A Clinical Ladder Is On Its Way! - Mission Health

News for and about Mission Nurses • Volume 6, Number 5 • May 2010
A Clinical Ladder Is On Its Way!
For the past few years, Mission
Hospital has had the Professional
Educational Achievement Recognition
(PEAR) program, an incentive program to
recognize Registered Nurses for professional
development. As the organization
transitions, new opportunities are emerging
for the non-supervisory clinical nurses who
want to make a conscious decision to
move their career forward while remaining
at the bedside.This new program will be a
voluntary professional
development program to
provide opportunities for
the RN to earn financial
recognition for their
achievements.
Registered Nurses at the bedside with
advancement opportunities to promote
professional growth while improving
patient care outcomes.
As the team develops, we will share
details of Mission Hospital’s unique model
designed specifically for our Registered
Nurses.We anticipate the design to be
available by Fall 2010. In the meantime, stay
involved and keep track of everything you
do, as many of the same types of categories
from our PEAR Program will continue
to be professional development criteria
for the Clinical Ladder.
– Cheryl M. Gibson, RN, BSN,
Nursing Project Coordinator and Chair,
Clinical Ladder Development Team
– Cathy Retskin, RN, Labor & Delivery and
Co-Chair, Clinical Ladder
Development Team
The Clinical Ladder
Development Team was
formed in September 2009
to create an advancement
system for non-supervisory
Registered Nurses.The
team began with a literature
search and reviews of clinical
advancement models
and discussed the timeline
for implementation. During
the subsequent months and
currently, levels are being
defined. When the Clinical
Ladder is implemented,
Registered Nurses may
apply for Level III, and as the
program develops, additional
levels will be available.
The process will include a
professional application
process, career portfolio,
and a peer review panel.
The purpose of a Clinical
Ladder is to provide
The Clinical Ladder Development Team members pause for a photo after their April meeting discussing the details
of the upcoming implementation of a career recognition program for nurses who give direct patient care. Seated
left to right are Glenda McCall, RN, BSN, nurse manager of PMCU; Laurie Downs, RN, BSN, CCRN, nurse manager
of Coli ICU; Kimberly Hite, RN, BSN, CCRN, CSC, Cardiovascular ICU/Recovery Unit; and Cathy Retskin, RNC,
Labor and Delivery. Center row left to right are Regina Phelps, PhD, RN, NEA, BC, director of Nursing Practice,
Education, and Research (NPER); Martha Smith, RN, nursing unit supervisor, Renal Medicine; Carol Jackson, RN,
MHS, director of Nursing Support Services; Renea Hawkins, RN, BSN, OCN, Oncology; Darlene Schleider, RN, BSN,
CCRN, education specialist, NPER; Cheryl Gibson, RN-BC, BSN, NPER;Thresa Lukacena, media specialist, NPER; and
Kitty Ratzlaff, BSN, MA, CGRN, Endoscopy. Back row, left to right, are Glenda Wyatt, RN, BSN, Specialty Pool,
Nursing Support Services; Peggy Carlson, RN, CNOR, Cardiovascular OR; Barbara Bradley, RN, General Surgery
Megan Stewart, RN, BSN,Trauma Care; and Linda Y. Smith, RN, MSN, IBCLC, NPER.

Nurses Professional Practice Fairs a Success!
Nursing Professional Practice Fairs were held in April on both
the Memorial and St. Joseph Campuses. Sessions were held in the
morning, mid-day, and evening. Displays and discussions were available
to learn more about these topics:
• Magnet ® Recognition Program expectations
• Shared Decision Making Unit Councils
• Education Assistance
• Integrative Healthcare Modalities
• Hospital-wide Shared Decision Making Councils
Nursing Governance Board (NGB)
Nursing Research Council (NRC)
Nursing Practice Council (NPC)
Nursing Informatics Council (NIC)
Nursing Professional Development Council (NPDC)
Nursing Quality Council (NQC)
Nursing Administrative Council (NAC).
Attendees completed “Passports to Prizes” by visiting all the
tables and dropping their cards into a box for a drawing for gift
cards and the grand prize for one RN to attend the Magnet ®
Conference in Phoenix, AZ, October 13-15.To see a list of all the
prize winners, turn to page 4 of this issue of Nursing News.
Zach Clement, RN, BSN, nurse Manager for 7 North and chair of
NPC (left), prompted laughter when he agreed to wear the chicken
apron and pose with roosters offered by Janie Fielder, RN,
MSN, of NPER and advisor for NQC, from her country-fair
themed display about nursing quality.
Barb McElroy, RN, Nursing Support Services, and member of NIC
(left), talked with Darren Coleman, RN, of Oncology, (right) about
the involvement of bedside nurses in designing and revising
computer charting.
