Structural Empowerment Contents

  • Structural Empowerment - SE01

    Professional Engagement 

    SE 1 The structure(s) and process(es) that enable nurses from all settings and roles to actively participate in organizational decision-making groups such as committees, councils and task forces.

    The nurse leader provides leadership in the professional practice setting and the profession."   (ANA Nursing Administration Scope and Standards of Practice, 2009)

    The Chief Nursing Officer promotes nursing participation in organizational decision making groups.  Penrose St. Francis Health Services (PSFHS) Nursing Services established a shared decision making structure many years ago. Over the last four years, we have seen the tangible value of nurse participation, and as a result we have prioritized the importance of nurse membership in committees and work groups. PSFHS has increased membership and nurse participation from multiple settings and roles within our organization-wide decision making groups - at both Centura Health and at the PSFHS levels. Nurse competency and commitment to participation have grown through continuous encouragement, recognition, education, mentoring, and clear expectations from nursing leaders.  Recognizing the challenges of budgeting to pay nurses for participation, Clinical Nurse Managers have partnered with clinical nurses to ensure adequate patient care and meeting attendance coverage. In addition, participation at the Centura Health level is possible via technology capabilities which reduces the needed travel time for all PSFHS associates.

    As you will read below, we have established multiple structures and processes designed to recognize the value nurses bring from their different roles and settings to improve overall decision making and promote overall participation.

    Centura Health and South State Group:
    By maintaining frequent communication with all associates concerning overall goals, strategies, and progress updates the culture of PSFHS sets expectations for participation in decision making groups. Associate's comments, suggestions, and recommendations are actively sought via email along with messages that prompt recruitment of members for committees, councils, and task forces. The Evidence Based Practice Group frequently seeks feedback as demonstrated in the ICU Delirium Blog and the Sepsis Group Yammer . Centura Health is committed to seeking the active participation and input from associates in multiple ways, including innovative uses of technology.  A recent invitation to participate demonstrates the ongoing commitment and valuing of participation in organizational decision-making groups. ( SE1-1 , SE1- 2 )

    Several decision making groups at the Centura Health level include representation from PSFHS nursing. Our participation in these groups promotes the implementation of evidence based practices across our system; these improvements contribute to patient safety and demonstrate the shared decision making process. Some examples of Centura Health groups and PSFHS nursing participation are visible in the table below:

     

    Committee

    Representation

    Centura Joint Council

    Ann Kjosa, BSN, MBA/MHM, RN, FACHE, Chief Nursing Officer

    Centura Professional Development Council

    Sylvia Kurko, BSN, MBA, RN, Education Coordinator

    Kathy Guy, BSN, MSHA, RN, NE-BC, Director of Professional Resources

    Centura Nursing Practice Council

    Louise Wilson, BSN, RN, and Christine Tavenner, BSN, RNC-MNN, Co-Chairs of Nursing Practice Council

    Centura Health Evidence Based Practice Council

    Michelle Stephens, BSN, RN, Values Analysis; Candace Garko, MSN, RNC-OB, Clinical Manager, Labor & Delivery

    Centura Informatics

    Ramona Beal, BSN, RN, Clinical Informatics

    Frontline Leadership Development for Nurses

    Deb Nussdorfer, MSN, RN, NE-BC, Magnet Coordinator

    Centura Health Clinical Effectiveness Group: Acute Care

    Olinda Spitzer, MSN, RN, CCRN, Clinical Nurse Specialist

    Centura Health Cancer Network

    Judy DeGroot, MSN, RN, AOCN,  Cancer Center 

    Centura Health Advanced Practice Nurse Council

    Olinda Spitzer, MSN, RN, CCRN, Clinical Nurse Specialist

    Centura Health Values Analysis

    Michelle Stephens, BSN, RN, Director Values Analysis

    Centura Health Values Analysis Committee The role of the Centura Health Values Analysis Committee is to review the purchasing of materials, the ongoing standardization of equipment, and current evidence to support decision making. This is done to ensure that the organization is always using the best available product or method. Michelle Stephens, RN represents PSFHS in this Centura Health Committee and she reports the committee's findings to the PSFHS Nursing EBP/Research Council and other associates as needed. ( SE1-3 )

    The Centura Professional Development Council (CPDC) is composed of associates throughout the Centura system. Members of this council are representative of: nursing educators, professional staff development nurses, and nursing leaders from all specialties. This council collaborates with our standards division called, "Centura Quality and Regulatory," to identify core learning requirements for our associates. Additional goals of this council include: developing relationships with local universities and contracting with those schools for reduced tuition, onsite cohorts, cultivating online education, establishing new graduate residency programs, and furthering frontline nurse leader education. ( SE1-4 )

    Centura Nursing Practice Council (CNPC) This council supports the Centura nursing vision of achieving national distinction in nursing through actively promoting nursing excellence in areas of clinical nursing practice and patient care.  During FY2012 CNPC standardized processes for fall reduction, monitoring of BCMA scan rates, patient satisfaction specific to nursing, mitigating errors in order checks while awaiting the implementation of CPOE, and standardization of use of privacy codes.  Louise Wilson, RN, Co Chair of PSFHS Nursing Practice Council represents PSFHS nursing in this group.  ( SE1-5 )

    The CNPC seeks to lead outcome improvement across the family of hospitals. One way the council does this, is through time limited work groups. These are typically ad hoc groups that are organized to address a specific concern in order to improve patient care outcomes. Rapid Decision Making (RDM) teams meet to focus on specific clinical practices. These councils are multidisciplinary and they seek the input of a wide variety of nurse specialties.

    Cancer Center Network Current effort is on the MEDITECH Medical Oncology Module.  MEDITECH has an application that is focused on oncology.  It is designed to enable flow of patient information appropriately through the continuum of care for oncology patients receiving treatment at Centura facilities.  In order to achieve the goals of the Oncology System of Care, a fully integrated system needs to be in place that will capture patient information, as well as perform scheduling, tracking, billing, and follow-up. The ONC core team presented a basic view of functionality to the statewide oncology group at their quarterly meeting. Progress continues with enhancement requests and preparation of the system so a full implementation can proceed in a timely manner.  Currently seven physicians from PSFHS are also actively involved in this process. ( SE1-6 )

    Penrose-St. Francis Health Services :

    Our Chief Nursing Officer is a vital member of the PSFHS Senior Leadership Team. This position sets the stage for nursing participation in organizational decision making across PSFHS. Senior Nursing Leaders communicate and collaborate with inter-professional colleagues through Director Meetings and functional work groups. 

    Interdisciplinary Committees Communication between committees and councils promote decision making across multiple settings and roles. The following are inter-professional committees and they serve as examples of structural collaboration at PSFHS: 

    Clinical Effectiveness Committee: includes nursing managers from all settings, infection prevention nurses, clinical effectiveness nurses, and nursing directors.  The minutes attached demonstrate nursing participation and committee discussion of interdisciplinary quality practice and clinical outcomes. ( SE1-7 )

    The Infection Control Committee: includes directors, managers, infection prevention specialists, and clinical nurse membership. Nurses from surgery, intensive care, employee health, clinical effectiveness, medical floors, emergency departments, and other areas participate. ( SE1-8 )  This committee led the charge for employee and physician influenza vaccination.

    Patient Safety Committee: Chaired by the Chief Medical Officer, this interdisciplinary committee provides leadership and oversight for patient safety at PSFHS.  In addition, the PSFHS Risk Manager collaborates with Centura Health Risk Managers to promote standardization of patient safety practices when indicated. For example, this committee asked for feedback regarding the (then) current practice related to identification of patient allergies and the use of allergy bands. The Nurse Practice Council recommended the standardization of the process to improve patient safety. ( SE1-9 )

    Strategies that Enable Nurse Participation in Decision Making :

    Nurses work difficult schedules which impacts their ability to participate in formal decision making committees and councils.  The following are examples of strategies that have been developed in order to enable nursing participation.

    Coaching/Mentoring PSFHS Falls Committee, formerly chaired by the Director of Patient Care Services, is an organization wide team that includes membership from a wide variety of patient care settings and roles.  Nurses from inpatient and rehabilitation units collaborate with colleagues from Therapies, Medicine, and Patient Safety Risk to champion fall prevention throughout the hospital and grounds. Through membership and participation in the Falls Committee, a direct care clinical nurse advanced to become the Chair of this committee. ( SE1-10 )

    Administrative Support Agenda, handouts and minutes for organizational decision making groups is supported through expert business support staff that is present during meetings. As you review minutes from meetings you will notice the following names representing the business support provided to committee chairs:  Jill Clark, Kathy Creech, Vicki Randazzo and Jeanne Turk.  

    Financial Support Nurses are paid for their participation in committees and work groups. This is done to compensate for nurses' time as well as to encourage participation from as many parties as possible. In FY 2012 over 176,000 non-productive hours (hours spent during meetings, education or participating in organizational activities and not spent in their normal workplace) were paid to registered nurses.

    Providing information A list of organizational decision making groups was created in 2012 and made available to all nursing associates. When a new direct care nurse reviewed the committee list, he expressed interest in participating in committees and councils. Since then we elected to add this list to our Nursing Intranet to improve visibility and accessibility.   ( SE1-11 , SE1-12 )

      Inspiration and Education :

    Tim Porter-O'Grady, the innovative nurse leader who advocates for professional practice, innovation and adaptive health care models, presented to over 200 nurses in 2011 and 2012.  In both years, nurses from all levels in our organization attended the full day conference. The conference goal was to facilitate professional development through learning about leadership in the context of changing practices and health care reform. ( SE1-13 ) Kristina Davis, RN, PSF floor 9, night shift, shared her perspective following the conference:

    "The main ideas I took away from the Tim Porter O'Grady presentation were the importance of recognizing changes to the healthcare system, specifically to the roles of nurses….I feel like O'Grady placed emphasis on embracing changes, particularly technological changes…..  The main role of the staff nurse seemed to be that of self-motivation to strive for the best patient care/outcomes…..and our participation in decision making across the organization."

    This kind of response was typical of the educational experience. Feedback from nurses attending the conference was positive as demonstrated in the table below:

    Summary :

    PSFHS nurses from all settings, roles and levels actively participate in organizational decision-making groups such as committees, councils and task forces.  Direct care nurses, managers, directors, educators, clinical nurse specialists, clinical effectiveness nurses, and patient navigators use their skills and expertise to identify and make changes based upon evidence and they make decisions that improve nursing and our organization. Successful participation is enabled through educational opportunities, coaching, mentoring, leadership encouragement, administrative support, financial support, and meaningful group outcomes that improve our practice, environment, and outcomes.

    Comparing the results from our Press Ganey Satisfaction Surveys from 2009 and 2012, nurses indicated improvement in the category "Systems and Leadership" from a mean of 55 (2009) to a mean of 62.5 (2012).  This category includes questions related to the ability to influence and share opinions before decisions are made. Participation from nurses across PSFHS in organizational decision making is important and it will continue to expand. 

  • Structural Empowerment - SE01EO

    Professional Engagement

    SE 1 EO Describe and demonstrate two improvements in different practice settings because of nurse involvement in organizational decision-making groups such as committees, councils, and task forces.

    1.     Multidisciplinary High Risk Breast and Ovarian Cancer Clinic (MHRBC ):

    The goal of the MHRBC is to establish a formalized process to closely monitor women at a higher risk than normal of developing breast and/or ovarian cancer due to genetic abnormalities, strong family history, prior chest radiation, atypia on a breast biopsy, etc.

    Purpose and Background :

    The risk to develop breast cancer may be increased significantly for those with a strong family history of breast cancer, a genetic mutation, or an abnormal biopsy result.  Accurate risk assessment, counseling to discuss various medical options, and coordination of multi-faceted risk management can help reduce breast cancer risk in such individuals.  Primary care providers often lack the time to provide these services, and they may be unfamiliar with current management recommendations.  Penrose Breast Care Center established a Multidisciplinary High Risk Breast and Ovarian Clinic (MHRBC).  Patients consult with several breast health care specialists in a single visit to develop a risk management plan; Komen grant-funded imaging studies were available to un-insured and under-insured women in the high risk category. The Clinic services expanded beyond the existing oncological, breast health navigation, and hereditary cancer services at Penrose.  It widened the continuum of care to unaffected, but high-risk individuals under the age of 50.  The clinic intention is designed to either prevent breast cancer or to detect it at in the early and treatable stages.  This is the first such program in the Pikes Peak Region . ( SE1EO-1 )

    The goals for the MHRBC were:

    Methods and Approaches :

    This project was accomplished by a multidisciplinary committee which included: a breast surgeon, breast care nurse navigator, genetics counselor, imaging personnel, oncology nurse practitioner, and a representative from billing. Implementing a high risk breast/ovarian clinic was a multidisciplinary effort in that the patient interacts with several different departments and disciplines within our health care system.  The successful development and implementation of this clinic required regular collaboration between the aforementioned departments. The breast care nurse navigator, genetics counselor, and surgeon worked together as a sub-group to develop the documentation tools and high risk clinic brochure.  The genetic counselor wrote and secured a Komen Grant to cover the costs of diagnostic mammograms and breast MRI for the un-insured or under-insured women. Additionally, the Penrose Foundation provided the money necessary for imaging to purchase and install digital mammography.  Both of those grants were pivotal to the opening of the high risk clinic.  The Breast Multidisciplinary Care Conference (MDC) participants supported the project including review and recommendations for all cases presented. The Project Plan and timeline covered the time period through March 2011.  ( SE1EO-2 )

    The high risk clinic was implemented in late July 2010 with 4 high risk patients.  The initial goal was met; to establish a formalized process to closely monitor women at a higher risk than normal of developing breast and/or ovarian cancer due to genetic abnormalities, strong family history, prior chest radiation and atypia on a breast biopsy.

    In October 2010, progress toward grant goals was not being met. Several problems had emerged that had threatened the viability of the program; women within the target group that had been asymptomatic were not being referred to the program, patients routinely declined to pursue applying for public funding (as per the program requirement), and we had a significant turnover in program staff.  The Penrose Cancer Center requested to change the grant screening criteria to include symptomatic women regardless of their family history or risk for breast cancer. (SE1EO - 3 , SE1EO-4 ) The request was granted and the PCC continued the Multidisciplinary High Risk Breast Cancer Clinic tactics including education, screening, referrals and individual care plans for patients.

    Participants :  

    Dennis Bruens, Director of Cancer Center

    Judy De Groot, RNLead Nurse Navigator, Medical Oncologist

    Sharon Halla, RN, Breast Care Nurse Navigator

    Wendy Smith, Nurse Practitioner, Director of Imaging: Penrose Foundation

    Reimbursement staff from Penrose and PenRad

    Toni Green MD, Breast Surgeon

    Laura Pomerenke, MD, Breast Surgeon,

    GYN Oncologist

    Jeff Shaw, Genetic Counselor

    Kate Crow, Genetic Counselor

    Outcomes (July 2010-March 2011) :

    The attached chart demonsrates the overall trend of increasing awareness of this program. The most difficult aspect of this project was making the target patient group knowledgeable of their risk and their care options. As the data indicates, there was a perpeptual increase of referrals as providers and patients became more aware of the service and the grant revision opportunity.  The final grant report provides summary and indicates the majority of funds for screening were provided by the Colorado Indigent Care Program and Medicaid with administrative support for the service provided by PSFHS and contracts awareded by the National Cancer Institute's Community Cancer Centers Program. ( SE1EO-7 )

    Clinical Implications :

    Our ultimate goal is to reduce breast cancer morbidity by offering screening to asymptomatic, low-income, high risk women who do not qualify for other screening programs. In fall 2010, we received approval to expand our target population to include symptomatic women under age 40.  The grant from the Southeastern Colorado Komen affiliate helped Penrose Cancer Center establish a Multidisciplinary High Risk Breast Clinic to provide management for women with increased risks for breast cancer.

    By March 2011, the Cancer Center accomplished the following:

     The Multidisciplinary High Risk Breast/Ovarian Cancer Clinic continues to provide services per plan. Referrals to the clinic and the number of patients seen more than doubled from 2010 to 2011.  The Clinic continues to serve patients.

     

     

    2010

    2011

    Referrals

    19

    41

    Patients Seen

    14

    31

    References

    NCCN Clinical Practice Guidelines in Oncology Breast Cancer Screening and Diagnosis V.I.2010.  
    Lynn, J.M. & Segal, H. (2004) A model breast care center at George Washington University Medical Center.Comprehensive Breast Care Programs , May/June, 6-7.

    SE1EO Describe and demonstrate two improvements in practice settings because of nurse involvement in organizational decision making groups such as committees, councils and task forces.

    Exemplar 2:  Improving Patient Safety through Safe Management of Patient Pain

    Purpose and Background:

    The PSFHS Pain Committee provides oversight and leadership for safe and effective patient pain management. This inter-professional committee includes representatives from: nursing, medicine, surgery, pain specialists, psychology, and our pharmacy.

    In 2008, the Nursing Practice Council, Chief Nursing Officer, and Chief Medical Officer voiced concern with over-sedation of patients resulting in Narcan rescue. The PSFHS Pain Committee supported the creation of a specific group to examine the problem, identify potential solutions, research evidence based practices, and implement practice changes to reduce over sedation resulting in Narcan Rescue. While actions implemented by this inter-professional team led to some initial reductions in over-sedation, the patient safety issue remained a priority.

    In the first quarter of 2011, Narcan rescues for over-sedation on Penrose Patient floors were rising. The last two quarters of 2010 reported an average of 1.33 Narcan rescues each month.  The first quarter of 2011 averaged 4.6 Narcan rescues per month. 

    The graph below demonstrates outcomes prior to this project which shows the improvement from 2008 through 2010 and the resurgence of the patient safety concern in 2011.
     

    The goal for the Pain Committee was to reduce Narcan rescues on inpatient floors

    Methods and Approaches:

    The overall strategy to reduce Narcan rescues on inpatient floors was a collaborative interdisciplinary approach inclusive of nursing, medicine, and pharmacy. All three disciplines are focused on managing patient pain safely and are accountable for patient safety and clinical outcomes. In addition, these disciplines have unique knowledge, and expertise that improve safe, effective pain management.

    The PSFHS Pain Committee examined frequencies of Narcan use for over-sedation monthly, reviewed specific cases, identified strategies, and took the following actions to achieve the outcome of a reduction in use of Narcan on Penrose Hospital floors.

    Fourth Quarter 2010 During the fourth quarter we were encouraged by the reduction in Narcan use. In November there were zero uses of Narcan. This was only the third month in three years to be without a floor Narcan rescue. One record that was reviewed was “questionable nursing practice” and it was referred to nursing peer review. During this quarter Pain Booklets, designed by pharmacy and nursing, were printed and distributed to nursing stations, physician lounges, and by provider dictation phones. The goal of the booklet was to support safe pharmacological decision making by physicians and nurses. In addition, PSFHS was invited to participate in a national research study regarding pain quality indicators. We implemented the use of Fentanyl on the floors, one physician committee member educated his partners on risks of Valium, and the committee recommended changes to an order set conversion of sustained release morphine to improve safety.  (SE1EO-8SE1EO-9

    First Quarter 2011 Problem Identified The last two quarters of 2010 demonstrated a significant reduction in Narcan rescue use. Unfortunately, the first quarter of 2011 demonstrated a significant increase. 

    In March 2011, the Pain Committee met and examined the data. (SE1EO-10) Several actions were identified:

    1. CMO review of all Narcan cases in first quarter with possible referrals to Physician Peer Review
    2. Plan for physician education
    3. Consider separate order sets for different age groups with focus on elderly patient risks
    4. Review allergy classifications
    5. Consider pop up alerts 

    Second Quarter 2011

    1. Reviewed orthopedic order sets and revised to highlight sedation monitoring.  
    2. Team identified a possible trend of post-operative patients arriving on the floor with significant pain and/or symptoms of over-sedation. 
    3. Distributed and analyzed Pain Service survey. (SE1EO-11
    4. Created Cue Card to attach to WOW’s to increase awareness and knowledge of sedation scale (SE1EO-12)

    Fourth Quarter 2011 (SE1EO-13SE1EO-14)

    1. Pain Committee increases discussion of psychological elements impacting pain management. 
    2. Pain Service Protocols approved in December 2011. 
    3. Identified need for tele-ox monitoring for all patients using patient controlled analgesia (PCA) based on research. 
    4. Identified need to treat patients admitted with chronic, severe pain and on high doses of medication.
    5. Identified need for addition resources – psychiatry and pain nurse.
    6. Dan Chatelain RN asked by ANCC to help write certification exam.

    First Quarter 2012 (SE1EO-15SE1EO-16)

    1. Discuss protocol or trigger mechanisms that lead to automatic referral to Pain Service
    2. Decision made that patients on PCA will be monitored with tele-ox and PSFHS ordered more equipment
    3. Recommend no dose above 1 mg of Dilaudid be administered to patient
    4. Establish a performance improvement committee to review literature, identify and pilot practices to use with chronic pain patients admitted and experiencing acute and/or post-operative pain
    5. Pharmacy took action to stop duplication of pain medication orders from anesthesia and surgeon

    Second Quarter 2012 (SE1EO-17)

    1. Sent one record to physician peer review.
    2. Sent two cases to nursing peer review
    3. Performance Improvement team status update with recommendation for psychological evaluation and Pain Service consult prior to spine surgery for patients with chronic pain

    Third Quarter 2012  (SE1EO-18SE1EO-19)

    1. Committee review of all actions taken in last three years to improve patient safety:
    a. Decreased phenergan dosing on order sets and implemented pharmacy intervention of larger doses ordered
    b. Pain Train – nursing newsletter with education specific to pain management
    c. Developed and distributed Pain Booklet and Pain Tip Sheets
    d. Expanded patient monitoring
          i. Obstructive Sleep Apnea patients have increased monitoring requirements post-op
          ii. Patients with PCA required to be monitored through Tele-OX
    e. Decreased Dilaudid dosing
    f. Education to nurses and to physicians
    g. Participated in national pain indicator research study
    h. Sedation monitoring

    2. Recruited a second Pain Nurse Specialist
    3. PSFHS Nursing Practice Council reviewed evidence and checked with other facilities about waking patients at night. The NPC decided our standard of care will include waking patients at night to assess sedation levels if they are taking pain medications. 

    Education:

    Pain Resource Nurse Meetings (PRN) Dan Chatelain, MSN, RN-BC, Pain Specialist, provides monthly education to the PRN nurses based on new practices, recent evidence, safety issues. (SE1EO-20)

    Pain Train Newsletter for Nurses Every quarter we publish and distribute educational newsletters to all nursing units. Topics are selected based on education need or recent nursing practice issues.   (SE1EO-22)

    Related Research Studies (2011-2012) PSFHS nurses also participated in two research studies which promoted active nursing participation focused on safe, effective pain management.

    1. Study Title:  “Dissemination and Implementation of EBP Methods to Measure and Improve Pain Outcomes.”  Description:  “This project will disseminate and implement evidence-based approaches to measure and improve pain care and outcomes in a sample of 400 hospitals across the United States. The program is unique in forging a partnership with the National Database of Nursing Quality Indicators® (NDNQI)--the only national nursing database that collects and reports quarterly information on structure, process, and outcome indicators to evaluate nursing care at the unit level. We will replicate the NDNQI data collection strategy for pressure ulcers and collect data regarding pain care and outcomes at the patient level across multiple hospitals and units on a given day. Our approach is unique, however, as it will be the first time that NDNQI has gathered data by asking patients directly about their experience.” PSFHS Pain Resource Nurses participated in both phases of this national study.   (SE1EO-23)

    2. Safe Pain Management: Risk Factors for Over-sedation in Patients Treated in Community Hospital. The purpose of this inter-professional study was to identify patient factors that increase the risk of over-sedation/respiratory depression resulting in Narcan rescue in patients being treated in a community hospital. One hundred and three (103) medical records were retrospectively reviewed per protocol. Records included all patients who received Narcan for rescue of over sedation/respiratory distress following administration of opioid while hospitalized. The Research Final Report and IRB Closure Report are attached. (SE1EO-24)

    Participants

    PSFHS Pain Committee Pain Resource Nurses
    Jeff Oram-Smith, MD, CMO Dan Chatelain, CNS, RNC
    Kate McCord, RN, CNO Lenora Kraft, RN, Clin Manager
    Dan Chatelain, CNS, RNC Miho Dicke, RN, ICU
    Carlos Johnson, RN, PH 7 Gina Wamble, RN, PH PreOp
    Audrey Simpson, RN, Educator Jacqui Baldwin, RN, PH PACU
    Rose Ann Moore, RN, Director Sara Vigen, RN, PH 11
    Eric Jepson, MD Stephanie Christian, RN, SFMC 5N
     Mike Force, Pharm. Janet Laird, RN, PH PACU
    Allison Schlang, Pharm Phyllis Burton, RN, CVU Clin Manager
    Dale Mann, PsyD Louise Wilson, RN, PH 8 Rehab
    Carolyn Cusic, RN, Clin Mgr  Millissa Chesnosis, RN, SFMC PeriOp
    Doug Finn, MD Nicole Mason, RN, PH 9
    Kathy Guy, RN, Director Tamera Deibert, RN, PH 4
    Charlie Stine, Director, Rehab  Jane-Allin Cloutte, RN, PreAdmit Testing
    Deb Nussdorfer, RN  Laurie Chromy, RN, Mom Baby Unit

    Outcomes and Clinical Implications:

    Narcan Use for Over Sedation: The Graph below demonstrates the progress from January 2011 through July 2012.  The goal to reduce Narcan Rescue for over-sedation on Penrose Hospital floors was met.

    Summary and Clinical Implications:

    Nursing participation in the organizational, inter-professional Pain Committee led to decision making, practice changes, nurse and physician education, order set revisions and nurse participation in research that resulted in a reduction in Narcan Rescue use for over-sedation in patients in Penrose Hospital inpatient floors. 

     

    1. Educated at least fifty regional potential referring providers about MHRBC.
    2. Obtain referrals to see at least 20 uninsured, underinsured women at high risk.
    3. Assess risk for at least 25 patients seen in MHRBC.
    4. Create individualized risk management plans for at least 25 patients seen in target population.
    5. Goal: Educate at least 50 regional potential referring providers about MHRBC services. Educated 117 providers, more community health care providers than we anticipated.  Exceeded goal . 
    6. Goal: Obtain referrals to see at least 30 un-insured and under-insured women at high risk for breast cancer.  Mid-year grant and goal revision: provide diagnostic imaging for symptomatic women under age 40.  Twenty-one asymptomatic women in our target population were referred and an additional eleven symptomatic women under age 40 were referred for diagnostic imaging.  Initial target of 30 women was partially met.  With mid-year grant revision the goal was met.  
    7. Goal:  Assess risk for at least 25 un-insured or under-insured patients seen in MHRBC. All twenty one referred women were screened for risk in person. Twenty-nine percent were high risk.  Goal partially met (88%).
    8. Goal:  Create individualized risk management plan for at least 25 patients in target population who are seen in the MHRBC.  Only two patients completed the full MHRBC services and received a written, individualized risk management plan. The nineteen remaining referred women were screened and received written care suggestions at their request. Goal partially met . ( SE1EO-5 ,SE1EO-6 )
    • Established a unique clinical service in the community that addresses the special needs of women at high risk for breast cancer.
    • Educated more community health care providers about breast cancer risk management than we anticipated.
    • Extended our breast navigation services to pre-symptomatic, high risk patients.
    • Strengthened or established connections with local agencies (e.g. El Paso County Health Department) to better coordinate breast care for high risk women.
    • SE1EO Describe and demonstrate two improvements in practice settings because of nurse involvement in organizational decision making groups such as committees, councils and task forces.

    • Exemplar 2:  Improving Patient Safety through Safe Management of Patient Pain

      Purpose and Background:

      The PSFHS Pain Committee provides oversight and leadership for safe and effective patient pain management. This inter-professional committee includes representatives from: nursing, medicine, surgery, pain specialists, psychology, and our pharmacy.

      In 2008, the Nursing Practice Council, Chief Nursing Officer, and Chief Medical Officer voiced concern with over-sedation of patients resulting in Narcan rescue. The PSFHS Pain Committee supported the creation of a specific group to examine the problem, identify potential solutions, research evidence based practices, and implement practice changes to reduce over sedation resulting in Narcan Rescue. While actions implemented by this inter-professional team led to some initial reductions in over-sedation, the patient safety issue remained a priority.

      In the first quarter of 2011, Narcan rescues for over-sedation on Penrose Patient floors were rising. The last two quarters of 2010 reported an average of 1.33 Narcan rescues each month.  The first quarter of 2011 averaged 4.6 Narcan rescues per month. 

      The graph below demonstrates outcomes prior to this project which shows the improvement from 2008 through 2010 and the resurgence of the patient safety concern in 2011. 
       

      The goal for the Pain Committee was to reduce Narcan rescues on inpatient floors . 

      Methods and Approaches:

      The overall strategy to reduce Narcan rescues on inpatient floors was a collaborative interdisciplinary approach inclusive of nursing, medicine, and pharmacy. All three disciplines are focused on managing patient pain safely and are accountable for patient safety and clinical outcomes. In addition, these disciplines have unique knowledge, and expertise that improve safe, effective pain management.

      The PSFHS Pain Committee examined frequencies of Narcan use for over-sedation monthly, reviewed specific cases, identified strategies, and took the following actions to achieve the outcome of a reduction in use of Narcan on Penrose Hospital floors.

      Fourth Quarter 2010 During the fourth quarter we were encouraged by the reduction in Narcan use. In November there were zero uses of Narcan. This was only the third month in three years to be without a floor Narcan rescue. One record that was reviewed was "questionable nursing practice" and it was referred to nursing peer review. During this quarter Pain Booklets, designed by pharmacy and nursing, were printed and distributed to nursing stations, physician lounges, and by provider dictation phones. The goal of the booklet was to support safe pharmacological decision making by physicians and nurses. In addition, PSFHS was invited to participate in a national research study regarding pain quality indicators. We implemented the use of Fentanyl on the floors, one physician committee member educated his partners on risks of Valium, and the committee recommended changes to an order set conversion of sustained release morphine to improve safety.  ( SE1EO-8 , SE1EO-9 ) 

      First Quarter 2011 Problem Identified The last two quarters of 2010 demonstrated a significant reduction in Narcan rescue use. Unfortunately, the first quarter of 2011 demonstrated a significant increase. 

      In March 2011, the Pain Committee met and examined the data. ( SE1EO-10 ) Several actions were identified:

      1. CMO review of all Narcan cases in first quarter with possible referrals to Physician Peer Review 
      2. Plan for physician education 
      3. Consider separate order sets for different age groups with focus on elderly patient risks 
      4. Review allergy classifications 
      5. Consider pop up alerts 

      Second Quarter 2011

      1. Reviewed orthopedic order sets and revised to highlight sedation monitoring.  
      2. Team identified a possible trend of post-operative patients arriving on the floor with significant pain and/or symptoms of over-sedation. 
      3. Distributed and analyzed Pain Service survey. ( SE1EO-11 ) 
      4. Created Cue Card to attach to WOW's to increase awareness and knowledge of sedation scale ( SE1EO-12 )

      Fourth Quarter 2011 ( SE1EO-13 , SE1EO-14 )

      1. Pain Committee increases discussion of psychological elements impacting pain management. 
      2. Pain Service Protocols approved in December 2011. 
      3. Identified need for tele-ox monitoring for all patients using patient controlled analgesia (PCA) based on research. 
      4. Identified need to treat patients admitted with chronic, severe pain and on high doses of medication. 
      5. Identified need for addition resources - psychiatry and pain nurse. 
      6. Dan Chatelain RN asked by ANCC to help write certification exam.

