Highlighting 2013 Accomplishments and Outcomes

2013 Nursing Annual Report

I n t r o d u c t I o n

It is a privilege to present the 2013 Nursing Annual Report for St. Francis Regional Medical Center, recognizing key accomplishments and significant contributions achieved by our nursing staff. This year we officially began our journey to becoming a Magnet Recognized Hospital® formally recognizing our nurses and their commitment to quality patient care, nursing excellence and innovations in professional nursing practice.

Our nurses at St. Francis continually inspire me. They are leaders who are not afraid to speak up; who lead initiatives that will insure our patients are receiving the safest and best care possible. They meet demands of a more complex health care environment by furthering academic education and achieving certification.

Their professional development is apparent in many ways. Twenty of our nurses attended the American Nurses Credentialing Center’s medical/surgical national certification review seminar, hosted by St. Francis. The review course prepares RNs for national certification as specialized nurses in medical/surgical nursing

A newly created Nursing Practice Board, with representation from all patient care councils and departments empowered nurses to have a voice in their nursing practice and patient care. Patient care councils flourished in 2013, empowering nurses to suggest, test and implement solutions to issues in their area of care. Some of the greatest understandings took place at the first All Patient Care Council. By bringing all patient care units together, barriers were broken; best practices shared and patient care was improved.

This annual report clearly illustrates that we have a lot to be proud of at St. Francis and I am grateful for every St. Francis nurse and all they do to make a difference in the lives of our patients and their families.

Deb Ryan, RN Vice President, Patient Care

Greetings from St. Francis Regional Medical CenterDeb Ryan, Rn, ViCe PReSiDent, Patient CaRe

Introduction

Mission, Vision, Core Beliefs ...............................................................................................................2

Philosophy of Nursing .........................................................................................................................3

Nursing Indicator Survey Results .....................................................................................................4

Nurse Leadership ................................................................................................................................. 5

transformational Leadership

The Mentor Connection ......................................................................................................................6

Shared Lessons ......................................................................................................................................7

Better Insight Better Design ..............................................................................................................7

Structural Empowerment

Safe Transport ........................................................................................................................................8

Speaking up for Patient Safety....................................................................................................... 10

Communication First ........................................................................................................................ 11

Exemplary Professional Practice

Calming Young Patients ................................................................................................................... 12

Creating a Professional Practice Model ....................................................................................... 13

Reducing C-Section Deliveries ....................................................................................................... 14

Choices for Cancer Patients ............................................................................................................ 15

new Knowledge and Innovation

The Wait is over .................................................................................................................................. 16

Nurses Utilize a New Resource for Patient Experience ............................................................ 17

Inpatient RNs Cross-train to SCU ................................................................................................... 17

Increase in Certified RNs .................................................................................................................. 17

Creating an Environment of continuous Improvement .......................................................... 18

2013 Certifications ............................................................................................................................ 19

nurses Making a difference

March of Dimes Awards ................................................................................................................... 20

Eileen Dietz Award ............................................................................................................................ 21

Daisy Awards ....................................................................................................................................... 21

Mpls. St. Paul Magazine Outstanding Nurse Honors ............................................................... 22

Preparing for Baby ............................................................................................................................. 23

Creating Healthier Communities ................................................................................................... 24

tabLE of contEntS

I n t r o d u c t I o n I n t r o d u c t I o n

1

St. francIS rEgIonaL MEdIcaL cEntEr

in Shakopee is a partner with Essentia

community Hospitals and clinics,

allina Health and Park nicollet Health

Services. this unique structure enables

us to combine the caring and compas-

sion of a community hospital with the

modern medical technology, specialties,

and services found in the metro area. We

provide a full range of inpatient, outpa-

tient, and emergency care services on a

collaborative medical campus with more

than 30 other providers.

St. francis primarily serves residents in

Shakopee, Jordan, chaska, Prior Lake,

Savage, belle Plaine and carver as well

as those in new Prague, Eden Prairie,

bloomington, Lakeville, burnsville,

chanhassen, Victoria, cologne,

Excelsior, Henderson, Elko, new Market,

Montgomery and LeSueur.

I n t r o d u c t I o n

At St. Francis, we work together to provide all people the healing

experience we would expect for ourselves and our families.

Our Mission

• St. Francis will be nationally known and trusted for exceptional nursing practice.

• St. Francis nurses combine the best of science and caring to provide exceptional patient care through trusted partnerships and effective stewardship.

• St. Francis’ healing environment fosters nursing practice that is evidence-based, innovative, and patient/family centered.

• St. Francis nurses are powerful, passionate and diverse in talents and thought.

• Nursing career paths provide St. Francis nurses with dynamic opportunities for career enhancement to help them achieve their highest potential.

• Nursing leadership is relationship-centered, holistic, progressive, and responsive.

N u r s i N g V i s i o N

2

St. Francis’ Philosophy of Nursing was created by gathering feedback from direct caregivers who serve our patients in all departments. Patient Care Councils met jointly in June 2013 to create this unique philosophy from the feedback. It was then approved by the Nurse Practice Council. The St. Francis Nursing Philosophy has three elements:

Nursing practice at St. Francis is based on providing exceptional patient care through caring and advocacy within a healing environment that promotes health, and empowers patients and their families through the continuum of life, and supports them through difficult experiences.

St. Francis nurses combine the best of science and the art of caring, through collaborative partnerships and a commitment to professional growth and development that is supported by St. Francis’ Mission, Vision, and Values, the Allina Charter for Professional Nurses, and the American Nurses Association Code of Ethics and Scope and Standards of Nursing.

The registered nurse is the leader and integrator of patient care and St. Francis’ healing environment fosters nursing practice that is a hallmark of excellence recognizing staff as the most valued resource.

I n t r o d u c t I o n

P h i l o s o P h y o f N u r s i N g

• Advocacy• Caring• Continuous Improvement• Cultural Awareness and Recognition• Ethics• Leadership• Relationships• Stewardship

N u r s i N g C o r e B e l i e f s

3

I n t r o d u c t I o n

Evaluating the quality of nursing practice began years ago, when Florence Nightingale identified how important nursing care is to the quality of patient care. St. Francis nursing supports the delivery of high quality nursing care by participating in the National Database of Nursing Quality Indicators (NDNQI); the only national nursing database that provides reporting on the structure, process, and outcome indicators used to evaluate nursing care. Inspired care comes from inspired nurses, and by participating in the NDNQI, St. Francis nurses are able to track nursing sensitive quality measure and develop actionable opportunities that support excellent patient care.

