Apri l • May • June 2014

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Compiled by| Jacqulyn Robison, BSN, RN, GRN

Contact| Jacqulyn Robison BSN, RN, GRN

P 308.630.1450E Jacqulyn.Robison@rwmc.net

4021 Avenue B Scottsbluff NE 69361

rwhs.org

Find us on Facebook/RegionalWest

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A Note From The Editor 4

Nurses Week 5

Professional Development 6

Skin Care Notes 8

Safety Sense 9

Shared Governance Updates 10

Breakfast with Shirley 11

Table of Contents

This is my first edition of the Magnetic Times with Regional West Medical Center as your new Survey Preparedness/Magnet Coordinator. This edition I would like to touch on my two titles and break them down as to what I have discovered to be their powerful meaning to me. When I left Omaha, Neb., I had worked as an ICU nurse in the same hospital for 13 years. My peers were excited to see me go into this new role yet very sad because of the team we had built. It was a very bittersweet farewell. They knew my personality and knew that when it came to working on Magnet status for Regional West Medical Center, I would do well.

However, they kept asking me, “What does a survey preparedness person do?” I would respond, “I am going to be that Joint Commission person.” They would then respond, “Yes Jacqulyn, but what does that mean?”

If they just would have taken a few moments to look at dictionary.com they would find many synonyms to preparedness. Synonyms include: willingness, alertness, preparation, and zeal. Break it down further and this is usually someone who is prepared, usually ready to persevere, is determined to succeed, and is willing to act in any situation deemed necessary.

If you were to ask my husband, he would agree that yes I am ready: ready to be right. Yes I am determined: determined to be right. And yes I am willing: willing to prove him wrong. So that was an interlude into my humorous side. Which I think is something else a survey preparedness coordinator needs—a healthy balance of comedy and structure. When the Joint Commission comes in for a survey, people within the facility tend to sweat and get nervous. It is in our nature.

The other part of my title is Magnet Coordinator. Which when you break that down, it is really the person who guides the staff in how to obtain their Magnet accreditation. The culture of Magnet is very well known within the nursing world and hospital culture. It is the award that tells patients this hospital has met a standard of quality care.

Now that I have shocked you all with my sense of humor, let me shock you once more. We are changing our culture again (gasp). This is going to be toward obtaining our Pathways to Excellence Accreditation. Both Pathways and Magnet fall under the American Nurses Credentialing Center (ANCC) umbrella. However, the criterion is different. When I left my position in eastern Nebraska, I was currently helping my facility obtain this same certification after trying to obtain Magnet status. I hope to have some empathetic moments with all of the staff here while we skip, run, walk, or trudge along this path of “Pathways to Excellence.” As issues emerge and I get the chance to meet more people and more excellence grows within our team here at Regional West, I encourage you all to go to the website and read about Pathways. Coming in as an outsider of Regional West Medical Center, I can say that this establishment is doing most of this already, if not all of it. Now it is time to put it down in writing and let the world know that we deserve this renowned certification.

So I will end my first edition here in the Magnetic Times with this, “You can plan or you can procrastinate; you can do either one…but neither gets the job done unless you act.”

—Shaun (my dear husband)

Respectfully,

Jacqulyn Robison

Jacqulyn RobisonJacqulyn Robison, BSN, RN, GRNSurvey Preparedness/Magnet Coordinator

The 2014 Nurses Week was a success as the staff got to enjoy brownie sundaes on Tuesday, May 6 in honor of each nurse who makes a difference to our establishment. Leadership served the members of the hospital and the clinics while smiling and reminiscing about how they got their start in nursing. Another neat part of this week was enjoying the nostalgic nursing photos posted in the cafeteria of different nurses who work at Regional West.

The other exciting portion of this week was honoring different staff members who were nominated for certain awards based on their teamwork and efforts. They were then anonymously selected by a council for their individual awards. The following awards are a part of the Magnet awards that can be found on the Regional West Medical Center campus homepage, then clicking on the Employee Resources tab, and last the on the Nursing Resources tab. There is a link to nominate a nurse or employee who might meet the Friend of Nursing criteria. Please read through the directions and take the time to nominate someone.