Carey Estes, RN, BSN, Nursing Unit Supervisor (NUS) for Neonatal ICU and chair of the Marketing and Communications for Nursing Excellence
Council (far left), talks with VP and CNO Kathy Guyette, RN, MSN, CNA-BC (center), and Bryanna Gibbs, RN, BSN, PCCN, of 9 North Step Down
and chair of the NPDC (third from left), about the Councilor Model of Shared Decision Making. Amy Cooper, RN, 4 South, member of NPDC
(seated), talked with nurses about national certifications.

Forensic Nurses Staff Office of Decedent Affairs
Mission’s Office of Decedent Affairs
(ODA) cares for patients and families
when death occurs.We work closely with
the unit nurses, hospital chaplains and also
with funeral homes outside of the facility.
We also work with decedent issues involving
deaths in the community, since Mission
Hospital also acts as the County Morgue.
Morgue Director Larry McIntosh oversees
all aspects of the processing of decedent
issues, and works closely with ODA. He
acts as a vital link for families and funeral
services available in the community and
beyond the region.
The Forensic Nursing Staff has recently
taken on the responsibility of coordinating
and staffing the ODA. A Forensic
Nurse is covering the ODA 24 hours a
day, seven days a week. Our expanded role
is to act as a resource and as facilitators to
staff, chaplains and families in the hospital.
The process begins when we are contacted
by unit nurses and/or chaplains
when a patient has died. We will go to the
unit and talk with staff, assisting in all
Hello from Finland!
Nurses Week is celebrated each year
May 6-12. International Nurses Day is celebrated
on May 12.This year the United
Nations proclaimed a focus on nurses
internationally by passing a resolution
making 2010 The International Year of the
Nurse.This is the centennial year of the
death of the founder of modern nursing,
Florence Nightingale.The international celebration
of the estimated more than 15
million nurses promotes a commitment by
all nurses to bring health to their communities,
locally and worldwide.
Terhi Makela, RN, MSc, Director of
Nursing at the Toolo Hospital in Helsinki,
Finland, sends greetings to the nurses of
Mission Hospital. She wants to share information
about nursing in her country, which
punctuates how the patient mix there is
similar to ours at Mission.
Toolo Hospital, also called the Trauma
Center, has 185 beds and provides services
for 1.4 million residents in the Helsinki and
Uusimaa district. About 18,000 patients are
treated there annually.
aspects of the process, as requested.We
will assist in completing the necessary
paperwork involved, preparing and transporting
the decedent to “Suite M” with the
assistance from the unit, or preparing the
decedent for transport to the family-designated
funeral home.We are also a
resource for questions regarding contact
with Lifeshare, the Medical Examiner, or
any special situation or family request
regarding the decedent. We serve both the
Memorial and St. Joseph Campuses.
Here is information you need to facilitate
the process:
• Call the ODA early in the process so
we can be available to you; 213-0978.
• Be sure to follow Policy/Procedure
#9.00;“Medical Examiner Cases” regarding
the timing of removal of lines or tubes and
sending the patient’s chart to Health
Information Management.
• Wait to call a funeral home for
transport until you have clearance from
the ODA.
• For process details, see Clinical
Policy/Procedure #17.01;“Pronouncement
According to Terhi, “The emergency
specialized hospital care covers the fields of
orthopedics and traumatology, neurosurgery,
oral and maxillofacial surgery, hand
surgery, and plastic surgery. Patients are
referred from other hospital districts, especially
for neurosurgery, plastic and hand
surgery, and for the treatment of the most
difficult orthopedic and traumatological
problems.”
Terhi also talked about nursing education,
“In Finland, nurses receive their education
at polytechnic universities. Completing
the studies takes from 3.5 to 4.5 years.
When you’ve earned your degree, you can
attend shorter courses and become specialized
in (areas like) the operating room,
intensive care or geriatric nursing.”
There is no national board exam after
completing nursing studies, but “Nurses
must apply to the National Supervisory
Authority for Welfare and Health (Valvira)
in order to become licensed to work as a
nurse in Finland,” Terhi concluded.
of Death and Post-Mortem Care.”
• Please be patient with us! We cannot
predict who will need us where and when,
so it may take a bit of time before we can
be on your unit.We will communicate this
to you when you call.
The Forensic Nurses are committed
to supporting staff in the process so that
chaplains and nurses on the unit can concentrate
on the spiritual and emotional
needs of families at this special time of
transition.
Please contact us at any time at 213-
0978 or beeper number 207-3457. We are
here as your resource to answer questions
and assist in any way we can. We welcome
your feedback on these services.
– Helene Groarke, RN, MSN, CCRN, SANE-A;
Forensic Nurse Examiner
Terhi Makela, RN, MSc, (far right), Director of
Nursing at the Toolo Hospital in Helsinki, sends
greetings from Finland to Mission nurses. She is
shown, along with another nurse from Finland,
with Mission nurses Ginny Raviotta, (far left) and
Cherry Odom, (second from right), at the
recent Magnet Conference held in Salt Lake
City.
