Nursing Innovation and Excellence - Baptist Health South Florida

NURSING ANNUAL REPORT2009Nursing Innovation and Excellence___________________________Baptist Health South FloridaBAPTIST HEALTH 22 NURSING REPORT

BAPTIST HEALTH SOUTH FLORIDANURSING VISIONThrough shared governance, Baptist Health nurses will provide superior evidence-based, patient- andfamily-centered care utilizing a professional model of practice. By embracing leadership, collaborationand service excellence, nurses demonstrate advocacy and support for staff, patients, families andphysicians, making Baptist Health the community health system of choice.GOAL 1Nursing Workforce DevelopmentSelect and retain a qualified nursing workforce.GOAL 2Technology and System DesignDevelop and implement a standardized automatedpatient care documentation system.GOAL 3Quality Patient Care and StandardizationImplement standardized evidence-based nursingpractices across Baptist Health South Florida.GOAL 4FinancialEnsure staffing efficiency and cost effectiveness.GOAL 5Nursing Collaboration and Staff DevelopmentEnsure long-term growth and development of nursing.GOAL 6Customer ServiceEnsure sustainable, high-performance nursing serviceexcellence.

A MISSION OF CARINGIam proud to share with you — the members of the healthcare community and our much-appreciatedfriends and supporters — a comprehensive review of nursing at Baptist Health South Florida. BaptistHealth is the largest and most preferred not-for-profit healthcare organization in the region. Thesuccess of our organization and the high regard in which we are held in the community are a directresult of the outstanding patient care provided by our nurses.National recognition of the superior level of care provided by our nursing staff is evidenced by thedesignation of Baptist Hospital as a Magnet Hospital for Nursing Excellence — the first hospital inFlorida to achieve this accomplishment. It was soon followed by South Miami Hospital being recognizedwith the same prestigious designation. We anticipate that the excellent patient care provided by nursesat our other facilities also will garner Magnet recognition at Doctors, Homestead and Mariners Hospitals.As national leaders in patient satisfaction and quality care, we serve as a model for other healthcareorganizations. For example, our five-step plan for making evidence-based clinical improvements hasbeen shared with our nursing colleagues around the country. We also remain attentive to innovationsfrom other healthcare facilities and strive for continuous improvement in our efforts to provide the besthealthcare for our patients.“Today morethan ever, nursesplay a pivotalrole in healthcare— makingcritical decisionsthat affect andimprove patientcare.”In an age of miraculous technology and medical breakthroughs,Baptist Health is at the forefront, acquiring the latest equipment andperforming the latest procedures. While our nurses must remain on thecutting edge of new technology and advanced patient care techniques,they take equal pride in maintaining the human touch — that special doseof compassion and caring that plays an immeasurable role in healing. Ournurses embrace that role every day, through an innovative philosophy ofpatient- and family-centered care.Nursing excellence and quality patient care are top priorities forBaptist Health. That means we must continue our efforts to address theglobal nursing shortage and invest in the future nursing workforce.Since 2001, our Center for Excellence in Nursing has funded more than$11 million in nursing education scholarships for college students and for nurses seeking advanceddegrees. We have established nursing education partnerships with colleges and universities, and havehired highly experienced, master’s-prepared nurses to teach at those institutions. It is our hope thatmany of the nursing students will choose to enjoy long careers with Baptist Health. We also recognizethat a number of these students may later choose to take the benefits of their educational experience toless fortunate communities. In either scenario, Baptist Health’s nursing professionals are helping to meetthe healthcare needs of our friends and neighbors.BAPTIST HEALTH 2 NURSING REPORT

Today more than ever, nurses play a pivotal role in healthcare — making critical decisions that affectand improve patient care. Baptist Health remains committed to supporting and advancing the nursingprofession. Our organization provides nurses with opportunities to enjoy rewarding careers — fromentry-level positions that offer exceptional training and support to advanced positions that offerchallenges and growth. Yet, we remain always mindful of the need to provide an environment thatfosters a balance between the personal and professional lives of everyone in our organization.On behalf of the chief nursing officers of Baptist Hospital/Baptist Children’s Hospital, South MiamiHospital, Doctors Hospital, Homestead Hospital, Mariners Hospital and Baptist Outpatient Services, wehope you will find this review of nursing at Baptist Health South Florida both informative and inspiring.Sincerely,Deborah S. Mulvihill, R.N., MSN, FACHECorporate Vice President and Chief Nursing OfficerBaptist Health South FloridaBaptist Health’s Nursing LeadersBack row, left to right: Becky Montesino, R.N., Baptist Hospital of Miami; Denise Harris, R.N., Baptist OutpatientServices; Kathy Sparger, R.N., South Miami Hospital; Deborah Mulvihill, R.N., Baptist Health South Florida.Front row, left to right: Cheryl Cottrell, R.N., Mariners Hospital; Sandy Hyatt, R.N., Doctors Hospital; Gail Gordon,R.N., Homestead Hospital.BAPTIST HEALTH 3 NURSING REPORT

