CAROLINA
2013 Fiscal Year Nursing Annual Report UNC Hospitals Divisio n o f N ursing
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LETTER FROM DR. TONGES
6 TRANSFORMATIONAL LEADERSHIP Stephanie Bohling
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URSING STAFF PROFILE N John Gotelli
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URSING STAFF PROFILE N Noah Okafor
NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS Angela Overman
20 NURSING STAFF RECOGNITION AWARD WINNERS
STRUCTURAL EMPOWERMENT Christa Clark
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MAXIMIZING PRACTICE AT THE BEDSIDE
URSING STAFF PROFILE N Michael Langston
14 EXEMPLARY PROFESSIONAL PRACTICE Darla Topley
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Dear Colleagues and Friends, I’m very pleased to again have the opportunity to share Nursing highlights for the year. University of North Carolina Hospitals (UNCH) is strongly committed to advancing the art and science of nursing. We are very fortunate to work in an organization providing an environment that supports both the delivery of excellent nursing care and the workplace well-being of the nursing staff who provide this care. The high points of our work in Fiscal Year 13 can be summarized as follows:
PEOPLE
The 2010 Institute of Medicine report on The Future of Nursing recommended that the percentage of direct care nurses with a Baccalaureate or higher nursing degree be increased to 80% by the year 2020 because of evidence of a positive relationship between higher levels of nursing education and better patient outcomes. To assist UNCH RN employees in continuing their education and earning a BSN, our on-site RN to BSN program with Winston-Salem State University began on May 22. The Professional Development Council has done great work to help with increasing the number of UNCH RNs who are Baccalaureate prepared. Additionally, I’m so very proud to report that our on-site NA II program graduated 54 NA employees in the last 12 months with a 100% successful completion rate.
SERVICE
For the year ending June 30, 2013, our score for overall satisfaction is in the 87th percentile and satisfaction for nursing care was at the 91st percentile as compared to other hospitals in the Press Ganey database of 600 beds or more, and on the Center for Medicare and Medicaid’s Hospital Consumer Assessment of Health Plans Survey (HCAHPS) 83% of patients rank us highly on recommending UNCH to friends and families. We have the highest HCAHPS scores for 9 of the 10 items and are tied for 1 making us the best performer in the Triangle. Carolina CareTM is creating the best possible hospital experience for our patients and families. It’s also very important to note that our Diversity Council has helped UNCH achieve Health Equality Index (HEI) status for the care of our LGBT patients, part of the diverse population of patients we serve.
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QUALITY
On the NDNQI quality measures, 87% of units outperformed the national average for skin care, 80% for restraints and 70% for falls. More than half of our units are in the top 25 percent of NDNQI units nationally at least half of the time. We are contributing heavily to the Hospitals’ success in meeting or exceeding quality goals. Nursing played an especially strong role in reducing CAUTIs per 1,000 patient days from .73 last year to .61 against a goal of .65. Nursing has also contributed to the success in reducing the deep vein thrombosis and pulmonary embolism rate from 12.3 per 1,000 cases to 9.8 against a goal of 11.7. Clearly the nursing shared governance Quality Council has done excellent work again this year.
FINANCE
As the largest division in an organization in which at least 50+ percent of costs are salaries, Nursing’s financial performance is critical to hospital success. The following outcomes reflect careful stewardship of the resources for which the Nursing Division is responsible:
•B udget Index: Percent of budgeted expense dollars spent = 97.5% (2.5% under budget)
• P roductivity Index: Relationships between labor and budgeted volumes = 100.5% (.5% better than target).
In summary, this is quality with economy.
GROWTH
We continued to grow in Fiscal Year 2012-2013: • October 2012: Our newest unit, 7 Neuroscience, a 24-bed Surgical Oncology/ENT Unit opened • November 2012: Following the move to 7 Neuroscience, 6 East reopened as a 14-bed GI Surgery Unit • We are designing a new 24 bed Medical Progressive Care Unit on 3 Bedtower and a 24-bed Bone Marrow Transplant Unit on 1 Neuroscience to open in the summer/fall of 2014.