Watch for photos of the Nurses
Week May 6-12 celebration in the June
issue of Nursing News.

Manager’s Message on the Value of Staff
This message to the staff members of Coli ICU was written by Laurie
Downs, RN, BSN, in her weekly newsletter March 5, 2010, after a
time of high acuity patients, installation of new sky lifts, monitor training,
and, oh yes, heavy snow. It is reprinted with permission.
Many times, I find, it is difficult to convey the essence or trueness
of what a manager has to say to staff. Many managers, as
administrators, find it difficult to share thoughts and feelings with
staff. Honest, straightforward talk is sometimes misconstrued or
criticized.
Yet, as I led our staff meetings this week, I felt a fullness of
sorts in my throat, as I looked across the room at the faces of a
profession built on compassion, intelligence and vast ability. I cannot
help but share this with you. All of you listened as I told the
stories and made the proclamations of what we need to do to
keep ourselves compliant and up to speed.
Some of what we talked about was difficult. Much of what we
discuss was and is strategic, coming from the goals and objectives
of our organization and is evidenced-based for healthcare practice.
All of what we discussed, no matter how mundane, serves to
encourage meaningful, life-giving care to patients.
As I finished the meetings, I knew that most of you heard the
essence, will take the information and work like Trojans (someone
who is determined, strong, or courageous) to be the best and
provide thoughtful, patient-centered care. Every time we come
here, we can change a life. We can influence healing, inspire hope,
and make peace in the midst of despair. We are the movers and
the shakers, and we are the ones who can save lives or change
lives. My life has been touched and changed by you, and my heart
is full of gratitude.
– Laurie L. Downs,
Your most humble servant manager
Professional Practice Fair
Drawing Winners
Winners of gift cards in the Passports to Prizes drawing from submissions by attendees
at the Professional Practice Fairs held in February and April at Mission Children’s
Specialists, Asheville Surgery Center, Memorial Campus, and St. Joseph Campus are:
Bonita Wiedenhaupt, RN, Mission Children’s Specialists (MCS)
Debbie McCoy, RN, MCS
Jennifer Roberts, CNA, MCS
Ginger Frisbee, RN, Asheville Surgery Center
Jenny Wilkinson, RN, Neonatal ICU
Barb McElroy, RN, Staffing Pool
Myra Blackwell, RN, Spine Center
Kelly Phillips, RN, Operating Room
Glenda Wyatt, RN, Staffing Pool
Betsy Clark, RN, Oncology
Denise Anthes, RN, Integrative Healthcare
Brittany Shelton, RN, Oncology
Kathy Smith, RN, Orthopedics
Tammy Massey, RNC, Adult Medicine
Julie Mull, RN, Adult Medicine
Winner of the Grand Prize drawing for the trip to the Magnet ® conference in
Phoenix, AZ, October 13-15 is Carleen Trevino, RN, BSN, CCE, IBCLC.
Winners of the guessing game who came closest to guessing the number of candy
balls in three jars at the Nursing Quality Council table each received a large can of popcorn:
Jar #1 Mary Tosti, RN, 7 North
Jar #2 Vickie West, RN, Manager of 6 North
Jar #3 Marne Rogers, RN, 9 North
Nursing Mission and Vision
Mission Statement:
Mission Nursing - Promoting Health and
Wellness; Providing Compassionate,
Quality Care.
Vision Statement:
Mission Nursing - A Nationally
Recognized Model of Professional Nursing
Practice Committed to Excellence.
Nursing News is Produced for the
Nurses of Mission Hospital,
Asheville, NC
Cherry Odom, RN,
Writer/Editor/Photographer
Nursing Documentation
Coordinator
Email comments/submissions to
cherry.odom@msj.org.
Carole Donnelly, Layout
© 2010 Mission Hospital
Other than the three top winners, Kathy Smith, RN, orthopedic clinician, came the
closest in guessing the correct number in all three jars.

Council Reports
Nursing Governance Board (NGB)
Susan Cadwell, administrative assistant,
received a Nursing Excellence Ambassador
Award from NGB co-chair Jeanie Bollinger,
RN, BSN, CCRN, CSC at the April 21
monthly meeting. Susan was recognized for
her help with the minutes of each meeting
and correspondence for the group.
Topics discussed were:
• Major council reports
• Hospital Peer Review Committee policy
• Development of a Nursing
Strategic Plan
• Upcoming addition of Advanced
Practice Nursing Council
• Selection of attendees by directors for
the October Magnet® conference
Future agenda items are:
• NGB bylaws
• Certification goals
Jeanie Bollinger, RN, BSN, CCRN, CSC, of
Cardiovascular ICU (right), presented a Nursing
Excellence Ambassador Award to Susan
Cadwell, Administrative Assistant (left).