A CULTURE OF QUALITY60%Baptist Health South Florida,with its not-for-profit, faithbasedmission, has createdand embraced a culture of qualityand safety through patient- andfamily-centered care. Nowhere isthis more evident than in nursing,the backbone of Baptist Health’sfive hospital campuses and10 outpatient centers.Nursing excellence is a traditionthat has driven Baptist Healthfor decades. In fact, in 1998 ourlargest hospital, 680-bed BaptistHospital, was the first in Floridato be honored by the AmericanNurses Credentialing Center’sMagnet Recognition Program.In 2008, 460-bed SouthMiami Hospital celebrated Magnetredesignation, while BaptistHealth’s remaining hospitals —Homestead, Doctors and Mariners— launched a rigorous, two-yearcampaign that will culminatewith Magnet applications.2009 National Quality MeasuresA founding member of theNational Patient Safety Foundation’sStand Up for Patient Safetycampaign, Baptist Health is workingto engage patients in newways to foster safe care. One wayis by including patients and familymembers on our Quality andPatient Safety Steering Council,which implements improvementprojects across the organization.Increasingly, consumersnationwide have access to bothobjective data and patients’opinions about the quality of carehospitals give. These nationalquality indicators show BaptistHealth’s leading role in highquality,safe and evidence-basedhealthcare, with a special doseof compassion and caring — ahallmark of our organization.A few highlights from 2008-2009 include:■ Baptist Health joined theNational Quality Forum, aprivate not-for-profit organization,to help set nationalpriorities and goals in qualityand patient safety improvementthrough performancemeasurements, public reportingand pay for performance.■ Baptist Health hospitals scoredmore than twice as high asother hospitals in Miami-Dadeand Monroe counties onpublicly reported nationalquality measures establishedby the Center for Medicareand Medicaid Services.■ The National Database ofNursing Quality Indicators(NDNQI), which is designed tomeasure the role of the nursingworkforce, also showed thatBaptist Health hospitals typicallyscore above the median.■ Baptist Health hospitals alsocame out on top for patientsatisfaction, according to boththe federal government’sconsumer survey and those ofPress Ganey, the national leaderin patient satisfaction measurement.Overall, patient satisfactionscores for nursing hit highmarks, with inpatient, urgentcare and outpatient surgerydepartments achieving scoresabove Press Ganey’s 90thpercentile. Outpatient surgeryranked in the 99th percentile.50%40%According to data compiled by the federal government, 53 percent of BaptistHealth’s quality measures are in the top 10 percent of all hospitals nationally —better than all of the U.S. News & World Report’s Honor Roll hospitals.30%20%10%0%BAPTIST HEALTH SOUTH FLORIDA53%UNIVERSITY OF PITTSBURGH MEDICAL CENTERMAYO CLINIC, ROCHESTERMASSACHUSETTS GENERAL HOSPITALBARNES - JEWISH HOSPITALSTANFORD HOSPITALVANDERBILT UNIVERSITY MEDICAL CENTERDUKE UNIVERSITY MEDICAL CENTERUNIVERSITY OF MICHIGAN HEALTH SYSTEMJOHNS HOPKINS HOSPITALOHIO STATE UNIVERSITY HOSPITALUCSF MEDICAL CENTERUNIVERSITY OF WASHINGTONMEDICAL CENTERBRIGHAM & WOMEN’SHOSPITALBAPTIST HEALTH 4 NURSING REPORTYALE - NEW HAVENHOSPITALCLEVELAND CLINICHOSPITAL OF THEUNIVERSITY OFPENNSYLVANIAMETHODISTHOSPITALNEW YORK -PRESBYTERIANHOSPITALNYUMEDICAL CENTERRONALD REAGANUCLA MEDICALCENTERMOUNT SINAIMEDICALCENTER

Baptist Health South Florida Patient SatisfactionInpatient Survey — Nursing Overall Mean ScoreFiscal Year 2009 (Oct. ʻ08 - Sept. ʻ09)100989694*Current 90th Percentile*Current 75th Percentile929088868482807876747270BAPTIST HEALTH SOUTH FLORIDASource: Press GaneyBAPTIST HEALTH 5 NURSING REPORT

WORKFORCE DEVELOPMENT AND PROFESSIONAL GROWTHRecruitment and RetentionBaptist Health has developeda comprehensive program torecruit, train and retain the bestnurses. As a result, significantinroads continued to be made inaddressing the national nursingshortage, with Baptist Healthcutting its nursing vacancy rateto 10 percent, compared with astatewide nursing vacancy rate of15 percent, according to a FloridaHospital Association survey. Wealso purchased and renovated a199-unit apartment complexnear Baptist Hospital to expandthe temporary housing availableto newly hired nurses. Theeconomic crisis in 2009 helped tofurther cut the nursing vacancyrate to 4 percent, as some nursesput off retirement or returned tothe workforce.Nurse ScholarsIn 2001, Baptist Healthlaunched our innovative ScholarsProgram, a crucial and effectivecomponent of our recruitmentand retention plan. Each year,about 210 new nursing studentsbecome Nurse Scholars, receivingscholarships for clinical and classroominstruction in partnershipwith a community college oruniversity. In addition, experiencedBaptist Health nurses guide andmentor students on-site. In returnfor receiving the scholarship,Nurse Scholars commit to workat a Baptist Health affiliate. Sincethe program started, we haveaccepted more than 1,600 nursingstudents in the continuallyexpanding program.Baptist Health has formednursing education partnershipsfor entry-level registered nurseswith Miami Dade College, BarryUniversity, Nova SoutheasternUniversity and Florida KeysNurse Scholars have classroom instruction at local colleges and universities, as well as at Baptist Health hospitals.BAPTIST HEALTH 6 NURSING REPORT

