110-19 Quality care close to home. j^SPRING VALLEY HOSPITAL,,.
MEDICAL CENTER
The Valley ' Health System'
October 23,2018
Legislative Committee on Healthcare
To Whom It May Concern:
Pursuant to Chapter 449 of the Nevada Revised Statuses, Spring Valley Hospital Medical Center, a 358 bed licensed hospital in Clark County, Nevada is enclosed the required elements of the bill.
The hospital established a Staffing Committee on August 27,2009 and prepared a policy outlining the establishment, activities and progress, and measurement of efficacy of the Committee. We added a certified nursing assistant to the committee on September, 2013. Enclosed is the Committee Report describing the activities and resolutions of issues brought forward which determines the efficacy of the Committee. The Committee consists of not less than one-half of its total members from the licensed nursing staff as well as a certified nursing assistant and another half of those appointed by Administration. Thank you for your review of the enclosed report.
Sincerely,
Patricia Gilliano, MSN/MBA CNO Chief Nursing Office cc: Leonard Freehof, CEO
Attachment Staffing Committee Report Staffing Plans Policy
5400 South Rainbow Boulevard • Las Vegas, Nevada 89118 Telephone (702) 853-3000* Facsimile (702) 853-3340 STAFFING COMMITTEE REPORT
HOSPITAL NAME: Spring Valley Hospital Medical Center 5400 South Rainbow Blvd. Las Vegas, NV 89118
TITLE OF INDIVIDUAL RESPONSIBLE FOR COMMITTEE Chief Nursing Officer
TELEPHONE NUMBER: (702)853-3332
DATE COMMITTEE WAS INITIATED: August 27, 2009
MEMBERS IN ATTENDANCE: Sign-in sheetson site
COMMITTEE MEMBERS: Consists of Registered Nurses, Imaging technician, Emergency Room technician, Certified Nurse Aides, Unit Coordinators, Administration Coordinator
COMMITTEE ACTIVITIES: The Staffing Committee has been set up in accordance to SB 362. Forthe year 2018, the Committee
• Discussed methods of improving patient care
• Analyzed Staffing Despite Objection Forms (SDO)
• Considered the number of refusals and objections to work assignments, reviewing the why and examining trends
• Reviewed the timeliness of response to licensed nurse/certified nurse aide requests
• Considered patient load issues
• Examined issues related to floating staff to other areas
• Reviewed staffing plan
• Continued quality initiatives related to nursing care
• Discussed relevant hospital updates
• Maintained recognition and reward for staff
o DAISY Award
o STAR Awards
MEETING SCHEDULE: The Staffing Committee is scheduled to meet quarterly the first week of the month as noted on Ecalendar with invites out to all members for the 2pm meeting. STAFFING COMMITTEE EFFICACY: The Staffing Committee established on August 27, 2009 has been effective in reviewing and resolving issues in a collaborative manner. U sing data presented through SB482 and Staffing Despite Objection (SDO) Forms, initiatives have been put in place to assist with patient load and staffing. Certified Nurse Aides have been cross-trained as Unit Coordinators, and mid-shift Certified Nurse Aides were implemented to supplement staffing during the busiest part of the day. To improve employee morale, recognition boards have been placed on each department to help expand awareness and employee engagement. A Coffee Shop has been opened in the hospital lobby to improve the patient and staff experience.
SIGNATURE OF RESPONSIBLE PARTY:
Patti Gilliano MSN/MBA CNO Chief Nursing Officer
SIGNATURE OF STAFF MEMBER OF COMMITTEE:
SIGNATURE OF STAFF MEMBER OF COMMITTEE: POLICY
Title: Refusal to Work Assignment
Location: Spring Valley Policy Number: Page: 1 of 4
Department of Document Owner: NURSE ADMIN Original Effective Date: 10/2013 Last Review Date: 3/2018 Last Revision Date:
Section: Clinical Practice (HW)- General Nursing
I. SCOPE:
Nurse Division
II. PURPOSE:
To provide a systematic method for reviewing the circumstances under which a licensed nurse or certified nursing assistant may refuse a work assignment.
