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Event ID : AONE_PURCHASE
The American Organization of Nurse Executives
American Organization of Nurse Executives
Indianapolis, IN
April 9-13, 2010


The AONE 43rd Annual Meeting and Exposition offered more than 40 educational sessions designed to help you address the critical issues facing nursing and health care today. The sessions here represent those sessions that AONE received permission to record and share with you. Plenary and concurrent sessions focused on health care transformation within the following educational tracks: 
 
•    Patient Safety and Quality   
•    Health Care Delivery   
•    Technology   
•    Workforce Development

Where available, session handouts and additional materials are identified. For those seeking additional continuing education credit, the maximum credits you can receive are 17.5 once you have completed evaluations and post tests for those sessions. Plenary sessions do not have posts tests, but do require a completed evaluation to receive credit.

Accreditation Statements

The American Organization of Nurse Executives (AONE) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The American Organization of Nurse Executives is authorized to award 17.5 hours of pre-approved Category II (non-ACHE) continuing education credit for this program toward advancement, or recertification in the American College of Healthcare Executives (ACHE). Participants in this program wishing to have the continuing education hours applied toward Category II credit should indicate their attendance when submitting their application to ACHE for advancement or recertification.

As an AONE Member, you can receive a 15% discount off the purchase of the 2010 Annual Conference programs listed here. Please contact us at info@dcprovidersonline.com for the member Coupon Code

To purchase sessions and receive continuing education credits you MUST create an account.  Please click the "Create New Account" link located to the let in the "My Account" box. Once you have created and account, you can add material to your shopping cart for purchase.

For technical support please contact us at
info@dcprovidersonline.com



Please note that The American Organization of Nurse Executives is authorized to award a
MAXIMUM 17.5 hours


Array ( )
ULTIMATE PACKAGE PRICE : $349.00


Table of Contents
Plenary Sessions
Patient Safety and Quality

Health Care Delivery

Technology
Workforce Development


Plenary Sessions

Objectives :

Individual learning objectives for each session are included in the presentations.



______________________

Making Patient Safety and Quality of Care a National Priority

Speaker(s) : Lucian Leape

  • Lucian Leape, a pediatric surgeon, is Adjunct Professor of Health Policy at the Harvard School of Public Health. He is internationally recognized as a leader in patient safety, starting with the 1994 publication in JAMA of his seminal article, Error in Medicine, which formed the basis for the 1999 Institute of Medicine report, “To Err is Human”, which he co-authored. He has been an outspoken advocate of the nonpunitive systems approach to preventing medical errors; his research has focused on redesigning systems to prevent errors, full disclosure, and assessing physician competence. In 2004, he received the John Eisenberg Patient Safety Award from the JCAHO and National Quality Forum, and in 2006, Modern Healthcare named him as one of the 30 people who have had the most impact on healthcare in the past 30 years.

  • Download Evaluation Form Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

The Transformation of Health Care into a Patient-Centric, Digital Field

Speaker(s) : Bill Felkey

  • Most experts feel that the complexity of health care practice has exceeded the limits of the unaided human mind. All information has the purpose of reducing decision makers’ uncertainty for both clinical and business purposes. To achieve optimal outcomes, we need high-quality, evidence-based information on which to base our decisions impacting patient care. Moreover, we need enterprise-wide connectivity and an electronic health record for continuity throughout acute, ambulatory, long-term care and finally into the patient’s home. Technology is used in two ways in health care practice. It can completely replace the work of humans in those tasks that are repetitive and tedious. Technology can also enhance a knowledge worker's ability to perform work. Even though many of these technologies are considered to be disruptive and will challenge our ability to change our business practices, it is imperative that all facets of health care become fully digital. The extent to which we become paperless will be a key predictor for the long-range success of any practice setting. Ultimately, integration has been identified as the highest priority we face in health care information sharing. The good news is that all of the pieces of the technology puzzle currently exist, but they are not completely integrated in any setting. Professor Emeritus Bill G. Felkey has made Auburn University his professional home since 1977. His research interests focus on the creation of knowledge-bases and the use of advanced technology in health care. He provides highly interactive educational sessions that will amaze, inform, entertain and overwhelm you with the wealth of technological resources that are available to you to increase your impact on outcomes and extend your organizational efficiency and effectiveness.

  • Download Evaluation Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Unintentional Intolerance: Creating Inclusion in Health Care Settings

Speaker(s) : Steven L. Robbins, PhD

  • Dr. Steven L. Robbins, a powerful storyteller, has an unmatched ability to inspire people even in the midst of disrupting and challenging the way they think about the world. Born in Vietnam, Dr. Robbins immigrated to the United States when he was five years old. He and his mother faced many challenges as Vietnamese immigrants in a new land, during a time when there was much anti-war and anti-Vietnamese sentiment. Working through and rising out of the challenges of poverty, discrimination and the tough streets of Los Angeles, Dr. Robbins now brings insightful perspectives on issues of diversity, inclusion and the power of caring. A published author and highly requested keynote speaker, he has presented at numerous conferences and workshops across the nation. He also writes and edits the premier electronic newsletter on diversity and inclusion, Inclusion Insights. His book, What if?: Short Stories to Spark Diversity Dialogue, is used by many organizations to help them further develop their ability to engage in much needed conversations about diversity and inclusion in the 21st century. His unique approach to creating diversity and inclusion challenges and inspires audiences to rethink their own realities and the realities of others. Often praised for his resonating, humorous style, his messages and stories bring a fresh and insightful perspective to the subject of diversity. Dr. Robbins’ life experiences have equipped him with an array of useful knowledge that he competently transfers to his audiences. Invariably, those who have heard him speak walk away motivated not only to think differently, but to behave differently. Dr. Robbins received his Bachelors in communication from Calvin College and his Masters and Ph.D. in communication from Michigan State University. He currently resides with his wife and four children in Grand Rapids, Michigan.

  • Download Evaluation Here



Presentation Format(s) : MP3



April 16th, 2010
Patient Safety and Quality


Objectives :
Individual learning objectives for each session are included in the presentations.

______________________

Nurse Staffing and Quality of Care
PS-OR01

Speaker(s) : Mary A. Blegen , Colleen J. Goode

  • There has been a great increase in research on nurse staffing and quality since the 1996 Institute of Medicine publication -“Nurse Staffing in Hospitals and Nursing Homes”. This presentation will review the evidence and provide the current state of the science related to nurse staffing and quality outcomes. The results of these studies do not provide a consistent foundation for administrative decision making. Dr. Goode and Dr. Blegen will present new research that used the University Health System Consortium operational and clinical databases to determine the impact of staffing hours on patient outcomes. The study included 54 academic medical center hospitals and their affiliates. Hospital bed size ranged from 197 to 925 beds. Data from 364 intensive care units and 903 adult units were included. Outcome measures as recommended by the National Quality Forum and the Agency for Healthcare Research and Quality were used in the study. In addition, the current science related to the effect of educational preparation of the staff on quality outcomes will be presented. Dr. Goode and Dr. Blegen will present a subset of data that looked at educational preparation of the staff and the effect on patient outcomes. This study used state of the art data for both staffing measures and patient outcomes. Attendees will learn about new patient outcomes that are positively affected by nurse staffing that have not been reported before in the literature. Implications for nurse leaders and for research will be presented.

  • Download Evaluation Form Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Institute Research Seed Grant - Nurse Engagement and Patient Satisfaction: The New York City Health and Hospitals Corporation Experience
PS-OR02

Speaker(s) : Marie L. Ankner

  • New York City Health and Hospitals Corporation, Corporate Nursing Services is conducting a study focused on the relationship between nurse engagement and patient satisfaction. Nurse engagement will be measured using the Health Care Advisory Board Nurse Engagement Survey and patient satisfaction will be measured using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data. Identifying staff engagement will be a valuable tool for nurse leaders and encourage nurse managers to evaluate their own skills in promoting an engaged workforce. This tool will permit comparisons among units and allow managers to proactively manage retention and recruitment of the nurse workforce. HCAHPS is the first standardized survey available to the public, which is designed to gather information from adult inpatients about their experiences with hospital care and services. It has already been established according to HealthStream that nurses’ listening performance is the item with the highest correlation to the overall rating on the HCAHPS survey. This study will survey Registered Nurses in the 11 acute care hospitals of New York City Health and Hospitals Corporation to identify nurse engagement. These data will be utilized to identify best practices, areas of strength, and opportunities for improvement. Nursing leadership and managers will be able to receive unitspecific data and develop a variety of strategies with staff input. The strategies developed will be implemented and evaluated. Story boards and brief communiqués will spread efforts to further engage staff in actions and initiatives. The annual Corporate Nursing Services Recognition event will include an expo soliciting poster presentations related to survey results and action plans developed across facilities. Criteria will be developed to determine the most successful implementation strategies. HCAHPS findings will be carefully monitored for changing trends. Study finding will be shared through the Corporate Nursing Services Web site and submitted to a nursing peer reviewed publication.

  • Download Evaluation Form Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

CEO/CNO Relationships and Nurse/Support Staff Relationships: Improving Productivity and Accountability
PS-OR08

Speaker(s) : Tommye Hinton , Patricia E. Natale , Diana Topjian, VP

  • -PS-OR08A Service Level Agreements at the Detroit Medical Center: A Nursing/Support Services Partnership for Improved Productivity and Accountability: Detroit Medical Center (DMC) is an eight hospital academic medical center affiliated with Wayne State University and Michigan State University. This presentation will describe a two-year process, beginning as a Process Improvement, called Service Level Agreements (SLA) to improve efficiencies and relationships between nursing and four support services: environmental services, linen and laundry, food and nutrition services, and transportation services. Using a relationship-based model, the improvement methodology included: 1) establishing and publishing service agreements; 2) instituting collaborative communication processes; 3) weekly evaluation rounds and 4) data-based evaluation of met/not met service levels by publishing a weekly report card. The project was phased-in, beginning with pilot units at three DMC hospital sites. The Project was led by the system CNO and CEO. Lived experience was gained and lessons from these pilots applied to full hospital rollouts at three sites. The remaining hospital sites will roll out by fall 2009. We will discuss successful methods regarding the engagement process, defining participant department expectations, determining processes for refining, and weekly report card postings. This program addresses a relevant topic and will provide meaning and a practical approach applicable to any size hospital. It applies team building and productivity principles using existing resources to achieve high level performance and workforce satisfaction. The experience at one site, DMC Detroit Receiving Hospital, where scores went from “C” to A” in 6 months will be the focus. Scorecards, results and lessons learned regarding the development and implementation process will be shared. The primary success of the effort was less about the result of the SLA and more about celebrating the transformed relationships among peers that enabled accountability and negotiation in an atmosphere of mutual respect.

  • -PS-OR08B Leader Roles of The Chief Executive Officer-Chief Nurse Officer Dyads: The purpose of the current descriptive, quantitative study was to examine the Chief Nurse turnover rate related to conflict with his/her respective Chief Executive Officer. Using Cameron and Quinn’s (2006) Competing Values Framework and Graen’s (1995) Leader-Member Exchange theory as the primary theoretical constructs the current study sought to describe patterns found within the Chief Executive and Chief Nurse Officer dyads in terms of leader roles and dyadic relationships. The Management Survey Assessment Instrument (Cameron & Quinn, 2006) and Graen’s (1995) LMX-7 surveys were used to determine practiced leader roles and perceived dyadic relationships respectively. Descriptive statistics mean, mode, and frequency were used to analyze the data. The survey sample consisted of 37 completed dyads representing a distribution of community and academic health care centers across the United States. The survey results identified that Clan/Clan leader roles were the most practiced by the CEO and CNO of the completed dyads. The majority of individuals responding to the survey described their dyadic relationship as very high or high using the LMX-7 (Graen, 1005) as the measurement tool. Although not all dyads scoring their relationship as very high or high were in complementary or same leader roles, there were sufficient number within the aforementioned combinations that would suggest further study is warranted to determine if there may exist a correlation between leader roles practiced and perception of dyadic relationships within the CEO/CNO leader pairing.

