Newsletter - Bartlett Regional Hospital

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Excellence in Nursing Advocating for patients and the nursing profession It is a busy day on Bartlett’s medsurg floor. Each nurse on duty is responsible for at least half-a-dozen patients, and, on this day, most of the patients are very sick. That there are very sick patients in a hospital may seem self evident, but their prevalence is a fairly recent trend—a result of increasingly prompt discharges and a high percentage of day surgeries. These days, the patients who spend time in a hospital are far sicker and often need much more attention than the average patient of a generation ago. It all adds up to more demands on the time and attention of med-surg nurses. This day, one patient is particularly needy—an elderly woman with mild dementia suffering from hypertension brought on by Type II diabetes, a condition that will put her at risk for serious infection if bed sores develop. The patient, who has been admitted because of breathing problems and low blood oxygen, is also suffering from anxiety attacks, not uncommon for people who can’t catch their breath. Her heart has been weakened by a lifetime of smoking, and she also has urinary issues. Her frequent trips to the rest room put her at risk for falls. Such a patient needs the full attention of her primary nurse. A patient with such a complex array of needs draws on multiple hospital resources. In addition to physicians, nurses, and nurse assistants, other professionals, such as pulmonary therapists, pharmacists, physical therapists, nutritionists, and discharge planners will need to be consulted. “Most people don’t realize how much goes on behind the scenes,” says Sarah Hargrave, RN. “This is a complex, multi-disciplinary system.” One way of addressing the present-day challenges of patient care, she explains, is by instituting the modern, research-based professional practice model known as Shared Governance. “In a Shared Governance model, frontline nurses come to the table with nurse managers to shape nursing policies and practices,” says Hargrave, who is the facilitator for Bartlett’s Shared Governance initiative. Simply put, shared governance provides “stakeholders,” in this case nurses, the means to change their practice. The Nursing Department [at Bartlett Regional Hospital] is launching its shared governance plan.... Shared governance brings a commitment from all aspects of nursing —staff, specialists, managers and administrators — to share in both the rights and responsibilities and to be accountable for nursing care in their facility. — Excerpt of a statement by Nancy Davis, RN, MS, President, Alaska Nurses Association, that appeared in the organization’s June 2011 “Alaska Nurse” newsletter. The efficiency of any complex system, Hargrave points out, can benefit by the implementation of new technology or streamlining a process. “We’ve all witnessed improvements in making travel arrangements,” she says of the transition from the time-demanding process of making reservations then getting tickets at airline counters, to the scheduling flights on-line, then downloading boarding passes from a website. How to introduce such process changes to improve patient care is the focus of the Shared Governance process now in its first year at Bartlett Regional Hospital. “The heart and soul of nursing is patient care,” says Susan Thompson, RN, who, along with Margie Fisher, RN, co-chairs the Coordination Council for Share Governance. Thompson, who previously served as an ER nurse for 15 years, is House Supervisor for Bartlett. “Shared Governance is about elevating the profession, with the ultimate goal always to improve patient care,” she says. “We believe that the professionals most knowledgeable and best suited to do that are the bedside nurses.” According to Fisher, the shared governance process seeks to increase quality nursing time spent at the bedside and improve the professional peer review process for nurses. “With the senior leadership and the board, we have support for doing this,” Fisher says. “We were given a budget, by which we were able to get materials that didn’t have to come out-of-pocket. Instead of upper management telling us what to do, they are saying, Hey, you are the front line staff — do it.” Thompson agrees that the administration has provided strong support. “They HouseCalls — 16
