Rush Oak Park Hospital Rush Oak Park Hospital 2017 Nursing Annual Report

WE ARE RUSH OAK PARK HOSPITAL RUSH OAK PARK HOSPITAL 2017 NURSING ANNUAL REPORT

OAK PARK HOSPITAL

2017 NURSING ANNUAL REPORT WE ARE RUSH OAK PARK HOSPITAL WE ARE INNOVATIVE PATIENT & FAMILY FOCUSED CARE THAT SUPPORTS & SUSTAINS WELLNESS TABLE CONTENTS

FOUNDATION OF NURSING EVIDENCE-BASED PRACTICE 2 Our Professional Practice Model 10 GETTING AHEAD OF IT Student clinical rotation model

CNO’S NOTE 3 REVOLUTIONIZING OUR ROLES CRITICAL THINKING 12 CONNECTORS IN CHIEF The CNL role catalyzes the team & outcomes THE NPGO LEADERSHIP 4 EMPOWERING STAKEHOLDERS TECHNICAL EXPERTISE 14 IMPROVING BEDSIDE HANDOFF WE ARE NPGO Transforming patient safety 5 Nursing Professional Governance Organization LEADERSHIP 16 RESPONDING TO THE OUR EXCELLENCE JOURNEY TRANSFORMATION 6 Our nurses, our facility, our interventions & institution-wide awards OF HEALTH CARE Ambulatory role growth & NSI work updates

RELATIONSHIPS & CARING 8 COMPASSION IN PRACTICE 17 DEMOGRAPHICS Community partnership to improve health awareness & BEST PRACTICES

FOUNDATION OF NURSING OUR PROFESSIONAL PRACTICE MODEL Rush Oak Park Hospital’s Professional Nursing Practice Model is ps ionshi and C a picture of our practice identity. Relationships and Caring lat arin Re g encircle and support all that we do as ROPH nurses. Supported by and through this, Technical Expertise, R e s y p Evidence-Based Practice and Critical Thinking work it e c iv Critical t it in synergy to propel us as nurses towards Leadership s n Thinking e S of the complex healthcare environment to meet the needs of our patients and the environment.

Leadership

Technical Evidence C Based o Expertise l Practice l a n b o i o t r a a c t i io n n u m m o C

Int e entional Presenc

2 TABLE OF CONTENTS RUSH OAK PARK HOSPITAL CNO’s NOTE

REVOLUTIONIZING OUR ROLES

rofessional nurses at Rush Oak Park Hospital (ROPH) are revolutionizing their roles in our care delivery model. Taking a lead in popula- Ption management, Clinical Nurse Leaders (CNLs) have expanded their responsibilities to include case management of individual patients, development of complex care plans to optimize care as a means of avoid- ing 30-day readmissions and improving nursing knowledge in all facets of nursing care. Nurses promote nursing excellence through proactive assessment of quality care, retrospective audits of performance, and peer assessments of professional practice. It is exciting to watch the ownership of nursing professional practice as embraced by the Nursing Professional Governance Organization (NPGO). The voice of the front-line nurse caregiver is as valued as any nurse in any specialty area including the Chief Nursing Officer (CNO). I delight in the respect garnered by the ROPH nurses in prob- lem-solving processes while working in concert with physicians and ancillary departments. I revel in the community recognition of ROPH nurses, be it in teaching healthy lifestyles, providing health screening in clinics, or packaging food for the food pantry. ROPH nurses use loving care in practicing their profession in all settings. That loving care has brought an unprecedented number of patients to our Emergency Department while maintaining shortest wait times, high patient satisfaction and best practice management of stroke and cardiac events. Subsequently, to expand our role in cardiology care, we are now the home for the Rush system Cardiac Rehabilitation Program. Nurses are active in planning a new Emergency Department. The NPGO is innovative in recognizing and supporting the need for more clinical sites for colleges of nursing on a 24/7 basis. NPGO is capitalizing on the 14% MSN-educated bedside RNs to offer clinical instructors who are current, relevant and available for those clinical rotations. ROPH nurses are unique and insightful as they innovate to meet the impending healthcare demand for more nurses and intervene for the future care needs of our community. ROPH

Karen Mayer PhD, RN, MHA, NEA-BC, FACHE Vice President of Patient Care Services, Chief Nursing Officer

2017 NURSING ANNUAL REPORT CNO’S NOTE 3 THE NPGO LEADERSHIP

EMPOWERING STAKEHOLDERS t is no surprise that the theme of nursing excellence has continued this past year at Rush Oak Park Hospital. I After receiving the ANCC ® Magnet Designation last year, ROPH nurses didn’t rest on their laurels. Our nurses recognize the importance of diligence in improving nursing practice and providing excellent care. They demonstrated this com- mitment by again receiving the Gold Seal of Approval THE JOINT from the Joint Commission for inpatient diabetes COMMISSION care. With this latest approval, ROPH nurses INPATIENT DIABETES can boast a decade of excellent nursing care CERTIFICATION in diabetes. In addition to this notable achievement, our nurses remain committed to improving our practice at the bedside through unit-based education, unit and hospital quality improvement projects and interdisciplinary collaboration. Despite the pursuit of excellence, gaps in nursing care can occur. Our nurses don’t shy away from these challenges. To address these nursing practice concerns, task forces are created. Professional Governance at Rush Oak Park Hospital supports these initiatives, which empowers all nurses to be stakeholders in the care they provide. Our nurses have remained committed to excellence outside the walls of Rush Oak Park Hospital by improving the health of our community. Our nurses volunteer their time by providing blood pressure screenings at food pantries and healthcare education for the homeless population at Housing Forward. Our nurses can be seen distributing water and providing first aid at local foot races. Coat and book drives are organized and provide vital resources to vulnerable populations within our community. We, the ROPH nurses, celebrate a year of many successful accomplishments. As we continue our journey of excellence, we remember that the well-being of our patients and families is at the center of all we do. ROPH

Colleen Chierici BSN, RN President-Elect NPGO

4 THE NPGO LEADERSHIP RUSH OAK PARK HOSPITAL WE ARE NPGO

WE ARE NPGO NURSING PROFESSIONAL GOVERNANCE ORGANIZATION

EVERY NURSING HOW IS NPGO PRACTICE AREA ORGANIZED? IS REPRESENTED

Rush Oak Park Hospital EXECUTIVE Board of Directors & President/CEO COMMITTEE REPS President, President Elect, 3Center, 6West, Ambulatory Clinics, APNs, Cath Lab/IR, CNL, CNO, Employee Health, Endoscopy, ER, ICU, Chief NPGO Nursing Practice, Nursing Supervisors, OR, Nursing President PACU, Quality, Rehab, Same Day Surgery, Skilled Officer Care Unit, Telemetry and Wound Care Clinic

NPGO STANDING COMMITTEES Peer Review Council, Evidence-Based Practice NPGO Nursing & Research, Education, Clinical Standards of Executive Administative Practice and Care, Staffing Nurse Advisory Committee Committee Board, Magnet Stars, Awards and Recognition, APN Practice Council, Nursing Excellence

NPGO UNIT/SPECIALTY AREA COMMITTEES NPGO NPGO Unit/ 3Center, 6West, Ambulatory Clinics, Cath Lab/ Standing Specialty Area IR, Endoscopy, ER, ICU, New Grad Float/ Committees Committees Resource, OR, PACU, Rehab, Same-Day Surgery, (UACs) Skilled Care Unit, Telemetry, Wound Care Clinic

Autonomy has, as its basic components, personal accountability, shared power and influence. An autonomous nursing staff is feasible. It is professionally exciting. It cannot be done for nurses; it must be done by them. (Christman, 1976)

2017 NURSING ANNUAL REPORT WE ARE NPGO 5 OUR EXCELLENCE JOURNEY

OUR NURSES

REGISTERED68 NURSE 1 CLINICAL11 NURSE ADVANCED15 PRACTICE LEADERS REGISTERED NURSES

REGISTERED107 NURSE 2

NURSING20 27NURSE 294NURSES ADMINISTRATION SPECIALISTS REGISTERED46 NURSE 3

EDUCATION CERTIFICATIONS PROFESSIONAL BOARD ORGANIZATIONS MEMBERSHIPS

NURSES69% WITH BSN 54% NURSES54% INVOLVED

NURSES 14%WITH MSN OR HIGHER NURSES CERTIFIED ORGANIZATIONS57 12 NURSES

OUR FACILITY

TURNOVER RATE 89,170 >25% visits IN 2007 DURING 2017 7.3% 140 ALL-CAUSE STUDENTS FACILITATED READMISSION FROM FOUR DIFFERENT 237 RATE ACADEMIC LICENSED BEDS 9% PARTNERS ON-GOING ONE REGISTERED RESEARCH STUDIES NURSE VACANCY 9 percent