  • Download Evaluation Form Here

  • Download Handout Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

The Road to Improved Nursing Outcomes and Optimal Staffing Mix - How Establishing a Peer Review Process and Using Technology Can Help
PS-OR09

Speaker(s) : Mary Krugman , Kathy Malloch , Carolyn Sanders , Susan West

  • -PS-OR09A Integrating Professional and Nursing Risk Management, Peer Review, and Clinical Quality to Achieve Improved Nursing Care Outcomes: In 1993, the Director of Professional Resources and Director of Professional Risk Management joined to structure a peer review committee to review nursing care variances rated level 4 or 5, quality or serious quality concerns. Over 16 years this committee has evolved to include reviewing all non-physician providers care variances across the hospital.The continuity and integration of committee functioning across all departments and peer review of serious care variances results in a seamless interface between risk management and quality, nursing and associated disciplines. The structure, outcomes and case studies will demonstrate how issues are uncovered and addresses individual, systems and inter-professional variances.Since inception, the Committee reviewed 824 cases from nursing, pharmacy, respiratory therapy, and all other ancillary services, reporting the highest number of cases involved inappropriate or inadequate intervention by provider (34%), followed by system failure (23%), medication errors (21.4%), incomplete assessment (20.1%), and inadequate documentation at 13.2%. The review structure begins with the UHC Patient Safety Net report, or a phone call to Professional Risk Management. A review of PSNs’ is conducted by risk, quality and professional resources director. Reported variances are investigated and scheduled for committee review. The structure of review process and membership are described. Outcomes include pharmacy interventions, changes or development of policies and procedures for the hospital, unit follow up with quality projects, and manager follow up regarding counseling and re-education. The process and structure of committee functioning and outcomes are presented, and case studies resulting in significant changes in care delivery, improved nursing competency, and systems changes are highlighted. The reporting structure means accountability for care outcomes permeates the culture; reports of improvement are required.This session will be interactive to include the audience through use of Clicker® technology, to permit rating cases and answering difficult questions about risk, quality issues so nurse executives are stimulated to consider their own institutional processes and outcomes during the session.

  • -PS-OR09B Perfect Staffing in the Digital World: How Technology, Never Events and Evidence are Making it Possible: The demands placed on contemporary nurse leaders and managers make it nearly impossible to create staffing schedules that achieve patient safety one hundred percent of the time. The economic downturn, shortage of qualified nursing staff and wide variety of documentation systems in use means nurse leaders often have to make a best guess in regard to optimal staffing mix. However, as hospitals adopt more ambitious patient safety policies, it is becoming more important than ever that nurse leaders have a method of defining, and replicating, “perfect” staffing scenarios_i.e., situations wherein no negative patient outcomes occur, patient and nurse satisfaction is high, and clinical goals are achieved. Utilizing real-time, evidence-based data to identify optimal staffing situations and then organizing that information into data sets that can be easily duplicated is the new work of the nurse leader. This presentation will explore how the collection, analysis and synthesis of specific data points can be used to determine the optimal staffing mix required to achieve zero medical errors within a hospital setting. Data will be presented from multiple facilities with varying bed sizes, with a focus on a medical-surgical unit, pediatric unit and outpatient unit. Variables measured will include hours of care per unit of service, labor costs, skill levels and the corresponding length of stay for selected DRG’s; patient and nurse satisfaction scores; medication error rates; and incidence of patient falls, pressure ulcers and nosocomial infections. A model for using data, technology and outcomes to identify and create optimal staffing mix will be presented to assist nurse leaders in assessing how close their day-to-day staffing is to the “perfection” level.

  • Download Evaluation Form Here

  • Download Handout Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

CNO Mod Squad: Engaging Multi-Generational Trans-Disciplinary Teams Through Transformational Leadership to Achieve "Systemness"
PS-OR15

Speaker(s) : Marcy Conti , Donna Hanly , Jann Marks , Lisa Pettrey , Lamont M. Yoder

  • The complexity and enormity of forces converging on healthcare organizations today are unprecedented.[1] Distinct, non-duplicative and positive contributions towards improved outcomes in quality of care and service for patients, quality of worklife for nurses, and financial strength for the organization are proven benefits of creating synergistic and collaborative working relationships among CNO’s and nurse leaders in healthcare systems. Like the police drama featuring a diverse team of crime fighters, the five regional CNO’s of this large healthcare system with no CNE have worked to embrace organizational, demographic, and leadership team diversity during the economic downturn to create an innovative, synergistic model of transformational leadership that has resulted in becoming a national leader in safety, quality, service, worklife, technology and low cost leadership. This presentation will provide the framework to enable nurse leaders to take advantage of the power of collaboration and systemness. Attendees will learn how to move shared governance to a level of multiple hospital governance to impact nursing practice, nursing research, information technology and expense control. Discussion will include a systemness approach to nursing and nursing leader participation in statewide legislation on nursing staffing. Finally, the presentation will describe how to achieve most wired status and connect with multi-generational trans-disciplinary teams through traditional and innovative media. This CNO Mod Squad has used diversity, humor, and experience as strengths to collaborate, compromise and achieve the following results: 7.9% Annual RN turnover with 1.75% RN vacancy rate; 100% participation and compliance with state legislation for nursing staffing plan; 93% increase in patient safety coach observations in less than one year; 20% reduction in malpractice insurance two years in a row due to reduction in serious safety and sentinel events; Recognition by The Joint Commission in top 10 list of national leaders in quality and patient satisfaction.

  • Download Evaluation Form Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Institute Research Grant-Measuring Safety Behaviors in Nurses: Development of a New Instrument
PS-OR16

Speaker(s) : Esther M. Chipps

  • Fostering an environment of patient quality and safety is an important strategic initiative of nursing leaders. Nursing service literature provides sufficient evidence of heightened awareness about threats to patient safety; however, overall gains in ensuring patient safety are hampered by a limited number of empirically based tools to measure outcomes. Moreover, the connection between a culture of safety in a healthcare environment and the safety behaviors displayed by front line nursing staff is not clear. The safety behaviors and performance of nurses is inextricably linked to understanding the workflow of nursing and how decisions are made and executed at the bedside. This includes understanding how nurses working in complex patient situations become cognizant of the potential for error, make decisions to avoid error and recover from making potential errors. The purpose of this study is to develop an instrument to measure the behaviors that Registered Nurses use to respond to gaps in care that can potentially lead to safety failures and to pilot test and examine the psychometric properties of this instrument. This presentation will discuss the progress and findings to date on the development of this instrument including the process used to develop the instrument, revise and test the instrument.

  • Download Evaluation Form Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Innovative Approaches to Delivering Safe Patient Care
PS-OR22

Speaker(s) : Jennifer A. Bello , Margaret Brock , Patricia Ebright , Mary Sitterding

  • - PS-OR22A Maintaining Patient Safety Through Innovation: An Electronic Sbar Communication Tool: As the transition to an electronic health record gains momentum, the need for accurate and precise Hand Off communication, including inter-shift and when patients travel within an organization, becomes paramount. White Plains Hospital Center operates with an all-electronic health record and physician order entry. The electronic health record, despite its innovation, poses a unique challenge to the nursing staff on how to communicate all patient information while toggling between multiple screens. As a result of an internal survey, a communication committee consisting of staff nurses from all departments and nursing infomaticists was formed. It was determined that an electronic report would be created to decrease and/or eliminate the need for multiple screens and optimally incorporate the SBAR format to maintain a standardized approach to hand off communication. The SBAR format organized the information and populated the following: patient demographic information, admitting diagnosis, chief complaint, health care proxy contact information, past medical history, code status, complete nursing assessment, IV drip adjustments, intake and output, active medications with next administration times, active physician orders, recent lab values and any recent interdisciplinary consultation. An icon was added to the desktop screen to allow all hospital staff with approved access to patient medical records to have the most up-to-date information readily accessible. The SBAR report, with its concise and organized format, provided all the information needed to deliver safe patient care with the benefit of utilizing only one screen, demonstrating its overall clinical, fiscal, and technological advantages.

  • -PS-OR22B Patient Safety And The Cognitive Work Of Nursing: Advances In Nursing Science And Implications For Organizational Support: Nursing work environments are considered high hazard settings given the work is demanding and with little margin for error. Studies describing organizational traits characteristic of professional practice environments that influence nursing care have positively influenced our ability to quantify professional nursing practice. Meanwhile the economic burden of resources instituted to meet regulatory standards is phenomenal with little evidence that organizations have addressed contributors to the complexity of work environments or barriers to the cognitive work of nursing. This presentation will review current studies describing the work of nursing, including a focus on a recently completed descriptive study conducted to identify common attributes of RN stacking, a process of RN workflow management across multiple clinical settings and experience levels. Aims of the study were to describe 1) types of activities stacked by RNs in the context of actual care delivery situations; 2) factors that influenced RN decisions; and 3) types of decisions made in the process. The investigators used a multi-method ethnographic approach that included continuous observations and follow-up interviews of individual RNs in multiple healthcare settings. An additional five focus groups stratified by experience level were also conducted. After repeated iterative analyses and consensus by investigators, findings included 1) a hierarchy of RN work activities demonstrating factors that influence ordering of work; 2) eight stacking management decision strategies; 3) variation in flexibility and use of strategies across experience levels; and 4) constraints leading to use of strategies. The presenters will discuss study findings and propose specific implications for organizational design of environments and operational processes, and orientation of new RNs for providing support for the cognitive work of RNs and decreasing unnecessary costs for the nurse leader.

  • Download Evaluation Form Here

  • Download Handout Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Health Care Reform and Its Implications on Quality and Safety
PS-OR23

Speaker(s) : Deirdre M. Baggot , John Welton

  • -PS-OR23A Obamas Healthcare Reforms and the Implications to Quailty and Safety in the Acute Care Environment: Ready or not, healthcare reform is coming and global fees are one mechanism gaining momentum in healthcare reform discussions. President Barak Obama pledged to reform healthcare and expand coverage to the nearly 50 million uninsured in America. Specifically, Obama has referenced the bundled payment system as one of many emerging cost-containment strategies he intends to use to expand healthcare coverage to the nearly 48 million uninsured while minimizing dependence on tax increases (June, 2009). What has not been discussed are implications to quality and patient safety. Beginning in April, 2009, as part of healthcare reform, the Centers for Medicare and Medicaid Services (CMS) announced a bundled payment demonstration. The Acute Care Episode (ACE) demonstration aims to test a model which changes the way healthcare is paid for (CMS, 2008). In five cities in the states of Texas, Oklahoma, Colorado and New Mexico the demonstration of payment bundling for select Cardiac and Ortho DRGs began. Exempla Saint Joseph Hospital’s Cardiac Program was honored to be selected for this demonstration. Under the demonstration, Exempla Saint Joseph Hospital receives a single payment for both Medicare hospital services (Part A) and physician services (Part B). Twenty-Eight Cardiac and nine orthopedic procedures are included in the demonstration-elective procedures selected for their history of high volume and high price. Exempla Saint Joseph Hospital will share their learnings related to how ACE has impacted patient safety and quality of care, and the interventions Exempla put in to place to ensure that the quality that our cardiac program has been known, was not eroded in the name of healthcare reform. Reference: Obama, B. Address to American Medical Association, June 15, 2009, Chicago, Illinois.

  • -PS-OR23B Does Hospital Adoption of Safe Practices Improve Patient Safety?: PURPOSE: The purpose of our study was to examine (1) hospital, patient and market characteristics associated with adoption of safe practices and (2) how hospital safe practice scores (SPS) change over time and are related to outcomes of care. METHOD: We analyze hospital responses to the Leapfrog Group’s survey of adoption of National Quality Forum Safe Practices. These data were merged with Medicare Cost Reports and American Hospital Association Annual Survey data between 2003 and 2006 using a generalized linear model with controls for selection bias using a first stage logistic analysis of participation in Leapfrog that includes instruments such as the size of employers in the hospital catchment area. There were 2108 hospitals in the 31 Leapfrog roll-out regions during the time frame and 785 hospitals responded to the NQF Safe Practices questions. RESULTS: Hospitals that responded to Safe Practice questions were: larger (bed size 250 vs.147), urban (80.9% vs. 44.1%), high-tech (Saidin index 2.55 vs. 1.58), likely to be in a system (70.6% vs. 46.7%), and more profitable (Gross Margin -0.4 vs. -3.2) compared to hospitals that did not participate (all p<.01). Respondents improved composite SPS from 789 to 838 (out of 1000; p <.001) in the last two waves and increased the percent of registered nurses from 89.2 to 90.4%, (p= .026) and nurses per hospital bed (1.63 to 1.76, p=.013) compared to hospitals that did not respond to the survey. Hospitals with SPS between 800 to 1000 had higher: RN % skill mix; nursing intensity; nurses per bed, and lower ancillary to accommodation cost ratio compared to hospitals with lower SPS and non-participating hospitals (all significant at p<0.001). For each 100 point increase in SPS, hospitals replaced 6 LPNs with 6 RNs. Higher SPS were associated with lower rates of skin breakdown and fewer post-operative wound dehiscence cases. CONCLUSION: There appears to be a “Leapfrog Effect” as participating hospitals improved their SPS in conjunction with increases in nurse staffing measures. Hospitals with high SPS had more and better nurse staffing compared to hospitals with lower SPS and those that did not participate. This association may reflect that adoption of safe practices is more likely when hospitals have sufficient nursing resources in place and improvements in patient safety are costly.

