ACHIEVING NURSING EXCELLENCE THROUGH

Data-Driven Results NURSING ANNUAL REPORT 2007

ACHIEVING NURSING EXCELLENCE THROUGH DATA-DRIVEN RESULTS CHILDREN’S MEDICAL CENTER NURSING ANNUAL REPORT 2007

Table of Contents Nursing Division Overview

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Awards and Accolades .

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Advanced Practice Nursing .

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Asthma Management Program .

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Hemodialysis Program:

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Endocrine Center .

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Bloodstream Infections (BSI) Initiative

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Professional Development and Research .

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Clinical Education .

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Center for Cancer and Blood Disorders .

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Interactive Audits and the Reduction in

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C6 Progress Improvement Initiative .

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B4 Overview

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B6 Overview

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C7 Overview .

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Tissue Tracking .

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Surgery .

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Evidence-Based Practice and Research .

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NDNQI RN Satisfaction Survey .

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Accomplishments – Presentations & Publications .

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Community Involvement .

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Research .

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CHILDREN’S HAS KNOWLEDGEABLE, STRONG, RISK-TAKING NURSE LEADERS WHO ALSO ACT AS STAFF AND PATIENT ADVOCATES.

A message from Mary Stowe It certainly has been a banner year at Children’s. This annual report reflects the enormous work that has been done by nursing professionals throughout the organization and the many positive outcomes achieved as we move toward Magnet designation. I could not be more proud! Among our many achievements in 2007 was the immensely successful survey by The Joint Commission in early October that resulted in no recommendations for improvement associated with nursing activities. Additionally, Children’s was selected as one of the “Best Children’s Hospitals” by USNews & World Report, in no small way thanks to the strengths of our nurses. The organization also saw an 89% response rate on the NDNQI survey, with our 2007 scores significantly higher than 2006 scores on eight of the 11 subscales. Together, your daily contributions are propelling us toward our vision of preeminence and achievement of Magnet status. I hope you will read of our many accomplishments in this annual report and feel a tremendous sense of pride, camaraderie and satisfaction. I love to make rounds and visit with you because there is a palpable sense of excitement, energy and commitment to the tasks at hand here at Children’s. As we celebrate the many accomplishments of 2007, we anticipate even more progress in 2008. We start out our year with the new Professional Development Process and the next evolution of our Shared Governance Model. Your voice has been heard, and this is definitely the place to be if you wish to grow as an individual and a professional. Thank you for everything you do to make life better for children. You are a highly valued group, and I am grateful beyond words for your continued service.

Mary Stowe, RN, MS, CNAA, BC Vice President Chief Nursing Officer

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Children’s Medical Center | 2007 Nursing Annual Report | Nursing Division Overview

Nursing Division Overview Children’s Medical Center is dedicated to the mission of making life better for children, especially those children and their families with great needs. When the dream every parent envisions of a healthy happy child is shattered, Children’s stands strong and ready to serve. The mission is highly integrated into the culture at Children’s. The professional model of care for nursing is compatible with and complimentary to the mission, vision, guiding principles and overall philosophy of patient care.

THROUGH SHARED DECISION-MAKING, WITH STRONG NURSING REPRESENTATION, THE STRUCTURE AT CHILDREN’S IS DYNAMIC AND RESPONDS TO CHANGE.

Clockwise from upper left: From left, Rosalinda Mireles, RN, BSN, and Myeshia Westbrooks, LVN, from General Surgery; Judy Vance, RN, BSN, CPN, C8. Vance has been a nurse at Children’s since 1977; from left, Jim Allard, RN, BSN, CCRN, and cardiac care nurse Chris Angeletti, RN, BSN, CPN, review a patient chart. Angeletti is a certified pediatric nurse; from left, Donna Taylor, RRT-NPS, Marilee Soto, RN, and Jonda Leitch, RN, BSN, CCRN, from CVICU.

The nursing team at Children’s believes

Within this context, nursing has adopted

“no one cares how much you know until

this vision statement: To support the orga-

they know how much you care,” said Mary

nizational mission to “make life better for

Stowe, RN, MS, CNAA, BC, vice presi-

children” by providing high quality care

dent and chief nursing officer.

based on our strong commitments to practice, education, research, innovation

Staff and leadership frequently use the

and collaboration.

word “preeminent” as the strategic vision for the organization.

The vision statement for nursing is anchored by the belief that nursing leader-

Guiding principles for achieving the mission

ship in partnership with staff and other

and vision are:

disciplines:

• Quality care

• Integrates the caring art and human sci-

• Research and innovation • Education and advocacy • Excellence and accountability

ence in our delivery of care to the patients across the care continuum. • Fosters a collaborative, interdisciplinary, relationship-based approach.

Nursing Division Overview | 2007 Nursing Annual Report | Children’s Medical Center

• Delivers compassionate, culturally sensitive, family centered care. • Follows ethical principles to protect the rights of our patients, families and colleagues. • Educates patients and families to

• Fosters open, respectful communication to enhance interpersonal understanding and healing. • Supports empowerment and accountability through shared governance. • Nurtures and supports accomplish-

promote an optimum level of health

ments, self-esteem and a love for the

and wellness.

profession of nursing.

• Achieves excellence in patient outcomes through continuous performance improvement using evidence-based practice and research.

“No one cares how much you know until they know how much you care.” – MARY STOWE, RN, MS, CNAA, BC, VICE PRESIDENT AND CHIEF NURSING OFFICER

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Children’s Medical Center | 2007 Nursing Annual Report | Nursing Division Overview

Shared Governance Shared Governance is another guiding principle at Children’s. Quality care is delivered to patients by a

The care delivery model at Children’s is best understood by review of the Shared Governance struc-

professional nursing

ture. Positioned at

staff working within

the center of the

their scope of practice

model are three

and in collaboration with

core groups: the

other caregivers. The

Patient and

unifying philosophy of patient and family centered care is the basis for clinical practice that is carried out in the context of a professional practice environment. Great consideration is given to the special needs of children and their families.

Family Centered Care Committee, Clinical Practice Council and Professional Development Council.

Nursing Division Overview | 2007 Nursing Annual Report | Children’s Medical Center

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Professional Development Council In 2007, the Professional Development Council introduced a new look for the Professional Development Program, putting each nurse in control of his or her career at Children’s. The Nursing Leadership Team offers each nurse help in planning his or her career and provides opportunities for growth. Nurses have access to career counselors, career planning, career tracks, clinical nursing, management, education (BSN, MSN, PhD, DnP) informatics and research opportunities. They have the ability to become certified in their specialty, be a preceptor, a charge nurse or a team leader.

Clockwise from left: Preceptors Rachel Arbuckle, RN, BSN, Christie Scioneaux, RN, BSN, Heather Paterson, BS, MS, RN, CCRN, CPNP, clinical educator in the Pediatric ICU, and Kristina Long, RN, ADN, CPN; from left, nurse extern Ashley Buchner, SN, and her preceptor Jocelyn Reynolds, RN, BSN, with patient Sarah Smiley, 6, on C7; the Clinical Practice Council; from left, nurse interns Sara Cahill, RN, BSN, and Clara Cousineau, RN, BSN; from left, Amanda Dean, RN, BSN, and Jump Start summer intern Melissa Hopson confer on C6.

