When Current Practice Is Not Best Practice: Using the Iowa Model to Change Practice

page 3

conehealth.com Winter 2013 • Vol. 10 No. 1

T H E P U L S E O F N U R S I N G A T C O N E H E A L T H

1200 North Elm Street, Greensboro, NC 27401conehealth.com/nursing

THE MOSES H. CONE MEMORIAL HOSPITAL

Nicole Baltazar-Holbert, RN, MSNAssistant Director, Departments 2500, 2600, 6500

Ashley Jarrell, RN, BSN, BADepartment 2300, Surgical Intensive Care

WESLEY LONG HOSPITAL

Maura Barber, RN, BSN, Copy Editor3West, Oncology

WOMEN’S HOSPITAL

Beth Smith, RN, MSN, NE-BCDirector, Mother Baby Unit, Central Nursery,

Lactation and Perinatal Education

ANNIE PENN HOSPITAL

Debbie Green, RN, DNP, CENPVice President, Nursing and Patient Services

BEHAVIORAL HEALTH HOSPITALAkeysha McMurren, RN, MSNAdministrative Coordinator

SPECIALTY AREAS

JC Cooper, RN, BSN, CTRN, EMTCareLink

Lelia Moore, RN, BSN, FCNCoordinator, Congregational Nurse Program

AT LARGE

Ann Finch, RN, MSN, PMHCNS

SYSTEMWIDE

Lisa Boland, RN, MSN, CHCRManager, Nursing Outreach and Retention,

Setting the Pace Editor

Belinda Hammond, RN, MSN, CEN, CCRNClinical Nurse Educator-Critical Care

Danyel Johnson, RN, MSNClinical Nurse Educator-Medical Surgical;

Research Council Representative

Ruthie Waters, RN, MSNRelationship Based Care Coordinator

Melody Bullock, RN, BSN, BS, MS, CRNIRelief Nurse, Pediatrics

SUPPORT SERVICES

Peggy Wynn, MLISLibrarian, Wesley Long Hospital

EDITORS

Co-Editor, Nursing Practice Thresa Haithcock, RN, DNP, APRN-BC

Co-Editor, Nursing EducationPeggy Hewitt, RN, MSN

Department 2000

Co-Editor, Nursing ResearchNancy Summerell, RN, MSN

Clinical Orientation Nurse, ED Academy

Editor-in-ChiefSarah Lackey, RN, MSN, CCNS

Magnet Program Coordinator, TraineeRapid Response Team, Relief

Editorial Board

NURSING BEAT MISSION STATEMENTTo communicate and celebrate the

dynamic power of nursing innovations

and enduring values.

Read Nursing Beat online. Go to the intranet home page and click on the Nursing Beat logo.

Message from the CNO

CONE HEALTH

MAGNETTRANSFORMATIONAL LEADERSHIP

2 19

This time of year, as I sip on

my hot chocolate and

wish for snow, (Wait a

minute! I’m from New

Jersey – I never want

to see snow again!)

I think back on 2012

and all of our won-

derful accomplish-

ments. Because of

all of your hard work

and efforts, we had a

very successful year in

nursing.

Some examples include our

systemwide Cone HealthLink Go Live;

a successful Joint Commission survey; our nursing re-

search symposium held at the Koury Convention Center;

23 nurses being named to the Great 100; our Emergency

Department, Medical/Surgical and Critical Care Nursing

Academies; our new Professional Nurse Advancement

Program (PNAP); our new DermaTherapy linen rollout; and

countless nurses participating in research, publishing and

presenting across the country.

2013 promises to be just as exciting for us. This year we

will seek Magnet re-designation, an honor Cone Health

nurses have enjoyed since 2005. Many of you will be asked

to share your stories and examples of transformational

leadership; structural empowerment; exemplary profes-

sional practice; new knowledge, innovations and improve-

ments using evidenced-based practice and research; and

empirical outcomes that contribute to the well-being of

our patients, our work environment and our community.

In October, we will hold our second nursing research sympo-

sium. Dr. Linda Akin, our keynote speaker, is a professor at

the University of Pennsylvania and is one of the most well-

known investigators and speakers on nurse-patient ratios,

nursing educational levels and the nurse work environment.

Currently, we have more than 233 nurses attending school

to advance their degrees. Our dream in 2013 is that even

more nurses take advantage of our REACH scholarship

program and return to school to advance their education.

Whatever changes 2013 brings to the healthcare industry, I

know the Cone Health nursing staff will be prepared to lead

the way by constantly searching for a better way to provide

care to our patients, our families and our communities.

As always, thank you for all you do!

Respectfully,

Theresa Brodrick, RN, PhD, CNS, CNA

From the EditorI had the privilege of work-

ing with the Rapid Response

Team at The Moses H. Cone

Memorial Hospital on Sun-

day, Nov. 4, the day Cone

HealthLink went live at Moses

Cone Hospital, Wesley Long

Hospital, Cone Health Behavioral Health Hospital and Cone

Health Cancer Center. The bridge to the new system actu-

ally occurred about 3 a.m. At 7 a.m. when the day shift folks

walked in, we did not know how it was going to be - we just

knew we had to walk in and do it.

I have to tell you, I have never been so proud of the place I

work. As I walked the halls that day, I saw more heads bent

together focusing on common problems than I ever have be-

fore. There was laughter but also hard work. There was gra-

cious accommodation for mistakes and a struggling together

for accuracy; there was a sense of triumph alongside a subtle

underlying sense of unease. We wanted to get it right; we did

not want to mess up. We wanted to learn quickly and well so

we could get on with the real work of our day.

Our leaders came in to cheer us on. There was food every-

where – apples, oranges, health food bars, pizza, sodas,

sandwiches. How welcome was that sweet taste of a Nature’s

Own bar in the middle of mental gymnastics. Stories from

rounding leaders, support staff and employees were varied

in their degree of catastrophe. The teamwork prevailed. We

did not falter. We soldiered on, taking one problem at a time,

climbing up that mountain.

