Geisinger Magnet Application by Ellen Jarvis

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Introduction Leadership style, relationships with others, and communication are essential elements in achieving organizational goals. Sue Hallick, CNO, consistently focuses the leadership team and hospital council staff on the “big picture.” She expects staff at all levels and their leaders to gain perspective from professional organizations and credentialing bodies so that Geisinger Medical Center’s healthcare providers fulfill their founder’s directive to “Make my hospital right. Make it the best.” Abigail Geisinger’s visionary philosophy lifts the careers of nurses beyond the day-to-day operations and into the future.This is accomplished routinely and consistently through open discussions and open-ended questions in both formal and informal settings. Leaders and staff at all levels regularly converse with Sue regarding the internal and external environment of nursing at GMC. Many staff suggestions from these discussions are incorporated into GMC’s Nursing Vision document. Effective communication to and from a large number of employees is a challenge for any organization. GMC meets this challenge through a matrix of hospital councils and a flat, well-defined management structure. Communications that start at the CNO and executive level are shared with the inpatient and outpatient management teams. Solid processes are in place to disperse information throughout every level of nursing. Because GMC does not have multiple layers of management, information flows quickly and easily–from the CNO through her direct reports and then directly to the staff nurses, educators, and support staff. Concurrently, the council structure provides information that moves in the opposite direction–from staff nurses, educators, and support staff directly to Sue. Sue attends all council meetings to share information downward and receive information upward from council members.These council members are charged with taking information back to their colleagues. Council leaders easily share information with each other because the nursing council structure provides such an effective opportunity for information exchange.Verbal communication through these avenues is supplemented through numerous written and electronic formats to reinforce and ensure that communication touches each employee in every department and every staff. Visibility is a key characteristic of the transformational leader—the foundation of leadership behavior at GMC. Nurse leaders are visible in the hospital and in their designated units every day. It is a routine function and part of the GMC culture because the leaders’ span of control allows them accessibility to build the strong relationships needed to be successful leaders.

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EVIDENCE 1 Describe the CNO’s leadership style and give at least two (2) examples related to the components referenced above.

eadership is the art of getting someone to do something you want done because he/she wants to do it. It is a way to get things done to a standard and quality above their norm and doing it willingly1. Leadership is a dynamic relationship between the leader and the follower who share a common purpose. When dealing with change, the leader influences followers to move to a higher level of motivation to affect real change. Leadership is a process that involves inspiring, motivating, and influencing people. Sue Hallick, Geisinger Medical Center’s CNO, possesses these very important leadership characteristics. She is a dynamic leader with many years of experience. Because of her interest in steadily improving her own performance, Sue participated in a 360-degree evaluation several years ago. This evaluation involved a written self-assessment as well as feedback in such areas as communication, leadership, and approachability from her peers and staff. The documents were then scored, analyzed, and presented to her. They listed her strengths and opportunities for improvement so Sue was able to understand and use her strengths to their best advantage and work on areas where she might improve. Feedback from her peers and direct reports are incorporated in her ongoing performance appraisals. Sue felt that the 360-degree evaluation was such a valuable “Leadership is a experience that she requested that Associate Vice Presidents Denise Beechay and Crystal Muthler also complete a 360-degree dynamic relationship evaluation. She has also encouraged a few of the operations between the leader and managers to do the same. the follower who share a Sue is a transformational leader. Transformational leaders common purpose.” guide their followers in the direction of established goals. As a transformational leader, Sue inspires her followers to transcend their own interests for the good of the organization as our system grows and heads in new and challenging directions. As changes occur, Sue instills confidence and commitment in her managers and staff. She serves as a role model and is actively involved as a coach, advisor, and educator. She provides positive reinforcement to the nurse managers and staff as they adapt to a constantly changing healthcare environment. The three stories that follow reflect that commitment.

Kostelnikov,Vadim (2007), Effective Leadership, http://www.1000ventures.com/business_guide/crosscuttings/leadership_main.html

UA S E CIUNG R I N GTHE T H ELEGAC L E G A C YY • INNO I N N O V AVATIO TION N QUA Q L IT YL I•T YSECUR

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STORY: MOVING AHEAD Transformational leaders guide their followers in the direction of established goals. An example of Sueâ&#x20AC;&#x2122;s leadership philosophy can be found in the presentation she gives on the Nursing Service Line to the Geisinger Board, nursing councils, and at other leadership and nursing forums (3:1:A; see also FORCE 1, EVIDENCE 1).

3:1:A

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Sue recognized that the reason many nurses leave their employers is a poor relationship with their managers. Because of this, Sue has set the bar high for her management staff. She has developed expectations for performance, fiscal accountability, and leadership. Leadership expectations include positive attitudes, creative problem solving, quick test-of-change thinking, skill in communication, and data-driven decision making (3:1:B). Sue decreased the span of control for nurse managers to afford these managers time to devote to the unit and increase their visibility by staff. The number of managers increased from 11 to 17 so that (with a few exceptions) each manager is responsible for only one unit. The change was made to enable the managers to effectively mentor their staff and build strong, high-performing teams.

3:1:B PERFORMANCE APPRAISAL GRID Operations Manager, Nursing Date: Key Elements

FISCAL RESPONSIBILITY

HPPD (Paid Total) target met YTD

SLHO % YTD

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Supplies within budget

TIMELINE

OUTCOME

Manpower within budget

Dollars

FTEs (Total costs within budget)

LEADERSHIP

Strategic planning for unit development

Magnet Force of Magnetism Cochair activities:

1. Meet established timeline markers

2. Collect and/or submit documents as required

Mentor Team Coordinators with growth and

development, problem solving, and communication

Lead staff through constant change

Support risk-taking ideas

ACCOUNTABILITY

Day-to-day operations:

1. Drives retention/recruitment strategy

2. % RN and LPN vacancy rate/unit

3. Manages care delivery process

a. Skill mix

b. RN-to-patient ratios

Drives compliance with standards of care

Patient Satisfaction:

1. Press Ganey results within 90th percentile

2. Service standards are complete and active

COMMUNICATION

Employee:

1. Holds at least six unit meetings each year

2. Day-to-day communication methodology understood by all employees

Keeps the Leadership Team informed

Ensures professional positive inter- and intradepartmental communication

JOINT COMMISSION/DOH REGULATORY STANDARDS

Documentation within compliance:

1. Develop unit processes that will produce steady results

a. Seclusion/restraint in accordance with hospital standard

b. Pain assessment in accordance with hospital standard

Environmental needs are within compliance

Process to ensure compliance of all standards is active

Accrues staff competency:

1. Performance evaluations completed on time

2. Annual staff competencies completed

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QUALITY/SAFETY

Evidence of a patient safety culture:

1. Review process in place on each unit

2. Quarterly updates to CNO

Prevention of falls:

TIMELINE

OUTCOME

1. Review unit % of compliance with current policy Pneumococcal and influenza vaccine process:

73 74

1. Staff awareness and compliance

Adverse drug events:

1. Staff aware of policy and follow practice to report

Rapid Response Team:

1. Staff awareness

Staff aware of ORYX measures and accountability to process

EDUCATION Staff Education:

1. Setting performance standards with annual competencies 86 2. Support attendance at inservices, conferences, etc.

3. Set annual educational credit requirements

4. CEP have active role in staff education

5. Assist staff with professional career planning

Goal: Staff verbalizes educational needs are met

Individual Education:

1. Develop individual educational goals

2. Professional organization membership

PROFESSIONAL PRACTICE ENVIRONMENT

Unit Councils:

100

1. Identify council members and chairs

101

2. Unit Assessment

102

3. Identify key elements and develop timeline

103

4. Engage staff in problem solving; develop Unit Story Evidence-based practice and research:

104 105

1. Best Practice benchmarks

106

2. Review of literature-based practice changes

107

3. Quick test of change

108

4. EB Practice changes

109

5. Nursing research conducted on unit

110

Professionalism of Staff:

111

1. Unit appearance and pride

112

2. Core values for nursing integrated

113

3. Staff expectation: professional organizations and certifications

114

4. Nurse satisfaction scores (NDNQI)

115

5. Plan to improve patient satisfaction

116

Staff collaboration process with:

117

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1. Other nursing units

TIMELINE

OUTCOME

118

2. Other healthcare professionals

119

3. Physicians

120

Goal: Promote staff involvement and awareness of collaborative practice

121

STORY: THE DIFFICULT CHOICE As a transformational leader, Sue Hallick inspires her followers to transcend their own interests for the good of the organization as our system grows and heads in new and challenging directions. She helps the nursing staff deal with change; adapting is one of our core concepts in accordance with Roy’s Adaptation Model. Sue Ruckle, RN, the long-time operations manager of surgical unit BP5, died after a long and brave battle with cancer. She possessed excellent leadership skills, and her interpersonal skills were top-notch. She was viewed as a dedicated GMC employee, serving the system for thirty years. She was a true nurse and a patient advocate. To the BP5 nursing staff, the thought of trying to replace Sue seemed nearly impossible and appeared to be a long and difficult process. Three internal nurse candidates were considered for the open operations manager position. With Sue Hallick’s support, the staff began the interview process. Resumes of the candidates were posted on the unit for the staff to review. Sue requested staff (of all levels) to participate in the interview process. Several staff members volunteered and, together, the staff submitted a list of questions for the interviews. After the first round of interviews was complete, the staff did not feel that any of the candidates could replace Sue. Sue Hallick met with the staff representatives participating in the interviews to obtain their feedback and help them through this difficult process. She asked the staff to rank the candidates but, according to Mary Ann Ebert, interim team coordinator, “they could not rank any.” Sue then did her magic. She helped the staff accept Sue Ruckle’s death, but acknowledged that no person would fully replace her. She helped the staff realize they needed to adapt and pick the best person to lead them into the future. She provided leadership in helping the interview team see the strengths and weaknesses of each candidate. Through this process, Sue helped them identify the top two candidates and open a discussion among the unit’s staff. The staff was able to understand their need to adapt and accept this as an opportunity for change. Each of the remaining two candidates spent a four-hour block of time on the unit to allow the staff to assess each candidate’s fit with the unit. After the second round of interviews, Sue and the staff nurses came together for another group meeting. They discussed the benefits of each candidate and worked to identify the best fit for the unit. OUTCOME Securing the legacy is a strong theme throughout Geisinger Medical Center. The idea of having a homegrown leader who had risen through the ranks appealed to the group. Sue pointed out that many homegrown leaders have worked out well. Sue herself began her career at GMC as a staff nurse and the interview group had the utmost respect for her. Sue also helped the staff realize that they would have an

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important role in the development of this new manager. Sue’s role in this process proved vital in steering the group to their final decision. With Sue’s assistance, support, and expertise, the group made their final decision as to who would serve as operations manager. Cheryl Examitas, RN, was chosen as the new leader. She is currently in the process of transitioning, and things are looking brighter for the unit. As Mary Ann Ebert, RN, team coordinator states, “Sue Hallick helped us to see this candidate’s potential.” Charity Whitmire, BP5 staff nurse, adds, “I think Cheryl is going to do just fine. We will get to know each other and help each other.” Joan Mervine, RN, CNE, indicates, “I know Cheryl from some of the courses I have taught. She has a lot of exciting new ideas, and her critical care background is a positive attribute.” Janice Kozloski, BP5 nursing assistant, says, “It will be a little rough at first getting used to someone new, but Sue Hallick helped us move on and realize we need to work with Cheryl. Things are going to work out.” PERSPECTIVES FROM TWO MANAGERS Two managers—Crystal Muthler, RN, AVP, and Bonnie Patterson, RN, the CNO’s operations manager— were also involved in the selection process and have shared their opinions about Sue’s role in this process. The mournful passing of a beloved nurse manager recently became testament to GMC’s philosophy of growing its own leaders and stands as evidence in this force. One of Susan’s closest allies during her tenure at Geisinger Medical Center was Bonnie Patterson, RN (an operations manager). The pair were friends since the days when both worked together in the GMC’s Recovery Room (surgical suite). “I was comfortable and familiar to the staff because I had covered for Susan when she was well and then when her health was failing,” Bonnie recalls. “So I was brought in by our CNO to work temporarily with the staff to help them with the healing process after the loss of their leader and to help them select a new manager.” “Selecting a new manager would be difficult, but the CNO was determined to actively involve all of the staff in the selection no matter how long the process took,” Bonnie recounts. “Sue was terrific in working with the staff and leading open and honest communication about what the team was looking for in a new leader,” remembers Crystal Muthler, RN, a GMC associate vice president. Crystal was also involved in the selection process. “The staff was mourning. I think they felt left behind in a sense when Susan died, although they did recognize that they needed to pick up the pieces and move forward.” The nurse manager position was posted internally, and many applicants stepped forward, but none from BP5. Much as they wanted a leader like Susan, the nurse who rose to the top in the interview process was a young critical care nurse who had no experience in orthopaedics. Crystal said that she, the CNO, and the staff met to talk frankly about the important qualities they wanted in a new leader. “There was no coercion or pressure to hurry the process,” Crystal says. “Sue Hallick, our CNO, explained that we would continue looking until we found the right person. Sue’s philosophy was that it had to be the right fit for the staff, no matter how long the search took.” “By the end of the first long meeting, the team had decided they were looking for someone who could keep the unit moving in a positive direction. They would choose strong leadership skills over orthopaedic experience if the candidate had the right qualities.”

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“Sue’s crucial conversation with the staff opened their minds and changed their mindset so they could separate the person from the position,” Bonnie says. Of all the applicants, one candidate—Cheryl Examitas, RN—had the strongest leadership skills. Cheryl was welcomed as BP5’s new manager on April 15, 2007. “During the interview process, Cheryl spent the day on the unit wearing scrubs and getting to know everyone,” Bonnie explains. “It was clear to everyone that, as a critical care nurse, she could bring a different perspective to the unit and new qualities that could enrich the staff.” Cheryl dove right into her work. Bonnie reports, “One of the things that she did almost immediately was to provide an opportunity for the medical-surgical nurses to become certified in Advanced Cardiac Life Support. Doing so created a better level of patient care. For the staff, Cheryl found a way to accommodate everyone’s desired shift schedule, adding a 12-hour rotation if requested. “This wasn’t easy to accomplish, but the staff had wanted this type of flexibility in their schedules for years,” Bonnie recalls. “Cheryl found a way to get it done and it really did improve the quality of life for each staff member. Staff satisfaction and patient satisfaction continues to be exceptionally high” (3:1:C).

3:1:C NDNQI Quality of Nursing Leadership for BP5 4 3 2 1 0 2006

4 = highest 0 = lowest

2007

BP5

National Rate

GMC Rate

EVIDENCE 1: SOURCES OF EVIDENCE 3:1:A

Slides from Nursing Vision Presentation

3:1:B

Performance Appraisal Grid for Managers

3:1:C

NDNQI: Quality of Nursing Leadership (BP5)

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EVIDENCE 2 Provide examples of effective and ineffective leadership-style outcomes and follow-up action as appropriate.

he effectiveness of the leadership style at Geisinger Medical Center is reflected in the NDNQI Quality of Nursing Leadership data.

NDNQI Quality of Nursing Leadership for Geisinger high

low

1 2006

2007

GMC Rate

National

STORY: WHAT HAPPENED? A SUCCESS STORY At times even an expert manager with years of experience can revert to an ineffective management style. This can occur for many reasons, but the story here is how one manager was helped to regain credibility and effectiveness with her staff. This story is one of discovery, growth, and success. CNO Sue Hallick’s open communication style enabled staff to discuss concerns with her. In this particular case, these talks revealed dissatisfaction with a staff ’s manager. That manager was Linda Miller, RN, a long-term, well-respected manager who was responsible for three nursing units. With an extremely heavy workload, she did not notice the staff ’s increasing dissatisfaction. As Sue Hallick was making rounds on the nursing units, the staff revealed their concerns to her. Some of these issues included the decreased visibility of their manager, poor (or lack of ) communication, and lack of attention to details important to the staff (such as shift scheduling). In addition to what Sue heard on rounds, the staff expressed concerns directly to her through Emails. Sue also noticed that there was an exodus of team coordinators from these units. Sue realized that this manager needed help to regain the credibility and effectiveness she had lost. She met with Linda and expressed her concern regarding the staff ’s comments. Linda was willing to accept Sue’s guidance and, together with Crystal Muthler (AVP), developed an action and performance improvement

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plan. This plan addressed communication, visibility, mentoring, and staffing issues. Work had begun on the journey back to credibility. OUTCOME Linda has regained her effectiveness and credibility. Her span of control has been decreased from three to two units. Linda continues to meet routinely in follow-up meetings with Sue and Crystal. Sue keeps in contact with the staff nurses from both of Linda’s units as well. She has been happy to see the improvement. The overall average nurse satisfaction scores from the NDNQI RN Satisfaction Survey have increased on Linda’s units from 45.61 in 2005 to 49.93 in 2006 and 50.60 in 2007. Another positive outcome is that Linda has developed strong team coordinators who work well together. Comments from the staff reflect that Linda is back on track and they are back to being a strong team. Beth Brening, RN, staff nurse on CH2 states, “Things are going pretty well on our unit now. Linda is such a good manager. Things are always up and down depending on how busy we are and how staffing is, but we are OK.” Sevasty Chamberis, RN, staff nurse on CH3 also states, “The busy pace of our unit can [at times] put a strain on all of us. I have worked with Linda for a long time and wouldn’t want to work anywhere else.”

Date:

3/30/2007 5:21:01 P.M.

Subject: Re: Linda Miller Terri, I just wanted to let someone know how wonderful Linda has been to work with. She has been extremely supportive of me both in my work and in my personal life since I’ve been in this position. She always makes herself available to meet with me and offers to help me even before I can ask. I just thought that someone should know! Share this with whomever you see fit. Thanks Terri! Emily Mowery, RN CNE, CH2, and CH3

Linda stated that “this experience made me stop and take a good look at my performance. It has helped me put things into perspective.” She indicated that she has been able to be more visible for the staff since she is down to two units. She also has increased the number of team coordinators available on the off shifts to help lead the staff.

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NDNQI Job Satisfaction for Children’s 2 and Children’s 3 (combined average) 60%

40%

20%

2005

GMC Rate

2006

CH2/CH3 Combined

2007

National

STORY: A NEW LEADER Every new manager needs to establish strong relationships with staff, physicians, and patients. An excellent example of new effective leadership is Joyce Keister, RN, the new nurse coordinator of the Orthopaedic Ambulatory Care Clinic. Joyce took over the nurse coordinator role in the orthopaedic clinic, an extremely busy clinic with large patient volumes. Joyce had been working in the clinic as a staff nurse before assuming her role as coordinator. She viewed this new role as an opportunity to grow professionally and a chance to improve patient outcomes. Joyce was a credible leader because she has an orthopaedic background and she had established relationships with the clinic staff by working there. Joyce was also familiar with the orthopaedic doctors who can be challenging at times. Soon after Joyce started as coordinator, CNO Sue Hallick, during one of her routine Quality Rounds, identified some concerns in the clinic related to survey readiness expectations and patient safety. Several issues were causing these concerns: • Due to large patient volumes, patients arriving for appointments had to wait in long lines before signing in for their appointment. • Staff had the wrong documentation tool for monitoring medication refrigerator temperatures. • Doctors were not using the electronic health record (EPIC®) for prescription refills. • There was no bathroom in the back of the clinic for patients to use while waiting for their physician. • The medication reconciliation process was inconsistent. • Medication storage and security practices needed to be improved. • Handwashing practices and equipment cleaning and storage needed to be improved. As Joyce began her role as coordinator, Diane Engelhart, RN, nurse coordinator for the Urology Clinic, served as her mentor. Mike Enriquiz, the operations manager for the Orthopaedic Clinic, was also very supportive. Because Mike has a business background and Joyce has a nursing background, they make a good management team.

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OUTCOMES Sue met with Joyce to provide guidance and mentoring. Joyce was empowered after their interactions and began to make changes she felt were necessary. She instituted daily rounds and, while on those rounds, asked staff for input. She worked with the staff to make sure that they introduced themselves by name and title to all patients when beginning their interactions. Joyce set up a number system so arriving patients could be seated and then called by number when it was their turn to sign in. This helped alleviate the long lines at sign-in and increased patient satisfaction. Joyce also worked with the Facilities Department to have a bathroom installed in the back of the clinic. To address the regulatory issues, Joyce instituted the proper refrigerator logs. She worked with the doctors to stress the importance of using EPIC to renew prescriptions. She moved the printers out of the hallways to protect patient confidentiality. Joyce worked with Crystal Muthler, AVP, to define Career Enhancement Program (CEP) roles for the RN, LPN, and clinic technician. She also created the position of triage nurse to answer emergency questions and address postoperative patients’ inquiries. She set up monthly department meetings to discuss issues and staff concerns. Joyce also contacted Pat Campbell, RN, Infectious Disease (ID) nurse director, to conduct ID rounds through the clinic to assure the safest environment. She had Avagard handwashing systems installed in the hallways, revamped the entire equipment cleaning process, and obtained storage carts for needles and syringes. Since Joyce has instituted changes in this clinic, patient satisfaction scores have improved. Staff satisfaction has also improved . NDNQI Job Satisfaction for Orthopaedics (Surgical Outpatient) 80% 60% 40% 20% 0% 2006

2007

GMC

Ortho

National

The following are testimonials from staff on Joyce’s integration into her new management role: • Clinic desk clerk: “Joyce is more visible. She has helped patient flow tremendously by implementing the number system. Patients no longer have to wait in long lines to check in. She helps staff with workload whenever possible.” • Rita Mirello, LPN: “Joyce is very helpful. She takes time for us and listens to our concerns. If you are having a problem, she is there to help you find the best solution. She works to help solve family and patient concerns.”

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•

Shawn Meighan, RN: “Joyce helps in the clinic if it is busy. Joyce is pleasant. She has done a good job improving MD/nurse relationships. She has done really well since she started in her role. I cannot say enough good things about her.” • Kevin Tersavage, cast technician: “Joyce is very fair; she knows what it is like to have worked her way up. There is more bonding between staff, like a family now. She is always willing to help. She is the best thing that has happened to this clinic.” During the last performance improvement audit there was a 90- to 94-percent compliance with medication reconciliation. Medication Reconciliation Audits: Orthopaedic Clinic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

12/2006

6/2007

8/2007

Joyce’s future goals include the development of a spine coordinator nurse position. This nurse will work closely with patients with spinal injuries. Joyce continues to work with the staff to provide a safe environment for patients and improve patient outcomes.

Patient Satisfaction Scores: Orthopaedic Clinic 95% 94% 93% 92% 91% 90% 89% 88% 87% 86% 85% 84% 83% 82% 81% 80% Overall Rating

Care Received

2006* 1/1/06 - 6/30/06

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EVIDENCE 3 Provide examples of how direct-care nursesâ&#x20AC;&#x2122; feedback is used in organizational decision making.

urses are involved in organizational decision making by participating in hospital and unitbased councils and numerous task forces or committees related to almost every aspect of the organization. Input from direct-care nurses, especially with regard to point-of-service and staff issues, is valued by the organization. NDNQI Decision Making 3 2.9 2.8 2.7 2.6 2.5 2006

2007

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National

AVENUES OF COMMUNICATION The most common way for direct-care nurses to provide input or feedback is through the Shared Governance Councils and other committees. Nurses from inpatient and outpatient areas are represented on the shared governance councils and various other committees (3:3:A).