  • Download Evaluation Form Here

  • Download Handout Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Innovation in Outcomes: Driving Acuity and Injury Prevention Through Safe-Patient Handling
PS-OR29

Speaker(s) : Beverly Bokovitz , Jill Mason , Nancy Panthofer , Connie Stopper

  • - PS-OR29A Innovation in Outcomes-Driven Acuity: Crossing the Finish Line via the Utilization of Online Clinical Documentation: Illinois Staffing Legislation requires integration of patient acuity into the staffing plans and patient assignments. The nursing leadership adopted an innovative acuity methodology focused on the identification of variability in patients' nursing care needs, tracking patient outcomes, and doing so as a by-product of routine electronic clinical documentation. Patient acuity and the nursing workload associated with admissions, discharges and transfers supports real time charge nurse and staffing office resource decision making. The outcomes acuity approach identified the nursing actions and interventions required to assist patients to achieve desired outcomes. The evidenced based Nursing Outcomes Classification provides the systematic and standardized language. Expert nurses caring for patients selected relevant outcomes and validated the mapping to clinical documentation and the acuity alignment to hours per patient day. Staff nurse engagement was key to the overall success of the project. The acuity assessments have demonstrated workload variability within clinical populations and high levels of inter-rater reliability and validity. Staffing and patient assignments are adjusted by patient acuity and this meets the state staffing legislation. Nurses value the acuity adjustment and appreciate no additional steps to yield these data. Lastly, nurses perceive organizational recognition of workload associated with high patient turnover. An increase in nursing documentation compliance was noted as a positve secondary benefit. This new generation acuity methodology is reproducible across organizations and overcomes the obstacles of the past, making the contribution of nurses to patient outcomes visible.

  • -PS-OR29B Injury Prevention Through Safe-Patient Handling Using Mechanical Overhead Lift Equipment: Over the past ten years, ergonomic hazards have emerged as a serious health and safety concern among health care workers. Healthy People 2010 identified occupational safety and health and chronic back pain as areas of specific concern. In addition, the American Nurses Association launched a ‘Handle with Care’ Ergonomics Campaign. ANA highlights that more than one third of all nurses are affected by back-related injuries. A culture of safety and safe patient handling is of major significance to health care institutions embracing an evidence-based professional model of care and a caring-healing environment. It is well documented that patient handling activities and the principles used in such activities have been ineffective. According to the Bureau of Labor Statistics (2002), nursing personnel are among the highest at risk for musculoskeletal disorders with nursing aides, orderlies and attendants ranking first and RNs sixth in a list of at-risk occupations for strains and sprains. Not included in the injury data are injuries caused by repetitive movement or serious injuries such as herniated discs. The majority of nurse back injuries are to lumbar discs, not just muscle strain. The purpose of the initiative described was aimed at strengthening a culture of safety as it relates to safe patient handling. A transformational change model is used to outline the development of an infrastructure for sustaining change that includes formation of an Ergonomics Committee, institutional data analysis, deriving algorithms for decision-making, and creation of an educational program for staff. Outcomes and challenges that include funding, sustainability, and usability following implementation are presented. It is well known that change involves resistance, especially when current practice is deeply entrenched in past methods. It is recommended that healthcare institutions undertake programs aimed at changing methods for patient handling that include mechanical lift equipment. The initiative, including steps of an action plan, decision-points, and strategies for sustainability can be applied to acute care facilities regardless of size and location.

  • Download Evaluation Form Here

  • Download Handout Here

  • Download Handout Here



Presentation Format(s) : SAV

______________________

Improving Patient Outcomes: Communication Skills and the Role of a Social System on Behavioral Change
PS-OR30

Speaker(s) : Leslie Coonfare , Deborah DAurora , Scott Day , Ann Evans

  • -PS-OR30A Crucial Conversations for Safety Coaches: Putting the Skills to Work at OhioHealth: Clinical Issue: As part of a safety initiative begun in 2005 peer safety coaches were established on each clinical unit at OhioHealth. Anecdotal interviews revealed multiple comments from these individuals that intervention with peers regarding safety commitments was difficult. Evidence documented in the article “Silence Kills” supports this to be true throughout health care nationwide. Recommendations: I. Implement “Crucial Conversations” Training for Safety Coaches The skill required to speak with peers regarding safety issues is not inherent. In fact there is data demonstrating that less than 1% of health care providers feel safe in sharing concerns about competence with their peers. As an employer, OhioHealth has an obligation to associates that have been asked to shoulder this additional responsibility to provide education to acquire or strengthen these skills. 193 safety coaches were educated as a pilot group for Crucial Conversations classes scheduled during the summer of 2008. The goal was to assist these associates in their efforts to coach their peers in following safe practices in the clinical setting. Post instruction data revealed that these skills can be learned and the results can be measured in improved patient outcomes, fewer medication errors and decreased safety events. II. Sustain Attention: Monthly meetings of the safety coaches include practice with communication skills. Also available is the classroom course “Silence Kills, Dialogue Heals: putting the Crucial Conversation’s skills to work.” This 2 hour class created just for OhioHealth associates provides reinforcement of good communication basic tenets. Evaluate Effectiveness: Safety coaches’ interactions with their peers are recorded and trended based on documentation on their “Observation Tool" prior to Crucial Conversations education and again after the classes has ended. In addition, The Vital Smarts “Style Under Stress Inventory” was administered prior to and 3 months after the course to measure an increase in use of rational dialogue. This information will be used to modify the program as indicated. Data analysis of the "Crucial Conversations Survey" administered to 198 associates showed up to a 32% increase in likelihood of speaking up after learning and practice took place.

  • -PS-OR30B Unleashing the Subconscious to Improve Pain Management: Acute pain management is not only the most common nursing diagnosis, it is at the very core of nursing practice. It is disheartening to find that current Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data, suggests only 33 percent of patients report having their pain managed effectively. How can there be such disparity between the skilled and caring intentions of nursing and the patient’s experience of effective pain management? The answer may be found in the differences between our cultural learning and belief systems about pain and pain management and the delivery of pain management in nursing practice. Required standards were established and tools were designed that promised consistency in the delivery of care and pain relief for patients. Yet despite these efforts, effective management techniques and improved outcomes for pain management for hospitalized patients have eluded us. It is not uncommon for caregivers to follow the mandated protocols recommended and respond to the specific request of patients, yet still receive low rankings in pain control on patient satisfaction surveys. Such failure can be demoralizing for the caregiver as well as the patient receiving care. The apparent disconnect between recommended pain management protocols and the low levels of satisfaction reported by patient being taken care of by caring nursing staff may be symptomatic of an underlying misalignment between the cultural imprint or archetype of how we learned others respond to us when we are in pain and the way nurses typically respond to patients in pain. This paper suggests that uniform relief from pain for patients and increased patient satisfaction may be possible though the alignment of cultural memory, nursing practice, and operations. To test this idea, a team of clinical experts were assembled to investigate, design and test an exploratory model. The results suggest an innovative approach to revealing these differences thereby allowing nurses to integrate cultural memory into daily operations so that they may more effectively deal with and improve the experience of those being treated for acute pain.

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April 16th, 2010
Health Care Delivery


Objectives :
Individual learning objectives for each session are included in the presentations.

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How Model Transformation will Impact Patient and Financial Outcomes: Exploring Mechanisms to Develop Nursing Cost and Reimbursement Practices
HD-OR03

Speaker(s) : Paul Cornell , Donna M Herrin , Maureen Swick , Joan D Thomas , JoAnne Webb , John Welton

  • -HD-OR03 Update: AONE CMS Task Force on Nursing Costs, Billing, and Reimbursement: This presentation is a summary of the work of the AONE CMS Task Force. The principal charge to the TF is to: Provide guidance to the AONE Board of Directors on emerging issues related to proposed CMS reimbursement practices & quality initiatives that potentially impact the relationship between nursing cost & reimbursement practices. Methods: An expert panel made up of AONE members, nurse executives, researchers, and faculty have met on a regular basis since 2006. They have addressed the lack of existing costing and reimbursement methods for nursing care and the potential linkage between nursing and high value outcomes of care. The current reimbursement system places nursing in room and board and this makes nursing invisible at the payer and policy making levels of the health care system. The Centers for Medicare and Medicaid Services (CMS) has determined this practice is distorting the payment system and asks the hospital and nursing communities to devise a plan to correct this problem. The overall goal of the task force is to guide discussion and development of national models to recognize nursing in the payment system. Results: The work of the TF has focused on the following areas: collaborating with other nurse executives to foster models and methods to cost, bill, and reimburse nursing care; develop stronger ties with other professional groups such as HFMA and AHA; identify the contribution of nurses to quality and valuebased purchasing systems; and explore ways to develop nursing pay for performance metrics. Several hospitals have developed alternative costing and billing models for inpatient nursing care and these will be discussed and compared with different approaches that use nursing acuity or intensity as the basis for allocating nursing care to each patient. One additional benefit to be discussed is the potential to enhance hospital revenue by accounting for differences in nursing care within the billing system. Conclusions: New costing and reimbursement models for inpatient nursing care are rapidly emerging due in part to introduction of real-time nurse scheduling and demand staffing and assignment software. The role of nursing within health care reform will also be discussed relevant to changes in payment practices that are likely to affect all health care settings.

  • -HD-OR03B Transformation of the Care Delivery Model: A Revolution Is Near: The national debate regarding transformation of inpatient care delivery continues without answers. In fact, as healthcare has evolved, patient care delivery models have been the one constant, unchanging process in healthcare. The purpose of this presentation is to describe the transformed care delivery model devised by a partnership of nurse leaders and researchers. Members of the partnership performed work analysis studies which found medical-surgical nurses switch priorities often, experience high variability in duration of activities, interact with one another in a rapid, spontaneous manner, and spend approximately the same amount of time with computers as patients. The pace of nurses was frenzied, chaotic and intense with much focus on accomplishing tasks. The partnership envisioned a transformation requiring two waves: implementation of lean design and re-definition of professional nursing roles. The partnership envisioned medical-surgical units undergoing lean design, not as the transformed care model, but rather as the initial mechanism to improve system processes which would lead to greater success of the transformed care model. The new care model described in this presentation requires that professional RNs, prepared at the BSN or higher level, manage aspects of patient care that are critical to quality outcomes while delegating the numerous, yet essential, just-in-time tasks to a new healthcare worker, the Patient Care Technologist. The care domains of the professional RN and the new Patient Care Technologist will be described. Changes required in the nursing educational system will be discussed. Licensure and state nurse practice acts will be required which is complex and controversial. However, current care models unable to meet the needs of the health system create even greater problems. The time for change has arrived and nurse executives must spearhead this charge.

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How to Provide a Business Case for Magnet and Using Lean Methods to Save Costs
HD-OR10

Speaker(s) : Sharon A Cusanza , Karen Drenkard , Sarah Roberts , Paul Tobin

  • -HD-OR10A The Business Case for Magnet: The purpose of this presentation is to present the information necessary in a case study format for a chief nurse executive to create a business case for the pursuit of Magnet Recognition. Amidst financial prioritization, the chief nurse has a responsibility to present the strongest case possible. During the nursing shortage of the 1980s a group of insightful researchers took a unique approach to understanding the shortage of that decade. This groundbreaking research identified themes that were called the forces of magnetism. Chief nurse executives serve as leaders in partnership with their staff, and are executive champions during the entire Magnet process. One of the responsibilities of a chief nurse executive is the translation of what is good for nursing to the rest of the executive team, including those in the “C-suite.” When a financial investment is required, a convincing case is key for engaging the executive decision makers. Achieving Magnet status has been equated to a journey, and as such requires time and loyalty from the entire healthcare organization. Magnet status is not a prize or an award; it is an organizational recognition credential. The process requires organizations to develop, disseminate, and enculturate evidence based tactics that result in a positive work environment for nurses, and by extension, all employees. It is a multi year commitment, and requires the full support of the executive team and Board of Directors. A key responsibility of the chief nurse is to present the business case to these key stakeholders. A review of the literature will be presented that provides evidence for cost savings in areas of quality, service, and cost reductions in Magnet hospitals. Based on this menu of cost savings in Magnet hospitals, a process is described that a chief nurse can follow to build the business case for their hospital. A business case will be presented of a typical 500 bed hospital taken from the ANCC database of Magnet hospitals. In addition, evaluation measures are discussed that can be followed that allow tracking over time of financial opportunities. Based on this data, a return on investment analysis is reviewed that reveals a tenfold return based on investment. The role of the chief nurse as an effective communicator in delivering the Business Case will also be stressed.

