St. Francis Hospital The Heart Center ®
A Member of Catholic Health Services of Long Island
2010 Nursing Annual Report
Leading theWay… Every Day in Every Way.
In This Issue 03 Message from the Senior VP, Patient Care Services, Chief Nursing Officer 04 Magnet Redesignation Journey Empirical Outcomes 05 Our Commitment to Patient Satisfaction 06 S.K.I.N. Champions Prevalence Study Teams 06 Urinary Tract Infections 06 Patient Fall Prevention Program 07 Ventilator Associated Pneumonia 07 Central Line Associated Bloodstream Infections 08 What Our Patients Say 08 R.N. Satisfaction Transformational Leadership 09 Philosophy/Mission/Vision 10 Advanced Nurse Practitioners 10 Presentations at National Conferences 11 Tomorrow’s Nurse Leaders 11 Direct Mail Campaign Structural Empowerment 12 Nursing Orientation Program / Life after Orientation 14 Relationships with the Community 14 Financial Accountability Council 15 R.N. Advisory Council 16 Professional Development Council 16 Quality Outcomes Council 17 Certified Registered Nurses 18 Position Statement
19 Nurse Recognition 20 Registered Nurse Demographics 21 By the Numbers 21 South Bay Cardiovascular Exemplary Professional Practice 22 Palliative Care Program 23 Peer Case Review Council 23 Beacon Journey 24 Pain Management Performance Improvement Team 24 Minimally Invasive Lumbar Decompression 25 St. Francis Hospital Nurses Rank Among the Top 10% 25 The Culture of Patient Safety 26 Interdisciplinary Care Coordination Rounds 26 Professional Nursing Practice Model New Knowledge and Innovations 27 Medtronic CoreValve 28 Cerebral Angiograms / Stroke 29 Electronic Medical Record 29 Celebrating Research 30 Moisture Associated Skin Damage 31 Impact of Educational Strategies on Preceptor Development 32 Sense of Belonging and the Process of Socialization 32 Cardiovascular & Lifestyle Habit Survey Tribute 34 Tribute to Nancy Kostel-Donlon, R.N.
Empirical Outcomes At St. Francis Hospital, registered nurses pay close attention to numerous measures of quality and performance. From research to training, to the implementation or introduction of new lifesaving treatments and procedures, our registered nurses consistently use multiple strategies to improve effectiveness and care at every level.
Transformational Leadership Nursing leaders at St. Francis Hospital recognize the importance of providing an environment that combines time-tested standards with the values, beliefs and behaviors required to move our staff forward.
Structural Empowerment At St. Francis Hospital, proven structures and processes are combined every day with strong leadership, resulting in professional partnerships at every level that aim to improve patient health outcomes and community relations. This is called the St. Francis Hospital Professional Nursing Shared Governance Model. At St. Francis, Shared Governance provides a structure that supports decentralized decision-making and encourages collaboration on clinical outcomes, professional practice, performance improvement, education, and evidenced-based practice.
Exemplary Professional Practice Registered nurses consistently work individually and collaboratively to promote professional values and a healing environment aimed at meeting the exemplary standards established in the Professional Nursing Practice Model.
New Knowledge and Innovations At St. Francis Hospital, registered nurses play a critical role in bringing clinical innovations to patients. Establishing new ways of achieving high quality, effective and efficient care is the outcome of transformational leadership, empowered structures and processes, and exemplary practice in nursing. Cover: Left to right: Barbara Codignotto, MA, R.N.; Noelle DeSantis, BSN, R.N.; Mary Eckstein, AAS, R.N.; Donna Hobbs, BSN, R.N., CNOR; Amy Devine, BS, R.N.; Barbara Martino, MS, R.N., CCRN; Theresa Caputo, BSN, R.N., CMSRN; Hannah O’Connor, R.N., CMSRN; and Ildiko Kutasi, BSN, R.N., CMSRN (missing from photo; Mary Gallagher, MA, R.N. and Alan Kiernan, BSN, R.N., CCRN)
“Leadership is much more an art, a belief, a condition of the heart, than a set of things to do. The visible signs of artful leadership are expressed, ultimately, in its practice.” – Max DePree, Writer
Ann Cella, MA, MEd, R.N., NEA-BC
Message from the Senior VP, Patient Care Services, Chief Nursing Officer There is no question that today’s nurses play a key role in leading healthcare reform. They are crucial to meeting the nation’s healthcare needs, and they are more widely recognized for their contributions. That is why we are focusing on our registered nurses in the Patient Care Services Division at St. Francis Hospital and how they are leading change in the advancement of patient care. In these pages you will find nurses whose dedication, spirit, and continual display of high quality patient care are testaments to the remarkable leaders they truly are. The year 2010 was a busy one for us. The tremendous effort of our registered
Tomorrow’s Nurse Leaders program.
nurses in preparing for Magnet redesignation ultimately paid off. For the sec-
• Receive Stroke Center redesignation. Our first rate stroke center has been
ond time in a row, we received the prestigious Magnet designation for excel-
recognized with the Gold Plus Award
lence in nursing services, proving that our registered nurses are among the best
• Achieve 82 percent of direct care nurses with minimal preparation at the
in the country. With this remarkable distinction, St. Francis became one of
baccalaureate degree in nursing.
just three hospitals on Long Island and the only hospital in Nassau County to
I cannot express how proud I am to be a part of St. Francis Hospital and to
hold this international honor. In addition to receiving Magnet status again,
work with such admirable men and women. Our nursing staff is the most ex-
St. Francis was named by U.S. News & World Report as one of the best hospi-
ceptional group of registered nurses I have ever encountered. I commend each
tals in the nation for nursing care. Among the elite medical centers cited on
and every one of them for always wanting to improve patient care. Their hard
the magazine’s “America’s Best Hospitals” website, St. Francis was ranked
work, commitment, and professionalism knows no bounds. They are truly
among the top 10 percent for patient satisfaction. Our registered nurses are
devoted to doing what is best for our patients, and they never lose sight of that
extremely proud of both of these exceptional accolades.
goal. They have my deepest thanks.
But we still have many goals to accomplish, and here are a few highlights
I would also like to thank our entire healthcare team, particularly our elite
we look forward to in the coming year:
medical staff, who are our loyal partners in patient care. I would also like to
• Launch the open-heart surgical program at Good Samaritan Hospital. This will be a major imitative to bring our outstanding expertise in open-heart sur-
M.D., for the genuine support, guidance and leadership that you have con-
gery to Suffolk County
stantly shown us. I am especially thankful for the Sisters of the Franscisan
• Improve our central line-associated blood stream infection (CLAB) rates. • Expand the campaign we have recently launched to reduce the amount of
Missionaries of Mary and our Bishop, the Most Reverend William F. Murphy, whose prayers, compassion and inspiration have blessed us all and
noise in the Hospital. A quieter hospital makes for a more relaxed patient.
touched a special place in our hearts.
thank the Board of Trustees and our President and CEO, Alan D. Guerci,
• Continue to cultivate our successful and rewarding Tomorrow’s Nurses and
St. Francis Hospital, 2010 Nursing Annual Report 3
“To be a Magnet Champion means being involved with my peers in supporting and promoting the Magnet Redesignation Journey. I feel proud of our Magnet status and as a champion I like sharing this sense of pride with my fellow nurses.” Kathy Dittmeier, BSN, R.N. Clinical Nurse - ACU
Magnet Champions
Magnet Redesignation Journey St. Francis Hospital was first designated a Magnet Hospital in 2006 by the American Nurses Credentialing Center (ANCC). The Magnet Recognition Program, which is based on quality indicators and standards established by the American Nurses Association (ANA), was developed by the ANCC to identify and recognize excellence in nursing services. In 2009, St. Francis Hospital submitted an application for redesignation. Our document, which demonstrated the outstanding quality and exceptional care provided by our registered nurses, was submitted in support of our application in August 2010. The significant contributions that our registered nurses make to the profession became even more evident during our journey to achieve Magnet redesignation status. Our registered nurses are not only skilled clinicians, they are award winners, innovators, researchers, mentors, transformational leaders, community volunteers, and consummate professionals who serve as mentors and role models. On April 20, 2011, we were elated to receive our first Magnet Redesignation. We view the redesignation not as a destination, but as an acknowledgement of the quality of care that we provide to the patient, family and community, and the knowledge and expertise that our registered nurses consistently demonstrate as we continue our journey of discovery and innovation in the discipline of nursing. Here is an excerpt from the memo that Alan D. Guerci, M.D., President and CEO, and Ann Cella, MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO, sent to all the registered nurses at St. Francis Hospital upon receiving the redesignation:
It is with great pride that we report to you that St. Francis Hospital has once again earned Magnet recognition, the most prestigious honor for nursing excellence in the nation. On behalf of the Administration and Board of Trustees of St. Francis Hospital, we would like to congratulate you for this impressive achievement. As you know, Magnet recognition is the highest honor that a hospital can receive for nursing, a distinction earned by only 6 percent of the hospitals in the United States. The program was developed by the American Nurses Credentialing Center (ANCC) to recognize healthcare organizations that provide the very best in nursing care and uphold innovative professional nursing practice. Clearly the Magnet surveyors were impressed by what they saw when they visited St. Francis, because ultimately they validated externally something that we have always known: St. Francis Hospital nurses are among the very best in the nation. Please except our heartfelt thanks for this remarkable recognition and for your extraordinary dedication to the high quality, compassionate care that is at the heart of the mission of St. Francis Hospital.
“Being part of the Magnet Redesignation Journey has reinforced to me what an honor and a privilege it is to be part of the St. Francis Hospital nursing family. The teamwork and dedication shown throughout this journey has cemented the pride I feel when I say I am a nurse at St. Francis Hospital. When I come to work in the morning, I don't feel as if I am coming to a job; I feel as if I am coming home!” Theresa Caputo, BSN, R.N., CMSRN, Clinical Nurse - 2 East 4 St. Francis Hospital, 2010 Nursing Annual Report
“Our outstanding patient satisfaction results are a reflection of the excellent care that we provide to our patients. As a team we work together to provide high quality care with a compassionate and caring approach.” Sandra Bastidas, BSN, R.N., CEN Clinical Nurse - ED
Carolyn Broderick, BSN, R.N.
Sandra Bastidas, BSN, R.N., CEN and Elizabeth Ring, MS, R.N., ANP-BC
Empirical Outcomes Overall Rating of Care Given
Our Commitment to Patient Satisfaction
100 80 60 40
Patient satisfaction is a priority at St. Francis Hospital. It is viewed as a core
20 0 1Q10
strategy for achieving and sustaining the mission of the Hospital. Providing an environment that creates the ideal patient experience while exceeding patient expectations is embedded into the culture of caring that exists at St. Francis. Each member of the healthcare team is committed to ensuring a high level of
2Q10
3Q10
4Q10
Overall Nursing Care 100 80 60 40
excellence in the care of all patients who choose to come to our hospital. Patients at St. Francis are very satisfied with their care experience. This is a reflec-
20 0 1Q10
2Q10
3Q10
4Q10
tion of the commitment of our registered nurses to ensure patients have an Friendliness/Courtesy of the Nurses
exceptional experience.
100
For three consecutive years, St. Francis has been recognized for its commit-
80 60
ment to excellence by HealthStream Research with the “Excellence through
40
Insight Award.” This award was received in 2010 for our overall inpatient
20 0 1Q10
HCAHPS ratings. HealthStream is a leading provider of learning and research solutions for the healthcare industry. The “Excellence through Insight Award” recognizes hospitals that excel in their ability to gain insight into their patients
2Q10
3Q10
4Q10
Skill of the Nurses 100 80 60
and use that information to build excellence within the organization.
40
In addition, the DeMatteis Center for Cardiac Research and Education has been honored two consecutive years with the prestigious Summit Award from
20 0 1Q10
Press Ganey Associates for outpatient satisfaction. Press Ganey Associates, the nation’s leader in patient satisfaction measurement, created the award to high-
2Q10
3Q10
4Q10
Staff Worked Together to Care for You 100 80
light outstanding healthcare organizations. Awardees must maintain an overall patient satisfaction ranking in the 95th percentile or above for at least three consecutive years. As a recipient of this award, St. Francis sets itself apart from
60 40 20 0
the competition by demonstrating our dedication to improvement and sustaining excellence in both quality of care and patient satisfaction.
1Q10
2Q10 SFH Mean Score
Empirical Outcomes 5
SFH LI Ref, Grp. Rank
3Q10 SFH Nat’l %-tile Rank
4Q10
“Our S.K.I.N. Champion Program has positively impacted patient outcomes by decreasing the incidence of hospital acquired pressure ulcers. The effectiveness of this program is measured by utilizing performance improvement principles which are part of the framework of our Professional Nursing Practice Model.” Chenel Trevellini, BSN, R.N., CWOCN Wound Ostomy Continence CNS
S.K.I.N. Champions
S.K.I.N. Champions Prevalence Study Teams
• Perform appropriate care of the indwelling urinary catheters
The 5 Million Lives Campaign has brought about an increased awareness of
• Timely removal of indwelling catheters
the importance of implementing hospital quality initiatives that help prevent injury to patients and save lives. As of October 1, 2008, the Centers for Medicare & Medicaid Services (CMS) implemented a non-payment policy for hospital-acquired pressure ulcers. CMS estimates the average costs associated with providing acute-care hospitalization to a patient with a pressure ulcer is $40,000 per hospitalization. Since 2008, the S.K.I.N. Champion Prevalence Study Team program has contributed to patient safety by decreasing the incidence of hospital-acquired
• Develop a process to assure the appropriate use of indwelling urinary catheters
The measures to meet these goals included: • The use of a urinary sticker which identifies a reason for catheter necessity and documents that care was provided while the catheter is present • Quarterly monitoring of the UTI rate and Foley Utilization Ratio as per National Health Safety Network • Following Surgical Care Improvement Project recommendations for removal of urinary catheters on post-op patients
pressure ulcers. At St. Francis Hospital, the patient is the center of the Professional Nursing Practice Model (PNPM). The PNPM provides the framework for the S.K.I.N program, measuring its effectiveness by utilizing performance improvement principles. S.K.I.N. Prevalence Teams are established specifically to conduct monthly pressure ulcer prevalence studies for an entire quarterly data collection period. Each team consists of a clinical nurse specialist, clinical nurse, and ancillary staff. The teams begin each prevalence study day with one hour of didactics, which includes data collection requirements. The teams then proceed to their assigned units and conduct a pressure prevalence study, concluding each day with an hour-long post-conference, for a total of six CEUs
Patient Fall Prevention Program Although our patient fall rate is consistently well below the national benchmark of 3.5 per 1000 patient days, we are constantly striving to improve. The population we serve consists of elderly patients who often use multiple medications including anticoagulants, which can worsen any injury sustained during a fall. The innovative process developed to further enhance our falls reduction program incorporates a multi-faceted approach: • The use of a new falls risk assessment tool, which is completed every 12
for participants.
hours and enables the clinical nurse to score patients on their gait, mental status, falls history, use of narcotics/sedatives, hemodynamic status, and other factors.
