ORGANIZATIONAL OVERVIEW
A letter from the Chief Nursing Officer of Sanford Fargo
As I reflect on the past year, I am so proud and thankful for the incredible journey we shared together. 2023 was a year of remarkable growth, achievement and collaboration for our nursing team. Our strength as a unified team has never shined brighter and our collective efforts have led to incredible milestones that deserve to be recognized.
One of the most inspiring aspects of the year was the overwhelming recognition of our nurses. We had a record number of 717 nominations for our annual nursing awards, a testament to the dedication, compassion and excellence each of you bring to our organization every day. Out of these nominations, 29 outstanding nurses were honored with awards, showcasing the depth of talent and commitment within our team.
Our journey towards Magnet® designation has continued with great momentum.
Throughout the year, our team gathered information, compiled data and began the process for writing over a hundred stories that will be submitted in 2024. This process has highlighted the incredible work our nurses perform daily, reinforcing our commitment to excellence in patient care and nursing practice. I look forward to continuing this Journey to Nursing Excellence® with you all into 2024 and 2025.
The spirit of shared governance has been a cornerstone of our progress, empowering nurses at all levels to contribute to decision-making processes and shape the future of our practice. This collaborative approach has fostered a culture of inclusion and innovation, leading to enhanced patient outcomes and professional satisfaction.
We were honored to receive the Vizient Rising Star Award. Our ranking as the 19th out of 116 comprehensive academic medical centers, including a 4th place ranking in the safety domain, has earned us a 4-star designation. These accomplishments are a testament to our persistent pursuit of excellence.
Another significant highlight of 2023 has been the welcoming of over 200 internationally educated nurses to our team. They have not only helped us address staffing needs but also enriched our team with diverse perspectives and skills, enhancing the quality and inclusivity of the care we provide.
As we look forward to the coming year, I am excited about the opportunities ahead and confident in our ability to continue growing stronger as a team. Together, we will build on our successes, overcome any challenges that come our way and continue to provide exceptional care to our patients.
Thank you for your continued dedication, passion and excellence. It is an honor to lead and work alongside such an extraordinary team.
With gratitude,
Theresa Larson, MSN, BSN, RN Chief Nursing Officer, Sanford Fargo Medical Center and Clinics
OUR MISSION
Dedicated to sharing God’s love through the work of health, healing and comfort.
OUR VISION
Improving the human condition at every stage of life through exceptional care, spiritual enrichment, innovation and discovery.
OUR VALUES
Calling
Demonstrating enthusiasm for those we serve, our vocation and the organization’s mission.
Courage
Having strength to persevere, innovate, use our voices and take action.
Family
Celebrating the connection and commitment we have to each other through it all.
Community
Providing care in a diverse range of settings and environments with a focus on the wellness of individuals.
Service
Sharing God’s love through actions that reflect compassion, acceptance, love, humility and sincerity in keeping with the common Lutheran heritage of our legacy organizations.
Resolve
Adhering to systems that align actions to excellence, efficiency and purpose.
Advancement
The pursuit of individual and organizational growth and development.
ABOUT SANFORD HEALTH
Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization serves more than one million patients and nearly 200,000 health plan members across 250,000 square miles. The integrated health system has 45 medical centers, 2,900 physicians and advanced practice providers, 540 active clinical trials, 160 Good Samaritan Society senior living centers, and world clinics in nine countries around the globe.
Sanford Health includes:
45 medical centers
211 clinic locations
160 Good Samaritan Society senior care locations
152 skilled nursing and rehab facilities
Nearly 200,000 Sanford Health Plan members
44,000 employees
2,900 physicians and advanced practice providers and 7,944 registered nurses delivering care in more than 80 specialty areas
Centers of Excellence:
Sanford Cancer Center
Sanford Children’s
Sanford Heart
Sanford Orthopedics & Sports Medicine
Sanford Women’s
Sanford Health’s annual patient statistics for 2023:
5.8 million outpatient and clinic visits
80,880 admissions
143,217 surgeries and procedures
9,541 births
224,223 emergency department visits
Sanford Medical Center Fargo, which opened in 2017, serves as a regional health care hub, with 60% of patients coming from outside the metro area. Sanford Medical Center Fargo takes care to the next level, combining expertise, state-of-the-art technology and compassionate patient care. The center is also home to a Level 1 adult trauma center, a Level II pediatric trauma center and an emergency air transport service covering a three-state area. Additionally, the center has The Joint Commission-approved advanced comprehensive stroke center and the highest level of stroke certification.
Quick facts about Sanford Medical Center Fargo in 2023:
3,562 nurses
395 APRNs
708 PCTs
82 clinic locations
938,484 clinic visits
752 licensed beds
27,624 inpatient admissions
63,241 emergency department visits
27,147 surgical procedures
15,331 outpatient dialysis treatments, including support for 12 home hemodialysis patients and 31 peritoneal dialysis patients
Home dialysis penetration of 30%
2,743 deliveries
Average daily census of 422.76 patients
Average length of stay (LOS) of 5.00 days
Case mix index (CMI) of 1.79
Quick fact about Sanford Fargo’s rural network:
697 nurses
145 APRNs
71 PCTs
114 clinic locations
496,466 clinic visits
1,817 inpatient admissions
11,464 emergency department visits
1,819 surgical procedures
23,868 outpatient dialysis treatments, including support for 7 home hemodialysis patients and 38 peritoneal dialysis patients
Other services offered at the center include:
Emergency and trauma care
Family birth center
Children’s hospital
Brain and spine surgery
Heart surgery
Interventional cardiology
General surgery
CULTURE
At Sanford Health, we believe quality health care should be available close to home for everyone, everywhere.
From our roots in the Midwest, we are proud to set the standard for delivering worldclass care. By building on the talents, experiences and beliefs of our employees, we aim to improve the lives of patients and residents throughout the diverse communities we serve. Through our shared commitment, we can become the nation’s most-connected, widest-reaching health care system, shrinking the distance between every patient and their best, healthiest life.
Journey to Magnet® Excellence
The American Nurses Credentialing Center’s Magnet Recognition Program distinguishes health care organizations that meet rigorous standards for nursing excellence, making it the gold standard for nursing practice. This credential is the highest international honor for professional nursing practice.
To achieve initial Magnet recognition, organizations must pass a rigorous and lengthy process that demands widespread participation from leadership and staff. This process includes an electronic application, written patient care documentation, an on-site visit and a review by the Commission on Magnet Recognition.
In August of 2023, Sanford Medical Center Fargo submitted its formal application to the American Nurses Credentialing Center (ANCC) as our letter of intent and demonstration of meeting eligibility requirements to pursue Magnet designation. On August 29th, 2023 we received notification from the Magnet program office that our application for designation was approved. This is a significant milestone in our organization’s journey to excellence and puts us well on our way toward achieving designation in 2025. With this acceptance, we are now able to use the ANCC Journey to Excellence seal as we continue our Magnet journey.
The next significant milestone will be submission of documentation providing examples of how Sanford Medical Center Fargo is meeting Magnet standards. We plan to submit over 100 examples of data and stories by August of 2024. Nurses from inpatient and ambulatory settings are continuing to identify and write examples of nursing excellence to include as many areas across the organization as possible so we can demonstrate integration of Magnet principles in all areas of clinical practice.
Magnet designation is an organizational designation demonstrating that our nurses collaborate with all areas to provide the best quality of care to those we serve. One of the major requirements to submit our documents in 2024 includes our RN Satisfaction scores. On September 11th 2023, the NDNQI RN Satisfaction Survey was deployed to Fargo Metro nurses. We received results of our survey in December 2023 which showed amazing results and we “outperformed” other hospitals across the nation in eight out of nine categories as shown below! This shows the great work environments our nurses participate in and gives leaders an opportunity to put resources towards improving the areas we may have decreased. As we continue our Journey to Magnet Excellence, we look forward to showing the Magnet program the amazing work happening here at Sanford Medical Center Fargo.
