Rex Healthcare Nursing Annual Report 2012

Rex Nursing Seven East: Journey to Excellence Also Inside: Heart Failure Zones

Special Care Nursery CSI Academy What’s Your Sacred Cow?

ANNUAL REPORT 2012

Dear Rex Friends and Colleagues, For the most part when one engages with a healthcare entity they choose their physician and the hospital system. However, someone else chooses your nurse! At Rex, we have assembled an army of top notch professional nurses who live our mission: “To make a positive difference in the lives of our patients every day.”

The nursing report is a mechanism to share the state of nursing at Rex with our professional colleagues, patients, families and community. Rex receives many awards for excellence in patient care, and nursing is woven through every one.

Rex has been designated as a place where systems, processes and culture join to attract and retain nurses. The Magnet designation we hold from the American Nurses Credentialing Center serves as the “Good Housekeeping Seal of Approval” and a statement to our patients for quality nursing care.

As the U.S. health system is transforming under the Affordable Care Act nursing will be integral for maintaining quality while reducing costs. Every day nurses are there at the beginning and end of life; they are there to assess and develop a plan to assist patients in their response to illness and their journey back to home. We are clinicians, researchers, administrators, educators and advocates who are there for patients any hour of the day.

We are pleased to share some of our stories in this report.

Mary Lou Powell RN, MSN Senior Vice President Patient Care Services/Chief Nursing Officer

Seven East:

Journey to Excellence Rex Healthcare has a rich history and tradition of providing outstanding surgical care for the Triangle area.

Before, during and after surgery, patients have many questions about their care and outcomes. The thought of surgery can be frightening to many people, and requires an expert team of doctors, nurses and specialists to provide excellence, care and compassion. Seven East is one of the inpatient surgical units at Rex, providing postoperative care to general surgery and bariatric surgery patients.

In 2012, Seven East was awarded the highest patient satisfaction award, the Top Performer Award, by Professional Research Consultants (PRC) for overall quality of inpatient surgical care. This annual award is presented to the inpatient surgical unit with the highest overall quality of care within the national PRC database. This award is highly prized and highly competitive throughout the nation.

If you ask any one of the team members how this level of patient satisfaction has been achieved on Seven East, the word “teamwork” would top the list. The relationships among the surgeons, nursing team, and departments such as pharmacy, radiology, and nutrition, are second-to-none and drive outstanding patient care. In fact, higher levels of teamwork have been shown to improve patient satisfaction, quality of care and patient safety. Seven East team members are known throughout Rex for saying, “Care for your patients the way you would expect your own family cared for.”

Donna Balint, B.S.N., R.N., C.P.N., has worked on Seven East for 28 years. She can sum up the success of the unit in two sentences: “We love what we do, and who we work with. Our patients always come first, and everyone who works on Seven East is committed to the same mission.”

What Three East Is Doing With Heart Failure Patients!

Heart Failure Zones T

he staff on Three East, a cardiovascular unit, conducted a trial for patients who experienced heart failure beginning in December 2011. The purpose of the trial was to decrease the 30 day readmission rates of these patients. (If a patient was admitted to a skilled nursing home they fell out of the trial.) There were eight patients in December 2011. Six patients had not been readmitted in 30 days, and the other two patients had until January 23 and 24 (2012) to make the mark of no readmission in 30 days. With the patient’s permission, they were called two or three days post discharge. The purpose of the call was to check on whether they were experiencing symptoms, if they were weighing themselves and as a reminder of their seven-day follow-up appointment.

Four East also followed their fluid overload patients in the same manner.

Goal: Decrease 30 day heart failure readmission rates Who is involved: All staff (nurses, nursing assistants and secretaries)

What are the important points for consistent teaching and a successful trial: • The patient watches heart failure videos • Staff must use the heart failure teaching pathway • Staff must use the teaching binders • The pathway is placed in front of the chart as it is being completed • When the pathway is completed, it is placed in the heart failure box • The seven day post-discharge appointment is crucial

Everyday the patient should: • Weigh in the morning before breakfast, write it down and compare it to yesterday’s weight.

• Take medicine as prescribed.

• Check for swelling in feet, ankles, legs and stomach.

