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Our Magnet efforts are rooted in knowledge, Cultivated with a passion for excellence, And nurtured to sustain continued growth.

2010 Nursing Annual Report


The Providence Commitment

Mission

As People of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service.

Core Values Respect

All people have been created in the image of God. Genesis 1:27 We welcome the uniqueness and honor the dignity of every person. We communicate openly and we act with integrity. We develop the talents and abilities of one another.

Compassion Jesus taught and healed with compassion for all. Matthew 4:24 We reach out to people in need and give comfort as Jesus did. We nurture the spiritual, physical and emotional well-being of one another and those we serve. We embrace those who are suffering.

Justice This is what the Lord requires of you: act with justice, love with kindness and walk humbly with your God. Micah 6:8 We believe everyone has a right to the basic goods of the earth. We strive to remove the causes of oppression. We join with others to work for the common good and to advocate for social justice.

Excellence Much will be expected of those who are entrusted with much. Luke 12:48 We set the highest standards for ourselves and for our ministry. We strive to transform conditions for a better tomorrow while serving the needs of today. We celebrate and encourage the contributions of one another.

Stewardship The earth is the Lord’s and all that is in it. Psalm 24:1 We believe that everything entrusted to us is for the common good. We strive to care wisely for our people, our resources and our earth. We seek simplicity in our lives and in our work.


Providence Holy Cross Medical Center was founded in 1961 to provide healing and health care to the San Fernando, Santa Clarita and Simi Valleys. A 254-bed, not-for-profit facility, the medical center offers both inpatient and outpatient health care services, including state-of-the-art Cancer Centers, a Heart Center, Orthopedics, Neurosciences and Rehabilitation Services as well as Women’s and Children Services. Located in the San Fernando Valley of Southern California, Providence Holy Cross Medical Center has a nursing staff representing more than 600 nurses.

Services Include: Cancer Heart & Vascular Women’s Services Orthopedics Neuroscience Rehabilitation Subacute Surgery Digestive Disorders Trauma & Emergency

2010 Statistics of Interest: Employees: 1,900+ Medical Staff: 650+ Licensed Beds: 254 (377 in 2011) Births: 2,938 Admissions: 14,565 Average Daily Census: 187 Outpatient Visits: 59,501 Emergency Room Visits: 61,591 Trauma Cases: 1,588 Inpatient Admissions: 15,229 Inpatient Surgeries: 5,469 Outpatient Surgeries: 1,912

1


Table of Contents

2

Message from CNO

3

Transformational Leadership

4

Structural Empowerment

8

Exemplary Professional Practice

16

New Knowledge, Innovations & Improvements

34

Awards & Recognition

40

In Memoriam

41


Dear Colleagues, It is with pleasure that I write and send a report to you in regard to the achievements of the nursing staff at Providence Holy Cross Medical Center. As you turn the pages of the annual report, you can feel the pride, recognize the accomplishments and wonder what lies in store for 2011. This will be a Magnet® Re-designation year full of energy to underscore the great work achieved by nurses, doctors and ancillary services to achieve the quality initiatives.

The 4 C’s of PHCMC: Caring, Compassion, Competence and Collaboration have become the foundation for the core values, vision and Mission. Our professional practice model, based on nursing theorists Patricia Benner and Jean Watson, support the 4 C’s in caring, education, professional growth and retention. As a Magnet® designated hospital, we demonstrate every day the excellence in patient care that our community expects and deserves for themselves and their loved ones. Our nurses exemplify professionalism in their journey to expand their knowledge to provide the best evidence-based practice possible. Many nurses have become certified in their specialties, have returned to school for advanced degrees and have attended the wide array of education opportunities that our Nursing Education Department provides. Our nurses have taken a leading role in system-wide projects, as well as multidisciplinary and multi-organizational projects. We have had a consistent

TRANSFORMATIONAL LEADERSHIP

Message From Our Chief Nursing Officer

presence as presenters at conferences. The support of Providence Holy Cross Medical Center for these nursing opportunities and experiences speaks to the high regard for nurses within our organization. Among our highly recognized programs this year were our Stroke Program, which received Disease Specific Care Certification for Stroke from Joint Commission, Level 2 Trauma Program that is Verified by the American College of Surgeons Trauma Committee, Lactation Program that has been Baby Friendly USA-designated since 2007 and received the Workplace Accommodation Award, Diabetes Program, which is both Sweet Success-Certified and recognized by the American Diabetes Association, and many, many more. As Providence Holy Cross Medical Center grows in size, it also grows in the talent pool, level of education and contributions to patient care in both our internal and external communities. As we grow and extend our roots further, we will strive to maintain the sense of family among our staff and within our community that sets us apart from many other medical centers. We expect to rise to the challenges of growth by building on our strengths from our foundational leaders. Our staff has been extremely patient with our construction processes and we all look forward to settling into our expanded surroundings to continue our traditions of excellence, stewardship, compassion, justice and respect.

Betty Newsom, RN,MS,CNAA

3


Our Nursing Vision THE 4 C’s OF PHCMC NURSING M

NG

CO SI

CA

RI

S PA

Patient and Family

ON

PHCMC Nursing Philosophy Achieving Excellence in an Evidence-Based Practice Environment

CO

LL

A

PH&S Nursing Vision Statement

BO

RA TI

O

N

Mission and Core Values

CO

M

PE

N TE

CE

Professional Practice Environment

Our Providence Health & Services Nursing Vision Statement: Providence nurses embrace their heritage of compassion, courage and leading-edge care as a steadfast, sacred presence in protecting and easing the way for those in need. Our Providence Holy Cross Medical Center Nursing Philosophy Statement reflects the unique theoretical underpinnings of our approach to nursing care and professional development: In concert with the Mission and core values of Providence Holy Cross Medical Center, our professional nursing staff is dedicated to the promotion of health and wellness as the basis for nursing practice. In collaboration with the healthcare team our nurses attend to patient needs with the highest level of ethics, judgment, confidentiality and respect for human rights, dignity and diversity. It is our belief that a holistic and caring environment nurtures and supports the patient on a journey toward self care. We are responsible for illuminating the path and competently leading the way.

NURSING STATS

4

MAGNET AVERAGES

PHCMC

RN TURNOVER

11.52%

8.9%

RN VACANCY

3.6%

1%

RN CERTIFICATION

27%

24%

LEADERS CERTIFICATION

45%

57%

BSN

46%

37.5%

MASTER’S DEGREE RN AT BEDSIDE

3.7%

2.6%


Betty Newsom, RN, MA, CNAA, Chief Nursing Officer Ken Archulet, RN, CFN, Manager Epidemiology and Infection Control Deborah Bergida, RN; MSN/MHA, OCN, CMSRN, Director Medical Surgical Missy Blackstock, RN, BSN, Director, Emergency Department Jerilyn Brown, RN, OCN, Director Patient Care Support Services Tricia Burkholder, RN, BSN, Director Maternal Child Health Linda Coale, RN, RN, MBA, Magnet Program Consultant Kate Connolly, RN, BSN, Director, Post Acute Annette Cordero Britton, RN, BSN, PHN, Director Occupation Health and Safety Jane Flaherty, RN, MSN, CNS, PCCN, CCRN, Director Education

TRANSFORMATIONAL LEADERSHIP

2010 Nursing Leadership

Sherri Friedrich, RN, MSN, FNP-BC, Manager Stroke Program Yvonne Gaffney, RN, BSN, MBA, CNOR, Director Perioperative Services Heinrich Huerto, RN, MSN, ONC, Manager Orthopaedics Kathy Kirby, RN, BSN, Manager Telemetry Joanna Kuzmak, RN, BSN, CCM, Manager Case Management Ronda McPhail, RN, BSN, Manager, Labor and Delivery Patricia Mayberry, RN, Director Clinical Project Implementation Sherri Mendelson, PhD, RNC, CNS, IBCLC, Director of Nursing Research and Magnet Program Lisa Pettinelli, RN, RRT, CEN, Manager, Respiratory Care Services Pam Rick, RN, BSN, Director, Critical Care Services Barbara Rozewicz, RN, MSN, CCRN, CMC, NP-C, Manager Cardiology Jennifer Wobig, RN, BSN, Director, Trauma Services Cathy Yee, RN, MSN, CCRN-CSC, Clinical Nurse Leader Surgery

5


Message About Employee Service & Excellence The email below was written by the hospital’s Chief Operating Officer and was distributed to all employees via email. The note speaks about the employees and our family-like culture at Providence Holy Cross. From: Berz, Derek W Sent: Friday, March 05, 2010 2:59 PM To: CA HC All E-mail users Subject: Thoughts from Service Awards On Wednesday of this week, Providence Holy Cross held the Service Awards at the Odyssey restaurant. Every year this is an amazing event recognizing our employees who have reached years of service ranging from 5 to 40 (sometimes more….) years with Providence. As I drove home and had some unexpected traffic, I had time to reflect on what this really represents. It is incredible to think that as we look back over the 5-40 years of this hospital, how many changes there have been – from re-births after disaster, trailers and temporary workspace, service changes, census changes (1994 census was 80) etc…and now in 2010 we are still transforming in many of the same ways. That evening we heard wonderful stories of dedication and compassion of our employees who make Holy Cross. The history of our ministry is rooted in the people who sustain it. You each carry on the ministry the Sisters of Holy Cross and Sisters of Providence started. It is inspiring how, no matter what your role is in the organization, you are part of creating new stories of touching people’s lives. It is comforting to know that such a group of dedicated and talented people are here for the vulnerable who seek our compassionate care. Since I have been at Holy Cross I have been involved with patient/family care, hospital management and personal changes (being married and now having twin boys) and so I also recognize that we touch each other’s lives providing care and friendship to each other, in good times and when we ourselves are vulnerable, as team members, as we go through life. Look around and you will see that we could not do what we do without the team around you. The strength of the years of service is also a strength of the Holy Cross “family”; the strength of common mission and core values drives the culture we need to fulfill our responsibility to those who trust us with their care in the future. I am not a great writer or experienced with getting these thoughts out, but I wanted to share this reflection in the context of thanking you and also inviting you to reflect on how this will reveal itself for you in your future daily lives here as we go through the growth of our medical center and we continue to strive for excellence in quality and safety.

