2010 Nursing Annual Report Nursing’s Mission
To make a positive difference in the life of a patient every day
Rex Healthcare Nursing is grounded in purpose by our mission statement and empowered to act by our structure that allows the nurse at the bedside to make decisions that are the most beneficial to patients. Our nurses are committed to meeting nationallyaccepted benchmarks for excellent nursing care, and data indicate we consistently do so. We are proud that our efforts have been rewarded with the prestigious designation and redesignation as a “Magnet Nursing“ facility that has processes in place to attract and retain professional nurses. Working along side our physicians and other care team members, Rex nurses oversee care 24 hours a day. They are the sentinels for safety, role models for
We Value...
compassion and tireless advocates for quality.
• patient safety
Patients in our community will choose their doctor
and outstanding
and hospital, but at Rex we choose your nurse.
care • superior service • a working partnership
You can expect EXCELLENCE! Need photo
with our medical staff • our workforce • sound business practices • market-responsive growth and development
Mary Lou Powell, C.N.O.
Shared Decision Making Nurses at Rex are an integral part of decisionmaking through a process called shared governance. Shared governance involves co-workers at all levels working together to make decisions about professional nursing care, education and development, and unit operations. This type of decision-making model fosters collaborative relationships and engagement in nursing practice that leads to excellence in patient care. Improved patient outcomes, enhanced nurse-physician relationships and improved job satisfaction are all results of shared decision-making. The shared decision-making process is accomplished through unit-based councils as well as broader, system-wide councils. Best practices in nursing care, monitoring outcomes, nursing research, documentation, and patient education are all decided through these councils.
Nursing Congress Professional Development & Education Council
Practice Council
UNIT-BASED COUNCIL
Quality Improvement Council
Research Council Informatics Council
Rex Healthcare Emergency Department: Exemplary Professional Practice Emergency Department (ED) patient length
AMAs (Against Medical Advice) - 2010
various venues including journals, list services and even newspaper articles for many years. Nursing research shows that decreasing length of stay for patients improves patient and co-worker satisfaction. Rex Emergency Department developed and tested a Balanced Work Flow Model, using information gained from evidence-based practice. The goal for a balanced work flow process was to utilize all available resources in a more efficient manner and to improve patient flow. The department completed a trial during the month of August 2010 prior to making any changes in day-to-day protocol. All co-workers were educated via email, bulletin boards and meetings during shift change for three weeks prior to the initiation of Balanced Work Flow. During this trial, the workgroup which included representation from each discipline met on a weekly basis to review co-worker comments and possible “quick changes� that could be made to improve the process. Co-workers could make suggestions by email or on comment pages posted in all medication rooms and co-worker lounges. Needless to say, the test was a success! The length of stay decreased, patients who left before being seen (Against Medical Advice or AMA) decreased also, and patient satisfaction increased. The ED continues to use the balanced work flow model as the standard of practice.
Number of patients who left before being seen
of stay has been researched and discussed in 300 250 200 150 100 50 0
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Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
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Caring for Patients with Diabetes Diabetes is one of the fastest growing epidemics in our country and is estimated to affect some 25.8 million children and adults in the United States. Even more alarming, diabetes and pre-diabetes are expected to affect half the U.S. population by 2020. In 2010, 22,964 diabetes patients were seen and cared for at Rex Healthcare. In April 2010, nurses from each patient care unit came together to become Diabetes Resource Nurses and focus on improving the care provided to patients with diabetes. An interdisciplinary team developed several continuing education programs for the resource nurses including:
• Diabetes Meal Planning
• Medications for Management of Diabetes
• Defining Diabetes
• Intensive Insulin Therapy
• Chronic Complications of Diabetes, and more.
Bariatric Surgery Center of Excellence Obesity is one of North Carolina’s most serious health problems, and individuals with severe obesity are often faced with numerous other life-threatening conditions such as high blood pressure and diabetes. Rex Healthcare is committed to providing
Each resource nurse took this information back to their coworkers
world class care to patients choosing
and has been working to increase knowledge about patients with
bariatric surgery and in 2010 achieved
diabetes. These nurses serve as daily resources to their peers and
designation as a Center of Excellence
have provided multiple educational posters, learning programs and
for Bariatric Surgery from the Surgical
in-services throughout the year.
