2015 PATIENT SERVICES ANNUAL REPORT
Our Shining All-Stars
Our All-Star Roster 2015 PATIENT SERVICES ANNUAL REPORT Welcome
Microsystem Stress Report
Kappa Kidney Camp
Division of Adolscent and Transitional Medicine
The Liberty Campus Expansion
Liberty Simulation Training
Psychiatry's Care Journey
Equine Behavioral Therapy
NICU Live Video Feed
Patient Services Awards
Year in Review
Nationally Recognized Nursing Certifications
Writers: Chris Klein Lora Lucas Suzanne McMillen Jennifer Myers - Managing Editor Design: Laura Kujawa
TABLE OF CONTENTS
Colleagues and Friends, Last year we heard a considerable amount of talk about "All-Stars" in Cincinnati – in July we hosted Major League Baseball’s All-Star extravaganza. At Cincinnati Children’s, our All-Stars weren’t limited to one night on the baseball field. In 2015 our All-Stars brought their best to our patients and families every day of the week, every week of the year. This annual report highlights some of the reasons why Cincinnati Children’s staff are deemed All-Stars every day. From our outstanding nurses to our incredible social workers, physical therapists and other allied health professionals, this report captures the dedication and enthusiasm of our entire Patient Services team. It also highlights some of the innovative ways we are helping patients reach their full potential. From neuromotor therapy to horticulture and equine therapy, we’re providing every patient individualized care to reach their goals. You’ll also learn how we expanded our Liberty campus to better serve our families, and how our leaders are improving staff and patient satisfaction through rounding.
“Every day our All-Stars are stretching their capabilities to improve the outcomes for our patients.” I am proud to share their stories with you. Sincerely,
Cheryl Hoying PhD, RN, NEA-BC, FACHE, FAAN Senior Vice President of Patient Services
Decreasing staff stress, patient harm The Cancer and Blood Diseases Unit (CBDI) formed a multidisciplinary team to reduce catheter associated blood stream infections (CABSI). They initiated a study to determine which quantitative and qualitative factors correlated to cause an increase in events of patient harm. The team developed predictive measures and prevention/mitigation strategies in order to minimize the impact of the microsystem stress. Their overall aim was to reduce events of patient harm in units which were stressed, believing that higher levels of stress resulted from unpredicted and sustained increases in patient volume and acuity.
MICROSYSTEM STRESS REPORT
By reviewing literature, experience and historical data from Cincinnati Children’s, the team looked at a large number of possible metrics. They narrowed the list to those that best correlated with patient harm, specifically in CBDI and the Neonatal Intensive Care Unit. They determined the following factors to be most important for analysis on a shift by shift basis: • • • • • •
Nursing hours per patient day Volume ADC Capacity Staffing measures Float staff Qualitative stress scale measures
Although plenty of data existed already, it was not available as often as necessary, nor was it consolidated into a single report that could help to predict and avoid staff stress. Through input, assessment and trials, the Steering Committee coordinated the development of a Microsystem Stress Report which provides relevant, reliable information on the Medical Center’s 17 inpatient units at the Burnet Avenue location. A separate report provides inpatient data for Psychiatry. The report effectively consolidates quantitative and qualitative data that is shared weekly with directors, assistant vice presidents, vice presidents and the chief nursing officer.
Success Learnings from the committeeâ€™s work are significantly impacting operations. These learnings include:
1. Prolonged stress in complex medical systems with high-risk patients can contribute to an increase in harm to patients. 2. By identifying key processes and reliably executing mitigation strategies, outcomes due to staff stress can be stabilized. 3. A defined plan to support a stressed microsystem is key to dealing appropriately with the situation. 4. Prediction and prevention are key elements of a successful plan. Data enables leaders to quickly identify areas that need further analysis, and helps signal week-to-week trends. Data is used to support interventions that include: pre-assigning float pool, increasing full-time staff, redeploying full time staff from other programs, establishing a Knowledge Incentive Bonus. Mitigation strategies also can be reliably developed from the report. Although future changes to the Microsystem Stress Report are in the works to make it even more useful to hospital leaders, the report is frequently shared at conferences, enabling it to positively impact staff and patients far beyond the walls of Cincinnati Childrenâ€™s Hospital Medical Center.
Cancer & Blood Diseases Institute (CBDI) CLABSI Task Force L to R: Kelly Vu, RN; Alyssa Rickert, RNII; Rosalie Weakland, MSN, RN, CPHQ, FACHE, Ohio Hospital Association/Ohio Patient Safety Institute; Deanna Hawkins, MSN, RN, NEA-BC
6th Annual Ohio Hospital Association/ Ohio Patient Safety Institute, Dr. Frank Dono Best Practice Award: "Outcomes resilience after system stress: a rapid-cycle response to mitigate the impact of system stress on CLABSI"
Members of the Patient Services Steering Committee include: Whittney Brady, DNP, RN; Deb Browning, MSN, RN, CENP; Laura Flesch, MSN, RN, CRNP; Jackie Hausfeld, MSN, RN, NEA-BC; DeAnna Hawkins, MSN, RN, NEA-BC; Barb Tofani, MSN, RN; Bill Vidonish, MBA, BSIE
MICROSYSTEM STRESS REPORT
Kappa Kidney Camp
On the surface, Kappa Kidney Camp might look like any other youth summer camp. There is a pool for swimming and a lake for boating and fishing. There is horseback riding, rock climbing, and arts and crafts. In the evenings there are camp fires and karaoke. But Kappa Kidney Camp offers something else that most other camps donâ€™t â€“ a full medical care staff to support children age 8 to 18 who are undergoing dialysis or who have had a kidney transplant. This includes the ability to either transport campers to a local facility or provide on-site dialysis, depending on patient
KAPPA KIDNEY CAMP
need. And, supported by sponsors and volunteers, the five-night, six-day camp is also offered free of charge. Cincinnati Childrenâ€™s Hospital staff encourages patients in dialysis to take advantage of the camp opportunity. Staff members including
social services, child life, nurses, doctors, and pharmacists all support the campers throughout the week and visit them at camp during the day. Some staff members have even given up personal time to register campers in Bellefontaine, Ohio.
Korie Frost, LISW, Dialysis/Nephrology, sees the opportunity as not only a time for her patients to get the camp experience, but also a time to form bonds with the other campers. “People don’t truly understand what these kids are going through,” she says. “So it’s awesome that this camp is available to them. All the kids there have had a transplant or have dialysis, so they know what each other are going through - they have all been there.” She adds that if there is a patient there currently waiting for a kidney transplant, he or she can talk to other campers who have already been through the experience.