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Children’s Medical Center | 2007 Nursing Annual Report | Awards and Accolades

Awards and Accolades 2007 Nursing Excellence Winners Elizabeth Brantley, RN, BSN Richard Clearfield, LVN Debra Eshelman, RN, BSN, MSN, CPNP 2007 Nursing Excellence Award Nominees Yvonne (Bonnie) Aguero, RN, BSN – SOTP Cherita August, RN, BSN – Special Procedures Beverly Flynn, RN, BSN – Pre-surgical Assessment NaShawn Guillory, RN, BSN – CICVU Christin Morrell, RN, BSN , C10 – CCBD Linda Neff, RN, BSN, CNOR – OR Jennifer Norris, RN – B2 Sarah Thompson, RN, BSN – PACU Cheneil (Brooke) Torbert, RN, BSN – Variable

Susan Webber, RN, BSN, CPN, CEN – ED Ginger Young, RN, BSN – ED Christie Zotter, RN, BSN – C6 Marilyn Cox, RN, MSN, CNS, CDE – Endocrine Nurseweek Excellence Awards Finalist Clinical Care Nurse Category Elizabeth Brantley, RN, BSN Advance for Nurses Best Nursing Team Texas and Louisiana Center for Cancer and Blood Disorders ERSD Network of Texas, Inc. Recognized Facility Status for Superior Performance in Hemodialysis Adequacy Management Children’s Medical Center Dialysis Unit

Awards and Accolades | 2007 Nursing Annual Report | Children’s Medical Center

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CHILDREN’S HAS A STRONG PRESENCE IN THE COMMUNITY.

The Joint Commission Disease Specific Certification Dean Foods’ LEAN Families Program nonsurgical weight management Emergency Nursing/Pediatric Nursing Nursing Advisory Committee Inaugural Board of Certification Susan Webber, RN, BSN, CPN

Department of the Air Force Commendation Medal Joseph Bowley Jr., USAF Reserves, RN, BSN Association of Professionals in Infection Control and Epidemiology Infection Control Hero Infection Control Director Pat Metcalf, RN, BSN, MA, CIC

Drexel University Bayada Technology Award Judy Leflore, PhD, RNC, NNP, CPNP-PC, CPNP-AC

Texas Leadership Summit Marie Gilbert Ratcliffe, RN, BSN

UT Arlington School of Nursing Innovation in Teaching Judy LeFlore, PhD, RNC, NNP, CPNP-PC, CPNP-AC

Bridget Krumbholz, RN, BSN

Epic First Certified Clinician Honored by Information Services

Cross Timbers’ Outstanding Volunteer of the Year Award Debra Thompson, RN, BSN, MSN, PNP-BC

AOHP Business Recognition Award Certificate Carolyn Amrich, RN, COHN

University of Victoria, British Columbia Studies Fellowship for Canada Graduate Roxanne Baier, RN, BSN

Texas Nurses Association Continuing Nursing Education Committee Provider Application Renewal Clinical Education Children’s Hospital Association of Texas Outstanding Clinical Practice Poster Michelle Pinker, RN, MSN, and Kaye Schmidt, RN, MSN, CPNP, CPON Pediatric Nurse Credentialing Board Acute Care Nurse Practitioner Exam Top National Score Tammy Robertson, RN, MSN, PCCNP, CPNP-AC, APRN-BC Nation Kidney Foundation of North Texas Nephrology and Transplant Volunteerism, Patient Advocacy Carolyn Atkins, RN, BS, CCTC

Pre-Brandon Carroll Symposium PNCB Presentation Recognition, Test Item Writer Linda Grande, RN, BSN, MSN, CPNP-PC

Clockwise from lower left: Elizabeth Brantley, RN, BSN, with patient Logan Johnson, 5; left to right, Vicky Califf, RN, BSN, CPN, MBA, E4 charge nurse and team lead, Stacey Bryant, RN, BSN, supervisor, Variable Staffing, and Lisa Browne, RN, BSN, administrative supervisor, Variable Staffing, discuss staffing requirements; Richard Clearfield, LVN, with patient Jessica Morgan Woolfolk, 12; Kaye Schmidt, RN, MA, CPON, senior director for the Center for Cancer and Blood Disorders, accepts the Advance for Nurses Best Nursing Team award from Lynne Timm; Carolyn Amrich, RN, COHN, manager, Occupational Health and Wellness, and Dana Howard, executive assistant to the Office of the CEO, discuss heart disease in women and heart health during Howard’s pre-employment screening; Debra Eshelman, RN, BSN, MSN, CPNP, After the Cancer Experience program, with patient Albert Young, 18.

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Children’s Medical Center | 2007 Nursing Annual Report | Advanced Practice Nursing

THE MODELS OF CARE GIVE NURSES THE RESPONSIBILITY AND AUTHORITY FOR PROVIDING DIRECT PATIENT CARE.

Advanced Practice Nursing Children’s employs 110 advanced practice nurses (APNs) in a number of specialty areas including critical care, cardiology, hematologyoncology, emergency services endocrinology, otolaryngology, surgical services and orthopedics. The Advanced Practice Service encourages Advanced Practice Service Members: From left, back row: Maureen Edwards, RN, MSN, CPNP; Karen Corlett, RN, MSN, CPNP; Joe Don Cavender, RN, MSN, CPNP; Lisa Milonovich, RN, MSN, PCCNP; Elizabeth Heyne, PA-C. Front row: Sharon Posey; Barbie Drews, RN, MS, CPNP; Aimee Dunnam, RN, MSN, CNNP; Paula Dimmitt, RN, MS, CPNP; Myrna De La Hoya.

networking among APNs by providing the opportunity for collegial interaction leading to a connected network of Advanced Practice providers within the organization. The main opportunity for networking is via the monthly Advanced Practice Service

Group meetings, which are multi-focused and include employee updates, recognition of APN achievements and a practice spotlight to allow specialty service APNs to describe their role. This practice spotlight allows the specialty service APNs to highlight the service they provide to the organization as well as when and how to consult them for their expertise. Joe Don Cavender, RN, MSN, CPNP, is the director of Advanced Practice Services at Children’s and is also a Pediatric Nurse Practitioner (PNP) in the Center for Cancer and Blood Disorders (CCBD). Advanced Practice held its second annual conference, “Nurses and Practitioners on the Cutting Edge,” in August. The conference, open to nurses, nurse practitioners, physician’s assistants and physicians, presented up-to-date practice and technology in pediatric care and provided both CNE and CME credit hours.