St. Francis nurses participated in the 2013 NDNQI survey, reporting steady increases in job enjoyment, ranking well above the national comparison, and we outscored the national comparison in key nursing functions such as multi-disciplinary communication, autonomy, professional status, and development. Information and feedback obtained from the 2013 RN Survey was shared through all levels of nursing from direct care givers to nursing leadership, and action items were developed to continue to inspire nurses to create solutions that support a working environment that reinforces the Mission, Vision, and Values of St. Francis.

Using NDNQI data, St. Francis nurses have the advantage of gaining insight into nursing-sensitive indicators; patient outcomes directed related to nursing care. Making the data meaningful has led to creating solutions as nurses’ work through collaborative teams to improve care for our patients and the work environment of nurses. The knowledge and insight gained through the NDNQI data has helped establish goals for continued improvement throughout all nursing teams and the evaluation of nursing care related to exemplary patient outcomes.

N u r s i N g i N d i C at o r s u r V e y r e s u lt s

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J o b e n j o y m e n t t- s c o r e s<40 = Low, 40-60 = Moderate, >60 = High

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6 6

6 4

6 2

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5 8

5 6

5 4

5 2

5 02 0 0 8 2 0 1 2 2 0 1 3

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5 8 . 1 2 5 8 . 3 1

6 3 . 2 4

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■ N a t i o n a l C o m p a r i s o n ■ s t . f r a n c i s — l i n e a r ( s t . f r a n c i s )

I n t r o d u c t I o n

e x Pa N d e d N u r s e l e a d e r s h i PBack row, left to right: Deb Gunderson, Brianna Thompson, Mary Beth Heilman, Nancy Wolf, Sarah Amendola, Jon Bartlett, Nancy Menth, Karen Ortman, Sara Van Horn, Annette Yolitz, Ann Friedges, Chris Kroeg, Monique Ross, Dorinda Vloo. Front row, left to right: Mary Bothof, Jamie Stolee, Kathy Mason, Deb Ryan, Chris Wolf, Liz Rodgers. Not pictured: Steven Ashelin, Kelly Beck, Andrea Gerth, Mary Giesen, Greg Jones, Erin Kiernan-Johnson, Cheryl Laine, Candace Lano, Nancy Menth, Debbie Reynolds, Julie Such, David Tetley, and Robin Winterfeldt.

N u r s i N g P r a C t i C e B o a r dLeft to right: Kristina Pennertz, Deb Ryan, Bethany Anderson, Jen Buel, Renee Geske, Julie Schwartz, Jessica Gallagher, Jackie Kalal, Sarah Amendola. Not pictured: Ashley Vellance, Robin Winterfeldt, Patti Simones.

5

It is relatively easy to lead people where they want to go; the transformational leader guides people

where they need to go to meet the demands of the future. This requires vision, influence, clinical

knowledge, and strong expertise relating to professional nursing practice. It also acknowledges that

transformation may create turbulence and involve creative approaches to solutions.

transformational Leadership

t h e M e N t o r C o N N e C t i o N

Helping new float nurses acclimate to diverse

care responsibilities and strengthen colleague

connections.

The Nurse Mentor program was started in 2013 by nurses in St. Francis’ float pool in an effort to help new nurses acclimate to the versatility of the float pool responsibilities and to strengthen nurse retention in the department. Float pool nurses work in a variety of units, including inpatient care, surgical care, emergency and more. They treat a diverse range of patients under changing circumstances and challenges, as needed. Float nurses enjoy schedules that are more flexible and the opportunity to explore areas in which to specialize. However, it is not uncommon for new nurses to feel ‘disconnected’ and without a ‘workplace home’ initially. By providing a mentor to new nurses, they become more confident and at ease with the different skills needed in different departments.

“Our manager, Chris Wolf, brought up the idea of a mentor program at a Unit Council meeting,” Sara Pherson, RN, said. “We all jumped right on board. Some of us had been involved in mentor programs as new graduates and others remembered what it was like to be a new nurse in a float pool and how much a mentor program would have helped. We all supported it right away.”

Mentors participate in a two-hour education class and are then paired with a new nurse based on interests and a possible personal connection. Nurses who have been in a preceptor position with the new hire are discouraged from being their mentor. They agree to complete a two-year commitment that includes follow up meetings with both the mentee and managers.

According to Pherson, the program is doing well. “I know the feedback has been good and that the mentees enjoy it,” she said. “The hardest part was finding enough mentor volunteers for the large number of new nurses we’ve had. Otherwise, I think it’s a project that’s gone very well.”

“some of us had been involved in mentor programs as new graduates and others remembered what it was like

to be a new nurse in a float pool and how much a mentor

program would have helped. We all supported it right away.”

– Sara Pherson, RN

6

Nurses in Surgical Care were integral in designing a status board that satisfied

communication needs for families, physicians and staff.

Surgeries are stressful, for both the patient and the family. Even with a beautiful waiting area, pagers, Wi-Fi and the nearby Legacy Café there is still a level of anxiety during the surgery. Because of this, the surgical nurses saw a critical need to implement status boards to help families better understand where loved ones are during procedures. The boards also help caregivers to track patients’ progress instead of having to depend on others.

When the surgical suites area was undergoing renovations, status boards became part of the upgrade. Surgical nurses were on board immediately. Because the boards are products of Excellian, the Electronic Medical Record (EMR), the project was supported by Allina Health’s Information Technology (IT) team. Ten nurses worked with the IT team for almost two years to insure that correct workflows and specific information were included for each care area.

“It was an in-depth, lengthy project and we were excited to be involved,” Vicki Johnson, RN said. “Our overall goal was to make it efficient and as simple as possible. For instance, some systems require the nurse to formally document when the patient moves in the system, creating an extra step. We knew that because of the EMR connection, the OR documentation could be programmed to drive this automatically, so we fought hard to eliminate this extra step.”

While the nurses did not design the status boards from scratch, they worked very closely with Allina Health’s Information Systems team in charge of the project. “There was a whole team at the Allina Health level and our council was instrumental in developing, tweaking and making it user friendly,” Kristina Pennertz, RN said. “Patient privacy is always critical in projects like this, so the final design went through an extensive approval process.”

