitive quality indicator, St. Patâ&#x20AC;&#x2122;s nurses are successful in preventing pressure ulcers. This graph shows Stage II ulcers or worse. In total, 21 of 24 (six units over four quarters) quarters had zero HAPU, which is below the national (NDNQI) benchmark.
Q2
Q3
St. Patrick Hospital Telemetry
NDNQ1 Benchmark
Hospital-Acquired Pressure Ulcers (HAPU)
Q1
Q4 NDNQ1 Benchmark
Percent of Patients with Hospital-Acquired Ulcers 7 6 5 4 3
2.60%
2 1
0.94% 0.00%
0 Q1
NDNQI Hospitals Upper Benchmark
2010 N U RS IN G A N N UA L R E P O R T
0.00% Q2
Q3
NDNQI Hospitals Lower Benchmark
Q4
St. Patrick Hospital
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Central Line-Associated Blood Stream Infection (CLABSI)
St. Patrick Hospital ICU CLA-BSI Rate per 1000 Central Line Days
At St. Pat’s, we track central line bundle compliance in the OR, ED, ICU, all nursing units and radiology with bundle compliance >95%.
3.00
2.68
2.50 2.00 1.50
1.30
1.30
1.30
0.94
1.00
0.92
0.50 0.00 2008
Ventilator-Associated Pneumonia (VAP) In our ICU we have been assessing daily VAP bundle compliance for VAP prevention. This bundle approach includes nurses, intensivists and respiratory therapists. Compliance with the bundle has been tracked monthly since 2008.
2009
2010
St. Patrick Hospital ICU Rate
NHSN Mean
St. Patrick Hospital ICU VAP Rate per 1000 Ventilator Days 2.50 2.00
1.91
1.50
1.20
1.20
1.00
1.20
0.81
0.80
0.50 0.00 2008
2009
2010
St. Patrick Hospital ICU Rate
NHSN Mean
Patient Satisfaction St. Pat’s nurses treat the whole person. It is important that patients feel they were treated with respect and courtesy. St. Pat’s nurses outperformed the Press Ganey National Benchmark in all four quarters of 2010 in these two categories. Friendliness and Courtesy of Nurses 94.1
Nurses’ Attitude Toward Requests 94.1
93.3
93.4 92.3
92.3
91.1
90.7 92.3
92.3 89.6
Q1
Q2
St. Patrick Hospital Mean
17
Q3
91
90.3
Q4
Press Ganey Benchmark
Q1
89.6
Q2
St. Patrick Hospital Mean
89.6
Q3
89.6
Q4
Press Ganey Benchmark
2010 N U RSI N G A N NUAL REPOR T
Journey to Magnet Nurses at St. Patrick Hospital developed Shared Governance in 2005. Since then, they have worked on processes and outcomes to include nursing in decisions about nursing practice. In 2008, they developed an interest in becoming a Magnet hospital. In 2009, nurses developed and approved their three-year Nursing Strategic Plan. Also that year,
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several staff nurses in Shared Governance asked administration to move ahead with this goal. In the fall of 2009, Shared Governance made the commitment to start the journey toward being a Magnet hospital. Much has happened in 2010, our first full year of the Magnet Journey. This “Magnet Mountain” helps depict our progress.
Magnet Mountain Nurses, educator, director to to Magnet Conference, Oct 2010
EBP Conference Nov 2010
EBP Workgroup begins planning education and mentors, Dec 2010
Cochrane Library goes live Nov 2010 Innovation award winners decided Oct 2010 Research Council meets Oct 2010 Magnet talking points sent to directors Oct 2010
Peer Review program for all nurses begins Nov 2010 Workgroups and Keen group begin organizing, writing and assigning SOEs Nov 2010.
Care Delivery System description completed Dec 2010 Call for 2011 Nursing Research Fellows, Dec 2010 Communication and Nursing Recognition workgroups combined, Dec 2010
Magnet newsletter begins July 2010
Peer Review program developed, Sept 2010
Magnet Hotline and Intranet go live, Sept 2010
ANA Scope and Standards and Nursing Bill of Rights posted on floors Aug 2010
Nursing Reference Center goes live, Sept 2010
NDNQI results and revamping begins Sept 2010
Shared Governance - Review Council name changed to SG-Advisory Council, Sept 2010
Gap Analysis, Dec 2009 Begin collecting data, stories, etc. PPM and CDM Work Group meets March 2010 Communication Work Group meets March 2010 Nursing Research Project winners selected March 2010
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Templates Work Group meets April 2010
Magnet Journey announced May 2010
Expanded Review Council meets April 2010
Unit Councils meets Summer 2010
Night Shift and Research Council members recruited July 2010
Nightshift Council meets Sept 2010
Evidence-Based Practice Committee formed April 2010
Essay Contest on Magnet impact of Winners to Magnet conference
Peer Review Planning begins April 2010
“What is EBP” rollout and education June 2010
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Magnet Readiness The Journey to Magnet is long and challenging. 2010 was the year of structure, to ensure that the structure, process and outcomes of our Magnet goals are in place. Some of these accomplishments include: Transformational Leadership Nurses at St. Patrick Hospital know that their voices are heard, their input valued and their practice supported.
Journey to Magnet Sources of Evidence (SOEs) 120% 100%
Nursing Strategic Plan: The threeyear Strategic Plan was finalized in January 2010. Goals and aims were aligned with our Magnet Journey to help streamline the work we are undertaking. Nursing Annual Report: This report was initiated in order to capture the accomplishments and high points of our nursing work this year. Nursing Leadership Training and Shared Governance Mentoring: The Professional Development Council has provided leadership and education on effectiveness in the councils and in leadership roles. Next Steps: Peer Review at all levels of nursing, improved succession planning for leaders, more efficient use of direct-care nurses’ input into clinical decisions.
