sentara martha jefferson nursing annual report 2019 · 2020-04-30 · sentara martha jefferson...

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SENTARA MARTHA JEFFERSON NURSING ANNUAL REPORT

2019

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Johnsa Greene-Morris, MBA, MHA, BSN, RN, NE-BC

TRANSFORMATIONAL LEADERSHIP

2019 was a phenomenal year. As we journey into 2020, I am hopeful you each have taken time to reflect on your positive contributions to safe nursing practice, our continued path to our fourth Magnet designation, and your impact on our community.

We have reason to celebrate many accomplishments from 2019. One of our goals this year was to improve our nursing recruitment and retention. We have a Recruitment and Retention Committee that has been working on various initiatives to fill our open nursing positions and retain nurses that are part of our workforce.

Over 2019, we demonstrated marked improvement in our nurse sensitive metrics. The processes implemented have been noted organization wide. I know we can continue to improve in 2020 by continuing to practice with a renewed dedication to patient safety and infection prevention.

We continue to strengthen our commitment to our bedside nurses making decisions about nursing practice, the work environment, and coordination of care across our disciplines via our Nursing Shared Governance structure. I greatly value the input of our nurses at the “sharpest point of care” and know that it is only through our partnering together that we can achieve our goals.

Lastly, I just want to say thank you. Thank you for being yourselves, for taking your job seriously, for owning our patient outcomes and for just trying your best to be better. Sentara Martha Jefferson Hospital is what it is, because of YOU!!! I am encouraged for nursing and a great 2020.

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Johnsa Greene-Morris, MBA, MHA, BSN, RN, NE-BC

Inpatient Measures

The National Database of Nursing Quality Indicators (NDNQI) allows nursing units to benchmark their performance nationally with nursing units of similar composition. Trends are measured for eight running quarters, which is equivalent to two years, and the most recent 8 quarters for Falls with Injury, Hospital Acquired Pressure Injuries (HAPIs) Prevalence, Central Line Associated Blood Stream Infections (CLABSIs), and Catheter Associated Urinary Tract Infections (CAUTIs) will be lifted up in our Magnet document. Magnet organizations are expected to maintain outperformance of the national benchmark for the majority of units for the majority of the most recent 8 quarters (at least 5).

Inpatient Nursing Quality Indicators: Last 8 Quarters Results (2017 Q4 – 2019 Q3)

Unit Falls with Injury HAPI ≥ 2* CLABSI CAUTIC1 3/8 7/8 7/8 6/8C2 5/8 7/8 8/8 8/8C3 8/8 8/8 6/8 8/8W1 6/8 8/8 5/8 4/8W2 3/8 7/7 8/8 5/8

# of units outperforming the majority of the last 8

quarters

3/5 Units 5/5 Units 5/5 Units 4/5 Units

QUALITY AND PATIENT SENSITIVE MEASURES


QUALITY AND PATIENT SENSITIVE MEASURES QUALITY AND PATIENT SENSITIVE MEASURES

Ambulatory Nursing Quality Indicators: Door to Balloon (2017 Q4 – 2019 Q3)

Ambulatory Measures

Q4 -‐ 2017

Q1 -‐ 2018

Q2 -‐ 2018

Q3 -‐ 2018

Q4 -‐ 2018

Q1 -‐ 2019

Q2 -‐ 2019

Q3 -‐ 2019

SMJH PCI Units 100.00% 100.00% 100.00% 98.15% 100.00% 100.00% 100.00% 100.00%

CathPCI Registry, All registered hospitals, Median ProporMon of

STEMI paMents receiving immediate PCI w/in 90 min

95.14% 95.14% 94.66% 94.67% 94.62% 94.54% 94.75% 94.75%

70.00%

75.00%

80.00%

85.00%

90.00%

95.00%

100.00%

Prop

or%o

n of STE

MI Pa

%ents R

eceiving

Percu

tane

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Corona

ry In

terven

%on (PCI) w

ithin 90 Minutes of H

ospital A

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Minutes from Hospital Arrival to Proportion of STEMI Patients Receiving Percutaneous Coronary Intervention (PCI) within 90 Minutes of Hospital Arrival Ambulatory, PCI Units

Percent of Acute Ischemic Stroke Patients with Time to Intravenous Thrombolytic Therapy of 45 Minutes or Less Ambulatory, tPA Units

Door to Needle (2017 Q4 – 2019 Q3)

Ambulatory Measures

4Q2017 1Q2018 2Q2018 3Q2018 4Q2018 1Q2019 2Q2019 3Q2019 SMJH tPA Units, % Time of 45

minutes or less 100.00% 45.50% 100.00% 75.00% 66.70% 75.00% 100.00% 50.00%

Get With the Guidelines, All hospitals, % Time of 45 minutes or

less 40.70% 41.40% 43.50% 43.50% 43.80% 50.20% 53.20% 55.00%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

Perc

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f Acu

te Is

chem

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trok

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Dent

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trav

enou

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45 M

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QUALITY AND PATIENT SENSITIVE MEASURES QUALITY AND PATIENT SENSITIVE MEASURES

Inpatient Patient Satisfaction – # of the last 8 quarters that outperformed the national benchmark

Ambulatory Patient Satisfaction – # of the last 8 quarters that outperformed the national benchmark