      First Quarter 2012 ( SE1EO-15 ,  SE1EO-16 )

      1. Discuss protocol or trigger mechanisms that lead to automatic referral to Pain Service 
      2. Decision made that patients on PCA will be monitored with tele-ox and PSFHS ordered more equipment 
      3. Recommend no dose above 1 mg of Dilaudid be administered to patient 
      4. Establish a performance improvement committee to review literature, identify and pilot practices to use with chronic pain patients admitted and experiencing acute and/or post-operative pain 
      5. Pharmacy took action to stop duplication of pain medication orders from anesthesia and surgeon

      Second Quarter 2012 ( SE1EO-17 )

      1. Sent one record to physician peer review. 
      2. Sent two cases to nursing peer review 
      3. Performance Improvement team status update with recommendation for psychological evaluation and Pain Service consult prior to spine surgery for patients with chronic pain

      Third Quarter 2012   ( SE1EO-18 , SE1EO-19 )

      1. Committee review of all actions taken in last three years to improve patient safety: 
      a. Decreased phenergan dosing on order sets and implemented pharmacy intervention of larger doses ordered 
      b. Pain Train - nursing newsletter with education specific to pain management 
      c. Developed and distributed Pain Booklet and Pain Tip Sheets 
      d. Expanded patient monitoring 
            i. Obstructive Sleep Apnea patients have increased monitoring requirements post-op 
            ii. Patients with PCA required to be monitored through Tele-OX 
      e. Decreased Dilaudid dosing 
      f. Education to nurses and to physicians 
      g. Participated in national pain indicator research study 
      h. Sedation monitoring

      2. Recruited a second Pain Nurse Specialist 
      3. PSFHS Nursing Practice Council reviewed evidence and checked with other facilities about waking patients at night. The NPC decided our standard of care will include waking patients at night to assess sedation levels if they are taking pain medications. 

      Education:

      Pain Resource Nurse Meetings (PRN) Dan Chatelain, MSN, RN-BC, Pain Specialist, provides monthly education to the PRN nurses based on new practices, recent evidence, safety issues. ( SE1EO-20 )

      Pain Train Newsletter for Nurses Every quarter we publish and distribute educational newsletters to all nursing units. Topics are selected based on education need or recent nursing practice issues.   ( SE1EO-22 )

      Related Research Studies (2011-2012) PSFHS nurses also participated in two research studies which promoted active nursing participation focused on safe, effective pain management.

      1. Study Title:  "Dissemination and Implementation of EBP Methods to Measure and Improve Pain Outcomes."  Description:  "This project will disseminate and implement evidence-based approaches to measure and improve pain care and outcomes in a sample of 400 hospitals across the United States. The program is unique in forging a partnership with the National Database of Nursing Quality Indicators® (NDNQI)--the only national nursing database that collects and reports quarterly information on structure, process, and outcome indicators to evaluate nursing care at the unit level. We will replicate the NDNQI data collection strategy for pressure ulcers and collect data regarding pain care and outcomes at the patient level across multiple hospitals and units on a given day. Our approach is unique, however, as it will be the first time that NDNQI has gathered data by asking patients directly about their experience." PSFHS Pain Resource Nurses participated in both phases of this national study.   ( SE1EO-23 )

      2. Safe Pain Management: Risk Factors for Over-sedation in Patients Treated in Community Hospital. The purpose of this inter-professional study was to identify patient factors that increase the risk of over-sedation/respiratory depression resulting in Narcan rescue in patients being treated in a community hospital. One hundred and three (103) medical records were retrospectively reviewed per protocol. Records included all patients who received Narcan for rescue of over sedation/respiratory distress following administration of opioid while hospitalized. The Research Final Report and IRB Closure Report are attached. ( SE1EO-24 )

      Participants

      PSFHS Pain Committee Pain Resource Nurses
      Jeff Oram-Smith, MD, CMO Dan Chatelain, CNS, RNC
      Kate McCord, RN, CNO Lenora Kraft, RN, Clin Manager
      Dan Chatelain, CNS, RNC Miho Dicke, RN, ICU
      Carlos Johnson, RN, PH 7 Gina Wamble, RN, PH PreOp
      Audrey Simpson, RN, Educator Jacqui Baldwin, RN, PH PACU
      Rose Ann Moore, RN, Director Sara Vigen, RN, PH 11
      Eric Jepson, MD Stephanie Christian, RN, SFMC 5N
       Mike Force, Pharm. Janet Laird, RN, PH PACU
      Allison Schlang, Pharm Phyllis Burton, RN, CVU Clin Manager
      Dale Mann, PsyD Louise Wilson, RN, PH 8 Rehab
      Carolyn Cusic, RN, Clin Mgr  Millissa Chesnosis, RN, SFMC PeriOp
      Doug Finn, MD Nicole Mason, RN, PH 9
      Kathy Guy, RN, Director Tamera Deibert, RN, PH 4
      Charlie Stine, Director, Rehab  Jane-Allin Cloutte, RN, PreAdmit Testing
      Deb Nussdorfer, RN  Laurie Chromy, RN, Mom Baby Unit

      Outcomes and Clinical Implications:

      Narcan Use for Over Sedation: The Graph below demonstrates the progress from January 2011 through July 2012.  The goal to reduce Narcan Rescue for over-sedation on Penrose Hospital floors was met.

      Summary and Clinical Implications:

      Nursing participation in the organizational, inter-professional Pain Committee led to decision making, practice changes, nurse and physician education, order set revisions and nurse participation in research that resulted in a reduction in Narcan Rescue use for over-sedation in patients in Penrose Hospital inpatient floors.

  • Structural Empowerment - SE02

    Professional Engagement

    SE  2 The structure(s) and process (es) that enable nurses at all levels to participate in professional organizations at the local, state, and national levels. Include international participation, if any.

    The following was written by a new graduate nurse during the ASCENT Residency Program:

    I joined both the national and local Oncology Nurses Association when I was a BSN student because of my passion to identify myself as part of a unique care team. I have attended monthly meetings and I long for the day when I have the experience to be considered a professional oncology nurse. The only reason I have an oncology nursing position right out of school is because of the networking I did in the local organization.  And I will continue to be active in the Pikes Peak Oncology Nursing Society.  I look forward to being a model to my colleagues of professional nursing practice, based on evidence and research, and our shared experience as passionate, educated professionals. Traci Mullins, BSN, RN, Penrose 11

    Traci Mullins was awarded the Rising Star Award during Nurses Week 2012.

    Professional Practice Model:

    Within our Professional Practice Model, nurses are accountable for practicing within the scope and standards of our profession and the ethical framework as presented by the American Nurses Association. The ANA Code of Ethics (2001) Provision 9 states that, "The profession of nursing, as represented by associations and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy."  The goal of this section is to provide information that demonstrates that PSFHS encourages nurses to participate in professional organizations through the decisions of leadership, the availability of resources, and the variety of benefits that participating nurses have experienced due to these relationships.

    Leadership:

    Nursing leadership utilizes a variety of methods to foster an environment in which nurses of all levels are encouraged to be involved in organizations and activities. Our Chief Nursing Officer leads by example as she participates in nursing professional organizations as a member, board member, and presenter. The following are several examples:

     • Our former CNO's (2005-2012) Professional Affiliations: American Association of Critical Care Nurses since 1981, Past Officer, Southern Colorado Chapter, Association of Critical Care Nurses. Secretary, 1990 - 1991; Treasurer, 1985-1987; Membership Committee, 1987-1988, Sigma Theta Tau National Honorary Sorority since 1982, Colorado Society for Nurse Executives since 1992, American Organization of Nurse Executives since 1992, Board member Colorado Organization of Nursing Leaders-2000 to 2004, Society for Critical Care Medicine since 1990, Emergency Nurses Association since 1990, American Society for Pain Management Nursing since 2000

    • The CNO encourages the nursing directors to participate in the annual Colorado Organization of Nursing Leaders Conference, reimbursing registration and accommodation fees

    • Nursing directors are encouraged to belong to the Colorado Organization of Nursing Leaders

    • Nurses are reimbursed to present to the professional nursing community and regional and national conferences

    Resources:

     • Penrose-St. Francis Health Services (PSFHS) hosts the district level of the Colorado Nurses Association meetings as one strategy to improve our nurse's access to professional organization participation. In addition, Kate McCord, MSN, RN, NEA-BC, CNO has provided educational presentations for our district association. ( SE2-1 ) (SE2-2 )

    • Nurses from varying organizations inform their colleagues of meetings, share minutes and coordinate staffing to support participation.  The oncology nurses in the Cancer Center, inpatient unit and infusion center share minutes, host meetings and education on our campus and arrange coverage to support participation.

    • The Clinical Advancement Program (CAP) offers credit/points for participation in professional nursing organizations. Seventy-seven percent (77%) of the CAP applicants in 2011 belonged to professional organizations. ( SE2-3 )

    • Nurses who receive scholarships from their respective professional organizations attend conferences and share both the knowledge obtained from the conference, and they highlight the benefits of participating in a professional organization.

    • Nursing Administration will financially support nurses who are scheduled to present at their professional organization conferences.

    • To support rehabilitation nurses in joining their professional organization, PSFHS hosted and presented an educational meeting in September 2011.  Peggy Plylar, MSN, RN, CNS, CRRN at PSFHS served as President for many years and is currently Past President of the Association of Rehabilitation Nurses, Central Colorado Chapter.  PSFHS hosted this meeting because of its potential importance to our nurses. The organization meets regularly in Denver, roughly seventy miles north of Colorado Springs, which limits our nursing participation. Due to our hosting of this introductory meeting, interest among other nurses has increased significantly. These meetings support networking amongst rehab nurses in Colorado Springs and Denver. PH 8 Inpatient Rehabilitation has increased certification from 35% to 44% in 2012.  ( SE2-4 )  ( SE2-5 ) 

    Benefits of Participation in Professional Nursing Organizations:

    Nurse involvement in professional nursing organizations and activities benefits PSFHS nurses and the nursing community through opportunities to:

    • Participate in current professional development courses and presentations 
    • Network with colleagues in the same specialty 
    • Develop relationships with nursing leaders in the community 
    • Share knowledge, seek innovative ideas, and learn about evidence based practices

    The following are examples of specific nurses within our organization, and the benefits which accompany their participation in these professional nursing affiliations:

    Faith Young, BSN, RN, CCRN, ICU is active in the local Critical Care Nursing Association organization. Her passion for excellence in nursing and commitment to professional development is evident as she creates a link between the professional organization and PSFHS. This relationship has resulted in co-hosting educational events for nurses in our state and community.

    Kate Peterson, BSN, RN, CCRN, Critical Care Unit has continued to expand her participation in the Colorado Nurse Association (CNA). Beginning in the Student Colorado Nurse Association, Kate joined the CNA immediately following graduation.  She began her nursing career at PSFHS as a new graduate nurse. Within a year, she accepted the editorial responsibilities for the district newsletter. Peterson writes and distributes the monthly newsletter to members of the CNA in our locale. Voicing her passion for nursing and recognizing generational differences, Kate has encouraged CNA to update and to utilize technology and has helped the CNA establish a presence on Facebook.  She has continued her participation in the district meetings as well as at the state level, with a particular focus on the retention of new graduate nurses. Kate has been a DNA 3 Convention Delegate. ( SE2-6 )

    JoAnn Pinto, MSN, RN, CAPA, SFMC Perioperative Services/PreOp is passionate about nurses participating in professional organizations. She sees membership in these affiliate groups as a hallmark of nursing professionalization and as a result she has advocated for the wider incorporation of our nurses in these societies. The following is a quote from Pinto regarding her views on the subject, "Seven of our nine RN's belong to the American Society of Perianesthesia Nursing (ASPAN).  All of us have recently completed the ASPAN orientation program/standards and have decided this will be a requirement for new RN hires.  We are purchasing the orientation program for our CNAs.  I am certified and have offered to coach any of our nurses in preparation for taking the Certified Ambulatory Perianesthesia Nurse (CAPA) examination.  Two registered nurses restarted the Rocky Mountain chapter of ASPAN (RMPANA) which meets monthly.  The nurses coordinate scheduling to support participation in the annual chapter meeting/education in Estes Park, CO."  (SE2-7 )

    Martha Brown, MS, RN, OCN, Head and Neck Nurse Navigator is particularly drawn to organizations that advance professionalization, continuing education, and a sense of unity. She is grateful for the opportunity to travel and present at conferences, and the support that she has received from PSFHS in doing so. The following is from a statement Brown made regarding her membership in professional nursing organizations:

    "For the last 25 years, I have worked with oncology patients.  During most of that time, I have belonged to the national Oncology Nursing Society (ONS) as well as to the local chapter of ONS. Membership in the national organization provides a professional framework for all oncology nurses.  The literature and emails help to keep me current on the latest treatments, new drugs in the pipeline, results of clinical research, management of symptoms, etc.  There is always encouragement to become certified in the field...OCN.  Membership in the local chapter is fabulous for networking, for camaraderie, support away from the workplace and for continuing education.  Pikes Peak ONS (PPONS) provides an educational meeting monthly, usually with a funded dinner.  Participating on the Board of PPONS is a way to give back.  I was President-elect for 2 years, President last year and am now the past-President.  As such, I try to share my enthusiasm for cancer nursing with others, mentor new nurses to our field, encourage nursing students to consider a career in cancer nursing and participate in a community event honoring cancer survivors.  It's a very rewarding experience.

    I applied and was awarded a $1000 scholarship from PPONS to attend the national ONS Congress in San Diego.  Going to meetings with 5,000 others who do what you do is definitely exciting!  Formally and informally we shared practice issues, patient stories and organizational supports from all over the world.  It made me feel that all of the hard work and heartache is worth it.  This year I did attended a pre-Congress workshop on Patient Navigation.  The timing was perfect as Penrose is developing the roles of Nurse Navigators as we speak.  In addition, I was able to purchase a "Virtual Congress" which will allow an unlimited number of PPONS nurses to view the educational sessions presented on their own time and get CEU's for participating."

    Sara Vigen, BSN, RN, OCN uses her membership with nursing orginizations for networking and to pursue innovative ways to incorporate evidence based practices into the workplace. As a member of the board of the ONS, she has direct insight into the effectiveness and benefits that professional association membership can bring. According to Vigen, "I belong to the Oncology Nursing Society.  In 2009 I was able to go to the ONS convention in San Antonio TX. It was a great experience and it was tremendous to be with thousands of nurses who love oncology nursing and are dedicated to making nursing a profession that is on top of the most recent developments, treatments, and evidence based practices.  I attend most of the local meetings (monthly) and area wide ONS events.  It's always positive for me to learn more about my profession. I realize nurses can really make a difference in our profession and improve the outcomes of our patients.  I am currently serving on the board of the ONS.   Our meetings are a good way to network with other Oncology Nurses in the Pikes Peak area and collaborate to develop more local education opportunities.  I love my oncology journals and read them or at least skim the articles every month.  I look for new ways - evidence based ways - to improve our nursing practice."

    Rachelle Fante RNC-OB is a frequent conference attendee. She uses her membership in professional associations to continue her professional education and how research findings can be integrated within our evolving medical practices. According to Fante, "I joined The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) in 2009 and since I have been selected by my unit to go to the national AWHONN conference in San Diego (paid by PSFHS). My obligation was to come back and give a formal presentation about something I learned.  Our Clinical Nurse Specialist helped me put the presentation together since that isn't something I do.  I had the best time at the national conference and I'm making plans to go to the one next year in Denver.  I loved the networking at the conference.  I also loved that what I heard there really reinforced all the changes we've been making at St. Francis during the past few years.  It felt good to know that we are on the right track.

    When I read the 2 monthly journals that I get from AWHONN I am able to see that our policies and practices come straight from national research.  For example, I've been hearing for a couple of years about 2nd stage management during labor.  Just a few months ago I was surfing around the AWHONN website and found that they are supporting an active research project titled Management of Women in the Second Stage of Labor.  I am anticipating the outcomes of this research and how we can use in our practice setting. It is awesome to see the links between research, practice guidelines and actual practice." ( SE2-8 )

    Candace Garko, MSN, RNC-OB is very involved in the aforementioned AWHONN. She has served in several leadership roles for the organization and she is appreciative of the support from PSFHS in allowing her to participate in these activities. Garko describes her experiences with the professional organization as such, "I have taught the intermediate and advanced fetal monitoring programs offered by AWHONN for the past 8 years. I was an editor for the 3rd edition of the intermediate course in 2005.  I was one of 6 authors of the on-line basic fetal monitoring course (EFM) that was released by AWHONN in 2007 .  Because I've taught the required fetal monitoring course through AWHONN and I have to hold membership, PSFHS has paid my membership dues for the past 4 years. PSFHS has also sent me to the national AWHONN conference twice so that I can continue to grow professionally and gather information to bring back and share with our nurses."

    PH 11 Medical/Oncology Unit Ben Barton, BSN, RN, OCN  is a member of the Oncology Nursing Society (ONS) who recently earned his certification as an Oncology Certified Nurse (OCN).  He states "an email was sent out to all ONS members who were also OCN prepared. This email was requesting participants for an OCN Passing Score Study. I submitted my application to take part in this study, and a month or so later, I learned that I had been selected to participate. The two-day meeting brought together 11 oncology nurses from around the country that had been selected from roughly 500 applicants. Led by a psychometrician from Pearson Vue, the group worked to arrive at the minimum passing score for the OCN exam. This score will be in place for the next 5 years of testing. It was a great opportunity, and an honor, to participate in a collaborative process with other RN's that helps the certification process which allows oncology RN's to demonstrate that they have exhibited significant proficiency in oncology nursing. It was a great learning experience and a privilege to contribute to the progression of oncology nursing."  ( SE2-9 )

    PH Emergency Department Clinical Manager encouraged ED nursing colleagues to participate in the Emergency Nurse Association (ENA).  He provided information, encouragement and collected applications to join ENA. ( SE2-10 )

    PSFHS Nursing Intranet provides easy access to links for professional nursing organizations, as well as process and forms to apply for funds for conference attendance.  ( SE2-11 )

    Outcomes:

    PSFHS nurses are active in professional nursing organizations. The table included in the Organizational Overview OO 7 demonstrates both participation and leadership in professional nursing organizations.

    Changes in Practice based on Participation in Professional Organizations:

    The following are examples of changes in regular nursing practices at PSFHS based upon data that participating nurses have gathered, analyzed, or interpreted as a direct result of their participation in professional nursing organizations. Each section is divided into their respective categories for ease of reading.

    SFMC Perioperative Unit Practice Council Accomplishments: FY2011 Annual Report

    • Revised fluid resuscitation formula for replacing preoperative/or fluids based on hours without fluids/food and specific surgery

    • Initiated "Bair Paws" (patient gowns with warmer capabilities) to improve normothermia during the perioperative process

    • Reduced nausea and vomiting through consistent screening and use of alcohol aromatherapy, fluid resuscitation, pressure points

    • Improved knowledge of anesthetic drugs and pain control options to optimize discharge

    Cancer Center  Use of the Neurotoxicity Assessment Tool in the Cancer Center

    • In the Cancer Center, nurses complete assessments with patients who have cancer, using a combination of questions, physical data, and self assessment instruments. Some patients may not report all symptoms during the discussion especially if not specifically identified by the nurse.  Neurotoxicity is often difficult to predict and may present late in the chemotherapy cycle. Symptoms may be quite debilitating, impacting the quality of life and they are difficult to quantify.

     • Martha Brown, MS, RN, OCN writes "During our local Oncology Nursing Society meetings we share ideas and best practices and include speakers to support our professional development.  One speaker brought in a Neurotoxicity Assessment Tool used by other organizations in the nation. The references for the tool highlighted tool validity.  I started using it with my patients on clinical trials and found it prompted a more thorough discussion between patients and physicians of this known side effect of some chemotherapies.  I brought the tool to our PSFHS Cancer Center nurses for discussion. We decided to use it in all of the out-patient settings where symptoms and side effects are discussed."

     • Allowing the patients to complete the neurotoxicity tool themselves has helped them to evaluate how the treatments are affecting their daily lives.  In turn, the information it provides enables clinicians to make better decisions about dose reductions and/or holding the offending drug until symptoms resolve, thereby avoiding permanent toxicity.  ( SE2-12 )

    Creating community connections for safe transitions of care for the geriatric population in Colorado Springs

    • Patient safety is a critical priority within the health care system. At the November 2011 DNA 3 meeting, Deb Center of the Colorado Center for Nursing Excellence presented on safe patient "hand-offs" both in and outside of home health care. Deb Center discussed her work with innovation in home health care as part of the project, Partners Investing in Nursing's Future Grant. Her findings highlighted the need for partnership and a collaborative approach. Unfortunately, information is often not shared or not shared well as patient's transition throughout the home health care continuum. Upon receiving a new admission, nurses often have to embark on a "fishing expedition" to obtain patient information. This lack of information translates into inadequate patient care and can place both the nurse and the patient in unsafe situations. Every transition of care is a high risk time for the patient. When information is not passed on to the next care provider during the transition, patient care is compromised. This translates to an increased risk of unnecessary early readmissions and poor patient outcomes. Today's home health care patient often presents with complex challenges. The incidence of chronic illness continues to increase and the patient often has multiple co-morbidities. A trend that is expected to continue is that home health care is expected to provide care for increasingly more acute patients. As part of the project, handoff checklists were created for patient transition from home health care to another health care setting as well on discharge to a physician office. The checklists were designed to reduce delays in care, avoid duplication of services and to ensure safe and effective transitions of care. The nurses attending were overwhelmed by the lack of mechanisms in place to safely transition patient's home health care continuum.

    • We recognize this as a system wide issue that has a dramatic impact on patient care and safety in our community. In November, DNA #3 created a task force with initial members Mary Wall, RN, Aimee Doman, RN, and Kate Peterson, RN with Deb Center, RN acting as a liaison from the Colorado Center for Nursing Excellence. The task force determined that a Safe Transitions summit would be the best method to invite all stakeholders in Colorado Springs to the table to develop solutions. Representative from acute care, long term care, assisted living, hospice, home health care as well as home care agencies were invited to the Summit to collaborate and design a an effective, efficient process to improve communication as patients are transferred among healthcare providers. 

    • The Safe Transitions Task Force had its first meeting January 18, 2012. The task force members expressed excitement to be part of a collaborative effort to address safe transitions in our community. The complexity of multidimensional aspects of care transitions was discussed and a priority was identified, "Creating community connections for safe transitions of care for the geriatric population in Colorado Springs." The elderly population was selected due to their vulnerability, demands upon the health care system, and their increasing numbers.  The Summit plans to provide education to promote a better understanding of the different care settings, act as a foundation for building community connections and focus on process change.  On April 5, 2013 the Task Force is holding a Safe Transitions Summit to improve patient care and safety in Colorado Springs. 

    • Members of the task force include:

    o Kate Peterson, BSN, RN, DNA #3, Penrose-St. Francis Health Services 
    o Aimee Doman, BSN, RN, DNA #3, Penrose-St. Francis Health Services 
    o Geri Caldwell, RN, DNA #3, Penrose-St. Francis Health Services 
    o Richard Thomas, M.D., Colorado Springs Health Partners 
    o Mary Wall, RN, DNA#3 
    o Deb Center, RN, Colorado Center for Nursing Excellence 
    o Sonya Neumann, Gentiva Home Health 
    o Sharon Seaton, Odyssey Hospice 
    o Michelle Smith, MSN, RN, Chief Nursing Officer, Memorial Health System 
    o Dave Stannard, Odyssey Hospice 
    o Amanda McGee, RN, Director of Nursing, Liberty Manor 
    o Nancy Smith, MSN, RN, Dean of Beth-El College of Nursing/Health Sciences 
    o Deb Savage, Comfort Keepers 
    o Andy Harris, BEO

    Summary:

    PSFHS nurses from all settings and specialties participate in professional nursing organizations.  As the above evidence notes, our nurses have identified the benefits of education, making changes, and improvements in their practice.  These improvements are visible in a number of ways; hosting meetings onsite, giving advice on the development of a clinical advancement program, or by sending nurses to conferences, PSFHS enables nurses to participate in a wide variety of organizations.  Most importantly, the ideas and passions brought into our organization from these nurses are implemented, and the professional practice of nursing is thereby elevated and outcomes are improved.

  • Structural Empowerment - SE02EO

    Professional Engagement

    SE 2 EO: Two improvements in different practice settings that occurred because of nurse involvement in nursing organizations.

    Background/Purpose:

    In September 2011, four Mother/Baby nurses attended the 14th National Mother Baby Nurses Conference. As per unit policy, nurses who attend the conference come back to the unit and teach what they learned to their peers. The nurses who attended "From Infant Mortality Review to Human Simulation: What's the Connection?" taught by Cheryl Bodamer PhD, MPH, RN and "Postpartum Emergencies" by Mary Ellen Burke Sosa RN-OB, MS identified a need for postpartum hemorrhage simulation at St Francis Medical Center. Postpartum hemorrhage is the leading cause of maternal mortality (7 to 10 out of 100,000 live births in the United States). 

    Methods and Approaches:

    These four nurses decided to teach a unit in-service on postpartum hemorrhage and discuss simulation. As part of the course, there was a discussion about simulation among staff.  Interested staff members were encouraged to start a committee to look at the current process of response to a postpartum hemorrhage, how to improve that response, and how to teach staff.

    A nursing committee of direct care nurses formed (dubbed the "Code White Committee") and began by identifying gaps in our current process and staff knowledge base. The nursing unit educator provided her expertise to the committee. Postpartum hemorrhages are not commonplace on our unit and we have many new staff members. Our goal was to enhance staff knowledge, skills, and competence related to postpartum hemorrhage. The goal of education and skill competence is to improve practice and patient outcomes in a postpartum hemorrhage. ( SE2EO-1 , SE2EO-2 )

    The Committee's Actions

    • Reviewed Code White Policy 
    • Created a postpartum hemorrhage "tackle" box that includes supplies needed during a Code White 
           o Obtained additional supplies from Central Supply for the Code White "tackle" box 
    • Created a list of medications that may be used during a postpartum hemorrhage emergency, including the dosage and routes of administration ( SE2EO-3 ) 
    • In collaboration with a Labor and Delivery Surgical Tech, the sterile postpartum hemorrhage kit was opened and labeled with instrument names and descriptions.  
    • Designed a Suspected Postpartum Hemorrhage flow chart identifying practice steps when excess bleeding is identified ( SE2EO-4 ) 
    • Posted flow chart throughout the unit 
    • Produced a poster with pictures of possible postpartum hemorrhage medications and the suspected postpartum hemorrhage flow chart 
    • Collaborated with pharmacy on use of postpartum hemorrhage kit in the PYXIS   
    • Reviewed order set with obstetricians on our unit

    Education Plan and Implementation

    • Demonstrated tackle box and sterile pack at monthly staff meeting 
    • Reviewed poster and flow chart in staff meeting 
    • Decided to include Code White process in annual competency skills review 
           o Designed a simulation game, "Guess the weight" of a hemorrhage to remind staff of the importance of accurate weight

    Sustaining Competent Practice

    • Identified Code White champions 
    • Designed Code White Drills and peer evaluation process

    Participants:

    Laurie Chromy RNC-MNN 
    Jenn Ury, RN 
    Tami Jefferis, RNC 
    Amy Goss, RN 
    Brenda Kelemen, BSN, RNC-MNN 
    Kathleen Radetsky, BSN, RNC 
    Lou Ann Cox, BSN, RNC-MNN 
    Nancy Marts, RN 
    Stephanie Weisburg, BSN, RN 
    Calvin Eisenach, Pharmacist 
    Central Supply 
    All nursing associates on Mom Baby Unit

    Outcomes:

    The SFMC Post Partum Mom Baby Unit direct care nurses used their new knowledge acquired through participation in their professional organization conference to improve nursing practice in a Code White (Post Partum Hemorrhage event). Through a review of the policy and discussions with their colleagues they identified the need to make changes to improve access to necessary supplies, designed a flow chart to improve efficient and effective communication, as well as collaborating with obstetrics, the pharmacy, and central supply in making changes. Finally, the Code White Committee implemented ongoing monitoring of process through a Code White Drill with Peer Review resulting in demonstrated practice improvements. ( SE2EO-5 , SE2EO-6 )

     In the context of this low volume but life threatening event, we do not have data on mortality pre and post practice improvement. The outcome is demonstrated staff competence and an improved structure and process to respond to post partum hemorrhage. 
    Implications:

    The nursing staff on the Mom Baby Unit learned the importance of identifying areas of needed education, designing education based on evidence from participation in professional nursing organizations, and following through to learn and practice those skills. Direct care nursing leadership of this project not only improves patient care but empowers direct care nurses to continue to advance their professional nursing practice. In addition, the nurses realized and acted upon the benefits of participating in a professional nursing organization.


    SE 2 EO: Two improvements in different practice settings that occurred because of nurse involvement in nursing organizations.

    2. Perioperative Evidence Based Residency Program for  the Intra Operative Professional based on the Association of Perioperative Registered Nurses (AORN) PeriOp 101Online Modules

    Background/Purpose:

    In 2010 and 2011, Centura Health staff development and perioperative educators had met sporadically to evaluate current orientation and to discuss vacancy, recruitment, and competency issues. The group reviewed current literature with a primary focus on the position, evidence, and resources available through the Association of Perioperative Registered Nurses (AORN).  Across Centura Health and within PSFHS, the average age of the perioperative nurse was increasing and recruitment of experienced applicants was not successful. In addition, Centura Health Talent Management program challenged us to develop and promote from within when possible. The goal of this project was to reduce OR nurse vacancies.

    Methods/Approach:

    PeriOp 101 was developed by AORN and is based on AORN's standards and recommended practices. The Centura Health PeriOp Nurse Educators adopted content provided by AORN to create an eight week residency program consisting of didactic sessions, clinical practicum, and online instructional modules complete with exams. The didactic portion was developed and is taught by the Centura Health PeriOp Educators, company representatives, and guest speakers. The clinical practicum is held in the associate's respective hospital with designated preceptors to provide oversight and teaching. The online modules are provided by AORN and are available to the students via our internal learning website (LEARN via Health Stream). At the completion of the program, the student must pass a comprehensive final exam before beginning their department orientation. The educators have pooled their resources, share content and tools, and work together to give the students an interesting, informative and thorough learning experience. ( SE2EO-7 , SE2EO-8 )

    Application - the Selection Process

    1. Initial contact with applicants is either through referral, or via hospital recruiter 
    2. The PSFHS PeriOp educator screens the applicant through a phone interview, asking about their expressed interest, and providing initial information on job requirements and the training program 
    3. If the applicant passes the screening, they are invited to a day of OR observation, which provides them a first-hand look at surgical nursing 
    4. They are required to write a letter of intent, explaining what they gained from the observation experience, their understanding of the desired job, and why they consider themselves a "good fit" for perioperative nursing 
    5. If accepted, applicants participate in a formal group interview with the following associates: 
            • Members of surgery leadership team 
            • Direct care surgical nurses 
            • PeriOp nurse educator 
            • Member of the current PeriOp program 
    During the interview, applicants are assessed on their problem-solving skills, prioritization abilities, coping mechanisms for stress, potential needs and overall desire to be a part of the perioperative team. Applicants have an opportunity to ask about the job requirements and training program 
    6. The interview team accepts, rejects, or offers a second interview

    Open spaces are limited and determined by staffing needs, ability of preceptors to accommodate the students, and the education program's ability to provide adequate oversight. ( SE2EO-9 )

    The first cohort was offered in Denver and was composed of 10 students. Four nurses in Cohort One came from PSFHS; one external nurse, one nurse from PACU, and two UCCS Beth-El Scholars (The Beth-El Scholars receive scholarships for nursing school in return for a commitment to work at PSFHS). PeriOp 101 - Cohort One was 10 weeks. On some of the scheduled days content did not warrant a full day of teaching and the nurses in training requested increased hands on experience in the OR. The schedule for Cohort 2 was rearranged to address both issues.