Advanced Practice Nursing | 2007 Nursing Annual Report | Children’s Medical Center

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2007 APS Faculty Appointments NAME

TITLE

AFFILIATION

Adams, Sally RN, MS, CPNP

Adjunct Faculty

Texas Woman’s University

Adjunct Faculty

The University of Texas at Arlington

Adjunct Clinical Professor

The University of Texas at Arlington

Assistant Clinical Professor

Texas Woman’s University

Bookout, Kimberly, RN, MSN, CPNP, CWOCN

Cavender, Joe Don, RN, MSN, CPNP-PC Coleman, Beth, RN, MSN, CPNP, CPNP-PC

Adjunct Clinical Professor

Brookhaven College of Nursing

Adjunct Clinical Instructor

The University of Texas at Arlington

Assistant Clinical Professor

Texas Woman’s University

Adjunct Faculty

Texas Christian University

Adjunct Faculty

Harris School of Nursing

Corcoran, Kathleen, RN, MS, CPNP, PNP-AC

Adjunct Clinical Instructor

The University of Texas at Arlington

Corlett, Karen, RN, MSN, PNP-BC, CPNP-PC, CPNP-AC

Adjunct Faculty

The University of Texas at Arlington

Cox, Marilyn, RN, MSN, CDE, CNS

Adjunct Clinical Instructor

The University of Texas at Arlington

Crawford, Shellye, RN, MSN, CPNP-PC

Adjunct Clinical Instructor

The University of Texas at Arlington

Davies, Kimberly, RN, MSN, FNP-C

Adjunct Clinical Instructor

The University of Texas at Arlington

Dimmitt, Paula, RN, MSN, CNS, CPNP Glazier, Mary Pat, RN, MSN, CPNP, CPNP-PC Gregory, Karen, RN, MSN, CNS, APRN-BC

Adjunct Clinical Instructor

The University of Texas at Arlington

Assistant Clinical Professor

Texas Woman’s University

Adjunct Faculty

Texas Christian University

Adjunct Faculty

Harris School of Nursing

Graduate Preceptor

The University of Texas at Arlington

Harrington, Christina, RN, MSN, CPNP-PC

Adjunct Clinical Instructor

The University of Texas at Arlington

Humphreys, Stacey, RN, MSN, CPNP-PC

Adjunct Clinical Instructor

The University of Texas at Arlington

Kindred, Chris, RN, MSN

Full time Faculty

Texas Woman’s University

Madden, Linda, RN, BSN, CPNP

Adjunct Professor

Texas Woman’s University

Adjunct Professor

The University of Texas at Arlington

McKay, Howard, RN, MSN, FNP-BC, PNP-AC

Assistant Clinical Professor

The University of Texas at Arlington

McNeil, Nancy, RN, MSN, CPNP

Assistant Clinical Professor

Texas Woman’s University

Adjunct Faculty

The University of Texas at Arlington

Milonovich, Lisa, RN, MSN, PCCNP, CPNP-AC, CCRN

Adjunct Faculty

The University of Texas at Arlington

Moake, Lindy, RN, MSN, CPNP

Adjunct Clinical Instructor

The University of Texas at Arlington

Kathy Speer , RN, Ph.D.,CPNP

Adjunct Faculty

The University of Texas at Arlington Texas Woman’s University

Nurses participate actively in monthly Continuous Quality Improvement (CQI) reviews. Month-End Census, Admissions & Discharges

Mortality Trending Tools

Vascular Access Long-term Care Plan Review with Medical

Patient Care Trend Analysis

Physical Plant Safety Checklist

Clinical Safety Audit Checklist

Bicarb Results of Machines

Infection Control Audit

Technical/Water Treatment Logs & Tests Results

Random Medication Administration Audit

TB Risk Assessment

Machine Preventive Maintenance Schedule

Catheter Management

Incident Report/Adverse Patient Occurrences

Medical Records Audits

Transplant Review

Patient/Family Complaints

CMS & State Survey

Reports from ESRD Network #14

Staff Issues

Joint Commission Survey

Reports from Texas Dept. of State Health

Anemia Management

Other Governmental Survey/Audits

Infiltration Rates

Director

Service Reports from CMS (Medicare)

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Children’s Medical Center | 2007 Nursing Annual Report | Asthma Management Program

Asthma Management Program The Asthma Management Program is a six-month comprehensive program that focuses on asthma education, self-management skills and coordination of care for children from birth to age 17 with a diagnosis of asthma.

Statistics show a 74% reduction in missed school days, an 86% reduction in asthma-related Emergency Department visits, an 85% reduction in asthmarelated inpatient admissions and a 15% increase in asthma Quality of Life scores.

The program includes biweekly telephone

in asthma Quality-of-Life scores six months

contact with an RN AE-C certified care

prior to enrollment in the asthma manage-

coordinator to assist families in self-man-

ment program until six months post-

agement strategies and to review the

enrollment. The program has achieved

progress of environmental control plans

certification in disease-specific care for the

and medical follow-up. It also provides two

past six years by The Joint Commission.

home visits by pediatric RNs who equip the family with education about asthma medication and asthma triggers. The family is provided with a peak flow meter, a spacer and asthma education workbooks. An asthma education class is offered to families to provide additional education. Current statistics show a 74% reduction in missed school days, an 86% reduction in asthma-related Emergency Department visits, an 85% reduction in asthma-related inpatient admissions and a 15% increase

From left, Elyse Tyler, MS, RD, CSP, LD, program manager of the Dean Foods Lifestyle Exercise And Nutrition (LEAN) Families Program; Loretta Oshel, RN, RN-C, CEN, MBA, program manager of the Diabetes Program; Robin Brown, RN, BSN, AE-C, program manager of the Asthma Management Program; and Karissa Luckett, RN, BSN, MSW, AE-C, director of the Disease Management and Wellness department, discuss patient outcomes. All three disease management programs at Children's — The Diabetes Program, Dean Foods LEAN Families Program and the Asthma Management Program — were awarded disease-specific care certification by The Joint Commission, an honor that is unprecedented among pediatric hospitals in the U.S.

Asthma Management Program | 2007 Nursing Annual Report | Children’s Medical Center

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INDEPENDENT JUDGMENT IS EXERCISED IN THE CONTEXT OF INTERDISCIPLINARY AND MULTIDISCIPLINARY APPROACHES TO PATIENT CARE.

Pre/Post Program – ER Utilization for Asthma Patients Source: Tecsys Database Numerator: For patients who exit and complete the program in a designated quarter, the total number of reported ER visits, related to asthma, in the six months prior to participation in the program. Denominator: The total number of reported ER visits related to asthma, during the six-month program, for patients who exit after successful completion of the program in a designated quarter.

100% 95 90 85 80 75 70 2004 ER Utilization

2005

2006

2007

Threshold

Pre/Post Program – IP Utilization for Asthma Patients Source: Tecsys Database Numerator: For patients who exit and complete the program in a designated quarter, the total number of reported inpatient admissions, related to asthma, in the six months prior to participation in the program. Denominator: The total number of reported inpatient admissions related to asthma, during the six-month program, for patients who exit after successful completion of the program in a designated quarter.

100% 95 90 85 80 75 70 2004 IP Utilization

2005 Threshold

2006

2007

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Children’s Medical Center | 2007 Nursing Annual Report | Hemodialysis Program

CHILDREN’S HAS PROCESSES TO MEASURE QUALITY AND PROGRAMS TO IMPROVE QUALITY.

Hemodialysis Program: Successful Vascular Access Management The Centers for Medicare & Medicaid and the 18 End-Stage Renal Disease (ESRD) Networks across the U.S. launched a major project called “FISTULA FIRST” in October 2003.

