Volume 13│Issue 1│Spring 2022
Conduct at the Core: Engaging Contract Nurses
Brooke Hickman, MBA, BSN, RN - CRMH 11 West Unit Director The evolution of healthcare will never cease. Many who came into the world of medicine have spoken to its everchanging platforms. Change can be seen as forward progress if those in leadership can adapt to the momentum. Since the start of the COVID pandemic, unit-level nursing leaders have seen fluctuations in staffing. Leaders may have thought their areas were immune to the “Great Resignation,” only to see it hit later. 11 West went from a functional vacancy of 31% in October 2020 to 56.19% in December 2021. There continues to be limited applicants to backfill needs. Nurse leaders must adapt to the current market. Leaders must explore strategies of how to best manage contract staff. Seasonally, we have found it harder to obtain contract staff, leaving our hospitals without resources to care for the community. Our overreaching goal needs to be the provision of necessary resources for the community the organization serves. The organization must switch from seeing contract staff as short-term support and resolve to retain them as long as possible. This may involve determining how to include contract staff and engage them on their assigned unit. Contract staff can be a valuable resource due to their experiences within various organizations.
On 11 West, unit-level leadership has identified several strategies to better engage contract staff that may be useful to leaders of other units. For instance, nurse leaders meet one-on-one with core staff to discuss growth, expectations on both sides, and to obtain suggestions toward forward progress. This can be expanded to include leadership one-on-one meetings with contract staff. Some questions for contract staff that could be included are: • • • • •
How long have you been traveling? Why do you travel? What do you look for when you are deciding on an assignment? What makes you re-sign on this or any assignment? What are things you have seen in the workflow or on the unit, in general, that could be improved based on your previous experiences?
During one-on-one sessions, contract staff on 11 West have been open and honest with their suggestions and feedback. Their feedback can help the personal growth of leaders and the critical thinking skills of core staff, in addition to improving unit functionality. Setting unit expectations should occur just as one would when onboarding permanent core staff. The culture of the unit is an essential driver of contract staff satisfaction. Including contract staff in one-onone sessions, unit activities, and recognition is paramount. They want to be on a unit that is welcoming and inclusive. They want a comparable acuity assignment with available resources. Unit culture can and will determine the length of time a contract nurse is retained. Of the eleven nurses that 11 West has contracted, 72% (8 out of 11) renewed their contract, some several times. Currently, seven of those eight remain working on the unit. Consistency of unit staff can ensure maintenance and improvement in quality scores. The first contract nurse was added to the unit approximately July of 2021. Since that time the unit has maintained zero CLASBIs and zero HAPIs. *Continuation of this article on page 3 Carilion Clinic Roanoke Campus
Page 2
Within REACH
ARTICLES/NOTIFICATIONS 1 Conduct at the Core: Engaging Contract Nurses Brook Hickman, MBA, BSN, RN 4 Nursing Work Related Stress in the ICU and Aromatherapy Sandra Hubbard, BSN, RN, TCRN 8 Summary of Proposed National Legislation: Workplace Violence Prevention for Healthcare and Social Services Workers Act Raymart Gerena, BSN, RN 10 Improving Work Environment and Retention in a Progressive Care Unit (Part 1) Suzanne Beels, MSN, RN, AGCNS-BC, CCRN; Susan Blankenship, MS, BSN, RN, PCCN
RECOGNITION/EVENTS 13 Brandon Jones - Virginia Board of Nurses - New President 14 Time is Brain - Celebration of Door-to-Needle Time Pam Flinchum, BS, RT(R)(CT), RN, SCRN Citations & Recognitions
15 16 Additional Recognition 18 Virtual Healthcare Hot Topics Journal Club 19 Classes & Events 20 See Where Our Nurses Have Presented Their Work 21
External Conference information
Carilion Nursing Research Editorial Board: Deirdre Rea, DNP, RN-BC, PMH-CNS - Interim Editor-in-Chief Reviewers Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCNS, CCRN-K Ann Beheler, ADN, RN Sarah Browning, DNP, RN-BC Charles Bullins, DNP, RN, AGACNP-BC Monica Coles, DNP, RN-BC, ACNS -BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, PhD, RN, CNE
Cindy W. Hodges, BSHS, RNC, FCN James Ingrassia, MSN, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Laura Reiter, DNP, RN, CCRN, CNRN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC
Page 3
Practical Applications of Nursing Inquiry
(*Continued from page 1)
In the same time span, 2 CAUTIs were called on the unit and were remediated with staff education. In effort to decrease CAUTIs, feedback from contract and permanent staff was solicited and a goal of foley removal prior to 11 am was identified. At this point in the fiscal year,11 West has not had a CAUTI. •
•
Leadership Takeaways Round as a leader: Many organizations have set expectations for leaders to round on patients. Use that time in between patient rounds to focus on individual staff members. Hear what they are saying and see how you can support them in the moment. There may be tangible action items in the moment but providing time to listen to staff increases trust and rapport. Both contract and core nurses need this support. Unit-based shared governance restructure: Shared governance has always given staff nurses a voice into how the unit operates and allows shared decision making. With fewer core staff many councils have dissolved. Shared governance and decision making is directly tied to employee engagement and with creativity by the leader these councils can remain active and effective. Leaders should seek out the change agents on the unit whether core or contract. Using combinations of formal and informal meeting options provides various forums for staff to provide feedback and ideas. When the council chair or change agent is scheduled clinically, give them the support to seek out suggestions/answers from others, encourage resolutions to council goals.