    PSFHS hosted the second cohort for PeriOp 101 Residency Program. PSFHS enrolled two new graduate nurses and two experienced medical-surgical nurses.  ( SE2EO-10 )

    After completion of the program, PSFHS nurses complete a 10-12 week department rotation dedicated to learning the different procedures in each service line. Then nurses in training complete a 6 week day shift rotation functioning independently as the primary circulator. These new surgical nurses are supported and their skills evaluated by the multiple resources available on the day shift. Following successful completion of the Residency Program, department rotation and day shift rotation, nurses are then assigned to their working shift as competent perioperative nurses. The residency process takes approximately 6 months.

    Participants: 

    Centura Health Educators 
    Noreen Bernard, MSN, RN, NEA-BC, Centura Health Director of Professional Development 
    Cindy Caton, BSN, RN, CNOR, PSFHS Educator 
    Kristin Varnes, MSN, RN, Director of Penrose PeriOp Services 
    Kelly Ledbetter, BSN, RN, Director of SFMC PeriOp Services 
    Human Resources 
    Nurse Recruiter 
    Manuel PazSoldan PSFHS RN Preceptor 
    Carly Chapman PSFHS RN Preceptor 
    Donna McGee PSFHS RN Preceptor 
    Belinda Russell PSFHS RN Preceptor 
    Esther Keeports PSFHS RN Preceptor 
    Ruby Hernandez PSFHS RN Preceptor 
    Diane Huth PSFHS RN Preceptor 
    Charlene Lancaster PSFHS RN Preceptor 
    Bruce Gorski PSFHS RN Preceptor 
    Vicky Addison PSFHS RN Preceptor 
    Jaime Carlstedt PSFHS RN Preceptor 
    Josie Rucci-Kelly PSFHS RN Preceptor 
    Jeff Matthews RN Staff Class Teacher 
    Ron Allen RN Staff Class Teacher 
    Lynn Otte RN Staff Class Teacher 
    Daniel Blackwell RN Staff Class Teacher 
    Barb Heath RN Staff Class Teacher 
    Loretta Halliday RN Staff Class Teacher 
    Allison Gammon RN Staff Class Teacher 
    Melissa Garcia RN Staff Class Teacher 
    All OR nursing staff 
    Surgeons 
    Anesthesiologists 
     

    PSFHS Outcomes:

    Prior to PeriOp 101, PSFHS had 27 RN vacancies in the OR with 60% of these vacant for six or more months. One year after implementing PeriOp 101, we have 5 vacancies.  This represents an 82% reduction in vacancies following program implementation. 

    The initial outcome is positive. Staff and physicians have embraced the new nurses and they are functioning independently. We will continue to evaluate the program through training completion and retention of our new surgical nurses. Our long term plan is to measure retention at 6 months, 12 months, 18 months, and 2 years. In addition, PeriOp Residency Program is a program offered in multiple locations in Centura Health and we will be able to compare retention across our system. 

    Implications for Practice:

    Nurse participation in AORN and our challenges with surgery registered nurse recruitment led to the implementation of the PeriOp 101 Residency Program. This program provided an effective learning structure and process for new surgical nurses.  In the context of limited surgical exposure for students in nursing school, a professional organization tested and proven residency program provides an effective way to recruit nurses to the surgical suites.

  • Structural Empowerment - SE03

    Commitment to Professional Development

    SE 3 How the organization sets expectations and supports nurses at all levels who seek additional formal nursing education (e.g. baccalaureate, master's, doctoral degrees).

    Educational Expectations of Nursing Leadership:

    Kate McCord, MSN, RN, NEA-BC, CNO (2005-2012) supported the goals of the IOM Future of Nursing Report (2010), with her clearly stated expectation that all nurse managers will have at least a BSN and that nursing directors will pursue and complete a MSN.  By working towards a PhD in Bioethics, McCord led by example and demonstrated that PSFHS Nursing Services is committed to the standards of continuing education and professional development. We recognize that professional development is one factor in creating positive patient outcomes; and that a commitment to lifelong learning is crucially important in that development. (SE3-1 , SE3 - 2 ) This section will demonstrate our organization's expectations and support structures that are at the crux of our pursuit of additional education.

    Structures Associated with Expectations:

    Position Descriptions PSFHS nursing position descriptions include specific requirements for education or professional certification and all require professional development. The Chief Nursing Officer position requires a master's degree in nursing or if related a field, a bachelor degree in nursing. Directors of Nursing and VP of Nursing positions require a bachelor degree in nursing and master's degree in related field. Our Clinical Managers are expected to have a Bachelor in Nursing.  In the past several managers were hired without a BSN but with the stated goal to earn a BSN. With support through tuition reimbursement and flexible scheduling these managers are completing their BSN. As of January 2013, only one non-BSN nursing manager remains and he will complete his BSN in May 2013.

    This educational expectation was met with a certain degree of trepidation among Clinical Managers without a BSN. Through the support of the organization's administration, nursing leaders, and individuals' own tenacity, the pursuit of furthering one's education has become enjoyable:

    Lenora Kraft RN, Clinical Nurse Manager stated "I enrolled in a BSN program when Kate stated her expectation. I had been thinking about returning to school but it is a lot of money and takes time. I searched for online options, talking with nurses who were in school as well as colleagues who already had a BSN or MSN degree.  Now I love it. I am constantly challenged and learning. My class comes from across the country and as we talk online and share our perspectives, I grow - professionally and personally. I share articles of interest with my colleagues at work and encourage them to continue to grow too"  (Kraft earned her BSN in 2012)

    Shared Decision Making Council Structure The Nursing Professional Development Council promotes continuing formal education, certification and professional development.  The goal set by this council for FY2011 was to increase the BSN rate of direct care nurses by 1%. The council in collaboration with the Education Department and with Centura Health promote and support education through a variety of strategies including Education Fairs, discounts, and tuition reimbursement. Reviewing the IOM Future of Nursing Report and Recommendations, as well as recent research, on the impact of higher education in healthcare, council representatives have met with senior nursing leaders and reprsentatives from schools of nursing to identify actions to increase BSN rates. (SE3-3 )

    The Professional Development Council recommended a change in hiring to include establishing a contract with any nurse hired without a BSN to enroll in a BSN program within two years and complete within five years. ( SE3-4 ) Nursing Leadership supported the recommendation and Human Resources is working with the legal department to establish a contract and process for implementation.

    Nursing Orientation During Nursing Orientation, the Magnet Coordinator introduces new associates to the Magnet Journey and the Professional Practice Model.  During this discussion, one consistent question is "Do we have to get a BSN to work here?" This question is answered by referring to our Professional Practice Model, which identifies the expectation of professional development which includes formal education, certification, or continuing education activities. In addition, orientation includes references to current evidence that indicates positive impact of advanced formal education on clinical outcomes and a brief review of IOM Future of Nursing Recommendations.

    Performance Feedback and Development Discussion between managers and associates during annual performance appraisals include setting professional goals such as achieving nurse specialty certification and increasing formal education. April McPike, RN shares her story.  "I am back in school. It was always my goal since graduating with my associates degree 18 years ago to go back for my BSN.  In April 2008 I became the Clinical Coordinator for Labor and Delivery.  The Clinical Manager was a great mentor as she questioned me about returning to school and made comments about classes she was taking for her BSN. Our Clinical Nurse Specialist encouraged me and my career path seemed inevitable.  With tuition reimbursement and the flexible schedule my manager approved I returned to school.  I love it! I know I will be able to complete one of my goals.  I am so thankful to everyone for helping me take this step."  (2010)  Addendum: April accepted an interim and then permanent position as Clinical Manager of Neonatal Intensive Care Unit as she completed her BSN and in 2012 enrolled in a MSN program.

    Supports for Nurses who Seek Additional Formal Education:

    Clinical Advancement Program (CAP) When we designed the Clinical Advancement Program (CAP) we took the opportunity to include recognition (points) for formal education at a BSN and above.  In our first year, eighty-six percent (86%) of the applicants received points for education levels. In addition one nurse received points for completion of college classes. In CAP 2011,  92%  applicants received points for formal education. The PSFHS Clinical Advancement Program recognizes a BSN, MSN or doctoral degree with points toward advancement.   In addition, the CAP requires a BSN for higher levels of recognition. (SE3-5 )

    Financial Support Nurses are supported to return to school utilizing Human Resource's policies for tuition reimbursement and access to PSFHS' own library resources. PSFHS provided over $300,000 in tuition reimbursement in FY2010 and over $400,000 in FY2011.  ( SE3-6 )

    Centura Health has established discount tuition with schools of nursing. The Centura Professional Development Council (two PSFHS nurses are members) makes recommendations on schools to Human Resources who negotiate rate reductions and additional assistance. Our intranet system provides a quick resource for information on partnered schools. ( SE3-7 )

    Scheduling Options The Float Pool was introduced to provide flexibility in departments with regular patient or employee flux. With regards to educational programs, this staffing tool is helpful as it allows associates to pursue courses that may otherwise conflict with their demanding work schedules. Weekend staffing options are available for nurses returning to school when that schedule meets the unit's staffing and scheduling needs.

    Education Department Support The Educational Resources Department, managed and staffed by registered nurses, provides support for all associates seeking to increase their formal education.  Kim Shockley, RN, in the education department provides callers information on accessing colleges and tuition reimbursement. In addition, PSFHS hosts educational seminars which promote direct communication between our associates and colleges. ( SE3-8 )

    Partnerships with Schools of Nursing As an organization committed to our community, we continue to employ nurses from the local community college program.  During orientation every nurse is informed of the expectation of ongoing learning including formal education and certification.  This expectation is based on the ANA Nursing Standards and the responsibilities of a professional for which PSFHS nurses are accountable. In addition the Chief Nursing Officer met with the Dean's of the BSN and the ASN nursing programs to support their collaboration to improve transitions from the ASN to the BSN program. The University of Colorado at Colorado Springs (UCCS) and Pikes Peak Community College Schools of Nursing have established a "dual enrollment" program to ease the transition from ASN to BSN.

    Recognition across the PSFHS is provided to those associates who are pursuing higher education through a section in our monthly nursing newsletter entitled, "Moving Forward." This segment announces when a nurse achieves advanced degrees. In addition, in the fall of 2010, the Nursing Professional Development Council initiated name badges that reflects the achievement of BSN or higher for all nurses. ( SE3-9 )

    Preceptor and Mentors Nurses returning to school for advancing their formal education often seek mentors or preceptors in their workplace.  The Education Department coordinates these assignments though often "word of mouth" connects nurses in school with potential mentors and preceptors.  Our goal is to support the nurses learning through meaningful connections based on nurse interests and professional development goals and credentialed, available staff.  The table below demonstrates PSFHS support for nurses advancing their education during CAPSTONE or Master's degree experiences. 

      Capstone/MSN Students 2012 

      Placement   Mentor
      Audrey Simpson, RN   Administration   Kate McCord, CNO
      Robin Tillman, RN   Leadership   Deb Nussdorfer, Magnet Coordinator
      Colleen Eisman, RN   Education   Diana Patterson, Education
      Roni Ferrenberg, RN   Leadership   Pam Assid, Clinical Manager
      Rose Ann Moore, RN   Quality   Kelli Saucerman, Director of Clinical Effectiveness
      Rhoda Santos, RN   BSN-RN   Olinda Spitzer, Clinical Nurse Specalist
      Alexandra Hale, RN   Administration     Kate McCord, CNO
      Rachel Hogan, RN   Administration    Ann Kjosa, CNO; Pam Assid, Clinical Manager

    Summary:

    Formal structures including position descriptions, nursing councils and annual performance appraisals set expectations for all nurses to seek additional formal nursing education.   Tuition reimbursement, mentoring, unit cultures/peer support, recognition, flexible scheduling, and facilitating access to colleges and other resources reflect our process to support nurses who seek additional education.  While we are proud of achieving our goals, we recognize the opportunity to expand our growth as we move towards achieving the IOM Future of Nursing goals.  Nursing colleagues and peers are increasingly taking the lead to challenge, encourage and support peers with educational goals, reflecting the change in our culture. A nurse in the Critical Care Unit at Penrose writes::

    "We are all very excited and well into our third week back to school.  As far as the list I know that Turner, Tillman, Smith, Prantl, Francis and I are all going for our BSN as well as Isela Lerma, RN-ICU at SFMC.  We all felt that it was finally time and it is fantastic that we all work so well together in the ICU and we can work through school together too.  We are all at differently time frames when it comes to how long everyone has been out of school or working as a nurse.  We can keep each other accountable for getting through this!"  Davi Ann Howard, RN (January 2011)

  • Structural Empowerment - SE03EO

    Commitment to Professional Development

    SE 3 EO Describe and demonstrate that the organization has met goals for improvement in formal education.  Graphically summarize at least 2 years of data to display changes over time.

    Background:

    PSFHS' nursing associates are committed to evidence based practice including taking actions to encourage lifelong learning and increasing our percentage of direct care nurses with a BSN or higher educational level. Nursing research and "The Future of Nursing Report" both state that higher levels of education and higher percentages of direct care nurses with a BSN/MSN/DNP positively impact patient outcomes. 

    Methods/Approaches:

    The Professional Development Council (PDC) sets goals for each fiscal year. For FY2011, they met and developed many of the following methodological approaches.

    1. The PDC set the goal to increase by 1% the number of direct care nurses with a BSN or higher in FY2011. Our Nursing Leader decision to seek Magnet Recognition provided a second goal. By January 1, 2011 75% Nurse Managers must have at least a baccalaureate or master's degree in nursing.

    2. We encourage and promote higher education through multiple actions including: 
    • Tuition Reimbursement 
    • Scholarships (Beth-El Clinical Scholars, Healing Ministry Scholarships) 
    • Flexible scheduling 
    • Position Descriptions and requirements for advancement 
    • Career Counseling through Education Resources 
    • Peer Support

    3. In addition, the criteria designed in the Clinical Advancement Program (CAP) provided incentives and rewards for earning a BSN (or higher) degree. Direct care nurses had requested compensation for earning a BSN and the CAP Peer Review Board included an option to earn points toward a CAP reward for the completion of additional education.  

    4. The PDC asked Education Resources to resume "Education Fairs," which had provided opportunities for associates to meet with various representatives from colleges, schools and universities.

    5. During Fall Education Days 2010, the PDC held a Booth Fair. One booth was entitled "So You Want to Go Back to School?" This venue provided easy access and dialogue about options for returning to school and strategies to manage academic challenges.

    6. In FY2011, Human Resources negotiated discount rates with a variety of local colleges and universities to improve the affordability of formal education for our associates.

    7. Recognition of nurses in school and completing degrees was highlighted in the nursing newsletter, TLC.

    8. Peer support has also been a force for returning to school.  A group of nurses in Penrose Intensive Care are in school together!

    Participants: 

    Professional Development Council 
    • Candace Garko, RNC, MSN, CNS, Birth Center 
    • Rochelle Salmore, MSN, NE-BC Clinical Manager 
    • Debra Nussdorfer, MSN, RN, PMSHCNS-BC Magnet 
    • Diana Patterson BSN, RN, Educator 
    • Lynne Wahl MSN, APRN-BC 
    • Deb Kenny PhD, RN, FAAN, University of Colorado 
    • Olinda Spitzer, MSN, CNS, CCRN, ICU Educator 
    • Bonnie King BSN, RN, Trauma 
    • Lou Ann Cox RN, Mom/Baby Educator 
    • Judy De Groot MSN, RN, AOCN, Lead Navigator

    Nursing Senior Leadership 
    • Rose Ann Moore, MSN, RN, NE-BC, Director of Patient Care Services at Penrose 
    • Kathy Guy, MHA, BSN, RN, NE-BC, Director of Professional Development Council 
    • Kate McCord, MSN, RN, NEA-BC, Chief Nursing Officer

    PSFHS Education Department 
    • Sylvia Kurko, BSN, MBA, Education Coordinator 
    • Kim Shockley, BSN, RN, Education 
    • Diana Patterson, MA, BSN, RN, Education 
    • Patricia Spoerl, BSN, RN, Education

    Clinical Advancement Program Peer Review Board 
    • Cassie Tumanis, BSN, RB, CEN, PCCN 
    • Deb Nussdorfer, MSN, RN, NE-BC 
    • Nancy Steele, BSN, RNC-OB 
    • Vicki Raub, BSN, RNC-OB 
    • Debbie Avery, BA, ASN, RN, CEN 
    • Sara Vigen, BSN, RN, OCN 
    • Wendy Lowery, BSN, RN

    Outcomes:

    PSFHS nursing has met the FY2011 goals for formal education set by the Nursing Leadership and by the Nursing Professional Development Council. 

    1. The Professional Development Council set a FY2011 goal to increase by 1% the number of for direct care nurses to be BSN or higher.  At the end of FY2010, we had 47.7% BSN or higher direct care nurses. By the end of FY2011, we had 51.2% BSN or higher direct care nurses. 

    During one year, we exceeded our goal of a 1% increase and demonstrated a 3.5% increase.

      

    Our Professional Practice Model guides our nursing practice and it includes a focus on evidence based practices and a provision of excellent patient care.  Increasing our percentage of direct care nurses with a BSN or higher is one strategy aimed to support this goal.  We have continued to increase the percent of nurses with a BSN or higher degree.  Our target goal for FY2013 is 53.6%.

    2. Our nursing leadership's decision to seek Magnet Recognition provides a second goal.   By January 1, 2011, 75% Nurse Managers must have at least a baccalaureate or master's degree in nursing. Organizations applying January 1, 2013 100% Nurse Managers must have at least a baccalaureate or master's degree in nursing. We have exceeded the goal of 75% and increased to 100% in 2012.

      
    Implications:

    Established research in nursing literature makes a clear argument that the higher percentage of direct care nurses with a BSN (or higher) positively impacts patient outcomes.  In addition, the IOM Future of Nursing report recommends that we increase the proportion of nurses with a baccalaureate to 80% by 2020 and double the number of nurses with a doctorate by 2010. We are clearly on the path to increase the level of formal education of our nurses and we continue to set goals regarding increases in education and certification.

  • Structural Empowerment - SE04

    Commitment to Professional Development

    SE 4 How the organization sets goals and supports professional development and professional certification, such as tuition/registration reimbursement, and participation in external conferences.

    Standard 8: The registered nurse attains knowledge and competency that reflects current nursing practice. ( ANA Standards of Professional Performance , 2004)

    Our professional nursing discipline sets the expectation and accountability for competence which can only be achieved through ongoing education, professional development and experience. PSFHS selected two nursing theorists to guide our development and practice: Patricia Benner and Florence Nightingale. Both of these nurses speak to the essential training, education, and ongoing learning required for professional nurses.

    Shared Decision Making Nursing Councils:

    The Nursing Professional Development Council's purpose is "To advance clinical practice of all healthcare providers through the use of research, education, collaboration and mentoring of evidenced based practice resulting in improved patient outcomes".  We demonstrate our organizational commitment by establishing a council focused on setting goals and supporting professional development and professional certification. This council includes representation from multiple levels of nursing with strong support from our advance practice nurses, clinical nurse specialists and educators. 

     The Professional Development Council Functions are:

    • Assess educational needs of nurses 
    • Promote professional development through education 
    • Promote certification 
    • Develop programs for education 
    • Monitor orientation process 
    • Research and improve relationships with Schools of Nursing

    Position Descriptions:

    Position descriptions set expectations for educational and certification credentials which encourages our associates who strive for different positions to seek appropriate education and certification. The RN Nurse Navigator and the Clinical Nurse Specialist job descriptions indicate certification requirements and preferences.

    Policies:

    Certification Pay is intended to recognize associates who have achieved certification (unless certification is a requirement for the position) form a nationally recognized professional association identified by Centura Health. This pay is intended to recognize the advanced knowledge that certification represents. ( SE4-1 ) 

    Certification Policy Many of our infusion nurses transferred from the oncology inpatient unit.  These nurses had earned oncology nurse specialty certification and were surprised to find they would not be eligible for certification pay once they were clinically eligible for infusion nurse certification. Coached and supported by several nurse leaders the infusion nurses drafted a proposal to revise the current policy. They demonstrated the number of oncology patients they serve remains high.  A comparison of the two different certification topical areas supported their request to receive certification pay for the oncology certification. The nursing Professional Development Council supported their proposal, Nursing Leadership Council approved and the CNO provided final approval. 

    Performance Feedback and Development process includes a review of continuing education. Many nursing unit require specific annual continuing education to promote current competent practice on the unit in addition to demonstrating competency skills. The PFD process includes individual associate identification of a professional development goal.  

    Resources:

    Clinical Expert Resources for Professional Development and CertificationPSFHS employs clinical nurse specialists and nurse educators to provide education, promote professional development and certification, and evaluate education effectiveness on assigned units. The Department of Education, coordinated by Sylvia Kurko MBA, BSN, RN coordinates nursing orientation, student placements throughout the hospital, mandatory online learning and professional development opportunities.  Providing continuing education contact hours promotes participation in education and supports requirements for recertification. The education department coordinates requirements and provides approval for contact hours.

    Clinical Nurse Specialists are employed and promote professional development through informal mentoring, coaching and formal educational presentations in the following areas:

    • Palliative Care 
    • Pain Management 
    • Critical Care, Medical-Surgical, Oncology, Cardiovascular and Orthopedic  Nursing 
    • In addition, we are recruiting a Clinical Nurse Specialist in Emergency Nursing

    The Post Partum/Mom Baby Unit and Penrose Surgical Services have selected expert direct care nurses to assess and meet educational needs in these two services.

    Nurses Week and Nurse Educational Days Educational offerings are traditionally provided during these annual events. Internal and external speakers present on topics requested by nurses or identified by work groups for each of these events to meet professional development needs. CE's are provided for most classes. ( SE4-2 )

    Financial Support:

    Reimbursement for certification preparation classes and successful completion of the certification exam are available.  Reimbursement for professional conference participation is also available.  During the recent three years we have piloted and revised the process for this financial support.   In 2010 we initiated reimbursement for certification exam. In 2011 and 2012 we have expanded the reimbursement for the preparation classes. The exam is reimbursed through Human Resources/Education Department and the preparation class was reimbursed through Nursing Administration.  ( SE4-3 )

    In 2012 we implemented an Education Approval Committee for nursing conferences and professional development, excluding formal education, which is reimbursed through a specific tuition process. The Education Approval Committee is in process of determining a FY2014 Budget request to support Vascular Access. (SE4-4 )

    Recognition:

    The Chief Nursing Officer is always proud and eager to congratulate our nurses who achieve certification.  Each nurse receives a personal email from Kate McCord,

    From: Assid, Pamela A (ED Clinical Manager)       Sent: January 19, 2011 
    To: All Emergency Department Staff, PSFHS Nursing Leaders, CNO 
    Congratulations Felicity!! Please join me in congratulating Felicity on passing her CEN!   The Certified Emergency Nurse designation indicates achievement of clinical expertise in emergency nursing.  Patients like it because certification assures them that nurses are current, competent and responsible which strengthens their belief in the nurse's ability and the institution's credibility.  Way to go Felicity!  We are proud of you!

    From: McCord, Kate Chief Nursing Officer.  Felicity---congratulations!    I am always pleased whenever someone gets certified.   I appreciate your commitment to improving the care you deliver to our patients!!

    TLC the monthly nursing newsletter includes a section called "Moving Forward" to showcase our newly certified nurses.  ( SE4-5 )

    Nursing Annual Report The 2011 Nursing Annual Report highlighted with graphs and photos the increase in nursing certification from 18.7% to 23.1%. In addition, each annual report lists the names of all nurses who have earned certification. (SE4-6 )

    The PSFHS Clinical Advancement Program (CAP) rewards professional practice demonstrated through continuing education, formal education, certification, community service, participation and leadership in quality/performance improvement, nursing research, implementation of evidence based practices, patient and colleague teaching, participation in shared decision making structures, and positive standards of behaviors. Each applicant is evaluated through a peer review process first on their unit and then by the CAP Peer Review Board. Eighty to ninety percent of the CAP applicants submit proof of completion of professional development courses/classes.

    Exemplars:

    Individual unit cultures have expanded to focus on professionalism, quality indicators, evidence based practices, education and certification. Supported and encouraged by clinical managers, the direct care nurses are setting up study groups, sharing materials to prepare for certification, attending certification preparation classes and partnering with clinical nurse specialists and physicians as they expand their knowledge and skills.

    SMFC GI Endoscopy Lab Story 

    "Certification for me has always been a natural progression of attaining education to validate knowledge and competency.  The nurses researched and studied the Core Curriculum for GI Nursing and Practice Guidelines from our professional organization.  We  joined Society of Gastroenterology Nurses Association (SGNA) and attended the Rocky Mountain SGNA conferences.  Our goal was to attain CGRN certification. Janet Laird came on board with us in January; she was a natural fit with her quest for knowledge and her personal goal to become CCRN certified which she achieved in March 2011.  During her interviews she asked me  " was I certified?".  I proudly told her that I maintain my CAPA certification as it is still my practice area and many of our cases involve anesthesia as well as both Phase 1 and Phase 2 Post-anesthesia Care.  Janet told me that she too would like to seek CGRN certification. It is awesome that we have a manager that is certified and that recognizes and supports all nurses to become certified."              Victoria Jack-Blue RN, BSN, CAPA, CGRN

    SFMC Emergency Services

    From: Assid, Pamela A (Clinical Manager)    Sent: October 07, 2010 
    To: ED Nurses, ED Physicians, Nursing Directors    Subject: Congratulations to Alese! 
    Alese Bagby, RN, CEN, took her Certified Pediatric Emergency Nurse (CPEN) test today and passed with flying colors!  She is the second ED nurse at PSF to have taken and passed this rigorous exam.  Please congratulate her when you see her!   The CPEN was created to recognize ED nurses who exemplify particular expertise, knowledge, and skills for pediatric patients.  Although pediatric patients comprise about 20% of all ED visits (averaged nationally), fewer than 6% of EDs are actually equipped with proper supplies and knowledgeable staff to care for the specific population (abstracted from AAP's joint policy statement, Guidelines for Care of Children in the ED, Oct 09).  To attain the CPEN shows excellence with pediatric patients (who comprise 30-35% of our specific patient population) and is especially meaningful since there are only 1,000 CPENs in the nation!   Congratulations, Alese!

    When Bagby was asked why she chose to do this she responded: 

    "I chose to take this exam because I have been an ENPC (Emergency Nurse Pediatric Course) instructor for 12 years, and I have also taught TNCC (Trauma Nurse Core Course) for that length of time.  I have had my CEN for about 16 years.  So when this new certification came out last year I was curious what the test was like.  Pam, our manager, took this exam this past spring and encouraged me to take it as well.  Every time I have taken the CEN exam, I have been amazed at all the things I have learned.  I strongly believe nursing certification for any specialty increases the level of excellence we can provide to our patients in the way of patient care.  Since I already have my CEN, I paid for this exam myself, and I realize am not going to receive any further hourly wage benefit.  I did this to satisfy my own curiosity, for personal satisfaction, to benefit my patients, and hopefully to provide encouragement to other RNs in our department to pursue this certification."

    Penrose Critical Care Unit (PH CCU) The Clinical Manager purchases pins and the unit associates hold a "pinning" ceremony in recognition of the nurse achievement.   A wall in the unit displays their specialty nurse certification certificates.   The Critical Care Unit demonstrates growth in certification and outperforms the Magnet Hospital comparison group 50th percentile. The Clinical Nurse Specialist on this unit provides frequent education through classes, articles, and individual teaching which communicate the expectation of and support professional development.  In addition, this unit is the first unit to initiate an evidence based practice council demonstrating their passion for high quality patient care.

     

    Oncology Unit The nurses on the oncology unit encourage and support one another to achieve certification.  They are confident they will achieve the 50% certification rate that entitles them to a display board from their professional organization.

     

    Labor and Delivery Unit Nurses on the Labor and Delivery Unit want to see their certificate and photograph on the Wall of Honor.  Visible to everyone as they enter the unit, this recognition spurs the nurses to demonstrate their professional development through certification and formal education. The Clinical Manager, formerly the unit Clinical Nurse Specialist, is a strong proponent of evidence based practice and recognizes the role of individual and unit commitement to professional development for all associates.

     

    Neonatal Intensive Care Unit Neonatal Nurse Practitioners (NNP) model professional practice and share their clinical expertise with the NICU nurses.  In support of the unit practice goal to increase certification, the NNP's are offering educational certification preparation classes for all nurses. The NNP's have consistently offered education to their nursing colleagues so the education process is not a change, but the promotion of certification is an added bonus.  ( SE4-7 )

    Professional Development - Conference Presentations and Participation:

    Birth Center and Mom Baby Unit nurses regularly participate in the national The Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN).  Funding support for conference fees comes through monies earned through classes or donations to the PSFHS Foundation. In 2011, Candace Garko, Clinical Manager in the Birth Center presented at the national AWHONN conference. 

    Wound Clinic nurse professional development opportunities occur through conferences and webinars.  In July, the clinical manager sent out the following information to all wound care nurses which allowed nurses to access education from work or online from home as well as plan their work schedule to allow for conference attendance.  The Unit Based Skin Experts continue to participate in quarterly educational offerings to improve their skills, knowledge and ability to champion expert skin care on their respective units.

    Upcoming webinars and conferences: 

    • July 29, Assessing and Preventing Wound Complications noon 
    • August 19, noon:  Wound Assessment and Coverage Criteria Documentation Pitfalls 
    • Sept 23, noon:  Optimizing Wound Healing with Debridement and advanced Therapies. 

    • KCI Wound Healing Seminar - free - October 5 at PH.  4 CE 
    • Rocky Mountain WOCN - October 14,15,16 in Denver.  "Best Practices for PU Management, Old Concepts, New Ideas".  $225. 14.25 CE

    Summary:

    The organization sets goals for certification and professional development through position descriptions, Shared Decision Making Councils, and Unit Provision of Care Plans. Resources to support these goals include education, finances, clinical nurse specialists, our education department, and a growing culture of professionalism resulting in unit level champions. We are headed in the direction we seek - exceeding mere compliance in pursuit of excellence.

  • Structural Empowerment - SE04EO

    Commitment to Professional Development

    SE4EO: That the organization has met goals for improvement in professional certification. Graphically summarize at least 2 years of data to display changes over time. Include participation of nurses in all specialties.

    Nursing Professional Development Council Goals for FY2011 - Increase certification rate by 2%

    The Nursing Professional Development Council sets organization goals for certification and coordinates educational opportunities, advocates for financial resources and recognizes accomplishments. 

    1. The FY2011 Goal was to "Increase nursing certification by 2% or achieve 20.7%".  PSFHS nurses exceeded the goal by achieving a 23.1% certification rate.

    FY2011 Goal Exceeded. Goal was 20.7% and rate was 23.1%.

    Selection Group: Direct care nurses in all areas, clinical nurse specialists and nursing department leaders.  Excluded are nurses in clinical effectiveness, auditors, case management, education, and program coordinators in trauma and stroke.

     

    The Nursing Professional Development Council Goal for FY2013 - Increase Medical Surgical Nursing Certification by 1%

    2. The FY2013 Goal was to "Increase medical surgical nursing certification by 1% or achieve 6.8".  PSFHS nurses met the goal at 6.8% by December 2012.

