Journey to Excellence

Journey to Excellence Department of Nursing, 2013–2014 Annual Report

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. . . advancing the practice of nursing through our unwavering commitment to clinical excellence, driving innovations through research, fostering collaboration among colleagues and serving as a valued neighbor in the community.

Welcome W

elcome to our inaugural Nursing annual report from Christiana Care Health System. This report provides an opportunity to highlight key accomplishments and initiatives from the 2014 fiscal year, and to illustrate the impact our nurses make every day to improve the health of our patients and neighbors.

At Christiana Care, our mission is one of service, guided by The Christiana Care Way. This is the promise we make to our patients, to our neighbors and to each other. From the expert, respectful care our nurses provide to our patients and their families with each interaction, to a deep understanding of the cultural differences and preferences among the diverse population we serve, our nurses are ever-mindful of the essential role they play in every aspect of patient care.

Diane Talarek, MA, RN, NE-BC Chief Nursing Officer and Senior Vice President, Patient Care Services

It is this commitment that led Christiana Care to achieve Magnet Designation from the American Nurses Credentialing Center in 2010—the highest level of national recognition for sustained nursing excellence. This distinction underscores the tremendous professionalism, leadership and compassion of our nurses.

In the following pages, you will learn more about our blueprint for advancing the practice of nursing through our unwavering commitment to clinical excellence, driving innovations through research, fostering collaboration among colleagues and serving as a valued neighbor in the community.

The world of health care is evolving, and nurses can and must have a substantial influence on its direction. It is our responsibility to provide the tools to continually advance the practice of nursing and achieve success on our journey to excellence.

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excellence clinical

At Christiana Care Health System, our nurses deliver clinical

Department of Nursing by Level of Degree Associate’s in Nursing

920

excellence every day.

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rom hourly rounds when nurses visit each patient to shift reports that occur in the presence of each patient and family where vital information can be exchanged, we are dedicated to providing the highest possible level of quality care.

Diploma in Nursing

197 Bachelor of Science in Nursing

1,709 Master of Science in Nursing

408 doctorate

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One of the most powerful influences in advancing the practice of nursing in 2013-2014 has been the introduction of the Value Scorecard. Through these unit-based report cards, we measure each unit’s performance in key quality areas such as hand hygiene, falls, hospital-acquired infections, and patient satisfaction. Report card grades are based on the fiscal year performance-to-date. Data is posted monthly, providing each multi-disciplinary team with a platform to set tangible performance improvement goals. The Value Scorecard is leading to significant improvements across every unit and fundamentally transforming how we work.

Our Team Of the more than 10,500 employees at Christiana Care Health System, 2,480 are nurses. We are steadfast in ensuring that our nurses are practicing to the highest level of their license and strongly encourage the pursuit of BSN and MSN degrees, as well as specialty certifications. Currently, 81 percent of all RN’s and 41 percent of clinically-based RNs are certified by a nationally recognized organization, compared with 63.1 percent of all RNs and 31.6 percent clinically-based RNs overall in like-sized Magnet hospitals.

Forensic Nurse Examiner Team Honored

Recognizing Excellence Christiana Care Health System has received distinguished awards recognizing nursing excellence. This is a tribute to the exceptional proficiency and dedication of our nurses, and serves as a source of great pride and satisfaction across our entire system.

Magnet® Designation since 2010

Christiana Care Heath System is among only 7 percent of the nation’s hospitals—and the first in Delaware—to have earned Magnet designation from the American Nurses Credentialing Center. Magnet recognizes health care organizations for nursing excellence, leadership and professional development and innovations in nursing practice and care delivery, and is the ultimate credential for high-quality nursing.

Beacon Award for Excellence

Our Cardiovascular Critical Care Complex earned a gold Beacon Award for Excellence in 2013 from the American Association of Critical-Care Nurses (AACN) for optimal outcomes and exceptional patient care. The AACN announced only 27 gold-level awards nationally in the past year. The Medical Intensive Care Unit at Christiana Hospital was also recognized by the AACN with a silver Beacon Award. We congratulate the members of our winning teams for earning these prestigious honors.

