2014-2015 nursing annual report - memorial · pdf file2014-2015 nursing annual report . table...

2014-2015 NURSING ANNUAL REPORT

TABLE OF CONTENTS

01 Message from the Chief Nursing Officer02 Nursing at Memorial Hermann Memorial City Medical Center07 Transformational Leadership08 Structural Empowerment19 Exemplary Professional Practice25 New Knowledge, Innovations and Improvements31 Empirical Outcomes

1

Message from the Chief Nursing Officer

I always welcome the opportunity to feature and talk about our professional nurses here at Memorial

Hermann Memorial City Medical Center. There is so much to be proud of at our hospital.

The passion and compassion evident in the care our nurses deliver every day at Memorial Hermann

Memorial City is truly amazing. Having earned designation as a Magnet® hospital in 2009, and in the

process of undergoing redesignation in 2015, it is clear that our nurses have made the commitment to

sustain the highest excellence in nursing practice.

We consistently challenge ourselves to do more for our patients and more for our community. Our nurses

are furthering their professional education, achieving new certifications and participating in Professional

Nurse Development councils across the facility, all with the goal of serving our patients better while

advancing their careers as registered nurses.

Our nurses continue to have a voice in their professional practice. Their voices are heard through our

unit-based councils and facility-wide shared governance councils. With their focused and enlightened

perspective from the bedside, they frequently bring new ideas and improvements forward. Many of their

ideas have been implemented hospital-wide.

At Memorial Hermann Memorial City, our nurses’ hearts and hands often work outside the hospital walls

as they take personal time to volunteer for the community. Our nurses partner with and mentor students

pursuing a career in health care. They’re developing our future and shaping the healthcare workforce.

Whether you’re an experienced nurse, a new graduate, a nursing student or an individual who is

considering nursing as a potential career choice, I think you’ll be impressed by what it means to be a

Memorial Hermann Memorial City nurse.

As we are focused on creating our future in our efforts to improve and refine the clinical care

and services we provide to every patient and family member, I invite you to learn more about our

accomplishments highlighted in this report. We’re so very excited to share our clinical results, our

accomplishments and our commitment to our profession with you. Please drop me a note to let me

know what you think at [email protected].

Dan Kelly, M.B.A., B.S.N., RN Vice President, Chief Nursing Officer

MEMORIAL HERMANN MEMORIAL CITY MEDICAL CENTER

2

“It was a nurse who held me, aided me, saved me, helped me, taught me, inspired me.” – Unknown

Nursing at Memorial Hermann Memorial City Medical Center

The Nursing Mission: to advance the health of our

community by partnering with patients, families and

physicians to provide patient-centered, quality care, in a

collaborative environment while promoting growth and

operational excellence.

The Nursing Vision: to promote trusting partnerships that

deliver the best patient experience, through the selection,

development, and retention of the highest performing

nurses, while creating systems that achieve consistency

and excellence in patient care.

The Nursing Pledge: As a nurse at Memorial Hermann

Memorial City Medical Center, I believe in making a positive

difference for those I serve through compassionate,

innovative, and evidence-based nursing care.

Nursing Strategies

• Provide highly reliable, customer-centered nursing

care with a focus on service excellence, quality and safe

clinical practice

• Enhance the professional image of nursing

• Partner with physicians to improve patient care outcomes

• Drive high-quality outcomes by protecting, promoting,

and optimizing the health and wellbeing of the patients

we serve

• Advance the professional growth of nurses to expand

our service to the community

• Optimize and demonstrate fiscal responsibility

3

Memorial Hermann Memorial City nurses demonstrate

excellence by emulating the core values of quality

patient care, continuous improvement, partnerships,

and professional development and growth. This allows

them to elevate the professional image of nursing as

reflected in increased accountability, leadership and

fiscal responsibility.

Since 2009, Memorial Hermann Memorial City has

been designated by the ANCC’s Magnet Recognition

Program®. Ultimately, Magnet designation is reflective

of nursing care and quality and is considered the

highest level of recognition the profession can receive.

Organizations that obtain the designation must

consistently outperform national benchmarks

regarding nursing and patient satisfaction

scores and nursing-sensitive indicators including

Catheter-Associated Urinary Tract Infection (CAUTI),

Hospital-Acquired Pressure Ulcers Stage II (HAPU

Stage II and Above), Central Line-Associated

Bloodstream Infections (CLABSI) and Patient Falls.

Research supports that Magnet facilities foster

an environment conducive to achieving improved

patient safety outcomes.

Provide highlyreliable, customer- centered nursing

care with a focus onservice excellence,quality, and safeclinical practice.

Nursing Goals:

Enhance and utilizea culture that

maximizes customerexperience through

hourly rounding,leadership rounding,bedside report and

accountability.

Reduce readmissionthrough effective

communication andeducation of patients

and families fromadmission to discharge.

Enhance theprofessional image

of nursing.

Nursing Goals:

Hire and retain adiverse, caring,compassionate,connected, andcommitted staffthrough shared

governance.

Improveinterdisciplinarycollaboration as

the coordinator ofthe patient’s care.

Advance healthwith a passion and

inspiration forpatient and family

centered care.

Partner withphysicians to

improve patient careoutcomes.

Nursing Goals:

Achieve effective,high quality,

nurse-physiciancommunication.

Promote a positiveculture for

nurse-physicianrelationships.

Engagephysicians in the implementation

of evidence-basedpractice to ensurehigh quality patient

outcomes.

Drive high qualityoutcomes by protecting,

promoting, andoptimizing the

health andwellbeing of the

patients we serve.

Nursing Goals:

Utilize evidencebased practice and

research in allpatient care areas.

Eliminate serioussafety events, falls

with injury, andhospital acquired

infections.

Utilize data to drive processimprovement.

Advance theprofessional growthof nurses to expandour services to the

community.

Nursing Goals:

Create anenvironment that

inspires professionaldevelopment

through internal andexternal educational

opportunities.

Promote academicpartnerships andimproved talent

acquisition processes.

Pursue new patientpopulations through

the creation andexpansion of services.

Optimize anddemonstrate fiscal

responsibility

Nursing Goals:

Increase employeeretention through

best practices in staffing.

Optimize supplycosts and improveresource utilizationto ensure the right

supplies andequipment are

available for theright patient at the

right time.

Standardize careand improve

efficiency in patientflow using current

technology.