TRANSFORMATIONAL LEADERSHIP
Magnet® Day 2023: Nurse-Led Excellence: Magnetized & Energized
Inpatient and ambulatory nurses from the Fargo area came together on Nov. 15 for a special event focused on our Journey to Magnet Excellence®.
Tiffany Lawrence, Sanford Fargo president and CEO; Theresa Larson, MSN, BSN, RN, Sanford Fargo chief nursing officer; and Kristen Jones, MPH, BSN, RN, director of the office of nursing practice (ONP), set the tone by focusing on our mission as nurses and our “why.” Participants dove into Magnet® designation, shared governance and the professional practice model (PPM). Kayla Howard, DNP, RN, ONP, introduced a new “Magnet Toolkit” aimed to assist teams with designing projects and sharing information throughout their units, departments and clinics regarding Magnet. Teams worked together to develop a plan for improving care and spreading the word about Magnet. The morning was lively with a timed puzzle competition led by Becky Moch, MS, BSN, Q & A sessions, polls, and shared stories from both teams and individuals. At the end of the event, attendees gathered for a group photo wearing our newly designed t-shirts featuring our Magnet excellence theme “NURSE-LED EXCELLENCE: Magnetized and Energized,” symbolizing our collective journey towards Magnet designation. The Magnet Toolkit and the PowerPoint from the event are located on the Fargo Nursing SharePoint. With the dynamic synergy of Magnet Steering, the unwavering dedication of the Nursing Senate, and the unparalleled commitment of our Magnet Champions, our journey towards designation is certainly energized. Sanford Medical Center Fargo is about to make history as our meticulously crafted document is prepared for submission in August 2024, paving the way for an eagerly awaited site visit in 2025.
Journey to Vizient 5-Star
Sanford Fargo ended the 2023 Vizient calendar year with an overall rank of 19th out of the top 116 academic medical centers in the United States, improving 33 spots since 2022! In recognition of this achievement, we were presented with the Rising Star Award at the Vizient Summit in Las Vegas last month. This distinguished award, given to select facilities that both improve at least 20 rankings within a single year and secure a spot among the top 25 facilities in their cohort, underscores your dedicated efforts toward continuous improvement and the pursuit of excellence.
As we analyze our end-of-year domain performance, our commitment to safety takes center stage. Contributing to our impressive ranking are some remarkable patient safety milestones. In the last year, we saw a 24% improvement in patient safety indicators, including going 197 days without a catheter-associated urinary tract infection. Your ability to prioritize safety is not only enhancing the patient experience but also spotlighting us nationally as a trusted health care provider.
Leadership Day
To support leadership growth, the Sanford Health Fargo region hosts a leadership day for managers and above annually. At the event on Sept. 28, 2023, guest speaker Mark Willmarth presented on how to become better leaders and be more conscious and intentional about giving appreciation to others. This event and those from years prior continue to foster meaningful connections and development amongst Fargo leaders.
Diversity, Equity & Inclusion
The Sanford Diversity, Equity & Inclusion Council, established in late 2023, convenes monthly to cultivate a transformative culture of awareness, support and celebration for historically marginalized communities. This initiative aims to enhance patient care standards by promoting inclusivity and addressing health care disparities within diverse populations. Comprising Sanford Health providers and leaders from departments such as patient experience, nursing, quality and employee experience, the council collaborates closely with community partners to ensure equitable access to health care.
Central to its mission is the commitment to fostering employee satisfaction and professional growth. By promoting an inclusive workplace environment, the council aims to enhance employee engagement, retention and development across Sanford Health. Appointed by executive sponsors, council leaders maintain accountability and facilitate communication with senior management to align diversity, equity and inclusion efforts with organizational goals. Through a structured approach with membership terms spanning 24 months and staggered classes for continuity, the council’s mission is to advance its commitment to delivering culturally responsive care.
Nurse Well-Being: 21st Annual Nursing Symposium: Refresh. Renew. Revitalize.
The 21st Annual Sanford Nursing Symposium: Refresh. Renew. Revitalize. was held on May 4, 2023. This event holds significant importance within not just Sanford Health, but the regional health care community as a whole, serving as a vital platform for nurses to come together, exchange knowledge and foster professional growth. This gathering of nursing professionals offers a myriad of benefits that extend beyond the confines of a hospital setting. The in-person segment of the event was celebrated in a beautiful new venue, the Avalon Events Center. Throughout the day, participants could choose to attend up to four concurrent education sessions in addition to the keynote speaker sessions. One exciting new advancement this year was the ability for attendees to access recordings of the sessions in Sanford Success Center after the event, and even claim ANCC credit for viewing these recordings. The recorded sessions allowed over 40 individual learners to obtain, on average, five additional ANCC contact hours in addition to what they earned by attending the live in-person or virtual symposium. (That’s an added 200+ hours of ANCCaccredited education provided.)
In addition to the top-caliber education sessions, attendees had more opportunities than in prior years to connect with exhibitors. There were 27 exhibitors featuring nursing schools, various Sanford Health departments and services, and, for the first time, a variety of local businesses and non-profits. (Thunder Coffee, 4 Luv of Dogs, Turtle Mountain Animal Rescue, and the Bracelet Bar were a few of the attendees’ favorites.)
Structural Empowerment
Structural empowerment provides nurses with the ability to have a meaningful say in the way they practice as professionals through councils and input on policies and processes. This develops them professionally to achieve the highest degree of clinical excellence and professional fulfillment.
STRUCTUAL EMPOWERMENT
Shared Governance
Nursing Senate
2023 for Nursing Senate brought a variety of changes to the sub-councils, the structure of Nursing Senate, and support for frontline nursing staff. With the influx of internationally educated nurses (IEN) over the fall and wintertime from late 2022 into 2023, a need was noted that nurses and families coming from warmer climates did not have clothes that were warm enough to navigate the Fargo winter. Nursing Senate decided to set up a winter clothing drive to help meet this need. The senate coordinated and sent out information to the Fargo region soliciting donations of gently used winter garments for adults and children. Open space was available in the Sanford North Fargo Clinic for the clothing to be set out and new nurses arriving to Fargo from across the globe were able to come and take donated items for themselves and their families. The senate ended up helping 127 staff members and their families during the drive, and additional items were donated to case management and our Sanford Children’s Southwest Clinic to give out to patients leaving the hospital, as well as families in need. We are so proud of the senators that helped solicit donations and worked during the times the drive was open to our IEN nurses and their families. They made an impact by supporting our Sanford Health family.
Nursing Senate also approved the revamping of the former Healthy Work Environment group to form “The Wellness Collaborative” whose goals focus on staff and workplace wellness and well-being. Structure changes also brought the resurrection of the NA/PCT Council which is comprised of a group of engaged nursing assistants and patient care techs who focus on nursing assistant practice and the well-being of our support staff. Nursing Policy and Procedure Council was also approved as a shared governance council and reports to Nursing Senate starting in 2023, and the Nursing Patient Injury Prevention (NPIP) Committee was formed by combining Falls, HAPI, CAUTI and CLABSI workgroups to focus on all nursing sensitive indicators (NSIs) in one meeting. Nursing Senate was also champions for the NDNQI RN Satisfaction Survey. Senators brought back the energy, education and promotion of the survey to ensure high participation for the groups and high reliability in the survey results, which had an overall response rate of 68.6%.
Throughout the year, Nursing Senate approved a variety of initiatives that would reduce documentation burden, assist with documentation compliance, decrease alarm fatigue, and promote safe and reliable nursing practice. Some of these initiatives included:
• CareAssist alert tone to match Rauland Nurse Call System tones
• Progressive mobility bundle group in Epic
• Removal of unnecessary virtual medication kits in AccuDose systems
• Support the integration of the NA/PCT council, Wellness Collaborative, NPIP Committee, and the Nursing Policy and Procedures Council into a shared governance structure.
