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nursing annual report
When a seed is planted, the ‘seed’ does not decide to grow‌ it is the gardener who makes this happen.
Our Magnet efforts are rooted in knowledge, Cultivated with a passion for excellence, And nurtured to sustain continued growth.
The Providence Commitment
Mission As People of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.
Core Values Respect
All people have been created in the image of God. Genesis 1:27 We welcome the uniqueness and honor the dignity of every person. We communicate openly and we act with integrity. We develop the talents and abilities of one another.
Compassion
Jesus taught and healed with compassion for all. Matthew 4:24 We reach out to people in need and give comfort as Jesus did. We nurture the spiritual, physical and emotional well-being of one another and those we serve. We embrace those who are suffering.
Justice
This is what the Lord requires of you: act with justice, love with kindness and walk humbly with your God. Micah 6:8 We believe everyone has a right to the basic goods of the earth. We strive to remove the causes of oppression. We join with others to work for the common good and to advocate for social justice.
Excellence
Much will be expected of those who are entrusted with much. Luke 12:48 We set the highest standards for ourselves and for our ministry. We strive to transform conditions for a better tomorrow while serving the needs of today. We celebrate and encourage the contributions of one another.
Stewardship
The earth is the Lord’s and all that is in it. Psalm 24:1 We believe that everything entrusted to us is for the common good. We strive to care wisely for our people, our resources and our earth. We seek simplicity in our lives and in our work.
2012 nursing annual report
The start of our hospital in Mission Hills, California In the mid-1950s, an airplane crash in Pacoima dramatically emphasized the lack of acute-medical care in the Northeast section of the San Fernando Valley. The people of Mission Hills turned to the Sisters of the Holy Cross (from Notre Dame, IN) to build the much needed hospital, which opened in 1961. Disaster struck the San Fernando Valley in 1971 in the form of a 6.6 earthquake, then again in 1994 when the Northridge earthquake severely damaged Holy Cross. Each time the hospital came back to serve the acute and trauma needs of the Valley. In 1996, Providence Health System took ownership of the Medical Center. Strategically located near the intersections of the 405, 5, 118 and 210 freeways, the Medical Center serves both the San Fernando and Santa Clarity Valleys. An $180 million LEED Silver Certified patient care wing expands Providence Holy Cross Medical Center to 377 beds, making it one of the largest hospitals in the San Fernando Valley. It also is one of the very few Medical Centers in the greater Los Angeles area that have achieved the prestigious ANCC MagnetÂŽ designation for excellence for nursing services and is one of only two hospitals in the San Fernando Valley with Level ll Trauma Center Designation, verified by the American College of Surgeons.
Services Include: Cancer Heart & Vascular Women’s Services Orthopedics Neuroscience Rehabilitation Subacute Surgery Digestive Disorders Trauma & Emergency
Statistics of Interest Employees: 1,900 + Medical Staff: 600+ Licensed beds: 377 Annual (2012 data): Births: 2,757 Inpatient Admissions: 17,038 Average Daily Census: 216.0 Emergency Room Visits: 81,986 Inpatient Surgeries: 4,382 Outpatient Surgeries: 1,978
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Table of Contents Message from CNO............................................................................. 5 Transformational Leadership................................................................ 6 Structural Empowerment................................................................... 14 Exemplary Professional Practice.......................................................... 28 New Knowledge, Innovations & Improvements.................................. 42 Awards & Recognition....................................................................... 47
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Letter from the Chief Nursing Officer Like many organizations, Providence Holy Cross Medical Center (PHCMC) faced many challenges in 2012, including layoffs, major turnover in the C-Suite, implementation of a new electronic medical record, survey after survey from outside agencies and seismic renovation. 2012 challenged our mettle, and yet our wonderful nursing staff, physicians and ancillaries came through with flying colors. As we continue to navigate the constantly changing health care landscape, I am pleased to be a part of Providence Health & Services and especially PHCMC. Our nurses continue to demonstrate courage, commitment and compassion as they work collaboratively to achieve our vision that says; Together, we answer the call of every person we serve: Know me, care for me, ease my way. Challenges have only made us stronger. This past year we have shown our knowledge, innovation and compassion, while caring for those we serve. You will see throughout the report, our many successes, as nurses went back to school for higher nursing degrees, obtained certifications, implemented evidence-based practice, engaged in research, improved nurse sensitive outcomes and traveled to other countries to care for the poor and the vulnerable.
The major focus this last year and next is to continually strive for innovation and excellence in everything we do. Yet, even as we do this, we are acutely aware that what touches our patients most is our compassionate service. I receive so many letters about the caring and compassion of our nursing staff. One woman, an RN whose mother had a stroke and was rushed to the ED, said, “I am grateful to the angel RN who provided me with tissue and compassionate presence. I do not remember what she said to me, but I am holding in my heart the kindness she showed me.� I am proud of all the nurses at PHCMC and am honored to be their Chief Nursing Officer. Being at PHCMC is a blessing in my life.
Ann Dechairo-Marino, PhD, NEA-BC Chief Nursing Officer Providence Holy Cross Medical Center
Transformational Leadership
To better support our nursing staff, the management team worked along side them to enhance many structures and processes. Collectively, we started the evaluation and modification of our shared governance structure, updated our nursing strategic plan, opened new units, began the implementation of a new evidence-based staffing and scheduling system and revamped the innovative 6/2 program to retain experienced night-shift RNs in our most critical areas.
transformational leadership
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2012 Nursing Leadership Ann Dechairo-Marino, PhD, RN, NEA-BC, Chief Nursing Officer Ken Archulet, RN, CFN, Manager Epidemiology and Infection Prevention Missy Blackstock, RN, BSN Director Emergency Department and Patient Placement Center Annette Britton-Cordero, RN, BSN, PHN Director Occupation Health and Safety Tricia Burkholder, RN, BSN, Manager Maternal Child Health Ronald Carpio, RN-BC, MSN, MHA, NE-BC Manager Telemetry, Neuro-Stroke, Acute Rehabilitation Laura Castro, RN, BSN, Manager Medical Surgical Mara Collins, MSN, RN, RNC-NIC, Manager Neonatal Intensive Care Unit Kate Connolly, RN, BSN, Director Post Acute Services and Float Pool Chris Consolo, BSN, RN, CCRN, Manager Critical Care Jane Flaherty, RN, MSN, CNS, PCCN, CCRN, Director Education Sherri Friedrich, RN, MSN, FNP-BC, Coordinator Stroke Program Yvonne Gaffney, RN, BSN, MBA, CNOR, Director Perioperative Services Kendra Hahn, BSN, RN, OCN, Manager Oncology and Telemetry Heinrich Huerto, RN, MSN, ONC, CMSRN, Manager Orthopedics and Medical Surgical Patricia Mayberry, RN, Director of Clinical Business Services & Projects Sherri Mendelson, PhD, RNC, CNS, IBCLC, Director of Nursing Research and Magnet Program Kimberly Murphy, RN, ACNP-BC, Manager Trauma Program Lisa Pettinelli, RN, RRT, CEN, Manager Respiratory Care Services Judy Pharris, BSN, RN, Manager Acute Vents and Stepdown Cathy Yee, RN, MSN, CCRN-CSC, Clinical Nurse Leader Surgery
2012 nursing annual report
2012 Nursing Statistics: RN Turnover 8.9% RN Vacancy 12.76% (affected by new wing additional positions)
All Nurses • BSN or higher among PHCMC Nurses • Certifications among PHCMC Nurses
50% 27%
Patient Care Managers/Directors • BSN or higher among nurse leaders • Certifications among nurse leaders
100% 71%
2012 PHCMC Nursing Strategic Plan Development The strategic plan for 2012 was developed based on input from nurse leaders and direct care nurses throughout the organization. Staff input came from several avenues: • Skills Fairs • Councils • Providence Information Exchange (PIE) meetings and Rounds with CNO and other leaders The strategic plan for 2012 is reflective of nursing’s vision, mission, values, as well as, PH&S system and hospital strategic and quality plans and priorities. Nurses at every level of the organization advocate for resources to support unit/dept goals within the strategic plan for 2012. The strategic plan for 2012 continues the heritage of advocacy for patients and staff that is embedded in the day-to-day operations of PHCMC and Nursing Services.
Transformational Leadership
• Nursing Unit/Department meetings
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Nursing at Providence Holy Cross Our 1st Magnet Re-Designation: Continuing Our High Standards 2012 was a busy year with our Magnet Re-Designation. Our documents were submitted in June and following their acceptance our site visit occurred in December. This certainly took a village to accomplish! It was an energizing experience for our entire staff in partnership with Nursing. Our Magnet Champions proudly welcomed the Magnet Surveyors when they visited their units and our Magnet escorts eased the way for the surveyors from one meeting to the next. Our Support Nurses in the Command Center were invaluable, as were our Administrative Secretaries and Quality Team. The Command Center, itself was a fabulous idea from Ann Dechairo-Marino, our CNO. Many staff members were so engaged in the redesignation process that they gave up personal time to attend survey sessions. We are grateful to all of them. A special thank you goes out to Ken Archulet, RN, Infection Prevention Manager, Tim Gilmore, RN, MHA, Quality Special Projects, Steve Tanner, Director of Quality Improvement, and Liz Salazar, Magnet Program Secretary.
