2012 Nursing Annual Report

2012 NURSING ANNUAL REPORT

Celebrating Our Heritage

Celebrating Our Heritage 2 0 1 2 N U R S I N G A N N U A L R E P O R T S A I N T F R A N C I S M E D I C A L C E N T E R2

This year we celebrated our rich history and 125th anniversary of Saint Francis Medical Center serving our communities in central Nebraska. In their wisdom more than 125 years ago, the Sisters of Saint Francis believed that as the state was moving west with the railroad, Central Nebraska needed health care. The Sisters, partnering in the com-munity, developed our medical care to meet the patient and community needs. Our rich history in nursing at Saint Francis parallels the development and growth of Saint Francis programs and specialties.

In our first annual report we wish to celebrate our successes and honor our nurses as they continue to live the mission of the sisters nurturing the healing ministry of the Church by bringing it new life, energy and viability in the 21st Century. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities. In living the mission, our nurses demonstrate the core values of reverence, integrity, compassion and excellence in our quest for clinical excellence in utilizing evidence-based practice, critical thinking and evidence-based leadership. Our first annual report also recognizes the nurses in their accomplishments and leadership.

In our journey for clinical excellence and the American Nurses Credentialing Center’s Magnet recognition, we completed our first Magnet Readiness Assessment this year to verify our readiness, dates for application, and document submission. The findings confirm that we rate extremely well compared to other medical centers and our goal to be recognized for excellence is obtainable. I am very proud of the teams, individual nurses and our clinical outcomes as we continue to advance in our journey to excel-lence in patient care and Magnet status. Thank you for all that you do!

Sincerely,

Francine Sparby, RN, MSVice President for Patient Care Services

Celebrating Saint Francis’s heritage and history!

Culture of Service ExcellenceSaint Francis Medical Center is committed to creating a culture of service and operational excellence. As a member of the Catholic Health Initiatives ministries in Nebraska, we strive to achieve excellence focused on the pillars of People, Quality, Stewardship and Growth. These pillars are the core strategies of the Catholic Health Initiatives strate-gic plan and serve as our focus as we live out our mission of nurturing the healing ministry of the Church in order to create healthier communities.

People Quality Stewardship Growth

S A I N T F R A N C I S M E D I C A L C E N T E R 3

About Saint Francis

Since 1887, the employees and physicians of Saint Francis have carried out our mission of building a healthier community by providing increasingly sophisticated healthcare to all central Nebraskans. Our goal is to provide the medical care our patients need close to home, where they can be supported by family, friends and community. We have grown from a community hospital to a regional referral center with some 100 physicians and more than 1,100 employees.

MissionThe mission of Saint Francis Medical Center and Catholic Health Initiatives is to nurture the healing ministry of the Church by bringing it new life, energy and viability in the 21st Century. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities.

VisionGuided by Catholic heritage of healing ministry, in part-nership with the community and our healthcare providers, Saint Francis Medical Center creates wellness, cures ill-ness and provided comfort and compassion utilizing best practices in medicine.

ValuesSaint Francis Medical Center’s core values define our organization and serve as our guiding principles. They are the roots or anchors from which all activities, decisions and behaviors follow.

REVERENCE: Profound respect and awe for all creation, the foundation that shapes spirituality, our relationships with others and our journey to God.

INTEGRITY: Moral wholeness, soundness, fidelity, trust, truthfulness in all we do.

COMPASSION: Our capacity to share another’s joy and sorrow.

EXCELLENCE: Preeminent performance, becoming the benchmark, putting forth our personal and professional best.

S A I N T F R A N C I S M E D I C A L C E N T E RCelebrating Our Heritage 2 0 1 2 N U R S I N G A N N U A L R E P O R T4

The Magnet Recognition Program® recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice. Consumers rely on Magnet designation as the ultimate cre-dential for high quality nursing. Developed by the American Nurses Credentialing Center (ANCC), Magnet is the leading source of suc-cessful nursing practices and strategies world-wide. Saint Francis Medical Center is in the early phases of the Magnet® journey.

