Transformational Leadership
Joan Simon, CNO
Joan Simon, CNO Opening Thoughts
Our 2015 Nursing Annual Report highlights many amazing contributions by our nurses and inter-professional team members. 2015 was a busy year as we completed our Magnet re-designation document, prepared to move into our new patient care wing, opened the rapid decision unit for observation patients, and began serving patients in the new Northern Idaho Crisis Center.
New leadership positions, the designated charge nurse and clinical coordinator, were implemented to create more support for frontline staff and improve reliability of care. We also created the patient engagement specialist role to oversee patient education materials, optimize the use of our interactive patient system and assist our nurses in fully engaging our patients and families in care. The Professional Development and Continuing Education Council sponsored many clinical nurses so they could travel to national conferences. Many returned with energy and innovations to implement here at Kootenai. The research council approved four new studies and assisted nurses with two podium presentations, six poster presentations and one published article. They also kicked-off “Sparking Innovation,” an things, I inter-professional journal club that has been well-attended.
Our nurses initiated many best clinical practices: reduction in restraint usage by our critical care nurses, the launch of a behavioral response team and the implementation of the “golden ticket to ride” for safe patient transition through surgery. Operating room nurses also demonstrated top-oflicense practice by assuming responsibility for applying surgical tourniquets. Nurses Among all were instrumental in a big improvement in am most proud of hand hygiene compliance as well as reductions in hospital-acquired conditions such the way our nurses as catheter-associated bloodstream and urinary tract infections, patient falls, and continually live our hospital-acquired pressure ulcers. Among values of Safety, all things, I am most proud of the way our nurses continually live our values of Safety, Compassion and Compassion and Engagement.
2016 will be an exciting year for Kootenai nurses as we prepare for our Magnet site visit, begin extensive remodels of the emergency and surgery departments and continue the adoption of GetWell, our Interactive Patient Care system.
Engagement.
With the Professional Nursing Council (PNC), we advanced our nurses’ contributions to the organization with a three-year strategic plan to support Kootenai Health’s strategic plan. The PNC’s work to enhance the practice environment is reflected in improved scores in all Gallup q 12 domains and in the National Database for Nursing Quality Indicators (NDNQI) overall score, which outperformed the Magnet hospital mean. Clinical nurses are now involved in developing a Clinical Advancement Program that rewards and recognizes nurse contributions to their profession and patient care. In collaboration with North Idaho College and our Northwest Hospital Alliance, we began Nursing Grand Rounds, a first at Kootenai. Additionally, in partnership with Washington State University, Kootenai Health presented a regional symposium educating nurses about the evolving role of nurse navigation. 2
I would like to thank our nurses for their extraordinary efforts. Without them, we would not be able to fulfill our mission and vision for Kootenai Health. I would also like to thank our hospital board and administration for their ongoing support of nursing services, without which we would not be able to provide our high standard of nursing care to our patients. Most importantly, I would like to thank our patients and community for trusting us to care for them when they are most vulnerable; it is our honor and our privilege.
Joan Simon, MSA, BSN, CENP, NEA-BC, FACHE Chief Nursing Officer
Noteworthy Awards for 2015: Joan Simon Joan Simon, Chief Nursing Officer, was awarded the Women of Distinction Award for Healthcare by the Soroptimist International of Coeur d’Alene on Nov. 20. Founded in 1948, the Soroptimist International of Coeur d’Alene works on many projects that benefit women locally and globally. Simon was recognized for exceptional leadership focused on patient safety.
Noteworthy Awards for 2015: Amy Ward Amy Ward, BS, BSN, RN, CIC, was named “Inspiring Nurse Leader” for 2015 by the Nurse Leaders of Idaho (NLI) during a ceremony held June 4. In the absence of a department manager, Amy led the Infection Prevention department through the annual compliance survey conducted by DNV-GL without Amy Ward, BS, BSN, any citations, implemented a manRN, CIC datory influenza vaccine policy and established Kootenai Health as a CDC-designated Ebola assessment facility (still the only one in the state). Amy was praised as courageous, not afraid to ask questions and professional at all times. NLI advances nursing
leadership, practice and education through networking, workforce development and health policy advocacy. The following Kootenai Health nurses were also nominated for NLI awards in 2015: Chad Bailey, Molly Walker, Zach Lorenz, Linda Stewart, Linda Heise, Mary Sweeney, Ashley Miller, Adam Wabs, Colleen Zwiers, Sheri McIlvain, Sandra Albritton and Robin Beard.
