Our nurses

in actiOn

Dear nursing colleagues and friends,

It’s no secret that in so many ways nurses are the heartbeat of East Tennessee

Children’s Hospital. Every day, in every department, our nurses are on the

front lines—helping save lives and making important decisions that affect

the health of thousands of children. Last year was an incredible one for our

nurses—f illed with continued growth and opportunities, as well as challenges

that our staff met with compassion, knowledge and dedication. I’m proud to

share some of the many ways our nearly 450 nurses made a difference in this

year’s nursing annual report. Using hospitalwide data, this report highlights

some of the accomplishments our nurses achieved from January 2013 to

December 2013.

As you read the report, you will see that our nurses and their tireless

dedication to their profession are making an impact in our hospital and

beyond. The family-centered, pediatric-focused care they bring to our patients

helps make Children’s Hospital the special place it is. I’m honored to not just

serve as a leader for our nursing staff, but to learn from them and witness the

compassion they show our young patients every day.

Sincerely,

Laura Barnes, M.S.N., R.N., N.E.A.-B.C. Vice President for Patient Care Services and Chief Nursing Off icer

3

Seeing our nurses in action Though their most important role is serving at the bedside of our young patients and ensuring they receive the best possible care, our nurses are thriving and making an impact at Children’s Hospital in other ways. They’re seeking educational opportunities to help them stay at the forefront of nursing. They’re providing input about the upcoming hospital expansion that will enable us to better care for East Tennessee’s children. If it affects their daily duties and the children they care for, our nurses want to be part of it.

In 2013, we launched our professional practice model (PPM). Represented visually by a pinwheel, the PPM signif ies how nurses at Children’s Hospital practice, communicate and collaborate to provide the highest-quality care for our patients. At the core of the pinwheel, of course, are our patients and their families, with all components moving in concert around them, supported by our strong philosophy of family-centered care. The PPM represents our nurses in action as we continuously respond to the needs of our patients and the environment. The pinwheel’s petals symbolize the many components that are important to our practice as nurses, including core values, shared decision-making, exemplary practice, professional growth and empowerment to improve. A pinwheel is especially appropriate because it is always moving, much like our strong nursing staff who are always adapting to the needs of the patient and changes in health care.

We’re not the only ones noticing our strengths. In 2013, Children’s Hospital received the Tennessee Nurses Association’s Outstanding Employer Award. This is the f irst time Children’s Hospital has received the award from the association, a professional organization representing nurses throughout the state. This award is especially important because it recognizes our nurses and the passion they bring to work each day.

Exemplarypractice

grow

thPr

ofes

sion

al

Em

powered

to improve

Shareddecision-

making

Nursing corevalues

Fam

ily-c

ente

red

care

Patientfamily

4

It also spotlights the hospital’s support of nurses and nursing excellence. The selection process for the award is specif ic and highlights many of our hospital’s strengths, including encouraging nurse representation on decision-making bodies, having policies and procedures that permit nurses to express their concerns regarding their professional practice environment and having leaders who are dedicated to improving the quality of nursing by contributing to nursing professional development.

The work of our nurses and staff was also recognized on a national level in 2013, when The Leapfrog Group included us on its 2013 list of Top Hospitals. Children’s Hospital was one of 13 pediatric hospitals honored for setting the highest standards in safety and quality. Out of all the adult and pediatric hospitals in the U.S. receiving the award in 2013, we were the only hospital in east Tennessee and one of only f ive in the state.

5

6

Empowered to improveI am a Children’s Hospital nurse. I have control of my practice, and I know I can improve quality in patient care.

We take pride in patient safety and infection prevention. We measure patient safety in a number of different ways. The following data is a sampling of some of the most common types of potential safety issues associated with a child’s stay at Children’s Hospital.

Pediatric Intensive Care Unit (PICU)

0 in 2013 1 in 2012

Neonatal Intensive

Care Unit (NICU)

2 in 20131 in 2012

Central line-associated blood stream infections (CLABSIs) Because central lines are used for longer periods of time, we have to work hard to make sure they do not become infected, which can be very serious.

How we are improving: Using nursing research and literature to identify best practices, we have implemented standard ways to insert and maintain central venous catheters to prevent CLABSIs.