6 OUR EXCELLENCE JOURNEY RUSH OAK PARK HOSPITAL 10 RUSH OAK PARK 2017 HOSPITAL NURSING ANNUAL REPORT

OUR INTERVENTIONS

CAUTI CLABSI HAPI FALLS 9.2% 2.3% 24% IN 2007 IN 2007 IN 2007 INJURY 0% 1.38% 0.76% 1.03%

AMBULATORY NURSE CORE MEASURES NURSING SENSITIVE INDICATOR CHF, AMI, VACCINES, SCIP ENGAGEMENT WCC, ENDO, SDS, CCL/IR OUTPERFORMING OUTPERFORMING ALL BENCHMARKS 100% BENCHMARKS COMPLIANCE ON ALL MEASURES IN 17/18 AREAS INSTITUTION-WIDE AWARDS

ANCC CENTERS OF CENTERS OF MEDICARE & MEDICAID MEDICARE & MEDICAID SERVICES (CMS) SERVICES (CMS) MAGNET FOUR STAR FIVE STAR LEAPFROG RECOGNITION PATIENT SKILLED CARE GRADE MARCH 2016 RATING RATING FOR PATIENTA SAFETY st

RECOGNIZED AS A THE FIRST 1HOSPITAL IN THE WESTERN SUBURBS TO OFFER THE JOINT THE JOINT THE JOINT A NEW MINIMALLY INVASIVE COMMISSION COMMISSION COMMISSION LEADER IN LGBT TREATMENT FOR HEALTHCARE U.S. ENVIRONMENTAL PERIPHERAL TOP PERFORMER INPATIENT PRIMARY PROTECTION AGENCY’S ARTERY DISEASE ON KEY QUALITY DIABETES STROKE CENTER EQUALTIY ENERGY STAR BY THE HUMAN RIGHTS CERTIFICATION USING OPTIC COHERENCE CAMPAIGN FOUNDATION TOMOGRAPHY MEASURES CERTIFICATION CERTIFICATION

NURSES IMPROVING CARE FOR HEALTHSYSTEM ELDERS U.S. NEWS & WORLD REPORT RATED ROPH A TOP AMERICAN COLLEGE HIGH OF SURGEONS NATIONAL PERFORMING SURGICAL QUALITY GENERAL IMPROVEMENT PROGRAM HOSPITAL FOR IN CHRONIC NICHESTAGE 3 OBSTRUCTIVE PULMONARY TOP SURGICAL “SENIOR FRIENDLY” DISEASE (COPD) & HEART HOSPITAL FAILURE CARE DESIGNATION HOSPITAL ONE OF ONLY 56 HOSPITALS AWARD

2017 NURSING ANNUAL REPORT OUR EXCELLENCE JOURNEY 7 RELATIONSHIPS CARING

COMPASSION IN PRACTICE COMMUNITY PARTNERSHIP TO IMPROVE HEALTH AWARENESS

Excerpts taken with permission from: Stewart, E. (2017) A program to increase health promotion for processes around this program. it stipulates that if a behavior women in residential treatment for substance abuse disorders. Rush College of Nursing Paper There was a concern that the change is desired, a change in Women’s Treatment Center (WTC) in the region treats program was not evidence the level of intention must be women who have suffered from substance abuse as well as based, lacked structures such as facilitated through the changes Atheir families. The mission of the WTC is to provide women a formalized curriculum and was in the attitudes and beliefs about with continuum of care, tools for recovery and parenting skills to not supportive of Department subjects norms and perceived be- maintain a sober lifestyle as they rebuild their life and future. The of Alcohol and Drug Abuse havioral control (Ajzen, 2001). services provided are as follows: detox, residential treatment for (DASA) regulations to which pregnant/postpartum women, women with children OBJECTIVES and women without children, outpatient treatment, Implementation of this program recovery home, methadone clinic, children’s ser- was done in multiple phases. vices, criminal justice program and parenting classes Early inclusion of principles re- and counseling. Elizabeth Stewart, Unit Director lated to professional governance of the Skilled Care Unit at ROPH, as part of her structures and behaviors helped Doctorate of Nursing Practice in Advanced Public propel the success of both nurse Health, worked to implement a set of important empowerment and client benefit health promotion strategies to improve outcomes in in the program. The objectives both the clients as well as the staff of this WTC. for the program were: Beth described in her final paper and presen- + Create a nurse education tation that health promotion is important to the committee to guide program process of recovery from substance abuse. She development and to manage describes that people with substance use disor- evaluation and sustainability ders have higher rates of both infectious disease of the program. and chronic illness coupled with lower levels of + Develop a standardized, self-care related to their substance use than the evidence-based curriculum for general population (Kelly, et al, 2015). She found use by nurses in already estab- that health promotion activities such as screenings, lished weekly HA Groups. health education, exercise, journaling and smoke + Formalize the Center’s insti- cessation during recovery have been linked to tutional structures supporting extended lengths of sobriety (Bradbury-Goals, 2013; Fareed et. Al, the WTC is responsible to the HA Groups. 2010; Weinstock, Barry & Petry, 2008) In the population that lives adhere. Surveys of the nurs- + Create evaluation tools for at the WTC, the rates of some of these illnesses are far greater than ing staff elicited that 90% of use as a part of a formalized those of the national average for the same illness. Hepatitis inci- WTC nurses did not feel they evaluation plan. dence is at 10.9% compared with 1% nationwide, HIV/AIDS inci- had the necessary resources dence is at 3.2%% compared to less than 1%, sexually transmitted to effectively lead the HA. OUTCOMES infections incidence is at 8.8% compared to less than 1%, respirato- Clients expressed that the HA All 10 nurses at the WTC ry disease incidence is at 24.8% compared with 11.3% and anemia meetings were often chaotic completed surveys before incidence at the WTC is at 10.6% compared with less than 1% in and disorganized. education and curriculum roll the general population (Center, 2016; Centers for Disease Control As Beth began to utilize this out. In the pre-survey, only and Prevention (CDC) 2016a; CDC, 2016b; CDC, 2016c; Healthy feedback to create a compre- 10% of the nurses agreed that People 2020, 2016; American Society of Hematology, 2016). hensive strategy to improve they possessed the knowledge Beth engaged administrators, clients and nurses in a variety of these gaps, her program goal was and had adequate resources to activities to elicit feedback on how to best impact these import- to “increase self-management lead the HA Group. Post survey ant disparities. Through surveys, interviews and focus groups, she of health issues and positive elicited that 90% of them felt gathered information on how to implement a program that would lifestyle choices in women being they had the knowledge and best meet the needs of the organization in addressing health treated on Residential Units 2 the resources to be successful. promotion of the clients at the center. A weekly Health Aware- and 4 at the WTC.” She utilized Nurses particularly discussed ness Group (HA) had previously been established at the Cnter to the Theory of Planned Behavior improved knowledge related to attend to the need for health promotion as part of the treatment to guide the interventions. This nutrition and chronic disease program, however clients and staff expressed dissatisfaction with theory was supportive because management.

8 RELATIONSHIPS & CARING RUSH OAK PARK 2017 HOSPITAL NURSING ANNUAL REPORT

36 client chart audits were the physical activity/chronic ize, empower and advocate for is proud to have had Beth’s conducted before program disease session and 43% for the the nurses at the WTC was leadership in a community implementation and 33 were 20 clients who attended the the first step in impacting the setting, improving nursing audited post program imple- smoking cessation/substance overall health outcomes of the practice and patient outcomes mentation for nurse observa- abuse and the body session. clients at the WTC. The cur- and transforming healthcare tions of client behavior. The Because literature links riculum content and activities for the better. Outcomes of this mean percentage of document- engagement in health-pro- directly met the unique needs project were impressive and the ed engaged clients compared moting activities and contin- and health promotion topics WTC was very thankful to have with disengaged increased ued recovery from substance very uniquely needed in this had Beth contributing through from 67% pre-program to 74% use (Bradbury-Golas, 2013) vulnerable population. ROPH her DNP in this capacity. ROPH post-program. Some activities and because regular health that highlighted this engage- screening and health edu- Ajzen, I. (2002). The Theory of Planned Behavior. In van Lange, P.A.M., Kruglanski, A.W., & Higgins, E.T. (Eds.), Handbook of theories of social psychology (pp. 438-459). New York: Lawrence Erlbaum Associates. ment were clients reading out cation lead to reduced drug American Society of Hematology. (2016). Anemia. Retrieved from:http://www.hematology.org/Patients/Anemia/ loud, asking questions, speak- use (Fareed et.al., 2010), it Bradbury-Golas, K. (2013). Health promotion and prevention strategies. Nursing Clinics Of North America, 48(3). ing about the topic and/or was imperative for a program CDC. (2016). Hepatitis C FAQs for the public. Retrieved from: http://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ22 CDC. (2016). HIV in the United States: At a glance. Retrieved from: http://www.cdc.gov/hiv/statistics/overview/ataglance.html participating in the activities. like this to be developed at Centers for Disease Control and Prevention. (2016). Reported STDs in the United States 2015: National data for chlamydia, gonor- Pre- and post-tests were given the WTC. A program may rhea, and syphilis,. Retrieved from: http://www.cdc.gov/nchhstp/newsroom/docs/factsheets/std-trends-508.pdf Healthy People 2020. (2016). Respiratory diseases. Retrieved from:https://www.healthypeople.gov/2020/topics-objectives/topic/respirato- each week of the HA program. have failed and not made an ry-diseases Correct answers increased an impact if developed without Fareed, A., Musselman, D., Byrd-Sellers, J., Vayalapalli, S., Casarella, J., Drexler, K., & Phillips, L. (2010). Onsite Basic Health Screening and Brief Health Counseling of Chronic Medical Conditions for Veterans in Methadone Maintenance Treatment. Journal Of average of 28% for the clients the engagement of the clinical Addiction Medicine, 4(3), 160-166. Kelly, P.J., Baker, A.L., Deane, F.P., Callister, R., Collins, C.E., Oldmeadow, C., Attia, J.R., Townsend, C.J., Ingram, I., Byrne, G., & Keane, C.A. (2015). who attended the nutrition/ staff and administrators in Study protocol: a stepped wedge cluster randomized controlled trial of a healthy lifestyle intervention for people attending infectious disease session; 90% professionally stimulating residential substance abuse treatment. BMC Public Health 15(465). Weinstock, J., Barry, D., & Petry, N.M. (2008). Exercise-related activities are associated with positive outcome in contingency for the 24 clients who attended work. Beth’s work to standard- management treatment for substance use disorders. Addictive Behaviors 33, 1072-1075 IMPLEMENTING THE PROGRAM

