2021 Patient Care Services Annual Report

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bayhealth YO U R T R U S T E D PA R T N E R I N H E A LT H

2 0 2 1 N U R S I N G & PAT I E N T C A R E S E R V I C E S R E P O R T

Honoring the Heart of Healthcare BAYHEALTH’S PATIENT CARE SERVICES TEAM, INCLUDING 2021 OVERALL NURSE OF THE YEAR MICHELE KLIPPERT, GOES ABOVE AND BEYOND, EVEN IN CHALLENGING TIMES


welcome

A Message From Our Interim Chief Nurse Executive

If the challenges of the past two years have shown us anything, it’s the power of teamwork. I’ve seen some amazing displays of teamwork at Bayhealth. In December and January, when the call went out that nursing needed assistance dealing with the latest COVID surge, the entire organization—from our CEO on down—pitched in, doing everything from answering phones to assisting patients. We also got support at the state level, with the National Guard helping in some of our darkest moments. I’ve seen nurses working out of their comfort zones, jumping into different assignments and doing things they wouldn’t normally have done. All of this is proof of our resiliency as an organization and shows that we are agile, flexible and adaptable. I have such pride and gratitude when I think about everything that we have been through this past year and what we were able to accomplish. Our patient experience scores continue to improve every day thanks to our staff’s commitment to serving our community. Now, we look to the future as we rebuild our team bigger, better and more resilient than ever before. We’re working at the leadership level on long-term strategic plans to strengthen and grow our workforce. Part of our rebuilding is reinvigorating our Shared Governance Councils and getting back to our roots with shared decision-making; we are committed to moving forward together. Finally, let me say a few words about Brenda Blain, who unexpectedly left her role as chief nurse executive last year due to health reasons. During her four years at Bayhealth, she touched so many lives. Brenda is a great leader and amazing colleague, and there isn’t a day that goes by that people don’t ask after her. She is in our thoughts, and we all send our love and appreciation. Sincerely,

Sharon Urban, MSN, MHA, RN-BC, CNML, NE-BC, FACHE Interim Senior Vice President, Chief Nurse Executive and Senior Director of Patient Care Services

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TABLE OF CONTENTS 3 TRANSFORMATIONAL LEADERSHIP 8 A TRIBUTE TO NURSES 10 STRUCTURAL EMPOWERMENT 12 EXEMPLARY PROFESSIONAL PRACTICE 14 EMPIRICAL OUTCOMES 16 NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS 17 BAYHEALTH NEWS AND RECOGNITIONS

Bayhealth’s mission is to strengthen the health of our community, one life at a time. As central and southern Delaware’s largest healthcare system, Bayhealth comprises Bayhealth Hospital, Kent Campus and Bayhealth Hospital, Sussex Campus, the freestanding Emergency Department in Smyrna as well as numerous satellite facilities and employed physician practices encompassing a variety of specialties. Terry M. Murphy, FACHE President and Chief Executive Officer ­— Deborah Watson, FACHE, FACMPE Senior Vice President and Chief Operating Officer ­— Gary Siegelman, MD, MSc, CPE Senior Vice President and Chief Medical Officer ­— Sharon Urban, MSN, MHA, RN-BC, CNML, NE-BC, FACHE Interim Senior Vice President, Chief Nurse Executive and Senior Director of Patient Care Services ­— Michael J. Tretina, CPA, MBA, FHFMA, FACHE Senior Vice President and Chief Financial Officer ­— Lindsay A. Rhodenbaugh, DMin Senior Vice President, Chief Development Officer and President of the Bayhealth Foundation ­— John Van Gorp Senior Vice President, Planning, Business Development and Government Relations


transformational leadership

Our Patient Care Services Leadership Team

Terry M. Murphy FACHE, President and CEO

Sharon Urban MSN, MHA, RN-BC, CNML, NE-BC, FACHE, Interim Senior Vice President, Chief Nurse Executive and Senior Director of Patient Care Services

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Transformational Leadership

Angeline Dewey MSN, APRN, ACNS-BC, CCRN, CNRN, Director of Education

IN N U R SIN G & HE Structural Empowerment

EMPIRICAL OUTCOMES New Knowledge, Innovations & Improvements

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Gust Bages MHA, BSN, RN, Senior Director of Patient Care Services

Christie Tomaseski MSN, RN-BC, NEA-BC, Professional Excellence and Magnet Program Director

Cheri Briggs BS, PharmD, MBA, Senior Director of Pharmacy Services

Anita Witzke MSN, RN, NE-BC, Senior Nurse Manager and Interim Director of Patient Care Services

FOLLOWING THE MAGNET MODEL

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Faith Colwell-Dorio MSN, RN, NEA-BC, VHA-CM, Senior Director of Perioperative Services

Jessica Alvarez MHA, BSN, RN, C-EFM, Director of Women’s & Children’s Services

Exemplary Professional Practice

Magnet ® provides the framework to guide and achieve excellence in nursing practice. Magnet recognizes organizations that demonstrate consistent patient, staff and community partnership outcomes through evidence-based practice and outperform national benchmarks. An ethical and professional responsibility is owned by Magnet organizations to contribute new knowledge, innovations and improvements to ensure future success.

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transformational leadership

Nursing Strategic Plan 2020-2022 The goals outlined are based on our Professional Practice Model and Organizational Strategic Plan. They are an extension of Bayhealth’s brand promise, mission, vision and values.

ORGANIZATIONAL EXCELLENCE • Increase overall inpatient patient satisfaction to meet or exceed annual organizational targets. • Increase Emergency Department overall satisfaction to meet or exceed annual organizational targets. • Reduce hospital-acquired conditions to meet or exceed annual organizational targets. • Reduce 30-day readmissions to meet or exceed annual organizational targets. • Reduce serious safety events through continued High Reliability Practices. • Continually assess unit-level nursing quality indicator data to ensure that Magnet peer group benchmarks are met or exceeded.

