Nurses of USC | Special report 2012

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Tr ansforming the Art and Science of Nursing • Special Report 2012

A true team effort How the nurses, doctors and staff of 7 South ICU changed their playbook and improved patient care.

Respect the sash

There’s no place like home

Make it so

Special report 2012 Profiles 5 Meet Hilda Diaz: Making a difference in Peru 16 Meet Cynthia Wallingford: From graduate to nurse manager in two years

Features 6 Respect the sash: No interruptions equals greater accuracy with medications 12 There’s no place like home: Nurse retention soars at Keck Medical Center of USC

Cover story

8  A true team effort: How the nurses, doctors and staff of 7 South ICU changed their playbook and improved patient care

Nurses of USC A publication of the Keck Medical Center of USC

The Keck Medical Center of USC is a world-class academic medical facility for translational medical research and compassionate patient care. It is comprised of two hospitals—Keck Hospital of USC and USC Norris Cancer Hospital—and the 500+ faculty physicians of USC’s renowned Keck School of Medicine.

14 Make it so: The Nurses of USC help design the next generation of medical records

Executive Editors Ellen Whalen Chief Nursing Officer, Keck Medical Center of USC Annette Sy Interim Chief Nursing Officer, Keck Medical Center of USC Theresa Murphy Associate Administrator, Inpatient Nursing, Keck Hospital of USC Brenda Maceo Vice President, Public Relations and Marketing, USC University Relations Geoffrey Baum Interim Assistant Vice President, USC Health Sciences Public Relations & Marketing

Ina Fried Executive Director, Communications, USC Health Sciences Public Relations & Marketing Sara Reeve Assistant Director of Publications, USC Health Sciences Public Relations & Marketing Tania Chatila Hospitals Editor/Writer, USC Health Sciences Public Relations & Marketing Editor Sandra Levy Business Manager Elaine Sawitskas Distribution Eva Blaauw and Carol Matthieu

Message from the Chief Nursing Officer

Departments 2 News briefs 4 Spotlight photos 17 Appreciation corner: Daisy Awards—How small kindnesses can reap great rewards

Welcome to the Nurses of USC special report 2012. This publication is all about bringing to the forefront the tradition, accomplishments and the spirit that is USC Nursing. 2011 brought a new name to the health care enterprise at USC—Keck Medical Center of USC. Our innovative team includes the newly renamed Keck Hospital of USC, USC Norris Cancer Hospital, 500 faculty physicians of the Keck School of Medicine of USC and nearly 1,000 Nurses of USC spanning the depth and breadth of the medical center. As members of the Trojan Family, we are called to think boldly and to be the engines of creativity and ingenuity. As Nurses of USC, we are called to play a prominent role in the provision of extraordinary care and service to our patients and families. This report features our nurses’ success in the translation of research to innovative practice, stories that challenge our thinking and warm our hearts. We draw your attention to the team of the 7 South ICU, also known as the Neurosciences intensive care unit, who developed a unique cross-disciplinary collaboration that has resulted in reduced infection rate, improved patient outcomes and reduced staff turnover. I hope you enjoy the report. We created it to celebrate the hard work of the Nurses of USC and the dedication of nurses everywhere. For extraordinary patient care… Fight On!

Photo Scheduling Monica Padilla

Ellen Whalen, R.N., M.S.N. Chief Nursing Officer, Keck Medical Center of USC

Graphic Design Warren Group | Studio Deluxe Printer Color Graphics Photography Walter Urie Permission to reprint articles with attribution is freely given. No artwork may be reproduced without the artist’s consent. Our mailing list comes from several sources. If you receive duplicate copies of this magazine, please send us all the label information and we will strive to eliminate the duplication. Direct inquiries to USC Health Sciences Public relations & Marketing, 1975 Zonal Avenue, KAM 400, MC 9029, Los Angeles, CA 90033. Phone: 323-442-2830, Fax: 323-442-2832. 1

Nurses of USC honored for outstanding work, expand their education


Versant R.N. residency class honored with invitation Newly graduated registered nurses participating in the Versant R.N. residency program at Keck Medical Center of USC took the results of recent process improvement research on the road to New Orleans, La., to present at a prestigious national Versant Client Conference last November. The 7th Annual Versant Client Conference attracted more than 175 nursing professionals from across the country from chief nursing officers to preceptors. During a two-hour presentation that included an extensive question and answer session, the residents presented their posters and

2 Keck Medical Center of USC

As the demands of offering care increase, the Nurses of USC continue to provide outstanding service. Five USC nurses were honored during Nurse Week 2011 for their hard work and commitment to excellence. The awards ceremony was part of Nurse Week, held May 2-6, 2011. Individuals were nominated by patients, visitors, physicians and staff and judged on their individual contributions to patient care and the success of the USC hospitals. Nurse Week 2012 is scheduled for May 7-11.