Patient Experience

Unit Pt-ctr Care Safety Courtesy/Respect Responsiveness Patient Ed Pain Careful

ListeningC1 3/8 4/8 4/8 5/8 5/8 3/8 4/8

C2 2/8 5/8 5/8 3/8 8/8 4/8 5/8

C3 8/8 6/8 5/8 5/8 8/8 7/8 8/8

W1 8/8 6/8 5/8 5/8 8/8 6/8 4/8

W2 8/8 8/8 8/8 8/8 8/8 7/8 8/8

# of units outperf

3/5 Units 4/5 Units 4/5 Units 4/5 Units 5/5 Units 3/5 Units 3/5 Units

Pt-ctr Care Safety Courtesy/Respect Responsiveness Patient EdFSED Total 6/8 8/8 8/8 8/8 8/8

ED Total 2/8 5/8 3/8 3/8 1/8

OAS CAHPS (SIPC/

Procedural Areas

8/8 7/8 5/8 2/8 7/8

Cancer Center 7/8 7/8 8/8 5/8 8/8

# of units outperf 3/4 Units 4/4 Units 3/4 Units 2/4 Units 3/4 Units

HAI HuddlesDaily 15 minute HAI huddles were implemented in January of 2019 to address healthcare-associated infections (HAIs) and conditions including CAUTIs, CLABSIs, hospital-onset Clostridium difficile infections, and HAPIs. The team of inpatient Nurse Managers or Unit Coordinators, inpatient Nurse Directors, Wound/Ostomy/Continence Nurse, Patient Educator/Readmission Site Coordinator, and CNE met each morning prior to the hospital-wide safety huddle to review the patients on each of the units that have: Foley catheters, central lines, midlines, loose stools (appropriate for C. difficile testing), and Braden scores indicative of high risk for developing pressure ulcers. Opportunities for device removal, documentation gaps, and patient-specific challenges were discussed. Other members of the team including Nursing Directors, Managers of the Surgical and Procedural areas, Nurse Educators, and Manager of Professional Practice attended as needed. Infection Preventionist Andrea Chapman leads the daily HAI huddles, and provides daily and weekly email summaries.

In 2019, we implemented multiple strategies focused on reducing our healthcare-associated infections (HAIs) and conditions.

HAI ChampionsThe HAI Champions are representatives from each nursing unit that work to provide safe, quality care to patients by reinforcing evidence-based practice related to healthcare-associated infection prevention, serving as a resource to team members, and providing peer-to-peer coaching. The team met monthly and was co-facilitated by Andrea Chapman and Ashley Mawyer. Our HAI Champions in 2019 were: Whitney Digney (Nursing Quality Improvement Coordinator), Lara Richards (C1), Katelyn Ludwig (C1), Karina Guinn (C2), Deanne Mullins (W1), Cameron Welch (W2), Becca Hoover (Obs), Trena Berg (OR), and Brian Flood (Float pool).

Nursing Quality Improvement CommitteeThe Nursing Quality Improvement Committee was also formed in 2019 in order to ensure an optimal level of patient care is provided to all patients through the identification and resolution of nursing quality issues. Comprised of Nursing Directors, Nurse Managers, bedside nurses, representatives from SMJH Quality and Safety, Infection Prevention, and Nursing Education, the group met at least monthly and strived to create a culture of zero harm to patients. The committee was led by Chair Whitney Digney, RN, M.Ed, CMSRN (Nursing Quality Improvement Coordinator), Co-Chair Andrea Chapman, MPH, CHOP (Infection Preventionist), and Executive Sponsor Johnsa Morris, MBA, MHA, BSN, NEA-BC (CNE).


PROFESSIONAL DEVELOPMENT

Nursing Degrees

BSNs:Karina Guinn, BSN, RN (C2)

Kable Pluger, BSN, RN (C2)

Nikki Eppard, BSN, RN (C2)

Lindsey Fletcher, BSN, RN (C2)

Lara Richards, BSN, RN (Cornell 1)

Amy Brown, BSN, RN (Obs)

Tamara Talley, BSN, RN (Obs)

Jackie Van Der Linde, BSN, RN (Obs)

Keith Martin, BSN, RN (C2)

Carrie Thompson, BSN, RN (ED)

Deanne Mullins, BSN, RN (W1)

Brittany Moore, BSN, RN (C3)

Silke Meyer, BSN, RN (W1)

Erika Halloran, BSN, RN (W1)

Katelyn Sykes, BSN, RN (C3)

Samantha Carter, BSN, RN (ED)

Congratulations to those nurses who advanced their nursing degrees in 2019:

By year-end 2019, 68.8% of nurses at SMJH had a BSN or higher degree. 84.7% had a BSN or higher degree or were under contract to get their BSN degree. SMJH continues to make strides towards the 2010 Robert Wood Johnson Foundation recommendation for 80% of hospital nurses to have a BSN or higher degree by 2020. We are able to achieve these results through the work of the nurses who pursue the advancement of their nursing degrees and through the generous funding provided by our community members for the Haden Nursing Foundation scholarships as well as the Sentara Tuition Reimbursement program.

MAPP participants

2019

2018 YE

2017 YE

2016 YE

2015 YE

Martha Jefferson RN Education 6-Year Trend

0% 20% 40% 60% 80% 100%

15.3% 15.9% 68.8%

16.3% 16.7% 67.0%

19.5% 18.4% 62.1%

19.4% 22.2% 58.3%

28.2% 15.8% 55.9%

Non-BSN Degree

Non-BSN w/Contract

BSN or Higher Degree

PROFESSIONAL DEVELOPMENT

Wesley Gass BSN, RN (CFP)

Emily Helm, BSN, RN (C1)

Luis Morales, BSN, RN (W1)

Megan Huckins, BSN, RN (Admit/Recovery)

Frank Signoretti, BSN, RN (Admit/Recovery)

Cisco Langley, BSN, RN (C3)

Logan Howey, BSN, RN (Practices)

Bridget Kirby, BSN, RN (Practices)

Samra Litric, BSN, RN (C3)

Kelly Rousseau, BSN, RN (C2)

MSNs:Anne Roane, MSN, RN (ED)

Allyson Michaels, MSN, RN (W3)

Meghan Rowland, MSN, RN, FNP (C3)

Shaune McKinnon, MSN, RN, PMHNP (W2)

Camilla Washington, MSN, RN (Practices)

Tee Goyer, MSN, RN, CNOR (OR)

DNPs:Jennifer Kilel, DNP, RN (W1)

Jean Jun, DNP, MSN, RN, FNP-C (ED)

Professional Nursing Certifications:Thank you to our nurses for their professionalism and leadership in achieving and maintaining national board certification in their nursing specialty.