34 Campers Each loving the experience of trying the new experiences offered at Kappa Kidney Camp.
170 Marshmallows toasted for s'mores Accompanied by all our favorite campfire songs.
112 Cannon balls into the pool Nothing beats showing off your best bomb to your new friends.
56 Strikes at the bowling alley During the pizza party at the lanes.
Friends “Even if you go there and you know absolutely, positively nobody,” she says, “you will leave with friends.” Kristen Robbins, a 14-year old dialysis patient at Cincinnati Children’s, looks forward to attending camp each year and swimming in the pool. For most kids, going to summer camp is a normal part of life, but for those undergoing dialysis, normal isn’t always easy. Frost says she likes to make her patients feel as normal as possible. “There are always barriers and a lot to juggle in [their] lives,” she says, “but I want them to be able to do everything a normal kid can do. This camp is something nice we can offer as a piece of that normalcy.” KAPPA KIDNEY CAMP
Division of Adolescent and Transitional Medicine
Treatment, Support and Community found at the Transgender Health Clinic
The families of these transgender youth have needs very specific to their child’s treatment and the Clinic is equipped to handle them. *American Society for Suicide Prevention- National Transgender Discrimination Survey (NTDS) 2014 7
DIVISION OF ADOLESCENT AND TRANSITIONAL MEDICINE
The need for the Transgender Clinic at Cincinnati Children’s is undeniable, reflected in the fact that 4 in 10 transgender teens in the United States attempt suicide.* Our Division of Adolescent and Transitional Medicine at Cincinnati Children’s has been in existence for more than 40 years and is a recognized leader in the field; so it was no surprise that we led the way in establishing a transgender health clinic in July of 2013. The Transgender Health Clinic was founded by Dr. Lee Ann Conard, DO, RPh, MPH, a recruit from Pittsburgh familiar with transgender youth, along with social worker Sarah Painer, MS, MSW, LISW-S. The Clinic offers treatment and services for transgender children in a variety of methods ranging from puberty blocker and gender affirming hormones, to legal referral, as well as patient and family support. In December 2014, the clinic was put to the test with Leelah Alcorn’s tragic and very public suicide. The death of the 17-year old from Kings Mills, OH was a call to action for the transgender
Acceptance “The love Dani and I have felt from the staff of the Trans Clinic, is immeasurable.” Dani’s mother, Shar shared about her experience at the Clinic
community. This global issue had become a local issue, with the face of a young child, Leelah. When the community demanded a resource for children like Leelah and their families, Cincinnati Children’s Hospital was ready. Together, Conard and Painer further developed the Transgender Health Clinic at Cincinnati Children’s main campus to be a framework of transgender education, offering exceptional treatment options and support for patients aged 5-24 years old. Cincinnati Children’s Hospital believes that together we can change the outcome for child health: Dr. Conard and her staff at the Transgender Health Clinic are doing just that for transgender youth. In January of 2015, 115 patients attended the Clinic; by January of 2016 that number was at 365. Although becoming more common in the medical community, the work being done at the Clinic is a revolutionary step for the physical and mental health needs of transgender youth. The success of the Transgender Clinic has allowed for interdisciplinary days for patients and families to see all of the providers necessary for this life-altering process. This combination of expert medical care enables the Clinic to support needs ranging from endocrinology to social work. Without these services many transgender youth would go without medical supervision. "The Transgender Clinic made me feel like people cared about transgender kids, when I didn’t think anyone ever could." Dani, a patient of the Clinic, described how his experience at the Transgender Clinic changed his entire outlook on, not only being transgender, but how the world saw him. Dani came to Children’s after his mother reached out to a physician about her son’s special needs. A few months later, Dani
was sitting in the Transgender Clinic having discussions about top (breast) surgery and testosterone-implants, something he never thought possible. "The interconnected continuity of care at Children’s is what makes them so special. The love Dani and I have felt from the staff of the Trans Clinic, is immeasurable," Dani’s mother, Shar shared about her experience at the Clinic. The benefits of the Transgender Clinic go far beyond that of just the patient. The families of these transgender youth have needs very specific to their child’s treatment and the Clinic is equipped to handle them. Monthly meetings, designed to support the youth as well as their guardians, allow issues such as legal questions and social problems to be addressed. These support groups create a community support system for these very special families, and the number of those attending continues to grow. Preventing more tragedy is the ultimate goal of the Clinic. Regardless if a child receives surgery or suppressive therapy, the treatments at Cincinnati Children’s Hospital are changing lives – perhaps even saving lives. As Dr. Conard said, "...because these kids have a high rate of suicide, we're kind of doing something to keep them alive." DIVISION OF ADOLESCENT AND TRANSITIONAL MEDICINE
The Liberty Campus Expansion A Full Service Hospital
A3N oriented a total of 60 RNâ€™s to surgical nursing for the Liberty Inpatient unit. These nurses included all A6S RNs and new RNs who were hired to work at the Liberty Inpatient Unit.
THE LIBERTY CAMPUS EXPANSION
Liberty Inpatient Unit, A3N, A6S – Teamwork that benefits patients and families Families of Butler and Warren counties now have the best of both worlds. The newly expanded Liberty Campus officially opened in mid-August establishing the facility as a fullservice hospital. The expansion provides a clearer choice for community pediatricians once faced with having to choose between proximity and pediatric expertise for their patients. With the addition of the Liberty inpatient unit on the 4th floor, and Children’s mission to begin caring for an increased number of surgical patients, it was vital that experienced surgical RN’s be recruited to Liberty from A3N, the surgical short-stay unit at the Burnet campus. In order to maintain continuity of safe patient care it was imperative to get the appropriate skill mix of RNs and ensure that nurses from A6S and new hires to the Liberty Inpatient Unit were properly oriented to care for surgical patients.
hall unit meetings were held followed by direct emails to staff to clarify specific information. As a result, seven full-time RNs were selected to transfer to the Liberty Inpatient unit. The A3N leadership team worked diligently to re-fill those positions, and all seven positions were filled and oriented prior to the A3N RN transfers departed from base. While hiring their own new staff, A3N also oriented a total of 60 RN’s to surgical nursing for the Liberty Inpatient unit. These nurses included all A6S RNs and new RNs who were hired to work at the Liberty Inpatient Unit. This was a tremendous undertaking for the A3N nursing team and especially the A3N Education Specialist, Beth
Dendler. This partnership leveraged the talent and clinical expertise of RNs at Base to train and orient the Liberty inpatient team in order to achieve safe and competent care for surgical patients at Liberty. Today A3N remains involved in a "Sibling Unit" partnership with A6N/S and the Liberty Inpatient Unit. As a Sibling group, they work together with the Manager of Patient Services to ensure that staffing needs are covered among all surgical units. A3N continues to work with A6S and the Liberty Inpatient Unit as they hire new staff to complete their surgical orientation.