Nurse of the Year Katharina Villanueva, R.N., Clinical

distributed affiliated leaflets and pamphlets they produced. Keck Medical Center of USC offers the 20-week Versant R.N. residency program to transition new nursing graduates from student to safe, confident and competent professional practitioners. All new graduate nurses hired by the hospitals are required to participate in the program, which includes guided clinical experience with a preceptor, education and curriculum, formal mentoring, debriefing/self-care sessions, and a 360-degree evaluation and measurement process. An integral part of the program for each cohort (class) is to choose a process at the hospital they believe needs improvement and develop solutions with the goal of potentially submitting their ideas for presentation at the national conference held annually. The cohort of March 2011 was comprised of 10 R.N. residents, split into two groups of five. The first group chose to study SBAR, the process by which nurses present patient reports to each other when they transfer care of a patient between shifts. The

second group studied patient education, specifically the process of how information is presented to patients. The groups distributed surveys, collected data and conducted research about best practices then presented to the medical center’s Nursing Quality Committee. “The Nursing Quality Committee members were very impressed with the results of each group. Their reports were extremely thorough and they presented workable solutions,” said Tania Zwick, R.N., manager of the Versant R.N. residency program for Keck Medical Center of USC. Project abstracts of both groups were later submitted to Versant, and word was soon received that both were accepted to present at the national conference. Zwick also said, “One of the greatest intrinsic rewards of the resident’s participation in these projects is that it solidifies their engagement into the art and science of nursing. It allows them the opportunity to be an empowered member in this profession and to improve the quality of patient care provided at the bedside.”

Nurse Leader Daniel Hudson, R.N., Nurse manager Nurse Advocate Alejandra Quinonez, R.N., Operating room Nurse Rookie Tuesday Crews, R.N., Staff Nurse Preceptor Emma Meza, R.N., Clinical

Not only are USC nurses outstanding in their efforts, but they’re also continually expanding their education, knowledge and skills. Congratulations to the following Nurses of USC who completed a master’s or bachelor’s degree in 2011: M.S.N. Sulma Bravo, R.N., Coordinator M.H.A. Debora Peterson, R.N., Nurse manager B.S.N. Teresa Godinez, R.N., Clinical Rebekah Oh, R.N., Clinical Armenuhi Zaratsian, R.N., Clinical Sara Zigman, R.N., Clinical

Nursing quality committee promotes excellence The Keck Medical Center of USC Nursing Quality Committee (NQC) is changing the face of patient care. The NQC supports excellence in nursing practices by formulating policy initiatives to improve quality and the delivery of patient care. “As nurses we always want to strive for the highest quality of care for our patients,” said Gina Greco, M.S.N., director of EvidenceBased Practice. “The committee is open to any medical center nurse to join and provides a terrific opportunity for us to give input on new policies, products and data.” Specifically, the NQC drives decision-making behind new policies, evaluates new products and systems, conducts peer case reviews and assists with quality initiatives, including gathering data for quality-related studies. Most recently, the committee participated in a study to measure pressure ulcer occurrences in patients. And the NQC is already seeing positive results. “Pressure

In addition, the following nurses have recently received certifications in progressive care, critical care, oncology, nurse management and leadership, and operating room:

OCN: Mavis Ikeda, R.N., Staff Hilary Sykes, R.N., Staff

PCCN: Oralia Aragon, R.N., Clinical Eugenia Chong, R.N., Coordinator Nerio Gregorio, R.N., Coordinator Marisa Hayashi, R.N., Clinical Sumian Huang, R.N., Clinical Kuri Otsuka, R.N., Clinical

CNOR: Jeanette Coffin, R.N., Operating room Elaine-Marie Walker Earle, R.N., Operating room Badria Fodda, R.N., Operating room Glenis Wansley, Coordinator-Hepatobiliary

CNML: Debora Peterson, R.N., Nurse manager

CCRN: Charina Abdelkhaliq, R.N., Clinical Rico Arceo, R.N., Clinical Kimberly Sanchez, R.N., Clinical

ulcer prevention has been a major focus at our hospitals, and in the past year we were able to decrease reportable pressure ulcers by 39 percent,” Greco said. In addition to driving excellent patient care, the NQC is also leading efforts to achieve Magnet Recognition from the American Nursing Credentialing Center (ANCC), a title that less than six percent of U.S. hospitals have achieved. “Through our continued participation in evidence-based practices and working to improve quality and patient outcomes – led by the Nursing Quality Committee – we are getting closer to the ANCC’s Magnet designation every day,” Greco said. NQC advisory board officers serving for 2012 include Latrice Holmes, R.N., chairperson; John Alexiou, R.N., co-chairperson; Michell Fang, R.N., secretary; and Jordan Huang, R.N., historian.

