I N D I A N A
AUTUMN 2013
Q U A R T E R LY
Magnet Recognition Program
Recognize excellence among health care organizations
Eskenazi Hospital
New facility, greater capacity to heal
Taking a stand
Find shoes that are comfortable, supportive, durable and attractive
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Cover:
Renee Twibell, associate professor, 0Ball State University School of Nursing
Cover photo: Marc Lebryk
Inside 4-5 On the Pulse 6 Clips & Tips Careers & Training 8-9 Continuing education 10 Hospital design 12 Health and wellness 14-15 Eskenazi Health 16 New NICU 17 A skilled specialty Your World 18 Taking a stand 20 Q&A with Kathy Staples
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On the Pulse
Fun Walk, Kathy Staples, awards
Spotlight On Nursing For Tomorrow’s Nurses 10K/5K/1-Mile Fun Walk
Spotlight on Nursing For Tomorrow’s Nurses
The 12th annual Spotlight On Nursing run/walk, For Tomorrow’s Nurses, is a family-oriented 5K/10K run/walk and 1-mile fun walk to raise awareness of the critical issues facing the nursing profession. Since 2002, the event has raised more than $395,000 for undergraduate and graduate nursing scholarships. The run/walk is open to participants of all ages, skills and abilities and will be timed and scored by Tuxedo Brothers Event Management. You can pre-register at www. spotlightonnursing.org. Same-day walk-up registration also is available.
10K/5K/1-Mile Fun Walk When: Saturday, Oct. 12, 7 a.m. Where: Buggs Temple, downtown Indianapolis Info: www.spotlightonnursing.org awards will be presented to the top three finishers in each run category. If you’d like to form a team, contact Heather Ladd at (317) 733-3300 or heathertuxbro@ indy.rr.com. If you’d prefer to volunteer, there are many ways you can help on the day of the race. Volunteers are needed for set-up, registration, course directions, water stops, refreshments, finish-line scoring, and photography. For more information, call (317) 715-9146.
Kathy Staples achieves certification as patient-centered medical home content expert
Fun Walk runners
If you’re interested in a career in nursing, vendors at the health and career fair can provide information, plus a variety of screenings, activities and demonstrations. Participants can get ready during the Zumba pre-race warm-up sponsored by IU Health. Indianapolis Mayor Greg Ballard and other central Indiana nursing leaders will speak during the opening ceremony. The 1-mile fun walk is a casual walk along the canal. The 10K run starts and finishes in front of the IU Health Fairbanks Hall with a loop around the city streets before turning onto the Downtown Canal. Awards will be given to the top three finishers in the run, and age division A custom advertisin
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Salute to Nurses
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Go to www.indystar.com/salutetonurses and read about the 2013 honored nurses.
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Shelly Brossea Ruth Kueper Renee Twibell
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Kathy Staples, MBA, BSN, RN, patientcentered medical home (PCMH) operations manager at Community Physician Network, has received certification as a PCMH content expert through the National Committee for Quality Assurance. Her two-year certification became effective July 9. She currently is the only PCMH certified content expert in Indianapolis. “Kathy’s certification as a PCMH content expert is quite an accomplishment that brings fresh expertise to our organization,” said Leisa Hills, RN, BSN, clinical excellence director at Community Physician Network. “Her in-depth knowledge will assist us in implementing innovative and improved primary care models while working within the standards established by the NCQA.” According to NCQA, the PCMH is a health care setting that facilitates partnerships between individual patients, and their
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On the Pulse personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner. NCQA developed the PCMH content expert certification program to help practices and other interested parties identify experts with a demonstrated understanding of the PCMH recognition program and to provide professionals with a way to validate their knowledge base. “Certified NCQA patient-centered medical home content experts receive thorough training and demonstrate in-depth knowledge to assist organizations applying for NCQA PCMH recognition,” said NCQA President Margaret E. O’Kane. Source: Community Health Network
Observed Nurse Excellence Awards 2013 Nine Johnson Memorial Hospital nurses were recognized for their commitment to service and patient care during the annual Observed Nurse Excellence (O.N.E.) awards. Chris Broering, RN, in the Case Management Department, was named the overall O.N.E. award winner. “I work with such dedicated professionals in all departments who strive daily to positively impact our patients and families,” Broering said. “To be chosen by my peers as the winner of the O.N.E. award is an enormous honor.” Other winners were, Donna Scheidler, Chris Broering maternity; Karen Frank, CCU; Jenny Waters, med/surg; Rebecca Davis, surgery; Ken Fessler, outpatient surgery; Nicole Zupancic, Todd Aikens Acute Rehab Unit; Andrea Eden, emergency department; and Beverly Bragg, home health care/ancillary services.