III. POLICY:
It is the policy of Spring Valley Hospital Medical Center that:
A. A licensed nurse or Certified Nursing Assistant (CNA) refusing an assignment will communicate specific conditions concerning the request in the following manner: • Will report to his or her immediate supervisor or person in charge, in writing, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient as defined in NRS 449.205 Section 1, Subsection 1(b), as verified by documentation in the personnel file of the licensed nurse or CNA - concerning his or her competence to provide various nursing services to the patient, unless the refusal constitutes unprofessional conduct as set forth in Chapter 632 of NRS or any regulations adopted pursuant thereto. • Will provide prior notice to the immediate supervisor or person in charge of the licensed nurse or CNA prior to accepting an assignment. • If a licensed nurse or CNA is assigned a position or task for which he/she feels unqualified or unsuited, he/she should immediately express such concerns to the immediate supervisor or person in charge. • The immediate supervisor will assess options and then seek to remedy the situation. • If no possible alternatives are identified, the immediate supervisor, or person in charge will contact his/her Manager/Director. • The Manager/Director will review the written request and attempt to resolve the situation utilizing available resources he/she determines appropriate • All refusals filed will be reviewed by the staffing committee at the quarterly meeting to determine trending . Policy Title: Refusal to Work Assignment Page: 2 of 4
B. The supervisor may approve or deny the request • Approval of request The licensed nurse/CNA will be relieved of his/her assignment • Denial of request If the supervisor fails to approve the request without proposing a remedy, or a remedy is proposed but inadequate or untimely, the licensed nurse or CNA can file a formal complaint with the Health Division within (21) business days of the refusal if the licensed nurse/CNA feel, in good faith, the refusal meets the condition of the written policy for refusal of assignment. The supervisor, Manager or Director has (14) days to investigate and provide a written response to the licensed nurse/CNA. A copy of the investigation will be submitted to the Staffing Committee. The refusal will be reviewed by the Staffing Committee members quarterly and a written response will be provided to the licensed nurse or CNA.
C. The facility shall: • Maintain records for at least two years of each request to be relieved of a work assignment, and refusals of a work assignment made by a licensed nurse or CNA. • The facility shall provide to the staffing committee the number of requests to be relieved from work, refusals of a work assignment and objections to a work assignment. • The facility shall provide to the staffing committee an explanation of how the requests, refusal and objections were addressed. • Ensure compliance with the written policy.
D. The facility shall not retaliate or discriminate unfairly against employees and certain other person’s as defined in NRS 449.205. Policy Title: Refusal to Work Assignment Page: 3 of 4
Refusal of Work Assignment Form
Instructions:
A licensed nurse or Certified Nursing Assistant (CNA) refusing a work assignment is encouraged to communicate this concern in the following manner:
A. Report in writing to his or her immediate supervisor or person in charge, that he or she does not possess the knowledge, skill or experience to comply with an assignment to provide nursing services to a patient as defined in NRS 449.205, Section 1, Subsection 1(b). This would be verified by documentation in the personnel file of the licensed nurse or CNA – concerning his or her competence to provide various nursing services to the patient, unless the refusal constitutes unprofessional conduct as set for in NAC 632.890, or any regulations adopted pursuant thereto. B. Will provide notice, prior to accepting an assignment, to the immediate supervisor or person in charge of the licensed nurse or CNA at the time of the objection. C. If a licensed nurse or CNA is assigned a position or task for which he/she feels unqualified or unsuited, he or she should immediately express such concerns to the immediate supervisor or person in charge. D. The immediate supervisor or person in charge will assess options and then seek to remedy the situation to relieve the licensed nurse or CNA from their work assignment E. If no possible alternatives are identified, the immediate supervisor or person in charge will contact his or her immediate supervisor on duty. F. Documentation of the “Refusal of Work Assignment” will be submitted to the staffing committee for review G. The nursing supervisor will review the written request and attempt to resolve the situation utilizing available resources he/she determines appropriate. H. If the nursing supervisor fails to approve the request without proposing a remedy, or a remedy is proposed but inadequate or untimely, the licensed nurse or CNA can file a formal complaint with the Health Division within 21 business days from the date of refusal, if the licensed nurse or CNA feel, in good faith, the refusal meets the condition of the written policy for refusal of assignment. Timeframe for Action
Nurse or CNA Supervisor Staffing Committee Timeline At time of objection 14 Days Quarterly Action File Complaint with NSHD, Investigate Review and examine complete Refusal of Work trends for Assignment Form with effectiveness and copy to Supervisor and quality improvement Staffing Committee Await response Respond to Nurse/CNA Respond to Nurse/CNA Policy Title: Refusal to Work Assignment Page: 4 of 4
Refusal of Work Assignment Form
I, a licensed nurse/CNA at (Name) (Hospital) on , _, hereby refuse to the assignment as: (Shift) (Date) o charge nurse o licensed nurse o Certified Nursing Assistant o other
In my professional opinion, the situation described here is not adequate to meet the needs of the patients assigned to me at this time.
