5927507-nursing-report-2014

Mercy Health System Nursing Annual Report

TRANSFORMATIONAL LEADERSHIP

STRUCTURAL EMPOWERMENT

EXEMPLARY PROFESSIONAL PRACTICE NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS

TABLE OF CONTENTS

MESSAGE FROM THE SYSTEM PRESIDENT/CE0 AND CNO

TRANSFORMATIONAL LEADERSHIP TRANSFORMATIONAL LEADERSHIP at Mercy ......................................................7 Nursing Strategic Planning......................................................................................10

07

Advocacy and Influence .............................................................................................11 Visibility, Accountability and Communication ......................................................11

TRANSFORMATIONAL LEADERSHIP

STRUCTURAL EMPOWERMENT STRUCTURAL EMPOWERMENT at Mercy..............................................................13 Professional Engagement Professional Practice-Shared Governance...................................................15 Council, Committee and Task Force Achievements ....................................16

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Supporting Magnet Excellence..............................................................................24 Professional Development and Growth ..............................................................33 Teaching and Role Development ...........................................................................34 Nurse Residency Program..............................................................................36

STRUCTURAL EMPOWERMENT

Partnerships with Nursing Schools ............................................................. 37 Clinical Experiences .......................................................................................37 Recognition of Nursing ...........................................................................................40 Commitment to Community Involvement .............................................................41

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EXEMPLARY PROFESSIONAL PRACTICE EXEMPLARY PROFESSIONAL PRACTICE at Mercy ............................................43 Nursing Professional Practice Model ..................................................................45 Practice Excellence..................................................................................................46

EXEMPLARY PROFESSIONAL PRACTICE

Nurse Satisfaction ...................................................................................................52 Patient Satisfaction ................................................................................................53 Patient Safety and Quality of Care .......................................................................54 Interprofessional Care.............................................................................................58 Nursing Website .......................................................................................................59

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NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS NEW KNOWLEDGE at Mercy ...................................................................................61 Evidence-based Practice and Research ..............................................................63

NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS

Innovation: Mercy’s Professional Nursing Continuum .....................................70 Journal Clubs ............................................................................................................72 Nursing Newsletters................................................................................................73

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MESSAGE FROM SYSTEM PRESIDENT AND CEO It is my pleasure to present the 2014 Mercy Nursing Annual Report. The features, outcomes and recognition presented here are snapshots of the outstanding work Mercy nurses are doing every day.

2014 was an exciting year for nursing at Mercy. Following years of hard work, Mercy earned Magnet速 recognition, awarded by the American Nurses Credentialing Center. Magnet recognition recognizes the quality patient care, nursing excellence and innovations in professional nursing practice that are alive and well at Mercy.

As the gold standard of nursing excellence, Magnet recognition is one of the highest honors a health care facility can receive. Mercy Health System is one of a few organizations in the nation to have received Magnet for our entire health care system including all components of our organization. This is an amazing accomplishment.

But even more important than earning this honor is the confidence and autonomy our nurses have gained throughout our Magnet journey. They put evidence-based practices into everything they do, sharing best practices and challenging one another. Through these efforts, they advance safe, compassionate and professional patient care, ensuring the best possible patient experiences and clinical outcomes.

2014 brought other exciting changes, as we merged with Rockford Health System. Together, we will create a dynamic, regional health system comprising five hospitals, more than 550 physicians, over 80 outpatient clinics and other service sites throughout southern Wisconsin and northern Illinois. I am excited for our nurses to work together as we align our services for the health and well being of those we serve. I have the utmost confidence that our mission, vision, values and professional nursing practice model will guide our nurses, and all our partners, as we work to exceed expectations for decades to come.

Sincerely,

Javon R. Bea President and CEO, Mercy Health System MERCY HEALTH SYSTEM // 4 // NURSING ANNUAL REPORT 2014 TRANSFORMATIONAL LEADERSHIP

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MESSAGE FROM SYSTEM CNO Across the country, health care continues to change at a very rapid pace.

Accountable Care Organizations (ACOs), bundled payments, pay for performance, shared decision-making and value-based purchasing are just a few of the payors’ initiatives to decrease the cost of care and hopefully improve the quality. We are all involved in these initiatives as we look at providing health care to populations and more readily coordinate care for our individual patients. This is an exciting time for people working in the health care professions, as we rework how we assist patients in achieving and maintaining wellness.

At the end of the last year, we saw the expansion of our System as we merged with the Rockford Health System in northern Illinois. The new MercyRockford Health System will boldly meet the health care challenges of the future. It will be exciting to share and compare nursing practice across the new System.

The coming year will bring many opportunities and synergies for partners in the care of patients in the MercyRockford Health System.

I have saved the best for last! Most importantly, last year our Magnet journey culminated in a site visit that resulted in earning Magnet® recognition. During the visit, our nurses’ knowledge, expertise and commitment to serving others was overwhelmingly evident. All Mercy partners verbalized and demonstrated the collegial relationships we share with each other throughout the System.

These relationships showed that together we deliver exceptional care to our patients. Many citizens from the communities we serve stepped forward to tell their Mercy stories to the Magnet surveyors. These were sincere and heartfelt stories about the exceptional care and services they or their families had received at Mercy. I am very proud of our nurses—and all Mercy partners—for this wonderful accomplishment.

Thank you, Mercy nurses for your life-saving care and passion for excellence.

I’m proud to work alongside you.

I hope you enjoy reading this 2014 Mercy Nursing Annual Report.

Sue Ripsch, BSN, MS, MBA, RN, NEA-BC CNO, Vice President, Mercy Health System

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TRANSFORMATIONAL LEADERSHIP Strategic Planning Advocacy and Influence Visibility, Accessibility and Communication

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CNO MESSAGE

TRANSFORMATIONAL LEADERSHIP

Jan Botts Caryn Oleston MHA, BSN, RN, CPHQ, NEA-BC MSN, MHA, RN, NEA-BC, FACHE CNO, Ambulatory clinics CNO, Critical access hospitals and settings

Deb Potempa MSN, RN, NEA-BC CNO, Mercy Hospital and Trauma Center

Sue Ripsch BSN, MS, MBA, RN, NEA-BC CNO, Vice President, Mercy Health System

Transformational leaders are able to identify needed change and create a vision to guide the change in an inspirational manner.

Mercy Health System spans three hospitals and numerous clinics and outpatient settings throughout southern Wisconsin and northern Illinois. To accomplish transformational leadership across this span while enhancing motivation, morale and job performance, Mercy Health System positioned a chief nursing officer (CNO) at Mercy Hospital and Trauma Center (Deb Potempa), a CNO at its two critical access hospitals (Caryn Oleston) and a CNO over all ambulatory clinics and settings (Jan Botts).

All three CNOs report to the System’s CNO (Sue Ripsch).

This model allows all entities to provide a collective identity for the organization. Mercy’s CNOs meet on a routine basis to ensure expectations are communicated and there is a focused process that allows enhancement of performance through the nursing strategic plan.

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Nursing mission, vision, professional practice model and strategic plan The System CNO and entity CNOs, in collaboration with nurses at all levels of Mercy Health System, review the nursing mission, vision, values and strategic plan. The nursing mission supports the organizational mission statement but with a focus on nursing as a discipline.

The organizational strategic plan is reviewed at the annual board of directors retreat with input from the executive leaders. Recommended changes are made with respect to strategic objectives and long-term action plans. Changes and additions are made to the strategic plan and operational plans are developed.

The nursing vision is based on Mercy’s pillars of excellence: Quality: Excellence in patient care Service: Exceptional patient and customer satisfaction Partnering: Best place to work Cost: Long-term financial strength

The System CNO reviews the finalized System strategic plan with the entity CNOs. The existing strategic plan is reviewed and information is captured from all entities and levels of nursing for completion of goals from the previous year.

The four pillars are what supports the nursing professional practice model and are widely used within the organization to support the organizational vision.

The System CNO, entity CNOs and nurses from all levels of the MHS organization gather to review and update the nursing mission, nursing vision and strategic plan. The strategic plan is then formalized and taken back to the entity-level shared governance to develop action plans.

The nursing values represent the eight letters of PRACTICE that represent what MHS nursing stands for.

Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE CNO, Critical access hospitals

Mercy Health System mission: The Mission of Mercy Health System is to provide exceptional health care services, resulting in healing in the broadest sense.

Mercy Health System nursing mission: It is the privilege of Mercy Health System nursing to advocate for each patient while providing exceptional, evidence-based, patient- and family-centered care, resulting in healing in the broadest sense.

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ORGANIZATIONAL AND NURSING STRATEGIC PLAN ALIGNMENT PILLAR: VISIONARY STRATEGY Strategic Objectives Quality: Excellence in patient care

MHS Objectives

MHS Nursing Objectives

Demonstrate excellence in patient care using evidence-based medicine, best practices and industry benchmarks to ensure continuous improvement.

Promote a culture of patient safety.

Foster a culture of compliance.

Provide information systems and technology to support excellence in health care.

Demonstrate excellence in patient care using evidence-based medicine, best practices and industry benchmarks to ensure continuous improvement and a culture of patient safety and compliance.

Identify information systems and technology to support excellence in health care.

Service: Exceptional patient and customer satisfaction Provide exceptional patient service using customer satisfaction best practices and benchmarks to ensure patient-focused care.

Provide exceptional patient service using customer satisfaction best practices and benchmarks to ensure patient-centered care.

Continually improve integrated programs and services based on patient need.

Identify and participate in educational programs and Provide educational programs and health initiatives to improve community health. health initiatives to improve community health with special concern for the poor.

Strive to improve the community good with special concern for the poor.

Partnering: Best place to work Cultivate high partner engagement and satisfaction by being a best place to work.

Cultivate high partner engagement and satisfaction by being a best place to work.

Recruit and retain board-certified physicians and other qualified partners.

Recruit and retain qualified partners.

Promote a safe and healthy work environment.

Promote a safe and healthy work environment.

Encourage a culture of learning and continuous improvement.

Encourage a culture of learning and continuous improvement.

Cost: Long-term financial strength Continue growth initiatives and integration strategies.

Emphasize cost containment through efficient operations.

Emphasize cost containment through efficient operations.

Promote accountable care strategies to meet the changing needs of patients and purchasers of health care services

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Advocacy and influence

been involved in efforts leading to improved clinical practices and improved patient outcomes. Here are four examples:

Nursing leaders at all levels of Mercy Health System are strategically positioned to achieve the level of influence required to lead others. Sue Ripsch, vice president and the System CNO, reports directly to the CEO of Mercy Health System. Sue mentors and develops her CNO team. Together they develop a strong vision for the future of nursing and communicate this throughout the organization.

Capnography — The Sedation Committee, under the leadership of Joy Prom, BSN, RN, and Nichelle Jensen, BSN, RN, CCRN, both at Mercy Hospital and Trauma Center, developed a protocol to use capnography monitoring for all patients undergoing sedation to improve patient outcomes. They presented their protocol to Mercy CNOs and VPs and a request for purchasing capnography equipment in all areas performing sedation. A two-year plan to purchase capnography equipment for all areas providing sedation was approved and will be completed by December 2015.

Nursing’s mission, vision, values and strategic plan align with Mercy Health System’s strategic goals. Each year, Mercy nurses at all levels review nursing’s strategic plan and identify priorities and responsibilities that will improve the organization’s performance and support system initiatives.

The CNO council embraces transformational leadership and inspires its nursing leaders to create a supportive environment that encourages and values participation and feedback.

Nursing leaders are accessible and communicate effectively with all staff. They engage with nurses in a way that motivates and raises their level of performance. They challenge their staff to take greater ownership of their practice and support them to participate as active members of councils, committees and task forces.

Wherever nursing is practiced, Mercy CNOs and nursing leadership councils develop structures and processes for clinical nurse input, and set the expectation for their involvement to lead improvements in nursing practice and patient care. In this environment, clinical nurses have influence and autonomy to advocate for their patients and families. Nurses should perceive that their voices are heard, their input is valued, and their practice is supported.

As a result of this supportive environment, Mercy nurses have

Medication reminders — Inspired by a journal article and supported by the CNO, ambulatory NPCs have begun to optimize patient reminder calls to include asking patients to bring in their medications to each clinic visit. In doing so, patient medication lists are more accurate and complete. This supports patient safety and ensures effective medication reconciliation.

Early visitation in the PACU — As a result of attending the AORN Conference, nurses at Mercy Harvard Hospital PACU adopted the evidence-based practice of allowing early visitation after surgical procedures. Visitors are now taken directly to the post-anesthesia care unit; this has shown to improve patient outcomes.

Staffing by acuity — At Mercy Walworth Hospital, Tracy Perkins, RN, searched literature to provide the unit-based council with the latest tools for staffing by acuity. The council adapted a tool that helps make assignments that align the needs of patients with appropriate nursing staff.

Deb Potempa, MSN, RN, NEA-BC CNO, Mercy Hospital and Trauma Center

Visibility, accountability and communication Visibility, accountability and communication are key to developing effective relationships between partners and leaders.

MHS’ servant-leadership philosophy is based on the belief that when leaders provide excellent service to partners, partners provide excellent service to customers.

Our CNOs, in collaboration with leaders in all areas, continue to focus on developing those partnerships with the goal of improving communication and engaging partners in shared decision-making and issue resolution. This fosters a workplace environment that promotes collaboration, continuous learning and celebration.

Over the past year, our leadership teams have guided and supported our nursing partners, promoting a culture of transformation and engagement. They do this by connecting with partners in a variety of ways, such as through routine rounding and participation in shared governance councils, and in supporting system-wide celebrations such as the Nursing Graduation celebration, our PRACTICE recognitions, and Nurses Week activities.

Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC CNO, Ambulatory clinics and settings MERCY HEALTH SYSTEM // 11 // NURSING ANNUAL REPORT 2014 TRANSFORMATIONAL LEADERSHIP

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STRUCTURAL EMPOWERMENT Professional Development Commitment to Professional Development Teaching and Role Development Commitment to Community Involvement Recognition of Nursing

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CNO MESSAGE

STRUCTURAL EMPOWERMENT Structural empowerment is a framework to create an environment that promotes open communication, collaboration, continuous learning, and celebration—the foundation of our professional practice model.

Having solid structures and processes in place that create an innovative environment where strong professional practice flourishes and the mission, vision and values of the organization come to life, allows Mercy Health System to achieve exemplary outcomes reflective of our quality care. This also allows us to create and foster positive partnerships across the organization and in the community to promote a positive image of nursing.

Leaders play a key role in supporting career development and empowering Mercy nurses to actively engage in the development of themselves and others, to share knowledge and provide continuous feedback for ongoing improvement, and to use their expertise to strengthen the nursing profession and contribute to the growth and sustainability of the organization.

Our Magnet journey over the past several years has supported our nurses being more actively engaged in defining their practice and creating an environment that is dynamic, innovative and responsive to change. The strength of our structures and processes, supported by our peers and partners throughout the organization, was demonstrated as the Magnet surveyors heard story after story that spoke of our innovation, integration and collaboration, both within Mercy and within the communities we have the privilege of serving.

I am honored to work with great nurses who give freely of their time and talents in order to act as advocates for each other, our patients, and Mercy Health System. We have accomplished a great deal in a short amount of time.

I look forward to our continued contributions to the discipline of nursing with the goal of providing the best care possible to our patients.

Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC CNO, Ambulatory clinics and settings

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Professional Practice–Shared Governance The Mercy Health System Nursing Professional Practice Model incorporates shared governance to provide the structures and processes for nurses to make decisions about clinical practice standards, quality improvement, professional development, and research. Our shared governance model provides a framework that ensures the organizational strategic plan is understood and sets expectations for each council to align their goals to support Mercy’s strategic goals.

The model empowers clinical staff to actively participate on policy-making bodies that impact the professional nursing practice environment. We have adopted a councilor model of shared governance. In this model, issues that impact areas of nursing at the unit, department or organizational levels are identified, addressed and resolved by the appropriate committee in the following committee structure: Nursing Coordinating Council — Oversees the work of all councils. Develops the Nursing Annual Report. Reviews council charters and the shared governance model.

Chief Nursing Officer Council — Develops structures and processes to ensure there is staff input and involvement throughout the organization. Ensures there is alignment and integration of nursing practice with nursing’s mission.

Advocates for resources, including fiscal and technology resources to support organizational goals.

Nursing Research Council — Creates an environment that

assures the integration of evidence-based practice and research into clinical and operational processes. Mentors and coaches nurses to understand and participate in research.

Nursing Education Council — Ensures the knowledge, skills and resources identified by the staff as necessary to practice are available and accessible to all. Provides ongoing continuing education based on a system-wide needs assessment.

Nursing Informatics Council — Develops and maintains the system-wide nursing intranet site. Reviews nursing application of the EMR and documentation for consistency and compliance.

Advanced Practice Nursing Council — Provides a forum for advanced practice nurses to share practice improvement and quality outcomes. Provides a structure and process for collaboration by APNs. Nursing Leadership Councils — Provide the vehicle for merging the mission, vision, and values of the organization with those of nursing’s professional practice. Develop management standards guided by the ANA Scope and Standards of Practice for Nursing Administration.

Nursing Practice Councils — Provide the structure for clinical nurses to share best practices. Empower clinical nurses to define their practice in order to ensure improved outcomes in quality, patient satisfaction and nurse engagement.

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Notable nursing council, committee and task force achievements in 2014 Read about them on pages 17-24.

Nursing leadership achievements Chairs: Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC; Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE; Deb Potempa, MSN, RN, NEA-BC • Ensure that our Nursing Mission, Vision and Values are reviewed by nurses at all levels across the system during the annual Nursing Strategic Planning session.