• Eat low-salt food.

• Balance activity and rest periods.

Determine Heart Failure Zone and respond accordingly.

Which Heart Failure Zone are you today? Green, Yellow or Red?

GREEN ZONE

YELLOW ZONE

RED ZONE

ALL CLEAR

CAUTION

“EMERGENCY”

This zone is your goal.

This zone is a Warning Zone

Your symptoms are under control.

You have: • no shortness of breath – breathing easy • no weight gain of more than 3 pounds in one day • no swelling of your feet, ankles, legs or stomach • no chest pain

Call your doctor’s office if you have any of the following: • weight gain of 3 pounds or more in one day • weight gain of 5 pounds or more in one week • more shortness of breath – breathing harder • more swelling of your feet, ankles, legs or stomach than usual • feeling more tired than usual (no energy) • a new or unusual cough • feeling dizzy • feeling uneasy; you know something is not right • harder to breathe when lying down (need to sleep sitting in a chair)

Go to the emergency room or call 911 if you have any of the following: • struggling to breathe, unrelieved shortness of breath while sitting still • chest pain or discomfort • feeling faint

An

Extraordinary Year for Nurses in Rex Nurseries Throughout 2012, extraordinary efforts were made by staff nurses in the nurseries to promote patient and family centered care, to improve information sharing, and to increase participation by all nurses in advancing clinical practice and in collaborating with parents.

Special Care Nursery Parent Advisory Council The birth of a baby is one of the most joyous events for parents. For families that experience an unexpected early arrival or illness of their baby, it becomes a time of fear and uncertainty. To help parents feel the support and caring of Rex Healthcare during this difficult time, the Special Care Nursery redefined their mission. In 2012, the Special Care Nursery (SCN) began the journey of building

a program that identified parents as partners in the delivery of excellent care to babies and families. Staff nurses partnered with parent volunteers to create a Parent Advisory Council. Each of these wonderful parent volunteers dedicated their time, caring and firsthand knowledge of their own families’ experience in the Special Care Nursery. The Parent Advisory Council and staff nurses identified core values related to excellence in family-centered care. They wanted support in the following ways: ✤ Information and comfort provided to families during the SCN hospitalization of their baby, during the transition home and in the event of a baby’s death. ✤ The opportunity to provide mentoring support to other families experiencing the hospitalization of their baby. ✤ To participate in decision making related to parent support programs and in providing feedback on environmental improvements to the SCN. Nurses supported parents in the achievement of these goals by helping the Parent Advisory Council with the creation of a Mission Statement: “Building a partnership between families and the Special Care Nursery team that supports excellence in family-centered care.” To effectively build this partnership, the Council agreed to host an annual SCN Family Reunion, provide parent education on the benefits of Kangaroo Care (skin to skin contact with the parent and baby), organize a support group meeting for former SCN parents and host a fund raising event to benefit parent programs in the SCN.

A Special Family Reunion The Special Care Nursery Family Reunion was held on Saturday, September 22, 2012 at the Dr. Annie Louise Wilkerson Nature Preserve Park. More than 400 parents, children and staff members attended this wonderful event. It was a special event that focused on the caring relationships that had been built among the nurses, doctors and families and the pinnacle of the collaboration to improve care by nursing and parents.

Strengthening Patient Care In 2012, SCN nurses were also actively involved in projects that advanced clinical nursing practice. All nurses actively participated in a two year education goal to obtain low- or high-risk neonatal certification.

Monthly education modules were developed and mentoring was provided by Neonatal Nurse Practitioners and Staff Nurses. The Unit Based Nursing Practice Council chose focus areas to strengthen patient care: ✤ Rounding on every patient and involving parents during rounds ✤ Team STEPPS for improved team communication during resuscitations and other critical patient care events ✤ The use of white boards in patient rooms to improve communication with the family and provide improved continuity of care ✤ Contacting every parent after discharge to follow up on the discharge plan ✤ Concentrate on compassion in all interactions ✤ Increase the use of simulation training to improve the quality of care ✤ Creation of a central line bundle to reduce the risk of central line infection

Safe Surgery Checklist

S

urgery is a busy program at Rex with more than 30,000 surgical procedures each year performed by 500 surgeons, 200 anesthesiologists and nurse anesthetists, and 250 operating room staff. Rex surgical nurses and physicians continually work to improve safety in the operating room in order to make each surgical procedure as safe as possible.