The Nephrology Council – Standing: Stephen Pottoore, RN, BSN, MBA; Laura Moore, RN; Vickie Strong, administrative assistant; Rebecca Nolde- Hurlbert, RN, CNS; Mary Goode, RN; Regina Medlock, patient access representative; Haridas Thankappan, RN, BSN, CNN; Eduardo Casas, RN, BSN. Sitting: Tammy Mcnally, secretary; Kimberly Smith, clinic scheduler; Sharon Blend, secretary; Thanh Tran, business manager; Martha Richardson, RN, CPNP.

The focus of the project was to educate

rate, less frequent narrowing of the blood

dialysis care providers and dialysis patients

vessels and that the fistula can last for many

about the benefits of an AV (arterio-venous)

years problem free.

fistula instead of having hemodialysis (HD) catheters as long-term vascular access. It is

The primary goal of this project was to

estimated that vascular access problems are

establish a vascular access that is reliable

the single most common cause of hospital-

and long lasting.

izations for dialysis patients. Studies have shown that patients who have an AV fistula

In August 2005, 100% of Children’s

have a lower infection rate, lower clotting

hemodialysis outpatients still used hemodialysis catheters as the primary vascular access point. By November 2007, 57% of the eligible patients had an AV fistula instead. The bar will again be raised for 2008 with the goal of having 65% of all eligible patients having permanent vascular access placed. Kendra Rutter, RN, has taken on this mission as the new vascular access manager.

Endocrine Center | 2007 Nursing Annual Report | Children’s Medical Center

Endocrine Center The Endocrine Center offers Diabetes Self-Management Training classes that meet the diabetes education criteria for recognition by the American Diabetes Association. The center also was recognized by The Joint Commission as meeting the requirement for disease-specific certification.

Diabetes Education Participant Satisfaction From January 2007 until September 2007,

Classes included Survival Education,

diabetes educators offered nine different

Diabetes 101, Diabetes 102, Take Charge,

diabetes education class topics to patients

Take Charge Spanish, Pump Mechanics and

and their families and had a total enrollment

Management, Kid Fit, Jump Start and

of 527 participants. Based on a preference

Graduation Debriefing.

range of 0 to 4.0 calculated from returned participant satisfaction surveys, the satisfaction score for the classes overall was 3.93.

From left, Christie Scioneaux, RN, BSN, and Deborah Sparks, RN, BSN, CPN.

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Children’s Medical Center | 2007 Nursing Annual Report | Bloodstream Infectioins Initiative

Interactive Audits and the Reduction in Bloodstream Infections (BSI) Initiative In January 2005, Critical Care Services joined a multi-center collaborative effort sponsored by the Child Health Corporation of America (CHCA) to reduce central venous catheter-associated bloodstream infections. Our commitment included all of the existing intensive care units at the time (the CVICU, general PICU and the Trauma Neuro ICU). Participation was multidisciplinary, with team members from the medical staff, advanced practice nurses, Critical Care Services management, Infection Control and frontline pediatric ICU staff. Team members examined current processes, integrated best clinical practice bundles, provided staff education and generally oversaw implementation and outcome analysis. Progress was slow, and gains were difficult to sustain.

Bloodstream Infectioins Initiative | 2007 Nursing Annual Report | Children’s Medical Center

At the beginning of 2007, the BSI Team

element of staff recognition and engage-

assessed the current state of the initiative

ment. She then began a new process, the

and renewed their commitment to engage

“interactive audit.” As she observed care

every clinical staff member in all of the

being delivered, she interacted with the clini-

ICUs – including the new NICU. The audit

cian – asking questions, answering concerns

process was examined, tools refined and

and heightening awareness of central line

data reformatted in a manner that frontline

care. White also made recommendations to

staff said were meaningful.

change standard practices related to IV tubing management that reduced the potential

Specifically, the team began sharing the

for introduction of pathogens.

“Days Since Last Infection” for each unit/ICU. In addition, CVICU nurse Holly

Since beginning this process, each of the

Tomlin, RN, BSN, CCRN, pioneered new

ICUs has experienced a drop in BSI rate (see

ideas and methods with staff. As a result of

chart). These improvements are expected to

Tomlin’s success, one team member,

be sustained as they are a result of better

Miriam White, RN, BSN, was permanently

understanding of evidence-based practice.

dedicated to the audit process by July. Like Tomlin before her, White quickly discovered that merely auditing for compliance with care expectations was insufficient to change and improve practice. While this method illustrated where there were gaps in practice, it failed to provide the necessary

Clockwise from left: nurse Liz Galloway, RN, BSN, checks on a patient on E11; Chris Angeletti, RN, BSN, CPN, takes precautions against infection in the CVICU; from left, Michele Macaluso, RN, MSN, infection control specialist, and Pat Metcalf, RN, BSN, MA, CBIC, Infection Control director, meet on infection control initiatives with the Gastrointestinal bloodstream infection reduction group.

C12 Central Line BSIs 35

January 2006 through September 2007

2006 Mean 6.0

2007 Mean 6.0

NHSN Mean 5.3 2006 Median 8.5 (Range 0-111)

M

30

Interactive Audits Begun

25 20 15 10 5 0 J 06

M

M

J

S

N

J 07

M

M

J

S

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Children’s Medical Center | 2007 Nursing Annual Report | Bloodstream Infectioins Initiative

C11 Central Line BSIs 40

January 2006 through September 2007

2006 Mean 7.4

2007 Mean 3.0

NHSN Mean 5.3 2006 Median 20.5 (Range 0-76)

35

M

Since beginning this process, each of the ICUs has experienced a drop in BSI rate. These improvements are expected to be sustained as they are a result of better understanding of evidence-based practice.

Interactive Audits Begun

30 25 20 15 10 5 0 J 06

M

M

J

S

N

C2 Central Line BSIs 35

J 07

M

M

J

S

January 2006 through September 2007

2006 Mean 6.4

2007 Mean 6.4

NHSN Mean 5.3 2006 Median 8.5 (Range 0-96)

30

M

18

Interactive Audits Begun

25 20 15 10 5 0 J 06

M

M

J

S

NICU Central Line BSIs BIRTH-WEIGHT CATEGORY

INFECTIONS

N

J 07

M

M

J

S

April 10, 2007 through September 30, 2007 CENTRAL LINE DAYS

CL-ASSOCIATED BSI RATE/1000 CL DAYS

LEVEL II/III NICU NHSN MEAN JAN-DEC ‘06

< – 750 gm 751-1000 gm

1

72

13.9

5.9

1

1130

7.7

5.2

1001-1500 gm

0

35

0

3.4

1501-2500 gm

3

107

28.0

2.4

> 2500 gm

2

218

9.2

4.2

Professional Development and Research | 2007 Nursing Annual Report | Children’s Medical Center

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Professional Development and Research The Clinical Practice, Research and Professional Development department offers educational opportunities throughout the year provided by 35 nurse educators.

EMPHASIS IS PLACED ON ORIENTATION, INSERVICE EDUCATION, CONTINUING EDUCATION, FORMAL EDUCATION AND CAREER DEVELOPMENT.

Children’s has two providers of nursing

• “20th Annual Ambulatory Nurse

education – the Texas Nurse Association

Seminar: Mental Health Issues of

(TNA) and the American Association of

Children and Adolescents.”