• Ensure contemporary principles of nursing are reviewed and incorporated into practice.

• Established peer review process for leads, supervisors, managers and program coordinators.

• Formal incorporation of peer review as it relates to the performance appraisal process.

• Provided leadership-focused education for leads, supervisors and managers related to the performance appraisal process, budgeting, action OI.

• • • •

Oversee content of the Nursing Annual Report.

Established the Magnet nursing dashboard process.

Completed writing of the Magnet document.

Continued support of the evolution of shared governance through NPC growth, PNC staging, and full deployment of RN self-appraisal.

• Support and engagement of partners leading to successful Joint Commission survey.

• Evaluation and restructuring of certain RN responsibilities as part of a collaborative interdisciplinary team.

• Continued support of system-wide quality improvement initiatives, such a CHF accreditation.

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System-wide achievements Nursing Coordinating Council Chair: Jan Botts, MHA, BSN, RN, CPHQ • Over the past year, NCC members have simplified and optimized the structure of the strategic plan to make it more user-friendly to direct-care nurses.

• Developed and implemented standardized nursing practice dashboards in all entities (quality).

• Achieved success in living the charter through ongoing support and evolution of our shared governance structure (partnering).

• Evolved the dissemination of information between the various committees with quarterly review of actions and activities of each council (service).

Nursing Informatics Council Chair: Chris Peterson, BSN, RN, BC • Promoted using Mosby’s Nursing Consult and made link available on partner intranet, nursing website, and within the Epic links.

• Supported CPM best practice and upgraded to CPM spring 14 content. CPM upgrades scheduled annually in the fall. Received and reviewed quarterly CPM care plan guideline usage reports, by unit.

• Documentation audits/peer review of charting. Developed general and unit-based audit tools; units require each nurse to audit a certain number of charts a month for quality and unit educators monitored compliance.

Nursing Education Council Co-chairs: Sabina Mason, BSN, RN, CPHQ; Shelly Brown, BSN, RN, CCRN, TNS • Nursing Needs Assessment survey completed and changes implemented based on findings.

• Nursing orientation optimized in both inpatient and ambulatory settings.

• Preceptor class updated and includes ongoing support for those who precept.

• Ongoing peer review within the educator group.

• Continued work to become a CEU provider.

Nursing Research Council Chair: Kara Sankey, MSN, RN, CNL, CMSRN • Investigation of and proposal for approval of participation in an ANCC international research study: Readiness Evaluation and Discharge Interventions (READI). Mercy Hospital and Trauma Center medical and surgical units will participate in this study beginning mid-2015.

• Ensuring mentor availability for nurses leading EBP and research projects

Advanced Practice Nursing (APN) Council Chair: Ann Bunnell, MSN, APRN • Maintained an APN representative on the Nursing Research Council • Added a re-credentialing requirement which includes two peer review forms be submitted.

Sue Ripsch, VP, System CNO, is now part of APN credentialing and re-appointment.

• Added a new process for precepting APN nursing students. This has been shared with all advance practice nurse preceptors.

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Mercy Hospital and Trauma Center achievements • Quarterly review of the data and discussion about fallouts and solutions to continue the understanding and look for possible solutions.

• Nursing policies came to the NPC for approval.

• We made great strides in understanding and revitalizing the NPC chairs. They believe and know that they can make a difference • Peer review was supported by video creation with Mercy nurses as actors.

• Nursing Education Council and NPC pulled together to support an increase in patient safety during blood administration.

Behavioral Health Unit (BHU) • Our unit added an occurrence report discussion time to each unit meeting as a form of peer review.

We choose one or two occurrences from the previous month to discuss and brainstorm ways the occurrence could have been prevented.

• We continue to work on our goal of pain reassessment within one hour to improve by 5% with a target of 90%.

• We researched, discovered and implemented an evidenced-based fall risk assessment tool specific to the mental health patients

Case Management • Established a “green sheet” that introduces the patient and their families to the discharge planner’s role. It was developed for patients who are out of the room when assessment is attempted and for the cognitively impaired. Patients were asked for their feedback and adjustments were made to the document.

• To promote uniform documentation for all patient navigators and social workers, we developed a doc flow sheet within guidelines of condition of participation. We supported monthly peer-to-peer chart review to monitor if our documentation tool is being used effectively.

Comprehensive Inpatient Rehab (CIR) • Focused on efficiency processes. As a result we are using laminated functional independence measured (FIM) cards attached to name badges as reference.

• To help maintain patient central lines and reduce the amount of Cathflo, we are looking to move from a 12-hour saline flushing schedule to an every 8-hour saline flushing schedule.

• To support documentation standards, we teamed with the Epic build team to create hundreds of requested selections for staff to choose when documenting.

Emergency Department (ED) • By increasing patient rounding and bedside reporting, we met our goals for improvement and maintenance of our patient satisfaction scores.

• We increased retention and recognition through staff satisfaction, measured by decreased turnover. The partner engagement survey for our department showed 88% favorable, and “All in all, I am satisfied with my job.”

Endoscopy Unit • Educated on ergonomics in order to provide a better work atmosphere and safer work environment for ENDO partners.

• Worked to ensure labeling of all medications on and off the procedural field.

Intensive Care Unit (ICU) • To decrease delirium in the ICU, a small taskforce was created. We chose a tool to monitor delirium.

Education was completed and the tool was implemented. While the EBP project was completed, compliance was low. Staff will be re-educated and tool use will continue.

• To prevent alarm fatigue, all critical alarms are reviewed at beginning of the shift and adjusted for patient appropriateness. Tele stickers replaced daily with bath to prevent artifact.

• HAPU reduction: Turns every two hours, application of skin protective ointment/care, two RNs assessing skin on admission, end-of-shift bedside report to include skin assessment with turn by the off- and on-coming RNs, and CNA education on their role in skin prevention and surveillance.

Interventional Radiology (IR) • Capnography use for all sedation cases: Goal met through the use of CO2 sampling cannulas, and documentation of CO2 in IR timeline within electronic chart.

• Follow-up calls on all OIB patients: Post-procedure calls are documented in electronic chart by end of next business day.

• Improve communication within department: Goal met thru the use of a communication book, with sign off of all partners.

• Control cost as related to staffing hours: Goal is a continuous process, short hours are rotated among staff during times of low volumes.

Maternity Unit • Worked to support many of the designated babyfriendly initiatives: Initial assessments and baths in the labor rooms, promoting skin-to-skin and

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breastfeeding attempts within an hour after birth and two hours post-C/S, and keeping our newborns in the OR for the remainder of a c-section.

Medical Unit • Worked to increase staff communication among all interdisciplinary staff including RNs, MDs, CNAs and LPNs by using communication boards installed in each patient room.

• Continue to work together to find strategies to decrease patient falls rates.

• Improved documentation of pain assessments and reassessments through chart audits.

Mercy Manor Transition Center (MMTC) • Improved our pain management times to address pain within five minutes of patient’s request for medication or intervention. We created pain slips to track time of request to administration.

• Continue to work to have Foley catheters discontinued prior to admission if not medically necessary, and if medically necessary, making sure adequate documentation is present.

Nursing Service Office (NSO) • Fulfilled our goal of each partner completing 12 age-specific competencies in the MLC. NSO partners completed 245 age-specific modules on MLC, exceeding the goal of 168.

• Tracking and maintaining an ED bed assignment time of less than six minutes.

• ED discharge calls maintained 100% which completed our goal.

Outpatient Surgery (OPS) • Consistency in partner hand hygiene as evidenced by our hand hygiene audits.

• An increase in placement of SCD/Teds/foot pumps to support VTE prophylaxis.

• Consistent point of care testing of diabetic patients pre- and post-op.

Post Anesthesia Care Unit (PACU) • Our goal to complete charting in 10 minutes or less after discharge was met as evidenced by quarterly data collection from Epic showing we staff met the goal.

• Random Epic data collection will be collected and shared at unit meetings to keep staff informed • Transfer of patients to the inpatient units met the goal set in the last year. This will no longer be monitored unless problems arise.

Special Care Unit (SCU) • Actively involved in the Transforming Care at the Bedside (TCAB) initiative. Looking at improving efficiency and making needed supplies available to staff.

• Worked on patient satisfaction improvement and using TIGR system to drive satisfaction of “readiness for discharge.”

• Fall reduction: Hourly rounding is standard of care. Leadership performs random audits for staff compliance. Signs are posted in SCU rooms for a visual reference. Increased use of bed checks.

Surgical/Pediatrics Unit

Operating Room (OR) • Reeducated staff regarding wrong site surgery.

• Redesigned timeout boards with “checklist boards.”

• Conducted a trial of a new timeout board in two OR rooms.

• Collected information on changes to move forward with permanent design.

• Initiated the discharge double check process to help the nurse provide patient-specific information to the patient.

• Develop a plan for keeping the unit nurse server cupboards stocked to increase the nurse time at the bedside by decreasing nursing steps.

• Initiation of a PDSA was implemented in order to assess the best technique in giving and receiving bedside report; still in progress.

Ortho/Neuro Unit • RNs and CNAs worked together to ensure Foley catheters were discontinued by post-op day 1 on all joint patients.

• Worked with all staff to ensure updating of patient white boards for consistent documentation of pain control and next pain medication availability time.

Treatment Coordination Center (TCC) • Worked to improve patient satisfaction for TCC patients receiving care after hours by implementing a communication tool. Developed a process for all after-hours patients to check in.

• Working to improve communication between MD, PA, and TCC staff for wound clinic patients.

• Working to revise wound care order sheets.

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Mercy Walworth Hospital achievements Nursing Practice Council Chair: Tara Leiting, BSN, RN • Improved communication among departments in regards to pharmacy and pharmacy issues. Surveys were sent to departments via council chairs to ask for any issues they were experiencing with pharmacy-related concerns (medications, service, pumps, Pyxis, etc.). Input was received and a list of issues was forwarded to the pharmacy director who met with the council during several sessions.

• Supported education to UBC chairs about Magnet, Magnet journey and various council activities.

Continued to provide a supportive platform for UBC council chairs to discuss, evaluate and implement peer review, PI and research projects.

• Magnet: More emphasis was placed on the identification of our gaps and more education time was planned during council meetings for those gaps.

Newsletters have been emailed, and CNO, lead and manager/directors have been rounding more frequently and helping provide reinforcement of Magnet education to council chairs.

• Our council has experienced several areas of growth and opportunities for improvement. We have seen new people step up into the role of chairs and have worked together across many disciplines to accomplish large goals to help improve the paths for those chairs who will come after us.

Emergency Department • Exceeded benchmark for key indicators of throughput and blood cultures achieved by staff education, task forces collaboration—laboratory, operating room, and medical-surgical.

• Striving to achieve best practices for NPSGs— challenges with incorrectly labeled specimens. Used staff education, individual feedback and ED/lab task force, and have shown significant improvement.

• We have improved ED PI measures largely due to peer review chart audits.

Medical/Surg/ICU • Bedside report has been reviewed weekly by the charge nurse. A report sheet is used when patients choose not to have a bedside report. A structural change model was used to introduce staff to bedside report, and bedside report tool was implemented.

• Positive peer review and verbal teaching was used to

promote the changes for hourly rounding compliance.

• Reducing patient falls and fall prevention program began with staff teaching and outlining unit-specific factors involved in patient falls. Patient fall initiatives were furthered by fall reduction posters placed in the rooms for patient teaching and call light reinforcement.

• Nursing staff have verbalized positive feedback to peer review supporting a teamwork environment.

Maternity • We have improved our Intellishelf compliance and charge capture in the past year. While there is still room for improvement, a great deal of staff education and practice changes have led to improved understanding and scanning compliance.

• Work to improve follow-up phone calls with a goal to answer questions, verify infant is feeding well and voiding/stooling, and identify areas of improvement for future patients. We noted our follow-up calls greatly decreased after monthly tracking stopped.

• We are working to change the process of collecting urine samples from newborns requiring toxicology screening to ensure collection of the first void.

OPS/PACU/TCC • Continue to improve on peer review chart auditing. Every staff audits three charts of assigned staff (continues). Peer review binder is monitored monthly.

• Staff has embraced calling patients since patients are more evenly distributed among RNs. Most preop calls are completed five days prior to surgery.

• Increased charging compliance from 80% to 90%.

Missing/low stock items not being restocked due to not charged in Intellishelf, therefore charge audits of stock items continues.

Operating Room • The process of transferring patients from the ED to surgery, and med/surg to surgery, has significantly improved. Required Epic documentation to be completed by these departments prior to bringing the patient to surgery has improved. The patients are generally more prepared for surgery (jewelry off, IV access, etc.).

• Research of the WHO checklist has been underway.

Preparation to adopt the WHO checklist and form our own version is in process.

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Mercy Harvard Hospital achievements Nurse Leadership Council

Long-term Care

Chair: Theresa Hollinger, MSN, MHA, RN, NEA-BC • Provided tailored partner education regarding Accountable Care Organization and nursing’s role on reducing readmissions through prepared discharge using teach-back, follow-up appointments, follow-up phone calls verifying understanding, and safety and enhancing primary care contact.

• Initiated education to enhance transparency regarding financial operating margins and census.

• Created processes to ensure partner recognition for positive contributions.

• Our goal of 97.5% of patients will be without facility-acquired pressure ulcers was achieved and supported by revision of skin care practices: Using new skin care products, peer review for weekly skin checks, and consistent rounding.

• Our unit-based NPC had a change in culture as members became more involved after seeing RNs do have a voice in change as well as understanding the significance in looking at patient outcomes.

Nursing Practice Council Chair: Kelly Howard, ADN, RN • Provided education and support to unit practice councils (UPCs) regarding Magnet preparedness.

Goal was supported by adding standing item to NPC agenda for Magnet updates.

• The NPC chair provided support and acted as a resource for UPC chairs for developing and implementing action plans, PI and peer review process.

• Exceptional community contributions involving many departments. We supported the McHenry Food Pantry, the Giving Tree, the Heart Walk and the Breast Cancer Walk. We coordinated and presented at the Harvard Community Health and Safety Fair to provide health and safety education and enhance health care access to the Harvard community.

Emergency Department • Peer review nurses for patients who present with suicidal/behavioral issues: For the safety of all health care workers and patients, a tool was devised to document standardized care of these patients.

• To support use of end tidal CO2 as a standard of care, education was provided on capnography and waveform interpretation. ETCO2 modules were obtained for ED monitors and additional training provided during Nurse Skills Fair. Nurses have gained greater understanding. ETCO2 is being used on critical patients and on conscious sedation in the ED.

Medical/Surgical Unit • Exceeded expectations of blood administration documentation.

• Improved our Peer Review process to become less cumbersome and enhance compliance. We encourage peer accountability with each other by real time peer review during handoff.

• Improved our actual versus stated weight compliance by working cohesively across departments.

Surgical Services: OPS/PACU • We achieved 100% labeling of IV sites by perioperative nurses for five consecutive months.

• We achieved our goal for Phase 1 PACU recovery patients to have body temperature equal to or greater than 96.8 degrees Fahrenheit within 15 minutes of anesthesia end time documented. If less than 96.8 degrees Fahrenheit, active warming was initiated and documented.

• Our post anesthesia care unit consistently exceeded goals to include family/friends with the recovery process in the PACU area. Patients awaken with a family member to reduce anxiety and stress.

• Continue focus on clear handoff to enhance continuity and patient safety in the OPS area.

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Ambulatory Nurse Practice Council achievements Home Health and Hospice

Rock County NPC

Chair: Traci Heintzelman, BSN, RN • Used evidence-based research to redefine bag technique policy and procedure.

• Continued development of the Pet Peace of Mind Project to support our patients.

• Interdisciplinary collaboration through the Journey Program.

• Collaboration with therapy to help patients achieve maximum independence at home.

• Continued use of the telehealth program to keep hospital readmission rates low.

Chair: Laurie Finke, BSN, RN • Created a Survey Monkey survey with five focus questions to improve staff satisfaction/engagement.

The questions were included in the Partner Engagement Pulse Survey 2014.

• Initiated steps to improve patient satisfaction by creating Indicators to focus initiatives and improve efforts: created clinic level reports, discussed current workflows in NPC council, discussed pilots for process improvements, brainstorming ideas for project, created two task forces one for ease of obtaining test results and one for information about delays. Work will continue in 2015.

McHenry County NPC Chair: Donna Dixon, ADN, RN • Active involvement in the Mercy Community Committee.

• Organization and implementation of community health education and screening events at the Woodstock Library.

• Work to improve pneumococcal screening rates in our McHenry County clinics. Reminder cards were sent to all clinics to screen all patients ages 65 and older in FP/IM practices. Cards were placed in exam rooms near computers.

• Improved the process of medication prior authorizations by decreasing the amount of RN time spent on obtaining medication prior authorizations.

Walworth County NPC Chair: Michael Kennedy, ADN, RN • Journal club inspiration generated interest in using our Televox to send out a reminder asking patients to bring their medication bottles to their appointment. This change supports the NPSGs. We piloted with the internal medicine and cardiology clinics; the results of generated data showing an increase in medication recording are promising.

• Another journal article review led to an improvement in patient education. A laminated educational card with pictures of melanoma will be placed in patient rooms.

Committee and task force achievements Community Committee Chair: Laurie Finke, BSN, RN • Focus on increasing nurses’ involvement in community education programs and health screenings in all service areas.

• Successful in engaging nurses from all three counties in identifying and supporting community activities supporting education and health screenings.

