Division of Nursing : annual report

              2013 Fiscal Year
Nursing Annual Report
CAROLINA
UNC Hospitals
Division of Nursing
2
4 LETTER FROM DR. TONGES
6 TRANSFORMATIONAL
LEADERSHIP
Stephanie Bohling
8 NURSING STAFF PROFILE
John Gotelli
10 STRUCTURAL EMPOWERMENT
Christa Clark
12 NURSING STAFF PROFILE
Michael Langston
14 EXEMPLARY PROFESSIONAL
PRACTICE
Darla Topley
16 NURSING STAFF PROFILE
Noah Okafor
18 NEW KNOWLEDGE,
INNOVATION AND
IMPROVEMENTS
Angela Overman
20 NURSING STAFF RECOGNITION
AWARD WINNERS
23 MAXIMIZING PRACTICE
AT THE BEDSIDE
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PEOPLE
The 2010 Institute of Medicine report on The Future of
Nursing recommended that the percentage of direct care
nurses with a Baccalaureate or higher nursing degree
be increased to 80% by the year 2020 because of
evidence of a positive relationship between higher levels
of nursing education and better patient outcomes. To assist
UNCH RN employees in continuing their education and
earning a BSN, our on-site RN to BSN program with
Winston-Salem State University began on May 22. The
Professional Development Council has done great work to
help with increasing the number of UNCH RNs who are
Baccalaureate prepared. Additionally, I’m so very proud
to report that our on-site NA II program graduated 54 NA
employees in the last 12 months with a 100% successful
completion rate.
SERVICE
For the year ending June 30, 2013, our score for overall
satisfaction is in the 87th percentile and satisfaction for
nursing care was at the 91st percentile as compared to
other hospitals in the Press Ganey database of 600 beds
or more, and on the Center for Medicare and Medicaid’s
Hospital Consumer Assessment of Health Plans Survey
(HCAHPS) 83% of patients rank us highly on recommending
UNCH to friends and families. We have the highest
HCAHPS scores for 9 of the 10 items and are tied for
1 making us the best performer in the Triangle. Carolina
CareTM is creating the best possible hospital experience for
our patients and families. It’s also very important to note that
our Diversity Council has helped UNCH achieve Health
Equality Index (HEI) status for the care of our LGBT patients,
part of the diverse population of patients we serve.
QUALITY
On the NDNQI quality measures, 87% of units out-performed
the national average for skin care, 80% for
restraints and 70% for falls. More than half of our units
are in the top 25 percent of NDNQI units nationally at
least half of the time. We are contributing heavily to the
Hospitals’ success in meeting or exceeding quality goals.
Nursing played an especially strong role in reducing
CAUTIs per 1,000 patient days from .73 last year to
.61 against a goal of .65. Nursing has also contributed
to the success in reducing the deep vein thrombosis and
pulmonary embolism rate from 12.3 per 1,000 cases to
9.8 against a goal of 11.7. Clearly the nursing shared
governance Quality Council has done excellent work
again this year.
FINANCE
As the largest division in an organization in which at
least 50+ percent of costs are salaries, Nursing’s financial
performance is critical to hospital success. The following
outcomes reflect careful stewardship of the resources for
which the Nursing Division is responsible:
• Budget Index: Percent of budgeted expense
dollars spent = 97.5% (2.5% under budget)
• Productivity Index: Relationships between labor
and budgeted volumes = 100.5% (.5% better
than target).
In summary, this is quality with economy.
Dear Colleagues and Friends,
I’m very pleased to again have the opportunity to
share Nursing highlights for the year. University
of North Carolina Hospitals (UNCH) is strongly
committed to advancing the art and science of
nursing. We are very fortunate to work in an
organization providing an environment that supports
both the delivery of excellent nursing care and
the workplace well-being of the nursing staff who
provide this care. The high points of our work in
Fiscal Year 13 can be summarized as follows:
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GROWTH
We continued to grow in Fiscal Year 2012-2013:
• October 2012: Our newest unit, 7 Neuroscience,
a 24-bed Surgical Oncology/ENT Unit opened
• November 2012: Following the move to 7
Neuroscience, 6 East reopened as a 14-bed
GI Surgery Unit
• We are designing a new 24 bed Medical
Progressive Care Unit on 3 Bedtower and a 24-bed
Bone Marrow Transplant Unit on 1 Neuroscience to
open in the summer/fall of 2014.
INNOVATION
The one-year anniversary of full implementation of our
Carolina Care Partners in PracticeTM model on 4 Anderson
North (4 And N), the Innovations Unit, occurred in May.