“The committee is open to any medical center nurse to join and provides a terrific opportunity for us to give input on new policies, products and data.” Gina Greco, M.S.N., director of Evidence-Based Practice 3

Spotlight  by sandra Levy

News from the Nurses of USC


3. Keck Hospital of USC

The Nurses of USC website offers up-to-date information on the latest nursing news at the Keck Medical Center of USC, including events, jobs and more. Visit

2. Keck Hospital of USC

nurse Martha Herrera throws out the first pitch at the Los Dodgers vs. San Diego Padres game on Aug. 29, 2011. Herrera was one of several hospital employees, physicians and patients to throw out ceremonial first pitches at Dodgers games during a former partnership between the two USC-owned hospitals and the Dodgers organization to promote the hospitals brand. Herrera was chosen for her commitment to the medical center and patient care. Chief Nursing Officer Ellen Whalen was there to catch her pitch on the field.

4 Keck Medical Center of USC

nurses Rose Young (left) and Tuesday Crews wear cardinalcolored scrubs with the Nurses of USC logo. The uniforms debuted in March 2011 as part of a nursing initiative to help patients, families, physicians and other staff to distinguish who they are. In addition to registered nurses, nursing support staff – licensed vocational nurses, patient care technicians, patient companions and unit secretaries – also wear distinctive, colored uniforms.


Keck Hospital of USC surgical technician Alejandra Martinez (left) and OR nurse Isabella Ou sign their names on the Keck Medical Center of USC mission statement, committing their dedication to providing quality health care that is personalized, compassionate and innovative. The renewed mission was unveiled during a celebration recognizing the recent $150 million W. M. Keck Foundation gift to name the Keck Medical Center of USC.

Profile  by sandra levy

Meet Hilda Diaz, R.N., B.S.N., P.H.N.

Making a difference in Peru Hilda Diaz works in the 5 South ICU Step-down unit. In September 2011, she traveled to Peru for four weeks with Hearts With Hope, a nonprofit organization that instructs Peruvian medical personnel in the treatment and care of children with congenital heart diseases, and provides financial, educational and emotional support for their families. Q: What was your job while in Peru? A: I worked as an outreach nurse traveling to remote areas of the country to assess children for heart problems and to educate them about dental hygiene. Usually we would get up at 5 a.m. each day and travel for three hours to churches and schools in outlying areas where we assessed children by observing them, listening to their hearts, administering echocardiograms and providing dental exams. Often we didn’t get back to our base camp until 11 p.m. Q: What stood out to you the most from your experience in Peru? A: It was really amazing to be able to travel and see what nursing is like in a different area of the world. It was a very humbling experience. We take so much for granted

here, like the abundance of supplies. In Peru, we had very limited supplies and needed to be extremely frugal. It also was a terrific feeling to help kids get better by educating them about basic hygiene and to see what a profound difference it made for them. Q: Did your volunteer experience in Peru affect the way you perform your job here? A: Yes it did. Because we didn’t have the diagnostic equipment we typically use here to gauge someone’s condition, we needed to rely on basic diagnostic skills like observing how the children’s chests rise, checking pulses, etc. I think those skills have translated to help me better assess my patients here at the hospital. ▪ 5


do not disturb Nurses don these neon yellow sashes while dispensing medications to prevent unnecessary intrusions or distractions. The goal: patient safety.

6 Keck Medical Center of USC

Feature  by sandra levy

Respect the Sash No interruptions equals greater accuracy with medications Mother’s instructions about minding our manners and not interrupting have taken on a deeper meaning at Keck Hospital of USC. Interruption Free Zones have proven to enhance both accuracy and safety during the administration of medications. The concept of interruption free zones—areas in the hospital that are free from intrusion or distraction during medication administration—began as a pilot study at Keck Hospital of USC on the 6 North Orthopedic and 8 West Oncology ICU units in July 2010. The program was so successful that it was expanded to several additional units in the hospital, including the 5 South Step-down ICU and 5 East Cardiothoracic Surgery Step-down units just six months later. “Medication errors are not uncommon in hospital settings, but that doesn’t mean we can’t come up with innovative ways to minimize those errors,” said nurse manager Daniel Hudson, R.N., who led the pilot study. “The idea behind the study was to provide our nurses with the tools they need to stay as focused as they can during medication administration, and this program is a simple, cost-effective way to make that happen.” The interruption free areas are clearly marked with signs and neon yellow sashes identifying nurses who are in the process of administering medications. While wearing the sashes, these nurses are not to be interrupted by other staff members, patients or visitors unless there are questions about the medications being administered or there is an emergency. According to a 2009 study published in the Journal of Nursing Scholarship,

almost 19 percent of all interruptions of a registered nurse per day arise when nurses are preparing or administering medications. Additionally, a 2006 National Institutes of Medicine report indicated that interruptions cause a stop in the process of administering medications, directly leading to medication errors that add up to an annual estimated adverse drug event cost of $3.5 billion. To address that issue, the hospital’s Medication Administration Safety Team— a group comprised of nursing management, charge nurses, direct bedside nurses and nurse educators—first launched the Interruption Free Zone pilot study, one of the many ongoing initiatives at the hospital, to enhance quality and improve patient outcomes.