Community College. To addressthe need for more nursing faculty,we have hired master’s-levelnurses to serve as clinical andclassroom instructors for nursingprograms at those institutions.We also have student affiliationagreements with the Universityof Miami, Florida InternationalUniversity, Keiser University,Florida State University and theUniversity of Florida, whosenursing students may do theirclinical rotations at one of ourhospitals. In 2009, more than 650nursing students did their clinicalrotations at Baptist Healthhospitals.Many Baptist Health nursesalso are pursuing advanceddegrees through our NurseScholars Program. To date, 160nurses have received master’sdegrees in nursing and four havereceived their doctorates. Theseopportunities contribute to keepingnurses at Baptist Health andhave created a culture in whicheducation is valued and promoted.We have given many of our employeesand members of the communitythe opportunity to pursueor advance a career in nursing,which otherwise many would havefound impossible to accomplish.In mid-2008, we established aScholars Alumni Association,which focuses on recruitment andretention activities with our staff,Human Resources and BaptistHealth Foundation.Versant RN ResidencyBaptist Health works hard tobridge the gap between educationand practice. The complex challengeof becoming a competent,confident member of the nursing“Versant really exceeded my expectations in all senses, andonce I was off orientation, I never felt left out or unprepared.I had the certainty of having all necessary tools to manageand care for all my patients safely and effectively.”Yaima Milian, R.N. — Baptist Hospitalworkforce has led to highturnover nationally among newgraduates. Maintaining a lowturnover rate for new nursesimproves employee and patientsatisfaction, keeps experiencednurses at the bedside and providesreplacements for retiringnurses.In the summer of 2007,Baptist Health standardized anorientation and training programfor all newly graduated nurseshired across the organization. The18-week Versant RN Residencyfor adult acute care (plus a22-week pediatric residency)ensures that new nurses developthe confidence, skills, judgmentand support they need to be satisfied,successful and committed.Each cohort of residents progressesto a level of competencyquickly, safely and efficientlywithin a structured program thatincludes guided clinical experiencewith a preceptor, instructor-ledclasses, a formal mentoringprogram and debriefing/self-caresessions.A recent cohort of Versant residents.

Ozzie Drago, R.N.Baptist Outpatient ServicesOzzie Drago coached high school basketballfor more than a decade beforereturning to college to become a teacher.But when he took a course to match hisinterests and goals with a career, herealized nursing was the better fit. “Iwanted to be able to help people and givemy family a good future,” said the father oftwo boys, “and nursing fell right in there.”After graduating, it was natural forMr. Drago to look to Baptist Health foremployment because his sister and“inspiration,” Lillian Bermudez, R.N., enjoysher work at Baptist Hospital. Mr. Dragowas the first Versant RN resident forurgent care, which set him on a successfulpath at Baptist Medical Plaza at Doral.“The Versant program gave me a reallygood foundation because I had no clinicalbackground,” said Mr. Drago, who is nowparticipating in the Emerging Leadersprogram. “I love being part of somethingwhere I can help people,” he said, “and Isee myself at Baptist for the rest ofmy life.”BAPTIST HEALTH 8 NURSING REPORT

Preceptors are Baptist Healthnurses who work with residents,formally tracking competencieswhile providing patient care experiencesthat enhance technicalskills, clinical knowledge andcritical thinking. Mentors — whoact as non-evaluative coaches —help the residents get theircareers off on the right track.They are someone the residentcan turn to in times of doubt andstress, as well as to celebrateprogress and accomplishments.By the end of 2009, more than400 nurses had graduated fromthe residency program, which iscredited with significantly reducingthe turnover rate of newnurses 12 months after hire.Nurse turnover has dropped from22 percent in 2006 to 10.2 percentin 2009, well below the nationalnew-nurse turnover rate forhospitals that don’t have aresidency program like Versant.Professional NurseAdvancement ProgramBaptist Health continuouslylooks for ways to improve theprocess by which nurses grow andadvance in their careers. In 2008,after a year of work, we unveiled anew advancement and compensationplan for bedside nurses calledthe Professional Nurse AdvancementProgram (PNAP). It wasintroduced to increase nursesatisfaction and retention, and todevelop nursing skills that improveclinical outcomes. PNAP ismodeled on the stages of clinicalcompetence as described bynursing researcher and theoristPatricia Benner, R.N., Ph.D.In both 2008 and 2009, more than 800 nurses attended the Robert B. Coleevening lecture and formal dinner.Center for Excellencein NursingBaptist Health’s Center forExcellence in Nursing has led theway in searching for solutions tothe global nursing shortage andestablishing a model program insupport of nursing. Since 2001,the Center has provided $11 millionin nursing education scholarshipsthrough the Nurse Scholarsprogram. Each year, the Centerholds a fundraising dinner fornurses, program graduates,donors and other supporters tocontinue its commitment toeducating new and experiencednurses.The Center was establishedat Baptist Hospital in 1988 “toimprove the quality of patientcare through innovations innursing care, nursing educationand nursing research.” The fundingbase came from a $100,000donation from Robert B. Cole,then chairman of the Board ofBaptist Hospital, who understoodthe vital role nurses play inhealthcare and wanted to empowerand reward them. Nursingleaders contributed to the fundas well, setting the tone forgiving back to their practice.By 2000, the Center hadexpanded to all Baptist Healthhospitals and affiliates. Focusingon recruiting and retaining thebest nurses, the Center promotesprofessional nursing practice andfosters professional growth inconcert with Baptist Health’snursing vision and strategic plan.Robert B. Cole DistinguishedNursing Lecture SeriesSince 1994, this event hasbeen funded with an endowmentfrom the late attorney and longtimeBaptist Health Board ofTrustees Chairman Robert B. Cole,who had a special appreciation fornurses. The lecture series is heldannually to honor Baptist Healthnurses and give them a chance tocelebrate together. Richard P. Cole,Robert B. Cole’s son and also anattorney, announced the donationof an additional $100,000 to ensurethe future of the lecture series.Evidence-based PracticeFellowship ProgramIn 2007, an Evidence-basedPractice Fellowship Program fornurses was established. It invitesbedside nurses to apply for thetwo-year fellowship, which isdesigned to develop clinicalleaders by helping them create,evaluate and implement clinicalchanges. The nurses begin byidentifying a clinical questionBAPTIST HEALTH 9 NURSING REPORT