Critical Care Nurses (AACN). Classes and

• “The 2nd Annual Advanced Practice

seminars in 2007 totaled more than 100

Conference: Nurses & Practitioners on

continuing education classes and 32 pediatric

the Cutting Edge.”

advance life support classes, including instructors’ classes. The number of partici-

These continuing nursing education activi-

pants totaled 2,660 nurses and non-nurses.

ties included lectures representing activities such as the Educator Academy, Clinical

Offerings in the community presented by

Grand Rounds, Child Abuse Rounds,

the Nursing Division during 2007 included:

Trauma Rounds and the Ethics Forum.

• “8th Annual Critical Care Conference: Innovation in the PICU.”

Educator Academy board session with (from left) Lindsay McKinney, RN, BSN, Becky Geise, RN, BSN, Sheila Johnson, RN, BSN, CPN, and LaTonisha Strahan, RN, BSM, CCTN, CPN.

20

Children’s Medical Center | 2007 Nursing Annual Report | Clinical Education

Clinical Education The Clinical Education department, led by Michelle Copeland, RN, MS, CNPD, with a team of more than 20 educators, provides comprehensive staff development activities for all RNs, LVNs, Clinical Technicians and Medical Assistants. These activities include structured orientation

Mental Health Issues of Children and

programs; formalized continuing education

Adolescents,” and internal offerings including

via inservices, seminars, computer-based

Clinical Grand Rounds and the Educator

training and simulations; informal bedside

Academy.

education; and ongoing assessments of staff competency. The department offers consul-

A total of 32 Pediatric Advanced Life Support

tative services for clinical care issues and

classes were offered. Over 150 unit-based

seminar planning. It is an approved provider

lectures and inservices and 25 skills assess-

of continuing education through the Texas

ment days also were provided.

Nurses Association and the American Association of Critical Care Nurses.

Orientation was provided to approximately 700 new nurses during the year, and over

More than 100 classes were approved for

2,000 nurses and staff participated in the

continuing education credit in 2007. These

ongoing classes.

included community offerings such as “The 20th Annual Ambulatory Nursing Seminar: At top, a “sim baby” used at a Nursing Skills Day with Alisha Scoggins, RN, BSN, and Denna Shives, RN, BSN, in the background; from left: Monica Fuller, RN, BSN, Dolores Isham-Colvard, Ph.D., RN, CMCN, manager for patient education, and clinical educator Tammye Britain, RN, BSN, CPN, at an Educator Academy session;

Nursing Facts Nurses enrolled in further nursing education

> 90

BSN Nurses

826

MSN nurses

131

Ph.D. nurses

5 and one doctorate in nursing

Master’s degrees

51

Certified nurse leaders

36

Ambulatory certified nurses

31

Certified nurses

357 (26% of all direct care nurses)

Nurses involved in community services/activities

227

Center for Cancer and Blood Disorders | 2007 Nursing Annual Report | Children’s Medical Center

21

Center for Cancer and Blood Disorders The Center for Cancer and Blood Disorders consistently has had a strong Performance Improvement council, and in the last year, it enhanced its efforts by adding medical staff representation to the group. One of the primary PI initiatives was monitoring the rapid response of treatment to patients with fever and neutropenia (F&N), a potentially life-threatening condition for a child with cancer. These patients enter Children’s in three ways; through the Emergency Department (ED), the Hematology-Oncology clinic, and as a direct admit to the inpatient Hematology-Oncology floor.

At top, Brad Cook RN, BSN, hangs a bag of red blood cells for transfusion; above, Kaye Schmidt, RN, MA, CPON, senior director for the Center for Cancer and Blood Disorders

22

Children’s Medical Center | 2007 Nursing Annual Report | Center for Cancer and Blood Disorders

The CCBD PI council initiated two changes that improved the ED response time such that in July and August, the ED was 100% successful in the timely administration of antibiotics.

Performance Improvement Council

the ED with fever. In addition, the chairper-

Due to the high volume of patients who

son of the PI committee was a member of

cycle through the ED, it was difficult to get

the Frontline Academy, where her project

the appropriate antibiotics administered

consisted of creating a collaborative effort

within the three-hour timeframe set by the

between CCBD and the ED to monitor

Clinical Practice guideline.

the process of F&N patients being treated in the ED and educating their staff on the expectations for treatment time.

The CCBD PI council initiated two changes that improved the ED response time such that in July and August, the ED

This collaboration created open dialogue

was 100% successful in the timely adminis-

and rapid feedback regarding the obstacles

tration of antibiotics.

and challenges the ED faced and allowed CCBD to assist and attempt to overcome

By the addition of the physician to the PI

these challenges. The efforts have been

council, CCBD was able to understand the

successful, and CCBD and the ED continue

referral process to the ED, ensure that it

to have a positive relationship with the ED

occurs 100% of the time and to initiate a

and celebrate its successes while providing

24-hour dosing of a broad-spectrum antibi-

safe quality for patients.

otic to all oncology patients presenting to

Fever and Neutropenia – Initiation of Antibiotics 240 180 120 60 0 J 06

A

S

ED Clinic Direct C10

O

N

D

J 07

F

M

A

ED and Clinic threshold 180 minutes C10 threshold 60 minutes

M

J

C6 Progress Improvement Initiative | 2007 Nursing Annual Report | Children’s Medical Center

C6 Progress Improvement Initiative In 2006, C6 was having a considerable number of diabetic ketoacidosis (DKA) patient-related incidents. Once the trend was identified, a meeting was set up to discuss the details. Attending the meeting were the managers, educators, both from the Emergency Department and C6, and the attending endocrine physician. Approximately 30 incidents were presented and reviewed at the meeting, with the primary cause of the incidents being identified as relating to the transitioning of care of DKA patients between the Emergency Department (ED) and C6. Once the opportunities for improvement

Since the initial meeting, the DKA transfer

were identified, an action plan was created

process meetings have taken place on a

to educate/re-educate the staff in both

monthly basis to review any incident

departments. Some of the education

reports that have occurred. Between

included: ED faxing report and diabetic

February 2007 and October 2007, there

flow sheet to C6; IV transfer guidelines;

have been a total of three DKA patient-

ED nurses offered the opportunity to

related incidents. The initiation and

20

attend the diabetic class; checking drips

continuation of the DKA PI initiative

15

during the transfer; and D10 IV fluids avail-

has proven to be highly effective in

10

able prior to transfer. Additionally, in

creating a smoother transition of care

March, C6 and the ED each created a

for DKA patients.

DKA Patient-Related Incidents 30 25

5 0

DKA poster. Each department presented

Jan. 2007

the poster to their staff and then the posters were switched between the units.

from left Jennifer Morgan, RN, and Christie Scioneaux, RN, BSN, during a Nursing Skills Day on glucometer usage on B6.

Feb.-Oct. 2007

23

24

Children’s Medical Center | 2007 Nursing Annual Report | B4 Overview

B4 Overview Because of the correlation between staff satisfaction and patient satisfaction, the B4 Unit Council has branched off into two groups: one half focuses on unit changes and the other half (Sunshine Committee) focuses solely on “fun” activities and team building. Both groups partner to achieve the unified goal of overall satisfaction as evidenced by the B4 data that depict staff satisfaction and the NSI data that show a steady increase to “Very Good” on Nursing Care and Patient Satisfaction ratings.