Core staff are valuable. Hospitals need contract staff to ensure we can care for our communities. Unit leaders must find the balance and flexibility to manage both. The answer is to foster a positive culture and engage them all with the same level of accountability.
Page 4
Within REACH
Nursing work related stress in the ICU and Aromatherapy Sandra Hubbard, BSN, RN, TCRN - 2020 Nursing Research Fellowship Background Due to the dynamic nature of their work environments, ICU nurses are at substantial risk of experiencing negative sequelae of anxiety. Nurses with higher resilience and a larger arsenal of coping mechanisms may be better able to cope with work-related stress and may be less likely to experience symptoms of anxiety. One potential coping strategy is aromatherapy. Existing knowledge regarding use of aromatherapy suggests a relationship between aromatherapy and reduced nurse stress and anxiety.1-16 However, the number and quality of studies is limited, supporting the need for further research.7 The purpose of this research study was to explore in ICU registered nurses, what is the effect of an inhaled aromatherapy blend containing lavender, bergamot, sweet orange, and ylang-ylang compared to placebo on perceptions of work-related state anxiety over a 30-day period?” Design This was an IRB approved randomized, blinded, placebo-controlled study with a quantitative (experimental) design. Study objectives were the following: Objective 1: Evaluate the effectiveness of an inhaled essential oil blend on state anxiety of ICU nurses versus use of a placebo. Objective 2: Evaluate the relationships between age, gender, years of experience, shift worked, and trait anxiety and state anxiety using regression.
This study used a convenience sample of RNs, 18 years and older, whose primary work locations were select ICUs at Carilion Roanoke Memorial Hospital (CRMH) and the ICU at Carilion New River Valley Medical Center (CNRV). Exclusion criteria included self-reported asthma or history of reactive airways, allergies to any components of the selected study aromatherapy blend or placebo - lavender, bergamot, sweet orange, ylang-ylang, normal saline, being pregnant, potentially pregnant or planning to become pregnant in the next 90 days or nursing, or a history of skin or respiratory reactions to inhalation of an essential oil. Methods Potential subjects were recruited through email via the secure platform REDCap. After the research coordinator consented potential subjects, a pre-intervention survey consisting of demographic information and the State-Trait Anxiety Inventory for Adults (STAI-A) was completed via REDCap. The study biostatistician randomized the consented subjects to either the placebo or intervention group. To maintain blinding, the research coordinator distributed the aromatherapy delivery devices. The intervention device was a personal wick shaped inhalation device with an aromatherapy blend composed of high-quality essential oils including lavender, bergamot, sweet orange, and ylang-ylang. The placebo device was a personal disk-shaped inhalation device containing normal saline. At the conclusion of the 30-day intervention period, subjects took a post-survey consisting of the same STAI-A and completed a device use questionnaire.
Page 5
Practical Applications of Nursing Inquiry
Findings Twenty-three nurses completed the pre-surveys, with 18 completing the post-surveys. To conduct paired t-test analysis, data from the five nurses not completing the post-surveys was excluded from data analyses. Ten nurses participated in the intervention group and eight in the placebo group. Sample characteristics are summarized in Table 1.There were no statistically significant differences in the demographic characteristics between the intervention and placebo groups. Objective 1: Evaluate the effectiveness of an inhaled essential oil blend on state anxiety of ICU nurses versus use of a placebo. Results: STAI mean differences within paired intervention and placebo samples did not meet statistical significance (p≥0.05). A reduction in the paired trait anxiety mean scores in the placebo sample from pre 38.875 to post 33.625 approached significance at 0.0586. There were no statistically significant differences between the intervention or placebo group mean pre or post STAI scores (p≥0.05). Results are summarized in Tables 2 and 3. Objective 2: Evaluate the relationships between age, gender, years of experience, shift worked, and trait anxiety and state anxiety using regression. Results: Regression analysis was not conducted due to the absence of statistically significant findings in bivariate analyses
Continued next page
Page 6
Within REACH