PHASE 1 ESTABLISHING AN PHASE 2 CREATING AN EVIDENCE-BASED CURRICULUM PHASE 3 EDUCATING NURSES EDUCATION COMMITTEE CURRICULUM TOPICS: AND ONGOING EDUCATION EDUCATION COMMITTEE Week 1 COMMITTEE MEETING FORMED + Healthy Recovery (HR): Nutrition 4-HOUR NURSE EDUCATION SESSIONS 3 Nurses: 2 Frontline Nurses + Health Topic (HT): Infectious Disease Introduction to Shared/Professional and 1 Clinical Coordinator Week 2 Governance + HR: Physical Activity Information on population assessment HEALTH AWARENESS + HT: Chronic Disease CURRICULUM DEVELOPED and program Week 3 Standardization of Processes Processes Secured + HR: Nutrition: Health Literacy Frame Detailed Orientation to New Curriculum Room Reservation + HT: Health Literacy Introduction to Engagement Scale Tool Schedules so that units do not Week 4 overlap + HR: Smoking Cessation + HT: Substance abuse effects on body and Stress PHASE 4 ADDRESSING EVALUATION METHODS DE- INSTITUTIONAL SYSTEMS VELOPED FORMAT OF CURRICULUM: Pre/Post Tests Created Four, 90 Minute sessions per client Via Nurse feedback several institutional ENGAGEMENT MEASUREMENT 5 min: Introduction systems that had been seen as challeng- TOOL ADAPTED 5 min: Meditation ing were reviewed, standardized and reconfigured as needed. Adapted from Behavioral 35 min: Healthy Recovery Observation of Students in + Evidence Based: Healthy Recovery Program School scale 45 min: Health Topic PHASE 5 SUSTAINABILITY Helps to meet DASA require- + Evidence Based: Content from CDC, NIH, etc PLANNING ments for individualized Curriculum was color coded, included a thumb drive with power evaluation of clients during points and videos, laminated flip charts developed, printed Nurse Education Committee Meetings group sessions sheets and activities included. scheduled for next year Executive Summary: Orientation and Nurse Survey Developed NURSE LEADER GUIDE handoff of new program to new Deputy Development of a detailed nurse leader guide helped promote a Director and other Key Stakeholders sustained, standardized program. Program Evaluation Checklist Developed EVALUATION MECHANISMS DEVELOPED: Communication line between Education Pre/Post Tests Created Committee and Quality Department Engagement Measurement Tool Adapted created Adapted from Behavioral Observation of Students in School scale Quality Reports “ordered” quarterly Helps to meet DASA requirements for individualized evaluation Client Satisfaction Results of clients during group sessions Length of Stay Results Nurse Survey Developed

2017 NURSING ANNUAL REPORT RELATIONSHIPS & CARING 9 EVIDENCE-BASED PRACTICE

GETTING AHEAD OF IT STUDENT CLINICAL ROTATION MODEL any sources are documenting and predicting a nursing shortage. This ROPH Clinical Rotations Program Mimpending shortage is multifactori- al. Firstly, the shortage will be caused by a 100% 2016 projected decreased supply of nurses in the 90% workforce. This is due to the following reasons: 2017 80% 91 1. Nurses who may have naturally left the work force have remained during the econom- 70% ic instability in recent years, as those nurses re- 60% tire, the artificial effect of their presence in the 50% workforce will be evident, 2. Nursing schools 54

report shortages in faculty and clinical rota- Individuals 40% tions which lessens the profession’s ability to 30% 40 40 prepare nurses and 3. There is an existent high 20% attrition rate in nursing due to the demands of the profession- the average turnover rate 10% across the country is approximately 17.2%. 0 (Snavely, 2015; Nursing Solutions, 2015). Students Preceptor Experiences ROPH nurses take accountability for adequate nurse staffing in all clinical areas and have developed a stra- diligently to achieve a current improving retention was aimed tegic plan to prepare for this nursing shortage, both at ROPH and rate of 9% for 2017. While this at preventing burnout and within the healthcare community as a whole. ROPH outperforms retention positively impacts the stress. Another opportunity for the national average for low nurse turnover rate and has worked staffing at ROPH, the goal of professional ownership to avoid

10 EVIDENCE-BASED PRACTICE RUSH OAK PARK HOSPITAL RUSH OAK PARK 2017 HOSPITAL NURSING ANNUAL REPORT

a nursing shortage lies with the nerships, ROPH has been able resources are needed to ensure were distributed. RN precepting preparation of increasing num- to participate in an advisory ca- accommodation of a greater of students education is being bers of nursing students through pacity to some of these schools, volume of students. developed both within ROPH partnerships with area colleges serving to help troubleshoot To address these issues, two and through partnership with of nursing. “The preparation how they can accommodate conference rooms were designat- colleges. A ROPH point person of an expanded workforce… has been assigned to be the liai- will require… advances in the son for both the colleges and the education of nurses across all organizational needs. A rotation levels… expanding nursing information sheet was created to faculty, increasing the capacity IMPROVEMENT be completed by the faculty and of nursing schools, and redesign- posted on each unit regarding the ing nursing education to assure INITIATIVES specifics and learning objectives that it can produce an adequate Some of the opportunities and changes have been made as of their groups. Feedback was a result of this ongoing initiative and growing partnerships. number of well-prepared nurses given to the schools regarding able to meet current and future ROPH IMPROVEMENT INITIATIVES/AREAS the availability of off-shifts and health care demands” (IOM, increased preceptor availability FACILITY 2010; Macy, 2016). + Conference rooms designed and designated for students with, if students were able to follow an In the past, ROPH had lockers, refrigerator space for lunches, mobile computers, ther- individual RN schedule rather requests from numerous colleges mometers, seating, and parking. than a whole class placed on a of nursing for clinical rotations PRECEPTOR unit on a set day and week. of varying types. Previous mind- + Need for competency education regarding precepting students Increased rotations on sets regarding these requests + Availability for RN orientees off-shifts, weekends and with pre- limited the amount of clinical ceptors is being realized. Perhaps COMMUNICATION rotations that ROPH would + Notice of preceptor assignments so that no student shows up one of the most valuable con- accommodate. Karen Mayer, without planning tributions that ROPH has made the CNO, realized the link + Better understanding of which activities of patient care each towards this program is the re- between clinical rotations and group of students can safely perform. cruitment of nurses to be clinical the preparation of future nurse + Clinical Instructor job role defined and developed instructors. Through negotiations + RNs had interest in being faculty, but were deterred by the fact employees for both ROPH and that they would lose their full time FTE status and thus have a with both ROPH HR and partner the nuring community was not benefits change- Karen Mayer advocated for HR to cover full FTE HR departments, ROPH RNs being considered. In Spring of and have colleges reimburse ROPH for time as instructors. have the opportunity to work 2017, the Nursing Professional as an instructor for .1 or .2 FTE Governance Organization Ex- PARTNER IMPROVEMENT INITIATIVES/AREAS within their 1.0 or 0.9 without ecutuve Committee led a new CLINICAL INSTRUCTOR needing to have overtime hours initiative to expand the number + Need to improve the matching of faculty to clinical area of during the semester. The partner expertise of clinical rotations that ROPH + Instructor clinical experience may be dated college then reimburses ROPH could accommodate and to + Expand faculty knowledge and student experience of non-acute for the instructor time and the greatly support the ongoing settings such as ambulatory and perioperative RN maintains their benefits as faculty shortage. The goal was ROPH RN EMPLOYEES AS FACULTY a ROPH employee. This has for all clinical sites and shifts + Full time benefits needed, only less than part-time positions incentivized a valuable pipeline to maximize their contribution available as clinical instructors. of instructors to area schools + Not interested in working over 40 hrs/week as a second job. for preparation of new nurses. + Onboarding education for clinical instructors varied and unstructured struggling to find enough faculty. Throughout this new initiative, ROPH is committed to a strong collaboration with SCHEDULING ongoing pursuit of the prepara- + Colleges all seeking only Tuesday/Thursday day shift rotations, several area schools of nursing due to didactic content on other days tion of the next generation of was established, namely, Rush + Early morning didactic classes impede pm or night clinical nurses. Please see graphic display University College of Nursing, scheduling of the increases made in only 2 + Faculty not available to work off shifts or weekends Dominican University, Loyola + Focus on inpatient care years. ROPH leaders are seeking University and Lewis Universi- + Students never experience full load of patients to proactively lead this initia- ty. Aside from placing prelicen- + Students never experience reality of off-shift or weekend hours tive recognizing if all hospitals + When organization is willing for 24/7 rotations, schools may have sure students, ROPH partners opportunity to alter teaching structure which will assist with increased clinical site availabili- with schools to facilitate many increased volume of student prep through clinical rotations. ty by 50%, the increased college doctoral level student projects enrollment might obliterate and clinicals as well as post-li- the pending RN shortage. The censure clinical nurse leader a greater volume of students. ed with lockers for student/faculty vision of ROPH nursing is to be (CNL) students learning the Additionally, ROPH direct care usage in the organization. Addi- a 24/7 nursing teaching facility CNL role as it is modeled at nurses and unit leadership have tional computers and workspaces that champions this concept ROPH. given input through a series were purchased for the units and and creates an excellent stream Through these various part- of meetings to ascertain what directions about available parking of nurses for the future. ROPH