The A3N leadership team led by Laurie Gregor, MSN, MEd, RN, clinical director; Beth Dendler, MSN, RN, CPN, A3N Education Specialist; and A3N clinical managers: Stephanie Greger, BSN, RN, CPN; Cori Gelvin, MSN, RN; and Heather Prichard, BSN, RN, CPN invited the Liberty inpatient clinical director to attend their unit meetings to provide information about the expansion of the inpatient surgical unit at Liberty and to recruit staff. A total of three town
THE LIBERTY CAMPUS EXPANSION
Liberty Simulation Training
Preparing Our Clinical Team for their New Space With the opening of the Liberty campus expansion in August of 2015, Patient Services leadership wanted to ensure the interdisciplinary clinical teams were prepared for their new environment. There was a desire to maintain the same level of confidence and assurance for our patients and families that they have grown to expect from Cincinnati Childrenâ€™s at the main hospital. This desire resulted in a robust simulation training program for clinicians transitioning to the newly expanded, 4th floor inpatient unit. Liberty simulations were multidisciplinary and multispecialty with a goal of identifying potential latent safety threats, refining processes and defining appropriate roles for this new setting. The simulation course work was provided by the Liberty Simulation Center led by Gary L. Geis, MD, Medical Director of the Center for Simulation and Research and was facilitated by unit and frontline leaders. The need for simulation training, both prior to the opening of the 42 bed inpatient unit and continuing into its opening, is due to the unique environment. The new inpatient unit consists of medical, surgical, intermediate care and Cancer & Blood Diseases Institute (CBDI) patients with all of the care providers working together on the same unit. In addition, the MRT and code team are built within this group, therefore the need to continue the training to maintain practice and care competencies. General participation included: CBDI; Pediatric ICU; Hospital Medicine RNs, Surgical APRNâ€™s, and physicians; Respiratory Therapists, Pharmacy and Telehealth MDs.
LIBERTY SIMULATION TRAINING
Patient Safety Simulation Training The Patient Safety Simulation Training is a four hour training session with the purpose of continuous, multifaceted training. This is an on-going staff training and team building for the interdisciplinary team, initial training of new hires, and implementation of standards and models identified as potential safety concerns. Scenarios are centered around what is current on the unit. The expectation is for all staff to attend two of these Patient Safety Simulation Trainings a year.
The Liberty Simulation Course Phases In situ: Liberty Expansion Course Scenario Development Sessions
Lab: Liberty Expansion Course “Pilot” Sessions
These were the initial in situ sessions used to pilot the proposed scenarios within the Simulation Center. Attendees at these initial sessions were educators from various key areas, as well as nursing leaders.
The pilot courses were run again within a 4-hour lab session in the simulation center, an introductory talk, a 5-10 minute talk on patient safety, and followed by a debriefing session. Attendees at these sessions were also educators from various key areas, as well as nursing leaders.
Lab: Liberty Expansion Course Training Sessions The actual 4-hour lab sessions in the simulation center used to deliver the training course to future Liberty providers. These were interdisciplinary team simulations that included current and new Cincinnati Children’s employees. Our team trained 175 participants including; Patient Services from the Medical/ Surgical unit, CBDI and Critical Care. In addition HM, CBDI and APRNs from the provider perspective were trained with Respiratory, Pharmacy and Telehealth as well.
Lab: Liberty Expansion Course “Pilot” Sessions These sessions took place within the actual environment at Liberty Township. The purpose was to test the rooms and equipment, while running through all eight scenarios. These took place over two full days prior to opening. Ongoing simulation sessions and the safety course continue within the existing space and are scheduled bi-monthly/monthly.
We continue in Phase IV with ongoing In Situ and Patient Safety Simulation Training. The In Situ training is completed on the unit each week; this is a mock MRT and/or code training for any and all staff on the unit at the time. The training incorporates the PICU through the use of telemedicine along with members throughout Liberty campus that are part of the Code team i.e., ED, transport team, MPS, Pharmacy etc. The session is organized with the Simulation Center and the unit educator to determine which patient scenario to simulate, schedule and facilitate. A weekly newsletter is later distributed to all disciplines for learning and sharing.
LIBERTY SIMULATION TRAINING
Mapping Out the Path to Success Psychiatry’s Care Journey
All families should have a similar experience regardless of the unit to which they are admitted. Cincinnati Children’s Hospital has the largest and most comprehensive Psychiatry/Behavioral Health Division in the nation for pediatric patients. In a continuing effort to be the best at getting better, staff concerns and family feedback prompted an idea to bubble up. Even with highly individualized content for each child/family, direct care providers noticed that the process for care varied across units in the division. There was a strong desire to enhance the education process and interactions with 13
PSYCHIATRY’S CARE JOURNEY
families to improve the comfort level of parents managing their child’s condition when they return home. As a result, the Psychiatry Cluster Coordinating Council and Psychiatry Patient Family Experience Committee collaborated to standardize the care process in the Psychiatry Division. In the spirit of relationship-based care the entire interdisciplinary team needed a clear understanding of what to offer families, how
to offer it, and how to document what was provided. Documentation needed to be purposeful, collaborative, non-repetitive and easily accessed. “If a child re-admits, we need to be able to easily see what work our team has previously done with the family and what their response was and then assess where to begin, rather than just start over,” says Heather Morath, BBA, BSN, RNII-BC, FY15 Psychiatry Cluster Coordinating Council Chair.
Psychiatry Care Journey Team Winner's of the 2015 Patient Education Advocacy Award Pictured from Left to Right: Rachel Zimmer; Adrienne Martin, MSN, RN; Adam Hill, MSN, RN-BC, CPN; Julia Elkus; Melissa Worrell, MA; Heather Morath, BBA, BSN, RNII-BC; Mica Dulle, MSN, RN-BC Award winners not pictured: Krista Keehn, MS RN-BC; Robin Brewer, MHSII; and Amberly Schmaltz, MSN, RN
The work began with staff training to provide individualized, empathetic relationship-based care to families. The training focused on mutual goals for staff education, a standardized path, available resources, and documentation. Next it was decided to develop a Care Journey Map as a visual tool for teach back to families. A subgroup of Patient/Family Education completed Design Thinking™ training under the leadership of Julie Elkus, Director of Innovation with the Anderson Center. They followed families from admission through discharge to gain a deeper understanding of their unique experiences. Several prototype maps were created to include agreed upon components. The Care Journey was discussed with the Patient/ Family Advisory Council and feedback was solicited on two versions of the map from parents and councils. The psychiatry Epic specialist then created a patient education record corresponding with the standardized tool and process. Joan Morris, MSHA, MBA, RN, program manager for Health Literacy provided training on the topics of health literacy, plain language and teach back processes for trainers. Small tests of change were performed with the new tool and electronic record on specific units utilizing nurse, social worker and staff feedback. The Care Journey Map was submitted to Center for Professional Excellence Patient/Family Education for content approval and to create additional resources in Health Topics. The Care Journey Map’s first test launch on unit P2W began with team training on the Care Journey process and tool. This work is a true example of transcending silos and working together to change outcomes through coordinated, collaborative work leveraging the unique skills of various groups and individuals in our organization. The work team was comprised of members from multiple groups of stakeholders including: Shared Governance, Patient Family Experience Committee, Patient and Family Advisory Council, Center for Professional Excellence, and the Anderson Center.