Review Corporation. This designation recognizes the high quality of the bariatric surgical program and the support provided throughout the system for bariatric patients. The Rex Bariatric Surgery program includes eight bariatric surgeons, a dedicated inpatient bariatric surgical unit, a full-time bariatric services coordinator, monthly support groups and ongoing educational events. Nurses and support staff have received special training in caring for persons of size and are committed to helping patients achieve their goals.
Skin and Wound Resource Nurse Team at Rex – 2010 Highlights
Rex nurses have been working several years to provide the best
A preventive sacral dressing (a bandage for the lower back) was tested
possible skin care to patients. The goal is to prevent patients from
in ICU for several months on patients at risk for developing a lower back
having skin breakdown which can sometimes result in difficult to
ulcer. The results were incredible – none of the 171 patients who had the
heal skin ulcers. In 2010, a “root cause analysis” process was put
dressing applied upon admission to the ICU developed a sacral pressure
in place on each nursing unit to investigate what could have been
ulcer. This product is being considered for use with all at risk patients.
done differently for a patient who was observed to have a skin ulcer. Nurses focused on turning and repositioning “at risk” patients every two hours and worked hard to make sure each patient received the appropriate nutrition.
This process has dramatically reduced the number of patients who suffer skin breakdown while in the hospital. The team of clinical experts has been asked to share this program with other hospitals and The Joint Commission as a model of great success.
Vascular Access Resource Nurses Team The Vascular Access Resource Nurses Team (VARN) at Rex is a special group of trained nurses who place difficult peripheral and Peripherally Inserted Central Catheter (PICC) lines in patients. Vascular access has become a huge topic over the years and requires special knowledge for the bedside nurse. The team’s goal for 2010 was to make sure each bedside nurse received education about peripheral and venous access and could then become the patient’s best advocate to help with the decision making. The nurse can help the patient by making sure the right type of intravenous (IV) line is selected and started. Approximately 98 percent of all patients admitted require some type of a intravenous (IV) line. Therefore, the team developed a teaching program for nurses. This program has four modules:
• Introduction to Intravenous Therapy
• Peripheral Intravenous Therapy
• Central Venous Therapy
• Infection Control for Intravenous Therapy
As a result of the work of these nurses, there has been an increase in the number of PICC lines. This means patients at Rex undergo markedly fewer attempts to have an intravenous line started and are more likely to complete their intravenous therapy.
Health Literacy Initiative In 2009, Rex nurses Mary Clare Prasnikar, R.N., M.S.N., C.C.R.N., and Mary Toma McConnell, R.N., became interested in the issue of health literacy – the ability of the patient to read, understand and act on health information. These nurses wanted to be sure their patients understood the healthcare information they were receiving. After attending a Health Literacy Conference, they developed Literacy Based Discharge Instructions for Acute Coronary Syndrome and presented a poster at The Institute for Healthcare Advancement (IHA) Conference in March 2010. Upon returning home, they met with quality programs department to discuss health literacy. In May 2010 an Interdisciplinary Health Literacy Program was formed to educate nurses and other healthcare professionals about the use of plain language in the development and revisions of patient education materials. The nation loses as much as $106 to $236 billion each year because people misunderstand or unintentionally misuse their medications. These nurses put together a campaign to educate Rex nurses about health literacy and help keep patients safer. All Rex nurses now learn: • You cannot tell a person’s health literacy level by their appearance • To communicate effectively with your patients: 1. Use plain language (avoid medical jargon) and identify three points you want to make sure the patient understands. 2. Use the AskMe3: What is my main problem? What do I need to do? Why is it important to me? 3. Do not ask yes/no questions. Instead ask patients: Tell me in your own words or show me….. This work has been accepted for a poster presentation at the annual 2011 American Nurses Credentialing Center national conference in Baltimore, Maryland.
Research and Evidence-Based Practice Nurses at Rex are committed to providing high quality patient care based on evidence of best practice, current research and knowledge. Many nursing units have research projects underway and several have been recognized at the national level through publication and presentation. Nursing research is coordinated by the Nursing Research Council and overseen by the Rex Institutional Review Board. In 2010, one nursing research project changed practice across the hospital.
