2016 ANNUAL REPORT excellenceON THE ROAD TO THE FUTURE

DEAR COLLEAGUE,

The pursuit of excellence is a hallmark of high-performing organizations. At MedStar Washington Hospital Center, the 2,400 associates in the Department of Nursing seek excellence in all they do, every day.

As you will see in this annual report, achieving excellence requires constant focus and support. Whether we are starting a new initiative to improve the experience, such as instituting bedside report, or continuing quality and safety initiatives, like preventing central line-associated blood stream infections (CLABSI), excellence means we keep refining our approach so we can sustain top outcomes.

Excellence is even more crucial when we are challenged by healthcare trends, such as the national , which affected so many healthcare systems in FY16. It is thanks to the critical thinking skills and high standards of our talented nurses and nursing affiliates that we were able to continue to exceed so many benchmarks and reach so many of the goals of the Department of Nursing Strategic Plan.

This year, many of our important nurse-centered programs reached a new level of engagement, which helps keep the voice of nursing front and center in the pursuit of excellence. The establishment of our fifth Collaborative Governance Council (Quality and Safety) and the launch of the Coordinating Council that orchestrates collaboration between the groups was excellencea true milestone for the department. Just as important: the role played by many MedStar Heart & Vascular Institute critical care nurses, who formed a vital team that assured that our new state-of-the-art Intensive Care Units gave patient needs the highest priority.

Excellence requires many such teams working in concert, with a mutual dedication to high standards. This annual report shows how nurses at the Hospital Center achieve these objectives, every day.

SUSAN ECKERT, MSN, RN, NEA-BC, CENP SENIOR VICE PRESIDENT/CHIEF NURSING EXECUTIVE MEDSTAR WASHINGTON HOSPITAL CENTER new cardiovascular ICU rooms 44

IN SPECIALIZED CARE units moved over three years to build the Nancy and Harold excellence Zirkin Heart & Vascular Hospital 16

NURSING AT THE HEART OF A NEW HOSPITAL When the Nancy and Harold to come in on their time off and Zirkin Heart & Vascular Hospital wanted to have a voice. It just opened at the end of FY16 at grew from there.” MedStar Washington Hospital During the two years, she Center, the new intensive care says, “management allowed us floor reflected the voice of a to be the driving force behind unique council of nurses with the change. Who better to make expertise in critically ill cardio- decisions that would directly vascular . impact nurses at the bedside?” The MedStar Heart & When Nye was promoted “We knew that combining toured the construction site to Vascular Institute (MHVI) Critical to leadership, CVRR colleague the different cultures of the update their plans and recom- Care Nursing Council, consist- Liz Nixon, RN, stepped in to different units, the different mendations. ing of 14 nurses from three co-chair with Leigha McGuin, schedules and float patterns, As a result, “in the weeks different BSN, RN, a weekend night nurse would take some planning,” leading up to the move, many units, began meeting almost on 3H. adds Denise “Deni” Estrada- staff volunteered to come in two years before the Heart “From the beginning, Palma, RN. “We began working on their days off, stay late and Hospital opening. Kelly Nye, nurses were able to say what we with our new colleagues, with even come in on the weekends BSN, RN, then a staff nurse in needed, what we use and what the nurse practitioners and to stock carts, label items and the Cardiovascular Recovery we could use to offer the best physician assistants as well, so create functional work environ- Room, asked her managers if patient care,” says McGuin. “We that the group functioned as a ments,” says Nye. “They really she could put together a council. really had a voice in everything team before we arrived.” stepped up and came together “They agreed, and we sought from where things went to how The group met socially as a team.” out volunteers who were willing the work flow would change.” several times, and regularly

PRACTICE MAKES SAFE The week prior to moving into the new MedStar Heart & Vascular Institute critical care units on 2NE and 2NW, approximately 130 nurses from CVRR, 3H, 4G and the hospital float pool attended a four-hour training block. This training spanned over one week, referred to as “Sim Week.” “The primary focus was to get the staff acquainted with the new work environment without the added stress of patients, says Kelly Nye, BSN, RN, patient care manager on 2NW. “The unit size alone, which was much bigger than anything we were used to, created new challenges for our staff.” Several stations were set up to include training on new defibrilla- tors, pacers, new progressive ICU beds, the high tech boom systems, a brand new HaemoBank™ system, where staff could retrieve blood products emergently on the unit, and a new medical materials supply system (Logi-D). MedStar Health’s SiTEL (Simulation, Training and Environment Lab) was enlisted to help design and implement a clinical training scenario with an emergent patient situation that required the staff to locate and use the new technology and equipment. One patient scenario involved excessive bleeding, cardiac arrest and rapid return to the Cath Lab, another consisted of a bleeding open heart surgery admission that deteriorated to a cardiac arrest requiring the patient’s chest to be opened at the bedside with a rapid return to the OR. “The