“The idea behind the study was to provide our nurses with the tools they need to stay as focused as they can during medication administration, and this program is a simple, cost-effective way to make that happen.” Daniel Hudson, R.N. nurse manager, 5 East

During bi-weekly meetings, the Medication Administration Safety Team worked with other departments to develop educational strategies for the program, including producing an educational leaflet about the process for patients to receive upon admission. The team is also working on revising the medication distribution policy for the hospital focusing on the

Ana Padilla, R.N., documents medication administration while wearing the yellow sash.

importance of minimal interruptions. “The nurses in our unit have embraced the Interruption Free Zone because it prevents interruptions during the most critical part of their day as they are administering medications,” said John Alexiou, R.N. in the 5 East Cardiothoracic Step-down unit. “Our patients love the program because nurses are not rushed or interrupted when the patients are receiving their medications. Overall, the Interruption Free Zone is a great success on our unit.” Initial data from the program showed that within four weeks of implementing the program on the 6 North Orthopedic unit, the average time it took to administer a medication decreased by almost five minutes per patient because interruption frequency decreased from 77 to 40 percent. “Medication errors are not isolated to our hospitals; they happen everywhere,” Hudson said. “But I am proud that we have found an effective way to help minimize those errors and enhance patient safety.” ▪ 7

Cover story  by sandra Levy

Practice with a

purpose 7 South ICU turns empowerment into success

Recipe for Success:



Take 43 critical care nurses with varying amounts of experience, charged with providing care for some of the most acutely ill patients in the hospital.

Add approximately 20 physicians, responsible for the successful treatment of those acutely ill patients.

3. Mix in input from other specialty areas, including pharmacy and respiratory therapy.


4. Add communication, education and empowerment.

The results are a successful paradigm shift and outstanding patient outcome improvements on 7 South, which came about this year after nurses, physicians and other staff members decided to come together as a team.

8 Keck Medical Center of USC

Known as the Neurosciences intensive care unit, 7 South is a unique department with a somewhat misleading name. At the Keck Hospital of USC, most intensive care units are dedicated to treating a single condition, such as cardiology, and nurses may work with an average of five doctors who specialize in that condition. But on 7-South, nurses handle much more than just neurosciences. Staff members are charged with caring for patients with five of the most acute conditions— neurologic diseases, pulmonary/critical care, otolaryngology, orthopedics and overflow from other service lines—making working conditions even more complex. The nurses in this ICU have to partner with more than 20 physicians to treat patients with some of the most complicated and diverse conditions in the hospital. “The demand on nurses in 7 South ICU

is profound,” said Deidra Bonner, R.N., the unit’s nurse manager. “One of the characteristics that separates 7 South from the other critical care units, is that the majority of our patients have very short ICU stays with many nurse-escorted trips to imaging. This rapid turnover means that we admit, transfer, and transport patients at a rate equivalent to what is expected in lower acuity telemetry and medical-surgical floors. Providing specialized treatment, combined with ICU care demands in our fast-paced environment, became so draining that we struggled with keeping our nurses.” Because nursing positions in 7 South weren’t completely filled with staff nurses, the unit had to rely heavily on contract and registry nurses. The more experienced unit nurses were then not only charged with caring for their patients, but also overseeing and training new nurses on the floor.

Staff members say these demands made working conditions hectic, with physicians, nurses and other support staff working with less than ideal collaboration or communication.

“…it made sense that we should no longer perform patient rounds separately, but that we should unite forces with the physicians and begin rounding together daily as a team.” Deidra Bonner, R.N. nurse manager, 7 south icu

“Individual caregivers of the multidisciplinary team were so focused on providing patient care from the angle of their discipline’s perspective that it was difficult to communicate patients’ status consistently,” said Bonner.