Annual Summit for Nursing Leaders: “It’s a Leadership Thing!”Orlando Betancourt, R.N.,BSN, MSN, ARNPBaptist HospitalMore than 90 nurse managers from across Baptist Health attended a one-day summit onnursing leadership. The conference updated nurse managers about all the innovativeefforts underway to engage and retain nurses. They also had a chance to talk with all of ourchief nursing officers, as well as Baptist Health’s president and CEO, Brian E. Keeley (picturedabove), and other executive leaders.they want to address. The ClinicalExcellence Through EvidencebasedPractice (CETEP) modelcreates the framework for thefellowship. In 2008, five nurseswere chosen to begin fellowshipsfollowing the rigorous applicationprocess.Goals of the program includeimproving quality of care byfostering innovative thinking andproblem-solving in the clinicalsetting, providing opportunitiesfor professional growth andpreparing participants forevidence-based practice.Retaining Talented NursesBaptist Health recognizes theimportance of grooming existingtalent in the nursing ranks andhelping all our nurses achievetheir full potential. Nursingmanagers across Baptist Healthparticipate in focus groups tocome up with tools and programsto support, recognize and advancethe careers of experiencedbedside nurses. In addition, tworegistered nurses have takenon new management roles tooversee retention, creatingprograms through researchfunded by the Florida Center forNursing and Baptist Health’sCenter for Excellence in Nursing.New resources for nurses includea retention helpline, a websiteand career developmentprograms. In addition, we havecompleted a study, Retaining theExperienced Nurse Past RetirementAge, which is detailed laterin this report in the Center forResearch & Grants section.Orlando Betancourt entered healthcareas an X-ray technician. “I wanted toexpand so I decided to go into nursing,”he said. At Miami Dade College, heheard about Baptist Health’s NurseScholars Program and applied. Heended up earning associate, bachelor’sand master’s degrees as a NurseScholar. “I’m pretty much the posterchild for Baptist Scholars,” he said. Hestarted working in critical care atBaptist Hospital and is still there. “I lovethe pace. I love the acuity. I love to takecare of the sickest patients and helpthem get better.” But some patientshave a different ending. “For those whodon’t make it, at least we have thecomfort of knowing we did everythingwe could, giving the best care andemotional support to the family members.”Mr. Betancourt says he is fulfilledin his career. “When I decided to go intonursing, I had this dream in my mind ofworking at the right place and doingthe best I could. I can tell you I am livingmy dream. I’ve been very lucky andvery blessed to work here — and nothave any student loans.”BAPTIST HEALTH 10 NURSING REPORT

Various surveys show that Baptist Health’s efforts are succeeding to create a challenging and rewarding workenvironment for nurses. In 2008, Baptist Health R.N.s overall scored high in job satisfaction when compared tothe scores of R.N.s in the 75th percentile of The Gallup Organization’s national database. In fact, our nursesscored higher on each of 12 questions that gauge job satisfaction. Baptist Health nurses engaged in directpatient care also scored consistently higher than Gallup’s 75th percentile when it came to job satisfaction.In 2009, nurses across Baptist Health scored above the “high satisfaction” mark — and significantly above thenational median score — in the National Database of Nursing Quality Indicators (NDNQI) R.N. Survey.Keeping Nurses Engaged and Satisfied2009 NDNQI R.N. Satisfaction T-scoreNational Comparative Information by Bed Size6866< 40 = Low Satisfaction40-60 = Moderate Satisfaction> 60 = High SatisfactionHospital Mean (Baptist Health)National Median by Bed Size64626058565452BAPTIST HOSPITALOF MIAMI> 500 bedsSOUTH MIAMIHOSPITAL300-399 bedsDOCTORS HOSPITAL200-299 bedsMARINERS HOSPITAL< 100 bedsHomestead Hospital is not included because it used a different survey tool.2008 Baptist Health South Florida Nursing Combined Compared to Gallup R.N. DatabaseBHSF Nurses Gallup R.N. 75th Difference% 5s Percentile % 5sThis last year, I have had opportunities at work to learn and grow. 67 56 11In the last six months, someone at work has talked to me about my progress. 66 52 14I have a best friend at work. 58 43 15My associates or fellow employees are committed to doing quality work. 59 50 9The mission or purpose of my company makes me feel my job is important. 64 50 14At work, my opinions seem to count. 47 33 14There is someone at work who encourages my development. 61 47 14My supervisor, or someone at work, seems to care about me as a person. 65 60 5In the last seven days, I have received recognition or praise for doing good work. 55 40 15At work, I have the opportunity to do what I do best every day. 63 50 13I have the materials and equipment I need to do my work right. 54 38 16I know what is expected of me at work. 78 70 82009 data not available at time of publication.BAPTIST HEALTH 11 NURSING REPORT

BAPTIST HEALTH 12 NURSING REPORT

ADVANCES IN NURSING: PATIENT- AND FAMILY-CENTERED CAREBaptist Health has embracedthe philosophy of patientandfamily-centered care,an innovative approach to improvingthe safety and quality ofcare by creating cooperativepartnerships among patients,families, nurses, doctors and theentire healthcare team. Promotedby national accrediting andpolicy agencies as a key toimproving safety in hospitals,patient- and family-centered carefollows four key principles:■ People are treated with respectand dignity.■ Healthcare providers communicatecomplete and unbiasedinformation with patients andfamilies.■ Patients and families areencouraged to participate inthe delivery of care anddecision making.■ Collaboration occurs amongpatients, family members andthe healthcare team.We have laid the groundworkfor our patient- and familycenteredcare journey. In the pasttwo years, we have launchedmany initiatives to involve patientsand families on hospital councilsand to expand involvement intheir own care.We understand the integralrole that patients and theirfamilies play in their recoveryfrom illness and injury, and wepromote patient- and familycenteredcare as our guiding philosophy.Families are the constantin the patients’ lives, andengaged patients and familieswill collaborate with the healthcareteam to improve healthcareprocesses. We recognize that patientand family involvement iscritical to healthcare outcomesand to reducing and preventingthe risk of medical errors.Baptist Health’s Quality andPatient Safety Steering Councilincludes members of the communitywho have been patientsor are family members ofpatients. The Steering Council’sAccelerated Change Teams (ACTs)take on a range of quality andsafety projects, from pediatriccare to serious events or hospitalacquiredconditions.Two examples: The Harmonyin Pediatrics ACT led to 24/7access for families visiting babiesin our NICUs. Systemwide, ACTsalso established Code HELP, anemergency response system thatpatients or family members canuse to call a medical team to apatient’s room for immediateassistance.Other activities over the pastyear have included Baptist Healthseminars with experts in palliativemedicine and pediatric care, andthe 2009 Patient Safety Symposiumfocused on patient- andfamily-centered care.Performance ImprovementIn addition to organizationwideprojects, hundreds ofperformance improvement projectsare ongoing at our hospitalsBAPTIST HEALTH 13 NURSING REPORT

