Vol. 4 Issue 11
United in Care
The Nursing Department
West Jefferson Medical Center, Marrero, LA
Nurses work together at healthcare facilities all over the country. But not all nursing teams have accomplished so much in a single year, least of all coming together in such unity to provide quality patient care and emotional support to each other during one of the most challenging times of their lives: the 2005 hurricane season in southern Louisiana.
West Jefferson Medical Center (WJMC), Marrero, LA, is where you'll find ADVANCE's 2006 Best Nursing Team, many who suffered tremendous personal losses, yet continue to put the well-being of their patients first.
After the hurricanes, they reached out to their battered community by holding a "welcome home" health fair for residents, providing compassionate care by making it convenient for people to get important health and other information as quickly as possible.
With many lessons learned and experiences shared, the nursing team also has made improvements to its emergency preparedness plans to help provide a calm, controlled plan of care should another hurricane come ashore.
Home Is Where the Hospital Is
"There is nowhere in the world I would rather work than right here, in the same hospital where I was born," said Sharon Brock, RN, pre-admit educator and 24-year WJMC nurse.
Nurses are in great demand and welcomed by nearly every hospital in the country. So what makes WJMC the place to be? The other nurses, Brock told ADVANCE.
"I've developed so many close friends here and am in awe by the talents of the nurses at this hospital. Each is so unique in their own way, yet they complete me personally and professionally as colleagues. We help each other out in whatever ways we can, including changing shifts, working in other departments, whatever is needed; we're there for each other."
'The Real McCoy'
Many Gulf Coast area residents ADVANCE spoke with in the past year believed last year's hurricane warnings of gloom and doom were just that: warnings.
"We thought we were just going to be at the hospital overnight, and that would be that," explained Lisa Dufrene, RN, CMSRN, charge nurse, clinical manager. "When we realized this was the real deal, everyone banded together in a way I had never seen before. Because we were separated from our families during such an unpredictable and scary time, during those days we were all we had. And even though a lot of the nurses I work with lost everything, they put patients above themselves," Dufrene said.
When someone became overwhelmed with emotion, they were met with a heartfelt hug and words of encouragement, the nurses noted. Staff members roamed the halls in their "off" time, offering to help anyone who needed it by doing whatever was asked.
Providence is an interesting thing. Brock, who was on surgical leave when Katrina came through, said she felt awful about not being at "her" hospital. However, she was able to help in a different way by providing news updates to her co-workers, offer moral and emotional support, and make phone calls to co-workers' family members when asked.
So, while Hurricanes Katrina and Rita were indeed the "real McCoys," so are the nurses at WJMC, according to the ADVANCE judges of this year's award.
Between preparing for this year's hurricane season less than a month away, continuing to provide patient care and rebuilding their personal lives, the nurses were surprised and thrilled at the news of their achievement.
Called to the hospital's lobby under the pretense of honoring WJMC's volunteer staff, many nurses leapt with joy and shed tears of exhilaration when ADVANCE made the announcement and presented an award plaque and certificates to Theresa L. Anderson, MS, RN, FACHE, senior vice president and CNO.
"We were so humbled and excited when you told us we were chosen for such a big award," Brock said. "We are so proud to be recognized with such a high honor."
Well done, good and faithful nurses at West Jefferson Medical Center.
Mary Aucoin is regional editor at ADVANCE.
The Nursing Department
West Jefferson Medical Center, Marrero, LA
The nursing department of West Jefferson Medical Center (WJMC) is a model of teamwork in action. Never has this been more evident than with the recent experience of Hurricane Katrina. The nursing team had a very challenging year filled with individual and department accomplishments.
Our nursing department has been on the forefront of stroke management, acute MI, CHF and diabetes care. Response time from onset to treatment in both strokes and MIs has occurred, meeting the national standards. Recently, HealthGrades recognized WJMC for clinical quality and excellence in overall stroke care and outstanding outcomes in orthopedic services.
Nursing has been involved in community education of MIs, stroke recognition, diabetes, and children and infant safety. This past year, health fairs were held for adult general health, stroke prevention, and children and infant safety. In the weeks following Katrina, a community health fair was held to welcome back the community and serve as an information resource on healthcare to the people of the surrounding communities.