MAGNET CHAMPIONS Patricia Cook, RN
Kristi Miura, BSN, RN, CCRN
Sandra Farrell, RN
Katie La Valley, BSN, RN
Stacey Beatty, MSN, RN,
Marjorie Marino, BSN, RN
Cristina Villafuerte, RN
Pam Appleton, MSN, RN, RNC-MNN
Teresa Louie, RN
Diep Le, RN
Deborah Felkel, RN, RNC-MNN, IBCLC
Teresa Kinsner, RN
Barbara O’Reilly, BSN, RN
Elaine Walker, RN, RNC-In Pt OB, EFM
Johanna Ongjoco, BSN, RN, OCN, CMSRN
Bullet Salvador, BSN, RN
Mary Zulueta, BSN, RN
Ingrid Blose, RN, OCN, CMSRN
Alejandra Ceballos, BSN, RN, PHN
Elizabeth Allin, RN
Alvin Arceo, BSN, RN,OCN
Taryn Hearst, BSN, RN
Cynthia Loyd, BSN, RN
Carolyn McManus, BSN, RN
Debra Key, BSN, RN
Jinae Crouch, RN
Jenny Carrillo, BSN, RN, CMSRN
Ana Bantug, RN
Nora Lucas, RN, CPAN
Bilma Pelissery, MSN, RN, CMSRN
Grace Nkwoji, BSN, RN, PCCN
Kathy Dibene, BSN
JP Grande-Urgino, BSN, RN, ONC
Sylvia Pacis, BSN, RN
Terri Halverson, BSN, RN, CEN
Terri Gately, BSN, RN, CCRN
Lajwanti Singh, RN
Kendra Holzman, RN
Lolita Leonor, BSN, RN
Carlotta Rzepska, RN
Jennifer Lindskog, BSN, RN, CEN
Kelly Pagel, BSN, RN
Sally Peterson, BSN, RN
Karen Watson, BSN, RN, CMSRN
Connie Cruz, BSN, RN
Kim Crabtree-Loyd, MSN, RN, PCCN, CPAN
Kathy Cadden, MSN, RN, CNS, CCRN
Vener Linesses-Diaz, BSN, RN, ONC, CMSRN
Betsy Jansen, RN, CCM, CHPN
Vanessa Guy, RN
Jennifer Dodson, RN, CEN
Trina Lite, RN
2012 nursing annual report
MAGNET greeters Kristi Miura, BSN, RN, CCRN
Jane Zema, BSN, RN
Renee Kilroy, BSN ,RN
Terrie Bybee, RN, CMSRN
Bilma Pelissery, MSN, RN, CMSRN
Alejandra Ceballos, BSN, RN, PHN
Jenny Carrillo, BSN, RN, CMSRN
Ingrid Blose, RN, OCN, CMSRN
Taryn Hearst, BSN, RN
Jinae Crouch, RN
Nora Lucas, RN, CPAN
Sandra Farrel, RN
Kathy Dibene, BSN
Edward Adjei, BSN, RN, PHN
Lorraine Phillips, BSN
Cambria Stephens, BSN, RN, IBCLC
Elizabeth Allin, RN
Cindy Cox, RN
Christina Villafuerte, RN
Cecile Salvador, BSN, RN
Marjorie Marino, BSN, RN
Sylvia Pacis, BSN, RN
Deborah Felkel, RN, RNC-MNN, IBCLC
Denise Willmarth, RN, OCN, CMSRN
Barbara O’Reilly, BSN, RN
Sylvia Pacis, BSN ,RN
Alejandra Ceballos, BSN, RN, PHN
Everson Concepcion, BSN, RN
Jinae Crouch, RN
Grace Nkwoji, BSN, RN, PCCN
Diep Le, RN
JP Grande-Urgino, BSN, RN, ONC
Taryn Hearst, BSN, RN
Christina Villafuerte, RN
Marisela Doyle, RN
Bullet Salvador, BSN, RN
Transformational Leadership
MAGNET escorts
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Pressure Ulcer Improvement Our Chief Nursing Officer is an example of a transformational leader who positively influences organizational-wide change in the prevention and treatment of hospital acquired pressure ulcers (HAPUs). Prior to Ann Dechairo-Marino, RN, PhD, NEA-BC, CNO, joining Providence Holy Cross in December 2011, the overall HAPU rate was consistently above the national mean, according to NDNQI. One unit in particular, ICU, was challenged with its HAPU rate that was three times the national mean of other hospitals. Ann met with Monica Tweddell, RN, WCC, and Deanna Flores, RN, BSN, the two Skin Care Team Leaders in early February 2012 to discuss the HAPU program. Based on the quarterly results and the monthly housewide audits conducted by Monica, Deanna and the Wound & Skin Care Committee, Ann chose to focus initially on HAPU’s in the ICU. A first step was to partner with the Volunteer Hospital Association (VHA) as part of a nationwide project to improve patient safety initiatives, specifically the reduction of HAPUs. In March, Deanna and Tim Gilmore, RN, MHA, Special Projects for Patient Care Services, were sent as representatives to the National VHA Meeting for training on processes in how to implement an organizational change in the reduction of HAPUs. The initial process was to conduct “observations” in the ICU to determine knowledge and/or process deficits. The observations were conducted weekly for two months by Monica, Deanna, Erin Flynn, RN and Judy Avila, RN who were trained in the observation and data collection process. In collaboration with Ann Dechairo-Marino, the two skin care team leaders, Sandy Whistler, RN, MSN, ICU educator; Chris Consolo, RN, BSN, CCRN, ICU Nurse Manager; Maria Ortega, RN, ICU skin care team member; Denise Bosey, RN, ICU skin care nurse; and Kathy Cadden, RN, MSN, CCRN, ICU skin care nurse, the group met in June to discuss the results and developed an action plan that incorporated several key elements: • Four eyes on admission (two RNs assessing every ICU admission) • Every patient upon admission/transfer to ICU receives photo documentation of the sacrum • Implemented a sacral dressing for early prevention (based on a research study conducted at PHCMC) • Re-position turn clocks & a ‘buddy system’ to ensure adequate staff for turning patients • Revised tracheostomy and Bipap protocol, in partnership with Respiratory Services, to eliminate HAPUs caused by these devices Mandatory ICU staff education included HAPU competencies over a two-month timeframe. Monica and Deanna meet with Ann on a monthly basis to review data and discuss next steps for the program, in partnership with the Skin & Wound Care Committee. Based on these interventions, the third quarter ICU HAPU rate was 9.09%, a 50% reduction compared to the previous quarter of 18.8%. ICU also conducts monthly prevalence studies by the two skin care team leaders, and for October 2012 and November 2012, the rate was 0% for HAPUs. Based on the success of photo documentation of ICU patients, Ann Dechairo-Marino, in partnership with the two skin care leaders and the Skin Care Team, standardized the process for photographic documentation on each unit by providing the necessary resources. These resources included the purchase of a camera and
2012 nursing annual report
printer for each clinical unit. To better standardize our resources, all units received a single type of camera and printer in December 2012. House-wide, the Nurse Managers and Nurse Directors receive the monthly and quarterly HAPU data. One of the interventions that Ann introduced is to ensure transparency in the HAPU data that are made available to unit staff. In partnership with Quality Management and the Nurse Managers, unit HAPU data and other quality indicators are displayed on staff bulletin boards so staff can see and speak to their outcomes. According to Monica Tweddell, RN,WCC, on having unit data available to staff: “It is a visible tool that nurses can see as a snapshot in regard to how well the unit is doing or opportunities to improve. And if the unit is not doing well, staff takes this very personally.�
2S Unit Example of their Quality Board
To better understand the cause of any reportable HAPUs, in early February 2012, Ann Dechairo-Marino implemented the use an abbreviated root cause analysis (RCA) tool using the fish bone diagram. During a monthly meeting with the skin care team leaders, Ann introduced this idea and received agreement from the skin care team leaders and the Skin Care Team. Within the last nine months, the skin care team leaders have facilitated six RCAs in partnership with Nurse Managers, RNs at the bedside, physicians and Risk Management. Results from the RCAs are shared with the departments who participated in the RCA, including Administration (Ann) and any ad hoc departments that were involved in the development of the HAPU; for example, Respiratory Services. One example of a patient care improvement from a RCA was on the topic of Bipap. Bipap is a treatment initiated by Respiratory Services and monitored by both Respiratory and Nursing. The protocol was revised to ensure the initial application included additional padding of the forehead and bridge of nose. This has been a collaborative effort between departments that has resulted in zero reportable HAPUs to the state as a result of the revision of the Bipap policy and staff education in June 2012. A second example includes a neonate from NICU who developed a full thickness wound in September 2012 that resulted from an IV infiltrate of calcium in the arm. Soon thereafter, an RCA was facilitated by Deanna Flores that included Dr. Hartleroad, NICU Medical Director; Mary Alice Melwak, PhD, RN, CCRN, NICU CNS; Mara Collins, RN, MSN, CCRN, NICU Nurse Manager; Patrick Seeley, Risk Management; NICU RT, John Bell, NICU RN; Sandra Sletski, NICU RN; and Arvy Quizo, BSN, RNC, NICU ANM. Based on the RCA, there was an action plan that included staff education on five opportunities for improvement:
Transformational Leadership
2S Unit Example of HAPU Data
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Pressure Ulcer Improvement cont’d • IV site inspection by both RNs at change of shift • Unit-wide consistency in taping IVs by all RNs to ensure visualization of the site • Hourly IV site checks • No lab draws are done from the limb that has the IV infusion • A lower concentration of calcium is infused over a greater timeframe when a bolus is not medically necessary All five interventions were implemented in early September 2012 by NICU staff and to-date, there have not been any additional pressure ulcers or wounds caused by IV infiltrates or other equipment.