Charge Nurse Program The charge nurse role at Kootenai Health is a frontline leadership position critical for high-performing teams. The role was redesigned in 2015 with best practice evidence that has emerged across the country. Departments have designated charge nurses who help to ensure continuity of care and meeting strategic goals at the unit level that are in line with organizational goals. Kootenai believes this investment in our frontline leaders will provide charge nurses the opportunity to develop more leadership skills, which will allow them to take on a more active role in overseeing quality, safety and patient satisfaction on their respective units. This role also offers an opportunity in succession planning for future leadership in the organization.
Kootenai believes this investment in our frontline leaders will provide charge nurses the opportunity to develop more leadership skills. Northern Idaho Crisis Center (NICC) Opens: A Much-Needed Resource Northern Idaho residents face many mental health challenges, including the highest suicide rate in the state and limited access to behavioral health providers and services. Now there is another resource for those experiencing acute mental health and substance abuse issues. The crisis center officially opened Dec. 9 and has seen over 250 clients (as of March 2016). Open 24 hours a day, 365 days a year, the crisis center provides a warm, safe environment where individuals experiencing a behavioral health crisis can be stabilized and receive recommendations for their next level of care. The center can accommodate up to 20 adults. All services are voluntary, and clients can stay for up to 23 hours. The center is a result of over two years of collaborative work by Kootenai Health employees such as Claudia Miewald, Director of Behavioral Health; Heritage Health; law enforcement agencies; the Panhandle Health District; Idaho Department of Health and Welfare; and the Kootenai County Prosecutor Office. Northern Idaho Crisis Center grand opening: (from left) Don Robinson, Manager; Ben Wolfinger, Kootenai County Sheriff; Jon Ness, Kootenai Health CEO; Claudia Miewald, Ed Spec, MSN, RN, PMHCNS-BC, Director of Behavioral Health; Governor Butch Otter; and Thomas Nickol, MD
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Rapid Decision Unit On Oct. 5, the rapid decision unit (RDU) opened. The goal of the 10-bed unit is to care for observation patients that might normally remain in the Emergency Department (ED) for testing, labs, and other diagnostic work until the patient is discharged home or a need for inpatient admission is determined. The RDU creates more capacity for patients to be seen in the ED, which saw a record 51,000 patients in 2015. The patient’s length of stay is intended to be from 8 to 24 hours. The RDU team consists of 10 registered nurses and 5 certified nursing aides. The nurses who are Advanced Cardiac Life Support trained come from a variety of nursing experiences. Last day of training for Rapid Decision Unit staff prior to opening day, October 2015.
The NICHE approach helps nurses develop plans of care that achieve positive outcomes for older In 2015, Kootenai Health was designated as a NICHE (Nurses Improving Care for Healthsystem Elders) organization, with Paula Wyatt and Kara Baron serving as NICHE Nurse Leaders. Eleven nurses have trained or are currently training to be geriatric resource nurses (GRNs). From left, Christine Abbott, Liz Cameron, Rebecca Glenn, Paula Wyatt, Angela Korver, and Kara Baron. Not pictured: Anna Wiley, Summer Jones, Bo Schramm, Shawntel Calligan, Tonya Alexander, Rose Mulcahy and Lara Jarrett.
adults.
Improving the Care of Older Patients—NICHE Designation In 2015, Kootenai Health was designated a Nurses Improving Care for Healthsystem Elders (NICHE) organization. As part of our commitment to providing patient-centered care for older adults, Kootenai sponsored staff for leadership training and conducted NICHE’s Geriatric Institutional Assessment Profile (GIAP) survey to assess knowledge, attitudes and perception of elder care. The survey results provided a baseline of our current knowledge and practice, and will help guide the NICHE steering team in developing evidence-based, inter-professional plans of care that achieve positive outcomes for older adults. As part of NICHE designation, Elizabeth Cameron and Christine Abbot have completed NICHE’s rigorous 20-hour geriatric resource nurse (GRN) education, and nine nurses are engaged in the certification process: Anna Wiley, Bo Schramm, Angela Korver, Summer Jones, Tonya Alexander, Rose Mulcahy, Rebecca Glenn, Lara Jarrett and Shawntel Calligan. 4
Patient Experience Challenge: Increasing Communication With Nurses The quality of nurse-patient communication profoundly influences the patient’s experience while sick and hospitalized. Communication with nurses is measured as part of the mandatory HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey. The communication with nurses score has been found to correlate closely with overall patient satisfaction. The category consists of three questions: ◗◗ How often did nurses treat you with courtesy and respect? ◗◗ How often did they listen carefully to you? ◗◗ How often did they explain things in a way you can understand? Each respondent can answer Never, Sometimes, Usually and Always. A “top box” response is an Always answer. Starting in April 2015, a house-wide patient experience challenge started. One question related to nursing communication was chosen for each unit. Current data was reviewed in the morning staff huddles every Monday and Thursday, providing each unit a chance at rewards. As a result of this work, during 2015, Kootenai Health was able to increase the number of patients who gave top box responses to the three questions about communications with nurses.