“The inconsistencies in communication created a great deal of ambiguity and served as an added obstacle in providing patient care,” she continued. “Often nurses were left to sort through conflicting orders and recommendations from multidisciplinary team members.” With so many conditions leaving the unit’s nurses overwhelmed, Bonner approached the physicians in May 2011 with some potential solutions. “Our goals were to reduce infection, improve patient outcomes, realign the team and increase the morale of the unit,” Bonner stated. “We brainstormed possible solutions with the physicians and determined which ideas to try.” That’s when the idea of multidisciplinary rounding was suggested—bringing together physicians, nurses and other support staff From left: Adele Allen, R.N., Laura Roberts, R.N., Michell Fang, R.N.

7 South nurse turnover rate, prior to 2011:


Overall nurse turnover rate at Keck Medical Center, prior to 2011:


% 9

“We’ve seen some astonishing successes in a very short period of time on 7 South. We have improved patient outcomes. And we have created a new culture among the staff working here.” Deidra Bonner, R.N. nurse manager, 7 south icu

= Proactive solutions resulted from the paradigm shift in 7 South ICU: • Active engagement of the entire team, led by the nurses • Empowerment of nurses fueled by relevant education • Improved patient outcomes including infection reduction due to the value of multidisciplinary involvement Key tools for success included: • Multidisciplinary rounding • Active surveillance patient checklist tool • Consistent messaging • Relationship building through education and recognition

10 Keck Medical Center of USC

to provide a more complete, hands-on approach to patient care. “As nurses we serve as ‘gatekeepers’ of the patients’ information,” said Bonner. “We were already knee deep in efforts to reduce the incidence of infection on our own, and it made sense that we should no longer perform patient rounds separately, but that we should unite forces with the physicians and begin rounding together daily as a team.” This concept of physicians, nurses, pharmacists and other specialists working together as a true team represented a huge paradigm shift in the ICU culture. “Not only did the multidisciplinary rounding improve communication about the patients, it also provided a wonderful opportunity to educate each discipline about why various treatment options were planned,” said Kamyar Afshar, D.O., attending physician on 7 South ICU and assistant professor of clinical medicine (pulmonary and critical care) at the Keck School of Medicine of USC. In addition to the rounding, Bonner and the nursing team, in collaboration with physicians, developed an “active surveillance” tool—or a comprehensive checklist—to proactively integrate patients’ quality of care and safety measures. Nurses were also invited to informal 10-minute educational seminars, held every day, to help them learn more about the medical issues they encounter. Building upon the success of the change in communication practices, the multidisciplinary team created a mission statement to define and crystallize the unit’s goals and commitments. Within six weeks of implementing all of these programs, the unit was already seeing major changes. The length of time patients stayed in the ICU was decreased by 15 percent daily, as patients were being transferred more quickly to non-ICU areas. Medication errors were reduced by almost 80 percent. The decreased use of central venous and foley catheters and an

increased monitoring of preventable events also reduced patient infection rates by 80 percent. Three months later, the unit was seeing zero incidences of infection. Other results since that time have included a better understanding of patients’ goals and improved relationships, time savings for nursing staff due to less administrative duties and of course, the improvement of teamwork resulting in better morale and more full-time, permanent nurses to work in the unit. “By being valued as proactive professionals, we felt free to critically analyze information and voice our assessments and professional opinions as equal partners in the patient’s care,” Bonner stated. “It is extremely motivational for us and we also continue to be enthused to learn as much as possible.” Physicians on the unit also testify to the benefits of the improved communications—changes tangible and intangible. “It was encouraging to see the changes in all the staff, but especially in the nurses,” said Afshar. “It went from ‘What do I have to do today?’ to ‘What are we going to learn about today?’” As a result of the more effective partnerships and programmatic changes, more skilled nurses have chosen to remain in the unit and less experienced nurses have taken on more challenging responsibilities. “The advent of interdisciplinary rounds has provided the opportunity for nurses to feel like a truly integral part of the health care continuum,” said Lisa Goettl, R.N., 7 South ICU. “Although I have been a nurse for six years, I am fairly new to the ICU. My transition on the unit has been supplemented by the benefits of rounding and the emphasis on continued education. I feel a great sense of pride to be part of such a cohesive and encouraging team on 7 South.” The changes in 7 South have not gone unnoticed by the hospital’s leadership. “I am proud of the staff on 7 South because they are setting the standard for

From left: Sara Zigman, R.N., patient care technician Sean Frazier and Doris Arroyo, R.N.