The winners included:

Becky Avila, RN Emergency Department Nurse Preceptor

Brooke Dollarhide, RN ICU/PCU Structural Empowerment

Josh Beals, RN ICU/PCU Transformational Leadership

Ellen Otto, RN Interventional Radiology Exemplary Professional Practice

Sandra Schwartz, LPN Birth and Infant Care Center Outstanding LPN Award

Melissa Amateis, RN Emergency Department Empirical Outcomes

Gillian Allen Blaha, RN ICU/PCU New Knowledge, Innovations, and Improvements

Jeanette Weimer Unit Secretary, 3rd floor Med/Surg Friend of Nursing

Josh Lively, BS, RT (R)(VI) Special Procedures Technologist, Interventional Radiology Friend of Nursing

Nurses Week

Tom Moore Tom Moore is the newest certified Emergency nurse for the Emergency Department. This makes 39 percent of the Emergency Department staff who are certified. Why did you become a nurse? I became a nurse because I love people. I think humans are a strange breed of animal!! I love hearing their stories, and I love that every patient is different and unique in their own way. My mother was a nurse for over 40 years, and out of 10 siblings (yes I said 10), I am the only one who went into the medical field. I love not knowing, and anticipating what might come through the door next.

Hobbies? I have kept and studied rattlesnakes since I was 16 years old. I have studied the venom and its effects for over 20 years now. I love photography, and still shoot

film photos. My wife bought me a real nice digital camera and I am trying to learn how it works!!! I love fishing, hunting, hiking, sports, and pretty much anything outdoors. I love spending time with my wife and three children. We live and farm near Eaton, Colo.

Why did you get certified? I got certified because my managers asked me to. I have been doing emergency medicine for over 20 years in some form or another. I always told myself I would do it, but never felt that I needed to take a test to prove I knew what I was doing. I am glad I did do it. It gives me a sense of pride; I think it’s a step in the right direction for

promoting the nursing profession. I continue to challenge my co-workers to get it done as well.

What is your background? I started out in the crazy world of emergency medicine when I was 19. I have been a firefighter/EMT for over 20 years now and I continue to enjoy being a volunteer firefighter for the Galeton Fire Department, where I have been Chief, assistant Chief, and Medical training Captain at one time or another. I worked for the Weld County Paramedic Service for six years. I also worked in the Northern Colorado Medical Center Emergency Room in Greeley for almost 15 years.

Josh Beals Josh Beals is the newest certified Critical Care nurse in the ICU/PCU.

Why did you become a nurse? Much of my family is involved in nursing. Growing up, it was clear how diverse the field was and this always interested me. I saw how nursing shaped my family members and provided well for them. My brother is a surgical RN and has been my largest inspiration for becoming a nurse.

Hobbies? My hobbies are computers and anything high-tech :) Also spending time with my friends and family.

Why did you get certified? When I started filling in as a charge nurse in ICU, my goal

had been to ‘eventually’ get CCRN certification. I am now a clinical resource nurse and my goal of attaining CCRN became stronger. I felt I had enough clinical experience under my belt and so I began the process of studying and preparing for CCRN.

What is your background? I was born in Gering, and moved to Scottsbluff in Junior High. I graduated from Scottsbluff High School in 2002 and went straight on to pre-professional nursing at WNCC and then attended the UNMC College of Nursing, graduating in 2007. I did my transition in surgery at Regional

West Medical Center and then worked as a CNA in the ICU before passing NCLEX boards. I started working as a charge nurse in 2008 and am now a clinical resource nurse in ICU/PCU.

I am married and have one daughter, Janie Mae, and we live in Scottsbluff.

By Rachelle Noe, RN, Wound Care Nurse

Acute care: Vac Ulta-with instillation capabilities.

Patients at home: ActiVac.

Proper wound management is important for wound healing. The length of time to heal a wound is different for each patient. We look at their age, comorbidities, and nutritional status, as well as the wound itself by measuring the size, location, and cause.

Often a wound needs advance therapies to assist with wound closure. VAC therapy or negative pressure wound vac therapy (NPWT) is an advance therapy using a device system that promotes wound healing by delivering negative pressure (a vacuum) directly at the wound site. Unlike gauze/foam dressings that cover the wound and collect drainage, VAC therapy actively works to help the wound in the healing process. Vac therapy is routinely used to manage acute and chronic wounds. Any wound can benefit from the negative pressure, drawing the wound edges

together, removing wound exudate and potentially infectious material, while promoting granulation tissue formation. Furthermore, having vac therapy decreases the dressing change frequency, as the vac dressing requirement to be changed three times a week is less than the twice daily change required with traditional gauze dressing.

An additional therapy available to hospital patients is the VAC Ulta. These new vac machines have the ability to instill a variety of topical solutions directly to the wound bed during vac therapy without removing the dressing.

We have several wound vacs available in-house to be place immediately if the patient’s health care provider orders vac therapy while he or she is an inpatient here at Regional West Medical Center. Wound vac therapy can be placed on the patient immediately after surgery. Home vac machines are available in Central Supply as well. An online application is completed and approved through the patient’s insurance and usually can be released to the patient in less than a 24 hour time period.

