Rex Healthcare Nursing is grounded in purpose by

our mission statement and empowered to act by

our structure that allows the nurse at the bedside

to make decisions that are the most beneficial to

patients.

Our nurses are committed to meeting nationally-

accepted benchmarks for excellent nursing care, and

data indicate we consistently do so. We are proud

that our efforts have been rewarded with the

prestigious designation and redesignation

as a “Magnet Nursing“ facility that has process-

es in place to attract and retain professional nurses.

Working along side our physicians and other care

team members, Rex nurses oversee care 24 hours a

day. They are the sentinels for safety, role models for

compassion and tireless advocates for quality.

Patients in our community will choose their doctor

and hospital, but at Rex we choose your nurse.

You can expect

EXCELLENCE!

Mary Lou Powell, C.N.O.

We Value...•patientsafety

and outstanding

care

•superiorservice

•aworkingpartnership

with our medical staff

•ourworkforce

•soundbusinesspractices

•market-responsive

growth and

development

2010 NursingAnnual Report

Nursing’s MissionTo make a positive difference

in the life of a patient every day

Need photo

PracticeCouncil

ResearchCouncil

NursingCongress

ProfessionalDevelopment &

EducationCouncil

InformaticsCouncil

QualityImprovement

Council

UNIT-BASED

COUNCIL

Shared Decision MakingNurses at Rex are an integral part of decision-

making through a process called shared gover-

nance. Shared governance involves co-workers

at all levels working together to make decisions

about professional nursing care, education and

development, and unit operations. This type

of decision-making model fosters collaborative

relationships and engagement in nursing

practice that leads to excellence in patient care.

Improved patient outcomes, enhanced

nurse-physician relationships and im-

proved job satisfaction are all results of

shared decision-making.

The shared decision-making process is accom-

plished through unit-based councils as well as

broader, system-wide councils. Best practices

in nursing care, monitoring outcomes, nursing

research, documentation, and patient education

are all decided through these councils.

Emergency Department (ED) patient length

of stay has been researched and discussed in

various venues including journals, list services

and even newspaper articles for many years.

Nursing research shows that decreasing

length of stay for patients improves

patient and co-worker satisfaction.

Rex Emergency Department developed and

tested a Balanced Work Flow Model, using

information gained from evidence-based

practice. The goal for a balanced work flow

process was to utilize all available resources

in a more efficient manner and to improve

patient flow.

The department completed a trial during the

month of August 2010 prior to making any

changes in day-to-day protocol. All co-work-

ers were educated via email, bulletin boards

and meetings during shift change for three

weeks prior to the initiation of Balanced

Work Flow. During this trial, the workgroup

which included representation from each

discipline met on a weekly basis to review

co-worker comments and possible “quick

changes” that could be made to improve the

process. Co-workers could make suggestions

by email or on comment pages posted in all

medication rooms and co-worker lounges.

Needless to say, the test was a success! The

length of stay decreased, patients who left

before being seen (Against Medical Advice or

AMA) decreased also, and patient satisfac-

tion increased. The ED continues to use the

balanced work flow model as the standard of

practice.

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AMAs (Against Medical Advice) - 2010

Rex Healthcare Emergency Department: Exemplary Professional Practice

Bariatric Surgery Center of ExcellenceObesity is one of North Carolina’s most serious

health problems, and individuals with severe

obesity are often faced with numerous

other life-threatening conditions such

as high blood pressure and diabetes.

Rex Healthcare is committed to providing

world class care to patients choosing

bariatric surgery and in 2010 achieved

designation as a Center of Excellence

for Bariatric Surgery from the Surgical

Review Corporation. This designation recognizes the high quality of

the bariatric surgical program and the support provided throughout

the system for bariatric patients.

The Rex Bariatric Surgery program includes eight bariatric surgeons,

a dedicated inpatient bariatric surgical unit, a full-time bariatric

services coordinator, monthly support groups and ongoing educa-

tional events. Nurses and support staff have received special training

in caring for persons of size and are committed to helping patients

achieve their goals.

Caring for Patients with DiabetesDiabetes is one of the fastest growing epidemics in our country and

is estimated to affect some 25.8 million children and adults in the

United States. Even more alarming, diabetes and pre-diabetes are

expected to affect half the U.S. population by 2020. In 2010, 22,964

diabetes patients were seen and cared for at Rex Healthcare.