Changing Practice with Bedside Nursing Research Blood clots are the most common life-threatening complication associated with orthopedic surgery. Historically, nurses have used specially-designed stockings called TEDS to provide pressure to a patient’s leg after surgery to prevent blood clots from forming. A group of inpatient orthopedic nurses decided to explore the incidence of skin irregularities on patients wearing knee-high TEDS after surgery. The research team consisted of principal investigator Regina Ohayon, R.N., and team members Kim Ebert, B.S.N., Carrie Lewis, R.N., Monica Vater, R.N., Roberta Rose, R.N., C.N.S.N., and Vicky Overby, R.N., B.S.N., M.S.N., C.M.S.R.N., who served as mentor for the group. The team met every two weeks to develop their research project and ultimately learned the stockings added no extra benefit to the patients to prevent blood clots and might cause skin problems. The nurses shared their research with the orthopedic surgeons and the routine use of the stockings was discontinued. The team developed a research poster which was presented by Lewis, Rose, and Ohayon at the North Carolina School of Nursing Sigma Theta Tau Research Day in Chapel Hill in February 2010 and by Rose and Ebert at the 1st Annual Sandhills Research Conference in June 2010.
Nursing Education Nurses at Rex are encouraged and supported in continuing their formal education as well as achieving certification in their area of specialty. Educational support is provided through scholarships to help with expenses, flexible scheduling to attend classes, tuition reimbursement, and on-site study groups. Advanced degrees in Health Administration and Business Management are offered in an on-site program through Pfeiffer University. In 2010, the number of Rex nurses with a Baccalaureate degree or higher was:
Bachelor’s.............655
Master’s..................52
Doctorate ................5
The Transfer Nurse – A New and Helpful Role A pilot project was set in place in March 2010 to evaluate the feasibility of having a nurse take charge of hospital-to-hospital
Nursing Certifications Reach a New High Rex Nurses are encouraged to pursue national certification in their area of specialty and are reimbursed for the exam fees when certified. Certified nurses have demonstrated advanced knowledge in their clinical area and nursing research has shown a clear link between certification and improved patient care. In 2010, the number of Rex nurses holding certification reached an all time high.
transfers. This responsibility includes assisting and talking with patients who are transferring from one room to another, discussing any of their concerns, working hand-in-hand with the administrative coordinator and responding to any needs. This pilot proved to be more than valuable and is now a permanent position held by Sharon Stocks, R.N. An intensive care nurse, Sharon is skilled in handling multiple tasks at one time.
Number of certifications
“I take information, screen and prepare this information for the physicians,” explains Stocks. “Answering the pager for physicians allows physi-
300
cians to concentrate and complete their admissions with little interruptions.
250
I direct admissions or transfers from the outside, as well as take consults for
200
the psychiatrist.”
150
“Sharon helps send patients to UNC and other facilities and also works with
100
Rex hospitalists to accept patients transferred to us,” says Joanne Kuszaj, M.S.N., R.N., director of cardiovascular nursing at Rex. “She does everything
50 0
she can to facilitate the process for doctors.” ‘06
’07
‘08
’09
‘10
Evolved from an idea to a full-time position, Sharon Stocks helps make a process much easier for both patients and physicians.
Mi
et
Rex Nurses: Reaching Higher, Shining Brighter
on to Magn ssi
To prepare for Magnet Redesignation, Magnet Nursing Champions created bulletin boards on each of their units to educate co-workers about nurse sensitive quality indicators, shared governance, standards of professional practice, research and evidence-based practice. The Magnet Champions and Nursing Congress developed a visual depiction of the Rex Nursing Professional Practice Model showing the Rex Levers of Excellence and incorporating our nursing values from the Rex Philosophy of Nursing. Mary Lou Powell, senior vice president, patient care services and C.N.O., clinical managers and nurses from Rex attended the National Magnet Conference held in Phoenix, Arizona in October 2010. Rex Healthcare was officially recognized as a redesignated organization at this event. This conference included podium and
Nursing Professional Practice Model
poster presentations by keynote speakers and nurses from magnet organizations. Helene
Ease of Use Quality
Economics
Technology MD Loyalty
Zehnder, M.S.N., R.N., N.E.-B.C., Elizabeth Rochin, M.S.N., R.N.C. and Wanda Adams, B.S.N., R.N.,
Excellent Outcomes
did a podium presentation titled Planning Strategically to Improve Patient Satisfaction. More than 800 nurses attended this presentation to learn about the Service Excellence program at Rex and how specific interventions have improved patient satisfaction within our organization.