Pillar:Patients

Pillar:People

Pillar:Physicians

Pillar:Quality & Safety

Pillar:Growth

Pillar:OperationalExcellence

Our Mission: to advancethe health of our

community by partnering with patients, families,

and physicians to providepatient-centered, qualitycare, in a collaborative

environment whilepromoting growth andoperational excellence.

Our Vision: to promotetrusting partnerships thatdeliver the best patientexperience through theselection, development,

and retention of thehighest-performing nurses,

while creating systemsthat achieve consistency

and excellence inpatient care. Dan Kelly

Vice President and Chief Nursing Officer

My Nursing Pledge: As a nurse at Memorial Hermann Memorial City Medical Center I believe in making a

positive difference for those I serve through compassionate,innovative, and evidenced-based nursing care.

The Nursing MVP(Mission, Vision and Pledge)

As a professional nurse atMemorial Hermann Memorial City Medical Center

4

Using components of the Magnet Model (on right),

our nursing leaders and clinical nurses transform

practice through empowerment of our staff and

use of our shared governance model to evaluate

and implement evidence-based interventions.

These innovations raise the bar on quality for nurses

at the bedside, creating an exemplary practice

environment for generating new knowledge

and improvements. As a result, excellence in

patient outcomes is achieved and supported by

empirical findings.

MEMORIAL HERMANN MEMORIAL CITY MEDICAL CENTER NURSING ORGANIZATIONAL CHART

Updated 5/21/2015

Director, Dialysis Margie Witt

Director, MFM/OB Special Care, OBED L&DLynneece Rooney

Sr. Admin. Director, Med/Surg

Maryellen McGlothlin

Manager, Labor & DeliveryJennifer Johnson

Manager, NICU, PediatricsKevin Hart

Director, MICU/SICUMargie Witt

Manager, MICUDora Barrows

Manager, IMCUPamela Mare

EducatorsMaryellen McGlothlin

Emergency ServicesPediatric ED

Manager, CDUChauntelle Long

Paul O’Sullivan, CEO

Office of Designations Magnet & Baldrige Coach

Mary Poe

Program Specialist,Emergency Management

Mike Barron

Manager, SICUPrince Balason

Director, NeurosciencesAngela Dever

Manager, Neuro ICUJason Hayes

Director, 6M/7M Mila Goldstein

Manager, 6M Olu Funke

Manager, 7E Elizabeth Bench

Director, 6E Maria Jardiolin

Manager, 6E Jenneta Manning

Sr. Admin. Director, Nursing Services

Vacant

OAs Patricia Howell

Float PoolHarold Engle

Director, CRMShayla Preston

Manager, EDMelanie Aluotto

Sr. Admin. Director, Emergency Services Adult

Harold Engle

Sr. Admin. Director, Critical Care

Patricia Howell

Director, Volunteer ServicesBailey Curtis

Manager, Chaplaincy Services

Rick Chandler

Project Manager, Magnet

Nadia Saiphoo

Sr. Admin. Director, Women’s & Children’s

Karen ChildsMary Poe

Manager, Family Life CenterRobin Gray

Manager, 7M

Vacant

Director, 5E/7E

Barbara Thomas

Manager, 5E Purisma “Dolly” Vingco

Dan Kelly, Vice President, CNO

5

StructuralEmpowerment

EmpiricalOutcomes

New Knowledge,Innovations, &Improvements

TransformationalLeadership

ExemplaryProfessional

Practice

Global Issues in Nursing & Health Care

MAGNET MODEL

Harold Engle, M.B.A., B.S.N., RN, CCRN-K Senior Administrative Director, Emergency Services

Maryellen McGlothlin, B.S.N., RN, NE-BCSenior Administrative Director, Medical/Surgical Services

Karen Childs, M.S.N., B.S.N., RN-OB Senior Administrative Director, Women’s & Children’s

Patti Howell, M.B.A., B.S.N., RN, CCRN-K Senior Administrative Director, Critical Care

Dan Kelly, M.B.A., B.S.N., RN Vice President and Chief Nursing Officer

Mary Poe, M.S.N., B.S.N., RNC Office of Designation, Magnet & Baldridge

Senior Nurse Leaders at Memorial Hermann Memorial City

7

In 2014, Memorial Hermann Memorial City nurses were

empowered to advocate for both fiscal and technology

resources. The process involves nurse leaders rounding

with direct care nurses monthly and asking each of

them, “Do you have the basic tools and equipment

to do your job?” This had an enormous impact in

improving the clinical nursing environment across the

Memorial Hermann Memorial City campus.

As an example, Administrative Director of Medical

Surgical Services Maryellen McGlothlin, B.S.N., RN,

rounded on several medical surgical units. On one of

these units, McGlothlin met with a direct care nurse who

requested a microwave, a refrigerator, and a workstation

on wheels (WOW). This request was documented using

the Spotlight Report. Requests from medical surgical

nurses on the 7 East/Cardiology unit Stoplight Report

included an additional BP machine, two microwave

ovens, a refrigerator, lockers, backboards, thermometers

and bedside commodes.

Stoplight ReportThe Stoplight Report is a tool used to document the direct

care nurses’ needs for fiscal and technology resources.

This helps to transform the clinical work environment in

practical ways, which is in line with the Memorial Hermann

Memorial City Nursing Strategic Plan that directly impacts

quality, safety, patients, operational excellence, people,

physicians and growth. The Stoplight Report is reviewed

each month with the direct care nurses.

As a result of this collaboration, all of the nurse requests

were granted. Additional WOWs were also purchased

so that direct care nurses could continue to improve on

developing personal and professional technology skills and

continue to provide best nursing practices.

The CNO must be strategically positioned within the

organization to effectively influence other executive

stakeholders, including the board of directors/trustees.

Nursing’s mission, vision, values and strategic plan

must align with the organization’s priorities to improve

performance, wherever nursing is practiced. Mechanisms

must be implemented for evidence-based practice to

evolve and for innovation to flourish. As a result, nurses

throughout the organization should perceive their voices

are heard, their input is valued, and their practice is

supported.

– A New Model for ANCC’s

Magnet Recognition Program, 2014

Nursing leaders at all levels of a

Magnet-recognized organization must

demonstrate advocacy and support on

behalf of staff and patients to transform

values, beliefs and behaviors.