Admit Recovery:Paula Alberts, RN, RN-BC

Jennifer Frashure, BSN, RN, CMSRN

Julianne Messner, RN, OCN

Kendall Crusse, BSN, RN, RN-BC

Melissa Proffitt, MSN, RN, RN-BC

Kelly Ritz, BSN, RN, RN-BC

Joy Rosson, RN, CPN

Susan Wheeler, RN, CMSRN

Linda White, RN, CMSRN

PACU:Nicole Lawson, RN, CAPA

Danielle Merritt, BSN, RN, RN-BC

Heather Noble, BSN, RN, CPAN

Rachel Ragland, RN, CPA

Radiation Oncology:Marsha Taylor, RN, OCN

Surgical Services:Marcia Arnold, RN, CNOR

Trena Berg, BSN, RN, RN-BC

Lori Boles, BSN, RN, CNOR, NREMT-B

Donna Freeman, BSN, RN, CNOR

Tee Goyer, MSN, RN, CNOR, RNFA

Julianna Hoback, BSN, RN, CNOR

Steven Thomasen, BSN, RN, CNOR

Victoria Wright, BSN, RN, CNOR

Kaitlin Young, BSN, RN, CNOR

Vascular Interventional Radiology:Andrew Fletcher, BSN, RN, CEN, CFRN

Sara Sandridge, BSN, RN, PCCN

Debbie Seusy, BSN, RN, VA-BC

Roy Tomlin, BSN, RN, CCRN

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PROFESSIONAL DEVELOPMENTPROFESSIONAL DEVELOPMENT

Endoscopy:Layne Brophy, BSN, RN, CGRN

Karron Good, RN, CGRN

Infusion Center:Hollis Campbell, BSN, RN, OCN

Patricia Kearns, RN, OCN

Brandy Maxton, RN, OCN

Mike Nelson, BSN, RN, OCN

Danielle Schrader, BSN, RN, OCN

Brandi Teel, RN, OCN

Medical Oncology/Cancer Services:Michele Bascle, BSN, RN, OCN

Janelle Gorski, MSN, RN, ANP-BC, AOCNP

Laura Trissel, DNP, RN, AGACNP-BC, AOCNP

Mary Beth Revak, BSN, RN, OCN

Cornell 1:Dana Graves, BSN, RN, PCCN

Lyndsey Schaffer, BSN, RN, PCCN

Ryan Thompson, MSN, RN, CNL

Wendel 2:Teresa Brock, BSN, RN, ONC

Jenna Masten, BSN, RN, RN-BC

Shaune McKinnon, MSN, RN, PMHNP-BC

Shannon Welch, BSN, RN, ONC

Cornell 2:Deborah Brown, BSN, RN, RN-BC, GRN

Julie Drexler, RN, RN-BC, GRN

Lindsey Fletcher, BSN, RN, RN-BC, GRN

Karina Guinn, BSN, RN-BC, GRN

Lauren Longenecker, BSN, RN, RN-BC, GRN

Keith Martin, RN, CMSRN, GRN

Kable Pluger, RN, RN-BC, GRN

Patricia Scott, BSN, RN, RN-BC, GRN

Danine Stoner, RN, RN-BC, GRN

Meredith White, BSN, RN, RN-BC, GRN

Cornell 3:Ebony Lindsay, BSN, RN, CMSRN

Susan Loomis, RN, PCCN

Melinda Schmidt, RN, CMSRN

Shaela Shifflett, RN, CMSRN

Stacey Williams, BSN, RN, RN-BC

Observation:Stephanie Riordan, BSN, RN, RN-BC

Tamara Talley, BSN, RN, CPN

David White, BSN, RN, CMSRN

Wendel 1:Amanda Beuttenmuller, BSN, RN, CCRN

Emily Brady, MSN, RN, CNL

Amber Campos, BSN, RN, CCRN

Rebekah Critzer, RN, CCRN

Nina Dennis, BSN, RN, CCRN

Kathleen Ellis, RN, CCRN

Jennifer Kilel, DNP, RN, CCRN

Laura Marino, MSN, RN, AGACNP-BC

Edie Markowski, BSN, RN, CCRN

Boyce McClennan, BSN, RN, CCRN

Sara Morris, BSN, RN, CMSRN

Emily Peterson, BSN, RN, PCCN

Kristin Rubenoff, BSN, RN, CCRN

Victor Somers, RN, CCRN

Hilda Taylor, DNP, RN, CCRN, PCCN, CNL

Tenaya Thurston, RN, PCCN, NREMT-P

Emergency Department:

Samantha Carter, BSN, RN, EMT-B

Greg Ford, BSN, MA, NHDP-BC

Jean Jun, DNP, MSN, RN, FNP-C

Gerald Perry, RN, NREMT-P

Anne Roane, MSN, RN, FNP-C

Carrie Thompson, BSN, RN, NREMT-P

Romantha Turner-Miller, BSN, RN, CEN

Free-Standing ED:Robert Kirk, BSN, RN, CEN

Brittany Shifflett, BSN, RN, NREMT-B

Rosemary Watson, BSN, RN, PCCN

Abigail Zuehlke, BSN, RN, CRNI

Wendel 3: Crystal Adcock, BSN, RN, RNC-OB, C-EFM

Kiley Bailey, MSN, RN, RNC-OB

Adrianna Chapman, BSN, RN, C-EFM

Stephanie Dennis-Bowers, RN, RNC-OB

Elizabeth Eldredge, BSN, RN, CLD

Sharon Fickley, MSN, RN, RNC-OB, C-EFM, CNL

Jennifer Gaines, MSN, RN, CHSE

Amanda Harrison, BSN, RN, C-EFM

Christine Hibbert, RN, RNC-OB

Adelle Karaca, BSN, RN, RNC-LRN

Esther Lozano, RN, IBCLC

Penny Merrel, BSN, RN, IBCLC

Allyson Michaels, MSN, RN, IBCLC

Erin Muller, BSN, RN, RNC-OB, IBCLC

Katherine Rainey, BSN, RN, IBCLC

Laura Salvatierra, BSN, RN, CLD

Bethany Shaffer, BSN, RN, CLD

Elaine Shinsky, BSN, RN, RNC-OB, EFM-C

Gabrielle Smith, BSN, RN, RNC-OB

Samantha Spiker, BSN, RN, RNC-LRN

Kristin Von Thelen, BSN, RN, RNC-OB

Surgical Program Development:Connie Summy, BSN, RN, ONC

Patient Educator:Whitney Digney, M.Ed, BSN, RN, CMSRN

Palliative Care:Aurora Durkee-Warren, RN, RN-BC

Peggy Bishop, MSN, RN, AANP, ACHPN

Integrated Care Management:Veronica Bernacchi, BSN, RN, PCN

Michelle Harper, BSN, RN, RN-BC

Jennifer Johnson, BSN, RN, CNOR

Kathryn Jones, BSN, RN, RN-BC

Susan Lebeis, RN, BA, CCM

Patra Reed, DNP, RN, CNML, CCCTM

Patient Safety & Quality:Christi Hankle, MSN, RN, RN-BC, CNRN

Outpatient Surgery Center:Dawn Haasnoot, MSN, RN, RN-BC, CAPA

Debra Rose, RN, RNC-OB

Patricia Sawyer, BSN, RN, CNOR

Robin Workman, BSN, RN, CMSRN

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MAPP is Sentara Martha Jefferson Hospital’s clinical ladder program. Nurses start at level I and progress up to level V. Financial incentives are provided to nurses at each level and for maintenance within levels. The MAPP levels are a reflection of 4 nursing competencies: clinical practice, education, leadership, and evidence based practice. The MAPP levels are:

Clin 1 – Novice

Clin 2 – Advanced Beginner

Clin 3 – Experienced

Clin 4 – Proficient

Clin 5 – Expert

Nursing seeking to climb to or maintain a level of Clin 3 or higher, are required to submit a written narrative describing an example of their clinical practice as part of the MAPP packet requirements. This written narrative is known as an exemplar and highlights some of the MAPP nurses’ most memorable clinical experiences. Heather Noble, BSN, RN, CAPA shared a powerful exemplar reflecting his experience as a nurse in the PACU.

MAPP

Heather Noble, BSN, RN, CAPA

Being a Post Anesthesia Care Unit (PACU) nurse requires a special set of skills. PACU is truly a specialty of its own, with this comes patients of all types. Some postoperative patients wake up crying and some wake up violent.

Mrs X was an elective surgical patient who was having surgery for continuing back issues.

Post-extubation, the anesthesiologist gave bedside report that included any lines, drains, advanced airways, past medical history, the medications given during the procedure, allergies, and any other pertinent information. She had a bone graft placed during surgery that was compressing her Iliac vein and would need to be possibly taken out. She also had foreign body bone fragments in her retroperitoneum due to a fragile lumbar bone that would possibly need to be removed. Report of these complications turned my assessment of the patient to be more circulation and neuro related. As with any back surgery, it was important to assess every 15 minutes for any change in the patient neuro assessment. Any change could be due to increasing pressure from the bone graft. This

would be an emergent surgery that would be an immediate return to the OR rather than the current admission to PACU for reassessment. Circulation was also a huge factor for this patient. She was at an extremely high risk of passing a clot due to being postoperative and also because she did not have much blood flow space for blood to pass by the bone graft that was being compressed. I assumed she would need a computed tomography (CT) scan to further assess her current condition. I immediately called the CT tech to see if there was time to get her in for the scan stat, and I was told yes. I notified the physician that CT was ready to go if he wanted it performed. He had me enter a verbal order and I brought the patient up to the CT suite. While transporting the