I brought my camera to work that day. I got some great

shots, some with rather amusing captions – Dr. Buccini in his

Superman tie; Ed White, RN, in the Emergency Department

in an “oh my” gesture; the staff of Department 5500-Medi-

cal/Telemetry at the problem list flip chart, markers in hand.

My camera let me into places I might not have been able to

go without a good reason. The command center was par-

ticularly impressive. Six of our leaders, surrounded by charts

and electronic monitors, communicated continuously with

command centers in the other facilities. They were going

through items one by one, listening, asking questions, giving

feedback. It reminded me of movie clips of NASA control

rooms because of the quiet, the gravity and the focus that

was weighty in the room.

We completed some major projects last fall: People Excel-

lence Celebrations, Cone HealthLink, Joint Commission, end-

of-fiscal-year activities, the holidays. In January, we turn our

thoughts to the next adventure – our Magnet redesignation.

Magnet is not something separate and apart from what we

already do or different from what we already are. The Magnet

application just pulls it all together in one place. The site visit

lets the appraisers see for themselves what we have done.

For the most part, writing the application and getting ready

for the site visit is a way to celebrate our hard work and ac-

complishments. It will be an opportunity to demonstrate the

amazing Cone Health spirit I saw that Sunday in November

as we launched the largest phase of Cone HealthLink.

Congratulations to everyone for integrating one of the most

innovative electronic medical record systems into practice in

such an amazing way. It is a pleasure and an inspiration to

work in this organization.

Sarah Lackey, RN, MSN, CCNS, Editor-in-ChiefMagnet Program Coordinator, TraineeRapid Response Team, Relief sarah.lackey@conehealth.com

CONE HEALTH

INSIDE THIS ISSUE2 Message from Theresa Brodrick3 When Current Practice is Not Best Practice5 NICU Creates the “Bubble” to Fight Infection 6 Care Delivery Model: What’s That?7 Marjorie Simpson Award7 Humpty Dumpty Award8 Changing the Culture of Nursing, One Idea at a Time

10 Destination RN: Cone Health’s High-Flying Nurse Extern Program12 2012 Press Ganey National Client Conference13 The House That Cone Health Nurses Built14 Meeting Acute Mental Health Needs16 Setting the Pace19 From the Editor

We serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care.

MAGNETEMPIRICAL OUTCOMES

When Current Practice Is Not Best Practice: Using the Iowa Model to Change Practice

318

Pressure ulcers. Sentinel event. Evidence-based practice

(EBP) project. All of these words may sound intimidat-

ing, but they became a harsh reality for the Department

6700-Medical/Renal nursing staff at The Moses H. Cone

Memorial Hospital.

Pressure ulcers adversely compound healthcare costs,

length of stay and patient satisfaction1. Experiencing a

sentinel event and finding two pressure ulcers during a

Pressure Ulcer Prevalence (PUP) survey in late 2011 required

an evidence-based practice project to change practice and

transform these negative patient outcomes.

The process of developing the EBP project began with

exploring the Iowa Model, the framework adopted by Cone

Health to guide the integration of research into practice.

The six steps of the Iowa Model direct the implementation

of the project to ensure the desired outcome is met.

Step One: Identifying triggers and formulating a burning

question. PUP results, a sentinel event and inaccurate skin

documentation were identifiable triggers. There also was a

knowledge deficit among nurses concerning wound identi-

fication, staging of pressure ulcers and the required docu-

mentation. A burning question developed: Will implement-

ing a skin care competency increase nurses’ knowledge of

skin and wounds, improve documentation, and decrease

the incidence of pressure ulcers among patients?

Step Two: Forming a Team. Skin Savers - which consisted

of nurses, nurse techs, wound, ostomy, continence nurses

and a clinical nurse educator - was organized. Serving as

the project leaders, the Department 6700 RN IIIs guided

and supported the team and staff throughout the duration

of the project.

Step Three: Reviewing the evidence. A literature review

revealed clinical practice guidelines and best practice in-

terventions specific to skin care. These were compared to

the current nursing practices in the department. A defi-

nite disparity between best practice and current practice

existed.

Step Four: Changing practice. All nursing staff were re-

quired to complete the National Database of Nursing Qual-

ity Indicators (NDNQI) Pressure Ulcer Training Modules,

attend a mandatory class led by the Skin Savers and com-

plete skin care competencies created by the team. Peer

education empowers staff and leads to the compliance

and integration of evidence-based prevention strategies

into practice and improves patient care outcomes (2). Ad-

ditional practice changes included using the Cone Health

Skin Care Nursing Protocol, body maps to facilitate nurse

tech to nurse communication, and mirrors for improving

skin assessments.

Continued on page 4

By Allyson Daniels Kirkman, BSN, RN III, and Danyel Johnson, MSN, RN, CNN

CONE HEALTH THE MOSES H. CONE MEMORIAL HOSPITAL

Shannon Love, RN, PCCN, Depart-ment 3300-Intermediate Care Unit, Moses Cone Hospital

Carol Mead, RN, PCCN, Women’s Nursing Unit, Women’s Hospital

Tina Miller, RN, BSN, PCCN, Intermedi-ate Care/Urology, Wesley Long Hospital

Donna Owens, RN, BSN, PCCN, De-partment 4700-Congestive Heart Fail-ure/Telemetry, Moses Cone Hospital

Chris Ralph, RN, BSN, PCCN, Depart-ment 3700-Progressive Care Unit, Moses Cone Hospital

Kim Sachs, RN, PCCN, Medical/Surgi-cal ICU, Women’s Hospital

Gretchen Stevens, RN, PCCN, Flexible Resources, Wesley Long Hospital

Jessica Sutter, RN, PCCN, Department 2000-Heart Unit, Moses Cone Hospital

Farrah Tarpley, RN, BSN, PCCN, De-partment 3700-Progressive Care Unit, Moses Cone Hospital

Jill Tsoutis, RN, PCCN, Department 3700-Progressive Care Unit, Moses Cone Hospital

Kelli Willard, RN, PCCN, Department 3700-Progressive Care Unit, Moses Cone Hospital