multidisciplinary rounding in the hospital. This type of rounding and increased communication among caregivers has proven a reduction of medication errors and shorter ICU stays,” said Donald Larsen, M.D., M.B.A., chief medical officer for the two USC-owned hospitals. “I am excited about the team’s multidisciplinary effort because it puts the patient in the center of the medical care we’re delivering.” In an effort to keep the collaborative momentum going on 7 South, unit clinicians are continuing to build on their programs. “We’ve held a couple of outside educational dinners that many of the nurses have attended,” Afshar said. “And we’ve started a medical ‘book club’ where we meet at restaurants to discuss what we’ve read about issues encountered in our ICU.” Building upon the successes seen in 7 South ICU, assistant professor, Division of Neurocritical Care/Stroke, Benjamin Emanuel, D.O., said he hopes nurses continue to proactively assist in planning patient care. “When it comes to how much we can do as a multidisciplinary team, we’ve basically only just begun,” Emanuel said. “We want to continue the dialogue and increase what we can do to get ahead of any potential quality issues in the future.” The staff of 7 South have addressed the complexity of their patients’ concerns— previously a handicap of the unit—and by improving their communication and teamwork, have made conditions better, both for patients and staff. “We’ve seen some astonishing successes in a very short period of time on 7 South,” Bonner said. “We have improved patient outcomes. And we have created a new culture among the staff working here. Now we retain more nurses in the unit, and because of the progressive atmosphere here, nurses even approach us because they would like to work here.” ▪


7 SOUTH ICU MISSION STATEMENT: We, the nurses of 7 South ICU, declare the possibility of providing the highest quality care in a collaborative interdisciplinary approach. We stand for: • Excellence, innovation, collaboration, compassion, accountability. We commit to: • Providing the highest level of critical care in order to meet and exceed the diverse needs and expectations of our patients. • Collaborating with the interdisciplinary care team consisting of: the patient and his or her loved ones, physicians, the pharmacy department, patient care technicians, respiratory staff, unit secretarial staff and all other team members.

• Delivering evidence-based practice and producing recognized clinical research. • An environment that promotes respect and effective communication among all members of the patient/ family/healthcare team. • You can count on us to deliver uncompromising individualized quality care— the USC way.

• Striving to be a regionally and nationally recognized center of excellence in ICU care and education. 11

Feature  sandra Levy

charge nurses have received combined annual market and merit salary adjustments of an average of



Victor Dimacali, R.N., employed by the hospitals for 5 years

In 2011, more than

$465,000 was spent on new equipment for the nurses

There’s no place like home Nurse Retention Soars at Keck Medical Center of USC

“Our retention rates are so high, I believe, because of all the wonderful incentives we offer our nurses.” Ellen Whalen Chief Nursing Officer

12 Keck Medical Center of USC

Of all the places Oralia Aragon could have started her nursing career, she chose Keck Hospital of USC for one very important reason—an established program for recent graduates. Now, almost seven years later, Aragon has a whole host of reasons for sticking around: career development, educational incentives, the backing of one of the most prestigious academic institutions in the country and support from her colleagues. “There is a tremendous sense of teamwork here and lots of encouragement,” said Aragon, R.N., a staff nurse on the cardiothoracic telemetry unit at Keck Hospital of USC. “This is a place where people see strengths in you and then help you develop those strengths.” Aragon’s sentiments are indicative of the nursing staff at the two USC-owned hospitals—Keck Hospital of USC and USC Norris Cancer Hospital—and help explain a

nurse turnover rate of approximately eight percent in 2011. That figure is far lower than the national average of more than 14 percent for bedside nurses. “Our retention rates are so high, I believe, because of all the wonderful incentives we offer our nurses,” said Chief Nursing Officer Ellen Whalen. “We are giving them more resources than they ever had before and we are also providing them with the on-unit support they need to better care for their patients,” she added. For example, in 2011 more than $465,000 was spent on new equipment for the nurses, such as cardiac monitors, ventricular assist devices and transport monitors. Additionally, a resource nurse has been added on each floor to assist the nursing staff, and more nurse managers and directors have been added so that each individual manager can spend more time with the staff on the units.

nurse turnover rate in 2011

“At USC, not only am I surrounded by others who share the same passion, but I work for an organization that strives for excellence, has tremendous resources and a commitment of service to patients and employees.” Aurora Baduria, R.N. outpatient surgery nurse, Doheny Eye Institute



national average is more than 14% From left: Holly Fernandez, R.N., and Yesenia Gonzalez, R.N., have been employed by the hospitals for 20 years and 7 years, respectively


nurses have been employeed by the hospital more than 25 years

Also, since 2011, charge nurses at the hospitals have received combined annual market and merit salary adjustments of an average of 6.3 percent. New nursing graduates also are attracted to the hospitals’ Versant R.N. Residency program, an 18-20 week course that helps residents transition from student to professional nurse. The program offers both continued study and hands-on experience to acclimate nurses and prevent them from feeling lost when they need to begin treating patients. Both Whalen and Aragon agree these perks are just some of the incentives that not only help attract nurses, but help to retain them as well. For Aragon, the USC hospitals have been a place to nourish and grow her nursing career. After receiving her associate’s degree in nursing in 2004, she went through the new graduate orientation program at Keck