% of top box response
Patient Satisfaction With Communications With Nurses 80 79
% top box response
78 77 76
CMS average
75 74 73 0
Trend
4 Qrtr 2014
1 Qrtr 2015
2 Qrtr 2015
3 Qrtr 2015
4 Qrtr 2015
Robert Mendenhall, RN, submitting the Magnet documentation Feb.1, 2016.
Electronic Magnet® Document Submission Kootenai Health submitted our third Magnet® designation document on Feb. 1, 2016. Compiling evidence demonstrating compliance with 69 standards involved 20 writers from all around the organization. Assigned Magnet appraisers are currently reviewing our document. During 2016, the team of Magnet champions will be providing education to all staff in preparation for an appraiser site visit/site celebration later this year. A special thank-you to the writing team!
Structural Empowerment
First Certification in State: Kiira Tietjen, MS-Certified Nurse
Kiira Tietjen, BSN, RN, MSCN
Kiira Tietjen, BSN, RN, MSCN, clinical navigator for the Kootenai Neurology Clinic, is the first Idaho nurse to be certified as a multiple sclerosis certified nurse by the Multiple Sclerosis Nurses International Certification Board. This certification represents competency in caring for clients with multiple sclerosis in the areas of clinical practice, advocacy, education and research. Stress can exacerbate symptoms of multiple sclerosis, so having a knowledgeable resource for individuals in an acute phase of illness can significantly reduce the amount of time to return to baseline. Kiira is set to receive her doctor of nursing practice degree from Rush Presbyterian University in May of 2016. 5
Providing a Voice Through PFAC
Patient and Family Advisory Councils (PFACs) are a best practice at hospitals across the country. In a continued effort to better serve our patients and our community, Kootenai Health formed its first PFAC in 2015, led by Paula Wyatt, MA, BSN, RN, Nurse Manager. The council serves in an advisory capacity and makes recommendations that influence the experience of patients and families. Council members have engaged with Kootenai Health staff in projects that have improved the patient and family experience in many ways: ◗ Patient Welcome Guide and Welcome Video: members reviewed and made recommendations to improve the guide and video ◗ Patient Portal: changes were made to make it more user-friendly ◗ Heart Clinics Northwest: educational materials given to new patients were reviewed ◗ GetWell :) Network®: Changes and additions were made to the Interactive Care Boards
From left, Charlie Linder, Sean Brannigan, J.T. Thompson, Joey Buckner, Liese Razzeto, Kalimae Blenkle, Julie Levine and George Rohlinger. (Not pictured: Jeff DeSmet, Bill Watt, Lynn Lauer)
Promoting Patient Engagement—Interactive Patient Care Boards
A growing body of evidence demonstrates better outcomes when patients are active participants in their care. Kootenai’s nursing belief statements say, “We believe in including patients and families as active participants in care, holistically integrating their unique needs into our plans and treatments.” In 2015, Kootenai Health made a significant investment in a new technology to promote patient involvement. The Get Well Network features an interactive care board that allows patients to communicate with caregivers, order meals, watch educational videos, access information about their medications, and more. Before committing to the investment, a team of staff nurses and leaders accompanied Joan Simon, CNO, on a site visit to determine whether these interactive patient care boards would be a good choice for Kootenai Health. Julie Hoerner, MA, BSN, RN, was selected as Kootenai’s first patient engagement specialist. A key part of her role is promoting effective use of the system. Initially installed in Kootenai’s east expansion, the interactive care boards will soon be placed in most inpatient rooms.
Navigator Symposium: Leading the Way for the Future of Nursing Patient navigation is an emerging field within nursing. Nurse navigators are filling gaps in the current U.S. health care system by providing one-on-one guidance and assistance to individuals as they move through the health care system. Navigators typically help patients with financial, communication, medical system, psychological and social service barriers. Recognizing the importance of this emerging role, Kootenai Health nurse leadership collaborated with Washington State 6
University’s School of Nursing to host the first Northwest Patient Navigator Symposium targeted at both nursing students and registered nurses. The event was held on the WSU campuses in Yakima, Vancouver and the Tri-Cities. The symposium featured a presentation by nationally recognized nurse navigator Cynthia Cantril, MPH, RN, OCN, who later joined in a panel discussion featuring several of Kootenai Health’s nurse navigators: Chad Bailey, Debbie Callins, Luke Emerson, and Mary Hander. Over 50 nurses and nursing students attended the conference.