Connection “I know what I’m responsible for and what things we are going to work on together.” From a family who had experience in the Care Journey process
PSYCHIATRY’S CARE JOURNEY
2 Please share your child’s history, and your concerns with us.
Psychiatry’s Care Journey Map
Partnering in the Care Journey To date all staff on one of our inpatient units (P2W) have been trained on the purpose and use of the Care Journey process, the map, and the interdisciplinary EMR documentation. The map was officially rolled out on P2W on November 16, 2015. A small team is auditing the P2W charts to track use of map, completions of map, and to identify opportunities for continued improvement. We continue to solicit feedback from the caregivers and unit management. We are working to identify inter-professional staff (RN, MHS, and social worker) "super users" to provide continuous peer-topeer feedback and coaching. Adjustments will be made as needed and the Care Journey process will roll out to our inpatient unit at the Lindner Center of Hope in early 2016. The Care Journey should reach all of our inpatient units by the end of the 2015/16 fiscal year.
“It gave me a heads up of what to expect and the when and where of the treatment. I had a better look at what to expect with the treatment. It was really helpful. Makes you feel like you are part of it.” From a parent of a child on 2W 15
PSYCHIATRY’S CARE JOURNEY
Together, we will create goals for your child’s hospital stay.
As of early December there were 15 patients that had been admitted and discharged from P2W since the initiation of the Care Journey process. We called the families involved to get their thoughts post discharge and have revisited the Patient Family Advisory Council as well. Here’s what families have said about their experience in the Care Journey process: • “Feels like, “Okay, I’m not alone” • “This feels more like partnering” • “This is what I wanted, what I needed” • “It makes me feel cared about” Here are some comments we’ve received with follow-up calls from parents on 2W since we started using the map: • “It kept me informed step by step of what was going to happen, ahead of time” • When asked to rate connection/relationship with the treatment team on a 1-5 parent stated: “I would give them a 10 if I could” • “It helped me walk him through his coping skills.” • When asked to rate connection relationship with the treatment team parent stated they felt: “very connected”
It sounds like we’re headed in the right direction mapping out the path for success in our psychiatric care journey process!
1 Together, we will talk about the needs of the entire family.
We will explain the purpose of family meetings, and how our team will partner with you in treating your child.
How are you?
We will share your child’s evaluation and any testing needed.
3 We will discuss your child’s diagnosis with you.
How are you?
4 If I have problems getting my child’s medications, I know who I can call.
I understand my child’s safety plan, and what steps to take if my child is in crisis.
I know and understand my child’s medication(s) (what they are for, time, dosages, possible side effects).
Sharing information together
I have made arrangements to fill my child’s prescriptions before discharge.
Understanding your child’s needs Working together so you can care for your child at home Transition home
I know my child’s triggers (things that make my child mad or sad).
Please share I know outpatient services youravailable, child’s and how to schedule history, and follow-up yourappointments concerns for medication, with us. therapies, etc.
Together we will discuss when my child can return to school and how I can help prepare for this transition.
I know interventions that I can use to help manage my child’s behavior and to support my child.
I know my child’s strengths and coping skills (things that help my child stay calm).
How are you?
PSYCHIATRY’S CARE JOURNEY
Equine Behavioral Therapy
Utilizing the therapeutic effect of animals to facilitate learning for our kids It is widely recognized among behavioral experts that animals, particularly horses, have a calming and therapeutic effect on people with behavioral and psychological challenges. Cincinnati Children’s Hospital Medical Center’s Division of Child and Adolescent Psychiatry has partnered with Cincinnati Therapeutic Riding & Horsemanship (CTRH) to bring equine facilitated learning (EFL) to our clients at the College Hill campus. For residential clients with behavioral issues, the opportunity to participate in the equine program provides them a goal to work toward, and a reason to learn and maintain positive relationship behaviors. Many of the kids at Cincinnati Children’s College Hill campus have a strained or turbulent family dynamic leaving them with minimal positive relationship role models. Our practice model of comprehensive coordinated care facilitates partnering with community-based organizations to promote the best possible outcomes for all of our patients at Cincinnati Children’s.
"Our program focuses on utilizing this alternative treatment modality to improve self-esteem, build healthy relationship skills, and learn effective communication techniques with an emphasis on assertiveness training," says Kristi Van Vranken, CTRS. Through this experiential therapy, participants learn about themselves and others by participating in activities with the horses, and then processing (or discussing) feelings, behaviors, and patterns. Non-verbal communication, assertiveness, creative thinking, problem-solving and leadership are among the many skills that equine therapy enhances.
EQUINE BEHAVIORAL THERAPY
Many clients have stated, “I never thought I would be able to ride a horse” and are often shocked at their progress within the program from start to finish.
In 2015, 14 clients participated in this equine learning program, both on and off site. We anticipate an increase in the numbers for 2016 with the end of construction on campus at College Hill.
Many clients form special bonds with their horse, and behaviorally are able to identify similarities and differences that exist with other significant people in their lives.
The Equine Therapy program was initiated 12 years ago by a Certified Therapeutic Recreation Specialist (CTRS) and equine therapist. The partnership with Cincinnati Therapeutic Riding allows clients to be transported in groups of two-three for sessions at their campus in Milford. The recent renovation of the small animal building on the College Hill campus and the addition of a "pole barn" and riding ring allows clients to participate at our own facility in the warm weather months. Treatment teams assess
potential candidates for the program to determine the best suited clients most likely to benefit from the interactive therapy. Each session consists of a recreation specialist and a horse expert alongside of the client. The total program lasts six weeks (2 sessions per week), but kids don’t actually ride until the end of week three. The beginning stages of the therapy focus on building a relationship with the horse through grooming and ground work.
Pride “It’s pretty hard to not feel important when you are on top of a horse.” A former participant
EQUINE BEHAVIORAL THERAPY
Planting, Growing and Harvesting Horticulture Therapy for Kids
Is planting seeds and harvesting vegetables therapeutic? Just ask the dozens of residential psychiatric patients at our College Hill Campus who visit the on-site greenhouses one or more days a week. Accompanied by a Recreation or Occupational Therapist, and assisted by horticulturalist Mardie Hay, patients have found that growing/nurturing plants can: •
Improve social skills
Decrease anger and aggression
Develop healthy relationship skills
Increase leisure awareness
Increase confidence and self-esteem
Pineapples, sugar snap peas, herbs and scented geraniums grow alongside lots of unusual plants throughout the greenhouses and in 12 raised beds just outside. The smells and humidity are a gardener’s paradise which explains why the program’s annual employee and family Plant Sales are such a hit. Employees love to wander the rows of fragrant plants. The next sale will be mid-spring at College Hill.