Status boards are now located in five areas: Patient Waiting Area, Staff Lounge, PACU, Anesthesia, Same Day Surgery (which is the control desk) and are updated until 8:00 pm. The color-coded electronic board gives continual up to date information so family and caregivers know exactly where the patient is at all stages during the procedure.

“Our nursing staff are key players in the success of the status boards,” Pennertz said. “Because of their participation they are efficient and user friendly and a great service to our patients and their families.”

B e t t e r i N s i g h t, B e t t e r d e s i g N

t r a n S f o r M a t I o n a L L E a d E r S H I P

Kristina Pennertz, RN and Vicki Johnson, RN played key roles in designing status boards for the surgery department.

St. Francis’ Float/Flyer nurses are integrated in every hospital department and as a result, they are competent in a variety of patient care areas. This expertise is a valuable resource for procedures that are not as routine in other nursing particular units.

When a Float/Flyer Patient Care Council was created, one of their objectives was to continually educate their peers. “As nurses, we need to always keep educating ourselves and sharing that information,” Jen Buel, RN, Float explained. “

Assistance with blood administration and documentation was a frequent request from the Family Birth nurses because it’s a procedure rarely needed in that area. The Float/Flyer Patient Care Council thought it would be a great opportunity for peer

education. After researching and reviewing evidence based practices and system wide resources for Blood Transfusion Education, the council created a curriculum specific to St. Francis.

Education was created that walked direct care nurses through the process, from the initial order, to requesting blood from the lab, to critical documentation. Members of the patient care council team took turns presenting the topic at Family Birth Place Clinical Development Days.

“Education with each department will be an ongoing project with our Council,” Buel said. “As different education opportunities arise, the council will determine whether there is something valuable we can contribute during education sessions.”

s h a r e d l e s s o N s

Float/Flyer nurses take departmental education seriously, sharing skills and educating colleagues in

procedures rarely needed in certain departments.

7

Solid structures and processes developed by influential leadership provide an innovative environment where

strong professional practice flourishes and where the mission, vision and values come to life to achieve the

outcomes important for St. Francis.

Structural empowerment promotes community relationships, promotes professional development and

provides for nurse recognition.

Further strengthening nursing practice are the strong relationships and partnerships developed among all types

of community organizations to improve patient outcomes and the health of the communities they serve. This is

accomplished through the organization’s strategic plan, structure, systems, policies, and programs.

Structural empowerment

S t r u c t u r a L E M P o W E r M E n t

s a f e t r a N s P o r t

After a Failure Mode and Effects Analysis (FMEA) study reported risks of injury to care team members

when transporting surgical patients by bed between the inpatient care units to surgical services,

St. Francis’ Safe Patient Moving (SPM) team championed change initiative that implemented rapid

cycle improvement pilots.

Lead by Patient Care Supervisor Brianna Thompson, RN and Health/Safety program manager Amanda Saathoff, the multidisciplinary team consisted of nurse leaders and direct care nurses from Same Day Surgery (SDS), Post Anesthesia Care Unit, Inpatient Care as well as members of the transport team.

“The nurses in the work group came together to find solutions to both reduce employee injury while maintaining the patient experience,” Thompson said. “Our goal was to proactively address safety risks in transporting patients.”

8

9

S t r u c t u r a L E M P o W E r M E n t

st. francis’ safe Patient Moving team

Brianna Thompson, RN, PCS,

Inpatient Care

Amanda Saathoff, Health/Safety

Program Manager

Chris Wolf, RN, PCM, Float/Flyer

Liz Rogers, RN, PCM, Surgical Services

Dawn Nesburg, RN, PACU

Kris Pennerz, RN, SDS

Ann Stenson, RN, SDS

Melissa Abeln, RN, Inpatient Care

Joanne Rosentretter, RN,

Inpatient Care

Brittney Mueller, RN,

Inpatient Care

Collaborating between departments was critical to insure a solution that would benefit everyone for obvious reasons:

• Nursingstaffwereintegralinchangingestablishedpatienttransfer processes in sending and receiving departments.

• Nursechampionsfromkeydepartmentswereexpertsandchampions in the change process.

• Initiativedemonstratedmultidisciplinarycollaborationbetween nursing departments.

The team thoroughly studied the issues, the options, and ultimate outcomes. As different products and processes were trialed, the team would reconvene to discuss how it worked. Everyone involved in the transport, including the patient, provided feedback on how it worked.

“It involved lots of intensive work from the team as well as the care givers on the units. By trialing, experimenting and providing feedback, a good work flow was identified,” Saathoff said. “It truly showed how well the care team collaborated across all units. Because of this, a process is in place to purchase the equipment and move the work forward.”

During the trial, it was discovered that guidelines do not require an RN in order to transport a stable patient, which enabled the team to create more efficient processes overall.

“If the transport staff can move the patient to their bed by cart independently, the inpatient staff can be there with the lateral transfer device when they arrive,” Thompson explained. “From a surgical perspective, it improves the patient flow from the operating room to PACU resulting in a better, quicker experience for the patient as well.”

In addition to working more efficiently and providing more comfortable moving experience for the patient, the multidisciplinary group unanimously approved use of a ‘motorized’ cart with a lateral moving device. Both Thompson and Saathoff agree that even though it might have taken longer to move the patient safely, the project is successful because of a highly engaged staff who took safety for both caregivers and patients very seriously.

9

S t r u c t u r a L E M P o W E r M E n t S t r u c t u r a L E M P o W E r M E n t

s P e a k i N g u P f o r Pat i e N t s a f e t y

One of the most critical facets of patient safety is empowering direct care givers to speak up when they see a patient situation that could be made safer. This is exactly what happened when Emergency Department (ED) nurses voiced their concern about patient care.

“We are only as good as what we know,” Greg Jones, RN and Patient Care Supervisor in the ED, said. “If we don’t know someone needs immediate attention, we can’t meet patient needs.”

ED nurses identified issues that needed to be resolved to keep patients safer. Alarm volumes were either turned off or not loud enough for care team members to hear. Secondly, the single monitoring station could not be viewed by physicians or the health unit coordinator (HUC), so if a nurse was not sitting directly in front of the station, critical heart arrhythmias could be missed. Finally, monitor settings that would default to one patient would not update to a newer patient, which could result in missing vital signs.

Nurses of the ED Patient Care Council took the concerns very seriously, coming to resolutions on each issue:

•AlarmVolumesweresetatbothaudibleandacceptablelevelsandstaffwaseducatedthattheywere not to change these levels. The ED Supervisor was charged with randomly checking the alarm volumes monthly.