Keeping Idaho Patients in Idaho: Helping New Families In 2015, 44 premature newborns and their families were sent to Washington hospitals due to a lack of room in the nursery or because the baby required a higher level of care. Collaborative planning by nurses, physicians and architects resulted in the opening of the new Family Birth Center on March 15, 2016. Our one-room nursery capacity for sick babies grew to 12 individual rooms accommodating up to 14 babies (two rooms are equipped for twins). The American Academy of Pediatrics defines four levels of neonatal care. Level I—well newborn care for neonates who are low risk; >= 35 weeks’ gestation Level II—stable or moderately ill newborn Mara Thorhaug, of Coeur d’Alene, feeds her baby Helen, the first infant to be treated in infants >= 32 weeks’ gestation or who weigh Kootenai Health’s new neonatal intensive care unit. >= 1500g completed over 80 hours of education. Maternal fetal Level III—infants < 32 weeks’ gestation, < 1500g medicine is a subspecialty recently added to assist in Level IV—same capabilities of Level III with pediatric managing these moms. NICU nurses and respiratory medical and surgical specialties available 24/7 therapists spent time at Level III/IV facilities, including a Mayo Clinic hospital, getting hands-on experience. Currently, the Kootenai Health Neonatal Intensive Imaging, lab, nutrition, lactation, pharmacy and infecCare Unit (NICU) is a Level II nursery. Over the past tion control have all been planning for the special care six months, planning, education and training has been considerations of smaller babies. Social Services and the carried out to move to a Level III. This will be a journey, but our first stop will be July 1, 2016, when the developmental follow-up clinic have readied to ensure nursery will be ready to accept babies >= 28 weeks and these newborns have the support they need when they >=1000g. go home. Finally, our NICU team will soon begin having outreach meetings with other hospitals to support them Expanding our level of service involves many departin the care of healthy newborns and share how Kootenai ments. Labor and delivery interprofessional staff have Health can support them with their babies in need of prepared to take on high-risk deliveries. All labor nurses more acute care.
Creating Change and Growing Nurse Leaders: CIT on 2 South 2 South joined the Care Innovation and Transformation (CIT) collaborative in 2015, which helps health care organizations improve patient care, hospital performance and employee satisfaction. Requiring a rigorous application process, Kootenai’s 2 South Surgical Unit is now part of a national cohort of 10 other units located throughout the nation that will last a total of 2 years. These units meet monthly via conference calls, online webinars and a CIT listserv. Administered by the American Organization of Nurse Executives (AONE), CIT helps to teach staff how to brainstorm new ideas, track those ideas and measure the change in the unit’s experience. During 2015, 2 South started trialing an RN buddy program and a decreasing clutter program. By providing resources to staff to make changes from the ground up, Kootenai is also investing in the future of Kootenai Health by growing our future nurse leaders. The 2 South cohort is represented by Amy Maykuth, Rebekah Letro, Michael Lambott, Kim Kraack, and Trisha Nielsen.
The CIT collaborative helps improve patient care, hospital performance and employee satisfaction.
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Welcome to Kootenai’s First DNP
Nursing Grand Rounds will
Bart Brinkman earned his first nursing degree from North Idaho College (NIC) in 2007, after completing his preceptorship in the Progressive Care Unit here at Kootenai. Dual-enrolled during his senior year, he completed his bachelor of science in nursing degree in 2008. While Bart went on to work with other facilities, he maintained contact Bart Brinkman, BSN, DNP with Kootenai as a clinical instructor for WSU, instructing the first Kootenai clinical rotation. In addition, he worked as a clinical instructor for NIC students coming through our organization. He earned his doctorate of nursing practice (DNP) in the spring of 2015. We are excited to welcome Bart as a nurse practitioner to Kootenai Heart Clinics Northwest in the Spokane office.
be presented quarterly with the intent of improving and standardizing patient care throughout Northern Idaho.
Inter-Professional Rounding In November of 2015, 2 North (a medical/surgical unit) Nursing Manager Paula Wyatt, MA, BSN, RN, directed the launch of inter-professional rounding, coordinating patient planning at the bedside with physicians, nurses, case managers and pharmacists. This allows all specialties with the necessary knowledge, skills, and experience to collaborate as a team to discuss optimal treatment outcomes, review the plan of care, and evaluate discharge needs of patients with an emphasis on improving quality of care and patient satisfaction. 2 North will use their experience to fine-tune the process to prepare launching in other units.
From left: Susan Serrato, Nurse Case Manager; Christine BrooksTrevino, Nurse Case Manager; Elizabeth Cameron, Charge Nurse; Julia Sawyers, RN; Dr. Kreps, Hospitalist; and Jolie Jantz, PharmD participate in inter-professional rounding on 2 North.
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Carlana Coogle, MSN, RN, CEN, presenting at the first Nursing Grand Rounds.