approved an operating budget— that we came under, by the way,” she says. Thompson praises Chief Nursing Officer Cathy Carter as being especially supportive and encouraging. “Overall, nurses throughout the hospital are very enthused about this.” “Previously, there wasn’t a formal structure,” says Hargrave. Bartlett’s Coordinating Council for Shared Governance held its first organizational meetings in mid-2010. There are currently two subcommittees: Clinical Practices and Professional Development. “Now we have the structure to make change. This is about nurses having control of their practice and having a robust structure that will improve communications, because it elevates the discussion to a professional level.” The front line staff: Sarah Sjostedt, RN, Billy Gardner, RN, Gail More head, RN, and Alicia Gillis, RN, discuss staff engagement in the shared governance process. The Origin of Shared Governance The concept of shared governance was first defined over 30 years ago as an effort to give nurses an equal voice with physicians within hospitals. Nationally, through the 1980s and 1990s, the concept broadened to one that embraced all levels of hospital management. A committee structure brings managers and staff to the same table where they address issues such as practice, management, quality, and education. Every department that utilizes the services of nurses is represented on Bartlett’s Shared Governance Council. “We are very early in the process,” says facilitator Sarah Hargrave. “Normally, it takes at least three years to have a robust structure.” “Shared governance to me is a means of pushing the nursing profession forward,” says Leslie Vianne, a Bartlett RN since 2004. “It will allow nursing across the country to self-regulate, to support more education that will get more nurses into the profession. It’s cool to be a part of it. I’ll be there supporting the effort, a brick in the foundation.” Coordinating Council for Shared Governance · Margie Fisher, RN (Co-Chair)- Bartlett Beginnings · Susan Thompson, RN (Co-Chair)- House Supervisor · Alicia Gillis, RN (Secretary)- Critical Care Unit · Brian Tennant, RN (Treasurer)- Emergency Department · Cece Brenner, RN- Medical/Surgical Unit · Cori Austin, RN- Same Day Care Unit · Hannah Mendelsohn, RN- Surgical Services · Sarah Sjostedt, RN- Medical/Surgical Unit · Amy Center, RN- House Supervisor · Robin Basque, RN- Mental Health Unit · Cathy Carter, RN- Chief Nursing Officer · William Gardner, RN- Medical/Surgical Unit Director · Gail Moorehead, RN- Staff Development · Sarah Hargrave, RN (Facilitator)-Quality Department Profile: Sandra Kohtz, continued from page 10 with shame and moral condemnation. Kohtz would prefer that people look at Rainforest Recovery Center in the same way they would a doctor’s clinic. “Alcoholism and other addictions are medical conditions like diabetes,” she says, noting susceptibility to addiction is most often an inherited trait. Addiction, especially in older adults, can be very difficult, and almost impossible to turn around without help. “At a certain point, the addict will no longer be able to make rational judgments,” says Kohtz. “Almost always, they blame their problems on something other than their addictions.” Kohtz has yet to encounter someone who has come in for treatment without being compelled by their circumstances or by another person. “No one wants to go into treatment . Once you have found the impetus, it helps in providing them with the appropriate treatment.” When Kohtz began her career in 1977, treatment was largely designed on the Alcoholics Anonymous model. “At the time, if someone did not remain abstinent, they would be out of the program—they had not reached bottom,” she recalls. Kohtz explains that while the goal of RRC’s treatment approach is eventual abstinence, she is not one for absolutes. “Through treatment and other interventions, we are seeing people seeking help before they have lost everything.” Kohtz has a Master of Social Work Administration degree, is a Licensed Clinical Social Worker, and a Certified Alcohol and Drug Abuse Counselor. In 2003, she was named “Manager/ Supervisor of the Year” for Nebraska Health and Human Services. She has also served on numerous boards of directors for substance abuse programs throughout her career. 17 — Fall 2011
Page 1 and 2: HouseCalls Fall We bring healthcare
Page 3 and 4: Caring for the Mentally Ill A highl
Page 5 and 6: me and describe the situation,” h
Page 7 and 8: earning a Bachelor of Science Nursi
Page 9 and 10: Heart Attack Care We achieved a 100
Page 11 and 12: New Diagnostic Imaging Director: Ro
Page 13 and 14: wait for home health services to be
Page 15: and assisted Bill Palmer in finishi
Page 19 and 20: Profile: Dr. Saltzman, from page 10

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