Again, Thank you Derek Berz, MHA, CMAC, FACHE Chief Operating Officer Providence Holy Cross Medical Center

6


OPERATING COMMITMENTS

STRATEGIES

SUCCESS MEASURES

Mission Inspired

Palliative Care Program

Increased palliative care referrals

People Centered

Increase number of certified RNs

Number of certifications

Increase number of BSN/MSN prepared nurses

Number of new degrees

Recruitment and retention of qualified staff for new tower

Workforce model and staffing plan

Career Path Development (staff and leader group)

Succession Plan designed

Improve patient satisfaction via Press Ganey scores

Increase from 2009

Enhance process to support community outreach

Increased community education and programs

Innovative nursing research projects

2 completed studies

Nurse sensitive indicators (fall and hospital acquired pressure ulcers) scored at top half of cohort

Below the mean for NDNQI

Reduction of employee injuries

Number of injuries

Collaborate with Foundation to increase funding for Nursing Research and Education

Increased funding

New Wing expansion opening plan

Plan completed

Valley Services Integration Plan

Planning phase completed

Stroke Certification

Attainment

Preparation for Level II NICU

Completion of staff training

Service Oriented

Quality Focused

Financially Responsible

Growing to Serve

TRANSFORMATIONAL LEADERSHIP

2010 Nursing Strategic Goals

Completion of policies/procedures

7


Our Community

POPULATION BY AGE 0-13 28.48%

14-24 25-44 45-64

22.74%

22.05%

65-84 85+

17.65%

EDUCATIONAL ATTAINMENT Still in School/Too Young 12.13%

for School Out of School K-8th Grade

9.63%

39.71%

Some High School

11.80%

High School Graduate Some College - No Degree

7.88%

Associate’s Degree Bachelor’s Degree Graduate/Professional Degree

8

3.66%

11.77%

3.42%

7.81%

1.26%


STRUCTURAL EMPOWERMENT

POPULATION BY RACE

Asian Black

58.36%

Hispanic 27.95%

White Other

7.63% 3.64%

2.42%

INSURANCE STATUS OF COMMUNITY RESIDENTS

% of Total Uninsured

30.14%

% of Medi-Cal % of Medicare

17.45%

27.50%

% of HMO % of PPO

8.40%

16.51%

9


Priority Healthcare Issues in Our Community • Mental health services that are affordable and accessible, especially

for children, older adults, homeless, veterans and undocumented.

• Affordable and portable health insurance and providing access for

undocumented individuals.

• Permanent supportive and affordable housing including more

Section 8 housing and emergency shelter beds.

• Chronic disease management and prevention with a focus on diabetes,

hypertension, obesity and asthma.

• Dental health services that are affordable and accessible especially

for adults, seniors and low-income children.

Emergency Room Upgrades Technology to Increase Health Care Efficiency Providence Holy Cross Medical Center has embarked on a technology upgrade, funded by a $500,000 grant from Verizon that will improve the hospital’s efficiency, increase accuracy of patient records and initiate health care outreach for uninsured Californians. The two-year grant - awarded by the Verizon Foundation, the philanthropic arm of Verizon Communications - was announced in early 2010 at a reception attended by Assemblyman Felipe Fuentes, retired Assemblyman Keith Richman, M.D., and executives from Providence Health & Services, Southern California region, which operates the medical center. Verizon’s generosity will help take Providence Holy Cross Medical Center into the future. And with our entire nation so focused on health care, this gift is a shining illustration of how private enterprise can work with healthcare providers in reaching out to those most in need. The grant will fund a kiosk in the hospital’s busy emergency room where patients will check themselves in, following instructions in either English or Spanish. The system will reduce the time people wait for treatment, increase the accuracy of medical records and alert the staff to the most urgent cases so they are treated immediately. The grant also will establish an outreach program to help uninsured patients find cost-effective primary health alternatives to treatment in the emergency room, and will enable the purchase of new software for computers in the medical center’s 138-bed expansion, which opens in 2011. The computer system will enable staff to print identification bracelets at a patient’s bedside and help ensure all laboratory orders and tests are matched with the correct patient. Verizon’s generosity and commitment to our community will improve the delivery of health care services to the uninsured and is an important contribution to the health care issue. At the same time, Verizon’s donation will help relieve the pressure on the hospital’s emergency room.

10


Our nurses have ample opportunity for participation, to help form the direction for the Department of Nursing and to collaborate with other departments through our Shared Governance Structures. The following list includes the Nursing Committees and Chairs for 2010.

COUNCIL/COMMITTEE CHAIR Acute Rehabilitation Collaborative

Kate Connolly

Assistant Nurse Manager Council

Cary Faulkner

Brain Trauma Injury Committee

Jennifer Wobig

Breast Feeding Task Force

Sherri Mendelson

Chapter Chair Council

Laurie Marx

Clinical Education Council

Jane Flaherty

Core Measures/Nursing Quality

Deborah Bergida

Clinical Ladder Committee

Cynthia Funakoshi

Clinical Practice Council

Patricia Porter

Clinical Nurse Leader Committee

Ronda McPhail

CPR Committee

Chris Consolo

Critical Services/Trauma Clinical Practice

Kathy Cadden

Cultural Diversity Council

Kate Connolly

Disaster Council

Connie Lackey

Documentation Management Committee

Jeri Brown

Donor Council

Phil Abraham

Emergency Department Unit Based Council

Carol Carter

Falls Committee

Ramona Rojas

Interdisciplinary Palliative Care Team

Karen Roberson

Interdisciplinary Patient and Family Education

Kate Connolly

Labor and Delivery Clinical Practice

Marilyn Herrick

Magnet Council

Karen Watson & Sherri Mendelson

Mother-Baby Clinical Practice Committee

Sherri Mendelson

Med Surg Unit Based Management Team

Terrie Bybee

Med Surg/Post Acute Divisional Practice

Kathy Christian

Medication Management/Safety Chapter Chair

Tawny Bui

Meditech User Group

Michelle Dressback

Nurse Manager Council

Kate Connolly

Nursing Research Committee

Sherri Mendelson

Patient Care Leadership

Betty Newsom

Patient Safety

Jean Marie Kane

Performance Review

Tim Gilmore

Peri-operative/Invasive Meeting Group

Lisa Fetterolf

Products and Standards

Ken Archulet

Provision of Care Council

Jeri Brown

Recruitment and Retention Workforce Planning

Jeri Brown

Nursing Director Council

Betty Newsom

Safety Committee

Connie Lackey

Telemetry Unit Based Management Team

Linda O’Reilly

Tracer Team

Laurie Marx

Wound/Skin Committee

Monica Tweddell

STRUCTURAL EMPOWERMENT

Nursing Shared Governance

11


Clinical Ladder The Clinical Ladder provides a vehicle to expand and advance the practice of professional nursing at PHCMC for the registered nurse. The Clinical Ladder helps to demonstrate the forces of magnetism inherent in the structures and processes of the nursing organization at PHCMC. Our Clinical Ladder design is based on Benner’s Novice to Expert theory and recognizes the contribution of nursing excellence within our organization.

CLINICAL LADDER COMMITTEE Cynthia Funakoshi (Chair) Tanya Haight (Co-chair) CLINICAL LADDER LEVEL 3

CLINICAL LADDER LEVEL 4

EDUCATION

EDUCATION

Aurora Tweddell

Cynthia Funakoshi

Mary Juarez

Tanya Haight

EMERGENCY DEPARTMENT Terri Halverson ICU Melissa Tell LABOR AND DELIVERY Kristina Shannon

Kathy Christian Kristi Muira Karen Watson ICU Carole McKennan Christina Consolo LABOR AND DELIVERY

NICU

Linda Harrington

Barbara Russo

Yajaira Angulo

Pensri Choti

Tenesa Reid

SUBACUTE

MED/SURG/ONCOLOGY

Susana Austria

Terrie Bybee

TELEMETRY Edeliza Rosales

Teodora Tiongson Ingrid Blose

Cecile Salvador

TELEMETRY

Linda O’Reilly

Debbie Welch Wendell Garcia Beverly Gumodga

CLINICAL LADDER LEVEL 5 EDUCATION Sherri Mendelson Kimberly Crabtree Loyd ICU Kathy Cadden

12


As part of our Nursing Clinical Ladder application process, nurses must submit their personal nursing philosophy statements. Below are selected portions of a sample of statements from 2010 applicants. Jessica Horst, RN, BSN In keeping with Benner’s nursing philosophy, I acquired my BSN degree through the University of Phoenix in 2008. I have since aspired to expand my knowledge and experience as a critical care nurse by applying my BSN education as a Neurotrauma nurse, Second Charge nurse and Rapid Response Team nurse. I have had the pleasure of sharing my knowledge and clinical expertise precepting new grads and new employees to the critical care unit. I have also just recently had the opportunity to be a member of the new Night Shift Council and participate in its pilot meeting, as well as acquire the position of co-chair. I am excited to partake in this new endeavor in order to address the concerns and unique needs of night shift nurses hospital-wide.