• Promoted Ambassador program and education on role of the committee to elicit membership.

Collaboratively worked with marketing to improve process of logging hours in order to better measure participation.

• Improved communication about opportunities for participation through articles in Mercy Connection,

Clinic Voice and Nurses Week.

• Organized Mercy Clinic East health screening and wellness events.

Fall Prevention Committee Chairs: Deb Sitter, MEd, BSN, BSM, RN ; Sue Kautz, BSN, RN • This group has standardized signage (Call … Don’t Fall) and breakaway bed cords throughout all three hospitals.

• Improving our fall investigation and huddle form.

This new investigation/huddle form will provide more detailed information on every fall. By using evidence-based research, the committee created this form to identify the reasons patients are falling and to promote prevention strategies.

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• Created a fall prevention patient brochure focusing on a team approach to fall prevention including the patient, family and staff.

Hand Hygiene Committee Chair: Bridget Pachay, BSN, RN, CIC • Empowering staff to peer review all co-workers about wash-in/wash-out.

• Engaging our patients in the importance of hand hygiene.

Insulin Pump Task Force Chair: Joni Flister, ADN, RN • New insulin pump policy approved • Task force sub-group worked together in collaboration with information systems department and Dr. Timothy Reid to develop and fine-tune the EMR documentation piece.

• Working with the Nursing Education Council to develop an education plan for nursing across the system.

Nursing Recruitment and Retention Committee Chairs: Kathy Adams, human resources and Jan Botts, MHA, BSN, RN, CPHQ • Focus on recruitment, retention, recognition, enhancing communication, partner engagement, and career development (partnering).

• Supported ongoing recognition of nurses through graduation celebration, certified nurses day, PRACTICE awards.

• Created opportunities for nursing involvement in job fairs, and sponsors system-wide career fairs.

• Education of nurses on charter and activities of the committee through newsletter articles, website development with subsequent expanded systemwide participation.

• Formal review and subsequent action plans related to outcomes supporting R & R: turnover, vacancy, 90-day and exit interview feedback.

capnography in all areas which provide procedural sedation.

Professional Nursing Continuum Committee (PNCC) Chairs: Corrine Kohn, BSN, RN ; Melissa Krueger, BS, RN, CNOR, PN • Completed the MHS Professional Nursing Continuum Policy.

• Created education for PNC and educated leadership and staff.

• Barb Haag-Heitman helped train leadership, coaches and panel members.

• Began staging direct-care nurses.

• Continuous education system-wide for PNC including MLC modules.

Vascular Access Committee Chair: Dawn Lentz, ADN, RN • Collaborated with IS regarding required documentation for central venous catheters.

• Scrub the Hub campaign implemented at Mercy Walworth Hospital and Mercy Harvard Hospital.

• Vein viewer education was added to new hire orientation and preceptor pathway in various departments.

• Pain Ease added to MPC-07-Local Anes policy as additional numbing agent to improve culture surrounding peripheral venous access.

• MPC-02-Blood Admin policy revised to include best practices.

• Collaborated with the only Oncology Department on port education for nurses, review of MPC-07-Vasc Access Port, and evidence collection surrounding best practices in the use of heparin for flushing central lines.

• Collected data on cathflo and vein viewer usage.

Procedural Sedation Committee Chair: Joy Prom, BSN, RN • Reviewed and updated the MHS Procedural Sedation Policy • Reviewed the results of the capnography project in endoscopy department at Mercy Hospital and Trauma Center. Wrote recommendation for using

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Our Magnet Journey: Celebration of a Wonderful Year of Nursing Milestones The Magnet Recognition Program®, which is administered by the American Nurses Credentialing Center, is the largest and most prominent nursing credentialing organization in the world. It recognizes health care organizations that provide the very best in nursing care and professionalism in nursing practices. The Magnet Recognition Program serves as the gold standard for nursing excellence and provides consumers with the ultimate benchmark for measuring quality of care.

Supporting Magnet Excellence TM •

All partners contribute to and benefit from the Magnet journey. Achieving Magnet correlates with our System-wide Pillars of Excellence, Quality, Service, Partnering and Cost. Here are ways nurses personally contribute:

•

Use quality outcome as defined by our system dashboards to drive process and practice improvement.

•

Pursue organizational and personal learning opportunities and professional development: • Earn continuing education credits (CE) • Join a professional organization • Attend a conference or workshop • Achieve a professional certification • Continue formal education

•

Strive to use evidence-based care and best practices when providing patient care: • Search nursing consult or other databases to discover best practice evidence.

• Use clinical practice guidelines (CPGs) to integrate evidence into patient care plans.

• Conduct a research project (contact the research council chair for assistance with your idea).

• Use best practice initiatives as defined by your unit/clinic.

•

Take advantage of opportunities to promote health and service in your community and beyond.

•

Support the System’s strategic plans.

•

Actively engage in your department’s goals and work to make decisions and resolve issues.

•

Communicate with colleagues and leadership team: • Check emails at least once a week.

• Participate in email surveys.

• Use the MHS nursing intranet, MercyNursing.org.

• Attend partner forums.

• Regularly attend departmental meetings.

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February 2014

Planning, writing and uploading our system Magnet document to a website.

Release of Mercy’s all-partner Destination Magnet bi-monthly newsletter.

April 2014 Submission of Mercy’s electronic Magnet document to the American Nurses Credentialing Center (ANCC).

May 2014 Mercy’s electronic Magnet document website Mercy4Magnet.com viewable by all Mercy partners.

June 2014

July 2014

Nursing Magnet Survey Readiness Guide distributed. Physician Magnet Survey Readiness Guide distributed.

Magnet readiness meeting for leadership. Magnet readiness meeting for champions, educators and NPC chairs.

July 29-August 1, 2014 Magnet mock site visit with Vicki George.

August 2014 Non-nursing Magnet Survey Readiness Guide distributed. Site visit preparatory meetings across the system.

September 10-12, 2014 Onsite evaluation by Magnet appraiser.

October 21, 2014 Phone call with Magnet commissioner notifying us Mercy is granted the honor of Magnet recognition!

November 2014 System-wide cupcake celebrations!

Magnet Excellence

October 2013-March 2014

January-February 2015 Magnet jacket distribution to partners.

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Thing BIG, go Magnet!

Annual 3-Day Magnet Conference • 7,000 RN attendees • Gather to share evidence-based practices • Celebration of accomplishments • Seek to improve nursing excellence • Attendees return to their hospitals energized to improve nursing practice in their organizations

2014 Magnet conference participants: Front row (l-r): Angie Cooper, educator, MHTC, Patty Tierney, direct care, MHTC, Michael Kennedy, direct care ambulatory, Jessica Lauretic, direct care, MHTC. Back row (l-r): Chad Salmon, direct care, MHTC, Deb Sitter, educator, MWH/MHH, Laura Leahey, direct care, MHH, Jessica Schumacher, direct care, MHTC, Eric Abbott, direct care, MHTC, Kendra Minich, ambulatory team lead.

Not pictured: Leann Wasemiller, Magnet program coordinator

Magnet site visit: September 10-12; Excellence in action!

In June 2014, we learned the American Nurses Credentialing Center (ANCC) approved our Magnet application. That meant we met the written requirements to move to the next steps in achieving Magnet designation—a known key indicator by which the nation’s very best hospitals are measured.

While we must meet The Joint Commission’s regulatory requirements to operate, Magnet designation is totally voluntary. Magnet organizations are recognized for quality patient care, interdisciplinary collaboration, nursing excellence, and innovations in professional nursing practice.

On September 10-12, ANCC appraisers were here to verify, clarify and amplify what we wrote in our application document. The same appraisers which read and scored that document also performed the site visit.

The appraisers were here to see, hear and feel our “excellence in action.”

During the 3-day site visit, the appraisers interacted with many partners in special meetings and by touring the units. Hundreds of partners system-wide had the opportunity to engage with the appraisers, display their pride, and talk about the excellent care and service we provide. The Magnet appraisers were not here to cite us for lack

of compliance; instead, their goal was to reward and recognize excellence in nursing practice, professionalism and interdisciplinary collaboration that extends to Mercy’s entire health care team.

The appraisers visited Mercy’s three hospitals and several clinics in order to cover as many patient care units and practice areas as possible. They spoke with many members of the health care team, plus patients and families.

Their questions focused on: • How teams work together • How involved partners are in making care better for patients and families • Job satisfaction • Care provided to patients and families • How Mercy supports education and other opportunities Appraisers also spoke with patients and families about their perceptions of care, the staff and our Mercy environment.

Our Magnet site visit was an opportunity for us to showcase the excellent care we give patients and families throughout our System.

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“The speakers at the Magnet conference were very inspiring and made me want to achieve more personally and to help raise the bar for nursing.”

—Patty Tierney, RN

WE DID I T !

Mercy achieves nursing excellence recognition

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A message from Mercy’s Chief Nursing Officers (CNOs) The Magnet journey is one we took with all Mercy partners: Physicians, partners who provide direct patient care, and all those who support the healing environment in which we practice.

Since our journey began, we have been guided by the Magnet principles to build a shared governance structure, develop processes to improve patient safety, improve quality, use evidence-based practice and research, and achieve excellence in many of our clinical patient outcomes all of which have improved the patient experience, ensuring they receive the best care possible.

We are honored to work with all partners across the System who have contributed to furthering the mission and vision of Mercy Health System. Together we achieved what only 7% of the nation’s hospitals have achieved—Magnet recognition!

Sue Ripsch, BSN, MS, MBA, RN, NEA-BC, VP and System CNO Wynn Biederman, DNP, RN Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE Deb Potempa, MSN, RN, NEA-BC

Mercy’s Magnet exemplars True system integration

Next steps: Closing the gaps Define and implement strategies to decrease patient falls.

Define and implement additional nursing peer review strategies.

A caring presence in the communities we serve

Magnet re-designation timeline True partners in health care

2015

2016

Re-designation goals Maintain Magnet visibility Encourage, guide and monitor EBP and research projects Closely measure and monitor outcomes 1) Nurse sensitive indicators (NSIs) 2) Core measures 3) PI projects

2017

2018

• Submit interim monitoring report: demographic data and deficiency update • Collect Magnet stories • Submit interim monitoring report: demographic data, nurse satisfaction, patient satisfaction, quality outcomes • Collect Magnet stories • Submit interim monitoring report: demographic data, nurse satisfaction, patient satisfaction, quality outcomes • Collect Magnet stories • Write Magnet document • Submit application • Submit Magnet document to the ANCC • Magnet appraiser site visit

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Many thanks to Mercy’s amazing Magnet champions!

Ambulatory Magnet Champions Sherilyn Aures Beth Brauns Corrine Kohn Tina Langnes Julie Lebakken Paula Lynch Sabina Mason Lea McCarthy Heidi Rye Sally Stavn Roberta Serpe Constance Tetrev

Achieving Magnet recognition: October 21, 2014

Mercy Harvard Hospital Magnet Champions Becky Johnson Kelly Parker Vanessa Prather Mercy Hospital and Trauma Center Magnet Champions Beth Burdick Danielle Brotherhood Mark Dantuma Joni Flister Ali Hayden Pat Kendall Stephanie Leuchtenberg Tina Middleton Rich Ruthe Chad Salmon Dana Schaitel Chris Schroeder Jessica Schumacher Peggy Schuyler Lynn Theis Dawn Verhagen Mercy Walworth Hospital Magnet Champions Tara Leiting Andrea Lysaght Erika Moore

Mercy Health System was granted Magnet Recognition® by the American Nurses Credentialing Center on October 21, 2014. The recognition is considered the highest honor in the country given to a health care organization for nursing excellence. In fact, Mercy Health System is one a few organizations in the country to achieve Magnet for an entire health care system, including all components of the organization across the two states of Wisconsin and Illinois.

“The decision to grant the designation was an easy decision by the credentialing commission.

It demonstrates to patients and families that Mercy Health System, through its 70 facilities in 29 communities and two states, provides the highest level of care and is a model for all health systems,” said Deborah Zimmermann, DMP, RN, NEA-BC, FAAN, chair of the Commission of Magnet Recognition, in an announcement call to nurses and staff.

“Mercy Health System is among the best and is a model system for all health care organizations in the nation,” continued Zimmermann. “Mercy demonstrates to patients, their families and the community, it provides efficient, expert care at the highest level possible. This honor is a testament to Mercy’s commitment to doing what’s right for their patients.”

Magnet Excellence

These Mercy partners went above and beyond the call of duty to learn about Magnet excellence and educate and motivate others.

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Magnet Excellence What Magnet means to our patients and community “Patients receive first-class treatment from the moment they arrive. From the valets who help those who need assistance, to the physicians, nurses and specialists who provide compassionate, quality care, to our employee/partners who make sure our facilities look great, every person at Mercy is here to do one thing— provide exceptional service to everyone who walks through our doors.”

– Chad Salmon, RN Mercy Hospital and Trauma Center

“The doctors that treated me were excellent, and the nurses gave me the best possible care that I can imagine. They were terrific! They always made me feel at ease, and helped me feel like myself again. I’m even able to play tennis every day!”

– Richard Brodie Patient, Mercy Hospital and Trauma Center

“I’m so thankful Mercy gives opportunities for their partners to volunteer in the community.

Because of the volunteers Mercy provides for the HealthNet Clinic, many community members receive health care services that they otherwise would not. Magnet recognition is about outstanding patient care, and without a doubt, the care at Mercy is unsurpassed.”

– Jean Randles Previous executive director, HealthNet of Rock County

MAGNET®, MAGNET RECOGNITION PROGRAM® and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). This mural is neither sponsored nor endorsed by the ANCC.

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This artistic mural was displayed on large walls in each of our three hospitals and symbolized our System-wide journey to Magnet Excellence. It was used to both raise awareness about Magnet among our staff and patients, as well as to communicate important milestones we made along our journey. Local landmarks and our own hospital renderings were used in the mural to show how Mercy is embedded in the communities we serve. The wall was updated on a quarterly basis with new information.

Magnet® Recognition Granted Mercy received Magnet recognition by the American Nurses Credentialing Center in October 2014. As the gold standard of nursing excellence, this recognition is one of the highest honors a health care organization can receive.

What does Magnet mean for our patients?

• Higher patient satisfaction • Staff who spend more time at the bedside • Better outcomes • Shorter hospital stays Only 6% of hospitals in the nation earn this honor Only 9 hospitals in Wisconsin are Magnet recognized* *as of October 2014

Mercy Nursing Milestones Professional Nursing Continuum Mercy’s Professional Nursing Continuum is grounded in an evidence-based framework and Mercy’s Professional Practice Model is a way for nursing to celebrate our profession through peer review.

Nursing Grand Rounds The “For our nurses, by our nurses" forum supports a sharing of clinical knowledge that fosters an environment for professional development.

Patient Safety Initiatives Nurses lead efforts to support patient safety by working to reduce the risk of patient falls and pressure ulcers through improving risk assessment and partnerships with patients and families.

Evidence-based Practice and Research

Best Research Evidence EBP Clinical Expertise

Patient Values

Mercy Hospital and Trauma Center medical and surgical units participate in a nationwide research study investigating patient readiness for discharge.

Nurses in clinics and hospital units work on various research and evidence-based practice projects.

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Professional nursing certification: In pursuit of nursing excellence Here at Mercy, we are dedicated to our patients’ effective and safe treatment and excellence in the care we provide. Several RNs within the system have found a great way to continue on this journey by achieving certifications within their specialty.

Certifications have been around since the 1970s, however, approximately 27.6% of Magnet credentialed hospital RN staff have achieved a certification, according to statistics at the 2009 ANCC National Magnet Conference (Callicut, et al, 2011).

So, what is a certification? A certification is the verification of possession of expert knowledge in a specialty or subspecialty that often requires ongoing education and competency acknowledgement. Certain certifications have different requirements and expectations. Over 200 nationally recognized certifications exist!

A certificate and certification are not the same. The Institute of Credentialing Excellence distinguishes between assessment-based certificate programs, certificate of attendance, and professional or personal certification programs. These criteria can be further investigated within the websites listed below.

Certification has been linked to increased patient satisfaction, improved patient outcomes, and improved patient safety. It has also led to increased job satisfaction and confidence in RNs. Furthermore, it also improves employee retention and higher organizational profitability (Callicut, et al, 2011). Certifications are yours to keep as well. Wherever you might go in your career, you will have it. It sounds like it is good for everyone involved, doesn’t it? Well that’s because it is!

Several barriers have existed in the past as to why an RN would not pursue a credential: time, money, fear of failure, etc. The ICU staff supports each other with peer sessions and group education. Staff support, assist and challenge each other’s expertise. Many ICU RNs have achieved TNC and/or CCRN certifications in the past few years. Currently, the SCU is working as a group to study for individual achivement of the Progressive Care Certified Nurse (PCCN) Certification.

Mercy has certified emergency, critical care, medical-surgical, pediatric, infusion and rehabilitation RNs, just to name a few. Every Mercy nurse should consider certification to support career development and support practice expertise.

This is what those who have achieved certifications have to say about their experience: “I feel that the accomplishment validates my knowledge to my peers and my patients. I also feel proud of what I have achieved.” — Shelley Brown, BSN, CCRN, TNS “Any review of extra learning is important and awesome.