Simulation dolls prepare OB nurses for real-life emergencies The Franciscan St. Anthony Health – Crown Point Obstetrics Unit, led by director Kathy Podorsek, recently acquired labor and delivery simulation dolls and two fetus replicas, to allow nurses to practice real-life-type scenarios. The dolls will prepare them for routine, complicated and emergency delivery situations, as well as treating newborns in the hospital’s neonatal intensive care unit. The dolls perform numerous lifelike functions. Nurses Christie Demo, Jaimie Arcella and Amber Kirrin received training from a company representative and now lead hospital sessions. “The equipment can simulate any obstetrics or newborn emergency, or normal delivery,” Podorsek said. “It is especially useful for new nurses who can practice emergencies before they are in them.” All of the obstetrics and NICU units’ approximately 100 nurses are receiving the training. Source: St. Anthony Health – Crown Point
Source: Johnson Memorial Hospitalv
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Autumn 2013 5
Clips & Tips Verbal abuse associated with negative work environment
Medicare payment rate increases,” said Center Director Charles Roehrig. “We will be watching hospital jobs closely in the next couple of months to see if this is the start of a longer-term trend.” Ambulatory care employment rose by 6,600 in July, well below the 24-month average of 15,600, while nursing and residential care job growth is essentially flat, according to the report.
A new study by the RN Work Project found that high levels of physician verbal abuse are closely associated with more negative work environments. The study found that nurses who experienced high (more than five times in the last three months) or moderate (one or more times in the last three months) levels of verbal abuse by physicians had less favorable perceptions of their work environments, lower intent to stay in their jobs, and lower commitment to their organizations. Higher levels of verbal abuse from physicians were also correlated with more verbal abuse among nurse colleagues. “Physicians’ verbal abuse of nurses is a long-standing problem and one we need to do much more to address,” said Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University. “It hurts morale, breeds further verbal abuse, and is associated with nurse intention to leave, particularly among younger nurses. All of these things ultimately reduce the quality of patient care. Health care organizations need to do much more to create positive, healthy work environments.” The RN Work Project is a program of the Robert Wood Johnson Foundation. The study was published online in Nursing Outlook. Investigators for the study were: Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo; Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University; Rana Obeidat, PhD, RN, Faculty of Nursing at Zarqua University in Jordan; and Wendy Budin, RN-BC, PhD, FAAN, adjunct professor at the College of Nursing, New York University.
Source: AHA News
Employing nurses with BSN leads to fewer patient deaths When hospitals hire more nurses with four-year degrees, patient deaths following common surgeries decrease, according to new research by the University of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research as reported in the March issue of the journal Health Affairs. Less than half the nation’s nurses (45 percent) have baccalaureate degrees, according to the most recent data available (2008). A 10 percentage point increase, say from 30 to 40 percent, in the overall percentage of BSN-prepared nurses in the hospitals
Source: Medical News Today
Source: Medical News Today
Health sector job growth flat for first time in decade Health care employment rose by only 2,500 jobs in July, well below the 24-month average of 22,000 and the lowest increase since July 2003, according to the latest Labor Brief from the Altarum Institute’s Center for Sustainable Health Spending. Hospitals have lost 13,000 jobs over the past three months, including 4,400 in July, the report notes. “This jibes with reports of unexpectedly low hospital utilization rates and belt tightening in anticipation of very low 6 Indiana Nursing Quarterly
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studied between 1999 to 2006 saved about 2 lives for each 1,000 patients treated on average, according to lead author Penn Nursing professor Ann Kutney-Lee, PhD, RN, who is also a senior fellow at the Leonard Davis Institute of Health Economics. The researchers surveyed 42,000 registered nurses in Pennsylvania in 1999 and 25,000 in 2006. “This adds to the importance of public policies to help direct a substantial shift toward the production of nurses with baccalaureates in nursing,” said Kutney-Lee, noting that a recent report from the Institute of Medicine recommends that 80 percent of nurses hold at least a baccalaureate degree by 2020. “Nursing is both hightouch and high-tech requiring honed critical thinking skills in our complicated health care system.” While the study did not pinpoint why more patients survive surgeries, previous work in the Center found that better-prepared nurses offer higher levels of surveillance of patients, noticing subtle shifts in their patients’ conditions that can lead to death from complications while there was still time to intervene.
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Continuing education the force behind magnet status By Shauna Nosler
Not all that long ago, smoking was considered good for you — as was getting a Saint-Tropez tan and practicing other unhealthy habits that now seem as absurd as using leeches to treat illnesses.
Renee Twibell — PhD, RN, CNE, Ball State University School of Nursing — states that magnet hospitals have structures in place so that nurses at all levels have continuing education programs available.
Through research and education, old wives’ tales have been debunked
and the truth has come to light. And while a learning curve still exists in the medical world, it’s greatly accelerated by continuing education. Industry leaders assert that continuing education should be mandated in the nursing profession. Yet only 14 states require RNs and LPNs to earn CE credits as a condition of renewing their licenses — and Indiana is not one of them. Even so, many medical facilities in the state are setting their own higher standards.
