PRA C TI C E A C HIE V E PART N ER PRO M OTE
Nurses are opening doors to the HEALTH, CARE and wellness of the nation. Baylor Nursing July 2012-June 2013 Annual Report
TO health care and wellness
Exceptional nurses ARE OPENING DOORS. Mahatma Gandhi said, “Be the change you wish to see in the world.” I couldn’t agree more, and I’ve never seen a group of people who embrace that sentiment like the nurses I’m so proud and humbled to work with every day. We are leading change in health care. Nursing is a calling for each of us. Many years ago, I was a music major. But after taking a between-semesters secretarial job in a hospital, I quickly learned that I could make a tremendous difference for people, for the community, for patients and for their families in nursing. And I’ve never looked back. Not only did nursing change me, but I like to think I’ve played a small part in helping you change nursing as well. This year, we’ve chosen a very active theme for our annual report: Practice. Achieve. Partner. Promote. These four simple words embrace the spirit of both the American Nurses’ Credentialing Center (ANCC) model for the Magnet Recognition Program® and the Institute of Medicine key messages to meet the demands of reformed health care. To me, they are how we become the change we wish to see. We are making great strides toward our goals each and every day. As you read through this report, you will see shining examples of nurses stretching their limits; making personal sacrifices to advance the profession; and, indeed, transforming the health, care and wellness of the nation.
Rosemary Luquire PhD, RN, FAAN, NEA-BC Senior Vice President Corporate Chief Nursing Officer Baylor Scott and White Health, North Division
Baylor Nursing 2012-13 Annual Report
Practice to the full extent of your capabilities each and every day. Achieve both personally and professionally through continuing education, teaching and leadership. Partner with peers and non-nursing colleagues to create better outcomes and innovative strategies. Promote the nursing profession as a whole and nurses individually to build stronger career paths and opportunities.
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Transformational Leadership Advancing the practice of nursing. Intense reform in health care is creating new demands on the profession of nursing. While yesterday’s leaders focused on growth, today’s nurse leaders must focus on many more difficult and complex issues, such as:
Bi-Jue Chang, RN, MS, OCN, CCRC; Baylor Regional
> > > > > >
The shift from sick care to wellness Data and empirical outcomes The role of informatics A keen understanding of finance and budgeting Short- and long-term planning and strategy Leading research and innovation
Medical Center at Plano
Baylor Health Care System nurses are actively embracing these challenges as witnessed by the success we’ve had not only with Magnet designations, but re-designations as well. While fewer than 7 percent of hospitals achieve Magnet designation, only about 3.5 percent achieve re-designation. Once a hospital is Magnet-designated, the criteria for re-designation becomes even more intense because not only does a hospital have to maintain the quality to achieve Magnet initially, but also must continue to improve and demonstrate that improvement on every measure. It is within this context that we are tremendously proud of the Baylor hospitals that have achieved Magnet designation, but even more so for those who have been re-designated.
Baylor Nursing 2013-14 Annual Report
Baylor University Medical Center at Dallas third designation
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Baylor Hospitals with Magnet Designation
Baylor University Medical Center at Dallas (BUMC) holds its Baylor University Medical Center at Dallas longstanding record of Magnet designation. First designated in Baylor Jack and Jane Hamilton Heart and Vascular Hospital 2004, the hospital was re-designated in 2009 and then again in 2013. Each time the hospital was re-designated, they raised Baylor Regional Medical Center at Grapevine the bar, looking for even more outcomes around the Magnet Baylor Medical Center at Irving standards. Baylor Regional Medical Center at Plano “The initial application was about documenting what you did. THE HEART HOSPITAL Baylor Plano Now it’s about proving it,” said Claudia Wilder, DNP, RN, NEABC, VP and CNO, BUMC. “On the journey to Magnet, the process becomes more about data on the one hand, but then about how that data is used to improve practice, on the other hand.” For the third designation, three staff nurses, Pam Ruiz, BSN, RN; Judy Joiner, BSN, RN; Caton Cadigan, BSN, RN; mentored by nurse scientist, Dr. Marygrace Hernandez Leveille, were required to present research, while other nurses were interviewed about quality patient care, innovations and how they work in a collaborative manner. Of particular interest was their work with newborns.