• One Chart flowsheet and Nursing Dysphagia Screen changes
• Medication patch assessments to be listed in MAR every 12 hours
• RDOS Scale and GIP build into an Epic flowsheet for nursing documentation
• Unit-to-unit transfer checklist
• Adding the pain assessment to the Pediatric Urgent Care Epic department rooming navigator
New Patient Injury Prevention Committee
In 2022, it was identified that there were three separate work groups that met monthly to discuss all the nursing sensitive indicators. It was also identified that clinical nurses were not attending all the workgroups. To ensure that clinical nurses were involved in the workgroups, a nurse-driven NSI Committee was developed and started meeting in July of 2023. The Nursing Patient Injury Prevention Committee includes a nurse representative from each inpatient unit to meet once a month to discuss Falls, HAPIs, CAUTIs and CLABSIs. Fall reduction has been one of the main focuses of this group and they will be promoting and rolling out Fall TIPS in 2024.
Advanced Nursing Certification
Today’s patient care is increasingly complex, requiring highly skilled nurses, both in acute care and in ambulatory settings. Nurses prove their expertise through advanced board certification and recertification, which involves ongoing learning and practice. By voluntarily becoming specialty certified, nurses show commitment to their careers and dedication to providing the highest quality of patient care.
Sanford Health supports nursing specialty certification by offering free review courses and some study materials. Nurses can also get a CE Direct license for online certification review courses and continuing education to maintain certification. Those who pass their certification exam are reimbursed for their exam fees through the Education Assistance –Enterprise policy. Sanford Medical Center Fargo aims for 50% of nurses to have advanced certification, with 40.63% of eligible RNs certified by the end of 2023.
2023 Certified Nurses Event
We celebrated National Certified Nurses Day at an event recognizing all our certified nurses with speakers, prizes and recognition. The event was held at the Holiday Inn in Fargo in March of 2023 where 200 certified nurses were in attendance. A nursing certification affirms and validates a nurse’s specialty knowledge for practice in a defined functional or clinical area of nursing. In the Sanford Fargo region, we have over 450 nurses certified in approximately 84 different specialties from 50 different certifying bodies.
DEPARTMENT SPOTLIGHT
The Sanford Children’s CARE Clinic offers a supportive and child-friendly environment tailored for children who may have experienced injury or abuse. CARE stands for Child Abuse Referral and Evaluation. Our clinic utilizes a comprehensive team approach to diagnose, treat and prevent abuse, as well as to evaluate injuries that lack a known cause or accident. North Dakota currently has three nurses certified as Sexual Assault Nurse Examiners for Pediatric/Adolescent (SANE-P) patients. We are proud to have all three of these highly qualified professionals working at the CARE Clinic, where they can apply their specialized expertise to support and care for our patients.
Sanford Children ' s CARE Clinic
Nursing Students
Hosting nursing students at Sanford Health is a privilege that embodies the spirit of nurturing the next generation of health care professionals. As we open our doors to these aspiring nurses, we embark on a journey of mentorship, knowledge-sharing and collaborative learning. Guiding these students through hands-on experiences, we have the opportunity to impart practical skills, ethical values and the art of patient-centered care on them that extends beyond textbooks. By creating an environment that encourages questions, exploration and growth, we not only contribute to their educational journey, but also invigorate our own practice through fresh perspectives and enthusiasm. As hosts of nursing students, we play a vital role in shaping the future of health care, leaving a mark on their development and, in turn, the well-being of the patients we serve.
Culture of Caring
The Culture of Caring initiative kicked off on 6AB, 6CD and 5SE with our academic partner North Dakota State University on Aug. 21, 2023. The initiative is designed to bridge the gap between student and new nurse, supporting nurses to meet the demands of their new career. Every NDSU student doing clinicals at Sanford Health will read an assigned article around a central theme each week.
Articles range each semester from basic to complex, covering topics such as communication, quality and safety/EBP/research, outcomes of care, teaching and learning, and mindfulness.
Students notice how their preceptor and unit nurses exemplify the topic, reflect on it, and respond to the topic after the conference. This allows the learner to consider how the topic will influence their future career. As the initiative progresses, students will increase partnerships with the nurse preceptor to provide care for multiple patients. This allows the faculty to support each student in diving deeper into understanding their assigned patient.
LPN Apprenticeship Program
The LPN Apprenticeship program offers students the opportunity to work in an apprenticeship role while attending nursing school.
On Aug. 14, 2023, five LPN apprentices started their nursing journey with Sanford Health and Lake Region State College with orientation.
Students participated in onboarding orientation in the LEAD Center which included a meet and greet lunch with department leaders.
Students see and practice their nursing skills as they progress through the nursing program. The 2023-2024 LPN apprentices are in our Sanford Mayville Medical Center, Sanford Veterans Square Clinic, Sanford Children’s Southwest Clinic, endocrinology clinic and neurology clinic.
Med-Cert Medical Assistant Graduates
In April of 2023, a simulation lab was started to support Med-Cert graduates with handson skill building.
In October of 2023, the North Dakota Board of Nursing determined graduates from online-only medical assistant programs are not eligible for medication assistant III licensure per NDCC 54-07-05. To determine eligibility, the board looks at transcripts for content in pharmacology, as well as practical experience in medication administration. In collaboration with human resources, the LEAD team met with the Board of Nursing to gain clarity and create an externship to support online-only medical assistant graduates with experience and competency validation documentation to obtain the medication assistant III registration.
2023 Sanford Student Nurse Internship (SSNIP)
89 total summer SSNIP
• 6% of Minnesota State University Moorhead nursing interns
• 6% of network sites (all University of North Dakota students)
• 79% are new to Sanford Health
The internship celebration was held on July 27, 2023, at the Courtyard by Marriott in Moorhead with 135 staff in attendance, including interns, preceptors, managers, directors, executive directors and VPs! Five preceptors received awards in categories characterizing the nursing preceptor – Mentor, Educator, Socializer, Leader and Role Model. Each award recipient received a certificate, a statue and a pin. We also had opportunities for those attending to sign up to win door prizes. The event was fun and engaging. With the conclusion of the summer SSNIP program, we hope their experiences lead them back to Sanford Health as their future employer.
Internationally Educated Nurses
The Internationally Educated Nurses (IEN) program has been a pivotal initiative in addressing the nursing shortage by integrating skilled nurses from diverse backgrounds into the health care workforce. The program not only enriches the cultural competence of health care teams, but also ensures that the growing demand for quality patient care is met. Through orientation and training, the IEN program equips these nurses with the necessary skills and knowledge to thrive in their new professional environment.
In 2023, the IEN program welcomed 140 nurses, with 127 remaining with the organization, resulting in a retention rate of approximately 90.71%. This high retention rate highlights the program’s effectiveness and the strong commitment of the nurses.
Additionally, the Office of Nursing Practice (ONP) hosts quarterly social gatherings that bring the IENs together for socialization, food and fun activities. These events promote trust, build a supportive community, and enhance the overall experience for the nurses, contributing to their satisfaction and retention.
IEN Fellowship
In 2023, the International Nurse Fellowship Program expanded in many ways to meet the growing needs of nurses working within Sanford Health. In 2022, after starting the International Nurse Fellowship Program, many needs were identified that could help strengthen the program to better support the transition of Sanford Health nurses working in the U.S. for the first time. In January of 2023, the Enterprise Learning Strategies team was approved to move forward with developing a more robust curriculum. The program was expanded from four seminars to six in order to ensure the nurses overcome their cultural and transitional shock phases. Nurses typically start the program after being in the U.S. for two to four months, allowing the program benefits to start impacting them as the challenges of working and living in a new country settle in.