    FY2013 Exceeded Goal by December 2012. 

    Selection Group: Direct care nurses in all medical surgical inpatient units.

  • Structural Empowerment - SE05

    Commitment to Professional Development

    SE5 The structures and processes used by nursing to develop and provide continuing education programs for nurses at all levels and settings. Include how the organization provides onsite internal electronic and classroom methods. Do not include orientation.

    PSFHS's nurses utilize a wide variety of continuing education programs, which they develop and participate in. These programs are multifaceted, innovative, and pedagogically sound. This section will describe and demonstrate the structure and process used by nursing to address continuing education needs at all levels and settings.

    Structures:  

    Professional Practice Model (PPM) To support our PSFHS nursing vision our nurses recognize and demonstrate a commitment to learning and professional development required to live our vision.  Maintaining current competence in the changing healthcare environment requires both formal and informal education. 

    Our selection of nurse theorists Florence Nightingale and Patricia Benner to guide our professional practice provide the foundation for maintaining competence and prioritizing professional development. A quote from Nightingale reflects our commitment to lifelong learning, "For us who nurse, our nursing is a thing which, unless you are making progress every year, every month, every week, take my word for it, we are going back" -Florence Nightingale, 1872

    RN Job Description requires registered nurses to maintain competence and continue personal and professional development.  Excerpt included below.

     "RN Position Responsibilities 
    PROFESSIONAL DEVELOPMENT -10% 
    • Seeks out learning opportunities and continuing education. 
    • Seeks experiences that reflect current practice in order to maintain skills and competence in clinical practice or role performance. 
    • Maintains professional records that provide evidence of competency and life long learning. 
    • Evaluates one's own integrity and nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules and regulations. Takes action to achieve goals identified during the evaluation process. 
    • Demonstrates a commitment to the organization through ongoing participation at hospital and unit based meetings. 
    QUALITY OUTCOMES/QUALITY IMPROVEMENT/RESEARCH/EBP -10% (15%) 
    • Verbalizes an understanding of the value of measurement and the importance of continuous quality improvement data. Use quality measures to improve performance and accountability for patient outcomes, patient experiences and safe delivery of care. 
    • Participate in unit-based Quality improvement, evidence-based practice and research activities. 
    • Use current healthcare research findings and other evidence to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues. 
    Nurse Educator Position Responsibilities 
    1: Conducts on-going needs assessments to determine where training and education is appropriate as a means of improving organizational and departmental effectiveness, professional development and competence. 25% 
    2: Designs, coordinates and presents educational programs/activities to meet the assessed education/training needs of the organization. 25% 
    3: Evaluates the effectiveness of training/educational activities. 25% 
    4: Acts as a resource/role model in areas of training/education program development and associate development. 25%"

    The structural design for professional development is three pronged:

    • Shared Decision Making Councils and Unit Level Educators 
    • Education Department 
    • Director of Professional Resources and Clinical Nurse Specialists

    Shared Decision Making Councils provide a structure for assessing needs and enacting continuing education programs. 

    Centura Health Nursing Professional Development Council includes representatives from across Centura Health.  The Director of Professional Resources and Education Coordinator represent PSFHS on this council.  CNPC has designed professional development residency programs in multiple areas and presented research on these programs.  The minutes and the current strategic plan is attached as evidence. ( SE5-1 , SE5-2 )

    The PSFHS Nursing Professional Development Council (NPC) is a nursing shared decision making council reporting to the Nursing Leadership Council.   The purpose of the council is "to advance clinical practice of all healthcare providers through the use of research, education, collaboration and mentoring of evidence based practice resulting in improved outcomes". Collaborating with all nursing councils including leadership, management, quality and patient safety, practice and evidence based practice, this council strives to provide our nurses with the education, information and training needed to provide patients with safe, effective, and evidenced based care. Committee membership includes a nurse chair, clinical nurse specialists, the Director of Professional Resources and interested staff nurses. Unit educators are participants in this council and include nurses from Surgery, Trauma and PostPartum/MomBaby.  In addition, there is a representative from Education Resources which provides an important link that improves efficiency and effectiveness across the hospital. ( SE5-3 , SE5-4 )

    The Clinical Advancement Program (CAP) Peer Review Board reports to the NPC.  The CAP rewards completion of continuing education beyond required education and training. Seventy to ninety percent of CAP applicants seek points for continuing education.  In addition, the CAP program rewards advanced nursing education and leadership in multiple areas including quality improvement, council chair, special projects and research.  ( SE5-5 )

    Education Department Staffed by nurses the Education Department coordinates educational opportunities through space allocation, approval of continuing education credits and assigning online education modules. In addition the Education Department teaches orientation, preceptor training and the ASCENT New Graduate Residency Classes. Penrose-St. Francis Health Services is approved by the California Board of Registered Nursing, Provider Number 15587. 

    Director of Professional Resources This position newly created in 2011 promotes professional development through the employment of clinical nurse specialists (CNS) and educators. The CNS/Educator team is a decentralized team of experts, some of whom provide direct care and others that primarily provide education, consultation, and research.  In 2013 the Director called a meeting of educators, CNS's and the Education Department to improve collaboration, build strength and share best practices. 

    Processes to Develop Continuing Education at All Levels and Settings:

    Nursing Annual Needs Assessment and Plan PSFHS has piloted several strategies to conduct a nursing annual education needs assessment. An individual survey process was not effective.  Response rate was low and ideas varied from education to support professional development to topics more related to personal interests. During other years, a primary nurse educator has systematically sought feedback from multiple groups and presented this information to nursing leaders.  Patient safety/risk management, infection control, clinical effectiveness, multiple interdisciplinary committees (falls, code blue, RRT), managers, unit direct care nurses, educators, clinical nurse specialists, nursing peer review, pharmacy and others provided recommendations for education based on analysis of their data, risk areas, new practices, and safety priority. 

    In 2011 the Nursing Professional Development Council conducted an annual educational needs assessment through a similar process as the educator led process.  In 2011, we sought input from all nursing councils including unit practice councils. The Professional Development Council created a small subgroup and added the education department to help review the data and develop a plan for education.  One process recommended by our education department included screening topics to assess for true educational needs. This process led us to exclude topics that would respond more effectively and efficiently to compliance or monitoring processes. ( SE5-6 ) In addition, nursing leadership completed an assessment as a foundation for designing education. ( SE5-7 ) 

    Online Web Based Learning Tools The organization's web-based educational opportunities through HealthStream/LEARN provides nurses with numerous and ongoing learning opportunities. Courses are listed in the LEARN Course Catalog, which is available through our hospital intranet, My Virtual Workplace. All employees can register and take these online courses from the facility or from any home computer. Courses include clinical, regulatory, technology and leadership topics.

    Centura Professional Development Council (CPDC) comprised of nursing educators and staff development professionals from all organizations provides a structure for continuing education at the corporate level.  This collaborative group identifies common education needs and designs standardized education when needed.  In the spring of 2011, the CPDC examined the time required for mandatory education and the increasing use of LEARN Online modules for mandatory and continuing education programs. Recognizing the benefits of online learning, the group also sought to establish parameters for decisions relating to the promulgation of online modules. At PSFHS Sylvia Kurko RN, Education Coordinator designs online modules upon request. In addition, she collaborates with requestors to ensure this is best teaching strategy.  Changes in the use of online modules during the last several years include use of pretests that allow the learner to pass and not have to complete the module.  ( SE5-8 )

    Classroom Education is developed through a collaboration of content and professional development experts.  For example, in developing classes for Nurses Week the planning committee sought internal and external experts to develop and provide classes. When the Centura Health and PSFHS identified a need for frontline nurse leadership education a core group met for months to develop continuing education modules with primary learning classroom based.

    Process to Provide Continuing Education for Nurses at All Levels and All Settings:

    Following the assessment and identification of nurse education needs, and development of continuing education programs, provision of education occurs through both onsite classroom and online programs. Continuing Education Opportunities are announced through email, flyers posted on units, and the Nursing Intranet.  ( SE5-9 )

    Education Opportunities

    • Nursing Grand Rounds.  Nursing Grand Rounds 2011 was a quarterly forum for education and case study presentations. 

    • "Domestic Violence-Hiding in Plain Sight" featured expert speakers from community agencies and provided 6 Contact Hours.  Approximately 80-90 nurses and other healthcare providers participated in this conference. 

    • Nurses Week offers a variety of continuing educational opportunities.  In 2012, the Nurses Week group added a Mock Trauma which was filmed and available for review at other times.

    • Tim Porter-O'Grady provided a daylong conference in 2011 and 2012.  The Penrose St Francis Foundation provided funds for his services.

    • Preceptor Academy is available to all preceptors based on unit practice council and clinical manager approval.  The purpose of the Preceptor Academy is to provide education on roles and responsibilities, teaching strategies and rewards/challenges of being a preceptor.  Nurses who complete this program are eligible for preceptor pay based on our policy. 

    • Leadership Education includes:

    o Essentials of Nurse Manager Orientation (ENMO) is an online options offering for nurse managers and assistant nurse managers, paid for by PSFHS. 
    o Leadership Excellence Accountability Professionalism (LEAP) program is a twenty hour program to develop frontline nursing leaders. The course was offered in Colorado Springs in Spring 2011 and Fall 2012.  In addition courses are offered at other Centura Health facilities and open to PSFHS nurses.  (LEAP will be discussed in SE5EO) 
    o Nurse Executive Residency Program is a one year program designed to prepare the nurse leader who aspires to a nurse executive position.  Currently two nurses at PSFHS are enrolled in the program. 
    o Online Leadership courses available through LEARN include topics such as financial basics, healthcare finance overview, journey of a claim, patient satisfaction, spirituality in the workplace, courageous conversations, rounding for outcomes, personal accountability through integrity, five fundamentals of patient communication, adjusting to change to achieve excellence and understanding discrimination and sexual harassment

    • Specialty Education provides knowledge to care for specific patients or specific needs. All educational opportunities are open to nurses at all levels and all settings.

    o Pain Resource Nurse Program participates in monthly education to improve effectiveness of nursing practice on safe patient pain management. 
    o Advanced Stroke Life Support Class, 8 hours free CE.  Taught multiple times a year this class always includes nurses and certified nursing assistants. ( SE5-10 ) 
    o Annual Trauma Conference is provided and attended by many PSFHS nurses.  
    o PSFHS Nursing hosts a Bariatric Nursing Conference every two years

      
    • Nonviolent Crisis Intervention Training Program provides education and skills to improve competence and safe strategies to reduce disruptive behavior.

    • PeriOp 101 is a ten week course provided to prepare nurses to practice in perioperative settings. This course includes online, classroom and experiential onsite education.

    • ICU Training Program is an intensive three month program to prepare nurses to practice in intensive care settings. This course includes online, classroom and experiential onsite education.

    • Evidence Based Practice, Research and Innovation Conference is held annually in November.  This conference promotes best practice sharing across Centura Health as well as other healthcare organizations and offers opportunities for PSFHS nurses present.  Overall attendance ranges from 100-130.

    • Mosby Suite (Nursing Index, Nursing Consult, Nursing Skills) is an integrated on-line service to assist nurses to find answers to clinical questions.  Nurses have access to medication information, professional journals, patient education, evidence-based content and continuing education from any computer in-house or from home.

    Simulation In addition to providing traditional didactic education and skills training, the Education Department in collaboration with Clinical Nurse Specialists and Educators provide learning experiences through simulation training. Simulation training is used weekly during the ASCENT New Graduate RN nursing program, annually during nursing skills review and for specific education programs.  Simulation programs are designed based on a needs assessment and include actual simulation and a debriefing session following the scenario. 

    In 2012 Centura Health implemented evidence based practices to reduce catheter associated urinary tract infections (CAUTI). Implementing standards of practice and a revised policy related to prevention of CAUTI required completion of an online learning module, review of revised policy and actual demonstration of practice on a mannequin. Educators and Clinical Nurse Specialist provided hours of training on mannequins during summer/fall 2012. 

    Written Resources Many units keep a notebook of relevant journal articles to support continuing education.  In addition, nursing council members frequently notify units of current articles. Easy access to professional journals through the library website promotes continuing education.  Some nursing journals offer contact hours for completion of an article and post test.  

    The nursing newsletters ( TLC ) provide education for nurses at all levels and all settings.  The standard TLC is published monthly.  The Pain Resource Nurses and the Evidence Based Practice Council both publish quarterly newsletters to provide current, easy to access relevant education.  In addition, several units publish a newsletter including education. ( SE5-11 )

    Unit Specific Continuing Education and Skills Validation Annual Skills Validation is an evolving process for PSFHS.  Traditionally all medical surgical units completed the same skill demonstrations with unique structures and process focused on other specialty areas.  During the last several years, medical surgical units have also opted to host unit specific validation days with skills unique to each unit specialty.  In 2013, the decision is that we will not host a major medical surgical skills review but educators will partner with each unit to develop and provide their own skills review.  This process aligns with the current process in perioperative, labor and delivery, postpartum, pediatrics, emergency room and NICU units.  

    In 2012 SFMC Emergency Department revised their process for annual skills review.  Instead of setting up stations and modules and classroom lectures, the education was provided during actual patient care. Specific areas and skills were identified by the ED team, checklists developed, preceptors coached and the change implemented.  The overall feedback was great from staff and patients!  In addition, the ED used education time and dollars more effectively and efficiently. In addition the SFMC Emergency Department received specific education on customer service and caring to improve patient satisfaction based on unit goals.  (This education and outcomes will be discussed in SE5EO)

    Evaluation:

    Evaluation of continuing education is done through individual class feedback, clinical outcomes and nurse feedback. Formal nursing feedback occurs through the Press Ganey Associate Engagement Survey. Individual class feedback is used to make changes to the offering; an example of this process is presented in SE8 when we revised our new graduate program based on feedback. Nursing Grand Rounds 2011 included the implementation of evidence based practices related to delirium. The Intensive Care Unit Practice Council monitors clinical outcomes.  The Press Ganey Survey results on the question "Given opportunities for education" increased from the 56th percentile in 2010 to the 74th percentile in 2012.  In addition, one goal of education is to improve the quality of care and nurses rated " Quality of Care is excellent here" at 80.2 (2012) and increase from 73.6 (2010).

    Summary:

    Each nurse is accountable for lifelong learning and professional development to ensure current competence.  PSFHS develops and provides continuing education programs in a variety of formats and often with approved contact hours.  Our Professional Practice Model and Shared Decision Making nurse councils lead the charge to identify and meet nurses needs for education.  The Performance Feedback and Development process highlights the importance of professional development by including a separate module to address this area.  Professional nurses at PSFHS design, participate and teach continuing education demonstrating their expertise and dedication to professional practice. 

  • Structural Empowerment - SE05EO

    Commitment to Professional Development

    SE5EO The effectiveness of two educational programs provided in SE5.

    1. LEAP: Leadership Excellence Accountability Professionalism

    Purpose and Background:

    Centura Health employs 15,000 associates, of which 5,000 are nurses. Approximately 340 nurses are identified as frontline nurse leaders with job titles inclusive of Assistant Nurse Manager, Coordinator, Supervisors and Charge Nurse. Overall academic preparation of our nurses is 53% BSN or higher and 18% certified.

    Our ANA Nursing Standards of Professional Performance (2004) hold all nurses accountable for leadership. 

    Standard 12:  The registered nurse provides leadership in the professional practice setting and the profession.

    Today's multifaceted healthcare environment requires nurses that are proficient in complex thinking as well as possessing clinical and leadership skills for decision making in their role on the healthcare team. Equipping nurses with clinical skills is a well established process; however, equipping nurses with leadership skills is not as well engrained into conventional role definitions (Swearingen, 2009).  

    Every nurse, due to the definition of the role, assumes a leadership function. Therefore, leadership exists at the front line in the role of the clinical nurse (Iacono, 2003).  Leading and transforming nursing practice at the point of care necessitates attainment and nurturing of professional and organizational leadership competencies. Leadership is required for advocacy roles which keep patients safe, promote healthy lifestyles, and design better health care systems (Robinson, 2006).  Nurses who develop excellent leadership abilities add value to any healthcare organization, by influencing and directing change; and through innovation that affects patients' outcomes as well as the work environment (Grindel, 2006).

    Centura nursing leadership designed a schematic which represents the developmental tracks for nursing leadership at all levels. The ASCENT residency program contributes to this goal of empowered nurses by initiating new graduate nurses in leadership development at the foundation level. The LEAP program takes the next step for our frontline nurse leaders.  ( SE5EO-1 )

    The educational effectiveness of LEAP will be assessed by comparing pre and post self assessment scores and evaluating retention rates of participants. In addition, LEAP participants will be educated to move into advanced leadership positions.

    Methods and Approaches:

    A twenty hour education program was designed by nurse leaders from six Centura hospitals. Curriculum topics include: building relationships, planning patient care, making decisions, utilizing practice standards, quality improvement, patient safety, communicating, developing people, setting goals, financial stewardship, service orientation and patient outcomes.  The consistent themes throughout the program included a shift to transformational leadership, professionalism and accountability.  We titled this program LEAP for Leadership, Excellence, Accountability and Professionalism.

    The design group created a tool for the frontline nurse leader that was designed for the self assessment of clinical competencies.  This tool was modeled upon evidence based practices from The Advisory Board (Advisory Board ©, 2003) and the American Organization of Nurses Executives.  (We adapted an Advisory Board tool for frontline clinical leaders to assess their leadership competencies.)  We added free text questions to encourage reflection and to allow us to review and compare expectations of these frontline leaders across our system.  In addition, we piloted the self assessment with nineteen frontline nurse leaders at one Centura Health facility prior to implementation in the LEAP program. ( SE5EO-2 )

    Using available evidence based literature, we designed the module content and processes to support development of the major competencies frontline nurse leaders need. The module content is provided below:

    • Module 1: Focus on transformational leadership including overview of Centura Nursing Strategic Plan and Outcomes 
    • Module 2:  Focus on planning, decision-making and relationships 
    • Module 3: Understanding and applying nursing standards, accountability and patient safety/quality initiatives and process 
    • Module 4: Interpersonal communication skills 
    • Module 5: Developing people and coaching

    Registration for LEAP modules was available through our Centura Nursing Education Webpage.  In addition we included all handouts and recommended applicable reading on this webpage.  ( SE5EO-3 )

    Participants:

    Lavone Hastings, M.MGT, BSN, RN-BC, Manager, Professional Development, Porter Adventist Hospital, Centura Health 
    Noreen Bernard, MSN, RN, NEA-BC, Director Professional Resources, Centura Health 
    Kathy Bradley MSN, RN, NE-BC, Director, Performance, Practice and Innovation, Porter Adventist Hospital, Centura Health 
    Carrie McDermott MSN, RN, NE-BC, Director Professional Practice, St. Anthony North Hospital, Centura 
    Debra Nussdorfer MSN, RN, PMHCNS-BC, NE-BC, Magnet Coordinator, Penrose St. Francis Health Services, Centura 
    Maribeth Trujillo, MSN, RN, NE-BC, Director, Professional Resources, Littleton Adventist Hospital, Centura 
    Cynthia Oster, RN, PhD. Nurse Scientist 
    Chief Nursing Officers from Centura Health 
    Janet Selden, Leadership and Learning Department 
    Nurses from all settings and all levels throughout several Centura organizations participated in the LEAP Classes 
     

    Outcomes:

    The outcomes of Cohort 1 and Cohort 2 are displayed below.  While PSFHS nurses were both faculty and participants in both cohorts, PSFHS nurses comprised 48% of Cohort 2 as compared to less than 5% if Cohort 1.  By evaluating both cohorts and comparing outcomes, we have the opportunity for an additional evaluation perspective of educational effectiveness. 

    Outcomes identified include:

     Differences in self assessment rating pre and post LEAP 
     Retention of LEAP participants

    Transfer into advanced leadership positions

    Cohort 1 included primarily hospital based nurses from across Centura Health including two nurses from PSFHS.  The LEAP Modules were offered once a month over a 5 month period and included faculty from 5 hospitals, including PSFHS.  The difference of the self assessment ratings pre and post LEAP were statistically significant as demonstrated in the following graph: 

    Cohort 2 included nurses from PSFHS, St. Mary Corwin Hospital, and Centura Health Senior Services. Participants rated themselves higher post LEAP than their pre LEAP self assessment, though the differences were not statistically significant. 

    Comparing Cohort 1 and Cohort 2:

    • Cohort 2 self assessment ratings pre and post LEAP were lower than Cohort 1.

    • Different results from Cohort 1 and Cohort 2 may be related to educational level of nurses or LEAP time schedule.  The length of the program for cohort 2 (2.5 months) may not have allowed for integration and application of new knowledge and skills and may be related to the lack of statistical significance with improved post LEAP self assessment ratings.

      Reported level of Education 
      Cohort 1      BSN or higher       57%   
      Cohort 2      BSN or higher       47%

     Length of time for LEAP module series 
     Cohort 1 5 months (once a month classes) 
     Cohort 2 2.5 months (every other week classes)

    • While many of the same faculty presented in both cohorts, LEAP Day 2 had different faculty.  LEAP Day 2 includes education related to quality improvement, patient safety and patient satisfaction.

    Nursing Retention:

    • Cohort #1 (July, 2010) = 93.1% retained 1 year post course completion 
    • Cohort #2 (February, 2011) = 91% retained in organization 1 year post course completion 
    • Three of thirty-one (10%) PSFHS nurses who completed LEAP moved into Clinical Nurse Manager positions. Another nurse accepted a position as a Patient Representative, and one nurse is now an Administrative Nursing Supervisor.  Overall 5 of 31 or 16% PSFHS nurse participants moved into advanced nursing leadership roles.

    Open Ended Question Response:

    Finally, the following graph depicts one of the highlights from the open ended questions asked of all participants.  As we continue to advance nursing practice in our organizations, clinical nurse perception of their ability and power to implement change is an essential competency.  While the self assessment does not evaluate competency, it does reflect individual nurse's perception of their power and their ability to influence the health system.  
      

    Committed to dissemination of new knowledge, the LEAP program team submitted an abstract to the International Nursing Research Administration Conference entitled, Transforming Nursing Leadership through Evidence and Education. We presented a podium break out session at the conference in Denver in the fall of 2011.  ( SE5EO-4 )

    Curriculum and content areas were revised and expanded based upon feedback, program evaluation and our LEAP program team's reflection. The attached windowpane reflects our plan for LEAP 2012. ( SE5EO-5 )

    Clinical Implications:

    Frontline clinical nurse leadership is essential as we continue to advance nursing practice and build a strong shared decision making structure.  As we expand our succession planning, provide opportunities for nurses to expand their formal educations, and support opportunities to translate this learning into their work environments, the goal is that this project will continue to promote competency and confidence development-which  may lead these frontline nurse leaders to consider management positions. By building leadership competencies appropriate to the frontline nurse role, we demonstrate our commitment to professional development and our recognition of the value of nursing leadership at all levels.

    The outcomes from the LEAP Educational Modules demonstrate the educational effectiveness and advances for frontline nursing leadership within PSFHS.

    References:

    American Nurses Association (2004). Nursing: Scope and Standards of Practice, Washington, D.C: Nursebooks. Org. 
    AONE Nurse Executive Competencies. (2005). Nurse Leader, 3(1), 15-22.

    Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley, pp. 13-34.

    Grindel, C. (2006). Staff Nurses as Clinical Leaders. MEDSURG Nursing,  15(4), 193-194.

    Iacono, M. (2003). Leadership at the Bedside. Journal of Perianesthesia Nursing, 18(5), 348-351.

    Robinson, C.A. (2006). The Leader Within. Journal of Trauma Nursing, 13(1), 35-36.

    Swearingen, S. (2009). A Journey to Leadership: Designing a Nursing Leadership Development Program. The Journal of Continuing  Education in Nursing, 40(3), 107-112. 
    The Advisory Board Company, Advisory Board ©, 2003.

    2. SFMC Emergency Department: Improving Patient Satisfaction

    Background:

    St. Francis Medical Center opened in late 2008. The facility's emergency department has seen consistent growth between 10-12% annually. Due to this growth, the manager was focused on ensuring adequate numbers and competent staff to meet the need as well as effective management of throughput processes.  Improving patient satisfaction in the context of the growth was a department goal.

    The emergency department did not have specific customer service expectations or training. In addition, some nurses were doing post discharge call backs on pediatric patients with data used informally to monitor satisfaction and initiate changes. The call back process did not include a specific script nor were staff trained in the process.

    An intensive care nurse requested to do her leadership semester for her master's program with the clinical manager and emergency department. The manager elected to use the nurse's expertise and interest to evaluate customer service, design a standardized process for call backs and provide training to emergency department staff on customer service.  The goal was to improve patient satisfaction through staff education.

    Approaches/Methods:

    Patient satisfaction as measured through our organization HCAHPS process was reviewed.  Four question areas were identified to serve as measures related to overall customer service.

    • Treating the Patient as a Whole Person 
    • Likelihood to Recommend 
    • Overall Rating of the Emergency Department 
    • Patient Care Staff -Overall Rating

    Based on our Professional Practice Model and philosophy of Relationship Based Care, the project lead RN, decided to develop customer service guidelines for callbacks and general customer service based on Jean Watson's theory of human caring. A "caring occasion" occurs when the nurse and the patient come together and involves and action and choice by the nurse and patient (Watson, 2006). The nurse cannot control how the patient handles a situation, but does control their own actions and behaviors.  "The nurse can create a caring, healing environment through the use of intentional presence and caring connection" (Herbst, Swengros & Kinney, 2010, p. E6). Caring is defined as "behaviors that are gentle, kind, respectful, attentive, considerate, and recognize the patient's uniqueness" (Green, McArdle & Robichaux, 2009, p. 296). By making the nurse aware of how these gestures are perceived and encourage their use, patients will be able to feel they experienced caring during their visit. ( SE5EO-6 )

    During this project timeframe, an evidence based practice called AIDET (Acknowledge, Introduce, Duration, Explain, Thanks) was being implemented across the system. Concurrently, members of the Nursing Practice Council were learning about appreciative inquiry and education on emotional intelligence was offered within the system. This convergence of education and application of evidence based practices provided an opportunity for leverage. The addition of training specific to caring concepts and practices for emergency department staff had a synergistic effect. The training was provided in collaboration with the VP of Customer Services and the Director of Employee Assistance Program. ( SE5EO-7 )

    The project nurse in collaboration with the ED team designed a standardized scripting process to use with all discharge call backs. ( SE5EO-8 )

    Continuing education for all ED staff was designed based on the following evidence based practices and concepts. The Clinical Manager paid all ED staff to participate in the training.

    • Caring Theory based on Jean Watson 
    • AIDET 
    • Emotional Intelligence

    Participants:

    Pam Assid, MSN, RN, CEN, CPEN, Clinical Manager, SFMC Emergency Department  
    Laurie Kennedy, Vice President of Customer Services 
    Steven Tucker, Ph.D., Director of Employee Assistance Program 
    Roni Ferrenberg, RN, ICU nurse 
    All SFMC Emergency Department staff were required to complete the continuing education

    Outcomes:

    Education and training on caring practices, AIDET, resilience and emotional intelligence provided to the ED staff resulted in improved patient satisfaction. 

    Education/Training and Discharge Call Backs were implemented in first quarter 2011.  The graphs depict fourth quarter 2010, first quarter 2011 (implementation) and the following three quarters of 2011 demonstrating improvement and sustained improvement following education and implementation of call backs.   The four following categories within HCAHPS were used to evaluate progress following education.

    • Treating the Patient as a Whole Person 
    • Likelihood to Recommend 
    • Overall Rating of the Emergency Department 
    • Patient Care Staff -Overall Rating

      1Q2011 was the Intervention Point

    Patient Satisfaction demonstrates sustained improvement (blue line on graph) outperforming the HCAHPS National Mean (red line on graphs).

     

     
     

     

    Implications:

    Healthcare is growing and the population has choices of health care providers.  Improving customer satisfaction through an environment of caring is likely to increase customer loyalty. In addition, a caring environment contributes to the overall healthy work environment which enhances associate satisfaction.  Cost effective and efficient methods to improve practice and the work environment benefit the organization.

  • Structural Empowerment - SE06

    Commitment to Professional Development

    SE 6 How the organization provides career development opportunities for non-nurse employees and members of the community interested in becoming a nurse.

    As a leading healthcare organization in our community we make ourselves visible through local media, in health fairs, community services, partnerships, and schools.  Through each of these interactions, we are presented with opportunities for us to demonstrate our professionalism and commitment to excellence. Additionally, we are fortunate that we can talk with individuals and groups about health care and nursing. Our professional presentation includes positively framed responses to questions about nursing, and it provides a foundation to encourage others to pursue nursing. 

    Within our organization, nurses model excellence in practice and they partner with other associates to not only care for patients but to also create a healthy work environment.  Our philosophy of relationship-based care identifies "relationships with others" as one of the three primary interactions.  As we build positive relationships with our non-nurse partners, we have the opportunity to teach and encourage others to consider a career in nursing.

    Organizational Structures:

    Formal and informal structures exist to support the career development of non-nurses. Associates working as certified nursing assistants and unit secretaries may be working towards nursing school or they may be enrolled in nursing classes. These associates bring their current skills and commitment to professional development into our environment and they stimulate discussions about healthcare. Flexible scheduling, library resources, tuition reimbursement, grants, and scholarships are some of the benefits in place that are designed to support their ultimate career goals.  Recruiting a nursing assistant or unit secretary to participate in unit practice councils benefits the unit immediately, by developing teamwork and decision making skills in our future nurses. 

    Human Resources and Education Department Kim Shockley, RN, Education Resources talks with anyone about a career in healthcare and especially in nursing. Kim answers questions about tuition reimbursements, the differences between online and "brick and mortar" nursing programs, or how to balance school and work, always encouraging others to grow professionally.  Schools from across the country are eager to showcase their programs, and we are eager to link our associates with an educational program that best meets their needs. Monthly Education Fairs provide time for schools and potential students to visit. Additionally, local schools (both K-12 and post-secondary) seek speakers for their classes. Kim keeps a speakers list available and facilitates connections as needed, "We have great people here and I want them to be able to share with our schools.  You never know who may decide they want to be a nurse."

    Healing Ministry Scholarships Centura Health and PSFHS understand that professional growth is not only a success for the associate, but is also a success for the organization. Healing Ministry Scholarships have been available to associates who wish to pursue "high need" jobs within Centura. The "high need" jobs include: nursing, clinical technicians, therapists, pharmacists, and many more. Scholarships were allocated to Centura Health entities based on the number of associates. Each scholarship was worth up to $5,000 for the school year and expenses. Scholarship recipients remained eligible for tuition reimbursement (if applicable) during the same year the scholarship benefits.