Urinary Tract Infections
• The incorporation of Intentional Rounding, whereby a caregiver asks the patient each hour if they are comfortable, checks to make sure they have nec-
As part of a Catholic Health Services of Long Island Performance Improve-
essary items within reach, questions whether they have any pain, and offers
ment approach to decreasing urinary tract infections (UTI), the Use and
assistance to the bathroom.
Care of Indwelling Urinary Catheter Performance Improvement Team was
• The emphasis of our fall prevention program is implementing the appro-
created in 2010. The team met on a monthly basis and set the following
priate intervention. FEET is the acronym used for the plan of care. The fall
goals to prevent urinary tract infections: 6 St. Francis Hospital, 2010 Nursing Annual Report
“Prevention of Central Line Associated Bloodstream Infections is a primary initiative at St. Francis . As a nurse sensitive indicator we are vigilant about maintaining our CLAB Bundle which has had a significant impact in keeping our CLAB rate very low.” Richard Dalling, AAS, R.N. Clinical Nurse - MICU2
Zulma Yissel-Sanchez, PCA and Kathleen O’Leary, BSN, R.N.
Richard Dalling, AAS, R.N. and Marina Yusupova, BSN, R.N., CMSRN
• Upon admission, all patients and families partner with the staff and re-
Central Line Associated Bloodstream Infections
ceive a falls contract. The contract remains posted on the patient’s bulletin
The risk for Central Line Associated Bloodstream Infections (CLABS) in criti-
prevention plan of care lists nursing interventions categorized as Functional, Equipment, Education, and Toileting.
board for the duration of the hospitalization.
cal care patients is high because of the frequent insertion of multiple catheters. These catheters are frequently inserted under emergency circumstances, repeat-
Creative Unit-Based Council Initiative Reduces Ventilator Associated Pneumonia Reduction of Ventilator Associated Pneumonia (VAP) in critically ill patients is
edly accessed every day and often needed for extended periods of time. MICU 2, a 20-bed critical care unit, has been successful in creating a culture of patient safety and decreasing CLABS. The National Healthcare Safety Network’s (NHSN) recently published benchmark was 1.0 per 1,000 patient days. The MICU 2 staff continuously works hard to meet or outperform the NHSN benchmark.
an important focus of the critical care unit-based councils at St. Francis Hospi-
Even though MICU 2 has been successful in decreasing their CLAB rate
tal. The critical care unit-based councils created a process from evidence-based
over the past couple of years, the unit continues to strive to meet the Hospital’s
research that dramatically decreased the incidence of VAP and formed an at-
stretch goal of zero CLABS. MICU 2 had nine months with zero CLABS in
mosphere whereby compliance and collaboration achieved positive patient out-
2010. To achieve this accomplishment, MICU 2 embraced the Hospital’s ini-
comes. Data statistically supports our continued decrease in VAP rates.
tiative for Zero CLABS and instituted the measures and processes set forth to
Ventilator Associated Pneumonia has fast become a national focus and a quality care indicator. This is a very important indicator to our patients since St. Francis has four critical care units and 80 critical care beds. A culture of
improve the patient outcome. The clinical nurses in collaboration with the critical care Mid-Level Practitioners assess the necessity of all central lines on a daily basis, and the early re-
safety in decreasing the incidence of VAP is paramount. In 2010, St. Francis
moval of these catheters, when appropriate. The use of full barrier technique, as
had a significant decrease in the incidence of hospital-acquired pneumonia.
well as chloraprep and asepsis, are monitored with each line insertion and a
The critical care unit-based councils continue to embark on an educational pathway to reduce VAP. The FAST HUG rounds were established and the
clinical nurse has the authority to stop the procedure if these practices are not in place.
hospital became a participant of the HANYS-VAP project and that partnership continues today. The FAST HUG checklist includes Feeding, Analgesia, Sedation, Thromboprophylaxis, Head of the bed elevated, Ulcer prophylaxis, and Glycemic control. Our Vent Bundle has advanced dramatically along with our commitment for quality care and positive patient outcomes. To further improve care, the MICU Unit-Based Council developed an Emergent Intubation order sheet that is placed in the intubation trays to address all areas noted on the FAST HUG checklist. Empirical Outcomes 7
Grace Licata-Mendelson, BS, R.N.
Cheryl Li, BSN, R.N. and Joann Iaboni, R.N., CCM
Christine Dellacorte, BSN, R.N. and Sr. Katherine Murphy, MS, RN-BC, CCRN, CHPN, ANP-C
What Our Patients Say My 86-year-old mother underwent aortic valve replacement/double bypass
of my questions. Your professional staff truly understood the meaning and
surgery at St. Francis Hospital, but despite receiving superior medical care,
importance of good “bedside manner.”
she passed away. She simply did not have the energy reserve to rally after Most Sincerely,
such extensive surgery. My family will forever be indebted to her outstanding St. Francis medical team which included Richard Shlofmitz, M.D. and Roberto Colangelo,
Howard Bruce Linden Syosset, N.Y.
M.D. We especially want to acknowledge the exceptional nursing staff. For 58 days they gave my mother impeccable medical care, treated her with the utmost respect and dignity, and supported our entire family every step of the way. While we are devastated by the loss of our family matriarch, we are comforted by the fact that she received such expert and compassionate care
We want to give our highest commendations to the staff in the Day-Op department for their outstanding attention and care. We came to St. Francis because of its mission to provide the most personal and competent environment. The nurses and physicians demonstrated the highest quality of skills and showed genuine concern for our comfort. They exhibited such a blend
from this extraordinary group of nursing professionals.
of warmth, wit and intellect that we had to convey our praises. Sincerely,
Sincerely,
Robin Camhi Baum
Louis and Susan Cataliotti
Scarsdale, N.Y.
East Norwich, N.Y.
During my stay at St. Francis, your staff proved that your
The NDNQI R.N. Satisfaction Survey provides St. Francis Hospital with an overall assessment of how our direct care nurses perceive that they are providing high quality patient care. Below are the results of the 2010 NDNQI R.N. Satisfaction Survey:
hospital is a world class health institution—a model that others should follow. Both the medical expertise and the staff’s professionalism allowed me to receive the best care possible.
80.00 70.00 60.00
Several nurses and technicians were at my bedside and while
50.00
performing their required tasks, I was most impressed with
40.00
how they repeatedly checked my information for accuracy.
30.00
Throughout my pre-surgical testing, the nurses were courte-
20.00
ous, sensitive to my requests, and eager to answer any and all
10.00 0.00
Task R.N._R.N. R.N._M.D. Decision AutoInteract Interact Making nomy
Prof. Status
Pay
Prof. Nursing Nursing Job Enjoy Develop. Managt. Admin.
47.98 71.01 62.43 50.78 55.89 71.76 48.64 57.75 69.27 59.13 55.79 50.18 68.34 60.19 48.82 52.80 66.29 42.77 57.57 62.26 56.93 54.49 SFH 2010
8 St. Francis Hospital, 2010 Nursing Annual Report
Avg. of All Comparison Units in Hospitals
“St. Francis Hospital’s dedication to the longstanding values of their nursing philosophy has created a foundation of excellence that is conveyed to every patient and visitor. As a member of the healthcare team I am proud to uphold the professional values of trust, empathy, honesty, authenticity and respect. My colleagues and I work daily in collaboration with the interdisciplinary care team to provide the best care possible to our patients.” Janet Sica, BSN, R.N. Clinical Nurse - 2 West Janet Sica, BSN, R.N.
Ann Cella, MA, MEd, R.N., NEA-BC; Margaret Ochotorena, MS, R.N., NE-BC; Kathleen GilliganSteiner, MA, R.N., NE-BC; Anna Baracchini, MA, R.N., CPHQ; Donna Rebelo, MS, R.N., NE-BC; Kathleen Engber, MA, RN-BC, NE-BC; and Diane Mamounis-Simmons, MS, R.N., NEA-BC, CNOR
Transformational Leadership Mission:
Nursing’s mission to provide compassionate, patient-centered care, together with our Nursing Philosophy’s commitment to excellence, aligns with the organization’s mission which includes a commitment to excellence Vision: The Nursing program’s vision to be recognized as a national leader by maintaining Magnet designation aligns with the organization’s vision to be a national leader in cardiovascular and select specialty programs. It is also in alignment with the organization’s vision of “total staff engagement” as nurse engagement/shared decision making is an essential element of our Magnet/Professional Practice environment.
Philosophy: The Philosophy of Nursing, at St. Francis Hospital, stems from a commitment to excellence in patient care based on the principles of Christian charity, nursing theory and scientific knowledge. The Professional Nurse is dedicated to total patient care, assessing and meeting the needs of the individual patient in ways that are appropriate to the person and his situation. The Nurse strives to restore the individual to his optimal level of function and well being, to promote good health practices, to identify potential problems and to prevent further illness. This commitment is also concerned with respecting the terminally ill patient’s right to die with dignity. Nursing, at St. Francis Hospital, is at all times patient-centered. Patient independence is fostered with both the patient and family actively participating in the planning and administration of care. Nursing is an ongoing process of vital importance in the continuum of care, which reaches beyond the hospital in restoring the patient to the community. As a member of the health team, the Professional Nurse unifies and coordinates interdepartmental patient services and functions as a role model to this team in the practice of Nursing diagnosis and intervention. The Nurse keeps abreast of new trends and concepts within the profession through continuing education and is expected to innovate, initiate and effect change. Professional Values: Honesty • Empathy • Authencity • Respect • Trust
Transformational Leadership 9
“I think you will find that every St. Francis Nurse Practitioner considers nursing to be at the core of their practice. The combination of nursing experience and advanced education make Nurse Practitioners uniquely qualified and valued members of the SFH community. We provide high quality individualized care, taking a comprehensive approach to disease management, patient education and health promotion.” Debra Chalmers, MS, R.N., ANP-BC Nurse Practitioner
Back Row: Michelle Cuoco, MS, R.N., FNP-BC; Donna Ramharrack, MS, R.N., ANP-BC; Debra Chalmers, MS, RN, ANP-BC; Roberta Schieda, MS, RN, ANP; Jill Oswald, MS, R.N., ANP-BC; Jaclyn Thorez, MS, ANP-BC. Front Row: Maria Vitsentzos, MS, R.N., ANP-BC; and Kim Go, MS, R.N., ANP-BC
Advanced Nurse Practitioners There are over 40 nurse practitioners at St. Francis Hospital. They are em-
their health and well being. As nurses, nurse practitioners are adept in pre-
ployed in cardiology, the cardiac catheterization lab, cardiothoracic surgery,
vention, education and management of chronic disease. As a result of the
congestive heart failure, critical care, electrophysiology, medicine, noninvasive
unique focus of nurse practitioners, patients who choose nurse practitioners
cardiology, and palliative care. Nurse practitioners employed by private prac-
care often have fewer emergency room visits, shorter hospital stays and lower
tices in cardiology, gastroenterology, hematology/oncology and pulmonary
medication costs while reporting an extremely high level of satisfaction with
medicine also care for patients at St. Francis Hospital.
the care they receive.
Nurse practitioners are advanced practice nurses who provide high quality healthcare services. Today, nurse practitioners are mainstream providers found in both primary and specialty care. Nurse practitioners diagnose, treat and prescribe across a wide range of health problems, taking a holistic approach to patient care.
Presentations at National Conferences Participants
Conference
Title of Presentation
Ann Cella, R.N., Denielle Lawtum, R.N.
47th Annual Isabel Maitland Stewart Nursing Research Conference (Columbia University Teachers College)
Poster Presentation
Catherine Pirolo, R.N. Mary Walquist, R.N.
Academy of Medical Surgical Nurses National Conference
Life After Orientation Poster Presentation
Maria Vitsentzos, NP
CAPSE National Conference
Poster Presentation: Palliative Care Brochure Assists APN Program Development
Chenel Trevellini, R.N.
Clinical Symposium on Advances in Skin and Wound Care Conference on Prevention and Healing
Poster Presentation: Evaluation of a Cyanoacrylate Protectant to Manage Peristomal Skin Irritation under Ostomy Skin Barrier Wafers
Chenel Trevellini, R.N.
OWCN Northeast Region Conference
Poster Presentation: Skin Protectents for Peri Stomal Skin Irritations
Chenel Trevellini, R.N.
Columbia University School of Nursing Entry into Practice
Wound, Ostomy and Continence
Chenel Trevellini, R.N.
Catholic Health Services of Long Island
Treatment of Moisture Associated Skin Damage
Catherine Vicari, R.N. Marie Levinson, R.N.
LIHN Symposium
Poster Presentation: Excellence in Patient Satisfaction: First Impressions”
Catherine Pirolo, R.N. Tara Kurz, R.N.
AMSN Chapter Meeting
S.K.I.N Champions
Joanne Catapano, R.N.