  • -HD-OR10B Using Lean Methods to Cash-in on the Trifecta: Time, Space & Supplies: The rising cost of healthcare mandates innovative solutions to cost-effective healthcare delivery. According to the Institute for Healthcare Improvement, waste reduction programs can significantly impact the cost of providing healthcare up to 3% a year. This translates into a potential annual cost savings of $1 million for a 300-bed hospital and $12 million for a hospital system. Although many factors drive cost, nurses’ time, and access to space and equipment are frequently sources of waste. The purpose of this presentation is to discuss a process improvement project used to decrease hunting and gathering, recapture space, increase supply organization, and adjust on-hand supplies to match demand. Lean 5S (sort, set in order, shine, standardize & sustain) methods were applied to 8 units across 4 acute care facilities in the system. Each 5S project began with an extensive pre-work assessment to measure waste within a work process. Lean data collection methods included: circle of work, time value analysis, spaghetti map diagramming, and voice of customer. Team members participated in a 4-day event to improve the work environment and eliminate waste. Sustained success is dependent on daily and monthly audits. Reorganizing supplies and equipment storage, and adjusting unit par levels resulted in the restoration of a patient room, an operating room, a dialysis bay, and a chemo room to patient use. In addition, $159,000 of inventory has been returned to central supply, and care provider travel distance has been decreased by 76,000 miles (annualized) per unit. This project positively impacted nurses’ time spent acquiring supplies and freed resources associated with supplies, equipment, and space. Savings translate into an estimated annual cost savings/avoidance of $1.2 million for the 4 participating facilities.

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Best Practices for Improving Safety, Throughput and Patient Satisfaction
HD-OR17

Speaker(s) : Carol F Cleek , Brian Selig , Wrenae Shabel

  • -HD-OR17A Evidence-Based Practice for Hand-off Communication: Meaningful communication is essential to avoiding treatment delays, medical errors and unsafe practices that may lead to sentinel events. The purpose of this study is to identify evidence-based practice that promotes the transfer of care between caregivers. Phelps County Regional Medical Center (PCRMC) formed a research council to evaluate the effectiveness of communication among caregivers, including time measurements and surveys of existing methods. Results showed that methods did not provide adequate information to support sound clinical decision-making. Leadership identified a process combining telephone delivery and online access to hand-off records. Outgoing nurses enter hand-offs by phone, and incoming nurses access reports when starting a shift or receiving a new patient. Leaders use a web tool to view report status in real-time and listen to audio files for quality assessment. Staff voted to implement the technology following a 3-month trial period. Followup studies revealed a 50 percent reduction in time required for hand-offs, allowing more time for direct patient care. Patient flow was improved by eliminating phone tag between units. Staff surveys showed a 62 percent improvement in hand-off confidentiality and a 39 percent improvement hand-off convenience and efficiency. Project outcomes also included a 10-point improvement in HCAHPS scores for communication with nurses and responsiveness of staff. For ongoing improvement, PCRMC built communication competency measures into yearly performance appraisals. Nurse educators initiate employee monitoring and training activities. Evidence-based practice improves hand-off efficiency, allowing more time for direct patient care. Outcomes are improved safety, throughput and satisfaction among both staff and patients.

  • -HD-OR17B A Systems Approach to Improving Throughput:While many organizations focus on the Emergency Department to improve the flow of patients through the continuum of care, the impact of changes made in the ED cannot be fully realized if the rest of the system of care is not operating as effectively and efficiently as possible. This presentation will describe the approaches undertaken by a large academic medical center to evaluate and improve all components of the patient care process in support of effective patient flow. These approaches include effective triage, communication, tracking and management of the patient in the ED, analytical systems to accurately project daily admissions and discharges to effectively manage the inpatient population, and the establishment of a Clinical Decision Unit for the ongoing evaluation of patients and effective discharge planning. Since implementation of a variety of initiatives directed to improve throughput, the organization has realized a 99% decrease in ambulance diversion, greater than 50% reduction in patient elopements, complete resolution of diversion or inability to accept external transfers related to bed availability, while improving staff retention and development. This has all been achieved while maintaining a 92% hospital Press Ganey patient satisfaction rating and patient mortality index of .56 with an ever increasing CMI. These initiatives were accomplished without a significant outlay of capital resources. In conclusion, participants will be able to identify similar components in their own patient care systems that impact patient flow and begin to strategize around ways to overcome bottlenecks. In addition, participants can learn the ways to utilize a throughput metric scorecard to motivate hospital leadership to work collaboratively toward system goals.

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Health Care Delivery Best Practices
HD-OR24

Speaker(s) : Karen A Aloe , Paula Blizzard , Tammy Lightner , Lori Raffaniello , Marybeth Ryan , Lisa Williams

  • -HD-OR24A Creation of an Intermediate Respiratory Care Unit to Decrease Intensive Care Utilization: Specialized respiratory care often results in lengthy stays in critical care, and LTV (long term ventilator) support can be financially draining to hospitals. Limited and high cost resources for intensive care has prompted investigation of other delivery models that could provide such care at a more reasonable cost, while at the same time increasing the quality of care delivery in a specialized setting. Creation of a Respiratory Care Unit (RCU) staffed by specially trained, non-critical care nurses optimized the use of Hospital resources (including revised staffing ratios), facilitated improved patient throughput and patient/family satisfaction, and promoted provision of LTV care and positive patient outcomes. Impact on organizational effectiveness was assessed by studying selected outcomes. Measures included (1) weaning time (2) time to tracheostomy (3) average length of stay in the ICU requiring mechanical ventilation in days (Table 1 and Figure 2). Table 1, indicator 3 illustrates decrease in length of stay (LOS) in the ICU and Figure 3 depicts cost analysis of patient days and cost per day of the RCU vs. the ICU. ICU statistics reveal important features of utilization of critical care beds. Acuity increased in the ICU post RCU implementation although multiple system dysfunction did not differ among patients before or after creation of the RCU. Subsequently, more timely bed availability facilitating earlier admission to the ICU was realized, and cost comparison of patient days and cost per day projects nearly $348K annualized savings gained from utilizing the RCU venue for care of LTV patients. The RCU project supports the replication and investigation of this delivery model at other institutions as an alternative setting to validate cost-savings, increase quality of care, and improve patient throughput.

  • -HD-OR24B Early Assessment Program: Best Practices to Assess Patients in Need of Vascular Access: Vascular Access Teams (VAT) provide cost efficient, safe and friendly central access through the placement of Peripherally Inserted Central Catheters (PICCs) at the bedside. In 2008, the majority of PICCs in a Magnet facility were placed in Interventional Radiology (IR) exposing the pt to the risks associated with transfer throughout the hospital, and the increase costs of having the PICC placed by Radiologists. Only 145 PICCs were placed by the RN driven VAT. Recognizing the need to increase productivity and improve pt outcomes, VAT implemented an Early Assessment Program (EAP), Restructuring of VAT and implementation of EAP began in September 2008 when VAT began using ultrasound (US) to assist with PICC placement at the bedside. After 4 months of utilizing this new technology, no significant increase was seen in PICC placement or success rate. This set into motion an initiative to identify pts who would benefit from the safer, more cost effective PICC placement with VAT. The first step required education of medical and nursing staff regarding the guidelines indicating the need for a PICC and the capabilities of VAT. VAT distributes flyers that review these guidelines to all in-pt units and the Emergency Department. Physician education is periodically provided at inhouse meetings to update on current VAT practices. A full time Nurse Manager and Educator were appointed to continue these educational efforts and provide additional leadership structure and support to VAT. The next step required collaboration with Pharmacy and Admissions. Daily lists of identified medications and admissions are generated and assessed by VAT each day. VAT consults with the RN/Resident to suggest PICC placement as appropriate. This consultation and intervention results in placement of central access earlier in treatment, improving pt outcomes. Since implementation of EAP, VAT has increased PICC placement by 500% from 2008. In addition, more advanced US technology including PICC tip locating system (TLS) was introduced. With these improvements and continued efforts, the success rate of VAT placed PICCs have increased from 45% to 88%. With the use of the TLS, radiation exposure is reduced significantly. Providing education and insuring competence to decision makers regarding the need for PICC placement is vital to success of an EAP.

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Strategies for Using Modeling to Improve Patient and Staff Outcomes
HD-OR31

Speaker(s) : Michelle A DeStefano , Valerie Hardy-Sprenkle , Mary Jo Snyder

  • -HD-OR31A Building a More Cohesive Organization: Implementing Change through Simulation Modeling: Using data from simulation modeling at five urban and suburban community based hospitals, this paper demonstrates the outcomes of coordinating change among all units within the hospital. It allows all stakeholders to evaluate the consequences of the proposed change for a unit and for the hospital as a whole. Through the use of simulation modeling whose boundaries and constraints are determined by collecting and inputting unique hospital level data, we are able to demonstrate a cost effective and efficacious way to test change ideas and understand how changes in one unit create positive and negative consequences throughout an entire organization. This methodology allows hospital staff at every level from every department to have meaningful and significant input into the boundary conditions and constraints of the simulation model, and allows every staff person to have their change ideas tested and evaluated by an interdisciplinary team of providers, administrators, and support staff. This approach was used in five US urban and suburban community based hospitals. This paper analyzes how we constructed and implemented the simulation model at each site, how it was used in decision making, and how choices about resource allocations were made not based on the needs of one department but on the needs of the hospital as a cohesive organizational structure. The implications of our work include all staff having a greater role in decisions about changing the work environment and staffing responsibilities and making decisions with attention to all departments. Including staff in decision making coupled with the commitment to understanding how one department fits within the entire organization and making decisions accordingly is likely to enhance quality of care and improve the work environment.

  • -HD-OR31B From Conceptualization to Practical Application: Integrating a Professional Nursing Practice Model with a Nursing Care Delivery Model: A professional nursing practice model (PPM), integrated with a nursing care delivery model, serves as the foundation for the delivery of quality patient nursing care. Professional nursing practice models and care delivery models have been used interchangeably in the literature. Thus, analyzing their effects on outcomes has been challenging. A community teaching organization successfully integrated an innovative PPM comprised of eight interlocking components with the Relationship Based Care Delivery Model (RBC) to ensure the delivery of quality patient care. These interlocking components/guiding principles include: shared decision-making for patients, families, and staff; integration of information technology; interdisciplinary collaboration; professional nursing practice; outcome management; evidence based practice; and patient safety. The eighth component, patient centered care, is the nucleus of the model, integrating patient centered care with the RBC model. Staff has been at the forefront in the design, implementation, and evaluation of this PPM integrated with RBC. Patient Centeredness (RBC) being the nucleus of our design, ensures that our systems and processes reflect a patient driven model. The conceptual framework illustrating the PPM and its integration with RBC provides the vision for how we deliver care to all of our patients, regardless of the practice setting. The sustainability of the model implementation has been created through utilizing the I2E2 Change theory (Infrastructure, Inspiration, Education, and Evaluation). To date, the model has shown an increase in NDNQI Nurse Satisfaction, particularly in the domains of RN-RN interactions, RN-MD interactions, decision-making, and autonomy. In addition, patient satisfaction has increased in the caring domains of NRC Picker (nurses listened carefully, nurses treated you with respect and dignity) on units where full implementation of the model occurred.

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April 16th, 2010
Technology

Objectives :
Individual learning objectives for each session are included in the presentations.