3:3:A SHARED GOVERNANCE COUNCILS NURSING RESEARCH COUNCIL Terri Bickert, MSN, RN, CNA-BC Director of Magnet and Nursing Education

Deb Stayer, RN, Clinical Nurse Educator (PICU)

Mary Ann Bloskey, RN, MSN, MHA, Center for Health Research

Margaret West, RN, MSN, DNSc, Assistant Dean,Thomas Jefferson University

Pat Campbell, RN, MSN, Director of Infection Control

Lori Lauver, RN, MSN, PhD Assistant Professor,Thomas Jefferson University

Cindy Matzko, RN, MSN, APRN, BC, CCRC Rheumatology Clinical Nurse Specialist and Certified Research Coordinator

Deb Wantz, MSN, RN, CCSN, CCRC, Clinical Nurse Specialist, Heart Failure Section Department of Cardiology

Sheila Hartung, PhD (BU)

Marylee Scholtis, RN

Deb Zimmerman, RN, Cardiology

Jody Bachman, RN Clinical Nurse Educator (OB/GYN)

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 Robin Steimling, RN, Clinical Nurse Educator (BP6/BP7) NURSING RETENTION AND COMMUNICATION COUNCIL INPATIENT STAFF NURSES

OUTPATIENT CLINIC NURSES

Beyer, Melissa, RN (CH2)

Bidelspach, Lisa, LPN (Eye Clinic)

Brink, Janice, RN, BSN, CEP (NICU)

Corrigan, Sandy, RN (GIM)

Brokenshire, Judy, RN, CMSRN (BP6)

Fulmer, Sherri, RN (Dialysis)

Chamberis, Sevasty, RN (CH3)

Gaugler, Jatina, RN–Staff Nurse (Pain Therapy)

Evans, Sarah, RN (BP5)

Heath, Sally, RN (PSC)

Grunden, Marie, LPN (AGP5)

Ikeler, Kristen, RN, BSN (OCN Knapper Clinic)

Harris, Danielle, RN (AICU)

Jones, Carol, RN,Team Coordinator (Emergency Department)

Henrie, Sandra, RN (BP8–alternate)

Madden,Tracey, RN (I&O)

Heuermann, Jane, RN (AGP2)

Moore, Janet, RN (Orthopaedics)

Hons, Sara, RN, BSN (Labor & Delivery)

Ney, April, LPN (Sunbury Women’s Health)

Intintolo, Joan, RN–Staff Nurse (BP7)

Reichenbach,Teresa, RN (Dermatology)

Karnes, Pamela, RN (AGP5)

Sekulski, Connie, RN (I.V.Therapy)

King, Megan, RN (WP1)

Strzempek, Lynda, RN (Radiation)

Kleman, Cheryl, RN, CEP (PACU)

Shotwell, Betsy, RN (Emergency Department)

Lerch, Lyndsey, RN–Staff Nurse (AGP5)

Worhach, Stephanie, RNC, CBC, CCE, CLSS–Team Leader (OB/GYN)

Lines, Red, RN (Life Flight®)

Wright, Christianne, RN–Staff Nurse (I&O)

Lizardi, Lynn Ann, RN (SCU3)

Yocum, Kay, RN (Endoscopy)

Long, Mary Ellen, RN, CCRN (PICU) Mattis, Deb, LPN (BP2)

OTHERS

Michael, Nicole, RN/CEP (AGP4)

Danilowicz, Gerri Ann, RN–Clinical Nurse Educator (SCU4)

Nariskus, Kristy, RN (OR)

Gordon, Nancy, RN, CNC–Clinical Nurse Educator (ED)

Newsome,Vanessa, RN (NICU–alternate)

Horan, Kate, RN, Clinical Nurse Educator (OR)

Peterman, Elizabeth, RN, BSN (CCU)

Hallick, Sue, RN, CNO–Nursing Leadership

Provow, Amanda, RN (OR—alternate)

Marks, Jami, RN–Advisor, Operations Manager (Inpatient OB/GYN)

Reiner, Amy, RN (CCU)

Endress, Steve, RN, Flight Nurse, Life Flight (Cochair)

Smoyer, Karen, RN, CEP (BP8)

Varano,Tess, RN–Cochair (AGP4)

Spatzer, Barbara, RN (AICU)

Botella, Judy, RN–Supervisor

Spickard, Sandra, RN (MSF)

Clutcher, Kathy, RN–Nurse Recruiter

Strunk, Lori, RN (AGP4)

Curtin, Colleen, RN–Nurse Recruiter

Swartzentruber, R. Elaine, RN–Staff Nurse (Cancer Center)

Gibson, Eileen, RN (IT)

Thomas, Elizabeth, RN

Hoffman, Lynn, LPN (GHP-QI)

Wallish, Mary, RN (CCF)

Lamont, Susan, RN (Human Resources)

Wemple, Jennifer, RN, BSN (SCU4)

Merrill, Michele, RN (Vitaline)

Wonlschlegel, Mandy–Extern (BP5)

Miller, Becky, RN (Human Resources)

Zimmerman, Rebecca, RN (BP5)

Miller, Cindy, RN (Human Resources) Petrovich, Susan, RN (QI) Schoch, Michelle, RN (QI–alternate) Young, LaVera, RN (Neuro Services Line)

CLINICAL PRACTICE Jody Bachman, BSN–CNE (NICU)

QUALITY

Lisa McGinty, RN–Staff Nurse (I&O)

SECURING THE LEGACY

INNOVATION

F3-16

G E I SI N GER ME D IC A L CE NTE R FORCE 3 Melania Balzer, BSN–Staff Nurse (OR)

Judy Malatesta, RN–Staff Nurse (CICU)

Carol Bettleyon, RN–Clinic Nurse (EHS)

Dave Mensch, RN–Staff Nurse (BP2)

Candace Bossler, RN–Staff Nurse (SCU3)

Darlene Mensinger, RN–Staff Nurse (NICU)

Ann Bower, RN–Staff Nurse (BP7)

Joan Mervine, RN–CNE (BP5 and BP6)

Sue Brown, RN–Patient Ed (Pt. Safety)

Emily Mowry, BSN–CNE (CH2 andCH3)

Vicki Cragle, RN–Staff Nurse (CICU)

Tracey Nicholas, BSN (PI)

Joan Callahan, BSN–Staff Nurse (PACU)

Sharon Novak BSN (IFD)

Donna Deitz, RN–Clinic Nurse (Hematology/Oncology)

Devon Orner, BSN–Staff Nurse (OB)

Tracey Eddinger, BSN–Staff Nurse (AGP5)

Bonnie Patterson, RN–Operations Manager (AGP5 and I.V.Therapy)

Eileen Gibson, RN–Clinic Nurse (Urology)

Kathy Politis, RN–Staff Nurse (AGP4)

Jason General, BSN–Staff Nurse (NICU)

Linda Rea, RN–Staff Nurse (PICU)

Kathie Green, RN–Staff Nurse (BP5)

Carol Rudy, RN–Clinic Nurse (Preadmission Testing)

Sue Hallick, RN, BSN, CNO

Tonya Sellard, RN (Leave)–Staff Nurse (SCU4)

Krissy Haulman, RN–Staff Nurse (AGP2)

Stacie Semborski, RN–Staff Nurse (Pediatric Sedation Team)

Sabrina Heddings, RN–Staff Nurse (SCU4)

Ann Shaffer, RN–Staff Nurse (ED)

Kristin Hogan, BSN–Staff Nurse (BP2)

Renee Smith, BSN–CNE (PACU)

Carol Hughes, RN–Staff Nurse (AGP4)

Jody Snyder, BSN–Clinic Nurse (Endoscopy)

Jackie Janovich, RN–Staff Nurse (BP6)

Hope Spigelmyer, RN–Staff Nurse (CCF)

Katie Jones, RN–Staff Nurse (AICU)

Deb Stayer, MSN–CNE (PICU)

Holly Kasper, RN–Staff Nurse (CH2)

Robin Steimling, RN–CNE (BP7 and BP8)

Mary Kleiner, BSN–Clinic Nurse (OB)

Dennis Tanner, RN–CNE (BP2)

Carol Krohn, RN–Clinic Nurse (OPH)

Mike Treese, BSN–Staff Nurse (MSF)

John Krohn, RRT–Staff RRT (RCS)

Deb Watkins, RN–Clinic Nurse (Foss 7)

Barb Knowlton, RN–CNE (I.V.Therapy)

Jenifer Wemple, BSN–Clinic Nurse (SCU4)

Adrienne Lonczynski, BSN–Staff Nurse (BP8)

Ann Wilver, RN–Clinic Nurse (Foss 6)

Rene McCloskey, RN–CNE (EPIC, PI)

Jessica Yancoskie, BSN–Staff Nurse (AICU)

PERFORMANCE IMPROVEMENT Staff Nurse/Clinic Nurse Representatives Abram, Georgette, RN (CICU)

McElroy, Amanda, RN, BSN (PICU)

Baney,Virginia, RN (AGP5)

Miller, Cindy, RN (SCU4)

Blessing, Antionette, RN (I&O)

Nuemeister, M. Jean, RN (AGP4)

Bogart,Tiffany, RN (AGP5)

Phelps, Sheila, RN (CICU)

Bower, Gail, RN, OCN–Hematology/Oncology Clinic

Reinard, Cindy, RN (BP6)

Cicero, Shirley, RN (BP2)

Rezykowski, Stacy, RN (BP7)

Cochran, Mary Jo, RN (BP8)

Scheller, Ashley, RN, BSN (Labor & Delivery)

Dennen, Maureen, RN (AGP4)

Schieber, Pam, RN (AGP2)

DePoe, Ann, RN (CCF)

Sellard,Tanya, RN (SCU3)

Derr, Charity, RN (BP5)

Skocik, Lenore, RN (NICU)

Gerringer, Melanie, RN (BP7)

Snyder, Deb, RN, CPON (F3/F6)

Gelbaugh, Diane, RN (Pre-surgery Center)

St. Clair, Deanna, RN (AGP4)

Harter, Kate, RN (Labor & Delivery)

Witt, Barbara, RN (OR)

Hartzel, Sue, LPN (MSF)

Yankoskie, Jessica, RN (AICU)

Hogan, Kristin, RN (BP2)

Yost, Marianna, LPN (MSF)

Houseknecht, Melissa, RN (Labor & Delivery)

Zechman, Deb, RN (MSF)

QUALITY

SECURING THE LEGACY

INNOVATION

F3-17

G E I SI N GER ME D IC A L CE NTE R FORCE 3 Janovich, Jacqueline, RN, ASN, CMSRN (BP6)

Ziller, Melissa, RN (WHC)

Kieffer, Jan, RN (Periop Area) Kister, Nicole, RN (CH3)

Ad Hoc Members

Loeffler, Kim, RN (ED)

Aukamp, Greg, RN (Respiratory Therapy) Bowman, Ann Marie, RN (Infection Control)

Chairman

Kutza, Joey, RN (Life Flight)

Breining, Bethann, RN (CH2)

Nicholas,Tracey, RN (PI)

McCloskey, Rene, RN–Clinical Nurse Educator

Vought, Cindy, RN (EPIC Inpatient)

Mensch, Deb, RN–Operations Manager Administrative Support Hallick, Sue, RN, CNO–Nursing Leadership Bickert,Terri, RN–Director of Magnet and Nursing Education

Direct-care nurses can also talk directly to Sue Hallick at the councils or through Sue’s frequent rounds to patient care areas. Sue and other nursing leaders are also visible and accessible to staff. Staff can offer feedback on every aspect of the organization—from patient care to employee issues. They can also contact Sue through her Email or beeper. EXAMPLE: CLINICAL PRACTICE COUNCIL The Clinical Practice Council contributed to the organizational Patient Identification Policy and Procedure that was developed to cover both the inpatient and outpatient areas (3:3:B).

3:3:B NURSING PROCEDURE MANUAL POLICY 10.3 SECTION: PROVISION OF CARE, TREATMENT, AND SERVICES TITLE: PATIENT IDENTIFICATION (INPATIENT AND OUTPATIENT) PURPOSE The Patient Identification policy establishes guidelines to accurately identify every patient at all times with all patient encounters. PERSONS AFFECTED All hospital personnel. POLICY The policy of Patient Identification is to ensure: • The Geisinger Medical Center staff shall adhere to the statues of the federal government, Commonwealth, Joint Commission, DOH, Geisinger Medical Center, and other regulatory bodies. DEFINITIONS Not applicable

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RESPONSIBILITIES All hospital personnel are responsible for identifying every patient. EQUIPMENT/SUPPLIES Color-coded bands—Red Name Alert Stickers and Signs PROCEDURE 1. All staff will identify patients in the patient care setting using a minimum of two unique patient identifiers: Primary Identifiers: a. Full name b. Date of birth (month/day/year) c. Medical record number d. Trauma name and number Secondary Identifiers: a. Patient’s social security number b. Patient’s telephone number c. Patient’s address 2. These two unique identifiers must be used, and match, whenever the staff is: a. Taking lab samples from the patient (blood, urine, culture, tissue, and fluids). Prior to taking lab specimens, two identifiers must match the patient armband, each specimen label, and each request form. Circle or highlight the name on each label to ensure all labels have the same patient name.This will serve as documentation that the patient armband, each specimen label, and each request form was checked prior to taking the lab sample. Each specimen label should be dated and have the tech code of the staff member collecting the specimen. Refer to Phlebotomy Procedure. b. Administering any medications c. Administering any blood product d. Starting I.V.s e. Performing any procedures or treatments f. Sending patient off unit for tests—The RN or LPN will document in the medical record verification of patient identification and correct diagnostic test by initialing the physician order prior to sending the patient off the unit for the test. * In an emergency or life threatening situation, the diagnostic test may be performed without adherence to these requirements. g. Transferring a patient, following a procedure or surgery, discharge, and when replacing identification bands. h. On the Behavioral Health Unit, an individual’s photograph may be placed in the Kardex and may be used for purposes of visual identification by staff. 3. Patient must wear identification band during entire inpatient hospital stay (see Color Coded Patient Identification Bands). 4. If identification band is removed for any reason (such as I.V. lines or surgery), the identification band must be replaced as soon as possible or before leaving current location/department.The nurse assigned to the patient is responsible for replacement of the armband. 5. If patient has an armband with a temporary name and medical record number (Trauma), once the patient is identified and has a band with full name, medical record number, and full date of birth available, do not remove the temporary band. Keep both bands on throughout admission. 6. If patient expires, leave the identification band in place. 7. If patient is coherent, ask patient to state full name and full birth date (Month/Day/Year), and compare this information to the patient’s armband and request form/computer label(s). 8. Never use patient's room number as an identifier. 9. Never state patient’s name and ask patient to confirm it. 10. Same name alert:

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a. Place red name alert sticker on blue addressograph plate, census boards, spine of medical record. b. Whenever possible, separate same name patients geographically or by nursing teams. 11. For all operative and other invasive procedures, refer to the Correct Site, Procedure and Person Surgery/Procedure (Guidelines for Assuring), located in the Patient Care Manual, Policy 904. 12. If applying identification band on patient, check the patient’s full name and medical record number and date of birth, with the medical record prior to placing identification on patient. At bedside, verify information with the patient, having patient state their full name and medical record number. If patient is unable to state medical record number, ask patient to state full date of birth (Month/Day/Year). Once identification is verified, apply band to patient’s wrist or ankle (infant’s ankle). 13. If patient cannot communicate (infants, language barriers, cognitive impairments, sedated, unconscious), ask family member or attendant to verify the patient’s identity. Use trauma name and number, or if identification band is on patient, check information against identification band. 14. When rooming all patients in the Outpatient setting, the clinic nurse or the medical assistant will state, “As part our patient safety efforts and to assure proper identification, please state your full name and date of birth.” * 15. The clinic nurse or medical assistant will verify and document the verbal response with the patient medical record information and then place the patient in the exam room. 16. In cases where conscious sedation is used or an invasive procedure is performed, it is recommended that a patient identification band is applied to the patient and that the band is used for patient identification. * In the event that the patient is unable to participate in identifying himself/herself, a reliable caregiver should be asked this question.

Several online manuals are filled with policies and procedures that demonstrate direct-care nurses’ input in organizational decision making. A sample of the extensive list of policies and procedures developed by and for direct-care nurses include: • Patient Identification (Revised) • Medication Reconciliation (Revised) • Standardized Approach to Handoff Communication (New) • Continuous Pulse Oximetry Monitoring (New) • Protocol for Specialty Beds (Revised) • Nasogastric Insertion/Removal (New) • Adult Gastric Feeding (New) • Ankle/Brachial Index (New) • Restraint/Seclusion Policy (New) • Irrigation of Apheresis Catheter (New) • Fem-O-Stop (New) • Airway Suction-Pediatrics (New) • EKG (Revised) • Pleural Catheter Drainage System (New) • Safeguard—The Pressure-Assisted Dressing (New) • Medication Administration—EPIC (New) • Blanket and Fluid Monitoring (New) • Bed Zeroing—Versa Care Bed (New) • Insulin Storage and Administration on Patient Care Units (Revised) • Personal Alarm (New)

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EXAMPLE: DECISIONS MADE BY UNIT COUNCILS UNIT

COUNCIL AND MANAGER

STAFF DECISION MAKING

BP5

Advisory—Unit Practice Council and Cheryl Examitas, RN

Move lab slips to other side of counter. Patients transported to gym and back by unit staff rather than transporters. Move staff lounge to a larger area and staff involved in all decisions—color, layout, and equipment.

BP6

Advisory—Unit Practice Council and Michele Long, RN

Started the process of using Memory Boxes; group developed the practice for unit. Requested increase in barichairs—purchased.

BP7

Advisory—Unit Practice Council and Peter Price, RN

Employee “Coin Recognition” program developed. Reorganized supply room. Developed competency fair with CNE and CEPs. Requested door for med room so can lock and decrease distractions.

BP8

Advisory—Unit Practice Council and Michele Long, RN

Staff requested an open full-time LPN position be converted to 0.5 LPN and a 0.5 NA positions.

AGP2

Unit Staff and Dee Hollenbach, RN

In transition to new manager: developing new councils; suggestion box put up; headsets for desk clerks purchased; changed time of NA shift to accommodate vital signs better; more to come.

AGP4

Unit Practice Council and Phyllis Knorr, RN

Belongings sheet process changed to increase documentation. Determined how to assign the third NA on each shift. Creating a med room at request of staff—increase safety.

AGP5

All for Five—Unit Practice Council and Bonnie Patterson, RN

Hook outside of rooms to hang lab coats when patient is in isolation. Standardize stocking cart. (I.V.Team—LED head lamps for I.V. insertions)

BP2

Safety Council and Deb Ulrich, RN

Change process for handing out patient belongings; remove boxes of gloves from patient rooms; provider must carry pair; change time laundry and shower open. Develop NA role new to unit; staffing and scheduling policies; interviewing new candidates. All requests for conference go through them and are approved by them. Schedule and guidelines established.

Nurse Executive Council Conference Council AICU

Unit Practice and Angelo Venditti, RN

Insulin protocol rounded to nearest whole number to decrease potential for error. Color code admission system to communicate attending doctor. Staff lounge being moved to other space to enable window per staff request. Turn volume with set standard parameters

CICU

Unit Practice Council and Deb Mensch, RN

Noise Reduction Task Force formed by council—implemented several techniques: white noise, signs to remind quiet zone, pad tube system, and more. Discovered an I.V. line separator; requested pharmacy to use larger labels and print on I.V. bags to decrease error/respond to aging nurse population.

SCU3

Advisory—Unit Practice Council and Kim Kuhn, RN

Standardized isolation carts on unit. Hooks and shelves for equipment requested. New scheduling pattern for 8- and 12-hour shifts (more days in a row). Lock certain supplies on weekend when they appear to be hard to find.

SCU4

Advisory—Unit Practice Council and Dawn Troutman, RN

Portable phones purchased for patients to communicate with families. Move fax machines and rearrange desk area to increase efficiency. New staff lounge—all aspects decided by staff: how, what is in it, no phone or computer wanted in there.

CH2

Advisory—Unit Practice Council and Linda Miller, RN

Started to assign lunch groups and set up guidelines to decrease interruptions. Visitation guidelines reviewed. Safety issues related to communication discussed.

CH3

Advisory – Unit Practice Council and Linda Miller, RN

List of medications requiring vital sign checks developed and in med room; combined to meet every other month with CH2; revising the visitation guidelines.

NICU

Maureen Lloyd, RN, and Clinical Care Team Renovation Group

“Glitches” board to give insight to help everyone on staff practices; booklets for parents and visitors developed. Number and type of monitors, capital items, and other equipment needed.

QUALITY

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INNOVATION

F3-21

G E I SI N GER ME D IC A L CE NTE R FORCE 3 UNIT

COUNCIL AND MANAGER

STAFF DECISION MAKING

PICU

Unit Practice Council and Maureen Lloyd, RN

Unit ground rules. Several requests for new equipment done, refrigerator, phones, computers, patient care items. Patient/family call backs.

WLL Bereavement Council and (OB/GYN) Jami Marks, RN Advisory—Unit Practice Council

Requested room for “demise” cases to allow a private experience, needed supplies. Mission and vision for unit revised.Visitation guidelines revised.

Education Council and Charmaine Tetkoski, RN

Memory Boxes instituted in ED; Blue fall signs used throughout hospital; CEP group redesigned orientation process.

PACU

Unit Practice and Education Team Cindy Bird, RN

Requested door applied to break room; due to other construction—requested keys to come in through front door during off hours; an emergency exit is being installed; “grease” board kept in waiting room for family to track patient in OR themselves.

OR Workgroup and Deb Strausser, RN

Hang brackets for clamps; hooks on doors for isolation signs; laser goggle designated and hook to keep; flip binders with phone numbers in each room.

When issues need to be addressed or a proposed change needs feedback, Sue Hallick and the other nursing leaders listen to what staff nurses have to say. When an issue needs to be resolved, the leaders consult the staff. Some of these issues have included practice issues, communication failures, and retention issues. Although direct-care nurses have direct access to Sue, they also share input and feedback with their coworkers and unit managers, either one-to-one, through unit councils, or through unit meetings (3:3:C and 3:3:D).

3:3:C SCU3 TEAM PRACTICE COUNCIL MINUTES 9/13/07 DIRECT-CARE PROVIDER COUNCIL MEMBERS: Melissa Shambach, RN—Team Coordinator

Martha Downs, RN—Team Coordinator

Candace Bossler, RN—CEP

Tonya Sellard, RN—CEP

Gavin Claycomb, RN

Wendy Onvsconage, RN—CEP

Bethann Herriman, NA

Lori Valentine, RN, CCRN

OLD BUSINESS Tonya Sellard, RN, CEP, presented the council with the Geisinger job descriptions for the nurse extern. As a reminder to everyone, the extern has similar responsibilities to a nursing assistant. There was a revision of the unit council teams. Taping of report is not permitted. If you have any questions about a certain situation see the charge nurse. Revision of the titration book continues to be in progress by Candy. Isolation cart par items are going to be looked at and revised by Beth Herriman, NA, and Gavin Claycomb, RN. Please remember not to take the Hemacult and Gastrocult developers into the Isolation rooms. Have someone place a drop on the card or take a few drops in a medicine cup into the room. Just a quick reminder that it is not necessary to check the pH levels on a corflo. There is going to be a trial on the Nov. 11th – Dec. 8th schedule. Full-time employees are who this is going to affect. We are going to trial three 12-hours shifts one week and three 12-hours and an 8-hour shift another week. If you think about it, it will eliminate

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G E I SI N GER ME D IC A L CE NTE R FORCE 3

one full shift that you need to come to work. It will also make it easier for those of you who like to do overtime. It was discussed and decided that although you will work overtime by four hours one week, you will not receive the bonus and the week that you work the 12 hrs you would have to work four hours beyond your shifts in order to get overtime but you will get the bonus. In the end it all works out. We also talked about putting that date in the book the week you do the extra eight, and we figured out that in order to put a date in the book you have to work beyond the hours that you are scheduled. NEW BUSINESS Weekend position call-ins were discussed. It was decided that if on a Saturday or Sunday a person who works perm. weekends calls in, it will be made up on a Friday.Therefore on the next schedule, they will need to work three Fridays. Vacations for weekend positions were also discussed. If a perm. weekend person is scheduled for vacation the same weekend as a nonperm. weekend person on the opposite shift, you will both get the weekend off. If a day-shift and a nightshift perm. weekend put in for the same weekend, they will both be permitted to be off.Two perm. weekend people who are on the same shift will not be permitted to be off together; the person with the most seniority gets the weekend off. This is all permitted that staffing allots it; otherwise you will need to find someone to work for you. Reinforcement was made on the fact that if you call in the day before or the day after your scheduled holiday to be off, you will not get paid for the holiday. Any changes on the schedule that are going to be made need to go through the team coordinators. Scheduling guidelines were discussed and more will be coming on that.There is going to be a subcommittee consisting of Martha Downs, RN, Missy Shambach, RN, and Candy Bossler, RN, who are going to look over the guidelines. The nightshift holiday pay was discussed, and we just want to make sure that you night-shifters are aware that you will now be paid for 12 hours of holiday time for working the night before the holiday starting at 1900. There is going to be a new contract form coming around the corner. If you void a contract, be aware that you will not be able to contract the next schedule, and it will be up to Missy Shambach, RN, and Martha Downs, RN, if you will be able to contract after that. We are looking into preparing an equipment box that will be for emergencies; it will consist of extra cables, BP cuffs, etc.These supplies will be locked, and you will need to go to the charge nurse to get the key in order to use these supplies.There will be a sign-out sheet so we know when to replace what is used. Charge nurses, please be aware that you need to sign when the line cart is restocked. Gavin Claycomb, RN, and Tonya Sellard, RN, were elected to replace Mike Beaver, RN, in designing the SCU web site. Gavin Claycomb, RN, is going to join the scheduling committee. Candy Bossler, RN, is going to look and revise the critical care nursing guidelines pamphlet and make it more SCU friendly. A Christmas party is going to be planned. Look for the sign-up sheet in the lounge. We are going to plan the party during the week so that everyone will have a chance to come. We will keep you informed on more details as the time nears.Tonya is going to be looking into locations. Gavin Claycomb, RN, and Gordan Cole, RN, CNE, were elected to work on a packet to give to patient's families so that they can find their way around. Issues and concerns with EMAR and CPOE were discussed. For the first two weeks, superusers will be available to help and will not be counted in the numbers. At this time, we will not run short. There was discussion on the role of the nursing assistant in SCU. It was decided that we are going to do a week trial with the nursing assistant doing Q2 hour vitals and urine outs and putting them into the computer. Beth and Tonya are going to look into figuring out guidelines when the nurse needs to be told right away if there is a problem. We are going to hire four new nursing assistants.The positions will be posted soon.There will be two D/N, one nighter, and one D/E. Beth Herriman, NA, is going to work on an orientation packet for the nursing assistant.There is going to be a change in that nursing assistants are going to be crossed-trained as unit secretaries.The orientation is going to be increased to 10 weeks because of this. Week 1

General orientation

Week 2

Spend a week with a nurse (learn how to do general care of patients)

Weeks 3-4

Spend with the nursing assistant

Weeks 5-8

Desk

Weeks 9-12 Back with nursing assistant Gordon Cole RN, CNE, gave a proposed orientation packet for new nurses.

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3:3:D STAFF MEETING MINUTES SCU4 DIRECT-CARE STAFF NURSE ATTENDEES: Sept 6, 2007

Sept 17, 2007

Denae Cole, RN

Donna Plotts, LPN

Christy Muthchler, RN Sabrina Heddings, RN Melanie Feick, RN Bonnie Caratetter, RN Marcy Lutz, RN Heather Yost, RN Mary Bosco, UDC Beth Snyder, UDC Kim Castillo, RN STAFFING We are in the process of hiring two new NA for D/E. Jobs have been offered. I will keep you updated on our progress. Four of our new RNs will be off orientation starting in October. All our new approved positions are posted. NDNQI Benchmarks reviewed for staffing levels. Discussed ways to meet our staffing needs with staff participation. INFECTION CONTROL Reviewed handwashing before and after entering the rooms. There is to be no food or drinks at the desk. Drinks were found at the desk during ID rounds. Individuals will be addressed. Reviewed C-diff isolation and the need to wash your hands and not use Avagard because it is ineffective.There is a green sign that needs to be placed outside C-diff rooms so everyone knows to wash hands. Outside shampoo or soap discussion with staff. Team decided we should use shampoo provided by hospital to limit outside infection possibility. Please use what is provided by the hospital. RESTRAINTS/VO/TO Restraints audits reviewed and need to have order match nursing charting reviewed. When someone gets OOB we need a dc order for rails and when they get back to bed we need a reorder of rails. So if we take anything off or add anything, the order needs to match what we are doing and the time we are doing it. Any questions see Dawn or Sabrina. We did not have one care plan when our restraints were audited by PI. Everyone is responsible for checking the restraint care plans when you have someone in restraints. We only missed one Q2 hour documentation. Continue to match your charting to the physician orders. When ever you dc, start, or change what you are using, there needs to be an order in the chart that matches what you did at the same time you did it. Daily restraint audits are continuing and we are doing well. Remember any time four gates are up, this is a restraint and requires an order. No exceptions. Our VO order audit was 100% in all areas. Keep up the good work.