Bilma Pellissery, RN, MSN My nursing philosophy is based on the ANA definition of nursing (American Nurses Association, 2004, p. 7). I believe

STRUCTURAL EMPOWERMENT

Personal Nursing Philosophy Statements from a Few of Our Clinical Ladder Applicants [excerpts]

this to be the core characteristics of nursing. My nursing philosophical aspects consist of advocacy, respect, compassion, patience, knowledge, time management, caring and a positive attitude. I do adhere to more than one nursing theory such as Patricia Benner’s Novice to Expert model, Leininger’s Transcultural theory, Jean Watson’s Caring theory, and Orem’s Self-care theory. This approach allows me to function as an excellent care-giver. I do believe that nursing care should consider the physical, psychological, social and spiritual well being of each person. My future goals as a clinical nurse, level four, include earning my NP or CNS and eventually a PhD in nursing education.

Stacey Beatty, RN, BSN In my nursing practice I incorporate several nursing theories. I strongly believe in patient-centered care. Involving patients and their families in their care promotes independence. Faye Abdullah’s grand nursing theory on patient centered approach encompasses this belief. She developed a list of 10 nursing skills to help identify a patient’s problem and develop a treatment plan. One of the 10 steps includes knowing your patients by understanding their viewpoints regarding their illnesses. As a nursing instructor, mentor and preceptor, I incorporate Patricia Benner’s Novice to Expert model. I use this model to assist a student or new graduate nurse to advance to the next level and develop critical thinking skills.

Lisa Fetterolf, RN My philosophy in nursing is really quite simple. I take care of my patients as if they were my mother or father. My calling as a nurse started out in 1976 when I took a nurse’s aide class. I was 16 years old, but found the job rewarding. I felt good helping people. My mother graduated nursing school the next year; the same year I graduated high school. Later, my mother, my sister and I all worked at the same hospital. Twenty-eight years later, as a Registered Nurse, I am pursuing my BSN. I came to Providence Holy Cross Medical Center in 1993. It was still run by the Sisters of Holy Cross. Many changes have taken place through the years in the hospital as well as in nursing. I feel fortunate to be part of it. Sure, no more metal bed pans or standing when the doctor walks on the unit, but the changes in our profession, I feel, have allowed for better care for our patients. We, as nurses, have more opportunity for education. We work together with the physician as well as other disciplines to ultimately provide better education and care to our patients.

13


Helping Other Communities Trip to Haiti February, 2010 On February 6, 2010, I flew to Haiti to help with healthcare needs that already existed prior to the earthquake and were now complicated because of the disaster that struck their country. I was accompanied by two physicians from our Southern California area and four other nurses and four EMT/paramedics. I came in a dual role on this trip knowing what I do about health care, years of being a nurse’s aide and years of being an EMT/Paramedic/Nurse. I felt I was up for the challenge. This was my first trip for missions out of the country and having the disaster made it more of a challenge. God had told me to go and so I had a calling to answer to as well. We all were asked to gather supplies to take. I got on the phone and called Peter Barry with Providence Hospital. He was so amazing and helpful in getting me supplies to take. Our group had over 30 suitcases full of supplies in total on the day we left Los Angeles International Airport. There were literally thousands of people outside the Haiti airport, I think looking for loved ones, and they were loud. We had a bus waiting for us from the Youth with a Mission group and this is where we stayed for five hours before getting on the bus to Port au Prince, Haiti. We encountered a nine-hour ride instead of the six we were told it would take to get there, and what a ride it was. The damage was apparent: broken roads from the earthquake and bridges that were now gone, so we just drove right through the rivers. We were able to see the many healthcare workers from around the world who came and the lines of people getting food. The children were standing alone without any adults and under the wings of a nurse in a line of the crowd. We drove up to our destination, Mission of Hope. The address is 777, so praise God, we all shouted, as we saw the sign and the gate opens for our welcoming. We had all brought sleeping bags and tents and had been told we could have a bunk and that there was some running water here. The next morning we had set up our supplies and opened bottles of medications and started labeling bags for prescriptions. We did this for eight hours while a few others helped at the warehouse unpacking supplies that came on train cars and such. Some helped at the clinic as well. Pastor Andre was right at work, praying for the sick. He even married a couple in their hospital room. I could hear singing and I wanted to be where it was, so I came down the hill to the bottom of the road where a huge crowd was in the open air sanctuary singing worship songs that had a familiar tune. This was overpowering. We had a trip to a village called Orange where there is no running water or electricity and only a generator. We were told to be sure and leave by 4 pm as it would be dark. We arrived at the village, a primitive area, and were greeted by the people who helped us move the supplies to their church building to set up for a clinic. There was a man who sat in the front entrance and logged in the name and age and complaint on a paper and also in a book for the church record. From there the patients went to triage and had vitals signs taken and then went over to a bench to wait to be called by the doctor who was at a table with a nurse and translator. If they needed an IV for rehydration or any immediate intervention it was done: fever control, wound cleaning, cast change. We treated malaria and impetigo, yeast infections, urinary tract infections, respiratory infections, otitis media, hypertension, congestive heart failure and atrial fibrillation that day. After patients were seen, they took their papers to the pharmacy section to get medication and teaching by another translator and RN.

14


was going to deliver their babies. The answer was, they deliver their own. It was now 3 pm and we had seen the last of the 250 people. This was the first day doing a mobile clinic and we were already out of doxycycline, much needed here for malaria. We all prepared for the next day of clinic in a city in the worst part of Port Au Prince called the land of Black. We set up clinic the next day for three days at this location. We encountered an anaphylactic reaction on arrival, a man who had urinary retention for two days and a 10-year old with a femur fracture from the first day of the earthquake who hadn’t yet been treated. The line of people was forever it seemed, but each one was so kind and not once did anyone say “I have been here for hours, what’s taking so long?” We gave out so many things, but most of all, hope. There was a call to prayer and fasting while we were there for three days and we had the pleasure of hearing singing the whole time. It was powerful. We treated more than 667 people in the outside clinics away from the orphanages’ home base hospital and clinic, and used almost all of our medication and supplies that we brought with us. We left the rest behind for use as well

STRUCTURAL EMPOWERMENT

We also noted that the pregnant mothers had never been seen by a doctor. We gave out vitamins and asked who

as our bags for transport. The goal to go back is in the planning stages as I will return with a team of nurses to teach a few to be midwives in the villages. There is a big need for education to pave the way for safer passage into this world for these women and babies as many die in childbirth each year. I can never forget the people we met and the lives touched by our faithfulness to go to this country and help. I am working on the birthing project and hope that the Sisters of Providence will let us come to join them in Haiti also. I am Faithful

Susan Ortiz RN, FCN, Pastor

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Providence Holy Cross Becomes an Advanced Primary Stroke Center In June, 2010 PHCMC received Disease Specific Care Certification for Stroke from the Joint Commission. We are recognized as a primary stroke center and Emergency Medical Services diverts patients with stroke signs or symptoms to facilities such as ours with this designation. All five Providence hospitals in the Southern California region are now designated stroke centers. We Received the Bronze Award from The American Stroke Association in November 2010. This recognizes PHCMC as being competent with stroke core measures at least 80% of the time. Holy Cross will be eligible for the Silver Award from The American Stroke Association in January, 2011. Our Stroke Program has been actively involved in the community and is dedicated to providing education for stroke prevention. We have held two health fairs and one community lecture during 2010 at our Porter Ranch health center. Included in our community education and screenings were blood glucose screening, blood pressure screening, BMI testing and education regarding risk factors, signs and symptoms, as well as treatments. For high-risk patients we also offered carotid ultrasounds and cholesterol screening. This year we initiated a stroke support group available to the public that is administered through our rehabilitation therapies department.

16


The Providence definition of palliative care is comprehensive, specialized care provided by an interdisciplinary team to patients and families living with life-limiting, advanced illness or decline, where care is particularly focused on patient- and family-directed goals of alleviating suffering and promoting quality of life. Palliative care delivers pain and symptom management, information sharing, advance care planning, psychosocial and spiritual support and coordination across the care continuum. Providence Health and Services has set a goal that by 2012 every patient with a life limiting illness or condition will receive palliative care services. Palliative Care is one of three major focuses for Clinical Advancement within nursing leadership. The five ministries in California are collaborating as a region to help shape the model of palliative care throughout our organization. At Providence Holy Cross Medical Center, palliative care was fortunate to have received a generous grant from Unihealth Foundation to promote advance care planning and palliative care for the inpatient setting and at the primary care level. Over a two-year period primary care physicians, patients, community and hospital staff received education and encouragement regarding advance care planning. After an exhaustive search, we successfully added a palliative care physician to our program. The palliative care team includes the physician, palliative care nurse and house-based social workers, chaplains and case managers.