Outcomes
Hospital Acquired Pressure Ulcers All Units % of patients with HAPU
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6.00 5.00 4.00 3.00 2.00 1.00 0.00
Q3 ‘11
Q4
Q1 ‘12
Q2
Q3
All Units
5.43
4.80
4.78
1.66
0.69
CalNOC-All
1.28
1.50
1.67
1.78
1.42
2012 nursing annual report
6.00 5.00 4.00 3.00 2.00 1.00 0.00
Q3 ‘11
Q4
Q1 ‘12
Q2
Q3
All Units
5.43
4.80
4.78
1.66
0.69
NDNQI-All
3.13
0.0
3.04
2.64
Hospital Acquired Pressure Ulcers ICU 25.00 20.00 15.00 10.00 5.00 0.00
Q3 ‘11
Q4
Q1 ‘12
Q2
Q3
All Units
0.00
12.50
13.04
18.75
9.09
CalNOC-ICU
4.78
4.12
3.26
3.28
3.00
Hospital Acquired Pressure Ulcers ICU 25.00 20.00 15.00 10.00 5.00 0.00
Q3 ‘11
Q4
Q1 ‘12
Q2
Q3
All Units
0.00
12.50
13.04
18.75
9.09
NDNQI-ICU
6.29
6.74
6.36
6.02
Transformational Leadership
% of patients with HAPU
% of patients with HAPU
% of patients with HAPU
Hospital Acquired Pressure Ulcers All Units
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Advancing Nursing Education Jane Flaherty, MSN, RN, CNS, PCCN, CCRN, Director of Nursing Education Jane retired at the end of 2012 after 19 years of exceptional leadership at PHCMC. Jane set a high bar for excellence in teaching and clinical practice. She mentored numerous educators during her tenure. She is an exemplary teacher who demonstrated outstanding presentation techniques and a wealth of knowledge. Jane’s specialty is Critical Care. Her classes on EKG Interpretation and other Critical Care topics were extremely popular. Jane maintained excellent clinical practice. She taught by example, always keeping her clinical skills current and using evidence-based practices. She refused to accept anything but the best, in consideration of the rights of patients to receive the highest standards of care. Jane was an integral member of the Magnet team for both our initial designation in 2007 and our re-designation. She helped expand the Education Department to 14 Nurse Educators, assumed management of the Diabetes Education Department and provided leadership to expand our certification preparation courses, development of a Preceptor Education Program and adoption of an on-line system for staff education. Jane spearheaded websites for each of the PHCMC nursing units and ensured that her staff had appropriate avenues and support for continuing education. Jane’s high standards, high energy and outstanding nursing care for the past 19 years at PHCMC are appreciated. She will surely be missed by her colleagues!
2012 nursing annual report
Back in School Some of our current students share their feelings about continuing their education
Kate Connolly, MSN, RN How do I begin to describe what my MSN quest has done for me? I went into the program thinking that I had seen it all, done it all, why go back to school now. I soon found out that the programs were going to make me seek the knowledge that I wanted to learn. As simple as this: If I wanted to learn, I needed to seek the resources and educational opportunities to make it happen. No one spoon feeds you the information in the Master’s program. There isn’t one book you read and then ‘Aha, I have it!’ You get what you seek. Nothing more and certainly nothing less than that statement is true. Very early on I realized that my perspective changed from ‘I have to do this to keep my job’ to ‘I WANT to do this for my staff, my patients and most of all ME.’
I especially enjoyed the review of the theorists and how this impacts our model of care and professional practice model. I’m working with the regionalization of the professional practice model for our ministries. Without the information I learned and reviewed I wouldn’t be able to intelligently participate in this process. Research of course is the bread and butter of how to enhance evidence-based practice. How do I know the studies I’m reading are valid and reliable? How do I know that I can translate them to our setting? There is no evidence, what then? I can now answer all of these questions and more. I’ve actually done my own research and have ideas on how to expand on it. Now that’s hands-on learning. I could go on and on but I won’t. Let me end with this. If I need to know the answer, I can find it. If it doesn’t exist, I can deal with that now, too. I feel empowered now.
Structural Empowerment
I enjoyed learning about politics and finance. How do those regulations, laws and bills go through the process? Where can I have a voice and impact the outcome of the legislation? How will this impact health care in the future? How can I explain this to everyone that needs to know? I now am very active in working with the bedside staff to enhance the patient experience thus improving our HCAHPS reimbursement.
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Patricia Mayberry, MSNc, RN Earning my RN from Pierce College, I joined Providence Health & Services-Saint Joseph Medical Center in 1977. After working as a staff nurse in several areas including a heavy surgical unit, ICU, PACU and Nursing Supervision, I was recruited to the Information Systems department as the Nursing Analyst for a new computer system install. Working directly with nursing as the Nursing Division Director for I.T., I programmed all of the screens for this new EMR as well as the Reports. Facilitating the integration of data and knowledge to support patients, nurses and other providers in their workflow, decision processes, training tutorials and access programs, the system was installed, maintained, with the integration of new systems emerging. Fast forward several years later, I was promoted to the Service Area Director for Information Systems role with additional responsibilities as the Nursing Informaticist, Project Manager and Green Belt. Should I go back to school? Yes and soon. The decision to outsource the I.T. department to a third-party vendor required me to make a very hard decision to move locations and jobs, joining a sister ministry Providence Holy Cross Medical Center. Initially joining the Administrative Team as the Clinical Project Director, I was given our building Expansion Project and forged forward into the world of construction. Once the building was completed, opened and occupied, I was placed in a new role as Operations Director with Pharmacy, Lab, Physical-SpeechOccupational Therapy, Contracts, Project Management and Contracts reporting to me. Fast forward to present day, I am the Director of Clinical Business Services & Projects with a collection of departments. I am back in school currently pursuing my Master’s in Nursing – Leadership track in an effort to take on more leadership opportunities should they arise. Should I go back to school? Yes and NOW. It has taken many years, as well as excellent mentors and encouragement from friends, family and peers, to help me see the importance of my education path as obtaining my Master’s degree was not something that I originally aspired to, but knew I should, as quite honestly much of my career path had been away from the bedside. But I have to say, even though I struggled through the decision, I can only say how much I have learned and this experience thus far has been an enlightening adventure toward learning about nursing excellence. I believe that evidence-based practice is essential to the growth of nursing and improving patient outcomes, and it comes through loud and clear in this educational track. Nurses are incredible individuals who are not only advocates of their patients, but who are at the forefront of health care. I look forward to completing this journey very soon!! The philosophy of graduate nurse education is that the practice of nursing is constantly changing as health needs and health delivery systems are altered. Having an elevated degree will allow me to work more effectively and collaboratively with other disciplines and community services to promote health.
2012 nursing annual report
Sandy Wisler, MSNc, RN I graduated from Indiana University in 1980 with my ADN in Science. I immediately enrolled in the BSN program but life got in the way! I got married, had two children and moved to several states following my husband’s career as a Toxicologist. In each state I looked into programs for my BSN and enrolled in two, one in Maryland and one in Michigan. Not having a degree did not prevent me from getting the job I wanted. Recently both of my kids have graduated with their bachelor’s degrees which prompted me to feel it was my turn! I chose Western Governor’s University because it accepted all of my previous credit hours from various programs. I also was given credit for being an RN with more than 30 years of experience.
It does take some time management and learning to write APA style is a challenge. I have been able to use many of my real life experiences in nursing to write about. While we were going through our Magnet recertification I was writing a paper about it! My mentor has been wonderful. I did not have to repeat any classes I had previously taken. No group projects either. The cost is $3,200 per semester so it really has been a bargain compared to many other programs. My only regret is that I didn’t do it sooner!
Structural Empowerment
I initially started working on my MSN in Leadership since I was working in management at that time. I have since changed it to MSN in education. I love teaching, having been an ACLS and BLS instructor for many years. The program is a great fit for me. I have completed the BSN portion and am now working on the MSN courses. I am hoping to finish this year. I initially didn’t have a lot of computer skills I needed but I have learned a lot along the way. My kids are proud of me and promise to be there when I walk to get my diploma.
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Our Community Providence Holy Cross Medical Center serves a diverse population of nearly 2 million residents in the San Fernando and Santa Clarita Valleys. As a not-for-profit facility, we offer a full continuum of health services, from outpatient to inpatient to home health care. As our communities continue to grow, we have expanded our hospital and its services to meet their ever-changing healthcare demands of our patients and families
1.42%
Population by Age 8.22%
22.51%
0-14 15-24
23.67%
15.08%
25-44 45-64 65-84
29.10%
85+
2.34%
Population by Race Asian Black Hispanic White Other
3.43% 10.72%
30.36% 53.13%
2012 nursing annual report
Priority Healthcare Issues in our Community • Mental health services that are affordable and accessible, especially for children, older adults, homeless, veterans and undocumented. • Affordable and portable health insurance and providing access for undocumented individuals.
• Chronic disease management and prevention with a focus on diabetes, hypertension, obesity and asthma. • Dental health services that are affordable and accessible especially for adults, seniors and lowincome children.
• Permanent supportive and affordable housing including more Section 8 housing and emergency shelter beds.
Educational Attainment
7.38%
<9th Grade
13.96% 10.74%
17.52%
Some High School High School Graduate Some College - No Degree
22.12% 20.71%
Insurance Status of Community Residents
Associate’s Degree Bachelor’s Degree Graduate/Professional Degree
15.52% 12.8%
Total Uninsured Medi-Cal/Medicaid Medicare Private Insuramce
61.88%
9.8%
Structural Empowerment
7.42%
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Nursing Shared Governance Our nurses have ample opportunity for participation helping form the direction for the Department of Nursing and to collaborate with other departments through our Shared Governance Structures. One goal of each of the Divisional Nursing Committees is to review policies as presented to the committee to ensure the policy aligns with best practice and scope of practice for the nursing area and sub specialties. The following list includes the Nursing Committees and Chairs for 2012.