Implications for Practice This study is the first randomized blinded placebo trial to investigate the impact of an inhaled aromatherapy intervention versus placebo on ICU nurse anxiety. Although there is limited published data on normative registered nurse anxiety scores measured with the STAI, recent literature suggests scores between 40-59 are indicative of moderate anxiety in adults.17 The mean state and trait anxiety scores for the nurses in this study ranged between 33.625 and 44.3 with standard deviations ranging between 7.6146 to 11.7. These scores suggest moderate anxiety levels in the study sample similar to those reported in prior nurse studies, supporting the need for identification of effective resilience strategies for nurses in the ICU setting. Most prior studies support a relationship between aromatherapy and reduced nurse stress and anxiety; however, not all studies demonstrated direct linkage to reduced stress or anxiety. This study did not demonstrate significant differences in state or trait anxiety levels pre to post intervention within study groups or between intervention and placebo groups; however, the study sample size was insufficient to achieve power. Conducting a study during a pandemic, even a study designed to reduce anxiety, could have been a factor in our recruitment efforts and may have impacted STAI scores. An important study finding is that use of an aromatherapy intervention inhalation device can be used by ICU nurses safely in the clinical setting without any reported untoward impact. On average, subjects in this study used their inhalation device 15 times during the 30-day study period and only one subject reported scent was noted by a bystander. These findings are consistent with prior research demonstrating aromatherapy interventions can be safely implemented in the clinical setting.9, 11
Page 7
Practical Applications of Nursing Inquiry
Conclusions There is a dearth of research on the impact of aromatherapy on nurse anxiety in the clinical setting in general and, specifically, in the ICU setting. This study, as the first randomized blinded placebocontrolled study in the ICU setting, serves as a pilot to explore the impact of aromatherapy on anxiety in ICU registered nurses. The study supports additional research is needed to evaluate the impact of aromatherapy on reduction of nurse anxiety in a variety of settings. References
1. Eren, N., Oztune, G., (2017). The effects of aromatherapy on the stress and anxiety levels of nurses working in Intensive Care Units. International Journal of Caring Sciences,10(3), 1615-1623. 2. Roberts, R. & Grubb, P. (2013). The consequences of nursing stress and need for integrated solutions. Rehabilitation Nurse, 39(2), 62-69. doi: 10.1002/mj.97. 3. Rushton, C., Batcheller, J., Schroeder, K., & Donohue, P. (2015). Burnout and resilience among nurses practicing in high-intensity settings. American Journal of Critical Care,24(5), 412-420. doi: 10.4037/ajcc2015291. 4. Johnson, K., West, T., Diana, S., Todd, J., Haynes, B., Bernhardt, J., & Johnson, R. (2017). Use of aromatherapy to promote a therapeutic nurse environment. Intensive & Critical Care Nursing, 40(1), 18-25. doi: 10.1016/ j.iccn.2017.01.006. 5. Johnson, C. (2019). Effect of inhaled lemon essential oil on cognitive test anxiety among nursing students. Holistic Nursing Practice, 33(2), 95-100. doi: 10.1097/hnp.0000000000000315 6. American Holistic Nurses Association. www.ahna.org. (2019). Accessed 2019. 7. Li, H., Zhao, M., Shi, Y., Xing, Z., Li, Y., Wang, S., Ying, J. … Sun, J. (2019). The effectiveness of aromatherapy and massage on stress management in nurses: A systematic review. Journal of Clinical Nursing, 28(3/4), 372-385. doi: 10.111/jocn.14596. 8. Chen, M., Fang, S., Fang, L., (2015). The effects of aromatherapy in relieving symptoms related to job stress among nurses. International Journal of Nursing Practice, 21(1), 87-93. doi:10.1111/ijn.12229. 9. Pemberton, E. & Turpin P. (2008). The effect of essential oils on work-related stress in intensive care unit nurses. Holistic Nursing Practice, 22(2), 97-102. 10. Zamanifar, S., Bagheri-Saveh, M. I., Nezakati, A., Mohammadi, R., & Seidi, J. (2020). The effect of music therapy and aromatherapy with chamomile-lavender essential oil on the anxiety of clinical nurses: A randomized and double-blind clinical trial. Journal of Medicine & Life, 13(1), 87–93. https://doi-org.lib-proxy.radford.edu/10.25122/jml2019-0105. 11. Han, X., Gibson, J., Eggett, D., & Parker, T. (2017). Bergamot (citrus bergamia) essential oil inhalation improves positive feelings in the waiting room of a mental health treatment center: A pilot study. Phytotherapy Research, 31 (1), 812-816. doi: 10.1002/ptr.5806. 12. Donalson, J., Ingrao, C., Drake, D., Ocampo, E., (2017). The Effect of Aromatherapy on Anxiety Experienced by Hospital Nurses. Medsurg Nursing, 26(3), 201-206. 13. Cooke, M., Holzhauser, K., Jones, M., Davis, C., Finucame, F. (2007). The effect of aromatherapy massage with music on the stress and anxiety levels of emergency nurses: Comparison between summer and winter. Journal of Clinical Nursing,16(9), 1695-1703. doi:10.1111/j.1365-2702.2006.01709x. 14. Hongratanaworakit, T., Buchbauer, G. (2004). Evaluation of the harmonizing effect of ylang-ylang oil on humans after inhalation. Planta Med. 70:632-636. 15. American Psychological Association. (2020). Anxiety. Retrieved from apa.org/topics/anxiety 16. Hume, L. (2018). An investment in staff well-being, Nursing Management. Springhouse. 49(12), 9-11 doi: 10.1097/01.NUMA.0000547833.17955.8a . 17. Akinci, A., Keles, F., & Savci, C. (2021). Anxiety levels and clinical decision-making skills of nurses providing care for patients diagnosed with COVID-19. Electron Journal of General Medicine, 18(6):em22. https:// doi.org/10.29333/ejgm/11300.