2017 NURSING ANNUAL REPORT EVIDENCE-BASED PRACTICE 11 CRITICAL THINKING

CONNECTORS IN CHIEF CNL ROLE CHANGE CATALYZES THE TEAM & OUTCOMES s presented in the past in Rush Oak Park Hospital (ROPH) at least one CNL to partner with and needs. It became evident Care Management Across Continuum Clinical Annual Reports from Nursing, the Clinical Nurse Leader one Social Worker (SW) per that the CNLs wereNurse integral to Leader Organizational Initiatives A(CNL) role has been integral to patient outcomes, staff unit on care management needs. many organizationalNew Roleinitiatives. engagement and interdisciplinary collaboration. The CNL role was Karen Mayer, CNO, ROPH and Each CNL was assigned as a supEducation- & Quality: Unit & Organization Level originally piloted in 2012 on the Telemetry unit with a focus on the the Unit Directors from each pa- port to various initiatives such as Congestive Heart Failure population. Initial success with Centers tient care unit partnered together The Joint Commission Diabetes for Medicare and Utilization Management Medicaid core Clinical Documentation measure compliance Improvement Care Management Across Continuum Average Length of Stay for All Payors relative to that & Medicare Patients population as well 5.5 Clinical 5.31 ALOS Medicare as a decreased read- Nurse ALOS All Payer Organizational Initiatives Care 5.0 4.9 mission rate fostered Leader Management: 4.71 New Role Patient 4.5 4.47 & Family replication in the 4.49 4.19 4.39 3.96 Clinical 4.25 Social 4.0 ICU and on Nurse Education & Quality: Unit & Organization Level Workers 4.06

Leaders Number of Days 6 West, another 3.5 3.72 Medical Surgical 3.55 3.0 Unit for other 2013 2014 2015 2016 2017 YTD patient populations. to create a budget neutral CNL and Stroke certifications, ANCC In 2015 and 2016, there was a movement within the Rush Program expansion. This part- MagnetAll Designation, Cause Readmission NICHE Rate Readmission SNF Rate 50% 13% 47% System for Health to redesignUtilization the Care Delivery Model relative to nership has been key to ongoing Designation, IDPH Regulatory 45% Readmission SNF Rate 12% 12% All Cause Readmission Rate Management 40% care management. A partnership between social worker and clinical programmatic success as regular 11%requirements, Colleges of Nurs- Clinical 35% 10% 9.3% Documentation 8.9% expert care manager roles was established. This change, which was meetings between the unit ing10.2% Programs and Community 30% Improvement 9% 25% 9.1% 7.6% directed by NPGO based on the widespread success the CNLs had management and CNL program 8%Engagement, to name a few. 20% Average Length of Stay for All Payors 18% 15% accomplished, initiated the formation of a separate unit for the CNLs leadership seek to find optimal 7% The CNL role does not 15% 12% 11% 11% & Medicare Patients6% 10%

at ROPH, under one Unit Director (UD), with matrix reporting ways to meet both the unit needs 5%detract from the expertise of Rate of 30 Day Readmission 5% 5.5 centage of 30 Day Readmissions 4% 0

to the Rush System for Health Care Management department and as well as organizational needs. Per any one discipline, rather they 5.31 2013 2014ALOS2015 Medicare2016 2017 YTD 2013 2014 2015 2016 2017 YTD the Chief Nursing Officer. The creation of this unit allowed for the Under the direction of function as ALOSconnectors All Payer between creation of standardized role competencies,Care education and metric NPGO5.0 Executive and4.9 Education the disciplines and the patient’s responsibilities house wideManagement: so a comprehensive CNL Program could Committees, the CNLs assumed4.71 care plan, with an emphasis on be established at ROPH. DenisePatient Wienand was hired as the UD of the responsibility4.5 of housewide nurs- improving4.47 patient education, & Family CNL Program in 2016 and the CNL structure was shifted to allow for ing-related4.49 educational programs outcomes and4.19 seamless coordina- 4.39 3.96 Clinical 4.25 Social 4.0 Nurse Workers 4.06

Leaders Number of Days 12 CRITICAL THINKING 3.5 3.72 RUSH OAK PARK HOSPITAL 3.55

3.0 2013 2014 2015 2016 2017 YTD

All Cause Readmission Rate Readmission SNF Rate 50% 13% 47% 45% Readmission SNF Rate 12% 12% All Cause Readmission Rate 40% 11% 35% 10% 9.3% 8.9% 10.2% 30% 9% 25% 9.1% 7.6% 8% 20% 18% 15% 7% 15% 12% 11% 11% 6% 10%

5% Rate of 30 Day Readmission 5% centage of 30 Day Readmissions 4% 0 Per 2013 2014 2015 2016 2017 YTD 2013 2014 2015 2016 2017 YTD RUSH OAK PARK 2017 HOSPITAL NURSING ANNUAL REPORT

Care Management Across Continuum tion throughout the continuum.Care Management Across Continuum upon arrival to the ED to enact Complex CarClinicale Planning The CNL support the MDs 14 Nurse evidence-based care coordination Clinical Organizational Initiatives for CoreNurse Measure compliance, 12.2 Leader Number of CCPs Implemented strategies that troubleshoot the Organizational 12Initiatives 11 New RoleAll Cause 30 Day Readmission Rate transitionsLeader of care, advanced Inpatient Admits for FAPs patient’s ongoing physical, social, New Role 9.9 9.7 care planning and complex care 10 9 psychological or emotional needs. 9 9 8.6 8.5 Education & Quality: Unit & Organization Level 8 planning. The CNLs connect 9 8 7.4 These have been successful at Education & Quality:8 Unit & Organization Level 7 with the RNs on quality metrics, 6.2 reducing the incidence of these 7.2 6 6 7 education support, patient flow 6 patients’ admissions so they are 4 and patient education. The 4 5 4 able to thrive in the community

CNLs lead interdisciplinary 3 3 and at home more independently. Patients Readmitted 2 Utilization2 rounds every day, reviewing com- Management There are multiple other 1133344510 plexUtilization and high utilizer cases on 0 Clinical strategies within the CNL Management Jan. Feb. Mar. April MayDocumentationJune July Aug. Sept. Oct. Nov. Dec. Jan a dailyClinical basis, with participationCar e Management Acr2017 oss2017 Continuum2017 2017 2017 Impr2017ovement2017 2017 2017 2017 2017 2017 2018 Program. A CNL-led admission Documentation fromImprovement the entire interdisciplinary process tracksAverage outpatient Length goals of Stay for All Payors Clinical team. TheNurse CNLs connect with Average Length of Stay for All Payors and connects the team& Medicar and pa- e Patients APNs bothLeader within the hospital Organizational Initiatives & Medicare Patients tient5.5 with the overall care plan. 5.31 ALOS Medicare and in Newthe ambulatory Role or skilled 5.5 The CNLs engage in discharge ALOS All Payer nursing environment to assure 5.31 ALOS Medicare education both inpatient and Education & Quality: Unit & Organization LevelCare 5.0 4.9 ALOS All Payer 4.71 safeCar transitione or to divert un- 5.0 4.9Management: outpatient. They engage in social Management:necessary admissions. The CNLs Patient4.71 determinant4.5 screening and meet 4.47 & Family communicatePatient with ambulatory 4.5 4.47 weekly with4.49 SW to discuss outli- 4.19 4.39 3.96 RNs& Famil and yadministrators to create Clinical er patients that are not meeting4.25 4.49 4.19Social 4.0 Nurse 4.39 3.96 4.06 better continuity of the patients 4.25 Workers key benchmarks for care. They