Surgical programs have been required for several years to assure that a “time-out” is performed by all team members immediately prior to beginning surgery. During this “time-out,” each member of the surgical team is expected to stop what they are doing and verify that the patient on the operating table is the correct patient, prepared for the correct surgery, and the correct consents for surgery have been completed. In 2012, Rex nurses noticed inconsistency in the use of the “time-out” and the hesitancy for some staff to speak up and ask questions. The idea of possible error caused concern and resulted in an interdisciplinary team of nurses, physicians, surgical technicians and administrators working together to expand the “time-out” to a full Safe Surgery Checklist.

In order to get started on this project, the project team – led by Bernadette Purser, R.N. – attended a workshop to learn more about the concept. They were quite enthusiastic to get started despite some initial hesitation from other team members who felt the “time-out” process worked well enough.

The project really gained momentum when the team gained the full support of Dr. Bradley Vaughn, orthopedic surgeon and Dr. Seth Weinreb, general surgeon. From the start, these two surgeons served as project champions and role models.

One of the early challenges in implementing the checklist was how to handle staff introductions as cases are starting. (Staff introductions are a key element of the Safe Surgery Checklist because it is not always easy to recognize people behind surgical masks or to know what each person’s role is.) The team quickly decided there was a need to limit room traffic to facilitate introductions and improve safety.

Another project challenge was educating the different surgical teams. The project team developed a script to assure consistency in education across all OR personnel and then trained “Super Users” to teach others in huddles. All anesthesia staff, surgeons and OR workers were included.

Communication was a high priority to make sure everyone knew what to expect and how to perform the checklist correctly. Posters of the checklist were hung throughout the department and signs were hung on doors, scrub sinks, bathrooms walls and in lounges. The key to success was making sure everyone knew the new process. The Safe Surgery Checklist was successfully implemented on December 14, 2012 and continues to make Rex a safer place each day!

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When you’re a patient in the hospital, relying on others to help with even your most basic needs, waiting for a call light to be answered can seem to take a long time, even when the response is quite prompt. From a patient’s perspective, they are watching and waiting for a caregiver to arrive, and may see hospital staff walk past the door. This can cause the patient or family to become anxious or frustrated. Recognizing the importance of quality care, patient safety and service excellence, 7 West implemented the “No Passing Zone” in April of 2012 to address nursing response to the patient call bell.

The “No Passing Zone” initiative means that call lights are everyone’s responsibility regardless of the specific patient assignment. No one passes by a room where the call light is on, and clinical team members are expected to take the time to acknowledge a call light and ask what the patient needs, and then make the connection with the appropriate team member who can assist the patient. Signs such as those on roadways designating “No Passing Zone” are posted in the hallway to remind co-workers to respond to call bell lights.

The “No Passing Zone” has increased coworker awareness and helped to close the gap between co-worker perceptions of satisfaction and actual patient satisfaction. Creating a “No Passing Zone” for co-workers has reduced response time to patient calls which can be interpreted as a lack of concern for patients.

Due to the success of this initiative, the “No Passing Zone” has been implemented to other units throughout the organization.

Patient Safety Associates Patient safety is a primary focus for nursing. Over the past few years there has been a sharp increase in the number of patients who require one-on-one monitoring. Patients who may need monitoring are those who are identified to be at risk for suicide, who may harm themselves or others, those who are involuntarily committed or who may be withdrawing from alcohol or other drugs. This increase is due in large part to the general shortage of available mental health facilities, the aging population and the continued growth in Wake and surrounding counties.

In order to safely monitor these patients, Rex was using available nursing assistants as “sitters,” as well as “sitters” provided by area staffing agencies. As the need increased, so did the cost. While, these expenses are important to patient safety, they are not reimbursable.

In July 2012, the Patient Safety Associate Program was introduced. This program focused on developing a team of Rex coworkers who can work as sitters under the direction of a Rex nurse and who can also provide some consistent patient care.