B4 Overview | 2007 Nursing Annual Report | Children’s Medical Center

The Unit Council has partnered with Guest

monthly newsletter. The newsletter honors an

Relations to develop scripting, service recov-

employee of the month, has a nursing joke,

ery, rounding for success and a parent

recipes, fun facts, crossword puzzles, listings of

suggestion/comment box. The floor-assigned

birthdays, weddings and new employees, and

Guest Relations representative is invited to the

pictures of community service.

25

monthly meetings to review scripting and scenarios that actually have occurred on the unit.

The committee also picks four “Everyday

The comment box is checked daily, and par-

Heroes” to highlight, with the focus being

ents are contacted.

that we are all heroes in the patient’s eyes in our quest to provide superior care. The

The Sunshine Committee keeps the unit festive

heroes section provides biographies, and

and fun. There are monthly meetings. and each

their pictures are posted on unit bulletin

month is assigned to a particular committee

boards. The parents have given feedback

member. That person is responsible for plan-

that they like to read the bulletin boards and

ning a floor theme, unit celebration and an

learn about who is taking care of their kids.

outside outing. Both day shift and night shift per-

Above: Ramonda Busby, RN, BSN, CPN, director of Inpatient Medical Services and former clinical manager on B4. Opposite page: Amy Van Hooser, RN, BSN, reviews a patient’s chart.

sonnel also plan and attend outings together. The committee keeps a scrapbook and

The committee also picks four “Everyday Heroes” to highlight, with the focus being that we are all heroes in the patient’s eyes in our quest to provide superior care.

B4 Patient Satisfication – Nursing Care 100 90 80 70 60 50 Q4 2006

Q1 2007

Q2 2007

Q3 2007

Average Score

Bench Score

Actual % Very Good

Bench % Very Good

Q4 2007

26

Children’s Medical Center | 2007 Nursing Annual Report | B4 Overview

Both groups partner to achieve the unified goal of overall satisfaction as evidenced by the B4 data that depict staff satisfaction and the NSI data that show a steady increase to “Very Good” on Nursing Care and Patient Satisfaction ratings.

B4 Parent Satisfication – Overall Care 100 90 80 70 60 50 Q4 2006

Q1 2007

Q2 2007

Q3 2007

Average Score

Bench Score

Actual % Very Good

Bench % Very Good

Q4 2007

B4 Parent Satisfication – Pain Management 100 90 80 70 60 50 Q4 2006

Q1 2007

Q2 2007

Q3 2007

Average Score

Bench Score

Actual % Very Good

Bench % Very Good

Q4 2007

B6 Overview | 2007 Nursing Annual Report | Children’s Medical Center

27

CHILDREN’S AND NURSING LEADERS FOSTER AN ENVIRONMENT THAT ENCOURAGES AND VALUES PARTICIPATION AND FEEDBACK FROM STAFF. B6 Overview Kathryn Pecenka-Johnson, BSN, MN, director of Variable Staffing/Bed Management, is excited to report that the Patient Family Centered Rounding being conducted on B4 and B6 is actively engaged and showing great potential. Both nursing units are home to general medical programs with a Residency and Hospitalist physician team. “The similarities between the two nursing units provide an opportunity to evaluate changes in care delivery and the impact on patient and family satisfaction,” Pecenka-Johnson said. An interdisciplinary healthcare team rounds

“We realize that family involvement is key

on patients daily between 10 a.m. and 11:30

to insuring that the patient does what is

a.m. Families are encouraged to participate in

necessary to go home,” Pecenka-Johnson

healthcare team discussions of their child.

said. “Our families come from diverse

Because the interdisciplinary team starts plan-

backgrounds, cultures and socioeconomic

ning for discharge on admission, the family is

circumstances. Because a large percentage

aware of the daily goals that need to be met

of our families are Spanish speaking, a

for discharge. Family participation in the

translator is also part of the team.

process enhances the potential to discharge

Additionally Web-based technology allows

earlier and allows the family to feel prepared

us to provide services in multiple lan-

for the discharge home. This care delivery

guages. The most important result of our

model assures family, staff and physician max-

design change is the increased satisfaction

imizes efficiencies and communication

in care delivery.”

amongst the healthcare team.

Kathryn Pecenka-Johnson, RN, MN, CPN, director of Variable Staffing and Bed Management, and former clinical manager on B6.

“Family participation in the process enhances the potential to discharge earlier and allows the family to feel prepared for the discharge home.” – KATHRYN PECENKA-JOHNSON, BSN, MN BC

28

Children’s Medical Center | 2007 Nursing Annual Report | C7 Overview

C7 Overview During the third quarter, C7 experienced an increase in NSI “Very Good” responses in three of four areas of Parent Satisfaction, NSI, Nursing Care, Overall Care and Pain Management. The improved responses may be attributable to the implementation of the Emergin telephone system in August, which alerts staff of patient alarms and decreases response time. Bedside staff also started to ask the following question before leaving a patient room: “Is there anything I can do before I go? I have time.” In addition, C7 performed pain audits, which tracked improvement in the areas of identifying onset of pain, location and reassessment.

From left, Leafar Rafael, RN, BSN; Chasey Branch, RN, BSN, with the Emergin wireless call system on C7.

C7 Patient/Parent Satisfaction – Pain Management

C7 Parent Satisfication – Pain Management 100

90

90

80

80

70

70

60

60

50 Q4 2006

Q1 2007

Average Score Actual % Very Good

Q2 2007

Q3 2007

Bench Score Bench % Very Good

Definition: Average score for # questions related to nursing care: 6 questions Inpt Goal: Meet or exceed score for 90th percentile of peer group, averaged for these questions

50 Q4 2006

Q1 2007

Q2 2007

Q3 2007

Average Score

Bench Score

Actual % Very Good

Bench % Very Good

TIssue Tracking | 2007 Nursing Annual Report | Children’s Medical Center

29

Tissue Tracking In 2005, The Joint Commission initiated a new provision of care, 17.1017.30. Kimberly Collier, RN, quality manager, Perioperative Services, developed a one-page Tissue Tracking Spreadsheet that follows the tissue sample throughout the entire process, from point of entry to final disposition, including follow-up data such as information cards sent and recalls. An electronic database was created where all information is inputted. The database has the capability to search all patients since the inception of the tissue tracking spreadsheet by various search methods such as name, keyword, surgeon and date. Since the implementation of the tracking system, the hospital has been close to 100% compliant in filling out all fields in the electronic database as well as returning information cards in all months. In two mock surveys, one in 2006 and one in 2007, the surveyors commented that they would be taking the Tissue Tracking Process back to The Joint Commission as a Best Practice.

Top, Linda Neff, RN, BSN, CNOR, clinical educator; bottom, C11 trauma nurse Meg Malone, RN.

Tissue Tracking – 2007 M Target 100.0 99.5

What are we trying to accomplish?

99.0

Goal: 100% compliance with fields completed and information cards sent.

98.5

How will we know that the change is an improvement?

98.0

Operational Definition: The % of compliance of completed fields in the tissue tracking record. The % of information cards sent. Conclusion: 3rd Q—Met goals Recalls: None

97.5 97.0 96.5 96.0

What changes can we make that will result in improvement?