    In return for receiving the scholarship, the program required a 12 month full-time work commitment at a Centura facility on behalf of the associate for each year a scholarship is awarded.  One new registered nurse who received scholarships for several years wrote:

    "Nursing is my calling. I believe a nurse must be passionate, motivated, compassionate and hard-working to be successful. My passion began when I was six years old. I watched my best friend, my grandma, die from emphysema. I recall sitting in the waiting room at Penrose-St. Francis Hospital eager to see my grandma, but I was not allowed to enter her room. I felt helpless that I couldn't make her better. I had campaigned for her to quit smoking daily, by hanging homemade posters around every corner she would pass, but I didn't understand the addiction she battled. At six, I couldn't help, but I knew as I got older I could take a path allowing me to help others. This life changing event inspired me to pursue the dynamic field of healthcare. I love to learn and the prospect of nursing excites me. I am hard-working and will strive to be compassionate, to go above and beyond the call of duty, and provide the best care I can. I believe that my passion, motivation and hard work will bring happiness and healing to o thers. The Healing Ministries Scholarship program has helped me to reach my goals. I am able to focus on my priorities and not worry about how I can afford to pay the bills. I am very appreciative of what Penrose St. Francis has done for me and the support it continues to provide me along my educational path. Knowing that the company I work for is behind gives me motivation and inspiration to continue to succeed every day." -Liz Berardi (Prior to earning her RN)

    This scholarship program provides dual benefits for the recipient as it covers a generous amount of school related expenses but it also provides work for the beneficiary, with the salary and experiences that accompany that work. PSFHS cannot be prouder of the outcomes of this project since it helps people and through those people it helps the community. Following up on those who have received this scholarship, the data demonstrates that the vast majority of them complete their educational goals.  The following table identifies the 2011 outcomes from our Healing Ministry Scholars; eighty percent (80%) achieved their nursing degrees in two years: 

    2009 Scholarship Winners Goal Outcomes by 2011
    Todd Farina, RN, Clinical Coordinator BSN BSN
    Gerrod Groubert, Unit Secretary/CNA Nursing Pre-Nursing Classes
    Tanya Topping, CNA ASN ASN
    Cathy Sullivan, LPN BSN Left Centura Health
    James Shipley, CNA ASN ASN
    Anna Brinker, Pt. Access ASN Left Centura Health
    Erika Rodriguez, Unit Secretary BSN BSN
    Rebecca Morland, RN, Clinical Manager BSN BSN
    Elizabeth Berardi, Wellness Center BSN BSN
    Diane Huth, OR Tech BSN BSN

    University of Colorado, Beth-el College of Nursing and Health Sciences Scholarships In 2005 PSFHS initiated a plan to financially support nursing students enrolled at the University of Colorado, Colorado Springs' Beth El College of Nursing and Health Studies. In collaboration with the school, PSFHS provided scholarships to nursing students with the expectation that they would begin their nursing career at PSFHS following graduation. In six years, ninety-two nurses have graduated and joined our organization. Only thirteen nurses dropped from the program, a 12% drop rate. We anticipate an additional fourteen nurses completing the Beth-El Scholars program in 2012. To date, PSFHS has contributed over one million dollars for these nursing scholarships. Recipients of this scholarship are, as one might expect, particularly grateful for the ability to pursue their dreams. Further, the school is appreciative as it has received dedicated students through this process as the attached letter from the Dean describes. ( SE6-1 , SE6-2)

    Processes: 

    Career Days Hosting Career Days showcases the healthcare world to community members and students. These events involve presentations from a wide variety of healthcare disciplines including nursing, education, and marketing. Annually, Diana Patterson RN, Education Resources hosts a group from Pikes Peak Workforce (a local organization designed to help people find careers), providing hands on demonstrations, simulation, and exposure to a variety of opportunities in healthcare. While some of these young adults may pursue nursing, we also view this as an opportunity to build interest in the myriad of careers open in healthcare. ( SE6-3 , SE6-4 )

    St Francis Medical Center hosted a High School Career Fair in 2010.   More than 65 students and accompanying counselors from School District 11 participated in the event. The students were treated to a light breakfast before hearing personal stories from CEO Nate Olson, Board Member Tom Bennett, and Vice President of HR Gary Morse. A mock OR was set up in the Julie Penrose Health Education and Research Center wet lab, where students donned scrubs, caps, and booties to give them the impression of what it is like to be in an OR setting. They also visited different areas of the hospital, where they were able to gain insight into how many different areas of expertise it takes to run a hospital. Tour stops included the Birth Center, Maintenance, Nutrition Services and Radiology.  Booths were also set up in the Julie Penrose Center where students were able to talk to associates in other disciplines such as Accounting, Marketing, Human Resources, Patient Registration, Pre-Hospital, and Rehab.  Everyone who participated in the event felt that it was a rewarding and beneficial experience. ( SE6-5 ) 
      

    In April 2011, Penrose-St. Francis Health Services hosted a career day for high school students from the Colorado School for the Deaf and the Blind. The goal of the event was to share career opportunities in the medical field that these particular students may not have considered.  When the students began their day at St. Francis Medical Center, they had the opportunity to see a mock trauma and mock surgery. ( SE6-6 )

    Media:

    Vim & Vigor , a quarterly publication from Centura included an article "17 Reasons to work in healthcare." In order to pique potential interest in pursuing a career in healthcare, PSFHS facilitated in the distribution of this article throughout the community. ( SE6-7 )

    Individual Stories:

    While we have many non-nurse associates who have worked and completed school to become an RN, we are presenting the story of Yun hui Yi . She joined PSFHS as a certified nursing assistant and then she had moved into a unit secretary position for our seventh floor. She writes, "I started Nursing school so I wasn't able to help out at all for a couple of years, but I asked if I could do my final Capstone, which is 210 hours on 7th floor prior to graduating, because I LOVE THE CREW ON 7th floor."  Yui successfully completed her capstone project and rejoined her team on 7 as an RN. Yui wrote the attached letter thanking the many people who supported her through her career development. ( SE6-8 )

    Katey Johnson is a certified nursing assistant (CNA).  She shares her story as she works toward her RN. "I love being in the float pool and I am very happy to work at Penrose. This hospital is my family hospital. I started as a Candy Striper, and then volunteered in transport. I earned my CNA at 16 and have worked everywhere! I left to work for Hospice and came back to the hospital to go back to nights and floating so I can continue my nursing education. My orientation was thorough and I feel welcomed to all units.  Being able to float gives me the opportunity to see many aspects of nursing and find my own path in my nursing career. I will continue to treat all the patients with the respect and caring that I was given when I was here as a patient." Johnson's experience is typical as she is empowered to pursue schooling through various aspects of PSFHS. Her working irregular hours and in a float capacity enable her to dedicate herself to her studies while also earning experience and forging connections with those she will be continuing to work with after graduation.

    Diane DeMasters, RN, Clinical Manager at Penrose Hospital states "I have worked at PSF for 32 years. I started in the lab washing test tubes after school and now am the manager of the GI Lab. This journey has been a valuable growing experience. I can honestly say that I have loved every position because they were appropriate for me at that time in my life and have given me opportunities to learn from several supervisors. Being Charge Nurse in the GI Lab for 4 years has been the most challenging!  I never thought that I would ever be the manager of this great department but worked hard at developing my skills and knowledge so that if the opportunity arose I could accept the challenge. The opportunity came and the deciding factor was the staff in the GI Lab. The teamwork and camaraderie in the GI lab is the best.  We work hard, share ups and downs and always pull together.  People make this an awesome place to work!" DeMasters' background is demonstrative of the enduring culture of care this organization gives to those who wish to become nurses. By supporting and investing in DeMasters while she was attending nursing school, we have benefited from decades of her work.

    Volunteers supporting a Faith Based Community Nurse Immunization Clinic handed out " You Can Be a Nurse " coloring books produced by non-profit sponsors Johnson and Johnson. Available in both English and Spanish, children colored while they waited and asked questions about the pictures. Other nurses have spoken at and performed hands off activities in children's classrooms, sharing their love of nursing and providing youngsters with a glimpse of the type of people who become nurses.

    Summary:

    PSFHS is fundamentally committed to expanding the number of future nurses, both through non-nurse employees and throughout our community. Our organization pursues this goal by creating structures within our hospital to provide flexibility for non-nurses who are seeking to complete or continue their education and by providing opportunities for outside parties to accomplish their career goals. 

  • Structural Empowerment - SE07

    Teaching and Role Development

    SE 7 The structures (s) and process (es) used by the organization to promote the teaching role of nurses.  Include examples related to patients and staff members.

    Professional Nursing Standards:

    Teaching Patients and Families Professional nurses are responsible for practicing according to the ANA's "Nursing Scope and Standards of Practice," and as a result they are accountable for the outcomes of their service. In addition, The Joint Commission and Centers for Medicare and Medicaid regulations require patient education.  Our PSFHS Policy T-01-f states " Patient teaching is the element of professional practice designed to enable patients and their families or significant others to assume responsibility for self-care, successfully participate in the management of chronic health problems, continue to recover from acute illness, and adopt positive health behaviors." The Interdisciplinary Patient/Family Education Committee supports the provision and coordination of inpatient, outpatient, and family educational activities; including the approval of internally developed materials.  ( SE7-1 ) 

    Teaching Staff Members APHON's Nursing Standard 10, "Collegiality" states that "The registered nurse interacts with and contributes to the professional development of peers and colleagues" (ANA, 2004). Our internal structure identifies specific roles (Educators, Clinical Nurse Specialists, Diabetic Educators, Lactation Specialists, Family Educators, among others) that are responsible for the education and training of associates.

    Organizational Strategic Plan:

    Our organizational strategic plan includes the concept of "moving upstream." This conceptual image directs us to be active in health promoting community activities which include community education. This will be discussed in greater detail in SE9.

    Nursing Practices:

    A key expectation within PSFHS nursing is the role of nursing as teachers. Embedded within our job descriptions are clear expectations for teaching.

    • The RN Job Description states nurses will "Provide patient/family education through assessment of patient/family learning readiness, needs, and ability. Provide teaching and evaluate effectiveness of teaching." 
    • The RN Nurse Navigator Job Description includes: 
    • Initiates and documents patient teaching including family and significant others based on assessment of needs, including responding to patient request for information regarding the disease process, expected side effects of treatment and community resources.  Documents the above appropriately as well as communicating teaching completed to the patients other health care providers as appropriate. 
    • Continually assesses the patients treatment progress and educational needs, making adjustments to care based on the assessment; consults with primary physician or designee and other members of the care delivery team as needed; refer to appropriate physicians,  NPs or programs when needed. 
    • Clinical Nurse Specialist (EDUCATION - 20% of Position) 
    • Educates patients and their families about current and potential health problems, the goals of medical therapy, and self-care skills to achieve independence and maximize wellness. 
    • Provides formal and informal education and guidance on patient care to other members of the health care team at designated hospitals within the Centura Health system.

    Teaching Patients and Families:

    Patient teaching is a nursing responsibility and is based upon patient and family needs, assessments, and their specific care plan.  Our Standard of Care includes specific teaching requirements, when indicated, that are related to patient safety such as: fall prevention, pressure ulcer prevention, medication teaching, peri-op patient education, pain management, and others.  A snapshot of our internal guidance structure entitled, "Patient Intervention: Teaching General Education Topics," is shown below; this table indicates the most frequently taught education topics. Meditech provides a structure to guide evidence based processes for patient teaching, demonstrating an effective use of technology to support clinical practice.  Additional standard of care interventions within Meditech include teaching on Infection Prevention, stroke, patient falls, and others. The attached screenshot demonstrates the requirements for patient teaching. ( SE7-2 )

    Nurses demonstrate teaching through documentation on individual patient records, navigator tracking of community education, and all nurse presentations to professional audiences.  The effectiveness of patient teaching can be evaluated through patient satisfaction ratings on HCAHPS.  The graph demonstrates Top Box ratings are above 50% on most inpatient units for two HCAHPS question areas.

    Stroke Education:

    Our award winning Stroke Program is supported with a Stroke Education Manual and ongoing consultation from the Stroke Coordinator. Pat Wilfong-Mager RN on one of our designated stroke treatment floors stated, "I gave the patient the Stroke Patient Education book. She was so excited. Each time I came into her room she had marked a page and had questions.  I was glad she had the book to take with her so when she has questions at home, she can refer back."   The graph below demonstrates the effectiveness of the Stroke Booklet in supporting patient teaching.

      

    Resources:

    Financial and physical resources are made available to support nurse teaching opportunities. These include the electronic charting system (which provides documentation reminders), Micromedix intranet patient education materials, and Mosby's Nursing Consult, the nursing resources service.  In addition, we have specific disease/diagnosis patient teaching materials available for a range of issues.  For example, nurses use a video to reinforce teaching of cardiac patients prior to angioplasty.

    Teaching Staff Members:

    A key element in our educational program is having nursing staff teaching other staff members through orientation, preception, or our new graduate orientation. This topic will be explored in greater detail in SE 8 and SE 10.

    PSFHS has provided funding for conference attendance with the expectation of sharing and teaching their conclusions upon return to their units.  This process promotes the teaching role of nurses and the expectation of expanding our overall practice through conference participation. 

    Unit Based Skills Review:

    Each unit provides at least an annual skills review; with topics determined through collaboration with managers, Unit Practice Councils, clinical nurse specialists and nurse educators.  These competency and education experiences provide opportunities for formal peer teaching.

    • Inpatient Rehabilitation Unit. Nurses creatively designed a skills review where one nurse used a water balloon to simulate a full bladder to practice using the bladder scanner. Demonstrating the success of this innovation, another RN borrowed the simulated bladder for suctioning demonstration and training. 
    • SFMC ED revised their annual skills review in 2012.  The charge nurses identified opportunities for staff to become proficient and demonstrate competeny with high risk/low volume skills at work.  During a set period of time, all staff completed the required competency review with a charge nurse.  Charge nurses created a review list to ensure the pertinent points of the skills were highlighted, verbalized and/or demonstrated by staff.  The outcome was all staff completed annual competency reviews during work shifts and within the actual patient care environment.  Even the ED Physicians watched and shared their ideas.  Patients and families provided anecdotal comments stating "I really understand now why staff was doing exactly what they were doing!"  In addition, the ED were able to use hours assigned for annual reviews for other educational opportunities.  A surprise outcome was the nomination of one of the charge nurses for an annual nursing excellence award for her leadership.  The ED Skills Review outline is attached. ( SE7-3 )

    Teaching Opportunities:

    We encourage all nurses to share their expertise with their colleagues through informal discussions, our peer review process, and through formal education.  Some formal teaching opportunities for nurses include:

    • Nurses Week includes Educational Days with the committee recruiting nurses to teach in areas of their expertise.  (SE7-4 ) 
    • Nursing Fall Education Days ( SE7-5 , SE7-6 , SE7-7 ) 
    • Nursing Grand Rounds  
    • Unit Based Skin Experts Class ( SE7-8 )

    These formalized processes promote the teaching roles of nurses among the general staff of PSFHS, making these pedagogically adept nurses a focus for all of our associates.

    Clinical Advancement Program:

    Our Clinical Advancement Program (CAP) provides points for staff education including presentations, posters, and storyboards which promote the teaching roles of nurses.  (Snapshot CAP Educational Points). In 2011, 54% of the CAP applicants received points in this category.

    Holly Downing, RN, Labor and Delivery (L&D) presented her role as an electronic medical record auditor, resource and educator for the L&D nurses. "I had over 12 hours of training for this role.  I help the admission of patients go smoothly, gather monthly statistics and ensure documentation between our two systems is consistent. I assist my coworkers in charting correct accounts and I train all new staff nurses in the documentation process. I also wrote a reference manual to provide an immediate resource for our nurses."

    This example demonstrates the role of a nurse teacher/trainer is crucial to the smooth operation of our organization. Patients rely upon our nurse teachers and so does our community.

    Teaching Colleagues at St. Mary Corwin Medical Center (SMC):

    SMC is transitioning from a Level IIa nursery to Level IIb.  During the last year SMC has sent nurses and respiratory therapists to St. Francis Medical Center NICU to build competencies through clinical rotations.  SMC intends to continue to send nurses who are new to SMC nursery to SFMC for a similar rotation. In addition, PSFHS Neonatal Nurse Practitioners travel to SMC in Pueblo to teach STABLE classes to their neonatal nurses. 

    Nursing Grand Rounds (2011):

    Nursing Grand Rounds provide another opportunity for nurses to teach and share their practice with colleagues. Scheduled quarterly, a Clinical Nurse Specialist provides coordination and coaching to direct care nurses to present on a specific topic. During these rounds in September 2011, the topic of, "Co-managing a pregnant patient with ICU Acuity" was presented by Candace Garko, RN, Nancy Steele, RN, and Nancy Prantl, RN; all of whom had been nurses assigned to attend the titular patient. This presentation focused upon a patient in OB triage with significant respiratory problems and in preterm labor. Respiratory functions decompensated quickly, which resulted in intubation and a transfer to the ICU.  A Labor and Delivery nurse remained in the ICU during the patient's entire stay, and these nurses' responsibility was monitoring the fetus. This presentation's center was on areas of competence and personal/professional comfort in caring for a patient with unique needs outside their specialty.  

    Teaching through Training:

    Resource Nurses, such as Dacia Gunn RN lead mock code blues to teach and promote practice for codes on the units. These exercises and training scenarios increase nurses' awareness, confidence, and response times.  Gunn's email below conveys her pride as she notes the effectiveness of code blue training: 
      

    The following are additional examples of nurse teachers and their relationship towards patients and PSFHS associates.

    Clinical Nurse Specialists teach staff members internal and external to PSFHS.  Dan Chatelain, RN, Pain Specialist teaches at Pain Resource Nurse Conference in our region.  Recently he taught at the 2012 Pain Resource Nursing Conference & Integrative Therapies Workshop sponsored by the Memorial Hospital system in Colorado Springs.  (SE7-9 )

    Stroke Coordinator Heidi Stouffer, RN frequently teaches the Advanced Stroke Life Support class to healthcare providers across the state. ( SE7-10 )

    Cancer Center Nurse Navigators are expert teachers and they are encouraged to teach in both community education and staff education forums in addition to their patient/family teaching responsibilities.  PSFHS hosted a conference "Multidisciplinary Management of Lung Cancer and Lung Nodules" in 2011. Medical oncology, social work, thoracic oncology, radiation oncology, and nursing presented at the conference. Pam Williams, RN Nurse Navigator discussed coordination of care and the nodule clinic. ( SE7-11 )

    Teaching Patients/Families and Staff Members:

    The Health Learning Center is comprised of an interdisciplinary team dedicated to healthy living with a focus on prevention, wellness, exercise, and the management of chronic disease. This learning center addresses a wide variety of issues, including diabetes and podiatric care. The Certified Diabetic Educators provide education in management for those with diabetes in both individual and group formats.  They provide these services in our Diabetes and Renal Care Clinic, which is ADA certified.  The PSFHS Foot Care Nurse Specialist assesses and evaluates the feet, trims nails, teaches and develops a plan of care with the patient.  Educating patients on proper hygiene and foot care is provided and it is crucial to the overall operation of the Health Learning Center.

    Wound Care nurses work in the Wound Clinic and consult, treat and educate in the inpatient setting. he Wound Clinic is staffed by nurses with special training in the care of skin diseases, skin wounds, burns, and ostomy problems.  Comparing our healing information from the last 12 months with data from 260 other Wound Centers, our wounds heal faster than the national average (45 days in our Wound Clinic versus 64 days, nationally). 

    The specialized nurses in diabetic and wound care serve patients and families in the hospital as well in the clinics.  In addition, these nurses teach staff as they consult on the units and offer classes for our associates.  ( SE7-12 )

    The Palliative Care Clinical Nurse Specialist (CNS) and the Pain Clinical Nurse teach patients during consultations and staff members individually or in groups.  Staff teaching occurs in the context of patient consultations, conferences and during committee meetings. The Pain Resource Nurses meet monthly which includes educational presentations from the Pain Clinical Nurse.

    The Palliative Care CNS participates in Interdisciplinary Rounds on the Critical Care Unit at Penrose Hospital. This allows her to informally teach colleagues in the actual units. In addition, she offers classes periodically for all staff.  Responding to consultations with patients includes providing education to both individual patients and families based on needs and care plan.

    Summary:

    PSFHS promotes the teaching role of nurses by creating job descriptions based on nursing standards of care and practice, ongoing evaluation of patient teaching through regular review of patient satisfaction data and valuing the teaching expertise of preceptors with pay differential. PSFHS nurses incorporate teaching in all traditional and nontraditional nursing roles. Nurses teach within our organization and in our communities. Nurses share their expertise with their colleagues through: informal unit teaching, creation of storyboards, articles in newsletters, formal presentations at conferences, Grand Rounds, Skills, and Peer Review.

  • Structural Empowerment - SE08

    Teaching and Role Development

    SE 8 How nursing facilitates the effective transition of new graduate nurses into work environment.

    "Diana Patterson has a heart for education and her students. During the new graduate program, Diana made me feel welcomed and appreciated. She taught us about the new graduate basics, IV pumps, protocols, etc.  She also taught me about compassion, respect and kindness. Diana made me feel like I can become
    the person…the nurse I am striving to be." 

    Kelsey Dennison RN (ASCENT New Graduate Nurse)

    The Centura Nurse Executive Council wrote a white paper in spring 2008 outlining the issues related to the effective transition of new graduate nurses into our system.  Recognizing the average age of our nurses, the research showing turnover rates for new graduate nurses, as well as identifying specific quality and risk issues, our organization set out to design a new program for these nurses.  PSFHS had been providing additional orientation to new graduate nurses as had several other facilities. A collaborative team of staff development experts met over a year period to review the literature, identify goals, outcomes, and to design a curriculum.  The white paper had established a clear business case for this modification and the program was implemented statewide in late 2009. (SE8-1) The program was named "ASCENT" whose acronym stands for Autonomy, Safety, Competence, Evidence-based practice, Nursing excellence, and Transition to practice.

    With the support of the Chief Nursing Officers in Centura Health, the planning team had used the current evidence to standardize orientation for new graduate nurses across our system.  The standardization process would also allow nurses to select a site in north or south state based on their schedules and needs.  In reality, north state hospital associates attended the north state program, St Mary Corwin in south state had a separate program based on grant funding they had received prior to this initiative and PSFHS nurses selected the south state program hosted at PSFHS. (SE8-2SE8-3)

    Information on the ASCENT program is easily accessible on our Centura Health Website and the Education Department responds quickly to questions from nurses outside our organization, new hires and clinical managers. (SE8-4) Our monthly nursing newsletter and weekly PSFHS newsletter introduce our ASCENT Program graduates to the organization. (SE8-5)

    Maintaining standardization in the context of feedback from our nursing associates was challenging.  The nursing educator discussed the feedback with her colleagues and nursing managers and had elected to make modifications in the ASCENT program.  A registered nurse completing a student placement with the nurse educator evaluated the program modifications based on feedback from associates.  She noted improvement in feedback and made a suggestion for one additional modification based on feedback, her experience as a nurse, and new knowledge from her formal education program. (SE8-6) Feedback has remained positive and managers and preceptors have not identified the need for further changes at this time.

    ASCENT Retention Summary:

    Retention is one of our goals for our nursing department.  The baseline retention rate for new graduate nurses prior to the ASCENT program was 88% (FY1008).  The ASCENT Program retention at one year currently ranges from 98% to 100%. 

    FY2009 Participants     28      One Year Retention     100%
    FY2010 Participants 38 One Year Retention 100%
    FY2011 Participants 37 One Year Retention  98%
    • Relationship Based Care within ASCENT:

    • The ASCENT program provides opportunities for PSFHS nurses to teach and participate in a panel discussion as they welcome these new nurses into our profession and organization.  Nurses who have completed ASCENT have volunteered to return to a future class to provide support and encouragement.  Reflecting on Patricia Benner's "Novice to Expert model," we have found our advanced beginner nurses and competent nurses are effective in connecting with new graduate nurses.

      In the context of a relationship based care philosophy, PSFHS builds relationships with our new nurses by encouraging them to understand the value we place on our individual associates.  When an eager, compassionate nurse joined PSFHS she knew exactly what she wanted to do.  She had accepted a position on the oncology unit based on her personal history.  Unfortunately, caring for oncology patients led to significant emotional distress for her.  Her relationship with the ASCENT Coordinator allowed her to have an open discussion about her reactions and needs, leading to a successful transfer into another specialty.  (SE8-7)

      Pre-Employment:

      The ASCENT Program is one piece of the transition process. In fact, the transition of new graduate nurses begins before hiring. Some of our new graduate nurses have received PSFHS scholarships for their nursing education and some of our new graduates have been working as certified nursing assistants in our organization.  Prior to hiring, we have talked with these soon to be nurses and identified their strengths and interests.  The nursing managers "hold" spaces to interview and hire, building upon these prior connections between the new nurses and the current associates.

      Collaboration between local schools of nursing and our clinical managers provide structures and processes to plan for the transition period. This is evidenced by our organization's participation on advisory boards and the strong relationship between PSFHS and clinical faculty.

      In 2005 PSFHS initiated a plan to financially support nursing students in the Beth El School of Nursing, University of Colorado, Colorado Springs. In collaboration with the school, PSFHS provided scholarships to nursing students with the expectation they would serve in PSFHS following graduation.   In six years, ninety-two nurses have graduated and joined our organization.  Only thirteen nurses dropped from the program, a 12% drop rate.  We anticipate an additional fourteen nurses completing the Beth-El Scholars program in 2012.  To date, PSFHS has spent over one million dollars for these nurse scholarships.

      Unit Nursing Preceptors:

      Connecting a new graduate nurse with the right preceptor makes a difference. All nursing preceptors are required to attend initial training and complete an annual update or refresher class.   Penrose 5th floor identified Mary Jane Nickell, RN as a strong nursing preceptor to ease this transition. Nickell has earned a reputation in our organization as someone who is passionate about nursing and as someone who goes out of her way to help new nurses.  Holly Jiles RN (an ASCENT new graduate) wrote this about her preceptor:

      "Along came Mary Jane"

      Mary Jane Nickell, RN is my preceptor. Her attitude is pleasant, positive, patient and caring. Initially Mary Jane observed me quietly, allowing me to find my way on the unit with gentle guidance. Mary Jane's kind words and comforting manner always guided me in the right way; I never was made to feel inadequate. I watched her interact with patients - emotionally, spiritually, mentally, and physically. One of the best pieces of advice Mary Jane has given me is, "Nurse the patient, not the task." I could not have picked a better nursing mentor for myself than Mary Jane -- or a better facility than Penrose Main to begin my career as a RN. I am so proud to call Penrose Main my hospital of choice and place of employment. - Holly B. Jiles, RN

      Summary:

      We know that our ASCENT program, welcoming highlights via newsletters, and our expert preceptors have made a difference. The support of our Finance department allowed us to establish a separate cost center and it has facilitated the implementation of our programs. Our programs which exchange academic scholarships for years of service at PSFHS have brought us grateful and competent nurses. Retention numbers are improved and nurse feedback is positive. We are confident that we will see consistent positive outcomes as we continue to fully implement our new Preceptor and our ASCENT programs.  Our actions to create an effective transition for new graduate nurses are evidence and relationship based.  Retention rates are a strong and feedback tool from our new graduates, and the general feedback is positive.

  • Structural Empowerment - SE09

    Teaching and Role Development

    SE9 How nurses support community educational activities.

    The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health need.
    Code of Ethics for Nurses, 2001

    Multiple structures within our organization support and encourage associate participation in community educational activities.  Recognizing the teaching expertise of our nurses and valuing the role of education in improving health and wellness PSFHS has identified and directed resources to specific areas of community need.  In addition, our nurses identify needs in their own communities and are quick to educate and serve as part of their job or as a volunteer.

    Structures and Processes:

    Two primary structures exist to support and encourage nurses in community educational activities.

    • Identified paid nursing positions which include the expectation of community education

    • Volunteer opportunities through the volunteer department or through special events coordinated through the marketing department or others

    PSFHS Programs:

    The Family Education Department at St. Francis Medical Center is an invaluable asset to  Penrose-St. Francis Health Services. Comprised of fourteen instructors, all certified in their area of expertise, some of whom work in other departments in various capacities throughout our facilities, they are led by Jolene Bedford RN who also manages the Lactation Center at SFMC.

    The instructors provide classes for families that include: Early Pregnancy Class, Prematurity Prevention, Child Birth Preparation, Breastfeeding, Baby Care, Infant and Child CPR, Car Seats, Sibling Classes, Infant Massage and more.  Support groups are offered to aid families with breastfeeding and adjustment to parenthood after discharge. The Family Education Department also includes "The Fertility Care Center of Colorado Springs" - a natural family planning program that supports our catholic mission and core values.

    Often unseen by their fellow associates, as most of the classes provided are after-hours, the Family Education instructors and the services they provide are often the first exposure that many expectant parents have to the Penrose St. Francis System.  The instructors assume an ambassador role, highlighting hospital services and demonstrating our core values and mission as they teach and help parents prepare for their new babies.   

    Family Education Teaching in Schools Fetal Growth and Development Class for Middle and High School Students   (Story from:  Jolene Bedford RNC MSN LCCE IBCLC, Coordinator Family Education/Lactation Retail)

    I began this job in 1996 and quickly took over teaching this class in District 20 Schools.  The hospital supported me in this process.  Sometimes I taught as many as 3000+ students in a year! Several years ago we discontinued this program. Then a Cripple Creek teacher called out of the blue asking if we could provide any assistance to her child development class and provide some education. She stated she had too many kids getting pregnant. I explained that coming from a Catholic hospital I did not speak on Birth Control.  Rather, I taught about Fetal Growth and Development and the reasons pregnancies should be planned.  In the context of fetal growth and development I discuss some common birth defects and problems that are largely preventable if a pregnancy is planned such as fetal alcohol syndrome, spina bifida, problems related to drug use etc.  I stress the health of the mother prior to and during pregnancy as well as the man's responsibility to not cause a pregnancy in a woman known to be involved in risky behaviors. "Whatever kind of baby you get is yours to care for and pay for...." I discuss unexpected pregnancy events like preterm labor.  I also review the stages of labor and mechanism of birth. The students are then taken on a tour of the Birth Center. The class is very well received and the teachers claim it is helpful in stemming the number of teen pregnancies and teaching what kind of healthy behaviors are appropriate prior to getting pregnant to increase chances of a healthy baby.

    Penrose Cancer Center The Penrose Cancer Center hosts multiple community educational events. PSFHS employs one full time outreach nurse who participates in many of these events. In addition nurse navigators often teach in community educational events in collaboration with other healthcare disciplines.  Patty O'Connell, MS, RN, OCN, led an interdisciplinary team community education event related to lung cancer. (SE9-1)

    Peggy Thomas, RN, Cancer Center Outreach volunteers with Komen for the Cure.  In 2012 she provided seventy hours of service including community education and facilitation of two workshops for grantees and reviewers.  (SE9 -2)  She will receive points on her Clinical Advancement application during the March 2013 review.

    Faith Community Nurse Mission Outreach Team These employed nurses provide education through the Neighborhood Nurse Clinics across town.  Individual and group classes vary based on current needs 

    Health Fairs, Community Events, Support Groups Nurses provide education in multiple venues through the year.  These events provide opportunities for community education and increasing awareness of our services.

    • PSFHS is certified by The Joint Commission as an Advanced Primary Stroke Center. In addition to implementing the American Stroke Association's "Get with the Guidelines" treatment protocols, our Stroke Coordinator participates in community events, with displays and education, and teaches the Advanced Stroke Life Support class to first responders.

    • Bariatric Center of Excellence hosts a monthly support group. Fran Jackson RN, CBN, Coordinator assists with this group as indicated as well as provides education for people interested in bariatric surgery.

    • Cheryl Imlay, RN, CEN, CFRN is passionate about breast cancer education and is the lead education coordinator for the Komen Run in Colorado Springs.  She receives credit at PSFHS for this role via the Clinical Advancement Program.  (SE9-3)

    Publications/Media Vim & Vigor and Bloom are two community publications through PSFHS. An article published in Vim & Vigor included education from our Stroke RN Coordinator. (SE9-4)

    Marketing Department Our Marketing Department sends out emails to all associates announcing community education events and interviews referring us to websites, television or radio channels or specific journals.  By sharing this information with all associates our nurses are recognized and encouraged in their participation in community education. (SE9-5)

    Summary:

    Nurses support community educational activities through direct participation as part of their position or as a volunteer.  Education is provided through classes, media and booths. The marketing department may contact nurses and other healthcare providers to participate in community education during specific events.