TRIM =PerformanceImprovementOn behalf of Baptist Outpatient Services, Dominique Turgotaccepted the TRIM Award from Thinh Tran, M.D., BaptistHealth’s chief quality officer.BAPTIST HEALTH 14 NURSING REPORT

and outpatient centers, using aninclusive, multidisciplinary,grassroots approach. Innovativethinking is encouraged andrewarded. The same tools andframework are used to gatherand analyze data and measureperformance, so best practicescan be shared, replicated or modifiedfor use at any Baptist Healthhospital or outpatient center.We have adopted TransformingCare at the Bedside, a newcare delivery model developedby the Robert Wood JohnsonFoundation and the Institute forHealthcare Improvement toaddress the complexities ofhealthcare in the 21st century.Our performance improvementprojects focus on giving bedsidenurses the freedom and authorityto identify an opportunityand come up with their ownplan to develop measurableimprovements.In 2008, we also launched anew initiative called TRIM (Teams,Refocus, Imagine, Measure). It’s atool for nurses and other frontlinecaregivers to identify areasof improvement and make fasttrackchanges that enhancesafety, quality of care, nurseretention and patient satisfaction.Best nursing and evidence-basedpractices are shared across theorganization and honored atBaptist Health’s annual PerformanceImprovement Conference.TRIM projects are reviewedand judged by Baptist Health’sQuality and Patient Safety SteeringCouncil, based on their creativity,teamwork, impact, sustainabilityand spread. The TRIM Award recognizesthese efforts to improveproductivity and efficiency.In 2009, the Medical ArtsSurgery Center (MASC) at Baptistwon the top TRIM Award forimproving its operating roomturnaround time. When it becameclear that MASC staff was failingto consistently meet their goal ofa 15-minute turnaround time forthe operating rooms, a team ofnurses, physicians and executiveswas formed to review and improvethe process. The team concludedthat staff needed to be educatedabout the impact of turnaroundtime on physician satisfactionand profitability. The team establishedclear targets, createdincentives and discussed thevarious issues with staff. In theend, MASC increased its volumeand revenue while maintaininga high level of patient andphysician satisfaction.Other TRIM projects haveaddressed:■ MRI safety, South Miami Hospital.A nurse-led team mappedout potential hazards andcreated better-defined safetyzones, installing large stopsigns to keep patients and employeeswell out of range of theMRI magnet. Nurses and otheremployees also receivedadditional education, and anMRI safety brochure for patientswas updated.■ Phototherapy in the Mother-Baby Units, Baptist Hospital.Nurses were losing time at thebedside when they had totrack down three separatepieces of equipment neededfor light treatment to correctjaundice in newborns. To solvethe problem, additional equipmentwas purchased and allequipment was stored inCheryl Signor, R.N.Mariners HospitalNursing was always Cheryl Signor’scareer plan, but after high school, shewas lured into the family real estatebusiness. When the business was sold,Ms. Signor discovered she was stillinterested in becoming a nurse. “Mygrandmother passed away from gallbladder surgery due to a surgical error.That piqued my interest.” She startedout at Mariners as a patient care techfour years ago, then became a BaptistHealth Nurse Scholar to earn herassociate degree from Florida KeysCommunity College. She is now studyingin an R.N.-to-BSN program. “Workingwith Baptist, there are so manyopportunities to advance and furtheryour education,” said Ms. Signor, whowas named Mariners’ Nurse of the Yearfor 2009. As a preceptor for the VersantRN Residency program, she wasmatched with her first Versantresident in 2009. “I can sympathizewith her because I’m still a newernurse. It makes me realize how farI’ve come along in only three years.”BAPTIST HEALTH 15 NURSING REPORT

specific locations, enablingnurses to spend more timewith their patients and reducingthe time it takes to orderand administer phototherapy.■ Nursing Informatics MedicationAdministration Check(MAK) Flow, Baptist Health.This team addressed delays ingiving medication when apatient’s ID armband doesn’tscan correctly, creating theincreased possibility of amedication error if the armbandscan is overridden. Thesolution was to place morearmband printers throughouteach hospital and outpatientcenter to decrease the time ittakes to print a new armbandand to avoid overriding thenonfunctioning armband.■ Nursing Department’s OfficeSupply Management in theAdmissions Process, DoctorsHospital. The TRIM team linkeddelays in the initial assessmentof patients by the admittingnurse to management ofsupplies, such as allergy armbands.The office supplies andequipment were centralized,increasing efficiency, patientsafety, and patient andemployee satisfaction.The Center for Research& GrantsThe Center for Research &Grants is the hub for researchacross Baptist Health, supportingnurses as well as physicians,graduate students and otherhealthcare colleagues. The Centerseeks and oversees funding andgrants, and evaluates researchfindings, equipment, programsand projects.We recently completed astudy, Retaining the ExperiencedNurse Past Retirement Age, and areimplementing new programsacross Baptist Health that weresuggested by our older nurses. Thisorganizationwide research aimedto understand what types of incentivesand organizational supportwould keep nurses at the bedsideas they near retirement. Fortyeightfull- and part-timefemale registered nurses betweenthe ages of 55 and 70 participatedBAPTIST HEALTH 16 NURSING REPORTin the study through focus groupsor one-on-one interviews witha researcher and the corporatechief nursing officer.The nurses were asked: “Whatkeeps you at Baptist Health, andwhat would make you stay longer?”Initiatives already adoptedinclude priority parking, retirementseminars and biannualforums for older nurses with thecorporate chief nursing officer.Several Baptist Health sites arepiloting new part-time positions,and classes are being created to