After all the work was done to improve the program and the outcomes of the fellowship program were reviewed, we were able to showcase the results. At the 2023 Nursing Symposium on May 4, the International Nurse Fellowship Program was featured in the Gallery of Excellence in the Innovation category for bringing a new program to Sanford Health.
The poster presentation shared information about the enterprise program but featured Fargospecific data regarding the impact of the program from May of 2022 to April of 2023. Fargo was the first location to start the fellowship program and used the results to help improve the program and the participating nurses’ experience. It was a pleasure to share the work being done to support bedside nurses, and it was evident the judges at the nursing symposium agreed. The poster presentation titled ‘International Nurse Fellowship: Uniting Nurses from Around the World,’ won first place in the innovation category.
Nursing Residency
Sanford Health’s Nursing Residency program combines classroom instruction with reallife examples specific to nursing challenges experienced by bedside nurses as they begin their careers. It is a blend of activities, sharing relevant content, and comparing clinical experience, and the goal is to improve patient outcomes, job satisfaction and communication. Each month there is an education topic, a wellness topic and group mentoring. In 2023, the Nurse Residency program focused on enhancing the residents’ experience to increase program satisfaction, increase leader engagement, and further the residents’ EBP project development to the point of implementation. The Sanford Health Nurse Residency program is PTAP accredited by the ANCC.
DEPARTMENT SPOTLIGHT
In 2023, as a collaborative effort involving LEAD, Risk, Quality and Accreditation, a simulation was developed to identify patients with moderate suicidal ideation. Led by Lea Schiltz, MSN, RN, and Alison Haecherl, MSN, RN, the simulation took place in three Moorhead, Minnesota, clinics, where staff successfully recognized and addressed suicidal cues in two out of three scenarios. Post-simulation, the team engaged in robust discussions, further refining their approach to patients with suicidal ideation. Two additional clinics are slated to participate in the simulation by 2024 with ongoing educational meetings planned to support mental health awareness. This initiative highlights the commitment to proactive patient care and sets a standard for addressing mental health challenges in ambulatory clinical settings.
Moorhead Ambulatory Clinic
NURSES IN THE NEWS
DATE STORY TITLE
May 11, 2023
July 18, 2023
Oct. 4, 2023
Oct. 9, 2023
Sept. 1, 2023
Feb. 8, 2022
Feb. 25, 2022
“Sanford recognizes its employees during Nurses Week”
NURSES FEATURED
Kristen Jones, MPH, BSN, RN, Director for Office of Nursing Practice
“Mother’s tent at the Street Fair” April Swafford, BSN, RN, IBCLC, Lactation Consultant
“Latest COVID-19 vaccine available at Sanford”
Sarah Roth, BSN, RN, Nursing and Clinical Services manager
“Sanford Spotlight: Sadie Luepke” Sadie Luepke, ADN, RN, FBC
“With school back in session, it’s important to make sure kids’ vaccinations are up to date”
“At-home hospice care leaves lasting impressions on Fargo family”
“1–2 punch of worker shortage, pandemic leaves Sanford, Essentia with job vacancies over 16%”
“Sanford Health introduces global nursing mentorship”
April 7, 2022
Dec. 19, 2023
“Sanford nursing director back home after an opportunity to help a hospital in Costa Rica”
Brittany Maher, BSN, RN, Clinical Supervisor, Sanford children’s
Jenna Clark, BSN, RN, Nursing Specialist
Theresa Larson, MSN, BSN, RN, Vice President of Nursing
Johna Kern, Nursing Consultant
Morgan Hand, BSN, RN, Flight Nurse
Wanda Hanson, MSN, RN, Ambulatory Clinical Informatics Manager
Jackee Haak, MPH, BSN, RN, NE-BC, IBCLC, Sanford Family Birth, Nursing Director
April 18, 2023
Month of April
“Pilot reunites with caregivers who helped save him”
Alicia Pederson, BSN, RN, ICU Nurse
“Noon Hour Morning Show” –Community Awareness, Education, and Resources for Child Abuse Prevention Month”
Morgan Wiedmeier, BSN, RN, SANE-P, CCRN, Ambulatory
2023 Magnet® Conference
The 2023 ANCC National Magnet® Conference was held in Chicago, Oct. 12–14. Over 13,000 U.S. and world nurses were in attendance. Over the course of the conference, our team learned about different innovations and programs that were designed by, or for, nurses. It was also reassuring to see that Sanford Health already does many things that other Magnet health care systems are doing! Our group particularly enjoyed listening to the keynote speaker Shawn Anchor (author of “The Happiness Advantage”) speak about happiness amid challenges and adversity. We learned how hard it is not to smile when someone is smiling at you! Suneel Gupta, CEO of RISE, taught us how to create and keep momentum in our teams, preventing burnout and overcoming adversity. We each took away a lot of information from our concurrent sessions and the poster gallery, learning about microlearning, mentorship programs, structural empowerment, shared governance, certifications, nurse well-being, transformational leadership, and much more. Even walking through the exhibition hall was inspiring. We were able to see all sorts of health care inventions and innovations. Our group even met Moxi – the robot designed to help and support nurses. We all left the conference refreshed, renewed, revitalized and encouraged! We are looking forward to continuing our Journey to Magnet, and we can’t wait to demonstrate how Sanford Health in Fargo demonstrates the Magnet principles.
Global Nurse Mentorship
Jackee Haak, MPH, BSN, RN, NE-BC, IBCLC, the director of nursing for the Sanford Family Birth Center at Sanford Medical Center Fargo, was selected to collaborate with Hospital Metropolitano in Costa Rica the inaugural year of Sanford’s Global Nurse Mentor Program. Jackee was selected to help expand the hospital’s maternity services and participated in training to simulate real life situations that could end up saving patients’ lives. Jackee said that an experience like this allows her to think outside the box, which she will keep in mind as she continues her work back in Fargo. Jackee’s experience working with maternity policies and procedures made this project the perfect match and gave her an exciting opportunity.
Kamp KACE
Several nurses from pediatric oncology at Sanford Roger Maris Cancer Center and Sanford Children’s Hospital Fargo volunteered their time to support Kamp KACE (Kids Against Cancer Everywhere) in June of 2023. The weeklong camp is for children with cancer, survivors and their siblings. Kamp KACE is in central Minnesota and accommodates over 100 campers. Doctors and nurses are on site and on duty to provide medications and any necessary treatments. Nurses who volunteer to support Kamp KACE are an integral part of the camper’s experience and are enthusiastic about the benefits of the camp and their experience with Kamp KACE. Several staff spend the entire week at Kamp, and many more volunteer with their volunteer hours to come and support these kids.
Medical Mission Ecuador
In February of 2023, Becky Rydell, MS, RN; Jane Roggensack, MS, RN; and Robert Sticca, MD, FACCS, FSSO volunteered their time and clinical expertise to serve the people of Ecuador through Medical Mission Ecuador (MME). Volunteers from Fargo have been involved in this mission for decades and the Sanford Health Foundation supports the work with funding for supplies brought by the team to Ecuador. The Fargo team joins with other volunteer teams for a week to provide care to children who would otherwise not receive this care.
Corrective surgical procedures provided by the volunteers with MME offer improved quality of life, reduced pain and suffering, and reduced strain on the socioeconomic status of the family. Surgical correction of physical deformities and injuries may contribute to greater educational opportunities because the child can now travel to school and participate, leading to employment opportunities in adulthood and a more stable income, stable housing, and improved nutrition and health.
Team Hope: Sanford World Clinic – Visit to Guatemala
In September of 2023, ten Sanford Health nurses traveled to rural Guatemala to help provide medical care for over 1,000 patients in the span of five days. Sanford World Clinic sponsored the Sanford Health nurses to make the week-long trip where nurses worked in either an inpatient procedural area or in a community clinic. Holly Wolf, BSN, RN (Emergency Department) and Elvis Silveira, MPH, BSN, RN (Clinical Decision Unit) worked in the hospital while Jen Matthees, MA, BAN, RN (Innovation Unit) worked in the clinic. The last two days of the trip were spent exploring and relaxing in Antigua, Guatemala.