Page 8
Within REACH
Summary of proposed national legislation: Workplace Violence Prevention for Health Care & Social Services Workers Act Raymart Gerena, BSN, RN - CNRVMC Surgical Care Suite One in four nurses has been abused in the workplace. Overall, the likelihood of healthcare workers being exposed to violence is higher than prison guards or police officers (American Nurses Association, 2021). In 2020, the American Nurses Association (ANA) heard directly from nurses telling their stories of patients assaulting them, throwing objects at them, biting them, and more (Stand, 2021). Policymakers have begun to recognize the need to prioritize violence prevention in the healthcare setting (National Nurses United, 2021). The Workplace Violence Prevention for Health Care and Social Service Workers Act (HR. 1195, Courtney, 2021) sponsored by Connecticut Representative Joe Courtney would mandate the Occupational Safety and Health Administration (OSHA) to promulgate a standard that would require all covered employers to develop and implement prevention plans to reduce workplace violence (WPV) incidents (National Nurses United, 2021). There is currently no OSHA standard that requires employers to implement violence prevention plans that would help reduce workplace violence injuries among healthcare and social service workers (Scott, 2021). This paper explores the need for violence prevention standards within the healthcare setting from a legislative perspective. Workplace violence is bad for patients and hospitals (National Nurses United, 2021). Workplace violence experienced by nurses has been associated with decreased productivity and increased employee turnover (National Nurses United, 2021). It can reduce the level of nurse job satisfaction, and adversely affect quality of patient care and case outcomes (Stand, 2021). This is in addition to nurse injury and lost time at work (Stand, 2021). A 2018 report by the Joint Commission, Bureau of Labor Statistics (BLS) data showed that violence related injuries are four times more likely to cause healthcare workers to take time off from work than other kinds of injuries (National Nurses United, 2021). Yet, the actual number of violent incidents involving healthcare workers is likely much higher because reporting is just voluntary (National Nurses United, 2021). In a 2015 study, 88 percent of respondents had not documented in their employer’s electronic system an incident they had experienced in the previous year (National Nurses United, 2021).
This bill will require federal OSHA to issue a final standard mandating employers to develop comprehensive, workplace- specific plans to prevent violence before it happens (Scott, 2021). It will set a quick timeline on implementation to ensure timely protection for healthcare workers (National Nurses United, 2021). It will set minimum requirements which include unit-specific assessments and implementation of prevention measures including physical changes to the environment, staffing for patient care and security, employee involvement in all steps of the plan, hands-on training, robust record keeping requirements including a violence incident log, protection from retaliation for employees to report WPV to their employer and law enforcement among other requirements (National Nurses United, 2021). Workplace violence often causes both physical and emotional harm (Scott, 2021). Victims of these incidents often suffer career-ending post-traumatic stress disorder that takes away their livelihoods and weakens an already stretched healthcare workforce (Scott, 2021). The American Nurses Association (ANA) reports that workplace violence continues to be a top concern for nurses during the COVID-19 pandemic (American Nurses Association, 2021). According to ANA president Ernest J. Grant, PhD, RN, FAAN, employers must take action not only to implement plans but also to enforce zero tolerance policies and remove all barriers that discourage nurses from safely reporting occurrences of violence and abuse. This legislation would have a good impact in nursing as this would make nurses feel secure and less stressed while working to provide effective patient care (American Nurses Association, 2021). In conclusion, a bill that tackles workplace violence prevention will ensure the well-being of patients and staff in the hospital. Currently, the legislation passed the House with broad bipartisan support on a 254166 vote and has moved to the Senate for approval (Robinson, 2021). If passed in the Senate, this bill would then be sent to President Biden to be signed into law (Robinson, 2021). There has been opposition by the American Hospital Association (AHA) who expressed concern about the bill citing “prohibitive costs” compounded by significantly decreased hospital revenues due to COVID- 19 related losses (Robinson, 2021). On the other hand, the Congressional Budget Office (CBO) acknowledged that
Page 9
Practical Applications of Nursing Inquiry
there are projected cost savings to healthcare facilities because of reduced occupational injuries, a consequent reduction in absenteeism and, reduced employee turnover (Scott, 2021). If this bill becomes law, this will truly help public sector health care and social service workers in the 24 states not covered by any OSHA protections (Scott, 2021).