Delaware Excellence in Nursing Practice Awards

Two Christiana Care nurses won 2013 Delaware Excellence in Nursing Practice Awards from the Delaware Nurses Association in partnership with the Delaware Organization of Nurse Leaders.

We congratulate Lynn Weaver Campbell, RN-BC, BSN, on her award in the Clinical Nurse-Inpatient, Hospital-Based category, and Jacqueline Kreydt, RN, BS on her award for New Registered NurseGraduate. Both exemplify Christiana Care’s standard for nursing excellence.

“Delaware Today” Names Christiana Care Top Nurses

The May 2014 issue of “Delaware Today” features Christiana Care nurses as “the very best at what they do.” Selected by members of the Delaware Nurses Association, the top nurses include nine Christiana Care nurses plus seven honorable mentions. The honorees demonstrate the professional excellence and value our nurses bring to our patients and their families.

The U.S. Department of Justice presented Christiana Care Health System’s Forensic Nurse Examiner program with the Allied Professional Award for providing emergency care to thousands of crime victims and forensic expertise at trials across the country at the National Crime Victims’ Service Awards ceremony in April in Washington, D.C. This is the second national award for Christiana Care’s Forensic Nurse Examiners this year.

The Emergency Nurses Association honored them with its 2013 Team Award.

Christiana Care has one of the few emergency departments in the U.S. with a forensic nurse on staff 24 hours a day, seven days a week. We salute the 19 specially trained members of our forensic nursing team for their achievements.

Medicaid Best Practices Award

Medicaid Health Plans of America recognized Christiana Care’s Visiting Nurse Association with a 2013 Best Practices Award for “Control Your Heart for the Future,” a telehealth program for Medicaid patients with congestive heart failure. In partnership with Delaware Physicians Care, the program incorporates web education, self-monitoring and medication management with attention to socioeconomic needs to help patients more effectively manage their condition. The award speaks to the success of our VNA nurses in being partners in care with their patients.

“Training” Magazine’s Top 125

For the third consecutive year, Christiana Care has earned a coveted spot as one of “Training” magazine’s Top 125 best companies for training and learning development. Christiana Care placed at number 28 on the list of all industries and retained its top ranking among hospitals on the list.

The distinction acknowledges the commitment of nurses and colleagues in Christiana Care’s Learning Institute to best-practices educational opportunities for all levels of the organization.

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Building Knowledge Our professional advancement program—commonly referred to as the Clinical Ladder, first introduced in 2002, has expanded to four levels. Our Clinical Ladder recognizes and rewards experience, knowledge and clinical expertise, and is the result of thoughtful planning by more than 150 direct-care nurses who represent their colleagues on the Professional Advancement Council.

Our Professional Practice Model

the future: Three Specialized Tracts Clinical Tract // Education Tract // Leadership Tract

Level 4: Christiana Care’s professional practice model is guided by the American Association of Critical Care Nurses (AACN) “Synergy for Clinical Excellence: The AACN Synergy Model for Patient Care”

by Hardin and Kaplow (2005).

Expert

Highest Standard of Professional and Clinical Practice Participates in Leadership and System-wide Initiatives Support the Image of Nursing Able to Direct, Support and Influence Nursing Practice Active in the Achievement of Unit and Department Goals

The key components: Our Care Delivery Model

Level 3:

Proficient

Recognized Role Model and Mentor Clinical Resource // Unit Leader // Problem-Solving Skills Involved in Unit Initiatives // Demonstrates Practice Excellence

Our Professional Advancement Program (Clinical Ladder)

Our Mentorship Program

Active Commitment to Achieving Unit Goals Actively Develops Others

Level 2:

Competent

Increased Knowledge // Professional Practice Our Peer Review Program

Mentoring // Teamwork // Evidence-Based Practice Identifying Improvement Opportunities Continued Professional Development

Each is owned by a system nursing council, with a Professional Practice Model Steer providing oversight and support for all four components.