Patients could see several different specialties including dermatology, dentistry, pediatrics, endocrinology, physical therapy, optometry and general medicine. Patients also received necessary medications like antibiotics, analgesics and vitamins. The hospital team completed 124 surgeries in four days. Common surgical procedures included hernia repairs, cholecystectomies, appendectomies and strabismus surgeries. The team often worked 14+ hours per day and saw patients of all ages.
All services, procedures, and medications were provided to patients at no cost. This trip was a partnership between Sanford World Clinic and the International Esperanza Project. Sanford World Clinic was established in 2007 with a goal of providing permanent health care services through partnerships around the world. The program currently has a footprint in ten countries around the world, and the program will sponsor another ten nurses to work in Guatemala in September of 2024.
Network Food Banks
Recent updates highlight significant strides in addressing food disparities in health care, with multiple initiatives focusing on increasing access to nutritious food and improving health outcomes for underserved communities. Below are areas we are helping with, including the total pounds of food for each clinic and community.
Sanford Health Oakes Clinic – 9,246 lbs.
Sanford Valley City Clinic – 3,716 lbs.
Sanford Mayville Medical Center – 10,762 lbs.
Sanford Hillsboro Medical Center – 6,866 lbs.
Vaccination Blitz Events
In 2023, our nursing and clinical support staff demonstrated unwavering commitment and resilience to protect our community during the respiratory illness season. Through three major vaccination events held in the Fargo metro area from Oct. 7 to Oct. 28, we served a total of 1,971 patients. With nearly 2,000 influenza and approximately 1,000 COVID-19 vaccinations administered during these blitzes, alongside numerous vaccinations provided at multiple vaccine events held across Fargo and surrounding regional clinics and hospitals, our staff’s efforts were pivotal in safeguarding the health of our communities. Their focused work not only exemplified our commitment to excellence in health care, but also underscored our role as a trusted provider within the Sanford Health family.
Sanford Children’s Southwest Clinic and Sanford Moorhead Campus Food Donations
Sanford Children’s Southwest Clinic’s wellness pantry and Sanford Moorhead Campus’s food box program have continued their partnership with Great Plains Food Bank to address food insecurity by screening and offering food items during any clinic visit.
In 2023, Sanford Children’s Southwest Clinic provided 723 families with shelf-stable and fresh food items. The food box program at Sanford Moorhead Campus was implemented in October of 2023 and provided 30 families with food boxes from October to December. Patients and families are screened during their clinic visits and provided with food items on site. They are also given information about resources like other local food pantries.
AWARDS & RECOGNITION
2023 Annual Nursing Recognition Event
During National Nurses Week, we celebrated our nurses at our Annual Nursing Recognition Event that was held at the Delta by Marriott in Fargo. We had over 700 people in attendance and awarded 30 nurses and friends of nurses for their contribution to the nursing profession. In 2023, we had a record-breaking number of annual nursing award nominations with 717 submissions, which is over 200 more than the previous year. Nurses were celebrated throughout the week with various activities, contests and giveaways. Below are the annual award winners given at the event.
Evelyn Quigley Spirit of Nursing Award –The Legacy Award
This award recognizes a nurse who has significantly contributed to the art and science of nursing throughout their career. Through strength of character, commitment and competence, this recipient is recognized as one who “lights a flame” for nursing practice, leaving a legacy for others by elevating professional nursing within Sanford Health and the community. This award is named in honor of Evelyn Quigley, MN, RN, Chief Nursing Officer Emeritus. This year’s recipient is:
Debra Hanson, BSN, RN, CCRN-K
Exemplary Professional Practice Award
The Exemplary Professional Practice award recognizes nurses who practice, collaborate, communicate and develop professionally to provide the highest quality of care for patients served at Sanford Health. They exemplify professional accountability, teamwork and high ethical standards, supporting a culture of safety and performance improvement. Those awarded the Exemplary Professional Practice Award are:
CALEB BEHM, BSN, RN, CFRN, CCRN, SCRN
AMANDA DOLLINGER, BSN, RN, CEN, CPEN
HANNAH OSBORN, BSN, RN, CPHON
Florence Nightingale Award
This award recognizes nurses who are involved in the provision of the art and science of nursing, contributing to the evolution of the nursing practice. This year’s winners are:
Friend of Nursing Award
The Friend of Nursing Award recognizes individuals who have supported the nursing profession and the professional practice of nursing. It also recognizes the value of nursing to the patients we serve, the organization and our community. The award recipients are:
Willie Battle, Lead Security Officer
Josh Arneson, Supply Chain Operations Manager
Beverly Suppa, Unit Secretary
Wendy Iwerks, Child Life Specialist
Joan Becker, Occupational Therapist
SAM HANSEN, BSN, RN
ALISHA BIRCHEM, BSN, RN, CPN
PATTI KEMMER, ADN, RN
TAMI SARLI, BSN, RN
KELSEY CARIVEAU, BSN, RN, OCN
BECKY THOM, BSN, RN
JENNA CURTIS, LPN
JENNIFER JACOBSON, MSN, RN
New Knowledge, Innovations, and Improvements Award
This award recognizes registered nurses who conscientiously integrate evidence-based practice, research and innovation into clinical and operational processes. This person explores the safest and best practices for their working environment, and this individual has created or led innovation and improvements with demonstrated outcomes. The award recipient is:
Amy Hall, BSN, RN, OCN
Star of Nursing Award
This award recognizes nurses in their first two years of practice. This is given to a nurse who has a demonstrated passion for their newly chosen career through involvement in our nursing organization. This year’s winners are:
Structural Empowerment Award
The Structural Empowerment Award recognizes a nurse who demonstrates professional engagement, development and commitment to community involvement. This nurse is an active member of shared governance and serves on committees and task forces that address excellence in patient care. The winner of this award is:
Heather McIntyre, ADN, RN
MOLLY BOHN, BSN, RN
BRYCE BENAVIDES, BSN, RN
SOPHIA SONDREAL, LPN
SARAH KLINER, BSN, RN
LISA OLSON, LPN
Transformational Leadership Award
This award recognizes registered nurses who demonstrate leadership development, communicate expectations and evolve the departments to meet current and anticipated needs and strategic priorities. The winners are:
Golden Stethoscope Award
This award is presented to providers who support nursing, participate with them as a team member, and assist them in providing patient-centered care. Winners in 2023 include:
Carlos Miranda, MD
Melanie Chihak, DO
Zaid Rahman, MD
Sammantha Kouba, DO
Samantha Simley, PA-C
Helping Hands Award
The Helping Hands award is presented to a non-nurse who demonstrates support of nursing in patient care areas. Winners include:
Jessica Nielsen
Misty Lowe
Sharon Deavy
ZACHARY HOLM, BSN, RN
MORGAN WIEDMEIER, BSN, RN, SANE-P, CCRN
DANA GENTZKOW, BSN, RN
LOGAN BUCHELE, BSN, RN
ALYIA KUEHL, BSN, RN
Guardian Angel Awards
Our Guardian Angel program gives patients and families the opportunity to celebrate exceptional care by making a gift in honor of a caregiver. Nurse recipients are listed below:
Sanford Fargo Hospice
Jodylee Lyons, LPN, Home Hospice
Skylar Just, BSN, RN, OCN, Infusion Center
Angela Irwin, BSN, RN, Gastroenterology Clinic
Jessica Sims, MSN, APRN, NP, Neurosurgery
Sanford Hospice House
Taylor Keimig, MSN, APRN, NP, Wound Care
Samantha Anderson, BSN, RN, CHPN, Home Hospice
Hannah Lentz, BSN, RN, Oncology
Angela Milner, NA, Home Hospice
Roger Maris Cancer Center Staff
Melanie Noonan, MSN, APRN, NP, Neonatal
Joseph Dirks, BSN, RN, CCRN, Critical Care
Meghan Kotchian, ADN, RN, Heart Services Research
Lindsey Martinson, ADN, RN, CEN, Emergency Department
Michelle Polries, BSN, RN, Infusion Center
Kristin Tehle, ADN, RN, Operating Room
Alicia Pederson, BSN, RN, Critical Care
Jennifer Kringlie, MSN, APRN, NP, Sanford North Fargo Clinic
Kyra Decker, MSN, APRN, AGACNP-BC, Sanford Moorhead Campus
Karen Norman, ADN, RN, CPN®, CPHON®, Clinical Learning & Development
Sunflower Award
The Sunflower Award recognizes and celebrates nursing assistants and patient care technicians who go above and beyond to deliver compassionate and excellent care to those we serve. Winners include:
Sadie Ketteman
Lynzi Schroeder
Mike Baukol
Innocent Nsengiyyumva
Janice Dahl
Jhak Chhantyal
Emma Gulleson
Sarah Fisher
Yazmine Gonzalez Bravo
Pamela Bertrand
Kyra Blanshan
Olivia Karzon
An acronym for Diseases Attacking the Immune System, The DAISY Foundation was formed in November of 1999 by the family of J. Patrick Barnes, who died at the age of 33 from complications of idiopathic thrombocytopenic purpura (ITP). The nursing care Patrick received when hospitalized profoundly touched his family. The DAISY Award has been presented to nurses in over 3,000 health care facilities across all 50 states and 13 countries. Patients and families touched by the nursing care they receive at Sanford Health can submit a nomination to recognize a nurse’s kindness, care and expertise.