2016 NURSING ANNUAL REPORT practice definitely made our transition safer for our patients,” says Nye. “We absolutely learned where to go to get help.” 4 UNITS ON THE MOVE

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involved,” notes Silvester that connected directly into Stokes, business manager for televisions in the room. uilding the Nancy and Harold the Department of Nursing. Although the new Heart BZirkin Heart & Vascular After three years, he & Vascular Hospital is now Hospital required moving 16 smiles, “we could move 30 complete, the moves will functioning units over the course patients in two hours.” continue as the Hospital of three years. Shifting units required Center updates other units that “When we started out, extra attention to maintaining were first constructed in the we’d take six or seven hours just a healing patient care environ- 1950s. Plans for FY17 include to get the patients from one ment while minimizing patient restructuring an immediate care location to another, and that discomfort from construction unit to provide overflow space was after months of strategizing noise. A team tasked with for the Emergency Department, and checklists and having providing solutions gave out and refurbishing several many different departments earplugs and headphones intensive care units. 2016 NURSING ANNUAL REPORT

5 million dollars in tuition reim- 3.3 bursement for 292 nurses nurses graduated from the Vizient® /AACN Nurse Residency program IN PROFESSIONAL DEVELOPMENT 240 excellence Nurse recruitment and retention became a major focus in the Department of Nursing in FY16, tied to the early arrival of a long-predicted nursing shortage. Long-standing professional development programs were strengthened and improved, including the Hospital Center’s Vizient®/AACN Nurse Residency Program. In TUITION REIMBURSEMENT GROWTH addition to adding an additional residency program coordinator to manage the more than 400 new-to-practice nurses who participated in FY16, the curriculum was revised to include more simulation train- ing, on-line modules, touch points with leaders throughout the year, and a redesigned completion ceremony. Additional professional development added in FY16: $1.46 $1.7 $3.3 • Resources dedicated to key areas for for specialty patient 258 272 292 populations • New certification preparation classes, including and FY14 FY15 FY16 FY14 FY15 FY16 Oncology Nurses $ Million • Simulation training in partnership with the George Washington University School of Nursing • Combined first year residency/bridge programs in Emergency Department, Critical Care, OR and Cardiac nursing • Developed and implemented the askNED mobile app to alert CREATING A nurses to education opportunities, practice updates, and to LEADERSHIP ACADEMY provide immediate access to the Department of Nursing policy Recognizing the well-docu- portal and direct email contact with nurse educators. mented fact that positive rela- tionships with nurse managers are vital to nurse retention, the Department of Nursing launched a Leadership Academy in FY16 to provide management skills, personnel engagement and work-life balance workshops for the Hospital Center’s 158 nurse leaders. “Today’s young leaders are highly motivated, well-educated critical thinkers,” DEDICATED TO says Susan Eckert, MSN, RN, PROFESSIONAL DEVELOP- NEA-BC, CENP, senior vice presi- MENT & ENGAGEMENT dent and chief nursing executive. Nurses at MedStar Washington “They are open to new ideas and Hospital Center received a new life-long learning. The Leadership professional resource in FY16, Academy grew out of a desire to a dedicated to engage our leaders, along with their professional development all our nurses.” Among the initial and engagement. workshops in FY16: For nurse educator Sara “This is a great opportunity • Pinpointing certifications • Work-Life Balance, led by Groff, BSN, RN, CMSRN, to support professional growth,” opportunities and classes Caren Lewis, MSHA, BSN, RN, the new position’s focus on she says. “My overall goal is to Vice President, • Assisting with Clinical supporting nurses who want to build a practice environment and Perioperative Services Advancement Program take advantage of the life-long that makes our quality staff — applications • Nursing Professional Develop- learning, education support, leaders and bedside nurses — • Expanding the Leadership ment Models used at MWHC: bonus programs and career want to stay here.” Academy program An Overview, led by Michael planning available here is a way Among the services Groff • Providing individualized Clarke, MSN, RN, NEA-BC to help colleagues make the provides to nurses who have information about education, • Finance Update: Decoding most of their experiences at the been here 18 months or longer: career development and 2016 NURSING ANNUAL REPORT Reimbursement, led by busi- Hospital Center. ness consultant Jessica Jones tuition support 6 INSPIRED... AND INSPIRING OTHERS