References • • • • • • • • •
American Nurses Association. (2021, April). Workplace Violence. https://ana.aristotle.com/sitepages/ WorkplaceViolence.aspxStand, L., Francis, R. (2021, September). Violence Prevention Measures Move in Congress. American Nurse Journal. https://www.myamericannurse.com/wp-content/uploads/2021/09/an9-NPI-825a.pdf National Nurses United. (2021, March 4). The Workplace Violence Prevention for Health Care and Social Service Workers Act HR 1195 Fact Sheet. https://www.nationalnursesunited.org/sites/default/files/nnu/ documents/0321_WPV_WorkplaceViolence_Federal_FactSheet.pdf Scott, R. (2021, February 22). Fact Sheet H.R. 1195 House Committee on Education and Labor. https:// edlabor.house.gov/download/workplace-violence-prevention-for-health-care-and-social-service-workers-act National Nurses United. (2021, February 22). Nurses Applaud Introduction of Federal Legislation to Prevent Workplace Violence in Health Care, Social Service Settings. https://www.nationalnursesunited.org/press/nursesapplaud-legislation-to-prevent-workplace-violence Robinson, D., Sporleder, J. (2021, June 16). H.R. 1195: Workplace Violence Prevention for health Care and Social Service Workers Act. https://www.mediapartners.com/blog/post/hr-1995-workplace-violence-prevention-forhealth-care-and-social-service-workers-act American Nurses Association. (2021, April 16). Passage of Workplace Violence Prevention legislation by U.S. House of Representatives. https://www.nursingworld.org/news/news-releases/2021/ana-applauds-passage-ofworkplace-violence-prevention-legislation/ National Nurses United. (2021, November 12). National Nurse Survey Exposes Hospitals’ Knowing Failure to Prepare for a COVID- 19 Surge During Flu Season. https://www.nationalnursesunited.org/press/national-nursesurvey-4-exposes-hospitals-knowing-failure-prepare-covid-19-surge Courtney, J. (2021, April 16). Rep. Courtney’s Bill to Protect Health Care And Social Service Workers Passes House with Strong Bipartisan Support. https://courtney.house.gov/media-center/press-releases/rep-courtney-s-bill -protect-health-care-and-social-service-workers-0
Page 10
Within REACH
Improving work environment and retention in a progressive care unit (Part 1 of 2) Suzanne Beels, MSN, RN, AGCNS-BC, CCRN; Susan Blankenship, MS, BSN, RN, PCCN - CVI Surgery & Educational and Organizational Development Methods and procedures In June 2020, concerns were brought to Cardiovascular Institute (CVI) leaders regarding high turnover rates amongst 7SPCU nurses, a Cardiovascular Progressive Care Unit (PCU). The 7MPCU and 9SPCU employees were combined in December 2019 to form a new CVI surgery PCU. Nurses were challenged with learning skills to care for cardiac, vascular, and thoracic surgery patients: creating a lengthy competency validation list of high-level skills. Purpose and aims The purpose of this quality improvement project was to appropriate a weekday floating charge nurse (FCN) to support RN staffing levels on the CVI Surgery PCU. Project aims were to increase RN retention rate and increase the overall ‘Appropriate Staffing’ Standard Score. Current state of knowledge The American Association of Critical Care Nurses (AACN) led the way in defining and measuring the impact of work environment on patient and nurse outcomes in acute and critical care units. The Healthy Work Environment (HWE) survey collected data and focused on six standards for creating an HWE: True collaboration, skilled communication, effective decision-making, meaningful recognition, appropriate staffing, and authentic leadership. Ulrich et al. identified five themes in their review of nurse work environment studies completed from 2005-2017, one of which was the positive correlation of HWEs with psychological health, job satisfaction, and retention (2019, p. 68). They also noted HWEs were negatively correlated with emotional strain and burnout (Lampo, 2019). Description of population and benefit 7SPCU is a 20-bed PCU. The benefits of establishing a weekday FCN were to develop and maintain frontline clinical expertise and improve the work environment. Methods and procedures The FCN role was developed to address employee feedback while meeting the project goals. The FCN did not carry a standard patient assignment but was available on the unit to fill any gaps in care. By utilizing the most experienced nurses in the FCN role, they were the most knowledgeable and versatile RNs to handle the responsibilities. Specifics of the role: •
Daily tracking of time allocation: Out of the 370-day pilot, the FCN was utilized 140 days
•
FCN hours were scheduled as 8-12-hour shifts during high churn as staffing permitted
•
Exclusions included nightshift, weekends, and holidays
•
The FCN was pulled back into staffing as a bedside RN with a patient assignment when 7SPCU or another PCU required support
FCN time was allocated into primary categories as identified on the graph below. Most of the shift was spent in direct patient care raather then managing throughput.
Page 11
Practical Applications of Nursing Inquiry
A planning team met weekly to identify if adjustments were needed. Employees gave ongoing feedback to the Unit Director. Quarterly updates were provided to surgeons and other CVI Unit Directors during interdisciplinary quality meetings and daily huddles.