Transformational Leadership

9

Solid structures and processes developed by influential

leadership provide an innovative environment where strong

professional practice flourishes and where the mission, vision,

and values come to life to achieve the outcomes believed to

be important for the organization. Further strengthening

practice are the strong relationships and partnerships

developed among all types of community organizations to

improve patient outcomes and the health of the communities

they serve. This is accomplished through the organization’s

strategic plan, structure, systems, policies and programs.

Staff needs to be developed, directed and empowered to

find the best way to accomplish the organizational goals and

achieve desired outcomes. This may be accomplished through

a variety of structures and programs; as one size does not fit all.



The second of the five Magnet model components,

Structural Empowerment, is integral to ensuring

that nurses have the tools they need to be

the central part of the patient care decision-

making process. The ANCC describes Structural

Empowerment as follows:

Structural Empowerment

ProfessionalNursing

DevelopmentCouncil

ProfessionalNursingPracticeCouncil

Memorial Hermann Memorial City Medical Center Shared Governance Councils Structure

Revised 4/16/2015

NursingQualityCouncil

NurseStaffing

EffectivenessCouncil

NursingResearch

and Evidence-Based Practice

Council NursingLeadership

Council

MagnetChamps

Unit-BasedCouncils

12

STRUCTURAL EMPOWERMENT

10

Nursing Shared Governance Council Our Shared Governance councils, which are nurse-driven,

support and demonstrate structural empowerment.

Each council has a chair and a co-chair who are

appointed or elected by the council members, who

are bedside care nurses. Each council is guided by a

specific mission and accountabilities, as described in

the Memorial Hermann Memorial City nursing bylaws,

which allows them to focus on different aspects related

to improving nurse practices.

• Professional Development Council

Mission:

• Define educational needs, structures, and

processes as they pertain to building a culture of

nursing excellence that attracts and retains quality

nurses, and develops rewards and recognition.

• Collaborate with Human Resources to determine

the structures and processes to recruit and retain

quality nurses.

• Develop in partnership with clinical nurse educators

to provide unit-based education and incentives

related to new knowledge and nurse recruitment,

retention, reward and recognition.

• Develop and guide formal and informal reward and

recognition of nurses.

• Participate in planning the annual Nurses Week,

Certified Nurses Day™, and other nurse-related

celebrations.

• Promote nurses’ individual accountability and team

ownership of retaining best nurses..

11


• Professional Practice Council

Mission:

• Support and implement the standards of the

nursing practice.

• Define the roles and responsibilities of patient care

support staff.

• Evaluate and implement evidence-based practices.

• Incorporate nursing research findings into clinical

practice as appropriate.

• Participate in the improvement of patient care

and safety.

• Participate in the improvement of employee safety

and address multidisciplinary issues that impact

patient care areas.

• Participate in the review and recommendation of

products and equipment brought into the patient

care areas.

• Review and approve applications and make

recommendations for clinical ladder advancement.

• Nursing Quality Council

Mission:

• Define structures and implement nursing quality

improvement programs.

• Collaborate in nursing continuing education and

patient education programs.

• Support evidence-based clinical practice, nursing

outcomes, and empirical outcomes.

• Integrate nursing performance improvement

programs with the hospital quality improvement

system (Six Sigma).

• Evaluate the effectiveness of the quality

improvement programs and make

recommendations to appropriate departments,

committees, and organizations.

• Assess and reassess both patient education and

nursing continuing education as it relates to quality

of care.

• Promote, facilitate, and evaluate the use of

evidence-based nursing practices on unit.

• Research and Evidence-Based Practice

Mission: Research and Evidence-Based Practice

(EBP) are essential to providing excellent nursing

care. Nurses define problems and use a process

where they improve their knowledge and skills

to affect positive clinical changes and outcomes.

A Research and EBP culture requires a structured

collaborative approach from nurses at all levels, as

well as an interdisciplinary problem-solving approach.

Use of Research and EBP in nursing is essential

to patient-centered care and safety, efficiency,

timeliness, equity and excellence.

• Nurse Staffing Council

Mission:

• Positively impact and address staffing-related

issues that affect the safety and quality of patient

care and nurse practices.

• Return the control of nursing practice back to those

having direct patient care, and return autonomy to

the workplace.

• Review risk indicator for nursing dynamics (e.g.,

staffing grids, actual staffing data, recruitment and

retention).

• Determine how correlation data (e.g., fall data)

applies to patient care and ascertains if there is a

correlation or not.

• Review staffing policies and accept input from all

areas of the hospital to ensure the needs of our

patients are being met.

• Provide direct care nurse input and

recommendations to the Nurse Staffing Plan to

ensure that we comply with the Texas Nursing Safe

Staffing Law (Senate Bill 476).

• Review skill mix and nurse characteristics with staff

to ensure that quality care is available on all shifts

and units.

12

DAISY Award DAISY is an acronym for Disease Attacking the

Immune System. The DAISY Foundation was formed

in November 1999, by the family of J. Patrick Barnes,

to honor the exceptional nurses who cared for

J. Patrick until his death at age 33 from complications

of idiopathic thrombocytopenic purpura.

The DAISY Award recognizes one nurse each month

for going above and beyond to deliver exceptional

patient care. The Memorial Hermann Memorial City

DAISY Program recognizes extraordinary nurses who

have been nominated for their compassion and clinical

skills provided to patients and families.

2014/2015 DAISY Winners

• Anton DeGuzman, A.D.N., RN, 7M

• Ian Binns, B.S.N., RN, 7M

• Tiffany Hatch, B.S.N., RN, CDU

• Sophie Harris, B.S.N., RN, NICU

• Nhu Do, B.S.N., RN, 7E

• Alberto Galvan, B.S.N., RN, MICU

• Ihechi Nwachokwu, B.S.N., RN, 7M

• Roselyn Flauta, B.S.N., RN, SICU

• Trinh Linh, B.S.N., RN, 7M

• Laura Wueste, A.P.R.N., RN

• Marisa Ehrich, RN, FLC


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COMMITMENT TO PROFESSIONAL DEVELOPMENT

CURRENT CERTIFICATIONS FOR NURSING BY SPECIALITY

Certified Case ManagerJennifer Johnson, CCMKathleen Nipper Johnson, CCM

American Case Management CertificationStephanie Campbell, ACMAKaren Charba, ACMASharon Humphreys, ACMADeborah Tarner, ACMA

Fellow American Academy of Case Management CertificationElaine Cavenall, FAACMRossanny Cerino, FAACMJoanna Davidson, FAACMMarietta Guinhin, FAACMSharon Humphreys, FAACMAbeni Jones, FAACMLeilani McCarthy, FAACMGail McNeal, FAACMJudy Roberson, FAACMShelia Rougeaux, FAACM