Patient Autonomy Teamwork Innovation Education Nurturing Tradition
Communication Accountability Research & Evidence Based Practice
Empowerment
The values stated in our nursing philosophy provide the foundation of our professional practice model and the provision of patient centered care. These values are integrated throughout our nursing practice and shared governance structure and support the organization's levers of excellence.
Congresswoman Renee Ellmers (center) celebrates Rex Hospital’s Magnet redesignation with chief nursing officer Mary Lou Powell, president David Strong, physicians and staff.
REX ‌ a Magnet Hospital Again! On September 28, 2010, Rex Healthcare received notification it was officially redesignated as a Magnet Organization. Magnet Designation by the American Nurses Credentialing Center (ANCC) is the highest international recognition an organization can receive for nursing excellence. Rex nurses are proud to be the first hospital in the Triangle recognized for achieving the American Nurses Credentialing Center Magnet Designation for the second time. This accomplishment signifies excellence in nursing care, patient outcomes, team work and interdisciplinary relationships and is awarded to only six percent of hospitals in the country. In 2010, UNC Hospitals became a part of this esteemed group with their initial designation as a Magnet Hospital. In order to be considered for the designation, hospitals must meet rigid criteria in the delivery of patient care and outcomes achieved, must promote and support nursing research and evidence-based practice and must achieve the highest scores in patient, physician and nursing satisfaction. The hospital must submit extensive documentation and successfully complete a multi-day on-site survey.
This year the surveyors noted there was so much excellence at Rex it had become the norm. We celebrate our team and our community for this recognition!
Rex Awards & Recognition Named as one of the Top 50 Best Hospitals in the nation by Becker’s Hospital Review for 2011. Named one of the 2010 top 50 N.C. Family-Friendly Companies by Carolina Parent Magazine 12 consecutive times - one of only four companies to attain this achievement. Ranked 9th among hospitals named to the 2009 Best Places to Work in Healthcare in the U.S. list by Modern Healthcare Magazine, listed 27th overall. Designated a Bariatric Center of Excellence in 2010 by the American Society for Metabolic
Rex Healthcare’s Mission & Vision To provide the best in health services by bringing together compassionate care and leading-edge technology. To be the healthcare provider of choice in Wake and surrounding counties.
and Bariatric Surgery (ASMBS) and recognized as a Blue Distinction Center for Bariatric Surgery® by Blue Cross and Blue Shield of North Carolina (BCBSNC). Rex received eight 2011 PRC Excellence in Healthcare awards for patient satisfaction scores:
• Medical Oncology - Top Performer Award and Five Star Award - Outpatient Oncology Services
• Three Women’s – Five Star Award – Inpatient OB/GYN Services
• Wakefield Surgery – Five Star Award – Outpatient Surgery Services
• Three East – Five Star Award – Inpatient Services
• Cardiac Catheterization Services – Outpatient Cath Lab Services
• Outpatient Services/Outpatient Surgery – Four Star Award – Outpatient Services
• Three West – Silver Achievement Award
Careers at Rex At Rex, we believe that high-quality health care means more than providing exceptional medical treatment, it means providing care by skilled professionals who care - people like you. When you pursue a career at Rex, you’ll be part of an award-winning team that genuinely cares about you and your family’s needs and goals so that you can better care for our patients. You’ll discover an environment that emphasizes respect and innova-
4420 Lake Boone Trail Raleigh, North Carolina 27607 rexhealth.com
tion – one that is recognized in our community and beyond for caring and commitment to excellence. For more information on how you can become part of our team, visit rexhealth.com today.