“Each patient has a treatment goal for their horticulture experience,” says Mardie Hay who has found that some kids take better care of the plants than they do themselves. "Some plants can be damaged if touched. It’s amazing how careful the kids are with those particular species." She adds, "I’m always surprised – and pleased – to see how many kids come on Friday afternoons which is optional, and get up for 9 a.m. sessions on Wednesdays and Thursdays. They obviously are benefiting from what they do here." Caring for plants can lay the foundation for kids to learn better self-care strategies and health management skills to calm one’s thoughts and feelings.
At our College Hill campus our caregivers strive to make a difference in improving every child’s health whether it is in the greenhouse or at the bedside.
Changing the Way They Play Some children are born with motor challenges. Others acquire them. In either case, a child with a neuromotor diagnosis often faces difficulties and frustrations with movement. The effect on daily life can be profound. Accordingly, many of these children find themselves in long term relationships with chronic care providers, including physical and occupational therapists. Innovators in the Division of Occupational Therapy and Physical Therapy are deeply committed to offering state-of-the-art opportunities for improved function. Their Neuromotor Program represents an important shift in the types of therapy services offered and the way that those services are delivered. It seems to be working. “Many of our patients have involuntary movements, difficulty with balance, mobility problems, or muscle weakness. But when we use innovative approaches and good science, we move in the right direction. And when the patient and family are a central part of our decisions, we almost always can celebrate significant progress in a short amount of time.” Jen Angeli, PhD, DPT and co-director of neuromotor research for the Division reflects on the power of optimized care. “Using the right tools, on the right kids, at the right time is powerful. In the Neuromotor Program, we watch children reach their full potential.”
In 2015, the Division of Occupational Therapy and Physical Therapy served over 600 kids in this program.
Occupational Therapy and Physical Therapy are home to many state-of-the-art pieces of equipment (including neuroprosthetic devices, virtual reality and biofeedback systems, robotic gait systems, and unweighting devices). The challenge for therapists working in the Neuromotor Program isn’t having access to good tools; it’s matching each patient with the tools that will deliver the very best results. The Neuromotor Program offers specialized assessments for infant motor performance, cortical visual impairment, and threedimensional motion analysis. The Program encompasses a wide range of treatment services, including serial casting, orthotic management, upper extremity neuromotor training, lower extremity locomotor training, constraint induced movement therapy, hippotherapy, goal directed task training, and evolving wellness offerings. Children in the Neuromotor Program can access a neuroprosthetic clinic, and their post-operative needs are managed comprehensively after
surgeries like selective dorsal rhizotomy or single event, multilevel orthopedic surgery. All services offered in the Neuromotor Program are bolstered by evidence. To ensure optimal outcomes, the Neuromotor Therapy team follows guidelines that identify the most effective ways to practice. “Where guidelines don’t exist, we accept the professional responsibility to review the literature and write them,” says Karen Harpster, PhD, OTR/L and co-director of neuromotor research. The group has presented their pioneering efforts at many rehabilitation conferences and now enjoys an international reputation for their bold leadership in the effective implementation of programming for children with neuromotor diagnoses. “This is a program full of clinical experts” says Harpster, “and leadership with pie-in-the sky vision.”
Results "In the Neuromotor Program, we watch children reach their full potential.” Jen Angeli, DPT, PhD
The challenge for therapists in the Neuromotor Program isn’t having access to good tools; it’s matching each patient with the therapeutic option that will deliver the best results.
Neonatal Intensive Care Unit
NICU Live Video Feed Giving birth is both a joyful and stressful time. But the added stress of having a newborn in the NICU is an extra challenge for parents, especially when struggling with the balance of wanting to be there for their infant and also needing to maintain their lives and care for other children. To help alleviate stress in NICU parents, Cincinnati Children’s Hospital was the first in the region to implement NICVIEW® live-video streaming. The camera system, placed behind each bed on the unit, provides parents with a real-time video feed of their infant. Parents can log into the feed twenty-four hours a day from any internet device – a computer at home, laptop, or mobile device – to see their baby.
Love The live video streaming sustains that intimate connection between child and parent. 23
NICU LIVE VIDEO FEED
The system provides a secure video feed protected by a special code, which parents can use themselves and also give out to family members or friends. This is especially important during flu season, when visitor restrictions on the NICU are strict. With video streaming available, parents have another option for allowing friends and family to “visit” their baby and can include friends and family all over the world. Implemented in October 2014, the cameras were in demand even before they ever hit their go-live date and were utilized immediately by a mother of twins on the unit. NICU clinical director Rachel Wilson, MSN, RN recalls being notified of a phone call from a University of Cincinnati Medical Center nurse who was caring for the new mother. It had been a traumatic delivery and she was depressed that she couldn’t leave to see her babies. They requested a Skype call, but Wilson knew those were not always reliable. Luckily, she
was able to offer the new webcam system. The video stream allowed the new mother to see her babies and bond with them. With that stress and depression alleviated, she could focus on healing herself. “People love it,” says Wilson. “When we weren’t fully live, parents wanted to stay in their bed spot and were refusing to move to a nicer private room – because [those rooms] didn’t have NICVIEW yet. Once they get it, they don’t want to lose it.”
The camera system, placed behind each bed on the unit, provides parents with a real-time video feed of their infant.
The video is only blocked when the “privacy” setting on the camera is activated, which caregivers use to stop the stream while they provide care for their patients. There were initial concerns on the unit that nurses wouldn’t want to be watched, “but when they see how much the families lean on it,” says Wilson,“ and that they can actually go home at night – that’s really what we’re all here for.”
NICU LIVE VIDEO FEED
Viewed Across the Country and Around the World Cincinnati Children's NICU Live Video Feed Connections 1
In 2015 usage of our NICU live video feed rapidly spread from the local region across the country and around the world. The maps indicate by color the highest viewing usage per location to our NICU. The bar chart on page 26 reflects viewing usage by month and correlates to patient census.
NICU LIVE VIDEO FEED
NICU Camera Use by Month - 2015 Views 30,000 22,500 15,000 7,500 0
"My parents in California can watch their grandbaby while I am at home with my other children; it makes them feel included." â€“ NICU mother
NICU LIVE VIDEO FEED
Leadership Rounding plays a starring role: Trust, Recognition, Innovation Exercising our strategic goal to enhance the development of staff and leaders, Cincinnati Children’s clinical leadership integrated the practice of leadership rounding into their daily work in 2015.