EXEMPLARY PROFESSIONAL PRACTICE

Palliative Care Expands to Serve Patients

The palliative care program at PHCMC received 366 referrals in 2010 (exceeding our goals) and that is expected to increase in 2011. We continue to provide education to hospital staff regarding palliative care and will be launching special training for the unit in our expanded wing, housing the newly established Comfort Care room. The focus will be on end-of-life care and the role of the interdisciplinary team in supporting patients and families. Overall, the support from physicians and hospital staff has been very positive. We are finding that many hospital staff are eager to learn more about palliative care and also participate in promoting the basic concepts of patientcentered care for our patients. The Mission and core values of Providence set an expectation and a climate that nurtures the concepts of care for our most vulnerable patients and families and fosters a quest for excellence in this important effort.

17


Organ Donation – Saving Lives

 

Providence Holy Cross, as a Level II Trauma Center, participates with One Legacy to ensure that families have the opportunity to fulfill the wishes of their loved ones. Particularly noteworthy in 2010 is the fact that 46 organs from 11 organ donor patients were recovered and transplanted. Ultimately, a total of 40 recipients (some recipients receive multiple organs) benefited from the gifts made by these donor patients and their families and obviously the good work of our hospital staff. The recipients ranged in age from 5 months to 71 years and included multiple kidney recipients who had been on the waiting list for more than 3,500 days! A strategic plan was developed in partnership with the following Hospital Representatives: The Donor Council with Kathy Cadden, RN, MSN, Assistant Nurse Manager ICU and Kristi Miura, RN, Clinical Educator, ICU. Performance goals included 100% timely referrals and maintain or exceed our 2009 conversion rates. Strengths and successes in 2010 include an active partnership between One Legacy and PHCMC, our high rates of early referrals and a conversion rate of 69%.

ADDITIONAL DATA Organs Transplanted by Organ 1st QTR

18

2nd QTR

3rd QTR

4th QTR

YTD

Lung

2

6

3

0 11

Heart

1

3 0

0 4

Liver

1

4

4

1 10

Kidney

2

6

6

4 18

Pancreas

0

3 0

0 3

Small Bowel

0

0

0

0

0


The Sub Acute Unit at Providence Holy Cross takes great pride in being able to provide a home-like environment for our chronically ill patients. For our patients, the unit is their home, sometimes for years and sometimes for the rest of their lives. We strive to make our environment family-friendly, a place of comfort and healing. Sub Acute patients have complex needs and present with varying levels of abilities. To meet criteria for Sub Acute care, the patient must have at least three skilled nursing needs. Presently, all of our patients have tracheostomies, half of our patients are on ventilator support, most have G-tube feedings and catheters. Some of our patients are comatose or in persistent vegetative states, but many are able to interact and participate in activities of daily living. Each month our Activities Team develops a calendar of events and activities. Patients participate in live entertainment, exercise, viewing movies and more. A dedicated volunteer comes in once a week to teach crafts (‘Crafts with Carleen’). We celebrate birthdays by ordering cakes and recognizing each individual with a birthday every month. Holidays are celebrated with planned festivities. One of the big events we celebrate each year is Cinco de Mayo. We open the invitation to this event not only to patients, friends and family, but to the whole medical center. On this day we barbecue more than 200 pounds of chicken and have a Mariachi band. Everyone looks forward to this event! We celebrate Christmas, Easter, the 4th of July and Thanksgiving by inviting friends and families to socialize and share food. Our patients are also in need of spiritual support, so we conduct religious services weekly in our Day Room. Chaplains read inspirational and Biblical writings. There is also fellowship in song, often with live musical accompaniment.

EXEMPLARY PROFESSIONAL PRACTICE

Sub Acute Unit Connects to Patients & Families

Knowing that our families need help to cope with feelings of loss and frustration, we conduct a monthly Family Support Group. At this group the families share their hopes, fears, stories of encouragement and tears. We serve light refreshments and have a new focus issue each meeting; educational, spiritual, informational, and/or psychosocial. When a loved one passes on, we have memorial services for our patients and family members. Due to the positive relationships we have forged with our patients and families, we have been able to conduct some important research studies in the Sub Acute Unit. Our research on gastrostomy tube residuals and repositioning has been possible because our patients and families trust us to do what is best for the patient’s safety and well-being. It also gives a sense of purpose to our population. The husband (and decision maker) of one patient, a former physician, signed the research consent and said, “She would have wanted to do this to help others”. At the Sub Acute Unit we recognize the worth of each individual life. We work with a great interdisciplinary team to treat our patients holistically. We provide the support necessary to promote independence and the best quality of life possible. The work is not easy, but it is rewarding.

19


How New Nurses Grow at Providence Holy Cross Two New Graduate Nurses Tell Us How They Learned About Physician Nurse Communication Robert Mejia, RN I believe that today’s experience with Dr. Gorakshakar was beneficial to my nursing career because it helped me understand the doctor’s routine and what is needed from me as the nurse. Rounding with the doctor helped reassure me that it is expected for a nurse and a doctor to converse and that it is perfectly acceptable for the nurse to approach the doctor with questions. I liked knowing what I should communicate with the doctor and how I should gather and save that information for them to be able to provide it more efficiently. I learned what daily information the doctors will likely want to know such as trends in WBC, H/H and PLT from the CBC and trends in Na, K, Cl, Bicarb, BUN, Cr and glucose from the BMP. I will also need to be familiar with the patient, their chart and vital signs to be effective in providing information to the physician and, of course, improving the quality of care to the patient. Other things I need to have ready for the physician would naturally be any other significant changes that may occur as well, such as ECG changes or unexpected elevated Troponin levels. Talking with the doctor also gave me a better idea of what I should be concerned with when taking or giving report such as being more aware of not only code status but also advanced directives, who their primary care physician is and what level of activity the patient is able to accomplish. As a new graduate nurse I have been most concerned with my day-to-day nursing activities and have not been very focused on advanced directives or who their consulted doctors are. I hope to make a greater effort to recognize that kind of information because it will help me know who to call or what type of care the patient is willing to have if anything unexpected should happen. In the end I think more positively about the type of relationship I can have with the physicians after my experience rounding with Dr. Gorakshakar. With the knowledge I have gained I hope to make a better impression on the doctors and in turn I hope it will make for the best patient outcome.

20


I just finished rounding with Dr. Gorakshakar and found the experience to be extremely helpful. We began in the ER where we observed an admission and H&P. Here Dr. Gorakahakar went through the generic order sets and explained the importance of handoff communication from the ER to the floor, stressing the need for code status, attending/primary physician and activity to be addressed. From the ER we headed to the PACU for a discharge. Dr. Gorakshakar went through the Med Reconcilliation for discharge to home and explained the importance of not only copying the printed version, but also copying any handwritten orders as well, such as narcotic prescriptions. Next we headed to 3C and 4C for patient rounds. Here I was fortunate to observe how a physician prepares for a patient by reviewing previous doctor’s notes, orders, labs, vitals and procedural results as well as the nurse’s role in communicating this information. As nurses, we can really help the doctors out by giving concise updates. Overall, I felt that today was very helpful and would recommend it for future new grads. Dr. Gorakshakar was great and did an excellent job of explaining a physician’s role.

EXEMPLARY PROFESSIONAL PRACTICE

Erik Nosker, RN

21


Outcomes & Excellence The Joint Commission Strategic Surveillance System (S3) scores for Q4 2010. Providence Holy Cross received a score of 5 (lower is better), which puts us in the top 10% for all hospitals in the country. The S3 score takes into account compliance with core measures (ORYX), past survey findings, complaints, and HCAHPS scores and indicates an overall level of compliance with performance expectations.

OVERALL PFP POINT TOTALS NOTE: Higher point totals may indicate risk as the data that assign points are primarily negative and outlier data.

PFP POINT TOTAL

100 80

66

60 45

40

33

38

27

Preliminary Denial of Accreditation (n=10)

Conditional Accreditation (n=95)

22

For Cause Survey (n=510)

COMPARISON GROUPS

University Health System Consortium Full Members (n=105)

US News America’s Best Hospitals (n=142)

2009 Thomson Reuters 100 Top HospitalsÂŽ (n=89)

Magnet Hospitals (n=314)

Region IX (AS, AZ, CA, GU, HI, NV) (n=466)

CALIFORNIA (n=252)

National (n=2678)

Providence Holy Cross Medical Center (n=1)

8

Top 25% Hospitals (n=681

0

6

Top 10% Hospitals (n=268)

20 5

47

37

37

32

52


The PHCMC Education services are directed by Jane Flaherty, RN, MSN, CNS, PCCN, CCRN. New educator positions were added in 2010 for the Perioperative, Telemetry and Medical-Surgical areas. A new course, Preceptor Renewal Workshop, was developed this year. This will help to ensure that preceptors are up-to-date on teaching methods and expectations as we add staff in 2011 to meet the needs of our expanding hospital. Particular sources of pride among our educators are the specialty new graduate intern programs and the specialty certification review courses offered at Holy Cross. In 2010 a full complement of classes were provided. This included an NICU course, an MICN course for the Emergency Department and Stroke education. These are among many educational areas that were added to our impressive list of classes offered to our nursing staff. A total of 1,303 contact hours of in-class nursing Continuing Education was offered at Holy Cross this year in addition to the basic orientation, CPR and on-line courses. Four PHCMC RNs were enrolled in the BSN program offered by University of Great Falls (Montana) in 2010. Remote nursing classes held at Holy Cross began in July 2010 and will be completed in December, 2011. Our nurses attended a two-week intensive session on the UGF campus in summer 2010, followed by the video and online instruction at PHCMC. Providence Health & Services offers significant scholarship assistance for tuition and fees. University of Great Falls is reserving 72 slots for Providence Health & Services nurses in 2011. Providence Holy Cross Medical Center is known within our nursing community for its excellence in education.