Winners
The DAISY Nurse Leader Award recognizes nurses who are extraordinary in the impact they have on compassionate patient care. Honorees can be any nurse leader who impacts patient care directly, including nurse managers, directors, supervisors, CCL’s, educators, preceptors, informatics nurses, and other roles. Congratulations to:
Fugleberg,
Stephanie
BSN, RN
Rylee Albertson, BSN, RN
Alyssa Jacobson, BSN, RN, OCN
Jean-Paul Mansour, BSN, RN, CEN
DAISY Award Recipients
Cari Schmitz, ADN, RN
Adrian Sevigny, BSN, RN
Rylee Albertson, BSN, RN
Madison Krause, BSN, RN
Sue Huseth, BSN, RN
Brenda Everson, ADN, RN
Alicia Pederson, BSN, RN
Ashtyn Olson, BSN, RN
Christy Matlock, BSN, RN
Jennifer Kringle, APRN, NP
Bryce Benavides, BSN, RN
Cyril Rojo, BSN, RN, BSN, RN
Makenzie Neshem, BSN, RN
Alyssa Jacobson, BSN, RN, OCN
Patricia Carew, BSN, RN
Jean-Paul Mansour, BSN, RN, CEN
Claire Baker, BSN, RN
Gabrielle Schoenborn, BSN, RN
Abigail Schoeneck, BSN, RN, OCN
Amanda Tracy, MSN, RN, RNC-OB
Marryn Lundeen, BSN, RN
2023 Sanford Health Brand Ambassadors
The Sanford Health Brand Ambassador Program recognizes and rewards exceptional employees each year that embody the spirit of Sanford Health and what we’re all about –providing health, healing and comfort while serving our patients, residents, communities and each other. Following an annual nomination process, executive leadership selects 20 individuals whose stories of excellence and limitless passion embody those of a Sanford Health Brand Ambassador. Ambassadors are celebrated on a relaxing getaway before they act as ongoing brand advocates in and outside our walls. They are our champions and advisors, giving an authentic, impactful voice to our story as an organization. Nursing recipients for 2023 are:
Morgan Aakre, RN program specialist
Lydia Hasbrouck, RN, Ambulatory & Triage
Employee of the Year Nurse Winners
Every year, Sanford Health recognizes outstanding employees through the Employee of the Year program. Coworkers nominate each other based on how the nominee lives out Sanford Health values, how they have helped to better the organization for those we serve, how they have represented Sanford Health as a positive ambassador and how they exhibit leadership qualities.
Nursing recipients for 2023 are:
Clinical Employee of the Year – Bryana Kaiser, RN Navigator, Ambulatory
Sanford Health Network Clinical Employee of the Year – Leah Hochstein, NP, Internal Medicine, Detroit Lakes
Dr. Ben Perryman Sanford Research Employee of the Year – Lynnette Leone, PhD, RN
APP Awards
Every year, Sanford Health’s Fargo region hosts a special recognition dinner to honor its physicians and advanced practice providers (APPs). This year’s APP Recognition Dinner was held on Oct. 6 at the Avalon Events Center in Fargo. The event brought together APPs from across the Fargo region to celebrate their remarkable achievements and to acknowledge the recipients of the annual APP awards. It was an evening filled with camaraderie and appreciation, highlighting the dedication and excellence demonstrated by health care professionals within the organization.
Recipients of the 2023 APP Awards include:
APP of the Year – Vanessa Skolness, APRN, CNP, Endocrinology
Citizenship Award – Kimberly Haug, NNP, APRN, CNP, Neonatology
Trailblazer Award – Amy Schmidt, APRN, CNP, Radiation Oncology
Nexus Award – Mindy Anderson, APRN, CNP, Family Medicine
Enrichment Award – Summer Schauer, APRN, CRNA, Anesthesiology
HERO Awards Given to Nurses
This award is presented to providers who support nursing, participate with them as a team member, and assist them in providing patient-centered care. Winners in 2023 include:
COURAGE
Cheyenne Blotsky, RN (January)
Sue Praska, RN, Pelican Rapids (March)
Jane Erickson, ambulatory procedure RN (April)
Angela (Larson) Gentzkow, RN inpatient (June)
Andrea Trzynka, RN, vascular access team (September)
Vida Williams, RN, vascular access team (September)
Angie Milner, Jena Kitsch, and Paula Hatzenbuhler, Hospice (October)
Whitney Kohoutek, RN program specialist (November)
RESOLVE
Donna Steinhofer, LPN, Pelican Rapids (January)
Aimee Grose, inpatient RN case manager (March)
Ivorie Pierson, inpatient RN (April)
Sally Johnson, RN case manager (June)
Brooke Maatz, NP, Becky Winther, LPN, Ryan Biewer, LPN, Sara Benge, LPN, Emma Jordet, RN, Karlie Amundson, nursing supervisor, and Casey Naastad, nursing manager, Grand Forks (November)
COMMUNITY
Mayville ER Team (January)
Denise Thiner, RN diabetes educator (April)
Katie Gavere, RN, Ambulatory, and Carolyn Vanmackelberg, RN, Ambulatory (June)
FAMILY
Kelsey Cariveau, inpatient RN, Sanford Broadway Medical Center (February)
Siri Thaden, Women’s nursing manager (May)
Sam How, inpatient RN, Sanford Medical Center Fargo (September)
Leah Hochstein, NP, internal medicine (December)
CALLING
Sanford Broadway Medical Center Day Unit nurses (February)
Sanford Thief River Falls Medical Center (April)
Mary Langseth, RN, program specialist (November)
SERVICE
Stephanie Fredrickson, LPN, labor and delivery unit, Sanford Medical Center Fargo (March)
Carrie Holt, NP, Hawley (May)
Jessica Krabbenhoft, nursing manager, Sanford Hawley Clinic (May)
David Mrozla, nursing practice specialist (June)
ADVANCEMENT
Angel Kordovsky, RV navigator (March)
Ashley Cohen, nursing assistant, inpatient (June)
EXEMPLARY PROFESSIONAL PRACTICE
Professional Practice Model and Ensuring Excellence
Exemplary professional practice is nursing practice that represents the best of the best. The Professional Practice Model (PPM), outlined below and developed by nurses at Sanford Health, guides nurses to achieve this level of nursing practice.