of my nursing director, Evelyn surgical unit, he is enrolled in Ougo,” he says. “She worked a program to get his Bachelor with me on my schedule. She of Science in Nursing, and is would sometimes sit me in her aiming for a Master’s degree in office and tell me how to get nursing informatics. hen Olakunle Ayanwale college, earning prerequisites to things done. I cannot tell you “I am so thankful to (above, middle) started get an associate nursing degree. W how helpful those words were.” everyone on this unit—they work as a patient care techni- “I was inspired by the caring Last year, Ayanwale— all supported me and encour- cian on unit 1C, he didn’t really nurses I saw working here.” known as “Idris” on the unit— aged me.” Now Idris is the one have a career plan. That was The next five years, he says, received his degree and RN encouraging others: his success 2009, and, he says, “I just knew were not easy. Working full time license, and returned to work has inspired eight other PCTs I wanted to move up. I wasn’t and going to school presented on 1C—this time as a nurse on the unit to enroll in nursing sure where.” By 2010, however, challenges. “I could not have resident. Even as he works full programs. he was enrolled part-time in done it without the support time on the geriatric medical/

SUPPORTING PROFES- At the top of the record Nursing Professional Develop- SIONAL DEVELOPMENT number of applicants: Zainab ment Council, Wound Resource “Sara” Turay, RN, who started Nurse, Safety Coach, volunteer Applications to the Clinical at the Hospital Center in 1998 for the Biocontainment Unit, Advancement Program (CAP) and currently works on Mother/ unit champion for Language of professional development Baby units 5D and 5F and Caring, and M.O.S.T (Maternal recognition program doubled in previously worked in Obstetrics/ Obstetric Safety Training). FY16, and bonuses rose to more Gynecology. Wherever she Turay looks forward to than $16,000 in the most recent works, “I have always been earning a CAP bonus next year, quarter. The CAP application involved” she says. “I like to too. Already on her list: working was also simplified, and dead- be ‘in the know.’” Among the on Pathway to Excellence lines standardized, based on numerous professional develop- and earning her Mother/Baby participant suggestions. ment activities that earned her certification. the highest score in CAP: the

7 excellenceIN SKILL AND RECOGNITION

As an academic medical center, MedStar Washington Hospital Center seeks nurses with the critical thinking skills, training and the educational background to thrive as they provide care in a fast- paced environment with leading-edge services. CLINICAL Training is available for all nurses at the Hospital Center. In addition, the Nursing Education Department provided training in INSTRUCTION seven specialty bridge programs (Intermediate Care, Critical Care, Class Attendance Emergency Department, Operating Room, Obstetrics, Neonatal Intensive Care and Post-Anesthesia Care Unit) for 237 nurses. To make information about classes, policies and opportunities 2,704 3,081 easily available, the Nursing Education Department created and launched a mobile app, askNED, which was downloaded by FY15 FY16 692 nurses. With 82 percent of all nurses having a BSN degree, the Hospital Center surpasses the national average. Among the other notable accomplishments of the Hospital Center nursing workforce: Percent of nurses at the Hospital • Approximately 50 percent are ACLS certified Center who have worked here more • 16 percent are certified in their clinical or role specialty 31.7 than 10 years • 30 percent belong to their professional organization