95.5 95.0 Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Completed Fields Tissue Tracking Record Information Cards Sent

Sept

Oct

Nov

Dec

Improvement plan: (All changes were tested using the PDCA model) 1. Continue monthly review of tissue tracking fields and information cards. 2. Correct any missing fields monthly that are reconcilable. 3. Notify physicians of any recalls.

30

Children’s Medical Center | 2007 Nursing Annual Report | Surgery

Surgery In any operating room, the number of completed cases drives revenue. If the operating rooms have cases that cancel the day of surgery, it results in poor utilization of staff, OR space and physicians.

Top, Peri-operative Service nurse Brandi Goldey, RN, wheels patient Elena Janelle Martin, 8, out of surgery; bottom, Karen Norton, RN, clinical manager of the cardiovascular OR, checks a headlight prior to its use in one of the cardiac suites.

The percentage of cases that canceled the

To achieve this goal, Surgery standardized

day of surgery averaged 10% in 2007.

the pre-surgery telephone call both by

Surgery looked at these cases by reason for

assigning one person to make the calls and

cancellation, and found that approximately

by creating a simplified check sheet for infor-

one-third were due to parents feeding their

mation given to parents.

children. (Children may not have anything to eat or drink prior to surgery).

As a result of the standardization efforts, cancellations the day of surgery due to eating or

The goal was to decrease the number of

drinking prior to the procedure decreased.

cancellations on the day of surgery due to

Also noted was a rise in the Press Ganey

eating or drinking prior to the procedure.

Parent Satisfaction Scores regarding the information received prior to surgery.

Evidence-Based Practice and Research Cart | 2007 Nursing Annual Report | Children’s Medical Center

31

Evidence-Based Practice and Research Healthcare procedures and practices are often performed the way the nurse initially was taught no matter how the information may have changed due to new studies or other evidence. In 2007, Children’s established a department of Evidence-Based Practice and Research. The challenge was to increase staff knowledge about evidence-based practice when it is often difficult to leave the patient care unit. An EBP/Research cart to take to patient care units was developed as a way to showcase EBP and research. The cart is unique and allows staff to participate and receive information quickly without having to leave their units. Journal Club The journal club meets twice a month. During the meeting, a relevant research article is analyzed. Generally, the articles have been chosen based on high priority clinical issues in the hospital. The participants identify areas of weakness, strength and relevance to clinical practice.

EBP and Research Intranet site The Intranet site has been enhanced to offer important links for staff to access EBP Web sites, determine staff involved in research and to submit clinical questions to the department.

From left, Brittany Hamilton, LVN; Kathy Speer, Ph.D., RN, CPNP, director of Evidence-Based Practice and Research; and Monica Hoover, RN, on B6 during a demonstration highlighting the difference between research and evidence-based practice. To help nurses understand the difference, they compared different types of chocolate chips and then discussed how to translate those research findings into clinical practice.

Kathy Speer, Ph.D., RN, CPNP, director of Evidence-Based Practice and Research

“I want to empower staff with the idea that it’s OK to ask questions about practice and to search the literature to see what are the best care guidelines and research. Nurses need to question why they do what they do and to determine if it is the best practice. We will be infusing current best evidence into all our clinical policies.” – KATHY SPEER, PH.D., RN, CPNP

32

Children’s Medical Center | 2007 Nursing Annual Report | NDNQI RN Satisfaction Survey

QUALITY IS THE DRIVING FORCE FOR NURSES AND CHILDREN’S. NURSES IN LEADERSHIP DRIVE AN ENVIRONMENT FOR POSITIVE PATIENT OUTCOMES. NDNQI RN Satisfaction Survey The NDNQI RN Satisfaction survey measures RN satisfaction from the perspective of the unit level work group on 11 subscales. A total of 755 RNs from 33 units/clinics returned survey responses in September 2007 for a response rate of 89%, the highest response rate to date for the NDNQI survey at Children’s. The scores are shown in NDNQI’s “modified t-score transformation” so that satisfaction ratings can be compared among groups. Overall, Children’s showed significant

Based on NDNQI’s modified t-score,

improvement over last year’s results in

three subscores represented high satisfac-

many areas. Scores in 2007 are significantly

tion (RN-RN Interaction, Professional

higher than 2006 scores on eight of the 11

Status and Professional Development).

subscales (Task, Decision-making,

The other eight subscores represent

Autonomy, Professional Status, Professional

moderate satisfaction, while none of the

Development, Nursing Management,

subscores represents low satisfaction.

Nursing Administration and Job Enjoyment).

Top, nurse Diane Grzywacsz, RN, CCRN; bottom, Critical Care Council. Opposite page, back row, from left: Lisa Mason, RN, BSN, MHA, MBA; Barry Owen, RN, BSN, CCRN; Melissa Whitehead, RN, BSN. Front row (from left): Maria Bagtas, RN; Christie Zotter, RN, BSN; Heather Hughes, RN, BSN, MS, CEN.

NDNQI RN Satisfaction Survey | 2007 Nursing Annual Report | Children’s Medical Center

33

NDNQI RN Satisfaction Survey 70 60 50 40 30 20 10 0 Decision 2006

Admin. 2007

Pay

Task

Auto

Job Enj.

Mgt.

High Level of Satisfaction Moderate Level of Satisfaction Low Level of Satisfaction

RN-MD

Prof. Dev.

Prof. Status

RN-RN

Scores: Scores range from 0-100. Low score 60 indicates high satisfaction; statistically significant at p < .05.

34

Children’s Medical Center | 2007 Nursing Annual Report | Accomplishments – Presentations & Publications

175 NURSES ARE INVOLVED IN EITHER NATIONAL, LOCAL AND/OR INTERNAL PRESENTATIONS. Accomplishments – Presentations

From left, April Broussard, LVN, and Joddi Bronar, RN, CCTN, B2. Broussard is scanning medications. Opposite page from left, CVICU nurse Helen Maysonette, RN, and Kelley Streicher, Clinical Technician, review the status of a heart transplant patient.