address the needs of the agingemployee.Other leading-edge researchincludes a qualitative study onpalliative and end-of-life care thatwas funded with a $280,950 grantfrom the Health Foundation ofSouth Florida. The goal was to improvepatient care, keeping inmind our culturally diverse communityand the many differenttraditions, practices and beliefs thatcome into play at the end of life.Fifty-two racially and ethnicallydiverse people participatedin the study; 26 were BaptistHealth nurses and other healthcareproviders, and 26 werecommunity members who had aloved one die in a Baptist Healthhospital. More than 20 ethnicitieswere represented.Findings from this studyoffered insight into the complexprocess of caring for someonewho is dying in a multiculturalhospital and guided our palliativecare education program. Trainingfocuses on how to create a caregivingenvironment that leads toa good death by “expecting differencesand learning, acceptingdifferences and accommodating,and respecting differences andsupporting.” More than 800nurses and other healthcareproviders have participated inthe program.At Doctors Hospital, nurseresearchers undertook AnExploratory Analysis of theMedication Reconciliation Processin an Acute Care Hospital. Theyreviewed the effectiveness of theprocess at admission, transfer andat discharge, and identified gapsor barriers in the creation of accuratepatient medication lists. Thefindings sugested when and howmedication reconciliation lapsesare most likely to occur. Ongoingstaff education and synchronizationof the Emergency Center’selectronic medical record withthat used on the inpatient floorswere two recommendations thatemerged from the study.In addition, more than adozen research studies led by BaptistHealth nurses are underway orongoing, from water safety to alook at the effects of a communitycardiovascular screening program.Other nurse research highlights:■ Assessment of TransculturalCaring Practices at SouthMiami Hospital: This five-yearstudy attempts to measuretranscultural caring practiceslongitudinally as nurses learnto apply Madeline Leininger’sculture care theory.■ Healthcare Providers’ Perceptionsof Alcoholism and WorkingWith Patients ExperiencingAlcohol Withdrawal Symptomsin a Community Hospital:This study at Homestead andMariners Hospitals seeks todetermine healthcare providers’perceptions in order to developeducational programs aimedat increasing knowledgeabout alcoholism and alcoholwithdrawalsymptoms.■ Determination of the Reliabilityand Validity of a PediatricVenous ThromboembolismRisk Assessment Tool: ThisBaptist Hospital study willevaluate the reliability andvalidity of this risk assessmenttool, designed to identify onadmission children who are athigh risk for developing ablood clot in a vein.BAPTIST HEALTH 17 NURSING REPORTPalliative Care and PainManagementBaptist Health nurses havetaken a leading role in providingthoughtful and sensitive palliativeand end-of-life care inconsideration of the individualneeds of patients and theirfamilies. Our nurses receivespecial training to help patientswith acute and chronic pain andto set up the type of palliativecare that optimizes quality of lifeand prevents or relieves suffering.This approach takes into accountthe breadth of needs of thepatients and their families —physical, psychosocial, spiritualand cultural.Baptist Health’s palliativecare training program isdesigned to increase healthcareprofessionals’ knowledge, skills,ability and comfort level whencaring for seriously ill and dyingpatients, with a special focuson the diverse multiculturalpopulation of South Florida.The Baptist Health PalliativeCare Steering Council provides

overall direction for the individualhospitals’ palliative care committees.Specialized care is overseenby palliative care nurse coordinators,who work with staff whocare for end-of-life patients. Ourgoal is to achieve a certificate inpalliative care from The JointCommission by 2011.A 2008 study by the DartmouthAtlas of Healthcare foundthat in South Florida hospitals,end-of-life patients are frequentlyreceiving the most aggressivetreatments and interventions inthe nation, with a high financialcost. Baptist Health hospitals,however, were more likely tofollow a palliative care philosophyfor patients at the end of life.In addition, Baptist Health’sPain Committees develop standards,guidelines and educationalprograms, all with the goalof improving and ensuringconsistent pain managementfor patients. The committees areled by our pain managementclinical nurse specialists, who alsoserve as a resource for physiciansand nurses.Collaboration BreedsSuccessMagnet fever is on the riseacross Baptist Health as threehospitals are working their waytoward the special nursingrecognition bestowed by theAmerican Nurses CredentialingCenter. Two of Baptist Health’shospitals — Baptist Hospital andSouth Miami Hospital — haveachieved and maintainedthe highhonor ofMagnetstatus andnowoffertheir experiencestotheir sisterhospitals —Doctors, Homestead andMariners — which plan to applyfor Magnet recognition in 2012.While shared governance is ahallmark of the evolving nursingmodels across Baptist Health,each hospital sculpts its ownindividual style to meet theMagnet program’s high standards.We believe that giving bedsidenurses control over their practiceand a decision-making stake inmanagement creates an environmentof respect and support thatleads to high-quality healthcare.It’s also the best way to formnursing leaders, advanceresearch, improve quality andgenerate the innovationsnecessary to address the evolvingchallenges of healthcare.Karen Seetal, R.N., BSN, MSNSouth Miami HospitalWhen she was a little girl, Karen Seetalwould grab her mother’s stethoscopeand pretend to be a nurse, like hermother, who is still practicing after 38years in the field. “She is truly my inspiration,”said Ms. Seetal. It turned outthat her childhood dream turned intothe perfect career. She became aBaptist Health Nurse Scholar at FloridaInternational University before shestarted working at South MiamiHospital more than four years ago on amedical-surgical unit. After threeyears, she moved to Mother-Baby, “oneof the happiest places to be a nurse.”Ms. Seetal decided to continue withher education, graduating earlier thisyear with her master’s from FIU. “Iwanted to participate in a higher levelof practice and perhaps take commandof women’s health services or primarycare,” said Ms. Seetal, who did her MSNclinical rotation at Baptist Hospital.Ms. Seetal said choosing to connectwith Baptist Health “was the bestdecision I’ve made. I wanted to be partof something great.The opportunities togrow professionallyand scholasticallyare amazing andthey facilitatethat growth.”“Nurses appear to have taken advantage of the resourcesprovided to grow professionally in this organization…Nurses tend to stay here, some for their entire careers…You are growing the future of nursing.”From a South Miami Hospital Magnet surveyBAPTIST HEALTH 18 NURSING REPORT