EXEMPLARY PROFESSIONAL PRACTICE

Educating Our Nurses

23


Trauma Services – An Integral Role in the Hospital The Providence Holy Cross Level II Trauma Services saw 1,136 patients in 2010. One hundred thirty-six of those patients arrived by air to our hospital helipad. Our Trauma program is verified by the American College of Surgeons Committee on Trauma. This year, our Trauma Services had a particular focus on brain injury. Due to our location at the crossroads of two major freeways we have a high number of trauma patients resulting from car accidents. Motor vehicle trauma accounted for 28% of our cases in 2010. We developed a taskforce to standardize care of these fragile patients. Through this taskforce we were able to devise an order set for this specific patient population. Additionally, we instituted weekly brain injury rounds. The taskforce identified a need for a brain injury support group for patients and families. The planning phase will lead to action early in 2011. Also in 2011, as we open our new wing, a specialized Neurology Unit will finally be a reality at Holy Cross. Jennifer Lindskog, our clinical educator for the Emergency Department, helped develop an on-site trauma nurse’s MICN- core course. An instructor was brought in to train our nurses in this course. We now have six internal instructors and have received approval from the Emergency Nurses Association for our course participants to receive continuing education credit. In partnership with our Disaster Committee we developed a Trauma and Burn Surge Plan. This plan would be instituted during disasters to pair our Trauma Center with a Burn Resource Center to meet the diverse needs of patients in specific disaster scenarios.

24


2010 has been an exciting year at Holy Cross within our Lactation Services through our Baby Wise Programs. Holy Cross was awarded three very special recognitions for our lactation services. We received the Family Health Promotion Award from the Greater Los Angeles Breastfeeding Taskforce in Los Angeles and the Baby-Friendly Way Hospital Workplace Award at a ceremony at the state Capitol in Sacramento on August 4, 2010, for our accommodation of breastfeeding in the workplace. We were also recognized with the IBCLC Care Recognition Award by the International Board of Lactation Consultant Examiners and International Lactation Consultant Association.

The following comment by an employee exemplifies why we were chosen: Breastfeeding has been a blessing in my life. The first weeks were tiresome and painful and I thought breastfeeding was a torture. I did it because I love my baby. Then through the help of the Lactation Consultants at Providence Holy Cross, their guidance and constant support, and the many sessions at the Breastfeeding support group, Cecilia and I transitioned. I understood how breastfeeding builds a bond I could never have imagined. We always had our time together, to touch and hold. Breastfeeding was our calm moments away from the chaos of life. I truly believe Cecilia has been so healthy, with no ear infections, respiratory infections or really any illness her first year, because she breastfed exclusively the first six months and has continued breastfeeding even now at 19 months. The love it builds and the protection it gives are two reasons I am so grateful I am able to breastfeed. Thanks, Julie

EXEMPLARY PROFESSIONAL PRACTICE

Lactation Support Services Continue to See Success

Increased resources were provided for our Lactation Programs in 2010. A third full-time position was added for this program. The lactation consultants have been able to assist more in-patients with the addition of a third lactation consultant. Our newest Lactation Consultant, Cambria Stephens, RN, IBCLC, joins Terry Gass, RN, IBCLC and Carol Chacon, IBCLC. Cambria came to us with extensive NICU experience. This will be extremely beneficial as we open our new 12-bed NICU in 2011. In-patient lactation specialty availability has increased to seven days per week and includes night shift. We are building our outpatient consultation services to better meet the needs of our babies being discharged from the Special Care Nursery, allowing us to provide better continuity of care after discharge. Our community support groups are well established. We currently provide three support groups per week in three different locations for increased patient convenience. The attendance at our Breastfeeding Support Group meetings has steadily increased over the year.

2010 BREAST FEEDING INITIATION VERSUS EXCLUSIVE RATE 120

80 70 60 50 40 30 20 10 0

100 80 Q3 Q4

60

Initiation

40

Exclusive

20 0 DEC

NOV

OCT

SEP

AUG

JUL

JUN

MAY

APR

MAR

FEB

JAN

OUTPATIENT CONSULTS

Out-patient consults have increased from an average of 14 per month to 30 per month in the last two quarters of 2010. Future plans include initiation of a teen support group and establishment of a support group for NICU mothers.

25


Diabetes Program – Grows to Serve Patients In 2010 the Diabetes Education Department increased its total FTEs to 3.5. We currently have four diabetes educators that are CDE certified. One of our educators is also a certified insulin pump trainer. Our department is Sweet Success Certified indicating our excellence in provision of care for pregnant women with abnormal glucose conditions. We cared for 405 patients referred by their obstetrical care provider for this service in 2010. We are American Diabetes Association – recognized both at Holy Cross and at our Porter Ranch health center. In 2010 we have been working on The Joint Commission Disease Specific Inpatient Certification for Diabetes. One quality initiative in 2010 was management of hyperglycemia. We were able to decrease the rate of blood glucose values over 300mg/dL without increasing hypoglycemia rates. We also decreased the number of critical low results in 2010. Twenty-nine percent of the results < 70 mg/dL were < 50 mg/dL in 2008 and 2009. In 2010 this decreased to 25% < 50 mg/dL.

Hypoglycemia Management

No Regular Insulin Sub Q

Follow the basic hypoglycemia prevention “TRIC” below

Substitute Humalog . . . Dose:Dose

Assumes verified hypoglcemia (symptomatic and/or below 70 mg/dl)

T

The Best Intervention is Prevention!

Onset (Minutes)

Peak (Hours)

Duration (Hours)

Humalog (lispro)

5 - 15

1-2

4-5

Regular

30 - 60

2-4

6-7

Subcutaneous Insulin

reat with 15 grams of carbohydrate such as:1 tube of glucose gel (or 1 amp (25 ml) D50 (if unconscious.) or 1 Cup (8 Ounces) nonfat milk or 1/2 Cup of juice or soda (4 ounces)

R I nform the physician C

epeat the result in 15 minutes. The “Rule of 15’s”

If blood glucose is not above 100 mg/dl, treat again with another 15 gms of carbohydrate.

Regular Insulin (Humalin or Novolin)

Humalog (lispro) Subcutaneous only. “Rapid” Action - 4 hrs - Analog Insulin

. Include information that identifies possible contributing causes. (SBARR)

hart the event include symptoms, treatment, response, possible causes and corrective action.

ii

iiiii

8 am

26

10 am

IV use only – Immediate (as soon as 5 minutes - basal or bolus) As Subcutaneous has “Short” Duration – usually 6 hrs Caution:Increased risk of hypoglycemia, hyperglycemia

and greater variability of onset, peak and duration.

iii

iiinsulin 12 noon 2 pm

4 pm

iii

6 pm

iiiii

8 pm

iinsulin

10 pm

12m

2 am

4 am

6 am

8am


Cultural diversity is a reality in most healthcare environments. This diversity often exists among the staff and within the patient population they serve. Diversity can foster division and mistrust or promote education and understanding. We sought to better understand the needs of staff and patient population. We formed a Cultural Diversity Committee in 2009. This committee is composed of representation from nursing, education, administration, human resources, social services, patient relations, food and nutrition and spiritual care. In early formation of the committee we performed a SWOT analysis to determine our strengths, weaknesses, opportunities and threats. We then analyzed the patient demographics to understand the current needs. Understanding that almost half of our patient population is Hispanic, we sought to strengthen the cultural heritage that influences this patient population. We found evidence of progress in meeting generational, religious and Americans with Disabilities issues. The Committee produced a cultural diversity event in June 2010 that was named Four Corners of the World. The purpose for this event was to enhance staff awareness of how to respect diverse cultures. Each room was set up to simulate a typical home from each culture. The cultural practices across the life-span were represented, as well as foods and dress. Specific cultures included were: Mexican, Armenian, Black American, Southeast Asian Indian. Approximately 209 staff members attended this event with 170 staff members participating in the pre and post survey instruments. Our next step is to provide detailed education regarding a broader variety of cultures and cultural practices.

EXEMPLARY PROFESSIONAL PRACTICE

Celebrating Cultural Diversity Among Our Staff

27


Providence Holy Cross Grows & Expands

While 11 hospitals have closed in Los Angeles County in the last five years, including two major hospitals within a six-mile radius of Mission Hills, Providence Holy Cross Medical Center is expanding to meet the healthcare needs of a growing community. Due to these hospital closures, a growing population and an even faster growing senior population that is expected to double in 15 years, hospitals in the San Fernando and Santa Clarita Valleys are at capacity. Currently, Providence Holy Cross Medical Center is at 97 percent bed capacity – during an average day. Providence Holy Cross has seen its patient admissions grow by nearly 40 percent in the last five years. The new four-story patient care wing at Providence Holy Cross will provide 138 new beds to serve patients in the Valley. The new wing will include new labor and delivery suites, a GI (gastrointestinal) lab and a much-needed 12-bed neonatal intensive care unit for premature and high-risk babies. In addition, the pharmacy will be upgraded and the hospital will have a remodeled main entrance, lobby and cafeteria. Providence Holy Cross Medical Center’s new patient care wing also will be one of the first “green” hospital building sin the state of California by receiving LEED certification, the nationally accepted benchmark for environmentally conscious design, construction and operation of high performance green buildings. Providence Holy Cross is paying an additional $500,000 to ensure environmentally-friendly construction practices and for the “green” design.