Additional learning is a layering effect that is important in what we do. The administration was very helpful and supportive and so was the other staff. It was a great experience.” — Kerry Hess, RN, CEN, TNS “It was a great experience that was helpful in establishing a solid practice. It solidified my knowledge and transition into a new area since my background was in EMS.” — Juan Cullum, RN, TNCC “I feel like a well-rounded RN. I had great support from my director who offered classes and made it into a very manageable experience. Now I practice with more confidence and am able to participate in the clinical ladder at a higher level.” — Nichelle Jensen, BSN, RN, CCRN These sites are a great start to your search: AACN Certification Corporation: www.aacn.org/dm/mainpages/certificationhome.aspx ANCC Certification Center: www.nursecredentialing.org/certification.aspx The American Board of Nursing Specialties: http://nursingcertification.org/ Let’s start a buzz. Talk about the value of professional certification and look into your professional organization’s certification guidelines. We have achieved Magnet status and now we have another great opportunity. I challenge all of you to add another goal to your long list of accomplishments. Get certified and help us keep Mercy Health System on the cutting edge of excellence!

Nicholas Kajdan, ADN, RN SCU direct care, Mercy Hospital and Trauma Center Reference: Callicutt, D., Norman, K., Smith, L., Nichols, A., King, D. (2011).

Building an Engaged and Certified Nursing Workforce. Elsevier.

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Our goal: To increase certifications by 5% each year

Earned degrees in 2014

Nursing sets its professional certification goals in a System Allocation of Nursing Certifications number of ways, recognizing that each nursing specialty (Results: February 2015 nurse survey) has its own unique practice setting and certification requirements. A system-wide certification goal is part of SYSTEM Degree our nursing strategic plan. The goal set for both FY2014 MHTC MHH MWH AMB TOTAL allocation and FY2015 was to increase the number of nurses with certification by 5% in the 12-month period. Data 2014 70 9 21 61 161 19.8% collected shows we did not meet our 2014 goal. Setting an incremental goal allows the System to put resources 2013 82 16 18 61 177 22.13% in place to accomplish these goals in the future. MHS provides financial assistance up to $400 to nurses who make the commitment to become board certified. Managers and directors work with staff to encourage professional development and explore certification opportunities.

BACHELOR’S DEGREE IN NURSING TERRI BAUMAN ANDREA FIORITO LORI KLADE LEANN WASEMILLER JUANITA HENDRICKSON ERIC ABBOTT MICHELLE ROUM JOY PROM LISA GREEN BARBARA HERMENING CHRISTINA MCCCANN ANN SAROW KRISTS PUEBLITA JENNIFER SCHOENBECK ERIKA BROWN JESSICA GORGOGLIONE KAVITA DECKARD MARY REILLY ALISON HAYDEN MORGAN MCGUIRE COURTNEY CASTELEIN SEANNA WALLACE LINDA TIMPONE AMY BUCHOLTZ TRACI HEINTZELMAN LAURA LEAHEY MASTER’S DEGREE IN NURSING SANDRA LEE STEPHANIE WALTON AMANDA FARRELL KARA SANKEY JULIE BERNER PAULA BELTRAN CARMEN HUENERBERG DONNA LYNN FOSTER

Involvement in professional organizations Holding memberships in professional organizations provides a positive influence for professional growth, enhancing education and stimulating evidence-based practice and research. Because the organization appreciates the value of staff development,financial support and incentives are provided for nursing staff to join nursing professional associations. In addition, MHS pays for nurse memberships in non-nursing associations based on the nurse’s role or job description.

MHS offers varied opportunities to direct care nurses for professional growth, development, and involvement. Nurses at all levels are encouraged to join professional organizations to enhance their own education and skills, with reimbursement available to cover membership costs. Ideas and concepts captured through conferences and publications create a sense of inquiry that can stimulate research and evidence-based practice to improve care and patient outcomes. Nurses are paid for their time at conferences, and conference fees can be covered from organizational funding for education. Examples of organizations include: American Academy of Ambulatory Nursing American Association of Colleges of Nursing American Association of Nurse Anesthetists American Association of Neuroscience Nurses American Association of Nurse Practitioners American Nurses Association American Nephrology Nurses Association American Society of PeriAnesthesia Nurses Association of Women’s Health, Obstetric, and Neonatal Nursing International Association of Forensic Nurses Illinois Nurses Association Infusion Nurses Association Illinois Society of Advanced Practice Nursing National Nursing Staff Development Organization Oncology Nursing Society Society of Gastroenterology Nurses and Associates, Inc. Wisconsin Nurses Association Wisconsin Society of PeriAnesthesia Nurses

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The future of nursing: 80% BSN by 2020 The Institute of Medicine (IOM) The IOM is an American non-profit organization created to help those in government and the private sector make informed health decisions by providing reliable evidence.

Each year, more than 2,000 individuals volunteer their time, knowledge and expertise to advance our nation’s health.

Many of the studies that the IOM undertakes begin as specific mandates from Congress. Still others are requested by federal agencies and independent organizations.

Reference: http://www.iom.edu/About-IOM.aspx

Initiative on the future of nursing at the IOM Why more BSN-prepared nurses are needed In summary, an increase in the percentage of nurses with a BSN is imperative as the scope of what the public needs from nurses grows, expectations surrounding quality heighten, and the settings where nurses are needed proliferate and become more complex. The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care.

The goal and a plan for achieving In the IOM committee’s view, increasing the percentage of the current nursing workforce holding a BSN from 50 to 100% in the near term is neither practical nor achievable.

Setting a goal of increasing the percentage to 80% by 2020 is, however, bold, achievable, and necessary to move the nursing workforce to an expanded set of competencies, especially in the domains of community and public health, leadership, systems improvement and change, research and health policy.

The IOM committee anticipates that it will take a few years to build the educational capacity needed to achieve the goal of 80% of the nursing workforce being BSN-prepared by 2020, but also emphasizes that existing BSN completion programs have capacity that is far from exhausted. Regional networks of schools working together, along with health care organizations, may best facilitate reaching this goal.

Reference: The Future of Nursing: Leading Change, Advancing Health http://www.nap.edu/catalog/12956.html; Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine

tracks to master’s degrees in nursing programs. Grant support has been increased for nursing programs at the doctoral level as a way to increase the numbers of faculty needed to meet the growing demand for higher-level education for nursing.

All nurses must be aware of this movement within the profession and understand what it means for them personally. As the whole country begins the shift to increasing BSN-prepared nurses, this will become the standard for the profession. We feel strongly that we must keep our nursing partners informed so they make the best choice for themselves and their families over the next five years.

We are committed to our Mercy nurses as they make this choice to return to school. Mercy offers: • A generous tuition assistance program • The opportunity to attend classes on the Janesville campus through the Viterbo University cohorts • Informational resources as they begin to search for a program that will best fit their lifestyle.

The Nursing Recruitment and Retention Committee sponsors education fairs in Janesville, Harvard, and at Mercy Walworth. Many universities and schools of nursing have committed to attending and providing information to our partners on many of the BSN-level or higher programs they offer. The good news is choices are plentiful, and nurses should be able to find a program which fits their needs, including on-line, classroom and blended programs.

The care delivery models in acute care hospitals, ambulatory settings and home care settings are rapidly changing as health care shifts to wellness and prevention. Nurses’ roles are changing. There has been an abundance of choices for nurses historically—direct care, leadership, education and community care, to name a few. As the move to BSN as entry level becomes more the reality, choices will be limited for those nurses who have not attained this level of education.

Mercy Health System will continue to employ and hire nurses from community ADN programs for the next several years.

However, it will require new nurses to commit and agree to obtain their BSN or higher degrees within a set amount of time in order to remain employed. Mercy’s plan is to reach the stated goal of 80% BSN by 2020, as all other hospitals and health care organizations are doing the same. Please contact your CNO or human resources if you have questions.

What does this mean for Mercy nursing partners?

As you read about the activity within our academic institutions that have nursing departments or nursing programs, you will see them focusing their efforts on increasing access for BSN completion programs or fast

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A transition from RN to Advanced Practice RN (APRN) The shift in the health care delivery model has led to the explosion of NP graduates. The development of orientation and mentorship programs has struggled to keep up.

Transitioning from the role of an expert registered nurse (RN) to a newly licensed nurse practitioner (NP) left Lisa Wang asking herself, “Why did I do this?” She said the realization that she was now independently responsible for her patients was both overwhelming and humbling.

According to a recent article in Nurse Leader, Lisa is not alone. Over 8,000 NPs graduated in 2010, with the majority being previously experienced RNs. These NPs report the transition from expert RN to novice NP both overwhelming and challenging (Gerhart, 2012).

Lisa is a long-time, valued partner of Mercy Health System (MHS). She started as an RN in 1994, working in Mercy Hospital and Trauma Center’s medical-surgical and ICU departments. Through the years, Lisa took on additional responsibilities and was sought out as an expert RN in decision-making and policy writing. When she decided to become an NP, she focused on family practice and was hired at Mercy Delavan Medical Center. Lisa credits Dr. Edward Carlson as one of her biggest supporters during that time of transition. Lisa remembers Dr. Carlson encouraging her stating, “How do you ever grow if you don’t try?” Dr. Carlson provided Lisa with mentorship, and as he transitioned out of practice to retire, he recommended his patients see Lisa as their care provider.

Lisa also credits her initial experiences gained in a small rural hospital in Iowa as a new grad RN in 1986 as the foundation that has made her who she is today. Lisa describes the invaluable experience of two expert nurses taking her under their wings, sharing their knowledge with her and supporting her.

Lisa highlights the great need to support our nursing colleagues. Lisa has also given back much. Although she was new in her role as an NP, Lisa was known throughout the system as a great teacher. She is now in demand to as a preceptor for those going through NP programs. When she was approached to precept NP student externs, Lisa understandably hesitated, since she was learning a new role herself. After consideration, Lisa agreed to precept an NP student who was also a Mercy partner.

Lisa’s approach was very straightforward. She honestly shared her own struggles in her new role with the NP student, so the student could decide if she wanted to proceed. Since then, Lisa has taken on several other NP student externs. Their feedback, not surprisingly, was that Lisa provided an exceptional learning experience and that sharing her own journey actually helped the students because they realized they were not alone in their struggle.

Over the last year, Lisa has become proficient and confident in her new role. She is a role model and embodies what it is to be a nurse and servant leader

Lisa Wang, MSN, APNP, FNP-C, WCC, CCRN Excerpted from The Clinic Voice by Sabina Mason, BSN, RN, CPHQ. Reference: Gerhart, L. A. (2012). Mentorship: A new strategy to invest in the capital of novice nurse practitioners. Nurse Leader, 10(3), 51-53. Retrieved from Mosby’s Nursing Consult March 30, 2015.

System Allocation of Degrees (Results: February 2015 nurse survey)

MHTC

MHH

MWH

AMB

SYSTEM TOTAL

Degree allocation

Associate

153

17

28

152

350

44.08%

Diploma

22

5

1

43

71

8.94%

Bachelors

142

25

43

116

326

41.06%

Masters

16

2

4

21

43

5.42%

Doctorate

1

0

0

3

4

0.50%

Mercy’s RN education advancement goal supports the Institute of Medicine (IOM) initiative: To reach 80% BSN or above by 2020. Our 2014 data shows we are currently at 46.98% BSN (and above) and have exceeded our target goal of a 1% increase in a 12-month period!

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Nurse residency evaluation comments: “Being with other new grads and hearing their concerns and fears and not feeling alone in my fears.”

“I found the sim lab to be very educational.”

Nurse Residency Program

“I understand the resources available and how to implement them; I feel I have the skills to be a great nurse.”

Mercy’s Nurse Residency Program (NRP) is designed to help new graduate nurses ease the transition from theory to practice as they evolve from students to competent nurse professionals (Fink, Krugman, Casey, & Goode, 2008).

Partnerships with schools of nursing

New graduate nurses from our three hospitals are placed into a spring or fall cohort as close to hire as possible. The journey through the program in their established cohort is designed to create a supportive relationship with each other. The Nurse Residency Program in 2014 consisted of 41 residents with 38 completing the program.

Mercy is committed to the education and training of students in a variety of professions. The department of nursing recognizes the importance of providing clinical experiential learning to the next generation of nurses. While it is a privilege to be a part of the education of the next generation, it requires tremendous organizational resources and nursing staff commitments of both hours and dollars.

NRP curriculum consists of various topics to help enhance and develop the practice of the graduate nurse. Examples of session topics include communication, evidence-based practice, urgent and emergent care, ethics, and professional development. The NRP is becoming learner-centered by allowing the residents to help decide on topics and include active learning strategies, such as case studies and simulation. The NRP now includes two simulation sessions where the residents practice rapid response, mock codes, CODE STEMI and CODE STROKE scenarios.

The program continues to evolve based on the evaluations provided after completion of each session and a final program evaluation. This feedback is essential in helping to not only meet the needs of the residents to create valuable learning experiences, but to advance clinical performance, and increase retention and job satisfaction.

During 2014, MHS held many affiliation agreements with colleges and universities for nursing students at the ADN, BSN, MSN and APN levels. See the table for a list of affiliated schools and colleges. (See list at right.)

Thank you, Mercy nurses!

Mercy nurses continue to provide excellent learning experiences for students. They not only facilitate their formal learning, they offer emotional support and encourage professional development.

Nursing grand rounds— come one come all The establishment of a “for our nurses, by our nurses” forum supports a sharing of clinical knowledge that fosters an environment for professional development.

2014 Nursing grand rounds

Stephanie Walton, MSN, RN Mercy Hospital and Trauma Center education coordinator Reference: Fink, R., Krugman, M., Casey, K., & Goode, C. (2008). The graduate nurse experience: Qualitative residency program outcomes. JONA: The Journal of Nursing Administration, 38(7/8), 341–348. doi:10.1097/01.NNA.0000323943.82016.48

Date

Topic

Presenter

Apr. 24, 2014

Abuse Awareness

Jackie Friar-LeCaptain, BSN, RN, SANE-A, SANE-P

Nov. 6, 2014

DRESS syndrome

Laura Leahey, BSN, RN Laurie Samuel, BSN, RN

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School/College of Nursing

Degree

Alverno College

BSN/MSN

Anthem College-High Tech Institute

ADN

Auburn University

BSN/MSN

Augustana College

BSN

Ball State University

BSN

Blackhawk Technical College

ADN

Bryant & Stratton College

ADN

Carroll University

BSN

Chamberlain College of Nursing

BSN/MSN

Clarke University

DNP

Concordia University

DNP

Elgin Community College

ADN

Gateway Technical College

ADN

Herzing University

ADN

Kaplan University

BSN

Maranatha Baptist Bible College

BSN

Marquette University

BSN/MSN

Madison Area Technical College

ADN

Minnesota State University

BSN

Northern Illinois University

MSN/DNP

Olivet Nazarene

MSN/DNP

Saint Anthony College of Nursing

BSN

Saint Xavier University

MSN

University of Cincinnati

NP

University of Illinois

ACNP

University of Massachusetts-Boston

BSN

University of South Alabama

BSN

University of Wisconsin-Madison

BSN

Viterbo University

BSN

Walden University

BSN/MSN

Waukesha County Technical College

Mercy’s on-site Viterbo cohort In 2014, 18 students were enrolled in the program and attended classes on the Janesville site. Many will graduate in May 2015 or after the completion of summer classes. A student, Shannon Corwith, RN, MHTC endoscopy, shares: “I’ve nearly completed my BSN program and feel better educated to work with my patients in a holistic manner. I also feel I’ve gained effective leadership skills, especially when assigned to the charge nurse role.”

Ambulatory clinical experiences Supporting Mercy Health System partners as they pursue their professional goals and further their education is strongly supported at MHS. In the fall of 2013, Jan Botts, CNO of ambulatory, began discussions with ambulatory leadership to brainstorm ideas to optimize student placements. In January 2014, a centralized process for student placement was implemented to place nurse practitioner, RN and medical assistant students at MHS clinics in both Illinois and Wisconsin. During 2014, over 25 nurse practitioner student placements occurred, 11 RN students and 15 MAs. All Mercy partners who sought clinical experiences were placed due to the dedication of our Mercy nurses, advanced care providers and physicians!

Sabina Mason, BSN, RN, CPHQ Ambulatory services education coordinator

Hospital clinical experiences Mercy nurses are dedicated to contributing to the continuous development of the nursing profession by supporting nursing students. In 2014, Mercy Hospital and Trauma Center, Mercy Walworth Hospital, and Mercy Harvard Hospital were able to place almost 60 nursing students and approximately 30 CNA students. Mercy Hospital and Trauma Center was also able to accommodate clinical experiences for three different schools with instructor-led groups.

Overall, Mercy saw an increase in the number of Mercy partners who were able to complete their program by supporting their clinical placements. We are very lucky to have such dedicated nursing staff. Mercy staff is excited to support and develop students’ professional growth.

Stephanie Walton, MSN, RN Mercy Hospital and Trauma Center education coordinator

ADN

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Heart failure certification at Mercy Hospital and Trauma Center Mercy nurses have continued to demonstrate exemplary performance and patient care by achieving heart failure certification through The Joint Commission in May, 2014. Heart failure is in the health care spotlight nationally as the most common reason for readmissions.

Because of this, we are committed to the care of patients with heart failure. In recognition of this commitment, we strive to deliver high-quality, cost-effective health care in the communities we serve to facilitate healing in the broadest sense.

Mercy nurses identified an opportunity to improve the quality of life for patients with heart failure by using heart failure standards of care. Nursing staff is able to improve patient outcomes by using the latest evidence-based care as outlined in the American Heart Association’s Get With The Guidelines, incorporate secondary prevention through comprehensive evaluation and patient education, increase patient engagement in self-care, and ultimately decrease readmission rates for patients with diagnosis of heart failure.