Sanford Improvement Symposium
In October, our region had the opportunity to come together in person for the first time in four years to celebrate and participate in the Fargo region Sanford Improvement Symposium at the Avalon Events Center. The intent of the symposium is to give team members a place to present the innovative work they are leading in their spaces and the opportunity to network with colleagues. Additionally, this event is comprised of keynote speakers and panel discussions focused on high-quality care and the importance of interdisciplinary teams. We had an excellent turnout with approximately 250 attendees and 82 projects presented. Many of these projects were presented by our Performance Improvement Council members. The Performance Improvement Council is a nurse-led council intended to drive improvements and innovation in patient safety and quality care.
2023 Fargo Region Sanford Improvement Symposium Winners
CLINICAL CARE
1st Place: A Call for Universal Screening for Depression Using the PHQ-2 Screening Tool
Deserae Harstad, BSN, RN
2nd Place: The Reality of Mortality
Kim Wolf, MBA, BSN; Dev Mannuru, MD
COMMUNICATION
1st Place: Evaluation of Multi-Discipline PADIS Interventions on ICU Patient Outcomes
Hallie Thompson, MD; Dre Steinwehr, MD
2nd Place: ARU Surgical Readiness - To Page or Not to Page
Melanie Allen, BSN, RN; Rachel Leyk, BSN, RN, CMSRN, CPHQ
SAFETY
1st Place: The Clot Thickens
Melissa Misialek, BSN, RN; Rachel Leyk, BSN, RN, CMSRN, CPHQ
2nd Place: Reducing Colorectal Surgical Site Infections in the Broadway Operating Room
Kayla Loge, RN; Megan Breden, BSN, RN, CNOR
SANFORD EXPERIENCE
1st Place: Finding Opportunities for Efficiency during Morning Routine Draw Collection
Nihaar Joshi; Ishan Joshi; Dylan Roness
2nd Place: Improving Patient Experience: A Seven-Point Plan
Jennifer Matthees, MA, BAN, RN; Ericka Wambach, BSN, RN
EVIDENCE-BASED PRACTICE
1st Place: Reduction in Non-Actionable Patient Monitor Alarms
Katie Reese, BSN, RN
COST
1st Place: Children’s Waste Reduction & Cost Regulation
Shannon Burgard, BSN, RN, BSCN; Allison Scherr, BSN, RN
QUALITY OF LIFE
1st Place: RESTRAIN YOURSELF
Stephanie Hammers, MSN, RN; Zachary Holm, BSN, RN
SAFE Specimen Collection Improvements
Ambulatory clinic leaders identified the opportunity to make improvements in the way specimens are managed in their settings. A work group of frontline staff from nursing, lab and other interdisciplinary teams came together to identify ways the process could be more highly reliable. The team incorporated lessons learned from inpatient and outpatient nursing teams into the revised process. A continuous use reference tool complemented by ongoing education guided teams through the process and provided relevant policy links and contact information to ensure continuous support throughout the entirety of the process.
NSI Comparison by Year
On our Journey to High Reliability, a goal of zero preventable harm includes a reduction in our nursing sensitive indicators. From 2022 to 2023, we achieved significant improvements in patient safety and quality of care. Falls, hospital-acquired pressure injuries, central lineassociated bloodstream infections, and catheter-associated urinary tract infections tracking all showed positive signs of fostering a culture of safety. We saw a 32-rank improvement in the safety domain and a 23% reduction in the Patient Safety Indicator (PSI), ranking 4th for safety out of 116 hospitals.
Some improvements include:
• 11% reduction in falls with injury from 2022 to 2023
• 40% reduction in HAPIs
• 30% reduction in CLABIs
• 50% reduction in CAUTIs
NSI Celebrations 2023
Patient Experience
Patient satisfaction with their experiences with nurses is measured through the following six Magnet®–approved questions:
• Was there good communication between the different doctors and nurses? (Care Coordination)
• Did nurses listen carefully to you? (Careful Listening)
• Did nurses treat you with courtesy and respect? (Courtesy & Respect)
• Did nurses explain things in a way you could understand? (Patient Education)
• Did you have enough input or say in your care? (Patient Engagement/ Patient-Centered Care)
• Did you have confidence and trust in the nurses treating you? (Safety)
The percentage of ambulatory care settings with patient experience scores higher than the national average in the majority of quarters in 2023 are shown in the table below.
The percentage of inpatient settings with patient experience scores higher than the national average in the majority of quarters in 2023 are shown in the table below.
DEPARTMENT SPOTLIGHT
In 2021, the Fargo region Medical Oncology Unit (7S) launched a performance improvement project centered on improving multidisciplinary communication and the involvement of patients as crucial members of the care team. The project focused on four patient experience metrics: good communication between staff, safe and at ease with care team, thorough explanations from the nurse, and thorough explanations from the provider. A key component of the project was implementing the situation, background, assessment and recommendation (SBAR) tool to guide nurse and provider rounding. It also ensured daily rounds included the patient and family.
The team experienced immediate success, improving their performance on all metrics and surpassing benchmarks within six months. Two years later, they have sustained their performance gains and continue to exceed benchmarks on three project metrics. The staff’s commitment to exceptional patient-centered care was demonstrated by going above and beyond for a patient who had limited family support, including celebrating milestones and fulfilling the patient’s goal of “cupid shuffling” down the hallway upon discharge. The efforts on 7S significantly improved patient experience scores and net promoter scores, and they have shared what they have learned with other units and regions.
Med Safety Council
The Inpatient Medication Safety Committee has shown exceptional dedication to enhancing patient care and safety throughout the year. This interdisciplinary group of frontline nurses, pharmacists and providers serves as a central platform for improving medication administration. Here are some key projects from 2023.
One accomplishment was refining administration instructions for hemodialysis patients in the Medication Administration Record (MAR). After nurses raised concerns about confusing instructions, the committee rewrote them for clarity, ensuring safer medication administration.
Monitoring quality metrics such as barcode medication scanning and Smart Pump Drug Library compliance is a key responsibility. Upon noticing a decline in Smart Pump Drug Library compliance, the committee identified barriers to its use, added missing medications to the drug library and provided additional education to nurses. This pushed overall compliance to an all-time high and it has remained consistently above goal ever since.
To further bolster their influence, committee members received education on rounding to influence, empowering them to effectively share important information with their units, enhancing communication and safety measures.
The committee discovered a significant system barrier causing nursing staff to inconsistently implement the nicotine replacement therapy (NRT) protocol for patients – an incorrect order set was referenced, and a hard stop was missing in the protocol. On the committee’s recommendation, these issues were corrected, and additional nursing education was provided to ensure proper implementation moving forward.
Nurses and pharmacists reviewed and upheld the decision that adult total parenteral nutrition (TPN) does not require an independent double check by two nurses, based on updated Institute of Safe Medication Practices (ISMP) recommendations.
In response to epinephrine administration safety events, the committee collaborated with LEAD to develop a simulation-based competency validation for the Hospital Skills Fair. This lifelike scenario revealed significant knowledge gaps, and immediate coaching was provided during the simulation. Subsequent assessments throughout the year showed notable improvement, underscoring the effectiveness of the simulation-based training.
The committee worked with the accreditation team to clarify and disseminate expectations regarding the use, cleaning, storage and disposal of pill crushers, ensuring adherence to best practices and regulatory requirements.
Highlighting the committee’s responsiveness, a new graduate nurse raised a safety concern about the heparin infusion calculator during nurse residency. The issue was referred to the committee, which worked with IT to resolve it in less than 24 hours, demonstrating the group’s responsiveness and commitment to patient safety.