Members of our nursing team are involved with the emergency management of disasters and weapons of mass destruction (WMD) efforts in our community. One of our emergency nurses, Kerry Jennice, RN, serves on the governor's task force for WMDs. Their training and involvement with emergency management response aided our facility in meeting the challenges presented by Katrina.
Our nurses are involved in numerous community organizations such as Jefferson Parish Council for Battered Women, Mothers Against Drunk Driving and the breast cancer task force, to name a few. The nursing department has participated in national convention poster presentations. Gail Hay, RN, and Janice Taulli, RN, placed first for their poster presentation at the AACN NTI convention. Thirteen nurses in 2005 were recognized as Great 100 Nurses.
WJMC's nursing team was challenged to meet the needs of our community in 2005. Hurricane Katrina presented our team with unique challenges and situations. Our facility was one of three in the entire New Orleans area that remained opened throughout the storm and the following weeks.
Our nursing staff had the opportunity to work closely with a large DMAT unit located on our grounds. They worked with the DMAT unit, public health nurses and VA nurses from across the nation to meet the needs of the surrounding communities. Our nursing education department, unit clinical directors and emergency nursing staff provided a condensed orientation and welcome to the facility in the weeks following Katrina.
Our facility remains open and adapts daily to the needs of the communities. Our facility now accepts the major trauma of the area, as well as an increased number of patient visits due to the lack of healthcare facilities in the area. Nurses have worked extra shifts and hours to insure our patients receive quality care.
Communication, mutual respect, sharing of information and observations, delivery of quality patient care and, most of all, the human element of caring are the keys to the success of our nursing team. We excel in taking the lead and being innovative in our approach to challenges.
Leadership allows members of the nursing team to take an active role in decision-making and problem-solving. To improve teamwork, a boot camp for charge nurses was conducted this past year. This experience provided the foundation to improve and strengthen unit teams. Clinical nurse updates are held monthly for all nursing staff, providing communication, education and information. The updates keep the staff informed of hospital and nursing issues.
Our nursing staff has adjusted schedules, shifts and ratios to accommodate the needs of the community post-Katrina. The concept of "when working together more can be accomplished" was fully realized when our nursing staff and the DMAT unit devised methods of communication, work flow, triaging activities and sharing of staff during this critical time.
During Hurricane Katrina and the days immediately following, our nursing staff shared their fears, hard work, prayers, tears and the belief that together we will meet the challenges as individuals and as a team. Many of our nursing staff worked 12-hour shifts for 15 days straight to ensure our patients received quality care. Many of these days were without running water and on very limited electricity. In spite of their loss of homes, cars, property and being displaced from their families, the nursing staff remained on duty to care for our patients and community.
Our nursing department is creative in their recruitment and retention efforts. As a recruitment event, a CE cruise was planned and 200 nurses from our facility and the area attended. In addition, the nursing department provides the opportunity for free CEs. For 2005, more than 5,000 hours were awarded.
An established preceptor/mentoring program that involves classroom and unit-based activity is a plus for new nurses. A post-Katrina job fair was held for nurses and health professionals. Each nursing unit participated and had poster presentations on the "uniqueness of their area."
Post-Katrina local nursing schools that were damaged needed clinical opportunities and classrooms. Nursing made the arrangements to flex the schools on the units and provide classroom space, as well as provide some clinical class instruction by our staff.
The nursing department reimburses certification, ACLS, PALS and college hours. The growth and development of nurses is a goal of the department. A new clinical ladder was developed that incorporates the growth of the professional nurse as its base. Traveling in-services, as well as classroom and unit-based sessions, are conducted and planned by nursing education to impact the majority of nurses on new equipment, techniques and review of information.
The culture of this nursing department is one of teamwork. The team is motivated, creative and committed to delivering quality care. The WJMC nursing department is ready to meet the challenges of the present and the future, and is truly deserving of being recognized as the Best Nursing Team. Way to go WJMC nursing department!
Commitment to Clinical Knowledge
Coronary Care Unit
Michael E. DeBakery VA Medical Center, Houston
I would like to nominate the nurses of the coronary care unit (CCU) of the Michael E. DeBakey VA Medical Center (MEDVAMC) in Houston for the Best Nursing Team 2006. This team is recognized by the medical center as one of the most innovative and talented group of nurses in this healthcare organization. They are led by Loreta Tumangan, RN, nurse manager, who develops and encourages teamwork, critical thinking and quality patient care throughout her staff no matter what tour of duty.