CULTURE • Increase percent of nurses with BSN or higher by 0.5% annually. • Increase percent of nurses with national specialty certification by 0.5% biannually. • Decrease annual RN turnover. • Decrease RN turnover rate within one year of hire. • Ensure RN satisfaction meets or exceeds Magnet peer group benchmarks. • Formalize succession planning programs for nursing leadership and emerging leadership roles (nurse manager,

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clinical coordinator) to improve onboarding, career development and retention. • Collaborate with GME program to introduce the importance of positive physician-nurse relationships in orientation. • Build mechanisms to address nursing staff stress levels and burnout.

ACCESS AND GROWTH • Increase clinical nurse involvement in nursing research. • Increase the number of annual research projects that are completed and disseminated, both internally and externally. • Address care transitions across the continuum of care. • Execute key initiatives identified in the Bayhealth Community Needs Assessment Report. • Increase education and involvement in the community. • Increase annual prescription volume in the outpatient community pharmacies. • Apply new strategies to address behavioral health. • Expand the number of inpatient beds at the Kent and Sussex campuses. • Increase the number of beds at Sussex Emergency Center. • Collaborate with GME program to develop simulation lab.

CLINICAL INTEGRATION • Achieve PTAP certification. • Standardize operational and clinical nursing practices to promote efficiency and support a high reliability culture. • Expand telehealth services to assist in improving patient outcomes. • Leverage technology to increase accurate, automated actionable data collection and reporting. • Standardize format of NDNQI data presentation as it corresponds to Magnet requirements. • Streamline PI process. • Educate staff on LEAN principles for performance improvement initiatives. • Collaborate with pharmacy to strengthen the chain of custody of controlled substances.

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STRUCTURAL EMPOWERMENT

EMPIRICAL OUTCOMES

TRANSFORMATIONAL LEADERSHIP

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EXEMPLARY PROFESSIONAL PRACTICE

The Bayhealth team at the 2021 National Magnet Conference.

NEW KNOWLEDGE, IMPROVEMENTS

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PATIENTPA PA ATIE EN N NT T FAMIL FA MILY M LYCENTERED CEN NTERED NT D CARE CARE

T BILITY ACCOUNTA IT PIRIT SP S SPIRI

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Professional Practice Model • Our model of care is patient- and family-centered. • We embrace Planetree philosophies and believe in treating the whole patient, mind, body and spirit. • Our core values are aligned with the larger organization. They include compassion, accountability, respect, integrity and teamwork. • Our work as nurses is grounded in research and evidence-based practice. • Our goal is to achieve nursing excellence, and we achieve this through advocacy, empowerment and collaboration.

Bayhealth Nurses Celebrate Magnet Designation The American Nurses Credentialing Center National Magnet Conference is the largest annual gathering of healthcare workers and nurses worldwide. After participating in a virtual conference in 2020 due to COVID-19, Bayhealth celebrated our Magnet redesignation in person in November 2021—with team members proudly parading across the stage in front of thousands of nurses from around the world. Magnet designation is the highest recognition of nursing excellence that can be bestowed on an organization; only about 9% of medical facilities in the United States hold this honor. To earn Magnet designation, facilities are held to the highest standards and must show that they outperformed other medical facilities in the nation. This rare accomplishment must be earned every four years. Bayhealth has achieved Magnet status twice—recognizing eight consecutive years of excellent patient outcomes, innovation, staff and patient satisfaction, and meaningful community partnerships. Attendees at this year’s conference heard from globally known motivational speakers and authors as well as highly esteemed healthcare professionals. After a year of separation, the focus was simple: Take care of yourself and remember to keep humanity in all patient experiences. Patients should know they’re cared for as people, not just as room numbers. Along with offering education sessions, self-care activities and chances to network, the conference honored nurses, nurse practitioners and healthcare facilities for their hard work and dedication. Two years of Magnet and Pathway to Excellence designations were celebrated, given the virtual nature of the 2020 conference. After the challenges of this past year, the celebration and appreciation proved more vital than ever—rejuvenating many of those who have worked tirelessly to provide exceptional care for their patients.

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transformational leadership

Mentoring the Next Generation of Nurses When new nurses begin their first year of practice, they often face a stressful learning curve. Helping them succeed—and easing their transition to a clinical setting—is the goal of Bayhealth’s newly revamped Nurse Mentorship Program. “The first year of nursing is so overwhelming,” said Brittany Oakey, MSN, RN, the clinical educator at Bayhealth who helped develop the program. “So we match the new nurses with experienced nurse mentors who give them support with whatever they need—whether it’s professional development, self-care or emotional support.” The mentorship program, which began in 2019, was designed for nursing residents upon completion of their residency. “They get amazing support

in the residency program, but once it’s over, some of them flounder,” Oakey said. “Originally, we matched mentors and mentees on a personality basis and [based on] who had similar shifts. But it was pretty informal.” Oakey and her colleagues quickly realized that the program would benefit from a formalized approach. They saw that it had the potential to grow and encompass other healthcare professionals, such as nursing assistants and nurses working on their clinical ladders. When the pandemic hit, it became apparent that the need for a robust Nurse Mentorship Program was greater than ever. “We saw a lot of compassion fatigue and burnout among new nurses,” Oakey said, “and we wanted to give them the tools to ensure success.”

Oakey’s team developed a pilot program for nurses in four units, two each at the Kent and Sussex campuses. Residents assigned to the units are automatically enrolled in the program, which lasts for nine months. Typically, mentors meet with the mentees monthly, help create SMART goals for continued professional development, and communicate by email and text as needed. While the revamped program is still in its early days, mentees have already shared how grateful they are. “They have a look of relief on their faces when they learn about it,” said Erica McPhail, MSN, RN, APRN, AGCNS-BC, Adult Inpatient Nurse Residency coordinator. “They say, ‘It’s great I still have someone to reach out to who can continue to guide me.’ ”

From left: Brittany Oakey, Lauren Mixon and Erica McPhail are part of the revamped Nurse Mentorship Program.

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Senior Director of Patient Care Services Gust Bages has helped bring new nurses to Bayhealth through a variety of programs.