28


After the groom kissed his bride, after the flashes of a dozen cameras, after the cake was cut, three Providence Holy Cross ICU nurses shared a silent “high-five” outside Room 2103. The radiant couple and 20 or so teary-eyed family members were rejoicing in bride Susan Hinojosa-Lujan’s room, unaware of the heartfelt joy among the nurses who witnessed the Tuesday evening wedding. Just five days after their patient’s family told them Susan wanted to marry long-time love Vince Lujan, the Pavilion A team brought the Providence Mission to life. They revealed God’s love to this most vulnerable family, helping create a wedding to remember for a couple facing a rough road. Susan was suffering liver failure and had spent the last two weeks in ICU. These nurses provided so much more than clinical skills to help heal this family. They felt empowered by this spirit that lives in Holy Cross to reach out well beyond their training, knowing they were free to spend a few working hours plucking flowers from the hospital gardens, crafting congratulatory signs and tying ribbon bows about her room and on her wheelchair to briefly mask the sterile hospital equipment. “You’ve got the greatest nurses in the world,” said Richard Marquez, Susan’s brother. “They have given my sister and all of us so much love and compassion. These are not their patients, they’re their family. And it’s more than the nurses – the kitchen made this cake, security’s been great, when the custodians come in, they’re the kindest people.”

EXEMPLARY PROFESSIONAL PRACTICE

Nurses Honor Patient Wish with Wedding in the ICU

The next morning, a still-smiling Susan was transferred to a room on the third floor where the Just Married sign penned on pink construction paper was affixed at the foot of her bed. Behind the scenes, the wheels continued turning to get Susan on UCLA’s liver transplant list. “This isn’t about her illness tonight,” Richard said as the family enjoyed the chocolate wedding cake. “This is about life, it’s about hope.”

29


2010 Certifications ICU

MEDICAL/SURGICAL ONCOLOGY

Kathy Cadden, CCRN

Suzanne Bart, CMSRN

Chris Consolo, CCRN

Ingrid Blose, OCN, CMSRN

Shirley Ibarra, CCRN

DeeDee Bubalo, OCN, CMSRN

Melissa Tell,PCCN

Terrie Bybee, CMSRN

Carole McKennan, CCRN

Cynthia Dasaad, OCN

Brenda Mitchell, CCRN

Eileen Diaz, OCN

Melanie LaMadrid, CCRN

Marisia Duarte, ONC

Crystal Akao, CCRN

Estranero Riza OCN; CMSRN

Amy Rosengran, CCRN

Barbara Farrar, OCN

Jessica Horst, PCCN

Vener Lineses-Diaz, CMSRN, ONC

Stacey Beatty, PCCN

Gemma Francisco, ONC Kathy Gilmore, CMSRN Lori Galorneau, OCN Christian Gonzalez, CMSRN Heinrich Huerto, ONC Mary Mahn, CMSRN, ONC Bilma Pellissery, CMSRN Veronica Lozano, CMSRN Cathy Millan, CMSRN, ONC Johanna Ongjoco, OCN, CMSRN Lois Agler, CMSRN Maria Rodriguez, OCN Leticia Salvador, OCN Betsy Smith, CMSRN; OCN Jackie Sullivan, CMSRN Barbara Thomas, CMSRN Dory Tiongson, OCN; CMSRN Pamela Baylon, CMSRN Amy Revilla, ONC Alvin Arceo, OCN Sheila Cardoniga, OCN Maelene Owera, CMSRN Catherine Valbuena, CMSRN April Mijares, CMSRN Jenny Leon, CMSRN Michelle Tabar, CMSRN

SUPER FLOAT POOL Seta Velasquez, CMSRN Mary Ellen Hazle, CMSRN; WCC

30


NURSING MANAGEMENT

Karen Broggie, CPHQ

Bergida Deborah OCN; CMSRN

Sheila Ritchie, CPHQ

Brown Jerilyn OCN

Cyndie Speen, CPHQ, RN-BC

Gaffney Yvonne CNOR

Marianne Plakas , CCRN

Jane Flaherty , PCCN, CCRN

Laurie Marx, CPHQ

Betty Newsom, CNAA Barbara Rozewicz, CCRN, CMC, NP-BC

FAITH COMMUNITY NURSING

Carrie Sayeski-Reid, RNC-OB

Connie Cruz, RNC-OB

Joanna Kuzmak, CCM Sherri Friedrich, ANCC-FNP

NURSE PRACTITIONERS Brigitte Condie, ANCC-ACNP

Ken Archulet, CFRN Sherri Mendelson, RNC-OB, NIC, C-EFM, IBCLC

Deborah Tsunoda, ANCC-ACNP

Sandra Pieschel CDE

ACUTE REHAB/SUBACUTE

Barbara Rozewicz CCRN, CMC, AANP

Terri Gately, CRRN, RN-BC

EDUCATION SERVICES Kathy Christian, OCN, CMSRN Cynthia Funakoshi, PCCN Tanya Haight, OCN, CMSRN; ONC Adriana Basurco, RNC-NIC Monica Tweddell, WCC Karen Watson, CMSRN; RN-BC Kristi Miura, CCRN Yajaira Angulo, RNC-OB; C-EFM

CASE MANAGEMENT Joanna Kuzmak, CCM Betsy Jansen, CHPN Kathy Menard, CPHQ, CPRM Edna Tiongco, CCM, CRRN Jinky Rivera, CCM, CPUM Craig Hollaway, CEN, MICN Peggy Bronson, CCM

Lisa Pettinelli CEN

MATERNAL CHILD HEALTH Pamela Appleton, RNC-MNN Debbie Felkel, IBCLC, RNC-MNN Alexis Fischer, RNC-MNN Danielle Silvieri-Anthony, IBCLC

EXEMPLARY PROFESSIONAL PRACTICE

NURSING QUALITY ANALYSTS

Julie Tannaci, RNC-MNN Marilyn Haro, RNC-MNN Nancy McClenaghan, RNC- NIC Nanette Moffet, RNC-LRN Arvy Quizo, RNC-LRN; RNC-NIC Katie Walkowiak, RNC-MNN Lilia Nicholas, RNC-MNN Melinda Gruman, RNC-OB; C-EFM Linda Harrington, RNC-OB Jenni Kohl, RNC-OB Claudia Preciado, RNC-C-EFM Tenesa Reid, RNC-OB Delores Relucio, RNC-OB; C-EFM Sally Ritter, RNC-OB; C-EFM Kristina Shannon, RNC-OB Margaret Walker, RNC-OB Therese Gass, IBCLC Cambria Stephens, IBCLC

31


2010 Certifications cont’d EMERGENCY DEPARTMENT

TELEMETRY

Carol Carter, CEN

Beverly Gumogda, PCCN

Cathy Carter, CEN

Linda O’Reilly, PCCN

Jennifer Dodson, CEN

Ulla Smith, PCCN

Terri Halverson, CEN

Therese Villanueva, PCCN

Heidi Krause, CEN

Debbie Welch, PCCN

Alexandria Carey, CEN

Audie Gonzalez, PCCN

Jacquie Siddens, CEN

Tracy Kwak, PCCN

Sue Cassling, CEN

Wendell Garcia, PCCN

Rosanna Macklin, CEN

Emmanuel Palad, PCCN

Melissa Parsons, CEN Kim Murphy, CEN

CARDIOLOGY/RADIOLOGY Hannah Rhodes, PCCN Cathy Yee, CCRN-CSC Jackie Richardson, CCRN Cynthia Marsden, CRN

PERIOPERATIVE Frankye Bauerle, CPAN Kim Crabtree-Loyd, FNP-BC, CPAN Ed Betker,CNOR Renee Dove,RNFA, CNOR Lisa Eberhart, CNOR Mike Earnheart, CFRN Karen Kelsey, CNOR Nora Lucas, CPAN Mary Jane Pettee, CNOR Elizabeth Pleasant, CNOR Marilyn Seckar, CPAN Louisa Singer, CNOR, RNFA Melanie Ylagan, CNOR Susan Zavala, CCRN, CPAN Gail Zerby-Cook, CNOR, RNFA Janine Montero, CMSRN Denise Wilmarth, OCN, CMSRN

32


Mike Arquilles ICU

BSN

Judith Avila Telemetry

BSN

Deborah Bergida Medical-Surgical

MSN

Missy Blackstock

Emergency Department

BSN

Alex Carey

Emergency Department

BSN

Lillian Choe Telemetry

BSN

Carolyn Churchfield ICU

BSN

Charles Fox Telemetry

BSN

Cynthia Funakoshi

BSN

Clinical Education

Aileen Gonzales Telemetry

BSN

Marilyn Haro

Special Care Nursery

BSN

Heinrich Huerto

Medical Surgical

MSN

Anu Kashyap Telemetry

BSN

Karen Klein Quality

BSN

Jenny Leon

Medical Surgical

BSN

Ronda McPhail

Labor & Delivery

BSN

Cynthia Marsden Radiology

MSN

Carolina Martinez Telemetry

BSN

Bilma Mathews Medical-Surgical

MSN

Jennifer Medina Telemetry

BSN

Stefanie Misiura Telemetry

BSN

Erik Nosker Telemetry

BSN

Shelly Payne

Clinical Education

BSN

Marianne Plakas

Quality

MSN, NP

Ronnell Regidor Telemetry

BSN

Barbara Thomas Medical-Surgical

BSN

Ann Valladares

Emergency Department

BSN

Viriline Vienne Telemetry

BSN

Erin West Telemetry

BSN

EXEMPLARY PROFESSIONAL PRACTICE

New Degrees in 2010

33


New Knowledge, Innovations & Improvements PHCMC Annual Nursing Research Conference in May highlighted our own internal research activities. We also were privileged to have presentations by our academic center research partners including Lorraine Evangelista, PhD, RN from UCLA, Sheba Meymandi, MD, from UCLA Olive View Medical Center, and Susan Jackman, RN, MSN from The National Childrenâ&#x20AC;&#x2122;s Study. The following abstract, presented at this conference, is a wonderful example of the involvement of our staff nurses in research to improve the lives of both patients and fellow staff members.