Once a hospital is Magnet-designated, the criteria for re-designation becomes even more intense. Newborn resuscitations
From left to right: Monica Eisenbert, MSN, NNP-BC; Marygrace Hernandez Leveille, PhD, RN, ACNP-BC, Nurse Scientist for Baylor University Medical Center; Olha Prijic, BSN, RNC, Nurse Manager; Judith Joiner, BSN, RNC, Nurse Supervisor, at the BUMC New Family Unit
The heart rate of the newborn determines the need for and response to, resuscitative interventions. However, accurate heart rate determination by auscultation in the newborn in the delivery room is known to be frequently inaccurate. This study was undertaken to compare a novel auscultation counting device and monitor (Electronic Assisted Stethoscope And Monitor or EASAM) with Conventional Stethoscope Auscultation (CSA) using the NRP (neonatal resuscitation program) recommended “6-second heart rate count multiplied by 10” technique. A convenience sample of 10 stable, full-term newborns (high heart rate) on pulse oximeters and 10 stable, adult patients on EKG monitors in the adult ICU (low heart rate) were studied. The monitored (pulse oximeter or EKG) heart rate was blinded to the investigator carrying out the auscultated estimation of the heart rate. The EASAM device versus CSA was compared for accuracy (+ or - 5BPM) and speed in obtaining the heart rate. Speed was assessed with stop watch by one of the investigators. The study was approved by the IRB, and informed consent was obtained from all patients prior to the study. Using a novel EASAM device for counting the auscultated heart rate was significantly more accurate and faster in the newborn. In the adult, the EASAM was also significantly more accurate but proved no faster than the conventional method of auscultation currently recommended by NRP. We believe the potential for the EASAM to provide a quicker and more accurate assessment of the newborn HR is promising and could potentially decrease errors in resuscitation.
A mentor in science
Magnet re-designation and Press Ganey Award This year, the Baylor Jack and Jane Hamilton Heart and Vascular Hospital (BHVH) received Magnet designation for the second time —first in 2007 and again in 2013. It has also received the Press Ganey Beacon Award for the 99th percentile in patient satisfaction. “We were honored for the third straight year with the Press Ganey Summit Award. A second consecutive Summit Award means BHVH has had a patient satisfaction rate greater than the 95th percentile for 16 consecutive quarters, or 4 years in a row,” explains Nancy Vish, PhD, RN, NEA-BC, FACHE, President and CNO.
Baylor Nursing 2012-13 Annual Report
Marygrace Hernandez Leveille, PhD, RN, ACNP-BC (second from left) is a nurse scientist at Baylor. In her position, she regularly leads bedside nurses in finding and developing studies and research programs based on their experiences with patients. “Our nurses are tremendous at the bedside, and they are critical in our efforts to learn and develop improved practices. But they need some help putting together the science and rigor for a care-changing research program—that’s where I come in.”
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Structural Empowerment Achieving professional and personal goals. Nurse leaders not only need to embrace the challenges of health care reform, but also must motivate others to transform care along with them. A culture of life-long learning is fostered to support transformational change, which includes professional collaboration and promotion of role development, academic achievement and career advancement.