Assessment and outcome measures and data collection Power-Bi was used to evaluate RN turnover rates. Quarterly HWE surveys were administered to track ongoing engagement and feelings of support. Results were discussed during staff meetings and informally as situations arose. The project measures included “Appropriate Staffing” and “Skilled Communications.” Findings
Turnover
The RN turnover rate from fiscal year 2020 was 23.6%. In 2021, it decreased to 14.55%. Reasons for leaving the unit changed from concerns with workload and acuity to promotions, retirements, and relocation.
OVERALL STANDARD: Staffing must ensure the effective match between patient needs and nurse competencies. The overall pre-project score was 58.97% of RNs disagree the standard is being met. The post-project score was 15.56%. Three individual questions elicit the overall response to the overall standard. They included: •Q3. The pre-project score was 62.82% disagree. The post-project score was 13.33%. •Q8. The pre-project score was 53.85% disagree. The post-project score was 13.33%. •Q12. The pre-project score was 53.84% disagree. The post-project score was 20%. *See diagram next page. Continued on next page
Page 12
Within REACH
Impact The goal of maintaining current nurses was the impetus of the project, but the overall unit impact was significant. HWE surveys showed less dissatisfaction with appropriate staffing. There was a positive progression in morale and job satisfaction. The FCN role was performed less than half of the time, yet positive outcomes were still recognized. Anecdotal conversations with nurses reflected a more positive work experience. Multiple nurses who had either left the unit or submitted resignations had returned or remained. Additional incidental outcomes occurring simultaneously included: • • • •
decrease in CVI PACU hold times which improved throughput and decreased OR downtime low HAI rates increased number of quality rounds improved patient satisfaction
*See part 2 in the next Within Reach to learn about project recommendations. References • • • •
Lampo, D. (2019). American Association of Critical Care Nurses [AACN]: Staffing in acute and critical care. Retrieved from AACN https://www.aacn.org/clinical-resources/staffing# McGaffigan, P. (2019). American Association of Critical Care Nurses [AACN]: Keys to appropriate staffing. Retrieved from AACN https://www.aacn.org/nursing-excellence/nurse-stories/keys-to-appropriate-staffing Samoya, A. (2019, September). Creating healthy work environments: An evidence-based toolkit for nurses. Retrieved from AACN website https://www.aacn.org/~/media/aacn-website/nursing-excellence/healthy-workenvironment/hwetoolkit.pdf?la=en Ulrich, B., Barden, C., Cassidy, L., & Var-Davis, N. (2019). Critical care nurse work environments 2018: Findings and implications. Critical Care Nurse, 39(2), 67-84. Retrieved from http://aacnjournals.org’ccnonline/articlepdf/39/2/67/116850/67
Page 13
Practical Applications of Nursing Inquiry
CONGRATULATIONS!
PRESIDENT VIRGINIA BOARD OF NURSING Brandon Jones, MSN, RN, CEN, NEA-BC
Our very own Brandon Jones, System Patient Experience Manager, has been elected by his Board of Nursing colleagues to begin his term as President of the Virginia Board of Nursing. Brandon began serving on the board following gubernatorial appointment in 2019. Working along with board staff, the Board of Nursing licenses and regulates the Commonwealth’s more than 250,000 practitioners across a range of nursing professions and approximately 150 pre-licensure nursing education programs.
Page 14
Within REACH
“TIME IS BRAIN” Pam Flinchum, BS, RT(R)(CT), RN, SCRN RN Stroke Specialist ***************************** When a person is having a stroke, getting treatment fast is critical because it can save brain tissue from permanent damage. 1.9 million neurons or 1.8 quality days of life are lost per minute. About 80-85% of strokes are ischemic strokes, which are caused by a blockage of a blood vessel in the brain that leaves the surrounding tissue starved of blood. Restoring blood flow to the brain as soon as possible is crucial to give a person their best chance at a full recovery, like being able to walk and talk again. The national standard, set by the American Heart Association/American Stroke Association, recommends patients receive the clot-busting medication, called alteplase or TNK, in less than 60 minutes. Our team: Dr. Paul Haskins ED Physician, Dr. Jamison Zink ED resident Physician, Alexis Gliniecki ED RN, Kelly McAllister ED Pharmacy, Amanda Wilkes CT, Dr. David Keyes Radiologist, Dr. Nicholas Yelverton Neurology, and Dr. Narmada Mannem resident Neurology performed this in 22 minutes! This is our new record at CMC. Thank you for the teamwork and for striving to deliver the best patient care and outcome! ~ Pam
Page 15
Practical Applications of Nursing Inquiry