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MAGNET Magnet work is continuing. More info as it becomes available. POLICY CHANGES There is a new policy for the COURDE Cath placement. Please review the education in the staff bathroom. See Gerri with any questions. EDUCATIONAL ISSUES All education classes are cancelled the first two weeks we implement EPIC OCT 14th–Oct 28th.This is in an effort to have all of our resources available for the EMAR and CPOE PATIENT SATISFACTION Rounds are continuing in the unit. Noise at the desk is an issue with some patients. Be aware that our voices carry. No inappropriate conversations at the desk; those patients and others can hear. NEW STAFF/EXTERNS/ETC Steve Thomas starts 9/17 /07 as our new UCA. Welcome Steve. He will be full-time D/E. OTHER HOUSEKEEPING COWS, better known as computers on wheels, need to be kept in the patient’s room and plugged in.They cannot be in the halls. The computer on the wall by 15 needs to have its keyboard flipped up when it is not in use. Review of harassment policy. GMC has a no tolerance harassment policy 310 in the HR manual. Harassment definition was reviewed and the GMC policy discussed. Any questions or concerns see Dawn. Alarms in the unit are to be on at all times. Changes made to the alarms need to ordered by the attending service. Any attempt to turn off alarms or muffle them will not be tolerated and will result in disciplinary action. On Nov. 12, 2007, GMC is going tobacco-free.There are a number of programs to assist any staff who needs help to quit. See Connections for details. Submitted by Dawn Troutman, Ops Manager, SCU4

EXAMPLE: EQUIPMENT PURCHASED AS A RESULT OF STAFF FEEDBACK Managers also meet with Sue Hallick to share staff nurse suggestions and feedback. Direct-care nurses have provided feedback to management on the acquisition of direct-care equipment. Management presented this feedback from their reporting units at a manager’s meeting and set priorities for department-specific purchases (3:3:E).

3:3:E GEISINGER MEDICAL CENTER EQUIPMENT REQUESTS BY STAFF FOR MINOR EQUIPMENT FY07 UNIT

PRIORITY

ITEM

UNIT

PRIORITY

ITEM

BP5

Thermometer

BP8

Suction regulators

BP5

Desk chairs

BP7

Dinamap blood pressure machine

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 UNIT

ITEM

UNIT

BP5

PRIORITY 2

Dopplers

BP7

PRIORITY 7

ITEM Suction regulators

BP5

Pulse ox

AGP4

Telemetry transmitters

BP5

Bladder scan

AGP4

Patient recliners

BP5

Stretchers

AGP2

Bariatric chair

AGP5

Medication lockers

AGP2

AGP5

Dopplers

BP2

Geri chairs

AGP5

Shower stretcher

AICU

Family chairs

BP6

Bari chairs

SCU3

Triple pumps

BP6

Patient chairs

SCU3

Percussors

BP6

Pulse ox

CCU

Fluid warmer ranger

BP8

Refrigerator

CCU

Hillrom transfer chair

Patient lift

EXAMPLE: STRATEGIC STAFFING INCENTIVE (SSI) Another avenue for direct-care nurses to provide feedback is through meetings held by the CNO (Sue Hallick, RN), the associate vice presidents (Crystal Muthler, RN, and Denise Beechay, RN), and the nurse managers. Direct-care nurses met with Sue, Crystal, Denise, and several managers to come up with a plan to address staffing issues. The staff and managers were challenged to develop a plan in their unit-based councils that would encourage voluntary overtime. Additionally, a workgroup of direct-care nurses and managers developed a departmental plan that provides a monetary bonus for volunteering to cover unit staffing needs. It was implemented initially in 2005 and is revised at least every year (3:3:F).

3:3:F GEISINGER MEDICAL CENTER INPATIENT NURSING BASIC, PRESCHEDULED AVAILABILITY AND COMMITTED CORE STRATEGIC STAFFING INCENTIVE (SSI) REVISED: AUGUST 29, 2007 INTRODUCTION The Geisinger Medical Center Inpatient Nursing Strategic Staffing Incentive (SSI) is designed to provide incentive compensation for key inpatient employees.The purpose of the plan is: A. To recognize and reward staff for the commitment to patient care during periods of high census and resource shortages. B. To financially compensate staff for prescheduling additional or extra hours in advance. C. To enable staff to maintain control of when the extra hours are worked, benefiting the employee and department staffing needs. D. To increase staff ’s voluntary participation in preplanning to meet staffing needs. E. To promote a more even distribution of extra hours among staff members, meet core staffing needs on units, and eliminate mandatory overtime. I. DEFINITIONS A. When used in this Plan Document, the terms below are defined as follows: 1. “SSI” means this incentive plan in its entirety, including amendments, rules, and regulations adopted pursuant hereto.

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2. “Incentive” means a positive motivational influence—an additional payment as a means of rewarding increased cooperation and commitment to patient care. 3. “Employer” means Geisinger Medical Center. 4. “Geisinger” means Geisinger Health System. 5. “Voluntary time” means time that is preplanned or agreed upon prior to the end of the employee’s scheduled shift. 6. “Basic SSI” means Basic Strategic Staffing Incentive, an incentive paid to eligible inpatient staff that voluntarily preplan or agree to work additional hours within the designated time window as defined above. 7. “Prescheduled Availability Premium” means a lump sum premium paid to eligible individuals willing to make themselves available for a minimum number of time blocks per schedule on a preplanned basis to staff unexpected shortages on a designated inpatient unit. 8. “Committed Core Premium” means a lump sum premium paid on a per-schedule basis to eligible individuals willing to fill a minimum requirement of core time blocks per scheduled on a preplanned basis. II. IMPLEMENTATION CRITERIA A. The SSI will be implemented based on one or more of the criteria stated below with the Chief Administrative Office— GMC/System Chief Nursing Officer and Human Resources approval. 1. Above budget patient volumes 2. 10% or greater direct patient care provider vacancy rate (includes staff on leaves of absence) 3. For emergency staffing situations other than listed above at the discretion of nursing leadership. III. BASIC STRATEGIC STAFFING INCENTIVE A. To qualify for the Basic SSI, the eligible employee must volunteer to work additional or extra hours for a designated inpatientnursing unit. An employee from another department is eligible for the incentive as long as the extra hours worked are on a designated inpatient unit. B. All levels of nonexempt, budgeted personnel working on a designated inpatient unit are eligible for the incentive. C. A minimum block of two hours must be scheduled voluntarily as defined in Section II. D. Rates are as follows: 1. RN—$45.00 for every two-hour block of additional hours worked on a voluntary basis. 2. LPN, Paramedic (ED), Surgical Tech—$30.00 for every two-hour block of additional hours worked on a voluntary basis. 3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR, CSR Technician I, CSR Technician II, Lead CSR Technician—$22.50 for every two-hour block of additional hours worked on a voluntary basis. E. Only VOLUNTARY time as defined will be eligible for the incentive. If additional time is not prescheduled, the employee must declare his/her intent to stay prior to the end of his/her scheduled shift. F. Only two-hour increments or more will be counted toward the incentive, with the exception of the Women’s Pavilion, Surgical Suite, ETU, Foss 8, and Emergency Room, where one-hour increments or greater will be counted. G. Only extra hours for staffing purposes related to direct patient care will be counted toward the incentive. H. Flex Pool employees are eligible for the Basic SSI if a scheduled shift of eight hours or more is extended. I.

Committed Flex Pool employees are eligible for the Basic SSI if a scheduled shift of eight hours or more is extended or the employee works above their scheduled committed hours.

Additional hours worked as a result of switching shifts with another employee are not eligible.The incentive only applies to those hours scheduled to staff unexpected shortages on a designated inpatient unit.

IV. PRESCHEDULED AVAILABILITY PREMIUM* A. All Basic SSI guidelines apply. B. The Prescheduled Availability Premium is a lump sum premium (in addition to the Basic SSI) to be paid in the pay period following the end of each schedule period to an employee who preschedules availability for a minimum of six 4-hour blocks in addition to his/her regular work schedule.

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C. The premium will be paid regardless of whether the employee is activated at the following rate: 1. RN—$120.00 per schedule 2. LPN, Paramedic (ER), Surgical Tech—$90.00 per schedule 3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR—$60.00 per schedule D. Prescheduled availability must be scheduled in a 4-hour block. E. Should an employee who has committed to prescheduled availability refuse to work a prescheduled block, the premium in its entirety will be forfeited. F. Should an employee who has committed to prescheduled availability call in at any time during the schedule period without making up the time within the schedule period, the premium in its entirety will be forfeited. V.

COMMITTED CORE PREMIUM*

A. All Basic SSI guidelines apply. B. The Committed Core Premium is a lump sum premium (in addition to the Basic SSI) to be paid in the pay period following the end of each schedule period to an employee who commits to covering a minimum of eight 4-hour core blocks within the schedule, in addition to his/her regular work schedule. C. The premium will be paid regardless of whether the employee is activated at the following rate: 1. RN—$240.00 per schedule 2. LPN, Paramedic (ER), Surgical Tech—$180.00 per schedule 3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR—$120.00 per schedule D. Committed core coverage must be scheduled in a 4-hour block. E. An employee who enrolls in the Committed Core Premium program may be reassigned to another unit per Patient Care Manual Policy #328,Temporary Reassignment of Nursing Personnel; however, the employee may be offered the opportunity to reschedule core commitment time on their home unit within the current schedule period. F. Rescheduled time is at the discretion of the time-scheduling committee or the unit manager. G. Should an employee who enrolls in the Committed Core Premium program refuse to work a scheduled committed core block or call in at any time during the schedule period without making up the time within the schedule period, the premium in its entirety will be forfeited. 1. An employee who calls in during the schedule period must contact his/her manager to schedule an appropriate make-up day. Make-up days are not eligible for Basic Strategic Staffing Incentive payment. H. Individuals who enroll in the Committed Core Premium program and meet the requirements outlined in Sections B, D, and E will not be required to stay unexpectedly for that schedule period. *Prescheduled Availability and Committed Core Premium enrollment may be limited based on the needs of the unit. VI. GENERAL PROVISIONS A. This Plan may be amended, modified, or terminated with or without notice to participants at the discretion of the Chief Administrative Office—GMC/System Chief Nursing Officer Geisinger Health System or the Human Resources Department. B. A participant forfeits all rights to the incentives payable under the SSI if, prior to the payment of the award, the participant participates in behavior or misconduct that results in a formal performance improvement plan being issued. C. In the event of the death of an active participant, any earned incentive will be paid to the participant’s beneficiary as designated in the employee record.

In 2007, the workgroup that included staff nurses and managers was reconvened and worked with Gena Maize, a member of the Finance Department. The goal of the group was to revise the plan to improve nurse satisfaction and maintain quality. The NDNQI scores on overtime reflect our ongoing efforts (3:3:G).

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3:3:G UNIT RNS WORKING EXTRA HOURS % of Unit RNs Reporting They Did Not Work Extra

% of Unit RNs Reporting Working Extra Hours, Reason Given % Extra Money

% Unit Busy

% Unit Short-staffed

% Staff Pressure

Mean Change in Unit Overtime During Past Year % Required -1=decreased 0=unchanged +1=increased

Average of All Comparison Hospitals 20

0.23

Average of all units in Hospital

0.56

Adult Critical Care

0.31

AICU—Shock/Trauma

0.64

CICU—Cardiac—50150001

0.81

0.27

0.96

Adult Step-down SCU3—Special Care Unit SCU4—Special Care Unit

0.47

0.25

-0.12

AGP5—Cardiopulmonary

0.46

BP5—Bone and Joint Care

0.79

BP6—Surgical—50010012

0.50

BP7—Medical/General

0.48

Average of All Comparison Hospitals 20

0.23

Average of all units in Hospital

0.56

BP8—Hematology/Oncology

-0.08

Adult Medical-Surgical AGP4—Telemetry

AGP2—Medical-Surgical Obstetrics (LDRP)—50550001 Neonate NICU—Neonatal—50400010 Pediatrics

0.58

0.29

0.77

0.28

0.96

0.21

CH2—Infant/Toddler—50400070

0.88

CH3—School-age Medical-Surgical

0.85

PICU—Pediatric—50400050 Psychiatry BP2—Psych—50070001

1.00

0.17

0.50

0.20

0.67

Operating Room

0.93

Periop

0.57

Surgical Services In and Out

Rehabilitation

0.14

Emergency

0.38

0.69

0.18

Cards & CT Surgery Outpatient Clinic 33

0.57

Emergency Department Ambulatory Care

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 % of Unit RNs Reporting They Did Not Work Extra

% of Unit RNs Reporting Working Extra Hours, Reason Given % Extra Money

% Unit Busy

% Unit Short-staffed

Mean Change in Unit Overtime During Past Year

% Staff Pressure

% Required -1=decreased 0=unchanged +1=increased

Foss 3 and 6 Pediatrics

0.45

Hem/Onc Clinic

-0.23

Medical Outpatient

0.39

Surgical Outpatient

0.43

Women's Health Outpatient Clinic

0.42

0.15

Dialysis

0.67

Endoscopy

0.93

Interventional Labs

Comparison data are not provided for this unit type category because the wide variety of units included invalidates its use for comparison purposes. Clinical Nurse Educators

CRNA

Flex RN

Floats

I.V.Team

Life Flight

0.14

0.67

0.53

0.90

-0.08

0.33

Sue Bennett, RN, a direct-care nurse on the Hematology/Oncology unit (BP8), indicated, â&#x20AC;&#x153;I think that the SSI has helped to increase the amount of time people volunteer to help the unit. It is a fair way to deal with staffing issues. I actually look forward to being able to pick up the hours when it suits me and my family.â&#x20AC;? The SSI encourages more staff to work extra hours voluntarily, thus providing adequate staffing required for high quality, safe patient care. And employees feel a greater level of appreciation from the management team.

GMC Nursing Overtime Incentive Comparison $6,000,000 $5,000,000 $4,000,000 $3,000,000 $2,000,000 $1,000,000 $0

2006

2007

2006

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EXAMPLE: INFLUENCE OUTSIDE OF NURSING Direct-care nurses also have input that influences organizational decision making outside of the Nursing Department on issues that impact patient care. Some of these issues include: • EPIC (Electronic charting system)—Nurses assisted in developing the screens and the process of documentation for our electronic health record (EHR). These nurses are active in all phases of development and system rollout (3:3:H).

3:3:H GEISINGER HEALTH SYSTEM CONSOLIDATED CONTROL TEAM MEETING MINUTES Meeting Minutes: May 22, 2007 PRESENT GMC: Bernie Aurand, RN, direct-care BP7; Jody Bachman, RN, CNE, NICU; Gordon Cole, RN, CNE, SCU3; Carol Hughes, RN, direct-care AGP4; Kristin Hogan, RN, direct-care BP2; Alan Huntington, EPIC programmer; Lani Kishbaugh; Melissa Kratzer, RN, direct-care medical-surgical float; Joan Mervine, RN, CNE, BP5; Emily Mowry, RN, CNE, CH2/CH3;Tracey Nicholas; Sharon Novack; Debbie Stayer; Dawn Troutman;Tami Underhill; Alice Wilson; David Wolf, RRT, Respiratory Therapy; Cassandra Bell, EPIC; Melissa Eick, EPIC; Meredith Fowler, BP2, EPIC; Cindy Vought; Joanne Williams. GWV: Deb Tykosh, Crystal Hritzik, Louise Jenkins NOTE TYPES • Cindy: It has been decided the PROGRESS tab will be for physicians only and the INITIAL ASSESS tab will be changed to NURSING post CPOE go-live. • Group discussed if they want different note types under the NURSING tab; example:Telephone Contact, Initial Assessment, Nursing Progress Notes, Nurse Specialist Notes, Social Services. • Group decided three types of notes (Nursing Progress Notes, Initial Assessment and Telephone Contact) would be listed under the NURSING tab. • Question was asked if the fast note will work with this set-up. Melissa will investigate. • Question asked: How will Nutrition and Physical Therapy report their initial assessment? They are currently using the INITIAL ASSESS tab. Cindy will check with Wanda to find out which non-nursing groups are using the INITIAL ASSESS tab.They will need to decide where they will document their initial assessment FLOW SHEET GROUP 500021 (PERIPHERAL NERVE BLOCK) STATUS ROW ADDITION • Cindy asked the group if “capped” could be added to the status row as a selection under Group 500021—Peripheral Nerve Block.The Epidural group already has “capped” as a selection. • Group approved adding “capped” to Peripheral Nerve Block group. MED HISTORY • Joan Mervine addressed group on behalf of the Med Recon team regarding the Medication History. • Cindy told the group the Periop Nurses, PEDS, BP2, and L&D nurses are for the most part updating the Med Recon in EPIC and doing it on paper. • Lori reminded the group that they previously decided against using the Med Reconciliation in EPIC because the nurses would have to double document (EPIC and paper) until CPOE/EMAR goes live and paper is eliminated. She also had a concern that if we decided to use EPIC Med Reconciliation, we could not get the nurses trained before Joint Commission arrived on campus. (See 4/10/07 minutes where the group agreed not to add to navigator for adult world.)

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• Joan asked if updating med list in EPIC was not an option, could they view the ED meds.This would help nurses when communicating with patients about their preadmission meds. Melissa showed the group the Med Documentation Report in the Admission Navigator.The title of the report has been changed to “Update Prior to Admit Med.” • Group decided it was okay to add “Med Documentation” report to Admission Navigator for viewing by the rest of the adult world. Melissa will add it to navigator next week. POST-FALL GROUP EVALUATION • Joanne asked the group if they have frequent documentation under the Post-Fall Group. If so, do they need a reminder flag? • Gordon reported the policy would be reviewed in July and advised against making any changes at this time. We don’t want to start something that will have to be retired. EMAR SUPER USER TRAINING QUESTIONS • Joanne went over several questions that were asked at the EMAR super user training, but it was decided by the group that this was not the time or place to review them. • A comment was made that the super user questions are not getting answered. • Joanne said she would look into it. NEXT MEETING • June 12, 2007 • 1:30 p.m.–3:00 p.m. • Bush 3 Cassandra Bell Inpatient EPIC Team

NURSE ADMIT WORKFLOW 4/24/2007

Patient Arrives to Inpatient floor

Nurse enters patient’s chart in EPIC

Access the Nurse Admit from the Action Menu

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Nurse can update/edit the Allergies for the patient

Nurse selects if a line is available for a Nurse Draw (labs)

Nurse selects flow sheet link to be taken to the Flow Sheet Activity and selects the appropriate flow sheet to complete from under the Chevron dropdown

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Nurse selects and completes the appropriate Admit Database flow sheet

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FLOW SHEET COMPLEX CHANGES FOR 4/24/2007

Due to a policy change, the NGT Placement List will reflect the new order with additional choices.

Ostomy will sit on the Integumentary flow sheet as before but now it will be duplicatable so you are able to bring in another group and rename it.

TURN AND REPOSITION CHANGE

The Turn/Reposition row will be versioned and Rotobed will be added as an option.

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PATIENT EDUCATION FLOW SHEET CHANGES

The wording was changed to reflect the highlighted section below.

A new LDA group is available for the I.V. Management Flow Sheet called Midline Catheter.

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•

Equipment and supplies—Nurses have input into the type of equipment and supplies that are being considered for purchase through the Clinical Use Evaluation (CUE) Committee. These nurses help to test them and make the final selection (3:3:I).

3:3:I GEISINGER HEALTH SYSTEM CLINICAL USE EVALUATION COMMITTEE MEETING MINUTES: 4/26/07 LOCATION: GWV VMB VIDEO CONFERENCE ROOM GMC VIDEO CONFERENCE ROOM—HOSPITAL 3 TIME: 1 P.M. CLINICAL USE EVALUATION ATTENDANCE RECORD CALENDAR YEAR 2007 Members

April

J. Bachman, RN (D), CME

P. Baylor, RN (D), Risk Management

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Members

April

C. Bird, RN (D), operations manager

T. Bower, RN (CP), operations manager

C. Day, RN (W), direct-care nurse

S Heppding, RN (W), direct-care nurse

L. Kasper, RN (W), direct-care nurse

B. Knowlton, RN (D), CNE

J. Kopec, RN (W), direct-care nurse

K. Linn (D), Purchasing

G. Maize (D), Finance

B. Mullay, RN (W), operations manager

B. Patterson, RN (D), operations manager

B. Rice, RN (W), operations manager

G. Rittle, RN (D), direct-care nurse, ED

B. Rohrer, RN (D), direct-care nurse, Peds

B. Rozycki, RN (W), direct-care nurse, ICU

J. Santo, RN (W), direct-care nurse, ICU

D. Stump, RN (D), direct-care nurse, Anesthesia

R.Tronsue (GSWB)

L. Kearney, RN (D), purchasing (Facilitator)

UA–Unexcused Absence –No Meeting TD–Technical Difficulties

X–Attended EA–Excused Absence N/A–Not a member

REVIEW AND APPROVAL OF MINUTES Minutes of 3/22/07 corrected and approved. OLD BUSINESS THERMOMETERS Welch Allyn Core Tympanic Thermometers have been approved for use at all sites except Outpatient Peds (need reading in oral mode).Thermometers can be ordered now. The order from all three hospitals will be submitted at once. I.V. LABELING TAGS All hospitals will use the color-coded tags on tubing with the name of the day of the week, as when to change I.V. (same as GWV’s tags). Conclusion/Action: GWV to send sample. Policy to be changed as to tag tubing, the day I.V. is to be changed and describing tags. I.V. PUMP UPDATE Updates on pumps will be done sometime in June. All Pharmacies will be involved with adding upgrade and revising the Guardian Drug Library. GWV getting 20 single channel loaners and 20 poles until new exchange completed. Conclusion/Action: Other facilities will look into loaners. NEW BUSINESS ENEMA BAG KIT All hospitals will be using the same Enema Kit with a hanging plastic bag instead of a plastic bucket. Conclusion/Action: More cost saving.

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BARIATRIC BEDPAN Identified as a need by GMC and GWV. Holds 2 qts. of liquid and 1000 lbs of weight. Conclusion/Action: First check with present vendor to see if they have such item. If not, get cost from new vendor. LATEX CATHETERS At Children’s Hospital, have straight catheter kits with red rubber latex catheters and Foley insert kits with latex catheters.The red rubber catheters are also used for suctioning children.This poses a potential problem for exposure to latex allergic reactions to both patient and care provider. Conclusion/Action: B. Rohrer to check with present company (Bard) to see if they have non-latex products. GWV to check with Bonnie Rice to see if there is a problem at GWV. NEXT MEETING: JUNE 2007 Belt restraints to be addressed.

STAFF NURSE RECOMMENDATIONS FOR CUE I.V. tubing labeling

GMC converted to the system process for labeling I.V. tubing to indicate tubing change dates.This change also improved SCS production time because the staff does not have to place the label on the I.V. bag.

No rinse shampoo caps

Per a nursing request, sourced and obtained a product to aid with cleansing patient’s hair to cut down buckets, trays, and shampoo to one item.

Disposable BP cuffs

Per a nursing request that expressed the need to house disposable cuffs for patients in isolation, this was done in accordance with Infection Control to assist with decreasing the incidence of transferring isolation particles.

Mouth care kits

To assist with decreasing VAPs in accordance with clinical effectiveness and Saving 100,000 Lives Campaign initiatives, nurses worked with AICU staff to select the best products to accomplish this.To date, it has been effective (per Lani Kishbaugh).

Endure body wash and lotion

In conjunction with Infection Control, nurses requested a product to help decrease the microorganism growth on skin to decrease hospital-acquired infections.

Vest restraints

Removed vest restraints per Joint Commission recommendation and replaced with restraints that were approved by Nursing.

Patient admission kits

Developed an understanding of what Nursing needs from an admission kit and what is the most cost effective to provide. A mini-workgroup worked with a major assist from AVP Denise Beechay to review with Nursing the need to assess each patient before giving them a kit and to establish a basic kit so that individual nursing floors do not need to make their own. Savings derived from this effort will be determined.

Central line bundle kit

Worked in conjunction with clinical effectiveness as part of the Saving 100,000 Lives Campaign.

Thermal to bath blanket and disposable towels in the ED

This conversion is in process, savings to be announced next month.