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The Nurse Leaders Role in IT Implementation
T-OR04

Speaker(s) : Sandra Dalton , Carolyn Viall Donohue , Gail E. Latimer , Donna Y Schmidt

  • - T-OR04A Achieving "Meaningful Use": The Role of the Nursing Leader: With healthcare reform in the news daily, and the continued roll-out of the HITECH (Health Information Technology for Economic and Clinical Health Act) Act of the American Recovery and Reinvestment Act (ARRA) of 2009, we hear a lot about proposed changes and impacts to healthcare. Increasingly nursing leaders are faced with demands for quality reporting and transparency regarding clinical performance, knowing this will continue. It is understood that health information technology as a tool for the rapid transformation of the work environment, through the collection and monitoring of clinical data to supporting clinical decision-making is essential. The goal remains to improve quality, safety and efficiency of care for all patients. Seeking greater engagement with patients and families across the continuum of care, from prevention and wellness to care and treatment we know coordinating better care is essential to maximize efficiencies in healthcare processes and achieve positive clinical outcomes. Nursing leaders recognize the value of IT and how it can be leveraged to support the achievement of these goals, knowing that if done well it can mean quality and financial rewards for healthcare organizations. As we wait for the full definition of "meaningful use" of an electronic health record, it is clear that nursing leadership's role in the implementation and adoption of IT has never been greater. As nursing leaders consider their IT initiatives to support ARRA it’s valuable to apply AONE’s Guiding Principles for the Nurse Executive to Enhance Clinical Outcomes by Leveraging Technology as a frame work for developing strategies for achieving meaningful use. The recent AONE Guiding Principles outline three priorities for the chief nurse executive that used as a framework can provide the structure and focus necessary for success. In this session, you will learn how nursing leadership within a university medical center has mapped their work to the AONE Guiding Principles to create a roadmap for a successful IT implementation and address “meaningful use” requirements of the electronic health record. The organization will share their strategy for achieving success with an IT implementation that supports their clinicians in delivering clinical excellence while positioning them to achieve “meaningful use” under ARRA.

  • -T-OR04B CNO Role in Achieving Quality Improvements with an Electronic Health Record: Fletcher Allen embarked on an aggressive schedule for implementing an inpatient EHR that would transform clinical care delivery from a paper based system to fully electronic system within 15 months. This presentation will describe the importance of the CNO role in leading this major clinical organizational change and the value of the multidisciplinary team in designing and implementing clinical information technology focused on clinical quality improvement, not just technology implementation. The key elements of the project approach which contributed to Fletcher Allen's success include: ∞ The vision for an EHR was a strategic business imperative approved by executive leadership and the Board of Trustees. ∞ Senior leadership was committed to the value of clinical transformation and the effort and resources required. ∞ A governance process for the Clinical Transformation Initiatives was established to provide oversight for decisions and recommendations. The CNO and Chief Quality Medical Officers were leaders of the committee. ∞ Clinicians representing the multidisciplinary care team were actively involved in design decisions for the new technology and new clinical workflow. Our Results: 122 clinical transformation improvements were designed, documented and implemented. Examples of our accomplishments include: • CPOE policy mandated by senior leadership and fully adopted by Fletcher Allen providers and achievement of 100% CPOE adoption • Electronic medication reconciliation and electronic MAR • Hyperlink from eMAR to Vermont Department of Health to print Vaccine Immunization Statement and alerts to RN if vaccine not administered. • Standard order sets, best practice alerts, and documentation templates to consistently provide clinical care based on best practice standards and improve quality reporting. • Implementation of multidisciplinary documentation including the problem list and care plan

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The Impact of Decision Support Technology on Patient Safety and Quality of Care
T-OR11

Speaker(s) : Vicki A Lucas , Mary Myers , Linda Reed , Rhonda Smith

  • - T-OR11A Evaluating a New Care Delivery Model Utilizing eHospital Technology: Many health care systems across the country continue to face the challenges of an increasing trend in patient acuity and care complexity, limited progressive care level (PCU) bed availability, lack of clinical support for novice nurses along with clinical advancement for acute care nurses, financial restraints with limited options, and the immediate need to enhanced patient outcomes. A new delivery model of care which includes eHospital technology utilizes out of the box thinking to come up with new solutions. This unique delivery model is being tested to address not only the need to conserve and leverage nursing manpower, but to enhance staff satisfaction, patient satisfaction and clinical outcomes. This study is done in a 48 bed acute care inpatient medicine unit for the purpose of trialing a new care delivery model related to nursing practice. This model incorporates eHospital (virtual ICU) technology, along with the collaboration between the virtual ICU team and acute care bedside staff caring for a complex medical population. The components of this model includes movement to all private rooms (each with a bedside cardiac monitor); an increase in the number of support staff to the RN (patience care assistants); implementation of Lean and Kaizen methodology for efficient organization of workflow; streamlined progressive care education/orientation for staff along with 24/7 connection to an experienced critical care nurse (eRN) from a remote bunker with 2 way video. The goals of this new delivery model include an improvement in nurse satisfaction, patient satisfaction, and clinical outcomes with a financial model that is break even or less. The goal is also to be able to replicate this model throughout the healthcare system to meet the increase in demand for progressive care level patients.

  • -T-OR11B The Next Generation of Technology: Improvement of Patient Safety and Clinical Quality Through Imbedded Clinical Decision: The introduction of clinical decision support systems (DSS) into medical technology has elevated electronic medical records and electronic monitoring into an interactive component of patient care. DSS can prompt documentation, direct patient care, and measure and analyze this care. As a result of technologic innovations, a retrospective descriptive study was undertaken to measure the impact of DSS on patient safety and the quality of care. Patient safety and clinical quality are impacted by variability in provider, patient and processes. DSS standardizes clinical processes which decreases provider variability. Key clinical and documentation outcomes that represent patient safety and patient care quality were identified and defined by an expert panel after a thorough review of the literature and standards of care. These measures were: complication rate, infection rate, medication errors, identification of error and change of order, recognition, communication and management of complications, completeness of documentation, potentially compensable events (PCEs), and malpractice reserves. The outcome measures were validated with a pilot study prior to a retrospective review of 24,000 records. The findings indicated a significant improvement in patient safety as indicated by a significant reduction in: PCEs, malpractice reserves, errors, complication and infection rates. The findings also indicated a significant improvement in quality of care as indicated by: increased recognition of errors, change of the order, greater compliance with the standard of care guidelines, and significant improvement in documentation completeness. This technology can be utilized in various hospital sizes, geographies and medical specialties. The implications of this technology to monitor and improve nursing practice are significant. Inter-nurse and intra-nurse variability can be monitored and analyzed in order to empirically improve the quality of nursing care of each nurse. Nursing dash boards are under investigation to define, measure and report meaningful indicators of nursing practice. DSS are the next generation of technology due to their ability to positively impact patient safety, quality of care, and nursing education, research and practice.

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The Nurses Role in Championing Bedside Technology and Improving Documentation
T-OR18

Speaker(s) : Kathleen Black , Sheri L Miller

  • - T-OR18A Reducing Non-Clinical Tasks from Nurses: With the demands placed on today’s nurses and the increasing expectations of patients, introducing strategies to reduce the workload of nurses and drive higher levels of patient engagement are an important part of today’s patient care strategies. At a time when innovative patient care models are being explored, nurses are often forced to perform many non-nursing tasks. To help nurses focus on clinical patient needs, a number of hospitals are using bedside technologies to engage and empower patients. While many organizations are primarily using patient education as the foundation for efforts into this strategy, nursing has seen the benefits of expanding the platform into other departments throughout the hospital to create an all-encompassing patient experience that gives the patient more control of his or her environment and allows nurses to remain focused on clinical patient needs. Non-clinical support service functions can be integrated into the technology platform so that patients are able to use bedside technology to initiate non-nursing related service requests when rooms need to be cleaned or room temperatures adjusted. This session will explore how GetWellNetwork’s Interactive Patient Care was coordinated with hospital support services at Winchester Medical Center and how the strategy has impacted not only patient engagement and quality results, but also has been effective in reducing the number of nursing call lights for nonclinical tasks. Implications: An overview of the GetWellNetwork® PatientLife System® Interactive Patient Care bedside technology will be presented. This section will cover its ability to integrate support services, health education and other patient engagement capabilities. Specific examples will highlight outcomes and metrics. The presentation also will define how the bedside technology aligns and builds upon the work conducted by AONE and ARAMARK Healthcare around nursing satisfaction with support services in the clinical setting over the past three years. A case study presented by Winchester Medical Center in Winchester, VA, will be used to illustrate nursing’s role in helping to design and manage this strategy.

  • -T-OR18B Ka-ching! Cashing in on Electronic Documentation: Overcrowding, higher acuity and more complex patients and procedures increasingly limit the time ED nurses have to document during an age when federal, state and regulatory agencies and third-party payers require more detailed and extensive documentation. Under-documentation due to time constraints on nurses can lead to failure to capture appropriate revenue and inability to justify staffing levels, leading to decreased staffing and thus more time constraints. Ultimately, the frustration for nurses can worsen the nursing shortage. This project was a quality assurance project to improve documentation. It consisted of four parts: 1) documentation design integrating critical elements and simplifying standard charting, 2) training plan emphasizing understanding in addition to practice, 3) support team development to decrease stress and promote buy-in, and, 4) evaluation to determine effectiveness. The project took place in an emergency department in an urban, teaching, level II trauma center. Participants were part of a multi-disciplinary design team which included ED nursing leadership, systems analysts, informatics nurses, advanced practice nurses, staff nurses, specialty nurses (such as intravenous therapy and integumentary specialists), staff technicians, a pharmacist, respiratory therapists, medical records representatives and billing coders and levelers. ED Revenue was measured by revenue valued units. Other documentation indicators measured were audits of pain assessment, pain reassessment after medication, and medication reconciliation documentation. The result was that ED revenue increased 19% in the first month after implementation, pain assessment at triage increased to 100%, pain reassessment after medication increased from 67% to 90% and medication reconciliation improved from 61% to 89%. Incorporating critical elements for billing into documentation design can improve revenue and help justify the staffing levels needed for good documentation as well as good patient care.

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Uses of Technology in the Patient Care Environment to Empower Patients and Staff
T-OR25

Speaker(s) : Rebecca Hathaway , Nate Larmore , Bonnie Wesorick

  • -T-OR25A The Impact of Healthcare IT: Empowering Patients and Staff through Technology: No one can deny that technology has played an important role in healthcare delivery and reform and will continue to do so. Access to affordable and appropriate care has multiple points of impact, and information technology is clearly one of most important. The number one priority on the top ten list of healthcare technology issues is electronic medical records or electronic health record (EHR). On February 17, President Obama’s signature on the 1,100-page American Recovery and Reinvestment Act (ARRA) was hailed as a watershed moment for healthcare information technologies (IT). HIMSS President Sever Lieber described ARRA as “the most important legislation to ever impact health IT.” Others have compared the anticipated results of the ARRA with the technical advancements of the Project Apollo. The financial provisions of ARRA exceed $20 billion. They are intended to incentivize the development of IT infrastructure, as well as the implementation and utilization of EHR over the next five to seven years. However, the imbalance between the huge amount of funding and the narrow disbursement window leaves many healthcare IT executives doubtful. With payments scheduled to begin in FY2011 to those hospitals demonstrating “meaningful use of certified use of EHR’s”, there is little time for adequate planning. Some even speculate that healthcare organizations may choose non-compliance penalties rather than participate in ARRA. ARRA is an opportunity to redefine the application of technology within the healthcare environment. In an industry that desperately needs leadership that goes beyond speeches and politics, this is an unprecedented call to action. However, if healthcare organizations get lost in the cloud of confusion surrounding the act, they may find the ship has already sailed. This presentation will begin with a discussion of the healthcare crisis in America, the goals of healthcare reform, and the top ten technological issues being evaluated by healthcare organizations. These technologies will then be discussed in relation to innovations in the patient care environment. Advantages, disadvantages, applications, and desired outcomes of the technologies will also be reviewed. Case studies will be utilized to illustrate both how technology is being integrated today, as well as the possibilities for the future.