Clinical Number of Days Social 4.0 Leaders Nurse careUtilization plan, to ensure follow-up 4.06 have developed several tools in Management Workers 3.5 3.72 Leaders Number of Days appointmentsClinical are made and to the electronic medical record 3.55 Documentation 3.5 3.72 ensureImprovement the environment is safe 3.55 (EMR)3.0 to document their inter- when leaving the hospital. actions with patients and staff, 3.0 Average Length of Stay for All Payors 2013 2014 2015 2016 2017 YTD CNLs were added to other 2013 2014& Medicar2015 e2016 Patients2017 YTD both inpatient and outpatient. key areas such as the Emergency 5.5 The CNL program score- Department (ED), 3 center-or- 5.31 ALOS Medicare card reflects an emphasisReadmission on SNF Rate All Cause Readmission RateALOS All Payer thopedic and medical surgical care50% coordination, education All Cause ReadmissionCare Rate 13%5.0 Readmission4.9 SNF Rate 47% population, the Skilled Care 50% 4.71 and45% organizational initiative Readmission SNF Rate 13% Management: 12% 47% 12% All Cause Readmission Rate UnitPatient and Rehab units. With an 45% Readmission SNF Rate support.40% They work to improve 12% 12% All Cause Readmission Rate 11%4.5 4.47 emphasis& Famil ony the CNL as partner 40% the35% 30-day all-cause readmission 4.49 4.19 11% 10% 9.3% 3.96 to SW on every unit, the CNLs 35% 4.39 8.9% rate,30% decrease average length of Clinical 4.0 10.2% 4.25 10% 9.3% Social 9% Nurse had to redefine their8.9% job descrip- stay,25% improve applicable quality 10.2% Workers 30% 9.1% 4.06 7.6% 9% Leaders Number of Days 8% tion, associated competencies 25% indicators,20% enhance nursing staff 9.1% 7.6% 3.5 3.72 15% 7% 18% 8% and attend specialized education. 20% engagement15% and interdisciplin- 12% 11% 11% 15% 3.55 6% 18% 7% Some examples of the special- 15% 12% 11% 11% ary10% collaboration as measured in 3.0 6% ized education that CNLs have 5% Rate of 30 Day Readmission employee5% engagement surveys, 10% 2013 2014 2015 2016 2017 YTD centage of 30 Day Readmissions

5% received are: Rush Leadership Rate of 30 Day Readmission 5%4% and0 decrease observation case Per centage of 30 Day Readmissions 2013 2014 2015 2016 2017 YTD 4% Academy, American Academy 0 rates in 2013the ED, improve2014 2015effi- 2016 2017 YTD Per 2013 2014 of2015 Ambulatory2016 Care2017 NursingYTD 2013 2014 2015 2016 2017 YTD ciency of flow, communication All Cause Readmission Rate Readmission SNF Rate (AAACN) Care Coordination 50% and continuity throughout the 13% 47% and Transitions Management 45% Readmission SNF Rate organization. The CNL role 12% 12% All Cause Readmission Rate core curriculum, Milliman and 40% has optimized interdisciplinary 11% Interqual education to assess best 35% collaboration by functioning 10% 9.3% level of care, research8.9% competen- as a connector and advocate 10.2% 30% 9% cy modules to prepare the CNL 25% for the patients continuous 9.1% 7.6% 8% group for institutional review 20% provision of care across many 18% 15% 7% board (IRB) usage and study, and 15% 12% 11% 11% clinical settings. They support 6% National Incident Management 10% staff via mentorship, real-time

5% System (NIMS) to prepare the Rate of 30 Day Readmission 5% troubleshooting in the clinical centage of 30 Day Readmissions 4% group for disaster and emergency 0 setting and education. They are Per 2013 2014 management.2015 2016 2017 YTD 2013 2014 2015 2016 2017 YTD active in almost every organi- One major initiative the zational initiative at ROPH. CNLs have led is to develop, in Silver, CMO, ROPH, the better meet the needs of the most Their energy is palpable and the partnership with the interdisci- creation of complex care plans complex patients. These plans benefit to our patients and staff plinary team and Dr. Michael and high utilizer group plans to function to guide intervention is invaluable! ROPH

2017 NURSING ANNUAL REPORT CRITICAL THINKING 13 TECHNICAL EXPERTISE

IMPROVING BEDSIDE HANDOFF TRANSFORMING PATIENT SAFETY Excerpts taken with permission from Cooper, A. (2017) Improving Patient Safety and Patient Satisfaction through Bedside Handoff. Rush College of Nursing DNP Presentation. (AHRQ) Culture of Safety errors can result in poor patient survey, performed yearly at safety outcomes (AHRQ, 2015; ransferring essential information about patient care is an integral ROPH, to measure impact of Maughan, Lei and Cydulka, component of communication in health care. Within health- her project. Gleaning from 2011; Spooner, etal, 2015). The Tcare organizations this is known as “handoff”. Effective handoff the literature, she understood literature was very supportive supports the delivery of important safety and care coordination that staff perceptions of safety of effective bedside handoff as a information from one caregiver to another so that the continuity of directly correlate with decreased means to improve patient safety care can be seamless. The literature has been replete with examples of adverse patient outcomes and satisfaction, while also ineffective handoffs, especially during transitions, as they relate to in- within the hospital environment decreasing falls during change creased adverse events and patient safety risks (Friesen, M., White, S., (Huang, etal, 2010). With a of shift and other adverse events Byers, J. 2008). Angela Cooper, Director, Inpatient Nursing at Rush focus on improving AHRQ Cul- throughout the rest of the shift Oak Park Hospital (ROPH) sought advice and approval of the NPGO ture of Safety scores relative to (Radtke, 2013: AHRQ, n.d., Executive Committee and unit UACs to study this important concept staff perception of safety during Sand-Jeckin & Sherman, 2014; and seek improvements at ROPH as part of her Doctorate of Nursing handoffs, inpatient falls with in- Kerr, etal, 2013; Rush, 2012). Practice in Systems Leadership. jury rate, and a desire to increase Part of the planning for a Angela utilized the Agency for Healthcare and Quality Research the numbers of safety events focused improvement strategy reported as a reflector of aimed at improving patient AHRQ Culture of Safety Survey a healthier environment,Fall withsafety throughInjury effective Rate per 1,000 Patient Handoffs & Transitions Angela put in place many Dayshandoffs on focused Implementation on meeting Units 100 important 2.initiatives.0 with stakeholders, surveys She reviewed the liter- of staff relative to the topic 90 1.8 90th ature for themes that could of handoff,1.7 the development 80 75th guide her work.1.6 She found of a handoff process and 70 three themes1.4 that would comprehensive inpatient have potential impact at staff education related to 1.18 60 1.2 1.38 1.09 ROPH: the importance that process. A standardized0.95 50 1.0 centile 50th of inconsistent communi- handoff flowsheet was created 40 cation, interruptions0.8 and in the EMR and observations Per 25th 25th bedside handoff formaliza- were performed of real-time

30 Falls with Injury 0.6 tion. With relation to in- handoff process.0.73 Ancillary 20 25th consistent 0.communication4 departments within inpatient 0.53 10 the literature0.2 described nursing received education 0 only 70-80%0 of informa- as well. tion is documented in the Angela’s project was imple- 2010 2012 2013 2015 2016 2017 Q2 Q3 Q4 Q1 Q2 Q3 Q4 electronic2015 medical 2015mented over2015 the course2016 of 20162016 2016 2016 record (EMR), into 2017. Through Angela’s AHRQ Culture of Safety Survey Fall with Injury Rate per 1,000 Patient that inconsistent leadership the 2017 AHRQ Handoffs & Transitions Days on Implementation Units communication Culture of Safety Survey Hand- 100 2.0 Unassisted Falls During is linked to over offs and Transitions Section 90 1.8 Handoff Time 80% of adverse results increased to meeting 90th 25 1.7 events and often the 90th percentile benchmark 80 75th 1.6 21 times is the root score. Historically, this score 70 1.4 19 cause of sentinel from 2010 to 2013 had remained 20 1.18 60 1.2 1.38 1.09 events (Popovich, stagnant at the 10th to 25th per- 0.95 2011; Staggers centile, with some improvement 50 1.0 15 centile 50th 15 and Biaz, 2013; in 2015 and 2016 up to the 50th 40 0.8

Per TJC, n.d.) AHRQ percentile. This achievement 25th 25th and a variety of underscores the important work