NEW RECOGNITION: EXCELLENCE IN NICHE AWARD A GROWING THE CHIEF NURSE NURSING AWARD For the fourth year in a row, DEMOGRAPHIC EXECUTIVE AWARD Washingtonian Magazine MedStar Washington Hospital In 1970, less than four percent The Chief Nurse Executive honored four nurses from Center received Exemplar of the national nursing workforce Award, a new nurse recognition MedStar Washington Hospital Status, the highest designa- was male. By 2015, according to program started in FY16, honors Center at its 2016 Excellence tion possible, from the NICHE the Kaiser Family Foundation, nurses who exemplify best In Nursing Awards dinner in (Nurses Improving Care for males had reached nine percent nursing practices at MedStar May at the Carnegie Library. Healthsystem Elders) organiza- of all nurses nationwide. Washington Hospital Center. Pictured above, from left: Rachel tion. NICHE designation demon- Reflecting national trends, Nurses are nominated by peers Rosenberg BSN, RN, of 2H was strates a hospital’s organizational the percentage of male nurses and then chosen by the chief a finalist in the Critical Care commitment and continued at MedStar Washington Hospital nursing executive in one of four category; Tijeerah Henderson, progress in improving quality, Center grew from nine percent categories: Resource Nursing, BSN, RN, of the NICU, was enhancing the patient and family in FY15 to more than 11 percent Patient Care, Mentoring/Coach- a finalist in the Mothers and experience, and supporting the in FY16. The number of male ing and Leadership. There is Children category; Dionne Ross, hospital and other healthcare nurse leaders: 17 of 168. also a category for a Nursing BSN, RN, nursing director for organizations’ efforts to serve its Affiliate, defined as a Hospital the Cardiac Cath Lab and the communities. Center colleague who is cele- Electrophysiology Lab, was a brated for their support for finalist in both Critical Care and nursing. A total of 34 associates Nursing Leadership categories; Number of times the new askNED app, from the Department of and Pramila Jaladanki, BSN, RN, developed by the Nursing Education of the Nurse Responder Team, Nursing’s seven service lines Department, was accessed in FY16 2016 NURSING ANNUAL REPORT received the CNE Award in FY16. was a finalist in Critical Care. 5,859 8 ith the expansion of ambu- on a large scale like this before.” assistants who worked in the clinics now have “Safe Lift” Wlatory clinics affiliated with Renkema and the Nursing ambulatory settings had to take equipment and all ambulatory MedStar Washington Hospital Education Department looked a class so they could administer nurses and medical assistants Center— there are now 47 clin- first at suture removal, because flu and other routine vaccines — take a class at the Hospital ics with 178 nurses and medical many surgical patients arrive at and the list grew from there. Center in proper use of the assistants —“We realized there the clinic days after a procedure “We started with basics, then equipment. “Any of our ambula- was a lot of inconsistency of for this follow-up. “We created created checklists for the skills tory nurses are welcome to take practice,” says nurse educator a competency tool and then needed for specialty clinics. An classes through the Education Angela Renkema, BSN, RN. trained a number of ambulatory Ob/Gyn nurse will need compe- Department,” says Renkema. “About a year and a half ago, nurses who then trained the tency in cystoscopy, but medical “Ambulatory practices are grow- we began looking at how to others in their clinic. We created oncology will need to have ing, and we want to be certain establish competencies for a basic standardized process.” certain skills in infusion. There our nurses are skilled in best ambulatory nursing practice, The team then moved are many different areas.” practices.” which hasn’t really been done on to vaccination—all medical In addition, all ambulatory

A NEW EXPERTISE: AMBULATORY NURSING 2016 NURSING ANNUAL REPORT

9 Nursing Executive Safety Rounds 67 completed in FY16

percent reduction in Serious Safety Events IN QUALITY AND SAFETY 90 in two years

excellenceBoth patient and associate safety initiatives drove improvements in care at MedStar Washington Hospital Center for FY16. The year began with a “Protect the Line” initiative that focused on central line-associated blood stream infections (CLABSI). Hospital Center executives and clinicians teamed to round weekly on units, check on central line monitoring and keep associates focused on the steps involved in CLABSI prevention. In response to national headlines about increasing violence against care givers, the Hospital Center created a multi-disciplinary Workplace Violence Prevention Committee that reviewed policies and procedures, initiated new protections and began training programs designed to protect both associates and patients. Among the quality and safety improvements in FY16: • Hired a dedicated clinical specialist focused on patient and associate safety • Performed audits on all units to validate supply and use of C.diff prevention packets. • Conducted thorough audit of the Patient Safety Event system to capture and quantify workplace safety incidents • Initiated a Behavioral Emergency Response Team (BERT) as part of the Department of Nursing Strategic Plan initiative to focus on behavioral difficulties with patients and families • Enhanced nurse director/physician director dyad model to support monthly clinical dashboards

FALLS PRESSURE ULCER PREVALENCE SERIOUS SAFETY EVENTS Patient outcomes: FY16 is at benchmark for Inpatient Falls Patient outcomes (Target for FY16: 1.5%) Related to Nursing Care Target ≤ 1.6

2.6% 2.1% 2.0% 1.8% 1.8% 1.6% 4.0% 3.1% 2.1% 2.0% 1.7% 1.6% 30 33 20 9 2

FY11 FY12 FY13 FY14 FY15 FY16 FY11 FY12 FY13 FY14 FY15 FY16 FY12 FY13 FY14 FY15 FY16

IT TAKES A TEAM

Lina Pizarro, Maria Elena Ruiz, MD, BSN, RN, (left), (left) and Quincy Nicole and Chee Chan, Smith, BSN, RN – 2D MD – 1EIMC As one of the busiest When physicians medical-surgical units provided a lunch at MedStar Washington for the nurses on Hospital Center, the 1EIMC, it was a nursing staff on 2D cares celebration of for patients with every- the team work thing from tracheostomies that helped the intermediate care unit achieve one full year without to trauma. Even with its busy atmosphere and breadth of patients, a central line-associated blood stream infection (CLABSI). It was 2D hits many quality and safety benchmarks. The dyad, says nursing also, acknowledges Lina Pizarro, BSN, RN, nursing director for the director Quincy Nicole Smith, “is a partnership and a commitment. unit “a direct result of the constant communication between the We are both equally invested in safe patient care, maintaining high nurses and the physicians here.” That communication, she notes, clinical and performance standards, and developing our resolutions as starts at the top. “Dr. Chan and I are talking several times a day. We a team, especially our tough issues.” What makes it work? “Regular text, we phone . . . it’s seamless after five years.” meetings — three to five a month,” says Smith. “I can always reach Dr. Ruiz, she is present and involved, and she supports our staff and our leadership.” 2016 NURSING ANNUAL REPORT