Finally, the committee collaborated with the ONP and the Policy and Procedure Committee to recommend updates to the RN IV Medication Administration Guide, ensuring that it remains current, comprehensive and accurate.
The Inpatient Medication Safety Committee’s achievements throughout the year reflect their unwavering commitment to improving medication safety and patient care. The collaborative efforts between nursing, pharmacy and providers in the group continue to foster a safer hospital environment for both staff and patients.
NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS
External Poster, Podium & Virtual Dissemination
Robinson, K.R., Gierach, M., Bartelt, S., Wolles, B., McClellan, C., Hodge, J., & Lovro, J. (2023). Battle of COVID-19: Frontline nurses feel abandoned during the pandemic. Nurses need evidence-based support strategies. American Nurse. 18 (3), 12-16. https://doi:10.51256/ANJ032312. This particular article was the cover story in the March 2023 issue of American Nurse.
3/25/2023 – Karen Robinson, PhD, RN, FAAN, SMCF Nurse Scientist, presented at Xi Kappa Nursing Honor Society’s Induction Ceremony. Title of presentation was “Nurses using their voices to create healthy work environments.” Incorporated study findings into the presentation.
10/18/2023 – Karen Robinson, PhD, RN, FAAN, SMCF Nurse Scientist, and Michelle Gierach, EdD, RN, CNE, Augustana University, were invited to present “Battle of COVID-19: Overcoming Feelings of Abandonment with Strategies to Promote Wellness” at the 18th Biennial International Conference of Society for the Advancement of Modeling and RoleModeling. The conference was titled “Bridging Worldviews: Inclusion, Partnership, and Collective Wisdom.”
10/20/2023 – Karen Robinson, PhD, RN, FAAN. SMCF, nurse scientist, presented a poster at the North Dakota Nurses Association Interprofessional Research Symposium in Fargo, North Dakota. The poster detailed academia and clinical partnership collaboration in conducting the COVID-19 multi-site study. This same poster was presented at the Sioux Falls Sanford Nursing Research Symposium in November of 2023 by the Sioux Falls, South Dakota, study team members.
Mylynn Tufte, MBA, MSIM, RN, president of the North Dakota Nurses Association, presented Karen Robinson the NDNA Hall of Fame Award. This award is conferred on an as-needed basis to a registered nurse who has made a historically significant contribution of long-lasting importance to the practice of nursing in North Dakota.
DEPARTMENT SPOTLIGHT
Driven by a desire to provide exceptional patient care, Sanford Health’s critical care nurses in Fargo embarked on a journey to integrate the Clinical Practice Guideline for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility and Sleep (PADIS) Disruption in Adult Patients in the Intensive Care Unit (ICU) into practice. Updated guidelines were published in 2018 by the Society of Critical Care Medicine (SCCM) and inform the foundation of interprofessional critical care management. The PADIS Guidelines are endorsed by the American Association of Critical Care Nurses (AACN).
Co-led by nurses in collaboration with the ICU medical director, the PADIS Steering Committee began meeting in June of 2022. Results of this large-scale, evidence-based practice project began to shine in 2023 as the critical care patient all-hospital length of stay (LOS) reached 7.94 days in Q4 of 2023 from a previous LOS of 10.95 days in Q2 of 2022. Critical care patient all-hospital mortality also declined from 12.84% (Q2 of 2022) to 10.85% in Q4 of 2023. The lowest mortality rate was 9.34% seen in Q2 of 2023.
These significant changes in patient outcomes were accomplished through two essential interventions – daily interprofessional, patient-focused rounding (now known as PADIS rounds) and the PADIS Academy. PADIS rounds provide opportunities for a patientcentered conversation to happen among the intensivist, clinical nurse, respiratory therapist, dietician, physical therapist, case manager (registered nurse or licensed social worker), quality improvement advisor, and others. Questions regarding necessity of a line or level of mobility help patients progress through the ICU and prevent hospital-acquired infections and injury. PADIS Academy was held in January of 2023 with over 180 team members attending one of six offered sessions. This interprofessional education highlighted best practices in critical care nursing assessments, sedation and ventilator management, and the importance of progressive mobility to prevent delirium. One of the participants recognizing the value to patient outcomes noted, “I like the push for a culture change!”
Improvements in LOS and mortality for patients who were cared for in our ICUs undoubtedly had an impact on our 2023 Vizient score and continually align with Sanford Health’s journey toward being a Highly Reliable Organization (HRO). The PADIS project is also being showcased in our Magnet® application. Partnerships have been formed with nursing colleagues across the Sanford Health enterprise to improve documentation and share best practices. The Sanford Health Fargo Pediatric ICU team recognized the value of integrating the SCCM guidelines into practice and took the initial steps in 2023 to replicate the successes of the adult ICU work into the pediatric ICU.
A new course has been charted to ensure the gold standard of ICU care is given to the patients in our ICUs. Nurses led the way to jump-start this initiative and will continue to be at the forefront of embedding PADIS guidelines into practice.
Critical Care Outcomes and PADIS Implementation
Artisight: Transforming our model of care through technology
Artificial intelligence (AI) is seemingly everywhere – and that’s a good thing, especially for people living in rural areas. While rural people and health systems face many additional health care challenges like access, quality, sustainability and workforce shortages, integrating technology offers a myriad of solutions.
On 8AB, we implemented a technology called Artisight in August 2023. This technology incorporates video and audio connection from the bedside to a nurse at a remote workstation on the second floor of Sanford Medical Center Fargo. It has allowed us to shift many documentation tasks of bedside nurses (like admission navigators, discharge paperwork and charting patient cares) to a remote nurse. In addition to empowering our bedside care team, Artisight helps reduce fall risks for patients through its proprietary AI program.
In just 90 days (Aug. 2–Oct. 23, 2023) the new workflows and improved patient-centered care have contributed to several good catches:
• A remote nurse identified a patient attempting to steal materials with which they planned to inject drugs. The patient was stopped and interventions occurred.
• Several times, a remote nurse caught DNR and allergy bands that were then brought to the bedside staff’s attention to prevent error.
• A remote observer noticed a patient preparing to vape in their room and stopped them.
• Staff was protected when a patient lied about the staff stealing cash out of their purse and the remote nurse later saw the patient counting the money after their accusation.
• Staff proactively started completing other tasks including chart audits to remind bedside nurses to collect information, call remote patients and chart rhythms.
• Artisight tools were used to intervene in a patient getting out of bed which allowed the bedside nurse to assist and prevent a fall.
Bedside staff on 8AB have also reported wins, saying they appreciated the ability to delegate certain items to the remote nurse, which allows them to spend more meaningful time with patients, and often allows bedside staff to clock out on time as opposed to staying late to catch up on charting. Additionally, the unit saw increases and was above the Sanford Medical Center Fargo average in Peakon categories of Freedom of Opinion, Team and Management Support.
Through this technology, we’re changing the way we provide care to patients with positive results. By scaling to other units to build a more sustainable workforce, we can continue to address quality challenges and workforce shortages, ensuring care in our rural communities for years to come.
Contributors
Special thanks to the individuals and teams who contributed to this report:
Karen Baatz, MSN, APRN, ACNS
Samantha Bartelt, MSN, RN
Erika Brauner, BSN, RN
Amanda Hanson, MSN, RN, CMSRN®
Anne Heller, PhD, RN
Kayla Howard, DNP, RN
Adam Johnston, BAN, RN
Kristen Jones, MPH, BSN, RN
Theresa Larson, MSN, BSN, RN
Jen Matthees, MA, BAN, RN
Eman Mohammad, BSN, RN
Karen Robinson, DNP, RN
Sarah Roth, BSN, RN
Jessica Shindeldecker
Lyn Telford, MSN, RN, CPHQ
Ty Werven
Visit sanfordhealth.org/nursing-excellence to view this report digitally.