Global Issues in Nursing & Health CareStructural

Empowerment

TransformationalLeadership

ExemplaryProfessional

Practice

New Knowledge,Innovations &Improvements

EmpiricalOutcomes

The Magnet® ModelThe five Components of the Magnet® model are:

· Transformational Leadership

· Structural Empowerment

· Exemplary Professional Practice

· New Knowledge, Innovation and Improvements

· Empirical Outcomes

Magnet Vision


Visibility, Accessibility and Communication of CNO· Francine Sparby meets new employees at orientation and presents the nursing scope of practice at Saint Francis Medical Center.

· As the Chief Nursing Officer,

Francine leads daily huddles for SafetyFirst

· Francine publishes articles monthly in the

Nursing Bolus newsletter, giving nursing updates.

· Francine does leader rounding to floors.

Dates published in the Nursing Bolus.

Transformational Leadership

Strategic PlanningThe Nursing Strategic Plan of Saint Francis Medical Center is under development and aligns with the Strategic Plan of Catholic Health Initiatives and the Mission, Vision and Philosophy of Nursing and CHI Nebraska CNO Council.

Advocacy and Influence of CNOFrancine Sparby is a representative of CHI National Clinical Leadership Council, CHI National Nurse Executive Council, Nebraska Stroke Council, Patient Service Administrative Council, RN practice Coun-cil, Nursing Peer Review, Patient Family Advisory Council and American Organization of Nursing Executives. New Programs· Differentiated Practice Model

· Safety First

Transformational leaders have a clear vision for the organization. They inspire others to change expectations, perceptions and motivations to meet the needs of the future. They are passionate, influential and garner trust and respect. They challenge others to a higher level of performance through creativity and innovation.

Excellence Every Day

Structural Empowerment

Professional EngagementNurses participate in planning and decision-making processes at Saint Francis Medical Center through professional practice coun-cils and committee memberships.

The Professional Practice Councils:

· Patient Service Administrative Council

· RN Practice Council

· Quality Improvement Council

Structures and processes developed by an influential leader create an environment that fosters innovation and promotes positive outcomes. Staff in empowered to succeed through strong relationships and collabora-tive partnerships with community organizations.

COMMITMENT TO PROFESSIONAL DEVELOPMENTDifferentiated Practice Program/Advancements The differentiated practice program was launched in December 2011 with the first portfolio review being held in January 2012. Empowering nurses to advance in professionalism, leadership and to bring evidence-based practice to the bedside was the driving force behind this program. Portfolio building sessions were held in December 2011 to educate nurses on the components of the differentiated practice portfolio. The advancements for fiscal year 2012 are as follows:

UNIT NAME PROJECT

WC Billi Jo Tomasek, RN4 Mepilex Border Sacrum for Prevention of Pressure Ulcer FormationIRU Sharlene LaBrie, LPN-C2 DVT preventionER Rita Gallagher, RN3 EMS EducationMC Beth Deida, RN4 New procedure on newborn baths4th floor Hays, Emily, RN4 Acute Coronary Syndrome Order Set5th floor Cindi Deveney, RN4 Incorporating Lovenox VTE Prophylaxis for Improved Surgical Care and SCIPER Brenda Dankert, RN4 Disaster Preparedness and Self DecontaminationSkilled Sherry Berney, LPN-C2 Lives remembered: Telling stories of older people7th floor Tara Schelkopf, RN3 Improving Standardization of VTE Prophylaxis Regimens per EBPMC Denise Stinson, RN3 Changing method of oxygen delivery during intrauterine resuscitationOncology Darla Cleveland, RN4 Simulation of Adverse Drug reactions to chemotherapyMC Alice Quick, RN4 Changing method of oxygen delivery during intrauterine resuscitation7th floor Emily Christensen, RN2 Importance of Pressure Ulcer PreventionSSS Meagan Dubas, RN4 Standardization CHG wipes process and Patient EducationPACU Kimberley Lecce, RN3 Evaluation of tympanic temperatures PACUMC Linda Ulmer, LPN2 The Paradox of Breastfeeding-Associated Morbidity among late preterm infantsPACU Amy Djernes, RN3 Post op dismissal order/policyMC Dawn Splattstoesser, RN3 Standardization of orientation process in NICU


Emerging Leaders The Emerging Leaders program was launched in September 2011 through the ministries of Catholic Health Initiatives in Nebraska. The sessions covered during this program were: An over-view of CHI Nebraska, types of leadership, leadership skills, leadership and spirituality, strategic planning, managing change, a culture of service excellence, human resources nuts and bolts, healthcare finance/budget basics and quality.