Allen Worley, RN, BSN, MSN, PCCN, Department 3300-Intermediate Care Unit, Moses Cone Hospital

Janet Worrell, RN, PCCN, Department 3700-Progressive Care Unit, Moses Cone Hospital

Nurse Executive Certification

Mona Easter, RN, BSN, MBA, NE-BC, Department 300 and ICU, Annie Penn Hospital

Waqiah Ellis, RN, MSN, NE-BC, De-partment 2000-Heart Unit, Moses Cone Hospital

Kameka Totten, RN, BSN, MBA/MHA, NE-BC, 5 East Medical Unit and Flex-ible Resources, Wesley Long Hospital

Nurse Executive Advanced Certification

Anne T. Brown, RN, MSN, PCCN, NEA-BC, Nursing Administration, Wesley Long Hospital

Joan LoPresti, RN, BSN, MS, NEA-BC, Nursing Administration, Moses Cone Hospital

Annette Smith, RN, MSN, NEA-BC, Nursing Administration, Wesley Long Hospital

Ruthie Waters, RN, MSN, NEA-BC, Relationship Based Care, Systemwide Nursing Practice

Oncology Nurse Certification

Regina Baldwin, RN, ONC, 3 East On-cology, Wesley Long Hospital

ADVANCING IN EDUCATION

Doctor of Philosophy in Nursing

Crystal Dodson, RN, MSN, PhD, Inpa-tient Diabetes ProgramUniversity of North Carolina at Chapel Hill, December 2012

Master of Science in Nursing

Julie O’Neal, RN, MSN, CEN, Clinical Nursing SupportUniversity of North Carolina at Greensboro, December 2012 Master of Health Administration

Peace Dormon, RN, BSN, Flexible Re-sources, Wesley Long HospitalPfeiffer University, August 2012

Angela Moore, RN, BSN, Quality In-formaticsPfeiffer University, August 2012

Cheryl Poteat, RN, BSN, Palliative Care, Wesley Long HospitalPfeiffer University, August 2012

Bachelor of Science in Nursing

Sue Ellen Grounds, RN, BSN, Palliative Care, Wesley Long HospitalWestern Governor’s University, Octo-ber 2012

Margaret Steelman, RN, BSN, Quality InformaticsWinston-Salem State University, De-cember 2012

Marie Trogden, RN, BSN, Department 5500-Medical/Telemetry, Moses Cone HospitalWinston-Salem State University, De-cember 2012

Associate Degree in Nursing

Bonnie Gibbs, RN, General Surgery, Wesley Long HospitalForsyth Technical Community College, May 2012

Setting the Pace

Correction from the Fall 2012 Issue of Nursing Beat:Tina Miller, RN, BSN, PCCN, 4th Floor Urology/Intermediate Care at Wesley Long Hospital, received her PCCN certification. Our apolo-gies for this error.

Submit “Setting the Pace” items for our spring 2013 edition to lisa.boland@conehealth.com no later than Friday, March 1, 2013.

Requirements for submissions:• All submissions require: Employee Name, Campus, Department, Highest Degree Earned, National Certification(s) held at that time.• Category assignment: Publication, Presentation, Poster, Promotion, Certification or Graduation.• Graduations will also include: Degree Earned, Name of School and Date of Graduation.• Publications will also include: Title of Article; Title of Publication/Book, Volume number (Issue Number); Date (month and year); Page range.• Presentations (At the Podium) and Posters (On Display) will also include: Title of Presentation/Poster; Location (Name of Event/ Conference/Forum); Date of Event (month and year).

On the cover: Allyson Daniels and Angelina Leonar practice proper wound measurement on a simulated wound.

Allyson Daniels, with staff of 6700.

4 17

GROWING IN LEADERSHIP

Executive Director of Organization Integration

Karin Henderson, RN, MSN, CENP, CCRN, CS, GNP, Strategic Planning and Development

Assistant Director

Susan Geubtner, RN, BSN, PCCN, Emergency Department, Wesley Long Hospital

RN Care Coordinator

Christy Wicker, RN, BSN, RNC-OB, Labor and Delivery, Women’s Hospital

Raney Gagnon, RN, BSN, RNC-OB, Labor and Delivery, Women’s Hospital

Cone Health Medical Group Clinical Performance Manager

Robert Slaughter, RN, MSN, Cone Health Physician Services Quality and Safety Department

Triad HealthCare Network Quality Per-formance Manager

Kristie Payne, RN, MSN, Cone Health Physician Services Quality and Safety Department

Registered Nurse III

Delia A. Turner, RN, BS, CCRN, De-partment 2100, Moses Cone Hospital

GROWING IN PRACTICE

Advanced Practice Certification Exam for Wound Care

Dawn Engles, RN, MSN, CCNS, CWOCN, Inpatient Wound and Os-tomy Center

Ambulatory Care Nursing

Theresa Crabtree, RN-BC, BSN, Ur-gent Care Center

Certified Clinical Nurse Specialist

Dawn Engles, RN, MSN, CCNS, CWOCN, Inpatient Wound and Os-tomy Center

Sarah Lackey, RN, MSN, CCNS, Nurs-ing Administration

Certified Emergency Nurse

Bonnie Brown, RN, CEN, Emergency Department, Annie Penn Hospital

Certified Inpatient Obstetrics Nurse

Heather Koran, RNC-OB, BSN, Labor and Delivery, Women’s Hospital

Ashley Tuttle, RNC-OB, BSN, Labor and Delivery, Women’s Hospital

Certified Nephrology Nurse

Danyel Johnson, RN, MSN, CNN, Clini-cal Nursing Support

Certified Neuroscience Registered Nurse

Tom Bailey, RN, BSN, CNRN, Depart-ment 3100-Neuroscience ICU, Moses Cone Hospital

Certified Nurse Manager and Leader

Sandra Kuider, RN, MSN, Emergency Department, Annie Penn Hospital

Critical Care Registered Nurse

Brittany Deitz, RN, BSN, CCRN, De-partment 2900-Coronary Intensive Care/Step-Down Unit, Moses Cone Hospital