•AsecondmonitoringsystemwaspurchasedandplacedattheHUCstation.Thisgivesclearview of all heart rhythms to the HUC, EMT tech and physicians. It also serves as a second station for nurses passing through the station, and frees nurses to care for patients at the bedside.

•Themonitordefaultsettingsissuewasrecognizedasahospitalwideproblem.Agroupwasassigned to generate a new policy that will ensure greater safety and practices around alarms and monitoring throughout the hospital. Standardized default settings were locked in place, preventing any setting changes. New practices of “admitting” and “discharging” all patients from the monitors were established, assuring only patient specific data is stored.

Since these changes were integrated, no alarm or critical change in a patient’s vital sign status has been missed in the ED. Several critical changes were noted resulting in the ability to provide immediate action, thanks to the new system.

ED nurses identified the need for a monitoring station that could be better viewed by care providers.

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S t r u c t u r a L E M P o W E r M E n t

C o M M u N i C at i o N f i r s t

When patients are transferred to different departments, it is essential caregivers

provide clear and effective communications to ensure the patients’ continued safety.

In 2013, St. Francis nurses focused on a hand-off communications project between the Inpatient Care, Special Care and Emergency Departments. According to Jen Buel, RN and Patient Float/Flyer Council Chair, hand off communications is defined as “… any written or verbal communication that takes place when a bedside nurse hands over care of the patient to another nurse.”

These departments were most at risk for communications problems because of the ongoing exchange of patient care between the settings. At the time, the process in place consisted of a written and verbal ‘sign out’. The verbal sign out was done before the patient was transferred while the written hand off was documented on a computer.

Because of heavy patient volumes, emergency nurses were more likely to give the initial verbal sign out when transferring the patient, but entered written communications as time permitted. As a result, inpatient care nurses did not always feel adequately informed about the patient’s condition and became concerned the communication barrier could become a patient safety problem.

Collaboration among the float/flyer and ED Unit Councils facilitated discussions to identify breakdowns in the communication process.

“The first recommendation was to simplify the ED sign out to ‘need to know’ information, like fall risk, isolation and home medication,” Buel said. Inpatient nurses could access other information by reviewing the ‘ED Summary’

verification report in the electronic medical record. This reported, step by step, all actions done in the ED, including nursing and physician notes, lab, history, and medications among others.

The ED Summary Report is long and detailed, and reading it thoroughly to get necessary information was time consuming for inpatient nurses. While it provided too much information, the simplified written sign out didn’t provide enough necessary information for the nurses receiving the patient for care.

The issue was presented to Patient Care and Joint Unit Councils. These nurse councils agreed that the verbal handoffs seemed to be working well and should continue. The greater issue was the written sign out procedure. The process in place could be more effective. A new, written hand off communication was identified in a Situation-Background-Assessment-Recommendation (SBAR) format.

The new format populated each area with standardized critical content, which included vital patient information and supported the transition of nursing care and best practice.

The change in nursing communication has been successful, and is well utilized, according to Buel. “It took time to make sure all nurses got the right information to ensure patient safety,” she said. “However, using the SBAR communication tool clearly emphasizes key information and important details about the patient.”

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This entails the comprehensive role of nursing and professional practice through the delivery of

high quality care to patients, families and communities through multidisciplinary teamwork that is

grounded in a culture of safety. Autonomy empowers nurses to meet the unique needs of patients

and their families, and is grounded by the knowledge, skills, and resources nurses use to deliver

care based on best practices.

exemplary Professional Practice

Patients, especially children, treated in an Emergency Department are often anxious and frightened. Until recently, the only way to help calm them was to use an IV sedative, which required a painful IV insertion and hours of monitoring before the young patient could be

released. Area pediatric hospitals had started using nitrous oxide to help relax, but not sedate, children with great results. St. Francis emergency RNs Jenny Cameron and Greg Jones wanted to learn more about this innovation and hopefully integrate it into patient care at St. Francis.

Nitrous oxide is an odorless gas inhaled by the patient. It can reduce anxiety and increase tolerance to

pain for patients of all ages. It is especially effective for emergencies such as laceration repairs, fractures, and CT scans. Since it does not require IV access, it goes to work quickly with minimal side effects and does not create the added pain caused by an IV insertion.

Cameron and Jones took a course on safely administering nitrous oxide to pediatric patients, and then began writing a policy for St. Francis, which included changes necessary to include adult patients, after researching evidence based practices.

“We were surprised at the ease of administering nitrous and were excited to start using it at St. Francis,”

Cameron said. “We were surprised more facilities in the metro area were not already using it.”

The ED purchased a portable nitrous oxide system for procedural sedation and began training all staff on the process. Susan Haas, RN, created an Excellian (electronic medical record) doc flow sheet that encompassed all safety aspects, areas required for billing and general RN documentations, as the policy required. All ED nurses completed the nitrous course, which included documentation education.

As the process all came together, Allina Health asked the St. Francis ED nursing team to share their process and educate all ED departments and nurses in the system.

“Educating all of Allina’s care team members on nitrous oxide administration was a huge undertaking lead by our St. Francis ED nurses,” Jamie Stolee, manager, St. Francis Emergency, said. “The bottom line is that it’s been very successful and resulted in better care for our pediatric patients.”

Cameron agrees. “Just like certain medications, it does not work on every patient, but is a great option,” she said. “Before this, the medication we used for our pediatric patients kept them sedated for a long time. We had to monitor patients for hours before they could be discharged. Nitrous oxide leaves your system immediately once turned off so patients ‘wake up’ right way. Adult patients are even able to drive home immediately.”

Another benefit to using nitrous oxide is that the right level of sedation can be achieved, which is difficult or almost impossible to do with an IV medication.

“This has been extremely successful,” Haas said. “Nitrous oxide is very safe and has helped so many of our patients relax and the quick wake up time makes the patient, the parents and our staff happy.”

“educating all of allina’s care team members

on nitrous oxide administration was a huge

undertaking lead by our st. francis ed nurses. the

bottom line is that it’s been very successful and resulted in better care for

our pediatric patients.” – Jamie Stolee, RN

C a l M i N g y o u N g Pat i e N t s

Safely administering nitrous oxide to pediatric patients was a success in St. Francis’ Emergency

Department. So successful, in fact, Allina Health asked if the St. Francis team could share and

educate their process with all ED departments in the system.