INNOVATION
The one-year anniversary of full implementation of our Carolina Care Partners in PracticeTM model on 4 Anderson North (4 And N), the Innovations Unit, occurred in May. 6 East opened as a Partners Unit, and this care delivery model will be expanding to 7 Neuroscience. Outcomes on 4 And N are excellent. Comparing pre- and postimplementation of this staffing and care delivery model, patient and nursing satisfaction increased while the falls and Catheter Associated Blood Stream Infection (CABSI) rates decreased. More specifically, this unit had gone 135 days without a fall and had no CABSIs for a year. Nursing has contributed a great deal of talent to the building and implementation of the Epic health care information system: the Core team includes 11 UNCH RNs and 36 UNCH RN Subject Matter Experts. The Professional Practice Council has continued to create and implement nurse-driven protocols and standing orders to enable RNs to practice more autonomously to the full scope of their education
and competence. This year we implemented an electrolyte replacement protocol in the ICUs and extended the Foley Catheter Removal protocol house-wide. Last but not least, we’ve continued to expand Partnering with Patients and FamiliesTM beyond the Children’s and Cancer hospitals to include Family Medicine and the N.C. Jaycee Burn Center, as well as a number of committees. Patient/family advisors are actively involved in the design of our new units and information system, which has many features to facilitate access. These volunteers also help with reviewing patient education materials, participate in interviewing applicants and helping health care learners to better understand the patient’s perspective. Their advice and help are invaluable, and we so appreciate their time and insights. In summary, I’d like to quote Donna Shalala, former Secretary of Health and Human Service and Chair of the committee that wrote the IOM Future of Nursing Report, who has said:
“A strong, growing nursing profession isn’t a byproduct of a thriving health care system. It’s a prerequisite for it.” I couldn’t agree more. Sincerely,
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A new program opens a window on leadership challenges – and promotes a desire to stay at UNC Hospitals.
TRANSFORMATIONAL LEADERSHIP
Stephanie Bohling, BSN, RN, CAPA Clinical Nurse IV Children’s Intermediate Cardiac Care 6
Gaining a deeper understanding “It was an idea I had when I was a CN IV. The entire program is about nurses getting guidance from those already in leadership positions.�
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Geriatric nurse practitioner John Gotelli finds inspiration anew every day.
NURSING STAFF PROFILE
John Gotelli, MSN, NP Geriatric Nurse Practitioner – Geriatric Medicine Unit
“It’s amazing to talk to 80- and 90-yearolds about their life experiences and what they’ve gone through.” 8
Tapping into the inspiration
of the elderly
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“You sit with your patient to talk about something unrelated to why they’re in the hospital. That moment of caring directly relates to our caring theory.”
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Shared governance empowers nurses from the bedside to affect practice – including their choice of nursing theorist.
Translating caring theory into bedside practice
STRUCTURAL EMPOWERMENT
Christa Clark, BSN, RN, CCRN Clinical Nurse IV – Medicine Intensive Care Unit
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Bringing diverse skills together
“For anyone who wants to help people very holistically, nursing is the perfect career.� 12
After trying psychology, theology and social work, Michael Langston finds a career that brings his caring skills together.
NURSING STAFF PROFILE
Michael Langston, PhD, RN, NE-BC Clinical Nurse IV – 6 Neurosciences
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Transforming nursing practice
“Staff nurses can change practice. All you have to do is ask the question.�
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Getting patients moving helps get them home sooner, so Darla Topley led the development of a new protocol.
EXEMPLARY PROFESSIONAL PRACTICE
Darla Topley, MSN, RN, CCNS Clinical Nurse IV Surgical /Trauma Intensive Care Unit
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Fostering hope and healing
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Noah Okafor, a native of Nigeria, impacts lives at North Carolina’s Jaycee Burn Center.
“When they arrive, some have 95 percent burns. I see family members giving up. And when they start turning around, the family is the first to be very amazed.”
NURSING STAFF PROFILE
Noah Okafor, NA II Nursing Assistant – N.C. Jaycee Burn Center 17
NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS
Angela Overman, MSN, RN, CNML, NE-BC Nurse Manager – Innovations Unit
“Patients don’t know exactly what is different, but they can sense a difference in the level of care they receive.” 18
Partnering to focus care
UNC Hospitals’ Innovations Unit transformed traditional nursing care delivery.