The staff of this area thrives on challenges and led the way for many initiatives. They exemplify shared leadership. This governance model is embodied in every area of this unit. The staff has an equal voice in the decisions made and the positive changes for patient care.
The CCU has been recognized by the Veterans Health Administration (VHA) as one of the highest-performing teams throughout the VA system. This conclusion was based on an employee survey and interviews conducted by the Institute for Health Care Development on Working Environment Assessment. The CCU also has received the "Comet Award" from the Houston Gulf Coast Chapter of the American Association of Critical-Care Nurses (AACN) for implementing best practices for ICU patient care.
This team was the first to explore ways to increase the knowledge in care of patients' in restraints and, most of all, to develop strategies to decrease restraint use among ICU patients. They developed a restraint documentation form for use in the electronic medical record for initial assessment and reassessment of patients in restraints. They also initiated restraint competency questions for use in staff education.
This group was proactive in ensuring the National Patient Safety Goals were implemented. They make sure all clinical hemodynamic alarms are set to AACN guidelines and all are checked at change of shift report. A tool was developed to monitor the reporting of critical lab results that resulted in eliminating third-person reporting. This has improved awareness and compliance by the lab/nursing/medical staff.
The CCU nursing staff has received accolades from the recent JCAHO surveyor for their appropriateness and comprehensive assessment and reassessment of pain, documentation, and medication titration for pain and effectiveness of medications administered.
This area ranks among the highest in inpatient satisfaction among all units at the MEDVAMC. They greet everyone that enters their unit. Their kind and compassionate mannerisms embrace everyone who requires their services. The physician staff is continually complimenting the level of care provided and often seeks ways to have their patients moved to the CCU.
The staff are active members of medical center committees. They also support community efforts by participating at local health and career fairs, and the Houston Feed the Hungry/Homeless campaign.
During the recent disasters of Hurricanes Katrina and Rita, the CCU team led the way to assist the victims of the Louisiana area. When the VA patients arrived from New Orleans after Katrina, the CCU ensured beds were made available for the ICU patients and their care continued uncompromised.
With the pending Hurricane Rita, the CCU staff came to the hospital early and prepared to stay for the duration of the disaster. The patient care continued as preparations were being made for a potential disaster. Their support to their patients and the medical center were commendable. Their empathy and caring is exemplified in all that they do.
New Projects, Education
The CCU has supported the mission of the VHA by implementing new patient care initiatives to improve ICU care. They proactively initiated "ICU Bundles." These bundles have made positive changes in patient care to prevent ventilator-acquired pneumonia and strategies for central line insertion and care.
In an initiative to prevent hospital-acquired decubitus ulcers, the CCU actively participated in the "No Diaper Campaign" promoted by the medical care line. Their active skin care regimens have decreased the number of patients with hospital-acquired decubitus ulcers in the CCU.
The CCU and ED nurses noted a deficiency in staff education related to new patient care changes and treatment modalities. They joined together as a team and developed the KEEP (Knowledge-Enhancement Educational Project) program and now present quarterly in-services to the entire staff of the medical center, providing CEUs for their programs.
In addition, the CCU was the first ICU to obtain 100 percent ACLS certification of their staff. This has been the standard for the past 5 years. Staff members are also ACLS instructors and several function as competency validators for ICU and the general/telemetry units.
Recruitment & Recognition
Because of the reputation of the CCU, it is a sought-after area for staff nurses to learn and work. Since 1990, the turnover rate for this area is only 1 percent with the majority of turnovers coming from retirements and promotions to other positions. When a position becomes available, there is stiff competition and the CCU staff are the best recruiters for their work area and often solicit highly qualified staff themselves.
The MEDVAMC is only the second VA Medical Center to obtain Magnet recognition from the ANCC. In planning for the survey process, the CCU assisted nursing in educating colleagues on the standards and how our hospital met them. They also were Magnet cheerleaders, which was a marketing strategy to educate the entire facility on Magnet.