Certified Diabetes EducatorNadia Saiphoo, CDEGail Llewellyn, CDE

Certified Nurse Midwife Lynneece Rooney, CNM

Certified Emergency NurseMelanie Aluotto, CENKara Edwards, CENLauren Ivanhoe, CENSteven Talbot, CENMarcie Woodard, CEN

Certified in Infection Control Certified Nurse Manager LeaderHelen Nielsen, CNMLMargie Witt, CNML

Certified Low Risk NewbornJocelyn Guzman, RNC-LRN

Certified Neonatal ICU NurseRoxanne Cabori, RNC-NICSophie Harris, RNC-NICKevin Hart, RNC-NICKaren Parthum, RNC-NICCathy Singer, RNC-NICAmy Theall, RNC-NIC

Certified Nurse ExecutiveAnnette Conley, NE-BCLouise Hernandez, NE-BCDaphney Jacques, NE-BCMaryellen McGlothlin, NE-BC

Certified Advanced Nurse ExecutiveBernadette Pollard, NEA-BC

Certified Nurse Operating RoomJennifer Amedio, CNORAnjanette Bryant, CNORRebecca Burt, CNORWilliam Coakley, CNORDenise Collins, CNORConstance Curtis, CNORNathalie Desinor, CNORAnn From, CNORDeborah Lucas, CNORDina Roane, CNORBernita Russo, CNORBarbara Sparks, CNORAdoracion Tangalin, CNOR

Certified Orthopedic NurseMaria-Belen Jardiolin, ONCJoseph Galvan, ONCJenneta Manning, ONCThelma Redondiez, ONC

Certified Wound, Ostomy and Continence NurseBarbara Kebodeaux, CWONNnenna Nelson, CWONLarry Ong, WCC

Critical Care Registered NurseClinton Alsup, CCRNJennifer Amedio CCRNTammera Averette, CCRNBrenda Borhary, CCRNLaurie Brumley, CCRNMarian Buado, CCRNJeanne Caneda, CCRNNelia Collado, CCRNMargaret Conner, CCRNIrene DeLeon, CCRNNida Dumantay, CCRNSoyna Gaines CCRNMichael Garcia, CCRNHilaria Gascon, CCRNKatharine Hicks CCRNLinda Holifield, CCRNAndronico Inocenio, CCRNDaphney Jacques, CCRNTrudy La, CCRNMaria Luz, CCRNRobert Malinsky, CCRNJacquelyn Marchman, CCRNIrene Martin, CCRNMariam Namakar, CCRNIbrahim Noubani, CCRNBarbara Paredes, CCRNPaige Percoski, CCRNSuzy Robinson, CCRNDiane Stephenson, CCRNJean Talosi, CCRNJoseliza Tan, CCRNRubylyn Toquero, CCRNVicki Trask, CCRNLisa Verbeke, CCRNYu Wang, CCRNFelisa Wong, CCRNAmy Wriht, CCRN

Critical Care Registered Nurse-KnowledgeHarold Engle, CCRN-KPatty Howell, CCRN-K

Cardio-Vascular Certified NursingMaria Meneses, CVCRN

Certified Bariatric NurseDebbie Cook, CBNSuzanne Hovis, CBNTrudy Ivins, CBNLaura Moreno, CBNCaroline Wesgona, CBN

Certified Gastroenterology NurseJosefina Bernstein, CGNStaci Norman, CGNVicki Norman, CGNCary Yeary, CGN

Certified Medical Surgical Registered NurseIda Aristizabel, CMSRNMartha Awotwe, CMSRNLiz Bench, CMSRNMonica Climaco, CMSRNCharlotte Elizondo, CMSRNMureal Escano, CMSRNStaci Forcade, CMSRNMaria Hurtado, CMSRNMaria Lapat, CMSRNMaudheler Lewis, CMSRNCarla Mondelli, CMSRNIsioma Okoye, CMSRNAlana Pollard, CMSRNJenn Rivas, CMSRNOlofunke Taiwo, CMSRNBarbara Thomas, CMSRNPurisima Vingco, CMSRNMaria Wilson, CMSRN

COMMITMENT TO PROFESSIONAL DEVELOPMENT

CURRENT CERTIFICATIONS FOR NURSING BY SPECIALITY

14


Healthcare QualityDebbie Garbade, CPHQ

Certified Patient Safety OfficerDebbie Garbade, CPSO

Certified Healthcare Risk ManagementEllen Davis, CPHRMDebbie Garbade, CPHRM

Certified Neuroscience Registered NurseNelia Collado, CNRNGuoqing Fan, CNRNAmy Lewis, CNRNMaryann Mendoza, CNRNPaige Percoski, CNRN

Perianesthesia Certified Registered NurseVivien Swaren, CPAN

Stroke Certified Registered NurseAngela Dever, SCRNPaige Percoski, SCRN

Electronic Fetal MonitoringLeah Burnitt, EFMAngela Fraizer, EFMJennifer Johnson, EFMKystal Wilkins, EFMBarbara Wilson, EFM

Certified Obstetric Registered NurseKathy Armitage, RNC-OBLeah Burnitt, RNC-OBLucia Champange, RNC-OBKaren Childs, RNC-OBBrandy Duffy, RNC-OBAngela Frazier, RNC-OBVeronica Gaston, RNC-OBRobin Gray, RNC-OBBridget Ikejimba, RNC-OBJennifer Johnson, RNC-OBMargo Makowski, RNC-OBJennifer Maiorana, RNC-OBShean Manickchan, RNC-OBGail Matejka, RNC-OBTeena Middleton, RNC-OBJennifer Rocha, RNC-OBLynneece Rooney, RNC-OBBarbara Wilson, RNC-OB

Certified Hospice and Palliative CareCorrine Ferchak, CHPNTracie Meeks, CHPN

Certified Breastfeeding CounselorLucia Champange, CBC

International Board Certified Lactation ConsultantAida Alinsub IBCLCSusan Boehning IBCLCRebecca Ovbiaele IBCLCHeather Sanderson IBCLCLeslie Trevino IBCLCEvelyne Volny IBCLC

