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A Clinical Ladder Is On Its Way! - Mission Health

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News for and about <strong>Mission</strong> Nurses • Volume 6, Number 5 • May 2010<br />

A <strong>Clinical</strong> <strong>Ladder</strong> <strong>Is</strong> <strong>On</strong> <strong>Its</strong> <strong>Way</strong>!<br />

For the past few years, <strong>Mission</strong><br />

Hospital has had the Professional<br />

Educational Achievement Recognition<br />

(PEAR) program, an incentive program to<br />

recognize Registered Nurses for professional<br />

development. As the organization<br />

transitions, new opportunities are emerging<br />

for the non-supervisory clinical nurses who<br />

want to make a conscious decision to<br />

move their career forward while remaining<br />

at the bedside.This new program will be a<br />

voluntary professional<br />

development program to<br />

provide opportunities for<br />

the RN to earn financial<br />

recognition for their<br />

achievements.<br />

Registered Nurses at the bedside with<br />

advancement opportunities to promote<br />

professional growth while improving<br />

patient care outcomes.<br />

As the team develops, we will share<br />

details of <strong>Mission</strong> Hospital’s unique model<br />

designed specifically for our Registered<br />

Nurses.We anticipate the design to be<br />

available by Fall 2010. In the meantime, stay<br />

involved and keep track of everything you<br />

do, as many of the same types of categories<br />

from our PEAR Program will continue<br />

to be professional development criteria<br />

for the <strong>Clinical</strong> <strong>Ladder</strong>.<br />

– Cheryl M. Gibson, RN, BSN,<br />

Nursing Project Coordinator and Chair,<br />

<strong>Clinical</strong> <strong>Ladder</strong> Development Team<br />

– Cathy Retskin, RN, Labor & Delivery and<br />

Co-Chair, <strong>Clinical</strong> <strong>Ladder</strong><br />

Development Team<br />

The <strong>Clinical</strong> <strong>Ladder</strong><br />

Development Team was<br />

formed in September 2009<br />

to create an advancement<br />

system for non-supervisory<br />

Registered Nurses.The<br />

team began with a literature<br />

search and reviews of clinical<br />

advancement models<br />

and discussed the timeline<br />

for implementation. During<br />

the subsequent months and<br />

currently, levels are being<br />

defined. When the <strong>Clinical</strong><br />

<strong>Ladder</strong> is implemented,<br />

Registered Nurses may<br />

apply for Level III, and as the<br />

program develops, additional<br />

levels will be available.<br />

The process will include a<br />

professional application<br />

process, career portfolio,<br />

and a peer review panel.<br />

The purpose of a <strong>Clinical</strong><br />

<strong>Ladder</strong> is to provide<br />

The <strong>Clinical</strong> <strong>Ladder</strong> Development Team members pause for a photo after their April meeting discussing the details<br />

of the upcoming implementation of a career recognition program for nurses who give direct patient care. Seated<br />

left to right are Glenda McCall, RN, BSN, nurse manager of PMCU; Laurie Downs, RN, BSN, CCRN, nurse manager<br />

of Coli ICU; Kimberly Hite, RN, BSN, CCRN, CSC, Cardiovascular ICU/Recovery Unit; and Cathy Retskin, RNC,<br />

Labor and Delivery. Center row left to right are Regina Phelps, PhD, RN, NEA, BC, director of Nursing Practice,<br />

Education, and Research (NPER); Martha Smith, RN, nursing unit supervisor, Renal Medicine; Carol Jackson, RN,<br />

MHS, director of Nursing Support Services; Renea Hawkins, RN, BSN, OCN, <strong>On</strong>cology; Darlene Schleider, RN, BSN,<br />

CCRN, education specialist, NPER; Cheryl Gibson, RN-BC, BSN, NPER;Thresa Lukacena, media specialist, NPER; and<br />

Kitty Ratzlaff, BSN, MA, CGRN, Endoscopy. Back row, left to right, are Glenda Wyatt, RN, BSN, Specialty Pool,<br />

Nursing Support Services; Peggy Carlson, RN, CNOR, Cardiovascular OR; Barbara Bradley, RN, General Surgery<br />

Megan Stewart, RN, BSN,Trauma Care; and Linda Y. Smith, RN, MSN, IBCLC, NPER.