Pediatric Intensive

Care Unit (PICU)

0 in 2013

0 in 2012

Neonatal Intensive Care Unit (NICU)

0 in 20130 in 2012

7

Ventilator-associated pneumonia Because this type of pneumonia results from microorganisms that invade the lower respiratory tract and lungs, care must be taken to prevent infections.

How we are improving: We participated in regional efforts and developed standards to eliminate this type of pneumonia, which is the second most common hospital-acquired infection in Pediatric Intensive Care Units.

Solutions for Patient SafetyIn January 2013, Children’s Hospital became a collaborative partner in Solutions for Patient Safety (SPS). There are 78 children’s hospitals across the country that participate in the collaborative, which was founded in 2008 to create universally safe and healing environments for all children in the care of U.S. pediatric hospitals. Through an interprofessional approach to improving care, the collaborative empowers staff to improve through open discussion, transparency and learning of best practices. Team leaders, who include medical staff, respiratory therapists, clinical nurses, utilization review staff, pharmacists, physical therapists and nutritionists, are working in eight areas of concentration. The goal is zero harm to our patients.

Our team leaders include: • LorettaMaples,B.S.N.,R.N.,NursingDirectorofSupportServices:Adversedrug

events (ADE) • BillChesney,B.S.N.,R.N.,StaffDevelopmentSpecialist,PediatricIntensiveCare

Unit (PICU): Ventilator-associated pneumonia (VAP) • BarbBarr,M.S.N.,R.N.,NursingDirector,PerioperativeServices:Surgical-site infections (SSI) • AliGonzalez,B.S.N.,R.N.,C.P.N.:Fallsprevention • JudyMarciel,M.S.N.,R.N.,ClinicalNurseSpecialist:Pressureulcersprevention • PamMyers,B.S.N.,R.N.,C.M.L.,NurseManager,PICU:Centralline-associated blood stream infections (CLABSIs) and catheter-related urinary tract infections (CAUTI) • LauraBarnes,M.S.N.,N.E.A.-B.C.,VicePresidentforPatientCareServicesand Chief Nursing Off icer: Serious safety events (SSE)

Through the work of these teams, Children’s Hospital met the goal of reducing harm to children by 20 percent from 2012 to the end of 2013.

Catheter-associated urinary tract infections2 in 20134 in 2012

Falls with moderate or greater harm1 in 20134 in 2012

8

Pressure ulcers

Stage 3 and above5 in 201311 in 2012

9

2013 Leadership SummitAt Children’s Hospital, we strive to empower our nurses to improve the patient care they provide by seeking new and innovative approaches to their work. Several nurses from Children’s Hospital presented their work for improving care at the 2013 Leadership Summit sponsored by the Tennessee Center for Patient Safety and the Tennessee Hospital Association.

Podium presentations from our nurses included: •CarlaSaunders,N.N.P.,N.N.C.:NAS–NursePractitionerLeadQualityImprovement Project •BrandyPayne,B.S.N.,R.N.,C.P.N.,andLaurenBaumgardner,B.S.N.,R.N.C.-N.I.C.: Journey to Becoming a Safe Sleep Hospital In addition, poster presentations included: •TracieSavage,R.N.C.-N.I.C.,andSonyaMcGill,B.S.N.,R.N.C.,N.I.C.: Creating a CLABSI-free Culture in the Neonatal Intensive Care Unit •KaryPickard,R.N.,andKristenPowell,R.N.:CreatingaVAP-freeCultureinthe Neonatal Intensive Care Unit •SaraMatalik,B.S.N.,R.N.;BarbaraBarr,M.S.N.,R.N.;JenniferSmith,B.S.N.,R.N.; and Judy Marciel, M.S.N., P.C.N.S-B.C., C.P.N.P.-B.C., C.W.C.N.: Improving Patient Safety Through the Implementation of the Perioperative Safety Passport •SherryEdwards,B.S.N.,R.N.,C.P.N.:WelcometotheJungle–ACommunication Initiative •BettyGregg,R.N.,C.P.N.:Hello,Halo.FosteringPerformancethroughEducation and Collaboration •SarabethMayo,B.S.N.,R.N.:PerformanceExcellenceinAction–APerioperative Council Collaboration •GinaShelley,R.N.,C.P.N.:CommunicatingforaBetter,SaferTomorrow

Patient safety is apriority in this organization.