Nursing Grand Rounds Supporting the Kootenai Health Vision On Nov. 9, Kootenai hosted the first Nursing Grand Rounds for a diverse and enthusiastic group of nurses and other professionals. This inaugural event was a collaborative effort of North Idaho College School of Nursing and the Northwest Hospital Alliance. It was held live at Kootenai and broadcasted to Bonner General Hospital, Shoshone Medical Center, Benewah Community Hospital, and Boundary Community Hospitals. The presentation featured an actual head trauma case and included an ingenious “cauliflower brain” made by Kootenai educator Carlana Coogle. Others involved in planning the event were Claudia Miewald, RN; Greg Manning, RN; Jennifer James, Chaplain; Erlene Pickett, RN; Nicole Walters-Pickarski, RN; and Tari Yourzek, RN. Nursing Grand Rounds will be presented quarterly with the intent of improving and standardizing patient care throughout Northern Idaho. Each case review will feature a patient transferred from a Northern Idaho hospital to Kootenai Health. The rounds are an opportunity for exploring best practice care for identified populations and for identifying opportunities for improved communication and collaboration.
Exemplary Professional Practice
Making a Difference in 2015: Hand Hygiene
2015 Kootenai Health Hand Hygiene Compliance
100 Proper hand hygiene is 88% key to preventing hospital82% 81% acquired infections. Like many 80 73% organizations, Kootenai 71% 67% 67% Health struggled to perform 65% 65% 64% hand hygiene before and 60 after patient contact. Infec53% 49% tion Prevention nurses led 46% initiatives to boost perfor40 mance. After gathering staff input on multiple handwashing products, a new product 20 was introduced in October 2015. Now, a hand hygiene audit is conducted daily 0 on a random unit and the Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 results are reported at Daily Check In, where hospital leaders discuss safety issues. Handwashing education Overall, the Hand Hygiene compliance rate rose material for patients is also now available on the interac- from 65 percent in January 2015 to 88 percent in tive patient boards. January 2016.
Patient Safety: Reducing the Use of Non-Violent Restraints
500
Average Restraint Time (Hours)
The Critical Care Nursing Unit Practice Council addressed a national patient safety goal in 2015 by reducing the use of nonviolent restraints. Through evidence-based practices such as proactive rounding and reducing light and noise levels, the average time was reduced over 100Â hours for 2015.
Non-Violent Restraint Rate in Critical Care Total Restraint Time/Restraint Count
400
Average rate for 2014
300 Average rate for 2015
200
100
0
Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 June-15 July-15 Aug-15 Sep-15 Oct-15 Nov-15
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Update BRT Alert
Reduction of CAUTI and CLABSI Housewide
Sometimes medical– surgical nurses are uncomfortable caring for patients with behavioral health diagnoses. The behavioral response team, or BRT, was implemented in 2015 to address the high volume of behavioral health patients being cared for in these areas. This program allows staff members who do not work with behavioral health issues frequently to call experts to consult on best practice or to call an alert requiring an immediate response. The BRT began in April and by the end of the year had responded to a total of 15 alerts and 18 consults. A charge nurse from behavioral health, a licensed social worker, and security respond to each BRT alert.
Urinary catheters and central line devices provide an avenue for infections. Catheterassociated urinary tract infection (CAUTI) and central line-associated bloodstream infections (CLABSI) can increase length of stay, require additional antibiotics, increase hospitalization costs and cause patient suffering. For a given population, there is an expected number of these types of complications. Standardized infection rates indicate whether we have more or fewer infections than would be expected, with a number over one being more than expected and a number under one being less than expected. For the four quarters of 2015, both CAUTI and CLABSI numbers were below 40 percent of the expected number of infections. The use of the nurse driven urinary catheter protocol, the alcohol impregnated Curos© green caps for central1 lines, and the use of Vascular Access Team nurses to maintain central line dressings have all helped to keep CAUTI and CLABSI rates low for 2015. .8
Standardized Infection Ratio
CAUTI and CLABSI rates—Kootenai Health .6
.4
.2
0
0.373
0.35
instruction helped Emergency Department nurses improve their ability to assign ESI scores accurately— increasing from 63 percent to 85 percent in one month.
10
0.226
0.183
0 Q1 2015
CAUTI
Individualized
0.209
0.197
Q2 2015
0 Q3 2015
Q4 2015
CLABSI
Can It Really Be This Easy? Emergency nurses triage every patient presenting to the Emergency Department (ED) based on the Emergency Severity Index (ESI). Accuracy in assigning an ESI score enables ED nurses and physicians to provide the right amount of resources to each patient. Carlana Coogle, MSN, RN, CEN, ED educator, audited 175 patient charts over one week to determine the accuracy of ESI scores. She found that nurses correctly assigned the ESI score 63 percent of the time. Emails were sent to nurses bi-weekly for one month with patient scenarios asking the nurse to assign an ESI score. Nurses could obtain the correct answer by emailing the educator back. Using this technique allowed the educator to give individualized instruction to staff. A post-intervention audit was conducted following the same sampling method for one week, and accuracy had increased to 85 percent. The number of inaccurate ESI scores surprised nurses, leading to many conversations and questions among co-workers. Carlana continues to use vignette examples and email follow-up to further strengthen ESI accuracy in the ED.