Magnet status
The American Nurses Credentialing
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Center established the Magnet Recognition Program to recognize excellence among health care organizations. To earn Magnet status, facilities must meet rigorous criteria and maintain high standards for nursing quality and patient outcomes. Magnet hospitals demonstrate a high level of job satisfaction among nurses, with low turnover and appropriate grievance resolution procedures. These trademarks in turn appeal to consumers as they’re choosing a medical provider. “Magnet status signifies that a hospital is a designated site for the provision of excellent nursing care and an excellent work environment for nurses,” said Renee Twibell, PhD, • Autumn 2013
RN, CNE, an associate professor at Ball State University’s School of Nursing. “Magnet status also assures the public that they are receiving care in one of the best hospitals in the nation.” The primary factor behind such superior care is presumed to be welleducated nurses. “Typically, in Magnet hospitals, a high percentage of nurses hold professional certifications in specialty areas,” Twibell said. “In order to continue over time to be qualified as a certified nurse in a specialty area, nurses must complete a certain number of continuing education credits. So certification and continuing education are linked and provide assurance that nurses
Careers & Training are preeminently qualified to provide excellent care.” Magnet status is not easy to obtain, and less than 15 percent of U.S. hospitals have fulfilled the requirements. The American Hospital Association lists 5,724 registered hospitals, of which 391 have active Magnet status. Fourteen are in Indiana, and four — St. Vincent Hospital and Health Care Center, Inc., Riley Hospital for Children at IU Health, IU Health Methodist Hospital and Indiana University Health. A complete list of Magnet hospitals is available at www.nursecredentialing. org.
Improving outcomes
Mary Sitterding, PhD, RN, CNRN, executive director of nursing research, professional practice and operational improvement for Indiana University Health, is a Magnet appraiser for the ANCC. While she can’t assess hospitals in her own state, she travels the country to review existing Magnet programs and evaluate new applicants. “Magnet-status hospitals are required to set formal education goals and have the structures and procedures in place hospital wide to help reach those goals,” Sitterding said. “They have to enable ongoing education, set a target and achieve an outcome.” A recent Institute of Medicine report calls for 80 percent of nurses to have a bachelor’s degree by 2020, underscoring the role of education in strong nursing care. “Here at IU Health, it’s our mission to continue to improve on excellence. We spent $2 million for academic preparation and $69,000 for continuing education in 2011 and 2012,” Sitterding said. CE courses are widely available online and can fit into nurses’ workdays, making the process easy and accessible for busy professionals. “One of the many characteristics of Magnet hospitals is that they have structures and processes in place to ensure that nurses at all levels of an organization have continuing education programs available,” Twibell added. Such a structure amounts to a win for patients, health care providers and nurses. ●
SHUTTERSTOCK
The benefits of being a Magnet Hospitals can reap many benefits by participating in the Magnet Recognition Program through the American Nurses Credentialing Center. In facilities where nurses are highly educated, for example, the mortality rate is much lower than average. Magnet status illustrates a hospital’s emphasis on patient care, safety and satisfaction, along with a collaborative culture that encourages staff cooperation and communication at all disciplines and levels. According to the ANCC, Magnet hospitals have better retention rates among nurses and more effectively recruit talented nurses. These two factors contribute to the organization’s stability, productivity and ability to outperform competitors.
SHUTTERSTOCK
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Careers & Training
Deb Buehler
Health at work: Hospital design influenced by staff When building a brand-new facility from the ground up, hospitals have a unique opportunity to design spaces specifically to meet patients’ needs and shape more positive experiences. At the same time, it’s a chance to put in place the right resources and optimal environment for nurses to excel.
A design team also traveled nationwide to see what other hospitals were accomplishing through renovations and new construction. Mockup rooms were set up to allow staff to walk through spaces to weigh in on the set up and suggest improvements. Employees were able to provide input on all aspects, such as the location of storage areas and access to medicines and linens.
An environment for excellence
Like the Walt Disney theme parks, Denny said, the new Wishard-Eskenazi health facility will have on-stage and off-stage areas. These distinct spaces are designed to resolve past traffic-flow problems among hospital patients and visitors and hospital staff members. “There are main on-stage travel areas for families and visitors,” Denny said. “In the off-stage areas, activities happen without being seen by the patients, families or visitors. This is a huge difference from what we have now.”
A magical model
While the main focus in health care is to provide superior care for patients, hospital staff members need to be able to perform their responsibilities with safety and ease. To meet this objective, two local hospitals have sought out design strategies to make a more positive impact on workers. “For every 12 rooms, there are ancillary rooms such as the supply areas, and they are accessible from either side of the room. Outside every two rooms are documentation stations.” The women’s services unit and Marcy Carl, RN, MSN, CRRN, the burn units, for example, have CWCN, is the director of nursing at separate entrances so visitors won’t Community Rehabilitation Hospital’s get lost as they head to a particular new facility. The floor plan was treatment area. When a woman designed to reduce the amount of arrives in labor, she’ll be able to go walking nurses must do on each shift. directly to the fifth floor maternity Open since June, the 60-bed facility area. Visitors dropped off at the main serves individuals who have suffered entrance will be able to meet up a stroke, brain injury or spinal cord with the rest of their party through injury. The two-floor center is a a parallel hallway that connects the friendly, accessible environment. entrance to the parking garage. — Lynn Denny, RN, BSN, MBA, “Rather than having to hunt and director of women and children’s gather supplies, nurses are within Welcoming families services, medical surgery and telemetry close range of all they need,” Carl said. According to Thomas Ringham, at Wishard-Eskenazi Health “They can spend more time at the AIA, associate vice president of bedside.” facilities transformation for WishardOne strategy to reduce walking Eskenazi Health, the large spaces called for a new way to store linens. Outside every two designed in the past for families to gather are predominately patient rooms, linen storage cabinets are now located. unused today. Most visitors instead want to remain in the Nurses can simply step outside a room instead of hiking to patient’s room, not in a separate waiting area with strangers. the supply storage area. This observation influenced the design of new public areas Both the Wishard-Eskenazi and Community and patient rooms. Rehabilitation facilities are equipped with lift stations in all The new Wishard-Eskenazi Health’s public spaces likewise rooms, which reduce injuries for patients and staff during were designed for comfort, accessibility and entertainment. bed-to-wheelchair transfers. Two fountains await those who arrive through the main
“Staff won’t have to walk miles to get things they need.”