30 Falls with Injury 0.6 10 0.73 other sources that took place to engage staff 20 25th 0.4 0.53 discussed the fact in a solution, make that solution Unassisted Falls 10 0.2 6 that often errors possible and standardize the 5 0 0 occur as a result process for sustainability. An 2010 2012 2013 2015 2016 2017 Q2 Q3 Q4 Q1 Q2 1 Q3 Q4 of interrruptions indepth look at some of the 02015 2015 2015 2016 2016 2016 2016 and that these questions in the safety handoffs 2013 2014 2015 2016 2017 (2017, 1st 3 months) (Post-Implementation) Unassisted Falls During 14 TECHNICAL EXPERTISE RUSH OAK PARK HOSPITAL Handoff Time 25 21 19 20

15 15

Unassisted Falls 6 5

1 0 2013 2014 2015 2016 2017 (2017, 1st 3 months) (Post-Implementation) AHRQ Culture of Safety Survey Fall with Injury Rate per 1,000 Patient Handoffs & Transitions Days on Implementation Units 100 2.0 90 1.8 90th 1.7 80 75th 1.6 70 1.4 1.18 60 1.2 1.38 1.09 0.95 50 1.0 centile 50th 40 0.8 Per 25th 25th

30 Falls with Injury 0.6 0.73 20 25th 0.4 0.53 10 0.2 0 0 RUSH OAK 2010 2012 2013 2015 2016 2017 PARKQ2 Q3 2017Q4 Q1 Q2 Q3 Q4 HOSPITAL2015NURSING2015 2015ANNUAL2016 REPORT2016 2016 2016

Unassisted Falls During Handoff Time 25 21 19 20

15 15

Unassisted Falls 6 5

1 0 2013 2014 2015 2016 2017 (2017, 1st 3 months) (Post-Implementation)

and transitions section showed results showed internal staff some other important improve- perception of improvement of ments. The question, “Import- various handoff related activites. ant patient care information is The benefits of this project often lost during shift changes have impacted both staff ”score was 55.6% in 2015, satisfaction and patient safety. increased to 57.9% in 2016 and Subsequent to the outcomes was 75% in 2017, moving the achieved in the implementa- HANDOFF ROPH scores on this question tion units, Angela has worked from the 50th percentile to the to expand the project to an 75th percentile. The question, interdepartmental scope. She is SURVEY “Shift changes are problematic seeking to include to procedur- for patients in this hospital” al areas and implement within went from 47.1% in 2015 to the direct admission process. SURVEY PRE-SURVEY PRE-SURVEY 55.2% in 2016 to 75% in 2017, We appreciate Angela’s leader- QUESTIONS (N=79) (N=79) which moved the ROPH scores ship, the leadership of NPGO from the 50th percentile to the and all the staff that contrib- How many times are 75th percentile. Unassisted falls uted to this important culture you interrupted during a typical handoff? 69% 52% during handoff time decreased of safety and patient safety ANSWERED ANSWERED by 75%. Pre and post survey initiative! ROPH 2 OR MORE 2 OR MORE TIMES TIMES

Agency for Healthcare Research and Quality. (2015). Handoffs and Signouts. Retrieved from https://psnet.ahrq.gov/primers/primer/9/ handoffs-and-signouts Do you feel that Agency for Healthcare Research and Quality. (2015). Hospital Survey on Patient Safety Culture. Retrieved fromhttp://www.ahrq.gov/ interruptions (during professionals/quality-patient-safety/patientsafetyculture/hospital/index.html handoff) lead to errors Agency for Healthcare Research and Quality. (n.d.). Nurse bedside shift report implementation handbook. Retrieved from http:// 65% 46% in our current system? www.ahrq.gov/sites/default/files/wysiwyg/professionals/systems/hospital/engagingfamilies/strategy3/Strat3_Implement_Hndbook_508.pdf YES YES Friesen MA, White SV, Byers JF. (2008) Handoffs: Implications for Nurses. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 34. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2649/ Do you give handoff Huang, D. T., Clermont, G., Kong, L., Weissfeld, L. A., Sexton, J. B., Rowan, K. M., & Angus, D. C. (2010, April 9). Intensive care unit safety report at the bedside? culture and outcomes: a US multicenter study. International Journal for Quality in Health Care, 151-160. http://dx.doi.org/10.1093/ 54% 92% intqhc/mzq017 YES YES Kerr, D., Lu, S., & McKinlay, L. (2013). Bedside handover enhances completion of nursing care and documentation. Journal of Nursing Care Quality, 28, 217-225. http://dx.doi.org/http://dx.doi.org.ezproxy.rush.edu/10.1097/NCQ.0b013e31828aa6e0 Maughan, B. C., Lei, L., & Cydulka, R. K. (2011). ED handoffs: Observed practices and communication errors. American Following handoff Journal of Emergency Medicine, 29, 502-511. Retrieved from https://www-clinicalkey-com.ezproxy.rush.edu/#!/content/playCon- tent/1-s2.0-S0735675709006263?returnurl=null&referrer=null report, do you feel Popovich, D. (2011). Cultivating safety in handoff communication. Pediatric Nursing, 37(2), 55-60. that you have all the Radtke, K. (2013, Jan-Feb). Improving patient satisfaction with nursing communication using bedside shift report. Clinical information that you 68% 86% Nurse Specialist: The Journal for Advanced Nursing Practice, 27(1), 19-25. http://dx.doi.org/http://dx.doi.org.ezproxy.rush.edu/10.1097/ need to take care of YES YES NUR.0b013e3182777011 the patient? Rush, S. K. (2012, January). Bedside reporting: Dynamic dialogue. Nursing Management, 43(1), 40-44. http://dx.doi.org/http://dx.doi.org. ezproxy.rush.edu/10.1097/01.NUMA.0000409923.61966.ac Sand-Jecklin, K., & Sherman, J. (2014, October). A quantitative assessment of patient and nurse outcomes of bedside nursing report implementation. Journal of Clinical Nursing, 23, 2854-2863. http://dx.doi.org/http://dx.doi.org.ezproxy.rush.edu/10.1111/jocn.12575 Do you feel that giving Spooner, A. J., Corley, A., Chaboyer, W., Hammond, N. E., & Fraser, J. F. (2015). Measurement of the frequency and source of interrup- report at the beside tions occurring during bedside nursing handover in the intensive care unit: An observational study. Australian Critical Care, will improve/improves 28(1), 19-23. http://dx.doi.org/http://dx.doi.org.ezproxy.rush.edu/10.1016/j.aucc.2014.04.002 the care that you 67% 78% Staggers, N., & Blaz, J. W. (2013, Feb). Research on nursing handoffs for medical and surgical settings: an Integrative review. provide? YES YES Journal of Advanced Nursing, 69, 247-262. http://dx.doi.org/http://dx.doi.org/10.1111/j.1365-2648.2012.06087.x The Joint Commission. (n.d.). Sentinel event data causes by event type 2004-2014. Retrieved from http://www.jointcommission.org/ assets/1/18/Root_Causes_by_Event_Type_2004-2014.pdf

2017 NURSING ANNUAL REPORT TECHNICAL EXPERTISE 15 LEADERSHIP

RESPONDING TO THE TRANSFORMATION OF HEALTH CARE AMBULATORY ROLE GROWTH & NSI WORK UPDATES he American Academy of Ambulatory Care Nursing American Nurses Credential- academic centers working to (AAACN) published a position paper on the Role of the ing Center. Beyond Magnet prepare future nurses for this TAmbulatory RN in 2017. Underscoring the transforma- recognition, however, am- emerging healthcare setting. tive change that is underway in healthcare where the focus on bulatory nurses at ROPH are One ongoing national am- patient care is increasingly in the outpatient and community included in a culture of nursing bulatory initiative is that of the environment, this paper encouraged the empowerment and excellence through ongoing identification and development preparation of nurses in these settings. “Improving the health practice management. Nursing of Nurse Sensitive Indicators of our nation will require reframing our health care system from Professional Governance (NSI) for the ambulatory one that emphasizes acute, episodic, interventional care to one Organization (NPGO) unit setting. Just as the inpatient that engages patients and providers together, in health promo- advisory committee meetings, setting developed NSIs over tion, disease prevention and early intervention” (Bodenheimer, representation on NPGO’s twenty years ago such as Bauer, Syer & Olayiwola, 2015) Ambulatory nurses work across Executive Committee and CAUTI, CLABSI, HAPU and the continuum of care, in many cases as the only nurse in each inclusion in the Rush System Falls, the ambulatory setting setting, and increasingly, they are managing complex patients clinical ladder for ambulatory is seeking to do the same to with comorbidities and complex social determinants that make nurses encourages advancing measure the important impact effective access to care problematic. “Ambulatory care RNs are education and certification that nurses have on patients. well-prepared to assume an expanded role in the design and de- along with project manage- ROPH has begun reporting livery of high quality care, defying traditional boundaries, while ment, community outreach NSIs for the ambulatory surgery working in redefined interprofessional relationships, expanded and leadership in their own areas and is included in the community partnerships, and non-traditional health care set- clinical settings. Recently AAACN/CALNOC nation- tings”( AAACN, 2017). the Rush College of Nursing al pilot for it’s primary care Ambulatory RNs at Rush Oak Park Hospital (ROPH) and Clinical Nurse Leader masters clinics. Both of these initiatives Rush University Medical Center are well positioned to care program student was interested represent ROPH’s continued for this burgeoning, complex, aging patient population. They in the primary care setting. trend of leadership within have been included and recognized in achievement of ANCC The student was able to obtain the nursing profession and Magnet Designation for both organizations. The 2019 standards an immersion experience in it’s ability to have a visionary for ANCC Magnet designation have emphasized the need for the North Riverside Rush Oak response to the patient needs evidence from a variety of new ambulatory settings. ROPH Park Physician’s Group office. challenging healthcare around ambulatory nurses will be key in ongoing recognition by the ROPH is proud to support the world. ROPH