MAPP Exemplar, Heather Noble

PASS:Mary Huff, BSN, RN, RN-BC

Senior Services:Jessica Cooper, BSN, RN, OCN

Nursing Education:Mina Ford, MSN, RN, RN-BC, AOCNS

Amanda Deinlein, MSN, RN, RN-BC, PCCN-K

Ashley Mangum, MSN, RN, CNL, CCRN-K

Research Coordinator:Kathryn Reid, PhD, RN, FNP-C

Community Health:Setour Dillard, BSN, RN, OCN

Practices/Hospitalist Group:Elaine Alpern, MSN, RN, A-GNP

Caroline Brand, MSN, RN, CCRN, AGACNP-BC

Barrie Carveth, MSN, RN, FNP-C

Elizabeth Driscoll, MSN, RN, BC-ADM

Gina Gilmore, MSN, RN, CCRN

Jennifer Hall, MSN, RN, CEN, AGACNP-BC

Genevieve Harway MSN, RN, AANPCP

Angie Honeycutt, MSN, RN, ONC, FNP-C

Jessica Kenty, MSN, RN, NP-C

Nicole Lepsch, MSN, RN, FNP-C

Elizabeth Lawwill, MSN, RN, FNP-C, CMSRN

Barbara Martin, BSN, RN, CDE, WHCNP

Matthew Mildonian, MSN, RN, FNP-C

Sharon “JJ” Peacock, BSN, RN, RN-BC

Charles Sauls, MSN, RN, FNP-C

Imelda Solis, RN, RN-BC

Administration/Nursing Administration:Johnsa Morris, MBA, MHA, BSN, NEA-BC

Amy Black, DNP, RN, NEA-BC

Allison Crawford, MSN, RN, CRNI

Laura Decker, BSN, MSHA, RN, NEA-BC

Abby Denby, MSN, RN, NE-BC

Judy Kauffman, DNP, MSN, RN, CNN

Courtney Lambert, MSN, RN, NE-BC

Kelly Via, MSN, RN, RN-BC

Beth Vitolo, BSN, RN, NREMT-B

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patient, who was still quite sedated, we explained where we were going and why. She agreed and within a few seconds was back asleep. Usually I would give a patient some versed to have the CT done if they had any anxiety or inability to hold still while it was being performed. For this patient it was pertinent to have the CT performed without any medications that could mask new occurring neurovascular issues. The scan was completed with her still sleeping and was conclusive that she would need to be assessed by another surgeon who could fix the iliac vein compression. The next surgery would require two surgeons and it needed to happen as soon as possible.

The patient began to ask about her husband in the waiting room. She was worried he would be upset and wouldn’t know where she was or what was going on. I reassured her that he had been updated by the surgeon and asked if she would like for him to come back to the PACU and sit with her until she was able to go back into the operating room. She began to get teary eyed and said yes. After having

her husband with her, he not only helped calm the patient, but also kept her mind off of the pain, just as I had predicted. Distraction alone can help pain immensely. Once the husband was with the patient, the primary surgeon updated both on the need to go back to the OR and why. They both understood and were in agreement.

The husband was able to say his goodbyes for now and I escorted him back into the waiting room. I then asked the patient how she was feeling and offered to answer any additional questions she may have. She began to cry and grabbed my hand. She explained how it had been a long day and she was worried about whether she would wake up after this second round of anesthesia. I assured her that it was essential to have the compression fixed and that I would be waiting for her in the PACU just like the first wake up. Her vital signs were stable and she had done very well in the postoperative period even with some severe surgical complications. She said the encouragement made her feel better and she held my hand until

the operating room nurses came in to get her.

The second surgery was about 2 hours long. I was there to help wake her up and control her pain postoperatively. She did great!

This patient’s care was extremely organized and our team was ready for anything that may happen at any moment despite the tone of the situation. Being a PACU nurse prepares you for critical situations that may occur at any moment. The collaboration between the surgeons, nurse and anesthesia is always encouraged and in this situation it was confirmed by the handoff of care at the bedside, the suggestion to lower the amount of narcotics postoperatively pending the next surgery, and by confirming when to start the Heparin drip. Evaluation was shown in the assessment and reassessment of the blood pressure and pain. I applied clinical judgment while hanging Heparin which is not a common medication administered in the PACU, giving pain meds when needed, and when deciding the appropriate time

to extubate. Clinical judgment is not limited to that. It is constantly in the back of my head. Does the patient need a simple mask or a Bipap? Will one more dose of pain medicine cause her to not breathe? If she stops breathing do I have my supplies nearby to support her airway? What is my plan if she clots where the compression is occurring? Do I have the physicians contact information? These are questions I was constantly reviewing and assessing for while completing tasks. These answers can constantly change as the patient’s status changes. While moving the


MAPP

Exemplar, Heather Noble (continued)

patient to have a CT completed, I educated the patient on why this was needed and how they would do it. Education was given to the patient regarding pain medications when getting them and why they needed to be temporarily stopped. She was also provided verbal education regarding why she needed to have a new IV line for Heparin and repeat surgery. Caring was used when holding the patient’s hand and offering a listening ear and encouragement prior to heading back to the OR for the second surgery. Not only was having the husband back with the patient a

caring gesture for the patient, but also for comfort of the husband.

Caring for PACU patients is a passion that requires a special skill set that is not acquired easily. Each patient is different and for this reason PACU nurses are well rounded and have strong clinical skills. I truly believe the PACU is a place that patients feel completely vulnerable and have no control of their actions. I strive to be the PACU nurse that provides these patients the safety and security they need and deserve.


Clinician III:Kelly Ritz

Susan Brandt

Elizabeth M. Brooks

Nina Dennis

Mike William Bannister

Samantha G. Level

Shaela Shifflett

Lori Burnett

Shane Sims

Sarah Silverman

Samantha Sznajder

Linda White

Dannette McGee

Heather P. Kunk

Susan Barnard

Kable Pluger

Crystal Adcock

Paula Alberts

Rebekah Seay Critzer

Kendall Crusse

Aurora Durkee-Warren

Gabriel H. Henderson

Erin Kinsey

Esther Lozano

Ana Karina Guinn

In 2019, the following nurses participated in the MAPP program as a Clinician 3 or higher.