Council/Committee Chair
Acute Rehabilitation Collaborative
Ron Carpio, MSN, RN, NE, RN-BC Moonyeen Brubaker, RN
Assistant Nurse Manager Council
Kelly Pagel, BSN, RN
Brain Trauma Injury Committee
Breast Feeding Task Force
Chapter Chair Council
Kim Murphy, MSN, ACNP-BC, CEN Maria Knoll, MSN, CNL-BC, RN, IBCLC, CNL, RNC-OB, EFM, MNN Laurie Marx, RN, MPH, CPHQ
Clinical Education Council
Jane Flaherty, MSN, RN, CCRN, PCCN
Clinical Ladder Committee
Tanya Haight, BSN, RN, OCN, CMSRN; ONC
Clinical Practice Council
Coordinating Council
Core Measures/Nursing Quality
Critical Services Clinical Practice
Disaster Council
Donor Council
Emergency Department Unit Based Council
Falls Committee
Interdisciplinary Patient and Family Education
Yajaira Paredes, MSN, RN, CNS, RNC-OB; C-EFM Ann Dechairo-Marino, PhD, RN, NEA-BC Sandy Wisler, RN, CCRN, MSNc Kristi Miura, BSN, RN, CCRN Connie Lackey, RN Libby Wood, LCSW Terri Halverson, BSN, RN, CEN Sheila MacDonell, RN Betsy Jansen, RN, CHPN
Magnet Council
Karen Watson, BSN, RN, CMSRN; RN-BC Sherri Mendelson, PhD, RNC, CNS, RNC-OB, NIC, C-EFM, IBCLC
Maternal Child Health Clinical Practice
Elaine Walker, RN, RNC-OB, EFM Marilyn Herrick, RN
Med Surg/Post Acute Divisional Practice
Tanya Haight, BSN, RN, OCN, CMSRN, ONC
Medication Management/Safety Chapter Chair
Amy Rosengren, BSN, RN
Meditech User Group
Norma Arnau, BSN, RN Stacey Williams, MPT
Night Shift Council
Stacey Beatty, BSN, RN, CCRN
Nurse Manager Council
Nursing Leadership
Nursing Research Committee
Palliative Care Council
Patient Safety
Peri-operative/Invasive Meeting Group
Products and Standards
Recruitment and Retention Workforce Planning
Safety Committee
Telemetry Clinical Practice
Tracer Team
Wound/Skin Committee
Kate Connolly, BSN, RN Ann Dechairo-Marino, PhD, RN, NEA-BC Terri Gately, BSN, RN-BC, CRRN Betsy Jansen, RN, CHPN Michelle Tabar, BSN, RN, CMSRN Kelly Pagel, BSN, RN Johanna Ongjoco, BSN, RN, CMSRN, OCN Kendra Hahn, BSN, RN, OCN Connie Lackey, RN Kate Connolly, BSN, RN, MSNc Laurie Marx, RN, MPH, CPHQ DeAnna Flores, BSN, RN
2012 nursing annual report
Nursing Clinical Ladder The Clinical Ladder provides a vehicle to expand and advance the practice of professional nursing at PHCMC for the registered nurse. The Clinical Ladder helps to demonstrate the forces of magnetism inherent in the structures and processes of the nursing organization at PHCMC. Our Clinical Ladder design is based on Bennerâ&#x20AC;&#x2122;s Novice to Expert theory and recognizes the contribution of nursing excellence within our organization. CLINICAL LADDER COMMITTEE Terri Halverson (Chair) Kimberly Crabtree-Loyd (Co-chair)
GI Judy Albert Rochelle Nelson Denise Willmarth
Emergency Department Carol Carter Cathy Carter Terri Halverson
CLINICAL LADDER LEVEL 3 Emergency Department Jennifer Dodson Carey Faulkner Mary Herrera Melanie Ridgley Krista Zone
CLINICAL LADDER LEVEL 4 Education Kathy Christian Tanya Haight Jennifer Lindskog Aurora M. Tweddell Karen Watson
ICU Jessica Horst
ICU Stacey Beatty
ICU Christina Consolo Carole McKennan Kristi Miura
NICU Pensri Choti Barbara Russo Med/Surg William Lim Carolyn McManus Johanna Ongjoco Telemetry/Stepdown Susana Rioveros Edeliza Rosales Cecile Salvador Melissa Tell Lourgelie Vergel De Dios Jane Zema
CLINICAL LADDER LEVEL 5 Education Kimberly Crabtree Loyd Yajaira Paredes ICU Kathy Cadden
Labor and Delivery Tenesa Reid Kristina Shannon Margaret E. Walker Med/Surg/Oncology Ingrid Blose Terrie Bybee Jenny Leon Bilma Pellissery Teodora Tiongson Telemetry/StepDown Wendell Garcia Beverly Gumogda
Structural Empowerment
Labor and Delivery Susie Catalano Marilyn Herrick
Subacute Terri Gately
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2012 nursing annual report
Certified Nurses at PHCMC in 2012 Dory Tiongson, OCN; CMSRN Catherine Valbuena, CMSRN Erika Vega, CMSRN Nancy Volz, ONC Marietta Yuscon, RN, ONC
ICU Crystal Akao, CCRN Stacey Beatty, PCCN Kathy Cadden, CCRN Karen Gustillo-Ross, CCRN Rosanne Hinners, PCCN, CCRN Jessica Horst, PCCN Shirley Ibarra, CCRN Jheanifair Lam, CCRN Melanie LaMadrid, CCRN Carole McKennan, CCRN Brenda Mitchell, CCRN Kristi Miura, CCRN Wendy Roller, CCRN Amy Rosengren, CCRN Medical-Surgical/Oncology Lois Agler, CMSRN Alvin Arceo, OCN Pamela Baylon, CMSRN Monica Benitez, CMSRN Godette Therese Binas, CMSRN
Ingrid Blose, OCN, CMSRN Shiela Borelli, ONC Terrie Bybee, CMSRN Kirstie Caccam, CMSRN Sheila Cardoniga, OCN Jenny Leon Carillo, CMSRN Genyza Dawson, CMSRN Erin Flynn, OCN Maricel Delgado, CMSRN Cynthia Dasaad, OCN Eileen Diaz, OCN Loraida Donato, CMSRN Kristen Miller, OCN Riza Estranero OCN; CMSRN Barbara Farrar, OCN Gemma Francisco, ONC Christian Gonzalez, CMSRN JP Grande-Urgino, CMRSN, PHN Alex Kaddu, CMSRN Jonar Labog, CMSRN William Lim, CMSRN Vener Lineses-Diaz, CMSRN, ONC Chris Lopez, CMSRN Veronica Lozano, CMSRN, ONC Elizabeth Malaiba, ONC Carolyn McManus, RN ONC April Mijares, CMSRN, OCN Cathy Millan, CMSRN, ONC Rodomina Mungcal, CMSRN Claire Oâ&#x20AC;&#x2122;Leary, OCN Johanna Ongjoco, OCN, CMSRN Maelene Owera, CMSRN, ONC Bilma Pellissery, CMSRN Amy Revilla, ONC Tristan Robles, CMSRN Maria Rodriguez, OCN Betsy Smith, CMSRN; OCN Michelle Tabar, CMSRN Barbara Thomas, CMSRN
Super Float Pool Mary Ellen Hazle, CMSRN; WCC Seta Velasquez, CMSRN, ONS Nursing Quality Analysts Karen Broggie, CPHQ Laurie Marx, CPHQ Marianne Plakas , CCRN Sheila Ritchie, CPHQ Cyndie Speen, CPHQ, RN-BC Faith Community Nursing Connie Cruz, RNC-OB Lorena Soria, RN, FCN Nurse Practitioners Deborah Tsunoda, RN-BC, ANCCACNP Acute Rehab/Sub Acute Virginia Alegado, CRRN Terri Gately, CRRN, RN-BC Education Services Kathy Christian, OCN, CMSRN Kim Crabtree-Loyd, FNP-BC, CPAN, CCRN Tanya Haight, OCN, CMSRN; ONC Jennifer Lindskog, CEN Mary Alice Melwak, RNC-NIC Yajaira Paredes, RNC-OB; C-EFM Monica Tweddell, WCC Karen Watson, CMSRN; RN-BC Sandra Wisler, CCRN Case Management Betsy Jansen, CHPN Kathy Menard, CPHQ, CPRM Edna Tiongco, CCM, CRRN Craig Hollaway, CEN, MICN Leah Phillips, CCM, CRRN
2012 nursing annual report
Maternal Child Health Anna Apalon, RNC-OB; EFM Pamela Appleton, RNC-MNN Haley Barickman, RNC-NIC John Bell, RNC-NIC Brenda Benavidez, RNC-OB Jill Boucher, RNC-MNN Marilyn Currie, RNC-MNN Susan Egami-IBCLC Debbie Felkel, IBCLC, RNC-MNN Cristina Gaor, RNC-NIC Jenni Kohl, RNC-OB Maria Knoll, IBCLC, CNL, RNC-OB, EFM, MNN Julie Masson, RNC-OB Nancy McClenaghan, RNC- NIC Kristen Miller, RNC-OB, EFM Nanette Moffet, RNC-LRN Lilia Nicholas, RNC-MNN Michela Nueve, CCRN
Lourdes Parseghian, RNC-OB Arvy Quizo, RNC-LRN; RNC-NIC Tenesa Reid, RNC-OB Delores Relucio, RNC-OB; C-EFM Sally Ritter, RNC-OB; C-EFM Melinda Rub, RNC-OB, RNC-EFM Dawn Schultz, RNFA Kristina Shannon, RNC-OB Cambria Stephens, IBCLC Tirzah Suico, RNC-MNN Julie Tannaci, RNC-MNN Margaret Walker, RNC-OB, EFM Ann Wilson, RNC-EFM Emergency Department Melissa Barnes, CEN Carol Carter, CEN Cathy Carter, CEN Sue Cassling, CEN Jennifer Dodson, CEN Terri Halverson, CEN Heidi Krause, CEN Amber Lockhart, CEN Rosanna Macklin, CEN Sylvia Pabon, RNC-MNN Jacquie Siddens, CEN Cindy Sweem, CEN CardiologyRadiology Cynthia Marsden, CRN Hannah Rhodes, PCCN Perioperative Frankye Bauerle, CPAN Ed Betker, CNOR Jessica Canalejo, CNOR, CRNFA
Kathy Dibene CCRN Renee Dove, RNFA, CNOR Lisa Eberhart, CNOR Mike Earnheart, CFRN Maureen Jamgochian CHES Karen Kelsey, CNOR Nora Lucas, CPAN Margaret McMenamin, PCCN Janine Montero, CMSRN Mary Jane Pettee, CNOR Elizabeth Pleasant, CNOR Louisa Singer, CNOR, RNFA Denise Wilmarth, OCN, CMSRN Cathy Yee, CCRN-CSC Susan Zavala, CCRN, CPAN Gail Zerby-Cook, CNOR, RNFA Telemetry Vicki Cochran, PCCN Analisa Cohen, PCCN Beverly Foronda, PCCN Cynthia Funakoshi, PCCN Wendell Garcia, PCCN Beverly Gumogda, PCCN Tracy Kwak, PCCN Kaixuan Luo, PCCN Myrene Martinez, PCCN Nkoli Nkwoji, PCCN, CCRN Linda Oâ&#x20AC;&#x2122;Reilly, PCCN Emmanuel Palad, PCCN Devina Samonte, PCCN Denise Seth-Hunter, ONC Loorgelie Vergel de Dios, PCCN Debbie Welch, PCCN Danica Whisman, PCCN
New Degrees in 2011 Jennifer Lindskog, BSN, RN Lisa Fetterolf, BSN, RN Kelly Pagel, BSN, RN Michelle Irving, MSN, RN Stacey Beatty, MSN, RN Yajaira Paredes, MSN, RN, CNS Maelene Owera, BSN, RN, MHA
Mara Collins, MSN, RN Nkoli (Grace) Nkwoji, MSN, RN Honeylyn Gastelu Fortaleza, BSN, RN Mary Darnell Taylor BSN, RN Mary Arceo BSN, RN William Lim, BSN, RN Kate Connolly, MSN, RN
Structural Empowerment
Nursing Management Ken Archulet, CFRN, CIC Ron Carpio, RN-BC, NE-BC Mara Collins, RNC-NIC Chris Consolo, CCRN Ann Dechairo-Marino, NEA-BC Jane Flaherty, PCCN, CCRN Sherri Friedrich, ANCC-FNP Yvonne Gaffney, CNOR Kendra Hahn, OCN Heinrich Huerto, CMSRN, ONC Sherri Mendelson, RNC-OB, NIC, C-EFM, IBCLC Kim Murphy, ACNP-BC; CEN Lisa Pettinelli CEN
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2012 nursing annual report