Creating a Culture of Satisfaction
ED, The Methodist Hospital, Houston
The Methodist Hospital ED is committed to the delivery of excellent care and customer service to our patients and their families. We are committed to creating a healthy work environment where employee and patient satisfaction is high, continual learning is emphasized, and a collegial and collaborative working relationship is a reality among physicians, nurses, technicians and support staff.
We are involved in research and process improvement and have developed and implemented the following initiatives/programs:
• Offering families the option to be present during codes or invasive procedures
• Nurse-initiated protocols: pain, nausea/vomiting, community-acquired pneumonia
• Participation in stroke center and chest pain center certification
• Process improvement project investigating incidences and causes of hemolyzed blood specimens in ED
• Participate in LUNA III (Learning and Using New Approaches to Research), the Emergency Nurses Association's third national multisite study
A multidisciplinary team meets monthly to review survey results and develop further initiatives to improve satisfaction scores. Staff is rewarded/recognized on an individual and team basis for providing excellent customer service. As a result, our ED is in the 98th percentile in the UHC peer group.
This September, the ED received 160 elderly Katrina evacuees in a 6-hour period from a nursing home in New Orleans. Nurses prepared our facility for the arrival and care of the patients. Individuals continued to arrive at our ED as result of the evacuation of the Gulf Coast during Hurricane Rita.
Teamwork and commitment were palpable as we embraced the increasing need for emergent medical care for evacuees from two hurricanes within a 3-week period. ED volume was excessive, but patient satisfaction remained consistently high.
Management and nurses partner to develop strategies to meet budget. A new nurse graduate residency program and a unit-based flex team are examples of strategies. As a result, outside nursing agency use was eliminated. Nurses suggested changes in staffing levels and patterns resulting in cost savings. As a result, the ED has met budget and added additional staff, leading to increased patient and staff satisfaction.
Eight nurses have achieved emergency nurses certification and all nurses are ACLS-certified. Staff members attend yearly classes on nonviolent crisis intervention. Nurses teach CPR and ACLS, present posters at hospital and community learning fairs, teach and lecture, and participate in unit-based and housewide competency fairs. Nurses are preceptors for new nurses and student nurses. A nurse/physician team presented "The Option of Family Presence at Codes" at the hospital nursing grand rounds that challenged other units to consider this option.
A nurse educator position was formally implemented. It is dedicated to the educational, learning and research needs of the ED staff. Our educator produced a training video for disaster management and was awarded the hospital 2005 Nurse Innovation Award.
We have a "Team Player of the Month Program" that encourages staff members to recognize the efforts of one another on a daily basis. The recognition cards are tabulated monthly and the winner is recognized and rewarded.
Our nurses care about one another. When one nurse's family member was hospitalized, her co-workers volunteered to cover her shifts. Nurses consistently offer help without being asked. When a critical patient arrives, the staff works together to stabilize the patient. The hospital's annual employee satisfaction survey reflected that 95 percent of the ED nurses felt teamwork is strong in our unit.
The ED Nursing Excellence Council, a multidisciplinary, unit-based governance council meets monthly to make decisions regarding practice, staffing, recruitment/ retention, equipment needs and other issues impacting the ED.
The working relationship between nurses and physicians is positive and collegial. We partner with our physicians to provide efficient, friendly, quality care to our patients.
To enhance relationships with staff on other nursing units, the ED initiated an ambassador program. Nurses distributed candy to nursing units to express appreciation for their cooperation in facilitating patient admissions.
Recruitment & Retention
Our ED has a low turnover rate and all nursing positions are filled. Nurses who left the ED for other employment opportunities have returned in either a full- or part-time status. Staff routinely interview applicants and make recommendations regarding hiring. New employees are assigned to a preceptor. The ED has a strong student nurse program through affiliation with several major universities.
Nurses are encouraged to pursue higher educational degrees, and we embrace flexible scheduling to meet educational and personal needs.
Rewards and recognition programs are a significant part of maintaining employee satisfaction. One example is our celebration of Emergency Nurses Day. This year, our celebration included providing polo shirts for all staff, meals for all shifts, raffles for scrub sets and gift cards provided by ED physicians.
Transport Services, Children's Medical Center of Dallas
With 13 nurses, two aircraft and four ambulances, we transport the sickest of patients, 7 days a week, 24 hours a day. We lead and ensure the safe international and national transport of critically ill neonatal and pediatric patients. We transport more than 300 patients a month and over 3,500 per year. We are one of the busiest transport teams in the nation. We are the Children's Medical Center of Dallas Transport Services.