  • Structural Empowerment - SE10

    Teaching and Role Development 

    SE 10 How nurses support academic practicum experiences and serve as preceptors, instructors, adjunct faculty, or faculty.

    "I am excited to be precepting a new wound nurse from our sister hospital, St. Thomas More.  They are starting an outpatient wound clinic program so I am teaching her about our program, wound treatment evidence based practices, clinic challenges as well as introducing her to vendors!" -Cheryl Rudolph RN, CWOCN

    Guided by our nursing standards and code of ethics, PSFHS actively supports practicum experiences and the roles of preceptors, instructors, and faculty. The ANA's Standards of Nursing for Nurse Administrators is clearly stated, "The nurse administrator employs strategies to foster health promotion, health teaching and the provision of other educational services and resources. The nurse administrator interacts with and contributes to the professional development of peers and colleagues." (2004) In addition, the Code of Ethics for Nurses states that "The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development." (2001) These standards provide our nurses who support formal academic development with guidance and stimulation.

    Student Clinical Placement Structure:

    PSFHS has established agreements/contracts with close to 300 schools serving a variety of communities with access to a plethora of academic disciplines. (SE10-1)  Affiliation agreements are prepared and maintained by Centura Health Administration.

    Undergraduate student placements come primarily from the University of Colorado at Colorado Springs, Beth-El College of Nursing and Health Sciences and Pikes Peak Community College. In addition, we provide graduate capstone mentoring experiences for nurses from multiple schools including: University of Phoenix, Regis University, Walden University, Colorado State University - Pueblo, other branches of the University of Colorado, and Metropolitan State University. Nurses from PSFHS maintain contact with our primary schools of nursing in order to promote collaboration as well as maintaining an ongoing evaluation of student needs.

    Placement Process Overview:

    Two interdisciplinary policies guide student contracts and placements. (SE10-2SE10-3) A written contractual agreement signed by both Centura Health and the participating academic institution must be current prior to students beginning to practice at a Centura facility. Once a formal agreement between the two parties is established, the school will contact our Education Resources Department on behalf of an interested student to determine what steps need to be accomplished prior to the beginning of the educational experience. When the required procedures are completed, the student will begin their practicum. These educational experiences include shadowing direct care nurses of a variety of specialties, hands-on experiences, and observing the overall healthcare environment. If a contract does not yet exist, the Education Resources Department will provide Centura Corporate Services Contracts Coordinator with contact information for the school; for the purpose of negotiating a PSFHS/Centura contract.  This process may take up to six months to complete. Once a mutually acceptable agreement has been reached between Centura Health and the school, the Centura Corporate Services Contract Coordinator and the school will sign the contract. The Centura Contract Coordinator will notify PSFHS Education Resources that the contract is in place. No student(s) will be permitted to begin the educational experience until an agreement has been signed.

    Student education is a collaborative effort between the instructor/school and our clinical staff.  The clinical manager, direct care nurses, instructors, and students collaborate to facilitate an optimal learning experience.  Our Education Department coordinates between managers and schools to arrange scheduling options as PSFHS prioritizes patient care and then learning opportunities.  All nursing students complete a two hour orientation prior to student placement in PSFHS.

    Our support for clinical placements, academic practicum experiences, and for our nurses to serve as preceptors and faculty is demonstrated by the number of hours that we allocate for educational experiences. The following table provides evidence of the sheer numbers of groups, students, and hours that we have provided learning opportunities for:

    FY 2010

    # Groups

    # Students

    # Hours

    Clinical Groups

    36

    270

    29584

    Senior Practicum

    n/a

    28

    3536

    Re-Entry

    n/a

    5

    600

    TOTALS

    36

    303

    33720

           

    FY 2011

    # Groups

    # Students

    # Hours

    Clinical Groups

     52

    357 

     33081

    Senior Practicum

    n/a

    10

    985

    Re-Entry

    n/a

     5

     580

    TOTALS

     52

     372

     34646

    Undergraduate Student Nurse Clinical Rotation Placement:

    The following example from a student nurse placed on PH 9 demonstrates PSFHS' nurse expertise in serving as preceptors in the support of student placements. The attached letter speaks to the unit culture and it expresses gratitude to an individual nurse.  (SE10-4)

    Stephanie Martell, RN, PH 9 was my primary nurse on November 11 and I cannot say enough about how grateful I am to have worked with her.  She is a nurse that I would love to be like especially after I graduate.  She knows what she is doing and she is so caring towards the patients.  Even when she is very busy, she treats each patient as if they are the only one she is caring for.  She was also an amazing teacher.  She would come and get me to perform skills like removing staples or starting an IV, always making sure that she asked me if I would like to do it before she did.  She was very encouraging as she would watch me with the patients and she would explain the steps she was going through when I was observing her.  Stephanie is an incredible nurse and mentor that takes on the day with a great attitude-Caitlin Geerdes, RN, former student nurse

     This type of reaction from our in-house students is typical of their overall experience at PSFHS. While the locations of the student placement may change, the feelings of gratitude and preparedness are nearly universal.

    Examples of Nurses Supporting Practicum Experiences:

    The outcomes of these student placements are almost universally positive. This is partially due to how PSFHS makes the development of nurses and the role of the mentor/preceptor priorities. The following letter is evidence of this, as it comes from Roni Ferrenberg, who was already a nursing associate here when she began studying for her MSN: 

    Pam Assid did a fantastic job of providing preceptorship for me to complete my master's degree.  I spent 16 weeks with her for a total of at least 124 hours of time.  We discussed project ideas prior to my beginning and it was decided that I would assist with implementation of a customer service program for their telephone call backs and teaching to staff.  This program was based on Jean Watson's Theory of Human Caring.  I also helped her with creating a protocol for a drug called Hylenex. 

    During these 124 hours, I went with Pam to all of her meetings, sat in on telephone meetings, interviews and took away enormous amounts of information on how to successfully manage a unit.  Some of the meetings I attended were Nurse Manager Meetings, Code Blue meetings, Hospital-wide management meetings, Unit Practice council and many more. 

    My current nurse manager, Jennifer Robertson, was also awesome in that she worked with me to allow me to go to .6 status in order to fit in the time I needed to complete this degree.  She was super supportive.  I completed my Masters Degree in Nursing Leadership & Management through Walden University in February 2011. Roni Ferrenberg MSN, RN

    Ferrenberg's case is revealing as she was able to act as a student and as a registered nurse simultaneously. For the purposes of this particular section, attention should be placed on how she was able to adjust her working hours so that she could finish school and focus upon her capstone project / mentorships. This type of flexibility provides both students and teachers with the kind of negotiable environment which makes our organization attractive to nurses of all levels.  

    ASCENT New Graduate Nurse Residency Program.  Colleen Eisman completed her senior BSN Capstone project with the ASCENT Program Coordinator/Educator.  The ASCENT program coordinator had made revisions to the program based upon participant feedback. The scope of Eisman's project included the review, compilation, and analysis of the cohort feedback following the aforementioned revision. In addition, she recommended a simulation station related to wound care and the use of wound vacuums. These measures were implemented with positive feedback. 

    Rhonda Santos' "RN to BSN" capstone project was precepted by Olinda Spitzer, MSN, RN, CNS, CCRN. Spitzer challenged Santos throughout her capstone project, and this culminated in the student's acceptance of a leadership role. Santos states, "I became the chairperson of the CIWA Alcohol Committee in June of 2010 as part of my RN-BSN class project. This position challenged me to step up to the plate and take a more proactive role toward a cause, which I have to admit, is something I am not accustomed to.  This opportunity has helped me to grow both as an individual and as a nursing professional.  I cannot emphasize how great it is to know that you are part of a team that is working to improve patient outcomes, in this case our ETOH withdrawal patients, particularly since research states that 50% of untreated DTs are fatal.  It is remarkable to look back at where our committee started and see how far we have come in such a short amount of time especially in helping to update and revise our current Alcohol Withdrawal Order Sets and Interdisciplinary Practices."

    In April 2012, Cindy Caton RN, OR Nurse Educator wrote the following: "I was asked to precept a nurse who was in the Refresher Course at Beth El College of Nursing. The nurse needed 120 hours of clinical time following her Refresher course work. I agreed and met with her instructor to clarify the expectations. I mentored Clo for one month as she eased her way back into the nursing profession after being out of nursing for 20 year. Clo is now an employee in the same area where she did her clinical hours back in 2012."

    Recognition of PSFHS Preceptors:

    Nurses who serve as preceptors receive a differential pay for sharing this expertise. In addition, we recognize our preceptors each Nurses' Week by displaying their names and through special gifts. We provide name badge ribbons, have drawings for gift cards, or organize a Tea with Nursing Leadership in their honor. (SE10-5)

    Adjunct Faculty/Instructors:

    PSFHS supports our nurses' work as adjunct clinical faculty through flexible scheduling and sharing resources. At any given time, there are more than a dozen PSFHS nurses who are pursuing an outside teaching role. The following are just a few examples that demonstrate our support for nurses to serve as faculty and adjunct faculty:

    Cyndy Wacker, MSN/Med, RN, FCN is a Faculty member of Colorado Parish Nurse Education Consortium commissioned by the International Parish Nurse Resource Center as an educator for parish/faith community nursing.

    Pam Assid, MSN, RN, CEN, CPEN, NEA-BC teaches at Greenville Technical College in South Carolina, The American Institute of Forensic Education based out of California, plus her own private consulting firm.

    Nancy Newbold, MSN, RN is a faculty member for the University of Phoenix, with teaching responsibilities in nursing informatics.

    Candace Garko, MSN, RNC-OB, C-EFM teaches Fetal Monitoring to University of Colorado at Colorado Springs, Beth El College of Nursing and Health Sciences' students each semester.

    Cassie Tumanis, BSN, RN, CEN, PCCN has worked in multiple areas at PSFHS. Currently she is working on our Cardiovascular Unit and serving as clinical faculty for nursing students from the University of Colorado at Colorado Springs, Beth El College of Nursing and Health Sciences. Tumanis serves as Chair of the Clinical Advancement Program (CAP) Peer Review Board, and saw a unique opportunity to create a bridge between nursing colleagues and nursing students. As part of a CAP application, nurses are required to write an exemplar or narrative about their practice.  Cassie sought permission to share some of these exemplars with her students as a way to both recognize nursing expertise and bring "real nursing" to her students. 

    John Gentzel, BSN, RN teaches students as a clinical faculty member. By coordinating his night shift schedule in the ED with day shift adjunct faculty responsibilities, Gentzel is able to serve our community in multiple ways.  

    Lou Ann Cox, BSN, MAED, RN teaches with the University of Colorado at Colorado Springs, Beth El College of Nursing and Health Sciences and is the nurse educator on our Mom/Baby Unit at SFMC.  Using her gifts and expertise to teach to our future nurses as well as support the professional development and competence of nurse colleagues, Cox made time to write a note in appreciation to her PSFHS colleagues for their support. (SE10-6)

    Ronda Wantland, BSN, RN, OCN works on PH 11 Oncology and serves as a clinical adjunct faculty for the University of Colorado at Colorado Springs, Beth El College of Nursing and Health Sciences. With her specialty in oncologic nursing, Wantland developed education for her students and for her nursing colleagues. 

    Nursing Orientation:

    The hiring process for nurses is coordinated with nursing orientation, which is scheduled for every two weeks.  

    The medical surgical units receive most of the new nursing graduates. Established direct care nurses had expressed concerns with staff assignments with regards to preceptors and new graduate nurses. At the same time, all nurses were questioning the amount of paperwork associated with unit orientation and the inconsistency across units.  A team comprised of direct care nurses, preceptors, a new graduate representative, education, and manager met to examine the evidence for nursing orientation on medical surgical units. This groups' goal was the standardization of the processes and reduction of paperwork. Using our Nursing EBP Council approved Evidence Based Practice Implementation Model (Rosswurm and Larrabee), the committee proceeded.

    Additions to unit orientation included "education" to our Professional Practice Model, Code of Ethics for nursing, and in the use of evidence based practices. The team recommended reduced assignments for preceptors during initial days of new hire unit orientation. Managers requested support from finance to meet this recommendation. Collaboration with finance resulted in the development of a job code specific to new graduate nurse orientation, which was an internal adaptation that reduced the impact on unit budgets and productivity.  This was a significant accomplishment demonstrating collaboration and advocacy for limited resources and the roles of nursing teachers.

    The Renal Diabetic Unit at Penrose frequently accepts new graduate nurses. Seeking efficiency and effectiveness, the clinical manager and nursing team identified a strong preceptor and scheduled her without a patient assignment to orient and support small groups of new nurses. 

    The revised medical surgical orientation process was piloted in the summer/fall of 2009 and evaluated in 2010 as the process was implemented across all medical surgical units. External dissemination of this process occurred at a regional nursing conference in 2010.

    One of the recommendations from this committee was to review preceptor criteria, selection, training, and rewards.

    Preceptor Selection, Training, and Evaluation Revisions:

    In 2010, the Centura Nursing Professional Development Council set a goal to review the variety of preceptor structures and processes within Centura Health. A sub-group of nurses was tasked to evaluate the literature for current evidence based practices. Two primary programs were selected for further evaluation at each Centura Health organization. PSFHS included preceptor nurses, recent new hire nurses, educators, clinical nurse specialists, and managers in previewing the two programs.  Following the previews, PSFHS chose MidAmerica Nurse Preceptor Academy vs. Vermont Nurses in Partnership (VNIP). 

    In early 2011, we compared our current preceptor education with the MidAmerica program and made revisions in our program to align the structure and process. 

    In fall of 2011, a PSFHS Preceptor Task Force was formed to take the next step to implement MidAmerican Nurse Preceptor Academy processes. This Task Force includes:

     The work plan included:

    The plan is being implemented in FY 2013.  All current preceptors do not need to reapply, but they will have to complete the annual evaluation process and be approved or removed from the preceptor role by the Unit Practice Council. All potential new preceptors will apply using the revised process.  (SE10-8, SE10-9)

    Preceptor Process:

    Steps

    Responsible Person

    1. Complete application

    Potential Preceptor

    1. Review application for completeness, meeting criteria. Consider current performance of applicant.  Make recommendation to Unit Practice Council (UPC) if applicant meets basic criteria.

    Clinical Manager

    1. UPC members complete Preceptor Applicant Rating Form and either approve for Preceptor Academy or deny.

    UPC Members

    1. Complete Preceptor Academy if approved to be a unit preceptor.

    Potential Preceptor

     The Preceptor Program will be evaluated in June 2013, following one year of implementation. The team will review:

    Summary:

    PSFHS' nurses are supportive of the professional development of other nurses as teachers and the development of young nurses. We are so supportive of this, that we eclipse all other Centura Facilities (including sister hospitals that are Magnet Designated) in terms of precepted student hours. In 2012, PSFHS hosted 916 students for a total of 112,175 hours with Porter Adventist Hospital in a distant second with 35,624 precepted hours. (SE10-7) Further, our nurses support one another in their outside teaching activities as nurses act as faculty for higher learning across the region.

    References

    Green, M., McArdle, D., & Robichaux, C. (2009). Creating a culture of caring to foster a healthy workplace. Critical Care Nursing Quarterly, 32(4), 296-304.

    Herbst, A., Swengros, D., & Kinney, G. (2010). How to teach human caring. Journal for Nurses in Staff Development, 26(4), E6-E11.

    Watson, J. (2006). Part one: Jean Watson's theory of human caring. In M. Parker (Ed.), Nursing theories & nursing practice (pp. 295-302). Philadelphia: F.A. Davis Company.

    • Kathy Guy, RN, Director of Professional Resources -Task Force Leader
    • Phil Ainsworth, RN, SFMC 5 Surgical Manager
    • Carolyn Cusic, RN, PH 11 Oncology Manager
    • Lynne Wahl, RN, Med/Surg Clinical Nurse Specialist
    • Diana Patterson, RN, Education Resources
    • Deb Avery, RN, preceptor for PICC/ED
    • Mary Jane Nickell, preceptor for PH 5th Floor
    • Setting goals and identifying measurable outcomes for the preceptor program
    • Previewing current Preceptor Academy and gathering feedback
    • Reviewing preceptor selection criteria from the MidAmerica program
    • Designing an application form and process for Preceptor selection based upon criteria
    • Revising policy
    • Designing an evaluation tool
    • Recommending changes to the Nursing Councils
    • Planning for implementation
    • Preceptor evaluations including self, protégé, peer and manager
      • Identify positive feedback  to build on strength 
      • Consider revisions and improvement opportunitie
    • Analyze one year retention/turnover data as part of nursing's strategic plan
    •  Outcome will be improved retention

    • Assess reports of staff attending Preceptor Academy who state they were "volun-told" (PSFHS staff have stated they were "volun-told" to attend in the past, defined as a combination of volunteer and told or assigned to be a preceptor).  The Preceptor Academy faculty will follow up with the manager if staff describes themselves in this capacity.  The expectation is all units will implement the revised policy which does not support manager assignment of preceptors.
  • Structural Empowerment - SE11

    Commitment to Community Involvement 

    SE11 The structures and processes used to identify and allocate resources for affiliations with schools of nursing, consortiums, or community outreach programs.

    Our Mission: We extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities .

    Our Vision: Centura Health will fulfill a covenant of caring for our communities with excellence and integrity to become their partner for life.

    Structures:

    Our Centura 2020 Strategic Plan identifies three priorities, strengthen our foundation, move upstream and create systems of care. All three priorities required we identify and allocate resources for affiliations with community programs and consortiums. We recognize nurses provide a large percentage of service in our organization and affiliations with schools of nursing encourages professional development in our nursing associates, promotes the growth and competence of our new and future nurses and creates opportunities to partner to meet community needs.

    The Centura Health and PSFHS Senior Leadership establish priorities and allocate resources for consortiums and community outreach programs. Departments and individual associates may identify an opportunity for affiliations and refer these opportunities to PSFHS leadership. The Mission and Ministry, Penrose Foundation, Marketing Department, Human Resources, Contracts, and Education Department are additional structures to allocate and coordinate resources. 

    Nursing positions and roles include expectations regarding affiliations with schools of nursing, consortiums and community outreach.  For example the Education Department coordinates school contracts and placements while the Mission and Ministry Faith Community Nurses and Cancer Center Outreach nurses focus on consortiums and community outreach.

    Schools of Nursing:

    Colorado Center for Nursing Excellence Centura Health is a funding partner for Colorado Center for Nursing Excellence.  Formed in 2022, the Center's mission is to "Contribute to the promise for health by developing an excellent nursing and healthcare workforce that meets the needs of all Coloradans."  Our participation in this organization includes participation in summits and other activities in support of this vision.  In the fall of 2010, The Colorado Center for Nursing Excellence teamed up with the The Colorado Trust, the Colorado Health Foundation, Colorado Community College System and over 100 participants representing nursing organizations, employers and public agencies to hold a summit on the future of nursing and nursing education. The summit was the first of its kind in Colorado to bring such a broad coalition together to address challenges in the nursing workforce, taking into account not just the workforce issues, but also the implications of health care reform and the state's fiscal challenges.  The Chief Nursing Officer and Magnet Coordinator from PSFHS participated in this meeting.   ( SE11-1 ,SE11-2 )

    University of Colorado, Beth-El College of Nursing and Health Services Following the Summit in the fall of 2010, PSFHS met with our two local Colorado Springs nursing schools in support of improving access for associate degree nurses to baccalaureate nursing programs.  In 2012, the University of Colorado, Colorado Springs (UCCS) Beth-El College of Nursing and Health Sciences introduced a Dual Enrollment program to ease the transition from an associate program. Since PSFHS provides clinical placements for students in the Pikes Peak Community College program and employs graduates, the Dual Enrollment Program allows for liberal transfer of basic education credits and promotes the national and professional focus on increasing our baccalaureate nurses. ( SE11-3 , SE11-4 )

    In the fall of 2010, UCCS invited nurses from PSFHS to attend a joint workshop with the University of Colorado at Denver College of Nursing.  Five nurses from PSFHS were excited to listen and dialogue with Dr. Patricia Benner during this workshop and appreciated the UCCS invitation. ( SE11-5 )

    Pikes Peak Community College of Nursing - Board Membership Diana Patterson, BSN, MA, RN Educator is a member of the Pikes Peak Community College School of Nursing Advisory Board.  Kate McCord, MSN, RN, NEA-BC, former CNO is a Board member for Colorado Technical Institute School of Nursing.   In addition, the two local schools invite PSFHS nursing leaders to annual focus group meetings.

    Diana Patterson, RN writes "As part of my PSFHS duties on the Pikes Peak Community College (PPCC) Advisory Board, I serve as a liaison between the hospital and school to dispel rumors and answer questions regarding hiring practices and the graduate nurse program. At each meeting, I usually have to address the "rumor" that Penrose-St. Francis is only hiring BSN nurses, which causes much angst for these Associate's Degree in Nursing (A.D.N.) students.  The message being sent to the PPCC students is that A.D.N. is their entry level into nursing and that many hospitals require or will require a BSN within a few years as a condition of employment.  Students are encouraged to participate in the articulation program between PPCC and UCCS Bethel to begin taking transferrable credits toward their BSN while waiting to get into the PPCC nursing program. ( SE11-6 )

    At the PPCC NLN-AC site visit, the UCCS Bethel Nursing Program Dean and Lead Faculty discussed the aforementioned articulation program with the site surveyors.  This model is being reviewed as a potential template for the state of Colorado's other nursing programs."

    Clinical Placements The ANA Nursing Administration: Scope and Standards of Practice (2009), Standard 10 states "the nurse administrator interacts with and contributes to the professional development of peers and colleagues." PSFHS nursing has established affiliations with schools of nursing to support the education of our future nurses. We have contracts with schools of nursing in Colorado and across the nation. 

    Senior and Master's Degree nursing students select our organization for capstone and other educational opportunities. Our Education Department, which is made up entirely of nurses, coordinates between schools and our clinical managers and preceptors to facilitate placement.

    Pinning and Graduation Ceremonies Helen Graham, Ph.D., RN-C, manager of cardiology and cardiac rehabilitation, spoke at the Pikes Peak Community College (PPCC) 2011 Nursing Pinning Ceremony.  For more than 20 years, Penrose-St. Francis Health Services has provided many learning opportunities for PPCC student nurses. Some of these experiences include clinical rotations in the ED, OR, ICU and a 3-5 week rotation in the Birth Center and Pediatrics, as well as learning opportunities in Med - Surg.  Helen spoke to the graduating class about the "Journey through Nursing School." Helen was invited to speak to the graduating class because of her educational accomplishments and national reputation in the field of cardiac rehabilitation. ( SE11-7 )

    Nursing Research Deborah Kenny PhD, RN, FAAN, University of Colorado at Colorado Springs is an active member of our PSFHS Nursing Evidence Based Practice/Research Council. She serves as a peer reviewer of nursing research proposals prior to submission to the IRB and has provided education with nurses within PSFHS on nursing research and evidence based practices.

    Nursing Community Health Clinical Faculty Joint appointment:

    The goal for the joint appointment was to develop and implement programming for prevention and health promotion education for the vulnerable uninsured/underinsured populations in Colorado Springs in conjunction with UCCS Bethel School of Nursing as a joint clinical faculty member in Community Health Nursing. 

    The PSFHS Neighborhood Nurse Centers have been community health practicum sites for the UCCS Bethel College of Nursing and Health Sciences for several years. There have been frequent faculty changes for UCCS and therefore a constant learning curve to provide the best educational opportunity for students and for our sites to be able to fully utilize student opportunities to benefit our patients. To reduce these barriers PSFHS was approached to consider a joint faculty appointment in which one of our Faith Community Nurses would be also be faculty of UCCS. This appointment would be modeled after another community joint faculty agreement with the El Paso County Health department.

    A Memorandum of Understanding (MOU) was drafted and approved by both partners. The joint appointee nurse is a PSFHS employee with a 0.5 FTE. UCCS compensates PSF for joint appointee time in accordance with MOU. PSFHS hires and has responsibility for employee performance with input from UCCS as to job requirements and eligibility. There is a yearly evaluation of the employee and the agreement. ( SE11-8 )

    The position description includes:

    • Responsibility for one of the PSFHS Neighborhood Nurse Centers year round. 
    • Three 8 week periods of 20 hours/week community health class faculty plus monthly faculty staff meetings and specified other duties related to the faculty work at UCCS. 
    • Responsibility for coordinating the community health nursing students assigned to her to function in the uninsured/underinsured communities assisted through the PSFHS Neighborhood Nurse Centers. ( SE11-9 ) 

    The agreement works with the understanding that flexibility is the key when prioritizing the hours of the employee for both partners.  We are in the second year of this agreement.

    Community Board Membership:

    PSFHS organizational leaders participate on community boards. Examples of this participation is listed in the table below.

    PSFHS Leader

    Board

    Kate McCord, CNO

    Colorado Technical College Board

    Colorado Organization of Nurse Executives

    Colorado Healthcare Ethics Forum

    Ann Kjosa, VP of Nursing at SFMC, CNO

    March of Dimes Walk, Chair

    March of Dimes, Board

    Danny Reeves, CFO

    Service Center Governing Board

    Colorado Springs Eye Center Board

    Audubon Board

    Jameson Smith, VP CEO

    Penrad Board

    Pikes Peak Palliative Care Board

    Community Health Partnership Board

    Margaret Sabin, CEO

    Colorado Springs School Board

    Joint Initiative for Youth and Families

    Chamber of Commerce

    American Heart Association Ball, 2013 Chair

    Nate Olson, SFMC CEO

    American Heart Association Board

    YMCA Board of Directors

    Mark Hartman, VP of Ops. SFMC 

    Center for Non-Profit Excellence Board

    Ms. St. Francis Nursing Care Board

    Jeff Oram-Smith, CMO

    El Paso County Medical Society

     

    Community Outreach:

    Community Plunge An innovative strategy was used to introduce and immerse our senior leadership team in some of the community services sites in which we partner and support through scheduled events. Designed by our Mission Outreach Coordinator, Cyndy Wacker, MSN/MEd, RN, the day was a one of discovery and community engagement. Our leaders shared lunch with the homeless people in our community, visited with CEO's and patients of several safety net community clinics, and expanded their awareness and understanding of community organizations that we partner with in order to meet the needs of the under and uninsured in our community. Watching one nurse teach a mom about breastfeeding, led to a discussion of equipment needs. "I have 65 pumps but really need more for these moms" stated Janeen (RN). Senior leaders immediately approved an additional 100 pumps for $6500. One senior leader stated, "Face to face with the need, we felt a new urgency." Another senior leader spoke of how humbling the day was, stating that "we were greeted with graciousness everywhere we went. Some people talked about being homeless and yet they clearly took pride in their cleanliness and appearance. It was an eye opening day."  ( SE11-10 )

    Mission Outreach - Faith Community Nurse Program Our Faith Community Nurse Program (FCN) reaches out to serve the community through multiple partnerships.  PSFHS Mission Outreach and six neighborhood assistance sites cooperate to provide support for medically underserved members of our community.  Services include financial assistance for co-pay and acute or chronic short term prescription needs, patient and family education, or blood pressure checks. FCN also provide care management to include referrals to health care resources, coordination and navigation of care, health care counseling, and patient advocacy.  Individual and group prevention, wellness, and chronic disease management classes are provided on site at low cost or no cost to patients.

    FCN prevention clinics that include immunizations, prevention assessments and health risk appraisals are held in partnership with the six Neighborhood Nurse Centers and local schools of nursing for targeted populations. ( SE11-11 , SE11-12 )  Penrose-St. Francis Mission Outreach, in collaboration with UCCS Bethel School of Nursing and West Side CARES, hosted host a free Flu Shot Clinic for uninsured/ underinsured at Westside Community Center.

    Cancer Center Outreach The outreach department has been funded by a series of grants from different sources to provide services to disparate populations with a special emphases on African American, Rural, Latinos, and under/uninsured. The staff is comprised of two fulltime and one PRN staff member. The entire team works together to develop community partners and provide recourses/education on early detection and screening guidelines, breast health, cervical health/HPV, ovarian cancer, colorectal cancer, testicular cancer, and prostate cancer. In 2011, the Cancer Center Outreach nurse participated in twenty events focused on education outreach. ( SE11-13 ) In 2012 the Cancer Center Outreach team provided education at health fairs and education seminars to 2707 participants. 

    Through collaboration with community partners we participated in the 2012 Head & Neck, Skin and Prostate screening and served 723 people.

    The Cancer Center Outreach team includes: 

    Carolyn Kalaskie is the outreach coordinator with a primary focus for outreach to African Americans and rural communities.

    Peggy Thomas MSN, RN is the outreach nurse navigator who role is to provide education/navigation to patient requiring further follow-up after the head & neck, skin, and prostate screening.  She also provides navigation to breast patients from the San Luis Valley and community member with breast lumps.

    Cecilia Belardi-Thompson is our Latino Outreach Coordinator.

    Newborn Hope a Colorado 501(c)(3) non-profit organization, raises funds and supports programs for the advancement of maternal, fetal and neonatal healthcare and well being.  One of the Neonatal Nurse Practitioners is a member of the Board of Directors.  As a sponsor of Newborn Hope, PSFHS nurses and others volunteer time, participate in fundraising activities and in 2011celebrated with the Newborn Hope Featured Family and infant from our NICU In addition, our babies benefit from grants from Newborn Hope.  ( SE11-14 )

    The Outreach Committee PSFHS established an Outreach Committee several years ago. This is an interdepartmental group that partnerships with community organizations to collect donations.  In the fall, school supplies are collected from all our campuses and donated; during Christmas, we partner with Operation Shoebox and associates fill shoe boxes.  Toiletries, coats, gloves and sox are other items donated by associates and distributed to community organizations by the Outreach Committee. 

    Operation Christmas Child benefits children in Haiti Operation Christmas Child collected more than 260 boxes, as well as cash donations, for children in Haiti. PSFHS funded the shipping and handling costs.

      
    Be A Santa to a Senior The associates at Penrose-St. Francis generously donated 120 holiday gifts for seniors in our community who otherwise would not have received any gifts this Christmas

    Centura Global Health Initiatives (CGHI) offers short term medical mission trips for volunteer doctors, medical professionals and non-medical volunteers. We provide no-cost surgical, medical and community health programs, education, training and relief in areas where health care is often limited or difficult to obtain. Centura Health provides financial assistance to their Associates who need support in order to participate in these projects. 50% of the travel expenses for the mission project is available to Associates on a first-come/first-serve basis. A $100 credit for immunizations is also provided. Only a limited number of sponsorships are available.

    The current mission program has established ties with hospitals in the following locations:

    • Centura Health Relief Efforts in Haiti
    • Clinica Adventista Ana Stahl - Iquitos, Peru
    • La Loma Luz Adventist Hospital - Santa Elena, Belize
    • Mugonero Adventist Hospital - Mugonero, Rwanda
    • Scheer Memorial Hospital - Banepa, Nepal
    • Bach Mai Hospital - Hanoi, Vietnam
    • Gonaives, Haiti

    In addition, many of our nurses serve on mission trips through local church or other organizations. The PSFHS Clinical Advancement Program (CAP) recognizes outreach service.  In 2011, one nurse CAP applicant wrote her narrative about her mission trip in China. ( SE11-15 )

    Summary:

    Multiple structures provide leadership to identify, prioritize and allocate resources for affiliations. While PSFHS affiliations with schools of nursing are widespread, we maintain a strong emphasis on our regional partners through funding, participation in summits, clinical placements and partnering to improve nurse access to baccalaureate programs.  Our Mission Outreach Nursing Team comprised of seven nurses demonstrates the organizational priority for community outreach and allocation of significant resources. In addition a strong Cancer Center Outreach program receives grant funds as well as financial support through PSFHS.  Our shared decision making foundation can also be seen at work as units organize to support student placements and individuals arrange schedules to provide outreach.