Expert solutions When the new Wishard-Eskenazi facility was still in the design phase, hospital leaders sought input from staff members. Pharmacists, physicians, nurses, food service staff, maintenance workers and housekeepers all weighed on the layout and features.
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Winter 2013 • Autumn
entrance. The emergency department entrance features a soothing, glass-walled garden filled with native plantings. Elsewhere in the hospital, guests can view art displays and relax in the rooftop Sky Farm. Both new facilities have spacious dining area where family members can share meals. ●
Yummy in my tummy!
Check out 15 restaurants where kids eat free or for little cost. Join other Hoosiers saving money on their family meals at indystar.com/eatfree
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Careers & Training
Holly Wheeler
Beyond health, wellness is for the whole person “The wellness piece is something near and dear to my heart, as far as my fellow nurses and I needing help with the stress part of our job and with taking care of ourselves,” said Mary Robbins-Nierste, RN, HNB-BC, who heads the hospital’s wellness department. “Our program stemmed from and was built on that. It was started for nurses but now is available to all staff.” The wellness program has grown to include activities like exercise classes, such as Zumba, and Weight Watchers meetings. Each day a walking group meets for a brisk lap around the hospital’s trails. Some walkers track their activity with a pedometer as part of the Simple Steps program; others walk for sheer exercise and enjoyment. At St. Vincent Health, wellness is an organization-wide focus. Nurses like Mary Keller, RN, ICN, who directs the hospital’s infection control and patient safety program, are leading the way to create a health-friendly environment for employees. Three years ago, associates at St. Vincent Fishers Hospital saw the need for an onsite walking path. They’ve since raised more than $16,000 to construct the path, which will include exercise stations along the way. “We call it Pathway to Wellness. The associates here really wanted a place to exercise, and they have come together to raise the money for it,” Keller said. “We also call our cafeteria Pathway to Wellness. Each station includes the calorie count, fat content and other nutritional information for the food that’s being served that day.” St. Vincent Health’s overall wellness initiative includes a pedometer program. By logging their steps, associates earn points that can be converted into cash reimbursements of up to $200.
Wellness is a corporate buzzword today, and for good reason: Companies that invest in wellness programs can reduce their health insurance costs and increase employee productivity. Some of these programs began as grassroots initiatives among staff members who saw value in promoting healthy living to co-workers.
Health care organizations in particular are leading the way for wellness in the workplace. Nurses calling At Wishard-Eskenazi Health, a group of nurses recognized a need to take better care of themselves in order to manage work-related stress and improve their overall health.
For the fun of it Wellness programs that include fun elements are more likely to engage employees and keep them active. Many companies have chosen to model their wellness initiative after a TV show like “The Biggest Loser,” for example. “We have a program called Stairwell to Health — we have a lot of stairwells in this hospital — and it’s an easy thing to push people to the stairwells instead of the elevator,” Robbins-Nierste said. “We have a wellness garden, where we invited employees to help us by gardening a small spot. We asked one day, and the next day we had 35 spots taken.” At Wishard-Eskenazi, the wellness program is focused on offering employees healthy food choices. The hospital hosts a farmers market every two weeks, enabling staff to pick up fresh local produce. Along with their healthy ingredients, employees also get preparation instructions and recipe ideas for nutritious meals.
Connecting mind and body In some organizations, wellness programs focus exclusively on physical activity and healthy eating. For others, the concept is expanded to include mental and emotional wellness. To that end, Wishard-Eskenazi Health has designed “escape rooms” within several nursing units. Staff members who are feeling overwhelmed by their job’s physical and emotional demands can retreat there for a brief healing break. “One of the first things we did to address stress was to create a program we call Simply Escape,” Robbins-Nierste said. “It’s a room for nurses to escape to. This really stemmed from my own personal experience as a nurse, where there were really moments of personal and work stress and nowhere to escape to.” Escape rooms are outfitted quiet, relaxing music with low lighting and aromatherapy. The space is small, with nothing more than a place to sit. But it’s enough for staff members to step inside for 5 or 10 minutes, calm down and feel restored. ●
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Careers & Training
By Deb Buehler
Eskenazi Hospital: NEW FACILITY, GREATER CAPACITY TO HEAL
On Dec. 7, 2013, a major hospital transition will occur in Indianapolis. On that day at Wishard-Eskenazi Health, all staff and patients — and every aspect of caregiving — will transfer to the new Sidney and Lois Eskenazi Hospital. Today, the Wishard-Eskenazi Health system operates 17 buildings on the downtown campus known for decades as simply Wishard Hospital. Soon, the brand-new Eskenazi Hospital will open just to the west on the IUPUI campus. There, three state-of-the-art buildings will offer private rooms for all patients and increase the hospital’s capacity to serve more people. Staff members and visitors will have easier to access to spacious parking garages and hospital facilities.