11.25% 33.75%
80%
60% 60%
72.50%
40%
63% 40%
20% 0%
16.25% January 2010 % Green
Shared Governance Structure: In 2010, we deepened our Shared Governance, adding several councils 2010 N U RS IN G A N N UA L R E P O R T
0%
June 2010
Decmeber 2010
% Blue
% Orange
% SOEs Green (established), Blue (started) and Orange (not in place)
and increasing the number of staff nurses who participate. Nursing Recognition: The Innovation Awards were initiated in 2010. These honor staff who have suggested an innovative idea that was put into place and made a difference in patient care or staff functioning.
Structural Empowerment Nurses throughout St. Patrick Hospital are involved in self-governance and decision-making structures and processes that establish standards of practice and address issues of concern.
3.75%
Spirit of Nursing Award: This award is given each year to an outstanding nurse who captures “The Spirit of Nursing” at St. Pat’s. Next steps: Increasing efficiency in Shared Governance councils and meetings, increasing support of nurses returning for further education, increasing recognition of nurses who
have gained further education and certification, developing more options for recognizing excellence in nursing care.
Exemplary Professional Practice Our overarching conceptual framework for nurses, nursing care and interdisciplinary patient care depicts how St. Patrick Hospital nurses practice, collaborate, communicate and develop professionally to provide the highest quality of care for those served. Professional Practice Model and Care Delivery Model: Staff nurses and nurse leaders came together to create, describe and educate others about 20
“My experience in nursing research has given me more appreciation for the breadth of nursing and really opened my eyes to the possibilities that exist within the profession.” – J enna Hubbard, RN, ICU Our first Nursing Research Fellow, whose research project was “Night Shift Nurses Perceptions of Their Own Health” these two innovative models. In them, the nurses captured the essence of nursing care at St. Pat’s as we serve the people of Western Montana. Quality of Care: With a focus on patient outcomes, nurses have worked to put in place measures of quality outcomes and pathways for reporting them to staff. We began submitting data to NDNQI in 2010 in order to compare ourselves to a national standard on our primary nurse sensitive quality indicators. Nurse managers and unit-based councils continued the practice of discussing outcomes at staff meetings so directcare nurses can find the best ways to improve their work. Nurses as Teachers: Numerous St. Pat’s nurses speak at public events, high school classes, university classes, and with students who come to the hospital for their clinical practicum. Nurses also regularly write in the innovative series “Nurses Notes,” which provides information and education about various topics for the local community. 21
Focus on Culture of Safety: Nurses have been at the forefront of several important safety innovations, including the ARJO safe lifting equipment use, Bedside Medication Verification, HAI reduction techniques and handling workplace violence. Next steps: Further advance the understanding and use of the Professional Practice Model, increase interdisciplinary representation on Shared Governance Councils, drive patient outcomes higher among our nursesensitive indicators, continue to work with feedback from our patient satisfaction surveys to continue to improve care.
New Knowledge, Innovations and Improvement St. Patrick Hospital nurses integrate evidence-based practice and research into clinical and operational processes, nurses are educated about EBP and research enabling them to appropriately explore the safest and best practices for their patients and practice environment and to generate new knowledge.
Research: 2010 marked the beginning of formalized Nursing Research. With financial support from The St. Patrick Hospital Foundation, two nurses undertook projects to study aspects of nursing care. In addition, the Research Council was formed in order to provide ongoing Shared Governance support of this effort. Evidence-Based Practice: The EBP workgroup helped define what EBP is, crafted a vision statement for EBP at St. Pat’s and organized a terrific two-day conference with nationally recognized EBP experts. This change in culture was some of the most important work of 2010. Next Steps: Support Nurse Research Fellows in upcoming years; deepen our understanding of EBP and demonstrate use throughout nursing process; develop innovative approaches to solving patient care challenges.
2010 N U RSI N G A N NUAL REPOR T
Looking to the Future
Chris Tobiason, PharmD; Katie Rogotzke, RN, 5S; Betsy Weber, RN, Quality; Joel Karki, Pharmacy Tech
St. Patrick Hospital nurses are hard at work on various fronts. Goals for 2011 include utilizing more Evidence-Based Practice, further supporting Nursing Research, developing better and more comprehensive communication methods for busy nurses, and ensuring that our quality measures are well tracked and that our outcomes are above the national mean. Further, we are in the process of developing Unit-Based Councils house-wide. These engines of change are where direct-care nurses can have the most input into their practice. Nurses are also developing ways to recognize nurses for their excellent work. The Innovations Awards have been a good start and plans are underway to recognize areas that are meeting exceptional quality goals. Nursing education continues to grow with our excellent Learning Center. Nurses are taking advantage of the Great Nurses Great Falls program to obtain their Baccalaureate degree in Nursing. More nurses are expected to do this in upcoming years. We will soon be applying for Magnet, with the hopes of submitting our documents in the summer of 2012. 2010 N U RS IN G A N N UA L R E P O R T
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Our Mission As people of Providence, we reveal Godâ&#x20AC;&#x2122;s love for all, especially the poor and vulnerable, through our compassionate service.
Our Core Values Respect Compassion Justice Excellence Stewardship
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500 West Broadway Missoula, Montana 59802 406-543-7271 www.saintpatrick.org