EVIDENCE 3: SOURCES OF EVIDENCE 3:3:A

Shared Governance Council Rosters

3:3:B

Nursing Procedure Manual—Patient Identification Policy (developed by Nursing Practice Council)

3:3:C

Unit Council Minutes (SCU3)

3:3:D

Staff Meeting Minutes (SCU4)

3:3:E

Equipment Requests by Staff for Minor Equipment

3:3:F

Strategic Staffing Incentive (SSI)

3:3:G

NDNQI: Unit RNs Working Extra Hours

3:3:H

EPIC Consolidated Control Team Minutes

3:3:I

CUE Meeting Minutes

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EVIDENCE 4 Describe mechanisms or processes that create a practice environment that fosters horizontal and vertical communication between nurses at all levels throughout the organization. EXAMPLE: HOSPITAL-BASED SHARED GOVERNANCE COUNCILS The shared governance model creates an environment of open communication between staff nurses, advanced practice nurses, nurse managers, and administration. Vertical communication occurs when a staff nurse communicates directly to a manager or to Sue Hallick, our CNO. Horizontal communication occurs among peers. Working together on policies, projects, or practice-related problem solving fosters communication between nurses from all departments throughout the organization regardless of their level. The familiarity gained from working together on the councils enhances inter-unit interactions as well. Direct-care nurses serve on various Nursing Department councils. They share their opinions on the benefits that these experiences provide: • Nursing Clinical Practice Committee Cochair Mike Treese, RN, float/staff nurse: “As a float, I see a lot in the inpatient areas, but the Clinical Practice Council brings together inpatient and outpatient staff, managers, and representatives from other nursing councils. Through my council work, I am able to see the wide impact nursing issues have on the various specialties in and out of the hospital setting” (3:4:A). CLINICAL PRACTICE COMMITTEE MEMBERS 2007 Charlene Anselmo, RN

Women’s Health Pavilion

Staff Nurse

Jody Bachman, BSN

NICU

Nurse Educator

Melania Balzer, BSN

Operating Room

Staff Nurse

Patricia Baylor, RN

Employee Health Services

Clinic Nurse

Carol Bettyleyon, RN

Radiation Oncology

Clinic Nurse

Candice Bossler, RN

Special Care Unit 3

Staff Nurse

Ann Bower, RN

BP7

Staff Nurse

E. Sue Brown, MSN

Patient Safety

Patient Education

Joan Callahan, BSN

PACU

Staff Nurse

Donna Dietz, RN

Hematology/Oncology

Clinic Nurse

Tracey Eddinger, BSN

AGP5

Staff Nurse

Cathy Eyer, RN

Women’s Health Pavilion

Nurse Educator

Eileen Gibson, RN

Urology Clinic

Clinic Nurse

Sheila Clark, RN

BP5

Staff Nurse

Sue Hallick, MS, BSN

Nursing

CNO

Sabrina Heddings, RN

Special Care Unit 4

Staff Nurse

Carol Hughes, RN

AGP4

Staff Nurse

Dianne Nestor, RN

BP6

Staff Nurse

Dorothy Johnson, BSN

CH3

Staff Nurse

Katie Jones, RN

AICU

Staff Nurse

Holly Kasper, RN

CH2

Staff Nurse

Barbara Knowlton, RN

I.V.Therapy

Nurse Educator

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 Carol Krohn, RN

Eye Clinic

Clinic Nurse

John Krohn, RRT

Respiratory Therapy

Staff RRT

Juna Lewis, RN

AGP5

Staff Nurse

Adrienne Lonczynski, BSN

BP8

Staff Nurse

Judy Malatesta, RN

CICU

Staff Nurse

Devon Manney, BSN

OB/GYN

Staff Nurse

Lisa McGinty, RN

I&O Surgery

Staff Nurse

David Mensch, RN

BP2

Staff Nurse

Darlene Mensinger, RN

NICU

Staff Nurse

Joan Mervine, RN

BP5, BP6

Nurse Educator

Emily Mowry, BSN

Children’s Hospital 2 & 3

Nurse Educator

Polly Muthler, RN

AGP2

Staff Nurse

Tracey Nicholas, BSN

Performance Improvement

GMC Campus

Sharon Novac, BSN

Infectious Disease

GMC Campus

Jeanne Perch, RN

Pain Therapy

Clinic Nurse

Bonnie Patterson, RN

AGP5 & I.V.Therapy

Operations Manager

Vicki Patterson-Cragle, RN

CICU

Staff Nurse

Kathy Politis, RN

AGP4

Staff Nurse

Linda Rea, RN

PICU

Staff Nurse

Tonya Sellard, RN

Special Care Unit 4

Staff Nurse

Stacie Semborski, RN

Pediatric Sedation Team

Staff Nurse

Anne Shaffer, RN

Emergency Department

Staff Nurse

Renee Smith, BSN

PACU

Nurse Educator

Jody Snyder, BSN

Endoscopy

Clinic Nurse

Hope Spigelmyer, RN

Critical Care Float Pool

Staff Nurse

Deb Stayer, MSN

PICU

Nurse Educator

Robin Steimling, RN

BP7 & BP8

Nurse Educator

Dennis Tanner, BS, RN

BP2

Nurse Educator

Michael Treese, BSN

Medical-Surgical Float Pool

Staff Nurse

Timothy Troxell, LPN

BP6

Staff Nurse

Deb Watkins, LPN

Foss Clinic

Clinic Nurse

Jenifer Wemple, BSN

Special Care Unit 4

Clinic Nurse

Ann Wilver, RN

Foss 6

Clinic Nurse

Jessica Yancaskie, BSN

AICU

Staff Nurse

3:4:A GEISINGER MEDICAL CENTER NURSING CLINICAL PRACTICE COUNCIL MINUTES DATE: JULY 10, 2007 TIME: 0700 – 1100 TEAM MEMBERS KEY: X–PRESENT

E–EXCUSED

Charlene Anselmo, RN

A–ABSENT X Lisa McGinty, RN

X Jody Bachman, BSN

X Judy Malatesta, RN

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Melania Balzer, BSN

Dave Mensch, RN

Patricia Baylor, RN

X Darlene Mensinger, RN

Carol Bettleyon, RN

Joan Mervine, RN

Candace Bossler, RN

Emily Mowry, BSN

X Ann Bower, RN

Tracey Nicholas, BSN

Sue Brown, RN

Sharon Novak, BSN

Vicki Cragle, RN

X Devon Manney, BSN

X Joan Callahan, BSN

X Bonnie Patterson, RN

X Donna Deitz, RN

X Jean Perch, RN

X Tracey Eddinger, BSN

X Kathy Politis, RN

X Eileen Gibson, RN

X Linda Rea, RN

Dorothy Johnson, RN X Sue Hallick, BSN

X Tonya Sellard, RN

Sabrina Heddings, RN

Stacie Semborski, RN X Ann Shaffer, RN

Carol Hughes, RN

Renee Smith, BSN Jody Snyder, BSN

X Dorothy Johnson, RN

X Hope Spigelmyer, RN

X Katie Jones, RN

Deb Stayer, MSN

Holly Kasper, RN

X Robin Steimling, RN

X Carol Krohn, RN

Dennis Tanner, RN

X John Krohn, RRT

X Mike Treese, BSN

X Barb Knowlton, RN

Deb Watkins, RN

X Juna Lewis, RN

Jenifer Wemple, BSN

X Adrienne Lonczynski, BSN

Ann Wilver, RN

Rene McCloskey, RN

Jessica Yancoskie, BSN

Polly Muthler, RN

X Sheila Clark, RN

Diane Nester, RN

Tim Troxell, LPN

Facilitators: Barb Knowlton, Mike Treese Minute Taker: Chris Whitmire Guest(s): CALL TO ORDER Meeting called to order at 0700. APPROVAL OF MINUTES The minutes were approved as submitted. ANNOUNCEMENTS ADULT ECMO The policy is not quite done and will be tabled until next meeting. A policy for the Rotobed was passed out for group to review. Please make changes that may be needed. Changes will be made and brought back to the group for approval.

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VISUAL CHECKS Visual checks documentation in EPIC has been revised to include sleeping and breathing. Skin warm has been removed. Touch has also been removed due to patients reporting being awakened when touched in the middle of the night. Check unit policies to make sure the changes are done regarding the visual check policy. RESTRAINT POLICY Clarification is needed. When a patient has restraints in bed then is transferred to a chair, does the restraint order need to be rewritten for the chair and again when the patient is returned to bed. A meeting will be held next week to work on clarification. CATHETER TIPPED SYRINGES Catheter tips syringes can be left at bedside according to DOH.You cannot leave any syringe that a needle can be attached to at the bedside. CONTINUOUS PULSE OX MONITORING Bonnie will report at the next meeting. NEW MEMBER Sheila Clark will replace Kathie Green from BP5. A Life Flight representative will be joining the group in the future. UMBRIAC CLAMP/JUDY MALATESTA A clamp (Umbriac Clamp) invented by a Geisinger employee to be used when transporting a patient with multiple I.V. drips that need to be infusing constantly.The clamp is put on a pole for transport and is unclamped from the pole once in the room. In use CICU right now but will be hospital-wide eventually. SITE MARKING FOR SURGERY Physicians will now have to start marking their own surgical sites prior to surgery. It was the responsibility of the nurses previously. Information to follow. Lisa McGinty will forward the information to Barb who will forward it to the group. MEDIPORTS速/DONNA DIETZ Staff should be encouraged to use the Mediport for blood or I.V.s if the patient has one. Barb suggested the incidents be reported to the unit managers so they can be addressed. Clarification is needed to see if it is perceived or a real issue.Tracking should be done to try to clear up the issues. Donna will do some tracking to clarify issues. ASSESSMENTS Patient assessments are good for 12 hours. If you work 12-hour shifts it is fine, but if you work 16 hours you must assess the patient after 12 hours. I.V. IG POLICY The I.V. IG Policy is located in the Nursing Procedure Manual online. It is Policy 59A. ADMINISTRATIVE UPDATE JOINT COMMISSION Sue Hallick talked to the group regarding the Joint Commission visit. She explained the process and told the group how long they would spend in the hospital each day. She told the group they want to talk to the nurses and not the managers.

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The employee picnic will be held as scheduled. We will know by Friday their recommendations. Sue will get that out immediately INCENTIVES Sue told the group overtime incentives are being revised. Considering lowering the hours worked for the core incentive. Also being considered is a special incentive for weekend and off-shift hours. PARKING ISSUES Currently, security staff has other added responsibilities and cannot always take people to the North Zone parking lot when shifts end later in the evening. Sue will talk to Scott Bitting regarding the situation.There were also concerns regarding lighting and the bushes and weeds on the walk to the parking lot. NEW RESEARCH NURSE Our PhD nurse, Dr. Adele Spegman, will start July 16, 2007. She will work part-time for Nursing and part-time for the Research Center. She will bring the nursing component into the studies. NURSING VISION Sue will go over the Nursing Vision at an upcoming meeting. VACANT NURSING POSITIONS Sue shared vacancy and turnover rates for nursing nationwide, at GMC, and at GWV. THOMAS JEFFERSON Thomas Jefferson will have 50 graduates for the next semester. Five people have been accepted into the doctorate program for Thomas Jefferson. MAGNET UPDATE Sue talked to the group regarding Magnet. Groups are gathering information, and we have a person helping the group with writing the stories. She explained the process so far, and Terri will continue to keep the group updated.The Conceptual Framework will be discussed at a future meeting. TERRIâ&#x20AC;&#x2122;S MAGNET UPDATE Hard work is being done and we are on track for April 2, 2008 document submission. Magnet excitement for this July will be done at the Employee Picnic. August will be Ritaâ&#x20AC;&#x2122;s Ice. Conceptual Framework is a big topic.There will be discussion on how to continue to incorporate it into the practice to demonstrate how the process is done at Geisinger. Survey forms done at your evaluation are being turned in to Magnet. It is important to demonstrate how the nurses are involved with the community. Please let the Magnet groups know when an employee wins a reward regarding their community service. Employees receiving certifications are growing. We are above average on medical-surgical certifications. Keep up the good work. CEUs FOR LICENSE RENEWAL State board has passed the process regarding the need for a minimum of 30 CEUs to renew your license. It will begin with the 2008 renewal year.Terri will keep the staff informed regarding the free CEUs.The information is on the Nurse Channel for all to access. The state has not clarified the type of CEUs that will be acceptable.There have been recommendations on the acceptable programs, but clarification will come. Terri told the group to check with Judy Shipe regarding the CME classes and the possibility of getting PSNA credits for the programs.

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Turn programs in to Nursing Education, Chris Whitmire 01-51, to get credit on your transcripts. The monthly Growing Up, etc., articles will go into the GOALS program in the future. When you take the class and complete it will go on your transcript automatically. The OR Trauma is in GOALS and when completed goes to you transcript automatically. PEARLS There is an online program called Pearls. It can be accessed for a variety of topics that offer CEUs.Terri will send it to Barb Knowlton to send out to the group for all nursing staff.Terri will be sending it to GWV for their use also. Please submit the Pearls certificate with a sign-in sheet to get credit on your transcript. NURSING RESEARCH Terri spoke about the new research nurse. She will be visiting the Clinical Practice group in the future. RESTRAINTS Terri told the group that DOH thought we needed to improve our process with restraints.They think that we are overly strict with ourselves. Sue spoke to the DOH to figure out the process we need to go through. Hopefully by Monday we will have approval and things will not change. “Behavioral” and “nonbehavioral” have changed to “violent” and “nonviolent.” It relates to the people who know they are intending to harm you and ones who are not aware because of extenuating factors such as drugs, etc. Location does not distinguish the differences in patients. It is the diagnosis and the way they are being treated. The new process and reeducation will be done starting next week and will have to be done by August 1, 2007. URINARY INFECTION COMMITTEE Diane visited the group previously and took concerns from the group back to the committee. In some areas in the hospital, nurses are inserting the Coude catheter. In the past, placement of this catheter was a physician responsibility. It is important to educate staff in the use of the catheter in the future. ADJOURNMENT Adjournment at 11:00. MINUTES APPROVED BY: Barb Knowlton, RN

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Nursing Retention and Communication Council (NRCC) Cochair Tess Varano, RN, staff nurse, AGP4: “The members of the NRCC have an eight-hour meeting once a month that allows not only a forum to bounce ideas off each other but a comfort zone for addressing concerns to our CNO. Having nurses on the committee that represent the pediatric, ED, intensive care, medical-surgical specialties also gives the committee and its members unique insight to further address retention and communication issues.” Steve Endress, RN, staff nurse, Life Flight: “Working together during council meetings allows nurses from all levels to have the opportunity to communicate effectively and to collectively work as a team to enhance the overall function of each nursing unit and the nursing department as a whole. The NRCC council is a collective group of QUALITY

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nurses, a well rounded team formulated to maintain open communication, enhance the nursing practice, and promote the nursing image throughout the Geisinger system” (3:4:B).

3:4:B GEISINGER HEALTH SYSTEM RETENTION AND COMMUNICATION COMMITTEE MEETING MINUTES THURSDAY, SEPTEMBER 27, 2007, 0700-1530 LOCATION: ANESTHESIA CLASSROOM Attendance KEY: X–PRESENT

E–EXCUSED

A–ABSENT

INPATIENT NURSING

R = REPRESENTED

INPATIENT NURSING CONT.

Beyer, Melissa, RN—CH2 (NWM)

OUTPATIENT NURSING CONT

Spatzer, Barbara, RN, AICU (HWE)

Brink, Janice, RN, BSN, CEP—NICU (PS)

X Wright, Christianne, RN, Staff Nurse—I&O

X Spickard, Sandra, RN, MSF (NWM)

X Brokenshire, Judy, RN, CMSRN—BP6 (NWM) X Chamberis, Sevasty, RN, CH3 (HWE)

Yocum, Kay, RN, Endoscopy (PS)

Strunk, Lori, AGP4

NURSING LEADERSHIP

X Swartzentruber, R. Elaine, RN Staff Nurse, Cancer Center

Evans, Sarah, RN, BP5

X Hallick, Sue, RN, CNO

Thomas, Elizabeth

X Marks, Jami, RN—Advisor, Ops Mgr—Inpatient OB/GYN

Wallish, Mary, RN, CCF (PS)

X Endress, Steve, RN, Flight Nurse, Life Flight, Cochair

Wemple, Jennifer, RN, BSN, SCU4 (PS)

E Varano,Tess, RN, cochair, AGP4 (HWE)

Henrie, Sandra, RN, BP8 (alternate)

Wonlschlegel, Mandy, Extern, BP5

CLINIC NURSE EDUCATORS

Heuermann, Jane, RN, AGP2

Zimmerman, Rebecca, BP5

X Danilowicz, Gerri Ann, RN, Clinical Nurse Educator, SCU4

X Grunden, Marie, LPN, AGP5 (HWE) Harris, Danielle, RN, AICU

Hons, Sara, RN, BSN— Labor & Delivery (PS)

OUTPATIENT NURSING

X Gordon, Nancy, RN, CNC Clinical Nurse Educator, ED

Intintolo, Joan, RN, Staff Nurse, BP7

X Bidelspach, Lisa, LPN Eye Clinic (NWM)

X Horan, Kate, RN, Clinical Nurse Educator, OR

Karnes, Pamela, RN, AGP5

Corrigan, Sandy, RN, GIM

X King, Megan, RN, WP1 (PS)

Fulmer, Sherri, RN, Dialysis (NWM)

OTHER

Botella, Judy, RN, Supervisor

X Kleman, Cheryl, RN, CEP, PACU (NWM)

X Gaugler, Jatina, RN, Staff Nurse—Pain Therapy (NWM)

X Lerch, Lyndsey, RN, AGP5— Staff Nurse (HWE)

X Heath, Sally, RN, PSC (NWM)

Curtin, Colleen—Nurse Recruiter

Lines, Red, RN, Life Flight

X Ikeler, Kristen, RN, BSN, OCN Knapper Clinic (HWE)

Gibson, Eileen, RN, IT

Lizardi, Lynn Ann, RN, SCU3 (HWE)

X Jones, Carol, RN,Team Coord. Emergency Department

E Hoffman, Lynn, LPN, GHP— QI (PS)

E Long, Mary Ellen, RN, CCRN, PICU

Madden,Tracey, RN, Staff Nurse—I&O (NWM)

Lamont, Susan, RN, Human Resources

E Mattis, Deb, LPN, BP2

Moore, Janet, RN, Orthopaedics

Merrill, Michele, RN ,Vitaline

Ney, April, LPN, Sunbury Women’s Health (PS)

Miller, Becky, Human Resources

Michael, Nicole, RN—RN/CEP, AGP4 (HWE)

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INPATIENT NURSING

INPATIENT NURSING CONT.

OUTPATIENT NURSING CONT

Mutchler, Christy, RN, AGP4 Nariskus, Kristy, RN, OR

Reichenbach,Teresa, Dermatology

Newsome,Vanessa, RN—NICU

Miller, Cindy, Human Resources

X Sekulski, Connie, RN, I.V.Therapy (HWE) (alternate) (PS)

X Peterman, Elizabeth, RN, BSN, CCU

Schoch, Michelle, QI (alternate)

Provow, Amanda, OR (alternate for OR)

Strzempek, Lynda, RN, Radiation

Reiner, Amy, RN, CCU

Shotwell, Betsy, RN—ER

Smoyer, Karen RN, CEP—BP8 (PS) PS = Patient Satisfaction

Petrovich, Susan, QI

Young, LaVera, Neuro Services Line

X Worhach, Stephanie, RNC, CBC, CCE, CLSS, OB/GYN Team Leader (PS)

HWE = Healthy Work Environment

NWM = Nurses Week/Magnet

PATIENT SATISFACTION SUBCOMMITTEE Present: April Ney, LPN (Sunbury OB/GYN); Sara Hons, RN (L&D); Jenifer Wemple, RN (SCU4); Rebecca Zimmerman, RN (BP5); Megan King, RN Chair (Perinatal Edu);Vanesse Newsome, RN (NICU); Steve Endress, RN (Life Flight); Michelle Schoch (GHP); Stephanie Worhach, RN (OB/GYN GMC); Jane Heuermann (GP2). Guests: Deb Strouse (Scheduling Services); Ruth Carawan (Scheduling Services); Carol Hardee (CareLink). Meeting called to order at 7:05 a.m. Representatives from CareLink educated the committee on the IVR (Interactive Voice Response) system, which guides the user through the Geisinger system.The system has many capabilities to phone tree the client to the correct department and is also programmed to recognize clients that may mispronounce names or departments. CareLink is open 7:00 a.m. to 9:00 p.m., seven days a week, closing for Christmas.They handle about 130,000 calls per month with 80 schedulers that are mostly at the Wessner Building in Danville and in Glenmaura in the Northeast.The system is continually improving primarily by suggestions from clients.This meeting allowed us as patient advocates to get a better understanding of our appointment system. The poster and bookmark project are with Marketing, and a proof will be coming next week before going to print.This will be distributed as soon as it is received from Marketing—please get your comments back ASAP when you receive it. A journal article review was submitted by Rebecca Zimerman (BP5). Her article reviewed the correlation of patient satisfaction with patient education and pain control. She reviewed the standards of care for her floor (Orthopaedics) and the patient education that is done for joint replacements and the interdisciplinary approach to patient education and the high level of patient satisfaction in that population.There is increasing use of peripheral nerve blocks that allow patients to have a greater level of comfort in the immediate postoperative period. In addition, her floor has pictures and explanations for patients and families in common areas for education. Steve Endress impressed upon the committee to remind our fellow employees to consider taking time to nominate a worthy employee for Employee of the Month. For the entire Geisinger Medical Center hub, only six employees were nominated for this month’s consideration. Being recognized by your fellow employees is a significant employee satisfier. Employee of the Month is open to all employees—please look around not just your unit but all those you interact with to find someone that deserves recognition. It was suggested we have a “Kudos” section in E-Connections to recognize fellow departments, nurses, units, coworkers—this will be taken to Public Relations to get their feedback (great suggestion!). A field trip was initiated for the last 45 minutes of the meeting – everyone was asked to walk around the hospital and simply observe coworkers, keeping the “ten foot rule” in mind—the ten-foot rule says anyone—employees, patients, or families—within 10 feet should be greeted with either a smile, a nod, or a hello and also watch for people that may need help finding their way, getting their food, etc. Committee members returned with their reports and were generally surprised at the lack of acknowledgment of the people that surround us. It is suggested to see if you can find one person in your department to work on implementing the 10-foot rule, and see if we can get it to multiply. Jane Heuermann reported that a Patient Satisfaction Committee was being formed on her unit after she approached her operations manager who thought this was a good idea—great work Jane! October meeting will not be held due to EPIC rollout of CPOE/EMAR. November meeting will be Tuesday, November 20, at 7:00 a.m. in the Anesthesia Conference Room. If you have not brought a journal article on patient satisfaction, please bring one to share at the November meeting.The guest speaker will be Randy Hutchison, and we will share the results of our field trip and get feedback on any changes noted. Megan W King, RN, BSN Chair, Patient Satisfaction Subcommittee

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HEALTHY WORK ENVIRONMENT SUBCOMMITTEE The Healthy Work Environment group decided to have posters created to get the word out since communication is the biggest issue whether verbal or nonverbal.The group is looking to have a vendor visit GMC for technique training; a proposal is being submitted to Administration for approval of funds.The subgroup has employed Terri Bickert for guidance to move forward with this initiative.You can expect to see posters in November. NURSES WEEK AND MAGNET SUBCOMMITTEE Judy Brokenshire gave an update on Nurses Week 2008 and upcoming Magnet events. Nurses Week 2008: Nominations for Nurse Excellence awards will open December 1st. Nominees will receive their nomination printed on parchment paper. Flex staff will be included in the categories; they will not be singled out as in the past. Anyone wishing to nominate someone for the Nightingale Award can submit his or her requests to Judy Brokenshire or Nancy Gordon. Sunday, May 4th—Remembrance Ceremony Monday, May 5th—Nurse Excellence Awards Tuesday, May 6th—Infection Control Conference and Poster Contest Wednesday, May 7th—Speaker (considering different options for speakers) Thursday, May 8th—Certification Dinner Friday, May 9th—Care for the Caregiver Day Suggested themes from GMC: “Geisinger Nurses—The Driving Force of Excellence” and “Geisinger Nurses—Making it the Best!” Gift ideas: Fleece blankets or auto visors Magnet Excitement: October NRCC meeting and Magnet events have been canceled due to the EPIC implementation go-live on October 15th. November 19th will be the 3rd annual Turkey Bowl at 5 p.m. in the Hemelright Auditorium. All units are encouraged to participate by entering a team.Teams may consist of four individuals (units may have more than one team), but all teams are encouraged to bring along their cheerleaders. Start thinking about your team costume. December will be the annual distribution of the nursing calendars and a Christmas luncheon for the NRCC representatives (details forthcoming). WOUND VAC PRESENTATION KCI representatives were on hand to give a Wound Vac presentation during lunch. Some of the clinical nurse educators joined the presentation and enjoyed lunch with the NRCC members. GUESTS Diane Harlow, Employee Health;Terri Bickert, Magnet Program; Randi Hutchison, Patient Satisfaction; Sue Hallick, CNO; Jennifer Boxer, PR & Marketing. APPROVAL OF MINUTES The August 28, 2007 meeting minutes were approved as submitted. DIANE HARLOW, EMPLOYEE HEALTH—SMOKE FREE ENVIRONMENT Effective November 15th, Geisinger will be a smoke-free campus. Diane Harlow from Employee Health attended the NRCC meeting to address any questions the group may have on what can be expected and what Geisinger is doing to assist employees. A decision was made by senior leadership to have no tobacco products on health system property.Visit the Wellness site on the Geisinger InfoWeb for more details. (PowerPoint presentation attached). TERRI BICKERT, MAGNET UPDATES RN Satisfaction Survey: Currently at 88% completion; looking to meet or exceed last year’s response rate of 92%. Winners of those units reaching 100% completion are I.V.Team (<25 group); BP7 (>25 group); CCU (>50 group).There are many units at 100% completion; however, other groups have extremely low completion rates.Terri commended Lisa Bidelspach and the other outpatient representatives for the wonderful job they did encouraging outpatient areas to complete the survey.Terri reviewed some of the changes for next year’s survey, including clearer communication of eligibility requirements, eligibility of nondirect patient care staff taking the survey, and unlicensed staff survey questions.

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Magnet Update: Seven forces are near completion; seven forces to go. October 15th is the deadline for all information to be submitted. Currently, we are in the proof-gathering stage, but we need nurse stories. Please call or Email Terri with your spiritual, specific stories, or good deed stories. Magnet is also looking for examples of time-off requests/approvals and how nurses are involved in the scheduling process (time off for classes, meetings, schedule adjustments, etc.). Mock surveys will be conducted in the future to simulate what the actual Magnet survey will be like.Terri has been meeting with Magnet partners to educate them on what Magnet is and what it can mean for them. Partners are providing examples of their collaboration with nurses. Pharmacy Week is the same week as Hospital Quality Week; activities are being planned. EPIC Go-Live: Scheduled for Monday, October 15th. During our last EPIC rollout, patient satisfaction scores dropped at the same time we were submitting the first Magnet document.Terri urged the group not to let the frustrations affect the wonderful patient care they provide. A suggestion was made to have posters on the units notifying patients of the EPIC implementation and to “please bear with us during this time of change.” GROUP DISCUSSION Heart Walk Update: Connie Sekulski thanked NRCC members who participated in the Heart Walk; the group raised approximately $1,400. Volunteers: Roxie Shrawder is requesting volunteers for two upcoming events, the Milton High School Career Fair (11/1/07) and the Girl Scouts of America need a nurse to help them obtain the Nurse Exploration patch. OMNI Survey: The OMNI Survey for Employee Satisfaction results were recently released. Results have been given to managers for development of action plans for improvement. Once the results are published and action plans developed, common trends will be addressed. NRCC has been invited to participate in this initiative. General OMNI information is available on the InfoWeb for employees. Parking: A survey on the current parking situation is available online for all employees to take. Survey ends October 5th. No Meeting: The October NRCC Meeting is being canceled due to the EPIC go-live and the need to have all staff on the units during this transition. EMAR: All paper information will be transferred to electronic information by midnight 10/14/07. Superusers will be available 24/7 on the unit, and they will not be counted in the staffing numbers. Nurse shadowing will also be an option for those who may need additional help. Help will continue to be available through December with a command center in the Hemelright Auditorium.The first two weeks of implementation will be critical. Nurses are encouraged to support each other through this implementation period to ensure quality and safe patient care. RANDI HUTCHISON, PATIENT SATISFACTION After a brief introduction, Randi broke the committee into several different groups. Individuals within the groups were asked to reflect on difficult situations they’ve encountered and how they handled the situation. After a few minutes, the groups cited different scenarios, how they handled them, and how they can improve their handling techniques. Randi provided some very helpful tips on dealing with irate patients/families, etc. UPDATES FROM SUE HALLICK Subcommittees: Gave their updates to Sue. See specific subgroup reports above. RN Satisfaction Survey: Terri Bickert covered; see notes above. Parking Survey: Sue encouraged the NRCC to complete the online survey about the current parking situation here at Geisinger and provide their suggestions for improvement. Follow-up communication will be published on anticipated changes based on the outcome of the survey. SSI Trial: A three-month incentive trial will begin for RNs who volunteer during the weekend hours. Check with your unit manager for detailed information on SSI. Supplemental Education Funds: the Board has not yet reviewed this incentive plan.This will be readdressed in December, and Sue will report the outcome to NRCC.There are no sign-on bonuses at this time. Sue asked the group for suggestions on education opportunities and how to use the money appropriately. OMNI Survey: Sue reported that the OMNI Survey feedback sessions are in progress. Nursing Strategic Plan and Vision: Sue has been presenting the Nursing Strategic Plan and Nursing Vision to all newly hired nurses. EPIC: October 15th go-live date. Sue assured the group that there will be adequate staffing during this time of transition. NRCC Meetings: Sue asked the group to provide feedback on her role in this committee, her attendance at these meetings, and the information she provides. She stressed if urgent issues come up that may need to be addressed more frequently than once each month at the NRCC meetings, please contact her directly for guidance. Sue recognized the high stress levels that all nurses work under and the importance of everyone’s efforts. She thanked the group for their input and all their hard work.