Patricia Kearns

Brandy Maxton

Susan Wheeler

Allison E. Woodside

Josh Landis

Vanessa Lawson

Frank Signoretti

Shawna Stokes

Roben L. Boyd

Amber Eanes

Joshua Mohr

Carla Morris

Regina Perkins

Tamsey Dillenbeck

MAPP

Jessica Fox

Lucie LaFontaine

Camry Leake

Samantha Spiker

Sarah Garmey,

Clinician IV:Paula M. Pippin

Kathleen Ellis

Tammie W. Smith

Courtney Kimble

Michelle Sacre

Shannon Welch

Etta C. Toliver

Heidi Wolfe English

Laura T. Matheny

Stacey Riccardi

Amy C. Brown

Sara S. Morris

Barbara Petrella

Brittany Drumheller

Elaine C. Shinsky

Kathryn H. Butler

Roy G. Tomlin

Stacey L. Williams

Amy Bowman

Amy L. Brown

Jacqueline Conner

Kathy L. Krevansky

Emily Peterson

Kevin Proctor

Michele Bascle

Gabrielle Smith

Cary Squire

Tamara Talley (Gentry)

Kait Young

Rebecca (Becca) Hoover

Heidi Anderson

Crystal A. Rowe

Clinician V:Victoria Melander

Jessica L. Cooper

Deborah A. Brown

Marcia D. Arnold

Lila J. Smith


Joy P. Rosson

Karron Good

Jennifer Gaines

Allyson M. Michaels

Patricia Sawyer

Kristin Von Thelen

Heather Noble

Lisa Smith


SHIP Program

Scholarships awarded to date

MAPP participants

NRP graduates 23

183

8935.3%Specialty Certified

68.8%BSN

or higher degree*

*Percentage of eligible nurses: nurses with 2 or more years of service

In 2019, SMJH launched a Student Healthcare Internship Program (SHIP), an early workforce recruitment initiative offered for senior nursing students completing their last two semesters of an accredited nursing program. SHIP provides aspiring nurses unique opportunities to earn premium pay while working in our acute care facility as student nurses.

Workforce

PROFESSIONAL PRACTICEPROFESSIONAL DEVELOPMENT

84.7%BSN

or higher OR have a contract

to do so Sentara Healthcare’s Philosophy of Nursing outlines the beliefs that help to support the overall mission and vision. We believe:

• Our work is built on a foundation of safety and accountability.

• We seek to create the best possible experience of caring and healing for our patients, families and caregivers.

• As nurses, we influence care through evidence-based practice and shared decision making, and through collaboration, coordination, and innovation we accomplish positive patient outcomes.

MissionVisionValues

Sentara Healthcare Sentara Nursing

We improve health every day. We improve health every day through nursing excellence.

To be the healthcare choice of the communities we serve.

To create an environment of health and healing.

People, Quality, Patient Safety, Service & Integrity


PROFESSIONAL PRACTICEPROFESSIONAL PRACTICE

Posters and Presentations

Year Author/Authors Subject Title Place of Presentation National (N), Regional (R), or Local (L)

Hospital Affiliation

Publications

2019 Pam B. DeGuzman, Crystal Chu, Jess Keim-Malpass

Built and Natural Environment Barriers and Facilitators to Physical Activity in Cancer Survivors Living in Rural, Suburban and Small Urban Neighborhoods

Oncology Nursing Forum

Oncol Nurs Forum. 2019 Sep 1;46(5): 545-555. doi: 10.1188/19.ONF.545-555

SMJH

March/April 2019

Valerie Lacey, Karron Good, Chris Toliver, Shirley Jenkins, Pam DeGuzman

Evaluation of 12-Week Shelf Life of Patient-Ready Endoscopes

Society of Gastroenterology Nurses and Associates

Gastroenterol Nurs. 2019 Mar/Apr;42(2):159-164. doi: 10.1097/SGA.0000000000000364.

SMJH

Posters

2/20/2019 Ashley Mangum, MSN, RN, CNL, CCRN-K and Pam DeGuzman, PhD, RN, CNL

Improving Nursing Knowledge to Prevent Catheter-Associated Urinary Tract Infections

CNL Summit; Tampa, Florida (N) SMJH

Presentations

1/25/2019 Allyson Michaels. MSN, RN, IBCLC Dextrose Gel: An EBP Project University of Virginia School of Nursing (L)

SMJH

2/20/2019 Pam Baker DeGuzman, PhD, RN, CNL Finding Your Voice For Safe Patient Care

CNL Summit; Tampa Florida (N) SMJH


PROFESSIONAL PRACTICEPROFESSIONAL PRACTICE

Shared GovernanceOur Shared Governance Academy was held in December. We had two sessions this year: Shared Governance 101 and Shared Governance Pro.

In an effort to strengthen our awareness and engagement in Shared Governance throughout the hospital, each unit is scheduled to report out at a Nursing Leadership meeting. The unit manager and chair or other staff member from the unit council are asked to share what they were working on and allow for 2-way interaction, feedback, and guidance. This has proven to be a beneficial process for both Nursing Leadership and the unit councils to share in order to better understand the work being done in those councils.

Infusion Center/Medical Oncology• Quick Visits to improve patient

experience and care delivery• Increase rate of BSN or higher

degree for staff• Improve patient satisfaction• Chemo Verification – chart audits

to ensure a checklist of verifications is completed prior to administering chemo. Follow up is done with the nursing staff when verification is found to not have been documented.