Student HIMSS Conference, New York Academy of Medicine
Why Certify in Nursing Informatics? Poster Presentation
Focusing on health promotion, education, and counseling as well as disease prevention, nurse practitioners assist their patients in making healthy choices. Increasingly, the public has grown to rely upon nurse practitioners to provide high quality, individualized care – resulting in high levels of patient satisfaction. Patients who see nurse practitioners report extremely high levels of satisfaction for the care they receive. Nurse practitioners provide a full range of healthcare services and manage their patients’ overall care. Nurse practitioners typically devote more time to counsel their patients. They teach patients how their decisions and actions affect
Northeast Cerebrovascular Consortium Nancy Kostel-Donlon R.N. Barbara Colligan, R.N., Erin Markey, R.N., Lorraine Panella, R.N. Mary McMahon, R.N., Celeste Koske, R.N.,Linda Mendick, R.N. William Peabody, R.N.
10 St. Francis Hospital, 2010 Nursing Annual Report
Impact of the Use of a Multidisciplinary Rounding Tool on Compliance With Stroke Consensus Measures
"The Tomorrow’s Nurse Leaders program has helped me create a career path individualized for my professional nursing goals. It gives me the opportunity to develop my communication, management, and leadership skills so that I can pursue my passion in nursing and become a Nurse Leader of the future." Amy Devine, BS, R.N. Clinical Nurse - SICU
Cheryl Bush, BSN, R.N.; Amy Devine, BS, R.N.; and Deborah Feil, BSN, R.N., CMSRN.
Mary Kerry O’Brien, BSN, R.N.
Tomorrow’s Nurse Leaders
Direct Mail Campaign
Nursing is a dynamic profession in which registered nurses engage in various
“Thank You to Our Nurses”
roles. All professional nurses demonstrate leadership regardless of their professional practice setting. Registered nurses are key in the leadership at St. Francis Hospital. They are professionals and team leaders who participate on councils and committees, and possess a lifelong commitment to learning for themselves and their patients. Registered nurses represent their profession and advocate for nursing and the hospital through excellence in care, patient safety and quality.
In 2010, Ann Cella, MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO, collaborated with Sherry Friedman, Vice President of Development, to represent nursing via a direct mail appeal. The fundraising direct mail appeal letter, mailed to recently discharged patients and other members of the community in June 2010, focused on St. Francis Hospital’s quality nursing care. We received over 2,232 gifts totaling $98,026 in response to the 2010 nurses’ direct mail campaign. Here is an excerpt from the letter mailed to former patients:
Ann Cella, MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO, created the Tomorrow’s Nurse Leaders Program as an extension of her Tomorrow’s Nurse Program. The program invites registered
We receive many letters from our patients and their loved ones praising
nurses to expand their leadership skills in the field of nursing management,
the wonderful care at St. Francis Hospital. And frequently, these letters
administration and education. Registered nurses can devote a day with St.
commend our nurses for their highly compassionate and personalized
Francis nurse managers, clinical experts or nurse executives for first-hand ex-
approach to care which, in their words, is unlike any other hospital.
perience of the rewards and challenges of nursing leadership. The program’s
This is no surprise. After all, St. Francis is the only hospital in Nassau
goals are to provide exposure to the structure and processes of:
County to have Magnet™ designation for excellence in nursing services,
• Human resource management
a prestigious honor earned by only 6% of the hospitals in the country. We realize that quality patient care is something that starts with one
• Fiduciary responsibility • Creating the ideal patient experience
person helping another. And most frequently it begins when a nurse
• Applying evidence-based practice
reaches out to someone in need, and then quietly and competently goes
• Decision-making and autonomy
about his or her business of helping that patient recover... At St. Francis Hospital, we believe strongly in this type of personalized
In 2010, Ann welcomed Deborah Feil, BSN, R.N., CMSRN, Assistant Nurse Manager , K2; Amy Devine, BS, R.N., Clinical Nurse SICU; and Cheryl Bush, BSN, R.N., Nurse Manager, Cardiothoracic Vascular O.R., to the Tomorrow’s Nurse Leader Program.
care. And others – perhaps even yourself – apparently agree. Our reputation for providing excellent care has been recognized repeatedly. Your gift is an opportunity to say “thank you” to the nurse who cared for you or your loved one and ensure that St. Francis Hospital remains an acknowledged leader in patient-centered care.
Transformational Leadership 11
“The Life After Orientation experience has strengthened me as a new nurse because I can voice my concerns and know that they will be resolved for me and my colleagues. It has improved my ability to care for my patients as I continue to grow in this profession. This program has provided not only support and encouragement, but also wonderful opportunities to grow as a novice nurse.” Mary Walquist, BSN, R.N. Clinical Nurse - K1
Life After Orientation Group
Structural Empowerment It Is Not Just Words; Introducing and Demonstrating the Professional Nurse Practice Model Through the Nursing Orientation Program What makes the orientation program at St. Francis Hospital different from
Efforts of the Medical Staff
other organizations? The leadership team at St. Francis recognizes that an ori-
Creating a “Culture of Safety” is one of the goals that St. Francis Hospital is
entation program must include more than just an introduction to the new
hoping to meet by incorporating physicians into the registered nurse orienta-
nurses’ roles and responsibilities. Our nursing leadership has developed a pro-
tion program. One aspect of this culture is skilled communication which re-
gram that not only teaches the components of the Professional Nursing Prac-
quires that nurses’ communication skills be as proficient and well-developed as
tice Model to the new registered nurse, but also embodies the model in its
their clinical skills (AACN, 2005).
structure and content delivery, transforming the model from a schematic on
This idea was first formulated when Lionel Barrau, M.D., the Director of
paper to a living model in the classroom. Rooted in the caring theory of Jean
Nephrology, requested that some of the physicians participate in orientation in
Watson, our model at St. Francis Hospital is defined as a system which de-
attempt to improve collaboration. The Nursing Education Department thought
picts how nurses practice, collaborate, communicate, and develop profession-
it would be more beneficial if information regarding pertinent assessment or lab
ally to provide the highest quality care for those served by the organization.
changes (which warranted physician notification) could be discussed. For exam-
These are the highlights of our registered nurse orientation program, which
ple, one nephrologist discussed the importance of notifying a physician about a
emphasize the necessity of authentic relationships among caregivers to pro-
change in urine output and the importance of accurate documentation of I &
vide quality care.
O. This physician also described the proper assessment of an AV fistula or graft, and the complications that can ensue from incomplete assessment.
A Sense of Belonging
In the past year, several physicians attended Registered Nurse orientation
The Nursing Education Department, along with the nurse managers, estab-
and provided 15-20 minute lectures on information specific to their patient
lishes a personal connection with their new staff members by providing indi-
population. Among the group of participants were Marvin Tenenbaum,
vidualized welcome packets. These packets are addressed to each new
M.D., Chairman of the Department of Medicine, and the George Petrossian,
registered nurse and include a letter that welcomes each one to their specific
M.D., Director of Interventional Cardiovascular Procedures. The physicians
unit and also introduces their management team to the new employee. The
emphasized that they depend on the assessments of the registered nurses in
manager also introduces the new employee to their nurse preceptor. The feed-
order to assure that the needs of their patients are met and that quality care is
back from all new employees has been positive, leaving them with the feeling
provided.
that they have made a connection with their new coworkers.
Since the project’s inception, the feedback from the registered nurses has only been positive. The registered nurses found that the physician lectures not
12 St. Francis Hospital, 2010 Nursing Annual Report
only enhanced the knowledge received in orientation, but also demonstrated
designed to welcome new graduates and to assist experienced registered nurses
that their assessments and observations are valued by the physicians. Having
as well. Preceptors are chosen for their demonstrated leadership skills, clinical
the physicians participate during the orientation period allowed the profes-
expertise and ability to communicate effectively. When you combine willing,
sional relationship to begin in a less stressful environment. New graduate
professional nurses with a desire to teach and guide, the groundwork is set for
nurses have told us that they are less intimidated and apprehensive when
the development of excellent mentoring relationships.
speaking with physicians regarding patients or when asking general questions about a diagnosis or intervention they are unfamiliar with. Experienced regis-
Never Losing Touch
tered nurses are also impressed; they have stated that having the physicians in-
Throughout the clinical portion of orientation, managers and the Clinical
volved during orientation sends a clear message that physicians consider
Nurse Specialists meet with their new employees to assess the progress of ori-
registered nurses valued members of the heath care team.
entation. Additionally, midway through the clinical orientation period, there is a day where the orientation nurse meets with the nurse educator to evaluate
A Welcome from our Nursing Staff
progress.. We call this “Recap Day.” It includes the clarification of any ques-
Registered nurses from all units in the Hospital also play a role in welcoming
tions and provides for an immediate evaluation of the learning experience.
and supporting the new registered nurses by participating in “Skills Day,”
On Recap Day, registered nurses share their experiences, challenges and ac-
which introduces the registered nurses to various clinical tasks where they must
complishments. If any problems with clinical orientation exist, the nurse edu-
demonstrate competency. The experienced St. Francis Hospital registered
cator meets with the manager to discuss a plan for resolution.
nurses volunteer for two 8-hour shifts as part of the program that enables them to take ownership of their professional development. Experienced registered
Continued Support for the New Graduate Registered Nurse
nurses take the new nurses through policy and procedure and provide hands-
At St. Francis, the Life After Orientation Program was initiated to provide the
on learning opportunities such as IV insertion, aseptic technique, and safe ap-
support and structure necessary to help graduate nurses make the transition
plication of restraints. Participation in Skills Day yields much more than just a
from the student nurse role to a leader at the bedside. The program provides
completion of mandatory competencies. Through their enthusiasm, profes-
the new graduate with the opportunity to share his or her struggles with a
sionalism and leadership, the experienced registered nurses make a very positive
member of the senior nursing leadership team in an effort to assist in problem
and lasting impression on the new staff. This peer relationship encourages the
solving strategies, coping skills, and to network with other nurses who may be
staff to take care of each other in the clinical setting and recognize that support
experiencing similar frustrations.
and teamwork are necessary elements in the development of the new nurse.
The Life after Orientation Program welcomes new nurses by invitation and meets on a monthly basis. The membership consists of Assistant Vice Presi-
The Interdisciplinary Team
dent of Nursing, Donna Rebelo, MS, R.N., NE-BC, and clinical nurses with
New registered nurses have the opportunity to meet and learn about the roles
less than 18 months experience in the role. The clinical nurses collaborate
of several other departments they will be working with while caring for their
with nursing leadership who offer the new practitioner a safe, confidential en-
patients. A total of seven departments came to speak with the registered nurses
vironment in which experiences are shared. In this program, nursing leader-
to introduce their department and the resources available to the staff. Direc-
ship is there to celebrate their experiences and assist them with challenging
tors from risk management, infection control, clinical documentation, respira-
situations. The goal of the program is to assist in facilitating the new clini-
tory therapy, blood bank, care management, wound and ostomy care, and
cian’s personal adjustments to the practice role by role, modeling and influ-
palliative care come to discuss how their collaboration with the registered
encing professional behaviors. The close partnership between the leadership
nurse helps to keep patient safe and achieve the best outcomes.
team and graduate nurse provides an atmosphere of unwavering support and professional development during the first year of practice.
From Classroom to Clinical The preceptor program is unique in that it involves registered nurses, man-
Conclusion
agers and educators from the beginning and is aimed at continuous tracking
In the fast-paced and complex world of the acute care hospital, it is essential to
of the progress of new registered nurses. A key factor in the success of the pro-
draw upon all the resources and relationships available to the clinical nurse to
gram is that preceptors are hand-selected by the education and management
provide the best care and achieve the best outcomes. The Registered Nurse
team and enjoy working with new registered nurses. The preceptor program is
Orientation program fosters a supportive environment that welcomes nursing partnerships with colleagues, physicians, patients and their families.
Structural Empowerment 13
“Nurses at St. Francis serve a vital role in the community by partnering with churches, libraries, and senior centers to provide health screenings and flu immunizations throughout the year.” Joanne Kuplicki, MA, RN-BC Coordinator of Community Health and Education
Left to right: Cathy Kenyon, BSN, R.N.; Theresa Kelly, BSN, R.N.; Deidre Capozzoli, BSN, R.N.; Ruth Sorg, BSN, R.N.; and Joanne Kuplicki, MA, RN-BC
Relationships with the Community An important aspect of fulfilling the mission of Catholic Health Services
volunteering their time as camp nurses during the summer. Several of our
(CHS) of Long Island is to provide care, education, and health screenings to
registered nurses and advanced practice nurses work in health clinics and
the community.
offer nursing care to the uninsured population on Long Island.
St. Francis Hospital registered nurses rise to meet this challenge by volun-
Many of our registered nurses also volunteer in the community as Eu-
teering in a variety of ways:
charistic ministers, religious education teachers, class mothers, Girl
• Healthy Sundays is a CHS initiative where flu vaccinations and other
Scout/Boy Scout leaders, and PTA presidents and members. In addition,
screenings such as checking for abnormal blood pressure and glucose levels are
some of our registered nurses volunteer their time providing hot meals to the
done at parishes in which there is a higher proportion of uninsured and med-
homeless in local soup kitchens. Although they are not volunteering in a
ically underserved individuals. St. Francis registered nurses are an important
nursing capacity, their nursing influence touches all they come to serve.
part of the team who volunteer their time to make Healthy Sundays a success.
Our registered nurses help the underserved by donating food to the home-
• St. Francis registered nurses provide blood pressure screenings at local li-
less shelters during the Thanksgiving and Christmas holidays. With the help
braries and senior citizen centers.
of Sr. Concetta Russo, many of the departments adopt a family each year at
• St. Francis registered nurses participate in the DeMatteis Center’s annual
Christmas and provide them with clothing, toys, toiletries, and food in order
flu vaccination program for seniors and the loved ones in their household.
to make sure they have a nice holiday. Also, during back-to-school time, var-
• At the annual Health Fair, registered nurses assist with providing health
ious nursing units donate backpacks and school supplies to children in need.
screenings, setting up educational informational displays, and conducting a
Ultimately, St. Francis Hospital registered nurses support their community
heart healthy walk at the DeMatteis Center – to promote health awareness
in a variety of different ways. They volunteer their time and nursing expert-
and to teach preventative aspects of healthcare to community members.
ise to many different organizations with a vision and mission to serve those
• St. Francis registered nurses facilitate an annual prostate screening at the
in need.