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JEN BOXER, PR AND MARKETING—UPDATES Jennifer gave the group a quick update on the following items: • Healthcare Quality Week • Online Parking Survey • 2nd Quarter 2007 NDNQI Certification—GMC ranks higher than national average • HWE Posters—out and in circulation • Pt. Satisfaction: Poster and bookmarks in proofing stage • Nurse News: in final production phase • Nursing annual report: still being revised • ED Nurses Week October 7 – 13th • Nurses Week gifts: anticipate $5 each in 2008; Jen Boxer to order gifts; group recommended auto visors. NEXT MEETING Tuesday, November 20th, in the Anesthesia Conference Room after subgroup meetings ADJOURN The meeting adjourned at 3:30 p.m. REMINDERS OCTOBER: The NRCC meeting and Magnet Excitement event for October are being canceled due to the EPIC implementation. Hospital Quality Week will proceed as planned. NOVEMBER: The Turkey Bowl will be Monday, November 19th at 5 p.m. in the Hemelright Auditorium.The November NRCC meeting will be held on Tuesday, November 20th (changed due to the Thanksgiving holiday). Respectfully submitted, Kelly Hockenbrough Administrative Assistant Magnet Program, Nursing Education and Nursing Research

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Nursing Services Quality Performance Improvement Council (NSQPI) Cochair Beth Breining, RN, staff nurse, CH3: “Working together with the members of NSQPI, as well as nurse practice and Recruitment and Retention (R&R), gives the entire Nursing Department an added sense of cohesiveness. This networking gives you many resources for whatever problems or challenges you may encounter. This year, with all the changes and improvements that we have embraced on NSQPI, has opened so many doors to go forth with improvements based on the data we have collected. The added help that we received from Scott Berry’s group with the Geisinger Quality Institute (GQI) short course was also very beneficial in giving us the tools and skills needed to enhance our reports. All of this, of course, is to ensure quality care for our patients. That’s the reason we are all here” (3:4:C).

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3:4:C GEISINGER HEALTH SYSTEM NURSING SERVICE QUALITY PERFORMANCE IMPROVEMENT COUNCIL MINUTES WEDNESDAY, JULY 18, 2007; 0700 A.M.–1530 P.M. KEY: X–PRESENT

E–EXCUSED

A–ABSENT

Nursing Leadership

Chairs

Staff Nurses (Inpt)

Staff Nurses (Outpt)

X Hallick, Sue, CNO

X Breining, Beth, RN, CPN, CEP

X Baney,Virginia, LPN

A Bower, Gail, RN, ONC

X Bickert,Terri, RN, MSN

X Englehardt, Diane, RN, CNC

X Buck, Robin, RN

X Brown, Ryan, RN

X Muthler, Crystal, RN, AVP

X McCloskey, Rene, RN, CNE, MS

X Cicero, Shirley, BSN, ANC, CEP

X Gelbaugh, Diane, RN

X Mensch, Deb, RN, BSN, MHSA

AD HOC

Ancillary

X Cochran, Mary Jo, RN

X Huber, Mary Ann, RN

X DePoe, RN, CCRN

X Moore, Janet, RN, BSN

X Derr, Charity, RN, BSN, ONC

X Nagy, Sandra, RN, BSN

A Gerringer, Melanie, RN

X Pearse, Sandy, RN

X Harter, Kate, RN

X Persing, Karen, RN

A Hartzel, Sue, LPN

X Sim, Julia, RN

A Herrold,Teri, RN

X Snyder, Deb, RN, CPON

A Homan, Amanda, RN, CEP

A Sokol, Kristi, RN

A Jones, Katie, RN

X Umbriac, Mary Susan, RN

A Kieffer, Jan, RN

X Weber, Eileen, RN, CNC

E Bowman, Ann Marie, RN

X Aukamp, Greg, RRT RN, BSN

A Kister, Nicole, RN

A Zarick,Terry, RN

X Nicholas,Tracey, RN, BSN

X Kutza, Joey, NREMT-P, CEP

A Leitzel, Deb, RN, AD

A Ziller, Melissa, RN

E Vought, Cindy, RN

X Loeffler, Kim, RN, CEN, CEP X McElroy, Amanda, RN, BSN X Meredith, Jane, RN, CCRN, CAPA X Miller, Cindy, RN, BSN X Phelps, Sheila, RN X Reinard, Cindy, CMSRN

Alternates

Guests

E Abram, Georgette, RN, BSN

A Schieber, Pam, RN

X George,Vicky, RN ANCC Consultant

E Houseknecht, Melissa, RN E Rezykowski, Stacy, RN BSN, CEP

A Seidel,Terri, RN X Sellard,Tonya, RN, CEP

X Sitler,Tiffany, RN, CMSRN

E Scheller, Ashley, RN

X Skocik, Lenore, RNC X St.Clair, Deanna, RN, AD X Witt, Barbara, RN, CEP

CALL TO ORDER Rene McCloskey called the July 18th meeting of the NSQPI Council to order at 0700 a.m.

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REVIEW AND APPROVAL OF MINUTES The minutes from the June 20th meeting were approved. NURSING SERVICE SHORT COURSE GQI POSTER BOARD PRESENTATIONS Rene started the meeting by welcoming the new outpatient and inpatient members. Everyone stood and introduced themselves. The council members along with some managers and guests enjoyed breakfast and conversation about all the different poster board presentations. MANAGERS PRESENT • Linda Miller • Bonnie Patterson • Maureen Lloyd *Scott Berry and Janet Comrey were unable to attend, due to being at GWV for the day. CONCEPTUAL MODEL Rene handed out a paper on the Nursing Conceptual Model.This is going to be a contest. Every week, Rene will send information via Email about the conceptual model.There will be a test at our next meeting and if you receive an A on this test, you will receive a prize.The prize will be meal tickets. Action: Send out Conception Model information by Friday the 27th.

Person Resp. Rene McCloskey

JOINT COMMISSION RESULTS Deb Mensch talked about the Joint Commission survey. Deb congratulated everyone on a job well done. “Lego’s—we start out building small, but we continue to build to bigger and better things.” Keep up the momentum! Deb will get in contact with Public Relations about the placement of our poster boards throughout the hospital. Sue Hallick said this was one of the best surveys at GMC.The Joint Commission was impressed with all staff, pride, level of acceptability.There was an air of professionalism.The staff was superb.The data walls were great. At the leadership session, the question was asked, “Tell us how they (staff) did this?” Sue thanked and congratulated everyone, and said that we could not have had a better survey. Sue took time to look at and have discussion with all council members on their poster boards. • Crystal Muthler was in attendance. • Vicky George talked about the Magnet Program. THE INPATIENT COUNCIL WAS DISMISSED TO DO THEIR AUDITING. THE INPATIENT COUNCIL WILL RECONVENE AT 2:00 P.M. OUTPATIENT COUNCIL Rene welcomes all outpatient members.The outpatient council is meeting to be introduced to all NSQPI information.There were six new members at this meeting. We are very happy they are involved in this committee.There are 14 total outpatient members at this time. We are acting like a Magnet team. OUTPATIENT RECEIVED: • NSQPI Handbook • The web site (NSQPI) shown • GQI Short Course Handout • Data board If you need information posted to the web site, please contact Sharon and she will make sure the information gets put on the web site. • serabb@geisinger.edu (Sharon’s Email)

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Rene showed everyone how to log on to SharePoint and how to upload files. If anyone has a problem or needs assistance, contact Rene, and she will meet with you personally at your convenience. • rmccloskey@geisinger.edu (Rene’s Email) Indicator calendars: • All members need to develop an Indicator calendar by the next meeting. Instructions were given during the meeting. If you are in a unique area and need an audit form specifically for your area, let Rene know and she will make one to meet your needs. The three audits that need to be done next month: • Hand hygiene • Patient identification • Handoff Action: Indicator calendars due

Person Resp.

All Outpatient Council Members

THE OUTPATIENT COUNCIL WAS DISMISSED AND THE INPATIENT COUNCIL HAS RECONVENED AT 2:00 P.M. INPATIENT COUNCIL Rene reviewed the SharePoint process with all inpatient council members. All were in agreement after reviewing the Falls Policy that an extra line with Y/N needs to be added to the question “Is armband on?” All members need to check with managers to see who is responsible for auditing the Restraint Action Plan. Audits need to be in by the end of each month. Rene is also working with Pat Campbell on a solution for Life Flight and the use of Avagard.Tonya Sellard and Cindy Miller had some suggestions on making auditing a quicker and easier process.They did the auditing together with one looking at the charts and the other writing the information down.They completed three audits each in less than a half an hour.Tonya and Cindy both agreed if you are able to have someone help you, this is a nice and easy process. Action: All members need to check with managers to see who is responsible for auditing the Restraint Action Plan.

Person Resp.

All Inpatient Council Members

NEXT MEETING The next meeting for NSQPI is on August 15th at the Research Building Multipurpose Room.The Computer Lab has been reserved for NSQPI members for only the meetings that are held in the Research Building from 1:00 to 3:30 p.m. ADJOURN The meeting was adjourned at 3:20 p.m. Respectfully submitted, Sharon Rabb Nursing Education

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Research Cochair Deb Stayer, RN, clinical nurse educator, PICU: “I participate in many hospital and unit-based councils. It does not matter what a person’s level is, we all work together to get the job done. Better patient care is always at the center. Being involved in decisions and professional activities that have a positive impact on nursing is very gratifying” (3:3:D).

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3:4:D GEISINGER HEALTH SYSTEM NURSING RESEARCH COUNCIL MINUTES OCTOBER 8, 2007 LOCATION: INTERMEDIATE ROOM #4 CENTER FOR RESEARCH 2:00 – 3:00 P.M. KEY: X–PRESENT

E–EXCUSED

A–ABSENT

G–GUEST

X Terri Bickert, MSN, RN, CNA-BC Director of Magnet & Nursing Education

E Deb Stayer, RN, Clinical Nurse Educator (PICU)

X Mary Ann Bloskey, RN, MSN, MHA Center for Health Research

X Margaret West, RN, MSN, DNSc Assistant Dean, Thomas Jefferson University

E Pat Campbell, RN, MSN, Director of Infection Control

E Lori Lauver, RN, MSN, PhD, Assistant Professor, Thomas Jefferson University

E Cindy Matzko, RN, MSN, APRN, BC, CCRC Rheumatology Clinical Nurse Specialist and Certified Research Coordinator

E Marylee Scholtis, RN

X Deb Wantz, MSN, RN, CCSN, CCRC Clinical Nurse Specialist, Heart Failure Section Department of Cardiology

X Adele Spegman, RN, PhD, Director, Institute on Nursing Excellence

E Sheila Hartung, PhD (BU)

A Amy Birrane, CRC

X Deb Zimmerman, RN, Cardiology X Robin Steimling, RN Clinical Nurse Educator, BP6/BP7 E Jody Bachman, RN Clinical Nurse Educator, OB/GYN CALL TO ORDER Terri Bickert called the meeting to order at 2:10 p.m. ANNOUNCEMENT Terri Bickert announced her resignation from the Nursing Research Council effective with this meeting. Dr. Adele Spegman will lead the group through nursing research.Terri will be available to the council as an ad-hoc member and as necessary for guidance through the transitional period. Terri thanked the group for the assistance with this council as she pointed out the value in each member and what they have to offer this council. NURSING RESEARCH CONFERENCE Reminder about the conference “Current Issues in Clinical Research” being held at the Split Rock Resort on October 26th. Registration is around 100, and you can still register through the CME office if you’d like to attend.The conference will feature many speakers, including Janet Boyce from the Children’s Hospital of Philadelphia and many others. RESEARCH STUDIES Dr. Spegman reviewed the following research studies and their progress-to-date: Anderer study, Donna Fick study request,Treese study, CICU/HAM data collection study pre- and post-construction. REVIEW OF COUNCIL Dr. Spegman spoke with the group about what the council has done in the past, the status of some research projects that were

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requested but no outcomes reported, the RN Satisfaction Survey, and the need for IRB approval, and evidence-based practice.The NRC bylaws were also reviewed, including how the online requests are initiated with NRC mentor involvement. Dr. Spegman recommended adding Claire Huntington to the council as an ad-hoc member to access her resources and knowledge base. NRC SUBGROUP Dr. Spegman presented council with the idea of developing a subgroup of the NRC to facilitate EBP training using clinical nurse educators to teach our nurses. A training process will need to be developed, and NRC will serve as experts on the EBP. NEXT MEETING The next meeting of the Nursing Research Council will be on Monday, November 19th at 2 p.m. in the Jones Library on Foss Clinic 7. ADJOURN The meeting adjourned at 3:00 p.m. Respectfully submitted, Kelly Hockenbrough Administrative Assistant Magnet Program

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Administrative/Operations Managers Council Chair Peter Price, RN, medical-surgical manager, BP7: “I feel comfortable talking or approaching anyone regardless of their level in the organization. Working together to improve processes or our work environment is everyone’s goal” (3:4:E).

3:4:E GEISINGER MEDICAL CENTER INPATIENT/OUTPATIENT OPERATIONS MANAGERS MEETING MINUTES WEDNESDAY, SEPTEMBER 12, 2007 2:00 P.M. NURSING EDUCATION CENTER ROOM 2 KEY: X–PRESENT

E–EXCUSED

A–ABSENT

G–GUEST

MEMBERS Anderer,Tammy, MSN, CRNP Director, Best Practices, Comm. Practices

X Morgan, Marsha, RN Ops. Mgr., Ophthalmology Amb Care Fac

Basinger, Mark, LCSW Ops. Mgr., Psych

X Muthler, Crystal, RN, BSN AVP, Nursing Services

Bastian, Catherine, MA, RD, LDN Ops. Mgr., Clinical Nutrition Services

Myers, Donna, RN Ops. Mgr., Cardiovascular Medicine

Beechay, Denise, RN, MHA, CHE AVP, Nursing Services

Naugle, Lori, RN Clinical Nurse Coord., Pre-surgery Center

Bickert,Terri, MSN, RN, CNA-BC Director, Magnet/Nursing Education

Ososkie, Nancy, RN Ops. Director., Pediatric Specialities

Bird, Cindy, RN, BSN Ops. Mgr., Periop/In & Out Surgery

Parnell, Claude Ops. Mgr., System Therapeutics

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Cook, Pamela Ops. Mgr., Division of Medicine

X Patterson, Bonnie, RN Ops.Mgr., AGP5 and I.V.Therapy

Enriquez, Michael, MHA, FACHE Ops. Director, Orthopaedics

Payne, Brenda Team Leader, MRI

Examitas, Cheryl, RN Ops. Mgr., BP5

Pogge, Caroline, MHA Ops. Mgr., Neuroscience

Faden,Valerie Jean Project Mgr., Scheduling Services

Potsko, Kerri, RN Ops. Mgr., Hematology/Oncology

Fegley, Wendy, LPN Ops. Mgr., Shamokin/Selinsgrove Clinics

Price, Peter, RN Ops. Mgr., BP7

Fifield, Cheryl, MBA, MT Ops. Director, Lab

Richer, Arthur, CRNA, MS Divisional Chief Nurse Anesthetist

Frye, Susan, MBA Ops. Mgr., CV and Vascular Surgery

Rittle, George, RN Team Leader, ED

Graham, Marlair, RN Clinical Nurse Coord., Pain Medicine

Rubenstein, Linda, RN Clinic Coord., Pediatric Specialities

Hallick, Susan, RN, BSN, MHA CAO-GMC, System CNO

Sanders, Debra Ops. Director,Transplant Surgery

Hardee-Swank, Carol Director, Scheduling Services

Shrawder, Roxie, RN, BSN, MS, CHCR HR Manager, Recruitment

Hartranft, Carol Data Support Analyst

X Sim, Julia, RN

Hendricks, Daniel Ops. Mgr., Dental Med/ENT/Urology

X Singer, Scott, RRT Ops. Mgr.

Henninger, Deb, RN, BSN, CCRC Ops. Mgr., Clinical Trials Office

X Sledgen, Marie, RN Chest Pain Center

Hoffman, Dawn

Snyder, Kyle, MHA Ops. Director, General and Plastic Surgery

Hoffman, Janice, MHA Ops. Director, Anesthesia/Pain Mgmt. X

X Strausser, Deb, RN Ops. Mgr., OR

Hollenbach, Dee, RN Ops. Mgr., AGP2

Tetkoskie, Charmaine, RN Ops. Director, ED and Life Flight

Keifer, Lisa Ops. Mgr., Radiation Oncology

Thomas, Dave Clinic Coordinator, CVTS

Kemberling, Sharon, RN, BSN Ops. Mgr., Pt. Placement/Transfer Center

X Troutman, Dawn, RN, BSN, CCRN Ops. Mgr., SCU4

Kieselhorst, Kessey, MPA, RD Director, Regulatory PI

X Ulrich, Debra, RN, C Ops. Mgr., BP2

Knorr, Phyllis, RN Ops. Mgr., AGP4, MSFP, CCFP

Venditti, Angelo, RN Ops. Mgr., AICU, AICU South, RT

Kuhn, Kim, RN, BSN Ops. Mgr., SCU3, Staffing Office

Lloyd, Maureen, RNC Ops. Mgr., NICU, PICU, CH Floats

Wary, Andrea, RN, BSN, M.Ed Ops. Mgr., OB/GYN Dept-CP Clinics

Long, Michele, RN, BSN, OCN Ops. Mgr., BP6, BP8

West, Margaret, DNSc, RN Asst. Dean/Assoc. Prof,TJU

Marks, Jamie, RN Ops. Mgr., IP, OB/GYN

Wintersteen, Kim, RN Director, OSW

Martz, Linda Lee, RNC, CCRN Team Coordinator, NICU

Woll, Michael, BS Ops. Mgr., Division of Medicine (GIM)

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McDermott, Betsy, RNN, OCN Clinical Nurse Coord., Hematology/Oncology

McFadden, Ann, RN Ops. Mgr., OB/GYN

Womer, Sally, RT Radiology Coordinator of Quality Improvement and Business Development Janine Alexis, Guest

Mensch, Debra, RN, BSN, MHSA Ops. Mgr., CICU, Flex Pool X

Miller, Linda, RN, BSN Ops. Mgr., CH2, CH3

Miller, Lynn, CAO-GMC

Diane S. Harlow, Guest X Kim Tokar for Deb Sanders

OMNI SURVEY Wenda Hartzel provided the group with information to use in connection with upcoming OMNI survey meetings with staff. She stressed the importance of adequate preparation, which includes setting your goals (be realistic) and understanding your group, what matters to them, and what they are likely to focus on. Don’t forget to consider the tone you would like to set (more of a “town hall” discussion as opposed to a debate). Before the meetings, everyone should remember to center themselves and focus on what needs to be accomplished. Express your sense of welcome by arriving before everyone else, preparing the room physically and symbolically, and greeting each person with a smile as they arrive. During the meeting, make sure to secure a safe emotional environment for everyone, including you. Establish the ground rules, designate someone to record information, start with the positives, and then generate solutions for each area of challenge. Wenda provided some hints to enhance success. Let people know they are being heard! Be honest about what we can and cannot do. Plan a follow-up meeting, if necessary. Hold people accountable for timelines and make sure action plans get to the right people. The group thanked Wenda for her presentation. Handouts were available. TOBACCO-FREE INITIATIVE Diane Harlow, director of the Wellness Program, distributed the manager tool and cards to give to employees and patients.The Tobacco-free Policy is in final stage now—actually going to Executive Leadership tomorrow. Efforts are being made to spread the word now about not allowing smoking on Geisinger-owned or leased properties. Signage indicating intent is up now and will be replaced with permanent signage. Diane requested that everyone go to the Geisinger Wellness section of the InfoWeb for additional information. Messages are also going out with patient appointments. We may also look at our external web site and local media to get the word out.There are several programs being offered to help people quit smoking. We have a Quit and Win program that offers prizes, reduced prices on medications to help with smoking cessation, etc. Diane provided copies of the Employee Tool Kit, which does include some role playing suggestions. As of November 15, the smoking huts will disappear. Every other major health system locally, with the exception of the Bloomsburg Hospital, will be going tobacco-free. Packets of information were available for everyone to utilize. MAGNET UPDATE/EDUCATION UPDATE Terri Bickert provided an education update for the group. CPR/BLS certifications—Nursing Education has started offering more courses and we have increased the number of staff that can attend. On the Nurse Channel, continuing education is explained on the InfoWeb. As part of new employee orientation, nurses are able to view “The Vision for Nursing” hosted by Sue Hallick, Denise Beechay, and Crystal Muthler. Satisfaction surveys are ongoing.Tickets to the Bloomsburg Fair and meal tickets are being offered for survey participation. NEW PHYSICIAN ORIENTATION Lynn explained that Dr. Stephen Pierdon and Cynthia Bagwell have put together a draft that Lynn distributed. Kate Fleetwood will be sending this out electronically for review and comment. Please direct your comments to Dr. Pierdon and/or Cynthia. Lynn also discussed Midas reporting. She stressed the importance of quality discussions happening in all department meetings. Lynn

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will distribute a listing for assigning individuals to access the reports. Responses should be directed to Karen McKinley with the individual’s name. There being no further business, the meeting was adjourned at 3:00 p.m. Judy Rohland, Recording Secretary Note:This information is not intended to serve as formal minutes, but rather provide a listing of issues discussed as information and any follow up for those who were unable to attend.

All of these councils make decisions that impact hospital care. Policies may be changed, and nurses are empowered to make the changes that impact their work area and improve patient care at the bedside. Nurses at all levels communicate with one another on these councils and bring information back to their nursing units. In addition to the horizontal and vertical communication that occurs through these councils, Sue has an open-door policy that allows direct-care nurses to talk with her easily. All nursing leaders emulate this practice to enable information to flow in both directions and among all levels. EXAMPLE: UNIT-BASED COUNCILS A mutual exchange and sharing of information about experiences and common work problems—usually among peers—occurs in unit-based councils or meetings. A unit council committee consists of unit staff, all levels of nursing, and unit desk clerks. Unit council meetings are scheduled on a routine basis, usually monthly, throughout the year. The meeting agenda includes topics relevant to the unit. Ideas are shared and examined, priorities are set and action plans implemented. Many positive changes originate at unit council meetings. One example of a change that occurred on BP6 was shared by Judy Brokenshire, RN, staff nurse. As a result of a suggestion made by the unit practice council, the Unit Practice (Advisory) Council developed an Employee Appreciation Box. Staff members are encouraged to vote for a peer who they feel has gone above and beyond their expected duty. At the end of each month when votes are counted, an Employee of the Month is identified. A designated bulletin board on the unit displays the current Employee of the Month. It includes pictures of the employee and some of their favorite things (family, pets, hobbies, etc.). The employee of the month is congratulated at a monthly lunch celebration. Staff share by bringing in treats. Being aware of the nurses’ needs enhances working conditions within a unit. Appreciation shown to nursing staff is relevant in creating an environment conducive to high-quality, safe patient care (3:4:F).

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Employee of the Month bulletin board

3:4:F GEISINGER HEALTH SYSTEM ADVISORY COUNCIL (PRACTICE COUNCIL) MINUTES: SEPTEMBER 25, 2007 LOCATION: BP6 WORK ROOM MEMBERS Present: Cindy Reinard, RN—CEP Eileen King, LPN Lori Wetzel, NA—CEP Kim Nuss, UDC—CEP Patti Spotts, RN—CEP CALL TO ORDER Meeting was called to order at 0700. REVIEW AND APPROVAL OF MINUTES The council reviewed the minutes from the last meeting. OLD BUSINESS 1. There will be shoe covers on the unit for the staff to use for isolation rooms.

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2. Crystal Light is on the Stage I diet. 3. Cell phone reminder—DO NOT use cell phones for making calls and text messaging. It is a distraction and interrupts the work flow. Names will be turned in to Elaine and Michele. 4. Respiratory tubing needs to be changed every 24 hours and done on evening shift. 5. Coude catheters are now in par. NEW BUSINESS 1. When ostomy supplies are ordered, please take them into the patient’s room; do not leave at the desk. 2. We made up laminated cards with most important phone numbers to be given to our new hires. 3. Gastric bypass abdominal binders need to be put in the patient’s room. Lately they have been misplaced. 4. Anyone interested in being a member of the Advisory Council for 2008 needs to contact Elaine via Email. 5. The time schedule is posted for four weeks in advance, which should be ample time to fill in your time. REMINDERS 1. As a reminder, it is everyone’s responsibility to see if your coworkers need help. Please, if you are not busy, assist your coworkers. We ALL need to be team players. Work as a TEAM. 2. Please remember to document patient education daily and PRN. STAR OF THE MONTH Congratulations to Mary Aigler for being “Star of the Month” for October 2007. Date for a party will be announced. NEXT MEETING The Advisory Council’s next meeting will be December 5, 2007. Respectfully submitted, Lori Wetzel BP6 10/10/2007

EXAMPLE: ADMINISTRATIVE COUNCILS Operations managers from both the inpatient and outpatient areas also have an avenue for horizontal communication. They meet monthly to discuss issues related to the medical center and to work on solutions to mutual problems. The forums and administrative committees provide a mechanism for both horizontal and vertical communication. Direct-care nurses also serve on administrative committees, such as the Critical Care Administrative Committee, the CPR Committee, and the Trauma Committees. They provide each committee with staff input and feedback and bring back information to share with the staff (3:4:G).