Certified Lactation CounselorFoluke Akinola, CLC

Maternal Newborn NursingAmor Ballestero, RNC-MNNMimoza Duraj, RNC-MNNIrma Garza, RNC-MNNErica Huckaby, RNC-MNNLucy Langley, RNC-MNNRebecca Ovbiaele, RNC-MNNMemusa Paez-Cabangon, RNC-MNNMary Poe, RNC-MNN

Oncology Certified NurseArrian Amini, OCNJessica Burgess, OCNMaritess Castilan, OCNConstance Curtis, ONCKaren Davin, OCNNancy Evans, OCNAnton De Guzman, OCNMila Goldstein, OCN

Certified Cardiac Rehabilitation ProfessionalDonna McFadyen-Taylor, CCRP

Certified Pediatric NurseHolly Beck, CPNJan Davis, CPNJody Duncan, CPNPenny Kakoolaki, CPNLisamma Kurian, CPNJosephine Larbi, CPNJessica Oliveira, CPNCecilia Pangandoyon, CPNAimee Strech, CPN

Association of Pediatric Hematology/ Oncology NursesAshlyn Ward, APHON

Certified Pediatric Hematology/ Oncology NurseMary Higan, CPHON

Trauma Nurse CertificationClaire Lasiewski, TNCC

15

Certified Nurses Day TM Celebration Certified Nurses Day is a national day to honor and

recognize the important achievement of nursing

specialty and subspecialty certification. Certification

is a milestone of personal excellence along the

professional journey.

Charge Nurse Academy Memorial Hermann Memorial City promotes leadership

at the point of care and enhances competencies at all

levels. Memorial Hermann Memorial City knows that

charge nurses play a pivotal role in providing leadership,

and are vital to the overall improvement of patient

outcomes and effective management of the nursing

unit. The Charge Nurse Academy curriculum includes

healthcare economics/finance, effective communication,

conflict management, resource management and

self-development.


Memorial City Nursing Education Trend

*No data for FY13 Q4 or FY14 Q2

900

800

700

600

500

400

300

200

100

0FY2013 Q1

363BSNMSNTotal RN Count

19599

37220613

35814

605

3249

516

39317

667

43032

752

50225781

FY2013 Q2 FY2013 Q3 FY2014 Q1 FY2014 Q3 FY2014 Q4 FY2015 Q1

Tota

l RN

Cou

nt

Staf

f Cou

nt B

SN/M

SN

600

500

400

300

200

100

0

Insertion of PICC Lines and Dressing Changes Memorial Hermann Memorial City leadership promotes,

encourages, and supports the active participation of all

nursing staff in professional nursing organizations.

The Memorial Hermann Memorial City Peripherally

Inserted Central Catheter (PICC) team nurses attend the

Infusion Nurse Society (INS) and Association for Vascular

Access (AVA) chapter meetings. Through participation

in these professional nursing organizations, the

importance of avoiding hospital-acquired conditions,

particularly CLABSIs, is emphasized. Dora Li, M.S.N.,

RN, CRNI VA-BC, attended the Association for Vascular

Access Annual Scientific Meeting and returned to the

organization with a plan to provide more intensive

education for direct care nurses in dealing with access,

maintenance, and care of central lines.

In February 2014, the PICC team collaborated with

critical care educators to develop an educational

program for the Intensive Care Unit (ICU) nursing staff

that defined the interventions required for the proper

use, maintenance and care of central lines in order to

decrease the risk of CLABSIs. Best practice guidelines

from the American Association of Critical-Care Nurses

(AACN), the INS and AVA were used to develop the

educational program.

The education included instruction on maintenance

of central lines, causes of occlusions, dressing

change techniques, directions regarding medications

and adverse reactions. The educational offering was

held during the ICU annual competencies in March

2014, and included various teaching methodologies:

explanation, discussion, handouts, questions and

answers, and return demonstration. All nurses

employed by SICU, MICU, IMCU and Neuro ICU

received this education.

Nurse Practitioners Memorial Hermann Memorial City has employed

advanced practice registered nurses (APRNs) since

2011. Their hard work, attention to detail, and patient-

centered care has resulted in the cardiovascular program

receiving a three-star rating from the Society of Thoracic

Surgery. This award has elevated the Memorial Hermann

Heart & Vascular Institute-Memorial City cardiovascular

program to the top 8% of cardiovascular surgery

programs in the United States. The APRNs had a direct

impact on achieving this award based on meeting 100%

compliance with the required medications at discharge,

a decrease in the length of stay by two full days, a

decrease in readmission rates, and an overall increase in

patient satisfaction and consulting physician satisfaction

with the cardiovascular surgery service at the Institute.

16


17

instructor contacts Maryellen McGlothlin, B.S.N., RN,

the administrative director of Med/Surg at Memorial

Hermann Memorial City, several months prior to the

start of the upcoming semester and identifies the

number of preceptors needed. At the same time the

school will submit a clinical placement request form.

McGlothlin sends an email to all nursing managers and

directors to ask if there is willingness to precept a

HBU management student. The resources allocated by

Memorial Hermann Memorial City include approximately

120 hours of nursing leadership time for precepting an

RN management clinical practicum. Additional resources

allocated include the use of a conference room for the

student’s weekly pre- and post-conference with the

nursing instructor.

Nursing students are assigned to specific nursing

leadership who volunteer their time to teach and mentor.

Nursing leaders participate in each student’s review

and reinforce skills that support current nursing

strategic initiatives. One of the initiatives is customer

service: enhancing and utilizing a culture that

maximizes customer experience as it relates to effective

communication and education.

In the fourth quarter of 2013, the CLABSI rate in

all ICUs (SICU, MICU, IMCU, Neuro ICU) was 3.28.

After implementation of these interventions, in the

second and third quarter of 2014, the CLABSI rate

in all ICUs decreased to 2.5.

Affiliations with Schools of Nursing Memorial Hermann Memorial City is committed to

the health of the community and participating in and

supporting nursing’s involvement in education and

community projects. The nursing strategic plan promotes

growth through academic partnerships and improved

talent acquisitions. One objective within the strategic

plan is to support growth and nursing leadership

while advancing the professional growth of nurses to

expand our services to the community.

To support this nursing goal, resources are allocated for

affiliations with schools of nursing during the budgeting

process. Key initiatives are discussed with nursing

leaders to determine what resources, human and

financial, are needed. Each school of nursing affiliation

starts with a student affiliation agreement between

Memorial Hermann Memorial City and the school entity.