Additionally, nursing staff identified that many of these patients were not able to make their follow-up appointments in an appropriate timeframe, so they developed a discharge follow-up phone call program. Through this program, trained nurses contact all patients within three days of discharge from the hospital. Conversations during this phone call include review of the patient’s medications, weight, symptoms, and to answer any other questions the patients may have. Currently, 100% of our heart failure patients receive a follow-up phone call. This has resulted in decreased readmissions and better patient care.

Chest Pain Center Certification at Mercy Hospital and Trauma Center As the only accredited chest pain center in Rock County, Mercy Hospital and Trauma Center has resources fully in place to reduce the time from the onset of a person’s heart attack symptoms to diagnosis and treatment—and Mercy nurses are at the heart of it all. We use the latest evidence-based practice guidelines and protocols to treat patients faster during the critical window of time when the heart muscle can be preserved.

Through an interdisciplinary training approach, we are able to incorporate the high-fidelity Sim Lab to reinforce the latest changes and recommendations by the American Heart Association and American College of Cardiology. Simulations are created by nurse educators on each unit and can be custom-designed to address specific areas in which we’ve identified opportunities for improvement.

Additionally, by including community emergency medical services providers, emergency department staff, and in-patient nursing staff in our training, we’ve really strengthened the concept of continuum of care.

In early 2014, a needs-based assessment survey for the nursing staff identified that cardiac education was an area that most nurses felt they needed additional support in. Based on survey results, the chest pain program coordinator presented a nursing grand rounds focusing on cardiac topics, open to all MHS nurses. Attendance was unexpectedly high and is anticipated to be even higher, as the presentation was recorded and is made available to all staff through the Mercy Learning Center.

As needs continue, additional education opportunities have been made available to nursing staff using a variety of methods, including computer-based training, webinars, seminars and classroom trainings.

Additionally, several committees and groups were started to facilitate nursing-driven practices regarding the care of ACS (acute coronary syndrome) patients. Goals and concepts were presented to the Nurse Practice Council and left open for the direct-care nurses to identify areas of improvement and processes to meet these goals. Because of the direction of direct-care nurses, we were able to reduce our in-hospital onset of symptoms to activation of Code STEMI from over two hours to less than 30 minutes. The strength and power of our nursing staff have been the factors with the most influence regarding this improvement.

For recovery from a heart attack or heart surgery, our interdisciplinary approach helps patients return to a healthier quality of life. Beginning with the education provided by in-patient nursing staff, scheduling of time-sensitive follow-up appointments prior to discharge, referral to the cardiac rehabilitation program, and coordination with the cardiology clinic nursing staff, patients are cared for and supported throughout their healing journey.

Laura Kingsbury, BSN, RN, TNS, CEN, SANE-A Cardiology program coordinator

Laura Kingsbury, BSN, RN, TNS, CEN, SANE-A Cardiology program coordinator

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Chest Pain Center certification at Mercy Walworth Hospital In late 2013, a decision was made for Mercy Walworth Hospital to proceed with accreditation as a chest pain center (CPC) through the Society for Cardiovascular Patient Care (SCPC).

MWH chose to pursue accreditation to ensure we were able to meet quality-of-care measures for the care of the acute coronary syndrome (ACS) patient and to ensure we were providing the best possible care to the patients in our community.

The Society for Cardiovascular Patient Care (formerly known as The Society of Chest Pain Centers) was established in 1998 as a nonprofit international organization dedicated to eliminating heart disease as the number one cause of death worldwide. SCPC pursues this mission by providing education and accreditation to health care facilities to improve the care of the cardiac patient. The accreditation process, required for designation as a CPC by the Society, is multi-faceted, comprehensive and complex.

Our goal was to prepare and submit for accreditation by the end of the summer in 2014. A multidisciplinary committee that included ED and inpatient nursing, ED physicians, hospitalists, cardiologist, EMS personnel, laboratory staff, the nursing education coordinator, stress lab staff, administration and other partners was developed to help aid in the accreditation process.

This group performed a gap analysis to determine what was already in place to meet the standards for accreditation as well as identify gaps in our current processes. Task forces were developed to discuss and implement any changes and processes needed to improve the outcomes for ACS patients and to aide in the accreditation process. Multiple changes were made to processes by these groups during the journey for accreditation.

Several changes resulted in significant impact on patient care leading to improved outcomes, such as streamlining process causing a significant reduction in the door-in to door-out time for STEMI patients presenting to the ED. We submitted our application in the summer of 2014 and were surveyed in October. In November, MWH was successfully certified as a chest pain center. This success was largely due to the hard work and dedication of all of MWH partners caring for ACS patients.

Kris Corwin, MS, RN, CEN, CPEN

Mercy’s 2014 certification accomplishments Why certification? Certifications show hospitals meet or exceed standards for treating specific diseases as they adhere to practice guidelines established by top organizations. Congratulations to all Mercy partners and interdisciplinary teams who work together daily to achieve patient service excellence in these areas: • TJC Advanced Certification in Heart Failure, MHTC • TJC Advanced Certification as Primary Stroke Center, MHTC • TJC Total Joint Replacement-Hip, MHTC • TJC Total Joint Replacement-Knee, MHTC • Society for Cardiovascular Patient Care-Chest Pain Center certification, MHTC

Being a Magnet organization means that we have empowered our nurses in their practice and incorporated research-based nursing practice. It means having an engaged staff encouraging open communication between nurses and other members of the health care team. Staff engagement is the key to a successful organization.

Magnet achievement sets a precedent of a new level of delivering quality care.

—Randy McGrath, director, Mercy Clinic East MERCY HEALTH SYSTEM // 39 // NURSING ANNUAL REPORT 2014

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“

“

• Society for Cardiovascular Patient Care-Chest Pain Center certification, MWH • Primary Medical Home Certification through NCQA in Harvard • American College of Surgeons-Level II Trauma Center, MHTC • American College of Surgeons Commission on Cancer, Mercy Regional Cancer Center

NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS

National Nurses Week 2014 Recognizing the past and celebrating the future Mercy’s nursing staff celebrated with the following activities: • PRACTICE Award nominations • Theme baskets with random winners; every nurse’s name entered into the drawing • Fundraising for Harvard Food Pantry, Barrington Food Pantry, Family Health Partnership Clinic, Health Net, Delavan Food Pantry, Lakeland Animal Shelter • Pampering, relaxation tips and give-a-ways • Evidenced-based practice and research traveling poster fair • Celebration of quality improvement projects • Magnet Central Station: Interactive games to prepare for site visit MICHELLE PEMBER JACQUALYN WERNER JOAN FISHER JANE PHLEGER VICKY KITZMAN WENDY SMITH DEBRA CONWAY CHERYL KYLE BETH MESKE SANDRA LINSLEY LISA WANG MARY WETTSTEIN MELISSA WALNOHA BONITA NELSON LOUISE LUEDTKE KIM SIMONSON SHARON COSTERISAN KIMBERLY MAWHINNEY

Nurses with 20-24 years service MARCIA O'ROURKE LINDA VINEY ERICA WAGNER DIANE HULICK LESLIE CAMPBELL KAREN PHALIN ANDREA KUEHNI DEBORAH QUINN SHELLEY BROWN TERRY BEHREND VICKI GERAETS KIMBERLY NUTTER MAUREEN GAUGER MARY BROWN LEIGH CLEATON SUSAN ROHERTY PAMELA MITCHELL LORI KLADE KARRI RATZLAFF JENNIFER BESTLAND Nurses with 25-29 years service LAURIE OLIN ANN JOHNSON MAEVE BORAN LEANN WASEMILLER KARLA SCHIEFELBEIN PAMELA MONTGOMERY DEANN POHL BETH NATTER TAMMY OLSON GERALYN SUMMERBELL ELLEN CHURCH LINDA TIMPONE SUE RIPSCH DAWN OLSON Nurses with 30-34 years service DIANE PORTER JOY PROM SUSAN WARD CONNIE BAERTSCHY LISA ANACKER DEBORAH ROBERTS Nurses with 35-39 years service NANCY WISKIE JOCEIL SUDMEIER SHARON COWAN GAYLE GIBBS COLLEEN MAYFIELD BECKY BORGWARDT LORI BEGGS LINDA NEUENSCHWANDER DEBRA KNUDSON AGNES SCHENDEL KOPP Nurses with 40-44 years service KAREN TIFFANY MICHAELENE TULLAR CATHERINE GRANGER CINDY BIER

PATRICE BOBZIEN KATHY ROGERS MARY WALKER

• Sharing tea and baked goods to celebrate retired and current nurses • Health screenings and community education including discussing the profession of nursing • Celebrate and commemorate years of service, certifications, and advanced degrees • Wellness running clinic • Nurses’ memorable moments sharing • Council, committee and task force information and recruitment • Potlucks and sweet treat sharing

TERESA KELLY KATHY KUOLT RENEE KUEHNE CYNTHIA GUNN VALERIE PYNE MARY VEITH NANCY BUCHANAN PATRICIA KENDALL

ROBERTA KASTOR KELLY MILLER DANA FAHRNEY PAULA HELLER ANNE TRAPP KRISTINE CORWIN JUANITA HENDRICKSON SANDRA BERGE SUE SUNBY JUDITH WADE

MARLENE MASTERSON DEBBIE KESSLER LYNN THEIS CHERYL DROZDOWICZ MELANIE WENTLER KIM SCHNEIDER

BILLIE BURDICK LISA GREEN DEBRA SCOTT DOROTHY BLEGEN NANCY MANTHEI KATHLEEN PETERS MARY MCCANN JOHN KASTOR CINDI MORSE DONNA KRUEGER

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Mercy honored with a Magnet Exemplar: Commitment to community involvement Words from our Magnet appraiser During the site visit, the appraisers heard extensive feedback on the involvement and participation of nurses at all levels in service to the community. During the external stakeholder’s interview, representatives from 64 community agencies spoke of the numerous ways and events in which nurses from Mercy Health System supported the community. Examples were shared of nurses volunteering for health screenings, open houses, community events, city events, county fairs and many other events.

Mercy supports and recognizes such participation through setting an expectation of two hours of community participation annually. Our nurses exceed this benchmark and contribute substantially more than expected. The system covers 26 communities spread through eight counties in Wisconsin and Illinois. Feedback was received from representatives throughout this area about the contributions made through Mercy Health System nurses to the communities. One participant stated that through the efforts of the nurses reaching out to children during the county fairs, the nurses reduced fears of children with hospital encounters. Mercy refers to these nurses as ambassadors of the organization. Stories were also shared of nurses participating in community clean-up, expositions, food pantries and many other programs.

Nurses reported these activities as great opportunities to make a positive difference for others in need in our communities. Physicians spoke with appreciation and respect of the participation of nurses in many events. Leaders mentioned community activities as a natural extension of the work of Mercy nurses.

Mercy recognizes participation in various ways, including through the charitable contribution reports, the ‘With All Our Heart. With All Our Mind.’ publication, and in personal ways, such as through the ABCD (Above and Beyond the Call of Duty) recognition program. Many nurses discussed their involvement in community events as an enjoyable aspect of their work and as an extension of their mission.

Nurses are proud of their level of community support that is far beyond that seen in other organization. It covers a broader community area than seems feasible. It is an amazing level of participation and is supported and encouraged throughout the organization.

As an example, nurses reported a call that was received from another hospital with a request for a sexual assault nurse examiner (SANE). A Mercy SANE nurse went to the other hospital to provide care for the patient in need. Additional examples nurses mentioned include participation in blood drives, the American Heart Association’s annual Heart Walk, and breast cancer walks.

Nurses discussed an influenza immunization clinic they started in schools in Harvard, Illinois.

Additionally, nurses started an immunization clinic in the Woodstock, Illinois library; it was originally was an annual event and became so popular that is now offered quarterly. Nurses talked about crayon and coloring book drives for mission trips to the Dominican Republic in which Mercy doctors and nurses participate. Many of our Mercy ambassador events are so popular that some of them— such as the McHenry County 4-H Fair—have waiting lists.

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EXEMPLARY PROFESSIONAL PRACTICE Professional Practice Model Care Delivery Systems Staffing, Scheduling and Budgeting Processes Interprofessional Care Accountability, Competence and Autonomy Ethics, Privacy, Security and Confidentiality Culture of Safety Quality Care Monitoring and Improvement

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CNO MESSAGE

EXEMPLARY PROFESSIONAL PRACTICE Exemplary professional practice in Magnet-recognized organizations is evidenced by effective and efficient care services, interprofessional collaboration, and high-quality patient outcomes. Magnet nurses partner with patients, families, support systems, and interprofessional teams to positively impact patient care and outcomes.

2014 Magnet Application Manual Our Professional Practice Model supports an environment of respect that promotes all members of the health care team to make essential and meaningful contributions to the achievement of our organizational and nursing goals. Our nurses practice autonomously within the scope of their license and competence, exercising clinical and organizational judgment within the context of the larger, interdisciplinary health care team. They make evidence-based care decisions according to each patient’s unique needs. They work in collaboration with interdisciplinary partners to ensure that care is comprehensive, coordinated, and effective.

Mercy nurses at all levels across our system have actively participated in creating care delivery systems that delineate their shared accountability for evidence-based nursing practice, clinical decision-making and outcomes, performance improvement initiatives, and staffing and scheduling processes. They embrace nursing’s unique contract with patients as advocates for patient rights, patient privacy, patient safety, and by addressing ethical issues.

This was a year of great accomplishment for our nurses and Mercy Health System as we were awarded Magnet designation. Magnet is the highest and most prestigious credential a health care organization can achieve for nursing excellence and above benchmark outcomes for quality and patient satisfaction.

Our patients, families, and communities deserve our very best every day and this is the culture that can be found in each of our hospitals and clinics. I am grateful to be part of such an extraordinary team of professionals.

Deb Potempa, MSN, RN, NEA-BC CNO, Mercy Hospital and Trauma Center

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Nursing Professional Practice Model

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Communication. Collaboration. Continuous Learning. Celebration.

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PRACTICE

A Professional Practice Model (PPM) is a representation and illustration of nursing practice. According to the Magnet Recognition Program (ANCC, 2008), a PPM “depicts how nurses practice, collaborate, communicate and develop professionally to provide the highest quality of care for those served by the organization.

Professional Practice Models illustrate the alignment and integration of nursing practice with the mission, vision

Congratulations winners!

and values that nursing has adopted.” The three components of a PPM are Shared Governance, Model of Care and Care Delivery System.

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Patient- and family-centered care Respect Accountability Caring Transformational Interdisciplinary collaboration Competence Evidence-based care

• Communication, collaboration, continuous learning and celebration: These concepts show the way we support our continual journey to nursing excellence.

• Pillars: Foundational pillars of excellence continually support caring heart and hands.

• Hands: Shared governance is within the hands of nurses.

• Heart: Words describing how nurses provide care “With all our heart. With all our mind.”

• PRACTICE: Our acronym depicts and defines our nursing values.

“

“

I have truly seen new energy and enthusiasm in the lead RN and other staff in our department. They are excited about Magnet. It is great to see a sense of ownership and drive to develop the nursing practice and improve patient care.

I am also excited to see all the training opportunities for patient care staff and having that effort supported by the larger system!

—Lisa Usgaard, director, Mercy Options Behavioral Health Services

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Patient- and family-centered care

Nursing PRACTICE 2014 Excellence Award Winners Over 100 Mercy nurses were nominated by their peers, partners and leaders for the excellence they provide every day. During National Nurses Week 2014, the winners of the Nursing PRACTICE Awards were announced. Nurses model the behavior in the category for which they were selected.

“Cyndi has taken a role in the surgical services area that previously was not utilized to the fullest and has molded it into a valuable position that helps defines those departments in leadership and education. Whether it is playing jeopardy or Clue with appropriate buzzers (of course) to help staff understand patient safety or the use of the Sim lab to role play important processes in the OR, she looks for innovative ways to engage and encourage learning in ways that I have never seen in my 36 years of nursing. I do not think a better candidate could have been chosen for this recognition, and I am sure there were many to choose from. It is an honor and a privilege to work with this young nurse who offers hope to my generation that nursing is alive and well and will be in good hands in the future.”

—Sue Sunby, MHA, BSN, RN, CNOR, MHTC, Director surgical services

Richard O’Connor, ADN, RN Mercy Hospital and Trauma Center SCU direct care Nomination: “Richard is absolutely amazing the way he interacts with patients and families. He pulls up a chair, asks questions, and gets to know the entire family that is present by name. He is an excellent teacher to the entire family as well, and he always makes sure the family is updated as needed and understands the plan of care. Here’s an exceptional example: We had a patient in the SCU that was actively dying. We took care of him on and off for a few months, administering chemo. On the patient’s 30th birthday, he was here in the hospital to die. Richard came in on his night off to sit with the patient and his family, offering friendship and emotional support. The patient’s wife was very appreciative. We need more partners like Richard!” —Joni Flister RN Response: “Winning this award reminds me how blessed I truly am. I am blessed to have had some of the best preceptors Mercy has to offer. Lucy Odegaard, Joni Flister and Richard Ruthie are always there to help. Without these guys, every day would be a struggle. I’m blessed to work with a team on SCU who truly know the meaning of teamwork. We have gotten each other through some tough shifts and situations by taking care of each other and each other’s patients. I’m blessed to have such great and caring doctors who go that extra mile for their patients and expect the same from us. I’m blessed to have such a wonderful support team around me, from environmental services, SPD, pharmacy, maintenance, dietary, lab, radiology, respiratory (lots of thanks), telemetry, nursing supervisors and all of the float nurses. I’m blessed to have some of the greatest CNAs. I cannot thank you enough for all you do. I’m blessed to have many shoulders to cry on. Watching a mom and dad lose their son or daughter, a child lose their mom or dad, or a young person lose their spouse is awful. I like to think we can make a difference and give them comfort and hope in their time of loss. I want them to know we did our best. I’m blessed to give mercy for Mercy. That is what this award means to me.