New and incredibly improved Eskenazi Hospital was designed with input from staff, said Lee Ann Blue, RN, MSN, chief nursing officer. The entire Wishard team, from the facilities maintenance department to food service to nurses and physicians, weighed in on every detail from transporting people and resources to designing the ideal layout for singlepatient rooms. Patients who arrive through the ground-floor ambulance bay will be triaged in the trauma unit and then taken to the appropriate unit of the
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hospital. Staff members experienced in trauma care identified the need for large, bright, wide spaces. Each new trauma room will feature a windowed observation area where medical, nursing and pharmacy students can train and learn. This setup enables future care providers to observe procedures without interfering with the active trauma team. The trauma unit will have adjoining patient rooms, too. This setup supports family members who are injured at the same time, as in an auto accident, house fire or natural disaster.
On top of Indy By leaving the old facilities behind, hospital leaders have been able to develop a highly thought-out, organized facility with improved access. The old Wishard’s helipad, for example, is located at street level, and arriving patients are transported by ambulance to the emergency department. In the new Eskenazi Hospital, the helipad will be located on the roof. Patients from across the state •
Autumn 2013
can be flown in for emergency care. The nonstick surface offers deicing capabilities, which is much safer for landing, taking off and walking around. From the helipad, emergency staff can take patients by elevator straight down to the emergency department, simplifying the arrival and intake process.
Made in Indiana Before construction began, hospital administrators solicited bids from service providers across the community. Eighty-five percent of the work was performed by local companies, and 90 percent of contracts were made with Indianabased companies. The Eskenazi “Report to Our Community 2012” said these percentages represent 411 Marion County contractors, 100 additional contractors from the contiguous Central Indiana counties and 46 Indiana contractors outside the immediate area. Only 62 out-ofstate contractors were hired for the project. The report noted that 29 percent of contract commitments
Careers Careers&&Training Training
Some doorways in the new facility entirely fold back to allow easier access. were made with businesses owned by ethnic minorities, women, veterans or disabled persons. “The projects were broken into packages to reduce national interest,” said Thomas Ringham, AIA, associate vice president of facilities transformation. “[This strategy] encouraged local participation. At the peak of construction, there were as many as 650 people working each day.”
Count to 11 Ten of the hospital’s 11 floors are dedicated to providing patient care; the remaining floor supports the building’s many mechanical functions. Nurses influenced the design of patient care “neighborhoods,” with six rooms on each side of a hallway forming a 12-room unit. And rather than build traditional nursing stations, the hospital has designed collaboration stations to bring together entire medical teams. Central open spaces are equipped with conference tables, while standing stations have high-tech tools that enable staff members to communicate with ease.
board for information about on-duty medical staff. To reduce injuries among staff members and patients, Eskenazi Hospital will be a “no-lift” facility. Every room therefore has two ceiling tracks to enable mechanical lifts. Plus, each room’s private bath has a no-lip shower. “Patient falls have been attributed to two things: getting out of bed without help and falling over a lip into the restroom or showers,” Blue said. “The patient bathrooms feature shelves for toiletries and a plug for a hair dryer. Every room is the same wherever you are in the facility, and each will have a big-screen TV on the foot wall.” Outside every room, Blue said, builtin cabinets will hold supplies of gloves, gowns and caps. The facility’s floors are vinyl, which is softer and more comfortable than concrete. Carpet is used in some areas to decrease noise. Every element, including adjustable lighting for hallways, is designed to create a soothing environment for patients. Foot traffic and workflow were considered in the hospital’s overall design. In September, staff members will be trained to use the elevator system, which has separate cars for visitors and personnel. On every floor, new “team rooms” will provide a comfortable place for medical students and staff members to meet and learn. This helpful addition, suggested by a physician, will include computers, desks, chairs and a largescreen TV to enable video-based instruction. ●
The next level in patient care Eskenazi Hospital is one of just two Level I trauma centers in Indiana. But the beautiful new facility has the capacity to deliver much more to patients, staff and the central Indiana community. The hospital’s public facilities invite visitors to come and be inspired by art and nature. The front lawn opens to the historic Ball Gardens, and the Eskenazi Commons is a large plaza marked by two fountains. The commons area also features an interesting reflecting pond; as water ebbs and flows, inspirational words are revealed to passersby. Atop Eskenazi Hospital, a rooftop garden — or “sky farm” — will produce organic foods 10 months of the year. The plot is the first of its kind for any U.S. hospital. Vegetables and herbs grown in the garden will be used for cooking demonstrations and incorporated into the hospital’s menus. Lisa E. Harris, MD, the chief executive officer and medical director of Eskenazi Hospital, wanted to make nature a part of the healing process for patients. Other spaces will be used for community health and education, such as yoga classes. Inside the building, four original paintings by T.C. Steele will be displayed alongside artwork by 16 other Hoosier artists. In this “Art of Healing” exhibit, nearly two-thirds of the work comes from Indiana artists, many of whom are minorities.