January 2022 - April 2022 (& past presentations not noted prior to this edition) Kates, J., Whitehead, P., Fink, R., Tay, D., Johnstone-Petty, M., Frechman, E. February 12-13, 2022. A Scoping-Review of Nurse-Led Research to Improve Advance Care Planning: A Call to Action. State of the Science in Hospice and Palliative Care - Virtual. Seay, K. March 2-5, 2022. Improving Knowledge, Confidence, and Frequency of Pain and Sedation Assessment in Preterm Neonates. Virginia Council of Nurse Practitioners Annual Conference, Hot Springs, VA Alderman, A., Cady, G., Ramsey, K., Moses, K., Cleveland, R. March 13-19, 2022. Making Meaningful Connections: Implementation of a Virtual Communication Tool in the NICU. Carilion Quality Conference - Virtual Osborne, L., Wolfe, M., Lipes, A., Sink, D., Murphy, C., Mossadad, Y., Cleveland, R., Ward, C. March 13-19, 2022. Preventing Unplanned Extubations in Critically Ill Pediatric Patients: Beyond the Bundle. Carilion Quality Conference - Virtual Whitehead, P., Phillips., N., Neal, C. April 5, 2022. Advanced Care Planning (ACP) in Hospitalist Patients. Carilion Research Day - Virtual Gillman, J., Washofsky, A., Boggs, L., Wolfe, M., Osborne, L., Wooldridge, A., Kress, S., Cleveland, R., Ward, C., Hayes, A. April 5, 2022. Enhancing Inpatient Team Communication Among Pediatric Nurses and Residents. Carilion Research Day - Virtual
Stewart, C., Bower, K., Whitehead, P. February 9 -12, 2022. Donation After Cardiac Death Protocols for Best Practices in Patient Care - The Role and Integration of Palliative Services. The Annual Assembly of Hospice and Palliative Care - Virtual. Moses, K. February 24, 2022. Redesign of Quality Focused on People, Process and Patient Care. 2022 Virginia Patient Safety Summit - Virtual.
Bath, J. March 2022. Does Daily VTE Rounding Impact VTE Rates in Trauma Patients. March 1417, 2022. National Association of Clinical Nurse Specialists (NACNS) 2022 Annual Conference, Baltimore, MD. Harvey, E., Lucas, A. March 2022. Clinical Nurse
Specialist Collaboration Improves Catheter Associated Urinary Tract Infection Outcomes in a High Risk Population. March 16, 2022.
National Association of Clinical Nurse Specialists (NACNS) 2022 Annual Conference, Baltimore, MD. Harvey, E. March 2022. Ealry Recognition and Rescue of the Injured Patient. Society of Trauma Nurse TraumaCon 2022, Las Vegas, NV
Kronebusch, B., Kurt, D., Coles, M., Whitehead, P., et al. Jan/Feb 2022. A Call to Action: Leading the Charge for Diversity, Equity, and Inclusion Among Clinical Nurse Specialists. Nursing Economics, 40(1), 19-23. Retrieved from http:// ovidsp.ovid.com/ovidweb.cgi? T=JS&PAGE=reference&D=ovftx&NEWS=N&AN=00006073202201000-00004
Gerow, R., Altice, N., Wu, Y., Muthukattil, R., Carter, K. March 2022. Early Cardiac Rehab to Reduce Heart Failure Readmissions. Journal of Cardiopulmonary Rehabilitation and Prevention. Published online ahead of print.
https://journals.lww.com/jcrjournal/ Abstract/9900 Early_Cardiac_Rehabilitation_to_Reduce_ Heart.2.aspx
Coles, M. September 2021. Elected Chair of the NACNS newly formed Diversity, Equity & Inclusion committee Bath, J. October 28, 2021. Received the Medical Education Research Certification (MERC). Whitehead, P. March 17, 2022. Elected President of the National Association of Clinical Nurse Specialists
Page 16
Within REACH
Commitment! Danielle Liddle, BSN, RN (DNP student) CNRV The Birthplace Reduction in 1st Birth C-Sections Danielle Liddle, a nurse and educator at The Birthplace at CNRVMC, lead a nursing team to help reduce 1st birth c-section rates. Through several nurse-driven interventions, the unit realized a significant reduction in first birth c-sections. Danielle’s project was chosen to present at the Association of Women’s Health, Obstetrics and Neonatal Nurses’ national conference and will be published in the Journal of Obstetric, Gynecologic, & Neonatal Nursing (JOGNN). Excellent Work Danielle!
Courage! Kristy Massey, BSN, RN, CCRN-CSC Unit Director - CRMH CSICU Recognized by the American Association of Critical Care Nurses for “Promoting Excellence at the National Level” (As submitted by Sandy Sayre on the Wow Wall)
Kristy is well known and respected by her colleagues as the Unit Director for the Cardiac Surgery Intensive Care Unit at CRMH. But now the American Association of Critical Care Nurses (AACN) has also recognized Kristy’s talent, recruiting her to work on projects that impact the future of critical care nursing related to knowledge base, empowerment, and excellence. The AACN have asked her help with: • Poster Presentation Abstract Reviewer for the 2022 National Teaching Institute (NTI) typically attended by 5,000+ critical care nurses annually. • NTI recorded sessions review panel- live presentations from NTI are recorded and placed on AACN’s CE website. Kristy reviews for continuation or archives. • Cardiac Surgery Certification (CSC) Lead Subject Matter Expert for the newest version of the exam, released in January 2022. Ten question writers submitted questions to Kristy for content review/editing. Kristy reviewed and edited >250 questions for content/current practice for the newest version of the exam in addition to authoring several items. • ECMO micro credential (this is a new exam/micro credential offered through AACN later this year or early 2023). Kristy will serve as subject matter expert. • Beacon Application Reviewer – this is an AACN Award process for critical care units. Kristy will be on a team of application reviewers and will perform the initial application review.