DeMatteis Center, and other community locations. • St. Francis registered nurses are an important part of the High School Student Athletes Program where students receive a cardiac screening to search for previously undetected heart disease. The care, clinical expertise, patience, and compassion shown by St. Francis
Financial Accountability Council
Hospital’s registered nurses in all of these programs have been vital to the
The Financial Accountability Council is chartered to participate in the
success and the fulfilling of our mission to serve the community.
achievement of the financial goals of St. Francis Hospital and its Patient Care
In addition to volunteering in the programs affiliated with the DeMatteis
Division through the implementation of cost reduction and revenue generat-
Center, our registered nurses are supporting their communities in a variety of
ing initiatives. One of the objectives of this council is to promote activities
different ways. Some of our registered nurses share their nursing expertise by
that assist registered nurses and other members of the division in developing
14 St. Francis Hospital, 2010 Nursing Annual Report
“The R.N. Advisory Council has been our ‘go to group’ for resolving issues by empowering us and being proactive in our patients’ safety and care. With the creation of the Nursing On-Line E-Decision making survey, we now have a vehicle that brings a diverse group of registered nurses to resolve issues concerning our patients and units.” Mary Brittman, AAS, R.N. Clinical Nurse - Cath Lab
Financial Accountability Council Members
innovative solutions for cost reduction while considering safety, effectiveness
Caring Nurse Excellence Awards”
and impact on daily patient care.
• Adding a Rising Star category to the Heart of Caring Nurse Excellence
In 2010, the Financial Accountability Council continued to support an
Awards to acknowledge the novice nurses who exceed expectations
initiative to make more cost-effective use of linens and also worked to mini-
• Rescinding the weekend payback policy
mize the loss of patient valuables by heightening staff awareness, a measure
• Supporting unit council meetings as an option for advancement on the Pro-
that resulted in a reduction in replacement costs for 2010. In addition, the
fessional Development Program
council released educational literature about the appropriate use of red bag
• Implementing a new medication reconciliation form to promote patient safety
waste containers that resulted in significant cost savings compared to 2009.
• Promoting patient safety by using the slider boards when moving patients
The Financial Accountability Council was also proud to introduce their
back and forth off a stretcher
quarterly Operational Budget Brochure to keep the staff up-to-date on key
• Marking the patients name band with a “D” for dentures, “H” for hearing
operational statistics.
aid, and “G” for glasses
R.N. Advisory Council
comes by fostering a healthy work environment and improved patient care.
Empowerment is the focus of the R.N. Advisory Council at St. Francis Hos-
Advisory Council members, the future growth of programs at St. Francis Hos-
pital. This council was established 18 years ago and is chaired by Ann Cella,
pital is only a heartbeat away!
These accomplishments (only to name a few) positively impacted our outWith continuous participation and collaboration of the CNO and the R.N.
MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO. Mem-
R.N. Advisory Council Members
bership includes two registered nurses from the Medical-Surgical Unit, procedural areas, Critical Care Units, Emergency Department, Care Management, and the DeMatteis Center. At the monthly council meetings, nursing leadership and registered nurses communicate, collaborate, and agree to disagree on how to improve and maintain a safe and healthy work environment and accomplish superior patient outcomes. The council has become an exchange of information to and from the other Shared Governance Councils. This year brought several guest speakers and a variety of topics to the council table such as: Redesignation of Magnet, the Hospitalist Program, and the updates of construction and renovations of St. Francis facilities. The following are some accomplishments of 2010: • Changing the name of the Shared Governance Awards to the “Heart of Structural Empowerment 15
“The Professional Development Council is an extraordinary example of shared governance at St. Francis Hospital. It is comprised of clinical nurses who are passionate about developing a program for our nurses that cultivate an environment of professional advancement. It’s is an excellent representation of St. Francis nurses and our desire to always strive for excellence.” Rachel Cowan, BSN, R.N., CMSRN Assistant Nurse Manager - 2 West
Professional Development Council Members
Professional Development Council
Quality Outcomes Council
The fuel that drives the Professional Nursing Practice Model at St. Francis Hospital is a strong commitment to the professional development of each registered nurse. The shared governance structure ensures the input and collaboration of all stakeholders in decisions regarding the Professional Development Program. The Professional Development Council’s charter includes the recognition and celebration of the profession of nursing and the goal of creating a workplace where everyone chooses to bring energy, passion, and a positive attitude. Here are the goals and objectives of the committee: • Modify, enhance and communicate the Professional Development Pro-
The Quality Outcomes Council’s charter is to enhance the quality and effectiveness of nursing practice at St. Francis Hospital. The council members reviewed the 2009 Quality Outcomes data and approved the 2010 Performance Improvement Plan. The Council reviews and analyzes nursesensitive quality indicator data, including patient falls and pressure ulcers, noting the proactive approaches to fall and pressure ulcer prevention that resulted in rates well below national benchmarks for 2010. The Quality Outcomes Council supports staff education regarding all National Patient Safety Goals, reviews and analyzes patient satisfaction data, and develops, updates and revises performance improvement data collection tools.
gram for clinical nurses, managers, and educators • Foster professional development by encouraging registered professional nurses to attain national certification and recommending initiatives or programs that will provide registered nurses with necessary support and resources
In 2010, the council members reviewed the work of the Stroke Committee and the hospital-wide performance improvement teams as well as monitored core measure outcomes for patients with pneumonia, heart failure, and acute myocardial infarction. The Quality Outcomes Council enthusiastically sup-
to successfully accomplish professional certification • Provide input into programs that will meet and support staff members
ported the Sepsis Awareness Campaign which will be an ongoing hospitalwide focus in 2011.
who are interested in pursing formal nursing education • Celebrate the contributions and achievements of registered professional nurses through various recognition initiatives • Provide recommendations in the development of continuing education programs for registered nurses across all specialties • Advise senior nurse leaders on orientation and residency programs based on feedback from new nurses
Quality Outcomes Council Members
16 St. Francis Hospital, 2010 Nursing Annual Report
Certified Nurses
Certified Nurses
St. Francis Hospital 2010 Certified Nurses Andrea Adler, R.N., PCCN Stephanie Ajudua, R.N., CCRN Meulan Amen, R.N., CCRN Kathleen Anderson-Arnopp, R.N., CPHQ Roslynn Aquino, R.N., ANP-BC Juliette Arrastia, R.N., CCRN Warlita Au, R.N., CCRN Regina Bakota, R.N., CMSRN Joana Balsamo, R.N., CMSRN Anna Baracchini, R.N., CPHQ Sandra Bastidias, R.N., CEN Kara Benneche, R.N., CEN Maria Benner, R.N., CCRN, ANP-BC Carol Bertone, R.N., CMSRM Helen Birdsong-Abate, R.N., CCRN Kelly Bitran, R.N., FNP-BC Suzanne Bove-Bast, RN-BC Erina Boyle, R.N., CCRN Mary Brady-Costello, R.N., CNOR Mary Brosnan, R.N., CAPA Lori Brush, R.N., CCRN Elizabeth Busi, R.N., CEN Laura Buszko, RN-BC Lara Caniano, R.N., CCRN Evelyn Capriotti, R.N., CNOR Theresa Caputo, R.N., CMSRN Laurence Carlin, R.N., CCRN Rosaria Carlin, R.N., CCRN Christine Carman, RN-BC Lenore Carroll, R.N., ANP-BC Patricia Carroll, R.N., CMSRN Mary Carroll, R.N., CNOR Theresa Carroll, R.N., CCRN Susan Casey-Bernstein, R.N., CNE Joanne Catapano, R.N., CRN Ann Cella, R.N., NEA-BC Tiffany Chaffee, RN-BC Debra Chalmers, R.N., ANP-BC Dorothy Ciano, R.N., CCRN Danielle Cincinelli, R.N., ANP-BC Barbara Colligan, R.N., CMSRN
Natalia Constantino, R.N., ANP-BC Laura Costa, R.N., CMSRN Elizabeth Cotter, RN-BC Rachel Cowan, R.N., CMSRN Nicole Cregan, R.N., CCRN Ellen Cummings, R.N., CNOR Michelle Cuoco, R.N., FNP-BC Novlet Davis, R.N., ANP-BC Elana Darwish, R.N., CCRN Melissa DelGiorno, R.N., CCRN Gina Depietro, R.N., CNOR John Depietro, R.N., ANP-BC John Devins, R.N., CCRN Girannie Dilchand, R.N., CNOR Tara Donlon, R.N., CCRN Christine Dougherty, R.N., CCRN Miroslawa Drozdik, R.N., ANP-BC Kathleen Engber, RN-BC, NE-BC Michelle Esposito, R.N., CCRN Deborah Feil, R.N., CMSRN Ann Fioresi, R.N., ANP-BC Dawn Focazio, R.N., FNP-BC Mitzi Forman, R.N., CCRN Roalia Francucci, R.N., CCRN Karen Freeman, R.N., CCRN Giuseppina Gaglio, R.N., CCRN Colleen Garr, R.N., CCRN Jacqueline Garraway, R.N., CMSRN Rosemary Gilligan-Holmes, R.N., CMSRN Kathleen Giligan-Steiner, R.N., NE-BC Mary Jane Glander, R.N., CCRN Kathleen Gliganic, R.N., CCRN Kimberly Go, R.N., ANP-BC Jennifer Gomez, R.N., CNOR Beth Ann Grady-Acker, R.N., CDE Laura Gregorovic, R.N., CCRN Jill Grimaldi, R.N., CCRN Lynn Grimaldi, R.N., PCCN Michelle Grippo, R.N., CEN Philomena Grossmann, R.N., CCRN
Rose Guerin, R.N., CCM Gisella Guichard, R.N., CCRN Susan Gunaydin, R.N., CMSRN Elizabeth Haag, R.N., CCRP Eileen Hague, RN-BC Elaine Halloran, R.N., CCM Donna Handle, R.N., CNOR Deborah Harabedian, RN-BC Anne Marie Helmke, R.N., CMSRN Patricia Hendershot, R.N., CMSRN Arlene Hilado, R.N., CCRN Marianne Hill Day, R.N., CCRN Lauren Hills, R.N., CCM Donna Hobbs, R.N., CNOR Tina Hong, R.N., CCRN Linda Hosford, R.N., ANP-BC Holly Hynes-Morales, R.N., CNOR Carla Intrabartola, R.N., CNOR Marcia Irving, R.N., CNOR Lisa Jahrsdoerfer, R.N., CCRN Jan James, R.N., CCRN Barbara Johnson, R.N., ANP-BC Catherine Kaestel, R.N., CPAN Kaltherine Katz, R.N. CNOR Patrice Keenan, R.N., CMSRN Patricia Keller, R.N., ANP-BC Eileen Kenny, R.N., ANP-BC Alan Kiernan, R.N., CCRN Celeste Koske, R.N., CMSRN Patricia Krug, RN-BC Barbara Kunz, R.N., CNOR Joanne Kuplicki, RN-BC Ildiko Kutasi, R.N., CMSRN Danielle Lafont, R.N., CMSRN Mary Ellen Lagnese, R.N., CPAN Adelaide LaRosa, R.N., CCDS Patricia Lee, R.N., CCM Young Joo Lee, R.N., CNOR Kathy Ann Lobmeyer, R.N., CNOR Patricia Lupski, R.N., NE-BC Kathleen Lynch, R.N., CMSRN
Structural Empowerment 17
Danielle Mahon, RN-BC Diane Mamounis-Simmons, R.N., NEA-BC, CNOR Maranda Manieram-Arjune, R.N., ANP-BC Rosauro Maray, R.N., CNOR Jamie Marcello, R.N., CCRN Erin Markey, R.N., ANP-BC Marjorie Marron, R.N., CMSRN Jerrold Marshall, R.N., CCRN Pamela Mason, R.N., CEN Karen Maul, R.N., CNOR Tara Mautner, R.N., CMSRN Mary Anne McCoy, R.N., ANP-BC Jamie McDermott, R.N., CCRN Kathleen McGarry, R.N., CNOR Katherine McGrath, R.N., CCRP Jeannette McLaughlin, R.N., CCRP Mary McMahon, R.N., CMSRN Linda Mendick, R.N., CMSRN Kirsten Minerva, R.N., CCRN Donna Mohr, RN-BC Maureen Mondics, R.N., CNOR Cristina Moravec-Kossegi, R.N., CEN Dalia Mordekai, R.N., FNP-BC Judith Morrison, RN-BC Irene Moser, R.N., CNOR Michele Motekew, RN-BC Elaine Munoz, R.N., CNOR Kathy Muratore, R.N., ANP-BC Deborah Murawski, R.N., CMSRN Sr. Katherine Murphy, RN-BC, CCRN, CHPN, ANP-BC Meghan Murray, R.N., CMSRN Maria Jose Nappo, R.N., ANP-BC Brenda Nickens, R.N., CNOR Theresa Nicosia, R.N., FNP-BC Maria Nuzzolese, R.N., CMSRN Margaret Ochotorena, R.N., NE-BC Karen O'Brien, R.N., CCRN Hannah O'Connor, R.N., CMSRN
“Certification shows that the individual is an expert in their field. It enhances professional growth through continued learning that results in broader knowledge and expanded skills.� Judita Porter, R.N., CNOR Clinical Nurse - OR
Certified Nurses
(Certified Nurses continued...)