Our nurses: 4.55 overall score—out of 5National average: 4.46

Source: 2013 employee engagement survey

10

Exemplary practiceI am a Children’s Hospital nurse. I provide care that meets our patients’ needs and exceeds standards.

Providing palliative careWhen a child is seriously ill, it affects him and his caregivers in a profound way. Palliative care helps improve quality of life for the entire family by providing relief from the pain and stress of a serious illness and improving communication and coordination of care. In October 2013, in conjunction with Children’s Anesthesiologists,LornaKeeton,M.S.N.,C.P.N.P.,joinedtheChildren’sHospitalPalliative Care Program as the Pain/Palliative Care Nurse Practitioner.

Inthelastthreemonthsof2013,Keetonconsultedon46patientcases,including11thatrequiredpalliativecare.Inadditiontotreatingpatients,Keetonworkswithnursing staff to educate them about the importance of palliative care.

To provide the best care for our seriously ill patients,KeetonandthePalliativeCareCommitteemeet quarterly to work on policies and procedures, the Precious Print Program and a process for just-in-time staff support in response to crises related to emotional needs and debrief ing.

11

This organization provides high-quality care and services.Our nurses: 4.47 overall score—out of 5 National average: 4.31

Source: 2013 employee engagement survey

12

13

Professional growthI am a Children’s Hospital nurse. I have opportunities to develop skills to both better myself and the care I deliver to patients.

Recognizing Excellence At Children’s Hospital (REACH) REACH is a program designed to recognize the individual work that our nurses do each day. REACH offers four levels of achievement—each has required skill and educational requirements.• LevelI–EntranceNurse• LevelII–Prof icient Nurse• LevelIII–SkilledNurse• LevelIV–OutstandingNurse

Currently, the majority of Children’s Hospital nurses are Level II—unless they are new graduates, and then they must wait a year before participating in REACH.

Level III Meaning they must have the following: a nursing specialty certif ication and/or bachelor’s of science in nursing degree, a minimum of one year of nursing experience and all the required activity points.Lauren Baumgardner, B.S.N., R.N.C.-N.I.C.KarenBeeler,B.S.N.,R.N.C.-N.I.C.Bonnie Estes, B.S.N., R.N.Ali Gonzalez, B.S.N., R.N., C.P.N. Dana Hickey, B.S.N., R.N., C.P.N.Carol Hudson, B.S.N., R.N., C.P.N.Becky LeMarbre, B.S.N., R.N., C.C.R.N.Denise Majors, B.S.N., R.N. Amanda Parrott, B.S.N., R.N., C.P.E.N.Brandy Payne, B.S.N., R.N., C.P.N. Charla Purkey, B.S.N., R.N.C.-N.I.C.Joyce Riddle, B.S.N., R.N., C.P.N. Jennifer Schlomer, B.S.N., R.N.C.-N.I.C.Debra Schmid, B.S.N., R.N., C.P.N.KrystleSilva,B.S.N.,R.N.Linda Welch, B.S.N., R.N., C.P.N.

Level IVMeaning they must have the following: a nursing specialty certif ication, at least a bachelor’s of sciencein nursing degree and the required number of activity points.Becca O’Connor, B.S.N., R.N., C.P.E.N.EstherO’Hare,I.B.C.L.C.,C.F.N.P.Emily Savage, M.S.N., N.N.P.

New degreesNancy Bunch, B.S.N. Emily Collins, B.S.N.Peggy Grindstaff, B.S.N.Amanda Martin, M.S.N.Emily Oram, M.S.N.LaTosha Phillips, B.S.N.Ron Phillips, B.S.N.Carol Smith, B.S.N.Jennifer Smith, B.S.N.Lori Smith, B.S.N.