Becoming a Certified Nurse Words of Wisdom from Terri Gately, BSN, RN, CRRN-BC, MS In 1991, our hospital made the decision to open an Acute Rehabilitation Unit (ARU) and I decided to become a Rehab Nurse. Nurses and physical, occupational and speech therapists trained together as an interdisciplinary team for four weeks before opening the unit. It was exciting to have this opportunity and I felt well prepared by the time the ARU opened. It was while working in this specialty that I first learned about nursing certification. Our nurse manager was very supportive, urging all of the RNs on the unit to become certified as we reached our two-year mark. I felt that I had grown significantly as a nurse over those two years and the dedication I felt for rehabilitation nursing grew as well, so it was just natural that the next step would be to study and sit for the CRRN exam. At that time it seemed like preparing for the Nursing Boards all over again (the stress certainly felt the same). My good friend and colleague, Betsy Jansen, RN, CHPN, and I went to a review class together and studied for many more hours. The pay-off was realized when we both received news on the same day that we had passed the exam and with it a great sense of accomplishment.
Camis Implementation Norma Arnau, BSN, RN, Clinical Informatics Specialist, helped lead our nurses towards a new documentation system January 2010: The CAMIS Implementation team recommended that each ministry assign two staff members to participate in the role of “CAMIS Core Builder”. These staff members would be pulled out of staffing approximately eight months to assist the CAMIS analyst in the development/ build of the CAMIS screens starting with our first Providence ministry to go live-Tarzana Stacy Williams (Ancillary CAMIS Lead) and Norma Arnau (Nursing CAMIS Lead) interviewed seven staff members who submitted an application for the temporary position. We selected the two staff members: • Denise Willmarth, RN, Oncology • Patricia Marcella, RN, Mother Baby February 2010 through December 2010: Nursing staff from PHC participated in Regional ad hoc groups. The meetings alternated among locations of the Valley ministries and the South Bay ministries. The nurses were assigned based on the screen development planned, for example: Med/Surg/Tele nurses participated in the design of the “Med/Surg/Tele Assessment intervention in conjunction with the Clinical Analyst. There also were sessions for the Ancillary Specialties to meet with the analyst for screen design. Nursing Expectations included holding on to their current processes for each ministry, as we all felt we had the best processes. It took a few meetings sitting with other ministries to realize that compromises had
2012 nursing annual report
to occur in order to move forward. Among the take-aways that nursing had was to develop collaborative relationships with their counterparts and coming to consensus with the best possible outcomes. December 2012 Our training model included creating a core group of trainers-nursing staff that would be pulled from their usual unit assignments and would be the main instructors for the CAMIS classes. We felt that establishing this group of primary trainers would ensure optimal consistent training for all of our staff. Selection process began for the 8 core instructors that included: • Tony Kim, RN ICU, Nights • Tina Abengoza, RN ICU • Jenny Smolski, RN TELE • Jorge Ramos, RN TELE • Carolyn McManus, RN M/S • Everson Concepcion, RN M/S, Nights • Debbie Addison, RN Float • Christine Gaor, RN NICU January 2012 • Core Instructors were trained in CAMIS • Developed CAMIS Training material and schedules • Reviewed current workflow and developed strategies to deal with the CAMIS changes.
March- April 2012 • The team reviewed nursing workflow processes • Followed up on identified nursing issues and presented to governance body- CRDT for approval or denial of requests. • Reviewed reports already available and submitted requests for new reports • Met and collaborated with other departments, including Pharmacy to ensure medication order entry would work for nursing. Worked closely with Pharmacy to achieve excellent outcomes. • Collaborated with the Physician Liaisons and were trained on the PCM module that physicians would be using. This step was taken to ensure additional resources for the MD module as needed. April- May 31st 2012 • End User Training timeline included: PCS, Order Management and eMAR. • Training incorporated new workflows. June 1st 2012 • CAMIS Go Live- PHC had a very successful go-live with minimal issues not previously identified during our preparation phase.
Structural Empowerment
February 2012 • Core Instructors trained 72 Super Users from all the areas
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2012 nursing annual report
Helping Other Communities: Guatemala 2012 Nicole Bauer, RN, PACU, and Judy Albert, RN, GI Lab, joined a Providence Medical Mission
Nicole’s Thoughts Traveling to a foreign country can be daunting for many. Practicing medicine in unfamiliar surroundings without all of our familiar equipment and instruments can be equally challenging. Combining the two resulted in gratifying success for what was Providence’s inaugural international medical mission. Twenty-six clinical and non-clinical staff representing Providence’s five Southern California regional hospitals traveled to Retalhuleu (a small town nestled among the mountains), Guatemala to provide general surgeries for the locals. The surgeries were laparoscopic cholycystectomies and hernia repairs, mixed in with a few “lumps and bumps.” Approximately 80 patients were evaluated by our surgeons and anesthesiologists, resulting in 66 surgeries performed. The success of Providence’s first international mission was largely due to the relationship established between our own Providence Health International, and a non-profit called Faith in Practice (FIP). FIP operates and works in Guatemala, establishing and improving infrastructure to support a healthcare system accessible to ALL Guatemalans. Fifty-nine percent of Guatemalans live in absolute poverty. Upon arrival into the country, we began by watching our fearless leaders navigate through Guatemalan customs, transporting 65 large plastic totes containing laparoscopes, medications, endotracheal tubes, IV bags and all other needed surgical supplies. After much needed sleep (amazing what adrenalin can do) we had the privilege of visiting and learning more about FIP by touring Casa de Fe (House of Faith). This is a home-like facility equipped with dorms, individual rooms, laundry, kitchen and a chapel designed to assist recently discharged patients from the nearby hospital. This short stay allows patients to recover more fully before their often long commute back home, complete with unpaved and bumpy roads, which do not lend well to an otherwise painful recovery. After a four-hour scenic bus drive, we finally arrived to our much anticipated workplace, Hilario Galindo Hospital in Retalhuleu. Our first full day at Hilario Galindo was, unbeknownst to us, indicative of what was to come in the following four surgical days...a buzzing, active, hospital similar to any busy emergency room, filled overwhelmingly with appreciative and anxious patients, and a small few for whom more medical issues arose...all the while in Spanish.
2012 nursing annual report
Our surgeons, Dr. Patterson, Dr. Rivera, Dr. Morrow and Dr. Biderman, assessed patients, evaluated preop tests and determined appropriateness for surgery. Once through the physical exam, it was time for the anesthesiologists. Dr. Olson, Dr. Nguyen and Dr. Bendebel had the final word...the last hurdle for these trusting and hopeful people who never expected this rare opportunity. Behind the scenes were remaining team members charged with the task of creating a work space...three operating rooms, a pre-op and post-op area, admitting and finally a hospital ward for their overnight. The excitement and desire to be of service and help change lives was palpable. All this accomplished in a matter of four hours. Oh yes, and still on the adrenalin. Our doctors assessed and sat with 80 prospective patients, providing support and education. There were no hierarchy, politics or titles at Hilario Galindo. There was no assumption of whose job it was, rather, the question became, am I capable of doing it? The answer was overwhelmingly YES!! Despite the daily afternoon blackouts from fierce thunderstorms, and the broken autoclave finally repaired with WD40 and duct tape (yes, it’s the truth), the team pulled together, danced together, and fully supported one another for a common goal. Quite simply, we were 26 American professionals committed to living out our Providence and human Mission of making a difference in our shared world.