Patricia O'Connor', R.N., CCRN Lisa O'Hara, R.N., CCM Elma Ortiz, R.N., CCRN Ann O'Shea, R.N., CCRN Lauren Ostuni, R.N., CMSRN Jillian Oswald, R.N., ANP-BC Roberta Palmeri, R.N., CMSRN Suzanne Palo, RN-BC Patricia Pane, RN-BC Lorraine Panella, R.N., CCRN William Peabody, R.N., CCRN Laura Penfold, R.N., CNOR, CAPA Kim Pensabene, R.N., CNOR Kathleen Peppard, R.N., CMSRN Barbara Petrosino, R.N., CCRN Casey Pettersen, R.N., CCRN Asha Phillips, R.N., CCRN Catherine Pirolo, R.N., CNE, CMSRN Judita Porter, R.N., CNOR Irene Poulimas, R.N., CNE Meredith Pujdak, R.N., CCRN Lorraine Quirk, R.N., FNP-BC Donna Ramharrack, R.N., ANP-BC Margaret Raylman, R.N., CCRN Bliss Rayo-Taranto, RN-BC Donna Rebelo, R.N., NE-BC Ruth Reed, R.N., CEN Christine Rice, R.N., CMSRN Elizabeth Ring, R.N., ANP-BC Linda Rivenburg, R.N., CNOR Eillen Roddy, R.N., CMCN Sandie Romain, R.N., CCRN Diane Ross, R.N., CCRN Marguerite Roth, R.N., CCRP Sandra Roth, R.N., CCRN Allison Rudkin, R.N., CMSRN Jennifer Ryan, R.N., CMSRN Kelley Ryan, R.N., CEN Yasmine Sacristan-Kramer, R.N., CCRN Jennifer Salavec, R.N., CNOR Diane Sambo, R.N., CPAN Lyn Santiago, R.N., CCRC Luisa Santos, R.N., ANP-BC Michelle Sayson, R.N., CCRN
Linda Scharp, R.N., CCRN Stacy Schnell, R.N., CMSRN Susan Seiberlich, R.N., CCRN Dana Shapiro, RN-BC Jeannemarie Shore, R.N., CNOR Barbara Simek, R.N., CNOR Barbara Smith, RN-BC Dolores Smoot, R.N., CNOR Mary Lou Solliday, R.N., CIC Jacqueline Squicciarini, R.N., CCRN Elaine Stevens, R.N., NE-BC Katherine Stevko, R.N., CCRN Theresa Strain, R.N., CCRN Carol Streppel, R.N., CMSRN Cindy Sukhoo, R.N., CNOR Teresa Sullivan, R.N., CCRN Angela Tainter, R.N., CMSRN Carol Tambasco, R.N., OCN Gail Taylor, R.N., CNOR Remedios Teston, R.N., CCRN Benzy Thomas, R.N., ANP-BC, CCRN Maureen Torpey, R.N., ANP-BC, CCRN Allison Trevellini, R.N., CWOCN Patricia Trimboli, R.N., CCRN Elizabeth Vaas, RN-BC Sloan Vahldieck, R.N., ANP-BC Nancy Vannostrand, R.N., CMSRN Maria Vega, R.N., ANP-BC Karen Venice, R.N., CCRN Doris Villagonzalo, R.N., CNOR Maria Vitsentzos, R.N., ANP-BC Joan Wallace, R.N., CCRN Anne Walsh, R.N., CEN Bobby Ward, R.N., CMSRN Linda Weiner, R.N., CCM, NE-BC Christine West, RN-BC Elizabeth White, R.N., CAPA Roman Yagudayev, R.N., CCRN Marina Yusupova, R.N., CMSRN Dawn Zioba, RN-BC
Position Statement The senior nurse leaders of St. Francis Hospital support the belief that the registered professional nurse must be minimally prepared with a baccalaureate degree in nursing. We believe that a highly educated nursing workforce, with a requirement of minimal baccalaureate degree is vital if we are to maintain quality patient care and remain a leader in nursing excellence. The demanding and complex role of the nurse warrants that registered nurses possess an expanded skill mix and mastery of competencies. With projected advances in technology, nursing science, and medicine, nurses must have the ability to synthesize complex information and utilize well-developed critical thinking skills. They are expected to evaluate complex patient care issues and collaborate with the interdisciplinary team to ensure safe and evidence based nursing practice. The vision of the St. Francis Hospital senior nurse leaders is to increase the percent of registered nurses minimally prepared with a baccalaureate degree in nursing from 79 percent in 2010 to 90 percent by 2020. Transforming healthcare delivery recognizes the critical need for clinicians to design, evaluate, and continuously improve the context within which care is delivered. The core function of health care is to provide the best possible clinical care to individuals, families, and communities. The context within which care is delivered has a major impact on the kinds of care that are provided and on the satisfaction and productivity of individual clinicians. Nurses prepared at the baccalaureate level are most likely able to provide safe quality patient care, which significantly impacts positive health care outcomes. The United States is one of the few industrialized countries that does not require the registered professional nurse to have a baccalaureate degree as a minimum degree to attain licensure. The proposed educational preparation will afford some parity with other health professions to function as an equal partner, collaborator, and manager of the complex patient care journey. St. Francis Hospital is committed to working collaboratively with colleges and universities with nursing programs that are faced with faculty shortages
18 St. Francis Hospital, 2010 Nursing Annual Report
“The registered nurse who is minimally prepared with a baccalaureate degree in nursing provides a well rounded health care provider in both patient care and research. Registered nurses at St. Francis Hospital continue to lead the profession by providing quality patient care and outstanding patient outcomes.” Rachael Milton, BSN, R.N. Clinical Nurse - MICU
Tina Hong, AAS, R.N., CCRN; Carmen Saxida, AAS, R.N.;Lisa Sperling,
Rachel Milton, BSN, R.N. and Peggy Manzi-Berdat, BSN, R.N.
BSN, R.N.; Tova Guttman-Rich, BSN, R.N.; and Fran Szaluta, MS, R.N.
to prepare nurses at a baccalaureate level. Evidence of the collaboration is the
St. Francis for what they represent to the organization. Recognizing our reg-
evolution of the Dedicated Education Unit with Adelphi University. This is a
istered nurses for excellence can take place in formal and informal ways: a
collaborative initiative with Adelphi University, where our nurses are clinical
smile, a warm tap on the shoulder, or even a simple positive word spoken in
instructors. St. Francis has also responded to Molloy College and New York
the hallway by one of our senior nursing leaders or hospital administrators
University by actively recruiting clinical instructors among the many Mas-
can be very meaningful.
ter’s prepared registered nurses who are qualified and seek dual employment.
Here are some other, more formal ways we pay tribute to our nurses:
Research demonstrates that educational levels of registered nurses working in
• Nurses Week is a week-long celebration honoring the registered nurses
hospitals have a significant impact on patients’ mortality. The findings indi-
and is held from May 6 (National Nurses Day) through May 12 (Florence
cate that surgical patients cared for in hospitals in which higher proportions
Nightingale’s birthday). In addition, St. Francis commemorates each spe-
of direct care registered nurses held baccalaureate degrees, experienced a sub-
cialty in nursing by holding a week-long celebration for specific areas. Some
stantial survival advantage over those treated in hospitals in which fewer staff
of the nursing specialties honored are Medical Surgical Nurses, Critical Care
nurses had baccalaureate or higher degrees (Aikens, JAMA 2003).
Nurses,, Emergency Department Nurses, Operating Room Nurses and En-
St. Francis Hospital has a long history of valuing the baccalaureate-pre-
doscopy Nurses.
pared registered nurse. Since 1989, there has been a conscious effort to im-
• Each year, St. Francis Hospital elects one nurse from four different patient
prove the percentage of baccalaureate degree nurses. Currently, 79 percent of
care practice settings to receive the Heart of Caring Nurse Excellence Award.
St. Francis nurses hold a baccalaureate degree in nursing. There are more
Recipients of this award are elected by their colleagues. These honorees are
than five colleges and universities with baccalaureate nursing programs in a
revered for consistently demonstrating the St. Francis Professional Nurse
30-mile radius that continually populate our pool of potential candidates.
Practice Model and upholding the Hospital’s values and mission. The clinical nurses who received this award in 2010 were:
Nurse Recognition
Medical/Surgical:
Lisa Sperling, R.N., 1 West
Critical Care:
Tina Hong, R.N., CCRN, SICU
If you are going to achieve excellence in big things, you develop the habit in little matters. Excellence is not an exception, it is a prevailing attitude. –Colin Powell
Procedural Area:
Carmen Ann Saxida, R.N., Endoscopy Unit
Outpatient Area:
Fran Szaluta, R.N., DeMatteis Center - Women’s Center
St. Francis Hospital is a leader in healthcare. Our outstanding registered
Excellence Awards. This award is given to a registered nurse who has one
nurses, who serve our diverse patient population, are an important reason
year or less clinical experience and is held in high regard by his or her peers.
why the Hospital is consistently recognized for excellence, both locally and
The recipient of the Rising Star Award for 2010 was Tova Guttman-Rich,
nationally. Every registered nurse at St. Francis embraces the critical role they
R.N., 2 West.
play as a member of the healthcare team. The clinical nurses are committed
• In the fourth quarter of 2010, the Wall of Excellence was established near
to sustaining optimal patient outcomes while maintaining a culture of safety.
the entrance of Nursing Administration. The wall, a proud display of nurs-
Our Magnet designation recognizes and honors all of the registered nurses at
ing excellence, celebrates registered nurses who are truly dedicated to their
• In 2010 a “Rising Star” category was added to the Heart of Caring Nurse
Structural Empowerment 19
“It is imperative to recognize our nurses for their personal achievements and the excellent care they provide to the patients. The end result is an empowered professional with a confident, intelligent image.” Adelaide LaRosa, BSN, R.N., CCDS Director, Clinical Documentation Improvement Program
Nonette Schafer, AAS, R.N.; Adelaide LaRosa, BSN, R.N., CCDS; and Jean Marie Roth,
Jack Soterakis, M.D.; Tiffany Wickes-Demillio, BSN, R.N.; and Lesli Giglio,
BSN, R.N.
MPA, R.N.
profession and the Hospital’s healthy work environment. Every quarter the
American College of Cardiology
Professional Development Council selects six registered nurses to have their
- Karen Lamberti, R.N., Care Manager: Patient Safety Award
photograph displayed along with a self-written description of why they are
- Gina DiMonica, R.N., Infection Prevention and Control: Patient
proud to work at the hospital. The following registered nurses were honored
Safety Award
during the fourth quarter:
- Cheryl Cohen, R.N., PI Specialist Patient Safety Award
James King, R.N., CTICU
- Kathleen Gilligan-Steiner, R.N., NE-BC, AVP Nursing: Patient
Marixsa Menses, R.N., K2
Safety Award
Angela Tainter, R.N., CMSRN, K2 Jolie Gaglio, R.N., CCRN, CTICU
• In addition, two Operating Room registered nurses who deserve special
Sonia Schwenk, R.N., K2
recognition are Sabine Jean Bart, R.N., and Girannie Dilchand, R.N,
Sara Skiff, R.N., SICU
CNOR. Sabine utilized her operating room skills and helped the Overseas Medical Assistance Team in Haiti after the devastating earthquake and Gi-
• In 2010, 26 percent of eligible registered nurses were board certified in a
rannie Dilchand, R.N., CNOR, served the needy by participating in the
specialty area. St. Francis Hospital acknowledges these distinguished nurses
Mante Mission in Mexico.
by showcasing their names on an engraved plaque, displayed in the main lobby of the Heart Center, and exhibiting their names on a “Wall of Honor” on the Hospital intranet. In addition, registered nurses who have achieved board certification are honored during Nurses Week by receiving an invitation from Ann Cella, MA, MEd, RN-BC, Senior VP, Patient Care Services/CNO, to a “High Tea” in their honor. • The following nurses also received recognition in 2010: - Ildi Kutasi, R.N., CMSRN, Clinical Nurse, 2West: Long Island Health Network (LIHN) Shining Star Award - Adelaide LaRosa, R.N., CCDS, Director, Clinical Documentation: Professional Achievement Honors Award - Erin Markey, R.N., ANP-BC, CNS: SFH Spirit Award
Registered Nurses Demographics At St. Francis Hospital, there are 996 registered nurses. Of those, 728 are full time, 231 are part time, and 37 are per diem. Of the staff of registered nurses, 784 or 79 percent have a bachelors degree or greater. Below is a representation of the average years of service: Years of Service Range 0-5 years 377 6-10 years 204 11-15 years 136 16-20 years 109 21-25 years 83
- Vivian Geigel, R.N., Clinical Nurse, Cardiac Imaging: SFH Spirit Award - Antoinette Jordan, R.N., Nurse Manager, MICU2: SFH Patrick J. Scollard Managerial Award. - Kathy Muratore, R.N., ANP-BC: Downstate New York Representative for 20 St. Francis Hospital, 2010 Nursing Annual Report
26-30 years 31-35 years 36-40 years 41 or more years
50 25 10 2
Avg. years of experience 11.3
Nicola Crosswell, AAS, R.N.
Sheila Catania, AAS, R.N.; Patricia Keller, MS, R.N., ANP-BC; Diane Schultz, BSN, R.N.; and Lauren Somerville, BSN, R.N.
By the Numbers
South Bay Cardiovascular
2010 St. Francis Hospital Statistics
The preparations for South Bay Cardiovascular joining St. Francis Hospital
Services to Patients
began in July 2009. To meet hospital standards, a construction project was
Operating Room Procedures (Including Cardiac Surgery) 17,726
planned that would not interrupt patient workflow. Policies, procedures and
• Open-Heart Surgery
1,630
competencies were also developed to incorporate South Bay Cardiovascular as
• General Surgery
3,841
an outpatient extension clinic of the Hospital. Existing documentation was re-
• Ambulatory Surgery
7,504
vised and new forms were created. The practice was in full operation while this
• Other Cardiothoracic Surgery
4,751
Cardiac Catheterization Patients
12,018
Staff began orientation as St. Francis employees and registered nurses com-
• Inpatient Catheterizations
5,227
pleted competencies for tasks they had been performing for years. Completing
• Outpatient Catheterizations
3,366
the competencies validated the expertise of the nurses. The professionalism and
• Coronary Angioplasty
3,425
Non-Invasive Cardiac Lab Procedures
14,076
tion of the entire process. Changes to the physical environment, upgraded
Cardiac Rehabilitation Visits
62,271
equipment, and new crash carts gave the registered nurses the resources to im-
Cardiac Arrhythmia Procedures
4,107
• AICDS
1,010
was accomplished.
dedication of the South Bay registered nurses contributed to the smooth transi-
prove patient care. It is exciting to be part of an institution with Magnet status and the South
• Pacemakers
757
Bay registered nurses are looking forward to the continuing educational oppor-
• EP Studies
2,340
tunities that St. Francis Hospital provides. In just over a year, the Department of Health gave the approval on September 16, 2010 for the Article 28
Patient Care Number of Beds (in service)
312
Patient Admissions
18,197
designation.