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Nursing Staff Recognition Week
NURSE MANAGER OF THE YEAR
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NURSES OF THE YEAR
Megan O’Connor BSN, RN, NE-BC Patient Services Manager III Medicine Service
Jane Burrill MSN, RN-BC Clinical Nurse Education Specialist Nursing Practice and Professional Development
Christa Clark BSN, RN, CCRN Clinical Nurse IV Medicine Service
Jennifer Covington RN-BC Clinical Nurse III Surgery Service
Kimberly Meador BSN, RN, WHNP Clinical Nurse II Surgical Services
Katherine Mihalek RN Clinical Nurse II Women’s Services
Patricia Morfeld BSN, RN, OCN Clinical Nurse II Oncology Services
Tererai Mutyavairi BSN, RN Clinical Nurse II Psychiatry
AWARD WINNERS
Rufus Eller RN Clinical Nurse II UNC Center for Transplant Care
Joy Hazard BSN, RN Clinical Nurse III Children’s Services
Ellenita Kornegay BSN, RN Clinical Nurse II UNC Center for Heart & Vascular Care
Wade Mauser BSN, RN, CEN Clinical Nurse III Emergency Services
Debby Berry Administrative Coordinator Surgical Services
Brenda Farrington Health Unit Coordinator Women’s Services
Sheldra Holloway Health Unit Coordinator Oncology Services
ASSISTIVE PERSONNEL OF THE YEAR
Tasha Arendshorst Certified Nursing Assistant I Psychiatry
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Nursing Staff Recognition Week
AWARD WINNERS
ASSISTIVE PERSONNEL OF THE YEAR
Pamela Judge Health Unit Coordinator Children’s Services
Leah Mogaka Clinical Support Technician II Surgery Service
FACULTY OF THE YEAR
Vanesa Newby Health Unit Coordinator Medicine Service
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Sara Hubbell MSN, APRN, NP-C UNC-Chapel Hill School of Nursing Clinical Instructor
Vanessa Moore Health Unit Coordinator UNC Center for Heart & Vascular Care
COLLABORATIVE COLLEAGUE
Jennifer Barrow PharmD Department of Pharmacy Clinical Pharmacist
Eleanor Murray Medical Support Assistant III UNC Center for Transplant Care
FRIEND OF NURSING
Benjamin Haithcock MD, FACS, FCCP Assistant Professor of Surgery and Anesthesiology, UNC Chapel Hill Surgical Director, UNC Hospitals Lung Transplant Program
Maximizing Practice at the Bedside
Challenged with a goal of providing better, safer, and more affordable health care for more patients, UNC Hospitals (UNCH) nursing created Carolina Care: Partners in PracticeTM, a model that incorporates a partnership approach while improving bedside caregiver communication. This model uses an RN-Nursing Assistant II (NA II) or Clinical Support Technician II (CST II), which is a role that includes NA II as well as Health Unit Coordinator responsibilities, in a partnership to care for a group of patients. North Carolina State Board of Nursing (NCBON) certified NA IIs can perform a broader range
NA Training Program graduating class, June 2013
of skills than the NA I, thus enhancing the RNs ability to practice to the full scope of their practice and creating a more fulfilling job for NAs. To operationalize this model, the UNCH Nursing Division needed to increase the number of NA IIs on staff.
and recruitment of these employees. The curriculum consists of 80 classroom hours followed by 80 precepted clinical hours which the student performs on their home unit. During the application process, potential students
In response, UNCH established an on-site NCBON
identify their career development goals and describe
approved NA II Training Program on May 22, 2012
how their acceptance and participation in the program
under the leadership of Program Director Jami Howell,
will contribute to UNCHs’ commitment to excellence in
MSN, MBA, RN. The program expands the scope of
patient care. Additionally, the student’s nurse manager
responsibility of the Nursing Assistant by educating
provides a recommendation to enter the program and
NA Is to meet requirements set forth by both NCBON
a commitment to support and employ the NA II full-time
and UNCH policies, empowering them to perform to
after graduation.
their full capacity as NA IIs.
The program is offered quarterly and has the capacity to
In addition to providing better, safer, and more
train 120 NA IIs annually. To date, the program boasts a
affordable health care, goals of the program include
100% completion and graduation rate with 72 students
increased professional development and advancement
successfully completing the program.
opportunities for NA employees and improved retention
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Produced by The Division of Nursing at UNC Hospitals October 2013
www.unchealthcare.org/site/Nursing Producer: Peggy Mattingly, RN, UNC Hospitals Design: Sally Johns Design + Strategic Marketing Photography: Jim Colman Photography Video Production: Horizon Productions