The nursing staff from Saint Francis Medical Center who graduated from the Emerging Leader program are:

Kaycee Anderson, RNMarilyn Arnold, RNHeather Benzel, BSN, CCRPJamie Busch, RNSheena DeBoer, RNMelanie Frear, RNC-NICChad Gallagher, BSNLena Keen, RNKiley Grzywa, RNLauren Murphey, BSNToni Nielsen, RN, CCRNAdriane Ogden, BSNTina Stringham, BSNAmelia Swanson, BSNRebecca Svoboda, RNMaxine Vieth, MSNShawna Young, RN

Lean Six Sigma Lean Six Sigma is a business management strat-egy that is used among many sectors of industry. Lean Six Sigma seeks to improve the quality of process outputs by identifying and removing the potential causes of errors and minimizing vari-ability in processes. It uses a set of quality man-agement methods, including statistical methods, and creates an infrastructure of people with in the organization (black belts, green belts, yel-low belts). Each Lean Six Sigma project carried out within an organization follows a defined sequence of steps and has quantified financial targets (cost reduction and/or profit increase). Many nurses from different areas participated in Lean Six Sigma in Fiscal Year 2012.


TEACHING AND ROLE DEVELOPMENTAssociate Diploma Nursing Program· Saint Francis Medical Center partners with Central Community College (CCC) to offer an Associate Degree nursing program in Grand Island, Nebraska

· Saint Francis Medical Center has also partnered with CCC in a three year federally funded grant to establish a state-of-the-art simulation center that has been used to provide staff training and competency.

· The Simulation Lab had a total of 252 registered nurses from Saint Francis who completed competencies in Fiscal Year 2012

· The Simulation Lab had 718 visits with 545 being from registered nurses, 12 from licenced practical nurses and 65 from patient care assistants.

· Several members of Saint Francis nursing management team are members of the Central Community College Advisory Board.

Nebraska Nurses Association CE Provider· Saint Francis Medical Center is a Nebraska Nurses Association Provider for Continuing Nursing Education.

· In 2012, 75.15 continuing education hours were provided by Saint Francis to 600 participants. Of those, 397 participants were Saint Francis employees with 333 Saint Francis nursing staff.

·In 2012, 48 continuing education hours were offered via telehealth, webinar or onsite where Saint Francis was not the main provider of the education, but credits were still offered. A total of 171 Saint Francis employee participated with 145 of those employees being nursing staff.

TEACHING AND ROLE DEVELOPMENT

New Roles/New PositionsBeth Bartlett, MSN, RN, Director of Quality and Risk Management

Aimee Burch, APRN-CNS, Clinical Nurse Specialist for Medical Surgical Services

Candice Kennedy, MSN, RN, RNC-OB,Employee Education Facilitator

Sandra Krolikowski, BSN, RN, Director of Patient Care Services

Jennifer Meister, RN, Clinical Manager of Medical Surgical/Orthopedics

Anne Obermiller, MS, BSN, RNC-OB, C-EFM, Professional Practice and Magnet Specialist

Deb Wilson, MSN, RN, Nursing Quality Specialist

Educational Advancement Hilary Anderson, BSN, RNBeth Bartlett, MSN, RNKatie Bangert, BSN, RNSusan Briseno, BSN, RNAndrew Clark, BSN, RNMeagan Dubas, BSN, RNElizabeth Egging, BSN, RNStephanie Halpine, RN