BHCS Direct Patient Care RNs—% with BSN or higher (excludes PRN)
90%
October 2009
April 2014
80% 70% 60% 50% 40%
Nurses with doctorate
30%
degrees like Brenda Blain, DNP, RN-BC,
20%
FACHE, Chief Nursing
10%
Officer/Chief Operating Officer, Baylor Medical
BHCS
BHVH
BUMC
Irving
THHBP
Carrollton
Plano
BSH
Grapevine
All Saints
OCH
Garland
McKinney
Denton
WAX
0%
Center at Irving (left); and Beth Houser, DNSc, RN, FNP, NEA-BC, Chief Nursing Officer, Baylor
Baylor Nursing 2012-13 Annual Report
Regional Medical Cen-
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At Baylor, nurses are encouraged to pursue higher education. The IOM states, “Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.” In relative terms, we are also working with nurses who aspire to achieve Masters, PhD and DNP degrees. With the system goal of achieving 80 percent direct care RNs with BSN degrees by June 2015, Baylor partnered with local schools of nursing to make it easier for our RNs to access and complete courses toward this degree. For example, through the University of Texas at Arlington’s academic partnership for the RNto-BSN program, more than 700 Baylor nurses have enrolled and more than 300 have completed their BSN degrees between 2008 and 2013. During this same period, Baylor Health Care System increased its percentage of direct care RNs with BSN degrees from 47 percent to 73 percent. A lifetime of learning With over 100 free on-site continuing education classes a year for our staff nurses, Baylor shows its dedication to professional development. We also offer many certification review courses and certification support throughout the year to ensure our nurses are up to date. These courses, combined with partnership with schools of nursing, tuition reimbursement, and scholarship programs, are available to many who look forward to advancing their knowledge—and many do. This year, more than 100 continuing education activities were offered with 5962 participants and 265 CEs provided.
ter at Grapevine (right) are raising the bar for everyone.
The Doctor of Nursing Practice
“We hold a yearly celebration of shared governance outcomes. It’s making a big difference.”
The Nursing Doctor of Philosophy
“Learning is a gift you give yourself. And others benefit from your knowledge.”
PhD or DNP? While both are doctoral degrees in nursing, the PhD is a Doctorate of Philosophy focusing on research while the Doctor of Nursing Practice focuses on the practice. The PhD prepares nurse scholars and researchers who contribute to the growth of nursing science through scholarly research that advances the theoretical foundation of nursing practice and health care delivery. The Doctor of Nursing Practice is for nurses who practice at the highest level to expand the scientific knowledge required for safe nursing practice and growing concerns regarding the quality of patient care delivery and outcomes.
Baylor Nursing 2012-13 Annual Report
Nancy Vish has many titles—PhD, RN, NEA-BC, FACHE, president and chief nursing officer Baylor Jack and Jane Hamilton Heart and Vascular Hospital (BHVH)—but she credits everyone for the success of BHVH. “It’s like an orchestra,” Vish says. “Everyone here is a partner, from the people who clean rooms and sterilize equipment, to the pharmacy, social workers and physicians. We celebrate Partners in Care.” Nancy may not readily admit to being an over achiever, but her love of learning and encouragement from her family of 10 set her on a path to obtain a BSN from Indiana University of Pennsylvania, a Masters from Vanderbilt and a PhD in nursing research from Texas Women’s University. “Our successes are a result of one of the strongest leadership teams I’ve ever come across, and that has allowed us to build a rich culture and shared governance with the gifts of our own employees. Dr. Rosemary Luquire set the bar; Baylor developed the culture; and, as a result, we are playing at the top of our game.”
Like Nancy Vish, Brenda Blain (pictured on the left) has a few titles as well—DNP, RN, BC, FACHE, Chief Nursing Officer and Chief Operating Officer for Baylor Medical Center at Irving. Brenda’s journey to DNP hit a few roadblocks on the way. “When I moved to Nebraska in 1998, the hospital sold me on my ability to gain a doctorate. But then I found it required an 8-hour commute,” she laughs. When she moved to Missouri, she didn’t find the curriculum either. She then came to Baylor, and not only did they encourage her to pursue her DNP, but they offered tuition reimbursement. “My journey to DNP really changed my thinking process. I could tell I was becoming more research-based. I read my journals very differently now. I am a huge believer in shared governance and staff empowerment. And we’ve even put in place a Myers-Briggs approach to clinical coaching. We match coaches with new employees—introverts with introverts and extroverts with extroverts.” Coaching staff at all levels has made a significant difference to the nurses at Baylor Irving. Not only are more nurses participating in advanced education, but retention has improved to 90 percent—a very strong score in any profession.
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Exemplary Professional Practice Partnering for better practices. Safe passage is the optimal patient outcome of exemplary nursing practice. Supported by a healthy work environment, nurses partner with inter-professional teams to provide the highest quality care resulting in positive patient and family experiences and outcomes.