  • -T-OR25B The Call for Technology to Serve the Healers: Although automation at the point of care is in its infancy when viewed through the lens of scientific advancement of nanotechnology in health care, it is critical that nursing leaders today act to assure that the “essence of nursing” guides the technological evolution. The challenges for the clinicians are many but as Ray Kurzwell pointed out in his book entitled, “The Singularity is Near” and in his keynote presentation at AONE, that by the time of the Singularity, there “won't be a distinction between humans and technology”. He noted that “This is not because humans will have become what we think of as machines today, but rather machines will have progressed to be like humans and beyond”. But Ray’s projected outcome will depend on nurse leaders of today becoming active now in the development of technology and the strengthening of the healing science at the point of care in their organizations. This session will present 10 strategies and the lessons learned from an International Consortium of over 260 rural community and university settings engaged in the work to help their organizations remain human in the face of the incredible demands, fast paced healthcare cultures while leading the automation of practice at the point of care. The nature of the work essential to sustain a healthy culture and positively enhance the caring component of nursing in partnership with technology will be demonstrated through the use of a molecular metaphor grounded in a video of a real clinical scenario that brings alive the 10 fundamental elements found to be essential in the best places to give and receive care by an International Consortium. The outcomes of creating technology to serve healers will be shared and correlated to the typical JCAHO, IHI, National Quality Indicators and Magnet journey but most importantly open the door to a whole new paradigm of important clinical outcomes not yet reported.

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Implementing New Technology: Optimizing Core Processes and Making the Business Case
T-OR33

Speaker(s) : Shelly DeVore , Lee Galuska

  • - T-OR33A Perfecting Processes before Implementing Technology: Implementing technology without first designing the patient care processes around best practices can lead to less than optimal outcomes for patients and extra work for nurses. In 2008, a Midwest integrated delivery network with 9 community hospitals decided to standardize and optimize core processes among all hospitals and then use technology to enable the process. The first step in this process was to document all the workflows within the inpatient units of the hospitals. Using decision support tools, the processes for redesign were prioritized based on wasted steps and opportunities for error. Processes selected for redesign included gathering the patient history and assessment and planning and coordinating the patient’s care. Analysis of the current state for admission history/assessment showed an average of 79 minutes to complete (with interruptions). Time spent in data collection was 55 minutes. Through design sessions with MDs, RNs and pharmacists, the admission process was redesigned to include the sharing of data collection, asking questions only one time. The electronic documentation system was designed to enable the new admit/history process with the goal of decreasing the actual time nurses spend gathering information by 50%. Patient information collected upon admission originally was 188 data points and was decreased to 125, a 33% reduction. The care coordination process includes development of the patient’s plan of care. Analysis of the current state showed that doctors and nurses agreed on the same discharge date 44% of the time whereas there was only 20% agreement between the nurse and the patient. The design session goal was to develop a new care planning process that coordinated the patient’s care, using enabling technology to document consistent goals, including anticipated discharge date 100% of the time among caregivers and patients All too often, hospitals use technology to automate processes that are filled with errors and inefficiencies. The three step process of 1) selecting core processes for design which can bring rewards to patients and staff, 2) designing the processes using key stakeholder input and 3) enabling the design with technology after first optimizing the process can be used by hospitals of all sizes to improve patient satisfaction and labor productivity.

  • -T-OR33B Making the Business Case for New Technology to Improve Patient and Staff Safety: With the increased emphasis on quality and safety as well as fiscal accountability in health care, the role of the nurse in producing quality and preventing patient harm has become central. The nurse leader must support and advocate for the bedside nurse to enable the achievement of positive clinical outcomes by assuring that all the key elements for success are present. This includes such things as effective staffing models, sound clinical processes based on evidence and the tools and technology to facilitate the work. This poster will illustrate the process and tools one community hospital utilized to produce a convincing business and clinical case for purchasing new beds throughout the hospital. Beds are no longer just a place for patients to spend their hospital stay. They are tools to promote safety and reduce the risk of harm. New technology and features provide the nurse with a care environment device that can help to reduce the risk of falls, reduce the risk of hospital acquired pressure ulcers, facilitate the care of patients requiring regular weights for their plan of care and more. In addition, the technology has the potential to reduce the risk of caregiver injury. Our challenge was to tell the story of how this investment in the patient care environment with the all the associated clinical and safety benefits was fiscally sound. Our organization used a multidisciplinary, comprehensive process to: • evaluate our current status related to beds and how they compared with national standards; • research and evaluate products; • assess our current and historical performance on nurse-sensitive measures that could be impacted by beds and sleep surfaces; • evaluate our history of staff injuries related to patient lifting and moving that could be impacted by beds and associated costs; • evaluate our bed rental history; • evaluate our repair and maintenance history and cost; • complete a comprehensive cost-benefit analysis and return on investment; • prepare a proposal to replace about 400 beds in the organization. We were able to show that the investment in new bed/patient care environment technology would pay for itself in less than 3 years using conservative estimates of savings related to patient safety and staff safety measures.

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April 16th, 2010
Workforce Development

Objectives :
Individual learning objectives for each session are included in the presentations.

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Institute Research Seed Grant-Developing the Emotional Intelligence of Nurse Managers
WD-OR05

Speaker(s) : Estelle Codier , Cynthia Kamikawa

  • Background: Significant correlations have been demonstrated between emotional intelligence (EI) and performance, retention and organizational commitment across a wide range of professions and settings. A meta-analysis published in 2008 reviewed 141 research studies investigating emotional intelligence and leadership effectiveness concluded a strong relationship between measured emotional intelligence parameters of leadership effectiveness. . Research evidence outside of nursing has demonstrated the effectiveness of emotional intelligence development programs, particularly those which utilize a peer coaching model. Purpose: The purpose of this quantitative, quasi experimental study is to evaluate the impact of am emotional intelligence development program for nurse managers on measured emotional intelligence and leadership development criteria. Methods: A convenience sample of 35 nurse managers will be invited to participate in the study. Participation will consist of 1) Pre and post testing using the MSCEIT, a widely recognized instrument used for measuring emotional intelligence abilities, 2) demographic/career information survey completion, 3) Self directed peer coaching activities biweekly for a period of 10 months. Significance: Effective nursing leadership has never been more important than it is in the current health care climate, given 1) the anticipated overhaul of the health care industry in the US, 2) the severity of the anticipated nursing shortage across the next two decades, and 3) the rapid changes that will result from medical advances projected to revolutionize patient care in the immediate future. Emotional intelligence abilities have been demonstrated to have a significant impact on reducing these deterrents in other professions. If emotional intelligence abilities can be found to be improved, and if, in their improvement, significant manager outcomes are also improved, this would constitute a significant finding for managers.

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Nurse Manager Engagement: Developing the Strengths of Nurse Managers and Their Organizations
WD-OR06

Speaker(s) : Barbara Mackoff

  • This study addresses an urgent aspect of the current nursing shortage: the job vacancies and short tenure of nurse middle managers. This problem is directly linked to a projected vacuum in future nursing leadership. The purpose of this work was to create a transformative and actionable model to understand and develop workforce engagement. The study focused on gathering data that reveals reasons why outstanding nurse managers have stayed in the role. Engagement was defined as longevity of five or more years in current middle management role and designation as outstanding by senior leadership. The data was analyzed to pinpoint individual and organizational factors that create both success and longevity in the role. To gain a fresh perspective about this problem, the project focused on examples of nurse manager engagement, rather than retention or attrition. The study generated a new instrument, The Nurse Manager Engagement Questionnaire with questions that draw upon the techniques of appreciative inquiry and sought positive factors linked to excellence and commitment. The 1-1 �� hour interviews consisted of open-ended, guided questions designed to elicit highpoint experiences, enduring values and signature positive behaviors in individuals and organizations that contribute to engagement of nurse managers. Thirty in-depth interviews with nurse managers at six national medical centers were used to harvest signature individual and organizational factors that have contributed to the long- term engagement of nurse managers in those settings. The data suggested ten strengths/ signature indicators of individual manager engagement along with the implications for development and sustainment of nurse managers. It also suggested five organizational factors that contribute to engagement for nurse managers and the applications for building cultures of engagement. The study yielded a transformative model of nurse manager engagement with powerful implications for nursing graduate education, job descriptions and recruitment, organizational self-study/development and continuing nursing education.

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Positioning Yourself for Success: Advancing Your Career in Exciting Times
WD-OR07

Speaker(s) : Lyn Brennan , Susan L Davis , Richard J Henley , Linda J Knodel

  • This expert panel presentation is a thought leadership forum which utilizes case studies of career progression and testimonials to assist nurse leaders in the design, application and use of actual tools to position themselves in a progressive career trajectory. It is expected that attendees will learn critical attributes necessary for advancing careers and attaining key positions in healthcare leadership and how to attain those attributes and distinguish oneself from the competition. Based upon the diversity of the panel and the unique perspective each brings to the subject, there will be a rich interactive dialogue. A readiness assessment will be discussed along with lessons learned, attributes which contribute most significantly in advancing the nurse leader's professional career as well as elements which are cricial for success, both within and beyond the patient care arena. The panel will consist of very seasoned professionals including: * CNO with 30+ years who "came up through the ranks"; * RN-Ed.D. FACHE staff nurse to CEO of a major healthcare system; * RN Executive Recruiter for C-Suite Executives; * CEO who has recruited, mentored and coached nurse executives.

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Leadership Development Strategies to Facilitate a Collaborative Decision-Making Environment
WD-OR12

Speaker(s) : Leslie Becker , Vanita Bellen , Amy Brown , Susana Gonzalez , Ann Seliga , Angela Skalla

  • -WD-OR12A Valuing the Staff Nurse in Strategic Planning: To create a process where nursing staff at a shared governance hospital have the ability to provide useful input into the annual planning of fiscal resources and growth strategies. This grass-roots methodology improves the appropriateness and accuracy of budgets and strategic plans which leads to better outcomes. Each patient care unit and shared governance council discuss the strengths, weaknesses, opportunities and threats within each area of a defined and balanced model. Each discussion represents the group’s perspective. The information is synthesized, and commonalities as well as specific needs are identified, and aligned with the hospital mission, vision and values. The draft document is vetted by the nursing staff again and edited until final documents are created. These final documents are filtered into goals for nursing departments, councils, leaders and their staff. The resultant work culminates into the nursing annual report to celebrate achievements. 60 percent of nurses within the organization have direct input into the expense and capitol budgets and the strategic plan. 94 percent of the strategic plan was accomplished during the last fiscal year. Since adopting this process, there has been zero voluntary nurse turn-over for six quarters. Contract labor has reduced by 80 percent and customer service scores have increased by 40 percent. Both nurse satisfaction and engagement have increased year-over-year for three years. By engaging a majority of the nursing staff in this process, a hospital of any size or type would have improved ability to meet annual goals and budget.

  • -WD-OR12B Design and Implementation of an Interdisciplinary Shared Governance Model: This project involved designing and implementing a structure that facilitates quality decision making at the staff level throughout the organization. The goal was to enhance the current shared governance structure by maximizing interdependence between departments and promoting feedback between staff and leadership. Data from the NDNQI RN Satisfaction Survey and the employee engagement survey showed a need for an enhanced system of shared governance. Subject matter experts conducted a current state assessment, reviewed literature related to Microsystems, nursing and interdisciplinary shared governance in order to formulate an evidence based model of interdisciplinary shared governance. The resulting structure of 3 levels of councils facilitates a strategic link between the work being done at the staff level and the larger scope of work of the organization. The first level of connecting councils serves as the primary link between the overarching Performance Excellence Council and the coordinating councils. These are the Patient Care Council, responsible for patient care initiatives and whose membership includes nursing, medicine, and ancillary services; the Resource Council, responsible for operational efficiency and has representatives from human resources, finance, and education; and The Strategy Council, made up of senior leaders and staff who ensure the work done in the councils is aligned with the organization’s mission and strategic plan. The second level of councils consists of coordinating councils from each service line. The leaders of these councils make up the membership of the Level 1 councils, but at this level, include representation from each department that makes up the service line. Coordinating councils ensure work is delegated and communicated in both directions between Levels 1 and 3. The third level includes service teams and their work is to improve the quality of care provided at the point of service. Best practices are identified and communicated to the other two levels to ensure dissemination throughout the organization. The health care world is changing and organizations must change in order to remain viable and provide quality care. The interdisciplinary structure allows for diversity in decision making, ensuring organizations’ sustainability in a new health care environment.