Advantages for the hospital included lower cost, improved and broader skills for the sitter, ability to assure sitter competency and increased patient and employee satisfaction.

The program took off and the Rex Patient Safety Associates (PSA’s) are providing oneon-one monitoring for patients who meet the criteria. In addition, the PSA’s provide complete patient care, document in the electronic medical record system and, in the absence of a patient who needs a sitter, they may be assigned to work on a unit as a nursing assistant.

A comparison of the data between July through December 2011 and July through December 2012 shows an increase in hours that Rex Patient Safety Associates provided total patient care in combination with a cost savings using Rex PSAs. This program has been a success story of keeping patients safe and lowering cost!

Multidisciplinary Care Nurses At Rex, nurses are developing new programs, piloting new methods of communication, and traveling tireless miles from one end of the hospital to the other to ensure that patients are receiving care that is excellent, efficient and patient centered. This holds true for all nurses across the hospital, but is remarkably demonstrated within the Rex Cancer Center multidisciplinary care programs.

What is multidisciplinary care?

Multidisciplinary care is a collaborative care model in which a team of health care professionals work together to provide the best possible treatment plan and care for the patient. The team typically consists of physicians with different sub-specialty backgrounds, advanced practitioners, a patient navigator and support services staff (social worker, nutritionist, etc.) who help patients navigate their treatment from start to finish. With multidisciplinary care, a patient’s visit may include sitting with all of the physician specialists to create an efficient experience and a collaborative discussion of how their treatment plan will take care of them as a whole.

Rex Multidisciplinary Care (MDC) Nurses Six nurses work tirelessly to be certain that patients have an experience that is smooth and patient centered.

Bryant Washington, R.N., B.S.N., M.H.A., M.B.A., is the Coordinator of the Rex Cancer Specialty Center and developed the initial model for the Thoracic MDC Program as a Thoracic Patient Care Navigator. In his current role, Bryant is expanding the multidisciplinary care model to other disease sites and developing clinical pathways to ensure the patient receives expedited and comprehensive care. Bryant relies on his nursing knowledge and knowing the obstacles that patients face to establish processes that help reduce the barriers that the next patient may experience.

Jeanne Poole, R.N., Joan Freeborn, R.N., and Kristin Knott, R.N., engage with patients diagnosed with breast cancer and facilitate their care along the entire cancer continuum. This team meets with

Jeanne Poole, R.N.

Joan Freeborn, R.N. Bryant Washington, R.N., B.S.N., M.H.A., M.B.A.

Ensure Care is Patient Centered every newly diagnosed patient and assists them in understanding their options for treatment, and has diagnostic and treatment services across the health system to transition into survivorship or supportive care.

Jeanne Poole was the first Navigator at Rex Healthcare and identified the gaps that patients were experiencing.

Since then, given the volume of patients and the engagement of the Navigator in so many points of service, Joan and Kristin joined to ensure that patients are managed throughout the system.

Peggy Scott, R.N., developed the GI navigation program five years ago and provides similar care to patients from endoscopy through the hospital experience. Due to the diagnoses, patients are often inpatients at Rex from a couple of weeks to two or more months. During this time, Peggy engages daily with the patients to assist in identifying needs and supports the patient in healing and returning home or transitioning into supportive care. Peggy works with patients from the initial diagnosis in endoscopy, schedules multidisciplinary

care appointments, and establishes understanding for the patient of the next steps in care.

Jessie Weis, R.N., is the Patient Care Navigator for the Thoracic program. Since joining the team, Jessie has served as the pivotal member for the patient, the specialty physicians and the referring physicians.

Jessie coordinates care for the patient to ensure case discussion and manages the appointments for the patient in the MDC Clinic – a one-stop experience for the patients in their care. Jessie brings together the entire team around the weekly case discussion table, makes sure appointments run smoothly, and that next steps in care are facilitated.

All of these nurses are pioneers in multidisciplinary care and are patient advocates. Their commitment to excellence is seen every day.

Peggy Scott, R.N.

Jessie Weis, R.N. Kristin Knott, R.N.