“Leadership rounding provides the perfect avenue for staff to share their thoughts and successes.” Ashley Mantica, PharmD
The literature indicates that leadership rounding improves both staff and patient satisfaction as the one-on-one, vertical communication elevates trust and openness among colleagues. As a result, new managers in Patient Services received leadership rounding training during orientation. In all, Leadership Development Team members Julie Moody, MSN, MEd, RN and Sarah Herrle, MPH, BSN, RN, CPN met individually with 56% of Allied Health professionals and 33% of nursing leadership to streamline the rounding process and educate via individual coaching sessions and group classes. Here’s how several leadership stars describe their profound experiences with the rounding process. Assistant Vice President Jean Storey, MSN, RN, a champion of the rounding initiative, has seen the benefits not only within the Heart Institute which she helps lead, but throughout the Patient Services Division. She believes that one of the most beneficial aspects of rounding
is the connection and the trust that results between leaders and staff. “Rounding creates an environment that supports creative and innovative ideas from all members of the team,” she says. Not only is rounding a reliable method to identify areas of risk and concerns prior to an event, Jean sees other benefits that are equally important. “The consistent, focused and intentional conversation that occurs with rounding provides an avenue for meaningful recognition of team members and other departments. It’s an opportunity to celebrate accomplishments!” She adds, “Learning about and building upon our successes is an essential part of rounding and helps build morale and reaffirms our sense of purpose and meaningful work.” Sharon Kwiecinski, MSN, RN, clinical manager, Transport Team has been amazed at what she has learned through rounding. “When I was rounding with one of my team members and asked what would make his job easier, he said ‘putting Wi-Fi in the ambulance garage to get reports written immediately and save time.’ It was such an easy fix and made a big difference for everyone,” says Sharon. “I always thought I had my finger on the pulse, but rounding has really enlightened me.” Although Sharon tries to be predictive and schedule her staff for rounding in advance, it sometimes proves difficult when the person she schedules gets called out on a run. That doesn’t stop her, she just moves to the next person on her list and circles back later. Being a role model for her staff is Sharon’s tip for success. “As a leader, if I set the tone and make rounding a valuable tool, then I get great
information that improves everyone’ s work environment.” Being committed to her team’s success is what makes Sharon Kwiecinski a stand out Rounding Star! Before rounding was formally implemented, Ashley Mantica, PharmD already was meeting routinely with staff. She has found, however, that structured rounding increases communication and helps managers find and address issues that were not previously discussed. With the expansion of the Liberty campus, Ashley believes that formal rounding has helped the staff move through many departmental changes including moving into a new workspace, changing work flow and using a new automated dispensing technology. She has found that rounding is a great tool for tracking progress towards goals and highlighting staff accomplishments. “Leadership rounding provides the perfect avenue for staff to share their thoughts and successes.” Leadership Rounding also has strengthened Ashley’s relationships with the pharmacy team. “A personal meeting with each staff member and the subsequent casual conversation that
rounding incorporates, has boosted camaraderie and improved communication among the entire pharmacy team.” The cascading effect of information sharing, both vertically and horizontally across all levels of staff, has changed how we communicate our successes and opportunities for improvement in Patient Services. Leadership rounding has created a space for open dialogue and acknowledgment in the reporting structure that keeps everyone informed of what is working and what needs more attention, ultimately improving satisfaction for employees and the patients and families we serve.
“As a leader, if I set the tone and make rounding a valuable tool, then I get great information that improves everyone’ s work environment.” – Sharon Kwiecinski, MSN, RN
Patient Services Awards
Ruth Lyons Award of Child Life and Integrative Care Distinction Brian H. Schreck, MA, MT-BC
Zenith Award, Respiratory Therapy Shannon Alten, RRT, RTII
Ann Brandner Award - Social Work Yvonne Stepter, MSW, LISW
Director’s Award for Excellence-Speech Shannon Alten, RRT, RTII
Pease & Sporck- Nursing Awards • Burton R. Pease Award Nursing Leadership: Clarice E. Poe, BSN, RNII, CPN • B. Robison-Sporck Award: Angela Jordan, RNII, CPN
Melanie Hunt Registered Dietitian of the Year Award Therese O’Flaherty, MS, RD, LD, CSP
Lauren Grant, RNII Registered Nurse
Kiara Chitman, RMA Medical Assistant II Hopple Street Neighborhood Location
“We are All Stars for our patients at Cincinnati Children’s because we promote having healthy children in the community.”
NURSING AWARD WINNERS
David Gerard Huschart, RPh Pharmacist Excellence Award Denise LaGory, RPh
Barbara Jean Black Technical Excellence-Pharmacy Anna Yamson, CPHT
Award for Clinical Excellence in Occupational Therapy/ Therapeutic Recreation Jill Bakker, OTR/L, MEd
Award for Clinical Excellence in Physical Therapy Robyn McHugh, PT, DPT, OCS, CSCS
Award for Service Excellence in Division of OT, PT, TR Denise Speeg, AAB
Managing Success Award Carol Tierney, PhD, RN, NEA-BC
Patient Education Advocacy Award: Psychiatry Care Journey Team (Photo with story on page 14) • • • • • • • • • •
Rachel Zimmer Adrienne Martin, MSN, RN Adam Hill, MSN, RN-BC, CPN Julia (Julie) Elkus Melissa Worrell, MA Heather Morath, BBA, BSN, RNII-BC Mica Dulle, MSN, RN-BC Krista Keehn, MS RN-BC Robin Brewe, MHSII Amberly Schmaltz, MSN, RN
Robert E. Davis Award of Excellence-Patient Escorts Lonnie Banks
Maggie P. Montgomery Award-HUC
Russ Garrison, OTR/L Occupational Therapist Cincinnati Children’s Outpatient - Drake
Kimberly Woods, HUC
Carol McKenzie Award for Excellence in Advanced Practice Nursing-Winner Amy Myer, MSN, CNP
“I’m an All Star for our patients at Cincinnati Children’s because I help kids with brain injuries return to independence by challenging them in the unique aquatic environment.”
NURSING AWARD WINNERS
2015 in Review
Optimal Outcomes Cincinnati Childrenâ€™s strives to provide the best possible outcomes for our patients and families by growing our professionals and advancing clinical practice.
Hospital Facts and Figures - 2015 Number of beds licensed
Number of beds staffed
Number of ambulatory clinic visits Number of admissions
Number of RN FTEs
RN skill mix
RN turnover rate
RN vacancy rate
RN Professional Development
Total number of RNs who are members of at least one professional nursing organization
Percentage of certified direct care RNs
Total number of RNs who have nationally recognized certification
RN Continuing Education
Number of Nursing Grand Rounds live presentations
Percentage of certified RNs serving in leadership positions
Number of nurses who attended Nursing Grand Rounds
Other online clinicians across 11 US states and 2 countries
Number of nurses who attended Nursing Grand Rounds online
Undergrad cohort groups
Undergrad students completing clinicals Graduate students completing clinicals Role transition and leadership students Allied Health students
Total Nursing Students
177 135 309
Highest nursing degree for RNs who provide direct care ADN/Diploma BSN
Nursing Continuing Education
Staying current to maintain, develop, and increase the knowledge, skills, and professional performance of our nurses and allied health clinicians.