10 ASSOCIATE SAFETY CHECKUP

ment prevention as part of • Crisis Prevention Institute the safety picture. The broad Training in De-Escalation formula works. Among the safety techniques begun for nursing accomplishments in FY16: associates or Mark Marino, MSN, BSN, ing our associates from injury,” • Improved tracking and RN, CPPS, clinical specialist he says. Pictured above with • Implementation of Vanish- F ® trending of Patient Safety for safety, both patient safety Kathleen Timmons, director of Point syringes that signifi- Event reports and associate safety are vital to public safety and his co-chair cantly reduced needle stick MedStar Washington Hospital on the Workplace Violence injuries • Safety Contracts that better Center’s reputation as a safe Prevention Committee, Marino • OSHA Physical Environment manage or discharge disrup- facility. “For example, safe lift includes everything from phys- Assessment started tive patients with abusive behaviors equipment ensures a patient ical environment assessments • New Safe Patient Handling/ is comfortable and safe while and equipment to de-escalation Safe Lift equipment installed, • Identification badges replaced being moved, as well as protect- training and associate harass- including in ambulatory clinics to reflect first name only

A NEW RAPID RESPONSE an alternative for the clinician behavioral tech trained in psychi- pilot units.’ After implemen- In FY16, MedStar Washington so they did not need to call atric de-escalation respond to tation of the BERT response, Hospital Center launched a in public safety officers when the unit to assist the unit staff public safety officer calls went forward-thinking rapid response a patient was in a behavioral with patient management. BERT down to 12 per month,” says team, dedicated specifically to health crisis.” is able to call on psychiatrists, Griffin. behavioral interventions. “We The solution: the Behav- hospitalists and public safety Nurses appreciate the identified a while ago that when ioral Emergency Response officers, as needed. The BERT support. “The BERT responders we have psychiatric issues on Team, or BERT. Five units piloted team is available seven days per offer a wealth of experience and medical units, the behaviors can the program this year. When week/24 hours per day. have been invaluable in helping become difficult for clinicians unit staff cannot de-escalate a In just three months, the to manage the environment on who do not have psychiatric behavioral situation, they call a pilot produced dramatic results. the unit,” says Kathy Nasman, training,” notes Lourdes Griffin, special BERT code that triggers “In March, prior to the imple- BSN, RN, nursing director PhD, assistant vice president, an immediate visit from the mentation of BERT, Public Safety on 2C. The BERT program is Medicine and Psychiatry. team: a psychiatric nurse, a was called 60 times to respond expected to expand throughout psychiatric social worker and a to ‘disorderly patients on the the Hospital Center in FY17. “There was a desire to create 2016 NURSING ANNUAL REPORT 11

100%Department of Nursing participation in Language of Caring training launch

100%of inpatient units audited IN PATIENT CARE for bedside report compliance six months after launch Two of the largest initiatives of the FY16 Department of Nursing excellenceStrategic Plan involved improvements in patient care. The first: a hospital-wide rollout of bedside shift report, where the patient is involved in the conversation between nurses and, if possible, physicians at change of shift. The second: beginning extended patient communication and interaction training for associates, titled “Language of Caring,®” to more uniformly express the Hospital Center’s “Above All, Patients First” mission of care. Another patient care improvement in FY16 involved enhanced use of digital media for patient education and communication: • New white boards in each room for patient communication • Enhanced use of digital media for patient education