TECHNOLOGY DRIVES CHANGEPatient care and nursingpractice are being revolutionizedby sweeping advances in technologyat Baptist Health. Thissystemwide priority receivednational recognition again in 2009,for the seventh consecutive year,when Baptist Health was namedone of the nation’s “Most WiredHospitals and Health Systems” byHospitals & Health Networks.In the fall of 2007, we beganour Clinical Transformation Project,which positioned Baptist Healthto lead the national movementtoward evidence-based medicineand the computerization of allmedical records. In 2008, wetransitioned to a new corporatemodel for our Nursing Informaticsteam, composed of informaticsnurses at each of our hospitalswho have expertise and experiencein clinical workflow andhealthcare technology. In a unique,organizationwide approach, theNursing Informatics team providesinitial and ongoing on-site trainingand support for nurses as newtechnology and systems are rolledout at our facilities.With patient safety as theprimary goal, Nursing Informaticsexperts collaborate with InformationTechnology professionals tostandardize and automatemultiple clinical documentationcomponents, such as admissionassessment, shift assessment,interdisciplinary patient notes,critical values and the critical careflow sheet.In addition, more than 600state-of-the-art portable, wirelessWorkstations-on-Wheels (WOWs)were rolled out, enabling oureICUAt Baptist Health hospitals, the eICU LifeGuard team, composed of critical care nursesand physicians, uses cutting-edge computer technology to electronically monitor themedical conditions of patients in intensive care units. Over a two-year period, nearly500 eICU-related nursing interventions were documented, resulting in positivepatient outcomes.Robotic SurgeryAt South Miami Hospital’s Centerfor Robotic Surgery and at BaptistHospital, specially trained nursesassist surgeons using the da VinciRobotic Surgical System totreat gynecological, prostate,urological and colorectal diseases,as well as heart and lung problems.For patients, robotic surgeryoffers quicker recoveries,less pain and a shorterhospital stay.BAPTIST HEALTH 19 NURSING REPORT

Fabienne Goutier, R.N.Homestead HospitalWorkstation-on-WheelsFabienne Goutier planned on being alawyer, but the native of Haiti had achange of heart when she startedtaking criminal justice classes. Shethought nursing or teaching was herbetter calling. “I have a capacity forcaring,” she said. “I’d like to teach, but Iwould rather save someone’s life. Here,I can do both.” She became a registerednurse and was hired at HomesteadHospital in 2008. Ms. Goutier floatsbetween Emergency, ICU and PCU. Onher days off, the married mother oftwo young children cooks food for thehomeless and volunteers to help thehungry. “I think that’s all part ofcaring,” she said. “I can’t just do itinside the hospital. I come from a ThirdWorld country. I don’t want to go tosleep saying, ‘Well, I’ve eaten, but Ihaven’t helped anybody else eat.’ ” Ms.Goutier said she appreciates workingat a stable organization like BaptistHealth and enjoys her diverse group ofcolleagues. “I know there are so manyavenues for me here,” she said.Across Baptist Health, nurses use high-tech Workstations on Wheels (WOWs),reducing paperwork and increasing time spent with patients.clinicians to access all clinical data,enter orders and use electronicdocumentation. This means ournurses can spend more time withpatients at the bedside.Another important effort toimprove patient care focused onmedication administration safety.The medication administrationapplication (MAK) was implementedat all Baptist Healthhospitals. This computer applicationuses bar-coded patientarmbands and unit dosemedications, as well as wirelesstechnology at the point of care.This system is designed to helpreduce medication errors byensuring the “five rights” ofmedication administration: Rightpatient, right drug, right time,right dose and right route.In 2009, Baptist Healthbecame one of the first healthcaresystems in the country to open apatient Transfer Center staffedaround-the-clock by nurses, aswell as emergency medical technicians.The Center is equippedwith real-time computer accessto bed availability, EmergencyCenter and ICU status at all ofBaptist Health’s hospitals. Thishelps the Center’s nurses quicklyroute patients to the hospitalthat can best deliver the carethey need, whether the patient isbeing transferred from within theBaptist Health system or from anoutside hospital. In the first eightmonths of operation, the TransferCenter logged 12,400 cases, withthe average transfer taking fivehours and about 15 phone calls.Beyond the examples mentionedhere, numerous initiativesare taking place throughoutBaptist Health that leveragecutting-edge technology —ensuring that our nurses have themost advanced tools to providethe best possible patient care.BAPTIST HEALTH 20 NURSING REPORT