Respect Marcia O’Rourke, RN Mercy Brodhead Medical Center Nominations: I am nominating Marcia for her ability to show respect in every way to her patients, co-workers and other providers at her clinic. She shows her caring nature by individualizing care for each of her patients. She listens, communicates, advocates for and engages them and their families to help them reach their optimum level of health and functioning. Marcia relates to the patient’s needs with precise language and communication. She provides all procedures and cares with patient safety as a priority. Marcia is also a team player and shows caring to all other co-workers in her clinic. She is very open-minded and flexible and can handle any situation that arises with calm, clear-headed actions. She shows leadership at Mercy Brodhead by modeling empathy, dignity and respect to all who come in contact with her each and every day. I am a new nurse who was hired recently at Mercy.

Marcia has been a wonderful mentor and teacher for me, helping me learn the Mercy system and procedures with such patience and caring. I hope in time, I will be able to be the kind of nurse my nominee is.” —Sandra Sagona Response: “When I read the nomination for this award, I felt humbled and privileged that a new nursing graduate would write such a positive nomination about me.

Thinking about her remarks inspires meto live up to all of the positive comments made in the nomination and to strive to become a better me. I am proud and fortunate to be a part of the Mercy Brodhead team for many years, where the dedication of all staff to providing high-quality patient care makes thisclinic top notch. I deeply appreciate being recognized and selected for this award.”

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Accountability Stephanie Walton, MSN, RN Mercy Hospital and Trauma Center education coordinator Nomination: “Stephanie is one of the most hard-working, dedicated and competent nurses at MHS. Whenever she is given a project, she exceeds everyone’s expectations with her high-quality work. She is responsible and accountable to everyone that she works with and encourages others to do the same. She is following the advice she gives others by pursuing her master’s degree in nursing education. She also keeps up memberships to multiple professional nursing organizations to keep current on her professional practice. I have had the pleasure to work closely with her for many years and still am amazed by her dedication to MHS and the nursing profession.” —Nichelle Jensen Response: “I am honored to be recognized by my peers for this award. I enjoy the profession of nursing and am so glad we are able to highlight the great work we are doing! I am grateful to work with an outstanding group of nurses at Mercy. Thank you again for this. I am truly humbled by the recognition.”

Nursing PRACTICE 2014 Excellence Award Winners

The following is the CNO letter sent out to all nurses who were nominated for a PRACTICE award.

Competence Cyndi Hanson, BSN, RN, CNOR Mercy Hospital and Trauma Center OR educator Nomination: “Cyndi has brought a totally new way to look at education that’s taught to our department. She uses numerous offwork hours preparing. For example, she used a Clue game designed for the department that was very interactive and fun. She transferred the videos I recorded to our computers. Staff uses this OR educator program to improve their skills and awareness in order to deliver the best patient care. Cyndi listens well, is open-minded and very helpful and totally self-driven. She also gives me good advice and is a good role model for our department.” —Geneva Sbonik Response: “It is an honor to be chosen to receive a PRACTICE award in the category of Competence. Being recognized by a peer is amazing and a truly humbling experience. The work I do is minimal compared to the immense efforts my teammates in the operating room put forth each day. It is because of them that I strive to provide department education in a manner that is informative, timely and creative. I am fortunate to work with a group of competent and driven individuals who inspire me to work to their caliber.”

Dear nursing partner,

June 2014

You were a nominee for a 2014 Mercy Health System Nursing PRACTICE Award. Congratulations for being recognized as someone who personifies nursing PRACTICE excellence at Mercy Health System.

We are very proud of your work and accomplishments as a nurse at Mercy.

We exist as an organization because of the needs of others who are vulnerable. They deserve the very best we are capable of, and you bring this each day.

Thank you for your commitment to the profession of nursing and for demonstrating and role modeling this excellence over the past year.

Transformational Maggie Schultz, BSN, RN Director, Mercy Regional Cancer Center Nomination: “Maggie works so hard at making both medical oncology and radiation oncology efficient without compromising patient care. She has accomplished so much in her new role as director.

Day in and day out, regardless of what is thrown at her, she is always positive and brings out the best in her partners. She works hard to learn the processes that are in place and finds opportunities to enhance them. She doesn’t just accept the processes at face value. She researched them until she fully understands them, then makes them better. Maggie spends countless hours developing and implementing the foundations of the nurse navigator program and the oncology survivorship care plans along with Cindy Gunn. She works will with other departments in order to make a difference not just in oncology, but Mercy as a whole. Maggie rounds her departments and is not afraid to get into the trenches. She sees what works and what doesn’t. She involves the staff to find solution to issues. She is great at managing up her staff and physicians. She is so supportive, but firm and pushes partners to be their best. She encourages partners to strive for their full potential through education and learning. She welcomes feedback on all that happens within the departments. Maggie shows so much

Sincerely, Your CNO

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Nursing PRACTICE 2014 Excellence Award Winners

“I understand achieving the Magnet designation may lead to a reduced patient mortality and morbidity rates. I have already observed increased patient satisfaction, better working relationships with physicians, increased job satisfaction among nurses, and improved staff morale. I am proud to be a Mercy partner and willing to support our Magnet journey in any capacity.”

—Jere Johnson, Director of radiology services, Mercy Hospital and Trauma Center

professionalism, respect, honesty andcompassion to those who work alongside her. I would like to thank Maggie for making oncology services what it is today! She has mastered the art of integrating business with relationships.”—Rhonda Graf Response: “Throughout my time here, Mercy Health System has proven again and again that it is a progressive organization dedicated to providing the highest level of care to all of the people who entrust us with caring for their health and well-being. But even the most successful, progressive organizations need to, can and should embrace new ways of thinking. Being named the winner of the Transformational leadership award means that I have made a positive impact on my departments, my staff and how the Mercy system provides the highest level of health care to Janesville and its surrounding communities. I approach nursing and health care as an ever-evolving entity. It requires constant and consistent learning and refinement of skills. Lifetime learning should be encouraged, promoted and celebrated as an essential duty of all nurses and all other health care professionals. Through this learning, all members of my team or any other team within the system will begin to look critically at how we as a system provide our services, both interpersonally and technologically. Most times we see that we are functioning with the highest levels of health care, but occasionally new ideas come to light; transformational ideas that push our practice to the next level. This culture is what I promote within my departments. The Transformational leadership award is an award that, in my estimation, has been won by my departments. It illustrates that by promoting a culture where ideas are developed, shared, explored and implemented when appropriate. I have created departments full of health care professionals that can influence how medical services are provided at their optimal levels. I believe that when this culture of openness and progressiveness is embraced by our system, we can truly say that we are providing medical services with “all our hearts and all our minds.

Interdisciplinary collaboration Kavita Deckard, BSN, RN Mercy Hospital and Trauma Center maternity Nomination: “Kavita is one of the newest nurses in maternity but she has hit the ground running. She is an involved member in the community and one of Mercy’s biggest promoters out in the community. Kavita is a caring clinician whose patients bond with her— and not just while they are here having their babies. She has developed many friendships with her patients and often sees them in the community. Kavita has now undergone SANE (sexual assault nurse examiner) training and will add this skill set to her growing repertoire. We’ll be lucky to have her as our own resource in maternity. Our patients who are abused will benefit from her services. Thanks, Kavita!” —Gretchen Finley Response: “I am surprised and humbled to be recognized by my peers considering my relatively short tenure at Mercy. As a new grad, I have found Mercy to be the perfect place to immerse myself in a variety of nursing roles. Women’s health is my passion, and the various avenues Mercy allows makes my job so rewarding. Thank for this honor. It validates that I have found my niche.”

Caring Jodi Seales, ADN, RN Mercy Walworth Hospital OPS Nomination: “The OPS department had an increase in the pediatric population. Jodi saw the need for a comfort item for the children and took action. She took time out of her busy work schedule to contact Project Linus to see about getting quality blankets donated to the department. This took contacting several different people until she finally was put in touch with the right person. Jodi coordinated the donation of these blankets to the department.

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populations. They bring a touch of color to our department that is all blue scrubs and medical equipment, which can be scary for a child. These blankets follow the child throughout the surgical experience, providing a bit of consistency and, in turn, comfort.

Parents of these children have expressed their gratefulness and thanks for this comfort item for these children. I think this nurse should be nominated for nursing excellence because she saw a need and was not asked to take action, but did from the kindness of her heart. Her efforts have eased many fears and dried many tears. Jodi has a heart of gold that is portrayed every day in the care she provides. She goes above and beyond whenever she sees the opportunity arise.” —Taesha Georgalas Response: “I am very humbled and touched to be honored by my peers. I work with such a great group of nurses. They make me want strive to be a better nurse each and every day.”

Evidence-based care Kara Sankey, MSN, RN, CNL, CMSRN Mercy Hospital and Trauma Center patient navigator Nomination 1: “I nominate Kara for the category of evidence-based care. She has been a great leader in helping to bring research and evidence-based practice to the nurses here at Mercy. She has been the research council chair for over two years and has done an excellent job. She took the lead on the system-wide research project and has helped provide guidance to nurses who are interested in research or EBP. She has also helped with her own EBP project and has created a great relationship and networking resource with our Marquette researchers to help ensure the best evidence is introduced into practice. She is always willing to help with projects and puts 110% into what she does.

She is excited about the work she does and it shows when you talk with her. Kara is a great role model for new nurses and is always willing to talk about EBP and research for the nurse residency program. She just recently completed an advanced degree in a CNL role and is eager to learn more. She brings strength and ability to research and EBP here at Mercy and I am honored to work with her!”—Stephanie Walton Nomination 2: “Kara believes in the power of evidence-based practice and has gone above and beyond in assisting other nurses to delve into research as a nursing function. She personally assisted me through completing a research proposal in preparation for the IRB. I wouldn’t have been able to complete the proposal without her assistance.

Thank you!” —Leslie Kelly Nomination 3: “Kara has been a leader in the development and advancement of nursing research and evidence-based practice at Mercy. She has been the chair of the Nursing Research and EBP Council since it began and continues to lead the group in new projects. She is a mentor to the staff and has been a project leader for many important studies at MHS. Most notably, Kara was the primary investigator for the system-wide research project that impacted the barriers nurses feel to using research and EBP in their practice. She has also taken time out of her personal life to finish graduate school to further her understanding and knowledge of nursing research and evidence-based practice. Thank you, Kara, for all you have done for nursing research at MHS!” —Nichelle Jensen

Nursing PRACTICE 2014 Excellence Award Winners

“Achieving Magnet means that we have built and sustained a culture here at Mercy that allows (and demands) that nursing partners and all partners throughout the system practice excellence every day. It means partners are supported through change and personal growth, are encouraged to question practices and policies, and are provided the necessary tools to advocate for patients and families to ensure the best possible outcome ... healing in the broadest sense.”

Kris Phillips, MSN, RN Director of ICU/SCU Mercy Hospital and Trauma Center

Response: “Winning this award to me is very exciting. I feel very honored to be nominated by my peers. To me, it means all the time and hard work I put into trying to advance and support nursing research here is working. I think completing the system-wide research project and being able to help others complete their work with a structure and process is so exciting. When I started chairing the research council, I needed to step out of my comfort zone. But since then, I have found a passion in it and see the true value of nursing research and EBP at the bedside.”

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Nurse satisfaction

Ambulatory RN partner engagement Corrine Kohn, BSN, RN, Clinic quality PI coordinator Our leadership makes every effort to be available to their partners and offer support within their work environment. During our Magnet Journey to Excellence, our leaders incorporated the four Cs from our Professional Practice Model: • Communication • Collaboration • Continuous learning • Celebration

It engaged partners and empowered them to share their stories about how they cared for their patients and the importance of providing exceptional care by using best practices. It allowed nurses time to be with one another and visibly see the concern their leaders had for them. It gave nurses the ability to share and talk with one another how they do what they do for their patients.

They did this by developing an interactive game for partners to further their understanding of what it means to work for an organization that is Magnet Designated.

This event took place at many clinics throughout our ambulatory system and many partners were satisfied and thankful to their leadership for this opportunity.

It was a time of celebration for our nurses with their leaders, as well as a time to support the need for continuous learning.

Partners gathered to learn about Magnet and share their stories of how they do what they do for their patients by playing a game called Magnet Mania Jeopardy. This innovative board game format used our Mercy nursing shared governance model and its four components as the key categories with questions and answers under each one.

This game encouraged an atmosphere of openness.

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Patient satisfaction Patient satisfaction has been a part of our nursing dashboard under the service pillar since January of 2012 in the ambulatory system. Our patients receive a survey about their care and when they return it, the information is reported to Mercy customer relations from our vendor Press Ganey.

Two questions have been reviewed over the rolling quarters: 1., friendliness and courtesy of the nurse/MA, and 2., concern of the nurse/MA for the problem. Our ambulatory clinics review these reports with leadership at partner meetings and at NPC meeting and discuss ways to maintain and improve the care we provide to our patients.

We have consistently exceeded the benchmark and have developed action plans for areas that show need for improvement in order to maintain exceptional health care expectations for the patients we serve. At right is a graph demonstrating our achievements.

An Epic Tips and Tricks sheet was developed and partners received education. This strategy also allowed for improved data collection through the EMR. To improve the effectiveness of communication between caregivers enhanced the ability to report critical values to the provider within 60 minutes using the documentation work flow created in the telephone encounter and use of high priority to the physician to reach the patient with appropriate intervention for safe management of care in a timely manner.

Data collection started in August 2012. It was noted to improve our percentages to exceed the benchmark of 90%.

Successful rolling eight quarters led to increasing the benchmark to 95%.

Critical test reporting is our #2 NPSG and is one of our nurse sensitive indicators that we measure and report on our nursing dashboard under our quality pillar. The Mercy Walworth NPC reviewed reports from the quality department and decided to implement other strategies to improve the process of reporting critical lab values to the physician once received from the lab.

Collaboration with council members and the Epic team led to improving the documentation process by opening a telephone encounter versus placing under note only.

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Patient Safety and Quality of Care Pain assessment documentation As a quality nursing indicator chosen from our 2013 nursing strategic plan, the Rock County Nurse Practice Council decided to develop a universal procedure and follow up for pain assessment and documentation for patients receiving care in the office setting.

A pain task force was established and an action plan implemented to begin the process with the support of leadership. Two nurses led the task force and conducted research about asking the question, “Is pain a 5th vital sign?”

They conducted a best practice literature review and brought information to the council. The NPC voted to adopt pain as the 5th vital sign and brought this change in practice to the coordinating council for approval.

Upon approval, Mercy marketing was contacted to assist with creating pain reminder cards to distribute to staff with education. Epic was contacted to create functionality in the

EMR in the vital sign section for documentation and visibility of pain scale card. Mercy’s quality department obtained data monthly from the medical management team who collected the data from the EMR to provide clinics with a report reflecting their compliance with documentation of pain. A peer review process was established to engage nurses to review the fall-outs and discuss with each other their observations and encourage compliance.

A dashboard was created for partners to view progress and posted on Magnet boards/binders in all clinics. Achieving 8 rolling quarters of greater than 90% in a 2-year period led to increasing the benchmark for this CY15 to 95% and also to identify the data per county—Rock, Walworth and McHenry.

As an ambulatory system focused on quality of care, we continue to exceed the benchmark each quarter and share our data at NPC meetings and department meetings for pain assessment documentation and through peer review.

Patient falls reduction Patient falls in hospital settings nationwide have continued to be a growing concern. Mercy Health System is working to improve the process to identify patients at risk for falls and to implement best practice measures to decrease falls with the focus on falls with injury.

The system’s Fall Prevention Committee brought together members from nursing units, leadership, nursing services, and physical therapy to collaborate on improving our falls within the system. This group standardized Call … Don’t Fall signage and breakaway bed cords throughout all three hospitals. The group also created a fall prevention brochure focused on educating patients using a team approach to fall prevention—patients, family and staff.

A large achievement was the focus on improving our fall investigation and huddle form. This new investigation/huddle

form will provide more detailed information on each and every fall. With the use of evidence-based research, the fall committee created this form to identify the most frequent reasons a patient might fall. In adding to this information to the investigation, we can identify problems more efficiently.

As a system focused on patient safety, we continually look to update and improve our processes to decrease falls with injury.

Sue Kautz, BSN, RN Quality coordinator, Mercy Harvard Hospital, Mercy Walworth Hospital

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Maternity nurses support patient ambulation Early ambulation after Cesarean sections has shown to decrease maternal complications in the postoperative period. We identified that our patient population was remaining on bedrest for up to 24 hours after surgery.

Upon researching evidenced-based practices regarding postpartum patients who had Cesarean sections, we found that early intervention within 6 to 8 hours was key in proactively managing postoperative mobility and minimizing complications of surgery. Complications related to prolonged bedrest include, but are not limited to, VTE, atelectasis, decreased gastric motility and decreased ability to manage pain.

This issue was taken to our unit-based NPC for discussion.

It was decided that the best action plan was to change the physician postpartum order sets to be more prescriptive

Keeping mothers and babies together is key!