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E x E M P L a r y P r o f E S S I o n a L P r a c t I c E

C r e at i N g a P r o f e s s i o N a l P r a C t i C e M o d e l St. Francis nurses championed and created a professional practice model that clearly illustrates the complex components of professional nursing practice and care provided to patients and families. Nurses suggestions molded and formed the essence of the model’s design. Key terms, like advocacy, compassion, autonomy, leadership, respect, and collaboration, were integrated into the design to illustrate St. Francis’ unique nursing practice. Central to the design idea were the “hearts and hands of St. Francis.”

Two models were proposed and direct care nurses chose the design that they felt best incorporates the philosophy of nursing practice at St. Francis. Their professional practice model is a graphic depiction of the “hands of nursing” holding the “heart of nursing” that symbolizes and speaks to the art of caring and nursing at St. Francis Regional Medical Center.

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C - s e C t i o N d e l i V e r i e s

A multidisciplinary collaboration among direct care nurses,

certified nurse midwives and physicians produced outstanding

results in reducing primary cesarean section deliveries.

St. Francis’ Family Birth Place effectively reduced the number of women experiencing primary cesarean section delivery of their babies (cesarean delivery for the first time on a pregnant woman), with a rate of 9% compared to a national rate of 30%.

Lowering the cesarean birth rates at St. Francis starts with the goal of providing the best birth experience possible for each family. By working together, nurses and healthcare providers are able to honor the choices and traditions of the women and their families. Nurse midwives have contributed a culture of learning and mentorship that has had a positive effect on patient outcomes as well.

St. Francis nurses and providers create awareness and trust in the natural birth process, recommending minimal medical interventions to only those necessary for the safety of the mother and baby. This is reinforced by guidelines of the American College of Obstetricians and Gynecologists and the National Institutes for Health and Clinical Excellence, which recommend the induction of labor before 39 weeks only in cases of medical necessity.

Another practice that decreases the risk of medical interventions and possible cesarean births is a process called ‘labor down’. As the mother goes into labor, mothers are encouraged to work with her body through a process called “labor down”. Instead of forcefully and actively pushing with each contraction, laboring down allows the mother’s body to naturally bring baby further down and rotate while following only natural, gentle urges to push (or not push at all).

Labor and delivery nurses work one on one with the laboring mother and their families to provide physical and emotional support. Many have completed the Transformative Nurse Training (TNT) program which educates nurses on a holistic approach to patient care and the power of the mind/body/spirit connection.

Creating a healing environment helps decrease stress hormones and facilitates the natural process of labor. Flameless candles, and low lighting options are used in all labor rooms. Aromatherapy, such as lavender, decreases anxiety and promotes feelings of wellbeing. Massage and hydrotherapy also promote relaxation of mind and body and therefore facilitate the process labor. Water births give women another wonderful option that promotes a peaceful birth.

Nurses understand that if you want to move the baby, you need to move the mother. Positioning and stretching techniques assist the baby to rotate into the right position for birth. Peanut birthing balls, regular birthing balls and various yoga positions help assist with pelvic floor stretching, allowing the baby to descend further into the pelvis and facilitate cervical dilation. Walking is encouraged with all patients; intermittent fetal monitoring is used with low risk patients, and telemetry monitoring is used with patients who require continuous monitoring.

Being patient and respecting the natural process of birth allows a woman’s body to labor in synthesis with the mind and body connection and wonderful outcomes.

E x E M P L a r y P r o f E S S I o n a L P r a c t I c E

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E x E M P L a r y P r o f E S S I o n a L P r a c t I c E

g i V i N g Pat i e N t s o P t i o N s

Giving cancer patients access to new and innovative therapies takes

an understanding of our patients, physicians and the CCOP cancer

research consortium.

The Metro-Minnesota Community Clinical Oncology Program is a consortium of hospitals and clinics that bring the advantages of cancer research to the community. St. Francis’ Cancer Center has been a part of this network for several years, ensuring their patients have access to the newest therapies available for cancer treatment, management of treatment side effects and disease symptoms and cancer prevention.

For years, the clinic’s CCOP coordinator was contracted from another health service. When the decision was made to make the CCOP role an internal position, it made sense to recruit a nurse with an extensive oncology background as well as someone who understood the dynamics of the Cancer Center, its staff and patients.

Deb Sisler, RN, OCN, had been an oncology nurse for over 30 years and eight of those years were at the St. Francis Cancer Center. The position intrigued her. She knew it would be a challenge, but she felt ready. She knew the patients, she knew the physicians and she felt she could establish a system to not only maintain the CCOP but also improve it.

“I didn’t have a lot of time to learn,” Sisler said. “For 6 months I studied and studied, knowing I needed to put a strong process in place to make sure the right patients were fit with the right clinical trials.”

The sheer amount of data management was overwhelming at first. Patient consent forms are 40 pages long and some of the protocols were over 100 pages long. Simply completing an application form can take up to 8 hours. However, Sisler makes it a point to read and understand every trial recommended for every patient.

“I know these patients and I follow them for a long time,” she said. “I study the cancer controls and symptom management. I review lab work and what drugs might be appropriate for certain patients. Then I make sure the drugs are available and pick them up, personally, at the (CCOP offices) in St. Louis Park.”

In the past, connecting a patient with a clinical trial happened informally throughout treatment. However, becoming accepted into the trials was becoming increasingly competitive and Sisler was determined to give patients every opportunity available. She began researching suitable trials for patients before their first appointment with the oncologist.

“I make sure the doctor knows before that first consultation what studies would be appropriate for a particular patient,” she said. “I know the doctor appreciates it and it gives us a jump start on possible treatment options for the patient.”

Having a CCOP RN is an important part of the Cancer Center’s accreditation.

“As challenging as it was in the beginning, this position helped me refocus and grow,” she said. “It’s great to know that we have a great center that provides comprehensive care for our patients right here in Shakopee.”

“for 6 months i studied and studied, knowing i needed to put a strong process in place to make sure the right patients were fit with the right clinical trials.” - Deb Sissler, RN

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Our current systems and practices are constantly being redesigned and redefined as we move

successfully to the future of health care. This Component includes new models of care, application of

existing evidence, new evidence, and visible contributions to the science of nursing.

new Knowledge and innovation

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t h e W a i t i s o V e rEmergency Departments are known for long wait times and crowded waiting rooms, a frustration felt by both patients and providers. There are many reasons for these conditions, but the bottom line is that long patient waits can lead to delays in cares, inefficient patient flow for hospital and dismal patient satisfaction. It makes sense that timeliness of care and the time it takes to see a physician has a powerful impact on patient satisfaction.