My reason(s) for refusal to this work assignment are:
Brief statement of issue(s):
Those I notified about my refusal to this assignment:
(Signature) (Date/Time) (Home Phone Number)
Attention: Complete this form and have it signed by your immediate supervisor and fax to the Chief Nursing Officer at (702)_853 ‐_3340 . Provide one copy to your immediate supervisor or manager/director.
(Supervisor’s Name) (Supervisor’s Title)
(Action Taken)
(Supervisor’s Signature) (Date/Time)
(Chief Nursing Officer) STAFFING COMMITTEE MEETING January 30,2018 Present: See Attached Sign-In Sheet Agenda Item Action Responsible Completed (C) Bring Back (B) Introduction of Staff Roundtable introduction of all committee members present.
Staffing Committee Expectations In accordance with SB362, the staffing committee must Staffing (C) consist of not less than one-half of the total members from Committee the licensed nursing staff and certified nursing assistants Members who are providing direct patient care at the hospital. Meetings ‘must held at least quarterly. An overview of the December meeting was discussed and noted that the meeting schedule was distributed to all and posted in the glass case at the employee entrance. At least one elected member must attend. Elected alternate may attend, but please advise Patti if not able to attend. Review of Policy The Staffing Plans policy was distributed again for review Staffing (B) and to ensure understanding of staffing of the unit. The Committee ‘ staffing guidelines help drive what occurs in the Members department. Any questions, discuss with Director/Manager of department. High census and overflow was discussed. Over capacity is reported to the state. Current construction may be completed earlier than anticipated and this should improve overflow issues. • Review of Assignment Despite The Assignment Despite Objection Form was discussed Staffing (C) Objection Forms and reviewed. The form sets forth the circumstances under Committee which a licensed nurse or certified nursing assistant may Members refuse or object to a work assignment. The form must be completed and discussed/signed with department Director and turned into Administration for review at Staffing Committee Meetings. Agenda Item Action Responsible Completed (C) Bring Back (B) Open Discussion © Staff Vacancies — Patti discussed last year’s deficit in Patti Gilliano (C) staff and current open positions. She noted Department Directors, Managers and House Supervisors are available resources for any issues.
• PACU — Availability of resources in P ACU was Staffing (B) discussed (# of properly configured WOWs, no Committee speakers for WOWs, patient education in Pre-Op for Members open heart surgery, difficulty in completing LMS assignments on WOWs without speakers). Patti will follow-up with IT regarding speakers. Patti Gilliano (B) . Patient education to be trialed on iPads (reiterated that they cannot be lost/misplaced) and discussed at next meeting. Television education preview for Spring Valley coming in the near future (has been approved at Valley Hospital).
® Unit Clerk training for CNAs was discussed. Staff was Staffing. (C) advised to discuss with department Director/Manager Committee to request cross-training. Members
® CNAs/Sitters - Research has shown sitters do not Information only. (C) prevent falls. Staff advised to enlist the aid of family members or other resources to assist when patients need sitters.