Kelsey Henkel, BSN, RNJennifer Favinger, RNRita Foster, RNCandice Kennedy, MSN, RN, Erica Kuhn, RNAmy Leaming, BSN, RN RNC-OBJessica Kirby, BSN, RNJessica Lothrop, BSN, RN

Samantha Leu, RNMelissa Meyer, BSN, RNChad Paisley, RNMelissa Miller, RNTraci Penner, BSN, RNJacob Trierweiler, BSN, RNSarah Reher, RNEsther Semakula, BSN, RN

Sara Sindt, BSN, RNAshley Schultz, BSN, RNKatie Zacharias, BSN, RNStacy Paitz, RNSarah Williams, RNAmy Wood, RNLori Whitt, RN


CertificationsSaint Francis Medical Center had its first celebration of National Certification Day on March 19, 2012. National Certification Day is an opportunity for employers, certification boards, educational facilities and healthcare pro-viders to celebrate and publicly acknowledge nurses who are committed to earning and maintaining the highest credentials in their specialty. Sixty nurses were honored at a certification pizza party. A presentation on the impor-tance and perceptions of nursing certification was given by Linda Harrington, PhD, RN-BC, CNS, CPHQ, CENP, CPHIMS, FHIMSS. She is the CHI Regional Chief Nursing Informatics Officer for Nebraska.

The nurses that received their national certification during FY12 were:

Miranda Brabec, BSN, RN, RNC-OBDarla Cleveland, BSN, RN, OCNJessica Cook, RN, RNC-OBBeth Deida, BSN, RN, RNC-OBCathy Ferguson, RN, CHPNJennifer Gardient, RN, RNC-OBTiffany Johnson, RN, RNC-OBJacque Langford, BSN, RN, CBPN- ICDebbie Ridder, BSN, RN, CHPNTerri Saathoff, BSN, RN, RNC-OBJennifer Scott, BSN, RN, OCNDawn Splattsoesser, RN, RNC-OBBrandi Stein, RN, RNC-OBJennifer Wilbur, BSN, RN, CHPN

Recognition of Nursing2012 Nurses Week Celebration: Saint Francis Medical Center celebrated seven new nursing awards during the annual Nurses Week celebration.

NEW NURSE:Rylee Koepp, BSN, RN, Intensive Care Unit

FRIEND OF NURSING:Allison Sokol, BWS, Social Work

CLINICAL EXCELLENCE PCA:Cindy HansenHealthConnect at Home


LEADERSHIP EXCELLENCE:Jan Spale, RN, RNC-OB,Maternal Child Director

CLINICAL NURSE:Shawna Young, RN,Medical/Surgical Oncology

NON-CLINICAL NURSE:Sally Mingus, MSN, RN, Information Technology

CUSTOMER SERVICE PCA:Amber SmithSkilled Nursing Unit

Exemplary Professional Practice

Professional Model of CareSaint Francis Medical Center’s model of care is patient-centered care.

Care Delivery ModelSaint Francis Medical Center’s care delivery model varies depending on nursing unit. Most of the nursing units practice Team Nursing.

Professional Practice ModelSaint Francis Medical Center’s professional practice model is being developed by the RN practice council and Patient Service Administra-tive Council and will be published in the next fiscal year. The new Professional Practice Model will be aligned with Saint Francis’ mis-sion, vision and values, the Nebraska Nurse Practice Act, ANA Code of Ethics and National Standards of Specialty Nursing Practice.

Ethics, standards and best practices form the foundation for nursing excellence. Working with interdisciplinary teams, nurses establish strong professional prac-tice through the application of new knowledge and evidence.

CompetencyInitial competency is assessed through the use of the Performance-Based Develop-ment System (PBDS) program for critical thinking development. This is a validated tool that measures a nurse’s ability to recognize and manage patient problems with the correct sense of urgency. The tools within the PBDS library are focused on the nurse’s current skill level, with assessment tools designed for medical-surgial, critical care, operating room, neonatal intensive care, and labor/delivery. The results of the PBDS assessment are shared with the new hire’s clinical manager and their clinical coach, and are used to adjust the orientation to their individual learning needs. We have provided our clinical coaches with specific training on orientation skills, assessing learning styles, learning needs, communication, competency validation. Orientation is guided by unit-specific orientation tools that are designed to promote graduated independence. Additional tools and resources are available to assist the clinical coach and the orientee to foster safe nursing practice in our new hires.