Judy’s Thoughts
We were able to just be nurses. We were able to focus on patient care; true patient care. There were no time clocks or overtime to worry about. The day ended when the work was done. We had to be very creative with the limited resources available. We covered patients with scratchy blankets and odds and ends of scrap sheets. Make-shift IV poles held some of their IV bags. A trash bag hung on the end of our supply cart was used to collect the used O2 masks to be washed and re-used. Still, the patients were so grateful for all we had done. When I walked through the halls on our last day I thought to myself, “This can’t be my last trip“. I felt I had a part in helping these people get their lives back.
Structural Empowerment
The people of Guatemala touched my heart in a way I did not expect. The vast majority lack any government assistance, much less actual insurance. Our patients struggled to provide for their families while in pain for years. Their appreciation for our care was like none I’d ever seen. One elderly man touched my face to bless me and said that God would allow me to live for 150 years because I helped him.
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2012 nursing annual report
Our Nursing Professional Practice Model the 4 Cs of PHCMC nursing n io ss pa m co
Patient and Family
ca ri ng
28
PHCMC Nursing Philosophy Achieving Excellence in an Evidence-Based Practice Environment
co
PH&S Nursing Vision Statement
ll
ab o
ra ti
o
n
Mission and Core Values
e
c en
t
pe
co
m
Professional Practice Environment
Our Providence Health & Services Vision Statement: Together, as People of Providence, we will answer the call of every person we serve: KNOW ME, CARE FOR ME, EASE MY WAY
Our Providence Health & Services Nursing Vision Statement: Providence nurses embrace their heritage of compassion, courage, and leading-edge care as a steadfast, sacred presence in protecting and easing the way for those in need.
2012 nursing annual report
Patient Placement Center Missy Blackstock, BSN, RN led the development of the Patient Placement Center
350 300 250 200 150 100 50 0
Pre PHCMC PPC
Post PHCMC PPC
PHCMC PPC 2012
Average LOS in minutes in ED for admitted patients
290
165
120
Average ED PG percentile ranking for likelihood to reccomment
78.45
92
67.6
Exemplary Professional Practice
This program was created to improve throughput, decrease ER saturation and enhance community care, while eliminating duplicative and cumbersome bedding processes with a 24/7 one-stop bedding shop. The steps to creating this successful program included our black belts using Lean Six Sigma processes and a field trip to learn about a successful program at UCLA. This allowed PHCMC to view differences among our medical centers, evaluate goals to see what worked well and to experience the concept of one portal of entry for Patient Placement. Our results for 2012 have shown continued improvement from the inception of this program.
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Nurse 6/2 Program Tricia Burkholder, BSN, RN, helped revitalize a special staffing program for night shift nurses. In 2000, 6/2 was created to recruit and retain experienced night shift nurses. This was an innovative staffing program where Nurses work six pay periods (12 weeks) followed by two pay periods paid time off (four weeks). This was made available to night shift RNs working 0.8-1.0 FTE on units where four nurses were willing to participate. This requires a rotation system of four FTEs to fill three positions for three nurses to be on schedule, while one nurse is off. The rationale for this program was to provide work life balance to support nursesâ&#x20AC;&#x2122; outside interests; health benefits in accordance with data that show night shift is detrimental to health of nurses; increased safety due to general improved work life balance and to support professional development. Advantages of the program were improved staff satisfaction with scheduling, recruitment and retention of experienced night shift nurses and improved work attendance. Disadvantages included increased management time spent on employee time-keeping, updating employee on unit-specific changes during time off and increased cost. One aspect of the increased cost included nurses being allowed to work for premium pay during off-time. Additionally, the program became unbalanced through attrition. This program was closed to new participants in 2011 due to the disadvantages. However, in 2012, staff approached our CNO during night rounding to express concerns and request a re-evaluation of the program. Based on direct care nurse input, 6/2 program received further evaluation. It was determined that staff saw this as a very popular and desirable program. Nursing leaders and the Human Resources Department developed a taskforce to evaluate and align the program with organizationâ&#x20AC;&#x2122;s goals for stewardship. New guidelines were drafted for the 6/2 program, including a 0.9-1.0 FTE requirement and defined clinical areas that met eligibility criteria to include Emergency Department, ICU, L&D and Mother Baby Unit. Currently we have 56 RNs enrolled in this successful program.
2012 nursing annual report
Modified Early Warning System (MEWS) Comes to Providence Holy Cross Chris Consolo, BSN, RN, CCRN, introduced a new program to prevent failure to rescue.
To:
Providence Health & Services, Southern California Employees and Physicians
From:
Katherine Bullard, RN, Regional Chief Nursing Officer
Lanny Eason, MD, Regional Chief Medical Officer
June 4, 2012
Patient Care Early Warning System Debuts at Providence Southern California
By monitoring several key clinical indicators provided through the Amalga centralized data system, which draws from the California Advanced Medical Information System (CAMIS), MEWS will become a key tool in proactively identifying patients who are at risk for clinical deterioration. MEWS is automated behind the scenes by Amalga, which calculates the score and alerts caregivers, while it also tracks all the data to provide a way to improve the process over time. The MEWS scoring system is based on four clinical readings – blood pressure, heart rate, respiratory rate and body temperature – along with one observation of level of consciousness. Comparing these readings to the normal ranges, our staff will gain important information to act quickly and take appropriate patient safety measures. Depending on severity, these scores trigger a range of interventions from increased patient monitoring to consulting immediately with the patient’s physician to activation of a Rapid Response Team of clinicians and the physician. MEWS is being developed and implemented at Providence Southern California by a regional team of physicians, nurses, health care business intelligence specialists and performance improvement leaders. Our team is closely monitoring the existing research on MEWS, and learning from our colleagues across Providence where the system is already in place. We are excited that MEWS will give our clinicians immediately-reliable data and flexibility to shape a response to a patient’s condition, raising the quality and safety of care that we provide. MEWS is designed to support the Providence Quality Strategic Framework focusing on no preventable deaths or harm. This technology illustrates how we are living out the Providence vision: “Together, we answer the call for every person we serve: Know me, care for me, ease my way.”
Exemplary Professional Practice
Providence Southern California is taking another important step on our journey to transform the delivery of clinical care and increase patient safety with implementation of the Modified Early Warning System (MEWS) in our ministries. Known as a “clinical seat belt” for its role in saving lives, MEWS will enable our ministry nursing, medical and emergency staffs to quickly determine a potentially significant change in a patient’s condition and mobilize rapid response teams or direct other interventions to appropriately manage these changes.
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2012 nursing annual report
MEWS in Action From: Bitney, Alison K Sent: Monday, May 28, 2012 2:54 AM To: Consolo, Christina M Subject: Kudos from Dr Araya Chris, I wanted to pass on a great compliment from Dr. Araya. A patient on Med/Surg triggered a ‘3’ for HR 158 and a ‘1’ for RR of 16 from the electronic MEWS. Although the patient was asymptomatic when I arrived, I intiated an RRT and the bedside nurse was instructed to call the doctor. The Charge Nurse and the assigned nurse assisted me. The EKG showed SVT. I spoke with Dr. Araya, who then came to see the patient. The patient began to become symptomatic and was treated with nitroglycerine. The transfer went well. Dr. Araya accompanied us with the patient to Telemetry. After placing the patient on an Eagle, and with RT present and the physician present we gave the patient adenosine. The patient converted to normal sinus rhythm. Dr. Araya was very interested in how I knew to initiate the RRT when the patient wasn’t being monitored. I reviewed the MEWS system briefly with him. He was impressed and very pleased with the assistance from me, the M/S nurses and the Tele staff calling it “Outstanding”. Just wanted you to know that the system is working to intervene on the patient’s behalf and assist the physicians. Please pass on my sincere thanks to the Nursing teams on 2E and 3A. They performed at the highest level. What awesome RNs, RTs, and CNAs we have at PHCMC!! Dr. Araya was a pleasure to work with.
2012 nursing annual report
Nursing Outcomes/Excellence Below is a sampling of our excellent nurse sensitive outcomes during 2012. The ratio of observed-to-expected mortality is used as a quality of care indicator. It indicates what the observed mortality rate is compared to the statistically expected mortality rate.