Highest nursing degrees for RNs
Highest nursing degree for RNs in leadership positions
2015 in Review
Number of employees who received nursing degress in 2015 ADN/Diploma
Research in Patient Services As scientists with backgrounds in nursing, communication sciences and other allied health specialties, it is critical that we stay closely connected with our clinical colleagues in Patient Services. Through these connections we can most effectively translate discovery into clinical practice at the point of care.
Total Grant Value:
Calendar Year 2015
Nationally Recognized Nursing Certifications Certification demonstrates to patients and families that we are the most skilled and experienced nursing professionals. Margie Anna Abplanalp Christina Ackerson Rebecca Adkins Ashley Alford Brittany Allison Marcos Andreotta Jessica Andres Marie Apgar Michele Armstrong Emily-Ann Arnett Samrawit Asrat Debra Auciello Keyna Austin
Angela Babanskyj Denise Bach Vivian Bachman Nancy Back Morgan Baker Kristy Bamberger Sarah Barker Kimberly Bartholomew Samantha Bass Kayla Bayer Carla Beaty Emily Bell MaryPat Benham
Stephanie Bennett Pamela Bernard Lauren Bernatis Michele Bernhardt Jessica Berning Becky Berrens Kayla Berry Patti Besuner Kathy Bilz Andrea Binder Mary Bishara Tami Bishop Jennifer Bisig
Robyn L. McArthur, RN, CPHON, LMT, NCBTMB, HN-BC Burnet Campus
“I am an All Star for our patients at Cincinnati Children’s on the Cancer and Blood Diseases Institute because I treat the “whole” person - physically, socially, emotionally, and spiritually. I work with children and families from initial diagnosis and follow them throughout treatment. I support, comfort, promote wellness and well-being through the use of therapeutic presence and by utilizing various holistic modalities such as massage, relaxation, and coping techniques.”
NATIONALLY RECOGNIZED NURSING CERTIFICATIONS
Anne Blackmore Jennifer Blakley Honey Blankenship Katherine Bloomfield Erica Boelleke Lois Bogenschutz Jennifer Bolser Nancy Boosveld Monica Borell Annamarie Borich Kari Boswell Susan Bow Penny Bowden Jennifer Bowman Melissa Bowman Catherine Boyce Jaymee Brandenburgh Tracy Brennan Marji Bretz Nichole Brock Courtney Brockman Kristin Broering Karen Brown Kayla Buckley Martha Budd Meghan Buechel Stephanie Buganski Susan Bugg Brandi Buken Jenna Burgei Verretta Burk Ashley Burwinkel Stephanie Burwinkel Reilly Butler Megan Byerly Christina Byrd
Jamie Callahan Amanda Campbell Linda Carl Kimberly Carpenter Nicollette Carroll Kathryn Carter Samantha Carter Kelly Lynn Cherry Wendy Chouteau Julie Ciambarella Julie Clark Amy Marie Cline Kyle Cobb Piper Coleman Faith Coman Lauren Combs Lesa Combs Robert Combs Sharon Cook Lisa Cope Christopher Corbett Kevin Cornell Marissa Couto Amber Cramer Heather Crandall Natasha Cropper Kimberly Crowe Alonda Crowell Sarah Culver Carla Curry Teri Daniels Heather Darrell Kristen Daughters Gina Gay Davidson G Maria Davis Robyn Davis
Karen Day Amanda Dearduff Kathleen Dellerman Bethany Dendler Julie Denlinger Elizabeth Dewar Kimberly Dietrich Nancy Dodson Emily Donoghue Deborah Donovan Lise Dufresne Elaine Duley Mica Lynn Dulle Marykay Duncan Shannon Dunham Elizabeth Dupont Katie Dwyer Anitra Edwards Stephanie Eggert Felicia Eichelbrenner Heidi Elam Linda Elliott-Amann Rachel Ellison Veronika Elsaesser Natalie Elsbrock Wendy Engel Dorothy Everts Christine Faber Renee Fages Anna Fahey Julie Farrell Kate Farrell Angela Faulhaber Kristine Feld Gwen Feldhaus Lynette Fenchel Eileen Fiedler Timothy Fike Theresa Fischer Paula Fisher Robyn Fite Shannon Flaherty Lisa Flanigan
Kristina Fliehman Crystal Fluker Sarah Fojtik Tara Foltz Merry Jo Ford Tiffany Frank Cheri Franklin Debra Kay Freese Mary Elizabeth Frey Olivia Frias Frances Gadd Denise Annette Gaige Constance Gallagher Megan Gallo Kristen Gamm Amy Garcia Muriel Garcia Mary Garrison Jane Garry Junell Gertz Jennifer Giltz Julianne Godschalk Shelley Goldman Amanda Goodin Amanda Gorman Deborah Graef Maria Graham-Fedyk Lauren Grant Michelle Grau Lauren Gregerson Kayla Grethel Christina Groenke Jessica Grosheim Katelyn Grube Mary Guilfoyle Rebecca Gunn Jessica Haas Kimberly Haas Jaime Haase Jennifer Hacker Rebecca Ann Haehnle Deborah Hafley Dottie Hammersley
Lucia Hammons Sara Hansen Britney Harder Brenda Harkleroad Mary Harrah Jennifer Harrison Megan Hauger Adriane Hausfeld Heather Hayes Melissa Hayward Carly Heckmann Judy Heilman Karen Hendricks Stephanie Herber Jody Hessling Donna Hettinger Sara Hicks Deborah Lynn Highhouse Casey Hildebrand Helen Hingl Caryn Hogan Kristina Holder Tiffany Holt Debbie House Kelli Howard Sheila Howard Jeanne Hubbard Erin Hudson Sara Hughes Dana Hussel Lena Huster Amanda Huth Molly Ihlendorf Dawn Jack Stephanie Jackson Darlene Jacobs Cynthia Jansen Kelly Jeffcott Michelle Jeffries Amanda Jones Sean Jones Ann Katt Cheryl Keen
Mattie P Dunn Certified Child Life Specialist I
“I am an All Star for our patients at Cincinnati Children’s because as a child life specialist at College Hill, using play, I help children have a more positive experience with invasive procedure, such as blood draws.”