Building a Stronger Workforce Providing top-level care to our patients is at the core of what we do at Bayhealth, even in difficult times. As the healthcare industry, along with many other sectors around the United States, faced staffing shortages this past year, our team rose to meet those challenges. “The entire country is experiencing labor shortages,” said Sharon Urban, MSN, MHA, RN-BC, CNML, NE-BC, FACHE, interim senior vice president, chief nurse executive and senior director of Patient Care Services. “Everyone here has a true commitment to our community and our patients. That’s what separates us.” While many Bayhealth nurses retired or left the field for other industries, others came together—working to cover shifts and provide quality patient care. “Our staff did everything they could because this is their hospital,” said Gust Bages, RN, BSN, MHA, senior director of Patient Care Services. “The nursing

staff worked extremely hard. They took ownership of the hospital; they took ownership of the ED. The team that is left is stronger now than ever.” The leadership team at Bayhealth demonstrated that same dedication to the staff and Delaware community. “We had a tremendous amount of support from our chief financial officer and our chief executive officer,” said Urban. “When I went to them [last] September and outlined some of the challenges we were facing, right away they said, ‘[We’ll do] whatever it takes to support our community and our staff.’ That speaks volumes to their commitment to us and to making sure we have the human resources we need to provide the best possible care for our patients.” Several new and existing initiatives are in place to help support staffing, including traveling nurses (several of whom came from out of state and now

make Bayhealth their home) and shifting to a team-based model of nursing care that allows registered nurses and licensed practical nurses to work at the top of their licensure. The workforce is also bolstered by the Avant international nurses program and a part-time program for weekend nurses. The Avant program, which began at Bayhealth pre-pandemic, recruits nurses from 20 English-speaking countries. Participants work 4,500 hours and can then become full-time employees and get citizenship. There are currently five nurses in the program, and Bages hopes to bring in as many as 12. “The program builds diversity at the hospital and the surrounding community,” he added. The weekend program offers the opportunity for nurses to work weekends only but still receive full-time benefits. “It initially started to promote work-life balance for our staff who have families outside of Bayhealth,” said Urban. “It’s an option for those who need the flexibility of being home during the week but also need full-time benefits for their family.” Recruiting remains an important consideration, with new strategies that include a student loan forgiveness program; reexamining recruiting, retention and onboarding processes; and bringing in nursing professional development specialists to help mentor new hires across the system. Ensuring that the staff receives fair compensation is another priority. Urban said that bedside nurses and nonleadership positions received a pay increase, in addition to their annual performance appraisal increase. “We continue to do a market analysis to see if we can remain competitive in today’s market,” she added.

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a tribute to nurses

A handful of the Bayhealth nurses who go above and beyond for their patients.

The Heart of Healthcare DESPITE PANDEMIC CHALLENGES, BAYHEALTH’S NURSES AND OTHER PATIENT CARE SERVICES TEAM MEMBERS OFFER COMFORT DURING TRYING TIMES

Compassionate caregiving comes in many forms, especially for nurses. The COVID-19 pandemic is taking a tremendous toll on the world. To date, more than 996,000 lives have been lost in the United States, 2,919 of those in Delaware. Bayhealth has treated 11,052 COVID-related cases, saving nearly 95% of our COVID-19 patients since the start of the pandemic. Every day, our Magnet-recognized nurses face various challenges with grace and continue to go the extra mile for our patients. Sometimes those special efforts by Patient Care Services team members consist of little things with a big impact. For example, Bayhealth nurses fulfilled a COVID patient’s longtime dream

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of getting his picture in the newspaper by purchasing a half-page ad in the Delaware State News to wish him a happy 100th birthday. Or consider the prolonged support from ICU caregivers at Bayhealth Hospital, Sussex Campus, who provided comfort and companionship to a new mother fighting COVID just days after giving birth to her third child. The ICU team decorated the patient’s room with photos of her children and collected video messages from her family so she would not feel alone, playing them for her while she was on a ventilator and unable to speak. When the patient— who was also a Bayhealth Medical Group employee—was released from the hospital, a crowd of caregivers and

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Clinical Coordinator Crystal Shockley is a DAISY Award winner.


Bayhealth team members cheered her on as she left the building. Bayhealth’s nurses maintain that high level of dedication, even when dealing with their own problems. Take Clinical Coordinator Crystal Shockley, MSN, RN, who finished her master’s degree while battling COVID herself. “It was rough trying to write papers while experiencing fevers, chills and other symptoms,” said Shockley, who was honored with a DAISY Award in 2020. Her resilience and strength are an inspiration for her colleagues, who recognized her warmhearted support of a patient with pneumonia during the patient’s final days. “Crystal gave amazing care and kept the patient comfortable at all times,” wrote Shea Aviles, RN, in the DAISY Award nomination. “She kept the family updated and, when all was said and done, managed to stop the ambulance from leaving with the patient so that everyone had just a few moments to say goodbye. This was just above and beyond the call of duty and so unexpected and loving.” The sense of empathy that draws many nurses toward their calling is invaluable to patients and their families, especially those dealing with COVID visitation restrictions. Nurse Manager Verna Sellers, MSN, RN, CNML, was also recognized as a DAISY Award winner in 2020 for her unflagging efforts to keep a patient on her unit connected with loved ones and for comforting the family members during the difficult time. GIVING THANKS The pandemic is impacting even the most dedicated care providers, with more than half a million people leaving the sector nationally since February 2020. Some healthcare workers cited

Augustus “Gus” Raughley Jr. received a special 100th birthday surprise from his Bayhealth caregivers while he was battling COVID-19.

burnout, stress and job conditions as reasons for leaving the industry; others faced layoffs or quit due to personal factors such as health or family needs. In late 2021, Bayhealth launched a campaign to express our deep gratitude to our team and their families, with employees sharing their personal moments of strength and heartbreak. Said Megan Lawless, BSN, RN, of her work in the Critical Care Unit at Bayhealth Hospital, Sussex Campus, “We care for ventilated patients who can’t talk or do anything for themselves. We have to be everything to them. “Growing up, I always wanted to fix other people’s boo-boos,” she continued. “There’s truly a sense of pride in taking care of someone who can’t help themselves. Whether it’s recovery or end of life, I’m there to hold their hand through the whole process.”