Days of Patient Care
104,914
Average Patient Stay (Days)
5.8
Bed Occupancy Rate
92%
Emergency Room Visits (Gross)
21,677
Structural Empowerment 21
“Since joining the Palliative Care Department as a Nurse Practitioner this past year I am often asked how I like my new job, and with a smile I respond, I love it. Functioning as a Nurse Practitioner within the palliative care team I get to wear many “hats” including that of practitioner, educator, advocate and colleague. On a daily basis I have the opportunity to connect with patients and their families on a meaningful level, assist them in establishing GOC, optimize their QOL, all while collaborating with various disciplines and practitioners at SFH, what’s not to love!” Kelly Bitran, MS, R.N., FNP-BC Palliative Care Department
Left to right: Kelly Bitran, MS, R.N., FNP-BC and Maria Vitsentzos, MS, R.N., ANP-BC
Exemplary Professional Practice Palliative Care
(the only repository for national data on the structures and processes of hos-
The Latin translation of the word “palliative” is to cloak or to cover, which
pital palliative care programs) and has represented St. Francis at national and
evokes images of comfort. Winter comes and the temperatures cool, we
local conferences, and has dramatically reduced the frequency of SFH Ethics
can’t change the winter season but we can treat the symptoms we feel by
Sub-Committee meetings to resolve clinical ethical dilemmas.
dressing more warmly. Similarly, we can’t change the fact that someone has been diagnosed with a chronic disease, but we can address their symptoms and strive to improve their quality of life.
While there is good reason to stand back and reflect proudly on our program’s accomplishments every year, we also look ahead at its potential growth in years to come. St. Francis, ranked as one of America’s Best Hospi-
Inspired by Ann Cella, MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO, our Palliative Care Program was derived from the Pain
tals by U.S. News & World Report, will also be recognized for having one of America’s finest Palliative Care Programs.
and Palliative Care Process Improvement Committee and had humble be-
Francis Hospital, now receives an average of 48 referrals per month. As a re-
Nursing Service Peer Case Review Council
sult, the program added a part-time Nurse Practitioner, Kelly Bitran, R.N.,
The Nursing Service Peer Case Review Council, which was established in
FNP-BC, to assist with meeting the program’s growth. The Palliative Care
2010, is a venue for registered nurses to collaborate and brainstorm about
ginnings following a brief mentorship at Mount Sinai Medical Center. Our Palliative Care Program, entwined in the rich culture and mission of St.
Program has positively impacted ALOS and direct cost per case. It generates
ways to improve nursing service and enhance quality patient outcomes. This
revenue through Nurse Practitioner billing, has created a brochure and a Be-
council evaluates the quality and efficiency of services with a focus on im-
reavement Guide, and has its own email address: sfhpalliativecare@chsli.org.
proving patient outcomes. The council maintains a non-punitive, “just cul-
The program contributes annually to The National Palliative Care Registry
ture” environment in which registered nurses have open dialog in disclosing nursing practice issues and system failures.
Tracking Monthly Referral Trends 80
While maintaining the ANA Professional Standards of Professional Per-
70
formance through nurse accountability and collegiality, clinical nurses review
60
the quality and appropriateness of services ordered or performed by their
50
clinical peers.
40
On a monthly basis, members from the senior nursing leadership team,
30 20
along with clinical nurses from each specialty, convene to analyze specific
10 0
Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
22 St. Francis Hospital, 2010 Nursing Annual Report
“The CTICU is excited to be on the Beacon Journey in recognition of critical care excellence. This journey is possible because of the commitment of the nurses and the care we provide to our patients which is reflected in our excellent patient outcomes.” Donna Chacon, AAS, R.N. Clinical Nurse - CTICU
Left to right: Kedisha Palmer, BSN, R.N.; Elana Darwish, BSN, R.N., CCRN; Donna Chacon, BSN, R.N.; Mitzi Forman, BSN, R.N., CCRN; Jennifer Knudsen, BSN, R.N.; Bernadette Semenick, BSN, R.N.; and Kathleen Engber, MA, RN-BC, NE-BC
cases related to patient care issues. The council then develops recommenda-
On February 8, 2010, the CT-ICU officially launched their Beacon Jour-
tions based on a Clinical Scene Investigation (CSI) report to improve or pre-
ney with a celebratory breakfast. A Beacon Task Force has begun the docu-
vent the issue from reoccurring.
ment review and the projected submission date will be the summer of 2011.
It is the expertise of these registered nurses that enhances our practice and continues to foster quality patient care at St. Francis Hospital.
The requirements for beacon status are based upon 6 main categories which include: • Unit Profile • Leadership Structures and Systems • Appropriate Staffing and Staff Engagement
CT-ICU Journey for the Beacon Award
• Effective Communication, Knowledge Management and Best Practices • Evidence Based Practice and Processes
The American Association of Critical-Care
• Patient Outcomes
Nurses (AACN) launched the Beacon Award for Critical Care Excellence. The program gives national recognition to critical care units that attain high standards for quality and exceptional patient care in healthy, healing work environments.
Similar to Magnet, patient outcomes which include nurse sensitive indicators are benchmarked against others nationally. The Beacon Award includes three levels that a critical care unit can chart its excellence journey over time. They include bronze, silver and gold. Recipients of this award receive a three year designation. The CT-ICU is going for the gold!
Linda Scharp, R.N., CCRN, a clinical nurse in the CT-ICU, attended the National Teachers Institute (NTI) annual AACN conference where she was given information about the Beacon Award. Upon returning she recommended to her managers and peers that the CT-ICU begin the journey for the Beacon Award. Prior to the initiation of the Beacon Journey, the following CT-ICU Unit-Based Council members made a commitment to become Beacon Champions: Donna Chacon, R.N.; Bernadette Semenick, R.N.; Jamie McDermott, R.N., CCRN; John Devins, R.N., CCRN; and Elana Darwish, R.N., CCRN.
Exemplary Professional Practice 23
Left to right: Faith Papatsos, BSN, R.N.; Patrick Annello, M.D.; Thomas Murname, AAS, R.N.;
Monica Chao, AAS, R.N.
Kerry Affonso, BSN, R.N.
and Evelyn Capriotti, MS, R.N., CNOR
Pain Management Performance Improvement Team There are many different reasons people are admitted to the Hospital, but the goal of the Pain Management Performance Improvement Team is for all patients to be as comfortable as possible, as quickly as possible. We strive to optimize their comfort and enable them to breath, walk, eat, sleep and heal better. In our effort to improve pain management outcomes, the Pain Management Performance Improvement Team accomplished the following in 2010: • Facilitated the selection and purchase of a “Pain Management - It’s Your Right” DVD to be broadcast via the on-demand patient education TV channels • Created “The Patient’s Guide to Pain Management” • Expanded the Patient Controlled Analgesia (PCA) Program to 17 certified Mid-Level Practitioners involved in managing patients’ pain via PCA • Created an online educational module, “Pain Management Assessment and Treatment Options,” which is now available to all registered nurses and MidLevel Practitioners
MILD is performed under a local anesthetic with light sedation, using an image-guided probe, approximately the size of a pen. Dr. Annello locates and removes a small portion of tissue and bone that impinges on the spinal cord which then alleviates the pain that many of these patients have suffered for years. For most patients, it is an ambulatory procedure that takes approximately one hour and requires no sutures. Dr. Annello recommends MILD to people who have underlying medical conditions that put them at risk for surgery. For 74-year-old Clayton Johnson, an insurance sales executive, and 79year-old Theresa Bova, a retired secretary, Dr. Annello’s recommendation really paid off. They were the first two patients to receive the MILD procedure at St. Francis and afterwards said they felt almost instantaneous relief. The length of stay goal for patients having the MILD procedure is for them to be discharged the same day as the surgery. If the patient warrants a longer stay, they are transferred to a medical/surgical unit with an orthopedics sub-specialty. At St. Francis, the health care team works together with the patient and physician to achieve a level of comfort acceptable to the patient; monitors vital signs; and ensures that the patient can have a safe transition to home and resume their daily activities.
Minimally Invasive Lumbar Decompression In September 2010, the St. Francis Hospital operating room staff embarked on a new pain management procedure called Minimally Invasive Lumbar Decompression (MILD), with Patrick Annello, M.D., anesthesiologist and pain management physician. Dr. Annello facilitated a training session for the operating room staff which included a description of the patients who would be eligible for this procedure, the benefits, risk factors, alternatives, and the supplies and instrumentation required. Evelyn Capriotti, R.N., CNOR; Pia Yoon, R.N.; Virginia Fallon, R.N.; and Kathy Katz, R.N., CNOR, collaborated with Dr. Annello to implement this new procedure. 24 St. Francis Hospital, 2010 Nursing Annual Report
Left to right: Gina DiMonica, MS, R.N.; Cheryl Galgano, BSN, R.N.; and Mary Lou Solliday, MPH,
Left to right: Christina Rand, CCP; Julia Bebry, BSN, R.N.; Rosa Silverwaaser, PCA; Senaida Herrera, PCA;
R.N., CIC
Donna Battiste, BSN, R.N.; Teri Jordan, CCP; Melissa Fengler, BSN, RN-BC; Elise Aufiero, BSN, R.N.; Lauren Regan, BSN, R.N.; and Hannah Sarkis, PCA
St. Francis Nurses Rank among the Top 10 Percent in the Nation for Patient Care U.S. News & World Report has recognized St. Francis Hospital, The Heart Center as one of best hospitals in the nation for their exceptional nursing care. Among the prominent medical centers cited on the U.S. News “America’s Best Hospitals” website, St. Francis Hospital was ranked among the top ten percent for patient satisfaction. Based on the findings of a nationwide survey, St. Francis Hospital had one of the highest percentages of patients who said their nurses were “always” courteous, listened carefully and gave clear explanations. St. Francis Hospital was the only medical center in New York State to receive this prestigious recognition and 1 of only 17 hospitals in the United States to receive this esteemed ranking for nursing care. “Our nurses continually strive for excellence in patient care,” says Ann Cella, MA, MEd, R.N., NEA-BC, Senior VP, Patient Care Services/CNO. “Their level of commitment and professionalism is unsurpassed and the U.S. News ranking is a reflection of this fact.”
Preventing or mitigating potential harm is at the forefront of all patient care activities at St. Francis Hospital. Starting with a careful analysis of the systems in place, nurse leaders and staff identify potential pitfalls and work through solutions. A strong cohesive partnership at all levels is essential to develop sustainable strategies that support patient safety. A culture of safety encompasses the ability to hold ourselves accountable not only for the delivery of safe and quality patient care but to verbalize safety concerns and assist in finding solutions. The terms “culture,” “patient,” “safety,” and “nurse” are defined by Webster as follows: Culture is the shared attitudes, values, goals, and practices that characterize an institution or organization; patient is an individual undergoing medical care; safety is the condition of being safe from undergoing or causing harm; a nurse is someone who looks after a person or cares for the sick or infirm. At St. Francis Hospital, all of these definitions hold true but with the added emotion of passion, which is defined by Webster as a strong feeling of enthusiasm for something. Our passion for successful patient outcomes is fueled by our passion for a strong culture of patient safety. At St. Francis, establishing a culture of patient safety is facilitated through various venues. They include unit-based councils, performance improvement teams, committees, Executive Patient Safety Walkrounds, culture surveys, educational activities, and the implementation of programs such as Crew Resource Management that support the “delivery of safe, consistent
The Culture of Patient Safety at St. Francis Hospital
and superior quality of care through respectful teamwork.” Celebrating pa-
Entering into the profession of nursing begins with the strong desire to help
addressing patient safety concerns.
people. The emphasis on the delivery of safe, high quality patient care begins
tient safety further strengthens our patient safety culture. Annually, St. Francis recognizes Patient Safety Heroes for their contributions in identifying and Patient safety is ingrained in the passion of caring for our patients. Strong
early in nursing education and continues through orientation and training at
nursing participation in all patient safety-related activities is the cornerstone
the Hospital. Patients receive complex care for complicated illnesses and
of the quality outcomes we enjoy at St. Francis Hospital.
there is a deep sense of gratification and satisfaction in assisting patients and their families to recover from illness. Exemplary Professional Practice 25
“Interdisciplinary Care Coordination Rounds are customized for each patient in order to provide continuity of care as the patient transitions through their hospital stay while experiencing the best possible outcomes.” Lori Costello, BSN, R.N., CCM Care Manager
Interdisciplinary Care Coordination Rounds - 1 West
Angie Leung, BSN, R.N. and Jean Kittleberger, BS, PA
Interdisciplinary Care Coordination Rounds Interdisciplinary Care Coordination (ICC) Rounds provide a mechanism for the healthcare team to meet at regular intervals to discuss the patient’s medical, functional, nutritional, psychosocial and discharge planning needs. These rounds are conducted on each inpatient unit and led by the clinical nurses. In addition to the clinical nurse, participants include the Nurse Manager, Assistant Nurse Manager or Charge Nurse, the Clinical Nurse Specialist, Care Manager, Social Worker, Mid-Level Practitioner, and Unit-Based Pharmacist. Each patient’s plan of care is reviewed, followed by a discussion of the patient’s daily goal. ICC rounds are an important mechanism to identify and resolve barriers to safe and efficient movement of our patients through the continuum of care. These rounds facilitate interdisciplinary communication and coordination of all necessary patient services.
26 St. Francis Hospital, 2010 Nursing Annual Report
“Being a part of CoreValve is like looking through a window into the future of medicine. It’s exciting to imagine how advancements in cardiovascular procedures will improve the lives of cardiac patients in the not-so-distant future.” Brian Sayers, BSN, R.N. Clinical Nurse - Cath Lab
CoreValve Team (missing from photo: Daniel Lambruschi, AAS, R.N.)