Nurses Professional Practice Fairs a Success!<br />

Nursing Professional Practice Fairs were held in April on both<br />

the Memorial and St. Joseph Campuses. Sessions were held in the<br />

morning, mid-day, and evening. Displays and discussions were available<br />

to learn more about these topics:<br />

• Magnet ® Recognition Program expectations<br />

• Shared Decision Making Unit Councils<br />

• Education Assistance<br />

• Integrative <strong>Health</strong>care Modalities<br />

• Hospital-wide Shared Decision Making Councils<br />

Nursing Governance Board (NGB)<br />

Nursing Research Council (NRC)<br />

Nursing Practice Council (NPC)<br />

Nursing Informatics Council (NIC)<br />

Nursing Professional Development Council (NPDC)<br />

Nursing Quality Council (NQC)<br />

Nursing Administrative Council (NAC).<br />

Attendees completed “Passports to Prizes” by visiting all the<br />

tables and dropping their cards into a box for a drawing for gift<br />

cards and the grand prize for one RN to attend the Magnet ®<br />

Conference in Phoenix, AZ, October 13-15.To see a list of all the<br />

prize winners, turn to page 4 of this issue of Nursing News.<br />

Zach Clement, RN, BSN, nurse Manager for 7 North and chair of<br />

NPC (left), prompted laughter when he agreed to wear the chicken<br />

apron and pose with roosters offered by Janie Fielder, RN,<br />

MSN, of NPER and advisor for NQC, from her country-fair<br />

themed display about nursing quality.<br />

Barb McElroy, RN, Nursing Support Services, and member of NIC<br />

(left), talked with Darren Coleman, RN, of <strong>On</strong>cology, (right) about<br />

the involvement of bedside nurses in designing and revising<br />

computer charting.<br />

Carey Estes, RN, BSN, Nursing Unit Supervisor (NUS) for Neonatal ICU and chair of the Marketing and Communications for Nursing Excellence<br />

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<br />

and chair of the NPDC (third from left), about the Councilor Model of Shared Decision Making. Amy Cooper, RN, 4 South, member of NPDC<br />

(seated), talked with nurses about national certifications.