Verna Sellers MSN, RN, CNML

Sometimes that drive to care for others is directed internally. Even on their worst days, Bayhealth care providers such as Korinne Roach, BSN, RN, CPN, who works in Day Surgery, know they can lean on each other for support. Said Roach, “On tough days in Day Surgery or when dealing with the pandemic, my co-workers and I say to each other, ‘We got this!’ and try to focus on the positives and our patients.” Patient Care Services providers offer their colleagues, patients and their families unforgettable support in the times they need it most. As renowned poet Maya Angelou once wrote, “[Nurses] have the opportunity to heal the mind, soul, heart, and body of our patients, their families, and ourselves. They may forget your name, but they will never forget how you made them feel.”

Megan Lawless BSN, RN

Korinne Roach BSN, RN, CPN

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structural empowerment

Climbing the Clinical Ladder CAREER ADVANCEMENT OPPORTUNITIES FOR EXPERIENCED NURSES WHO PERFORM DIRECT BEDSIDE CARE ARE OFFERED THROUGH BAYHEALTH’S CLINICAL LADDER PROGRAM TO SUPPORT EXPERT CLINICAL KNOWLEDGE AND EXPERIENCE AT THE BEDSIDE. THE PROGRAM PROVIDES A TIERED STRUCTURE OF PERFORMANCE RECOGNITION AND ACCOUNTABILITIES, ENCOURAGING NURSES TO STRETCH THEIR ABILITIES AND BE MORE ENGAGED WHILE EARNING ADDITIONAL INCOME.

2021 CLINICAL LADDER PARTICIPANTS AND PROJECTS Sarah Swan, BSN, RN: Decrease hospital-acquired pressure ulcers Amanda Glass, BSN, RN, CCRN: Decrease hospital-acquired pressure ulcers Kathi Breeding, MSN, RN, CPAN: Improve preparations for surgery for the inpatient Kaitlyn Bang, MSN, RN: Create education series for less common, higher-risk surgical procedures Allison Carbine, BSN, RN: Create guidelines to help reduce hospital-acquired pressure ulcers Rotianne Cox, BSN, RN

Laura Cassidy, MSN, MBA, RN: Evaluation of simethicone use to improve endoscopy processes and outcomes Nina Pletsch, BSN, CPAN: Improve nurse-to-physician communication scores Rotianne Cox, BSN, RN: Decrease OR late case starts Staci Schmidt: Improve handoff communication to reduce preventable errors Roland Gillette, MSN, RN, CEN: Improve hand washing to decrease infection rates in the ED Leslie Merrell, BSN, RN, CMSRN: Decrease incidence of C. diff through use of new waste bags instead of commode buckets Korinne Roach, BSN, RN, CPN: Advocate for unit ACLS cart and provide related education and competency checks with team Shariyfa Cedeno, BSN, RN: Improve employee engagement scores Brooke Parks, BSN, RN: Improve patient experience scores Denise Anacay, BSN, RNC-OB: Improve patient experience scores Ira Platt, RN, CCRN: Improve knowledge and competency with advanced hemodynamic monitoring Taylor Richard, BSN, RN: Decrease hospital-acquired pressure ulcers MycKenzie Gillette, BSN, RN: Improve unit employee satisfaction

Focus on Professional Development THE EDUCATION AND GROWTH OF OUR NURSES IS A HIGH PRIORITY AT BAYHEALTH. WE BELIEVE IN CULTIVATING THE TALENT

2021 CLINICAL STATS 728 FULL-TIME NURSES 224 PART-TIME NURSES 1,300 TOTAL LICENSED NURSES 30%* RN TURNOVER RATE

OF OUR NURSES AND BUILDING THEIR CLINICAL AND LEADERSHIP

34% NURSES ARE CERTIFIED

SKILLS—THROUGH CERTIFICATIONS, CONTINUED EDUCATION AND

54% NURSES WITH BSN OR HIGHER

PROFESSIONAL DEVELOPMENT OPPORTUNITIES. THE CLINICAL

10% NURSES WITH MSN OR HIGHER

STATISTICS SHOWN HERE REFLECT THE TOP QUALITY AND ADVANCED KNOWLEDGE OF OUR NURSING STAFF.

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*National hospital nurse turnover range is as high as 66.5% for 2021, per NSI Nursing Solutions, Inc.


SCHOLARSHIP HELPS COVER CERTIFICATION COSTS According to the 2020 Bayhealth Nursing Needs Assessment, one of the top barriers to obtaining nursing specialty certification was paying for the upfront cost of the exam, which can range from $200 to $600. In response, the Patient Care Congress and Professional Development Councils created a scholarship in 2021 to help pay for certification exam costs. Funds for the scholarship are raised through the annual Nurse on the Run 5K event, which is also orchestrated by shared governance. “We are a Magnet facility and nurse-centered. Certifications show the knowledge base of the facility is above and beyond the standard,” said Emergency Department staff nurse Philip Fisher, RN, BS, BSN. “A scholarship that covers the out-of-pocket costs upfront eliminates that financial barrier for our nurses. We’ve received tons of positive feedback. The scholarship is there, but a lot of people don’t realize it.” Increasing certification is a Bayhealth nursing strategic plan goal. “There is research that ties certifications to better patient outcomes,” said Professional Excellence and Magnet Program Director Christie Tomaseski, MSN, RN-BC, NEA-BC. “Certification also helps make nurses better at their jobs, establishes professionalism and validates a higher level of clinical competence.” To date, 12 nurses have received scholarships. Take advantage of this opportunity if you don’t already have an active specialty certification and apply at Baynet > Initiatives > Magnet > Certification Scholarship. Review the information, then scroll to the bottom of the page and select the link to complete the application.