  • Structural Empowerment - SE11EO

    SE 11 EO The results of the affiliations with schools of nursing, consortiums, or community outreach programs described in SE11.

    Partnering with our Communities to Reduce Immunization Disparities:

    Background In 2003, Colorado was rated 50 of 50 states for a segment of childhood immunizations. "Between 1995 and 2003, Colorado declined from 24th to 50th in the nation in the share of children who receive their full vaccinations." "Colorado Childhood Immunization Rates: Policy and Practice," May 2005, www.coloradohealthinstitute.org/Documents/Q&A_final.pdf.

    One of the goals for the PSFHS Faith Community Nurse (FCN) program is to reduce disparities in health care access within our communities.  Prevention in the form of improving access to immunizations is evidenced based and all persons regardless of insurance status or ability to pay should have equal access to immunizations.  The FCN program led the community effort to create capacity for immunization access.

    The Faith Community Nurse program is provided through the PSFHS FCN Mission Outreach Program.  This nurse led program includes seven Registered Nurses who establish relationships in the community and partner with six neighborhood assistance sites to provide support for medically underserved members of the community.   In addition, this team of nurses partners with the University of Colorado in Colorado Springs, Beth El School of Nursing providing immunizations, seasonal flu clinics, prevention assessments and health risk appraisals as well as a joint venture in community health education for nursing students. 

    By creating community access for immunizations, the PSFHS Mission Outreach Program will increase the number of flu immunizations by 2012-2013 season.  The goal is to increase the number of flu vaccinations provided by through FCN partnerships.

    Methods/Approaches/Timeline

    2003: Obtaining a small grant from Pikes Peak Community Foundation our PSFHS FCN directed money to the El Paso County Health Department to provide the co-pay required to vaccinate FCN client's children. The outcome was that 100 needed vaccinations were provided through the El Paso County Health Department. Additionally, the health department realized that there were barriers to children receiving appropriate vaccinations through the Health Department and education for employees was implemented.

    2005-2011: Passionate to improve access and reduce disparities, the FCN affiliated with the Colorado Children's Immunization Coalition to develop, and facilitate an El Paso County Immunization Coalition that allowed for collaboration of immunization providers, pharmaceutical companies and administrators to communicate around gaps and barriers regarding immunizations. The FCN role in the coalition was and continues to be as an advocate for those who are not insured or have limited access to vaccinations.

    The FCN program utilized the provider status of PSFHS for Vaccine for Children (VFC) and established a systematic program to utilize VFC for community needs.  Setting up health fairs throughout the community took a lot of time and hard work. Recruiting and training volunteers, transporting supplies, marketing and setting up safe, accessible places was time consuming.  Children attended the health fairs to receive immunizations, however, the FCN vision remained - to make vaccines available during routine or urgent visits to providers and linking patients with established clinics so that appropriate health care access was assured for all families.

    While FCN continued to partner with community agencies and organizations to host school physicals and immunizations in the fall, they networked to design a system to meet the ongoing year long needs for immunizations for the targeted population of the underinsured/uninsured in El Paso County.

    The PSFHS Faith Community Nurses coordinated with and supported other community health fairs by establishing a Health Fair Collaborative to facilitate communication and access. The FCN program established immunization clinics at partnering site health fairs to assure access to and provide immunizations to children 4-18 years old who were not connected with a medical home and were uninsured.  A standardized clinic process was formulated and trainings were held for staff and volunteer personnel using the Centers for Disease Control (CDC) protocols and standards. Close to 500 immunizations was provided to children in this age group as well as assisting in the coordination of efforts for hundreds more through collaborative community sites.

    Continuing their partnerships with a variety of community organizations FCN continue to established, triage, support and educate regarding access to immunizations within the context of ongoing health care for people with limited incomes and/or homeless persons. They also assessed and addressed the barrier that many community clinics had only been offered during normal working hours which were inconvenient for parents that were attempting to provide immunizations for their children.

    FCN collaborated with SET Family Medical Clinic, a clinic for uninsured or low income people that were doing physicals for children routinely. Initially SET declined to add immunizations to their services. FCN obtained a grant through the Colorado Children's Immunization Coalition for SET and the FCN worked with State Health Department and SET to train staff, obtain VFC vaccine and supplies and support the initial clinics by mentoring staff. SET now provides vaccinations as part of their normal services as well as hosting free childhood clinics at times that are convenient for families.  The FCN program transitioned their childhood immunization activities to SET Family Medical Clinic as of 2011.

    2006-8: The Faith Community Nurse Program identified a community need to identify and create opportunities for low income adults to receive flu vaccinations.  PSFHS purchased vaccine and the Faith Community Nurses provided flu shots at each of their 6 neighborhood center sites.  Utilizing the clinic process and policy implemented for the childhood vaccination program, FCN began recruiting and training volunteers as they broadened their outreach to improve access to adults.  During this time 200-300 free flu vaccinations provided.

    2007-2008:  H1N1: Due to a Faith and Health Program Interfaith Health Program (IHP) with Emory University and the immunization program already established, the FCN were asked to participate in a grant to provide H1N1 vaccinations in El Paso County. As one of only 10 sites in the nation accepted by Emory for grant funds, FCN championed adult and children's access to flu vaccine.  1,514 H1N1 immunizations were provided in addition to the regular flu vaccinations this year.

    2009-2010: The American Reinvestment Recovery Act (ARRA) provided an opportunity to seek additional grant funding for non flu adult immunizations for 2009-2010. This state supported grant allowed the purchase of vaccines TDaP, pneumonia, shingles, Hepatitis A and  B for adults.  This one year grant funded an adult vaccination program. The Catholic Charities Soup Kitchen had a client base of close to 750 persons a day that were uninsured and high risk which met grant criteria. This site became the main site for adult vaccinations. In addition, the FCN provided  additional vaccines to established flu clinic sites.  FCN provided 670 non influenza vaccinations during this one year grant period.  (ARRA Grant available onsite)

    2009-2012: Emory University Rollins School of Public Health and the Interfaith Health Program (IHP) recognized the strength and benefits of partnering with the PSFHS Foundation who serves as the fiduciary agent and the leadership of our Faith Community Nurses through IHP to make vaccines available to identified vulnerable populations. IHP Colorado Springs led by the FCN Outreach Coordinator has been part of the grant funded national adult immunization initiative for targeted vulnerable populations for four consecutive years. The program has received $10,000-$11,000 a year that assists with staffing the immunization clinics, supplies and simple marketing. There is never a charge for clients. The FCN model for education and vaccinating the homeless and at risk homeless population is a model for other national programs through IHP Emory. (SE11EO-1SE11EO-2SE11EO-3SE11EO-4)

    Pikes Peak Flu and Immunization Coalition, co-chaired for five years by our FCN Outreach Coordinator, Cyndy Wacker, MSN/M.Ed., RN, FCN is comprised of representatives from El Paso County Health Department, PSFHS Faith Community Nursing, Beth El School of Nursing, Visiting Nurse Association and other organizations. In 2011 this coalition agreed to collaborate to combine flu and immunization clinics in our communities. This process improved access and efficient use of resources. In 2012 additional funds were received from the Colorado Immunization Coalition to promote immunizations.  Using these funds, Cyndy took the lead to develop and distribute public education material promoting immunizations. (SE11EO-5SE11EO-6)

    The PSFHS Faith Community Nurses coordinated with and supported other community health fairs by establishing a Health Fair Collaborative to facilitate communication and access. The FCN program established immunization clinics at partnering site health fairs to assure access to and provide immunizations to children 4-18 years old who were not connected with a medical home and were uninsured. The FCN program transitioned their childhood immunization activities to SET Family Medical Clinic as of 2011.  Walgreens and local fire departments joined the partnership and assisted with vaccinations in 2012. (SE11EO-7)

    The FCN model for education and vaccinating the homeless and at risk homeless population is a model for other national programs through IHP Emory. The FCN Outreach Coordinator has presented our program and outcomes to the national immunization partners at the annual Emory University Adult Immunization Conference held in Atlanta in 2010, 2011 and 2012. (SE11EO-8SE11EO-9SE11EO-10SE11EO-11)

    Participants
    PSFHS Mission Outreach: Faith Community Nurses
    PSF Neighborhood Nurse Centers: Northern Churches Care (Mercy's Gate), Catholic Charities,
    Westside CARES, Tri-lakes Cares, Ecumenical Social Ministries, Westside Community Center
    PSFHS Mission Outreach volunteers
    Emory University Rollins School of Public Health: National Partners: Centers for Disease
    Control and Prevention, NAACHO, ASTHO, White House Faith Based and Neighborhood
    Initiatives, National Adult Immunization Program
    Penrose Foundation
    University of Colorado, Beth-El School of Nursing, Colorado Springs (UCCS)
    Pikes Peak United Way
    Walgreens
    Colorado Children's Immunization Coalition
    Pikes Peak Flu and Immunization Coalition: El Paso County Department of Health , Visiting
    Nurse Association,  pharmaceutical company representatives, Peak Vista Community Health Center, Colorado Springs Health Partners,
    Colorado Springs Fire Department
    Latino American Health Network
    Multiple Colorado Springs Faith Communities
    C.A.T.C.H (Coordinated Access to Community Health): Mission Medical Clinic, Open Bible Medical Clinic, Peak Vista Community Health Centers, SET Family Medical Clinic
    IHP Colorado Springs: Bonnie Angotti, Mission Medical Clinic; Steve Brown, Westside CARES; Barbara Joyce, UCCS School of Nursing; Kathy Rice, El Paso County Public Health; Ada Toress, Latino American Health Network; Cyndy Wacker, PSFHS Faith Community Nurses; Amy Lindquist, CPNT, Walgreens; Ruth Boling, PSFHS RN

    Outcomes

    By creating community access for immunizations, the PSFHS Mission Outreach Program will increase the number of flu immunizations by 2012-2013 season.  The goal is to increase the number of flu vaccinations provided by through FCN partnerships.

    We have met the goal for this project.  The number of flu immunizations provided in the 2010-2011 season was 401. In 2011-2012 the immunization number increased to 523.  During the 2012-2013 season the FCN provided 1100 immunizations. This is an increase from 401 to 1100 or 64% increase.
     

    Implications Our Faith Community Nurses are dedicated to serving the underserved in our communities.  Their quest to develop, implement and evaluate strategies to reach vulnerable populations who are at higher risk is ongoing.  Recognizing the general population consensus that vaccinations are valuable as well as required by school, these nurses "use" vaccinations to provide a needed and valuable service and to build relationships with these populations that can lead to additional health promotion opportunities.  Cyndy Wacker, RN, Mission Outreach Coordinator states "Immunizations allow you to reach into the populations/culture and begin to develop trust as we provide a needed service."
     
    The Mission Outreach team continues to seek grant funding for immunizations.   In addition, these nurses maintain strong affiliations through the Neighborhood Nurse Centers in six locations.  They have developed a structure and process to get vaccinations out to the underserved population and established a small group of volunteers to assist.  Working with the School of Nursing provides student nurses both the opportunity for public health nursing education and engages them in meaningful service that they may continue post graduation.

    People receive a needed service. Grant funding is used effectively and efficiently.  Students actively engage in community nursing services.  Community agencies establish relationships and partner to reach a common goal.  Faith Community Nurses live their mission.  At PSFHS we are proud of our Faith Community Nursing Team, their mission and their outcomes.

    References

    Smith, P and Singleton, J. (2011) County-level trends in vaccination coverage among children aged 19-35 months -United States, 1995-2008. Centers for Disease Control and Prevention MMWR, 60 (4), 1-92.

  • Structural Empowerment - SE12

    Commitment to Community Involvement 

    SE12 How the organization supports and recognizes the participation of nurses at all levels in service to the community.          

    PSFHS nurses have always been committed to community service. Nurses participate on the Outreach Committee, serve as Faith Community Nurses in the Mission Outreach program, volunteer time and resources to meet local needs, serve on mission trips around the world, raise funds through participation in community walks, and respond to emergencies wherever they arise. 

    Organizational Support for Community Service:

    Our organization's mission, "to extend the healing ministry of Christ," calls us all to serve in our facilities and in our communities. The spirit of service lives within nurses at all levels. Nurses' desire to serve is supported with funds for products to hand out to others, flexibility with schedules to allow time to serve, marketing expertise, and organization recognition. Certain nursing positions include community service as part of the position's description. We employ Faith Community Nurses who practice in our communities and our Trauma nurses serve in education and outreach activities throughout the community (SE12-1).

    Our Vision says that "Centura Health will fulfill a covenant of caring for our communities with excellence and integrity to become their partner for life." This guidance provides the structural foundation to support and recognize the participation of nurses at all levels in service to our communities. Our Chief Nursing Officer models community service through her volunteer activities as a member of a college board, serving meals at the Marion House (a local soup kitchen) and spending time with dying patients through our No One Dies Alone Program.

    Our Professional Practice Model identifies "Commitment to our Community" as one of our Guiding Principles. Nursing Services Goals 2010-2014 related to this principle include:

    1. PSFHS Nursing will demonstrate a commitment to community involvement through  participation in outreach activities and community education activities.

    2.  PSFHS Nursing will participate in an annual community service project.

    In 2010 PSFHS nurses, including: direct care nurses, coordinators, managers, and directors sponsored a Mothers Prayer Walk. During this same year we recognized the many ways nurses volunteer their time with a display in our hospital lobbies honoring the nurses and their service. A Nursing Service Blood Drive in 2011 led to donations from all levels of nurses and provided the opportunity for several nurses to become regular donors. In December 2010 and December 2011, the Nursing Practice Council gathered many boxes of hats, mittens, and scarves for homeless patients we serve in our emergency rooms and Neighborhood Nurse Clinics. One way highlights of service are recognized and made visible is through the nursing annual report. (SE12-2SE12-3)

    While we respect the individual decision to serve or volunteer in the community anonymously, clinical managers ask about service during annual performance appraisals. The discussion between the manager and the nurse provides an opportunity to recognize service, identify volunteer interest areas that may be encouraged or supported through work at PSFHS and communicate our organization and professional practice commitment to our community.

    Clinical Advancement Program:

    Support and recognition for nurses serving in the community includes the Clinical Advancement Program (CAP). Nurses may receive credit for community service in their CAP application. In our first CAP year (2010) 43% of the applicants received credit for community service. (SE12-4)   

    National/International Sporting Events:

    PSFHS was the official on-site medical provider for the 2011 US Women's Open Golf Championship at the Broadmoor. Dozens of physicians, nurses and administrators volunteered throughout the week including thirty-five (35) nurses from PSFHS. (SE12-5)

    Centura Health was the official medical provider for the 2011 US Pro Cycling Challenge. During the Prologue on Monday, Penrose-St. Francis hosted a booth near the finish line. Attendees registered to win a mountain bike valued at $500, learned about car seat safety, and other trauma issues related to cycling and driving. During the week-long event, Centura Health physicians and nurses followed riders through the mountains, providing medical care to the riders before, during, and after each stage.

    Be the Change Program:

    The Rewards and Recognition Committee began a year long program in July 2010, called "Be the Change." Six teams of ten associates participated. To keep it fun and competitive, each team member gained monthly point for community service. The activities were meaningful to our community from donating items, to giving blood, participating in walk-a-thons or volunteering their time. At the end of the year, the team with the most points received $100 gift card for each member.  One team dubbed, "Chicks for Charity" a group of PSFHS associates including nurses and administrative staff, took on many community projects in 2010-2011. When they identified a need in the organization Rocky Mountain Kids (RMK) these associates collected donations, co-hosted a garage sale and cosponsored a picnic for these youth. PSFHS donated cookies for the picnic as well as items for the garage sale. Selecting another worthy organization, Jeanne Rice, Medical Staff Services, led a group of 25 PSFHS associates on a tour at Serenity Springs Wildlife Refuge. The benefit to the sanctuary was a donation of $350, 25 gallons of bleach and office supplies. (SE12-6)

    Television and Radio:

    During Nurses Week 2011, a nurse clinical manager and a nursing student discussed nursing on the local Fox television affiliate. The nursing student wrote, "Thank you for including me, I had a blast. I can't wait to be a nurse at Penrose." Two nursing coordinators from different settings participated in a thirty minute radio interview sharing experiences of nursing past and hopes for the future. Coordinated and supported by our marketing team, these nurses enjoyed their time and promoted nursing excellence in our community.

    Military Service:

    Many nursing associates have served in the military and some continue to serve in military reserve units. Sometimes their service expands community to places throughout the world.  When one surgical nurse was deployed, we kept in contact with occasional emails and welcomed her back to her position and committee participation upon her return. We dedicated a Nursing Newsletter to recognizing these nurses and thank them for their service. One nurse was excited to be honored at PSFHS and eagerly shared the photo of herself from the USAF Nursing Recruiting website. (SE12-7)

    Service to Global Communities:

    When Becky Wiltjer, RN wanted to go to Haiti following the 2010 earthquake, she found support from her colleagues as they changed their schedules to accommodate her request for time away. We recognized her actions in our Magnet Moments publication with photos and her story. 

    Phil Ainsworth, RN, Clinical Manager served on a Mission Trip to Peru in 2011 through Centura Global Health. PSFHS Volunteers promoted and supported the trip. (SE12-8)

    Gina Wamble, RN, coordinated time off with her colleagues over Thanksgiving so she could accompany a church group on a Mission Trip to China. Carolyn Cusic, RN, joined her church mission team in 2011 and served in Ninos de Baja Orphanage in El Porvenir, Mexico.

    Emergency Service to the Community:

    April McPike, RNC, Labor and Delivery Clinical Coordinator at St. Francis Medical Center, was shopping.  "I'll never forget aisle nine," said April. When she got there, she found a lady having a seizure. The patient's son was there and was able to offer a little medical history to help April and another nurse who showed up to help. As they began to care for the patient, her condition deteriorated rapidly. It wasn't long before the nurses agreed that they needed to begin CPR. April began compressions and the other nurse began giving rescue breaths. "This was the first time I have had to perform CPR outside of the hospital," said April. As they completed a few cycles of CPR, they stopped to check the patient and found that she had begun to breathe again on her own.  Paramedics arrived soon after and took over care of the patient and transport to St. Francis Medical Center. The patient was discharge several days later.  The Fire Department presented a Community Hero award to April in 2011.

    Community Events and Health Fairs:

    In addition to partnerships focused on delivering or coordinating access to health care, PSFHS actively participates in community events to provide education, skill building and referrals.  Examples from 2010-2012 include the following.

    • CPR Day at the Sky Sox stadium. PSFHS and the Colorado Springs Fire Department provided a free CPR training session for over 4400 community members.
    • Women's Expo, an annual community event provides screening education to women.  PSFHS nurses are always on hand to provide education on stroke, heart disease, women's cancer and children's services.
    • Partnering with Home Instead Senior Care, PSFHS offered "Operation Medicine Roundup" for safe disposal of expired and unused medication.
    • Located in the mountains west of Colorado Springs our Urgent Care Center nursing associates participated in the Sports Physical Event at Woodland Park High School.  Completing physical exams, providing education and handing out coolers demonstrated their support of the mountain community.
    • Woodland Park Urgent Care Clinical Nurse Manager and colleagues passed out mini-first aid kits and Frisbees to visitors during Independence Day celebrations.
    • Women's Event at the Shops at Briargate (Self Care, Cardiac and Cancer Care)
    • Prostate is the most common urologic cancer treated at Penrose. The radiation oncology department has a full time prostate nurse navigator able to coordinate all aspects of care.  In September 2011, Penrose Cancer Center, in collaboration with Peak Vista Clinic, Rocky Mountain Cancer Center, Man to Man Support Group and Memorial Health System, led an annual free prostate screening event. A total of 133 patients, approximately 50% of whom had no insurance or access to routine health care, received prostate cancer screening with PSA testing and digital rectal examination. 45 men were found to have an abnormal examination and 10 men had an abnormal PSA. Referrals for urologic evaluation were made and at least one man was diagnosed with cancer.

    Volunteer Partnerships:

    "I am a volunteer church nurse (parish care nurse) at Living Hope Covenant Church. This role grew out of my calling to be a nurse, wish to help people and share my faith. I took a 40 hr class at the University of Colorado. I loved the class and now I love taking care of my church family in a more organized way.  My husband, Ed, is a nurse also so we share our focus on health ministry.  I do a bulletin board (health care info, medical clinics, specific illness, prevention, etc.) and write a monthly newsletter. I help teach my Pastor; for instance he wanted to know the difference in care of a person with an acute illness vs. a chronic illness.  My church leadership team has embraced the having a church nurse and a new Health Ministry, so I am excited!"                                                         Kandy Hansen RN, SFMC 5N (Direct Care Nurse, Nights)

    "We have really grown our church health education and awareness during the last couple of years.  We check blood pressures, have education handouts and support our congregation to take care of themselves and to get medical treatment when needed. From our work at PSFHS we are able to identify education materials to share in our church." Audrey Simpson, RN, Clinical Manager and Earnestine Nichols, RN, Direct Care Nurse 

    Community Benefit Report:

    The annual Community Benefit report provides an overview of community services completed during each year. Since it is based on information shared by our associates on community services contributed on PSFHS time, it does not include the many volunteer hours our associates provided.

    The table below reflects additional nurse community service:

    Events

    Services

    First and Main Concerts (Summer Friday evenings)

    Nurses provide information and education to community members at various specialty booths including Birth Center, Rehab, Cardiac Services, Stroke Prevention, Trauma. (SE 12-9)

    Community Walks - March of Dimes, American Heart Walk, Liver Walk, Juvenile Diabetes Walk, Komen Breast Cancer Walk

    Nurses walk along side other PSFHS associates and community members to raise money for these organizations. PSFHS purchases t-shirts in support and recognition of our associates. Some nurses assume leadership roles coordinating these large community events.

    NICU Reunion Picnic

    Ask any nurse or NICU Associate about this annual picnic.  In fact ask the NICU Families.  You will hear words like fun, incredible, exciting, rewarding, heart touching.

    Bereavement Group - Resolve through Sharing (Infant Burial Service) 

    This evidence based practice is led by expert and compassionate nurses in collaboration with our spiritual care department to support families experiencing fetal loss.

    El Paso County Fetal Infant Child  Mortality Review

    Monthly case review. Also participation in the Sudden Infant Death Syndrome risk reduction project team for El Paso County, a subgroup of this Review team.

    SFMC Christmas Craft Fair

    Nurses host this annual fair to raise money for a community organization.  Making and selling arts and crafts has raised hundreds of dollars. Held on campus every year and coordinated by a group of nurses from varying levels.

    Immunization Clinics

     

    Nurse work and/or volunteer at immunization clinics throughout the year.

    School education

    Safe Bet

    Helmets

    Texting and Driving

    The Trauma Department including nurses supports safety and wellness through participation in multiple education and awareness events every year.  Educating and giving away helmets promotes individual safety.

    Summary:

    Nurses at all levels and in all settings are supported and recognized for participation in community services.  Some positions include an expectation for community outreach and service, though most nurses serve based on values and professionalism.  Financial, scheduling or information on opportunities encourages community service.  For global service nurses receive support through PSFHS as well as churches. The Penrose Pulse and Nursing Annual report recognize participation. "Being the healing ministry of Christ" is both a organizational mission statement and visible action at PSFHS

  • Structural Empowerment - SE13

    Commitment to Community Involvement

    SE 13 How the organization of nursing addresses the healthcare needs of the community by establishing partnerships.

    PSFHS associates are passionate about incorporating our organization mission and vision statements into real patient and community care. Our guiding statements are reinforced and operationalized through our Centura Health Strategic Plan.

    Our Mission: To extend the healing ministry of Christ by caring for those who are ill and by nurturing the health of the people in our communities.

    Our Vision: Centura Health will fulfill a covenant of caring for our communities with excellence and integrity to become their partner for life. 

    The above is a graphic description of how our mission and vision dictate the creation of policies and partnerships. Multiple structures and processes exist within PSFHS that allow for the creation of such partnerships to address the healthcare needs of our community.  Formal leadership sits with the Chief Executive Officer and her senior leadership team including the Chief Nursing Officer. Any associate may suggest ideas, which are considered and decided by the leadership team. In addition, associates often suggest and take a leadership role on many informal "partnerships" or acts of service to address community health care needs. The following documentation reflects examples of a variety of partnerships and their outcomes.               

    Community Health Partnership (CHP):

    The Community Health Partnership was formed in 1992 to foster a coordinated approach to health care issues in El Paso County. The alliance now has more than 20 dues-paying members, including Penrose-St. Francis Health Services, Memorial Health System, the El Paso County Medical Society, the El Paso County Department of Health and Environment, as well as Colorado Springs Health Partners. The primary focus for this partnership is to provide access to care for the uninsured, which is a growing issue in the current economic climate. CHP's efforts include a prescription drug-assistance program and Coordinated Access to Community Healthcare (CATCH), which has established a collaborative referral network of donated services to provide a safety net of integrated care for low-income, under insured, and uninsured residents of El Paso County.

    Tri-Lakes Health Advocacy Partnership (HAP):

    Our Faith Community Nurse Program partners with HAP to provide blood pressure screening, a macular degeneration/low vision support group, medical referrals, and pharmaceutical assistance.  Jackie Sward, RN, provides health actions and advocacy for people visiting the clinic. In addition, she partners with many organizations in the annual health fair. (SE13-1)

    Partnership -Rocky Mountain Cancer Centers (2010-2012):

    Penrose Cancer Center and Rocky Mountain Cancer Centers (RMCC) formed a partnership to collaborate and create a comprehensive oncology center for both inpatient and outpatient services. Through the partnership, Rocky Mountain Cancer Centers focuses on medical oncology services and Penrose Cancer Center provides radiation oncology services. The new partnership program began on January 3, 2011. While both organizations already provided outstanding care for the cancer patients in our community, this new partnership opened new resources that may not have been available to those patients in the past. The new partnership enables the program to provide our patients with coordinated multi-disciplinary care, high-quality clinical outcomes, access to leading edge technology, clinical trials, cost-efficient care, outstanding patient experience, research, innovation, and a holistic approach to patient care. In 2011, new patient consults at Penrose Cancer Center increased by 54 percent.  RMCC has experienced a 20 percent growth in new patient volume.

    El Paso County Detox Center:

    The El Paso County Detox Center is a 24-hour social model detoxification facility providing a safe environment for people to sober up.  Pikes Peak Mental Health closed its detox operation at The Lighthouse Assessment Center over financial concerns. PSFHS continues to provide medical detox services when indicated. With the closure of Pikes Peak Mental Health Detox the community needed to develop alternative resources.  A partnership including Penrose-St. Francis Health Services led to the establishment of the El Paso County Community Detoxification Facility to provide a safe and effective continuum of care for citizens in need of substance abuse and addiction treatment services in El Paso County. The cost per episode for "detox services" at a detoxification center is $225 compared to an emergency room visit with an average cost of $1,000. The El Paso County Community Detox Facility has received national recognition from the National Association of Counties and the National Criminal Justice Association

    Physician/Nurse Collaborative Committee:

    The El Paso County Medical Society is composed of representatives from hospitals including PSFHS, schools of nursing, the health department, and other providers host the Physician/Nurse Collaborative Committee. The mission of this committee is to:

    o Provide a forum for professional colleagues to bring diverse perspectives to problems, concerns, and serve as a communication conduit between nurses and physicians.
    o Serve as patient advocates by offering the opportunity to plan for patient care and by maximizing the integration of care to meet the needs of patients.
    o Work to assure that the physician and nursing communities recognize the changing environment of health care delivery while exploring ways to collaborate in educating professionals and the public. With particular regard to the changing role of medicine, towards prevention rather than just treating illness.
    o Serve as a resource to other committees of the medical society.
    o Review and recommend recipient categories and procedures for Excellence in Nursing Awards.

    PSFHS Women's Services Advisory Council:

    In 2010, PSFHS formed a Women's Services Advisory Council to develop a system wide strategy for women's healthcare in Colorado Springs. The council includes physicians, business leaders, administrators, PSF Governing Board members, and local community members.   The council is focused on services for conditions that exist only in women, such as pregnancy and menopause; conditions that occur more frequently in women, such as breast cancer and thyroid disease; and conditions that are biologically different in women, such as cardiac disease and osteoporosis.  The council is chaired by Mary Wall, a former Director of Nursing Services for PSFHS and a Nightingale Award recipient who is deeply involved in our community. 

    Grant for nursing mothers:

    The El Paso Physicians Association provided a $1,000 grant in 2010 to Jeannine Cabanellas-Kidwell, RN, PSFHS Faith Community Nurse.  The grant money was used to purchase:

    • 12 electric double pumps for mothers who are struggling to sustain a milk production that cannot receive a pump from WIC or any other source due to financial barriers
    • 11 single one hand pumps for those that need an occasional pumping
    • 10 Double Pedal Pumps for moms who have infants in the NICU and can't afford to rent an electric pump

    "One thing that is important to note is that Colorado passed a law that women in the workplace have to be provided the privacy to pump at their place of employment. So by providing these pumps to the working mothers, we will be able to keep infants healthier and moms working," said Jeannine.

    SET Family Medical Clinics:

    SET Family Medical Clinic is a safety net clinic for people who cannot gain access to affordable health care due to inadequate or a lack of health insurance.  Primary sponsors are Centura Health and Catholic Health Initiatives, with multiple secondary sponsors including Penrose-St. Francis Health Services (a member of the PSFHS leadership team also serves on the SET Board of Directors). SET provides services to over 11,000 patients and in FY2010 increased immunization clinics by 50%. SET operates a medical clinic, a homeless clinic, a Comprehensive Health Care Re-entry Program, and Senior Well Being Clinics.  (SE13-2)

    Closing St. Francis Health Center (2011):

    St. Francis Health Center had been in a gradual process of closure for several years. During this period, the building was leased to several tenets. When the strategic decision was made to completely close St. Francis Health Center, we collaborated with our tenants to develop options that were beneficial to all parties.  The following describes who was involved and what solutions were reached:

    • Pikes Peak Hospice & Palliative Care and Penrose-St. Francis Health Services Create Hospice Inpatient Unit at Penrose Hospital As values-driven, community-based, not-for-profit organizations, both PSFHS and PPHPC have a long history of service in southern Colorado.  Pikes Peak Hospice & Palliative Care (PPHPC) negotiated to relocate to Penrose Hospital.  PPHPC renovated the space for their purposes and moved in during 2011.  PSFHS welcomes their partnership and continues to provide the option to transfer to the unit if patients and their families choose this hospice and palliative care organization and service.

    • Select Long-Term Care Hospital (SLTCH) Select Long-Term Care Hospital leased space in the St. Francis Health Center location for 10 years prior to moving to the new St. Francis Hospital at 6001 E. Woodman Road.  SLTCH chose to move to the sixth floor of St. Francis Medical Center and to double their "footprint." The new 30-bed facility features all private patient rooms. Select Long-Term Care Hospital treats patients who need longer acute-care hospitalization for critical and complex medical and surgical conditions.

    Files of Life:

    Files of Life, a patient-healthcare provider communication tool, began as a relationship-building strategy between trauma first responders and emergency/trauma services from Penrose-St. Francis Health Services. Files of Life (FOL) is a mini medical history packet that can be filled out and posted for easy access to  help emergency medical personnel or family members to obtain a quick medical history on the individual.