6 East opened as a Partners Unit, and this care delivery
model will be expanding to 7 Neuroscience. Outcomes
on 4 And N are excellent. Comparing pre- and post-implementation
of this staffing and care delivery model,
patient and nursing satisfaction increased while the falls
and Catheter Associated Blood Stream Infection (CABSI)
rates decreased. More specifically, this unit had gone 135
days without a fall and had no CABSIs for a year. Nursing
has contributed a great deal of talent to the building and
implementation of the Epic health care information system:
the Core team includes 11 UNCH RNs and 36 UNCH
RN Subject Matter Experts. The Professional Practice
Council has continued to create and implement nurse-driven
protocols and standing orders to enable RNs to practice
more autonomously to the full scope of their education
and competence. This year we implemented an electrolyte
replacement protocol in the ICUs and extended the Foley
Catheter Removal protocol house-wide. Last but not least,
we’ve continued to expand Partnering with Patients and
FamiliesTM beyond the Children’s and Cancer hospitals to
include Family Medicine and the N.C. Jaycee Burn Center,
as well as a number of committees. Patient/family advisors
are actively involved in the design of our new units and
information system, which has many features to facilitate
access. These volunteers also help with reviewing patient
education materials, participate in interviewing applicants
and helping health care learners to better understand the
patient’s perspective. Their advice and help are invaluable,
and we so appreciate their time and insights.
In summary, I’d like to quote Donna Shalala, former
Secretary of Health and Human Service and Chair of the
committee that wrote the IOM Future of Nursing Report,
who has said:
“A strong, growing nursing profession
isn’t a byproduct of a thriving health
care system. It’s a prerequisite for it.”
I couldn’t agree more.
Sincerely,
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TRANSFORMATIONAL LEADERSHIP
A new program opens a window on leadership challenges –
and promotes a desire to stay at UNC Hospitals.
Stephanie Bohling, BSN, RN, CAPA
Clinical Nurse IV
Children’s Intermediate Cardiac Care
6
Gaining a deeper understanding
“It was an idea I had when I was a CN IV. The
entire program is about nurses getting guidance
from those already in leadership positions.”
7
NURSING STAFF PROFILE
“It’s amazing to talk
to 80- and 90-year-olds
about their life
experiences and what
they’ve gone through.”
Geriatric nurse practitioner
John Gotelli finds inspiration
anew every day.
John Gotelli, MSN, NP
Geriatric Nurse Practitioner – Geriatric Medicine Unit
8
Tapping into the inspiration of the elderly
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Shared governance empowers nurses from the bedside to
affect practice – including their choice of nursing theorist.
“You sit with your
patient to talk about
something unrelated
to why they’re in
the hospital. That
moment of caring
directly relates to
our caring theory.”
10
STRUCTURAL EMPOWERMENT
Translating caring theory
into bedside practice
Christa Clark, BSN, RN, CCRN
Clinical Nurse IV – Medicine Intensive Care Unit
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Bringing diverse skills together
“For anyone who wants to help people very
holistically, nursing is the perfect career.”
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NURSING STAFF PROFILE
After trying psychology, theology and social work, Michael Langston
finds a career that brings his caring skills together.
Michael Langston, PhD, RN, NE-BC
Clinical Nurse IV – 6 Neurosciences
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Transforming nursing practice
“Staff nurses can change practice. All
you have to do is ask the question.”
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EXEMPLARY PROFESSIONAL PRACTICE
Getting patients moving helps get them home sooner, so
Darla Topley led the development of a new protocol.
Darla Topley, MSN, RN, CCNS
Clinical Nurse IV
Surgical /Trauma Intensive Care Unit
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Fostering hope and healing
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NURSING STAFF PROFILE
“When they arrive, some have 95 percent
burns. I see family members giving up.
And when they start turning around, the
family is the first to be very amazed.”
Noah Okafor, a native of Nigeria, impacts lives
at North Carolina’s Jaycee Burn Center.
Noah Okafor, NA II
Nursing Assistant – N.C. Jaycee Burn Center
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“Patients don’t know exactly what is different, but they
can sense a difference in the level of care they receive.”
NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS
Angela Overman, MSN, RN, CNML, NE-BC
Nurse Manager – Innovations Unit
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UNC Hospitals’ Innovations Unit transformed traditional nursing care delivery.
