A Clinical Ladder Is On Its Way! - Mission Health
A Clinical Ladder Is On Its Way! - Mission Health
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