Jorden Kees-Futscher Geraldine Kelly.Mancuso Kimberly Kennedy Melissa Kerlin Dani Kientz Kelsey King Allison Kinkade Tonya Kirby Kathy Kirschner Amy Kitchens Kim Klotz Michelle Kodish Sarah Koetting Kerry Kohler Cynthia Ann Kollstedt Sara Kosel Mary Beth Kramer Stephanie Kruse Sara Kruszynski Katilyn Kusnier Linda Lacina Angi Landholm Kimberly Larva Kristen Laswell Karen Leigh Lawley Marla Layne
Jessica Lehn Courtney Leighton Rebecca Lynn Lelii Kelly LeMaster Denise Leonard Karen Beth Leonard Stacy Marie Levi Erica Lewis Michelle Lewyckyj Barbara Liedhegner Stephanie Lightner Courtney Little Mojra Logsdon Jill Long Michelle Lonnemann Kathy Lonzo Gina Louderback Jean Luchini Tricia Luckhaupt Corrie Lusk Stephanie Lux Theresa Lynn Lynch Debbie Sue Maas Jennifer Mack Karen Macke Amy Maher
NATIONALLY RECOGNIZED NURSING CERTIFICATIONS
Nationally Recognized Nursing Certifications Dawn Michelle Malone Paula Manning Kathleen Mapes Michelle Marowitz Tracey Martin Alexandra Mathes Brandy May Emily Mayhaus Denise McAdams Robyn McArthur Sarah McCall Bridget McKibben Patricia McLain Laurie Meckes Connie Sue Meeks Jamie Meister Jill Melchers McKenna Menees Sandra Menker Jennifer Margaret Merritt
Holly Meyer Deborah Milesky Danielle Miller Melinda Miller Vicki Miller Hillary Miniard Shawn Mock Susan Mohr Laura Mooney Carrie Moore Elizabeth Moore Katherine Moore Margaret Moore Jolyn Morgan Nichole Morgan Rebecca Morris Deborah Morse Avril Mortellite Morgan Moulin Ashley Muennich
Pamela Mulhall-Smith Julie Mullalley Chelsey Mullins Kimberly Mullins Deborah Murphy Christine Myers Nicole Myers Sarah Myers Autumn Naegele Mallory Naylor Lari Neal Nicole Nelson Jenifer Neltner Adam Neu Carolyn Nicholson Ann Niehaus Renee Niehaus Holly Michelle Nienaber Julie Nilles Karen Noel
Quannah Newton, CMA Medical Assistant II Fairfield Neighborhood Location
“I am an All Star for our patients at Cincinnati Children’s because every day I get the opportunity to help our patients and families with what can be frightening situations and turn those situations into positive, courageous experiences for the children. I love that all of our staff fits together like puzzle pieces to help educate, guide, and change the outcome for families and their children….. and I love to give out stickers.”
NATIONALLY RECOGNIZED NURSING CERTIFICATIONS
Robin Noel Matthew North Jennifer O’Connor Teresa Ohara Lucy Pui O’Quinn Gina Osterbrock Erin Osterkamp Amber Overly Brianne Owens Mary Susan Owens Tonia Owens Kimberly Padur Brigette Parker Gina Parsley Jessica Patti Janis Pember Tiffany Pendergrass Lori Perkins Tena Pham Ananda Pienaar Sara Pinkston Lindsay Pitcher Abby Pitman Amber Platt Anthony Prickel Molly Proctor Andrea Pyle Lindsay Rack Erin Rairden Bailey Ramsay Julie Ranz Amanda Recker Hannah Reed Leslie Reed Melissa Reed Brianne Reedy Meredith Reeve Deborah Reeves
Terri Rehn-Debruler Rebecca Lynne Rengering Barbara Rhymer Alyssa Rickert Maureen Rider Sally Rigby Kelsey Roat Sydney Robinson Olivia Roeder Molly Roell Laurie Rosendahl Kathleen Rosing Emily Rozsonits Zachary Ruehl Andrea Ruf Clare Rumpke Lisa Rust Jacqueline Ruter Christina Salyers Erin Sandfoss Megan Sandlin Stacey Van Santen Melissa Saylor Jennifer Schack Megan Schaefer Elisa Schaffer Margery Schaffer Jean Schott John Schroer Carla Schulte Allison Schulten Sarah Schultz Mary Schumacher Allison Schwandner Roma Seat Ann Segers Deborah Seider Gina Sharp
Elizabeth Shaw Anna Sheets Rachel Sheets Ashley Sheldon Kimberly Shepard Jeffrey Shoemaker Cherie Short Lois Siegle Michelle Siekerman Robin Siekman Christina Simon Lauren Simpson Catherine Sipniewski Elizabeth Skulas Jacqueline Smith Tracy Smith Julie Snider Jennifer Sorrell Lauren Spadafore Michelle Spaulding Elizabeth Spitznagel Lisa Spraul Jill Springmyer Shari Stafford Emalee Stallkamp Emily Stapp Jill Stein Laurel Stein Christine Steinmetz Erin Stephens Katie Stephenson Julie Stevenson Gabrielle Stires Daniel Strong Katrina Styles Lucille Sullivan Diana Swisshelm Bethany Taylor
Kristina Taylor Bonnie Tedtman Christina Thomas Juli Thomas Megan Thomas Arielle Thompson Erin Thompson Lori Tobias Sarah-Ross Tolin Jean Tomasic Stephanie Torrens Leslie Treadway Tricia Lee Trimble Laura Trimboli Jessica Trimbur Jennifer Tubbs Mary Tucker Angela Turck Kathleen Turner Rachelle Tutterrow David Ulmer Wendy Ungard Christy Unger Marcia Vaccariello Polly Vaughan Claudia Velez Laura Vest Michele Ann Vogelpohl Joseph Vormbrock Lisa Vormohr Donna Marie Walker Alainna Walley Shannon Rae Walsh Shannon Marie Wanderski Deborah Warden Amanda Warmoth Lisa Wartman Connie Wehmeyer
Mary Weingartner Tiffany Weisberg Jenny Werden Julie Ann Westbrook Carrie White Kerry Anne White Regina Whitney Susan Wieser Sarah Wilhelm Neka Williams Anne Willmann Rachel Wilp Kathryn Wilson Rachel Wilson Lauren Winters Amy Wiseman Brandie Wiseman Lisa Witte Laura Woeste Cheryl Wolfenbarger Katherine Woolery Cayse Wright Lauren Wright Tiona Wright Jane Wuebker Kaitlyn Wurtenberger Lacey Yeager Lane Yoder Lauren Young Margot Young Trinette Young Patricia Anne Yung Kathryn Ziegler Melissa Zimmer Shantel Zwissler
Our efforts to promote nursing certification have increased the percentage of certified direct-care nurses from 14.3% in 2008 to an impressive 42.52% in 2015.
NATIONALLY RECOGNIZED NURSING CERTIFICATIONS