Kyle Duncan, RN, BSN, PCCN, CCRN, Department 2300-Surgical Intensive Care, Moses Cone Hospital

Catie Duszlak, RN, BSN, CCRN, De-partment 2100-Medical-Surgical Inten-sive Care, Moses Cone Hospital

Hans Johnson, RN, BSN, CCRN, Inten-sive Care/Step-Down, Wesley Long Hospital

Kristin Mullins, RN, BSN, CCRN, De-partment 2900-Coronary Intensive Care/Step-Down Unit, Moses Cone Hospital

Emily Newsom, RN, BSN, CCRN, Department 2300-Surgical Intensive Care, Moses Cone Hospital

Kate Saftner, RN, BSN, CCRN, Depart-ment 2300-Surgical Intensive Care, Moses Cone Hospital

Brooke Simpson, RN, CEN, CCRN, CareLink Mobile Critical Care

Tvedt Woods, RN, BSN, CCRN, Intensive Care/Step-Down, Wesley Long Hospital

Maternal Newborn Nursing

Lorinda Shaw, RNC-MNN, BSN, Nurs-ing Administration, Women’s Hospital

Medical-Surgical Certification

Jakeema Bryant-McLaughlin, RN, BSN, CMS, 5 East Medical Unit, Wesley Long Hospital

Heather Bullins, RN-BC, BSN, CMS, 5 East Medical Unit, Wesley Long Hospital

Chasity Hearn, RN-BC, BSN, CMS, 5 East Medical Unit and Flexible Re-sources, Wesley Long Hospital

Melinda Kallam, RN-BC, BSN, CMS, Flexible Resources, Wesley Long Hospital

Progressive Care Certified Nurse

Karen Ambrose, RN, PCCN, Flexible Resources, Wesley Long Hospital

Katie Bloodworth, RN, PCCN, Depart-ment 3700-Cardiac Progressive Care Unit, Moses Cone Hospital

Sherry Bolen, RN, PCCN, Women’s Nursing Unit, Women’s Hospital

Amber Carter, RN, BSN, PCCN, De-partment 3700-Cardiac Progressive Care Unit, Moses Cone Hospital

Eva Cooke, RN, BSN, PCCN, Intermedi-ate Care/Urology, Wesley Long Hospital

Linda Curran, RN, PCCN, Department 2600-Step-Down, Moses Cone Hospital

Dana Dark, RN, PCCN, Intermediate Care Urology, Wesley Long Hospital

Tymeeka Davis, RN, BSN, PCCN, Department 2000-Heart Unit, Moses Cone Hospital

Pam Garman, RN, BSN, PCCN, Intermedi-ate Care/Urology, Wesley Long Hospital

Paige Grady, RN, PCCN, Adult ICU, Women’s Hospital

Christina Hall, RN, PCCN, Department 3700-Progressive Care Unit, Moses Cone Hospital

Kathy Heater, RN, PCCN, Intermediate Care/Urology, Wesley Long Hospital

Janet Humphreys, RN, PCCN, Depart-ment 3700-Progressive Care Unit, Moses Cone Hospital

THE MOSES H. CONE MEMORIAL HOSPITAL

Setting the Pace

CONE HEALTH

Step Five: Evaluate the practice change. After several weeks, the

team evaluated the changes in practice. Complete and accurate

skin documentation increased from 61 to 85 percent, documen-

tation of admission and transfer skin assessments improved

from 81 to 90 percent, and the documentation of pressure ulcer

prevention interventions rose from 20 to 60 percent. Ultimately,

the PUP rate declined to zero.

Step Six: Dissemination. Sharing the results of this EBP project

has been phenomenal. The Skin Savers poster titled “The Pres-

sure Is On: Skin Savers to the Rescue” has won first place in the

2012 Cone Health Nursing Research Day, third place at the Cone

Health Evidence-Based Practice and Research Symposium, and

the Nursing Leadership Excellence Award at the North Carolina

Organization of Nursing Leaders 2012 Conference. This project

was accepted as a poster presentation at the 2011 Southeastern

Region WOC Nurses Society Conference and the 2013 Annual

American Nurses Association Nursing Quality Conference.

Subsequent PUP surveys have warranted a need for continued

efforts in maintaining the practice changes established in this

EBP project. Further auditing, accountability and continuing

skin education will be the next steps in the unrelenting quest to

sustain quality nursing care.

“We have come a long way and still have a long way to go, but

the most rewarding accomplishment throughout this process is

seeing the positive impact our practice change has had on our

patients. How exciting!” says Allyson Daniels Kirkman, RN III,

BSN, Department 6700.

References1Fife, C., Yankowsky, K., & Ayello, E. (2011). Legal issues in the care of pressure ulcer patients: Key concepts for healthcare providers-A consensus paper from the International Expert Wound Care Advisory Panel. Journal of Wound, Ostomy & Continence Nursing, 2011 Jul-Aug (4S): Supplement: S11.2Keller, R., Frank-Bader, M., Beltran, K., Ascalon, M., & Bowar-Ferres, S. L. (2011). Peer education: An innovative approach for integrating standards into practice. Journal of Nursing Care Quality, 26 (2), 120-7

When Current Practice Is Not Best Practice, Continued

“We have come a long way and still have a long way to go, but the most rewarding accomplishment through-out this process is seeing the positive impact our

practice change has had on our patients. How exciting!”

- Allyson Daniels, RN, BSN

Pressure Ulcer Prevalence

6.7%

Skin and Wound Documentation in the Medical Record

% Preventive

Continued on page 18

516

WOMEN’S HOSPITAL

IN PRINT

Theresa M. Davis, RN, MSNConnie Barden, RN, MSN, CCRN-E, CCNSCarol Olff, RN, MSN, CCRN-E, NEA-BCMary Pat Aust, RN, MSMaureen A. Seckel, APN, ACNS-BC, CCNS, CCRNCrystal L. Jenkins, RN, MHIWendy Deibertm, RN, BSNPhyllis Griffin, RN, BSN, MSNPat Herr, RN, BSNCarrie Hawkins, RN, BSN, MSN, CCRNMary McCarthy, RN, BSNCo-author: “Professional Account-ability in the Tele-ICU.” Critical Care Nursing Quarterly; October/December 2012, 35(4), 353-356.