BETTER AT THE BEDSIDE her. After checking that the bed “How are you this morning?” and call button function and asks Ernestine “Tina” Leonidas, asking if the patient would like BSN, RN. Leonidas (pictured to use the restroom, the nurses above on the right in the first take the W.O.W. outside to finalize their handoff. image), admitted the patient “NICE WORDS WORK” development rolled out in FY16 to unit 3C and cared for her Welcome to the world Benedict Misterio, RN, above, designed to help all associates through the night. Now she of bedside report, where the knows how important it can at the Hospital Center better stands at the foot of the bed patient gets a status update and be to put patients at ease. As connect with and demonstrate with nurse Felicia Nyarko, BSN, meets each caregiver at change one of MedStar Washington their caring to patients. The RN (above left in fourth image), of shift. “If the patients are alert Hospital Center’s intravenous Language of Caring program who is taking over on the day and aware, they really appre- therapy (IVT) specialty nurses, teaches associates to begin shift, and the mobile computer ciate us talking next to them, “I’m usually using a needle on interactions with a message (“W.O.W.” for workstation on because it helps them know the patient,” he says. “They from the heart before getting wheels) contains all the patient’s what is going on and gives them aren’t always happy to see down to business. “Nice words charts and vital information. a chance to ask questions,” says me.” Indeed, Misterio walks work,” Misterio finds. “Instead Also observing: nursing resident Leonidas. five miles a day visiting units of looking at you like, ‘What are Lesley Fonjungo, BSN, RN. The Bedside report, piloted and procedure areas to draw you doing here?,’ the patients nurses confirm the patient’s in FY15, rolled out throughout blood or insert semi-permanent warm up to you when you start identification, then Leonidas the Hospital Center in FY16. peripherally inserted central by acknowledging their feelings introduces Nyarko, and gives Nurses credit the technique with catheter (PICC) lines. and show them you know an update to the patient and increasing patient satisfaction So when he was picked they are anxious.” Once they the day nurse simultaneously. scores and reducing patient to be the Language of Caring are comfortable, “everything They reconfirm each item with anxiety. “We had to adapt the unit champion for IVT, Misterio is easier. Even IV therapy is a the patient, and note when they process to the different rooms liked that he became responsi- much better experience.” expect the gastroenterologist and situations,” says Leonidas, 2016 NURSING ANNUAL REPORT ble for reinforcing professional will be coming by to talk with “but it’s working really well.” 12 ABOVE ALL, PATIENTS FIRST

Idi Marrah, above, the that he was there because he night unit clerk on 2E and wasn’t well, and if he cooper- 2EIMC, is one example of such ated and took his medication, atient care is the primary difference. When a patient he might recover more quickly. Pfocus at MedStar Washington on the stroke unit became “The patient said I could give Hospital Center, and the agitated, refused medication him his meds. I told him I can’t, Hospital Center’s 124 unit clerks and lashed out at his nurse, but I would wait next to him play a vital role in that care as Marrah stepped into the room. while the nurse did.” part of the nursing team. From “He wanted to go home, and Marrah received a Hospital managing patient requests and he was not happy,” Marrah Center SuperStar award for his organizing life on the unit to recalls. “I apologized for his help. “Sometimes I haven’t had helping in a crisis, unit clerks bad day, asked what I could do as much going on as the nurses can make all the difference to to help. I listened.” When the do, so I can bring in a new nurses, patients and other staff patient had calmed down some- perspective,” he says. “I do what members as well. what, Marrah told the patient I can to help.” 2016 NURSING ANNUAL REPORT

13 PATIENT CARING

“Every single day I hear from someone who says ‘I could not “ he helped so much.” “She RN, Third Floor Operating Room them to sudden changes in a have done it without her,” says was one half of the dynamic (TFOR) patient care manager. patient’s status and she won SBeverly James, BSN, RN, patient duo who took care of me.” A five-year veteran of the a Nurses Choice award from care manager of the Third Glowing comments arrive TFOR team who cares for those her colleagues for her excel- Floor Operating Room (TFOR). almost every day for patient care going through gynecology, lent teamwork. Inspired by her She’s talking about patient care technician Ashley Poindexter, orthopaedic and eye surgeries, coworkers, Poindexter is technician Ashley Poindexter, a above. “Patients tell me Ashley Poindexter helps patients before pursuing a nursing degree, five-year veteran of the TFOR makes them feel cared for and and after their procedures. She and aspires to be a Certified team who cares for those going safe,” says Myra Sumpter, BSN, supports OR nurses by alerting Anesthetist. through gynecology, orthopedic and eye surgeries as outpatients. 2016 NURSING ANNUAL REPORT