H E A LT H L I T E R A C Y On October 4, 2012, MaryClare Prasnikar, R.N., C.N.S., and Mary Kate Toma, R.N., 3 East, presented a brief lecture on Health Literacy and the Teach Back Method at the Department of Medicine, OB/GYN and Pediatrics Physician Grand Rounds. Below are fascinating excerpts from their presentation.

When medical terms are used instead of plain language, the information may sound like or look like the information below:

“Your naicisyhp has dedn emocer that you have a ypocson loc. Ypocson oloc is a test for noloc recnac.

It sevlovni gnitresni a elbixelf gniweiv epocs int your mutcer. You must drint a laiceps diuquil the thgin erofeb the noitanimaxe to naelc out your noloc.”

In one study, patients asked to “teach back” information and were able to remember

83.5% of their instructions.

153,000 Wake County adults read and write

below an 8th grade level

Studies show that doctors base up to

of their diagnoses on what patients tell them about their symptoms, history and lifestyle.

Discharge Instructions: Less is MORE List three or four critical things that the patient needs to know and build on. Number steps in order; otherwise do not list more than five bullet points in groupings.

Three ways to make sure you communicate effectively with your patients:

Use plain language.

Use visual models.

Ask patients to “teach back” care instructions. For instance,

“Tell me how you will take this medication.”

❶ ❷ ❸

22 Seconds

The average time a physician allows a patient to talk before taking the lead.

Most American adults have never had a human anatomy/biology course, including those with a college degree.

36%

of Wake County adults do not possess the necessary skills and reading levels for a high school diploma.

Readmission Prevention Clinic WHAT AND WHY The purpose of the Readmission Prevention Clinic is to provide continuity of care, education, improve quality of life by helping the patient to self manage symptoms and decrease hospital readmissions. There is no charge for a clinic visit.

HOW Consult Heart Failure Coordinator to have patient visit clinic if: • Newly diagnosed CHF • CHF patient readmitted within 30 days • High risk for non-adherence • No primary care provider (PCP) • Unable to arrange follow up appointment with PCP/Cardiologist within 7 – 10 days Information from the visit is faxed to PCP or Cardiologist.

WHO Clinical Nurse Specialist MaryClare Prasnikar, R.N., M.S.N., C.C.R.R.N. - Clinical Nurse Specialist - CV/Heart Failure Coordinator: Assess vital signs and knowledge of heart failure with patient Dietician Angie Perrou, M.S., R.D., L.D.N. - Registered Dietician: Review sodium restricted nutrition therapy and how to identify sodium on the Nutrition Facts label with patient Pharmacist Review medications and knowledge of medications with patient

WHEN Clinic opened October 16, 2012 Clinic Hours are Tuesday 9 a.m. - 1 p.m. and Thursday 1 - 5 p.m.

Patients should arrive 15 minutes prior to appointment

WHERE Cardiac/Pulmonary Rehab - Located in the Rex Women’s Center Drop off at Women’s Center Lobby Entrance Parking: Women’s Center Parking Deck

CONTACT (919) 784-3324

The Nursing Research Council wanted to know:

What is Your Department’s Sacred Cow? A Sacred Cow is a routine practice that is carried out without any thought given to why the action is being performed. A sacred cow is a tradition; the way we’ve always done something.

Cash Cow: The

Put the Cow Out to Pasture:

most expensive but costineffective traditional practice being performed without supporting evidence.

Everyone is aware there are no benefits to this practice and would like to get rid of it.

Mad Cow: The

I Never Saw a Purple Cow:

craziest, most bizarre, outlandish, weird and ridiculous traditional practice being performed without evidence.

A traditional practice of unknown origin being performed for the greatest number of years without supporting evidence.

Hol y traditional practice related to spiritual care that is not evidence based.

Don’t Have a Cow: Everyone would

be upset to give up this traditional practice, even though there is no evidence for doing it.

Other Cow he r C ow

w Co

Holy Cow: A

Ot

Entries were accepted through Friday, March 30, and the winner ________(name)_________________ enjoyed lunch with Mary Lou Powell, senior vice president of patient care services and chief nursing officer!

Better Communication

I

n the surgical world, one of the top goals is minimize the potential for infection and promote healing. In July 2006, the Centers for Medicare and Medicaid Services in partnership with other quality organizations identified guidelines aimed at reducing surgical site infections. These guidelines, called the Surgical Care Improvement Project or SCIP are all time sensitive when a patient is having surgery. In 2012, Rex nurses wanted to see if their good scores on timeliness of patient care could get even better.