Hospital of USC. She was able to complete a bachelor’s degree in nursing through an on-site program affiliated with California State University offered at Keck Hospital. She joined the Nursing Quality Committee shortly after and served as its chairperson. Aragon is now pursuing a master’s degree in nursing that she will complete in June. With assistance from the many educational and professional growth programs in place at the Keck Medical Center of USC, 360 experienced nurses and 103 recently graduated nurses have been hired over the last three years, which has helped to dramatically decrease the number of registry nurses in the hospitals. And with many nursing positions still vacant, Whalen hopes to quickly fill the nursing staff with permanent, part-time and full-time employees. “We are implementing a nursing recruitment program with the goal of hiring 60 nurses in six months. We

360 + 103 360 experienced nurses and 103 recently graduated nurses have been hired over the last three years

are aggressively recruiting because we want to expand our services and accommodate our increase in patient census,” she said, adding that the average daily census is about 203 patients. Aurora Baduria, R.N., an outpatient surgery nurse at the Doheny Eye Institute who has been employed by the hospitals for 35 years, sums up the factors that explain Keck Medical Center’s outstanding nurse retention rate. “Real success is finding your lifework in the work that you love. As a nurse, I know that every day I will touch a life or that a life will touch me,” Baduria explains. “At USC, not only am I surrounded by others who share the same passion, but I work for an organization that strives for excellence, has tremendous resources and a commitment of service to patients and employees.” ▪ 13

Make It So

The Nurses of USC help design the next generation of medical records It may not be Star Trek’s medical tricorder, but Keck Care—the new electronic health record (EHR) being designed at the Keck Medical Center of USC—will help nurses boldly go into the future of patient care. Nursing staff at the Keck Medical Center have helped to customize the new electronic health record (EHR) system currently being tested on the campus. Marnellie Maravilla, R.N., who works in the 5 East Cardiothoracic Step-down unit, is one of 10 nurses who participate in the Core Nursing Group, a nursing focus group for the EHR design. “It’s exciting to be able to develop a care plan, and an entire system, customized to our patient population and our hospital,” Maravilla said. She and other Core Nursing Group members have influenced the system’s design by providing input to the design team and testing the system’s applications, including its workflow design and data presentation options. “I am also looking forward to using the system because it will help streamline documentation so we can spend more time at the bedside caring for our patients,” Maravilla added. New Efficiencies Extensive work to implement the EHR system began two years ago, with initial phase testing beginning late last year. “I think our nurses will be excited about using the EHRs,” said Terry Pickering, R.N., director of nursing informatics,

Amy Zaratsian, R.N., uses a “WOW” (Workstation On Wheels) to document patient information into the new electronic health record being tested. 14 Keck Medical Center of USC

Feature  by sandra levy


“With EHRs providing more data, better efficiency and with safety checks built into the system, accuracy of charting improves and clinicians can easily track their work.” Terry Pickering, R.N., director of nursing informatics

who is supporting EHR development and implementation for the two USC-owned hospitals. “There will be so many efficiencies they can utilize. Probably the biggest win for nursing is they will have the ability to better manage their patients’ conditions using real-time data.” EHRs can streamline patient care with more efficient data capture and retrieval, giving providers the ability to automatically update and share information, including multi-media files such as medical imaging results, among different caregivers and locations. The digitized system also links records to sources of relevant and current research while standardizing services and patient care for greater efficiency. “As a team, we have worked diligently to ensure that this smarter, new technology will improve patient care throughout the Keck Medical Center,” Pickering said. “With all the automated features designed and built into the system, nursing staff can expect EHRs to save them time, which will enable collaboration in interdisciplinary care planning and better critical thinking.” One of the team’s contributions is the set of rules built into the system as a Care Planning Process, which prompts nurses to initiate the appropriate plan of care based on the assessment findings. “The improved care plan design helps to identify problems early on in the care process and suggests appropriate plans of patient care,” Pickering stated. “For example, if we know that a patient is at risk for falls, based on the initial assessment, the appropriate plan of care can be initiated to ensure that this patient has necessary precautions in place.” Care providers will also have the ability to leverage system data to more efficiently

