Best in Training & Education
Bayfront Medical Center, St. Petersburg
Nominated by Marcy Phipps, RN, CCRN
Jane Doe was a victim of a motor vehicle accident in which she'd sustained critical, life threatening injuries. When she was transferred from the emergency room to the intensive care unit Bayfront Medical Center's level II trauma center, the only bed available was assigned to the newest nurse on the unit - and that could have been devastating for Jane Doe.
The high-acuity nursing unit provides care for the sickest patients in the hospital, and lack of clinical experience has the potential to be a stumbling block when rapid intervention is imperative. The nurses in Bayfront Medical Center's trauma ICU pulled together in such moments, demonstrating a teamwork approach that guarantees the very best care to patients like Jane Doe - whether the nurse assigned to their care has 1 year of experience or 30.
In the situation described above, seasoned critical care nurses stationed nearby stood ready to assist the new nurse during the patient's admission to the unit. Critical assessments were carried out while stat orders were implemented. The novice nurse was an integral part of a fast-acting, experienced nursing team.
Newly hired nurses are a valuable part of the nursing team. New graduates from top schools around the country are routinely recruited into Bayfront's critical care internship, which incorporates access to the AACN Essentials of Critical Care orientation program and provides intensive training with experienced preceptors.
Mentorship helps promote a team approach to nursing and provides new nurses with a strong support network. Whether in need of clinical advice or words of encouragement, novice nurses are provided with a foundation of support from the nursing team.
Bayfront Medical Center's trauma ICU manager and clinical nurse educator have been part of the ICU team for a combined 51 years. Charge nurses and nursing leaders have been part of the team for up to 33 years, and 34 percent of the nursing team has been together for more than 5 years.
Despite a competitive employment market, retention of this cohesive and elite nursing team has not proved difficult. Staff take great pride in their work and enjoy the daily challenge of high-acuity patient care.
Best in Adaptability
Lakeland Regional Medical Center
Nominated by Jackie Yon, MSN, RN, CCRN, CCNS
When Lakeland Regional Medical Center's medical cardiology unit was selected to be pilot a new practice model, adapting to change became a constant. A clinical resource nurse (CRN) would lead staff in efforts to implement best and evidence-based practice. These bedside leaders also would collaborate with all disciplines that intersect with patient care needs.
Two CRN's cover weekday, 8-hour shifts, to address any discharge or clinical issues, and a third CRN works 12-hours shifts on weekends. In addition, team leaders on the night shift serve as clinical experts.
Shift huddles relay communicate critical information regarding the unit, and hourly rounding has helped improve patient outcomes and satisfaction. Walking rounds at shift change for RN-to-RN handoff have become a part of daily practice.
MD-RN rounds help ensure efficient communication about patient information and discharge plans, and the cardiology clinical nurse specialist leads weekly multidisciplinary rounds.
Recently, Lakeland Regional's medical cardiology unit added "lightning rounds" - a daily practice involving the social worker, manager, RN and clinical resource nurse - to facilitate patient discharge.
Most recently, several of RNs formed a unit based shared governance council that has found ways to improve care of heart failure patients.
Additionally, 42 percent of eligible staff are certified in their area of specialty, and 26 percent of RNs on the unit have BSN degrees. Another 25 percent are either enrolled in RN-to-BSN and master's degree programs.
The medical cardiology unit's efforts have resulted in impressive numbers - including an RN turnover of 2.13 percent in the past year. Additionally, patient falls are below hospital standard and there were no cases of hospital-acquired pressure ulcers during the last two PI surveys. Between 35 percent and 40 percent of patients are discharged daily - compared to 20 percent 2 years ago.
Many of these changes occurred because the staff were ask to identify roadblocks to care, then push back on processes that interfered with their ability to provide that care.
Moreover, because of CRNs' and team leaders' expertise and clinical skills, the medical cardiology staff launched changes at a faster pace than other units.
The majority the above changes are now part of the hospital's housewide 2009 Nursing Strategic Initiative.