One of the challenges they faced was difficult communication of critical information because they used a different electronic medical record than the rest of the hospital.

They decided to create a paper tool

called the Surgical Care Improvement Project (SCIP) Handoff Ticket to see if this would help their scores.

These timed measures included proper hair removal, timeliness of antibiotics and other medications, appropriate timing of use of urinary catheters and interventions to prevent formation of blood clots.

Since all of these SCIP measures were time sensitive, it was imperative to communicate the Anesthesia End Time to the nurses on the floor. This time started the clock for many of the other interventions.

Rex nurses decided this colorful form would supersede all other forms and be placed on the front of the patients chart for ease of use.

The nurses in pre-op would start

g n i s ... U P I C the S f f o d n Ha t e k c i T

filling out the SCIP Handoff Ticket with medication information. In the operating room, the circulating nurse next filled out the SCIP Handoff Ticket with antibiotic administration time and indicated whether a urinary catheter was inserted or not. The Post Anesthesia Care Unit (PACU) nurse recorded the Anesthesia End Time (AET) and faxed the form to pharmacy to ensure the post op antibiotic doses would be ready at the right time.

The use of the SCIP Handoff Ticket continues post-operatively as each nurse completes information about dates and times care is provided and when each quality measure is met.

The SCIP Handoff Ticket has clearly helped the quality scores increase and improved care provided to all surgical patients at Rex Healthcare.

Trends in the Educational Preparation of Nurses Influence Changes at Rex

by Mary Lou Powell, Sr. VP Patient Care Services/Chief Nursing Officer

There is a great deal of discussion taking place concerning the educational preparation of nurses.

The following explanation will give a perspective about what is occurring from three different arenas regarding the B.S.N. degree. Forces affecting Registered Nurses arise from three sources:

National trends: Institute of Medicine Report on the future of Nursing

Magnet standards: Requirements for B.S.N.

North Carolina trends: Future of Nursing Action Coalition

NATIONAL TRENDS In 2011 a national report on the future of nursing was published. Supported by the National Institute of Medicine, the official title “IOM Future of Nursing: Leading Change, Advancing Health” recognizes that nursing is integral to the future of health care in the United States.

There are eight broad recommendations in the report that have implications for national and state entities plus practicing registered nurses.

The purpose of recommendation number four is to “increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.” Under this recommendation the report continues, “Health care organizations should encourage nurses with associates and diploma degrees to enter baccalaureate nursing programs within five (5) years of graduation by offering tuition reimbursement, creating a culture that fosters continuing education...”

MAGNET TRENDS The Magnet Standards reference the B.S.N. in two ways. The first involves nurse managers and directors and the requirement is as follows: “One hundred percent of Nurse Managers must possess at least a baccalaureate degree in nursing by January 1, 2013.” This Magnet refers specifically to nurse managers in a 24/7 setting.

Magnet does not require this for facilities not open 24/7.

The second requires the organization to set a GOAL for percentage of B.S.N. prepared nurses and measure progress to achieve that goal. The goal for Rex is that by December 2012, we would have 50

percent of registered nurses hold the B.S.N. credential. As of September 30, 2011, when we submitted our interim report to the Magnet Commission, our rate was 48.4%.

However, we should be prudent and note that the recommendation from the National IOM report on the future of nursing recommends that 80 percent of nurses in the United States are B.S.N. prepared by 2020. Currently these are recommendations only but, based on these reports, we see the industry standard moving toward a B.S.N. degree and we feel that we should explain this trend to our nurses and counsel them accordingly.

NORTH CAROLINA TRENDS On April 11, 2011, a Statewide Summit for Creating the Future of Nursing and Health Care in North Carolina convened. This invitation-only event opened with Former Governor James Hunt presenting the Welcome and Call to Action to transform nursing as a major component of improving the health and delivery of healthcare of North Carolinians. I was honored to represent Rex nurses at this meeting.

One of the priority areas the attendees chose to address is to “increase the proportion of nurses with a baccalaureate degree to 80 percent by 2020.”