Clinical and leadership preceptors are needed for

nursing students from many nursing schools. Houston

Baptist University (HBU) partners with Memorial

Hermann Memorial City for their senior management

student clinical rotations. The HBU lead nursing


12

“Quality is never an accident. It is always the result of deliberate intent guided by sincere effort, intelligent direction and skillful execution. It represents the wisest choice among many alternatives.”

19

The true essence of a Magnet organization stems from

exemplary professional practice within nursing. This entails

a comprehensive understanding of the role of nursing; the

application of that role with patients, families, communities,

and the interdisciplinary team; and the application of new

knowledge and evidence. The goal of this Component is more

than the establishment of strong professional practice; it is

what that professional practice can achieve.



The professional nursing team at Memorial Hermann

Memorial City is committed to providing the safest

quality care for our patients and families, and

that means taking advantage of every possible

opportunity to learn and share best practices

with their colleagues. This commitment to both

the art and science of nursing is what transforms

someone with a gift of caring for others into a

nurse of Exemplary Professional Practice.

As the third of five Magnet model components

for nursing, Exemplary Professional Practice is

defined as follows:

Exemplary Professional Practice

20

Fall Project One of Memorial Hermann Memorial City’s safety initiatives

is to prevent patient falls. A hospital fall team was created

to develop best practices for fall prevention. The best

practices include: the use of the Post Fall Investigation

Tool, patients wearing yellow arm bands and yellow

socks to alert staff and family members, along with the

use of a fall sign on patient room doors. In addition, all

patient rooms display a “Please Call Stop a Fall” sign.

The Cardiology unit (7E) was chosen to be the pilot.

The goal was to decrease patient falls on the unit by

50 percent. The falls team used Define, Measure,

Analyze, Improve and Control (DMAIC) methodology

to identify critical factors leading to injurious falls, and

implemented targeted solutions to address the critical

factors. Periodic meetings of the fall team were held

and team members reported the following:

Define: Identified process issues of variation in

assessing presence of secondary diagnosis and

history of falls, patients unaware of falls risk levels,

subjectivity resulting in variation of interventions

selected, confusion on definitions of some interventions

(assistive devices, hip protectors, non-slip floor mats),

interventions selected on variance report either not in

use or not applicable, variations in reports.

Measure: Streamlined data collection process, implemented

new post-fall huddle tool, identified 28 contributing

factors. High priority factors: nurses not having completed

priorities, not rounding with purpose, staff not recognizing

patients in or out of the room, desensitization from treating

all patients at risk for fall. Completing high priority factors

resulted in a more accurate assessment and education of

fall risk. Memorial Hermann Memorial City also identified

patient education needs through interviewing patients and

their nurses.

Analyze: Implementation of robust data collection:

medication, call light response time, call light behaviors,

and change in condition. Through this analysis, Memorial

Hermann Memorial City found the following root causes

of falls on the Cardiology unit:

• Gender – males are injured more often than

females (66%)

• Lack of assistance – most falls with injury are

unassisted (93%)

• Bathroom-related activity prior to fall – injuries

related to the bathroom (54%)

EXEMPL ARY PROFESSIONAL PRACTICE

21


• Inconsistent patient education about bed alarms –

patients interviewed said they were not educated on

falls (64%)

• Bed alarm not on – patients injured did not have

bed alarm on (54%)

• Not calling for help – patients with injuries had

called for help (0%)

• Staffing – fall injury rate correlates with vacancy rate;

the higher the vacancy rate, the higher the fall rate

Improve: Fall team met and identified 22 targeted

solutions to address 16 root causes. A robust improvement

plan was developed and implemented.

Control: Continued safety audits are performed to ensure

appropriate interventions are in place (bed/chair alarms

on, arm bands, white board communication, door tags).

Monthly monitoring of Fall with Injury Rate and Total Falls

Rate is communicated in a timely manner. Full support

and buy-in has been obtained with all stakeholders.

Workplace Safety for Nursing In July 2014, Memorial Hermann Health System announced

a renewed focus and prioritizing of employee safety.

Memorial Hermann Memorial City Occupational Health

and Safety Metrics indicate that the most consistent

injuries to RN staff over the past two years have been trips,

falls, and injuries related to patient handling and needle

sticks. As part of our process, these injuries are tracked

in our SafetyNet reporting system, which enables the

employee’s supervisor to complete an injury investigation.

The intent and focus of the Workplace Safety Initiative at

Memorial Hermann Memorial City has been to develop

a culture where direct care staff is mindful of their

actions at all times and they are empowered to speak up

about safety concerns. The percent of RN injury related to

needle sticks in April – June 2013 was 27.27%. Memorial

Hermann Memorial City’s goal was to increase workplace

safety for nurses by reducing the percentage of RN

injuries related to needle sticks.

Through the utilization of the Professional Practice

Council, the Leadership Council, Education Resource

Specialists and direct care nursing, Memorial Hermann

Memorial City took the following steps to ensure direct

care nurse safety to prevent needle sticks. The suggestion

was to increase the use of Vacutainer® access devices

throughout the hospital. This new practice was taken to

the hospital Professional Practice Council. The Council

found that the Vacutainers® were not stocked on all the

RN Needle Stick Injuries

30.00%

25.00%

20.00%

15.00%

10.00%

5.00%

0.00%

27.27%

April - June2013 (Q4 FY

2013)

Perc

ent

April - June2014 (Q4 FY

2014)

July - Dec.2014 (Q1 &Q2 FY 2015)

August 2013 -Feb. 2014

% RN Injury related toneedle sticks

14.28% 8.75%

Intervention

The intervention was effective and the percent of RN

injuries related to needle sticks was decreased from

27.27% to 8.75% by the fourth quarter of 2014.

Rapid Response TeamThe Rapid Response Team (RRT) was activated during

the second quarter of 2013. The dedicated RRT has

decreased the number of codes called and the number

of times physicians and nurses were pulled from their

unit to address codes. The goal was to increase the

number of RRT calls and reduce the number of codes

called. In February 2014, the RRT department was 75%

staffed and their duties included reviewing the code

blue responses, and assisting with patient assessments

and emergency interventions. In March 2014, the RRT

nurses began attending staff meetings to introduce

themselves and explain how they could partner with

direct care nurses: educating, starting IVs, assessing

septic patients, and designing and conducting mock

codes. By the fourth quarter of 2014, the number of

RRT calls had increased to 202 and the number of

codes had decreased to 7.

units and that the staff was not consistently trained

to use them. The Council agreed these items and

education needed to be available to all direct care staff.