7%
Baylor HEALTH CARE SYSTEM PROFESSIONAL NURSING PRACTICE MODEL The Professional Nursing Practice Model is our guiding icon, remind-
decrease in sepsis mortality across the System Emergency Departments.
ing us that we are trusted leaders, making sure patients have a safe passage through our system.
Baylor Nursing 2012-13 Annual Report
The fight against sepsis
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Frontline emergency department nurses, empowered to use their critical thinking skills, are helping drive down mortality rates from sepsis. Thanks to their detective skills and Lean methodology, in the last year, ED deaths from sepsis were down 7 percent across the System and down 10 percent in the Baylor University Medical Center. If treated within three hours, sepsis mortality is greatly reduced. “Rapid identification of sepsis is critical and the triage nurse plays a key role in the process,” says Dr. John Garrett, Associate Medical Director. “We trained our triage nurses to recognize the hidden cases of sepsis and then put the trigger in their hands to expedite the diagnosis and treatment process.” Triage nurses now have specific criteria based on vital signs to make a diagnosis of suspected sepsis,” says Lisa Ball, RN, CEN, charge nurse and co-chair of the project at BUMC. “If a patient meets two of the five vital signs criteria and they appear to have an acute altered mental state, we initiate the protocol.” A nurse who suspects a sepsis case based on the criteria can now order a lactate test to confirm the condition. A positive lactate test triggers a sepsis alert and sets a rapid intervention in place. The goal is to expedite care and initiate antibiotic and IV fluids as soon as possible - all the time monitoring time to intervention.
Baylor Health Care Systems Emergency Departments
“It’s how we roll...it’s who we are”
Improved Sepsis Care | Decreased Sepsis Mortality
— Beth Houser, DNCs, FNP, RN, NEA-BC, Chief Nursing Officer, Baylor Regional Medical Center at Grapevine
Jun-13
Apr-13
Feb-13
Dec-12
Oct-12
Aug-12
Apr-11
30
Jun-12
40
Apr-12
50
Feb-12
60
Dec-11
70
Oct-11
80
Aug-11
90
HCAHPS stands for hospital consumer assessment of healthcare providers and systems. HCAHPS is a 32-item survey instrument and 0.82 data collection methodology for measuring Seps 0.80 is Mo rtalit y (HS patients’ perceptions of their hospital experiMR) b y FY 0.78 ence. It is a high standard against which exemplary professional practice can be mea0.76 hrs hin 3 it sured. So when Baylor Grapevine ED rose to w -ABX 0.74 or-to % do e the 97th percentile—the fourth year in a row c n lia Comp s 0.72 3 hr in above the 90th percentile—they knew they h wit olus id b lu were doing it right. The 97th percentile score f 0.70 IV r-todoo % means that Baylor Grapevine scored better e c plian 0.68 Com 511 deaths avoided than the 97 percent of all hospitals reporting. FY11 to FY 13 0.66 To reach above the 90th percentile and to stay there, they did a few things very 0.64 well. First, they hired for the right skills and attitude. Second, they adopted Studer Principles and AIDET. Foremost, they centered everything they do including, workflow and communications, around the patient. This process, combined with purposeful rounding, a commitment to be seen and diagnosed quickly and working as a team, made the difference. Beth believes hiring for the right skills and attitude has been the key to Baylor Grapevine’s success. “Putting the right people in the right jobs in the right places and at the right time changes everything.” 0.84
Jun-11
100
From Texas to Africa
From left to right: Baylor Plano ED nurses Lourdes Lauron, BSN, RN; Amy Garner, RN; Reena Bhakta, BSN, RN; David Mullens, BSN, RN, ED, Supervisor; and Anthony Arris, ED Tech, discuss how to keep sepsis at bay during their morning huddle.