Jennifer L. Zinn, RN, MSN, CNS-BC, CNORCharlotte L. Gugliemi, RN, BSN, MA, CNORPatsy P. Davis, RN, BA, CNORClara Moses, RN, BSN, MSCo-author: “Addressing the Nurs-ing Shortage: The Need for Nurse Residency Programs.” AORN J; 96(6): 652-657.

Susan Hummel Pedaline, RN, MS, DNP, RNCGail Wolf, RN, PhD, FAANLinda Dudjak, RN, PhDHolly Lorenz, RN, MSNMaribeth McLaughlin, RN, BSN, MPMDianxu Ren, MD, PhDCo-author: “Preparing Exceptional Leaders.” Nursing Management; Sep-tember 2012, 38–44.

Jean Reinert, RN, MSNAndrea Bigelow, RN, MSN “Overcoming Nursing Faculty Short-ages and Bridging the Gap Between Education and Practice.” Journal for Nurses in Staff Development; Septem-ber/October 2012, 28(5), 216-218.

Laurie McNichol, RN, MSN, GNP, CWOCNC.R. Ratliff, RN, PhD, APRN-BC, CWOCNCo-author: “Risk assessment, staff education, and interventions for pres-sure ulcer prevention programs.” Pres-sure Ulcers: Prevalence, Incidence and Implications for the Future; Washing-ton, DC: NPUAP, 2012: 197-226.

Laurie McNichol, RN, MSN, GNP, CWOCNC.R. Ratliff, RN, PhD, APRN-BC, CWOCNCo-author: “National Pressure Ulcer Advisory Panel accomplishments over the past 10 years.” Pressure Ulcers: Prevalence, Incidence and Implica-tions for the Future; Washington, DC: NPUAP, 2012: 231-237.

Joseph Coladonato, MDAnnette Smith, RN, MSNNancy Watson, RN, BSN, CMSRNAnne T. Brown, RN, MSN, PCCNLaurie l. McNichol, RN, MSN, GNP, CWOCNAmy Clegg, RN, MSN, CWOCNTracy Griffin, RN, MSN, CWOCN“Prospective, Nonrandomized Con-trolled Trials to Compare the Effect of a Silk-Like Fabric to Standard Hos-pital Linens on the rate of Hospital-acquired Pressure Ulcers.” Ostomy Wound Management, October 2012, 58(10), 14-31. Eva Hyde, RN, MSN, CNS, ONCBrenda Murphy, RN, MSN, GNP-BC“Computerized Clinical Pathways (Care Plans): Piloting a Strategy to Enhance Quality Patient Care.” Clinical Nurse Specialist-Journal for Advanced Nursing Practice; September/October 2012, 26(5), 277-282.

AT THE PODIUM

Sarah Clark, RN, MSN, CCRNBelinda Hammond, RN, MSN, CEN, CCRN“The Top 10 List: Lessons Learned Dur-ing the First Year of Simulation.” 7th Annual South Eastern Nursing Staff Education Symposium, Asheville, Nov. 3, 2012.

Laurie McNichol, RN, MSN, GNP, CWOCN“Health Economics and Pressure Ulcer Prevention.” Northeast WOCN Re-gional Meeting, Princeton, NJ, October 2012.

Joy Berrong, RN, DN, RNC-OB, C-EFM, FNE“Trauma in Obstetrics.” Piedmont Chapter Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Conference, Women’s Hospital, Greensboro, October 2012.

ON DISPLAY

Stephanie Cole, RN, BSN“Magnesium for Neuro Protection of the Preterm.” Piedmont Chapter AWHONN Conference, Women’s Hos-pital, Greensboro, October 2012.

Becky Zhang, RN, BSN, RNC-OBSandra Holleman, RN, BSN, RNC-OB“Foley Catheter use after an Epidural.” Piedmont Chapter AWHONN Confer-ence, Women’s Hospital, Greensboro, October 2012.

Stacey Toben, RN, BSN, CPENJamie Blue-Matthews, RN, BSN, CENDenise Rhew, RN, MSN, CEN “Simply Educate Me... Decreasing Blood Contamination Rates.” Emer-gency Nurses Association Annual Con-ference, San Diego, September 2012.

ACCOLADES

April Schamberg, RN, BSNAnn Councilman, RN, BSN, MHA/MBAWere selected by the American Orga-nization of Nurse Executives (AONE) to attend the AONE Emerging Nurse Leader Institute held in November 2012 in Chicago, Illinois.

Emmanuel Castro, RN-C, BSNAmy Clegg, RN, MSN, NP-C, CWOCNDawn Engels, RN, MSN, CCNS, CWONJan Goltare, RN-BCKimberly Gengler, RNDanyel Johnson, RN, MSN, CNNAllyson Kirkman, RN, BSNAngelina Leonar, RNAnita Mintz, RNBeth Passmore, RNLuz Rosero, RNPoster Presentation: “The Pressure Is On: Skin Savers to the Rescue.” North Carolina Organization of Nurse Lead-ers Research Day, Raleigh, November 2012. Recipient of the Leadership Award.

Setting the Pace

CONE HEALTH

By Beth Smith, RN, MSN, NE-BC

The Neonatal Intensive Care Unit (NICU)

at Women’s Hospital excels in quality

as they work to eliminate Central Line

Associated Blood Stream Infections

(CLABSI). For two years, the NICU

has participated in a two-year state-

wide collaborative through the Peri-

natal Quality Collaborative of North

Carolina (PQCNC) to help reduce the

CLABSI rate across the state. Overall,

statewide CLABSI rates in NICUs have been

reduced by 68 percent.