The Professional Practice Council decided to take the

recommendation to the Leadership Council to add to

the unit’s PLR and determine education needs of staff.

22


Rapid Response Team Activations and Number of Codes

250

Intervention200

150

100

50

0

6 Codes

RRTs 80 76 113 100

Q1-2013 Q2-2013 Q3-2013 Q4-2013 Q1-2014 Q2-2014 Q3-2014 Q4-2014

111 106 171 202

23 20 20 13 13 7 14

Num

ber o

f Act

ivat

ions

/Cod

es

Nurses are educated about evidence-based practice

and research, enabling them to appropriately explore the

safest and best practices for their patients and practice

environment while gaining new knowledge.

As the fourth of a five-component Magnet model,

New Knowledge, Innovation and Improvements is defined

as below:

Innovations in patient care, nursing, and the practice

environment are the hallmark of organizations receiving

Magnet recognition. Establishing new ways of achieving

high-quality, effective, and efficient care is the outcome

of transformational leadership, empowering structures and

processes, and exemplary professional practice in nursing.



Magnet-recognized organizations integrate

evidence-based practice and research into

clinical and operational processes.

New Knowledge, Innovations and Improvements

25

Journal Clubs Memorial Hermann Memorial City’s nurse-driven effort

to integrate best practices into the clinical environment

involved evaluating existing nursing practices through

Journal Clubs. Journal Clubs encourage nurses to review

evidence-based literature that may have an impact on

existing clinical practices.

A hospital-wide Journal Club was created by Pediatric

Nurse Educator Jessica Oliviera, B.S.N., RN, CPN,

to foster an evidence-based learning environment for

Memorial Hermann Memorial City nurses. A hospital-wide

presentation was given on the importance and benefits

of Journal Clubs. This served to support and encourage

the direct care nurses that attended to start individual

unit-based Journal Clubs. After attending the Journal Club

presentation, Amor Ballestro, B.S.N., RNC-LRN, charge

nurse in the Family Life Center, used the Journal Club’s

new knowledge as a platform for evaluating kangaroo

care at birth for full-term infants in the newborn nursery.

Kangaroo care is skin-to-skin contact with mother and

baby immediately after birth. The Journal Club provided

the necessary structure that enabled the nursery nurses

to evaluate the validity of kangaroo care for full-term

infants. This helped them to develop new knowledge and

skills, as they were already familiar with the importance

and necessity of providing kangaroo care in preterm

infants, but were not sure of its benefits or a needed

practice in full-term infants.

The process that Ballestro conducted included a

literature search that provided an article for the nursery

nurses to review via the Nursery Journal Club: Walters,

M., Boggs, K., Ludington-Hoe, S., Price, K., & Morrison,

B. (2007). Kangaroo Care at Birth for Full Term Infants

– A Pilot Study. MCN American Journal Maternal Child

Nursing. 2007 Nov-Dec; 32(6): 375-381.

The Nursery Journal Club met and reviewed the article,

and discussed their current practice compared to

the best practice identified in the article’s use of

kangaroo care for full-term babies. In addition, Ballestro

provided an article for the nursery nurses to review:

Cong, X., Ludington-Hoe, S., Vazquez, V., Zhang, D., &

Zaffetti, S. (2013). Ergonomic Procedure for Heel Sticks

in Kangaroo Care (Skin-to-Skin) Position. Neonatal

Network, 2013; 32(5):353-357. After a review of the

evidence, the recommendation was made to incorporate

kangaroo care into newborn nursery practice.

Surgical Attire Policy and Procedure Many of the nursing policies and procedures that guide

nursing practice at Memorial Hermann Memorial City

originate at a Memorial Hermann system level to ensure

consistency in nursing practice across the system.

The System and Entity Policy, Procedure and Guideline

(PP&G) process is set up to enable all staff to have access

to approved PP&Gs and to facilitate consistency in

the development and management of PP&Gs. When

a question, concern, or issue arises with an existing

nursing practice, and there is a PP&G involved, the item

is brought to the attention of the document owner who

is the Chief or Director responsible for owning a particular

policy, procedure, or clinical guideline, and for its periodic

review or update. The document owner assigns content

experts to review the issues and revise or write the

policy or procedure. Throughout the review process,

the policy is sent and reviewed by the PP&G committee

as well as stakeholders, which are interdisciplinary

healthcare providers (i.e., Critical Care Council, Med-Surg

Council, Physician Committees, Pharmacy), to ensure

the written information reflects their input and is accurate

and evidence- based.

For example, a Surgical Site Infection (SSI) task

force was created with the intention of eliminating SSIs

at Memorial Hermann Memorial City. The task force

consisted of a hospital-wide multidisciplinary team that

NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS

26

In June of 2013, a hospital-wide Journal Club was created by Pediatric Nurse Educator Jessica Oliviera, B.S.N., RN, CPN, to foster an evidence-based learning environment for Memorial Hermann Memorial City nurses.


Catheter-Associated Urinary Tract Infections (CAUTIs) The Memorial Hermann Memorial City nurse-led CAUTI

champion team implemented new knowledge collected

from evidence-based best practice and national

guidelines to reduce CAUTIs within our facility. CAUTI

numbers were collected, with data tracked for decreasing

the incidence of CAUTIs without successful improvement,

despite being below the national data average. In

November 2013, the pre-data showed that an average

of 3.5 CAUTIs occurred per month. The nurses saw

this as an opportunity to improve on the quality of

patient care and improved health outcomes with the

new knowledge by introducing new insertion techniques

and reconsidering whether patients truly required urinary

catheters. Their goal was to reduce the incidence of CAUTIs

as measured by the average number of CAUTIs/month.

Memorial Hermann Memorial City developed a task

force of point-of-care CAUTI champs supported by project

leader Maryellen McGlothlin. She was appointed to this

position based on her extensive nursing experience in the

acute care environment, and direct responsibility for five

was championed by our former Chief Operating Officer,

Jim Witt, M.B.A., B.S.N., RN. The task force adopted the

Pathway to Zero Surgical Site Infections created by Dr.

Waleed at Kaiser Sunnyside Medical Center in Clackamas,

Oregon. The first item in this pathway is Operating Room

(OR) attire. The task force assigned Annette Conley,

M.H.A., B.S.N., RN, director of Inpatient Perioperative

Services; Shanna Harris, M.H.A., MT (ASCP), Six Sigma

Master Black Belt; and Karen DeKay, manager of Infection

Prevention, to lead the work on developing a surgical

attire policy and procedure. Annette Conley was assigned

to be the document owner.