34


PU RP OSE Compassion fatigue in oncology nursing frequently manifests as physical, emotional, social and spiritual exhaustion. This may lead to a pervasive decline in the caregiverâ&#x20AC;&#x2122;s ability to feel and care for others and impact on work and personal relationships. The purpose for this study was to address and reduce compassion fatigue, and improve spiritual and emotional well-being and morale among the patient care staff team.

BACK G R OU N D & S I G N I F I C A N C E Nurses in an oncology unit suffer from significant care-giver stress. Taking time at the beginning of the shift and prior to leaving the work environment to decompress will allow nurses to shed their stress in a healthy way. This technique could work in any nursing setting.

METH OD S Members of the oncology staff were asked to participate in an action research study. All oncology team members were included in the study group. Interventions were aimed at reducing compassion fatigue by improving spiritual well-being of staff caring for oncology patients. The intervention included a caring circle for on-coming and off-going staff with an inspirational saying during shift change twice daily with selected inspirational readings

NEW KNOWLEDGE & INNOVATIONS

Compassion Fatigue and Spiritual Caring in Oncology Nursing Staff

chosen by staff members and read as a group. This intervention was applied for a continuous period of three months. IRB approval was obtained and consent was obtained from any staff member prior to participation as an ethical consideration to ensure that team members were aware of their right to refuse to participate and to help the team members learn important aspects of nursing research processes. The Spiritual Involvement and Beliefs Scale (SIBS-R) spiritual assessment tool measuring compassion fatigue, emotional and spiritual well-being by self-report was used pre and post intervention to measure change in spirituality in oncology staff. It is a well-validated instrument that was available for use without charge or restriction. It was administered pre- and post-intervention. Patient satisfaction scores were used as a measure of decreased staff compassion fatigue.

RE SU LTS Although the mean scores from pre-survey to post-survey for the group demonstrated a positive change, an analysis of variance was computed for the total score of the pre-intervention SIBS-R and the post-intervention SIBS-R indicating lack of significance for the positive change noted in spirituality. Patient satisfaction scores showed a significant upward trend during and after this intervention. The most striking result was the enthusiasm of team members who have chosen to continue this intervention after the investigation was completed.

CO N C L U SION This study demonstrated that a nurse-led research project can produce a positive effect on staff morale that may translate to improved patient satisfaction. Selection of an instrument that measures the intended outcomes is a vital part of a research study. This instrument may not have measured the effect well, as many of the participants began the study with a high level of spiritual connection. A qualitative aspect added to this study might have more effectively captured the effect of this intervention on promotion of a healthy work environment.

35


Publications, Presentations and Grants Publications Linda Harrington, RNC, From our readers...The Dance. American Nurse Today (2010). 5(2). Susan E. Sengezer – Ortiz, RN BSN; The Anointing of Mercy: From the Heart of a Parish Nurse. Xulon Press, 2010. Cathy Yee, MSN, RN, CCRN-CSC; Conquering Pulmonary Embolism. OR Nurse 2010; 4(5), 18-24.

Presentations/Lectures Adriana Basurco, RN, BSN, PHN, Yajaira Angulo, RNC, BSN, PHN, Sherri Mendelson, RNC, PhD, CNS, IBCLC; AWHONN National Conference, Las Vegas, NV; September, 2010; Poster presentation: Breaking Out of Our Silos. Missy Blackstock, RN, BSN, Diane Hanley, RN, Carey Faulkner, RN, California Emergency Physicians, Palm Springs, CA. October, 2010; Podium presentation: Alternate Bedding Sites for the Emergency Department. Ingrid Blose, RN, OCN, CMSRN; Terrie Bybee, RN, CMSRN; Dorrie Tiongson, RN, OCN, CMSRN; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: Compassion Fatigue. Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, ONC; 35th Annual ONS Congress, San Diego, CA; May, 2010; Poster presentation: Team Rounding: Preventing Falls on the Oncology Unit.

  ONC; 35th Annual ONS Congress, San Diego, CA; Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, May, 2010; Moderated Poster presentation: Improving Knowledge of Oncologic Emergencies.

Linda Coale, RN, BSN, MBA, 2010 Zynx Health Conference, Key Biscayne, FL; May, 2010; Podium presentation: 4A Project, Transforming Care at the Bedside. Linda Coale, RN, BSN, MBA, and Barbara O’Reilly, RN, 2010 Magnet Conference, Phoenix, AZ; October, 2010; Poster presentation: 4A Transformation of Care at the Bedside Project. Chris Consolo, RN, BSN, CCRN; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: RRT Improvement Project. Kim Crabtree-Loyd, RN, MSN, NP; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: Thermoregulation in the PACU. Cynthia Damboise, RN, MSN, MHA, PCCN, CCRN; Linda Coale, RN, MBA; ACNL, Palm Springs, CA; February, 2010; Poster presentation: For Your Information: Admission and Discharge Videotape. Cindy Damboise, RN, MSN, MHA, PCCN, CCRN and Linda Coale, RN, MBA; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: 4A Transformation of Care. Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD; Clinical Nutrition Week ASPEN 2010, Las Vegas, NV; February, 2010; Poster presentation: Do We Need to Check Gastric Residuals for the Sub Acute Patient? Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD; California Hospital Association, Huntington Beach, CA; October, 2010; Podium presentation: The Specialty Practice of Rehabilitation Nursing. Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD; ARN, Orlando, FL. , September, 2010; Podium presentation: Correlation between FIM Scores and Fall Risk. Terri Gately RN, DSD and Sylvia Pacis, RN, BSN; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: Continuation of Enteral Feedings During Patient Repositioning. Timothy Gilmore, RN, MHA; ACNL, Palm Springs, CA; February, 2010; Round Table: Environment of Practice Standard and Instrument for Measurement Healthy Work Environment Assessment Tool Introduction.

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Tanya Haight RN, OCN, CMSRN, ONC and Kathy Christian RN, BSN, OCN, CMSRN; 2010 Magnet Conference, Phoenix, AZ; October, 2010; Poster presentation: Reducing Falls in the Medical Surgical Unit. Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC; ACNL, Palm Springs, CA; February, 2010; Poster presentation: Regional Perinatal Documentation Project. Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC. Arizona State University, Nursing Research Conference, Phoenix, AZ; June, 2010; Podium presentation: Regional Perinatal Documentation Project. Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC; AWHONN National Conference, Las Vegas, NV; September, 2010; Poster presentation: Regional Perinatal Documentation Project. Sherri Mendelson RNC, PhD, CNS, IBCLC; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: Perinatal Docummentation Project. Sherri Mendelson, RNC, PhD, CNS, IBCLC; AWHONN National Conference, Las Vegas, NV; September, 2010; Poster presentation: SLE: A 36 Year Longitudinal Case Study. Sherri Mendelson, RNC, PhD, CNS, IBCLC; Greater Los Angeles Breastfeeding Task Force, West Covina, CA; September, 2010; Lecture: Breastfeeding and the Late Preterm Infant. Sherri Mendelson, RNC, PhD, CNS, IBCLC; Greater Los Angeles Breastfeeding Task Force, West Covina, CA; September, 2010; Lecture: The Effects of Labor and Delivery Practices on Breastfeeding-What is the Evidence?

NEW KNOWLEDGE & INNOVATIONS

Tim Gilmore, RN, MHA and Therese Villanueva, RN, BSN, PCCN; Providence Holy Cross Medical Center Nursing Research Day, Mission Hills, CA; May, 2010; Podium presentation: Healthy Workplace Environment.

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2010 IRB Approved Nursing Research Studies

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TITLE

PRINCIPAL INVESTIGATOR

STUDY TYPE

STATUS

The Identification and Prevalence of Patients with Chronic Wounds/ Ulcers in the Hospital Setting

Monica Tweddell, RN, WCC

Prevalence Study

Currently in data analysis

Prevalence of Chagas Disease in Pregnant Women From Latin America

Sherri Mendelson, RNC, CNS, PhD (In collaboration with Olive View Medical Center)

Prevalence Study

Study at PHCMC closed. Continues at UCLA-Olive View MC.