Set in a rapidly growing community, St. Francis has had good patient satisfaction scores in emergency care, but leadership knew it would be a struggle to continue keeping these scores in light of the higher volumes and fewer resources they anticipated from health care reform.

Jamie Stolee, RN and ED manager recognized that the department needed to evolve to meet these challenges and she suspected the change began at the front door. The idea of immediate bedding seemed to be the answer.

The immediate bedding concept is an emerging trend in emergency departments throughout the country. Under this model of care, triage is bypassed and the patient is immediately brought back to an open room if available. Therefore, triage becomes an action rather than a ‘room’. The model been credited for improving patient flow, decreasing physician-to-physician handoff times and improving the patient’s experience and satisfaction.

Changing to the immediate bedding concept at St. Francis would require a substantial cultural change for staff. When proposed, it was met with a strong ‘leave good enough alone’ attitude among many. There were

supporters, however. In their eyes, other hospitals in similar markets had made it work and so would St. Francis. This is the group that stepped up to the challenge and took ownership of the change.

First of all, it was important their colleagues understood that this would be a new way of doing things, rather than simply tweaking the existing process. The first step was researching immediate bedding practices by visiting other area hospitals that had successfully implemented the model and addressing their colleagues’ concerns. They presented their findings to the ED Council. With their support, the team completed several Plan-Do-Study-Act (PDSA) documents. When they found the process that seemed to benefit all, they went about educating staff and setting a target date to start the program.

“At the start of the program, staff had to break habits and get used to a new way to look at charting,” Tammy Svihel, RN, explained. “It was also a change for our doctors. In fact they seemed to have even more adjustments than the staff.”

In time, the process was hardwired and has improved patient flow and decreased arrival to room times. In fact, the ED was recently cited for having the second fastest ‘door to doctor’ time in the area.

The model has eliminated the need for patients to tell their story multiple times and has decreased times for EKG in chest pain patients, code stroke activation, and created better communication between all team members caring for the patient.

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C e r t i f i e d N u r s e s In order to validate knowledge and education, 20 nurses from Care North and Care South obtained certification in their nursing specialty of medical surgical nursing. Determined to support the ongoing education of staff, a certification review class was provided by the American Nurses Credentialing Center and hosted at St. Francis. 75% who attended went on to receive their certification. The success of the newly certified nursing staff was inspiring and contagious. In addition to medical surgical certification; other nurses received their certification in pediatrics, holistic nursing and sharp wound debridement. These 23 certified nurses join the 10 previously certified nurses on the unit with certifications in medical surgical nursing, infusion therapy, pediatrics, wound/ostomy, nurse executive and critical care.

N u r s e s u t i l i z e a N e W r e s o u r C e f o r Pat i e N t e x P e r i e N C eIn 2013, St. Francis nurses were joined by integrative health practitioners who supported their work in patient care. Nurses recognize that health care requires a holistic perspective, which includes relationship-centered care, behavioral change strategies and health promotion. Our integrative health practitioners provide therapies which support our holistic nursing practice.

Nurses independently order integrative medicine consultations based on nursing assessments. The practitioners provide multiple therapies—including therapeutic massage, aromatherapy, acupuncture and guided imagery. In 2013, patients reported a 50% decrease in pain as a result of the collaborative efforts of nurses at the bedside and the integrative practitioner providing holistic patient care.

Nurses and patients alike have experienced great benefits of the integrative interventions and recognize integrative therapy as another tool to support patient health.

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i N Pat i e N t r N s C r o s s - t r a i N t o s C uInpatient and Pediatric nurses have advanced their professional development by cross training to care for some of our most ill patients. In 2013 the Intensive Care Unit (ICU) was converted to a Special Care Unit (SCU) to broaden the scope of patients who could be cared for in this unit. SCU nurses are specifically trained to care for some of the most challenging patients at St. Francis. In anticipation of an increased census in the newly formed SCU, nurses from the Medical Surgical/Pediatric unit demonstrated professional development and an eagerness to expand their skills when they cross-trained to the SCU. The cross-training provided increased flexibility in caring for patients as well as optimizing the RN knowledge base.

By virtue of this cross training, these nurses have increased the collegiality and collaboration among the departments. This educational growth for the nursing staff has resulted in continued job satisfaction and an increase in employee engagement and patient experience for both units.

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Education for nurses is presented to empower nurses and to support exemplary professional practice as well as new knowledge, innovations, and improvements. This requires the commitment of significant resources in order to help our nurses stay current, learn new perspectives, and to challenge ourselves with continuous improvements in professional practice.

Each department developed and conducted unit specific clinical development education in order to support the clinical educational needs of nurses providing direct patient care, and all of St. Francis’s professional nurses also attended Professional Development Education Days that addressed:

•collaborativecommunication,

•CodeofEthicsforNursesasrelatedtopatientprivacyconcerns,

•sensitivityincaringforbariatricpatients,

•“HarmonyofConversation”understandingWitayaCareandthe cultural needs of the Mdwaketon Sioux Community

•the“Patient,Visitor,Safety,Report,”processandgoals,

•SharedNursingExperiencethatrelatedSt.Francis’s/Allinanursing theory - Swanson’s theory of “Caring” - to daily nursing practice.

Crucial Conversations was presented to 54 nurses beyond an introduction at Professional Development Days, in order to support collaborative multidisciplinary communication.

39 Nurses learned about Transformative Nurse Training (TNT) teaching nurses the knowledge, skills, and confidence to enhance care through an integrative and holistic approach.

True Colors fosters understanding and enhances teamwork by creating respectful relationships built on personal strengths, which helps promote healthy productive relationships and was presented to 56 nurses. Nurses learned to appreciate their strengths and the strengths of their co-workers.

21 of our nurses embraced the role of nursing preceptors as they participated in specialized education that supports an organized, evidence-based, outcome-driven approach to support nurses moving into new areas of professional practice. These new nurse preceptors serve as guides, mentors, and role models to nurses throughout St. Francis learning new skills.

Education for 10 new charge nurses focused on the skill development, behaviors, and leadership principles that are essential to front line nurse leaders in assessing, planning, and implementing quality patient care.