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GEISINGER MEDICAL CENTER DANVILLE, PENNSYLVANIA CPR COMMITTEE ROSTER 2007 PHYSICIAN AND NURSE MEMBERS Michelle Thompson, MD, Chairman Internal Medicine—Peds

Timothy Vollmer, MD,Vice Chairman Emergency Medicine

Cathy Knight, RN, Secretary Clinical Nurse Educator

Isabelle Amarose, RN, Staff Nurse, CICU

Jody Bachman, RN, Clinical Nurse Educator

Dylan Birkett, MD, Anesthesiology NICU

Judy Botella, RN, Nursing Supervisor

Nancy Braham, RRT, Respiratory Care Services

Cindy Derk, RN, Nursing Supervisor

Sara Field, RN, Staff Nurse, AGP5

Scott Girard, DO, Chief Resident

Dante Grassi, PharmD, System Therapeutics

Marilyn Haupt, MD, Critical Care Medicine

Emily Mowery, RN, Clinical Nurse Educator, Children’s Hospital 2 & 3

Maria Latovich, RN, Staff Nurse, AGP5

Nancy Nuss, RN, Blood Conservation

Jess Oren, MD, Cardiology

Peter Price, RN, Operations Manager BP7

Juan Salgado, MD, Chief Resident

John Shultz, RN, Staff Nurse, AGP4

Debbie Stayer, RN, Clinical Nurse Educator, PICU

Susan Hallick, RN, CNO

Nancy Gordon, RN, Clinical Nurse Educator, Emergency Department

MCPDP175.DOC

Revised: January 2004

Revised: February 2006

Revised: July 2003

Revised: March 2004

Reviewed: February 2007

Revised: December 2003

Revised: January 2005

Revised: July 2007

Kimberly Wilson, RN, Clinical Nurse Educator, AGP5 CONSULTANTS Barbara Brown, RPh, System Therapeutics Joan Mervine, RN, Clinical Nurse Educator BP5 & BP6

3:4:G GEISINGER MEDICAL CENTER DANVILLE, PENNSYLVANIA CPR COMMITTEE MEETING MINUTES APRIL 25, 2007; 1230–1400 HOURS NEC/ROOM 203 MEMBER Present

Excused

X Amarose, Isabelle, RN Birkett, Dylan, MD

X Latovich, Maria, RN, CMSRN

Botella, Judy, RN

X Mervine, Joan, RNC

Braham, Nancy, RRT

Nuss, Nancy, RN, CCRN

X Derk, Cindy, RN, CCRN

Oren, Jess, MD X Price, Peter, RN, CMSRN

X Field, Sara, RN

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Gordon, Nancy, RN, BSN

Shellenberger, Matthew, DO

Grassi, Dante, RPh

X Shultz, John, RN, BSN

Haupt, Marilyn, MD

X Thompson, Michelle, MD

X JWCH CNE: Bachman, Jody RNC, BSN Mowry, Emily, RN, BSN Stayer, Debra, RN, MSN, CCRN

Vollmer,Timothy, MD

X Knight, Cathy, RN, Presiding Recorder: Chris Whitmire, Secretary

Guest OLD BUSINESS APPROVAL OF MINUTES

Minutes from the January 24, 2007, were approved as written. LIFEPAK 20S AND LIFEPAK 500S The upgrades to the Lifepak 500 AEDs will be completed within the next week per Tom Berns, Clinical Engineering. Lifepak 20s updates were not available yet. New Medtronic Representative. Problems with FDA and no new Lifepaks can be shipped. PENDING. TRIAL WITH FIBEROPTIC LARYNGOSCOPE BLADES The trials with the fiberoptic blades are continuing.There are stocking supplies on the trial floors.The switch in code carts may occur after the start of the fiscal year if all goes well. REPLACEMENT OF WOODEN INTUBATION BOXES The boxes have been pulled from the areas that do not need them. UNITS Cathy asked the group if boxes could be removed from areas within the hospital.The boxes will stay in the areas without code carts. ANNUAL REVIEW AND REVISION OF EMERGENCY EQUIPMENT CONTENTS The Intubation Box Checklist was reviewed to see what needs to be kept and what will be taken out of the boxes. Cathy gave a list of suggested revisions and a discussion followed. Children’s 2 & 3 should reflect the boxes for PICU. The group made suggestions of the supplies that could be removed. Include everything except the items kept in the Children’s Hospital units. NEW BUSINESS HEART CODE ACLS—AVAILABILITY OF NEW CD The new CDs arrived Monday and Emails were sent out regarding their arrival. Your BLS must be done first.The CDs have been made available to RNs this year. Gordon Cole came up with a policy to guide people. Please encourage people to do the CD since there is such a backlog with the regular classes. REMOVAL OF CODE CART FROM PULMONARY FUNCTION LAB The cart will go back into the code cart exchange system.They will move to Woodbine Lane and will not need the cart. Cathy told the group they are looking for safety mechanisms for the code carts. It was questioned if the central line kit on the

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code cart could be taken out as we now have a central line cart available for all areas. It was suggested education be done regarding the central line cart locations. It was also suggested that an attached form be placed on the code carts. Cathy will check on the location of the central line carts. No changes will be made until after Joint Commission is done. MEETING ADJOURNMENT The meeting adjourned at 1320 hours. NEXT CPR COMMITTEE MEETING The next meeting will be held on July 25, 2007, from 1230 to 1330 hours. Location will be the CCU Conference Room. APPROVED BY Cathy Knight, RN PEER REVIEW GENERATED DOCUMENT SOLELY FOR THE QUALITY IMPROVEMENT PURPOSES PURSUANT TO 63P.S. 425.1ETSEQ and MCARE-NOT FOR REDISTRIBUTION OUTSIDE THE SYSTEM'S PEER REVIEW

EXAMPLE: ORGANIZATIONAL COMMUNICATION Several channels for organizational communication are available. The Nurse Channel (the nursing page on the GMC Intranet) is a common method to communicate throughout the Nursing Department. The quarterly publication of NursesNews is another means of communication to nurses of all levels (3:4:H).

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3:4:H

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The Connections newsletter, a hospital-wide publication, is distributed to all employees (3:4:I).

3:4:I

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EVIDENCE 4: SOURCES OF EVIDENCE 3:4:A

Nursing Clinical Practice Council Meeting Minutes

3:4:B

Retention and Communication Committee Meeting Minutes

3:4:C

Nursing Service Quality Performance Improvement Council Meeting Minutes

3:4:D

Nursing Research Council Meeting Minutes

3:4:E

Inpatient/Outpatient Operations Manager Meeting Minutes

3:4:F

BP6 Advisory Council Meeting Minutes

3:4:G

Cardiopulmonary Resuscitation Committee Meeting Minutes

3.4.H

NursesNews, Quarterly Nursing Newsletter

3:4:I

Connections, Hospital-wide Newsletter

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EVIDENCE 5 Provide examples of how direct-care nurses initiate change to improve patient care, nursing practice, and/or the work environment.

taff nurses are clearly at the frontline in patient care. They see issues firsthand and have the prime opportunity to consider solutions to problems. When staff nurses are encouraged to plan and implement their ideas, practice is improved and patient care is provided in a safer, more effective manner. Geisinger Medical Center can offer several examples of this care concept. EXAMPLE: THE PATIENT RESTRAINT DILEMMA—NURSING PRACTICE AND IMPROVED CARE

Patients often get restless and confused. When this happens, they can cause self-harm by falling out of bed or pulling out an I.V. line or catheter. In the past, the solution to this problem has been to restrain the patient. However, in today’s healthcare environment, this is not the preferred method. So how do nurses deal with this dilemma? On nursing unit AGP4, staff nurses developed a policy for “Least Restrictive Methods Utilized before Applying Restraints.” Phyllis Knorr, RN, AGP4’s operations manager, turned to her Nursing Practice Council to identify a way to reduce the need for restraints on the unit. The Unit Practice Council, led by Carol Hughes, RN, a staff nurse on the unit, developed their new practice (3:5:A).

3:5:A GEISINGER HEALTH SYSTEM AGP4 UNIT PRACTICE COUNCIL MINUTES: 7/26/07 CCU CONFERENCE ROOM MEMBERS Barry Tempesco, RN,TC; Carol Hughes, RN; Ruthann Urban, UDC; Kathy Newcomb, NA CALL TO ORDER 0700 REVIEW AND APPROVAL OF MINUTES Yes OLD BUSINESS We will be addressing the staff regarding use of the sliding scale insulin. If you haven’t been approached by someone already, please respond to Tera’s Email. We will address this at our next meeting. NEW BUSINESS The telemetry strips and trends will be moved up behind the med sheets in the mini charts.This was suggested by Dr. Harrison. He felt the only information in the mini charts that pertained to the physicians were the med sheets and telemetry strips and it would be nice if they were together.

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The insulin drip policy will be posted in the dictation room for the doctors to review. We are in the process of devising a policy for AGP4 on using the least restrictive method for restraints. 1. Anticipate toileting and hydration needs, pain management, provide ambulation opportunities, reorient patient to environment, turn and reposition, offer reading material, reduce sensory level, provide patient safety booklet. 2.

Find out what your patient’s bedtime routine is. What are their preferences? What is calming to the patient?

3. Involve family, and let them stay with patients when able. 4. Use bed alarms. 5. Utilize the Companion Program for neurology, vascular, and trauma patients. 6. Utilize high visibility beds (8 total). 7. Put the patient on 1:1 nursing care. When a patient has a restraint on or 4 side rails please put it on the report sheet.This is very important because starting August 1 (next Wednesday) management will be auditing 5 patients per week for the next 3 months. It will be the responsibility of the charge nurse on days, evenings, and nights at the beginning of each shift to print a report sheet for the 60s and 70s and place it the filing cabinet by the charge nurse.There will be a tab put in that will say report sheets restraint audits.Thank you for your help. Please remember to stamp the back of all forms that are part of the patient’s medical record.This needs to be done even if there isn’t a box on the back of the paper.They are scanned at medical records and it poses a problem if they are not stamped. Please keep up the good work on the unit. Just because Joint Commission was here, we don’t want to get back into any bad habits; for example: food and drinks at the desk, clutter in the hallways, remember good handwashing, keep top of med carts clean and free of meds, keep medication cabinet locked at all times, return stretchers to where they came from, and remember to log out of EPIC! When stocking the rooms, please place only 10 blue pads and 10 attends per Phyllis. We are wasting a lot because they are being thrown away when a patient is discharged. Try using the bed alarms more frequently. We may be able to prevent falls! Christmas Party Updates: It will be December 29 at the Front Street Station. We booked a DJ with Karaoke. We will be bringing our own desserts again. We discussed having a $10 gift exchange. We will provide food for evening shift but we will have those scheduled bring their own desserts. We have $433 left in the bank. More to come! NEXT MEETING 8/23/07 ADJOURN 1100 Respectfully submitted, Carol Hughes, RN

OUTCOMES The Least Restrictive Restraint practice has been adopted by the staff and is now in use. Use of restraints has decreased. LEAST RESTRICTIVE RESTRAINT PRACTICE Steps all staff will try and also document before asking physician for restraint order: 1. Anticipate toileting/hydration needs, pain management, provide ambulation opportunities, reorient patient to environment, turn and reposition, offer reading material, reduce sensory overload, provide patient safety booklet. 2. Find out your patient’s bedtime routine. What is their preference? What is calming to the patient?

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3. Involve family, and allow them to stay with the patient when able. 4. Utilize bed alarms. 5. Utilize the Companion Program for patients on the services the program is covering. (Neurology,Vascular, and Trauma, at present). 6. Utilize high visibility beds. 7. Discuss 1:1 nursing care with physician. Devised by: AGP4 Unit Practice Council, 7/26/07

EXAMPLE: NURSES INITIATE CHANGE—WORK ENVIRONMENT Lynn Fait, RN and ED team coordinator, and Brian Evans, RN, staff nurse, were very concerned about the patient flow in the ED and the resources available when high patient census results in lack of beds to admit patients in the hospital. When ED patients cannot get an available hospital bed, the ED can become an inpatient holding area—while still having to function in its role as an ED. Lynn and Brian considered this problem and worked with the ED Quality Improvement Team to develop a real-time intervention that matched the ED service demand to available resources. They also worked with senior leadership to develop a plan to facilitate ED improvements. Direct-care nurses involved in the process included Lynn Fait, RN; Brian Evans, RN; Kim Loeffler, RN; and Blanche Zawatski, RN. Leaders involved included Charmaine Tetkoskie, RN and director of Emergency Services; Denise Beechay, RN and associate vice president of Nursing; Sharon Kemberling, RN and coordinator of Patient Placement; and Dr. Joseph Bisordi, GMC’s medical director. Scott Berry of the Department of Clinical Effectiveness also helped assess the problem and evaluate possible solutions. The procedure that resulted from their efforts facilitated communication between staff physicians and ED nurses so that everyone would be aware of the status of the ED census and when to accept ED-to-ED transfer

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patients. This ED status is updated (at a minimum) every two hours. The decision to change the status is based on real-time ED and hospital capacity. The status changes are communicated to the department by a color-coded sign (Demand/Capacity Codes) mounted in the front of the ED. Colors on the sign indicate the following status: • Green: Accept • Yellow: Accept • Orange: All nontrauma pediatric patients should be sent to Knapper Clinic (when open) if declared medically stable after a pediatric screening by a triage physician. • Red: ED-to-ED transfers will not be accepted with the exception of all 911 calls, Level I cardiac patients, trauma patients, and all patients who present directly to the ED. If a patient is declined, an Email is to be sent to the director of Emergency Services and the coordinator of Patient Placement stating the patient’s name, diagnosis, and referring hospital. The requesting facility’s phone call is transferred to the Transfer Center for follow-up (3:5:B).

3:5:B

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OUTCOME Since the ED Demand Capacity Grid has been developed, communication between the ED staff and ED charge nurse has improved. The ED nurses have a greater sense of control over their working environment. It has also encouraged a multidisciplinary approach to communication among doctors, nurses, administrative supervisors, and patient placement staff each working to provide the best patient outcome.

NDNQI RN Satisfaction Survey ED Nurse Practice Environment & MD Relationship Score excellent

4 3 2 1 0

poor

2007

2006

ED Nurse - MD Relationship

National ED Nurse - MD Relationship

Mean PES Score

National Mean PES Score

Time to Admission: ED 10 9 8

Hours

7 6 5 4 3 2 1 0 7/05-6/06

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EXAMPLE: PATIENT COMPANION PROGRAM—IMPROVED PATIENT CARE There are times during a patient’s hospitalization when constant monitoring may be needed to assure safety. Several nurses recognized this need and made a commitment to finding a method to improve patient care. Using staff feedback, a team of nursing leaders was assembled to develop a Companion Program (3:5:C) that healthcare teams could use when a patient is identified by direct-care nurses as needing constant observation. PATIENT COMPANION WORKGROUP Bonnie Patterson, RN, operations manager

AGP5

Peter Price, RN, operations manager

BP7

Robin Steimling, RN, CNE

BP7, BP8

Kim Kuhn, RN, operations manager

SCU3

Rachel Arduini

Administration

Susan Standish Wallace, RN

Care Management

Dawn Troutman, RN, operations manager

SCU4

Dee Hollenbach, RN, operations manager

AGP2

Rene McCloskey, RN

Nurse Informatics

Lori Cole RN, team coordinator

AGP5

Kelly Klinger, RN

Nursing Supervisor

Cindy Derk, RN

Nursing Supervisor

Judy Botella, RN

Nursing Supervisor

Hospital administration was very supportive of this idea and challenged the team to develop an inclusive plan to provide a safe environment, companionship, and supportive care to patients requiring ongoing observation. The team developed the following plan of action: • Assessment: The team assessed the needs of the patients who required constant supervision to provide a safe and supportive environment. • Planning: First, evaluation of the current process of care and the types of patients who would benefit from this service was carried out. This plan would initially be available only for certain identified services and then later expanded to include all service lines. The Companion Program was initially provided to neurology, neurosurgery, trauma surgery, hematology/oncology, and medicine services (upon physician orders). We expect to add services (such as cardiology) to the complement. At the start of the program, a flow included identifying whether the patient was on the eligible service line and met the criteria for the program. If so, the nurse would check with the staffing office to see if a companion was available. The companion would then report to the staffing office and be assigned to the program’s patient. The patient’s need for a companion is evaluated every shift and the process repeats itself, as indicated. If there is no companion available, the staff evaluates the need for a safety watch, special room placement, and/or additional nursing staff.

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OUTCOME The Companion Program has been very successful. Patients who would have been considered in need of a high visibility bed may now be in rooms away from the nurses’ station since a companion is assigned at the patient’s bedside. Families welcome the program knowing that a companion will be with their loved one throughout the shifts and will keep the floor nurses aware of the patient’s needs. A patient and family program satisfaction survey is used to evaluate the program’s effectiveness. This survey includes questions regarding the helpfulness and friendliness of the companion and whether or not they met the patient’s personal needs. It also asks about how visitors were treated and overall satisfaction with the Companion Program.

Family/Patient Satisfaction Survey: Companion Program 5 4.5 4 Mean Score

3.5 3 2.5 2 1.5 1 0.5 0 Helpful/ Friendly

Met Personal Needs

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3:5:C

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EVIDENCE 5: SOURCES OF EVIDENCE 3:5:A

AGP4 Unit Practice Council Meeting Minutes

3:5:B

Emergency Department Demand Capacity Codes

3:5:C

Patient Companion Brochure

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EVIDENCE 6 Provide examples of how direct-care nurses’ feedback is used by nurse leaders to make changes to improve patient care, nursing practice, and/or the work environment. LISTENING TO EACH OTHER urse leaders and direct-care nurses work together to make Geisinger Medical Center the best place to work and to receive care. We listen to each other and try different ways to improve patient care and nursing practice. In addition to sharing ideas in one-to-one interactions, nurses in lead and direct-care roles share ideas during council meetings and unit meetings. The table below lists a few examples of feedback from unit direct-care nurses that was put into action by the nurse leader.

DIRECT-CARE STAFF FEEDBACK AND OUTCOMES UNIT

Operations Manager

STAFF Feedback from Unit meetings

OUTCOME

BP5

Cheryl Examitas, RN

Request an increase in the number of 12-hour shift positions available

Implemented through shared scheduling process *Improved work environment

BP6

Michele Long, RN

Request an increase in the number of 12-hour shifts positions available

Implemented through shared scheduling process * Improved work environment

BP7

Peter Price, RN

Request purchase of a bladder scanner

Purchased *Improved patient care and nursing practice

BP8

Michele Long, RN

Request for preprinted assignment sheets be instituted on unit

Implemented through Unit Practice Council *Improved nursing practice

AGP2

Deb Ulrich, RN

Employee Suggestion Box needed to enable “on the spot” record of ideas

Implemented and staff determined where on unit it was to be located *Improved work environment

AGP4

Phyllis Knorr, RN

Changes in scheduling to increase flexibility in response to nurses needs

Implemented through Shared Scheduling Council process; leader and staff worked together to revise guidelines *Improved work environment

AGP5

Bonnie Patterson, RN

Staff recognition for ongoing excellent performance in patient care and contribution to unit

Implemented “Blue Moon Award” through the All for Five Council (AGP5 Unit Practice Council) *Improved work environment

BP2

Deb Ulrich, RN

Request patient shower

Renovations done *Improved patient care

AICU

Angelo Venditti, RN

Create an employee needs list to capture ideas to improve unit and patient care

Implemented by Unit Council; list reviewed weekly by staff member before sending to management *Improved work environment and patient care

CICU

Deb Mensch, RN

Staff interested in finding another way to schedule for holidays and vacations

Implemented through shared scheduling process * Improved work environment

SCU3

Kim Kuhn, RN

Request bladder scanner to decrease need for repeat straight cath of neuro patients

Purchased; CEP Team provided education on new equipment *Improved patient care and nursing practice

SCU4

Dawn Troutman, RN

Staff voiced need for increased staffing due to increased census and acuity

After receiving approval, manager hired two agency personnel *Improved work environment

CH2

Linda Miller, RN

Request for more axillary thermometers

Purchased *Improved patient care

CH3

Linda Miller, RN

More triple channel pumps

Purchased *Improved patient care

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Operations Manager

STAFF Feedback from Unit meetings

OUTCOME

NICU

Maureen Lloyd, RN

Needed more infant swings

Purchased *Improved patient care

PICU

Maureen Lloyd, RN

Return to shared scheduling process with this change in leadership

Implemented; interested staff beginning to develop guidelines and process *Improved work environment

More thermometers needed

Purchased one for each room *Improved patient care

WLL Jami Marks, RN OB/GYN ER

Charmaine Tetkoski, RN New triage process

Implemented through CEP council and nurse educator *Improved patient care and nursing practice

PACU

Cindy Bird, RN

Request for increase in number of 12-hour shifts to be available

Implemented through shared scheduling process *Improved work environment

Deb Strausser, RN

Supply carts need to be restocked in afternoon

Implemented *Improved work environment

Outpatient managers listen to suggestions from clinic direct-care nurses as well. The table below lists a few examples. OUTPATIENT STAFF FEEDBACK AND OUTCOMES CLINIC

MANAGER

STAFF INPUT from unit meetings

OUTCOME

Foss 2 Psychiatry

Mark Basinger

Creation of depression privacy care screening

Effective flow for screening patient in a primary care setting; all screening is triaged by one person *Improved patient care and nursing practice

Pre-surgery Center

Janice Hoffman

Development of a new clinic flow process

Decrease appointment time from 90 minutes to 60 minutes *Improved patient care

Pain Therapy

Janice Hoffman

Redesign for staff and patient scheduling

Shared process with staff and leader *Improved work environment, patient care, and nursing practice

Gastroenterology/ Nephrology

Scott Singer

Saltines and soda after endoscopy

Implemented *Improved patient care

Urology

Dan Hendrick

Communication from nurse to Providers on what patient needs are for each Office Visit

Implementation of a Blue Note *Improved patient care

Women’s Outpatient

Ann McFadden, RN

The creation of an EPIC documentation encounter with an inpatient consult

Staff and providers worked with EPIC team to develop new order sets *Improved patient care

Hematology/ Oncology

Keri Potsko, RN

Clinic triage checklist

Developed by staff nurses *Improved patient care and nursing practice

Rheumatology

Pam Cook

Need to improve the documentation of adult immunizations

Instituted a process for PPD/adult immunizations prior to the start of biologic medications

GMC’s nursing leadership has always been open to feedback. According to Kristen Ikeler, RN, a clinic nurse from the Hematology/Oncology Clinic, “Management regularly seeks items for unit meeting agendas and ways to improve patient care.”

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Staff members are encouraged to help in problem solving at unit meetings. Working together to improve patient care is the standard. EXEMPLAR: A NEW WAY Staff nurses are encouraged to offer their input to nurse leaders on ideas for creating effective changes in patient care, nursing practice, and the work environments. The following example of this practice was evident in the Operating Room (OR). For many years, nurses working in the OR worked traditional eight-hour shifts. They were also required to be trained to work in all types of surgical settings. This antiquated practice had a considerable impact on nurse job satisfaction and retention of employees. The turnover rate in the OR in 2006 indicated that the OR’s work environment and staffing practices were in need of change. GEISINGER HEALTH SYSTEM 2006-07 OR TURNOVER TRENDING ANALYSIS 1st Qtr

FY 2007 Voluntary Total Turnover % 2nd Qtr 3rd Qtr

4th Qtr

Total YTD

AU-02000155090010

2.48%

1.55%

3.76%

1.54%

9.33%

AU-02000155090030

5.41%

2.78%

0.00%

8.19%

AU-02000155090050

0.00%

Overall OR Totals

2.55%

1.48%

2.44%

0.98%

7.45%

GEISINGER HEALTH SYSTEM 2007-08 OR TURNOVER TRENDING ANALYSIS 1st Qtr

FY 2008 Voluntary Total Turnover % 2nd Qtr 3rd Qtr

4th Qtr

Total YTD

AU-02000155090010

3.08%

AU-02000155090030

2.04%

AU-02000155090050

0.00%

Overall OR Totals

2.33%

Staff Nurse Deb Strausser, RN, had a vision for a concept that she thought could enhance the department’s working conditions. Her idea incorporated POD nursing to enable flexible scheduling within the OR. POD nursing incorporates certain surgical specialties into one group with nurses assigned to a particular surgical group. The term POD is not an acronym; it relates to the concept of “streamlining or grouping.” After talking to her manager, Deb presented the idea to Crystal Muthler, RN, associate vice president of Nursing and director of the Surgical Suite. Crystal was very receptive to this new model. She took the presentation to CNO Sue Hallick who also supported it and helped to make the vision a reality. Sue requested budget approval from the Executive Leadership Team to transform the requested changes into practice (3:6:A).

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3:6:A POD KICK-OFF MEETING MINUTES JANUARY 9, 2006 Present M. Renner, ST

B. Witt. RN

Judy Bowersox, RN

G. Edwards (Herrold), RN,Team Coordinator

J. Sheridan, RN,Team Coordinator

D. Decker, ST

S. Carnish, RN

S. Pritchard, RN,Team Coordinator

D. Strausser, RN,Team Coordinator

D. Rider, RN,Team Coordinator

MEETING The kick-off meeting was started by discussing the concerns members brought from the general staff.The following questions are listed with the discussion that each question brought forth. Q. What advantages would POD nursing have over the current structure of teams? Discussion: Scheduling and assignments could be more manageable in smaller PODs than the current structure where the schedule and assignment is working with a large volume of staff and individual needs of services are often compromised. Q. Why not free up team coordinators completely to have them manage their current teams and not be staffing rooms at all? Discussion: POD management structure is design to have the POD leaders still with the service 50 to 60 percent of the time, giving them contact with their service to still remain the hands-on expert and resource for the POD members. POD coordinators would be an additional layer of management that would manage schedule, assignments, and vacation and personal time requests in addition to the usual managerial duties, such as budget and operational issues. Q. Are their models to help with the transition? Discussion:Yes, the models show that this process must be staff-driven and governed. POD must balance the work.The PODs must have similar services. Q. Suggested PODs Discussion:Talked about how PODs are designed in other institutions that volume of work and block time must be considered. This led to a discussion of possible PODs. Deb Struasser agreed to Email each committee member samples of block time. K. Walley will also send each member information on average number of rooms running by day of the week and time of day data from Janâ&#x20AC;&#x201C;Oct 2005. Next meeting was scheduled for January 23. K. Walley is looking for possible time to meet sooner if possible.

The process of change began in November 2005 and was fully initiated by August 2006. The idea was taken out to the staff in unit meetings to gain feedback and identify a group to help work out the details. Several nurses and a surgical technician volunteered to help. Volunteers included Carla Travelpiece, RN, CNE; Kate Horan, RN, CEP; Diane Rider, RN, team leader; Barb Witt, RN; CEP staff nurses; and Melissa Renner, surgical technician. An extensive process of garnering information from the Association of Perioperative Registered Nurses followed. Other activities included talking with the staff and physicians throughout the OR and soliciting buy-in and ideas on how to best group the surgical specialties.