14 IN PATIENT SATISFACTION

Satisfied patients reflectexcellence the “Above All, Patients First” mission of MedStar Washington Hospital Center. Among the initiatives in FY16 that touched on maintaining high patient satisfaction rates: • Replacement of mattresses in half of all non-ICU beds, with other half to come in FY17 • New beds in ICU rooms 12,260 • New patient room furniture (recliners, trays and tables) Post-discharge follow-up phone calls to patients in FY16. • Continuation of “Baby Friendly” designation effort. In FY16, 95 percent of associates in Labor & Delivery, Mother/Baby and NICU/Nursery care units completed “Baby Friendly” education. Hospital- wide education involved informing the community about the benefits of breastfeeding and World Health Organization breastfeeding goals. • “Clean To Occupy” efforts in the Emergency Department and Post Anesthesia Care Unit to reduce wait time for patients to be moved to a unit 86,753 Nurse leader rounds on patients in FY16

implants and supplies are avail- able. She communicates with surgeons and clinical managers A BETTER WAY TO to schedule procedures in a OPERATE way that allows sterile process- “I always think, what if this ing to provide for and turn A BETTER WAY TO WAIT to arrive,” says Doris Medina, patient was a family member, around instruments as soon as BSN, RN, nursing director on or one of us? How do we want possible without delays. She In FY16, a new Discharge Hospi- to be treated?,” says Jennifer checks in with the management tality Center (DHC) opened at unit 3C, pictured above, who manages the Center. The DHC Dabuet, BSN, RN, pictured team in the evening, for conti- MedStar Washington Hospital above. That prompts her to nuity of preparation and follow- Center to provide a safe and also assists with day-of-dis- charge bed management, and make certain everything is in ups. On the day of surgery, comfortable area for discharged place for all surgeries in the Dabuet sees to it that patients patients to wait for a ride home. has succeeded beyond initial expectations. “The number of Ear, Nose and Throat (Otolaryn- are appropriately prepared With reclining chairs, snacks, gology) and Oral Maxillofacial in the holding area and that large-screen televisions, a patients utilizing the DHC has increased every month,” says services in the Main Operating the operating room and team dedicated restroom and patient Room at MedStar Washington assigned are all set. “It’s a good care technician coverage, the Medina. “We went from three patients per day at the start to Hospital Center. Since she thing to prepare, prioritize and DHC “supports patients who began working as the Clinical organize,” she smiles.“I hope want more than simply lying in about 21 on average, and we continue to grow.” Lead Nurse in 2015, OR to inspire others to give our bed while waiting for their ride turnover times have decreased patients the utmost care they and patient satisfaction scores deserve. At the end of day, we have increased. The secret: smile as we head home, know- preparation. Dabuet prepares ing that our preparation had a

for posted cases days ahead, great impact on the patient’s 2016 NURSING ANNUAL REPORT ensuring necessary instruments, surgery experience.” 15 IN EVIDENCE-BASED PRACTICE RESEARCH excellenceNurses at MedStar Washington Hospital Center develop their approach to patient care using evidence-based practice (EBP). In addition to training in EBP during the first-year residency program (all residents participate in an original EBP project), the Nursing Education Department supports original research, with grants from the Center for Excellence in Nursing, and provides financial reimbursement for nurses who present their research at national conferences. The number of these academic endeavors increased in all categories in FY16. The Nursing Education Department also conducts Nursing EBP FY15 FY16 and Research Grand Rounds on a variety of topics. Among the FY16 Grand Rounds: Scholarship Presentations 35 47 • Baby Friendly Hospital Initiative • Nurses’ Health Study and Heart • Bladder Scanning Policies Disease Scholarship Publications 11 15 • Patient Involvement in Fall • CLABSI 2.0 EBP Research/Research Projects 9 14 • Discharge Lounge Prevention • Fecal Incontinence • Unavoidable Pressure Ulcers Center for Excellence in Nursing Awards 12 15 • Medical Marijuana • V erbal De-Escalation of Agitation

FIFTH ANNUAL POSTER PRESENTATION MEDSTAR HEALTH Paige Simonson, BSN, RN, RESEARCH SYMPOSIUM (below) presented her poster MedStar physicians, nurses and in March at the Vizient®/AACN researchers presented more Nurse Residency Program than 200 posters and abstracts Annual Meeting in Bonita for the Fifth Annual MedStar Springs, Fla. This was the Health Research Institute (MHRI) evidence-based practice project Symposium. The Hospital Simonson completed with fellow Center presented eight posters, nursing residents Sarah Richards, and Dhaya Muthiah, BSN, RN RN, Elizabeth Sawicki, RN, and of 2H won the nursing poster Teresa Bullington, RN, during award for her poster, “Nurses’ their residency program at the INAUGURAL Research Collaborative Gover- attitudes, competency, and Hospital Center. The poster was EVIDENCE-BASED nance Council featured talks perceptions of the National one of only 30 accepted PRACTICE CONFERENCE on research topics, such as Institute of Health Stroke Scale.” out of more than 200 how to conduct an Iowa model submissions. More than 80 nurses from evidence-based research MedStar Washington Hospital project. The conference Center and other hospitals in included poster presentations the Washington, D.C. area and small discussion groups, spent a day discussing nursing and offered research networking evidence-based practice opportunities. The conference research at The Catholic was supported by the Hospital University of America Pryzbyla Center’s Center for Excellence Center last October. The first- in Nursing. ever conference hosted by the Department of Nursing’s Evidence-Based Practice and The last two councils were The Department of Nursing added in FY16: a Quality and Strategic Plan for FY16 called Safety Council and a Coordi- for the implementation of the nating Council, pictured above, final phase of the three-year consisting of the leaders of all new Collaborative development of a Collabora- five Collaborative Governance Governance Councils tive Governance structure at councils (Evidence-Based launched in FY16 MedStar Washington Hospital Practice and Research, Nursing 2 Center. The goal of the Collab- Practice, Professional Develop- orative Governance structure ment, Informatics and Quality is to have the voice of nurses and Safety). In addition, meet- directing many of the clinical ings were standardized to the and professional issues that arise same time each month and new in delivery of care. efforts to communicate the work of all the councils were started.