BAPTIST HEALTH 21 NURSING REPORT

COMMUNITY OUTREACHBaptist Health reaches out tothe South Florida community —and sometimes beyond — withfree health fairs and specialevents that educate and promotewellness and preventive care.Nurses have major roles and areoften the primary caregivers athealth-related events. They alsovolunteer their time representingBaptist Health at communityactivities and fundraising walks.For example, they help buildhomes for Habitat for Humanityand improve school buildingsand parks for Hands On Miami.Highlights for 2008-2009included:■ Missions of Mercy in Haiti: Inan ongoing program, a BaptistHospital surgical team, includingnurses, traveled to ruralHaiti to give patients free andoften life-changing surgeries.■ Thanksgiving Food Drive:Doctors Hospital partneredwith the YWCA of GreaterMiami to collect nonperishablefood for 250 needy families.■ Day of Smiles: Nurses at BaptistChildren’s Hospital gave theirtime, expertise and heart to 15South Florida children withouthealth insurance who receivedfree surgery to repair facialdeformities and birth defects.■ Mariners Hospital 5KWalk/Run: Each fall, nursesand other employees help organizeand participate in thiscommunity event that raisesmoney to support educationalprograms for Mariners nurses.■ Mariners Hospital nurses andother employees collectedtrash at Settlers Park during acleanup sponsored by thehospital’s VIP Team and GreenTeam.■ Men’s Health Day at SouthMiami Hospital: Nurses helpedperform more than 300 freehealth screenings at “Man-Power: Tackling Men’s HealthChallenges.”■ Special Olympics: BaptistHealth nurse practitionersgave free health screenings tochildren hoping to compete inthe Special Olympics.■ Partnership with Coral-Gables@HOME. DoctorsHospital nurses are involvedin educational programs forsenior citizens served by thenonprofit CoralGables@HOME,BAPTIST HEALTH 22 NURSING REPORT

which provides support andservices to older residents.■ American Cancer Society’sRelay for Life at Baptist andHomestead Hospitals: Nursesformed groups to walk inrelays, helping to raise $280,000for the cancer society.■ 17th Annual Women’s HealthDay: Nurses gave screeningsfor cholesterol, skin cancer,diabetes, blood pressure, footproblems and osteoporosis to3,000 women.■ NICU reunions at South Miamiand Baptist Hospitals: NICUnurses each year organize areunion for former patientsand their families to reconnectwith the doctors and nurseswho cared for them.■ Project Peru: Baptist Healthnurses traveled to the Andesas part of this surgical missionteam to help provide muchneededoperations for peoplewithout access to healthcare.■ Day in the Life of a Nurse:Nurses at all Baptist Healthhospitals give a one-day peekat the world of nursing to studentsfrom regional middle andhigh schools. Through handsonexperiences and shadowing,students learn about patientcare, technology and the skillsrequired for a nursing career.BAPTIST HEALTH 23 NURSING REPORT

Murielle Pariente, R.N.Doctors HospitalMurielle Pariente’s “lifelong dream”was to care for others as a nurse,especially after she watched a holisticnurse coordinate the care for herterminally ill mother in the 1970s. “Iwas superimpressed. I thought, boy, Iwould love to be able to do somethinglike that one day.” Ms. Pariente keptthat dream alive for the three decadesshe worked as a flight attendant,traveling the globe. Then, with ascholarship from Baptist Health, themother of two took the plunge, studyingnursing during the week at MiamiDade College while working as a flightattendant on weekends. She was amember of the first Versant RNResidency class in 2007, starting workat Doctors Hospital three days aftershe took her licensing exam. “It’s ahuge learning experience,” saidMs. Pariente, who works on 3 West, amedical-surgical-telemetry floor. Sheaspires to the R.N.-to-BSN Nurse Scholarsprogram. And she remains inspiredby the nurse who cared for her motherso long ago: “My goal is to get into thecritical care area.”2008-2009 MilestonesBaptist Health, a regional leader in the healthcare industry, receives numeroushonors every year in a wide range of categories. All these achievements reflect thequintessential role our outstanding nurses play as the foundation of our hospitalsand medical facilities.Baptist Health Top Employer Honors■ 100 Best Companies to Work For: FORTUNE magazine (2008 and 2009).■ 100 Best Places to Work in Healthcare: Modern Healthcaremagazine (2008 and 2009).■ Top 10 Companies for Working Mothers, Mature Workers and Part-time Workers:Working Mother magazine (2008).■ 100 Most Wired Hospitals and Health Systems: Hospitals & Health Networks(2008 and 2009).■ Top Five Nonprofit Companies for Female Executives: National Associationof Female Executives (2008 and 2009).■ Best Employers for Healthy Lifestyles Platinum Award: National Business Groupon Health (2008 and 2009).Baptist Hospital■ Consumer Choice Award as most preferred hospital in Miami, named winneror co-winner each year since the National Research Corporation started theprogram in 1996.South Miami Hospital■ Top honors in online Readers’ Choice Survey by Advance for Nurses, a regionalmagazine for R.N.s. Nurses at 279 Florida hospitals participated in the survey.South Miami Hospital scored at the top in all five categories: quality of care,organizational culture, professional development, communication andretention efforts (2008 and 2009).Doctors Hospital■ Patient satisfaction for inpatient units ranked above the 95th percentile asmeasured by Press Ganey (2008 and 2009).Homestead Hospital■ Beacon Council’s Healthcare Services Award for significant contribution to thediversification of Miami-Dade’s economy (2008).Mariners Hospital■ National Patient Safety Foundation’s Stand Up for Patient Safety ManagementAward for the hospital’s innovative approach to screening CT scan patients whomight be at risk for kidney failure (2009).Baptist Outpatient Services■ Press Ganey’s Summit Award, for sustaining a patient satisfaction ranking abovethe 95th percentile for at least three consecutive years, which was achieved bythree facilities: Medical Arts Surgery Center at South Miami, Baptist Medical Plazaat Miami Lakes and Baptist Mammography Center at Macy’s, The Falls (2009).BAPTIST HEALTH 24 NURSING REPORT

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