14

Certif icationsAmerican Nurses Credentialing Center (ANCC)Betty Gregg

Critical Care Registered NurseSusan MillerLaura Tilley

Certif ied Pediatric Emergency NurseWayne BaxterJudy LaneAmanda ParrottSharyn StylesRebecca Trout

Certif ied Pediatric Hematology Oncology NurseEmily DentonLawana Evans

Certif ied Professional in Healthcare Quality Janice Mays

Certif ied Pediatric NurseJustin Abbot Lacey Beeler Tomica BellamyTabatha BurrellJennifer CampbellKarenCarsonVeronica DoaneJennifer Essary-MatthewsLaurenFisherAmy GillilandLiza GravesJill GreenKimberlyHillKelseyHornerLisa JohnsonApril JonesMartha JordanStephanieKingCadyKingtonOlivia Lawless

Julie LeonardSamantha LowryLeshia Walker Martin Ashley McNeillyCarrie MillsapsSara NortonJody Ohsiek Sandra Partilla JenniferQuintoisGail RichKellyRiversBrittany RoweTierra SalyersCarol SeagrovesDeb SharpKimberlySheltonConnie SmithNancy TimmJennifer WacksDonna WallaceBarbara Westbrook

Certif ied Pediatric Oncology NurseKarenJohnson

Certif ication for Neonatal Intensive Care NurseLauren Baumgartner KarenBeelerAnna Hawkins Mindy Irick Corie JonesCharla PurkeyCasey ReynoldsTuesday ScalfJennifer SchlomerKellyWhite

6 percent increase

in nurses who received a

higher degree

9 out of 10 nursing units had an increase in certif ications

This organization provides career development opportunities.Our nurses: 3.97 overall score —out of 5 National average: 3.84Source: 2013 employee engagement survey

15

16

Shared decision-makingI am a Children’s Hospital nurse. I have autonomy to deliver excellent patient care. Every nurse is a leader with collaboration across disciplines to improve patient care.

17

Council leadershipClinical InformaticsChair: Vicki Collins, B.S.N.

Coordinating Chair: Crystal Blake, R.N., C.P.N.

Engagement Chair: Nancy Griff in, R.N.Co-chair: Veronica Doane, B.S.N., R.N.

Leadership Chair: Laura Barnes, M.S.N., N.E.A.-B.C.

Magnet SteeringChair:KarenBurchf ield, M.S.N., R.N., C.P.N.

Night ShiftChair: Melissa Veach, B.S.N., R.N.Co-chair: Tanya Belcher, R.N.

Nursing Practice Improvement Chair: Ali Gonzalez, B.S.N., R.N., C.P.N.Co-chair:MelissaKeasler,R.N.

Clinical Practice and Standards Chair: Chris Tolliver, M.S.N., R.N., C.P.N.

Professional DevelopmentChair: Donna Wallace, B.S.N., R.N., C.P.N.Co-chair: Christina Curry, R.N.

Research CouncilChair: Lauren Lisa, B.S.N., R.N., C.P.N.Co-chair: Stephanie Roberts, R.N.

The environment at this organization makes employees in my work unit

want to go above and beyond what’s expected of them.

Our nurses: 4.60 overall score—out of 5 National average: 3.57

Source: 2013 employee engagement survey

1818

19

Nursing core valuesI am a Children’s Hospital nurse. I use my core values, including quality and safety, professionalism, integrity, stewardship, compassion and innovation, as my foundation for providing care.

Daisy Award winners Stephanie Brock, R.N.KatelynHodge,B.S.N.,R.N.Janice Rivers, B.S.N., R.N.Brandy Payne, B.S.N., C.P.N.JenniferQuintois,B.S.N.,R.N.Lauren Wilson, B.S.N., R.N., C.P.N.Chad Tapp, B.S.N., R.N.Joyce Riddle, B.S.N., R.N., C.P.N.Becca Troutt, R.N., C.P.E.N.Janet Williams, R.N.

Clinical Excellence Award winnersDeena Cantrill, B.S.N., R.N.Maggie Dickson, R.N.KellyFilyaw,B.S.N.,R.N.Betty Gregg, R.N.-B.C.Dana Hickey, S.N., R.N.Megan Jones, R.N.Melissa Marsee, B.S.N., R.N.Lauren Wilson, B.S.N., R.N.

I would recommend this organization

to family and friends who need care.

Our nurses: 4.60 overall score—out of 5

National average: 4.33

Source: 2013 employee engagement survey

www.etch.com