New Knowledge and Innovations Medtronic CoreValve United States Pivotal Trial
was prepared for the first TAVI procedure, performed on February 2, 2011. The TAVI procedure requires the presence of a full cardiac catheterization and cardiac surgical team, prepared to perform TAVI or cardiac
St. Francis Hospital, the first of forty select U.S. investigational sites was
and/or vascular surgery. A selected team of registered nurses from the car-
approved for the Medtronic CoreValve U.S. Pivotal Research Trial in De-
diac catheterization lab, operating room and research department were ed-
cember 2010. The purpose of the CoreValve Trial is to evaluate the safety
ucated in the new and specific requirements to perform a TAVI procedure.
and effectiveness of the Medtronic CoreValve System in the treatment of
These nurses include: Brian Sayers, R.N.; Dawn Zioba, RN-BC;
symptomatic severe aortic stenosis in patients who are considered high risk
Suzanne Sonadod, R.N.; Peter Jennings, R.N.; Angela Bush, R.N.;
or extreme high risk for aortic valve surgery. This multicenter, random-
Linda Rivenberg, R.N., CNOR; Daniel Lambruschi, R.N.; Dolores
ized trial consists of two arms : those subjects determined as high risk for
Smoot, R.N., CNOR; Margaret Larigan, R.N., CNOR; Marcia Irving,
surgery are randomized to either conventional aortic valve surgery
R.N., CNOR; Judit Porter, R.N., CNOR; Lyn Santiago, R.N., CCRC;
(SAVR)or transcatheter aortic valve replacement (TAVI) using the
Jeannette McLaughlin, R.N., CCRP. and Eileen Hague, RN-BC.
Medtronic CoreValve System, while those patients deemed ineligible for aortic valve surgery are treated with TAVI.
Collaboration and cooperation among all team members is paramount to the success of the CoreValve protocol and particularly the TAVI proce-
Eligible subjects undergo a comprehensive screening process to include
dures. The staff in both procedure departments, as well as the entire re-
physician assessments by a cardiologist and cardiovascular surgeon, patient
search department, cardiac perfusion team, the cardiac imaging
and family education about the trial, detailed informed consent process,
department, biomedical staff, plant operations, and infection control de-
performance of screening evaluation tests and submission and approval by
partment have developed techniques, processes and systems to meet the
the Medtronic Screening Committee.
needs of each patient undergoing a TAVI procedure. After undergoing
The St. Francis Hospital Research and Nursing Departments provide
TAVI, each patient is recovered in the CT-ICU where their post-operative
key leadership, support and guidance to develop processes, education,
care is met by the skilled registered nurses, physicians and mid-level practi-
training and competency for all registered nurses and Mid-Level Practi-
tioners who are educated and competent in identifying any complications
tioners involved in caring for patients enrolled into the CoreValve Trial.
during the follow-up period. Once a patient is stable, they are transferred
Prior to the study initiation at St. Francis Hospital, team meetings and
to a medical surgical telemetry unit until discharge. After discharge, pa-
mock TAVI cases were held with physician, nursing, research and support
tients enrolled into the CoreValve Study, whether treated with TAVI or
personnel involved in the TAVI procedures. Under direction of nurse
SAVR are scheduled to be followed at regular intervals for five years after
managers Dana Shapiro, RN-BC, Cath Lab; Cheryl Bush, R.N., CV-OR,
study entry.
and Elizabeth Haag, R.N., CCRP., cardiac catheterization lab room # 6 New Knowledge and Innovations 27
Jacqueline Squicciarini, BSN, R.N., CCRN
Ellen Tramontano, BSN, R.N.
Left to right: Cynthia Freundlich, R.N.; Kathleen Anderson-Arnopp, MPA, R.N., CPHQ; and Maureen Gaus, MBA, R.N.
Cerebral Angiograms/Stroke Stroke and cerebral vascular diseases are leading causes of death in the
After celebrating their first anniversary as a designated Stroke Unit in Octo-
United States and are principal causes of major disabilities. As a designated
ber 2010, St. Francis Hospital’s Intermediate Care Unit (1 East) continues to
stroke center, St. Francis Hospital strives to be at the forefront of leading
be committed and dedicated to the care of stroke patients. All of the clinical
hospitals in the New York area and throughout the United States in stroke-
nurses on 1 East are certified in performing the National Institutes for
related care. The American Heart Association awarded the Hospital the
Health Stroke Scale (NIHSS), a measurable, reliable and valid tool utilized to
Gold Plus Award for Stroke Care in 2010.
assess the severity of a patient’s stroke.
Cerebral angiography provides precise anatomical imaging of the cerebral
Last year, the clinical nurses on 1 East began to use a multi-disciplinary
vasculature and its variations, with accurate identification of vascular territo-
rounding tool to achieve targeted timed goals. As a result, there was an in-
ries and their specific function. In October 2010, the St. Francis Hospital
crease in the overall performance and care of the stroke patient. This was re-
Catheterization Lab began performing comprehensive, outpatient/ inpatient
flected in our defect-free scores and composite scores in the “Get with the
cerebral angiograms. The goal for St. Francis Hospital is to treat both em-
Guidelines” and Coverdell Reports (CDC/COV).
bolic or thrombotic stroke patients, as well as hemorrhagic stroke patients
On October 29, 2010, 1 East participated in World Stroke Day. The
via percutaneous cerebral interventions. Treatment is planned for patients
theme for 2010 was “1 in 6.” A display containing information about strokes
who suffer from severe acute stroke symptoms caused by either blockage of a
was set up in the lobby of the DeMatteis Pavilion and blood pressure screen-
large cerebral artery or by bleeding aneurysms and arteriovenous malforma-
ings were available for the employees and the community. Stroke education
tions (AVMs) by using state-of-the-art microsurgical and endovascular tech-
DVDs and pamphlets were offered as well.
niques. For the acute embolic stroke patient, new technological advances
The 1 East staff is proud of the accomplishments they have achieved in the
have made it possible to mechanically remove the blockage in its entirety by
care of stroke patients at St. Francis and look forward to another challenging
placing a catheter system into the affected cerebral vessel while simultane-
and rewarding year.
ously using suction to remove the obstruction. This technology offers alternative treatment to a certain population of critically-ill patients who exhibit signs of severe acute stroke. It is essential to emphasize that stroke prevention begins with the treatment of vascular disease before neurological damage has occurred. St. Francis Hospital promotes community wellness with its Community Outreach Program and other services such as cardiac rehabilitation at the DeMatteis Center. However, if an acute stroke does occur, St. Francis remains dedicated to treatment that improves the quality of life. 28 St. Francis Hospital, 2010 Nursing Annual Report
EPIC Work Group
Research Commitee
Electronic Medical Record
keep their own medical history and medications electronically. Before Epic
In an effort to improve and better coordinate the quality of care, Catholic
the needs of its hospitals.
“goes live,” CHS will continue to customize the application in order to meet
Health Services (CHS) has made the commitment to implement a comprehensive electronic medical record (EMR) system. Epic is the vendor selected by a steering committee representing all CHS hospitals, and the system will be the first on Long Island to implement this particular EMR solution. Epic’s applications are structured to help organizations improve their clinical and administrative processes by providing efficient workflows for end users. When users log in, the application presets them with the targeted information that they need to complete daily tasks. Depending on the user’s role, the application leads him or her to clinical, registration, scheduling, billing information, and other functionalities, by logging in and logging out of multiple applications. The application, which includes information about
“Nursing Research Day is a true celebration of nursing's dedication to excellence in patient care through evidence based practice. St. Francis fosters an environment of innovation, inspiration, and integrity. Being part of the research process has guided me in my own personal pursuit of excellence in nursing. I feel very honored and grateful to have had the opportunity to conduct and present my Tempa-Dot research study.” Judith Morrison, BSN, RN-BC Clinical Nurse - ACU
the patient, links and documents the patient’s care from the physician’s office
Celebrating Research
to the hospital.
This past December, the 7th Annual Research Day was celebrated. Together,
St. Francis plans to “go live” in December of 2012 and will be the second
registered nursing leadership, clinical nurses, mid-level practitioners, faculty
CHS hospital to do so. The applications that will be installed are: CPOE,
and physicians celebrated the achievements of the St. Francis Hospital regis-
Clinical Documentation, Pharmacy, Radiology, HIM and the Emergency
tered nurses who engaged in significant research throughout the year. Our
Department.
“Celebration of Research” began with a heartfelt dedication to Nancy Kostel-
St. Francis Hospital registered nurses are currently involved with the proj-
Donlon, RN-BC, CEN, CPAN, CCRN, who was a driving force in estab-
ect as subject matter experts and are joining the other five facilities in the vali-
lishing a committee where new knowledge, innovations and the
dation and reengineering sessions with Epic staff. This includes
development of evidence based practice was created.
computerization of physician order entries (no more written physician or-
Nursing research provides a specialized scientific knowledge base that em-
ders); synopsis for clinical events which will allow the nurse to review orders,
powers the nursing profession to anticipate and meet constantly shifting
results, medications; IVs on a single view along with an electronic medica-
challenges and maintain our social relevance. As we began the celebration of
tion administration record; and convenient charting templates. Wherever the
nursing research, our registered nurses were able to learn about the integral
patient moves between units or between hospitals, the provider can have the
steps of the research process. Understanding the step-by-step process assisted
information at their fingertips. There is also the goal for the patient to have
the audience in developing the critiquing skills necessary to judge the sound-
access electronically to their health information online. This enables them to
ness of research studies.
New Knowledge and Innovations 29
“We have been using a new disposable drape in the operating room that wicks away moisture from the patient’s skin. By using this new product, the patients are kept moisture-free during the surgical procedure. Post-operatively, my patients have been free of any fluid accumulation, thereby decreasing the risk of skin damage.” Gail Taylor, BSN, R.N., CNOR Clinical Nurse - OR
Left to right: Chenel Trevellini, BSN, R.N., CWOCN; Gail Taylor, BSN, R.N., CNOR; Nathaniel Martin, BSN, R.N.; and Soon Yae Rhee, AAS, R.N.
Beth Cotter, Ph.D., RN-BC, and Elizabeth Haag, R.N., CCRP (co-chairs lating information about research. Beth presented a lecture on the impor-
Moisture Associated Skin Damage
tance of evidence based practice and research. Elizabeth discussed the
During St. Francis Hospital’s monthly skin prevalence study, patients are as-
of the Interdisciplinary Patient Care Research Committee), presented stimu-
Institutional Review Board process and the St. Francis Hospital research
sessed for pressure ulcers. Patients are also assessed for the presence of Mois-
structure. Kathleen O’Connell, Ph.D., FAAN, a nurse and research specialist
ture Associated Skin Damage (MASD), a category of skin damage
from Columbia University and a member of the Research Committee, gave
commonly misidentified as pressure damage. MASD is caused by skin expo-
an in-depth overview of different research designs. Finally, Simcha Pollack,
sure to moisture and associated skin irritants and it is critical to differentiate
Ph.D., St. Francis Hospital’s biostatistician, provided a lecture on statistical
between MASD and pressure damage, as the etiology drives the treatment
significance and the factors that determine optimal sample size.
interventions. MASD changes the tensile strength of the skin, making it
The celebration continued as St. Francis registered nurses presented overviews of their studies and their lessons learned in conducting research.
more susceptible to pressure ulcer development. In 2010, several product lines were introduced to decrease patient expo-
Jeannette McLaughlin, R.N., CCRP; Ruth Reed, R.N., CEN; Judith Morri-
sure to moisture. Rigorous nursing interventions addressing MASD and
son, RN-BC; and Erika Hassan, R.N., did a splendid job in walking the au-
pressure ulcer prevention are now implemented as part of the SKIN bundle
dience through the “Temp a Dot Journey.” William Peabody, R.N., CCRN,
once a patient is admitted to critical care or a medical/surgical telemetry set-
shared the “Sense of Belonging” study that focused on a sense of belonging
ting. Despite these interventions, in some cases, MASD eventually pro-
in the novice nurse. Mary Jane Galander, R.N., CCRN, and Roy Constan-
gresses to pressure ulcer development during the patient’s hospitalization.
tine, Ph.D., RPA-C, gave an example on the steps of “PICO” (developing a
Data collection has revealed a trend in post-surgical patients developing
research question) and the support that was provided by the Research Com-
higher incidences of MASD and pressure ulcers.
mittee through their current research process. Lastly, Tricia Krug, RN-BC,
Chenel Trevellini, R.N., CWOCN, and the clinical nurses continuously
gave a sneak peak of an exciting multi-site research project that St. Francis
stress the importance of identifying, treating, and preventing MASD. Ch-
will be participating in with the University of Maryland and the Johns Hop-
enel has provided instruction and translation of new knowledge for the staff
kins Hospital. This multi-site study will involve the clinical nurses on 2 East
to improve assessment skills, and the differentiation between MASD and
and congestive heart failure patients.
pressure ulcer damage. This education was geared towards the Hospital’s in-
The Research Day was a true celebration of what St. Francis registered nurses have accomplished. It was also a celebration of what is yet to come from our Evidence Based Practice Councils and the eager registered nurses
patient care settings, however, data showed a potential need for education and intervention in the operating room environment. Chenel, along with OR nurse educators Kathy Katz, R.N., CNOR, and
who want to be active participants in research. An important message con-
Karen Maul, R.N., CNOR, observed and evaluated the pre-operative skin
veyed throughout the day was that resources and support are available for
prep techniques, warming techniques/devices, support surfaces, and posi-
those who embark on the research journey. 30 St. Francis Hospital, 2010 Nursing Annual Report
Left to right: Erica Wilder, BSN, R.N.; Mimi Grossman, MS, R.N., CCRN; and Karen O’Brien,
Linda Stapleton, BSN, R.N. and Marvin Tenenbaum, M.D.