manage patients. Pickering continued, “With EHRs providing more data, better efficiency and with safety checks built into the system, accuracy of charting improves and clinicians can easily track their work.” Dynamic EHR Features With the implementation of the EHR, nurses will be able to document more accurately, due to the system’s drop-down menus and medical device interface capabilities. Data can be pulled in and validated by the clinician, rather than manually entered. Provider order entry will decrease both the amount of time needed and errors associated with order transcription. The system’s real-time dashboard will provide immediate patient information, while the populated screens, such as those for vital signs monitoring, will efficiently pull relevant patient data into one view. The ability to showcase only the most relevant patient data for the clinician or care venue enables better decision making at the bedside. The Situation Background Assessment and Recommendation (SBAR) tool will give nursing staff a standardized view for communicating a patient’s condition at shift change or when transferring care to another clinician. It will provide a comprehensive electronic shift hand-off allowing nurses to more efficiently convey specifics. “When testing the screens, we were especially impressed by the SBAR screen view,” according to Veronica Valenzuela, R.N., clinical information systems coordinator, who also is a Core Nursing Group participant. “It allows us to see all applicable laboratory results, vital signs, procedures, interventions, medications, consultation and other relevant information displayed in a very organized and useful view.”

How Nurses Will Use EHR The EHR system was designed for nurses to use at the patient’s bedside. Nurses will have options about how to chart records and access the system including using drop-down workstations located in hallways and patient rooms, or via portable workstations that can be wheeled into patient’s rooms. Pickering and the nursing team that helped design the EHR system are proud of the initial phase and already are planning for additional features and improvements in future versions. “In upcoming phases of the EHR implementation, we are working toward having the ability to leverage bar-code technology to collect lab specimens, administer medications and program IV infusion pumps with the goal of decreasing patient errors and providing a closed-loop process for the clinician to reduce human errors,” Pickering stated. Although EHRs offer many efficiencies for nurses and clinicians, in the end it is all about patient care. For patients at the Keck Medical Center, access to good care becomes easier and safer when records can easily be shared. “This technology will help our clinicians because they will have real-time patient data at their fingertips, wherever they need to review it,” Pickering stated. “By design, the system enables better communication and collaboration among clinicians; however it’s our patients who will have the most meaningful benefits from these efficiencies because our clinicians will have more time for their care.” ▪ 15

Feature  by sandra levy

Meet Cynthia Wallingford, R.N.

From graduate to nurse manager in two years Cynthia Wallingford serves as nurse manager in the 8 East surgical oncology unit. Drawn to the field of nursing after caring for her father as he battled cancer, she graduated from nursing school in December 2008. Cynthia was hired by Keck Medical Center of USC in March 2009; completed the Versant R.N. residency program in June of that year and in 2011—just two years later—was named nurse manager for 8 East. Q: What attracted you to apply to work at the Keck Medical Center of USC as a new graduate? A: I really wanted to work here because of the residency program. As a new graduate without a lot of clinical experience, it was important to me to work at an academic medical center that places value on educating its staff. Q: How did you progress so quickly from newly hired nurse graduate to nurse manager? A: I think my career path had a lot to do with Debbie Peterson, the nurse manager who hired me, and some opportunities that came my way. I think Debbie saw my potential to manage and started training me as a relief charge nurse. Then, Debbie

16 Keck Medical Center of USC

needed someone to fill in for her when she went on leave, and I stepped in to work as interim nurse manager. After Debbie returned to work, a nurse manager position opened on 8 East. Q: What advice would you give to new nursing graduates about choosing a place to work? A: I would advise new nursing graduates to look for the same things I found here at the Keck Medical Center—an academic environment that provides opportunities to learn, values its employees and supports their career development. The patientcentered care and diversity of perspectives are both highly valued here, and that’s why I am where I am today. ▪

Appreciation corner By Amy Hamaker


Christina Domingo, R.N. [ DAISY Award ]

Small kindnesses can reap great rewards Sometimes, it’s the small things nurses do that can make the biggest impact to patients. The simple act of bringing iced coffee to a recovering surgery patient with a caffeine craving helped earn Christina Domingo, R.N. coordinator at Keck Hospital of USC, the February 2012 recipient of the DAISY Award for Excellence in Nursing. One of Domingo’s patients had sinus surgery at Keck Hospital on Sept. 2, 2011, and stayed overnight as part of his recovery. In a letter praising Domingo, the patient describes Domingo as courteous and helpful from the start, bringing him juice and iced coffee and checking on him frequently during her shift. “[Domingo] is exemplary of what Keck Hospital of USC strives for in excellence from its nursing staff,” said the patient in

the letter. “My wife and I are very thankful for the great care she took of my needs during my stay there. Good deeds and services should not go unrecognized—job well done, Ms. Domingo.” The DAISY Foundation created the DAISY Award Program in 1991 in honor of the care given by nurses at the Seattle Cancer Care Alliance to Patrick Barnes during the last weeks of his life. The program is now a feature at more than 1,000 health care institutions internationally. DAISY Award recipients are nominated by peers, physicians, patients and families, and staff and administrators for clinical excellence and for extraordinary care and empathy shown when working with patients. Keck Medical Center recipients are announced every month.

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