16 LEADERSHIP RUSH OAK PARK HOSPITAL ROPH Journey to Retain Excellent Nurses 30% 25% PERCENT FTE EQUALS FTE TURNOVER/TOTAL RN FTE 25% MAGNET BENCHMARK

20% 17.6%

15% 13.1% over Rate rn

Tu 10% 11% 9% 5%

0% 2007 2010 2014 2015 2016 2017

ROPH RN Ethnicity/Race Compared to RN National Averages (NCSBN, 2013) 90% 83% 80% ROPH AVERAGE 70% NATIONAL AVERAGE 60% 53.6% 50%

40%

30% 22.2% 20% DEMOGRAPHICS12.3% BEST PRACTICES 8.4% 10% 6% 6% 3% 0.3% 1% 1.5% 1% 1% 1% 0% 0% 0% American Asian Black or Hispanic Two or White Native Other Indian African or Latino more Hawaiian or Alaska American races or Pacific TURNOVER & DEMOGRAPHICSNative Islander ROPH RN Gender Comparisons to U.S. RN Averages 100% 93% 90% ROPH Journey to Retain Excellent87% Nurses 30% 80% 25% PERCENT FTE EQUALS FTE TURNOVER/TOTAL RN FTE 70% 25% ROPH Journey to Retain Excellent Nurses MAGNET BENCHMARK

60% 20% 30% 17.6% 50% PERCENT FTE EQUALS FTE 15% 13.1% 25% 40% over Rate

TURNOVER/TOTAL RN FTE rn

25% Tu 30% 10% MAGNET BENCHMARK 11% 9% 20% 5% 13% 20% 10% 7% 17.6% 0% 0% 2007 2010 2014 2015 2016 2017 Male Male Female Female 15% 13.1% ROPH RN U.S. RN ROPH RN U.S. RN over Rate

rn ROPH RN Ethnicity/Race Compared to

Tu RN National Averages (NCSBN, 2013) 10% 90% 83% 11% 80% 9% ROPH AVERAGE 70% 5% NATIONAL AVERAGE 60% 53.6% 50%

0% 40%

30% 2007 2010 2014 2015 2016 2017 22.2% 20% 12.3% 8.4% 10% 6% 6% 3% 0.3% 1% 1.5% 1% 1% 1% 0% 0% 0% American Asian Black or Hispanic Two or White Native Other Indian African or Latino more Hawaiian or Alaska American races or Pacific ROPH RN Ethnicity/Race Compared to Native Islander RN National Averages (NCSBN, 2013) 90% ROPH RN Gender Comparisons to U.S. RN Averages 83% 100% 93% 80% 2017-2018 90% 87% 80% ROPH AVERAGE NURSING LEADERSHIP DEVELOPMENT & MENTORSHIP PROGRAM MENTEES 70% 70% Julie Griffiths Michelle Panock Elizabeth Hale Colleen Calhoun Colleen Chierici NATIONAL AVERAGE 60% 60% 50% ONGOING53.6% RESEARCH STUDIES 40% 50%Catrambone, C. Illinois Emergency Department Asthma Surveillance Project. Multisite M. Heitschmidt, Pet30% Pause: Impact of Pet Visitation on Hospital Workers Study. J. Sarazine, Mindfulness20% and13% Resilience for Nurses Mayer, K. Mealtime Difficulty Subjective vs Objective Assessment of Persons With 40% M. Janik, Improvement10% of Inpatient Colonoscopy7% Preparation Dementia in the Acute Care Setting. B. Hatcher, K. Mayer,0% J. Grenier, Incivility Study 30%M. Freitag and M. Heitschmidt, A Pilot Study of the Feasibility of Adapting CDC Male Male Female Female Surgical Site Infections22.2% and Multidrug Resistant Organism Incidence Measures to the M. Browning, R. Start, L.ROPH Roberston, RN U.S. PNS RN Leaders,ROPH Interprofessional RN U.S. RN 20%National Database of Nursing Quality Indicators Shared Governance Index Study 12.3% D. Wienand, K. Mayer, CNL National Study 8.4% 10% 6% 6% 3% 0.3% 1% 1.5% BEST PRACTICE DISSEMINATION1% 1% 1% 0% 0% 0% Hancock,America B., Portern O’Grady,Asian T., Mauer,Black M., Start, or R. (2017)Hispanic AONE DynamicTwo orLeadershipWhite for NativStart, eR., Matlock,Other A. (2017) Nurse Sensitive Indicator Updates Town Hall. AAACN SharedIndian Governance Conference FacultyAfrican Presentation.or Latino San Antonio,mor TX eand Abu Dhabi, UAE. HawaiianPodium. Jordan,or Alaska A., Wienand, D. (2017) AAmerica CNL Toolkit:n Interventions toraces Ease Care transi- or Start,Pacific R., Brown, D., Matlock, A., May, N. (2017) AAACN Preconference Presentation Native Islander tions, Reduce Readmissions and Improve Satisfaction. IONL Webinar. on Nurse Sensitive Indicators in Ambulatory. AAACN Podium Lavire, E., Schejbal, J., Wienand, D. (2017) Strategies for the Clinical Nurse Leader in Start, R., Morin, M., Matlock, A.. (2017) Measure the impact of ambulatory nursing a Critical Care Setting to Improve Quality Measures, Patient Safety and Patient in a value-oriented health care system. World Health Care Congress Podium, Satisfaction while Facilitating Care Transitions. CNLA Summit Podium. Washington D.C. Mayer, ROPHK., Robertson, RN L., Gender Start, R. (2017) Comparisons Engaging Millenials. to ANCC U.S. Magnet RN Confer Av-eragesStart, R., Haas, S., Swan, BA. (2017) Moving Nursing Forward: The Impact of Am- ence100% Podium. bulatory Nursing. Rush NAA Nursing Networks Podium. 93%Start, R., Matlock, A., Brown, D., Aronow, H. (2017) Nurse Sensitive Value Measure- Mayer, Start. (2017) Empowerment of Nurses through Professional87% Governance. Voice90 %of Nursing Leadership Publication. ment in Ambulatory. CALNOC Podium Start, R. (2017) The Rapidly Shifting Paradigm: The Emergence of Ambulatory Pavlak,80% D. (2016) Automated Alerts Generated from Illinois’ Extensively Drug Resistant Organism Registry Can Improve Awareness of Carbapenem-Resistant Nursing. IONL NC3 Webinar Presentation Enterobacteriaceae(CRE)70% Carriage at the Time of Hospital Admission. ID Week Hancock, B., Porter O’Grady, T., Mauer, M., Start, R. (2017) AONE Dynamic Leadership for 2016 Podium. Shared Governance Conference Faculty Presentation. San Antonio, TX and Abu Dhabi, UAE Start,60 Morin,% Battaglia, Nelson, Sullivan (2017) Registered Nurses Make a Difference Wienand, D., Start, R. and Mayer, K. (2017) A Dynamic Duo: Transforming the Care with Ambulatory Care Nurse- Sensitive Indicators. Nursing Economics Vol. 35 No. 4. Delivery System. ANCC Magnet Conference Podium 50% Start, R., Matlock, A., Brown,D., Aronow, H. (2017) Ambulatory Nurse Sensitive Wienand, D. (2017) The Role of the CNL. Society of Otorhinolaryngology and Indicator40% Trends. CALNOC Podium. Head-Neck. Nurses 41st Annual Congress and Nursing Symposium Podium Start, R. (2017) Magnet Trends regarding Ambulatory. Illinois Magnet Consortium Wienand, D. (2017) Care Delivery System Experts: A Unique Clinical Nurse Leader and Meeting.30% Lisle, Il. Social Worker Team Approach for Achieving Better Outcomes. CNLA Summit Podium 20% 13% 10% 7% 2017 NURSING ANNUAL REPORT DEMOGRAPHICS & BEST PRACTICES 17 0% Male Male Female Female ROPH RN U.S. RN ROPH RN U.S. RN BEST PRACTICES 2015-2016 NURSING LEADERSHIP DEVELOPMENT & MENTORSHIP PROGRAM MENTEES Lauren Robertson Denise Wienand Annalie Wiltshire