    Initially in the first nine months of 2010, Penrose-St. Francis distributed over 16,000 Files of Life (FOL). In 2011 the South State hospitals (Penrose-St. Francis, St. Thomas More and St. Mary-Corwin) partnered to promote the FOL and our emergency/trauma services to southern Colorado residents through a partnership with local news affiliate, KOAA News First 5 and Wal-Mart. In four weeks, we distributed over 21,000 Files of Life.  Our Wal-Mart contact gave us this comment:

    "This promotion went over VERY well. Most of my stores gave out every file! I just wanted to take a moment to thank you and your team! If in the future, there is anything else I can ever do.... please let me know." Carey File, market health and wellness director, Wal-Mart.

    This example of partnering with media and retail outlets is unusual but it could potentially save thousands of lives. 

    Peak Vista Community Health Centers:

    Peak Vista is a non-profit organization whose mission is "to provide exceptional healthcare for people facing access barriers." Established in 1971, Peak Vista annually offers primary medical, dental, and behavioral health services to more than 65,000 in El Paso and Teller counties. Most of Peak Vista's patient clientele come from working families without health insurance. In December, 2011, PSFHS agreed to sell the former Penrose Community Hospital to Peak Vista Community Health Centers, discounting the fair-market value by $1.5 million as a capital donation to Peak Vista. The partnership between PSFHS and Peak Vista will contribute to a healthier community for people across the socio-economic spectrum. The following quotes are from the leadership of Peak Vista and PSFHS respectively, and they speak to a community need that was addressed with this partnership: 

    "The addition of this new property allows us a wonderful opportunity to serve more people for primary outpatient care in the Pikes Peak Region." said Pam McManus, President & CEO of Peak Vista. "We are extremely thankful for our partnership with Penrose-St. Francis as our missions align to provide exceptional care for people facing access barriers in our community."

    "We've been talking a lot lately about community partnerships to enhance health care in Colorado Springs," said Margaret Sabin, president and CEO of Penrose-St. Francis Health Services. "This is just one more example of how we are joining forces with another healthcare provider to continue our mission of improving the health of our community."

    Peak Vista provides an Emergency Department Diversion program assigning an outreach staff in the ED at Penrose and SFMC. The staff attends to patients during business hours, Monday-Friday, and they follow up with patients that arrive during evening and weekend hours. Their goal is to promote the appropriate use of primary care and emergency departments.  For people in their priority groups - pregnant, age 60+ and youth under age 19.  Peak Vista provides a medical home for these patients and assists with enrollment and/or appointments. Uninsured patients may be referred to Peak Vista as well, but have to manage a waiting list. PSFHS physicians and ED staff appreciate this partnership as we all strive to provide care in the at the most appropriate level of intensity and effectively utilize resources for our community members. (SE13-3)

    Mercy's Gate:

    Mercy's Gate is a faith based human services agency that has been serving people in Colorado Springs for over 30 years through its emergency crisis support programs. The organization provides thirteen different services to families and individuals in needs.  Partnering with 55 local churches and several third party organizations, Mercy's Gate provided over 23,000 services with over $1.3 million going toward neighbors in need. PSFHS provides a part time Faith Community Nurse who advocates and facilitates whole-person health, healing, and well being. The nurse assesses health needs, provides health education, assists with medical co-pays/prescriptions and links Mercy's Gate clients with community resources. 

    Penrose-St. Francis Corporate Wellness Evolve Program:

    The PSFHS Wellness Team provided an outreach program paired with Kaiser Permanente to community members from School District 20 and Pikes Peak Hospice. The goal of this partnership was to empower and educate these people to make positive lifestyle changes.  This thirteen week program included wellness coaching sessions, educational classes and telephone check-ins. Kaiser selected 10 participants from each employer who had chronic health conditions including diabetes, hypertension, obesity or high cholesterol. Participant outcomes included weight loss and smoking cessation. (SE13-4)

    Colorado Springs Utilities:

    PSFHS Integrated Health provides screening and wellness activities to the Colorado Springs Utilities employees. The 2011 annual report (SE13-5) reflects increased overall participation from 2010.  PSFHS offered additional screening sites, educational classes and challenge activities which were well received. Close to 2000 influenza vaccines were provided.

    Healthy Community Collaborative:

    In April 2011, El Paso County Public Health (EPCPH) and Penrose-St. Francis Health Services convened community health leaders for a brainstorming and discussion session about health issues in El Paso County. This group became known as the Healthy Community Collaborative (HCC). HCC's initial endeavor related to submitting an application for a Community Transformation Grant (CTG), which is specialized funding from the Affordable Care Act. Funding was sought to support building capacity to develop a community collaborative to address diet and exercise, tobacco use, and risk factors for heart disease. The CTG application is submitted with HCC members reviewing content and providing letters of support.

    After the CTG grant application was submitted, EPCPH began facilitating a process with HCC to direct efforts towards developing a Community Health Improvement Plan. Using the model developed by Colorado Department of Public Health and Environment (CDPHE) called Colorado Health Assessment and Planning System (CHAPS), we organized our efforts into 4 major activities:

    • Interpreting results from the Community Health Assessment (CHA)
    • Completing a Capacity Assessment
    • Choosing a Focus Area for improving population health
    • Developing a Community Health Improvement Plan (CHIP)

    Unhealthy weight and mental health were the top two ranked priorities and collaborative selected unhealthy weight as first priority.  (SE13-6)

    Summary:

    Centura Health and PSFHS are active in establishing partnerships in our communities to address the healthcare needs of our population. (SE13-7) Clinical and administrative associates take active roles through a variety of collaborative teams including partnerships focused upon underserved populations, mental health, substance abuse, and wellness programs. Integrated Health is a structure within PSFHS leading the way to address the changing healthcare needs of people in our community and to achieve organizational goals related to the Centura 2020 Strategic Plan.  Integrated Health is a multidisciplinary team of associates (including nurses) that addresses healthcare changes in the external environment and positioning our organization to meet our mission and vision.

  • Structural Empowerment - SE14

    Recognition of Nursing

    SE 14 The structure (s) and process (es) the organization uses to recognize and make visible the contributions of nurses.

    PSFHS Health Services recognizes and values the contributions of all associates, including our nurses. We know that by providing the opportunity and mechanisms for nurses to be recognized for their accomplishments increases overall: enthusiasm, morale, retention, and a general motivation to continue to excel. Excellence, one of our eight organizational values, is described below. In all we do, we will:
    • Put forth our personal and professional best, providing the highest quality of care of  which we are capable
    • Commit ourselves to continuous improvement, seeking to set the recognized performance  standards within our industry
    • Deliver a superior experience for all of our customers, sensing their needs and exceeding  their expectations

    Our organization actively seeks examples of excellence so that they can be recognized. Whether they are individuals or teams, PSFHS makes these people visible through multiple structures and processes. Recognition for effort, expertise and outcomes occurs through both formal and informal processes.

    Formal Structures and Processes Used to Recognize and Make Nursing Contributions Visible:

    The Nursing Annual Report recognizes our nurses and their various contributions through narrative, graphics, and photos. This is a relatively new tradition as our first formal report was completed in 2009. While the recognition of nursing was evident in our first report, the Chief Nursing Officer supported the use of a professional designer in the following years. The designer has increased the professionalism of the report, consistent with the professionalism in nursing services. The document is developed by a select group of nursing leaders and an administrative support person. Stories are selected based upon outcomes and innovation; they are also inclusive of representation from across the organization. Photos of our nursing associates are highlights for everyone. The report is disseminated throughout PSFHS, Centura Health physicians, and our community partners. (SE14-1)

    Rewards and Recognition Program (R&R) is a multidisciplinary committee that strives to improve recognition through creative and fun programs. During football season, a football field display is set-up in the dining room. This promotes individual feedback, as associates write positive statements about their colleagues on football shaped pieces of paper. These "footballs" are displayed and eventually given to the subject of the statement. During the Easter season, a similar recognition system known as, "the Good Egg" is arranged. An example of a year round recognition tool is our STAR Award. STAR Awards are based upon our mission values and people are nominated by other associates. Quarterly awards are selected by a team from multiple nominations and then winners are presented their STAR Award in a public forum. Nursing associates usually make up 50% of the nominations each month. (SE14-2)  The attachment provides an overview of additional recognition and visibility strategies led by the Rewards and Recognition Program. The following are some examples of STAR Awardees:

    o SFMC 5th floor was honored as the Department of the Month in November 2010 which provided an opportunity to highlight the unit's culture and its focus on excellence.

    o STAR Associates in January 2011 included two nurses recognized from two different facilities. 

    o SFMC Star Associate Keila Dremstedt RN, ICU   Nominated by:  Janet Laird RN.  Compassion is defined as "A powerful, deep awareness of someone else's suffering, making it so that you want them not to suffer."  (Robert Longman Jr.) "I was privileged to witness a true example of compassion in May of 2010 when I witnessed Keila caring for a young suicidal woman. Keila immediately showed her that she cared for her deeply, and used words and a nurse's touch by holding her hand to convey she totally accepted the patient for who she was and recognized her pain. I could see there was a connection that was made between Keila and her patient, a strong, trusted relationship formed very fast. Keila was able to convey to her patient that she recognized her suffering and she wanted to do everything she could do to help the person get some relief.  When nurses care for patients, the connection we build is a sacred space in which compassion lays the foundation for a trusting and healing relationship.  Keila is able to accomplish this quickly because of her respect for a person's dignity and her desire to help people achieve optimal health and enjoy the beautiful gift of life."

    o The Rewards and Recognition Committee honored the Penrose Hospital 7th floor Ortho/Neuro Unit as the first recipient at Penrose for the greatest improvement in fall reduction. For the months of April, May and June 2011, the team reduced total number of falls from five in April to only one in May and June. (SE14-3)

    The common reaction, by far, when an associate receives any of the above awards is delight and pride. This is particularly true because these awards are based upon the nominations of the winners' own colleagues. 

    Halos for Heroes is a recognition tool used to identify extraordinary service. The PSFHS Foundation hosts Halos. Nomination cards are available throughout the hospital for patients and families to honor a "hero." This distinction includes making a donation to the Foundation in this honoree's name.  Foundation staff awards a certificate to the individual or team that has been identified.  Photos and names are posted on the internal TV system and in elevators; their names are placed on the Wall of Honor located in the main lobby of Penrose Hospital.  In 2011, over one hundred people were honored as Heroes; fifty-two percent of these heroes are nurses. (SE14-4) Marci Winslow, RN was one of many nurses honored in 2011 with this patient nomination:

     "I appreciate your work ethic.  I enjoyed watching you work together with the other nurses; like a well oiled machine - from arranging transport to necessary tests and scans, to handling some potentially embarrassing aspects of my disorder.  I am thankful for all you did to help care for me. Your bedside manner is top-notch!  You brought smiles and laughter to me while I was hospitalized. You have a 'can do attitude' and I wish you the best in your work and with your family. With my heartfelt gratitude of many thanks to you for your care while I was at Penrose."

    The Penrose Pulse is distributed weekly to all associates and provides a method to recognize and make visible contributions of nurses. The following are quotes and stories from specific issues that recognize outstanding nurses in a variety of scenarios.

    o September 20, 2011: "Bethany Monroe and Brett Skattum, two ICU nurses were hiking in Rocky Mountain National Park yesterday when they witnessed another hiker fall at about 11,000 feet. Due to their quick assessments and teamwork, they were able to summon help, including an incredible Flight for Life team from Denver to care for the patient. If it were not for their persistence and quick action and the skills of the Flight for Life pilot, the patient would have had to spend the night on the mountain. Way to go, Bethany and Brett!" (SE14-5)

    o September 5, 2011:  The Pulse showed SFMC 5N receiving an award for "the most dramatic decrease in falls". The award consists of a double picture frame which will contain a certificate and a picture of the staff enjoying a banana split. Phil Ainsworth, RN, clinical manager, attributes the low number of falls to the nursing staff being very vigilant and aware of what is going on with the patients. (SE14-6)

    o July 18, 2011:  Two nurses were on vacation traveling via train to California. When the train was hit by a car, these nurses saw the smoke and fire as they rushed to help the passengers in the car.  Honored as Everyday Heroes, their story was published in the Penrose Pulse.  (SE14-7)

    o November 2010: The Pulse published an article describing the role of a Patient Navigator, increasing associates awareness and understanding of the valuable contribution of patient navigators. (SE14-8)

    Talking Points are written by organizational leaders and distributed via email or handouts to associates, and others as indicated. This method provides an opportunity to recognize individuals, communicate changes, and introduce new leaders. (SE14-9)

    Magnet Moments is a bi-monthly communication to all associates and to the PSFHS Board Members, sharing examples of nursing excellence. (SE14-10)

    Email Communication is frequently used as a tool for recognition. When writing letters of recognition, many of our associates include managers and directors on the email thread. This process makes the nursing contribution visible to others in a rapid way. In addition, some of these stories are shared in Nursing Orientation to convey the culture of collaboration, patient safety, and recognition. (SE14-11)

    Medical Staff formally recognize nurses every year during Nurses Week, with a hand delivered rose to each nurse. Additionally, Steve Myers, MD, Chief of Staff, invited his colleagues to give monetary donations to support nurses. Myers heightened the visibility of nurses through his letter to all medical staff. (SE14-12) When members of PSFHS nursing staff hosts a manager or charge nurse retreat, our medical staff again honors nurses with engraved gifts in recognition of nursing contributions to our organization. Physicians also write letters of recognition. The attachment is an example of which; this particular letter was sent to the Chief Nursing Officer and Chief Executive Officer. (SE14-13)

    DAISY Awards an international program that recognizes nursing excellence, occur quarterly. In October 2010, PSFHS sent two direct care nurses to the national Magnet Conference.  One nurse returned with incredible passion for the DAISY Award.  She used her passion to espouse the award with the Magnet Champions, and she presented a proposal to the Nursing Leadership and Management Council to bring the DAISY Award to PSFHS.  The Magnet Champions implemented this program in 2011, including increasing awareness of program to all, reviewing all nominations and selecting quarterly DAISY winners. The fall Magnet Champion Newsletter, Whistlestop, was distributed to all associates and board members; it was also made visible on all units so that there would be widespread recognition for the nominees and the DAISY Winners.  The Chief Nursing Officer and other nursing leaders participate in all DAISY Awards.

    Name tags are a simple way to improve the visibility of nurses. As a result, PSFHS name tags include a large "RN" badge so nurses can be easily identified. In addition, nursing services through the Nursing Professional Development Council initiated special name tags for nurse who achieved a BSN or higher or specialty certification.  We value formal education and certification, knowing that they improve clinical outcomes for our patients.  Education and certification are two more ways nurses contribute to the organization and we make it a point to recognize such commitment.

    Nurses Week is an annual opportunity to recognize our nursing staff through visible modes. One of the many ways PSFH celebrates nurses is through Nurses Week education, acknowledgement, and awards. In 2011 the Nurses Week Planning Committee set the following activities in place:

    o Displays at both hospitals that are inclusive of photos of nurses, introduction of the Seton award nominees, recognition of nurses certified in their specialty, and recognition of nurse preceptors
    o Name badge ribbons for all certified nurses stating "Board Certified"
    o Name badge ribbons for all nursing preceptors stating "Preceptor"
    o Education classes with free continuing education hours
    o Drawings for gift cards
    o Weekly drawing for Preceptors and Certified Nurses for gift cards
    o Individual drink mug with free coffee/drink
    o Seton Award Luncheon including guest speaker, Seton Award Nominees and Winners. Lunch was served and PSFHS Vice Presidents participated in recognition time
    o Posters expressing gratitude from Centura which had large photos of our nurses. During prior years the posters included generic "stock" photos of other nurses. Our nurses had requested the photos be of them; our CNO advocated for their request with Centura marketing

    Clinical Advancement Program (CAP) recognizes the contributions of nurses and promotes professional development and individual nurse actions to support achievement of organizational goals. The 2010 CAP Nurses were recognized with a CAP pin and a bonus; their contributions were visible on units and in the nursing newsletter. (SE14-14) Some of their clinical exemplars are included in our Magnet Documentation expanding visibility beyond our walls. 

    Conferences present opportunities to learn from other healthcare institutions and providers; as well as the chance to add present to the growing knowledge of medical science. Encouraging and supporting our nurses to present at conferences recognizes their expertise and increases their visibility. The opportunity to present findings is a fundamental tool that promotes professionalism and development. In addition we highlight these presentations through our EBP Newsletters.

    SHARE Cards are completed by patients, families, and other associates. Their goal is to provide a formalized venue for complimenting the actions of another associate. These cards are reviewed by senior department leaders and managers; the cards are then presented to the associate. (SE14-15)

    By Posting Outcomes on individual units or in other areas, we acknowledge the importance of evaluating our practice based upon outcomes. Visual presentations heighten the awareness of successes as well as those areas needing improvement. Posting clinical outcomes is another strategy for the nursing community to recognize the value of nursing in the organization.  The Critical Care Unit proudly posts the number of days since last ventilator associated pneumonia as well as other nurse sensitive quality indicators. In fiscal year 2010, Centura initiated the first gain-sharing program (Centura Associate Reward for Excellence, or C.A.R.E. Program).  This program recognized excellence as demonstrated in specific metrics and paid out bonus dollars in the last two years. 

    Informal Recognition:

    Our Nursing Professional Practice Model and Relationship-Based Care directs us to build positive relationships as we improve our work environment and clinical outcomes.  Recognition by colleagues and peers is visible in all areas.  Each unit has designed unique ways to encourage recognition and display examples of excellence. Bulletin boards displayed on nursing units showcase comments from patient satisfaction surveys, thank you cards, and compliments from associates. Walls of Honor on several units include: certificates of each nurse achieving specialty certification, DAISY Awards, Halo for Heroes Awards, and other awards. (SE14-16)

    Nursing leaders send letters of appreciation for excellence to associate homes. These letters may stem from stories heard by a manager doing rounds with patients or colleagues.  We are all quick to share narratives and to recognize others publicly; the personal letters home are simply another way to say thank you and to make the individual's contribution visible to their family. 

    Summary:

    Our nurses have expertise and input that improves patient care and clinical outcomes.  By recruiting and including nurses in committees, task forces, and work groups we recognize their contributions and make them visible to many others.   While the above mentioned recognition programs make a difference, it is our commitment to shared decision making that truly recognizes nursing expertise and value.

    Our organization lives our values. Recognition is inherent in our values of excellence, stewardship, imagination, integrity, compassion, spirituality, and respect. Formally and informally, we consistently seek ways to recognize, reward, and to make visible the contributions of nursing - within our system and external to PSFHS. We are proud of our nurses.

    Finally, Centura Health published the book These Hands: True Stories of Care and Compassion to preserve and share some of the stories that reflect of who we are as an organization. The following story written by Diana Patterson, RN, the story tells of the community that is PSFHS:

    The View from the Other Side:
    This was not how I planned to spend my 50th birthday. Not me. I did not see cancer coming for me until I had an abnormal pap smear just before the big 5-0. I'm a nurse with almost 30 years of experience-I do the helping, the educating, the supporting - So, when I asked my colleagues to say some prayers after I'd gotten the abnormal pap smear result, I thought I was just being cautious. My co-workers went the extra mile and asked other to pray for me too. However, my world turned upside down and suddenly I was on the other side of the health care equation. I was diagnosed with fallopian tube cancer, facing surgery and chemotherapy. However, this story is not about that "Big C." It's story about another Big C: community. Once I was diagnosed, I knew that I'd need the prayers and support from my work family to get through the days, weeks and months ahead.
    Although my memories are somewhat blurred from surgery, the image I always see is the moment when I work up after surgery and looked into the kind eyes of my Chief Nursing Officer.  Her gentleness and loving eyes helped me to know that even thought the "pink elephant" was in the room, she was right there, next to me. There were many unknowns at that time, but I felt at peace that I was in the right place at the right time with the right people. Again and again, this community has risen up to carry me on their shoulders with their constancy and their love.
    On the first day of chemotherapy my friends in Spiritual care presented me with a prayer shawl. My parents and all of my co-workers gathered around my chemo chair to pray for healing. It was a powerful, moving time filled with many tears. How can I tell you all how much love and support I have received? These kindnesses may seem tiny-prayers, cards, visitors, meal, assistance with tasks that I was simply too tired to attend. Yet, it is in these small measure that God is found, that our mission lives and breathers. Mother Teresa said, "We can do no great things, only small things with great love."  It is that great love that is behind all those little acts of compassion that I feel every day as I fight cancer. It is the hands and feet of Christ in action.
     I have just completed two rounds of chemotherapy, so the journey is not over. There have been ups and downs with my treatment regimen. Many others have shared their stories with me so I know the telling matters. If I can help one other person cope of make it easier for someone to be less intimated about talking with me about my cancer, I'm happy to do it.
    While I would never have volunteered for this disease, I am confident that God will use this journey to help others.  I am blessed to be surrounded by such an awesome support system.  They are not only my work family, but I am honored to call them my friends! My amazing community, my Centura Health family.  - Diana Patterson RN, PSFHS

  • Structural Empowerment - SE15

    Recognition of Nursing

    SE 15 That the nursing community and community at large (e.g., local state, national, international) recognize the value of nursing in the organization.

    The Future of Nursing — Leading Change and Advancing:

    In October 2010, The Institute of Medicine of the National Academies released its future of nursing report, entitled The Future of Nursing: Leading Change and Advancing Health. The report provides a meaningful, realistic perspective on the current value of nursing and projections of its future value. The report explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform, and to advance improvements in America's increasingly complex health system.

    Nationally, the IOM report The Future of Nursing: Leading Change and Advancing Health (2010) and the reimbursement structures that reward positive clinical outcomes recognize the value of nursing in the organization. Nursing Councils and Leaders in interdisciplinary collaboration lead the charge to assess, evaluate, and take actions to improve quality of care.  Our nurses recognize the context and environment in which we work and continue to act in the best interests of quality care for our patients, families, and communities. By achieving positive patient outcomes, nurses and hospitals are recognized through changing reimbursement structures.

    Nursing Community:

    The larger nursing community, which is comprised of professional organizations, provides structures and processes to recognize and value the contributions of nurses to the organization and to the profession at large. Annual awards such as the Nightingale Awards and El Paso County Medical Society’s Excellence in Nursing Award provide regular opportunities to recognize our nurses. Invitations to speak at the graduation ceremonies of schools of nursing and “pinning” ceremonies occur annually and demonstrate regard for PSFHS’ nurses.

    Nightingale Awards The Nightingale Awards for Excellence in Human Caring was founded in 1985 to honor nurses who best exemplify the philosophy and practice of Florence Nightingale. Nightingale, a 19th century nursing pioneer who epitomized the art of helping people toward their optimal health, was recognized as the titular source of the award by the University of Colorado as a way to identify nurses who deserve acknowledgement. Registered nurses throughout the state are nominated in the fall of each year by solicitation from the Colorado Area Health Education Centers System (AHEC) and the Colorado Springs and Western Slope Nightingale Committees. Finalists are then selected by the regions and forwarded to the State Selection Committee, who ultimately determines the recipient. Each region also hosts a local event for their nominees. Olinda Spitzer, RN and Connie Wallace, RN were both recognized and awarded at the 2010 Colorado Springs Nightingale Event.  Olinda Spitzer, RN went on to the Colorado Nightingale event and received a Nightingale Award.  (SE15-1, SE15-2, SE15-3)   In addition, our 2011 Nursing Annual Report recognized all our PSFHS Nightingale winners.

    Nursing Professional Conferences Nurses from all levels in PSFHS present professional posters and podiums in regional, state, and national conferences.

    Community at Large:

    El Paso County Medical Society Physician/Nurse Collaborative Committee El Paso County Medical Society Physician/Nurse Collaborative Committee was founded locally in 1989. Ted Lewis, MD brought together physicians and nurses to look toward the future and determine how they could work together in a more collaborative manner to address challenges, like the nursing shortage facing our community at the time. From those discussions, the El Paso County Medical Society Physician/Nurse Collaborative Committee was born. The committee has established several programs over the years but the most enduring and successful has been the EPCMS Excellence in Professional Nursing Awards. Over the past 20 years, 154 professional nurses from our community have been honored.

    In October 2010, four PSFHS nurses were honored with this award: Kelly Ledbetter, Wendy Lowery, April McPike, and Patty O’Connell. (SE15-4)  In October 2011 four PSFHS nurses received this award including Aimee Doman, Janet Rae Wilson, Melody Gustafson, and Diane Ward.  One nurse nomination is reflected in the inset box.

    Media SFMC Neonatal Intensive Care hosts an annual reunion picnic each summer.  The media is always on hand to take photos and disseminate the story to the community. (SE15-5)

    Facebook Comments During Nurses Week in 2012, PSFHS’ Facebook followers were asked to provide some memory of nurses they may have encountered during any medical treatments. Some of these comments were published in the May 2012 TLC. One nurse posted on the board and her statement was

    “Melanie Evanson Williams PACU at Main.....it’s the Nirvana (An ideal condition of rest, harmony, stability, or joy) of nursing. We have an awesome group of RNs and CNA/US. Our new manager Jennifer and new charge nurse Lindsay make our unit a place of joy to work in. I love my job!!!! Happy Nurses week.” (SE15-6)

    Emergency Services On April 1, 2011, Joanne Gleeson, RN saved a man’s life on a flight between Colorado Springs and Dallas/Fort Worth. Story about nurse who saved gentleman’s life mid-flight. Her quick reactions and her clear thinking allowed her to stabilize her fellow passenger. This selfless service earned Gleeson a letter of gratitude from American Airlines as well as a feature in Magnet Moments. (SE15-7, SE15-8)

    Informal Feedback from a Centura Health Associate (2011):

    The kind of recognition that is perhaps the most meaningful for individual nurses is that of the informal sort. When nurses interact with the public, the kind of reaction and care they receive is substantial. The following story comes from an RN who experienced this type of spontaneous appreciation:

     A couple of weeks ago I was taking a flight out of DIA to go back east and see my daughter and family. Our flight had been delayed and myself and another woman decided to go have a glass of wine and wait. I asked the lady what she did for a living. She then asked me what I did and I told her that I did staffing for the ERs in Centura Health Hospitals.  At that time, a gentleman that was sitting on the other side of her leaned over and said “God bless you!”  I was a little taken aback as we had not been talking to him. I looked at him and said “Excuse me?” when again he said “God bless you!” At that point his eyes welled up with tears as he told his story. 

     “A few weeks ago my mom was taken to the Emergency Room and they didn’t know what was wrong with her. The staff in the ER was so wonderful and was able to assess very quickly that she had a brain bleed.  She was immediately taken to surgery and the family was told she had less than a 30% chance of survival.  Today she is in Rehab and is doing much better due to the fast and efficient treatment she got when she arrived at the hospital. She is still not out of the woods, but her chances of resuming a normal life look much better.”

     He also commented that he was so thankful with how open, honest and compassionate all of the personnel were with his family. The hospital that this gentleman was referring to was Penrose Main. Kudos to all of the staff who dealt with this woman and her family and to truly making a difference in this family’s life.

    National Recognition:

    National recognition of the value of nursing within our organization comes through multiple structures which monitor patient outcomes and that provide awards to outstanding performers.  Many of these structures focus on outcomes that require excellence in a multidisciplinary practice setting.

    The value of nursing is recognized by the Centers for Medicare and Medicaid as they announced that Medicare will no longer pay the extra cost of treating hospital acquired conditions.

    In most of these situations nursing practice is responsible for taking evidence based actions for patient safety and quality care to reduce the risk of hospital acquired conditions. The value of nursing is recognized when we receive optimum reimbursement for quality care that prevents these hospital acquired conditions. We have made significant improvement to date in FY2012 and are committed to continuing to take action to eliminate hospital acquired conditions. As Values Based Purchasing continues to unfold, recognition for nursing practice’s impact on clinical outcomes and patient satisfaction is reflected in reimbursement to the hospital.

    Another area the nurses of PSFHS receive national recognition is in academic research. Helen Graham, RN, PhD was asked to serve on the editorial board of the prestigious Journal of Cardiopulmonary Rehabilitation and Prevention. She has served in this capacity since January, 2012. This position requires organization, writing ability, and critical thinking in the examination of current medical research. Graham has also had several articles published in the journal, a fact that will be discussed in greater detail in the New Knowledge Section. (SE15-9)  

    Cardiac Rehab in Washington D.C. (February 2011):

    Helen Graham, Ph.D., RN-C, Manager of Cardiology and of Cardiac Rehab at Penrose Hospital and Beth Myers, RN, Manager of Cardiac Rehabilitation at St. Mary-Corwin, recently met with senators, congressmen, and their staff in Washington D.C.; they met on behalf of the American Association of Cardiovascular Pulmonary Rehabilitation (AACVPR). The purpose of the visit was to enlist support for legislative changes that would enable smaller/rural medical facilities to operate cardiac and pulmonary rehabilitation programs under the supervision of physician extenders. Their trip was sponsored by the Rocky Mountain Affiliate (RMCRA) of AACVPR where both representatives are active members. Graham is on the Board of Directors of AACVPR and Myers is on the Board of Directors for RMCRA.

    National Awards:

    National Recognition through the Distinguished Service Award Helen Graham, PhD, RN-C, and manager of cardiology at Penrose Hospital, received the Distinguished Service Award at the 24th Annual American Association for Cardiovascular and Pulmonary Rehabilitation Conference, in Pittsburgh, Pa., Oct. 2, 2010. The award is presented to people who have been resourceful to the organization for their ideas, committee work and leadership.

    Achieving awards and certifications indicates recognition for the value of nursing in our organization. Earning each of the following awards requires excellence in nursing practice either certified through site visits, inspections, statistics, or miscellaneous methodologies:   
    • PSFHS is certified as an Advanced Primary Stroke Center by The Joint Commission
    • PSFHS is certified by the National Accreditation Program for Breast Centers
    • PSFHS is the only Accredited Chest Pain Center in southern Colorado
    • Penrose Hospital is the only facility in southern Colorado designated a Bariatric Center of Excellence by the American Society for Metabolic & Bariatric Surgery
    • HealthGrades has ranked PSFHS as one of America's 50 Best Hospitals for the last five years, placing us in the top 1% of hospitals in the nation.

    We share the following award, recognizing this is not tied directly to our organization, but rather an international honor for one of our nurses as she told the story of adjusting to the move from Korea to the United States.  We celebrate with all our nurses as they strive for their dreams knowing their success advances their development and in some way contributes to our organization.

    Ji-Eun Jhon, RN, Case Manager, Penrose Critical Care Unit was honored in Seoul on September 30, 2010. She won Grand Prize in the 46th Annual Shin Dong A New Media Nonfiction Writing Contest.  Ji-Eun wrote an article (250 pages) based on her personal experience as an international nursing student and her family’s experiences over 26 years adjusting to life in America.  In Korea, Dong A News media is one of the major media companies with 90 years of history.  “I feel like I achieved my dream with this great award.” 

    PSFHS nursing and nurses are valued by the community for their professionalism, clinical outcomes and service through formal awards, presence in the media and reimbursement.

    Summary:

    Our nurses are regularly recognized for their contributions to the greater community. Our nurses are awarded for their “Excellence in Nursing” by the El Paso County Medical Society Physician/Nurse Collaborative as well as by the Nightingale Awards for Excellence in Human Caring. These awards are presented by those in the health care community for those in the health care community so they are particularly significant for the recipient. At the national level, our nurses are recognized individually and as a unit. Individually, nurses like Helen Graham represent PSFHS with national awards. While collectively, our nurses are recognized by the many illustrious awards granted to our organization by the Federal Government, HealthGrades, The Joint Commission, and many accreditation agencies.