Ongoing nursing competencies are developed based on an on-going analysis of learning needs for each department, targeting high risk/low and high volume cases. This is done through collaboration between nursing staff, clinical managers, clini-cal nurse specialists, and nurse educators using quality data, case reviews and new products and processes. Annual competency assessment is accomplished in targeted mini-skills fairs. Each mini-skills fair incorporates simulation to create a realistic atmosphere for competency evaluation. At the conclusion of the simulated scenario, intentional debriefing is completed to promote self-analysis of competency.


Sim-Lab Because of the success of simulation in our competency program, Saint Francis Medical Center has built a low-fidelity Sim lab on site. We now have three Sim-Lab rooms and a store room on the The Learning Center located on old unit 4. There are also three new conference rooms and updated audio visual equipment in the area.

SafetyFirstSaint Francis Medical Center’s journey to “high reliability” began in the spring of 2012. SafetyFirst supports the strategic goal of Catholic Health Ini-tiatives to eliminate serious safety events by 2020, and serves as the foundation for quality improve-ment at Saint Francis Medical Center. The nursing department plays a key role in helping to trans-form our organization’s culture to one of transpar-ency, where nurses feel comfortable to speak up when they have a concern, to report near misses and precursor events, and to actively participate on teams to help improve patient care.

Every nurse has been educated in the use of er-ror prevention techniques to prevent errors that could reach our patients. Process improvement is successful because our nurses, who are clos-est to the patient, are driving and informing the change process. Front-line nursing staff is actively engaged on many teams and several nurses have been trained as Lean Six Sigma Green Belts.

On our nursing units, nurses participate in daily safety huddles to discuss real or potential safety concerns. Nursing directors attend the organiza-tion’s daily safety huddle to report safety concerns identified on each of their units. Several members of the nursing leadership team are members the SafetyFirst Core team, an interdisciplinary team that meets weekly to review potential cases of patient harm. A Top Ten Priority List guides the work of our interdisciplinary process improve-ment teams across the organization.

ResourcesSaint Francis Medical Center has many educational resources for employees:

· Saint Francis Medical Center Professional Library has books, journals and computers for employee use.

· eClinical Reference Systems provides clinical procedural guidelines that are directly linked to the Saint Francis Medical Center Policy and Procedure library.

· In addition, eCRS includes a library of journals and nursing references.

· eClinical Pharmacy includes a vast reference to medication information (indications, dosing, titra-tions, compatibility, toxicology)

· Digital-Med offers over 450 free online CE courses

· CINAHL with Full Text is available via EBSCOhost

Balanced Lifestyle:

·The Employee Health nurse is available for all employees.

·Self-scheduling is practiced on many nursing units

·The Wellness Committee provides wellness education

and promotes healthy lifestyle choices.

·Wellness Center membership is available to all employees

·Employee Health Fairs offer onsite biometric screenings

·Nutritional Services offers healthy meal incentives

·Wellness challenges

·Weight Watchers at work

·Tobacco cessation classes

·Personal health coaches

·Personal trainers

·Physical therapist weekly

·Massage therapy weekly


QUALITY CARE

Trauma CertificationSaint Francis Medical Center was reviewed by the Ameri-can College of Surgeons on January 11-12, 2012 as a Level III trauma center, which provides care to both adults and pediatrics. We are pleased that we achieved verifica-tion for the third time in nine years by the American Col-lege of Surgeons. The state of Nebraska Trauma Board and the Region 3 Trauma Board has re-designated Saint Francis as a general level trauma center through 2015.

The trauma department is headed by Dr. Steven Schnei-der, trauma program director, Ed Nickel trauma program manager, and Schelly Young trauma program registrar. The reviewers were very impressed with the addition of the new tower, inpatient rehabilitation unit and two new oper-ating rooms. There were no deficiencies identified during the site review. They commented that this may be the best Level III trauma center they had ever reviewed.