In April, 2013 St. Francis hosted a “sold-out” two-day medical-surgical nursing review seminar conducted by the American Nurses Credentialing Center, this education led to ongoing professional development for many of our medical/surgical nurses who went on to validate their knowledge through national certification.

St. Francis supports nurses attending local, regional, or national conferences, in order to broaden and then share new knowledge and exemplary professional practice with their peers. Nurses attended conferences about diverse nursing topics such as: the National Magnet Conference, International Board of Lactation Consultant Examiners, Minnesota Organization of Leaders in Nursing, and Pain Management just to name a few. St. Francis Nursing is proud to support the ongoing efforts of our nurses to broaden their knowledge and expertise in the care and provision of patients.

Nurses actively educate staff at St. Francis’ annual Safety Fair. Above, Nancy Wolf, RN, shares information on Patient Safety initiatives.

Creating an environment of continual growth and lifelong learning empowers nurses, supporting exemplary professional practice as well as new knowledge, innovations, and improvements. This requires the commitment of significant resources in order to help our nurses stay current, learn new perspectives, and to challenge ourselves with continuous improvements in professional practice. Ann Yolitz, RN, pictured at left, is a learning and development specialist at St. Francis.

C r e at i N g a N e N V i r o N M e N t f o r C o N t i N u o u s i M P r o V e M e N t

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n E W K n o W L E d g E a n d I n n o V a t I o n n E W K n o W L E d g E a n d I n n o V a t I o n

Melissa Abeln

Jed Adams

Sarah Amendola

Bethany Anderson

Christy Anderson

Laurel Ann Anderson

Rebecca Argetsinger

Joel Aronson

Lynelle Aukes

Rebecca Barnack

Karyn Barry

Kelly Benning

Susan Berens

Heather Berndt

Kristine Beuch

Lori Bleck

Janeen Boggess

Chris Breimhorst

Peter Breimhorst

Lindsay Browning

Virginia Buddensiek

Kerry Callahan

Angela Christian

Megnan Clay

Gerri Clements

Arlanda Dahnert

Carole Doyscher

Claire Freking

Ann Friedges

Kerissa Garant

Marci Gatlin

Kathleen Giddings

Nicole Giesen

Jacqueline Gifford

James Gruenwald

Renee Geske

Kelly Gunderson

Kelly Hagen

Sarah Hallman

Mary Beth Heilman

Coleen Helberg

Jacqueline Hennen

Jennifer Hentges

Jodine Hruby

Christine Jeurissen

Greg Jones

Meagen Kelly

Mimi Kennedy

Erin Kiernan-Johnson

David Kimball

Dawn Kraus

Kathryn Kyler

Anita Laffen

Elizabeth Larsen

Misty Lopez

Sandra McGoldrick-Kendall

Christy McGuffee

Kathleen McKoy

Teresa Meyer

Kim Nachreiner

Beth Nelson

Laura Nielson

Mary Jo O’Malley

Jameen O’Neill

Karen Ortberg

Anita Pakiz

Farah Pieper

Nancy Pint

Debra Reynolds

Elizabeth Rodgers

Colleen Roethke

Cheryl Reino

Melissa Rezny

Rachel Ricke

Deb Ryan

Julie Schwartz

Kimberly Schmitz

Susan Schroers

Sharon Schwichtenberg

Susan Seifert

Lonna Selkirk

Pamela Sinness

Debra Sisler

Ruth Smith

Karen Sonnenburg

Carol Souhan

Gregory Spindler

Caroline Stacke

Becky Stacken

Ann Stenson

Sher Stiles

Jamie Stolee

Julie Such

Sharon Sunde

Tammy Svihel

Dean TeBrake

Cassy Terwey

Brianna Thompson

Starlett Thorson

Debra Turak

Benjamin Patrick Turner

Dorinda Vloo

Alina Vogel

Kimberly Wagner

Robyn Wagner

Cindee Walz

Nate Wiley

Rebecca Wilson

Mary Wizynajtys

Nancy Wolf

Jamie Wozny

Amy Zhdankin

John Zweber

2 0 1 3 r N C e r t i f i C at i o N s

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n u r S E S M a K I n g a d I f f E r E n c E

Two St. Francis nurses received Nurse of

the Year honors from the March of Dimes

in 2013. Sher Stiles (above) was honored

in the Staff Nurse, General Care category

and Beth Cantrell (below) received the

Rising Star award. Nineteen nurses

from St. Francis were nominated for the

prestigious awards, for displaying great

leadership skills and for making significant

contributions to their communities and to

the profession of nursing.

nurses Making a Differenceh o N o r s a N d a W a r d s i N 2 0 1 3Allina Best Care (ABC) Culture Award.2013 IBCLC (International Board of Consultant Lactation Care) Award.March of Dimes Early Elective Delivery Recognition Award.Consumer Reports-Highest safety surgery rating.2013 Healthgrades Outstanding Patient Experience Award.2013 Minnesota Business Ethics Award-Large Company.2013 Star Tribune Top 100 Workplace-Large Company.2013 HealthStrong Best in Strength Award-Top 100 Hospital.2013 Joint Commission Top Performer on Key Quality Measures.2014 Women’s Choice Award-Best Hospital for Patient Experience in Emergency Care.

March of dimes Nurse of the year award

Nominated nurses from St. Francis include, left to right: Beth Cantrell, Sue Seifert, Nicole Giesen, Kris Beuch, Jackie Giddings, Dawn Nesburg, Candace Lano, Renee Geske, Julie Schwartz, Sher Stiles, Lindsay Browning, Shandi Steffan, Peter Breimhorst, Jill Jahn, Steve Wilson. Not Pictured: Kathy Mason, Julie Such, Mary Bothof.

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the 2013 eileen dietz Nursing scholarship was awarded to st. francis nurses Mary Beth heilman and sarah hallman.

Heilman’s background is in maternal child nursing and her specialty is Nursing Professional Practice. This essentially facilitates communication, program management, operations, research, professional development, and team relations. Obtaining the scholarship will help her to continue her work toward a Master’s Degree in Nursing with a focus on Leadership and Administration, which she anticipates completing in April, 2014.

Hallman will earn a Masters in Nurse Midwifery. She has been a nurse for 12 years, specializing in labor and birth and high risk maternal-fetal medicine.