Through the work of a multidisciplinary team from the NICU, several changes

in practice for the care of infants with central IV lines have been success-

ful in helping reduce the CLABSI rate, according to Susan Jones, RNC-NIC,

NICU Assistant Director. One creative change to practice is the creation of

the “bubble,” the practice of screening off the area around sterile central line

procedures. Inside the bubble, other practices include using a face mask and

sterile gloves during IV tubing assembly; using a completely closed system

for IV fluid and medication delivery; scrubbing the needleless connectors on

the IV lines with friction for at least 15 seconds and allowing to air dry; and

changing central line dressings only as needed. As of Dec. 1, the NICU has

been 379 days CLABSI free.

In the fall of 2011, the NICU was invited to participate in a national collabora-

tive. Women’s Hospital was one of 91 NICUs from nine states who worked

to reduce their CLABSI rates. Through work on the national level, the NICU

added an additional goal to focus on removal of central lines as soon as the

infant’s condition allowed. The NICU has been invited to participate in the

next phase of the national collaborative. “This has truly been a team effort

among all staff to make this work a success. We are extremely proud of all

involved,” Jones says.

NICU Creates the “Bubble” to Fight Infection

MAGNETNEW KNOWLEDGE, INNOVATIONS

AND IMPROVEMENTS

“This has truly

been a team

effort among all

staff to make this

work a success.

We are extremely

proud of all

involved.”

– Susan Jones, RNC-NIC

6 15

We made it through the implementation of Cone Health-

Link, “One Patient-One Chart.” We also survived an in-

tense visit from The Joint Commission, and we received

a reprieve from another visit, for now. I had the privilege

of having an active role in both of these very important

events, and I am very proud to say that I work in an or-

ganization where I see caring demonstrated consistently,

across the board, no matter where you work or what your

role is.

You may be wondering, “What’s next?” Or, being the

strong and supportive team players you are, perhaps you

are saying, “Bring it on, I can handle it!”

Well, how about this? We are up for Magnet re-designation

in a few short months, and we need to have a clear under-

standing of how all that we do comes together to get us to

Magnet status.

One of the terms you will need to understand as we pre-

pare for our visit with the surveyors for Magnet re-desig-

nation is “care delivery system.” At Cone Health, our care

delivery system is Relationship Based Care (RBC).

A care delivery system is an infrastructure for organizing

and providing care to our patients and families. Plain and

simple, the care delivery system is what guides the way we

provide care to our patients every day. The primary focus

in our care delivery system is the relationship between the

nurse and the patient and family.

Other important elements of a care delivery system in-

clude: staffing and scheduling of patient assignments, how

we communicate with other members of the healthcare

team and how leadership manages the department. When

leadership promotes the therapeutic relationship between

the patient, nurse and all members of the care team, an

environment of caring and healing is established. Staff

develops and grows, and we meet our mission of caring for

our patients/families, our community and each other. That

is our care delivery system, RBC.

Look for a CBL coming soon to help connect the care de-

livery system to other important structures and processes

in nursing at Cone Health. Knowledge of how these drive

the actual care we give is important as we seek our third

Magnet designation.

Care Delivery Model: What’s That?By Ruthie Waters, RN, MSN, NEA-BC

During that stay, the multidisciplinary team assesses the need for further treat-

ment based on the patient’s needs. The Assessment Crisis Team (ACT), composed

of registered nurses, licensed clinical social workers, licensed professional coun-

selors and chaplains, is responsible for assessment and referral services, orders

for admissions and referrals from medical-surgical units. “It’s a challenging work

day – never dull,” Bartlett says. “We want to contribute to Cone Health and to the

community.”

The Behavioral Health Hospital “goes out of its way to include us,” says Jamie

Blue-Matthews, RN IV, BSN, CEN, Emergency Department, Wesley Long Hospital.

Staff and Community Response

The reality of mental health care today impacts the staff and the community.

Things are not always rosy in the Behavioral Health Emergency Department. On

some days, 10 beds are not enough, and the stress can be intense. “I use humor,”

Smith says. “I encourage the staff so we don’t get bogged down.”

Blue-Matthews thinks debriefing with the chaplain and “just talking among our-

selves” is the best way to deal with the challenges. “It takes a special nurse to do

this job,” Blue-Matthews says. “Emergency nurses think fast and act quickly. Here,

listening can be the best skill.”

According to Deborah Thomas, NT, patients have positive opinions about the fa-

cility and care in the Behavioral Health ED. “Thank you for not treating my mother

like a burden, for staying with her” is affirming to hear. Thomas chose to work in

this department and notes, “Every now and then I make a difference.”

MAGNETEXEMPLARY PROFESSIONAL PRACTICE

CONE HEALTH

Focus on Patient Safety, Privacy and Care

• State-of-the-art camera surveillance throughout the unit.

• Secured bedside emergency equipment.

• Hospital-provided nutrition.

• Two bathrooms with showers.

• Policies assuring patients’ and visitors’ rights.

• Restraints avoided if possible.

• Greensboro Police Department officer present 24 hours per day.

“Every now and then I make a difference.”

– Deborah Thomas, NT

14 7

Melanie Bradsher, RN, BSN, CGRN, Endoscopy Specialty Coor-

dinator at Annie Penn Hospital, received the Marjorie Simpson

Award for professional excellence.

The award was started in 1995 and has been awarded annually

since then by Surgical Services at Annie Penn Hospital. The

criteria for being nominated are:

• Member of the surgical services team for at least one year.

• Demonstrates integrity, honesty, accountability and functions

within his or her scope of practice

• Displays a commitment to patients, families and colleagues.

The nominees can be from any area of Surgical Services (OR,

Anesthesia, Short Stay, PACU, Endoscopy, Sterile Processing

Department) and any job category (nurse, tech, staff, leader, etc.).

Melanie Bradsher receives Marjorie Simpson Award

Opened in 2012 as part of the new Wesley Long Hospital Emergency Depart-

ment, the impressive Behavioral Health Emergency Department is striving to

meet the acute mental health needs of our community’s residents.

The 10-bed unit’s focus is on safety, stabilization and referral.

“I love it,” says Mike Smith, RN III, a former police officer and emergency

nurse who now works at the Behavioral Health Emergency Department.