The strengths of Saint Francis Medical Center include:· The trauma service including the trauma medical director, trauma program manager and the trauma registrar.

· Continued lack of trauma diversion; none in the last nine years

· The physical plant and administration

· The educational program throughout the facility, including EMS, nursing and physicians

· Esprit de corps of the institution

· Response to full activations by the radiologist, anes-thesia and the operating room nursing staff

· The massive transfusion protocol implementation and process assistance by hospital personnel

With the addition of the new neurosurgical service line and physiatrist in the inpatient rehabilitation unit, Saint Francis Medical Center looks forward to continuation of growth in the trauma field while meeting the needs and services of the community and surrounding areas.

Professional PresentationsHeather Benzel, RN, CCRP and Barb Nickel APRN-CNS have authored an article titled: Building a Clinical Trial Process in Oncology that was accepted for publication in the October 2012 Journal of Infusion Nursing.

National Data for Nursing Quality Indicators (NDNQI)· Deb Wilson, Saint Francis Medical Center’s nursing quality specialist, is the NDNQI site coordinator for Saint Francis.

· Saint Francis Medical Center has submitted data on nurse-sensitive indicators to a national database for the past two years.

NDNQI is a National Database of nursing quality indica-tors. It is the only national, nursing quality measure-ment program that provides hospitals with unit-level performance comparison reports for state, national, and regional hospitals. The NDNQI’s nursing-sensitive indicators reflect the structure, process and outcomes of nursing care. The NDNQI nurse job satisfaction survey was pilot tested in 2001 and began annual data collec-tion in 2002.

We use the data to compare Saint Francis Medical Cen-ter nursing outcomes nationally. For example, we have implemented an evidence-based fall program at Saint Francis. While we have decreased the number of falls, when we compare ourselves to like hospitals, we do not perform as well as the database. We decided to reorga-nize the fall team to see what we can do to upgrade the program. This work is still in progress.

We had a 55 percent response rate to our first NDNQI survey. One of the outcomes was nurses felt they could not get a break away from the patients. Individual units have changed their assignments and handoff situation so nurses are not interrupted during time off the floor.

Nursing Quality Council will review the data quarterly to determine trends and what opportunities in improvement to the quality of care we need to work on in the future.


Evidence-Based Practice and ResearchNursing care rarely ceases at the time of death. Many times the focus may shift from the patient to the remaining family and friends who are left at the bedside of the deceased loved one. When one has experienced the loss of a loved one, the actions of the nursing staff at the time of death can influence the memory of the event in a very positive or negative way. This is the focus of a research project titled Compassionate Care after a Patient’s Death. A small group research committee consisting of: Cathy Ferguson, RN; Adriane Ogden, BSN; Peggy Radke, MSN; Maxine Vieth, MSN; Don Voorhees; Diana Wing, RN; and Theresa Wood, RN; has formulated a research project that will tell us how we are respecting the patient who has died in our care. This committee is looking into how we might imple-ment best practices and what affect those practices have on our nursing staff.

New KnowledgeStrong leadership, empowered professionals, and exemplary practice are essential building blocks for Magnet-recognized organizations, but they are not the final goals. Magnet organiza-tions have an ethical and professional responsibility to contribute to patient care, the organi-zation, and the profession in terms of new knowledge, innovations, and improvements.

Care Value ManagementThe Care Value System implemented the tracking of patient acuity to improve quality while being cost effective.

Care Value is critically important for nursing to have the ability to quantify and document contribution. Care Value is an asset to vali-date and document nursing contribution to care outcomes and to the organization as a whole.


This began in 1889 with a vision and a passion to minister those in need. The nurses of today must embrace that tradition as we envision and embrace the future seasons of change. The foundation has been laid, but the future is still awaiting discovery.

The Legacy of Nursing Excellence


2620 West Faidley Avenue · Grand Island, Nebraska

www.SaintFrancisGI.org

www.facebook.com/ Saint Francis GI

2012 Nursing Annual Report

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