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Ways to Improve Financial Performance and Patient Outcomes
WD-OR13

Speaker(s) : Michael Malecki , Sharon McEwen

  • - WD-OR13A Nursing Unit Resuscitation Using ABCs, Attitude, Behavior, Communication and Collaboration: A healthy work environment is vital for recruitment and retention of nurses. Improved patient safety and outcomes are two important benefits of a stable nursing staff. When the turnover rate was 18% in the Surgical Intensive Care Unit, exit interviews were reviewed to identify areas for improvement. Comments focused on nurses feeling stagnant, unmotivated, not challenged and lacking managerial support. A change in leadership and a staff involvement program has decreased the turnover rate to 6.9%, increased morale and motivation. Leaders play a pivotal role in retention of nurses by shaping the clinical and cultural environment. Staff identified that the unit had no life and needed resuscitated. The unit was resuscitated with ABC’s - Attitude, Behavior, Communication and Collaboration. The staff embraced the need to have a positive attitude, behave professionally communicate effectively and collaborate skillfully. The ABC’s are reflected in annual evaluations. Objectives and Rationale: Objectives and rationale of the project focuses on creating a healthy work environment which decreases turnover, increases retention, and increases job satisfaction among caregivers, which leads to improved patient safety and better patient outcomes. Methodology: Communication classes were mandated by all staff members. A mission statement was created and adopted through these classes. Staff development and engagement was the next focus. Developing staff to be leaders of the future by assisting with teaching new hires, increasing knowledge with continuing education, becoming involved with shared governance, and beginning nurse driven research has led the unit to increased autonomy and increased job satisfaction. Results: The result of creating a healthy work environment at UPMC Shadyside was receiving the Beacon Award from the AACN! Other validated results were a ZERO turnover rate since December 2007. Patient safety has increased as evidenced by a decrease in falls and a decrease in med errors as well as a decrease in patient complaints. Evidence continues to mount that meeting healthy work environments standards (especially communication, collaboration and staffing) is related to increased safety and improved outcomes for patients. Keeping staff motivated and engaged is the key to sustaining a healthy work environment.

  • - WD-OR13B Improving Financial Performance Through Staffing Incentive Redesign: Incentives have been widely used for motivating staff to help meet the scheduling needs of patient care. However, with the pressures of today's competitive environment and rising labor costs, healthcare organizations are challenged to find innovative and cost sustainable alternatives to traditional incentive practices. Additionally, there is growing awareness of the cultural and cost implications of poorly designed incentive programs. To help ensure quality and cost-effective patient care, nursing and financial executives are adopting new solutions and incentive management programs that motivate the existing workforce to become an active part of the staffing solution. Open shift management technology focuses on finding qualified resources from within the existing workforce to work hard-to-fill shifts. Since the introduction of shift bidding technology a few years ago, it has quickly evolved from a new approach for filling open shifts to an enterprise-wide staffing strategy. Hospitals are effectively meeting workforce management challenges using the technology and reporting significant impacts on labor costs, retention, recruitment, and employee satisfaction. Several leading healthcare organizations are using non-monetary point-based rewards programs available through their open shift management systems (much like the successful frequent-flier point systems of the airline industry) as a means of increasing individual performance while providing incentives that directly help to achieve staffing effectiveness goals. Many are finding that by implementing point-based reward programs that are attractive and meaningful to employees, significant benefits and savings can be realized. This session will provide an overview of this new approach to incentive management, and through a case study presentation featuring a Detroit hospital, highlight the experiences and results associated with the use of a nonmonetary incentive program. The session will discuss the hospital’s staffing challenges prior to implementing the program, program goals, keys to program success, characteristics of an incentive program design, shift rewards as an incentive model, and results and outcomes.

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The Benefits of Staff Recognition: The Amazing DAISY Award
WD-OR14

Speaker(s) : Laura Caramanica , Colleen J. Goode

  • Research demonstrates the importance of recognizing nurses for the “not so ordinary work that they do”. Most nurses take for granted the extraordinary clinical skill and acts of compassion they provide to their patients every day. However, publicly celebrating nursing excellence throughout the year has a demonstrable impact on nurses’ long-term commitment to their profession and their attitude toward their day-to-day practice. Studies indicate the key role the nurse manager plays in providing recognition. This presentation will review the state of the science related to nursing recognition by synthesizing research articles that identify recognition’s effect on nurse retention and job satisfaction. Attendees will learn what constitutes meaningful recognition and the important role that nurse leaders, professional colleagues from all disciplines, and patients and families play in acknowledging the difference that nurses make “just doing their job.” The presenters will also provide information on an amazing award that provides on-going, public recognition to extraordinary nurses. The “DAISY Award for Extraordinary Nurses” program will be explained and its multi-layer impact will be analyzed, based on the experience of several of the 400+ healthcare organizations who participate all over the United States and in all size facilities. Survey results reflecting the impact The DAISY Award has on nursing staff at one major medical center will be presented. The survey included nurses from units who had a Daisy award winner and units that did not. For nurses who experienced a DAISY award on their unit, 97% indicated the DAISY award program had a positive impact on nurse satisfaction. Actual examples of extraordinary care by extraordinary nurses will be presented to demonstrate the nursing excellence the program rewards and helps elicit among nurses. Nurse Leaders will learn new approaches to providing recognition.

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Transforming Nursing Policy: One States Approach
WD-OR19

Speaker(s) : Fran Ricker , Carolyn Sanders , Jean Scholz

  • Many states have debated the best approach to assure adequate staffing in hospitals. Some approaches include mandated ratios, required staffing plans, public posting of staffing plans. Through debate and consensus building, Colorado selected a distinct approach that addresses more than the traditional staffing debates and includes the realization that nurses’ input into decisions may significantly and positively affect their practice and workplace culture. Colorado’s unique statewide process began with a Governor’s Taskforce on Nurse Workforce and Patient Care which examined critical nursing issues including nurse staffing and retention of nurses in hospitals. The Governor’s Taskforce required multiple stakeholders to meet which may not have happened without the Governor’s mandate. Recommendations from the Pilot Program Implementation Committee (PPIC) led to Colorado SB08-188, legislation that required a statewide research study and provided initial funding. The PPIC continued the unique process where multiple Colorado stakeholders included a representative from the Hospital Association, Organization of Nurse Leaders, Nurse Educators, Colorado Center for Nursing Excellence, Nurses Association, SEIU, Department of Public Health, and two staff nurses. The PPIC developed the two-phased research project over 6 months. The first phase of the study includes collection of qualitative data from direct care nurses, shared government bodies, and CNOs. The second phase is a quantitative descriptive comparative correlational study to measure and classify the level of staff nurse involvement in selected Colorado hospitals, and relate these to organizational and patient outcomes. The Colorado methodology provides a collaborative model for other states where all nurses can win on nurse involvement in decision making, nursing satisfaction and retention, and other nursing practice in hospitals.

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Innovative Ways to Improve Recruitment and Retention Strategies
WD-OR20

Speaker(s) : Jennifer Brewer , Paula Feeley Coe , Lauren E. Triplett , Debora L. Williams , Nancy Woods

  • - WD-OR20A Workforce Development Recruitment and Retention Strategies: The Norton Navigator program is a specialized mentoring program designed to help new graduate nurses, called protégés, learn to adapt to their new career as nurse in a environment. One of the most perplexing healthcare retention issues is keeping new nurses from leaving after just one or two years of employment, but our program seems to be making inroads. . Protégée receives specialized training in communication, conflict resolution, personal coaching, while mentors can polish their skills in areas such as communication and generational differences. The heart of the program is the relationship between the new nurse or Protégée and his or her mentor, or Navigator. This relationship gives the new nurse a resource when having questions about clinical issues but also having questions about balancing work and personal life, and adjusting to their new professional career. The navigator-protégé relationship allows for the release of frustrations, doubts or fears confidentially. The life cycle of the navigator and protégée includes building trust, exploring possibilities, navigating through the rough spots and continuing through the cycle again. Norton Healthcare was losing more than 30% of our new graduates within the first year. To date the metric success factors include 8% turnover rate since 2003. The current estimated cost of per nurse in turnover is $82,000-88,000. The navigators’ support and encouragement provides the new nurse with extraordinary and rewarding job experience. Norton Healthcare has realized significant improvements in the retention rates for new nurses with the implementation of this program. In conclusion, the purpose for implementing this program was to increase retention rates of new graduate nurses. This poster presentation focuses on concepts and approaches that can be implemented for the hospital- level RN workforce to identify and trend objective measures related to workforce improvement strategies. This program can be implemented in one unit or throughout a hospital wide system by using the core elements. By refocusing staff members and leaders on a shared objective of workforce development by using these retention strategies a positive work environment and a culture of engagement in the workplace can be achieved.

  • WD-OR20B Professional Nursing Values and Retention: Management and Staff Alignment?: Retention of nurses has become a major issue confronting health systems around the globe. Research indicates that nurses’ professional values are connected to retention. Organizational ethics created challenges for both nurse administrators and staff nurses. The ability to congruently link these attributes of staff and leadership is of paramount importance for workforce development and retention. The purpose of this study was to explore the values held by nurses at a 326 bed non-profit community faith based organization. A non-experimental, descriptive replication research design was employed to determine the effects of nursing values on retention of nurses. The Professional Values Scale-R (NPRS-R) was used to collect data for this study. The most important values (score of 4.5 or greater) were: protect health and safety of the public; accept responsibility and accountability for own practice; maintain competency in area of practice; act as a patient advocate; safeguard patient’s right to privacy; and maintain confidentiality of patient. Overall, nurses report strong professional values, with a mean Nurses Professional Value Scale (NPVS-R) score of 107 (possible range 26 - 130) and the vast majority (85.6%) at the highest tertile. Statistically significant differences in mean PNVS-R subscale scores for staff nurses compared to nurses in management positions were identified in 4 subscales as well as in the total NPVS-R score. Statistically significant differences were identified for several subscale scores based on position (staff nurse versus management) and education level (diploma/AA versus BSN/MSN). There was no difference in retention in the profession based on professional values. However, this may be due to sampling bias, since nurses with lower professional values may not remain in the profession. Nurse leaders can uses the information made available in this study to become more aware of the ethical issues that face the healthcare industry today and better understand how to exercise effective transformational leadership. Engagement of these individuals by using a nursing research such as this to better align staff and management values can be one powerful strategy to help build a relationship built on values, integrity and trust.

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AONEs Nurse Manager Fellowship: A Career Enhancing Program That Gives Back!
WD-OR21

Speaker(s) : Danette Alexander , Katherine Major , Erik R Martin , Tanya Osborne-McKenzie , Lindsey Osting , Jan Phillips

  • The AONE Nurse Manager Fellowship is a year-long professional development program designed to provide an in depth environment of learning. The fellowship incorporates the Nurse Manager Learning Domain Framework. Faculty for the program includes renowned nurse leaders, experts in nursing leadership and management, and focuses on a curriculum built upon: The Science: Managing the Business, The Art: Leading and Managing the People, and The Leader Within. The fellowship participants engage in a variety of learning modalities: fellowship retreats; four face-to-face sessions during the course of the fellowship year, experiential learning; application of classroom learning in the workplace, and virtual learning communities; year-round electronic communication with each other and expert faculty. A key component of the fellowship program is the completion of a capstone project by each fellow. The individual project focuses on an aspect of the learning framework-managing the business, leading the people, or creating the leader within. Each project is intended to benefit the sponsoring organization, by providing a measurable financial gain that will offset the program’s tuition fee. The fellows are required to provide mid-year and final reports to their respective executives and an electronic summary to their learning community of fellows. Panel members (presenters) will discuss their individual capstone project, the financial impact it had on the organization, and how the fellowship impacted their career as a nurse leader. The capstone projects include topics such as nurse retention, usage of attendants for patient safety, the role of APNs in the intensive care environment, and utilization of a double-flush system to improve the accuracy of PICC line placement. The presentation will conclude with ample time for discussion and questions.

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A New Look at Temporary Nursing: Unleashing its Potential to Improve Staffing in a Multi-Hospital System and Beyond
WD-OR26

Speaker(s) : Joan Shinkus Clark , Sherry Weier

  • Organizations today actively resist contract labor because of concerns with the quality of care delivered by staff unfamiliar with the organization or because of the enormous price tag. While organizations seek reductions, younger nurses are actively embracing this type of professional lifestyle and leaving to work at outside agencies for flexibility, travel and lifestyle. Texas Health Resources (THR) has implemented a solution that is driving down contract labor costs while recognizing needs of nurses seeking a more flexible and exciting career option. Through a joint venture with Medfinders, a nationwide staffing agency, THR is leveraging the expertise and agility of an experienced agency to set up an affordable and attractive, not for profit option for its hospitals to access temporary labor devoted primarily to staffing its 14 hospitals. With the development of the joint venture named Texas Health SingleSource Staffing(sm) (THSS), a centralized approach to staffing has also been established, pooling experts from hospital-based staffing offices to look at the whole picture for the system. The central staffing office functions to connect hospitals, creating options for staff being called off, or providing well trained staff for busier hospitals. The use of Medfinders’ SingleSource software allows THSS and THR staff to request available shifts around the system before reaching out to Medfinders, who coordinates other agency providers for the system. Each request is managed to find the least expensive and most qualified staff. For novice staff reaching 2-3 years experience, THSS provides an option to test out travel nursing anywhere in the nation. Should they want to return to permanent staff, THR will bridge their service benefits. Results include reduction in contract labor, reduced recidivism of 2-3 year nurses, decreased overtime, improved availability of specialized nurses, and improved metrics associated with electronic documentation. Quality metrics include reductions in errors and improvements in customer perceptions around quality of care. Total elimination of contract labor continues to be an elusive prospect for many nurse executives. THR has learned that investment in a financial partnership with Medfinders and creation of an innovative model has improved their solution to this dilemma.