85
%
63
%
Nursing Strategic Plan: Road Map for the Future Professional Nursing Council members spent the bulk of 2014 revising our professional nursing practice model, developing belief statements and writing/approving bylaws. On March 6, this group spent a retreat day with nursing leadership to begin development of a strategic plan to guide nursing services through at least 2017. Care was taken to closely align the plan to the Kootenai Health strategic plan and Kootenai Health values: Safety, Compassion and Engagement. The nursing strategic themes identified in the plan are:
Care was taken to
◗◗ Coordinated Care: Prepare our nurses to improve the health of our community and deliver coordinated care by advancing nursing education and knowledge and developing innovative nursing roles and care delivery models.
Nursing Strategic
◗◗ Healthy Work Environment: Promote a work environment that encourages and supports effective inter-professional communication, collaboration, safety and efficiency. ◗◗ Professional Engagement: Foster a culture that recognizes and rewards professional engagement and clinical excellence. ◗◗ Superior Patient Safety and Experience: Strengthen the foundations of nursing practice in order to deliver superior patient safety and experience outcomes through the implementation of our practice model and by engaging with our patients as full partners in their health.
closely align the Plan to Kootenai Health values: Safety, Compassion and Engagement.
◗◗ Evidence-Based Practice and Research: Integrate evidence-based practice, research, continuous improvement and innovation as core competencies in our daily practice. The PNC endorsed the Nursing Strategic Plan and Nursing Leadership approved it in September 2015.
1 North – Oncology/Nephrology Caring Moments Relationship-based care is at the heart of Kootenai’s professional practice model. In 2015, staff nurses and leaders began meeting to discuss ways to promote caring practices as part of daily work. Christie Koziol, BSN, RN, OCN, and her peers on 1 North highlighted caring by creating, sharing and celebrating “caring moments” on a daily basis. A caring moment takes place when a caregiver intentionally and without judgment connects with a patient. 1N nurses attempt to sit and engage with a patient for a few minutes each day to learn about their needs, beliefs and goals for care. They share successes at change of shift report, support each other in carrying out “caring moments” and track these occurrences on their unit’s quality board.
Launched in 2015, each unit now has a quality board, a communication tool allowing each unit to customize and prioritize their quality projects.
Christie Koziol, BSN, RN, OCN, charge nurse, stands by the 1 North quality board displaying unit statistics and caring moments.
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New Knowledge, Innovations, & Improvements
Recognizing Excellence in Nursing Research The first annual New Knowledge, Innovations & Improvements Award was given to Behavioral Health Team members Claudia Miewald, MSN, RN, PMHCNS-BC; Sheri McIlvain, MA, BSN, RN-BC; Brandee Lawhead, BSN, RNC; and Crystal Lederhos, MS, for excellence in nursing research. Among the four members, they have conducted, published, and nationally presented three research studies. These studies focused on improving outcomes for behavioral health patients and the staff that care for them. Joan Simon, CNO, presented the award to the team on Nursesâ&#x20AC;&#x2122; Day, May 6.
Igniting the Spirit of Inquiry Nurses from the Nursing Research Council launched a new platform for sharing information across disciplines and departments called Sparking Innovation. Designed similarly to a journal club, Sparking Innovation goals are to raise awareness about internal and external research to evaluate best practices and in addition, to provide an opportunity for presenting internal projects and studies that have been accepted to external organizations and conferences. Sessions provide information on a variety of topics from diverse sources such as Pharmacy, Nutrition, Nursing, Behavioral Health, Infection Prevention, and faculty from our academic partners. Sparking Innovation also collaborates with the employee wellness program to address urgent staff health concerns such as fatigue and substance abuse.
Evidence-Based Practice: Translating Research into Practice A hallmark of a MagnetÂŽ designated facility is performing nursing research. However, without translating that research into practice, no benefit is realized by patients or nurses. Integrating best practices by performing EvidenceBased Practice (EBP) Projects completes the circle of asking and answering important clinical questions. EBP/ Research Champions, nurses, staff members and managers implemented numerous projects, including: Proactive rounding, C-diff reduction, patient education, and fall assessment. One great example in the operating room was nurse-applied pneumatic tourniquets. This OR interprofessional project allowed nurses to practice at the top of their license by increasing their skill set to include the application of pneumatic tourniquets. The OR Unit Practice Council examined the literature, standards, legalities and policies, and then reached consensus to assume this procedure as a nursing responsibility. This project exemplifies evidence-based practice in action.