Evaluation of the Pediatric Assessment Triangle (PAT) as an Assessment Tool for Children in the Prehospital Setting (PAT Project)

Theresa Lacroix, RN- Site PI

Validity and Reliability Study

On-going

In-Patient Nursing Education Home Blood Pressure Monitoring To Manage Hypertension

Susie Parker, LVN, Sherri Mendelson, RNC, CNS, PhD, Debbie Tsunoda, ACNP-BC

Interventional one-group study

5 subject accrued

Do We Need to Hold Continuous G-Tube Feeding During Patient Repositioning

Terri Gately, RN, BS, MS, CRRN, DSD, Sylvia Pacis, RN, BSN-PI

Outcomes study

Data analysis

Compassion Fatigue and Spiritual Caring in Oncology Nursing Staff

Ingrid Blose, RN, OCN, CMSRN, Dory Tiongson, RN, OCN, CMSRN Terrie Bybee, RN, CMSRN Tanya Haight, RN, OCN, CMSRN

One group pre and post intervention outcome study

Completed

Project HOPE: Health Promotion for a Healthy Pregnancy and Family

Sherri Mendelson, RNC, CNS, PhD

One group Pre and Post intervention outcome study

Completed

RRT Intensive Rounds

Chris Consolo, RN

Two group Pre and Post intervention study

Completed

Correlation of Two Methods for Monitoring Hypothermia in the PACU

Kim Crabtree-Loyd, RN, MSN, NP

Correlation study of two methods of temperature measurement

Ongoing

High Protein Diet for Weight Loss

Sherri Mendelson-PHCMC Lorraine Evangelista-UCLA

Two group pre and post intervention study

Ongoing

BP Telemedicine

Jane Flaherty-PHCMC Lorraine Evangelista-UCLA

Two group pre and post intervention study

Ongoing

FIM Scores and Falls in the Acute Rehab Unit

Terri Gately, RN, BS, MS, CRRN, DSD

Correlation study

Completed

New Grad Retention on the MS Unit

Bilma Pelissary, RN, MSN and William Lim, RN

One group pre and post intervention study

Ongoing

Life Balance for Professional Women in Healthcare

Liz Septizipian

Ongoing


VISION: By 2012, PHCMC Nursing Research will have five new projects completed and ready for dissemination. PARTICIPANTS: Currently, Nursing Research at PHCMC consists of Staff Nurses, Nursing Managers, Nursing Directors, Quality Management and Registered Dietician. Other groups/individuals may attend as necessary.

OPERATING COMMITMENT

STRATEGIC PRIORITIES/GOALS

MEASURES OF SUCCESS

People Centered

Promote nursing research through mentoring relationships

Compile a list of internal and external research mentors. Each nurse researcher will be assigned a mentor.

Provide a nursing research mentorship program

Two mentorship programs will be provided with at least 5 participants enrolled in each. At least five completed projects will result from the mentorship programs.

Utilize academic partnerships to provide mentorship opportunities

Partner with academic institutions for 2 research studies. Assign one or two nurses as site primary investigators to work with the academic institution to further the research relationship

Develop education for clinical staff on Nursing Research and Evidence-Based Practice

Healthstream program will be developed and assigned to all licensed nursing staff. 80% or more of all licensed nursing staff will complete and pass the Healthstream program.

Determine areas of patient satisfaction and quality measures that demonstrate gaps in nursing care delivery

Initiate one research study based on a quality gap through discussion at Nursing Research Council.

Service Centered

Promote new nursing programs through nursing research studies and adoption of evidence-based care protocols. Partner with Stroke Program, NICU and other programs to determine nursing research opportunities and evidence-based practice needs.

One NICU-based study initiated. One Stroke Program-based study initiated.

Financial Centered

Enhance ability to conduct nursing research through grant acquisition

By 2012, Nursing Research will submit 2 grant applications to fund research studies. Nursing Research will work with PHCMC Foundation to identify grant opportunities and write and submit grants.

Support of EBPs that reduce costs to contribute to organizational stewardship.

Develop and complete one nursing research study for translation of an evidence-based practice to enhance stewardship.

Promote Magnet environment including aspects of shared governance through nursing research

Develop and promote annual Nursing Research Day to enhance internal and external participation in nursing research activities with inclusion of 4 nursing projects from PHCMC. Maintain nursing journal club and mentor nursing journal club as a sub-committee to NRC.

Participate (promote staff nurse participation) in national/state-wide/local nursing research conferences

Submit abstracts for poster/podium presentations to at least 6 conferences.

Promote research dissemination through publication

2 articles submitted to peer- reviewed nursing/ healthcare publications.

Encourage an interdependent partnership for inquiry between nursing, other disciplines and medicine to improve relationships and maximize resources

One interdisciplinary research project proposal will be completed and passed through Nursing Research Council and IRB.

Quality Focused

Growth Centered

NEW KNOWLEDGE & INNOVATIONS

2011-2012 Nursing Research Strategic Plan

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Awards & Recognition PHCMC NURSE’S WEEK AWARDS Wendell Garcia

Telemetry

Best Supporting Team Player

Jeri Brown

Administration

Best Role Model

Marilyn Sluka

Telemetry

Most Compassionate

Jenny Leon

Medical Surgical

Most Compassionate

Danica Whisman

Telemetry

Most Caring

2 Tim Gilmore, RN, MHA, Manager of Special Projects and Data Support was honored February, 2010 at the Association of Nursing Leaders awards luncheon for “Excellence in Nursing Leadership – South Region” 2 Family Health Promotion Award from the Greater Los Angeles Breastfeeding Taskforce in Los Angeles and the Baby-Friendly Way Hospital Workplace Award at a ceremony at the State Capitol in Sacramento on August 4, 2010 for our accommodation of breastfeeding in the workplace. We were also recognized with the IBCLC Care Recognition Award by the International Board of Lactation Consultant Examiners and International Lactation Consultant Association. 2 Steve Storbakken and Connie Lackey, RN were honored with the U.S. Geological Survey’s Eugene M Shoemaker Award in the multiple-project category for their work in planning the PHCMC’s participation in the Great Southern California ShakeOut Campaign. The award recognizes extraordinary effectiveness in communicating complex scientific concepts and discoveries to capture the interest of the American Public. 2 The Emergency Department was honored by California Emergency Physicians (CEP) as Emergency Department of the Year based on door-to-doctor, Core Measures, and Patient Satisfaction results. CEP voted the Emergency Department the best out of 70 sites. And we know it takes a village: doctors, nurses, respiratory therapists, etc.

2010 PH&S President’s Award: The 4A Transformation of Care at the Bedside Project In 2007, Providence Holy Cross Medical Center (PHCMC) received a grant from the UniHealth Foundation to develop an innovative Health Systems Enhancement Patient Care Redesign Project. The purpose of this project was to design reliable processes of care that assure consistent and timely delivery of evidence-based patient care each and every time, thus improving patient satisfaction and outcomes. Included in the project design was a process of team-based care, metrics-driven management, reduced cycle times, increased stakeholder loyalty and satisfaction and an enhanced learning organization. Improvement and change strategies implemented within this project were Lean, Six Sigma and Change Acceleration; statistical methodology coupled with change management and facilitation techniques. Prioritized short-term projects within the unit redesign umbrella were physical redesign components, quality of care delivery, the discharge process and coordination of care. Outcome and process measures included core measure compliance, patient satisfaction, nurse and physician satisfaction, climate of safety, reduction in the discharge process time, reduction in the average length of stay and improvement on the nurse sensitive indicators of pain management, patient falls and hospital-acquired pressure ulcers. Improvement targets were met for all measures. MD and Nurse satisfaction exceeded targets. Additional work and focus are needed for reliable control of patient satisfaction and pain control metrics. Translation of defined improvements, tools and processes has occurred across units, California ministries and was shared nationally at the annual Magnet® conference.

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Patty Brown

Arlene Garrido

Candy Hale

In Memoriam to The Nurses We Grieved for in 2010 When a calming, quiet presence was all that was needed, a nurse was there. In the excitement and miracle of birth or in the mystery of loss and life, a nurse was there. When a silent glance could uplift a patient, family member or friend, a nurse was there. At those times when the unexplainable needed to be explained, a nurse was there. When the situation demanded a swift foot and sharp mind, a nurse was there. When a gentle touch, a firm push, or an encouraging word was needed, a nurse was there. To witness humanity—its beauty, in good times and bad, without judgment, a nurse was there. To embrace the woes of the world, willingly and offer hope, a nurse was there. And now, that it’s time to be at the Great One’s side, a nurse is there.

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2011 Promises to Bring Changes and Challenges This is our Magnet速 Program Recognition re-certification year. It is an opportunity for our entire hospital to reflect on all of our successes of the past few years and direct our energies towards closing any identified gaps in our quest for excellence in patient care and as an employer of choice. We will open our new wing to accommodate significant growth in our medical center. We are working on creating a meaningful nursing peer review process and reevaluating our nursing shared governance structure. Along with significant economic challenges and a continued uncertainty in the healthcare area Providence Holy Cross Nurses face 2011 knowing we are among the best that nursing has to offer.

Thank you to all of our nursing colleagues for making Holy Cross a great place to work and a great place for our friends, families and neighbors to receive excellent health care!

1-888-HEALING www.providence.org/holycross Providence Holy Cross Medical Center 15031 Rinaldi Street Mission Hills, California 91346 (818) 365-8051


Providence Holy Cross 2010 Nursing Annual Report