The TEAM Approach
Although we work very cohesively together as a team of nurses, we actually work in a multidisciplinary, multi-vehicular department with registered respiratory therapists, paramedics and emergency medical technicians. Within our hospital and at referral hospitals, we continue to work as multidisciplinary teams. Our concept of teamwork is Together Everyone Achieves More. The work of the team in aggregate affects the safety of a program, direct patient care and patient care outcomes.
All our nurses serve as council chairs, and many are shared governance council members (comprised of council chairs) who are innately involved with the day-to-day processes of the department. Topics are shared through this committee, assessed and decisions made based on combined input from all areas. They are involved in hospitalwide councils and are industry representatives for neonatal, pediatric (Air Surface and Ground Transports), safety (Air Medical Safety Advisory Council) and air transport initiatives (National Association of Air Medical Services).
They participate directly in the regulatory aspects of transport services and actively ensured we obtained the gold-standard, first certification in the U.S. by the Commission on Accreditation of Medical Transport Systems (CAMTS) in rotor-wing, fixed-wing and ground transport services. They participate in the North Central Texas Trauma Regional Advisory Council and the Governor's EMS and Trauma Advisory Councils to improve the pediatric care standards provided by the state, improve the air medical standards required by the state, and participate in detailed projects such as creating an air disaster response plan for the state of Texas.
Answering the Call at Any Hour
Transport is an ever-changing environment. One example of adaptability this past year is our involvement with Hurricanes Katrina and Rita. We transported multiple patients from the New Orleans area. We were a part of the triage team receiving families and patients on planes from New Orleans. We staffed the Dallas Convention Center to create a link for all pediatric patients to be able to be seen at a children's hospital. We also dispatched our helicopter and fixed-wing aircrafts to the evacuation request of Driscoll Children's Hospital to move all patients when they were in fear of the Hurricane. We transported patients from Texas Children's Hospital and assisted in transporting offloads of the large C-130 aircraft. Along with four other premier transport programs, we transported more than 127 patients on 13 different aircraft in a matter of 32 hours.
It is imperative as flight crew that we work together and that we do so with respect, communication and what is always in the best interest of patient care.
Monthly, we lecture at referral hospitals to improve the care given to neonatal and pediatric patients, as well as the comfort level of the professionals providing it. We host a national conference for neonatal and pediatric transport care. We provide pediatric rotations to students in nursing and paramedic schools where we teach and mentor. We also provide pediatric rotations to other adult flight services. We attend high school career days to encourage the nursing pathway for teenagers entering college.
Taking the Initiative
Our nurses take the initiative to participate in creative scheduling. We modify team staffing dependent on the historical service. This may allow more vacation to be given and still maintain appropriate staffing levels.
The orientation process in our department is 3-6 months, depending on the needs of the new nurse. A thorough orientation process derived by the nurses is put into place and monitored closely for the needs of that individual.
Nurses participate with recruitment for the service when at national air medical conferences. These nurses participate in the retention of other nurses within our department by creating a work environment that is challenging, autonomous, creative and that desires participation in the industry, which in itself is intricate and interesting.
Strong Clinical Base
Our transport nurses have a strong clinical knowledge base that encompasses emergency, neonatal and pediatric intensive care. They also must learn about the emergency response system; ambulance, rotor-wing and fixed-wing vehicles; high-risk, low-volume technical skill competencies; and assimilating all this information together to provide the safest, best clinical environment possible. When not transporting, we also provide assistance to the hospital with critically ill patients, traumas, emergency care, and the pediatric floors as well.
It is with great pride I submit this application.
Innovation in Practice
Clinical Coordinators/Nursing Supervisors, Dallas VA Medical Center
Professional nursing supports the mission of the VA healthcare system by providing state-of-the-art, cost-effective nursing care to patients and families as they respond to health and illness. VA nursing service integrates a wide array of services encompassing patient care, clinical practice, education, research and administration.
In addition to med/surg and psychiatric units, VA nurses work in intensive care, spinal cord injury, geriatrics, dialysis, blind rehabilitation and organ transplant units. VA nurses provide a continuum of care across primary, ambulatory, acute, geriatrics and extended-care settings.