• Increase rate of nurses with specialty certification

Cornell 2• Staff morale – Employee of the

Month and team outings• NCP and RN teamwork–

implemented a morning huddle between the RN and NCP to facilitate better communication

SMJH Nurses Recognized at VNF Gala:On September 21st, the Virginia Nurses Foundation (VNF) held their annual Gala in Richmond, Va. 8 of our nurses represented Sentara Martha Jefferson Hospital as nominees for either VNF Leadership Excellence Awards or Virginia Magnet Consortium Awards. Nominees from SMJH were:

Sharon Fickley Sarah Glatt Abby Denby

Judy Kauffman Jennifer Wray Heidi Cabot

Ashley Mawyer Johnsa Morris

Sharon Fickley was presented with the Virginia Magnet Consortium Award for Nursing Educator; a well-deserved honor. Each of the nominees demonstrate exceptional contributions to the nursing profession through their leadership, engagement, and outcomes. Thank you to each of them for their dedication to nursing and patient care and to all of you for continuously supporting teams and efforts that allow us to continue to do exceptional work.

Pictured: Dana Graves, Kelly Via, Bethany Shaffer, Amy Black, Jennfier Wray, Abby Denby, Sarah Glatt, Sharon Fickley, Ashley Mawyer

• Patient satisfaction – provide warm washcloths to each patient first thing in the morning

Wendel 1• Worked to decrease HAPIs and

CLABSIs• IV pump storage• Developed a new design for an

ICU-specific whiteboard• Implemented use of the High

Reliability Board including a Project Tracker spreadsheet

Admit Recovery• Implement text communication

with family members waiting in surgical lounge

• Create a unit reference book for education/documentation

• Hold Quarterly Education – Bladder Bash and Central Line Dance

Some examples of the work done in our Shared Governance councils in 2019 include:

Cornell 1• Educate staff for transition to

Intermediate Care Unit• Patient Satisfaction improvements -

Hourly Rounds signs were hung in each room and the “Commitment to our Patients” cards and a letter from Nurse Manager were distributed to each patient

Cornell 3• Morning rounds for manager

and charge nurse so that nurses can focus on medication administration and assessments

• Developed clear role expectations for AA, RN, NCP, Charge/UC

• Employee of the Month• Monthly birthday celebrations

for staff

Wendel 2• CAUTI Stand-down to

reduce HAIs• Improve patient satisfaction – ear

plugs and sleep masks for patients

Professional Development• Worked to develop handouts with

top 3-4 certifications for each unit• Changed Graduation and

Certification celebrations to quarterly as part of Nursing Leadership instead of annually for more timely recognition of staff achievements

• Helped to implement RN Event Peer Review at SMJH

Shared Governance examples (continued)


PROFESSIONAL PRACTICE

Multidisciplinary “Flash” RoundsIn 2019, our Flash MDR model was chosen as the “best practice model” and rolled out to all Sentara hospitals by the system LOS team.

Multi-disciplinary Rounds (MDRs) at Sentara is a patient-centered process to ensure every patient has the right services at the right time, in the right setting to optimize Length of Stay (LOS) and prevent readmission. Goals of MDRs include to:

• Build the Team through improving communications with all members of care team so that everyone is on the same page at the same time.

• Discuss every patient

• Optimize LOS by assuring that clinical care is delivered in an efficient and objective manner using guidelines and data.

• Discuss and reduce any relevant barriers to discharge

• Reduce and eliminate and avoidable delays

• Integrate MCG & eLOS into daily discussions

Nursing facilitates daily MDRs. Nurses are the core of patient care provided in the hospital. Sentara is committed to empowering nurses to fully understand and communicate the needs of their patients throughout the entirety of their stay. Daily nursing participation in MDRs is critical to providing safe, quality, and effective care to our patients.

HEALTHY WORK ENVIRONMENT

DAISY AwardsDuring Nurses Week, we presented our annual DAISY Nurse-Led Team Award and DAISY Nurse Leader Award. Our Magnet Champions also serve as our DAISY Committee, and vote annually on DAISY nominations for these categories that are blinded and presented to them for review.

Daisy Nurse-Led Team Awards

2019 DAISY Nurse-Led Team Honorees:

Heather Bolus (RN), Sarah Cousineau (RN), Casey Hensler (RN), Amy Hunt (RN), Lori King (ED Tech), Lindsay Znotens (RN).

Others that were nominated for the 2019 DAISY Nurse-Led Team award:

The OR Team; Endosopy and the 5th floor med/surg office; Autumn Wilson (W1), Annet Mushabe (C1), Karina Guinn (C2), and Kelly White (C2).

Daisy Nurse Leader Awards

2019 DAISY Nurse Leader Honoree:

Melissa Proffitt, Manager of Admit Recovery and PACU

Others that were nominated for the 2019 DAISY Nurse Leader award:

Michelle Harper, Jennifer Lyons, Johnsa Morris, and Patti Scott.

Sentara System DAISY Nurse Leader Nominees:

At the annual Sentara Nurse Leader Symposium held in May, our system DAISY Nurse Leader Award was also presented. Our very own Michelle Harper and Patra Reed were nominated for this award.

DAISY Banquet

On October 4th, we held a DAISY reception for all of our DAISY honorees since the start of this program at SMJH in 2016. We recognized the exceptional compassionate care that all of our nominees and honorees provide every day at this hospital. Each person that attended the reception were given note cards and asked to write a note of gratitude or recognition to another team member and present it to them along with a daisy as they left.