A look inside Patient rooms have been carefully designed to accommodate the way nurses’ enter and move through these spaces. The doorways are wide, enabling patients and equipment to move through easily, and each room’s head wall is decked out with communication tools for the medical staff. Across the room, another communication board is located on the front of a wardrobe. Patients and their family members can refer to this
The “sky farm” at the top of the Eskenazi Hospital
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Careers & Training
By Shari Held
New NICU reduces stress, increases benefits Just a few weeks ago, the Level IV neonatal intensive care unit at Riley Hospital for Children at IU Health settled into new quarters on the Simon Family Tower’s fourth floor. The move is the culmination of more than three years of planning by hospital leaders, physicians, nurses and patients’ families. The old NICU’s open-room concept grouped eight or more babies together. Now, Riley patients enjoy private rooms. All 60 rooms offer sleeping accommodations for parents and room for families to gather. The unit also has comfortable lounges, with extra areas designated specifically for patients’ active siblings. The NICU is much more spacious, too, growing to 52,000 square feet from a mere 15,000.
Tiny patients, big benefits The improved design will greatly impact Riley’s smallest patients. “The older model had a higher level of stress consistently because of the noise, lights and acute intensive care activity,” said William A. Engle, MD, medical director. The private rooms now give parents and families better opportunities to interact with their babies -- and that change alone should yield positive long-term results. “We’re hoping that increased interaction will translate to a shorter length of stay and increased familiarity with the care their baby will need at home,” Engle said. “We also hope more frequent interaction during the hospital stay will optimize babies’ development.” The NICU’s nursing staff find that the new environment removes some of the physical and emotional strain from a typical workday. Nurses say they haven’t been as emotionally exhausted by the end of a shift.
Input for impact The nursing staff played a key role as the new NICU was being designed and built. They anticipated how workflow would change in a private-room
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environment, and their input was incorporated in the design. An advantage of the former openroom concept was that nurses and other caregivers could see and help each other. “We wanted to duplicate that because it provides comfort, security and community for the staff,” Engle said. As a solution, the NICU rooms’ windows and doors are positioned to give nurses, respiratory therapists and physicians a clear sightline. With this format, they still can see and interact with one another even as patients’ families can enjoy more privacy.
New additions The new NICU has abundant space for more amenities, including the
state’s first high-tech milk lab. Here, technicians can fortify a mother’s breast milk to meet her baby’s unique dietary needs. Milk also can be frozen, stored and marked with a custom barcode. Trained lab technicians ensure the consistency of fortified breast milk. That task previously was performed by nurses, who are now freed up to focus more exclusive on their tiny patients. The NICU’s new simulation room has a camera which enables staff members to participate in in-situ education and simulation programs, such as resuscitation and stabilization techniques and admission procedures. “Having a simulation program of education in place gives all of us an opportunity to fine-tune our skills before an actual event occurs,” Engle said. ●
Tiny transports As Riley Hospital for Children at IU Health prepared to open its brand-new NICU in June, the staff faced a logistical challenge. The unit’s patients — 38 tiny, fragile babies — had to be transported one by one from the old unit to a much larger space on the fourth floor of the hospital system’s Simon Family Tower. The important feat was accomplished in six hours thanks to a capable team of dedicated caregivers. Each of the sickest babies required up to 10 caregivers to safely traverse the blocklong route. When the first team arrived at the fourth-floor elevator, another team began moving the next baby. “We slowed down for a very little bump,” said Colleen Myers, RNC-NIC, BSN, clinical manager. “We watched the baby’s vital signs the entire time to see how the baby was tolerating the move. We took our time because we wanted to make sure it was safe.” Many of NICU nurses had experienced moving with other units in the past. Staff members began additional rounding three days before the move to identify potential risks for each patient. A simulated move — which involved beds, ventilators, equipment and staff but not the babies — allowed them to determine the best route. Two weeks before the move, parents were informed about the precautions being taken. “This helped a lot,” Myers said. “By the time the day The NICU is staffed 24 hours a day by a specially trained team came, they were ready of doctors, nurses, and other caregivers who provide the most and excited about the new advanced and comprehensive care for newborns and infants space.” with medical or surgical problems. • Autumn 2013
By Holly Wheeler
Careers & Training
specialty for a special
A skilled
kind of nurse
The practice of skilled nursing used to be devoted specifically to elderly individuals. Today, the specialty includes a broader range of patients with medical needs that can be met only by skilled nurses. Often, nurses in this field work in dedicated facilities, providing care for chronically ill, elderly and long-term rehabilitation patients. As the nation’s 78 million baby boomers continue to age, the demand is increasing for qualified workers — which points to skilled nursing as a career opportunity with long-term potential. Job responsibilities may include intubating patients, caring for wounds and managing tracheotomies and mechanical ventilation. Nurses may be called upon to care for patients who live at home or in health care facilities. “We hire RNs, LPNs, CNAs and QMAs,” said Ryan Gwaltney, RN, director of health services for Prairie Lakes Health Campus in Noblesville. “In long-term care, the biggest skill you need is time management. There are a lot of residents to care for. You’re also a charge nurse, so you have to have leadership skills to manage the CNAs under you.” Within skilled nursing facilities, nurses are supported by the full gamut of care providers: CNAs, physical and occupational therapists, respiratory therapists, speech and language pathologists, dietitians and social workers. All work together to provide for patients’ total health needs. These
facilities typically provide full-time care for people who have critical illnesses or require rehabilitation, psychiatric care or substance-abuse services. To deliver optimal care, staff members must be SHUTTERSTOCK adept at openly communicating with all members of the patient’s team.