The Eileen Dietz Scholarship award was established and dedicated in honor of Dietz, who was an OB Nurse in Family Birth at St. Francis when

she suffered a brain aneurysm that took her life. Family, friends, and co-workers created this $10,000 endowed scholarship in her memory. The interest earned each year provides the scholarship funds for this award.

st. francis nurses received daisy awards in 2013: linda stemig, rN, emergency services, renee geske, rN, Cancer Center, komba kelly, rN, inpatient Care and sarah hallman, rN, family Birth. (per placement)

DAISY is an acronym for Diseases Attacking the Immune System and recognizes nurses that personify St. Francis’ remarkable patient experience. These nurses consistently demonstrate excellence through their clinical expertise and extraordinary compassionate care. Nominated by both peers and patients, they are recognized as outstanding role models in our nursing community.

The DAISY Foundation was formed in November 1999, by the family of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP). They wanted to do something to honor the wonderful person Patrick was and to express their profound gratitude to nurses for the work that they do for patients and their families every day.

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n u r S E S M a K I n g a d I f f E r E n c E n u r S E S M a K I n g a d I f f E r E n c E

Mpls. st. Paul Magazine’s outstanding Nurses award

Colleen Roethke, RN, St. Francis Diabetes Education, was a finalist in Mpls. St. Paul Magazine’s Outstanding Nurses awards. Roethke was chosen from more than 270 nominations. Each of the finalists was chosen by a panel of medical professionals and the magazine’s editors as having demonstrated excellence in their field.

save our skin

St. Francis’ Safe Skin team was recognized for a Minnesota Hospital Association ‘Save Our Skin’ award for their

outstanding effort in preventing a pressure ulcer for an at risk patient.

This award is presented to Minnesota hospital health care teams who demonstrate their commitment to keeping patients’ skin safe by preventing a pressure ulcer in a patient who likely would have developed one — due to their high risk status — if not for the efforts of the team. The majority of serious pressure ulcers that are reported in Minnesota each year occur in patients that are medically complex and have lengthy hospital stays.

Team members include: Joyce Hartman, RN, Rebecca Argetsinger, RN, Becky Stacken, RN, Misty Lopez, RN, Mary Pat Parker, SLP, Bamboo Jaiteh, CAN, Carrie Costa, CAN, Renu Bhattarai, CAN, Ahmed Songa, CAN, Joel Aronson, RN CWOCN CFCN, Chad Harwick, CAN, Liz Kennedy, PA-C, Chris Cleveland, RT, and Denise Reiners, RD.

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Preparing for baby

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In 2007, Sarah Hallman, RN saw an advertisement for a baby shower in a nearby community and thought it would be a great idea to do something similar for patients in our community. That year the first St Francis Baby Fair was co-hosted with Shakopee Early Childhood Family Education (ECFE) at the hospital. 250 young families came to learn about local resources that help prepare and promote healthy parenting as well as information on birthing options available at St. Francis. In her mind, it would be a ‘one stop shop’ of supportive products and resources available to these young families.

“There is so much that people don’t know is out there and this helps bridge the information gap,” said Hallman. “One of the main roles we have as nurses is to get out in the community and bring education on health related issues to those who need it most. It’s about learning patient’s needs and providing an advocating helping meet their needs. We have to meet each person where they are on the health spectrum and sometimes we need to connect out in the community.”

Family Birth Nurses and care team members are an integral part of the fair, answering questions on the birth experience and breast feeding, as well as challenging dads-to-be in diaper changing contests.

The event quickly outgrew the hospital venue and moved to the local senior high school to accommodate the expected crowd of 2000 people and over 100 exhibits sharing their services with the young families. Demonstrations and presentations are made throughout the day by physicians, psychologists and even yoga instructors. Children can tour emergency vehicles, make crafts or have their face painted.

Hallman’s original idea to provide better information and education to young mothers has now become a premier event in the area. The Family Birth staff’s commitment to this event shows their dedication to providing an excellent patient experience on the hospital’s third floor and out in the community.

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Mary Bothof, RN, has been a nursing advocate and volunteer for the River Valley Nursing Center from

its inception in 2003. As manager of St. Francis’ Emergency Department, she originally represented

the hospital, but stayed on its board of directors as a community member when her term ended.

C r e at i N g h e a lt h i e r C o M M u N i t i e sIn 2003, deep cuts in local social service and public health budgets in Scott and Carver Counties resulted in a dramatic increase in the number of uninsured/under-insured residents. St. Francis joined six other organizations to create the River Valley Nursing Center (RVNC), a unique model that couples public health nursing and community resource referrals to this underserved population.

its mission, “…to serve vulnerable individuals and families in our community while promoting the leadership role of nurses” has been supported by st. francis and its nursing staff since its inception.

Mary Bothof, RN, has been a nursing advocate and volunteer for the center from the beginning. Bothof originally represented the hospital, but stayed on its board of directors as a community member when her term ended. She has seen firsthand how the organization has changed peoples’ lives.

“The impact of this nursing center has been profound,” she said. “Patients are being assessed and educated by a public health nursing staff. They are then connected with free and low-cost health care services for further care. Most don’t even know these services exist. That has been one of the very important purposes of this work.”

When further medical care is necessary, nurses at the RVNC may refer patients to the St. Mary’s Clinic, a completely volunteer run organization, whose Shakopee location is on the St. Francis medical campus. The clinic is staffed by volunteer physicians, nurses, admissions personnel, and interpreters, as well as well as a network of local health care providers, specialty physicians and pharmacies that provide their services free or at a discount

Mary Beth Heilman, RN, volunteers for the clinic. “Nurses at St. Mary’s are the voice of the patient since many do not speak English,” she said. “Working with interpreters, we’re able to establish and advocate for care needs.”

Nurses provide primary care – applying assessment, diagnosis, planning, implementation, and evaluation in a humanitarian way to care for people who are underserved. By collaborating with volunteer physicians and specialty care providers, the team is able to provide comprehensive care to vulnerable patients.

“Many of our patients are very hardworking people, where the financial stress of medical bills could literally overwhelm their family,” Heilman said. “All are gracious and extremely thankful for the care they receive.”

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S412870 19731 0414 ©2014 ALLINA HEALTH SYSTEM. TM - A REGISTERED TRADEMARK OF ALLINA HEALTH SYSTEM.

For further information, contact:Mary Beth Heilman, RNC

Nursing Practice Coordinatorstfrancis-shakopee.com/patients-quality-safety.html