“There’s a need for psychiatric help. I like meeting emergency medical

needs as well as emergency psychiatric needs. They are equally impor-

tant.”

Community Need

Toni Bartlett, RN, BSN, MHA, Assistant Director, Assessment Department, Cone

Health Behavioral Health Hospital, has witnessed the increasing demand for

emergency mental health services and Cone Health’s commitment to serve this

population. As a result of North Carolina mental health reform during the last

decade, local mental health departments have been consolidated and privatized

while the number of beds at state mental hospitals has been reduced. An unin-

tentional effect of reform was the increase in the number of patients relying on

emergency departments for care. A census of more than 20 mentally ill patients

in the Cone Health emergency departments has become common.

Multidisciplinary Collaboration

The Behavioral Health Emergency Department has a dedicated staff of registered

nurses and nurse techs who provide care 24 hours daily, seven days a week. The

unit sees patients with a variety of diagnoses. Many are depressed and suicidal.

Others are homicidal or psychotic while others need detoxification. Some are

homeless. Smith says the unit stays “about 99 percent full, with an average length

of stay of two to three days.”

Meeting Acute Mental Health Needs Through Multidisciplinary Collaboration

By Ann Finch, RN, MSN, PMHCNS

MAGNETEXEMPLARY PROFESSIONAL PRACTICE

BEHAVIORAL HEALTH HOSPITAL ANNIE PENN HOSPITAL

Humpty Dumpty Award

Working to prevent falls

The winner of the Humpty Dumpty award goes

to Department 6700-Medical/Renal, Moses Cone

Hospital, for an 82 percent reduction in falls.

For improvements between quarters 3 and 4,

honorable mentions go to Department 4000 -

Inpatient Rehabilitation, Moses Cone Hospital, for

a 29 percent reduction in falls and to 5 East of

Wesley Long Hospital for a 73 percent reduction.

Congratulations on these successful gains in one

of the most important nursing responsibilities for

our patients - keeping them safe and preventing

harm.

“It takes a special

nurse to do this

job. Emergency

nurses think fast

and act quickly;

here, listening can

be the best skill.”

– Jamie Blue-Matthews

Mike Smith, RN III, and Sheila Lilly, RN II, MSN-MHA, in the Behavioral Health ED.

MAGNETTRANSFORMATIONAL LEADERSHIP

From left to right: Nicole Small, Assistant Director, Surgical Services, Melanie Bradsher and Wayne Mcfatter, Director of

Surgical, Endoscopy and Radiologic Services.

Staff of 6700 pose with the Humpty Dumpty Award.

8 13

“Culture” has been a buzzword at Cone Health recently.

We as nurses are faced with the challenge of how to en-

hance current culture to improve the experience of both

patients and staff. Consider the recent experiences of one

unit: The Moses H. Cone Memorial Hospital’s Heart Failure

Unit (Department 4700) recently launched several new

initiatives that are helping to transform the Unit’s nursing

culture while improving patient care in their department.

• Unit 4700 recently implemented a fun and effective

way to educate heart failure patients. Following the

systemwide People Excellence Symposium, the unit

staff brainstormed ways to develop their own “sig-

nature” initiative. Mavis Nyako, RN, proposed send-

ing heart failure patients home with a fresh apple as

a tangible symbol of healthy lifestyle changes that

will be necessary. Nyako also proposed the acronym

APPLE: Acknowledging Patient’s Participation Length-

ens Life Expectancy. (The APPLE program also helped

to debut the new “ZONE” heart failure educational

tool, which is a stoplight visual to help patients assess

daily weight gain and overall health, guiding patients

when to contact a physician with the hope of reduc-

ing hospital readmissions.) Patients also leave with a

thank-you card designed by Assistant Director Lanisha

Hunter, RN, BSN, MHA, and signed by the staff. The

latest patient satisfaction results compiled by Press

Ganey revealed the APPLE initiative has skyrocketed

Unit 4700 to the 90th percentile in patient satisfaction

concerning discharge teaching.

• Monette Mabolo, RN, MBA, MSN, CPAN, NEA-BC,

Department Director for 4700, wanted a way to

chronicle the good things patients had to say about

the care they received on her unit. Mabolo’s idea led

to the creation of a “WOW” card (as in “Wow, I had a

great experience”). Some patients fill out their WOW

cards at the hospital, while others take them home

to mail them back later. One patient recently wrote

about how 4700’s staff “gets it”: putting patients first

with expert care. “The WOW cards have been a great

way for me to see more of the many wonderful things

the staff do for our patients,” Mabolo says. The cards

are also positive reinforcement for the staff and go on

display at the nurse’s station. Moreover, several other

units have “borrowed” the WOW card idea as a way

to celebrate the good things happening on their own

units.

By Nicole Baltazar-Holbert, RN, MSN, and Monette Mabolo, RN, MBA, MSN, CPAN, NEA-BC

CONE HEALTH MAGNET

Changing the Culture of Nursing,

One Idea at a Time

Cone Health’s High-Flying Nurse Extern Program

Recently launched

initiatives are helping to

transform this Department’s

nursing culture while

improving patient care.

Illustration by Bill Stork, StorkStuff

12 9

4700 also included staff orientation in its cultural

evolution, by aggressively soliciting feedback from

new hires to the unit. That feedback led to the

creation of a 4700 Orientation Model by Donna

Owens, RN, BSN, PCCN. “Lead” staff for each role

now collaborate with the Unit’s RN IV to review

orientation materials specific to their job titles and

develop the expertise to teach new employees

with the same knowledge as the unit educator.

A Nurse Secretary Monitor Tech (NSMT) serves

as the Orientation Materials Coordinator, whose

job is to compile an orientation notebook with

resource documents specific to 4700 competen-

cies, as well as to coordinate welcome gifts for all

new hires. Owens also created a tracking tool for

mandatory first-year education for new RNs. The

RN IV and lead staff meet with orientees once a

month for the first three months, and then at the

end of the first year. The goal of this strong Ori-

entation Model is that is supports experienced as

well as new-to-role employees. It is unique in that

Lead staff roles were created for RNs, NSMTs, and

Nurse Techs so that they could develop expertise

specific to their job titles. New hires this fall felt

better acclimated to the unit, Owens says. Another

“win” at Cone Health for employee-driven cultural

change!