Page 17
Practical Applications of Nursing Inquiry
Compassion! Phyllis Whitehead, PhD, APRN/CNS, ACHPN, PMGT-BC, FNAP, FAAN CRMH Clinical Ethicist/CNS Palliative Care/Moral Distress President, National Association of Clinical Nurse Specialists Phyllis has been elected the President of the National Association of Clinical Nurse Specialists. She is a clinical ethicist and clinical nurse specialist at CRMH Palliative Care Service and Associate Professor at the Virginia Tech School of Medicine. She is certified in pain management and as an advanced practice hospice and palliative care nurse. Phyllis has done numerous presentations on pain and symptom management, opioid induced sedation, moral distress, and patients’ end of life preferences locally, regionally, nationally and internationally. She is also President of the Virginia Foundation of Nurses. She is a founding member and Board of Director member of the Virginia Association of Clinical Nurse Specialists.
Commitment! Nancy Howell Agee, President & CEO, Carilion Clinic Virginia Business Magazine - 50 Most Influential Virginians 2022 Congratulations to Carilion President and CEO Nancy Howell Agee who was once again recognized in Virginia Business magazine’s list of “50 Most Influential Virginians” in 2022. This annual list includes representatives from Virginia’s businesses, non-profits media, state government and higher education. She leads a non-profit health system Carilion Clinic, which serves more than 1 million people in Virginia and West Virginia and is Roanoke Valley’s largest employer. In January, Ms. Agee was picked to serve on Gov. Glenn Youngkin’s medical advisory team, which is briefing him on the pandemic. Also, in July 2021, work started on the $15 million renovation of Carilion Franklin Memorial Hospital, and in October 2021, Carilion opened a new hub for children’s services at Tanglewood Mall. The health system is also raising $100 millon for a new cancer center. Over the next 7 years, Carilion will invest more than $1 billion through expansions and modernizations of its buildings, including a 500,000 square foot expansion of Carilion Roanoke Memorial Hospital.
Page 18
Within REACH
Introducing the Virtual Healthcare Hot Topics Journal Club! Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Research Council Unit Outreach Subcommittee The Unit Outreach Subcommittee of the Research Council has started a virtual journal club to provide an opportunity to read and discuss issues of concern in healthcare. The journal club is open to any employee. The most exciting thing about the Healthcare Hot Topics Journal Club is that it is virtual! Using the Teams platform will allow participants to post their comments and opinions when it is convenient for them. A new discussion will be started every one to two months. There will be a channel for each new topic with the article posted in the Files section. Discussion questions for the article will be located in the Wiki. A separate tab will give access to the evaluation form. Please complete the evaluation to let us know your opinion about the journal club and what future topics you’d like to discuss. Participation in a journal club can be used to fulfill the Research criteria for RN 2. The subcommittee will discuss ways journal club participation could be added to RN 3 and 4 criteria and make recommendations to the CAP Committee.
Questions? Contact: Cindy Ward - Clinical Nurse Specialist email: cwward@carilionclinic.org phone: 540-224-2508
Page 19
Practical Applications of Nursing Inquiry
CLASSES & EVENTS
Basic Research for the Healthcare Professional NR-CE333L
June 23, 2022 - 1:00-5:00pm August 18, 2022 - 8:00am-12:00pm October 20, 2022 - 1:00-5:00pm December 1, 2022 - 8:00am -12:00pm *Additional classes are being evaluated for 2022. Keep an eye on Within REACH or go to our hub on Inside Carilion for additions to our Nursing Research Classes schedule for 2022.
*All classes and events will be virtual at this time.
Page 20
Within REACH
“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom
Nottingham
Natl. Harbor, MD Williamsburg
Palm
Anaheim
Greenville
Lake Buena Vista
Page 21
Practical Applications of Nursing Inquiry
2022 NURSING CONFERENCE INFORMATION
AACN National Teaching Institute & Critical Care Exposition Date: May 16-18, 2022 Location: Houston, TX Association of Women’s Health, Obstetric and Neonatal Nurses 2022 Convention June 25-29, 2022 Aurora, CO 31st Annual AMSN Convention Date: September 29-October 2, 2022 Location: San Antonio, TX Speaker abstracts due 10/30/21 Poster abstracts due 5/15/22
ANCC 2022 MAGNET & PATHWAY TO EXCELLENCE CONFERENCE October 13-15, 2022 Philadelphia, PA
Carilion Clinic Roanoke Campus