In April 2010, nurses from each patient care unit came together to

become Diabetes Resource Nurses and focus on improving

the care provided to patients with diabetes. An inter-

disciplinary team developed several continuing education programs

for the resource nurses including:

•DiabetesMealPlanning

•MedicationsforManagementofDiabetes

•DefiningDiabetes

•IntensiveInsulinTherapy

•ChronicComplicationsofDiabetes,andmore.

Each resource nurse took this information back to their coworkers

and has been working to increase knowledge about patients with

diabetes. These nurses serve as daily resources to their peers and

have provided multiple educational posters, learning programs and

in-services throughout the year.

Rex nurses have been working several years to provide the best

possible skin care to patients. The goal is to prevent patients from

having skin breakdown which can sometimes result in difficult to

heal skin ulcers. In 2010, a “root cause analysis” process was put

in place on each nursing unit to investigate what could have been

done differently for a patient who was observed to have a skin ulcer.

Nurses focused on turning and repositioning “at risk” patients every

two hours and worked hard to make sure each patient received the

appropriate nutrition.

Skin and Wound Resource Nurse Team at Rex – 2010 Highlights

A preventive sacral dressing (a bandage for the lower back) was tested

in ICU for several months on patients at risk for developing a lower back

ulcer. The results were incredible – none of the 171 patients who had the

dressing applied upon admission to the ICU developed a sacral pressure

ulcer. This product is being considered for use with all at risk patients.

This process has dramatically reduced the number of patients who suffer

skin breakdown while in the hospital. The team of clinical experts has

been asked to share this program with other hospitals and The Joint

Commission as a model of great success.

Vascular Access Resource Nurses TeamThe Vascular Access Resource Nurses Team (VARN) at Rex is a special group of

trained nurses who place difficult peripheral and Peripherally Inserted Central

Catheter (PICC) lines in patients.

Vascular access has become a huge topic over the years and requires special

knowledge for the bedside nurse. The team’s goal for 2010 was to make sure

each bedside nurse received education about peripheral and venous access

and could then become the patient’s best advocate to help with the decision

making. The nurse can help the patient by making sure the right type of intra-

venous (IV) line is selected and started.

Approximately 98 percent of all patients admitted require some type of a

intravenous (IV) line. Therefore, the team developed a teaching program for

nurses. This program has four modules:

•IntroductiontoIntravenousTherapy

•PeripheralIntravenousTherapy

•CentralVenousTherapy

•InfectionControlforIntravenousTherapy

As a result of the work of these nurses, there has been an increase in the

number of PICC lines. This means patients at Rex undergo markedly fewer

attempts to have an intravenous line started and are more likely to complete

their intravenous therapy.

Health Literacy InitiativeIn 2009, Rex nurses Mary Clare Prasnikar, R.N., M.S.N., C.C.R.N.,

and Mary Toma McConnell, R.N., became interested in the

issue of health literacy – the ability of the patient to read,

understand and act on health information. These nurses

wanted to be sure their patients understood the healthcare

information they were receiving. After attending a Health

Literacy Conference, they developed Literacy Based Discharge

Instructions for Acute Coronary Syndrome and presented a

poster at The Institute for Healthcare Advancement (IHA)

Conference in March 2010. Upon returning home, they met

with quality programs department to discuss health literacy.

In May 2010 an Interdisciplinary Health Literacy Program was

formed to educate nurses and other healthcare professionals

about the use of plain language in the development and

revisions of patient education materials.

The nation loses as much as $106 to $236 billion each

year because people misunderstand or unintentionally

misuse their medications. These nurses put together a

campaign to educate Rex nurses about health literacy and

help keep patients safer. All Rex nurses now learn:

• You cannot tell a person’s health literacy level by their

appearance

• To communicate effectively with your patients:

1. Use plain language (avoid medical jargon) and identify

three points you want to make sure the patient

understands.

2. Use the AskMe3: What is my main problem? What

do I need to do? Why is it important to me?

3. Do not ask yes/no questions. Instead ask patients:

Tell me in your own words or show me…..

This work has been accepted for a poster presentation at

the annual 2011 American Nurses Credentialing Center

national conference in Baltimore, Maryland.