• Mid-shift CNA is being trialed on some units to assist Department (B) during peak hours. Assessed on a day to day, case by Directors / case basis. Managers
® Coffee Shop is coming to Spring Valley in Information only. approximately 8 — 10 weeks and will be located at the main hospital entrance. Agenda Item Action Responsible Completed (C) Bring Back (B) ® The next Staffing Committee meeting will be Monday, Staffing March 5,2018,1:00p.m. Committee Members
Respectfully submitted,
Patricia Gilliano, CNO STAFFING COMMITTEE MEETING March 5,2018
Agenda Item Action Responsible Completed (C) Bring Back (B) Staffing Despite Objection Form Assignment Despite Objection forms were reviewed: Review 1. Unit was short nurses, only staffing option was to (C) remove RN from orientation and given patient assignment of 3 patients.
Clinical Supervisor and Manager were informed of assignment despite objection. RN on orientation was an experienced Med/Surg nurse (new to 1MC), completed Critical Care course, EKG course, had enough orientation days to be off orientation, was provided additional days of orientation and would normally have been off orientation and independent by then. Assignment was located between preceptor and another helpful, experienced RN for support.
2. RN assigned 3 level 3 patients, felt too high of an acuity to practice safely. Patients not located together and other RN assigned that was partnered with, did not have patients in same location. 3 Level 3 nurses were cancelled, RN felt that could have made this and everyone clse’s assignments lighter as well as safer.
Assignment was made with staffing guidelines in mind. (C) Assignment had been 3 baby assignment for past several days with exception that previous day/night acuity allowed for two baby assignment but was Erst admit. Assignments were in beds #6, #7 and #9. RN POD mate had beds #7, #10 (in same space) and bed #12 (directly in space behind POD and within steps). Charge Nurse also shared POD space, located directly in front of the POD with beds #7 - #10. Previous RNs with same assignment had no safety issue complaints. Oncoming Charge RN offered to trade Agenda Item Action Responsible Completed (C) Bring Back (B) one of her patients but offer was rejected as feeling was that there should not be 3 level 3 babies together as an assignment. Charge RN ended up taking baby in bed #6 after first round of care. Committee Requirements Review Staffing Committee representatives were elected from each (C) department. Commitment required to attend every quarterly Staffing Committee Meeting. The next meeting is June 4,2018 Agenda Items by Staff for Staff Staffing Committee representatives should bring any (B) staffing issues/concems from their department(s) to each meeting. Send agenda items to Norma Gallardo (Norma. [email protected]). Follow-Up Current Staff Vacancies - 30 hospital wide. (Q
Cath Lab Call Schedule: Monday through Friday plus call. Patti to discuss (B) with Ryan, Ken Patient transfer from Cath lab to PACU holding. and House Supervisor.
Kudos - Zoe helping out, while working at desk, help feed (Q another CNAs patient.
Kudos - Kenny’s patients are always ready, always set. (C) Open Discussion
Daisy/Caring Hands Nominations Please submit nominations for Daisy/Caring Hands (C) Awards.
Recognition Boards Recognition boards are displayed on each unit for (C) recognizing staff and work done on unit.
Translation Webcam for IMC Translation phones don’t work and don’t reach three back Tosha/Carrie (B) rooms on unit. working on getting repaired. Agenda Item Action Responsible Completed (C) Bring Back (B) New Construction 3rd Floor is supposed to be done as early as June. Ortho (B) will move to 3rd floor, existing Med/Surg to be renovated.
Respectfully submitted,
Patricia Gilliano, CNO STAFFING COMMITTEE MEETING June 4,2018
Agenda Item Action Responsible Completed (C) Bring Back (B) Minutes Review Staffing Committee minutes from March 5,2018 were Committee (C) reviewed and approved. members.