BEST PRACTICE DISSEMINATION

Drum, K., Davis, K., Delaney, D., Gutierrez, E., Martenson, S., Quinn, B. (2015) Mayer, K. (2015). Subjective vs objective mealtime difficulty assessment of The Well Nurse. ENA Topic Brief. Institute for Quality, Safety and Injury persons with dementia in the acute care setting: A pilot study. Unpublished Protection. 9-2015 manuscript, College of Nursing, Rush University, Chicago, IL. Gutierrez, E. (2016) Meet me in Computed Tomography Suite: Decreasing Tissue Mayer, K. (2016). Subjective vs objective mealtime difficulty assessment of persons Plasminogen Activator Door to Needle Time for Acute Ischemic Stroke Patients. with dementia in the acute care setting: A review of the literature. Unpublished JEN Online. VOl. 42: 1 manuscript, College of Nursing, Rush University, Chicago, IL. Gutierrez, E. (2014) ENA Topic Brief: Compassion Fatigue. Retrieved from: https:// Mayer, K. (2016). Subjective vs objective mealtime difficulty assessment of per- www.ena.org/practice-research/Practice/Documents/CompassionFatigue.pdf sons with dementia in the acute care setting. Unpublished manuscript, College of Kleinpell, R., Lateef, O., Patel, G., and Start, R. (2015) Caring for ICU Providers, Nursing, Rush University, Chicago, IL. Chapter 10, The Organization of Critical Care, Respiratory Medicine. 18 DOE Morris, L., Bedon, A., McIntosh, E., & Whitmer, A. (2015). Restoring Speech to Tra- 10.1007/978-1-4939-0811-0_10, Springer Science +Business Media New York. Editors: cheostomy Patients. Critical Care Nurse 35 (6), 13-27. D.C. Scales and G.D> Rubenfeld Start, Battaglia, Morin. (2016) Nurse Sensitive Indicators for adaptation in the Martinez, K., Battaglia, R., Start, R., Mastal, P., Matlock, A. (2015) Nursing-Sensitvie ambulatory care environment. Nursing Economics. Oct/Nov, 2016 Issue Indicators in Ambulatory Care. Nursing Economics. Jan-Feb 2015. Vol 33.No.1 Start, R. Matlock, A.M., & Mastal, P. (2016). Ambulatory nurse-sensitive indicator Mastal, Matlock, Start. (2016) Capturing the Role of Nursing in Ambulatory Care: industry report: Meaningful measurement of nursing in the ambulatory patient The Case for Meaningful Nurse Sensitive Measurement. Nursing Economics. Mar/ care environment. Pitman, NJ: American Academy of Ambulatory Care Nursing. Apr. 2016 Weinand, D., Shah, P., Hatcher, B., Jordan, A., Grenier, J., Start, R. & Mayer, K. (2015) Im- Matlock, Start, Brown, Aronow. (2016) Ambulatory Care Nursing Sensitive Indica- plementing the Clinical Nurse Leader Role: A Care Model Centered on Innovation, tors. Nursing Management.6-2016 Efficiency, and Excellence. Approved for pending publication in Nurse Leader. 9/2015 Jordan, A., Mayer, K. and Start, R. (2016) Behavioral Action Response Team (BART) Start, R. and Nelson, D. (2015) Taking the Lead: Creation of a Statewide Ambu- Prevents and Responds to Workplace Violence. latory Consortium to Advance Ambulatory Nursing Practice. AAACN National Martinez, K., May, N., Matlock, A., Start, R. (2015) Establishing Ambulatory Nursing Conference, Orlando, Florida. Sensitive Indicators. ANCC Magnet® Conference, Atlanta, Georgia Start, May and Morin. (2016) Presentation to the American Nurses Credentialing ® Mayer,K., Arquilla-Maltby,L., Titze, J.& Start, R. (2015) Coordinated Care Transitions Center’s Commission on Magnet regarding the state of Ambulatory Nurse Program: Advanced Practice Registered Nurses Enhance Care By Connecting Care Environment and associated available nurse sensitive indicators as well as ® With Patients in Long Term Care Settings. AONE National Conference, Phoenix, recommendations to ANCC Magnet Manual for 2018. Silver Spring, MD Arizona. Start (2015) “Engaging Staff in Shared Governance”. American Organization of Mayer, K., Evans-Bergman, C., Start, R., Wound Care Clinic Benchmarkable Nurse Nurse Executives Webinar Sensitive Indicators. AONE National Conference, Phoenix, Arizona. Vasilj, A. (2015) Improving Communication: Integrating Instant Notify in Nursing Mayer, K. Subjective vs objective mealtime difficulty assessment in persons with Practice. Teletracking Client Conference, Las Vegas, NV dementia: A pilot study. Northwestern Hospital 7th Annual Nursing Research Wienand, D., Jordan, A., Schejbal, J. (2016) A CNL Toolkit: Interventions to Ease and Evidence-based Practice Symposium. Poster Presentation 3/2015 Care Transitions, Reduce Readmissions, and Improve Satisfaction 2014-2015 NURSING LEADERSHIP DEVELOPMENT & MENTORSHIP PROGRAM MENTEES Elizabeth Stewart Cristiane Bejarano Richard Auyeung Adam Spurlock

BEST PRACTICE DISSEMINATION

Cooper, A., Grenier, J., Hatcher, B., Jordan, A., Mayer, K., Shah, P., and Start, R., (2014) Kleinpell, R., Start, R., McIntosh, E., Worobec. S. (2014) Philanthropy as a Source of Role of the CNL and Innovative Care Models. Illinois Organization of Nurse Leaders Funding for Nursing Initiatives. Nursing Administration Quarterly NC3 Committee Presentation. Start, R. (2014) Owning the Future: Assuming Accountability for Leadership, Maltby, L. (2014) Improving Transitions Through Partnership Between Post-Acute Network Motivation and Health Promotion. Academy of Medical Surgical Nursing Chicago and Academic Medical Center. Gerontological Advanced Practice Nurses Annual Convention. Chapter Symposium. Maltby, L. Palliative Care: Goals of Care Discussions and How to Put the Caring Back into Healthcare. Nursing Grand Rounds. Rush Oak Park Hospital. Start, R. and Haas, S. (2014) The Rapidly Shifting Paradigm: The emergence of Maltby, L. (2014) The Rush Coordinated Care Program. Nursing Grand Rounds. Rush ambulatory nursing. Illinois Organization of Nurse Leaders Annual Conference Oak Park Hospital. Start, R., and Mastal, P. (2014) Town Hall: Report from Nurse Sensitive Indicator Maltby, L. (2014) Palliative Care and the Importance of Advanced Care Planning Taskforce and Facilitation of Discussion. American Academy of Ambulatory Care and Goals of Care Discussions. Case Management CNE. Rush Oak Park Hospital. Nursing National Conference Mayer, K. (2014) Managing ED Throughput with an APRN Managed Fast Track. Start, R., May, N., Matlock, A. and Mastal, P. (2014) Update from AAACN Task Force NC3- Illinois Organization of Nurse Leaders (IONL) & Metropolitan Chicago Healthcare American Academy of Coalition (MCHC) Collaborative Webinar. on Ambulatory Nursing Sensitive Indicators Presentation. Ambulatory Care Nursing National Conference. Mayer, K. (2014) The Road to Nursing “Systemness”: Paved or Potholes. Gamma Phi Chapter of Sigma Theta Tau International & The Center for Excellence in Nursing Start, R. (2014) AAACN Ambulatory Nurse Sensitive Indicators Task Force Update. Education Innovation and Scholarship (CENEIS), Rush University and again at Rush Oak American Academy of Ambulatory Care Nursing Viewpoint Publication. Park Hospital, Podium Presentations. Start, R. Mcintosh, E., Catrambone, C., and Waskiewicz, M. (2014) Promoting the McIntosh, E., Morris, L., Whitmer, A. (2014) The Importance of Tracheostomy Progres- growth and success of a shared governance organization: Lessons learned from sion in the Intensive Care Unit. Critical Care Nurse. 34:40-48; doi: 10.4037/ccn2014722. 30 years of shared governance. American Nurse Today. Vol 8:11 Mcintosh, E., Morris, L., and Whitmer, A. (2013). Tracheostomy Care and Complica- tions in the Intensive Care Unit. Critical Care Nurse 33 (5), 18-30.http://ccn.aacnjour- Start, R., Mayer,K., Reddy,T., Wilson, L., & Stewart, E.(2014) Setting Best Practice: nals.org/content/34/1/40.abstract Realizing Synergy, Culture Change and Community Outreach

18 BEST PRACTICES RUSH OAK PARK HOSPITAL WE ARE RUSH OAK PARK HOSPITAL WE ARE RUSH OAK PARK HOSPITAL RUSH OAK PARK HOSPITAL 2017 NURSING ANNUAL REPORT

OAK PARK HOSPITAL