Research and Evidence-Based PracticeNurses at Rex are committed to providing high quality

patient care based on evidence of best practice, current

research and knowledge. Many nursing units have research

projects underway and several have been recognized at the

national level through publication and presentation. Nursing

research is coordinated by the Nursing Research Council and

overseen by the Rex Institutional Review Board. In 2010, one

nursing research project changed practice across the hospital.

Changing Practice with Bedside Nursing ResearchBlood clots are the most common life-threatening complica-

tion associated with orthopedic surgery. Historically, nurses

have used specially-designed stockings called TEDS to provide

pressure to a patient’s leg after surgery to prevent blood

clots from forming. A group of inpatient orthopedic nurses

decided to explore the incidence of skin irregularities on

patients wearing knee-high TEDS after surgery.

The research team consisted of principal investigator

Regina Ohayon, R.N., and team members Kim Ebert, B.S.N.,

Carrie Lewis, R.N., Monica Vater, R.N., Roberta Rose, R.N.,

C.N.S.N., and Vicky Overby, R.N., B.S.N., M.S.N., C.M.S.R.N.,

who served as mentor for the group. The team met every

two weeks to develop their research project and ultimately

learned the stockings added no extra benefit to the patients

to prevent blood clots and might cause skin problems. The

nurses shared their research with the orthopedic surgeons

and the routine use of the stockings was discontinued.

The team developed a research poster which was presented

by Lewis, Rose, and Ohayon at the North Carolina School of

Nursing Sigma Theta Tau Research Day in Chapel Hill in

February 2010 and by Rose and Ebert at the 1st Annual

Sandhills Research Conference in June 2010.

The Transfer Nurse – A New and Helpful Role A pilot project was set

in place in March 2010

to evaluate the feasibility

of having a nurse take

charge of hospital-to-hospital

transfers. This responsibility

includes assisting and talking

with patients who are

transferring from one room

to another, discussing any

of their concerns, working

hand-in-hand with the

administrative coordinator and

responding to any needs. This pilot

proved to be more than valuable and

is now a permanent position held by Sharon Stocks, R.N. An intensive care

nurse, Sharon is skilled in handling multiple tasks at one time.

“I take information, screen and prepare this information for the physi-

cians,” explains Stocks. “Answering the pager for physicians allows physi-

cians to concentrate and complete their admissions with little interruptions.

I direct admissions or transfers from the outside, as well as take consults for

the psychiatrist.”

“Sharon helps send patients to UNC and other facilities and also works with

Rex hospitalists to accept patients transferred to us,” says Joanne Kuszaj,

M.S.N., R.N., director of cardiovascular nursing at Rex. “She does everything

she can to facilitate the process for doctors.”

Evolved from an idea to a full-time position, Sharon Stocks helps make a

process much easier for both patients and physicians.

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Nursing Education Nurses at Rex are encouraged and supported in continu-

ing their formal education as well as achieving certification

in their area of specialty. Educational support is provided

through scholarships to help with expenses, flexible sched-

uling to attend classes, tuition reimbursement, and on-site

study groups. Advanced degrees in Health Administration

and Business Management are offered in an on-site program

through Pfeiffer University. In 2010, the number of

Rex nurses with a Baccalaureate degree or higher was:

Bachelor’s ............655

Master’s .................52

Doctorate ...............5

Nursing Certifications Reach a New HighRex Nurses are encouraged to pursue national certification

in their area of specialty and are reimbursed for the exam

fees when certified. Certified nurses have demonstrated ad-

vanced knowledge in their clinical area and nursing research

has shown a clear link between certification and improved

patient care. In 2010, the number of Rex nurses holding

certification reached an all time high.

Rex Nurses:Reaching Higher, Shining BrighterTo prepare for Magnet Redesignation, Magnet Nursing Champions created

bulletin boards on each of their units to educate co-workers about nurse

sensitive quality indicators, shared governance, standards of professional

practice, research and evidence-based practice. The Magnet Champions and

Nursing Congress developed a visual depiction of the Rex Nursing Professional

Practice Model showing the Rex Levers of Excellence and incorporating our

nursing values from the Rex Philosophy of Nursing.