Project Takes on C. Diff Spread When Leslie Merrell, BSN, RN, CMSRN, looked at reducing the spread of C. difficile in the hospital through the use of disposable bedside commode liners as her Clinical Ladder project, fortuitous timing led to the expansion of her plan. Merrell ended up acting as the Unit Champion for a yearlong infection prevention initiative called the CDI Prevention Collaborative that was guided by the American Hospital Association and funded by the CDC. The project, beta-tested on Merrell’s unit, 6A, at Bayhealth Hospital, Sussex Campus, also engaged a team that included pharmacy, infection prevention and environmental services, among others. In addition to the commode liners, the CDI Prevention Collaborative involved physician and nurse education, antimicrobial stewardship, changes to the electronic medical record and specimen testing, and hand sanitizer on patient trays. “The resources that came out of being in a project at the national level were incredible,” said Merrell. “It’s the springboard for us to really focus on the broader contributing factors to C. diff. Patient satisfaction is also high as they see we are controlling the spread and lessening the negative environmental aspects in the room with the commode liners.” The project concluded this spring and data is still being evaluated; the goal is to disseminate the practices systemwide, said Infection Control Senior Manager Kelly Gardner, BSN, RN, CIC. Gardner lauded Merrell’s unflagging commitment to the project and the support she was given by 6A leader Erin Cranston. Gardner also touted the value of the Clinical Ladder: “It empowers nurses to feel like they can make an impact in providing quality patient care.” “It was hard work but very rewarding,” Merrell Leslie Merrell (left) added. “In the end, this is and Kelly Gardner part of why I am a nurse.” (right) take on C. diff through the CDI Prevention Collaborative.

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exemplary professional practice

Felicia Cruz, geriatric clinical nurse specialist, is working to improve safety for patients.

ED NURSE DARNELL BAILEY HELPS YOUNG BURN SURVIVORS HEAL—BODY AND MIND Darnell Bailey, RN, grew up surrounded by healthcare providers. “Most of my family members were nurses, and I was fascinated by medical shows such as ER and Trauma: Life in the ER,” he said. Now Bailey works in the fast-paced Emergency Department at Bayhealth Hospital, Kent Campus. He loves working alongside doctors, physician assistants and nurse practitioners to help patients recover from a sudden injury or illness. “Everyone’s opinions are considered when making decisions regarding the care that we provide, including those of the patient and their family,” he said. “As ED nurses, we see a lot of bad things—and we also see a lot of good things.” Bailey’s caregiving nature doesn’t stop when he’s off the clock. He has volunteered as a camp counselor at the Delaware Burn Camp in Dover, which promotes physical and emotional healing for young victims of burn injury, the only one of its kind in the tristate area. “It is a weeklong camp that allows them to be children and not focus on their injuries,” Bailey said. “Campers participate in fun activities such as swimming, horseback riding [and] building rockets. And one night, the fire company comes out and they do tug-of-war with the firehoses.” Due to their injuries, most of the campers cannot properly regulate their body temperatures, so medically trained volunteers like Bailey are on hand to help change bandages and deal with other issues that arise. While Bailey finds his ED work immensely rewarding, he enjoys getting to know the young people at the Delaware Burn Camp. “Volunteering at this camp has allowed me to hear these kids’ full stories and provided me a better outlook on the impact we had and continue to have on Darnell Bailey, RN them.” He says that kids with burn injuries are still just kids. “There was one camper from Philadelphia who feared swimming,” he recalled. “She would only swim in the shallow end. By the end of camp, she was doing cannonballs and floating in the deep end with all the other campers.”

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FOCUSING ON FALLS PREVENTION Patient falls resulting in injury are a top concern for hospitals across the country, including Bayhealth. Falls may result from patient confusion, dementia, hospital-acquired delirium, dizziness, or getting adjusted to mobility deficits after stroke or amputations, among other factors. While management of falls has long been a priority at Bayhealth, the organization formed a new multidisciplinary team and program in 2021 called Bayhealth Moves You Safely (BHMYS), which incorporates falls prevention, safe patient handling and early mobility. “Previously the [Falls Management team] had these meetings separately, but we found a lot of our initiatives overlap,” said Felicia Cruz, MSN, APRN, AGCNS-BC, RN-BC, geriatric clinical nurse specialist. Some of those initiatives include developing a standardized process to address patient refusal of safety interventions, presenting falls prevention tips and risk factors at all inpatient units, remote video monitoring, flyers explaining falls risk and prevention for patients, and a broader use of safety equipment such as chair-pad alarms. The efforts have already had demonstrable success at Bayhealth, with a 6.5% decrease in falls with injury in calendar year 2021 compared with the year before. Cruz said that falls prevention is an ongoing effort for Bayhealth. “We are forever changing and growing within our falls prevention plans. We continue to improve our Falls Management program to provide the safest care for our patients.” (See page 14 for more information.)

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Decreasing Length of Stay for Interventional Cardiology Patients For the past few years, Bayhealth has been leading the nation when it comes to length of stay (LOS) in the cardiac catheterization (cath) and electrophysiology (EP) labs. An impressive 88.7% of EP patients and 83.6% of percutaneous coronary intervention (PCI) patients were discharged the same day of their procedures in 2021. Traditionally, PCI and EP patients would stay in the hospital overnight, but in 2017, the Cardiovascular Services team established a new set of criteria that cut down LOS. The criteria included factors such as social support at home, procedure complexity, whether there were any complications and how well the patient recovered post-procedure. “When we came up with that criteria, it was rarely used in the PCI realm and is just now catching on in EP,” said Ben

initiative this year for same-day TAVR discharge. We continue to push the limit for our patients.” Among the benefits for decreased LOS are greater patient satisfaction and reduced chance for hospital-related infections. “We’re a community program bringing academic medicine to our patients and leading the nation in our outcomes,” said Collins. “I always tell my teams to be proud that we are offering such a high level of care right here in our community.”