Developing Others

Level 1:

Novice/Advanced Beginner

Learning // Growing // Collaborating Participating // Teamwork // Commitment Self-Development // Professionalism

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Innovations research

At Christiana Care, nursing research is a vital component of our ongoing journey to evolve our nursing care delivery model, to improve patient care outcomes and to define and expand the scope of nursing practice.

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esearch at Christiana Care is clinically driven and patient-centered. Our nurses often initiate research projects, recognizing problems at the bedside and working with nursing colleagues and interdisciplinary teams to identify solutions. As part of Christiana Care’s Nursing Research Program, two nursing research facilitators work with every level of our team—from new nurses to nursing leaders—to develop research projects and see them through from beginning to end with the goal of influencing the quality of practice.

With our ever-increasing number of publications and presentations, sharing important findings beyond our own walls greatly expands the impact our nurses have on patient care. We are nurses who make a difference, and the innovations we develop through research allow us to strengthen the delivery of health care.

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Research publications

72

Transforming Care delivery The Center for Quality and Patient Safety—one of four centers in the Christiana Care Value Institute—is led by Sharon Anderson, MS, BSN, RN, FACHE, senior vice president of Quality, Patient Safety and Population Health Management. Under her guidance, Christiana Care has achieved significant advancements in reducing patient harm, improving the quality of care through evidence-based practice and enhancing the patient care experience.

Our Quality and Patient Safety Program aligns priority areas with our annual plan and long-term strategic goals, driving accountability and promoting action. Three committees—Safety First, Clinical Excellence and Think of Yourself as a Patient—are co-chaired by a physician and a nurse leader.

Christiana Care is named among the nation’s 100 top hospitals—and is one of only 15 major teaching hospitals—in an independent analysis of quality, safety and efficiency of care. For the third consecutive time, we’ve scored an “A” in hospital safety from the Leapfrog Group, an independent, national nonprofit organization dedicated to improving the safety, quality and affordability of health care. Christiana Care Health System and Wilmington Hospital were honored with HAI Watchdog Awards for successful initiatives to reduce healthcare-associated infections.

In November 2013, five

research projects

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research presentations

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nurses were among the first class of 22 Christiana Care Participants in the program, through the Center for Organizational Excellence at Christiana Care’s Value Institute, studied the internationally recognized Juran Institute’s Lean Six Sigma business methodology. Supported by colleagues who served as their “champions,” the Lean Six Sigma Green Belts developed research projects that better the overall performance of a department by reducing overuse and improving quality and safety. We congratulate them.

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The President’s Award

Celebrating Excellence The four components of the Magnet model—Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; and New Knowledge, Innovations and Improvements—are integral among the categories recognized in the Christiana Care Focus on Excellence Awards. For more than a decade, these awards have challenged our physicians, nurses and staff to serve as health care innovators—forming teams to discover ways to improve what we do, and then competing for recognition as one of the best. This year, from 144 entries in 39 categories, more than 200 nurses were among the winning teams, including the recipients of the coveted President’s Award.

Submission

Improving Glycemic Control in the Adult Medicine Office

Team

Physicians, Nurses, Diabetes Educators

Primary Goal

Increase the number of adult patients whose diabetes was under control from 63 percent to 70 percent.

Results

More than 25 percent of patients with poorly controlled diabetes achieved control, and the overall rate of control increased to 70.8 percent.

employees to become

certified Lean Six Sigma Green Belts.

Pictured at left: Janet Cunningham (center), receives her Green Belt certificate with her champion, Chief Nursing Officer Diane Talarek, and President and CEO Dr. Robert Laskowski.