Whether patients have vac therapy at home or in the hospital, having vac therapy will not prevent patients from performing their normal routine. The patient may disconnect from the charge cord throughout the day to complete hospital therapies or continue their usual routine at home. Dressing changes must be done every 48 to 72 hours. Patients are routinely seen on Monday, Wednesday, and Friday while in the hospital; seen by Home Care; or seen in the Wound Clinic.

We have seen excellent results for difficult-to-heal wounds by using vac therapy on our patients here at Regional West Medical Center.

Wound vac therapy at Regional West Medical Center

Skin Care Notes Rachelle NoeRachelle Noe, RNWound Care Nurse

I love summer and sunshine, making this is my favorite time of year. The grass is green and the weather is warm. It’s a great time to be outside enjoying the warmth and all the fun summer activities. Since I love summer so much, it’s easy for me to get distracted with daydreaming about being outside and the activities I enjoy. When I do that, I’m not paying attention to the business at hand. Which leads me to the May/June Safety Bundle—Attention to Detail—and all the skill-based activities I do every day.

Do you remember what a skill-based activity is? Yes, that’s right! Those routine things we do every day that we don’t even have to think about. We do about 10,000 skill-based activities each day. That’s a lot. We are so accustomed to doing these activities that they just become automatic. It is very easy to smoothly move through our daily activities and not even think about what we are doing, especially if we’re distracted by the lovely weather. I live in Mitchell and drive to and from work Monday through Friday. I often don’t remember passing certain points on the highway. Sometimes I’ve driven into Scottsbluff to go to Walmart and find myself pulling up Avenue B and heading for the hospital instead. Ever done that? Driving to work is a skill-based activity. I do it five days a week, so whenever I head to town my brain automatically wants to take my car to the hospital. You can imagine the “groaning” I do when I realize I’m pulling into the parking lot when

I really meant to go to the church, or Walmart, or some other destination. It is so easy to get in that automatic mode, and that’s when we can make mistakes.

How do I avoid making an error when I’m moving comfortably along in a skill-based mode? Self-check with STAR – Stop, Think, Act, Review. I need to stop and pause for a couple of seconds, think about what I’m doing, go ahead and act, and then review to make sure I’ve done the right thing. It seems very elementary, yet so essential, since this affects every one of us with so much of what we do.

In order to keep our patients safe, we must take the time to make sure we are doing the right thing. It’s too easy to connect tubing to the wrong port, enter wrong information into the computer, click the wrong box when ordering or documenting, grab the wrong medication, transpose numbers, and on and on. So, when risks are high, slow down for a couple of seconds and make sure you are doing the right thing. Do the “STAR” self-check and keep you and our patients safe!

Have a happy and safe summer!

Susan BackerSUSAN BACKER, MSN, APRN‑CNS, ACNS‑BCPatient Safety Officer/Clinical Nurse Specialist

As previously discussed in the Note from the Editor, the vision of Magnet will take a detour and follow ‘Pathways to Excellence.’ Some might wonder what this is. Below is a preview as to what encompasses this accreditation.

What is Pathways to Excellence?

12 Steps1. Nurses Control the Practice of Nursing

2. The Work Environment is Safe and Healthy

3. Systems Are in Place to Address Patient Care and Practice Concerns

4. Orientation Prepares Nurses for the Work Environment

5. The CNO is Qualified and Participates in All Levels of the Organization

6. Professional Development is Provided and Used

7. Equitable Compensation is Provided

8. Nurses are Recognized for Achievements

9. A Balanced Lifestyle is Encouraged

10. Collaborative Relationships are Valued and Supported

11. Nurse Managers are Competent and Accountable

12. A Quality Program and Evidence-Based Practice are Used

Coordinating Council Coordinating Council has collaborated to talk about further projects and/or discussions being worked on by each council. During the month of May, it was decided that every other meeting would include an educational piece lead by Shirley that would benefit each of us with our skills. The month of June was the first month to include this educational piece in which Shirley presented “Fair and Just Culture.”

Quality & Safety Council Quality and Safety has been working on the health care fatigue project. They sent out a questionnaire to staff members through Survey Monkey asking about their feelings on the hours they work and the amount of staff utilized during shift work. The project

is still continuing and has already brought about helpful data to directors and frontline staff.

Professional Practice Council The Professional Practice Council wrapped up their Nurses Week celebration in May and is working on a speaker for October to help celebrate the hard work that nurses (and all health care staff members) do. They did a wonderful job in announcing the winners of the Magnet award winners. They even had members of the council come in and help pass out brownie sundaes to the night shift employees. The next project in the works includes the Nursing Ladder and how to compensate the efforts of each member involved.