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Orientation of the New Nurse
WD-OR27

Speaker(s) : Diane Bongiovanni , Beth Ulrich

  • - WD-OR27A Bridging the Gap: A Practice-Academic Partnership Orientation Model: Nursing in the twenty-first century has become very complex. Today’s nurses must care for patients with complex issues in a period of overwhelming nursing shortage. These issues, coupled with a technologically sophisticated healthcare arena, have produced a challenging clinical environment for nurses. Healthcare organizations are forced to recruit international nurses who are unprepared for the rigors and complexity of our nursing environment, and newly graduated registered nurses who are inadequately prepared to make necessary critical decisions. One of the most important challenges is to provide an effective and efficient method of teaching critical thinking to novice nurses. In the past, providing didactic information and clinical experiences were sufficient to meet the needs of nurses; this no longer holds true. The Emergency Department (ED) at an urban, teaching, level II trauma center, embarked on a piloted project utilizing an internally developed Practice- Academic Partnership model to ‘grow" and retain nurses in the ED without the cost of creating and staffing an independent clinical simulation laboratory. The highly integrated model used clinical scenarios and computer simulators in a controlled clinical simulation laboratory to create "near-reality" experience. The program leader was the Health Initiative Specialist with assistance and advisement from the ED Director of Patient Care. Participants included nurses new to the United States, newly graduated nurses and nurses new to the specialty. Registered nurse vacancy and turnover rates, nurse litigation expenses and orientation time were measured before and after the initiation of the program. The program resulted in reduction in vacancy rate from 37.33% to 9.30%, turnover rate from 17.89% to 9.38%, nurse litigation expenses from 2.425 million to zero and a 50% reduction in orientation time This model can help to minimize the anxiety associated with inexperience and fear of causing harm to actual patients and will help new grads increase their decision-making skills and aid in integration of knowledge. It can allow facilities to develop nurses at a higher level to manage the increased complexities of patients, decrease vacancy and turnover rates and reduce overall costs.

  • - WD-OR27B Improving New Graduate Nurse Retention: Results of a Ten-Year Study: This presentation summarizes the results of data collected from over 5500 new graduate nurses who have completed the 18-22 week RN Residency developed by Versant and adopted at their organizations over the past ten years. The RN Residency is a structured, evidence-based new graduate nurse immersion residency that includes application-driven curriculum, guided clinical experience, looping, and dedicated mentoring and debriefing/self-care. The purposes of the RN Residency are to facilitate transition into the professional RN role, accelerate the development of competence and self-confidence, and increase the retention of new graduate nurses. Outcomes of the RN Residency are measured using a wide variety of metrics including turnover at 12, 24, 36, and 60 months; organization ROI; 13 reliable and valid instruments that measure metrics as nurse satisfaction, organizational commitment, empowerment, nurse autonomy, turnover intent, group cohesion, and self-confidence; competency assessment; residency evaluations, etc. Data for the new graduates in the RN Residency is collected at various points throughout and following the RN Residency. Analyses performed for this presentation included data reduction and multiple imputation, correlation matrix analysis, generation and inspection of descriptive statistics for demographic variables as well as each scale and subscale and regression analysis. A correlation analysis was performed to obtain significant correlations between the variables of interest and turnover intent. Mean results for the RN Residency graduates were analyzed across time and compared to the organizational comparison groups. The results indicated an increase in competence and self confidence across the immersion portion of the RN Residency which generally exceeded the mean results of the organization comparison groups. Longitudinal turnover rates were a 12 month turnover of 7.1% and a 24 month cumulative turnover of 19.6%. The results of a qualitative analysis indicated that there are also a number of areas of positive organizational impact. The results of this longitudinal study present persuasive evidence that both new graduate nurses and their organizations benefit from the implementation of a structured residency. This presentation describes the results of this ten-year study.

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A Statewide Assessment of the Principles and Elements of a Healthful Practice/Work Environment
WD-OR28

Speaker(s) : Elizabeth T Beaudin , Sue Fitzsimons

  • In January of 2008, the Connecticut Hospital Association (CHA) launched the Hospital Nursing Workplace Environment Assessment Project. The purpose of the project was to ascertain nurses’ perceptions of their hospital workplace environments on a statewide basis, to utilize this information toward strengthening hospitals’ ability to meet key workforce advocacy goals, and to collaborate with AONE in piloting survey questions based upon the Principles & Elements of a Healthful Practice/Work Environment. Of 35 invited hospitals, 20 participated in the web-based Hospital Workplace Environment Assessment Survey that enabled staff registered nurses to submit responses directly and anonymously to CHA. Data from over 2000 surveys completed by staff RNs were analyzed and results reported for individual hospitals and the statewide aggregate. Survey results demonstrated hospital work environment strengths such as staff RN pride in work and hospital, ability to make meaningful contributions to nursing practice and provide quality patient care, work life balance and teamwork. Low scoring areas included involvement in decision-making related to nursing practice and allocation of resources. CNOs of participating hospitals discussed survey findings and planned statewide activities to address them including a Day of Sharing scheduled for September for nursing leaders and staff to share best practices for creating and maintaining healthful work environments. This statewide project has fostered a collective initiative of collaborative learning toward improvement of the work environment, rich dialogue among CNOs, and the ability to meet workforce advocacy goals. States, regions, or chapters might choose to adopt this assessment model to maximize learning and outcomes in their work environment improvement initiatives.

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Creating a More Highly Educated Nursing Workforce: A Model for the Future
WD-OR32

Speaker(s) : Dianne Cooney Miner , Deborah T Zimmermann

  • Advances in science and increasing patient complexity have accelerated the need for nurses with the knowledge to manage a challenging healthcare environment. The American Association of Colleges of Nursing, the National Advisory Council on Nursing Education and Practice, and AONE has called for baccalaureate preparation of registered nurses. Over the last four years, New York leaders and educators have made strides in the implementation of a comprehensive plan which may be duplicated nationwide. This five pronged approach includes: standardizing education requirements, providing seamless transition from associate degree to baccalaureate nursing programs, reducing financial barriers for education, increasing nursing faculty, and lastly, centralization of workforce indicators. Modeled after teacher preparation, legislation to revise the Nurse Practice Act currently is in the Higher Education Committees of both the Senate and Assembly. When passed, nurses must obtain a baccalaureate degree in nursing within ten years of completing an associate’s degree. Key to gaining support from stakeholders has been a unified message and collaborative approach among the NYS nurses association, Deans of nursing, the State Board of Nursing, and nurse executives. The NYS Deans have introduced a standardized statewide articulation agreement, proposed adoption of the AACN Essentials of BS Education, and like the state of Oregon, are piloting concurrent admission into AD and BS programs. Plans are underway to institute a multi-million dollar endowment for nursing and faculty scholarships. Since coordination of data management will improve forecasting and planning, the State Board for Nursing and the NYS Institute for Nursing are creating shared databases for research and policy making. This collaborative model responds to the need for nurses who are expert in the care of complex patients across the continuum. The challenges, obstacles, and successes of the strategy may be used by leaders in all states in advancing the profession through an investment in education.

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New Graduates
WD-OR34

Speaker(s) : Carol Brewer , Christine T Kovner , Renee Thompson

  • - WD-OR34A New Nurses Experience with Quality Improvement: In the fall of 2008 we used a cross-sectional mailed survey design, to ask new hospital nurses (licensed between 2 and 4 years prior to the survey) to respond to questions about their Quality Improvement (QI) education in their prelicensure nursing programs and their participation in QI activities at the hospitals in which they worked. Respondents (n = 460) (response rate = 69.4%) are a sub-sample of participants in a nationally representative panel survey of new nurses. Fully 38.6% of new nurses thought they were “poorly” or “very poorly” prepared, or “have never heard of quality improvement.” When asked about specific QI techniques such as root cause analysis almost 50% thought they were “not at all prepared.” Baccalaureate prepared new nurses reported higher levels of preparation than associate degree students in several QI areas: evidence-based practice, assessing gaps in practice, data collection, analysis, measurement, team work and collaboration, and measuring resulting changes. When asked about their participation in QI activities over the past 12 months, there were no differences in responses by educational preparation. Remarkably, 28.1% never “assessed gaps in current practice” and 46.2% never “participated in QI processes.” These findings are consistent with the IOM’s claim that health professionals, including nurses, are not adequately prepared to provide the highest quality of care. Nursing education accrediting organizations emphasize QI education in curricula; however, these findings suggest the content is either not adequate or is underemphasized. Health organizations and academic nursing programs could work together to provide QI activities for nursing students. In the short term organizations may want to assess new nurses’ knowledge and skills in QI and provide opportunities for these nurses to obtain the knowledge and skills needed.

  • - WD-OR34A New Nurses Experience with Quality Improvement: In the summer of 2008, UPMC launched a new system-wide Summer Student Nurse Internship Program: This program incorporates student nurses from both the local and national markets. Knowing that acute care facilities expect the graduate nurse to “hit the ground running” upon hire, enhancing their skills during an intensive 11-week program affords the students the ability to become more ready for practice upon graduation. Negative implications on the financial stability of the healthcare institution can influence decisions to reduce orientation time across the board leaving new graduates to struggle through new environments with little support. A student nurse internship program can address current issues in hiring top notch candidates that are more prepared upon graduation with reduced orientation time and costs. Return on investment includes, 1) increased student exposure to UPMC as a highly desired place to work post graduation, 2) increased exposure to UPMC beyond western Pennsylvania, 3) increased confidence of students nurses which results in improved patient outcomes, 4) decreased orientation times for student nurses transitioning to graduate nurses on same unit, 5) opportunity to identify and actively recruit the top students, 6) opportunity to identify current student nurses that do not meet the performance expectations within the vision of UPMC Nursing. The success of the 2008 program led to its expansion in the summer of 2009. Word of mouth from former student interns, an aggressive marketing campaign and the benefit of working in a large healthcare system lead to a significant increase in applications for the 2009 program. The competition for positions was high this year leaving many viable candidates without an internship. Having the ability to choose the best and the brightest for an internship can significantly increase the opportunity to select and retain top performing graduate nurses.

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Clinical Nurse Leaders: Clarifying the Role
WD-OR35

Speaker(s) : Heather M. Monaghan , Diana Swihart

  • WD-OR35B Healthcare Transformation, Patient Safety and Quality - The Clinical Nurse Leader Role: What it is and What it is not - A Model for Application to Practice: This presentation will 1) explore the development of the CNL role, 2) describe how organizations are engaging CNLs, and 3) discuss what opportunities lie ahead for building inter-professional partnerships that can eventuate in even greater patient safety and quality care outcomes. The IOM Committee on the Health Professions Education states, “All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics information, to coordinate a variety of care experiences, to use technology for health care delivery and evaluation of nursing outcomes, and to assist clients with managing an increasingly complex system of care.” The clinical nurse leader (CNL) is educated to be a clinical leader in nursing practice across all settings of the health care delivery system and specialize in patient safety and quality care outcomes related to performance improvement measures. Communication with physicians, physical therapists, social workers, pharmacists, quality systems, and direct-care nurses who provide services to the same client(s) in multiple settings can be complicated. Disruption in the ongoing inter-professional and interdisciplinary team communication can result in discontinuous and frequently unsafe, uncoordinated, inappropriate care. The CNL is a critical link to healthcare providers and point-of-care patient safety and quality outcomes. Many organizations struggle with knowing how best to utilize CNLs at the bedside. Confusion around the roles and responsibilities of the CNL in context with other advanced practice nurses and case managers has limited the potential impact on patient safety and quality these nurses bring to their practice settings. Clarity begins with nurse leaders.

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