RN Event Peer Review 2019 saw the launch of our RN Event Peer Review. To that end, we have a committee of clinical nurses from different departments throughout the hospital that review events as they are referred to evaluate the nursing care provided by their peers. This evidence-based best practice is meant to maintain standards of nursing practice in a non-punitive manner while encouraging peer support and evaluation in order to improve patient care. This exciting committee is made up of the following members:

Cornell 2: Kable Pluger

Cornell 3: Ebony Lindsay

Wendel 1: Edie Markowski

Cath Lab: Amanda Griffith

VIR: Hayden Whitworth

OR: Josh Mohr

Admit/Recovery: Kendall Crusse

Infusion Center: Shawna Stokes

ED: Josh Wright

Sponsors: Abby Denby/Kelly Via

Resource: Rachel Brooks


DAISY Awards


Elise Ruemmler, BSN, RN (OR) Elizabeth Showalter, BSN, RN (Practices)

Michelle Sacre, BSN, RN (Wendel 3)

Tenaya Thurston, RN, PCCN, NREMT-P (Wendel 1)

DAISY Award Winners

Deborah Crawford, LPN (Practices)


Brittney Gilmore, RN (Cornell 1)

Our Magnet Champions/DAISY Committee selected 12 DAISY honorees in 2019. The committee reviews blinded nominations each quarter and votes on honorees based on pre-determined criteria, the DAISY PETALS:

P – Passion/compassion for nursing and the care they provide

E – Empathy in the situation

T – Trust and Teamwork of families, patient, and peers

A – Admirable attributes possessed

L – Love for the patient and nursing profession

S – Selflessness

All nurses that receive a nomination are presented with a letter from our CNE and a DAISY nomination pin.

Catherine Kipps, RN (Cornell 1)Marti Brooks, BSN, RN (Wendel 1/SWAP)

DAISY Award Winners


DAISY Award Winners

Kathryn Murray, MSN, RN (Wendel 3)Kathy Wise, BSN, RN (Wendel 1)

Michael Nelson, BSN, RN, OCN (Infusion Center)


Sarah Silverman, BSN, RN (Radiation Oncology)


Workplace Violence Task ForceIn a focused effort to address workplace violence, Sentara formed a system-wide Workplace Violence Team in 2019 with representation from each of the divisions, including SMJH. This system team will be reviewing trends from STARS events related to workplace violence and developing action items to address those trends.

SMJH has also started a Workplace Violence Task-force to address immediate concerns and needs. The first meeting was held in October and continues to meet monthly.

As a result of feedback from staff, we now have Fast Pass installed which allows for visitor check-in during after-hours.

Presidents AwardsThe President’s Award recognizes outstanding Sentara Martha Jefferson employees who demonstrate excellence, make key contributions to Sentara’s mission, goals and commitments, and are exemplary role models. These awards began in 1992 and cover four categories: Support Staff, Clinical Staff, Management Staff, and a Safety Award, added in 2009. Congratulations to the following award recipients for 2019:

Support Staff—Patti Liles for her exceptional contributions to the Sentara Medical Group. Clinical Staff—Whitney Digney for her exemplary contributions to the department of Nursing. Management Staff—Patra Reed for her stellar leadership of the Integrated Care Management Department. Safety Award—Doug Paige for living and breathing safety every day.

These four Members of the Team all shine in their respective roles and are successful because of the interdisciplinary teams with which they work. Each award recipient was surprised by their family members—parents, spouses, and children—who attended the presentation.

Camilla Washington

Whitney Digney

ACE AwardsACE Awards were presented to the very deserving Camilla Washington and Whitney Digney.



Week of the Nurse and AwardsCongratulations to our nurses and nursing support staff who were presented with our 2019 SMJH annual nursing awards during Nurses Week. Thank you to everyone who was nominated and everyone who took the time to submit nominations. We appreciate all that you do!

Honorees: New Graduate or Inexperienced RN of the Year Award: Winnie Poggi-Dutnell (Wendel 1) Experienced RN of the Year Award: Heidi Cabot (Wendel 3) Preceptor of the Year Award: Samantha Spiker (Wendel 3) Holly Metz Award: Keith Martin (Cornell 2) Technical Support Staff of the Year Award: Felicia Fravel (Central Sterile) CNE Shining Star Award: Esther Lozano (Wendel 3)

The Haden Nursing Institute is an investment in arguably the single most important aspect of great care and outstanding outcomes—the expertise and compassion of the nurses who serve our patients. Made possible with the generosity of our community’s philanthropy through the Martha Jefferson Hospital Foundation, the Haden Nursing Institute will continue to focus on and support those expectations for the future good of our community.

With over $14 million raised in gifts and endowment, this multimillion-dollar initiative fosters nursing excellence through community philanthropic support for formal education and professional certification, funding for nursing research and evidence-based practice fellowships and practice innovations, support for a clinical simulation learning lab, funding for expansion of advanced practice nursing roles, and capital support for implementation of best practices and innovative care delivery models.

Scholarships, primarily for RN to BSN education, is a core component of the Haden Nursing Institute. 183 scholarships have been awarded to date with 47 nurses currently on scholarship

and in school. Scholarships have also been provided for Masters Degrees and for a few Nurse Practitioners. We are looking at how we can also support Hospital staff who may want to enter nursing as a career with support at PVCC for their Associates Program.

Below is a summary of the many nursing initiatives that are generously supported through financial contributions from the Haden Nursing Institute:

• Magnet® designation

• DAISY nurse recognition program

• Nurse Residency Program

• Professional conference attendance

• Research and Evidence Based Practice Fellowships

• CE Focus certification preparation courses

• Nursing Scholarship Program, especially RN to BSN

• Certification reimbursement

• Our Clinical Skills Laboratory

• Expansive roles in Nursing, such as NPs in Palliative Care, High-Risk Breast Cancer and Cancer Survivorship Programs and our new Senior Services Nurse Navigator.

THE HADEN NURSING INSTITUTE

3 2 / N U R S I N G A N N U A L R E P O R T 2 0 1 9

Sentara Martha Jefferson Hospital | 500 Martha Jefferson Dr, Charlottesville, VA 22911 434.654.7000 | www.sentara.com

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