Staffing Despite Objection Form None submitted. Patti noted the purposed of the Staffing Committee (C) Review Despite Objection Form is to provide staff the opportunity members. to discuss how staffing/assignment decision is made. Staff completing form should also discuss staffing/assignment with department Director and/or Manager. Committee members were asked to ensure staff members know where form is located on their unit Openings Patti discussed current construction and anticipated Med/Surg Nurse (C) completion date of last week in July/first week in August. Leaders Ortho will be moving to new 3rd floor, 3rd floor will move to Ortho while old 3rd is being renovated. 4th will move to new 4th floor area while old 4th floor is being renovated. ICU will be renovated (date TBD). Plan is being developed to staff new units (extension of Med/Surg), i.e. Job Fairs. Leadership Announcements Patience (Pat) Walker started today. Transition in Carolyn Hafen (C) leadership, Carolyn Hafen will be the Director of Critical Came Rocco Care Services (Interim ER/ICU), Carrie Rocco will manage ICU, Telemetry (Interim). Staffing Coordinator Update Jessica Andes is the full time Staffing Coordinator. Information only. (C) Candice Vega has resigned but will continue working per diem on some Saturdays. In the interview process for part time Staffing Coordinator. Quality Training Nice job understanding CLABSI/CAUTI/Sepsis. Fallouts Committee (C) will be meeting with Patti, Quality representative, Director members. and/or Manager. Learning process to encourage better understanding for staff. Counseling will be done if education process cannot be corrected after meeting. Agenda Item Action Responsible Completed (C) Bring Back (B) CNO Coffee is held the 3rd Wednesday of every month. Information only. (C)
Respectfully submitted,
J -f
Patricia Gilliano, CNO STAFFING COMMITTEE MEETING September 10,2018
Agenda Item Action Responsible Completed (C) Bring Back (B) Minutes Review Staffing Committee minutes from June 4, 2018 were Committee (C) reviewed and approved. members.
Staffing Despite Objection Form Staffing Despite Objection Forms and responses were Committee (C) Review reviewed for: members. • Jeffery Smith - 8/14/18 • Stephanie Gordon - 8/8/18
Openings Patti discussed filling several positions. Open positions are Med/Surg (C) being filled as needed. Nita Mathew, Recruiter will be out Nurse Leaders of office for two weeks, submit open positions to fill as soon as possible. Leadership Announcements Leadership of Dialysis, OBS and Psych has been Pam Clancy (C) restructured. Pam Clancy (Ortho and Dialysis); Gladys Gladys Easterling Easterling (3rd Floor, OBS and Psych) Staffing Coordinator Update Spring Valley currently has three Staffing Coordinators, Information only. (C) one full time, one part time and one per diem.
Quality Training Spring Valley Hospital has gone 54 days without CLABSI, Committee (C) 53 days without CAUT. Indicators are starting to look members. good but will not show until 18-24 months in the future. Falls have been in the green for two years. The goal is to have no falls. Efforts are being made toward staff understanding and critical thinking, not to just check the box. Patient Experience Update HCAHPS scores are trending well. Sometimes/Usually Committee (C) responses caused the scores to dip in August. Staff to members. continue to explain medications, use and side effects to patients. Validate with every patient/every day. Rounding needs to be purposeful, during handoff - try not to let anyone fall through the cracks. Agenda Item Action Responsible Completed (C) Bring Back (B) Shared Governance Update Shared Governance Committee will host an Open House Committee (C) for their next meeting. This is a great way to get involved, members. encourage other staff to become involved.
Turnover Turnover is down this month, 27% in June, 28% in July, Information only. (C) 15% in August. The goal is 15% turnover and we are working to get to 10%.
Respectfully submitted,
Patricia Gilliano, CNO Staffing Committee Elected Members:
Cath Lab Ashley Buckmister, Imag. Tech
Cath Lab Meagan Chastain, RN
ED Kenneth Davis, RN L&D Vanessa Bosco, RN
ED Jennifer High, RN L&D Danielle Ambrose, RN
ED Omar Urbina, ED Tech NICU Cathy Cabuhat, RN
ICU Chrisopher Martinez, Admin NICU Theresa Goudeau, RN Coordinator NICU Cissy Hannold, RN ICU Darla Manning, RN NICU Josh Williamson, RN IMC June Hilliard, RN OB Wendy Dooher, RN IMC Rey Ines, UC/CNA
2W Don Holman, RN
2W Porsche Love, CNA
M/S 4 Cody Leslie, RN
M/S 4 Kirstie Neilson-Radel, UC/CNA
3N May Riel, RN
3N Julia Sierra-Sanchez, UC/CNA
OR Mariane Reyes, RN
OR Mike Streva, RN
Ortho Whytny Coller, RN
Ortho Camdra Garcia, RN
Ortho Zachary McBride, CNA
Rehab Christina Mont, RN
Rehab Rowena Gapasin, RN