Care & Practice Council The Care & Practice Council has been brainstorming ideas on how to look at the charting of daily weights along with intakes and outputs. This is not the easiest project, as the culture changes from paper charting to electronic charting. Real-time charting will hopefully help ensure accuracy in charting these data fields. Paragon will be very beneficial in this process in 2015. In the meantime, this council is working to help staff find ways of ensuring that the charting of these data fields are current.

Nurse Finance Council The Nurse Finance Council has been working busily at creating cost-effective ways to practice health care that does not influence the patient or the safety culture. Ideas they have been working on include IV start kits, reusable blood pressure cuffs, and reusable oxygen saturation probes. They will be collecting the data in the area of savings to show the staff how this has been effective.

Night Shift Council The Night Shift Council has been working on ways to increase involvement and give a voice to staff who are part of the night shift culture. The chair, Matt Blaylock, is looking at ways to get people involved and is going around to different departments to enlist others. One change that night shift has been discussing is the way to have more food options available to the night shift team members.

Shared Governance Update

May 27

The first Breakfast with Shirley that I experienced was on May 27. During the breakfast we discussed the transition from working towards Magnet accreditation to the Pathways to Excellence accreditation. Shirley explained to the group that with the changes of rules and regulations with Magnet, Pathways would be a great fit for our hospital and the hard-working employees here.

Other discussions included were Shared Governance ideas and how to get staff to come to meetings as well as how different departments hold their UPC meetings. Some departments have smaller staffed areas so they might have quiet moments or informal meetings. Other approaches to get staff engaged in Governance include offering to utilize opportunities of technology and see if platforms like Skype will be useful for those who may live far away and are not able to attend. If daycare is a challenge, we have suggested

finding avenues of maybe volunteers to help watch children so parents could attend.

Paragon and the focus to drive this new Electronic Medical Record were discussed within the small group as well. There are some new exciting things to be developed and the super-users will have a huge impact at creating the platforms for Paragon that will be department specific. The year of 2015 will be one of change for staff as Regional West implements this new software but Leadership is supporting the change.

Jacqulyn Robinson

Attending:Shirley Knodel, Mary Coon, Jeanette McFeely, Ginny Blackburn, Chris Wiles, and Jacqulyn Robison.

June 24

The staff met with Shirley to exchange any thoughts or questions pertaining to the growing culture here at Regional West. A discussion that was circulated throughout the group concerned the attendance policy. On the Intranet homepage under Employee Policies, attendance policy 205.0.03 provides a thorough description of the expectations of staff members. It is important to remember that the policy is based off of a rolling calendar year.

There were some concerns related to the different departments and high-risk areas in when to call in. Shirley helped the staff to understand the policy and also explained that each director knows his or her staff very well and that at Regional West, the goal is to work as a team to provide safe care to our patients. The tiers of sick day occurrences are instituted to maintain staff accountability across the hospital.

Along with discussion of the attendance policy, we shifted to education days. When holding a professional license, it is important to maintain this and have the appropriate CEUs when renewal takes place. There are lots of opportunities to obtain online CEUs within SWANK.

Other key discussion thoughts were related to reimbursement topics that all hospitals are facing across the nation. With the Affordable Care Act and changes that are being felt, it is important for all of us to remember to be good stewards of our time and resources. The staff in this coffee session really worked on throwing out ideas on how to save money. Shirley shared

with the staff that a great way to get involved is through the Nurse-Finance Council and suggested submitting any cost-effective ideas to the Intranet homepage.

The discussion went on about health care costs and we discussed Jamie Orlikoff. He is an independent consultant who has worked with health care organizations internationally. His credentials have made him nationally known with health care leadership, quality, safety, and development. His vision is finding ways to cut health care costs without cutting safe and quality care. Value-based purchasing has components of bundled payments, hospital-physician integration, patient centricity, and delivery of quality/safety of care. This topic brought about some great reflection on how to be good stewards of our time and resources, but also to be prepared for change that is happening within health care nationally and internationally.

Last, we discussed the announcement of our new CEO for Regional West, John Megten. It was shared in this coffee break that he has a vision to help continue the path of success that Regional West is on. Part of his vision includes efficient health care, along with quality care. He has also showed interest in Shared Governance, which will help keep the vision of the hospital and also help us continue on the path of quality care that we provide our patients daily.

Attending: Shirley Knodel, Michelle Dillon, Carly Sanders (Temple), Bethany Reynolds, Kellie Witkofski, Michelle Keener, Paula Staman, and Jacqulyn Robison.