Forensic Nurses Staff Office of Decedent Affairs<br />

<strong>Mission</strong>’s Office of Decedent Affairs<br />

(ODA) cares for patients and families<br />

when death occurs.We work closely with<br />

the unit nurses, hospital chaplains and also<br />

with funeral homes outside of the facility.<br />

We also work with decedent issues involving<br />

deaths in the community, since <strong>Mission</strong><br />

Hospital also acts as the County Morgue.<br />

Morgue Director Larry McIntosh oversees<br />

all aspects of the processing of decedent<br />

issues, and works closely with ODA. He<br />

acts as a vital link for families and funeral<br />

services available in the community and<br />

beyond the region.<br />

The Forensic Nursing Staff has recently<br />

taken on the responsibility of coordinating<br />

and staffing the ODA. A Forensic<br />

Nurse is covering the ODA 24 hours a<br />

day, seven days a week. Our expanded role<br />

is to act as a resource and as facilitators to<br />

staff, chaplains and families in the hospital.<br />

The process begins when we are contacted<br />

by unit nurses and/or chaplains<br />

when a patient has died. We will go to the<br />

unit and talk with staff, assisting in all<br />

Hello from Finland!<br />

Nurses Week is celebrated each year<br />

May 6-12. International Nurses Day is celebrated<br />

on May 12.This year the United<br />

Nations proclaimed a focus on nurses<br />

internationally by passing a resolution<br />

making 2010 The International Year of the<br />

Nurse.This is the centennial year of the<br />

death of the founder of modern nursing,<br />

Florence Nightingale.The international celebration<br />

of the estimated more than 15<br />

million nurses promotes a commitment by<br />

all nurses to bring health to their communities,<br />

locally and worldwide.<br />

Terhi Makela, RN, MSc, Director of<br />

Nursing at the Toolo Hospital in Helsinki,<br />

Finland, sends greetings to the nurses of<br />

<strong>Mission</strong> Hospital. She wants to share information<br />

about nursing in her country, which<br />

punctuates how the patient mix there is<br />

similar to ours at <strong>Mission</strong>.<br />

Toolo Hospital, also called the Trauma<br />

Center, has 185 beds and provides services<br />

for 1.4 million residents in the Helsinki and<br />

Uusimaa district. About 18,000 patients are<br />

treated there annually.<br />

aspects of the process, as requested.We<br />

will assist in completing the necessary<br />

paperwork involved, preparing and transporting<br />

the decedent to “Suite M” with the<br />

assistance from the unit, or preparing the<br />

decedent for transport to the family-designated<br />

funeral home.We are also a<br />

resource for questions regarding contact<br />

with Lifeshare, the Medical Examiner, or<br />

any special situation or family request<br />

regarding the decedent. We serve both the<br />

Memorial and St. Joseph Campuses.<br />

Here is information you need to facilitate<br />

the process:<br />

• Call the ODA early in the process so<br />

we can be available to you; 213-0978.<br />

• Be sure to follow Policy/Procedure<br />

#9.00;“Medical Examiner Cases” regarding<br />

the timing of removal of lines or tubes and<br />

sending the patient’s chart to <strong>Health</strong><br />

Information Management.<br />

• Wait to call a funeral home for<br />

transport until you have clearance from<br />

the ODA.<br />

• For process details, see <strong>Clinical</strong><br />

Policy/Procedure #17.01;“Pronouncement<br />

According to Terhi, “The emergency<br />

specialized hospital care covers the fields of<br />

orthopedics and traumatology, neurosurgery,<br />

oral and maxillofacial surgery, hand<br />

surgery, and plastic surgery. Patients are<br />

referred from other hospital districts, especially<br />

for neurosurgery, plastic and hand<br />

surgery, and for the treatment of the most<br />

difficult orthopedic and traumatological<br />

problems.”<br />

Terhi also talked about nursing education,<br />

“In Finland, nurses receive their education<br />

at polytechnic universities. Completing<br />

the studies takes from 3.5 to 4.5 years.<br />

When you’ve earned your degree, you can<br />

attend shorter courses and become specialized<br />

in (areas like) the operating room,<br />

intensive care or geriatric nursing.”<br />

There is no national board exam after<br />

completing nursing studies, but “Nurses<br />

must apply to the National Supervisory<br />

Authority for Welfare and <strong>Health</strong> (Valvira)<br />

in order to become licensed to work as a<br />

nurse in Finland,” Terhi concluded.<br />

of Death and Post-Mortem Care.”<br />

• Please be patient with us! We cannot<br />

predict who will need us where and when,<br />

so it may take a bit of time before we can<br />

be on your unit.We will communicate this<br />

to you when you call.<br />

The Forensic Nurses are committed<br />

to supporting staff in the process so that<br />

chaplains and nurses on the unit can concentrate<br />

on the spiritual and emotional<br />

needs of families at this special time of<br />

transition.<br />

Please contact us at any time at 213-<br />

0978 or beeper number 207-3457. We are<br />

here as your resource to answer questions<br />

and assist in any way we can. We welcome<br />

your feedback on these services.<br />

– Helene Groarke, RN, MSN, CCRN, SANE-A;<br />

Forensic Nurse Examiner<br />

Terhi Makela, RN, MSc, (far right), Director of<br />

Nursing at the Toolo Hospital in Helsinki, sends<br />

greetings from Finland to <strong>Mission</strong> nurses. She is<br />

shown, along with another nurse from Finland,<br />

with <strong>Mission</strong> nurses Ginny Raviotta, (far left) and<br />

Cherry Odom, (second from right), at the<br />

recent Magnet Conference held in Salt Lake<br />

City.<br />

Watch for photos of the Nurses<br />

Week May 6-12 celebration in the June<br />

issue of Nursing News.