Enhanced Recovery Pathway During 2015, nurses on the 2 South Surgical Unit implemented the Enhanced Recovery Pathway (ERP), an evidence-based best practice for patients undergoing elective colorectal surgeries. To prepare for ERP, the team visited a Mayo Clinic hospital. Through the reduction of opioid medication usage via multimodal pain control, early and frequent ambulation, early oral intake, and through changes in anesthesia, the average length of stay of elective colorectal surgery patients fell to 2.2 days for November and December 2015. Lessons learned during 2016 will be used to provide care to additional populations for ERP.
Translating nursing research into Deb Callins, RN, explains evidence-based congestive heart failure information with (from left) John Barlett, RN; Colleen Zwiers, RN; and Antonia Babcock, RN.
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practice benefits patients and nurses.
Kootenai Health Nursing Research Nurses Are Principal Investigators, Investigators, or Key Research Personnel Title: Measuring Outcomes of Stress Management Education on Mental Health Staff Investigator(s): Sheri McIlvain, MA, BSN, RN-BC; Crystal Lederhos, MS; and Josh Burton, RN Research team members: Gio Santovito-Carducci, MPH, BSN, RN, CIC; Whitney Fehringer, RDLD, CHWC; Josh Burton, RN; and Jason Crouse, MS, CHWC Outcome: Poster presented at the national conference for the Western Institute for Nursing, April 2015 Title: Infection Prevention in Physician Clinics Investigator(s): Gio Santovito-Carducci, MPH, BSN, RN, CIC, and Cathy Mitchell, MSN, RN Research team members: Audra Dawson, BSN, RN Outcome: Poster presentation at the national conference for the Association for Professionals in Infection Control and Epidemiology Conference, June 2015 Title: The Effects of Educational Interventions on the Outlooks and Beliefs of Medical-Surgical Nurses Caring for Mentally Ill Patients Investigator(s): Claudia Miewald, MSN, RN, PMHCNS-BC, and Sheri McIlvain, MA, BSN, RN-BC Outcome: Presented at the national conference for the American Psychiatric Nurses Association, October 2015; Abstract submitted and accepted for the Inland Northwest Research Symposium, April 2016 Title: Complications Associated with Midline Catheters Investigator(s): Robin Beard, MS, RN, CRNI Research team members: Susan Hopkins, BSN, RN, OCN, CRNI, VA-BC; Shelly Ward, RN, CRNI; Anita Ward BSN, RN, VA-BC, RN-C Outcome: Poster presented at the national conference for the Association for Vascular Access, September 2015; Poster presented at the VA Nursing Research Day Conference, June 2015 Title: A Retrospective Chart Review of Spinal Anesthesia Dosing in Total Knee Arthroplasty Investigator(s): Sarah Pierce, RN, CRNA Research team members: Wendy deBlaquiere, BSN, RN Outcome: Internal presentation, June 2015 Title: Nurse Fatigue and Errors Related to Length of Shift in the Acute Care Setting Investigator(s): Cory Webster, MSN, RN Research team members: N/A Outcome: MSN degree awarded, May 2015; Internal presentation, August 2015 Title: A Prospective, Randomized Clinical Trial of Two Periarticular Multimodal Drug Injections in Total Hip Arthroplasty Investigator(s): Joe Bowen, MD; Chad Bailey, BSN, MN, RN, FNP, NP-C Research team members: Seth Rosenthal, PA Outcome: In Progress
Evidence-Based Practice Nurses Are Project Leaders or Team Members Title: Improving Emergency Severity Index Score With an Email: Can It Be This Easy? Project leader: Carlana Coogle, MSN, RN, CEN Team members: N/A Outcome: Abstract submitted and accepted to the national conference for the Emergency Nurses Association, September 2016
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Recognition: Acknowledgments/Achievements for 2015 Graduates Christie Koziol Michelle Cook Vanessa Albert Elizabeth Cameron Onalee Crockett Laurie Dutkiewicz Jacqueline Goldworm Angela Gregory Angela Korver Sheila Peine Alyson Peters Sarah Schooley Katie Thompson Anna Wiley Tina Brazill Fran deTar Trisha Nielson Sierra Ramos Bo Schramm Lori Ellis Julie Lowe Amanda Wallace Crystal Vlastelic Whitney Phillips Marina Cuk Lindsey Frew Mike Little Kim Secrist T.J. Tieman Molly Walker Marissa Armstrong Kimberly Hanna Maddy Himmell Kiira Tietjen Danielle Allen Maura Cash Jane Holloway Kathryn Jacobs Deb Kelstrom Julie Leiby Robert Mendenhall Sheena Peters Whitney Webb Rachel Davis Judy Groat
2015 Certification Palliative Care CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN PCCN CMSRN CMSRN CMSRN RN-BC RNC CCRN CCRN CCRN CCRN CCRN CCRN CMSRN CEN CEN MSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN CMSRN Nursing Staff Development
Department Oncology/Nephrology Rapid Decision Unit Medical Medical Medical Medical Medical Medical Medical Medical Medical Medical Medical Medical Surgical Surgical Surgical Surgical Progressive Care Unit Ortho/Neuro Ortho/Neuro Ortho/Neuro Adult Psych Family Birth Center Critical Care Critical Care Critical Care Critical Care Critical Care Critical Care Emergency Department Emergency Department Emergency Department Kootenai Clinics Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Family Birth Center Organizational Development
Kootenai Health is proud to honor the achievements of our nurses in 2015.