Strategies and tactics to achieve the goal include: (1) the expansion of the RIBN program which allows dual admission to a community college program and a baccalaureate program, (2) removal of barriers to seamless progression by implementing a statewide nursing educational framework, (3) promotion of educational advancement statewide, and (4) cultivatation and promotion of the nurse faculty role.

REX TRENDS So, with all the above information in hand what should be the position taken by Rex? Rex has decided that given national, state and industry trends, to take a “B.S.N. preferred” hiring philosophy as of July 2, 2012. I would like to clarify our position.

• NO current R.N., regardless of educational preparation, will be mandated to go back for a B.S.N. degree.

However, Rex will assist those who desire to further their education to do so. Co-workers who are currently enrolled in Associate Degree programs are eligible for employment as registered nurses when they graduate.

• When Rex reapplies for Magnet re-designation we will be in compliance with the nursing degree requirement for managers/directors.

• Managers have been asked to hire the B.S.N. prepared nurse versus other educational preparation IF all qualifications of candidates are equal. This allows discretion by the manager for current co-workers enrolled in Associate Degree programs. However, to fulfill the IOM recommendation, we will ask the manager of any new Associate Degree graduate to strongly encourage that graduate to pursue the B.S.N. degree within five (5) years of graduation.

I realize that there is a trend nationally, regionally and locally that registered nurses need to understand to prepare themselves for changes in the health care arena.

CSI: Academy

Celebra

Thank you for all y Wake and surroundi To provide the bes

AACN Clinical Scene Investigator Academy The AACN Clinical Scene Investigator (CSI) Academy is a 16 month nursing excellence leadership training program designed to leverage the staff nurse’s expertise to enhance patient care and decrease hospital expenses. Building upon a proven pilot project, this teambased program provides hospitals with both implementation tools and funding to groom nurse leaders who implement change initiatives resulting in improved patient and fiscal outcomes.

Med/Surg Day (above)

5 East (above) and 7 West (left) on Med/Surg Day

The RTP cohort for the academy includes nurses from Rex Hospital, UNC Hospitals, Duke Medical Center, Duke Raleigh, Durham Regional, WakeMed Raleigh and WakeMed Cary. These nurses will come together for regularly scheduled group education sessions over the next 16 months. Rex hosted the inaugural session.

GI Nursing Recognition (above)

2012 Research Council

3 West (left) and 4 West (abov

ating Rex Nurses!

you do to help make Rex the healthcare provider of choice in ing counties. You are invaluable to our our mission and vision: st in health services by bringing together compassionate care and leading-edge technology.

ve)

2012 Guild Day (right)

Valentine’s Day on 5 East (above)

Somebody (left)

Dedicated Education Unit There continues to be a critical shortage of both clinical sites for nursing student experiences in many areas of North Carolina and qualified clinical instructors and preceptors for courses that transition students into the professional nursing role. The University of North Carolina at Chapel Hill, School of Nursing, in collaboration with Rex Healthcare was awarded an AHEC grant to develop a Dedicated Education Unit (DEU). A DEU is a unique, collaborative partnership between a clinical setting and nursing program designed to provide an optimal teaching/learning environment for nursing students.

The DEU capitalizes on the expertise of both the clinical staff and academic faculty to support the student’s learning.

The purpose of this project has been to: • improve the learning opportunities for the students in order to more efficiently prepare the students for the workforce • increase clinical capacity for students • expand the role of the clinical staff and faculty • improve patient satisfaction The first year grant experience was highly successful and we were approved for a second year continuation grant to expand the model to a second unit. The project information has been shared throughout the state in an effort to promote the development of more DEU’s in North Carolina.

7 West (above)

Careers at Rex At Rex, we believe that high-quality health care means more than providing exceptional medical treatment, it means providing care by skilled professionals who care - people like you.

When you pursue a career at Rex, you’ll be part of an award-winning team that genuinely cares about you and your family’s needs and goals so that you can better care for our patients.

You’ll discover an environment that emphasizes respect and innovation – one that is recognized in our community and beyond for caring and commitment to excellence.

For more information on how you can become part of our team, visit rexhealth.com today.