Manager’s Message on the Value of Staff<br />

This message to the staff members of Coli ICU was written by Laurie<br />

Downs, RN, BSN, in her weekly newsletter March 5, 2010, after a<br />

time of high acuity patients, installation of new sky lifts, monitor training,<br />

and, oh yes, heavy snow. It is reprinted with permission.<br />

Many times, I find, it is difficult to convey the essence or trueness<br />

of what a manager has to say to staff. Many managers, as<br />

administrators, find it difficult to share thoughts and feelings with<br />

staff. Honest, straightforward talk is sometimes misconstrued or<br />

criticized.<br />

Yet, as I led our staff meetings this week, I felt a fullness of<br />

sorts in my throat, as I looked across the room at the faces of a<br />

profession built on compassion, intelligence and vast ability. I cannot<br />

help but share this with you. All of you listened as I told the<br />

stories and made the proclamations of what we need to do to<br />

keep ourselves compliant and up to speed.<br />

Some of what we talked about was difficult. Much of what we<br />

discuss was and is strategic, coming from the goals and objectives<br />

of our organization and is evidenced-based for healthcare practice.<br />

All of what we discussed, no matter how mundane, serves to<br />

encourage meaningful, life-giving care to patients.<br />

As I finished the meetings, I knew that most of you heard the<br />

essence, will take the information and work like Trojans (someone<br />

who is determined, strong, or courageous) to be the best and<br />

provide thoughtful, patient-centered care. Every time we come<br />

here, we can change a life. We can influence healing, inspire hope,<br />

and make peace in the midst of despair. We are the movers and<br />

the shakers, and we are the ones who can save lives or change<br />

lives. My life has been touched and changed by you, and my heart<br />

is full of gratitude.<br />

– Laurie L. Downs,<br />

Your most humble servant manager<br />

Professional Practice Fair<br />

Drawing Winners<br />

Winners of gift cards in the Passports to Prizes drawing from submissions by attendees<br />

at the Professional Practice Fairs held in February and April at <strong>Mission</strong> Children’s<br />

Specialists, Asheville Surgery Center, Memorial Campus, and St. Joseph Campus are:<br />

Bonita Wiedenhaupt, RN, <strong>Mission</strong> Children’s Specialists (MCS)<br />

Debbie McCoy, RN, MCS<br />

Jennifer Roberts, CNA, MCS<br />

Ginger Frisbee, RN, Asheville Surgery Center<br />

Jenny Wilkinson, RN, Neonatal ICU<br />

Barb McElroy, RN, Staffing Pool<br />

Myra Blackwell, RN, Spine Center<br />

Kelly Phillips, RN, Operating Room<br />

Glenda Wyatt, RN, Staffing Pool<br />

Betsy Clark, RN, <strong>On</strong>cology<br />

Denise Anthes, RN, Integrative <strong>Health</strong>care<br />

Brittany Shelton, RN, <strong>On</strong>cology<br />

Kathy Smith, RN, Orthopedics<br />

Tammy Massey, RNC, Adult Medicine<br />

Julie Mull, RN, Adult Medicine<br />

Winner of the Grand Prize drawing for the trip to the Magnet ® conference in<br />

Phoenix, AZ, October 13-15 is Carleen Trevino, RN, BSN, CCE, IBCLC.<br />

Winners of the guessing game who came closest to guessing the number of candy<br />

balls in three jars at the Nursing Quality Council table each received a large can of popcorn:<br />