IN COLLABORATIVE GOVERNANCE excellencedone by the councils and to Nurses Credentialing Center’s OPEN HOUSES The Collaborative Governance attract new members. The half- Certified Nurses Day in March. councils held several open day event was part of a larger More than 40 nurses interested houses in FY16. effort to increase visibility and in earning professional certifi- All councils joined in a participation. cations gathered for the early Collaborative Governance The Professional morning event in CTEC, where Open House, held in the fall in Development Council held a they learned about specialty the Center For Excellence in Certifications Open House, in certifications courses, financial Nursing, to showcase the work conjunction with the American support and training programs. 2016 NURSING ANNUAL REPORT

17 MedStar Washington Hospital Center nurses were celebrated for their community involvement and fundraising in FY16. In addition to a nurses Speaker’s Bureau operated through the Hospital Center’s Community Relations office and a Community Outreach committee that provides health screenings and informational outreach to the community, nurses participate in a number of organized charitable events.

MARCHING FOR DIMES babies, and then you also Nurses in the MedStar participate in our March for Washington Hospital Center Babies,” said Leib (center, in NICU (pictured above) received blue jacket, holding plaque). a plaque and a “Thank You” in “It’s our way of thanking those RACING FOR A CANCER CURE FY16 from the March of Dimes, who care for these important More than 50 MedStar Health associates participated in the presented by Kate Leib, diretor patients.” The mission of March Sprint Four the Cure through the Four Seasons Hotel Washington, of field services for the Maryland- of Dimes is to improve the DC. The annual event, which features a 5K run and walk as part of National Capital Area Chapter of health of babies by preventing the fundraising challenge, supports cancer research at the March of Dimes. “We know how birth defects, premature birth Washington Cancer Institute at MedStar Washington Hospital much you do every day for these and infant mortality. Center. Senior Nursing Director Jane McGee, DNP, MS, BSN, RN, led the team that included (pictured above): senior nursing director Ariam Yitbarek, MSN, BSN, RN, as well as nurses from throughout the Hospital Center. More than $174,000 was raised to support cancer research.

WHEELS UP FOR THE HOLIDAYS When EP Lab nurse Donna Brown-Redding, BSN, RN, heard about the Christmas wishes of 30 local children identified by the Hospital Center’s Community Relations Department, she claimed not just a few names on the wish list, but the entire list. Then, she rallied her colleagues into action, not stopping until every child’s request was IN COMMUNITY INVOLVEMENT fulfilled. She even recruited her son, Kamron Redding, BSN, RN, who worked in the Cardiovascular Recovery Room, to rally his unit to excellence contribute a new bicycle. Virtually everyone Brown-Redding called upon at MedStar Washington Hospital Center rose to the occasion: Five bicycles, a laptop, clothing, books, art supplies, toys, gift cards and more were donated. The 17-year Hospi- tal Center veteran credits the team for giving from their hearts. “We’re in healthcare, it’s what we do,” she says. Brown-Redding won a MedStar Washington Hospital Center Presi- dent’s Award for making dreams come true. 2016 NURSING ANNUAL REPORT

18 2016 NURSING ANNUAL REPORT

19 Department of Nursing 110 Irving Street, NW IN NURSING AT MEDSTAR Washington, DC 20010 excellenceWASHINGTON HOSPITAL CENTER

Distinct professional Total RNs at Percentage of RNs with development courses offered 1,777 end of FY16 50 ACLS certification 28 regularly throughout the year

Percentage of RNs Specialty bridge training Technical staff who belong to their programs 286 30 professional association 7 Evidence-based research projects Percentage of RNs as part of Vizient®/AACN Nurse Nursing Executive with BSN degree Safety Rounds 82 46 Residency Program 67