14
Graduate
Degree (received in 2015)
Department
Maribee Soverign Julia Sawyers Derek Anderson John Bartlett Lori Ellis Audrey Shinneman Shana Howerton Shana May Elizabeth McLaughlin Kimberly Rickel Marina Cuk Meghan Lorincz Loretta Myers Amy Ward Toni Wells Regena Tolle Eileen Haynes Danielle Allen Wendy DeBlaquire Robert Mendenhall Sheena Ragan Michael Shurtliff Sarah Barnes Melissa Yost Valerie Carpenter Mikel Freeman Stephanie Hammond Lorinda Sims Erika Sullivan Connie Wilson Christina Hatley Michelle Woodworth Tina Rieken Leah Chavez Krista Tickemeyer Luke Emerson Audrey Kuetemeyer Denise White
BSN BSN MA BSN BSN BSN BSN BSN BSN BSN MSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN BSN MSN MSN BSN BSN BSN MSN MSN BSN BSN BSN
Oncology/Nephrology Medical Ortho/Neuro Ortho/Neuro Ortho/Neuro Ortho/Neuro Adult Psych Adult Psych Adult Psych Adult Psych Critical Care Emergency Department Emergency Department Infection Prevention Kootenai Clinic–Hayden Kootenai Clinic–Navigator Kootenai Clinic–Rathdrum Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Nursing Resource Team Family Birth Center Family Birth Center Operating Room Operating Room Operating Room Operating Room Post Anesthesia Recovery Unit Post Anesthesia Recovery Unit–moved to Clinic Pediatrics and Family Care Pediatrics and Family Care Quality Short Stay Short Stay Trauma Youth Acute Youth Acute
Graduate Amanda Maloney Patrick Moorehead William Redican Isaac Regan Troy Serticchio Jerica Gordon Alison Stenson Patrick Sweet
Other Certifications (2015) Mental Health Assistant Restorative Aide Restorative Aide Mental Health Assistant Restorative Aide Surgical Technologist Certified Surgical First Assistant Surgical Technologist
Department Ortho/Neuro Ortho/Neuro Ortho/Neuro Ortho/Neuro Ortho/Neuro Operating Room Operating Room Operating Room
15
Daisy Award Winners Karla Benning, BSN, RN-C Fran deTar, BSN, RN, CMSRN Shari Gabourie, BSN, RN, CWOCN Roxanne Gadberry, RN, CMSRN Deirdre Gilmore, LPN Amy Maykuth, RN Terry Olson, RN, OCN Dan Rodewald, BSN, RN Valerie Rounds, RN, PCCN Adele Seurynck, RN-BC
Family Birth Center 2 South/Surgical Wound Care 2 South/Surgical Nursing Resource Team 2 South/Surgical Cancer Services 3 North/PCU 3 North/PCU 3 North/PCU
2015 Daisy Award Winners (l-r) Shari Gabourie, Fran deTar, and Deirdre Gilmore (not pictured: Karla Benning, Roxanne Gadberry, Amy Maykuth, Terry Olson, Dan Rodewald, Valerie Rounds, Adele Seurynck).
Our Patients
It is a privilege to care for our patients, their families and our community. We believe in including patients and families as active participants in care, holistically integrating their unique needs into our plans and treatments.
Our Team
We are committed to fostering a therapeutic healing and work environment that promotes respect, communication and collaboration among all members of the patient/family/health care team.
Our Organization
Our practice supports Kootenai Health’s Mission to “improve health one patient at a time in a friendly and professional culture committed to providing superior safety and quality”.
Our Profession
Integrity and accountability are the foundation of our professional practice. We are committed to building a legacy of nursing excellence based on compassion, lifelong learning, evidence-based practice and research, innovation and professional development.
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