Seeking special specialists Many skilled care nurses work with patients who are not able to communicate their own needs. These sensitive situations require attention from a special kind of person – one who is caring, patient and committed to understanding and serving the most vulnerable individuals. “We look to our direct patient care staff, who see the patients each day, to find out if there are changes to the patient’s behavior,” said Janean Kinzie, director of patient services for Indianapolis-based American Senior Communities. “When patients are not responsive or have dementia and can’t necessarily communicate their needs directly, it’s really important for the patient care staff and the social services staff to communicate and be aware of those changes.” Skilled care nurses need to be able to confidently take the lead in serving patients. In memory care units — where patients have diseases like dementia or Alzheimer’s — the work tends to be the most physically and mentally challenging, but also the most rewarding. “Nurses have to have a level of patience. They have to understand the disease process and act accordingly,” Gwaltney said. “You can’t ever argue with a patient; you have to be in their world. A lot of people can’t do it. It takes a very special person.” ●
Listening for the patient’s voice Every good nurse serves as an advocate for patients. In skilled care circumstances in particular, nurses may be challenged to understand a patient’s needs, let alone work to meet those needs. That’s why skilled care nurses must have specialized training and be good communicators. “When we have a patient who isn’t in a position to communicate their needs, we rely on the patient’s family to help us know that patient,” said Janean Kinzie, director of patient services for American Senior Communities, headquartered in Indianapolis. Kinzie urges family members to talk to nursing staff members about their loved one, making known his or her likes, dislikes, personality and preferences. “We pay special attention to changes in the patient’s disposition and eating habits, because they can be indicators of something that needs to be addressed,” she said. Skilled care nurses may even become the primary person who best understands the patient. Those who are called to this field have a tremendous opportunity to impact the patient’s comfort, well-being and quality of life. “As the individuals who are often most familiar with patients at the time they are under our care, our nurses are a voice for residents, helping them reach their health care goals,” said Alaina Butiste, HFA, executive director of Miller’s Senior Living Community in Indianapolis. There, nurses work not only with patients, but with families and all ranks of medical professionals involved in the person’s care. “We look for nurses with strong clinical skills and compassionate hearts who have a genuine interest in the senior population,” Butiste said.
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Your World
By Julie Young
Taking a stand Michael Jordan knew that good footwear had to be functional. Carrie Bradshaw believed it should be fashionable. Today’s nurses want the shoes they wear for long hours at work to be both.
Style meets comfort
1 shoe brand among teachers and nurses who are on their feet all day. Originally designed for the equestrian community, the shoes are now known for their good arch support and comfort during long periods of wear. Most Dansko shoes resemble clogs and have a low back. “They fit differently than other shoes, and they don’t cause blisters because they slip a little,” Mosser said. “On first glance, they don’t look like much and they can be a hard shoe for nurses to buy into at first. But once they’re on, nurses realize that it’s not only a comfortable shoe, but an attractive one as well.”