Linda Daniel, MSN, RN, CPHQ Director, Quality and Patient Safety for Women and Children Services

Lean Six Sigma Green Belts

Janet Cunningham, MHA, RN, NE-BC, CENP Vice President, Professional Excellence and Associate Chief Nursing Officer

Jaclyn Dobrzynski, MSN, CRNA Clinical Coordinator, Christiana Main Operating Room Project Manager, Perioperative Services Department of Anesthesiology

Susan Mascioli, MS, BSN, RN, CPHQ, NEA-BC Director, Nursing, Quality and Safety Susan Volk, MSN, RN, CCRN, CPAN Staff Development Specialist, Perioperative Services

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Strength collaborative

Time and again, evidence shows that innovative partnerships—a key principle of The Christiana Care Way—improve care for patients and their families.

At the foundation of our nursing practice is Shared Governance.

Christiana Care’s leadership team values our nurses’ expertise and perspective in effective improvements.

Our five system Shared Governance councils meet monthly to assess and advise on best practices and professional development.

Coordinating Council

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ach of our patient care units at Christiana Care Health System is led by a Value Improvement Team co-chaired by the nurse manager and the unit-based medical director—a unique approach based on the proven success of the Penn Model. These teams collaborate to drive the unit or area’s quality and safety goals.

Beyond our commitment to interdisciplinary collaboration, we also work closely with our Patient and Family Advisory Councils, garnering the insights of former patients and their family members as we work toward improving quality care and patient safety.

Quality and Safety Council

Research and Evidence-Based Nurse Practice Council

Professional Nurse Council Education Council

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More recently, many units have established Patient- and Family-Centered Interdisciplinary Rounds. These rounds occur daily at the patient’s bedside and include the family, nurses, physicians, clinical pharmacist, case manager, social worker, therapists and other team members involved in the patient’s care. Internal pilots of these rounds demonstrate marked improvements in quality and safety, efficiency and communication between nurses and physicians.

Sherian Lucchetta, RN, (right) and Susan M. Pugliese, DDS, two winners of Nurse-Physician Partner Awards in 2013, collaborate to bring dental care to adult and pediatric patients with special needs at Wilmington Hospital.

Leading the Way Christiana Care nurses coordinate many conferences that share evidence-based knowledge and research to inspire innovative learning among their nursing colleagues in the region.

21st Century Visions of Nursing Conference

This two-day conference, marking its tenth year in September 2013, drew 260 health care professionals from Delaware, Maryland, New Jersey and Pennsylvania.

Sponsored by the Delaware Academy of Medicine and Christiana Care, the conference’s educational tracks included critical care, oncology, surgery/trauma, professional enrichment and advanced practice nursing pharmacology.

Delaware Emergency Nurses Association Symposium

Partners in Improving Care In December 2013, Christiana Care’s Professional Nurse Council recognized exemplary interdisciplinary teamwork with our annual Nurse-Physician Partner Awards. These awards symbolize the fundamental importance of teamwork among nurses and physicians in providing value to patients, and reflect all that can be achieved through collaboration. From demonstrating the essential role of communication in positive patient outcomes, to markedly improving courses of care, our Nurse-Physician Partner Award winners demonstrate exemplary teamwork in every way.

The best patient care outcomes result from treating the whole patient, not just the disease. This requires more than one

In October 2013, Christiana Care nurses led this 11th annual symposium on advances in stroke management, postpartum emergencies, mental illness, teen suicide, and non-fatal strangulation, among other topics.

Perioperative Perspective: Latest Trends and Practices

Nearly 200 nurses attended this February 2014 conference at Christiana Care, featuring presentations by both internal and external speakers on such topics as working with people who have disabilities, contemporary management of facial trauma, and endoscopic ultrasound.

specific expertise—be it a doctor’s or a nurse’s—and comes from partnership, collaboration and communication among

APN Pharmacology Update

medical staff and with patients and their families.

Jennifer F. Cormier, MSN, RN, OCN Nurse-Physician Partner Award Recipient, Department of Oncology

In March 2014, the second annual Pharmacology Update for advanced practice nurses featured expert faculty presentations on pharmacologic management for treatment of diseases with focus on acute care, neonatology, primary care, psychiatry and women’s health.