Collins, MBA, BSN, senior director of operations for the Cardiovascular Service Line. “We were blazing our own trail.” The Cardiovascular Services team has also had great success with transcatheter aortic valve replacement (TAVR) procedures, with a one-day LOS in 2020 when the national average was 2.05 days; Bayhealth is the first healthcare system in Delaware Ben Collins, to be certified by the senior director of operations for the American College Cardiovascular of Cardiology Service Line, helps reduce TAVR Center of length of stay Excellence. for some cardiac procedures. Said Collins, “We just started an

Bayhealth’s criteria for the discharge of patients following electrophysiology (EP) and percutaneous coronary intervention (PCI) procedures greatly increased the number of same-day discharges. ➽ EP Same-Day Discharge Volumes by Year

➽ PCI Same-Day Discharge Volumes by Year

Patient population includes: ICD, pacer, ablations

300

300 275

250 200 150

207

184

250 200

201

150

100

100

50

50

0

93.9%

84.2%

91.3%

88.7%

0

196

199

83.6%

83.6%

143 71

46.4%

67.5%

Total Patients Sent Home by Year

Total Patients Sent Home by Year

■ 2018 ■ 2019 ■ 2020 ■ 2021

■ 2018 ■ 2019 ■ 2020 ■ 2021

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Supporting the Highest Levels of Safety and Quality FOR MAGNET REDESIGNATION, WE MUST PROVIDE NURSING-SENSITIVE INDICATOR DATA FOR MULTIPLE METRICS, LOOKING AT THE MOST RECENT EIGHT QUARTERS, AND DEMONSTRATE OUTPERFORMANCE OF NDNQI BENCHMARKS. THESE GRAPHS REPRESENT SOME OF THE METRICS FOR CALENDAR YEAR 2021, WHICH ARE ON TRACK TO MEET OR EXCEED MAGNET STANDARDS.

NURSING-SENSITIVE INDICATOR OUTCOMES: These indicators are the criteria for changes in a patient’s health status that nursing care can directly affect; they form the foundation for monitoring the quality of nursing care. ➽ Patient Satisfaction: Communication, Nursing Domain Performance. Bayhealth Inpatient Units, Calendar Year 2021. The goal is that Bayhealth’s score is higher than the Press Ganey mean score for the majority of the year.

Top Box: Mean Satisfaction Score

100 95

■ Bayhealth Inpatient Units, Top Box (meaning the percentage of times a patient provided the

90

■ Press Ganey Database Mean Score

highest possible feedback score on the Press Ganey Patient Satisfaction Survey)

85 80 75 70 65 60 55 50

2021 Jan.

2021 Feb.

2021 March

2021 April

2021 May

2021 June

2021 July

2021 Aug.

2021 Sep.

2021 Oct.

2021 Nov.

2021 Dec.

80.18

81.31

77.38

79.99

73.17

83.09

80

75.3

77.34

76.58

76.65

78.52

79.15

79.03

78.85

79.07

79.16

79.25

79.18

79.16

78.74

78.52

78.16

78.05

The graphs below reflect negative patient outcomes; therefore, the goal is to be below the 50th percentile (red benchmark line) for the majority of the year. ➽ Falls with Injury per 1,000 Patient Days—Bayhealth

Inpatient Performance against Magnet Hospitals Benchmark throughout CY 2021.

➽ Central Line Associated Bloodstream Infection (CLABSI)

per 1,000 Central Line Days—Bayhealth Performance against Magnet Hospitals Benchmark throughout CY 2021. 0.9

0.45

CLABSI per 1,000 Central Line Days

Falls with Injury per 1,000 Patient Days

0.5

0.4 0.35 0.3 0.25 0.2 0.15 0.1 0.05 0

0.7 0.6 0.5 0.4 0.3 0.2 0.1 0

2021 Jan.-March

2021 April-June

2021 July-Sept.

2021 Oct.-Dec.

0.24

0.24

0

0.53

0.27

0.42

0.82

0.74

0.81

0.78

2021 Jan.-March

2021 April-June

2021 July-Sept.

2021 Oct.-Dec.

0.45

0.26

0.28

0.42

0.41

0.43

■ Bayhealth System Score ■ Magnet 50th Percentile Score

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0.8

■ Bayhealth System Score ■ Magnet 50th Percentile Score

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empirical outcomes

Clinical Educator Wendy Radcliffe (left) and Workers’ Compensation Program Manager Alaena Collins (right).

EDUCATION AND TRAINING IN SAFE PATIENT HANDLING Efforts to improve patient handling throughout Bayhealth have greatly improved in recently years, thanks to a more formalized approach to education and equipment training. A Safe Patient Handling Education Team currently provides an annual class for all Bayhealth staff members involved in moving patients, as well as instruction for new hires and individualized trainings as needed. “Education is a huge piece of this. We want nurses and all the staff to feel comfortable and take the time to use the equipment,” said Clinical Educator Wendy Radcliffe, MSN, RN, CEN, CPEN. “The team is amazing. They go to staff members at all hours of the day to make sure they get the training they need.” Multi-department collaboration is another key component to the program’s success, said Workers’ Compensation Program Manager Alaena Collins. “We have the support from facilities, materials management and many other areas,” she said. “The whole organization plays a role.”

➽ Staff Outcomes: The number of injuries that resulted from patient

handling were significantly lower this year compared to previous years.

Bayhealth Patient Handling Recordable Injuries

35 30

■ 27

25

■ 19

20

■ 30

15

■ 22

10

■8

5 0

FY18

FY19

FY20

FY21

FY22

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new knowledge, innovations & improvements

Clinical Dashboards Streamline Data and Care Anita Witzke, MSN, RN, NE-BC, senior nurse manager and interim director of Patient Care Services at Bayhealth Hospital, Kent Campus, was looking for a tool to improve best practices around bedside nursing quality indicators—so her team helped build one. Working with Nursing Informatics, the clinical coordinators on 2 North created a dashboard that shows real-time patient data on the unit—including metrics regarding central lines, Foley catheters, pressure injuries and restraint utilization— drawn from electronic medical records and available at a glance. “It’s like you are an air traffic controller,” Witzke said. “You are perusing all the planes, and [the dashboard] helps you evaluate which ones you really need to pay attention to at that time.” The clinical dashboard was implemented on 2 North in late 2021, with nurse managers utilizing it to improve quality of care and decrease length of stay. Witzke says the hope is to eventually expand use throughout Bayhealth, modifying the dashboard data as needed for other units. “It’s a great tool with great value; we just haven’t realized it to its fullest potential yet,” she said. Witzke also recognizes the teamwork that went into the creation of the clinical dashboard. “This was something my bedside staff wanted to do to support their patients and their nurses,” she said. “It came from them wanting to do better at their jobs and collaborating with Nursing Informatics to make it happen.”