MAGNETSTRUCTURAL EMPOWERMENT

Staff and leadership of 4700 enhance current culture to improve the experience of both patients and staff.

2012 Press Ganey National Client Conference

The experts on how to achieve top-decile performance

nationally in employee, physician and patient satisfaction

shared their secrets with a standing-room-only crowd of

healthcare providers recently.

The experts? Cone Health’s own Dr. Debbie Green, Vice

President, Nursing/Patient Services, Annie Penn Hospital,

and Mickey Foster, President, Annie Penn Hospital.

The setting? The annual National Press Ganey Conference

on Nov. 13 in Washington, DC.

Press Ganey is a recognized leader in healthcare perfor-

mance improvement and works with more than 10,000

healthcare organizations nationwide, setting benchmarks

for best practices.

Green and Foster’s presentation was titled “Leading for a

Trifecta: Top Performance in Patient, Employee and Physi-

cian Satisfaction.” Their remarks focused on how employ-

ee and physician satisfaction translates into exceptional

quality and patient care.

Press Ganey reported that the mean score of Annie Penn

Hospital for the fourth quarter of 2011 reached the 95th

percentile in employee engagement; the 96th percentile

in physician satisfaction; and the 94th percentile in patient

satisfaction. Only a small number of hospitals nationwide

manage to achieve top-decile performance in all three key

areas.

Additionally, in 2012, Annie Penn Hospital achieved 99th

percentile ranking in employee engagement, making it

eligible to receive the Press Ganey Distinctive Workplace

Award in 2013. Hospitals need to achieve 95 percent or

above employee engagement scores for two consecu-

tive years to achieve this award. If successful, Annie Penn

Hospital would be the only hospital in the state of North

Carolina with this honor.

Green and Foster told the audience that successful organi-

zations know that one of their most valuable resources for

delivering superior care is dedicated employees. True part-

nership between employer and employee is a win-win-win,

resulting in quality improvements that benefit patients,

staff and operational outcomes.

Evidence of this partnership is evident in the National Da-

tabase of Nursing (NDNQI) RN Satisfaction Survey results

for 2012, in which Annie Penn Hospital scored at the 90th

percentile nationally in the Practice Environment Score,

and all five components of it, which include participation

in hospital affairs, foundations for quality, nurse manager

ability, staffing and resources, and nurse:physician re-

lationships. Additionally, nurses at Annie Penn Hospital

rated their job enjoyment at 5.58 points above the 90th

percentile rating nationally.

ANNIE PENN HOSPITAL

MAGNETTRANSFORMATIONAL LEADERSHIP

Clarification On page 10 of the Nursing Beat, Vol. 9 No. 4, Fall 2012, it states: “The PNAP review committee will then schedule a date

for an interview with the committee.” This should read: “Upon approval of your portfolio by the PNAP review committee,

you will be sent an email with information to schedule a time with the committee. RN IIIs will come to pick up their port-

folios at their scheduled time. RN IVs will give a brief (10 minute) presentation about their case study or project.”

Mickey Foster Debbie Green

10 11

Cone Health’s Nurse Extern program, “Destination RN,”

offers BSN nursing students paid externships during the

summer prior to their senior year. “Destination RN,” now in

its fourth year, uses a theme-based approach to support

the transition from student to the role of practicing nurse.

The extern program takes each nursing student on a 10-

week “trip.” Participants “board” a plane and journal about

their experiences. The trip culminates in a celebration at

their final destination – the end of the 10 weeks.

Cassandra Galloway, RN, MBA\MHA, and Lobel Lurie, RN,

MA, Extern Program Coordinators from the Staff Educa-

tion office, recently won “Best Practice” for their poster on

“Destination RN,” which was presented at the 2012 As-

sociation for Nursing Professional Development national

conference in Boston.

At a time when some other hospitals in the state and

region have curtailed or ended their summer extern of-

ferings, Cone Health’s nurse externship program, which

began more than 20 years ago, continues to flourish. For

example:

By Cassandra Galloway, RN, MBA\MHA, Jacqueline Clarke, RN, MSN, OCN, Ariella Singer, RN, BSN, and Maura Barber, RN, BSN

“It certainly was a rewarding experience

for me. I gained a lot of confidence for my

clinical classes, and I have stayed on at Cone

Health to work during my senior year,”

• The program has grown from 15 participants to as many

as 40 per year.

• Cone Health successfully retains many externs as nurse

techs during their senior year of nursing school.

• Upon graduation, 97 to 100 percent of previous nurse

externs join Cone Health as new graduate nurse

employees.

The goal of “Destination RN” is to expose the student ex-

tern to patient care in the acute care setting, while working

side-by-side with a registered nurse. The extern and nurse

share the same patient assignments, which enables the

student to observe and acquire new skills. For example, the

nurse extern must be certified to perform the same tasks

as a current “NT 1+3,” including using sterile technique,

IV care and urinary catheterizations. Externs also attend

weekly meetings with the program coordinators to de-

velop “soft” skills such as effective communication, team-

building and problem-solving.

Montressa Blount, NT 1+3, who currently works in the flex

pool, affirms the value of being a nurse extern. “It certainly

was a rewarding experience for me. I gained a lot of confi-

dence for my clinical classes, and I have stayed on at Cone

Health to work during my senior year,” she says.

Interested applicants may apply for an extern position dur-

ing the November through January period of their junior

year of nursing school. For more information, go to cone-

health.com and type “nurse extern” into the search win-

dow or contact the Staff Education office.

CONE HEALTH

“Destination RN”

MAGNETSTRUCTURAL EMPOWERMENT

Cone Health’s High-Flying Nurse Extern Program

100% of the 2010 Nurse Extern group became Cone Health nurses and are still employed in the network.