BSN, R.N., CCRN
tioning of patients during various surgical procedures. Brainstorming for ideas to reduce the operative patient’s exposure to moisture led the educators to trial a disposable OR sheet used to “wick” away moisture from the patient’s skin. The product was trialed in December 2010. Prior to the trial, Chenel provided nursing education on skin assessment and documentation to the OR registered nurses. The OR educators collaborated with St. Francis Hospital’s information technology department to modify the electronic
“At St. Francis Hospital preceptor selection and their educational development are seen as integral components to assure the success of the new nurses entering our organization. Learning and teaching critical thinking strategies rests with the preceptor’s ability to develop these skills in the novice nurse.” Beth Cotter Ph.D., RN-BC Nurse Educator
documentation system to include MASD assessment parameters and the type of drape used for surgical procedures. This was a real example of true
date class that focused on critical thinking strategies. The study evaluated the
collaboration.
effectiveness of a critical thinking program for experienced nurse preceptors. One hundred and twenty-one registered nurses participated in the study. The
Impact of Educational Strategies on Preceptor Development The core responsibility of a preceptor at St. Francis Hospital is to develop the reflective practice and critical thinking skills in the clincal nurse. It is important that healthcare organizations provide preceptor development programs to better prepare clinical nurses to educate new nurses entering the profession. Most preceptor educational programs incorporate the following content: adult learning principles, role development, principles on feedback, learning styles, communication skills, and conflict management. It is also recommended that the preceptors have the opportunity to enhance their own development. Consistent themes in the literature state that preceptors need more educational reinforcement as it relates to critical thinking and the evaluation
results of the study indicated that there was no statistically significant difference in critical thinking scores after attending an educational program. The results of this study will encourage educators to assist registered nurses in developing and implementing critical thinking skills. The results of this study increase awareness that the nursing staff (at all levels) is in need of critical thinking strategies and support to implement the strategies into practice. As a result of the study, curriculum revisions were made to all preceptor classes. With the support of nursing leadership, all preceptor classes will now place greater emphasis on critical thinking strategies such as brainstorming, concept mapping and reflection techniques. Critical thinking skills must be taught, supported and nurtured through all phases of the nurses’ profession. The changes made in the curriculum will provide our experienced nurses with the tools needed to enhance their own critical thinking skills and develop these skills in the novice nurse.
process. Enhancing professional development in contining education has always been supported by the leadership of St. Francis Hospital. Between March and July of 2010, a study was conducted to test whether or not critical thinking scores could be improved by attending a preceptor up-
New Knowledge and Innovations 31
“While St Francis Hospital enjoys a very high registered nurse retention rate and very low registered nurse turnover rate, this did not dissuade the Medical Surgical Evidenced Based Practice Council from pursuing research to understand the stresses and challenges faced by new graduate nurses in an effort to improve what is apparently already a successful orientation process.” Georgann Bronski, BSN, R.N. Clinical Nurse - 2 East
Left to right: Georgann Bronski, BSN, R.N. and Theresa Romano,
Left to right: Lisa Scarpino, BSN, R.N.; Beth Hauptman, BSN, R.N.; and Samantha
BSN, R.N.
Euler, BSN, R.N.
A Sense of Belonging and the Process of Socialization in the Novice Nurse New registered nurses experience the first months of clinical nursing in different ways. These initial experiences can be profound, some affecting their entire career. But when the novice nurse has a lack of socialization along with a diminished sense of belonging to the environment, unit or hospital, it can be very stressful. According to anecdotal information from the novice nurses at St. Francis Hospital, socialization and a sense of belonging are areas in need of development. Although the Hospital’s turnover rate for new graduates is low (2.0 in 2010) and considerably less than the benchmark of 10 percent to 30 percent reported by the Advisory Board, the Medical Surgical Evidenced Based Council decided to identify factors that would potentially guide and influence the development of changes to the existing orientation program and probationary period. An online survey was designed and given to new graduate medical surgical nurses with 6 to 18 months of experience. The survey analyzed which members of the health team had the greatest impact on the assimilation of the novice nurse into the St. Francis culture. Assisted by Simcha Pollack, Ph.D., the Hospital’s biostatistician, and Kathleen O’Connell, Ph.D., an external research consultant, the survey identified that the strongest influence on the socialization of and sense of belonging in the novice nurse is working side by side with experienced clinical nurses and assistant nurse managers.
Cardiovascular and Lifestyle Habit Survey The DeMatteis Center’s Evidence Based Practice (EBP) Council is comprised of registered nurses from the Women’s Center, the CAT Scan/MRI and Research Departments, as well as the Congestive Heart Failure Outpatient Program, Pain Management, the Diabetes Care Center, Community Health, and Cardiac and Pulmonary Rehabilitation. While all of our departments routinely provide health screenings and education about lifestyle modification, we realized that we were particularly passionate about the health of registered nurses. The DeMatteis Center EBP Council decided to conduct research on the health and risk profiles of registered nurses in various practice settings. The council found that registered nurses who practice cardiovascular risk reduction are perceived as more “believable” by patients and become better patient educators – an important goal for us. Problem Statement: Do nurses practice what we preach regarding cardiovascular risk reduction? Research Question: What is the cardiovascular risk profile of St. Francis Hospital nurses as compared to the Preventive Cardiovascular Nurses Association (PCNA) published study? Hypothesis Statement: This study will test the hypothesis that the nursing staff at St. Francis Hospital is aware of their own risk factors for cardiovascular disease and that their lifestyle practices for cardiovascular risk reduction are in accordance with the PCNA. Population: All registered nurses active on staff at St. Francis Hospital
32 St. Francis Hospital, 2010 Nursing Annual Report
“Nurses who incorporate health practices into their own lives are perceived as more ‘believable’ by patients and become better patient educators. And since registered nurses spend countless hours taking care of others, we decided to focus our efforts on the health of our nurses to learn more about taking care of ourselves, because we are worth it!” Suzanne Palo, MS, RN-BC Director Rehabilitative and Community Services
Back row left to right: Kathy McGrath, BS, R.N., CCRP; Fran Szaluta, MS, R.N.; and Joanne Kuplicki, MA, RN-BC. Front row left to right: Diane Lippman, BSN, R.N.; Sue Palo, MS, RN-BC; Marguerite Roth, BSN, R.N., CCRP; and Lynn Grimaldi, AAS, R.N., PCCN
(full time, part-time, per diem staff, and all specialty areas of practice).
at recommended physical activity levels (three or more exercise sessions per
Exclusion criteria: Any nurse not on active status. The study was for
week) increased from 36 percent to 44.17 percent. St. Francis registered
registered nurse staff only; other disciplines were not looked at for study
nurses also improved from a self-reported a decrease of no exercise partici-
purposes.
pation from 25.8 percent to 18 percent. This was proven to be statistically significant using the chi-square test analysis. The results were also mean-
Methodology: A survey of 34 questions was distributed to 1,004 St.
ingful since the exercise literature showed that the greatest health improve-
Francis registered nurses during a 30-day period. The survey was posted on
ments are made in getting the “no exercise” group (typically difficult to
the St. Francis intranet, on the web and distributed via hard copy. The self-
motivate) to engage in some form of physical activity.
reported survey focused on cardiovascular risk factors, lifestyle habits, medFuture Implications:
ications, work schedules and nursing experience.
• Continue to support employee wellness initiatives that promote increased Results: An outstanding 52 percent response rate was noted (as com-
participation in physical activity
pared to a 26 percent response rate from the PCNA group.) The results
• Investigate partnering with PCNA to consider a national study
revealed that St. Francis registered nurses were on par with the PCNA reference group regarding most risk factors. On a positive note, St. Francis had a greater percent of registered nurses with a desirable BMI of < 25 (56 percent St. Francis versus 49.2 percent PCNA group). An area noted for improvement was physical activity—St. Francis Hospital had fewer registered nurses who participated in the recommended physical activity levels, or fewer than three exercise sessions per week (36 percent St. Francis versus 56% PCNA). Also, St. Francis nurses self-reported a higher degree of no regular exercise (25.8 percent St. Francis versus 11.7 percent PCNA). We then conducted a second literature review and partnered with the Employee Wellness Committee to implement a six-week hospital-wide walking contest to promote increased awareness of physical activity. A pedometer was distributed to every employee for Employee Appreciation Day. After the walking program, registered nurses were re-surveyed on their physical activity. St. Francis Hospital registered nurses reported exercising
New Knowledge and Innovations 33
One Nurse, One Life, Many Legacies; A Tribute to Nancy Kostel-Donlon, R.N. (July 10, 1958 - September 17, 2010) inar which included an invitation to all CHS hospitals. The St. Francis Hospital senior nursing leadership team received many letters commending Nancy’s work and professionalism. One letter from the NY State Department of Health detailed the widespread influence Nancy had on improving stroke outcomes. Based on these outcomes, Nancy was elected as the Educational Chairperson for the Greater New York Metropolitan Stroke Coordinators Consortium. Through her work in the Emergency Department, Nancy encountered children of all ages accompanied by their worried guardians. Nancy knew how to quickly assess a child in distress, how to manage parents’ fear and collaborate with physicians to deliver the necessary care. Nancy was a trained Pediatric AdNancy Kostel-Donlon, MS, R.N., CEN, CCRN, CPAN, RN-BC
vanced Life Support instructor and as such willingly shared her expertise in the
Nancy Kostel-Donlon, MSN, CEN, CCRN, CPAN, RN-BC, an innovative
care of this most vulnerable population. She facilitated mock code scenarios on
nursing leader, was passionate about professional nursing practice and the people
a regular basis to ensure staff was prepared to act in an emergency. Nancy, in
she met along the way. Nancy’s nursing career began over 30 years ago at
collaboration with clinical pharmacy staff, developed an online emergency med-
Hunter College-Bellevue School of Nursing. When she entered the nursing
ication reference, an invaluable resource when seconds count. The youngest
profession she focused on the care of critically ill patients, practicing in the
patients at St. Francis hospital will benefit from Nancy’s innovative leadership
trauma unit of Mary Immaculate Hospital and Catholic Medical Center in
for years to come.
Brooklyn and Queens. In 1998, Nancy began to enrich professional nursing
Nancy’s impact on care delivery in the Emergency Department is evident in
practice at St. Francis Hospital. She brought not only a wealth of experience, but
her work to help decrease a patient’s wait time between arrival in the emergency
the ability to inspire and motivate others, and to question the status quo and
room and access to a hospital bed. As a member of the Emergency Department
seek new answers. Nancy’s accomplishments at St. Francis weave through many
Committee she facilitated a CHS safety initiative, Team Performance Plus and
facets of the organization; she made a difference on many levels but the com-
brought crew resource management to St. Francis. The First Impressions Pro-
mon thread was “what is best for the patient.” She consistently saw challenges
gram that she created included staff education for clinical nurses, physicians and
and opportunities, not problems and obstacles.
security personnel and led to improved patient satisfaction scores. This im-
As St. Francis Hospital prepared for Magnet designation in 2004, Nancy
provement was noted on a national level when the St. Francis Hospital Emer-
worked together with nursing leadership to nurture and expand nursing re-
gency and Outpatient Surgery Departments received the Summit Award for
search. She chaired the Nursing Research Committee and played a direct role in
Patient Satisfaction by HealthStream Research.
incorporating a Ph.D. nurse consultant from Teacher's College - Columbia Uni-
Nancy’s pride and dedication to nursing at St. Francis led her to present at
versity, who became a well-received coach and mentor to the staff. Today, nurs-
several national conferences including ANCC Magnet Conference, Emergency
ing research continues to grow at St. Francis, Nancy’s spirit of inquiry remains a
Nurses Association, and the American Heart Association. Nancy lived by the
strong motivational force.
adage, “do not hide your candle under a basket; rather let it shine as a beacon
In 2006, when the Hospital sought New York State Stroke Designation, the
for others.” Her colleagues recognized her spirit and her contributions with a
senior nursing leadership team knew the person who would be able to develop a
nomination as the St. Francis Hospital Nurse of Distinction Award in 2008,
quality stroke program and so Nancy was named the Stroke Coordinator. In
sponsored by the Nassau Suffolk Hospital Association.
this role she was instrumental in initiating the assessment of dysphagia on all pa-
Nancy’s influence was woven through other communities near and dear to
tients seen in triage and the development of a hospital-wide neurology RRT pro-
her heart. She was a woman of faith, very active in her parish and school, Holy
gram. Nancy was named Co-Chair of St. Francis Hospital Stroke Committee
Family in Hicksville New York. She was tireless in her advocacy for children
and through her work on this committee, she led the hospital to achieve the Sil-
with Autism. Her dearest community was her family, the center, the source of
ver Plus Award from the American Heart Association and helped St. Francis
her strength and commitment.
Hospital rank in Neurology and Neurosurgery in U.S. News and World Report. Nancy’s influence and expertise spread beyond the doors of St. Francis. She
People who touch so many lives and leave us too soon remain in the spirit of what they created. Nancy’s legacy is one of love and of service. A quote from
was an active member of the Catholic Health Services (CHS) Stroke Commit-
Mother Theresa seems to sum it up, “Intense love does not measure, it just
tee and presented educational sessions in collaboration with the other CHS
gives.” Nancy was and is a leader, and a role model for all who seek an example
stroke coordinators. Twice a year, she provided and coordinated the Stroke Sem-
of the practice of professional nursing.
34 St. Francis Hospital, 2010 Nursing Annual Report
“Some people come into our lives and quickly go. Others stay for awhile and leave footprints on our hearts, and we are never, ever the same.” –Author Unknown
St. Francis Hospital The Heart Center ® 100 Port Washington Boulevard Roslyn, New York 11576 Tel: (516) 562-6000 www.stfrancisheartcenter.com
The St. Francis Hospital 2010 Nursing Annual Report was produced by the Nursing Department in collaboration with the Office of Development and Public Affairs. We would like to thank everyone who contributed to the success of this publication.
The 2010 Nursing Annual Report is published by St. Francis Hospital, The Heart Center®. Questions or comments can be directed to St. Francis Hospital, Patient Care Services, 100 Port Washington Blvd., Roslyn, NY 11576 or (516)562-6060. Copyright © 2011. All Rights Reserved. St. Francis Hospital is a member of the Catholic Health Services of Long Island, the healthcare ministry of the Diocese of Rockville Centre. Editor and Project Coordinator: LaShieka Hunter • Designer: Roger Gorman, Reiner Design • Photographer: William Baker • Contributing Photographer: Steve Moors, Steve Moors Photography
36 St. Francis Hospital, 2010 Nursing Annual Report