Keeping mothers and babies together, including skin-to-skin contact after delivery, is an evidenced-based practice that improves maternal child bonding, maternal and newborn stability, and breastfeeding success. For both vaginal and Cesarean deliveries, mothers are encouraged to put their babies skin to skin until after the first feeding.

regarding patient postoperative activity. The order sets were then approved by the obstetricians and went into production. Currently, the majority of postpartum patients are ambulating by 12 hours after their surgery.

Reilly Tipton, BSN, RN Maternity educator, Mercy Hospital and Trauma Center, Mercy Walworth Hospital

and within 30 minutes of arrival to the recovery room after surgery. Skin to skin can be attempted in the operating room, barring any maternal or newborn complications. Babies are no longer taken to the nursery for admission procedures and assessments. Rooming-in is encouraged throughout the entire stay.

Reilly Tipton, BSN, RN

Our performance improvement initiatives include placing baby skin to skin within 30 minutes after vaginal deliveries

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Patient safety and quality of care ICU and SCU orientation at Mercy Hospital and Trauma Center Patient safety and quality was supported through education by improvements made in the orientation process for ICU and SCU RNs. New RNs beginning their practice in SCU or ICU are now spending the first week or two with the educator for one-on-one education time all within a controlled atmosphere; i.e., outside of the staffing matrix. The program includes general orientation, unit-specific in-services on equipment and processes in an interactive classroom environment, and 1:1 initial bedside training to include assessment, equipment, and daily routines. Orientees can then begin bedside orientation with their preceptor feeling a little more prepared for a patient assignment.

to the opportunity for this education and often ask to be included in the next class rotation.

Chemotherapy: Chemotherapy training for all SCU RNs has been completely revamped. The MHTC chemotherapy department now provides classes for initial competency training. New, more vigorous annual educational requirements were established with the help of the chemotherapy department to maintain RN competency.

Strategies will include annual Mercy Learning Center education, observation of chemo administration requirements, and testing. Outside educational opportunities will be posted routinely.

Coronary artery bypass (CABG) patients: An annual post-op CABG class was created for ICU RNs clinically ready to receive CABG patients from OR, usually in their second year of practice. The class uses education methods such as lecture, interactive demonstration, written references, and a Sims lab opportunity. Education is provided on interpreting and managing hemodynamics, common problems associated with this patient population, and specific equipment associated with these patients.

Three bedside orientation sessions with experienced RNs are required to complete the training. New nurses look forward

Shelley Brown, BSN, RN, CCRN, TNS Critical care educator, Mercy Hospital and Trauma Center ICU/SCU

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Excellence in the ED: Code stroke Mercy Hospital and Trauma Center is a certified Primary Stroke Center and to maintain quality of care, we are required to meet certain standards. The emergency room is looked at to get the best quality care done in the fastest time for better patient outcomes.

Standards we are meeting for these steps are door-to-lab in less than 45 minutes, and door-to-thrombolytic in less than 60 minutes. The ED continues to strive to provide the best quality of care in the most critical times of a patient’s life.

This is especially true when it comes to our Code Stroke patients. From the onset of symptoms till the patient is given IV thrombolytic therapy, TPA (Alteplace), the patient has 4.5 hours. During this time, many things need to happen including MD assessment, IV, CT and labs resulted, and consult with the neurologist. In the ED, we have improved our times by implementing new processes this year.

When a Code Stroke is activated, a page is sent to the following staff: CT tech, lab tech, shift coordinator, respiratory therapy, and registration. A Code Stroke may be activated by the RN, physician, or by EMS prior to the patient even arriving at the ED. When a Code Stroke is activated by EMS prior to the patient’s arrival, the patient now goes directly to CT after a brief assessment by the physician.

Rachel Luety, BSN, RN, TNS MHTC E.D. educator

This process has reduced our door-to-CT times greatly.

One standard we are required to meet is door-to-CT in less than 25 minutes, and we are meeting this. Once the patient is in the ED, a lab tech is there, waiting to obtain lab work. We now have the ability to do bedside lab testing, which is called ISTAT. This includes blood chemistry, hemoglobin, hematocrit and INR. If the ED physician feels the patient is a candidate for IV thrombolytic, these test results are needed prior to giving IV thrombolytic.

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Mercy honored with a Magnet exemplar Interdisciplinary Collaboration

Words from our Magnet appraisers: During our site visit, the appraisers noted interdisciplinary collaboration across the continuum that was innovative, creative and met the needs of the organizations’ unique patient population and setting in a dynamic and individualized approach. Nurses promote interdisciplinary collaboration across the continuum of care, incorporating 43 specialty clinics in 26 communities located in eight counties and two states. Their ability to cross, not only the continuum, but the regulatory and nurse practice differences between states, is remarkable.

Throughout the site visit, appraisers were presented with examples of the interdisciplinary collaboration and integrated delivery that has become known as the Mercy Health System. Nurses do not see the state border as an issue, but rather as an inconvenience, and they are dually licensed and practice in both states, often within the same work day. This promotes efficient use of expertise and allows patients in any setting the immediate access to the level of care required. Nurses in remote clinic settings reported that all that is needed is a telephone to link them to the expertise, consultation or advice needed for the patient with whom they are working.

Throughout the visit, appraisers heard examples of staff collaborating and having a trust between disciplines that is truly unique. Their interdisciplinary connection is facilitated by a strong informatics system through their Epic program and is augmented by care coordinators and nurse navigators. Through the Epic Cadence system they ensure that information is shared and follow-up visits are scheduled. Inpatient and outpatient settings routinely included follow up phone calls as a standard practice per discharge. These activities are documented with the Epic system and include areas for care completion and additional follow-up. Upon identifying additional needs,

patient arrangements are made for scheduled follow-up or coordination with other care providers.

The organization’s ambulatory services are structured through nursing with a CNO designated for ambulatory services. They have standardized 43 specialty clinics that are interdependent to the three hospital campuses but are highly integrated. Patient coordination through these entities and the inpatient and outpatient setting is highly coordinated with multiple disciplines. One such example was with their outpatient rehab and sports medicine clinic where staff visit patients in the hospital and then provide continuity of care in the outpatient setting. This starts with preoperative classes where therapists and nurses teach collaboratively.

Patient satisfaction and outcomes have shown consistent improvement with this coordinated effort. The organization has also developed an interdisciplinary care planning tool.

This tool is designed with the Epic platform and includes documentation from physical, occupational speech therapies and dietary services. These care planning tools are used for all patients in all hospitals and integrated to coordinate post discharge collaboration by ambulatory services. At Walworth Hospital these interdisciplinary care plans are the road-map to their daily interdisciplinary rounding. These team meetings also include the hospitalist, pharmacist and social services for the process of care coordination and discharge planning.

The level of interdisciplinary collaboration promotes optimal patient care throughout the continuum and is a truly unique system, integrated to a degree far beyond other systems.

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Mercy’s nursing website is for our partners Location: The nursing website link can be found on the Mercy partner intranet site, MercyPartners.org, under “Spotlight,” or by searching MercyNursing.org.

Goal: To provide Mercy nurses with access to a variety of resources including upcoming events, journal articles, blogs, opportunities for involvement, links for professional development opportunities, specialty certification programs and library resources. The site also features nursing accolades for PRACTICE winners and certified nurses.

Website Review Committee: The committee meets quarterly and is always looking for nurses to review the website and offer ideas for content enhancement. Email Chris Peterson at cpeterson@mhsjvl.org or Leann Wasemiller at lwasemiller@mhsjvl.org if you are interested.

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NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS Research Evidence-based Practice Innovation

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CNO MESSAGE

NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS New knowledge, innovations and improvements are key components of the Magnet Model and support the achievement of empirical outcomes. When nurses understand the importance of nursing research and evidenced-based practices, it allows them to have autonomy at all levels of their professional practice.

Changes to the patient care environment take place with solid evidence for implementation. Policies and procedures are changed based on evidence; new programs are developed, patient outcomes are improved, and nurses are empowered to have a say in how they practice.

At MHS, nurses are encouraged, supported and are provided with a mentor to help them evaluate and use research in their practice. MHS nurses are involved in research and evidence-based practice in all entities. The MHS research and quality committee provides the support, guidance and monitoring of all projects within the system.

Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE CNO, Critical access hospitals

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Evidence-based practice and research at Mercy Health System The system-wide Nursing Research Council has made many strides in 2014 and participation in evidence-based practice (EBP) projects has increased significantly. Nurses within the system are striving to incorporate the best evidence into their practice; this was demonstrated at the 2014 Mercy Nursing Poster Fair. We showcased 21 posters submitted by nurses from all three hospitals and various ambulatory settings. Posters highlighted evidence of practice changes focused on optimizing patient care.

The council continues to focus on mentors to assist staff participating in evidence-based practice or research projects. A mentor from the council is assigned to a nursing partner to be a resource and guide as nurses look to discover answers to their “burning questions.”

Burning questions are those questions that pop up in daily practice, are sparked when listening to a conference speaker, or when reading a professional article.

The Nursing Research Council supports and manages nursing research activities for all roles and all settings where nursing is practiced across the system. In the ongoing journey to ensure all levels of MHS’s professional nursing staff use research and EBP, the research council adopted the Iowa model using: P: I: C: O:

Who is the patient population?

What is the potential intervention or area of interest?

Is there a comparison intervention or control group?

What is the desired outcome?

Reference: Titler, Marita, et. Al. “The Iowa Model of Evidence Based Practice to Promote Quality Care.” Critical Care Nursing Clinics of North America. 13.4 (2001): 497-509

For postoperative adult patients who received general or regional anesthesia (P), does having visitation in the PACU (I) compared to no visitation (C) increase patient and family satisfaction (O)?

-Kelly Howard, RN, Mercy Harvard Hospital The ultimate goal of evidence-based practice is standardizing nursing care using science and the best evidence available. The bridge between what is known to be the best nursing practice and what is actually practiced is getting shorter with all of the information available every day.

Mercy nurses are fortunate to have Mosby’s Nursing Consult database (linked on the Mercy partner intranet) as a resource guide. Mosby’s contains evidence-based nursing monographs written by nurses, for nurses. These contain reviews of current evidence available to many clinical situations. Mosby’s also allows nurses to access respected leading resources in finding answers to clinical questions.

Delirium monitoring in the ICU In 2014, Amanda Drout, BSN, RN, led a Mercy Hospital and Trauma Center ICU team to explore if implementing the CAM score assessment method and providing structured nursing interventions versus no routine delirium assessment would decrease length of ICU stay, use of restraints and patient safety events over a three-month period in the adult ICU patients. Amanda presented her project to the Nursing Research Council and was provided a council mentor to help guide her project from start to completion. Kudos to Amanda and the ICU team on their success in driving practices to improve patient care and implement evidence-based practice changes in the ICU!

PICO question: MERCY HEALTH SYSTEM // 63 // NURSING ANNUAL REPORT 2014 TRANSFORMATIONAL LEADERSHIP

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Creating an insulin pump policy to support improved patient outcomes The story unfolded: Realizing the need for a change and making it happen begins with one person who believes in the vision.

Joni Flister, ADN, RN, (pictured at left) works in the Mercy Hospital and Trauma Center’s Special Care Unit and chaired the Nursing Practice Council (NPC) until June 2013. She described her year as chair as “an awesome growing experience and one that I will always cherish.”

Joni Flister, ADN, RN

The beginning of one of her greatest stories began during an NPC meeting when a unit chair reported patient dissatisfaction with Mercy’s discontinuation of insulin pump infusion during hospitalization. The council discussed this challenge and realized an opportunity to investigate best practices to support improved patient outcomes in stability of blood glucose as well as an increase in partnership with patients to increase satisfaction.

Phase 1: A task force was created with an established goal of looking at best practices to support patient maintenance of insulin pumps during hospitalization. Joni volunteered to chair.

The small task force initially consisted of direct care nurses from MHTC but quickly evolved into an interdisciplinary team that would include representation from all stakeholder groups: direct care nurses from other Mercy entities, nurse educators, dietitians, pharmacists, physicians, informatics nurses and nursing leadership.

The team reviewed both medical and nursing evidence-based practice journal articles, working policies from other facilities, and clinical practice guidelines. Together they drafted and approved a policy entitled Continuous Subcutaneous Insulin Infusion (CSII)-Insulin Pump. The policy was submitted for approval by MHTC, MWH and MHH Practice Councils, Policy Oversight, Education Council and Pharmacy & Therapeutics.

Phase 2: After the policy was approved, EMR documentation became the next priority. A task force subgroup consisting of pharmacy, information systems (IS) and nursing came together to determine workflow and documentation requirements and discussed integration into Mercy’s EMR. After completion of the IS build, representatives from the task force team practiced a variety of documentation scenarios in the Epic play environment to ensure comprehensiveness and flow.

Next steps will include a task force gathering to present electronic documentation and obtain final approval. The team will also discuss a preliminary education plan and decide on a rollout date for policy introduction. The nursing education team is working to develop a Mercy Learning Center module for insulin pump policy education. Once final approval is obtained, the team will create an MHS education plan to support Phase 3.

Dr. Timothy Reid will introduce and educate the physician team.

Looking ahead, Phase 4 will be an evaluation of the effectiveness of our change in practice as measured by satisfaction of our patients who are permitted to maintain their insulin pumps during hospitalization.

“This policy would not have been born without the collaboration of each member of the task force and the dedication of time, patience, knowledge and expertise of each member working to ensure best practice improvements for our diabetic patient population using insulin pumps.

Teamwork is truly the Mercy way!” —Joni Flister Joni Flister, RN Patty Tierney, RN Mary Bothum, RN Nick Kajdan, RN Aubrey Scimeca, RN Richard Ruthe, RN Laura Kingsbury, BSN, RN, TNS, CCN, SANE-A Rebecca Senn, RD, CD Stacey Budill, RPh Stephanie Walton, MSN, RN Lynn Hartwig, BSN, RN, CDE Beth Meske, RN, DCE Lisa Wang, MSN, APNP, FNP-C, WCC, CCRN Jessica Schumacher, BSN, RN, CEN, TNS Beth Burdick, BSN, RN Sasha Johnson, RN Chris Peterson, BSN, RN, BC Tammie Haling, RN Timothy Reid, MD Keith Konkol, MD James Horton, MPH, MD Antony Joseph, MD Glenn Milos, DO Executive sponsors: Deb Potempa, MSN, RN, NEA-BC Jan Botts, MHA, BSN, RN, CPHQ Wynn Biedermann, DNP, RN, NEA-BC Ad hoc members: Sue Ripsch, BSN, MS, MBA, RN, NEA-BC Kelly Howard, RN Aimee Blood, RN Shelley Pember, BSN, RN Ellen Gawrisch, MD Sue Sunby, BSN, MHA, RN, CNOR Don Janczyk, MS, PharmD, BCPS, CPHQ

Direct care MHTC SCU, task force chair Direct care MHTC OPS Direct care MHTC BHU Direct care MHTC SCU Direct care MHTC ICU/informatics Lead and direct care RN, MHTC ICU/SCU Cardiology program coordinator Nutrition care coordinator MWH pharmacist MHTC RN educator Diabetes educator, Mercy Health Mall Insulin pump educator, Mercy Health Mall MWH educator, Advanced Practice Nurse ED RN educator Information systems Information systems Information systems Information systems application analyst Family medicine, Mercy Diabetes Center MHS director of hospitalists MHS director of family medicine residents MHTC anesthesiologist MHS director of ED physicians

CNO MHTC CNO Ambulatory CNO MHH/MWH

CNO MHS MHH NPC chair MWH NPC chair Ambulatory NPC chair MHTC anesthesiology MHTC OR director Pharmacy director

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Mercy integrates evidence-based practice: End Tidal CO2 monitoring during procedural sedation The Procedural Sedation Committee is a system-wide committee that oversees practice and policies that relate to procedural sedation to help ensure safe, evidenced-based practice and improve patient outcomes.

In 2013, a request was brought to the committee to look at the benefits of implementing capnography during procedural sedation across the system. This came after several large published studies showed that adding capnography to standard monitoring practices improved patient outcomes and increased patient safety.

The committee agreed this could be beneficial to our patients and put together a multidisciplinary team to review the evidence. After reviewing the research, it was decided there was enough evidence to support moving forward with a pilot project in the MHTC endoscopy department.

This evidenced-based practice project began in January 2014 with the education and implementation of capnography monitoring equipment. Data was collected from March 2014 through September 2014 in four different quality indicators. The results showed a decrease in the number of mild and severe desaturations and a slight increase in the number of detected airway obstructions.

This information was presented to the Procedural Sedation Committee. It was requested that the project be expanded system-wide to provide the same standard of care to all patients receiving procedural sedation.

Nichelle Jensen, BSN, RN, CCRN MHTC clinical educator, capnography project coordinator, stroke program coordinator

“The Magnet journey recognizes the work Mercy nurses do every day. It raises the bar for achieving excellent patient outcomes through collaboration, collegiality, best practices and shared governance. Achieving the Magnet award supports the mission of the Mercy Health System in that it gives formal acknowledgment to the exceptional care that is given to patients, and recognizes the pride, excellence, and passion of nursing.�

Kandi Krajecki, BSN, MS, RN Director of medical, surgical, orthopedics and inpatient rehabilitation Mercy Hospital and Trauma Center

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Mercy’s research study successes hi

Mercy home health nurses present at national conference Winning with telehealth: best practices for integrating evidence-based telehealth into your plan of care Telehealth is cutting-edge technology available for in-home use to provide ongoing assessment of patients health during their full continuum of care. The telehealth equipment allows patient to transmit BP, O2 saturation, HR, and weight.