Jar #1 Mary Tosti, RN, 7 North<br />

Jar #2 Vickie West, RN, Manager of 6 North<br />

Jar #3 Marne Rogers, RN, 9 North<br />

Nursing <strong>Mission</strong> and Vision<br />

<strong>Mission</strong> Statement:<br />

<strong>Mission</strong> Nursing - Promoting <strong>Health</strong> and<br />

Wellness; Providing Compassionate,<br />

Quality Care.<br />

Vision Statement:<br />

<strong>Mission</strong> Nursing - A Nationally<br />

Recognized Model of Professional Nursing<br />

Practice Committed to Excellence.<br />

Nursing News is Produced for the<br />

Nurses of <strong>Mission</strong> Hospital,<br />

Asheville, NC<br />

Cherry Odom, RN,<br />

Writer/Editor/Photographer<br />

Nursing Documentation<br />

Coordinator<br />

Email comments/submissions to<br />

cherry.odom@msj.org.<br />

Carole Donnelly, Layout<br />

© 2010 <strong>Mission</strong> Hospital<br />

Other than the three top winners, Kathy Smith, RN, orthopedic clinician, came the<br />

closest in guessing the correct number in all three jars.


Council Reports<br />

Nursing Governance Board (NGB)<br />

Susan Cadwell, administrative assistant,<br />

received a Nursing Excellence Ambassador<br />

Award from NGB co-chair Jeanie Bollinger,<br />

RN, BSN, CCRN, CSC at the April 21<br />

monthly meeting. Susan was recognized for<br />

her help with the minutes of each meeting<br />

and correspondence for the group.<br />

Topics discussed were:<br />

• Major council reports<br />

• Hospital Peer Review Committee policy<br />

• Development of a Nursing<br />

Strategic Plan<br />

• Upcoming addition of Advanced<br />

Practice Nursing Council<br />

• Selection of attendees by directors for<br />

the October Magnet® conference<br />

Future agenda items are:<br />

• NGB bylaws<br />

• Certification goals<br />

Jeanie Bollinger, RN, BSN, CCRN, CSC, of<br />

Cardiovascular ICU (right), presented a Nursing<br />

Excellence Ambassador Award to Susan<br />

Cadwell, Administrative Assistant (left).<br />

Nursing Research Council (NRC)<br />

The highlights of the April 21 monthly<br />

meeting of NRC are listed below.<br />

• Research Fiesta May 5th from<br />

1300-1530 in Glenn Theater<br />

– 2.5 Contact hours; Register on<br />

WebInservice<br />

– Evidenced Based and <strong>Clinical</strong><br />

Research Projects to be presented<br />

– Snacks and Refreshments in Steven’s<br />

Board Room with display of Research<br />

Posters<br />

• Lisa Hicks-Kinney, the Women’s<br />

Research Coordinator from the<br />

Research Institute, is a new ad hoc<br />

member.<br />

• MAHEC Resident Research Day<br />

April 30th in Glenn Theater from<br />

0830-1130. Free to all<br />

– Contact Stacy Wise@mahec.net for<br />

more information.<br />

– Co-chair Lisa Clark, RN, MSN, CPAN,<br />

of PACU<br />

Nursing Informatics Council (NIC)<br />

Following are the highlights of the<br />

April 8 monthly NIC meeting.<br />

• Implementation of a discharge check list<br />

in depart in June<br />

• Completion of NIC by-laws<br />

• Review of the nuances of advance directives.<br />

– Chair, Karen Ward, RN, BSN,<br />

Nursing Informatics<br />

Nursing Practice Council (NPC)<br />

The April 8 monthly NPC meeting covered<br />

the following topics:<br />

• Ann Knupp presented the two programs<br />

being considered for Bar-Coding<br />

Medication Administration (BCMA). The<br />

group saw a demonstration of both programs.<br />

Members were encouraged to go<br />

back to their respective units and engage<br />

staff in deciding which BCMA program will<br />

work best for their area. BCMA previews<br />

for staff will be held on the Memorial campus<br />

on April 29 and the SJ campus on<br />

April 30.<br />

• The group is working to help develop a<br />

policy or guidelines that will be used by<br />

multiple departments (Lab, Nursing,<br />