Gina Collins, senior nurse manager of Dialysis, Vascular Access and Medical Infusion.

INNOVATIVE MONOCLONAL ANTIBODY INFUSIONS TREAT COVID As Delaware faced a second surge of COVID-19 in early 2021, Gina Collins, MSN, RN, VA-BC, senior nurse manager of Dialysis, Vascular Access and Medical Infusion, was placed in charge of Bayhealth’s new monoclonal antibodies (mAbs) clinic. She partnered with Vice President of Quality and Medical Affairs John Fink, MD, and other nurses to administer this innovative new treatment to help in the fight against COVID-19. These synthetically created antibodies mimic the action of natural antibodies in fighting viruses. While not a cure, mAbs infusions, when given early after symptoms appear, have been found to be effective in shortening the length of illness and preventing hospitalization.

SHARING KNOWLEDGE AT A NATIONAL LEVEL

Anita Witzke, senior nurse manager and interim director of Patient Care Services, helped develop a new tool to support patients and nurses.

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In 2021, Bayhealth’s nurses shared their research studies with peers across the country at virtual and in-person conferences. For example, Felicia Cruz, MSN, APRN, AGCNS-BC, RN-BC, geriatric clinical nurse specialist, presented findings from her co-conducted study, “The Therapeutic Use of the PARO Robotic Seal in Patients with Dementia in the Acute Care Setting,” at the National Association of Clinical Nurse Specialists 2021 Conference in March. Donna Simon, BS, CCLS, CEIM, nonclinical educator (pictured), and Cynthia Mather, MSN, RN, clinical educator, presented on Bayhealth’s Resuscitation Quality Improvement Program at the Cardiac Arrest Survival Summit in December.

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news & recognitions

Forensic Nurse Clinical Coordinator and DV Consultant and Gang Consultant Dawn Culp.

EDUCATOR OF THE YEAR FORENSIC NURSE DAWN CULP IS A FRONT-LINE ADVOCATE FOR THE UNHEARD

Forensic Nurse Clinical Coordinator and DV Consultant and Gang Consultant Dawn Culp, MSN, RN, SANE-A, SANE-P, FNE, identifies and aids patients who are victims of abuse, violence and human trafficking. “Forensic nursing doesn’t stop with the Emergency Department,” she said. “We connect people with shelters, mental health services, law enforcement and other resources so they receive the help, shelter and justice they deserve.”

It’s a big job. But Culp, the 2021 Educator of the Year, doesn’t stop there. With help from project manager Amanda Bergstrom, and Jeanne Mazzatenta, Bayhealth Foundation operation coordinator, Culp received a $200,000 Victims of Crime Act grant from the Criminal Justice Council of Delaware in 2019 and used it to create a forensic nursing education program for Bayhealth’s Emergency Department nurses. Rolled out this year, the program covers trauma as well as child, elder and intimate partner abuse. Katina Hernandez, RN, an Emergency Department nurse and sexual assault nurse examiner who nominated Culp for the educator award, describes her as “a front-line worker for the unheard.”

NURSE OF THE YEAR MICHELE KLIPPERT BRINGS COMFORT AND CONNECTION TO HER PATIENTS For Michele Klippert, RN, CCRN, nursing is all about connection—with her colleagues and her patients. Klippert, who was recognized as the Overall Nurse of the Year in 2021, is going on 18 years with Bayhealth. She got her start as a staff nurse then moved on to the Intensive Care Unit and Post Anesthesia Care Unit (PACU) at Bayhealth Hospital, Kent Campus; Klippert worked in Diagnostic Imaging before returning to the PACU last year. “I love talking to patients,” she said. “My husband died three and a half years ago, so when I get a patient whose husband passed away, it’s an instant connection. I hold their hand and talk to them and understand what they are going through. It makes a difference.”

Her strength as a communicator is one of the reasons Klippert was nominated for Overall Nurse of the Year. “I love to teach my patients and always explain [procedures] and put them at ease,” Klippert said. “My Michele Klippert works in the PACU at the Kent Campus.

Furthermore, Culp created a presentation with information and resources that all Bayhealth employees can use to help recognize abuse, violence and trafficking in hospital patients and the community. “A patient may be at Bayhealth for an injury or procedure or to give birth and may not talk about their home situation because they’re battered or isolated or pushed up against the wall in a life of turmoil,” Culp said. “Anyone they meet may notice something. We had a case where a patient originally from Haiti had a conversation with a food service employee who also spoke Creole. The employee realized something was wrong, and as a result, the woman got the help she needed.”

patients come first, but I’ve strived to be Nurse of the Year and it feels really good to get that honor.” Learning from her colleagues is also a priority. “The teamwork is great, I respect my managers, and I’ve learned so much from other nurses,” Klippert said. “I love working with young people because it keeps me on my toes. This newer generation speaks up for themselves and they know their limits. I feel like they are going to make changes in nursing.” Although she is looking ahead to retirement in a few years (she hopes to travel the country in a school bus retrofitted by her boyfriend, Bill, who works in the OR at Bayhealth), Klippert plans to work part time as long as she can. “I love nursing,” she said. “I never considered doing anything else.”

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news & recognitions

Bayhealth Nurses Among the State’s Best DELAWARE TODAY MAGAZINE’S 2021 LIST OF TOP NURSES INCLUDED MORE THAN 20 BAYHEALTH NURSES, HIGHLIGHTED FOR THEIR ASTOUNDING WORK. FROM BEDSIDE NURSES TO CLINICAL EDUCATORS, THESE NURSES WERE SELECTED BY THEIR PEERS FOR THEIR EXCELLENCE IN NURSING. WE COULDN’T BE MORE PROUD OF OUR NURSES FOR THEIR DEDICATION AND RESILIENCE. PLEASE JOIN US IN CONGRATULATING BAYHEALTH’S NOMINEES AND WINNERS!