Nursing Research Council (NRC)
The highlights of the April 21 monthly
meeting of NRC are listed below.
• Research Fiesta May 5th from
1300-1530 in Glenn Theater
– 2.5 Contact hours; Register on
WebInservice
– Evidenced Based and Clinical
Research Projects to be presented
– Snacks and Refreshments in Steven’s
Board Room with display of Research
Posters
• Lisa Hicks-Kinney, the Women’s
Research Coordinator from the
Research Institute, is a new ad hoc
member.
• MAHEC Resident Research Day
April 30th in Glenn Theater from
0830-1130. Free to all
– Contact Stacy Wise@mahec.net for
more information.
– Co-chair Lisa Clark, RN, MSN, CPAN,
of PACU
Nursing Informatics Council (NIC)
Following are the highlights of the
April 8 monthly NIC meeting.
• Implementation of a discharge check list
in depart in June
• Completion of NIC by-laws
• Review of the nuances of advance directives.
– Chair, Karen Ward, RN, BSN,
Nursing Informatics
Nursing Practice Council (NPC)
The April 8 monthly NPC meeting covered
the following topics:
• Ann Knupp presented the two programs
being considered for Bar-Coding
Medication Administration (BCMA). The
group saw a demonstration of both programs.
Members were encouraged to go
back to their respective units and engage
staff in deciding which BCMA program will
work best for their area. BCMA previews
for staff will be held on the Memorial campus
on April 29 and the SJ campus on
April 30.
• The group is working to help develop a
policy or guidelines that will be used by
multiple departments (Lab, Nursing,
Respiratory, etc.) to standardize the
process for labeling and transporting specimens
to the lab. The need for these guidelines
was generated from a rapid cycle
team.
• NPC by-laws were reviewed and finalized.
– Chair Zach Clement, RN, BSN,
manager of 7 North
Nursing Professional Development
Council (NPDC)
Highlights from the April 8 monthly
meeting of NPDC are as follows.
• Updates provided by representatives of
the Nursing Governance Board,
Clinical Ladder, and Retention and
Recognition committees.
• The development of the council bylaws.
• The council webpage design.
• Promotion of certification on individual
units.
– Co-chair Gina Hallstrom, RN, CMSRN,
8 North
Nursing Quality Council (NQC)
In the April 21 meeting of NQC, the following
items were outlined:
• Revisions to by-laws were discussed and
approved.
• Diana Wortham, RN, MSN, OCN, presented
data for 2009 from the Alaris Smart
Pumps.
• An overview of National Database of
Nursing Quality Indicators (NDNQI) was
given by Janie Fielder.
– Facilitator Janie Fielder, RN, MSN, NNP-
BC, the CNS for Nursing Quality
and Performance Improvement
Nursing Night Shift Council
(NNSC)
• Bylaws are closer to completion.
• Plans for Night Shift Staff Fair are in
progress.
• Issues across the system with the use
of call, call-back and flexing of staff
were discussed.
Nursing Administrative Council
(NAC)
Did not meet in March.
“I think one’s feelings waste themselves in
words; they ought all to be distilled into
actions which bring results.”
Florence Nightingale
1820-1910

Guide to Clinical Inquiry Process at Mission Hospital
Nurses, do you have a question or idea for a
study that relates to delivering excellent patient care?
Please refer to the diagram to help you decide
whether your project will be based on current literature
(evidence-based) or generate new knowledge
(nursing research).
To help formulate your question, use the PICO
mnemonic to describe the four elements of a good
clinical foreground question.This is most often used in
EBP.
• P – Patient: Describe as accurately as possible
the patient or group of patients of interest. How
would I describe a group of patients similar to mine?
• I – Intervention: What is the main intervention
or therapy you wish to consider? This includes an
exposure to disease, a diagnostic test, a prognostic
factor, a treatment, a patient perception, a risk factor,
etc.
• C – Comparison: Is there an alternative treatment
to compare? This includes no disease, placebo, a
different prognostic factor, absence of risk factor, etc.
• O – Outcome - What is the clinical outcome,
including a time horizon if relevant?
For assistance with this process, contact Kathy
Daley, RN, MSN, CCRN-CMC-CSC, CPAN, Clinical
Nurse Specialist for Research, kathy.daley@msj.org.
Thank you night shift
nursing staff!
Night staff on 4 South Orthopedics are among those who
take care of patients while the world sleeps. Seated is
Michael Devlin, LPN; standing left to right are Sheila Drye,
CNA II; Kristie Hensley, RN;Tracy Benedict, RN; KaSheena
Green, RN, Nursing Unit Supervisor; and Debb Aanonsen,
RN. Photo by Amy Cooper, RN