Nurses work shifts of eight to 12 hours at a time. When their feet begin to hurt, said Marci Jones, RN, BSN, MSN, MBA, clinical director for surgical services at Community Health Network, the whole body hurts. For a pain-free day on the job, nurses need shoes that are comfortable, supportive, durable and attractive. At what price? “Sometimes I feel a little like Mister Rogers changing in and out of my Nurses understand that good shoes shoes at night. People laugh at the are an investment in their career and amount of shoes I have under my desk, but when you wear blue scrubs all the time, your shoes are really the only way to add style and flair to the wardrobe,” she said. Some hospitals specify the types of shoes nurses can wear in clinical settings; others are more flexible. Indiana University Health requires Under her desk, Jones keeps five or more pairs of shoes, from flip flops and nursing clogs, to lace-up sneakers and flats. nurses to wear solid black shoes, while Community Health Network and St. in their own health. Allison Tann, BSN, Vincent Health stipulate only that RN, CEN, a night shift coordinator shoes be a solid material and have a for the emergency department at IU back. Health Methodist Hospital, said her Depending on their workplace shoes cost $100 to $120. parameters, nurses may opt for high“It’s not easy to find an all-black end athletic shoes by Nike or Reebok, women’s Nike. If you’re looking for a while others prefer specialized brands specific athletic shoe, in many cases like SAS, Naot and Dansko. they have to be special ordered,” Tann Bobby Mosser, of Englin’s Fine said. “I do wear Dansko Mary Janes, Footwear, said Dansko is the No. which work out well and are kind of
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cute, but they’re costly as well.” A sturdy shoe with the proper fit is worth the higher price tag, she said. Many manufactures are making strides to offer shoes that meet nurses’ work needs while showcasing their personal style. “We always keep an eye out (for new options),” Tann said. “I am on my feet at least 40 hours a week for 52 weeks a year, and we don’t have the time to have sore feet.” ●
If the shoe fits: Your foot’s best friend Gary Goodman, owner of Goodman’s Shoes in Nora, said customers who are nurses prefer Dansko, a slip-on shoe embraced by doctors and nurses. “They fit like a clog, and they have a back to them and a built-in arch support, which makes them comfortable when standing on your feet for long periods of time,” he said. “We also sell a lot of the European comfort lines, such as SAS and Naot.” What do you wear? “I wear Dansko and Alegria. One pair looks like disco balls, while the others have skulls embossed into them. They are super comfortable,” said Jolie Abel, RN, St. Vincent emergency department. “I wear New Balance and Nike. I wait for a coupon and try to catch them on sale, when they’re more affordable,” Jennifer Howell, RN, of the KidsExpress pediatric clinic.
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Your World
By Jen Bingham
Kathy Staples has a lengthy list of credentials, including MBA, BSA and RN. Plus, she recently became a patientcentered medical home Certified Content Expert, a designation given by the National Committee for Quality Assurance. Staples was among the first group of medical professionals to receive this status, which equips her to help facilities earn recognition from the NCQA.
with
Kathy Staples
MBA, BSA, RN
Below, Staples described her role as the PCMH operations manager for Community Physician Network. Q: What is a patient-centered medical home, or PCMH? A: The patient-centered medical home is a way of delivering care. It’s a model of primary care that focuses on the clinician–patient relationship.
Your primary care office is like your traffic control. It’s your home base, so they know you on a personal level. When you need care outside of that practice, they coordinate care with specialists, make an appointment for you and get you the care you need. This form of care creates a long-term relationship that should result in more personalized service. The patient gets care he needs when he needs it in a way he can understand. It’s really all about the patient now.
Q: What are the goals of PCMHs? A: We want our patients to get the best care we can give them. Some insurance companies are beginning to pay based on outcomes, and this seems to be where health care reform is going. The (PCMH) care model helps patients stay well, and if they have chronic conditions we help them manage them better.
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Your World
We’re still collecting information and looking at outcomes, but early studies indicate that this kind of care is helping.
Q: What is your role as a PCMH operations manager? A: I work with the Community Physician Network, which is an arm of Community Health Network. It consists of the employed physicians group — a large multispecialty physician group. I work with primary care practices to develop a patient-centered model of care using the NCQA guidelines to follow the PCMH delivery model. My role is to help the practices achieve NCQA recognition. Q: What’s your nursing background? A: I’ve been an RN for 35 years. A majority of it has been in ambulatory care settings in corporate and not-forprofit organizations. I’ve worked within the Community network for around 20 years with a few breaks. I have served in director roles in a variety of mostly outpatient service departments, including primary care practice management, occupational health, urgent care, community education, diabetes education, bariatric services, wound care and sleep centers.
Since 1999, I have been a Six Sigma Black Belt and worked on many different process-improvement projects over the years.
Q: What improvements are possible with the PCMH model? A: Better access. Patients are able to get appointments on the same day. We have a role within our practices called “nurse care managers.” These are embedded care managers within the practices who help patients manage chronic conditions like diabetes. They also want to keep the well healthy.
Nurse care managers are focused on developing relationships. My mom has a nurse care manager at her doctor’s office who calls her, asks about transportation needs, reminds her when she has appointments and helps hold her hand.
There’s a parallel program in hospitals called transitional care nurses. When the patient leaves the hospital, that transitional nurse calls to talk with the nurse in the practice who’s going to take over care. They discuss what’s going on with that patient — the successes, next steps, how the families are involved. We don’t want anything dropping through the cracks.
It’s so easy for patients to get conflicting information. Or a patient doesn’t understand the instructions, which leads to errors. We look for a more coordinated effort. ●
Putting patients first The concept of patient-centered care is a rising star in the health care field. Where past approaches tended to focus more on clinicians’ needs and knowledge, the patient-centered model is designed to enhance the care recipient’s experiences. The idea is not to focus so much on meeting patient demands, but on balancing the needs of care providers and recipients. In patient-centered care, a chief goal is to give patients more access to information. Naturally, technology plays a critical role in organizing and disseminating data. “It wouldn’t be possible without electronic medical records,” Staples said. Another goal is to encourage patients to “own” their care so they can make wellinformed decisions with confidence. The model calls for care to be coordinated in one central spot, to keep patients from undergoing repetitive tests or receiving conflicting instructions.
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