Respiratory, etc.) to standardize the<br />

process for labeling and transporting specimens<br />

to the lab. The need for these guidelines<br />

was generated from a rapid cycle<br />

team.<br />

• NPC by-laws were reviewed and finalized.<br />

– Chair Zach Clement, RN, BSN,<br />

manager of 7 North<br />

Nursing Professional Development<br />

Council (NPDC)<br />

Highlights from the April 8 monthly<br />

meeting of NPDC are as follows.<br />

• Updates provided by representatives of<br />

the Nursing Governance Board,<br />

<strong>Clinical</strong> <strong>Ladder</strong>, and Retention and<br />

Recognition committees.<br />

• The development of the council bylaws.<br />

• The council webpage design.<br />

• Promotion of certification on individual<br />

units.<br />

– Co-chair Gina Hallstrom, RN, CMSRN,<br />

8 North<br />

Nursing Quality Council (NQC)<br />

In the April 21 meeting of NQC, the following<br />

items were outlined:<br />

• Revisions to by-laws were discussed and<br />

approved.<br />

• Diana Wortham, RN, MSN, OCN, presented<br />

data for 2009 from the Alaris Smart<br />

Pumps.<br />

• An overview of National Database of<br />

Nursing Quality Indicators (NDNQI) was<br />

given by Janie Fielder.<br />

– Facilitator Janie Fielder, RN, MSN, NNP-<br />

BC, the CNS for Nursing Quality<br />

and Performance Improvement<br />

Nursing Night Shift Council<br />

(NNSC)<br />

• Bylaws are closer to completion.<br />

• Plans for Night Shift Staff Fair are in<br />

progress.<br />

• <strong>Is</strong>sues across the system with the use<br />

of call, call-back and flexing of staff<br />

were discussed.<br />

Nursing Administrative Council<br />

(NAC)<br />

Did not meet in March.<br />

“I think one’s feelings waste themselves in<br />

words; they ought all to be distilled into<br />

actions which bring results.”<br />

Florence Nightingale<br />

1820-1910


Guide to <strong>Clinical</strong> Inquiry Process at <strong>Mission</strong> Hospital<br />

Nurses, do you have a question or idea for a<br />

study that relates to delivering excellent patient care?<br />

Please refer to the diagram to help you decide<br />

whether your project will be based on current literature<br />

(evidence-based) or generate new knowledge<br />

(nursing research).<br />

To help formulate your question, use the PICO<br />

mnemonic to describe the four elements of a good<br />

clinical foreground question.This is most often used in<br />

EBP.<br />

• P – Patient: Describe as accurately as possible<br />

the patient or group of patients of interest. How<br />

would I describe a group of patients similar to mine?<br />

• I – Intervention: What is the main intervention<br />

or therapy you wish to consider? This includes an<br />

exposure to disease, a diagnostic test, a prognostic<br />

factor, a treatment, a patient perception, a risk factor,<br />

etc.<br />

• C – Comparison: <strong>Is</strong> there an alternative treatment<br />

to compare? This includes no disease, placebo, a<br />

different prognostic factor, absence of risk factor, etc.<br />

• O – Outcome - What is the clinical outcome,<br />

including a time horizon if relevant?<br />

For assistance with this process, contact Kathy<br />

Daley, RN, MSN, CCRN-CMC-CSC, CPAN, <strong>Clinical</strong><br />

Nurse Specialist for Research, kathy.daley@msj.org.<br />

Thank you night shift<br />

nursing staff!<br />

Night staff on 4 South Orthopedics are among those who<br />

take care of patients while the world sleeps. Seated is<br />

Michael Devlin, LPN; standing left to right are Sheila Drye,<br />

CNA II; Kristie Hensley, RN;Tracy Benedict, RN; KaSheena<br />

Green, RN, Nursing Unit Supervisor; and Debb Aanonsen,<br />

RN. Photo by Amy Cooper, RN

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