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Team coordinator positions were created for each newly created POD in the OR. Nurses expressed an interest in the POD they wanted to be assigned to according to the surgical specialty. Flexible hours, such as 10- or 12-hour shifts and varying start times, made it possible for nurses to adapt their schedules to meet the department’s needs as well as the needs of their own personal lives (3:6:B).

3:6:B GEISINGER HEALTH SYSTEM DIVISION OF SURGERY UNIT MEETING MARCH 22, 2006 OR LOUNGE 6:45AM–2:00 P.M. PRESENT RN–REGISTERED NURSE; ST–SURG TECH; TC–TEAM COORDINATOR Lowell Adams, RN; Melania Balzer, RN; Heather Barkasy, ST; Linda Barrick, ST; Nancy Bowen, ST; Judy Bowersox, RN; Mike Brezgel, RN; Michelle Brown, RN; Sharon Carnish, RN; Kathy Connaghan, RN; Grace Covington, ST; Sue Crouser, ST; Deb Decker, ST; Mike Dennen, ST; Denise Derr, ST; Deb Disabella, RN; Deb Donahue, RN,TC;Tami Dunbar, ST; Jamie Fetterolf, RN; Melissa Fisher, ST; Janice Flory, RN; Jodie Frasch, RN; Linda Frazier, RN,TC; Janice Garinger, ST; Jenelle Garinger, ST; Sue Gearhart, RN; Susan Hargraves, RN; Wendie Hess, RN,TC; Robert Hollenbach, ST; Michael Horan, ST;Tammy Hurst, RN; Deanna Ikeler, RN; Fran Kase, RN,TC; Heather Killian, ST; Coty Kimball, ST; Anne Kulick, RN,TC; Michelle Lindenmuth, RN; Patrick Masters, ST; Kim McCaffery, RN; Brady McGee, RN; Deb Miller, RN; Jennifer Miller, RN; Ginger Mott, RN; Zachary Moyer, ST; Kimberly Mylet, RN; Kristy Nariskus, RN; Ledell Neufer, RN;Tammy Noss, RN; Constance Polomski, ST; Amy Reamer, ST; Melissa Renner, ST; Diane Rider, RN,TC; Jake Sheridan, RN; Michele Shulski, RN,TC; Pauline Stine, ST; Mary Stratton Curtis, RN;Victoria Szot, RN; Stacey Taylor, RN; Barb Witt, RN; Bonnie Yagle, ST; Pam Zurick, RN OPEN POSITIONS • RN-7 • Support associate vacancies– 9 to 5:30 p.m. position open 3 to 11:00 p.m. position open 1 to 9:30 p.m. position open Robert Miller, a temp, started March 15th. New temp starting on 3/16/06. His name is Larry Witmer. Temp starting Friday 3/17/06. His name is Phillip Parker. CSR—CENSITRAC (JOAN COREY SPOKE IN THE P.M. ONLY) • Joan presented the live Censitrac information via PowerPoint.This showed the staff how inaccurate scanning has been. ALL trays need to be scanned at every point of departure from each area. • Censitrac is only as good as the staff who complies. • Accurate tracking is a necessity for instrument inventory. • Clipboard placed in PAR room; please place sticker on board with a note where the instrument was taken to if you do not have time to scan yourself. MAGNET • Thank you for participating in the Magnet Pep Rally on Tuesday, March 14. Jamie Fetterolf and daughter Makenzie Stacey Taylor

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Heather Killian Kim McCaffery Nancy Salwocki Carla Travelpiece Barb Witt • A good time was had by all. TEAM RECOGNITION • Please congratulate the General Surgery Team.They have been recognized by the hospital with the Bariatric Service Excellence Award. NEW REGISTRIES • Barb Devlin presented the new OR Registries. All of anesthesia charges have been taken off.The registry will stay in the patient’s chart.This will be implemented on April 3, 2006. COMMITTEE ANNOUNCEMENTS a. OR Workgroup— 1. Workgroup welcomes Michelle Brown, RN, to the committee. She will be replacing Donna Lindemuth, RN.Thank you Donna for all of your dedication to this committee and service to the OR. 2. Price is right—Wide safety strap-$95, Linda Frazier, RN-am, Sue Hargraves, RN-pm. 3. Wish List of Duties that can be assigned during slow periods has been given to each charge nurse including weekends and night shift. 4. ROSE Award—to be announced April 5. 5. Remember to sign up for adopt-a-room. 6. Stocking room inservice on April 5 with workgroup and IMAs. 7. We plan to purchase a digital camera in the near future. 8. Twenty new suction adapters were marked and put in service. 9. Next project: Designing a new booklet that will be placed by each addressograph and at desk of infrequent/special lab request with brief synopsis of test and a sample lab request form; anticipate completion ASAP. Any usual or infrequent lab request, please see workgroup with suggestions. 10. Avagard and glove box holders as requested by staff have been placed in the CSR Satellite area. b. Time Committee—See the attached Holiday Guidelines—Anne Kulick, RN • All staff must sign up in Martha and Marsha’s office. c. Performance Improvement/QI–Barb Witt, RN 1. Please make sure your patient has an ID band on when they are leaving the OR. 2. There was a low compliance for labeling of medications and/or solutions taken out of the original contain. Please label everything. 3. All clocks on the walls are synchronized house-wide. Please use them for documenting times on the pink sheet and registry. d. Policy and Procedure Review Committee • Allograft Policy—Policy complete; the yellow logbooks are on order. After they arrive we will implement and review the policy.This is only human or animal tissue. • Ortho and CV will maintain their own yellow binders. e. CEPs—No updates f. Retention Committee—March meeting was cancelled. If anyone has any issues they would like brought up, please see one of the members of the committee. • The Hospital Retention Committee is having a jelly bean counting contest. g. OR Relations—The form to report an OR relations issue is now at the control area. Upon completion of the form it may

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be turned in to operations director, team coordinator, or charge nurse.The committee will now meet on a quarterly basis; next meeting in June. h. Clinical Nurse Educators—New hospital uniform regulations policy has been revised and should be enforced. It can be found online under Manuals, Patient Care, Policy 307. • There are three trauma binders with articles in the lounge on the windowsill. One is pediatric, one is adult, and one is geriatric.The adult binder has two different articles, with two separate sign-in sheets and different tests (tabs are separating everything). By reading and completing the tests for theses four articles, your trauma education hours will be complete for the year 2006. • The gold sign-in sheets and tests will be collected monthly. Please sign your initials and date on the gold sheet and place the completed test in the back inside cover of the binder. i. Latex—List of products containing latex has been updated; the format will be different.The list will be on the latex-free carts. POD NURSING • Interviews are underway for POD coordinators. • OR staff survey will be done pre-POD and then after implementation. • Several physicians have given positive feedback about the planned change. • Staff should continue to decide which POD they want to participate in; selections are ongoing.

OUTCOME In 2007, nurses in each POD are engaged and committed to making their group work well. These changes greatly improve the working environment and the nurses’ perception of having a good day overall.

Overall Had a Good Day Score GMC OR 5 4

2005

2006

Had a Good Day

GMC Score

2007

National Score

EVIDENCE 6: SOURCES OF EVIDENCE 3:6:A

POD Kick-off Meeting Minutes, January 2006

3:6:B

Division of Surgery Unit Meeting Minutes, March 2006

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EVIDENCE 7 Describe how nursing leaders are visible and accessible to direct-care nurses.

eisinger Medical Center nursing leaders (administrators and managers) demonstrate visibility and accessibility. Visibility refers to the physical presence of the nursing leader in patient care areas. Accessibility is how open the nursing leaders are to being approached by direct-care nurses. The Nursing Department has an open-door policy that enables staff to approach them at any time.

NDNQI Nurse Satisfaction Survey: Managerâ&#x20AC;&#x2122;s Ability, Leadership, and Support of Nurses 4 3.5 3 2.5 2 1.5 1 0.5 0 2006

2007

GMC

National

Operations managers interact with their staff in a variety of ways, including during unit staff and unit council meetings and through one-on-one interactions by phone, beeper, or Email. Unit meetings offer attendees an opportunity to discuss the impact of policy changes on the organization, the department, and their unit. The unit councils provide opportunities for staff and managers to work together on issues that will benefit nursing practice, patient care, and the overall work environment.

SPAN OF CONTROL In the early 1990s, hospitals all over the country were forced to make organizational changes to stay financially solvent. These changes were evident in nursing departments where managers were spread across a number of nursing units. At GMC, managers were responsible for two or more nursing units, which drastically decreased their visibility and accessibility to staff. Here are some accounts in the nurse managersâ&#x20AC;&#x2122; own words.

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GMC nurse manager with staff nurses

•

Terri Bickert, MSN, RN, former manager of AICU, CICU, SCU4, AGP4, and AGP5: “Having multiple units was very challenging. It was a different kind of busy from having one unit. Splitting time every day between meetings and several high profile units was challenging. It was hard to move beyond day-to-day operations, to look at the unit vision and how to move there together with the staff. Implementing Shared Governance Councils and strong assistant managers was my key to success. The thing I enjoy most about leadership is guiding and mentoring staff. At times that was very hard when priorities were focused on day-to-day operations. Looking back, it is amazing we got through it.” • Bonnie Patterson, RN, formerly operations manager of AGP5, I.V. Therapy, and BP7; presently operations manager of AGP5 and I.V. Therapy: “Each nursing unit is unique, so even though they may have similar functions and responsibilities, their operational needs are very different. As a manager, I found that I needed to understand the strengths and weaknesses of each area and the staff working in those areas in order to best support their needs. I also found that it was not beneficial to make comparisons between the units or assume that because a process was successful in one unit it would be successful in the other. Each unit had its own culture and personality, and I had to use different approaches to similar situations because of these differences. I had to learn to balance time spent with staff and make sure that each area’s priorities were addressed as each area felt they needed to be. I was fortunate in that each unit took its turn having a crisis; only occasionally were the units in crisis at the same time. When this happened, I really needed to depend on the staff and team coordinators to help with the support and follow-through necessary to resolve their issues.” As the new millennium began, new nursing leadership assumed control of GMC’s nursing services. A number of new initiatives were undertaken stressing the importance of visibility, accessibility, and

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accountability. Sue Hallick, RN, CNO, identified the need to adjust the span of control for her team of inpatient operations managers to facilitate the Nursing Departmentâ&#x20AC;&#x2122;s success. In 2001, Sue began increasing the number of managers. They grew from nine in 2000 to 17 by 2007. The outpatient areas followed Sueâ&#x20AC;&#x2122;s example and also increased their number of outpatient operations managers and clinical team leaders. NUMBER OF OPERATIONS MANAGERS 2000

2002

2005

2007

Inpatient

Outpatient

This change in span of control has enabled managers to stay aware of day-to-day activities occurring on the unit, making sure patient flow is smooth and staffing is sufficient for demand. In addition to spending time on the unit, managers answer questions, address concerns, and solve problems. The operations managers or their team coordinators make patient rounds several times a week to ensure quality care and follow-up on identified issues. The reduced span of control has enabled the nursing leaders to coach and mentor nurses to grow and develop professionally. Unit-based councils are more productive, and operations managers have staff engaged in unit operations. There are still challenges day-to-day, but the staff and manager work as a team to find solutions (3:7:A).

3:7:A OUTPATIENT MANAGERS LIST COMPARISON Department

GMC 2003 Name

GMC 2007 Name

Division of Medicine

Susan Frye

Kim Rankin

Jan Hoffman

Sandy Whitmire

Donna Myers

Scott Singer

Kerri Potsko

Kerri Potsko Mike Woll Pam Cook

Division of Surgery

Becky Ruckno

Mike Enriquez

Jill Leiby

Marsha Morgan

Scott Gulliver

Caroline Pogge

Pat Campbell

Dan Hendricks

Chris Wargo

Chris Wargo Deb Sanders Kyle Snyder

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Department

GMC 2003 Name

GMC 2007 Name

OB/Women’s

Claire Varney

Anne McFadden

Psychiatry

George Godlewski

Mark Bassinger

Pediatrics

Nancy Ososkie

Donna Lapchak

OUTCOME This increase in the number of front-line managers has decreased their span of control and has allowed them to be more accessible and visible to staff. They can be on their units or clinics daily and are available to meet informally to discuss staff concerns and suggestions. They are also available to make patient rounds and can address issues in a timely manner. • Dee Hollenbach, RN and a new manager in 2007: “I cannot even imagine having more than one unit. I am on the unit every day and staff members know that they can approach me at any time. I am busy selecting a new team coordinator and working with the staff to determine our direction. I think working together is the only way.” • Michelle Long, RN, manager of BP8, and new manager of BP6: “I have had councils on BP8 for some time and am enjoying getting things going on BP6. The nurses have so many good ideas that are really making a difference in our unit and patient care.” • Charmaine Tetkoskie, RN and long-term director of Emergency Services: “The ED staff is the greatest. They have had Shared Governance Councils for so long that it is just part of who we are. The senior staff shows the newer ones how to make things happen. It really makes things better for me, too. The nurses on the councils are problem solvers, and I rely on them to keep improving patient care and ED flow.” • Marsha Morgan, RN and manager of the Ophthalmology Clinic: “I rely on my staff to keep the clinic running smoothly. I have experienced nurses who do what is needed to make sure the patients are cared for properly. I don’t know what I would do without them.”

STAFF NURSE PERCEPTIONS When nurses were asked about their perception of the visibility and accessibility of nursing leadership, their responses were very positive. Here are just a few examples. • Judy Malatesta, RN and CICU staff nurse CEP: “I have been an employee at GMC for 30 years and have seen many managers come and go. For the most part, I have been very fortunate to have had managers who care about the staff and the patients. Management has always been positive and supportive and shown that it cares.” • Deb Mattis, LPN, BP2 Psychiatry: “Now that our manager has only one unit, we get to see her every day.” • Tonya Sellard, RN, staff nurse SCU3: “I feel I can talk to my manager about anything. She is very open to discussing my concerns.”

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• • •

•

Ann Bower, RN, staff nurse BP7: “We really appreciate it when our manager comes out to pitch in when the unit is extremely busy.” Tracey Eddinger, RN, staff nurse AGP5: “I don’t know how she does it, but she seems to be here all the time, helping us all the time.” Lisa Bidelspach, LPN, clinic nurse, Ophthalmology Clinic: “Marsha is great to work with. This clinic is so busy and fast moving. Marsha used to be a staff nurse here, too, so she knows what we are going through and how to help us. I know I can go to her anytime to talk about what is going on.” Stephanie Worhach, RN, clinic nurse, Women’s Clinic: “Women’s Clinic is a great place to work. Ann is such a positive manager. She is committed to helping us make this the best clinic. She asks us for our opinions and I feel she is very approachable. I am very lucky.”

A VISIBLE AND ACCESSIBLE CNO CNO Sue Hallick routinely attends meetings of the Shared Governance Council where she conveys an image that is approachable and open to communication. She and the staff discuss current events as well as issues arising on their respective work units. Nurses throughout the organization are able to meet one-onone with Sue whenever needed. Sue leads by example and is visible and accessible to her management staff. It is not unusual for her to stop by a manager’s office and ask how things are going. She attends their management meetings and guides and supports them as they deal with the day-to-day operations of their units. Sue leads by example by being visible and accessible to direct-care providers. Beyond her interactions at the Shared Governance Council meetings, she schedules rounds on all three shifts and during weekends and holidays. This provides her an opportunity to interact with nursing staff on the units and to support the 24/7 operation of the department. CNO’S SCHEDULE FOR ROUNDS Wednesday, July 5, 2006

3:00 – 5:00 p.m.

Danville Campus

Thursday, July 6, 2006

3:00 – 5:00 p.m.

GWV

Tuesday, July 18, 2006

3:00 – 4:00 p.m.

Danville w/Admin Resident

Wednesday, August 2, 2006

1:00 – 3:00 p.m.

Danville

Thursday, August 10, 2006

9:30 – 11:00 a.m.

GWV w/Dr. Steele

Wednesday, August 16, 2006

4:00 – 5:00 p.m.

Danville

Thursday, August 17, 2006

2:30 – 3:30 p.m.

Danville w/Dr. Bisordi

Friday, August 25, 2006

3:00 – 5:00 p.m.

Danville

Wednesday, September 6, 2006

1:00 – 3:00 p.m.

Danville

Friday, September 15, 2006

1:00 – 3:00 p.m.

Danville

Monday, October 2, 2006

2:00 – 3:30 p.m.

Danville w/Dr. Steele/AVPs

Tuesday, October 17, 2006

7:00 – 8:00 a.m.

Danville

Wednesday, October 25, 2006

6:00 – 8:00 a.m.

Danville w/AVPs

Wednesday, October 25, 2006

2:00 – 3:00 p.m.

Danville

Thursday, October 26, 2006

11:00 a.m. – 12:00 p.m.

Danville

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 Wednesday, November 22, 2006

2:00 – 3:00 p.m.

Danville w/Wade/Bisordi/Miller/Beechay

Thursday, November 23, 2006

All Day Rounds

Danville—Thanksgiving Rounds

Wednesday, November 29, 2006

1:00 – 2:00 p.m.

Danville w/Wade/Bisordi/Miller/Beechay

Wednesday, December 6, 2006

3:00 – 5:00 p.m.

Outpatient Surgery—Woodbine Lane

Wednesday, December 13, 2006

10:00 a.m. – 12:00 p.m.

Danville

Wednesday, January 3, 2007

8:00 – 10:00 a.m.

Danville

Monday, January 8, 2007

2:00 – 4:00 p.m.

Danville

Friday, January 12, 2007

2:00 – 4:00 p.m.

Danville w/AVPs

Wednesday, January 17, 2007

2:00 – 4:00 p.m.

Danville

Friday, January 19, 2007

10:00 a.m. – 12:00 Noon

Danville

Tuesday, January 23, 2007

1:00 – 3:00 p.m.

Danville

Thursday, January 25, 2007

3:00 – 5:00 p.m.

Danville

Thursday, February 1, 2007

10:00 a.m. – 12:00 Noon

Danville

Wednesday, February 7, 2007

1:00 – 3:00 p.m.

Danville

Friday, February 9, 2007

9:00 – 11:00 a.m.

Danville

Wednesday, February 14, 2007

3:00 – 5:00 p.m.

Danville

Thursday, February 22, 2007

2:00 – 3:00 p.m.

Danville

Monday, February 26, 2007

3:00 – 5:00 p.m.

Danville

Wednesday, February 28, 2007

3:00 – 5:00 p.m.

Danville

Friday, March 2, 2007

8:30 – 10:30 a.m.

Danville

Monday, March 5, 2007

2:00 – 4:00 p.m.

Danville

Wednesday, March 7, 2007

9:00 – 11:00 a.m.

Danville

Thursday, March 8, 2007

1:00 – 4:00 p.m.

GWV

Friday, March 16, 2007

1:30 – 3:30 p.m.

Danville w/AVPs

Tuesday, March 20, 2007

1:30 – 5:30 p.m.

GSWB

Wednesday, March 21, 2007

3:00 – 5:00 p.m.

Danville w/AVPs

Monday, March 26, 2007

1:30 – 3:30 p.m.

Danville

Friday, March 30, 2007

10:30 a.m. – 12:30 p.m.

Danville

Wednesday, April 18, 2007

9:00 – 11:00 a.m.

Danville

Thursday, April 19, 2007

7:00 a.m. – 2:00 p.m.

GWV and GSWB

Friday, April 20, 2007

2:00 – 4:00 p.m.

Danville

Tuesday, April 24, 2007

8:30 – 9:30 a.m.

Danville w/AVPs

Wednesday, April 25, 2007

3:00 – 5:00 p.m.

Danville w/AVPs

Friday, April 27, 2007

3:00 – 5:00 p.m.

Danville

Monday, May 1, 2007

9:00 – 11:00 a.m.

Danville w/AVPs

Tuesday, May 2, 2007

9:00 – 11:00 a.m.

Danville

Monday, May 7, 2007

2:00 – 5:00 p.m.

Nurses Week Rounds—Danville

Wednesday, May 9, 2007

3:00 – 5:00 p.m.

Nurses Week Rounds—Danville

Thursday, May 10, 2007

7:30 – 10:30 a.m.

Nurses Week Rounds—Danville

Wednesday, May 23, 2007

2:00 – 3:00 p.m.

Danville

Friday, May 25, 2007

1:00 – 3:00 p.m.

Danville

Wednesday, May 30, 2007

10:00 a.m. – 12:00 p.m.

Danville

Thursday, May 31, 2007

7:00 – 10:00 a.m.

Danville

Friday, June 1, 2007

9:00 – 10:00 a.m.

Danville

Tuesday, June 5, 2007

2:00 – 4:00 p.m.

Danville

Tuesday, June 19, 2007

3:00 – 4:00 p.m.

Danville

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 Tuesday, June 26, 2007

12:00 – 2:00 p.m.

Danville

Tuesday, June 26, 2007

2:00 – 4:00 p.m.

Outpatient Surgery Center—Woodbine Lane

Wednesday, June 27, 2007

10:30 – 12:00 Noon

Danville

July 6, 2007

Quality Rounds 8:45 a.m. – 11: 45 a.m.

July 26, 2007

Quality Rounds 11:30 a.m. – 1:30 p.m.

August 14, 2007

Quality Rounds 9:30 a.m. – 1:00 p.m.

August 15, 2007

Quality Rounds 10:00 a.m. – 12:00 p.m.

August 24, 2007

Quality Rounds 10:00 a.m. – 12:30 p.m.

August 31, 2007

Quality Rounds 2:00 p.m. – 5:00 p.m.

September 3, 2007

Quality Rounds 2:00 p.m. – 5:00 p.m.

September 7, 2207

Quality Rounds 11:00 a.m. – 1:00 p.m.

September 11, 2007

Quality Rounds 3:30 p.m. – 5:00 p.m.

September 18, 2007

Quality Rounds 11:00 a.m. – 1:00 p.m.

October 5, 2007

Quality Rounds 11:00 a.m. – 1:00 p.m.

October 15, 2007

Quality Rounds 7:00 a.m. – 10:00 a.m.

October 19, 2007

Quality Rounds 9:00 a.m. – 10:30 a.m./1:00 p.m. – 3:00 p.m.

October 24, 2007

Quality Rounds 3:30 p.m. – 5:00 p.m.

October 31, 2007

Quality Rounds 3:30p.m. – 5:00 p.m.

November 2, 2007

Quality Rounds 11:00 a.m. – 1:00 p.m.

November 5, 2007

Quality Rounds 2:30 p.m. – 4:30 p.m.

November 6, 2007

Quality Rounds 9:00 a.m. – 11:00 a.m.

November 22, 2007

Quality Rounds 7:00 p.m. – 12:00 p.m.

December 7, 2007

Quality Rounds 3:00 p.m. – 5:00 p.m.

December 21, 2007

Quality Rounds 12:00 p.m. – 2:30 p.m.

December 27, 2007

Quality Rounds 7:00 a.m. – 9:00 a.m.

[Terri: Is this the correct time?]

If Sue hears that a unit may be going through a difficult time, she makes sure to visit the unit frequently. During her rounds, she engages the staff, asking them about how their day is going and how their families are doing, letting the staff know she cares. Sue has been at Geisinger for more than 20 years and knows many staff members. One example of why the staff respects her as a visible and accessible leader is demonstrated in this story. It occurred a year ago, close to Christmas. One of the staff nurses received a paycheck that was short of money. The error, according to Geisinger policy, was too small to be corrected before the nurse’s next paycheck. This nurse was very stressed because she planned to use her paycheck to finish buying her children’s Christmas presents. The operations manager tried to help but the amount was not large enough to warrant a special check. Taking a suggestion from one of her colleagues, Wendy Potter, RN, staff nurse, called Sue and explained the situation and the steps that had been taken in an attempt to resolve the payroll error. Sue was able to have a corrected check issued to the nurse. Sue listened and took the time to help, which meant a lot to Wendy and her coworkers. EVIDENCE 7: SOURCES OF EVIDENCE 3:7:A

Outpatient Managers List Comparison, 2003 and 2007

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EVIDENCE 8 Provide examples of mentoring and succession planning by and for nurse leaders and directcare nurses.

ne of the Nursing Department’s primary goals is to secure the legacy of its founder, Abigail Geisinger. It was Abigail Geisinger’s directive when she founded the hospital in 1915 to “Make my hospital right. Make it the best,” that has formed the basis for Geisinger’s nursing vision. One component of making Geisinger the best is its success in retaining strong professionals, which is due (in part) to its commitment to fostering professional growth. More than 41 percent of Geisinger’s nursing workforce has 10 or more years of tenure in our organization. Geisinger is committed to “growing our own,” which means that we believe in and recognize the potential for advancement and professional development of our staff. We believe that offering these opportunities plays a role in retaining quality staff. To that end, a mentorship program was developed several years ago (3:8:A). Its goal is to recognize individuals who engage in mentoring behaviors by offering them additional tools (knowledge) to enhance their performance. The program is available for those individuals who show mentoring potential. The mentorship program debuted with a large kick-off attended by all managers, team coordinators, and clinical nurse educators. It is now offered routinely.

3:8:A MENTORSHIP PROGRAM 2007 February 2

0730 – 1030

May 1

1200 – 1500

August 3

0730 – 1030

November 19

1200 – 1500

Location: Nursing Education Center Room 201, Second Floor COURSE DESCRIPTION The Mentor Class is a 3-hour program designed to assist nurses to develop their mentoring skills to the fullest. Any nurse who wants to become a mentor on their units is encouraged to attend. CEPs who have accepted the “mentor” role are encouraged to attend. Among topics to be included: • Difference between preceptors and mentors • Characteristics of mentors • How to get started If you have any questions on whether this program is for you, please discuss this with your Clinical Nurse Educator (CNE). TO REGISTER Online Patient Care Services Speed Schedule or call Chris Whitmire (570) 214-9205 PROGRAM CONTENT QUESTIONS Any Clinical Nurse Educator, Nursing Education

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GEISINGER HEALTH SYSTEM GEISINGER MEDICAL CENTER DANVILLE, PENNSYLVANIA EDUCATION RESOURCES PROGRAM RECORD Program date: ______________ Participant: _______________ Date attended: _________ CONTACT HOURS General Topic: 3.3 Age-specific topic: Pediatric Hours (0 – 17 yr old) ______ Adult Hours (18 – 54 yr old) _____ Geriatric Hours (55 yr old and >) _____ Verifying signature: ______________________

PROGRAM NUMBER: 20686 PROGRAM TYPE: CLT PROGRAM TITLE: MENTORING EDUCATION RESOURCES ASSOCIATE: Jody Bachman, RN Gerri Ann Danoliwicz, RN Judy Shipe, RN SPEAKER(S) Jody Bachman, RN Gerri Ann Danoliwicz, RN Judy Shipe, RN INTENDED AUDIENCE CEP staff and others who are interested in becoming mentors STATEMENT OF NEED Please check one: * Reg. Agency

Trauma

Orientation

X Provider credit

Advances

Staff Request

Management Request

Other—check all that apply: Pt. Pop.