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partnerships community

At Christiana Care, we are dedicated to fulfilling the unmet needs of our neighbors.

Our nurses live this promise in numerous ways, both in their professional roles and through volunteer work in the community.

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hrough our Visiting Nurse Association—the largest accredited home health agency in Delaware—we help residents in surrounding communities to live independently, manage chronic diseases, understand and manage their medications and obtain home health care that is affordable and of the highest quality.

Similarly, our nurse navigator program—one of the first in the nation—provides personalized support for cancer patients finding their way through treatment and survivorship. They are part of the highly regarded health care team at Christiana Care’s Helen F. Graham Cancer Center & Research Institute, designated as a National Cancer Institute Community Cancer Center.

Complementing our dedication to helping our own patients through this difficult journey, the staff at the Cancer Center offer onsite and web-based educational programs to train nurse navigators who serve at other community cancer centers.

Advancing Our Profession Supporting academic advancement is vital to attracting and retaining the most talented nurses, and to encouraging more nurses to seek bachelor’s degrees and advanced degrees in nursing, in keeping with the Institute of Medicine’s “Future of Nursing” report.

This landmark report calls for a minimum of 80 percent of all nurses in the United States to have a BSN by the year 2020.

With a dedicated Office of Professional Development and Education for nurses, Christiana Care offers tuition assistance, including pre-pay options, continuing education and other advancement support so nurses can reach their full potential.

Preparing Future Nurses Christiana Care is the primary site for student nurse clinical training in Delaware.

In partnership with dozens of nursing schools, Christiana Care offers student nurses a broad range of clinical experience at Christiana Hospital and Wilmington Hospital.

2,800 student nurses

“As a Magnet-designated health system, we are committed to the best possible career experience for each nurse and the best possible health care experience for every patient and family,” said Janet Cunningham, MHA, RN, NEA-BC, CENP, associate chief nursing officer and vice president for professional excellence.

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The Ripple Effect

clinical hours spent at Christiana Care

As a Level I trauma center, Christiana Care is committed to educating our patients and our community about injury prevention. With a grant from the Criminal Justice Council through the U.S. Attorney’s Office Project Safe Neighborhoods initiative, our trauma nurses and physicians created “The Ripple Effect,” a powerful documentary illustrating the medical consequences of gun violence. “The Ripple Effect” features live footage from the Emergency Department at Christiana Hospital and compelling interviews with our trauma nurses and surgeons, as well as a former gunshot victim who received treatment.

participating schools

300,000+ Christiana Care is a leader in preparing new and experienced nurses for the future of health care.

Christiana Care’s Kathy Boyer, MSN, RN, CCRN, injury prevention coordinator, shares the film at schools and community organizations and explains the physical consequences of gunshot wounds. It is a stunning and impactful presentation—and one we hope will dissuade countless young people from resorting to violence.

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The Christiana Care Way We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems that our neighbors value.

About Christiana Care Health System

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Christiana Care Health System is one of the country’s largest health care providers, ranking as the 22nd leading hospital in the nation and 12th on the East Coast in terms of admissions.

A not-for-profit teaching hospital affiliated with Thomas Jefferson Medical College, Christiana Care is recognized as a regional center for excellence in cardiology, cancer and women’s health services.

Christiana Care is home to Delaware’s only Level I trauma center, the highest capability center and the only one of its kind between Philadelphia and Baltimore. Christiana Care also features a Level III neonatal intensive care unit, the only delivering hospital in Delaware that offers the highest level of non-surgical care to the most critically ill newborns. Christiana Care includes two hospitals with 1,100 patient beds, a home health care service, preventive medicine, rehabilitation services, a network of primary care physicians and an extensive range of outpatient services.

For more information, visit www.christianacare.org/whoweare.

P.O. Box 1668 Wilmington, DE 19899-1668 800-693-CARE (2273) www.christianacare.org 14NURS18