Our team consists of six hardworking, compassionate and professional registered nurses whose duties and mission are to facilitate the nursing process, resolve patient care issues, communicate with other members of the healthcare team, identify nursing staff needs and enforce best nursing practices.
Nursing supervisors make rounds and visit patients and staff during their shifts. Nursing supervisors act as a resource for all nursing staff; whether the question is about the nursing practice or an ethical issue, supervisors are called and put to the test in a daily basis. For 2005, the nursing supervisors took part in the following processes:
• JCAHO-preparedness Successful survey, 2005, educated nursing staff about the 2005 National Patient Safety Goals and quizzed the staff during rounds.
• Patient satisfaction survey nursing supervisors and the medical administration services collected
data for 2004-2005 and presented a report to the director pointing out the areas needing improvement. As a result, several changes were made in the patient care areas.
• Clinical support For 2005, barcode medication administration system was implemented hospitalwide. Each nursing supervisor received the training as a super user and the task was given to the team to train all nursing personnel within 1 month. The task was successfully accomplished within 20 days and the hospital went through a smooth transition.
During 2005, the nursing supervisors initiated the following programs:
• Handwashing program Handwashing study was completed prior to the implementation of the program and again after the implementation. Data revealed a 40 percent improvement.
• Pain management program A computer template was created for nurses to document the effectiveness of the administration of the prn pain medication. This program was patient-focused and results were outstanding. Thirty percent of nurses contacted the physicians for the dose adjustment.
• Community service Nursing supervisors were responsible for stations at the Community Health Fair 2005. People received free blood sugar tests, blood pressure checks, cholesterol checks, breast exams, flu shots and immunizations. In response to Hurricane Katrina and Hurricane Rita, Furqan Khan, BS, RN, went to the affected areas as a nursing coordinator for the VA nursing team 280 VA nurses volunteered.
Adaptability & Teamwork
The nursing supervisors team works very close to each other and with the management team (i.e., nurse managers, associate chief nurses and the chief nurse). They act as a bridge between the upper management and the direct care staff. Appropriate staffing related to the patient census and authorization of overtime also is a daily routine of the team. The team makes appropriate decisions to keep overtime at the minimum and provides appropriate staffing for each nursing unit.
One of the most important parts of the nursing supervisor's job is to train the nurses and be able to troubleshoot any problem related to medical equipment, computer operation and other issues. All six members of our team came from different backgrounds and everyone brings their experience to the team. As a supervisor, every day is a different day, different issues, different nursing staff, different patients. Being a nurse is great, but being a supervisor is much more.
To ensure there was no conflict of interest between a judge and a team entry, ADVANCE for Nurses asked nurses from outside the region to judge the 2006 Best Nursing Team contest. Notable nurses from Illinois judged this year's entries.
They scored the contest based on categories including initiative, adaptability, teamwork, recruitment and retention, and knowledge. Subsections in each category could receive 1-5 points with 70 points as the maximum possible score.
The judges for the 2006 Best Nursing Team contest were:
The Maternal Child Services nursing team at Little Company of Mary Hospital and Healthcare Centers, Evergreen Park, IL, ADVANCE's 2005 Best Nursing Team.
Members of last year's winning team in Illinois brought knowledge and expertise in teamwork to their review of the 2006 nomination essays.
Karen Barnes, MSN, RN, is the director of clinical education patient care services at Evanston Northwestern Healthcare in Illinois. She previously served as director of recruitment and retention for Evanston. Before working in nurse recruitment, Barnes had 18 years of experience in nursing administration in academic medical centers and community settings in the Chicago area. She also has several years of experience in leadership development and nursing education. She was director of education for the American Organization of Nurse Executives during the mid-1980s. Her clinical nursing experience is in critical care, med/surg and women's health.
Cynthia Leslie-Shippy, MSN, RN,BC, APN, is clinical coordinator at Provena Mercy Center, Aurora, IL. She has more than 20 years of experience in cardiac and psychiatric nursing. Her previous positions include director of nursing, program nurse administrator, clinical nurse specialist in adult psychiatry, clinical nurse manager of inpatient psychiatry and nursing instructor. Leslie-Shippy has published articles for healthcare magazines and serves as a member of the American Organization of Nurse Executives.