PHCMC Mortality O/E - PHS Objective to Date (90% Confidence Intervals)
1.8 MEWS Implemented
1.4 1.0
0.95 0.77 0.80
0.63
0.73
0.67
0.77
0.88 0.74
0.79
0.89 0.56 0.75
0.6
Jan- Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov YTD Dec Total 2011 O/E Ratio Target
O/E Ratios 2011 = 0.80, 2012 YTD = 0.75 Lower Confidence Interval (LCI) YTD = 0.67 (PH&S Target for LCI = â&#x2030;¤ 0.76)
Exemplary Professional Practice
0.2
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2012 nursing annual report
Nursing Outcomes/Excellence PHCMC CAUTI RATE 2BN Oncology Q1 2011-Q3-2012 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Qtr Oncology Unit CAUTI Rate NHSN Oncology Mean
Q1 2011
Q2 2011
Q3 2011
Q4 2011
Q1 2012
Q2 2012
Q3 2012
2
0
0
0
1
1
0
2.4
2.4
2.4
2.4
2.4
2.4
2.4
Q1 2012
Q2 2012
Q3 2012
PHCMC Falls 2BN Oncology Q1 2011-Q3-2012 Rate per 1000 Pt. Days
34
4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 Q1 2011
Q2 2011
Q3 2011
Q4 2011
Falls Per 1,000 Patient Days
4.03
1.14
1.95
1.85
0.62
1.31
2.50
HC Mean
2.14
2.14
2.14
2.14
2.14
2.14
2.14
NDNQI Mean
2.9
2.9
2.9
2.9
2.9
2.9
2.9
2012 nursing annual report
PHCMC CAUTI RATE 3CN Neuro-Telemetry Q1 2011-Q4-2012 3.0 2.5 2.0 1.5 1.0 0.5 0.0
Q1 2011
3C Tele CAUTI Rate NHSN MedSurge Mean
Q2 2011
Q3 2011
Q4 2011
Q1 2012
Q2 2012
Q3 2012
Q4 2012
2
1
1
1
0
0
1
0
1.6
1.6
1.6
1.6
1.6
1.6
1.6
1.6
Rate per 1000 Device days
NICU CLBSI
2.0 1.5 1.0 0.5 0.0
Jan-12
Feb-12
CLABSI
0.0
0.0
Mar-12 Apr-12 May-12 0.0
0.0
0.0
Jun-12 0.0
NHSN NICU Mean
2.2
2.2
2.2
2.2
2.2
2.2
Exemplary Professional Practice
2.5
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2012 nursing annual report
Nursing Outcomes/Excellence Elective Vaginal Deliveries or Elective C-Sections at â&#x2030;Ľ 37 wks and < wks Gestation 15 10 5 0
Jul 11
Aug 11
Elective deliveries before 39 weeks Rate
0
0
Elective deliveries before 39 weeks Target=<12
12
12
Sep 11
Oct 11
Nov 11
1.59 1.64 1.22 12
12
12
Dec 11 0 12
Jan 12
Feb 12
1.56 0 12
12
Mar 12
Apr 11
May 11
Jun 11
0
0
0
0
12
12
12
12
2DN All HAPU 7.00 6.00
Rate
5.00 4.00 3.00 2.00 1.00 0.00
1Q11
2Q11
3Q11
4Q11
1Q12
2Q12
All HAPU
0.00
5.88
0.00
0.00
0.00
0.00
0.00
HC M-S Mean
0.93
0.93
0.93
0.93
0.93
0.93
0.93
NDNQI M-S Mean
2.08
2.08
2.08
2.08
2.08
2.08
2.08
3Q12
4Q11
1Q12
2Q12
3Q12
2DN All HAPU 2.5 2.0 1.5
Rate
36
1.0 0.5 0.0
1Q11
2Q11
3Q11 0.00
0.00
0.00
0.00
0.00
HC M-S Mean
0.93
0.93
0.93
0.93
0.93
0.93
0.93
NDNQI M-S Mean
2.08
2.08
2.08
2.08
2.08
2.08
2.08
All HAPU
2012 nursing annual report
Patient Satisfaction A sample of our patients are surveyed after discharge to determine their satisfaction with nursing care, as well as other indicators.
Percentile Rank
HCAHPS Nurses Listen Carefully to You 100 80 60 40 20 0
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
PHC Percentile Ranking against all PG Database
2Q12 3Q12
57
45
64
38
80
68
29
37
Percentile Middle Rank
50
50
50
50
50
50
50
50
100 80 60 40 20 0
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
PHC Percentile Ranking against all PG Database
2Q12 3Q12
72
70
87
50
79
79
67
65
Percentile Middle Rank
50
50
50
50
50
50
50
50
Exemplary Professional Practice
Percentile Rank
HCAHPS Responsiveness of Staff
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2012 nursing annual report
Percentile Rank
HCAHPS Pain Management 100 80 60 40 20 0
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
PHC Percentile Ranking against all PG Database
41
77
61
50
67
70
77
46
Percentile Middle Rank
50
50
50
50
50
50
50
50
2Q12 3Q12
HCAHPS Provide Info Regarding Symtoms to Look for at Discharge Percentile Rank
38
100 80 60 40 20 0
4Q10
1Q11
2Q11
3Q11
4Q11
1Q12
2Q12 3Q12
PHC Percentile Ranking against all PG Database
64
59
49
67
10
69
64
54
Percentile Middle Rank
50
50
50
50
50
50
50
50
2012 nursing annual report
Nursing Satisfaction The following graphs demonstrate our nursesâ&#x20AC;&#x2122; satisfaction across the five NDNQI indicators: nursing participation in hospital affairs; nursing foundations for quality of care; nurse manager ability, leadership and support, staffing resource adequacy; and collegial nurse-physician relations.
3.50 3.25 3.00 2.75 2.50 2.25 2.00 1.75 Nursing Participation in Hospital Affairs
Nursing Foundations for Quality of Care
Nurse Manager Ability, Leadership and Support of Nurses
Staffing and Resource Adequacy
Collegial NursePhysician Relations
PHCMC Sub Acute Mean
2.96
3.11
3.1
3.13
3
NDNQI National Non-Teaching Hospitals Acute Rehab Mean
2.91
3.15
2.99
2.87
3.06
Exemplary Professional Practice
NDNQI Nurse Satisfaction PES 2012 Sub Acute
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2012 nursing annual report
NDNQI Nurse Satisfaction PES 2012 Labor & Delivery 3.50 3.25 3.00 2.75 2.50 2.25 2.00 1.75 Nursing Participation in Hospital Affairs
Nursing Foundations for Quality of Care
Nurse Manager Ability, Leadership and Support of Nurses
Staffing and Resource Adequacy
Collegial NursePhysician Relations
PHCMC L&D Mean
3.01
3.13
3.03
3.14
3.17
NDNQI National Non-Teaching Hospitals OB Mean
2.82
3.09
2.88
2.75
3.06
NDNQI Nurse Satisfaction PES 2012 Emergency 3.50 3.25 3.00 2.75 2.50 2.25 2.00 1.75 Nursing Participation in Hospital Affairs
Nursing Foundations for Quality of Care
Nurse Manager Ability, Leadership and Support of Nurses
Staffing and Resource Adequacy
Collegial NursePhysician Relations
PHCMC ED Mean
2.99
3.15
3.36
2.66
3.41
NDNQI National Non-Teaching Hospitals ED Mean
2.85
2.99
2.97
2.55
3.28
2012 nursing annual report
NDNQI Nurse Satisfaction PES 2012 Cardiac Cath Lab 4.00 3.75 3.50 3.25 3.00 2.75 2.50 2.25 Nursing Participation in Hospital Affairs
Nursing Foundations for Quality of Care
Nurse Manager Ability, Leadership and Support of Nurses
Staffing and Resource Adequacy
Collegial NursePhysician Relations
PHCMC Cardiac Cath Lab Mean
3.64
3.74
3.88
3.85
3.87
NDNQI National Non-Teaching Hospitals Interventional Mean
2.9
3.16
3.07
3.03
3.12
3.50 3.25 3.00 2.75 2.50 2.25 2.00 1.75 Nursing Participation in Hospital Affairs
Nursing Foundations for Quality of Care
Nurse Manager Ability, Leadership and Support of Nurses
Staffing and Resource Adequacy
Collegial NursePhysician Relations
PHCMC 3CN Mean
3.14
3.3
3.2
2.89
3.17
NDNQI National Non-Teaching Hospital Step Down Mean
2.89
3.13
3.04
2.58
2.92
Exemplary Professional Practice
NDNQI Nurse Satisfaction PES 2012 Telemetry (Neuro) 3CN
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2012 nursing annual report
4th Annual Nursing Conference/1st Annual PH&S California Regional Nursing Conference In 2012, through collaboration among our five Southern California Hospitals, we developed and presented a research and evidence-based practice day, attended by 100 nurses. We were fortunate to have Suzette Cardin, DNSc, RN, FAAN, Assistant Dean of Student Affairs-UCLA, present a keynote lecture on Family-Centered Care.