Mary Lou Powell, senior vice president, patient care services and C.N.O.,

clinical managers and nurses from Rex attended the National Magnet Confer-

ence held in Phoenix, Arizona in October 2010. Rex Healthcare was officially

recognized as a redesignated

organization at this event. This

conference included podium and

poster presentations by key-

note speakers and nurses from

magnet organizations. Helene

Zehnder, M.S.N., R.N., N.E.-B.C.,

Elizabeth Rochin, M.S.N., R.N.C.

and Wanda Adams, B.S.N., R.N.,

did a podium presentation titled

Planning Strategically to Improve

Patient Satisfaction. More than

800 nurses attended this presen-

tation to learn about the Service

Excellence program at Rex and

how specific interventions have

improved patient satisfaction

within our organization. The values stated in our nursing philosophy provide the foundation of our professional practice model and the provision of patient centered care. These values are integrated throughout our nursing practice and shared governance structure and support the organization's levers of excellence.

Nursing Professional Practice ModelEase of Use

Economics

MD Loyalty

Technology

Quality

Autonomy

Teamwork

Nurturing Empowerment

InnovationAccountability

Communication

Research & Evidence Based PracticeEducation

Tradition

Patient

ExcellentOutcomes

Miss

ion to Magnet

REX … a Magnet Hospital Again!On September 28, 2010, Rex Healthcare received notification it was officially redesignated as a Magnet

Organization. Magnet Designation by the American Nurses Credentialing Center (ANCC) is the

highest international recognition an organization can receive for nursing excellence.

Rex nurses are proud to be the first hospital in the Triangle recognized for achieving the

American Nurses Credentialing Center Magnet Designation for the second time.

This accomplishment signifies excellence in nursing care, patient outcomes, team work and

interdisciplinary relationships and is awarded to only six percent of hospitals in the

country. In 2010, UNC Hospitals became a part of this esteemed group with their initial

designation as a Magnet Hospital.

In order to be considered for the designation, hospitals must meet rigid criteria in the delivery of patient care

and outcomes achieved, must promote and support nursing research and evidence-based practice and must achieve

the highest scores in patient, physician and nursing satisfaction. The hospital must submit extensive documentation and successfully

complete a multi-day on-site survey.

This year the surveyors noted there was so much excellence at Rex it had become the norm. We celebrate our team and our community for this recognition!

Congresswoman Renee Ellmers (center) celebrates Rex Hospital’s Magnet redesignation with chief nursing officer Mary Lou Powell, president David Strong, physicians and staff.

Rex Healthcare’s Mission & VisionTo provide the best in health services by bringing

together compassionate care and leading-edge

technology.

To be the healthcare provider of choice in Wake

and surrounding counties.

Careers at RexAt Rex, we believe that high-quality health care

means more than providing exceptional medical

treatment, it means providing care by skilled

professionals who care - people like you.

When you pursue a career at Rex, you’ll be part of

an award-winning team that genuinely cares about

you and your family’s needs and goals so that you

can better care for our patients. You’ll discover an

environment that emphasizes respect and innova-

tion – one that is recognized in our community and

beyond for caring and commitment to excellence.

For more information on how you can become part

of our team, visit rexhealth.com today.

Rex Awards & RecognitionNamed as one of the Top 50 Best Hospitals in the nation by Becker’s Hospital Review for 2011.

Named one of the 2010 top 50 N.C. Family-Friendly Companies by Carolina Parent Maga-

zine 12 consecutive times - one of only four companies to attain this achievement.

Ranked 9th among hospitals named to the 2009 Best Places to Work in Healthcare in the

U.S. list by Modern Healthcare Magazine, listed 27th overall.

Designated a Bariatric Center of Excellence in 2010 by the American Society for Metabolic

and Bariatric Surgery (ASMBS) and recognized as a Blue Distinction Center for Bariatric Surgery®

by Blue Cross and Blue Shield of North Carolina (BCBSNC).

Rex received eight 2011 PRC Excellence in Healthcare awards for patient satisfaction scores:

•MedicalOncology-TopPerformerAwardandFiveStarAward-Outpatient

Oncology Services

•ThreeWomen’s–FiveStarAward–InpatientOB/GYNServices

•WakefieldSurgery–FiveStarAward–OutpatientSurgeryServices

•ThreeEast–FiveStarAward–InpatientServices

•CardiacCatheterizationServices–OutpatientCathLabServices

•OutpatientServices/OutpatientSurgery–FourStarAward–OutpatientServices

•ThreeWest–SilverAchievementAward

4420 Lake Boone TrailRaleigh, North Carolina 27607rexhealth.com