This technology supports patients’ staying in their home and prevents the need to admit the patient to an alternative care facility. It is an invaluable tool in continuing to provide new education and reinforce prior education the patient received on their chronic or acute condition. The ultimate goal is to decrease ED/UC needs, decrease MD visits, and decrease re-hospitalizations.

Mercy RNs Sherilyn Aures and Nancy Bracken presented during the National Association of Home Care Conference in Washington, DC, in October 2014. They highlighted methods to establish a successful telehealth program for patients “without breaking the bank,” and making telehealth a standard part of patient-centered care across the continuum.

Health care leaders as well as legislators from all over the country attend this annual conference to remain current with the leading standards in the health care industry.

Conference presenters Sherilyn Aures, RN, CHPN Telehealth program nurse Nancy Bracken, MS, BA Director, home, health and hospice

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ighlighted at national conferences

Mercy’s system-wide nursing research project: barriers to research utilization within a health care system In order to achieve Magnet status, healthcare facilities must demonstrate that evidence-based practice (EBP) is being used to improve outcomes for patients and discover new knowledge by performing research.

The purpose of this study was to identify and compare barriers to research utilization before and after an educational plan in an integrated health care organization. The study was a longitudinal, quantitative study with a descriptive design that utilized the BARRIERS scale by Funk et. al (1991). The nurses were asked to complete the online survey before and after implementation of system-wide education on evidence-based practice and research.

The results found that there was a small, statistically significant reduction in barriers after education. Most of the education was provided via electronic communication and demonstratef how education can be successful throughout a health care system with the use of electronic communication and technology. Careful planning by nursing leaders to diminish barriers will foster an environment that supports the use of research and EBP. Principle Investigators Nichelle Jensen BSN, RN, CCRN Kara Sankey MSN, RN, CNL, CMSRN Stephanie Walton MSN, RN Stephanie Walton is presenting at the Association for Nursing Professional Development Convention in Las Vegas, July 2015.

Planning for Mercy’s next research project: Readiness Evaluation and Discharge Interventions (READI) In 2014, the Nursing Research Council worked with Marquette University researchers in preparation to support the READI study in collaboration with the ANCC and 32 other Magnet hospitals. Participating in this study will give Mercy the opportunity to engage in research at the bedside. The three-year READI research project will begin in 2015 and include the MHTC medical and surgical units.

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Research and evidence-based practice Mayo Clinic: prevention of catheter associated urinary tract infections (CAUTI) In June 2014, JoAnn Goodrich, BSN, RN, CWOCN, presented “A multi-modal approach to CAUTI prevention” at the 46th annual Wound Ostomy and Continence Society Nurses (WOCN) conference in Nashville, TN. After encouragement from MHTC CNO Deb Potempa, JoAnn also submitted her CAUTI abstract to the Mayo Clinic for consideration to present at the Evidence Based Nursing Conference in Rochester, MN, in March 2015. JoAnn received notification in October 2014 that the abstract was chosen to be presented!

JoAnn Goodrich

Abstract detail: “A multi-modal evidence-based approach to preventing CAUTIs in a threehospital health system was implemented under the leadership of the system’s certified wound, ostomy and continence nurse. The goals were process improvement to achieve 100% compliance with Foley catheter removal by the second post-operative day and outcome improvement in CAUTI occurrences. The system CAUTI rate was 4.21 per 1000 device days prior to the project, with a goal of 3.0 or lower.

“Evidence sources for the project were derived from literature review, surveys of hospital practices, and information presented at a regional WOCN meeting. The implementation plan included sequential implementation of strategies for staff education, remediation, and equipment innovation. First, a mandatory CAUTI module was introduced with a knowledge verification test placed on the system’s web-based learning center for completion by all RNs, LPNs, and CNAs. 96% compliance with completion was achieved. Next, traveling CAUTI posters which included evidence-based approaches to decrease CAUTI occurrences rotated through each nursing unit for a two-week period.

“A CAUTI bundle was initiated and copies were distributed to all nursing units. Chart reviews of CAUTI occurrences identified unit-specific problems which were addressed by unit educators. In evaluating the results of this multimodal approach, the hospital achieved 100% compliance in removing Foley catheters by post-operative day two. The CAUTI rate decreased to 1.47 per 1000 device days for the quarter following project implementation.

“Efforts continue. Mandatory learning modules with random peer reviews are targeting technique-related Foley catheter insertion and maintenance competencies. JoAnn says, “We identified the need for equipment modification and are preparing to implement an attachment device to our IV poles for hanging Foley bags to assure they are consistently lower than the bladder while the patient is ambulating or in bed. A random CAUTI audit will be held to identify catheter issues at the bedside.“ JoAnn describes her experience: “This conference was more intense than the WOCN conference I attended last June, as fewer posters were presented and the conference participants actually received CEUs for viewing the poster presentations. It was necessary for me to submit a description of the session, objectives, content, timeframe, faculty involved, and teaching methods. Our poster was cited in the top four because of the inexpensive attachment device that was placed on IV poles to ensure Foley bags are consistently below the level of the bladder with patients ambulating, decreasing CAUTI. In addition, Mercy Health System was recognized for implementing peer review of CAUTI, using both bedside and chart auditing of those staff caring for patients with Foley catheters. Many conference participants asked questions, requested handouts and took pictures of our poster, which made the whole presentation worthwhile.”

JoAnn Goodrich BSN, RN, is a certified wound, ostomy and continence nurse (CWOCN) MERCY HEALTH SYSTEM // 68 // NURSING ANNUAL REPORT 2014 TRANSFORMATIONAL LEADERSHIP

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From the desk of the research council chair Evidence-based practice, quality improvement and research…

What is the difference?

Many nurses intermingle the use of these words not knowing how they differ. A simple way to point out the differences is to define the terms.

Evidence by definition is proof. The evidence supports a theory.

Research is the investigation, or the collection of facts, to explain a theory.

Quality improvement is an interdisciplinary process that strives to deliver the highest possible quality of patient care based on evidence and research.

All of these interact with each other. Research collects facts and provides evidence to support a theory.

Evidence-based research improves quality.

At Mercy, nurses are fortunate to have Mosby’s Nursing Consult on the intranet. Mosby’s contains evidence-based nursing monographs written by nurses, for nurses. These contain reviews of current evidence available to many clinical situations. Mosby’s also allows nurses to access respected leading resources in finding answers to many clinical questions.

The ultimate goal of evidence-based practice is standardizing nursing care using science and the best evidence available. The bridge between what is known to be the best nursing practice and what is actually practiced is getting shorter with all of the information available every day.

Mercy’s first annual poster fair The Research Council was excited to hold their first annual evidence-based practice (EBP), quality improvement and research fairs, May 5-9, 2014. The fairs were held at MHTC, Mercy Harvard Hospital, Mercy Walworth Hospital and Mercy Woodstock Medical Center. Hospital unit and clinic nurses who worked on quality initiatives or EBP projects or research were encouraged to create a poster to display and share their great work with nurses across the System. Approximately 20 posters were submitted and many Mercy nurses attended the fair to view the posters and reflect on the work Mercy nurses have accomplished! The next fair is scheduled for fall 2015.

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Mercy’s Professional Nursing Continuum

Implementation of a peer review program for nurses at the bedside This continues to be an exciting time for direct care nurses here at Mercy Health System. Whether you work in the hospital or clinic setting, how you practice as a Professional Nurse impacts the care of those you touch. As we move forward in our commitment to care for others, we have a personal obligation to define our practice.

Establishment of a formalized and meaningful peer review program is essential for the on-going development of nursing professional practice.

Corrine Kohn, BSN, RN

Enhancing nurses’ competence and professional development to meet the Magnet standards of Exemplary Professional Practice requires an organized approach. A team of nurses representing all three Mercy hospitals and our 43 clinics developed the Professional Nursing Continuum (PNC), a clinical practice advancement model based on Dr. Patricia Benner’s theory, Novice to Expert. The PNC combined this theory with Mercy’s professional practice model to illustrate the behaviors of each nurse as it relates to the values of the organization.

Clinical narratives are used to identify, recognize, and acknowledge nursing practice to determine the stage of development along the growth continuum. Peer review through narrative writing is an expectation of every bedside nurse. Utilizing a trained panel of the nurses’ peers, the nurse will be staged on the developmental continuum according to clinical behaviors identified in the narratives. Advancement along this continuum is based on experience, acquisition of knowledge, and development of skills over time.

Melissa Krueger, BS, RN, CNOR, PN

Beginning in 2014, nurses began writing their narratives. It is our goal as a Magnet organization demonstrating nursing excellence to stage all direct care nurses within the next two to three years. Together we are providing exceptional health care to promote healing in the broadest sense for each of our patients, every day, every visit and every hospital stay.

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“

“

Magnet excellence is important for all professionals at Mercy, as we strive to provide optimal care with the highest level of collaboration. It raises the bar for knowledge and growth in all of us, and creates a path toward great patient care outcomes and satisfaction.

—Donna Storbakken, PT, director, Mercy sports medicine and rehabilitation services

Research and EBP Toolkit development A toolkit has been developed by the Research Council to help organize the process of starting an evidence-based practice project.

This toolkit is available on the Mercy nursing website under the tab “For Our Partners” in the “Nursing Research Council” folder.

If you are interested in starting a project, please contact leadership to connect you with the Nursing Research Council who will assign you a mentor to guide you through your project.

2014 Mercy evidence-based practice projects Project

Project leaders

Entity

Insulin pump

Joni Flister, RN

System-wide

TCC

Tara Leiting, BSN, RN

Delirium monitoring in ICU

Amanda Drout, BSN, RN

MHTC

Capnography monitoring during procedural sedation

NIchelle Jensen, BSN, RN, CCRN

MHTC, moving to System

Pain scale in mechanically ventilated patients

Amanda Drout, BSN, RN Heather Strand, BSN, RN

MHTC

Mock code strokes

Kara Sankey, MSN, RN CMSRN Nichelle Jensen, BSN, RN, CCRN

MHTC

MWH

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Journal clubs: Strengthening your knowledge The Harvard/Walworth Journal Club is an intranet blog site that shares current nursing articles with Mercy partners. This journal club originates from Mercy’s critical access hospitals, but it is open to any Mercy colleague.

Deb Sitter, MEd, BS, RN, NPD-BC Clinical nurse coordinator, Mercy Harvard Hospital and Mercy Walworth Hospital

Articles are posted on the Mercy nursing intranet and partners are invited to respond with their thoughts and ideas about the article. Articles are timely and are usually representative of current initiatives at Mercy Health System. Articles have included topics such as teachback, bedside reporting, nurse/patient engagement, pursuing Magnet designation, structural empowerment, discharge instructions with teachback, fall prevention, peer review, the Affordable Care Act (ACA), health literacy and, most recently, lateral violence in nursing.

Readers respond to the article and/or their peers about the material and are free to respond as often as they wish. The following response to a recent journal club blog is from ED nurse and diabetic educator, Sherry Kirkpatrick, RN: “I agree with several points made in this article. ‘What you ignore you condone’ I thought was the most important. Peer to peer accountability combined with personal courage is so important, no matter how many years of experience you have. I really believe ‘respectful communication’ as a skill is as important as clinical knowledge as stated in the article. I believe the verbal recognition of specific values in each other is not used enough, from administration to coworkers. Compliments are as powerful as complaints.”

The ambulatory journal club The Ambulatory Journal Club began in 2013. There are currently three ambulatory journal clubs: Home Health and Hospice NPC Journal Club, McHenry County NPC Journal Club, and Walworth County NPC Journal Club. Sabina Mason, BSN, RN, CPHQ, ambulatory education coordinator, worked closely with NPC members to develop their journal club.

Sabina Mason, BSN, RN, CPHQ Ambulatory educator

The approach on the ambulatory side has been to reserve time during the NPC meeting to review and discuss the journal article. NPC members take turns leading a journal club discussion. Sabina continues to mentor members in choosing evidence-based articles and how to perform a literature search with the goal of empowering NPC members to pass these tools on to other partners in the clinics.

The direct exchange of ideas during NPC meetings has led to lively discussion, practice changes and other projects. Articles reviewed over the last year have included such topics as peer review, patient satisfaction, advance care planning, med reconciliation, melanoma, infection prevention, pain management, cognitive impairment, successful implementation of a journal club, changes in pneumococcal vaccination protocol, and calciphylaxis.

Pictured below is the Walworth County NPC Journal Club. Walworth NPC council chair, Michael Kennedy, RN, states, “It is so exciting to see the changes that have come out of the work begun during our NPC Journal Club such as the Televox project and working with marketing to develop posters that will be displayed in all of the clinics highlighting melanoma prevention strategies. Our NPC is so excited and energized because we are seeing results from our efforts!”

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Communication: Nursing newsletters The Clinic Voice The ambulatory education coordinator, Sabina Mason, publishes a newsletter called “The Clinic Voice” that is distributed to all ambulatory partners. It celebrates partner achievements, highlights events, shares important education updates, and notes NPC and journal club initiatives leading to practice changes.

The Clinic Voice is also a platform to give the direct care nurse a voice in her/his practice. Ambulatory CNO, Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC, includes a personal message in each newsletter.

Below is an excerpt from Jan: “… what comes to mind when you think of spring? Besides the ‘springing ahead’ of the clock, I am always amazed as the season brings new life and new growth. The same can be said of our continued journey to excellence. This is the time of year when we begin our nursing strategic planning process where nurses throughout the organization come together and celebrate our accomplishments over the past year. We also come together to communicate and collaborate on our learnings and plan how we will meet this upcoming year’s goals. It is the fresh ideas that are brought forward that allow us to continue to improve the care we deliver to our patients every day.

Thanks for all you do.” ~ Jan Here’s an excerpt from a Clinic Voice article highlighting how Mercy has prioritized advance care planning: Mercy Health System has joined the statewide initiative Honoring Choices Wisconsin (HCW) to make advanced care planning, including sensitive and often difficult conversations about end-of-life care, a standard part of patient care. This initiative enhances the advance care planning efforts that were available at Mercy previously.

We now offer our patients advance care planning conversations under the HCW model. An initial pilot began March 1 at Mercy Clinic North and Mercy Milton Medical Center and is being offered to any patient or partner who is interested. These conversations help patients understand their health care treatment options, appoint a health care agent, clarify goals, and weigh options about the kind of care and treatment they would want or not want. More importantly, it helps the patient communicate their wishes to family, friends, clergy, physicians and others. “The Honoring Choices initiative is an important aspect of our patient services and helps our patients have open and honest conversations with loved ones,” said Kelly Fehrenbacher, MD, geriatrics, hospice and palliative care medicine physician. “Talking with our patients about their future care wishes and concerns when they are healthy allows them to live the last chapter of their life with as much meaning and quality as possible.”

Honoring Choices Wisconsin was launched in 2012 as an initiative of the Wisconsin Medical Society to promote the benefits of, and improve processes for, advance care planning across the state, in health care settings and in the community. Since then, more than 4,000 patients have discussed their future medical decisions at 22 participating organizations. Mercy Health System is proud to be a part of this effort.

The Critical Access Hospital Newsletter The critical access hospitals’ (CAHs) clinical nurse coordinator, Deb Sitter, has created a monthly newsletter for CAH partners to highlight information specific to their facilities. She includes patient compliments and comments submitted by patients and/or their families to let the partners see the way their care actions impact the lives of their patients. Information includes new policies, education, the journal club, congratulations for new certifications, unit celebrations, and a CNO blog.

The CAH CNO, Caryn Oleston, writes a message to CAH partners about current events that may affect Mercy Health System and the current state of health care.

For instance, Caryn wrote about preparing for The Joint Commission (TJC) inspections and participation in the Magnet survey. Here is an excerpt from two of her blogs: “We will be doing ‘tracers’ and if you aren’t familiar with that term, let me explain. If a patient were to come through several different departments, the TJC would trace the patient’s care through those units. So a patient coming in through the ED, having tests done, and being admitted would prompt a look at every department the patient interacts with. This is a favorite of the TJC so we will do a few tracers ourselves. We are working on the question of the week, as it is something that many of you have said you like. These will be coming out soon.

Remember the surveyors don’t want to speak with administration—they want to speak to you and the patient. If anyone has ideas from other hospitals they have heard from, please feel free to let me know. We are always looking for new fun teaching techniques.”

“Thank you to each and every one of you that participated in and prepared for the recent Magnet survey. The surveyors were extremely impressed with every partner and community member that they came in contact with.

I had the pleasure of sitting in on the exit interview with Mr. Bea and the surveyors and the surveyors sang your praises to your CEO. I heard from our Magnet champions and escorts that they learned so much about the system and other units and found a new pride in being a nurse at Mercy.”

MERCY HEALTH SYSTEM // 73 // NURSING ANNUAL REPORT 2014 TRANSFORMATIONAL LEADERSHIP

STRUCTURAL EMPOWERMENT

EXEMPLARY PROFESSIONAL PRACTICE

NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS

Nurses are the heart and soul of Mercy!

As frontline care providers, our nurses work tirelessly to meet the needs of our patients at all hours of the day and night. They are healers, advocates, teachers, confidants and friends.

Whether they practice in hospitals, emergency departments, clinics, home health, or any of the other areas that nurses work at Mercy, they remain a constant presence on which our patients and families can count.

Thank you, Mercy nurses, for your life-saving care and life-changing work.

MERCY HEALTH SYSTEM // 74 // NURSING ANNUAL REPORT 2014

MERCY HEALTH SYSTEM // 75 // NURSING ANNUAL REPORT 2014

M e rc y N u r s i n g. o rg

Mercy Health System 1000 Mineral Point Rd. Janesville, WI 53548