The team performed a literature review and decided to use

the Association of Perioperative Registered Nurses (AORN)

guidelines in developing their policy and procedure. The

team, led by Conley, worked on the policy and procedure,

asking for input from all affected areas. They presented

the Development Plan and Education and Communication

Plan to the Memorial Hermann Memorial City PP&G

committee and, with the approval of the committee,

proceeded in finishing the policy and procedure. The

policy and procedure was completed and published.

28

29

medical surgical units at the hospital. The CAUTI champs

were selected based on a volunteer basis.

In January 2014, the CAUTI champs held their first

meeting in which they reviewed current national legislation,

financial impact and adverse patient outcomes data.

Group discussion resulted in recommendations to reduce

CAUTIs at Memorial Hermann Memorial City.

In March 2014, the infection prevention specialists

(Shaunte Walton, M.S., MB (ASCP), CIC; and

Julia Thomas, MAOM, MT (ASCP)) presented data

to the CAUTI champs that showed current national

CAUTI data and highlighted the fact that Memorial

Hermann Memorial City was below the national

average. Recommendations were made to collaborate

with C.R. Bard, Inc., a company that manufactures

medical devices.

In April 2014, the Bard representatives performed

an insertion gap analysis in the Main Operating Room

(MOR), Emergency Department (ED), Labor and Delivery

(L&D), and the Medical Intensive Care Unit (MICU)

that showed significant improvement was needed

with insertion techniques. This new knowledge led to

a facility-wide awareness and improvement in nursing

practice with each Foley catheter insertion. The CAUTI

champs created a universal poster that was used in

each unit to present the new urinary catheter insertion

guidelines focusing on new knowledge. This new

knowledge included using a two-person/nurse insertion

team, having a valid reason for a urinary catheter

insertion, committed use of the catheter stat lock and

securement device, using best practices with catheter

and peri-care, and proper drainage bag placement.

This project continued through May 2014 when the

CAUTI team reviewed evidence-based literature and

focused on the following article: Parry, M. F., Grant, B.,

& Sestovic, M. (2013). Major article: Successful

reduction in catheter-associated urinary tract infections:

Focus on nurse-directed catheter removal. AJIC:

American Journal of Infection Control, 411178-1181.

doi:10.1016/j.ajic.2013.03.296.

This was used as a source of best practices that integrated

new knowledge with improving clinical practices.

In June 2014, this new insertion technique knowledge

was incorporated by the nurses and implemented

facility-wide as a best-practice change for insertion.

This also fulfilled a key focus of the 2014 National

Patient Safety Goal - NPSG.07.06.01: to use proven

guidelines to prevent infections of the urinary tract that

are caused by catheters.

The clinical nurse practice changes that were implemented

included:

• using best practices to ensure that there is a need

and indication for a urinary catheter

• using stat lock and green safety clip on catheter

• adhering to safe urinary catheter care and peri-care

• obtaining urine samples using the needleless

sampling port

• ensuring proper catheter bag placement

• providing patient and family education

To scrutinize the necessity of inserting a urinary cathether,

nurses employed the HOUDINI acronym: Hematuria,

Obstruction, Urological surgery, Decubitus ulcer(s),

Immobile, No Code, and Input and Output (I&O). This led

to a significant decrease in CAUTIs as well as decreased

the use of urinary catheters at Memorial Hermann

Memorial City. By the end of June 2014, all nursing

practice changes were effectively in place.


In the future, having a strong structure and processes are the first steps. In other words, the question for the future is not “What do you do?” or “How do you do it?” but rather, “What difference have you made?” Magnet-recognized organizations are in a unique position to become pioneers of the future and to demonstrate solutions to numerous problems inherent in our healthcare systems today. They may do this in a variety of ways through innovative structure and various processes, and they ought to be recognized, not penalized, for their inventiveness.

Outcomes need to be categorized in terms of clinical outcomes related to nursing, workforce outcomes, patient and consumer outcomes, and organizational outcomes. When possible, outcomes data that the organization already collects should be utilized. Quantitative benchmarks should be established. These outcomes will represent the “report card” of a Magnet-recognized organization, and a simple way of demonstrating excellence.



31

Today’s Magnet recognition process primarily focuses on structure and processes, with an assumption that good outcomes will follow. Currently, outcomes are not specified, and are minimally weighted. There are no quantitative outcome requirements for ANCC Magnet Recognition. Recently lacking were benchmark data that would allow comparisons with best practices. This area is where the greatest changes need to occur. Data of this caliber will spur needed changes.

Empirical Outcomes

Injury Falls Per 1,000 Patient Days

Hospital Mean 10th Pctl 25th Pctl 50th Pctl 75th Pctl 90th Pctl

2013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1

0.60

0.40

0.20

0.00

-0.20 -0.11 -0.11

-0.28-0.31-0.28

-0.50-0.43

-0.09

-0.34

0.03

-0.09

-0.40

-0.60

-0.80

Central Line Associated Blood Stream Infections per 1000 Central Line Days


0.60

0.40

0.20

0.00

-0.20

-0.40

-0.602013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1

0.05

-0.37

-0.14-0.11-0.19

0.06

0.00

-0.34

32

EMPIRICAL OUTCOMES

We benchmark our performance against the American Nurses Association (ANA) National Database of Nursing Quality Indicators (NDNQI).

Nursing-Sensitive Clinical Indicators

Catheter-Associated Urinary Tract Infections per 1000 Catheter Days <=2014


0.60

0.40

0.80

0.20

0.00

-0.20

-0.31-0.24 -0.20 -0.24

-0.04 -0.03

-0.40

-0.60

-0.802013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3 2014 Q4

-0.15

-0.07

Percent of Surveyed Patients with Hospital-Acquired Pressure Ulcers Stage II and Above


0.60

0.80

1.00

0.40

0.20

0.00

-0.20

-0.40

-0.602013 Q2 2013 Q3 2013 Q4 2014 Q1 2014 Q2 2014 Q3 2014 Q4 2015 Q1

0.84

-0.28-0.10 -0.18

0.09

-0.33-0.31

EMPIRICAL OUTCOMES

We benchmark our performance against the American Nurses Association (ANA) National Database of Nursing Quality Indicators (NDNQI).

33

Nursing-Sensitive Clinical Indicators

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