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OBJECTIVES At the conclusion of the program, the participant will: 1. Discuss the role of the mentor. 2. Identify the differences between a mentor and a preceptor. 3. Review the foundation and framework of mentoring. 4. Describe the importance of developing goals—short and long term—for both the mentor and mentee. 5. Discuss barriers to mentoring and methods to overcome them. 6. Identify the benefits to mentoring from a personal and organizational perspective. OUTLINE OF CLASS CONTENT (INCLUDE THE USE OF ANY SLIDES, OVERHEAD TRANSPARENCIES, HANDOUTS, ETC.) I.

Introduction and Overview

II. What is mentoring? A. Definitions B. Mentor vs. preceptor C. Characteristics D. Survey III. Theories/Foundations A. Stage/phase B. Novice to expert C. Adult learning IV. Personal development plan V. Barriers and methods to overcome A. Separation of roles B. Lack of support C. Time D. Poor communication E. Toxic mentors F. Limited availability of qualified persons G. Mismatching of mentor/novice VI. Benefits VII. Ongoing process A. Preventing burnout B. Evaluation C. Documentation D. Socialization

MENTOR ROLE IN CAREER ENHANCEMENT PROGRAM (CEP) Many years ago, when the Clinical Ladder Program evolved into the Career Enhancement Program (CEP), one of the roles that the staff nurses felt needed to be developed was that of a mentor. Typically, staff would seek out specific nurses on each unit with their clinical questions or when they needed a shoulder to lean on. The new role emerged from these discussions—the CEP mentor. The CEP mentor is a person who takes on additional responsibilities on the unit to help new nurses transition into their roles and to help other coworkers through their day-to-day struggles.

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CAREER ENHANCEMENT PROGRAM (CEP) MENTOR ROLE CHARACTERISTICS The mentor: The purpose of this role is to provide support and encouragement to new members of the unit staff. A mentor should be approachable and encouraging. A mentor should be a positive role model.This would include being up-to-date on all unit-required education, inservices, and promoting upcoming training. Mentors should demonstrate positive conflict resolution tactics and promote unit cohesiveness.They should be committed to continuing education themselves. Characteristics of a CEP mentor include: • Provides primary support for new staff on unit • Serves as a resource/preceptor on the unit • Ensures completion of required orientation paperwork • Monitors orientees’ progression through the initial six months of employment • Works with unit manager/clinical nurse educator to review/revise orientation program • Serves as a resource person to staff serving in preceptor role • Reviews orientees’ progress weekly with clinical nurse educator • Precepts the orientee >50 percent of the time during the orientation period • Serves as backup preceptor for other unit orientees

The following list includes many examples of how securing the legacy through mentoring and succession planning of leadership has worked at GMC. MENTORING AND SUCCESSION PLANNING EXAMPLES MENTEE: FORMER POSITION

MENTOR

MENTEE: NEW POSITION

Denise Beechay, RN Operations Manager, AICU

Sue Hallick, RN, CNO

AVP, Nursing

Crystal Muthler, RN Operations Manager, SCU, Float Pool

Sue Hallick, RN, CNO

AVP, Surgical Suite and Nursing

Phyllis Knorr, RN Administrative Team Coordinator, AGP4

Terri Bickert, RN, Operations Manager, AGP4

Operations Manager, AGP4

Peter Price, RN Administrative Team Coordinator, BP7

Bonnie Patterson, RN, Operations Manager, BP7 and AGP5

Operations Manager, BP7

Angelo Venditti, RN Administrative Team Coordinator, AICU

Denise Beechay, RN Operations Manager, AICU

Operations Manager, AICU

Charity Derr, RN Staff Nurse, BP5

Joan Mervine, RN Clinical Nurse Educator

CEP, BP5

Kimme Duffy, RN Team Coordinator, CH2 and CH3

Linda Miller, RN Operations Manager, CH2 and CH3

Administrative Team Coordinator, CH2 and CH3

Kerri Potsko, RN Team Leader, Hematology/Oncology Clinic

Cindy Vought, RN, Ops Mgr BP8, Hematology/Oncology Clinic

Operations Manager, Hematology/Oncology Clinic

Michelle Long, RN,Team Coordinator, BP8

Cindy Vought, RN Operations Manager, BP8

Operations Manger, BP8 and BP6

Judy Brokenshire, RN, Staff Nurse, BP6

Joan Mervine, RN, Clinical Nurse Educator

CEP, BP6

Heidi Cole, RN, Staff Nurse, CH2

Chris Raup, RN, Administrative Team Coordinator, CH2 and CH3

Team Coordinator

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G E I SI N GER ME D IC A L CE NTE R FORCE 3 MENTEE: FORMER POSITION

MENTOR

MENTEE: NEW POSITION

Jeanette Rowello, RN, Staff Nurse, AICU

Angelo Venditti, RN Operations Manager, AICU

Team Coordinator

Rene McCloskey, RN, CEP Staff Nurse, AGP5

Judy Haines, RN Nurse Educator, AGP4 and AGP5

Clinical Nurse Educator, BP7

Renee Smith, RN, CEP, PACU

Carla Travelpiece, RN Nurse Educator, OR

Nurse Educator, PACU

Cheryl Examitas, RN,Team Coordinator, AICU

Angelo Venditti, RN Operations Manager, AICU

Operations Manager, BP5

Dee Hollenbach, RN.Team Coordinator, AGP2

Deb Ulrich, RN Operations Manager, BP2 and AGP2

Operations Manager, AGP2

Jami Marks, RN, Nursing Supervisor

Sue Hallick, RN, CNO

Operations Manager, WLL

Andrea Wary, RN,Team Coordinator, Women’s Outpatient

Ann McFaddin, RN,Operations Manager, Women’s Outpatient

Operations Manager, Women’s Community Practice sites

CLINICAL NURSE EDUCATORS AS MENTORS UNIT

MENTOR

MENTEE

CICU

Artman, Susan, RN

Jim O’Connell, RN, staff nurse

NICU

Bachman, Jody, RN

Janice Brink, RN, staff nurse

SCU3

Cole, Gordon, RN

Candy Bossler, RN, staff nurse

SCU4, Critical Care Floats

Danilowicz, Gerri Ann, RN

Jennifer Wemple, RN, staff nurse

ED, Life Flight, Radiology

Gordon, Nancy, RN

Kim Loeffler, RN, staff nurse

AGP4

Haines, Judy, RN

Carol Hughes, RN, staff nurse

Horan, Kate, RN

Sherry Bottiger, RN

ICU

Kishbaugh, Lani, RN

Alex Brock, RN

Generalist

Knight, Cathy, RN

Alice Kuznicki, RN

I.V.Therapy

Knowlton, Barb, RN

Sue Ridall, RN

BP5/BP6

Mervine, Joan, RN

Cindy Rinard, RN

CH2/CH3

Mowry, Emily, RN

Melissa Narcavage, RN

Periop, I&O, Pre-surgery

Smith, Renee, RN

BP7

Steimling, Robin, RN

AGP2

Underhill,Tami, RN

Sharon Sudol, RN

WHP

Wilson, Alice, RN

Cathy Eyer, RN

Kristi Sands, RN

NURSING LEADERSHIP: MENTORING AND SUCCESSION PLANNING Succession planning establishes a process that recruits employees, develops their skills and abilities, and prepares them for advancement. In the past, succession planning across the country typically targeted only key leadership positions. In today’s organizations, it includes key positions in a variety of job categories. With the move to flattened management structures, succession planning provides replacement insurance when key people leave an organization. It is important that potential successors are identified early and given appropriate training so that when the time comes they can move into more senior roles. The expectation of mentoring and succession planning is built into many job descriptions (3:8:B and 3:8:C). With good succession planning, employees are ready for new leadership roles and can step up when a position becomes available. QUALITY

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3:8:B GEISINGER MEDICAL CENTER DEPARTMENT OF HUMAN RESOURCES JOB DESCRIPTION TITLE:

Inpatient Nursing Operations Manager

FAMILY/GRADE:

67 Managerial/10

JOB CODE: 2215

BARGAINING UNIT:

FLSA:

DEPARTMENT:

Nursing

LOCATION: GMC Campus

Exempt

JOB SUMMARY Manages nursing personnel and daily operational-related activities. Leads NSG team for assigned units with responsibility for all operational functions of the team. Works in partnership with the Medical Director/Physician Liaison of the inpatient unit to provide administrative and medical staff support to the operations of the inpatient unit. Responsible for developing and initiating improvements in the organization and delivery of high quality, cost effective patient care. Duties and responsibilities will include supporting the vision, mission, and goals of the NSG Department and the organization. Responsible for nursing clinical practice, budgetary personnel activities, regulatory activities associated with the unit and the clinical department, and the implementation and continuing support of EMR. Reports directly to the Chief Nursing Officer and is matrixed to the Department Service Line leaders (Vice President and Chair) as appropriate. MAJOR DUTIES AND RESPONSIBILITIES *A. Leadership: 1. Demonstrates characteristics and behaviors necessary to assure employee understanding and acceptance of the nursing and system driving strategies. 2. Effectively communicates the NSG and the organizationâ&#x20AC;&#x2122;s vision, goals, and initiatives at the unit/department level. 3. Effectively incorporates goals, vision, and initiatives into unit/department plans. 4. Participates effectively as a member of departmental/divisional/regional leadership teams. 5. Facilitates team-based problem solving within and between departments. 6. Develops, implements, and audits all departmental policies and procedures. 7. Develops an effective working relationship with the Medical Director/Physician Liaison of the inpatient unit. 8. Develops positive and proactive employee relations. *B. Human Resource Management: 1. Recruits, interviews, and hires applicants. 2. Participates in recruitment and retention process for all team members. 3. Accountable for staffing, vacation scheduling, cross-training activities, etc. with other team leaders as needed and/or required. 4. Maintains accurate payroll timesheets of staff. 5. Coordinates performance evaluation process for all team members. 6. Collaborates with Human Resource Generalist regarding employee performance improvement planning. 7. Develops, implements, and revises nursing retention strategies on an ongoing basis. *C. Strategic Planning/Implementation: 1. Develops and participates in the design and implementation of all strategic operational plans. 2. Anticipates, evaluates, and appropriately responds to changes in the healthcare environment. 3. Develops capital, clinical, financial, HR, IS quality, and service plans.

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4. Develops business plans identifying opportunities for new technology and anticipates future needs for personnel and equipment. 5. Monitors progress of goals and impact of respective plans. 6. Develops marketing strategies for the unit/department. *D. Financial Performance: 1. Demonstrates accountability for continuously improving the work unit, department, division, and system by developing performance expectations and goals that focus on service, quality, and cost. 2. Communicates a clear description of performance expectations and goals to employees, encouraging and supporting their participation and accountability. 3. Establishes and adjusts hours-per-patient-day (HPPD) for assigned units based on national benchmarks. 4. Develops, implements, and achieves budgets, which attain unit, division, and system goals. 5. Reviews reports to monitor all revenue and expense impacting activities. 6. Develops and implements operational contingency plans as financial needs arise. 7. Educates employees in the need to develop a cost-conscious approach to quality care and/or service delivery. *E. Service/Patient/Customer Satisfaction: 1. Develops and promotes service standards that foster a customer-sensitive environment, using a proactive approach. 2. Measures performance against standards and seeks team commitment to exceed standards. 3. Resolves patient and customer-related issues in a timely manner. *F. Risk Management: 1. Assists in dealing with risk management issues. 2. Assists in development and implementation of department PI plan. 3. Ensures all incidents, serious events, and sentinel events are reported to PI and addressed in a timely manner. 4. Proactively reviews the units/systems exposure to develop educational activities for employees/associates that will reduce liability. 5. Coordinates and communicates safety standards and processes. 6. Assists and maintains regulatory compliance. *G. Care Management System: 1. Works closely with care management to facilitate maximization of clinical pathways and case management system. 2. Assists in the implementation of organizational care management activities. 3. Works with appropriate personnel to ensure compliance with regulatory agencies. *H. Education/Coaching: 1. Facilitates continuing education and research opportunities for employees, self, and community to support growth and enhance the contribution to Geisinger Health System. 2. Utilizes leadership concepts to effectively facilitate team building by serving as a mentor, and teacher. 3. Collaborates with Clinical Nurse Educators to develop employee orientation, continuing education, and competencies. I.

Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.

*Denotes essential job functions.

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SKILLS AND ABILITIES Demonstrates successful nursing resource management and team coordinator development. Demonstrates budget management skills. Demonstrates successful recruitment and retention policies, medical staff and employee relations, and an educational program that ensures clinical competence. EDUCATION AND/OR EXPERIENCE RN presently licensed or eligible for licensure in Pennsylvania required. Bachelor’s degree in related field required. Master’s degree in Nursing, in Healthcare Administration, or related field preferred. BSN or commitment to obtain BSN required. Minimum five years line management experience in a healthcare setting required. Management experience in an academic medical center or integrated healthcare delivery system preferred. WORKING CONDITIONS/PHYSICAL DEMANDS Work is typically performed in a clinical environment. The specific statements shown in each section of this description are not intended to be all-inclusive.They represent typical elements considered necessary to successfully perform the job. REVISIONS: Devised: 7/06*

3:8:C GEISINGER HEALTH SYSTEM DEPARTMENT OF HUMAN RESOURCES JOB DESCRIPTION TITLE:

RN-Inpatient CEP

FAMILY/GRADE:

77 Inpatient RN-Licensed / 02

JOB CODE:

4623

BARGAINING UNIT: No

FLSA:

Nonexempt

DEPARTMENT:

LOCATION:

GMC Campus

Nursing

JOB SUMMARY Responsible for all aspects of the RN Inpatient position, including assessment, evaluation, and coordination of care (see Position Description, RN Inpatient). Performs additional duties under the following possible domains: Mentor, Educational Liaison, Performance Improvement Coordinator, Clinical Coordinator. Each of the above domains carries with them additional responsibilities as defined in the nursing Career Enhancement Program. Commitment to community service is encouraged and supported by the Geisinger Health System. MAJOR DUTIES AND RESPONSIBILITIES 1. Performs all aspects of the RN Inpatient Position Description (see Position Description, RN Inpatient). 2. Satisfactorily completes all aspects of the domain selected in the Career Enhancement Program (mentor, education, performance improvement, clinical coordinator). 3. Submits necessary documentation to operations manager of performance in the Career Enhancement Program prior to performance evaluation.

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4. Meets and follows the division’s and organization’s established Service Standards. 5. Performs other duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform. SKILLS AND ABILITIES Demonstrates good organizational skills and effective communication skills. Demonstrates consistently excellent clinical nursing skills, knowledge, judgment, and leadership in an independent environment. Demonstrates the ability to work independently as well as in team environment. Demonstrates ability to meet the requirements of the specific domain in the Nursing Career Enhancement Program. Demonstrates ability to meet the requirements of the specific domains renewal process to retain this position (see Nursing Career Enhancement Model). EDUCATION AND/OR EXPERIENCE Valid RN License in Pennsylvania required. Minimum one-year experience in the unit required. Satisfactory performance appraisal required (not in the active disciplinary process). Completion of introductory period in the hospital prior to application required. WORKING CONDITIONS/PHYSICAL DEMANDS Work is typically performed in a clinical environment. The specific statements shown in each section of this description are not intended to be all-inclusive.They represent typical elements considered necessary to successfully perform the job. REVISIONS: Revised: 11/07 Revised: 9/06 Devised: 6/03

EXAMPLE: MENTORING AN ASSOCIATE VICE PRESIDENT CNO Sue Hallick appointed two new associate vice presidents (AVPs). She had begun mentoring Crystal Muthler ten years earlier when Sue was an operations manager and Crystal was an administrative supervisor. Sue saw Crystal’s potential and began to teach and guide her while giving her opportunities to grow and develop. Sue’s protégé continued to shine—first as an operations manager, then a director—and now as an AVP. Sue values Crystal’s ability as a mentor so much that it is part of Crystal’s role to mentor the operations managers. According to Crystal, “Assuming an executive role on the nursing management team was both a growth opportunity and a new challenge for me. I had spent the previous fifteen years as a member of the nursing management team, filling operational roles. My strength was identifying areas of weakness and finding solutions to them. I believe that Sue had thoughts of an advanced role for me when, with her guidance, I became the clinical director of the Surgical Suite. As clinical director, I was challenged with many issues in areas other than nursing and had to hone my negotiating skills. As an AVP, Sue has taught me to ‘paint the

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picture’ in order to convey a broader message, increase understanding of issues, and to gain group consensus” (3:8:D).

3:8:D GEISINGER MEDICAL CENTER DEPARTMENT OF HUMAN RESOURCES JOB DESCRIPTION TITLE:

Associate Vice President, Nursing Services, GMC

JOB CODE:

1052

FAMILY/GRADE:

99/8

FLSA:

Exempt

DEPARTMENT:

Nursing Service Line

LOCATION:

GMC Campus

JOB SUMMARY Responsible for overseeing the operational activities of the nursing services GMC campus as directed by the Chief Nursing Officer. Manages assigned personnel daily operations and related activity in conjunction with the direct operational leadership teams in assigned areas. Duties and responsibilities will include supporting the operations manager teams and department service lines which interface with nursing services and the overall system Nursing Service Line strategy. Assists in the oversight of all nursing clinical practice, employee relations issues, budgetary process, and associated regulatory activities, quality, and safety of nursing practice on that campus. Performs all duties to promote and lead the highest level of patient care and maximum patient satisfaction. Reports directly to the Chief Nursing Officer. Works in conjunction with Service Line. MAJOR DUTIES AND RESPONSIBILITIES Leadership: 1. Demonstrates characteristics and behaviors necessary to assure employee understanding and acceptance of the system driving strategies. 2. Effectively communicates vision, goals, and initiatives at the Nursing Department unit level. 3. Effectively incorporates goals, vision, and initiatives into unit/department plans. 4. Participates effectively as a member of committees and departmental and divisional leadership teams. 5. Facilitates team-based problem solving within and between departments. 6. Leads the process to build a nursing leadership “bench” to assure leadership accountability is achieved and maintained. 7. Is a key role model and mentor for new nursing leaders within the Nursing Department at GMC. EDUCATION/COACHING/CAREER ENHANCEMENT 1. Facilitates continuing education and research opportunities for employees, self, and community to support growth and enhance the contribution to Geisinger Health System. 2. Utilizes team building concepts to effectively empower team members by serving as a mentor, teacher, and coach. 3. Assures educational needs of all staff and leaders are addressed and met. EMPLOYEE MANAGEMENT 1. Facilitates development, maintenance, and success of unit teams via mentoring of unit leaders and support of the Nursing Department philosophy. 2. Provides feedback to team regarding performance and job-related issues. 3. Enhances skills of team members, such as decision making, problem solving, conflict resolution, human resource management, communication, and leadership.

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SERVICE/QUALITY/COST 1. Demonstrates and establishes accountability for continuously improving the work unit, department, division, and system by developing performance expectations and goals that focus on service, quality, and cost. 2. Communicates a clear description of performance expectations and goals to employees, encouraging and supporting their participation. 3. Establishes appropriate benchmarks and directs action plans to address out-of-benchmark performance in conjunction with the Chief Nursing Officer. PATIENT/CUSTOMER SATISFACTION 1. Develops and promotes service standards which foster a customer-sensitive environment. 2. Measures performance against standards and seeks team commitment to exceed standards. 3. Facilitates staff â&#x20AC;&#x2122;s management of patients and customer-related issues. RISK MANAGEMENT 1. Collaborates with the Chief Nursing Officer, Medical Director, and medical staff on issues of patient care and nursing/physician standards. 2. Works with the team coordinators and operations managers to influence and share accountability for utilization management and cost-effective outcomes. 3. Proactively reviews the units/systems exposure to develop educational activities for employees/associates which will reduce liability. STRATEGIC PLANNING/IMPLEMENTATION 1. Anticipates problems/risks and supports change. 2. Effectively adjusts plans. 3. Develops and implements departmental and divisional program planning. 4. Develops capital, financial, human resource quality, and service plans. 5. Implements plans through team-based empowerment. FINANCIAL PERFORMANCE 1. Assists in the oversight of the GMC nursing budget in conjunction with the Chief Nursing Officer and financial liaison. UTILIZATION MANAGEMENT 1. Facilitates business and clinical decision-making issues involved in materials procurement and usage. 2. Monitors and maintains cost-effective utilization of resource. 3. Works in conjunction with Material Management to oversee materials resource utilization. PATIENT SAFETY IMPROVEMENT 1. Ensures that the patient safety improvement and management program will be given high priority and will support the program. a. Ensures that sufficient time is available for staff participation in patient safety activities at both the department and organizational level. b. Ensures that staff attends all required patient safety education programs. Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified to perform.

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SKILLS AND ABILITIES Demonstrated positive employee relations, staffing effectiveness, and resource management. Must possess successful conflict resolution abilities and budget management skills. EDUCATION AND/OR EXPERIENCE Current RN license or eligible for licensure in Pennsylvania required. Bachelor's Degree in related field required. Master’s Degree in healthcare administration or related field required or commitment to obtain. Minimum of 5 to 8 years line management experience in a healthcare setting required. Management experience in an academic medical center or integrated healthcare delivery system preferred. WORKING CONDITIONS/PHYSICAL DEMANDS Work is typically performed in a clinical/office environment. The specific statements shown in each section of this description are not intended to be all-inclusive.They represent typical elements considered necessary to successfully perform the job.

EXAMPLE: A SECOND AVP A similar situation occurred with the second AVP, Denise Beechay, who started as an administrative supervisor and interacted with Sue Hallick on a daily basis. It quickly became clear that the two shared many common interests and Sue was committed to helping Denise grow professionally. She offered Denise opportunities to increase her experience as an operations manager, then as a director, and now as AVP. Both AVPs credit Sue as being an integral part of their professional growth. EXAMPLE: AN OPERATIONS MANAGER’S ACCOUNT Ann McFaddin, RN, (operations manager of Women’s Outpatient) tells her story about her mentoring experiences: “The growth and development of people is the highest calling of leadership. Being a part of the Women’s Service Line team has, for me, been a time of growth and development as a manager. I stepped into the role of an operations manager after being a team leader for numerous years. My mentor to the role of team leader was the outgoing operations manager, Claire Varney, a fellow RN. She saw potential in staff and sought ways to develop those who showed energy and a desire to excel. Claire taught me a great deal about handling daily operations and increasing patient and staff satisfaction. Before her retirement, Claire opened my eyes to the aspect of management. As one of the operations managers of Women’s Health, I use the skills she taught me on a daily basis. “During the past year, I have learned a set of new skills. Our leader is Ruth Nolan, RN and vice president of the Women’s Service Line. I have great admiration for her. Ruth accepted this position in February 2006. She was new to Geisinger, but you would not know that by talking with her. She quickly learned the dynamics of the system and has taught us something new on a daily basis. Her philosophy about developing others is ‘I can contribute a small amount, but what the team can contribute is much more.’ “Ruth promotes a collegial atmosphere characterized by the entire team’s consideration and respect for one another. Each member of the team is valuable. Our strengths are recognized and acknowledged. Ruth asks our opinion on many operational issues and processes all our options. We process the positive and QUALITY

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negative issues and formulate an action plan. The team is unique in its design, the vice president and operations manager are both RNs. It allows us to look at the clinical side of an issue as well as the operational impact. “With the knowledge and building blocks I obtained, I was able to create a plan for the team leaders in my units. I began with four clinical team leaders, a lead ultrasound technician, and a team leader for the support staff. The year has seen much growth and development as we learn how to interact with one another and learn our roles. Together, we designed a plan for the team leader’s development that included biweekly meetings to allow me to provide the tools for success. Developing others in the team and empowering them to their full potential is very important to me. Formulating councils within the department has been very rewarding as I observed the staff becoming involved in process and flows that will ultimately improve the safety and satisfaction of staff and patients. Encouraging the staff to bring their thoughts and ideas to the table improves daily operations.”

MENTORING DIRECT-CARE NURSES Mentoring and succession planning at GMC is not limited to the leadership staff. It occurs throughout all levels of nurses. EXAMPLE: RAISING INTEREST IN CERTIFICATION Joan Mervine, RN, clinical nurse educator, has worked with two surgical units for five years and has worked hard to gain the unit staff ’s trust and confidence. She has mentored a number of nurses over the years, but one in particular—Charity Derr, RN—stands out. Charity works as a staff nurse on BP5 Orthopaedics. As Joan began to interact with the staff, Charity’s interest began to grow. Joan guided Charity’s progress and involvement. Charity became engaged in unit activities, in the Career Enhancement Program, and in one of the nursing department councils (NSQPI). Charity is active on this council and represents her unit well. She has become a unit leader and continues to take on more responsibilities. Through her mentoring efforts, Joan raised the interest of other staff nurses in obtaining medical-surgical certification. Charity was one of the first to take the challenge and now she, too, leads the charge for other qualified nurses on her unit to do the same. CERTIFIED NURSES ON BP5 Joan Mervine, RN

Medical-Surgical Certification

Bonnie McWilliams, RN

Orthopaedic Nurse Certification

Sheila Zanella, RN

Orthopaedic Nurse Certification

Carol Payne, RN

Orthopaedic Nurse Certification

EXAMPLE: STAFF-TO-STAFF MENTORING Experienced nurses also mentor newer, less experienced nurses. The process often benefits both participants more than either one anticipated. Ann Keilbasa, RN, one of the more experienced nurses in the Cardiac

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Intensive Care Unit, noticed that a new graduate—Ann Reiner, RN, who was just out of orientation—was struggling. Ann took Amy under her wing and offered her help and guidance. Ann would check in with Amy when they worked the same shift, making sure Amy understood her assignment and was adapting to the intense environment. Ann also intervened when other staff members were with the new nurse, encouraging them to help Amy learn. Now Amy is an experienced critical care nurse. She credits Ann with helping her survive those first few months and values her support and guidance. Amy still occasionally seeks out Ann for guidance. They have developed a long-lasting and trusting relationship. EVIDENCE 8: SOURCES OF EVIDENCE 3:8:A

Mentorship Program

3:8:B

Job Description Reflecting Mentoring Role: Inpatient Nursing Operations Managers

3:8:C

Job Description Reflecting Mentoring Role: RN Inpatient-CEP

3:8:D

Job Description Reflecting Mentoring Role: Associate Vice President

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