Partnering to focus care
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Nursing Staff Recognition Week
Jane Burrill
MSN, RN-BC
Clinical Nurse
Education Specialist
Nursing Practice
and Professional
Development
Christa Clark
BSN, RN, CCRN
Clinical Nurse IV
Medicine Service
Jennifer Covington
RN-BC
Clinical Nurse III
Surgery Service
Kimberly Meador
BSN, RN, WHNP
Clinical Nurse II
Surgical Services
Katherine Mihalek
RN
Clinical Nurse II
Women’s Services
Patricia Morfeld
BSN, RN, OCN
Clinical Nurse II
Oncology Services
Tererai Mutyavairi
BSN, RN
Clinical Nurse II
Psychiatry
Megan O’Connor
BSN, RN, NE-BC
Patient Services
Manager III
Medicine Service
NURSE
MANAGER
OF THE YEAR
NURSES OF
THE YEAR
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Rufus Eller
RN
Clinical Nurse II
UNC Center for
Transplant Care
Joy Hazard
BSN, RN
Clinical Nurse III
Children’s Services
Ellenita Kornegay
BSN, RN
Clinical Nurse II
UNC Center for Heart
& Vascular Care
Wade Mauser
BSN, RN, CEN
Clinical Nurse III
Emergency Services
AWARD WINNERS
Tasha Arendshorst
Certified Nursing
Assistant I
Psychiatry
ASSISTIVE
PERSONNEL
OF THE YEAR
Debby Berry
Administrative
Coordinator
Surgical Services
Brenda Farrington
Health Unit Coordinator
Women’s Services
Sheldra Holloway
Health Unit Coordinator
Oncology Services
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FACULTY OF
THE YEAR
Sara Hubbell
MSN, APRN, NP-C
UNC-Chapel Hill
School of Nursing
Clinical Instructor
Benjamin Haithcock
MD, FACS, FCCP
Assistant Professor
of Surgery and
Anesthesiology,
UNC Chapel Hill
Surgical Director,
UNC Hospitals Lung
Transplant Program
FRIEND OF
NURSING
Jennifer Barrow
PharmD
Department of Pharmacy
Clinical Pharmacist
COLLABORATIVE
COLLEAGUE
Nursing Staff Recognition Week
AWARD WINNERS
ASSISTIVE
PERSONNEL
OF THE YEAR
Pamela Judge
Health Unit Coordinator
Children’s Services
Leah Mogaka
Clinical Support
Technician II
Surgery Service
Vanessa Moore
Health Unit Coordinator
UNC Center for
Heart & Vascular Care
Eleanor Murray
Medical Support
Assistant III
UNC Center for
Transplant Care
Vanesa Newby
Health Unit Coordinator
Medicine Service
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Maximizing Practice at the Bedside
Challenged with a goal of providing better, safer, and
more affordable health care for more patients, UNC
Hospitals (UNCH) nursing created Carolina Care:
Partners in PracticeTM, a model that incorporates a
partnership approach while improving bedside caregiver
communication. This model uses an RN-Nursing Assistant
II (NA II) or Clinical Support Technician II (CST II), which
is a role that includes NA II as well as Health Unit
Coordinator responsibilities, in a partnership to care for a
group of patients. North Carolina State Board of Nursing
(NCBON) certified NA IIs can perform a broader range
of skills than the NA I, thus enhancing the RNs ability to
practice to the full scope of their practice and creating a
more fulfilling job for NAs. To operationalize this model,
the UNCH Nursing Division needed to increase the
number of NA IIs on staff.
In response, UNCH established an on-site NCBON
approved NA II Training Program on May 22, 2012
under the leadership of Program Director Jami Howell,
MSN, MBA, RN. The program expands the scope of
responsibility of the Nursing Assistant by educating
NA Is to meet requirements set forth by both NCBON
and UNCH policies, empowering them to perform to
their full capacity as NA IIs.
In addition to providing better, safer, and more
affordable health care, goals of the program include
increased professional development and advancement
opportunities for NA employees and improved retention
and recruitment of these employees. The curriculum
consists of 80 classroom hours followed by 80 precepted
clinical hours which the student performs on their home
unit. During the application process, potential students
identify their career development goals and describe
how their acceptance and participation in the program
will contribute to UNCHs’ commitment to excellence in
patient care. Additionally, the student’s nurse manager
provides a recommendation to enter the program and
a commitment to support and employ the NA II full-time
after graduation.
The program is offered quarterly and has the capacity to
train 120 NA IIs annually. To date, the program boasts a
100% completion and graduation rate with 72 students
successfully completing the program.
NA Training Program graduating class, June 2013
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Producer: Peggy Mattingly, RN, UNC Hospitals
Design: Sally Johns Design + Strategic Marketing
Photography: Jim Colman Photography
Video Production: Horizon Productions
Produced by The Division of Nursing at UNC Hospitals
October 2013
www.unchealthcare.org/site/Nursing