AMBULATORY CARE NURSING CATEGORY WINNER

Kim Campbell MSN, RN, CAPA Perioperative Services, Clinical Coordinator Lauren Durk BSN, RN Peri-Op/Day Surgery, Clinical Coordinator Korinne Roach BSN, RN, CPN Day Surgery, Staff Nurse Several of Bayhealth’s 2021 Top Nurses celebrate with some of the organization’s senior leaders.

ADVANCED PRACTICE REGISTERED NURSE

Bayhealth Patient Care Services, Senior Director

Sarah Knavel MSN, APRN, ACCNS-P, PCNS-BC Pediatrics, Pediatric Clinical Nurse Specialist

Angeline Dewey MSN, APRN, ACNS-BC, CCRN, CNRN Director of Education

Ludmila Santiago-Rotchford MSN, APRN, ACNS-BC, PCCN Cardiac, Cardiac Clinical Nurse Specialist Sandi Voss MSN, APRN, FNP-C, AOCNP Oncology and Hematology, Nurse Practitioner ADVANCING AND LEADING THE PROFESSION

Deborah Eberly BSN, RN, CEN, CNML Trauma, Trauma Program Manager Jacqueline “Renee” Griffith MSN, RN, PCCN, CNML Acute Care (Acuity Adaptable/ Med-Surg/Tele/IMC), Nurse Manager Deborah “Debbie” Hines MSN, RN, PCCN, CNML Progressive Care, Senior Nurse Manager Ambulatory Care Nursing

Gust Bages MHA, BSN, RN

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Trina Turner MSN, RN-BC, LNC Oncology, Lung and Colorectal Cancer Nurse Navigator Sandi Voss MSN, APRN, FNP-C, AOCNP Oncology and Hematology, Nurse Practitioner CLINICAL EDUCATOR Sylvia Stubbs MSN, RN, NPD-BC Professional Development, Clinical Educator Teresa Towne MSN, RN, NPD-BC, NE-BC Nursing Professional Development, Clinical Educator INFORMATICS Casey Gibson BSN, RN Informatics, Application Analyst III


The Nurse on the Run 5K benefits certification scholarships to help cover upfront exam costs.

Lindsey Klemash MSN, RN-BC Nursing Informatics, Analyst Nursing Informatics INPATIENT/ACUTE CARE NURSING Lori Brown MSN, RNC-OB Labor and Delivery, Clinical Coordinator Deborah “Debbie” Hines MSN, RN, PCCN, CNML Progressive Care, Senior Nurse Manager Denise Jones MSN, RN, ACCNS-AG, CCRN, SCRN Neurosurgical Intensive Care, Clinical Coordinator LICENSED PRACTICAL NURSE Gayle Myran LPN Occupational Health/Employee Health, LPN Charge Nurse NURSING NEWCOMER MycKenzie Gillette BSN, RN Labor and Delivery, Registered Nurse PSYCHIATRIC-MENTAL HEALTH NURSING Amanda Richter MSN, BS, APRN, AGCNS-BC, CEN Behavioral Health, Clinical Nurse Specialist QUALITY/SAFETY/RISK MANAGEMENT CATEGORY WINNER

Kelly Gardner, BSN, RN, CIC Infection Prevention, Infection Control Senior Manager VOLUNTEERISM AND SERVICE Trina Turner MSN, RN-BC, LNC Oncology, Lung and Colorectal Cancer Nurse Navigator

SUPPORTING NURSING EDUCATION The Bayhealth Foundation supports quality healthcare in our community. Since the onset of COVID-19, generous donors have given more than $3 million to Bayhealth, helping to purchase everything from personal protective equipment to remote monitoring technology to telehealth devices and training for staff. Furthering education for our dedicated Patient Care Services team is a key component of top-quality healthcare—one that is valued by donors like Karen Newell. The Milton resident is a retired military nurse who underwent an outpatient procedure at Bayhealth Hospital, Sussex Campus in 2021. “I chose it because of its Magnet recognition,” Newell said. “The knowledgeable, compassionate care and follow-up from the Day Surgery nurses far exceeded my expectations.” In appreciation for that care, she donated to the Nurse on the Run 5k and the nurse certification scholarship. “Medicine is always changing and it is essential that healthcare providers keep up their education,” she said. ➽ To

find out more about the Foundation’s current initiatives—including the Graduate Medical Education (GME) program and the Bayhealth Total Care facility coming in 2023—and donating to Bayhealth, visit Bayhealth.org/ Foundation or call 302-744-7015.

2021 DAISY AND SUNSHINE AWARD WINNERS The DAISY Award is given by the Daisy Foundation, honoring nurses for the compassionate care they provide. Honorees are chosen by nurses, administrators, peers, physicians, patients, volunteers and families. The Sunshine Award, an extension of the DAISY Award, recognizes extraordinary nursing assistants and surgical, OB and ED techs. DAISY AWARD March: Donna Dixon, LPN, Radiation Oncology May: Jessica Kuleck, RN-CMS, Special Care Nursery September: Michelle Groves, BSN, RN, CCRN, Cardiovascular Surgical Intensive Care Unit November: Jordan McCusker, Neuro Intensive Care Unit SUNSHINE AWARD February: Stephanie Cannon, 4A April: Cassie Johnson, Day Surgery/Endocrinology July: Valerie Fulton, Clinical Decision Unit October: Veronica DeVito, 4A

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Non-Profit Org. U.S. Postage

PAID

Permit No. 1584 Oakland, CA

640 S State Street Dover, DE 19901

ACCREDITATION SHOWS EXCELLENCE IN CARE Bayhealth is committed to providing compassionate, exceptional care and to strengthening the health of our community, one life at a time. Our nursing and Patient Care Services team members help us fulfill this mission every day. Their hard work and dedication aren't only recognized by our patients and community, but by the multiple awards and accreditations they have received. When it comes to nursing, two shining examples of these accomplishments are Bayhealth’s Magnet designation and the accreditation of our Inpatient Nurse Residency Program by the American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP). To see a full list of the awards and accreditations that Bayhealth has earned, scan the QR code.


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