Baylor Nursing 2012-13 Annual Report
Regional Medical Center at
Baylor nurses are always on the move. The “Africa Mercy” hospital ship, the largest non-government hospital ship in the world, is currently docked in West Africa, where it is providing hope and healing to the people in that region. The third deck of the ship contains the specialized surgical hospital with 70 inpatient beds, an ICU, five operating rooms, PACU and full service lab, radiology with CT scan and pharmacy. Baylor nurses who have served on the ship have enjoyed once-in-a-lifetime learning experiences. They come back more well-rounded and with a renewed spirit to serve and provide compassionate care. Scott Temple, RN, BUMC, Lindsey Briley, BSN, RN, BHVH, and Jennifer Angelo, BSN, RN, Baylor Grapevine were among the nurses who spent their personal time off helping others. “Maybe the most touching patients were the burn victims, who are primarily children,” said Lindsey, who stayed more than 12 weeks. “In Africa, many children are injured from falling into fire pits and pots of scalding water. “It was a privilege to spend time on the ship and work with people who need so much. Now, more than ever, I look at the health and well-being of the whole person. The ‘Africa Mercy’ ship brought me back to the reason I became a nurse in the first place”
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New Knowledge and Innovation Nursing never stands still. We are proud to be at the forefront of change. From patient care, to the Baylor Health Care System and to the profession of nursing as a whole, we are continually improving our knowledge, sharing innovation and improving our practice. Perhaps, never before, has nursing had the opportunity it does today to transform the way health care is delivered in this country.
Patients at home In 2011, Baylor received a $12.4 million grant from the Deerbrook Charitable Trust on Gerontology to better understand and improve the care of the elderly. One of the most stressful events is the transition to home for people who have had heart failure or pneumonia. Patients and their families are often frightened, confused about discharge instructions, and going home to an environment that isn’t outfitted for patient care. Today, we have a full-service approach to the transition to home. Through a combination of risk stratification, remote monitoring and weekly visits, an advanced practice nurse (APRN) coordinates and drives collaboration among physicians, pharmacists, social workers, chaplains, and home health professionals. The results have been impressive:
> Heart failure readmission rates reduced by 48% to 10% > Pneumonia readmission rates reduced by 72% to 4.5% > Combined heart failure and pneumonia readmission rates reduced by 60% Quarterly Readmission Rates: Combined Heart Failure and Pneumonia Interim Results 60% relative reduction
20 18 16 14 12 10 8 6
Baylor Nursing 2012-13 Annual Report
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2 0 Jul-Sep 12 Oct-Dec 12
Jan-Mar 13 Apr-Jun 13
Jul-Sep 13 Oct-Dec 13
These results validate the inter-professional team approach. Every bit as important, patients have actually enjoyed participating in this quality improvement project, and more than 80 percent are recommending tele-monitoring to other patients.
An inter-professional team works together to give patients and families the right treatments and the confidence to create safer passages. Left to right: Karen Polzer, RNBC; Paula Walker, RPh; Kellie Kahveci, MSN, RN, APRN-BC, GNP-BC; Mae Centeno, DNP, RN, CCNS, ACNS-BC; Tiffany Lackey, MSN, RN, APRN-BC, GNP; Valerie Douglas, MSN, RN, ANP-C; Alexis Early, LMSW; and Elaine Kim,
MSN, RN, FNP-C.
Staying close and getting better An 89-year-old woman was recently hospitalized for heart failure. Within 24 hours of discharge, she was engaged in the tele-monitoring program. On the third day, she became dizzy. Without returning to the hospital, the pharmacist contacted her and reviewed her medications to assure she was taking them as prescribed. Her physician and pharmacist collaborated on medications and reviewed instructions with the patient. Her nurse followed up and reviewed instructions again, monitoring the patient closely, although remotely. Soon, the patient was feeling better and had more confidence in her treatment and ability to help herself. Thus, the patient was able to remain at home and readmission to the hospital was prevented through timely intervention by the inter-professional team. Working for change
PRA C TI C E PART N ER PRO M OTE
Baylor Nursing 2012-13 Annual Report
A C HIE V E
Practice...Achieve...Partner...Promote...it’s what we do. Today and every day. And while we will never forget where we’ve been, and while we are proud of our accomplishments, we can’t spend but a moment looking back. For it’s not what we did yesterday that will advance health care and population health, but what we do tomorrow, and the next day and the next. That’s where we focus. That’s what we’ll work to change. To learn more about Nursing at Baylor and to see the details and graphics of the information we’ve highlighted here, please visit: BaylorHealth.com/NursingAnnual.
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