Providence Southern California Region Research & Evidence-Based Practice Day Program May 10, 2012 8:00-8:20 Welcome and Introduction - Katherine Bullard MSN, RN, Chief Nursing Officer, Providence Southern California Region
8:20-8:45 Induced Hypothermia in the Adult Survivor of a Non-Traumatic Cardiac Arrest with Return of Spontaneous Circulation (ROSC) AKA Targeted Temperature Management - Sherry Samson, BSN, RN, Jennifer Herz, BSN, RN, Kathy Sliff, MSN, RN, CCRN (PLCM-T)
8:45-9:10 Colostrum for Oral Care in the NICU - Rita Wadhwani, RN, MSN, RNC-NIC, ACNP, CNS (PLCM-T)
9:10-9:35 Management of Medical Intensive Care Unit Patients with IV Insulin Infusion: A Tale of Two Pilot Studies, and One Success - Katherine Rich, ADN, RN, CCRN, Lisa Blomley Encisco, RN, CDE Lisa Barile, MSN, RN, CCRN (PSJMC)
9:35-9:50 15 Minute Break
2012 nursing annual report
9:50-10:20 Engaging Your Medical Librarian in the Evidence – Based Research Process - Lisa Marks, MLS, AHIP (PSJMC)
10:20-10:45 Functional Independence Measure (FIM) & Falls Follow UP - Terri Gately, RN-BC, BSN, MS, CCRN, Sandra Farrell, RN (PHCMC)
10:45-11:10 Optimizing Cardiopulmonary Resuscitation Using End Tidal CO2 Capnography - Candy Corral, MSN, RN, CNS (PSJMC)
11:10-11:35
11:35-11:55 PACU Thermoregulation Study - Kimberly Crabtree-Loyd, RN, MSN (PHCMC)
11:55-12:40 Lunch (45 minutes)
12:40-1:30 Keynote Presentation: Family Centered Care - Suzette Cardin, DNSc, RN, FAAN, Assistant Dean of Student Affairs-UCLA
1:30-1:50 Surrogacy: Policy Development Required for the Real Parents to Stand Up - Lori J. Bacsalmasi, MSN, RNC-OB, CCE, Dawn Hernandez, BSN, NE-BC, RNC-OB, C-EFM, PHN (PSJMC)
1:50-2:20 Delivery Room Management Quality Improvement Collaborative - Jeff Hartleroad, MD, Debbie Camara MSN, NNP-BC, CCNS (PSJMC)
2:20-2:35 15 Minute Break
2:35-3:05 Does in situ Mock Code Blue Improve Code Blue Performance - Melissa Punnoose, MSN, RN-BC, Heidi Traxler, RN, MSN (PLCM-T)
3:05-3:30 Pain Management in the Women’s Health Patient - Margie Cambra, RN, CLE (PLCM-T)
3:30-4:15 Providence Southern California Nursing Institure - Kathy Harren, RN, MHA, Director, Nursing Institute, Providence Southern California
4:15-4:30 Conclusion
New Knowledge Innovations and Improvements
Cooling Malignant Hyperthermia Chaos with Crisis Event Checklist in the OR - Claudette Dorsey, BSN, RN, CNOR, Diane Dragotto, ASN, RN, CNOR, Melissa Punnoose, MSN, RN-BC, Heidi Traxler, RN, MSN (PLCM-T)
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2012 nursing annual report
Publications, Presentations and Grants Tim Gilmore, RN, MHA; Foundation for Nurse Leaders: Quality and Safety; Association of California Nurse Leaders, San Francisco, CA; April 27, 2012; Podium Presentation Kim Crabtree-Loyd, MSN, RN, FNP; PACU Thermo-regulation; PH&S Southern California Region Nursing Research Conference; May, 10, 2012; Podium Presentation Terri Gately RN, BS, MS, CRRN, RN-BC; Correlation Between FIM Scores and Fall Risk; PH&S Southern California Region Nursing Research Conference; May, 10, 2012; Podium Presentation Dr. Jeff Hartleroad, MD & Debbie Camara; MSN, RN, NNP; Delivery Room Management; Quality Improvement Collaborative; PH&S Southern California Region Nursing Research Conference; May, 10, 2012; Podium Presentation Sherri Mendelson, PhD, RNC, CNS, IBCLC; The Effects of Labor and Delivery Practices on Breastfeeding; AWHONN National Conference, National Harbor, Washington, DC; June, 2012; Podium Presentation Dr. Marwa Kilani, MD; Leah Phillips, BSN, RN; Improved Family-Centered Care: Infusing Palliative Care Philosophy; 7th National Learning Congress (NLC), Grapevine, TX; October 4-5, 2012; Podium Presentation Kim Murphy, RN, MSN, ACNP; Chris Consolo, Dr. Hanpeter, MD, Dr. Roth, MD ; Trauma Surgeon and Critical Care Nursing Collaboration Improves Organ Donation Outcomes; 7th National Learning Congress (NLC), Grapevine, TX; October 4-5, 2012; Podium Presentation Sherri Mendelson, PhD, RNC, CNS, IBCLC; The Effects of Labor and Delivery Practices on Breastfeeding; I Never Promised You a Rose Garden, Tarzana, CA; October19, 2012; Podium Presentation
IRB Approved Nursing Research Studies PROJECT NAME
LEAD(s)
DESCRIPTION
Increasing Smoking Cessation for Patients and Staff at a Community Hospital
Terri Gately, RN, BSN, MHA, / Staff survey on knowledge; focused interviews Sherri Mendelson, PhD, RNC, on views; CNS Phase 2 patient smoking on readmit (effectiveness of education)
In-Patient Nursing Education Home Blood Pressure Monitoring To Manage Hypertension
Susie Parker, LVN, Sherri Mendelson, RNC, CNS, PhD, Debbie Tsunoda, ACNP-BC
Interventional one-group study to provide focused education on BP monitoring including providing electronic BP machine
Project HOPE: Health Promotion for a Healthy Pregnancy and Family
Sherri Mendelson, PhD, RNC, CNS
One group Pre and Post intervention outcome study for intensive case management for new mothers/babies in the community. Qualitative focus group aspect. Funded collaborative project
CALNOC Interdisciplinary Nursing Tim Gilmore, RN, MHA Quality Research Initiative Study
Prevalence and correlation study
High Protein Diet for Weight Loss
Intervention study for reduction of obesity
Sherri Mendelson, PhD, RNC, CNS PHCMC Lorraine Evangelista, PhD, RN-UCLA/UCI
PROJECT NAME
LEAD(s)
DESCRIPTION
FIM Scores and Falls in the Acute Rehab Unit
Terri Gately, BSN, RN, MHA
Relationship of FIM Scores and Falls in Acute Rehab patients
Sacral Pressure Ulcer Prevention in the ICU
Kathy Cadden, MSN, RN
Clinical Trial of two different dressings to prevent sacral pressure ulcer
National Childrenâ&#x20AC;&#x2122;s Study
Yajaira Angulo, MSN, RNC, CNS
Collaborative National study â&#x20AC;&#x201C;Cedars Sinai
The Effect of Mentoring for New Graduate Nurse Retention and Satisfaction
Bilma Pellissery, RN, MSN; William Lim, RN, BSNc
Pilot study using triangulated methodology of survey and interviews
Use of Cranberry Extract Capsules to Decrease the Incidence of UTIs in Women in Labor and Delivery
Sherri Mendelson, PhD, RNC, CNS
Double blind clinical trial.
The Financial Implications of a Nursing Research Committee
Sherri Mendelson, PhD, RNC, CNS
Retrospective quantitative financial exploration of decision not to use silver coated urinary catheters made by Research Council and cost savings over another hospital that changed to silver-coated catheters.
The Effectiveness of a Nursing Research Committee
Sherri Mendelson, PhD, RNC, CNS
Survey Design comparison between two hospitals with long-standing research councils and two with new research councils
Unavoidable Pressure Ulcer Study
Sherri Mendelson Monica Tweddell, RN, WCC
Causal Study in the ICU with matched samples.
C-Difficile
Jane Boylan, BS, RD
One group retrospective study to determine the relationship of H2 Blockers and c-difficile in ICU patients
CMS Breastfeeding
Sherri Mendelson, PhD, RNC, CNS, IBCLC/Merav Efrat, IBCLC (CSUN)
Training college students to provide breastfeeding education to new mothers during hospitalization and the postpartum home period.
GI Lab-over 65 bowel prep completion
Lisa Fetterolf, RN, BSNc
One group descriptive study on appropriate bowel preparation completion for GI patients
Increasing Research Participation in Communities of Color
Marie Mayen-Cho, RN
Qualitative phenomenological study in collaboration with UCLA to determine why community members do not participate in research studies.
MEWS
Chris Consolo
Retrospective study to explore the results of the MEWS implementation to decrease Code Blue calls outside of the ICU.
Staff Acceptance of RRT
Stacey Beatty
One group descriptive study of staff nurse experience with the Rapid Response Team
Examining Time of Day as a Predictor of Patient Falls
Kate Connolly
Retrospective exploration of circadian rhythms and fall incidence in the Neurology Unit inpatient.
Delayed Cord Clamping
Sherri Mendelson
One group quasi experimental study on delaying cord clamping in the delivery room. Collaboration with OB Physician
Education on Care of Surrogacy Families
Dawn Hernandez
Pre and post education program for MCH staff
New Knowledge Innovations and Improvements
2012 nursing annual report
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2012 nursing annual report
Hands by Linda Harrington RNC (Nurse Emeritus) Frowning, I gaze down at my hands. My hands look sad and horrible. Their appearance embarrasses me. If I had a dime for every time I washed my hands, I would be rich. Alcohol hand sanitizers have increased the already dry and cracked skin; I feel abusive. Unattractive split nails and torn cuticles…, I wish I could somehow hide these pathetic looking hands. I hope my patients don’t notice how dreadful they look; how rough they feel. I reach for the hand lotion. The calm of the moment invites me to recall the day’s activities. I held the hand of a terrified patient this morning. Childbirth can have that effect on people. Remembering her powerful, desperate squeeze explains my sore right thumb. As other nurses filled the room, busy co mpetent hands prepared for a new life. Centered in this beehive of activity was my patient. Nurtured by this culture of caring her panic was soon replaced by a calming trust. Minutes later she set my hand free to touch the face of her newborn baby. I continue to massage the soothing lotion. The moment allows me to rearrange my perspective; to rethink my original assessment. These are fortunate hands; remarkable hands. Maybe I should insure these hands. My hands are the tools of my trade; they are beautiful instruments of caring. If I act responsibly these hands can make a positive difference in the lives that they touch. When I share my knowledge they can teach and guide. When words prove inadequate a sincere grasp can offer support and communicate a passion to help. And so it is that my patients reach out for my hand, and I am there to quickly take hold. The condition of my hands is irrelevant; they need only to be heartfelt in their work. A new appreciation for the responsibility and power of what I do washes over me. Looking down at my hands I vow to take better care of these priceless tools. Maybe I’ll make an appointment for a manicure. How silly to think I should hide them; I am proud of what they do. I imagine that if my hands could talk they would express gratitude for the opportunity to help and heal: They would forgive me for their somewhat shabby state. Contented, my fantasy ends; this time I smile as I gaze at my hands ….. ……. and in that moment, my hands smiled back.
New Knowledge Innovations and Improvements
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2012 nursing annual report
A Vision of Our Excellent PHCMC Nurses
Our Magnet Re-Designation Wall designed by our own Erin Flynn, RN, OCN
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Looking Towards the Promise of 2013 As we enter 2013, we are anxiously awaiting positive word about our Magnet re-designation. We look forward to a year of increasing our inter-professional collaboration and our regional nursing participation. In 2013 we will adopt a regional Professional Practice Model to strengthen nursing on a regional level across the continuum of care. Change is a given and we look forward to being at the forefront of positive changes within nursing at PHCMC, within our region, systemwide, nationally and internationally!
Thank you to all of our nursing colleagues for making Holy Cross a great place to work and a great place for our friends, families and neighbors to receive excellent health care!
Providence Holy Cross Medical Center 15031 Rinaldi Street Mission Hills, California 91346 (818) 365-8051
1-888-HEALING www.providence.org/holycross