Yvonne Aguero, RN, BSN

Lisa Cutright, RN, BSC, MS, CPNP

Carolyn Amrich, RN, COHN

Anne Day, RN, BSN

Lucy Antony, RN

Rebecca De La Rosa, RN, BSN

NiKole Armstrong, RN, MSN, NNP

Amanda Dean, RN, BSN, CPON

Lindsay Arnott, RN, BS, MHA, CCTC

James DeMasi, RN, MSN, CPNP

Carolyn Atkins, RN, BSN, CCTC

Paula Dimmitt, RN, MSN, CNS, CPNP

Roxanne Baier, RN, BSN

Jeanne Dispenza, RN, MSN, CPNP

Leah Balch, RN, BSN

Candice Dorsey, RN

Sheryl Bartlett, RN

Barbara Drews, RN, MS, CPNP

Tami Beaudin, RN, BSN

Joann Dudley, RN, MSN, APRN-BC, CPNP

Randall Bell, RN, CCRN

Aimee Dunnam, RN, MSN, NNP

Andrea Biermeier, RN, CPON

Leigha Eldridge, RN, BSN

Kimberly Bookout, RN, MSN, CPNP, CWOCN

Stephanie Emerson, RN, BSN

Jamie Boyd-Johnson, RN

Victoria England, RN, BS, MBA

Erica Brown, RN, MSN, CPNP-PC

Richard Escobedo, RN

Robin Brown, RN, BSN, AEC

Debra Eshelman, RN, MSN, CPNP

Geneva Burnap, RN, MBA

Leslie Everett, RN, BSN, WOCN

Ramonda Busby, RN, BSN, CPN

Jennifer Fickes, RN, BSN

Kari Cade, RN, BSN

Amy Field, RN, MSN, PMPHNP-BC

Kristi Calzada, RN

Patricia Flateau, RN, MSN, CPNP-PC

Julie Campbell, RN, BSN, CEN Sally Carmen, RN, MSN, CPNP

Dorothy Foglia, RN, MS, PhD, CCRN, CNAA, BC

Joe Cavender, RN, MSN, CPNP-PC

Kristin Gamble, RN, BSN

Cheri Clanagan, RN, CPN

Heidi Gerst, RN, BSN, CPON

Lynn Clark, RN, MS, RN-C, CPNP-PC, CPMN

Cecilia Gladbach, RN, BSN, CPON

Jennifer Clifton, RN, BSN

Mary Glazier, RN, MSN, CPNP, CPNP-PC

Cynthia Cochran, RN, MSN, CPNP

Diane Gollhofer, RN, BSN, CCRN

Judy Conedera, RN, MSN, RN-BC

Krystle Gregory, RN, BSN

Rebecca Cooner, RN, MSN, CPNP

Marsha Hamilton, RN, BSN

Tamara Cooper, RN, BSN

Loren Hamrick, RN, BSN

Michelle Copeland, RN, MS, CNPD

Beverly Hargrove, RN, BSN

Karen Corlett, RN, MSN, PNP-BC, CPNP-BC, CPNP-AC

Marla Hill, RN, CPN

Marilyn Cox, RN, MSN, CNS, CDE

Kimberly Hodges, RN, BSN

Maria Cummings, RN, BSN

Sandra Holdcraft, RN, BSN

Carol Hasty, RN, MSN

Accomplishments – Presentations & Publications | 2007 Nursing Annual Report | Children’s Medical Center

35

Glen Hopkins, RN, BSN

Anne Long, RN, BSN

Linda Neff, RN, BSN, CNOR

Joanne Jacobs, RN, BSN, CPNP

Kristina Long, RN, CPN

Dawn Nevers-Hazley, RN, CPN

Dolores Isham-Colvard, RN, PhD, CMCN

Serena Lucas, RN, BSN, CNAA, BC

Karen Norton, RN

Julia Jenkins, RN, BSN

Karissa Luckett, RN, BSN, MSW, AE-C

Cathy O’Neill, RN, BSN, CCRN

Mary Jones, RN

Michelle Macaluso, RN, MSN

Margaret Paterson, RN, MSN, CPNP-PC

Myesha Jones, RN, BSN

Janice Mangurten, RN, CCRN, CEN

Jennifer Pathak, RN, BA, MS, CCM

Phyllis Kelly, RN

Melayne Martin, RN, BSN, WOCN

Linda Payne, RN, BSN

Latieia Key, RN, BSN

Beena Mathew, RN, BSN, CNN

Jayme Pemberton, RN, BSN

Mary Kistner, RN, BSN

Susan McCollom, RN, ND, CPON

Michelle Pinker, RN, MSN

James Knapp, RN, MSN, CPNP-AC, APRN-BC

Deborah McElroy, RN, BSN

Brandi Polito, RN, BSN, CCRN, CCTN

Devon LaChappelle, RN, BSN

Nancy McNeil, RN, BA, MSN, CPNP

Rodica Pop, RN, MSN

Robin Landgraf, RN, MSN, CPNP-PC

Kim Miller, RN, MS,CPNP

Tracey Porter, RN

Kelly Lautzenheiser, RN, MSN, CPNP

Lisa Milonovich, RN, MSN, PCCNP, CPNP-AC, CCRN

Stephen Pottoore, RN, BSN, MBA

Brenda Lee, RN, BSN

Elizabeth Pullman, RN, BSN

Judy LeFlore, RNC, PhD, NNP, CPNP-PC, CPNP-AC

Kristin Milota, RN, MSN, CPNP-PC, CPNP-AC

Angela Rainey, RN, BSN

Sara Moore, RN, MSN, PNP-AC, APRN-BC

Sheila MarieRatcliffe, RN, BSN

Jonda Leitch, RN, BSN, CCRN

Michele Moreno, RN, BSN

Martha Ratliff, RN, BSN

Sharon Lemley, RN, RN,C,AE-C

Hector Murillo, RN, BSN

Jacqueline Reed, RN, BSN

Jane Levieux, RN, BSN, MS, PhD

Patricia Nabinger, RN, BSN, CPN

Jessica Reis, RN, BSN, CPON

Charlene Liverett, RN, BSN

Gay Nassri, RN

Scheena Renfro, RN, BSN

36

Children’s Medical Center | 2007 Nursing Annual Report | Accomplishments – Presentations & Publications

Patricia Rittgers, RN

Sarah Sullivan, RN, BSN

Jessica Rivera, RN

Veronica Teran, RN, BSN

Tammy Robertson, RN, MSN, APRN-BC,

Debra Thompson, RN, MSN, PNP-BC

CPNP-AC

Sarah Thompson, RN, BSN

Danielle Robinette, RN, BSN

Lori Thornton, RN, MSN, FNP-C

Linda Romero, RN

Brooke Torbert, RN, BSN

Glenda Sales, RN

Evelyn Torres, RN, MSN, CCRC

Claire Sartwell, RN, BSN, CPON

Olivia Torres, RN, BSN, CCRC

Michelle Schilling, RN

Michele Trinka, RN, BSN, CCRN, PCCN

Kaye Schmidt, RN, MSN, CPNP, CPON

Amara Van Hooser, RN, BSN

Debra Schumann, RN, BSN, MBA

Christina Villanueva, RN, BSN

Shari Scott, RN, MS, LMFT, LPC

Hope Villarreal, RN, BSN

Corianna Seelig, RN, BSN

Lori Vinson, RN

Christine Seibert-Oropeza, RN, BSN

Christine W. Wagner, RN, MSN, CPNP, AE-C

Allison Serr, RN, BSN

Shabina Walji-Virani, RN, MSN, CPNP

Elizabeth Shull, RN, BSN

Brook Warren, RN

Sandra Skipworth, RN, BSN

Susan Washington-St. Claire, RN

Joanna Spahis, RN, MSN, APNG, CNS

Desiree Whisman, RN, BA

Gwen Spector, RN, BSN, CWOCN, CGRN

Penny Williams, RN, MSN

Cassi Speed, RN, BSN

Amy Wilson, RN, BSN

Kathleen Speer, RN, PhD, CPNP

Louise Wissbaum, RN, NCC, CRNI

Judy Speir, RN, BSN

Nicole Woolen, RN, BSN

Lori Spors, RN, BSN

Charles Wyatt, RN, CCM

Cathey Staab, RN

Wendy Yeater, RN, CNOR

Nicholas Strittmatter, RN, MSN

Virginia Young, RN, BSN

19 NURSES AUTHORED AND/OR CO-AUTHORED ARTICLES PUBLISHED IN 2007. Accomplishments – Publications Nikole Armstrong, RN, MSN, NNP

Top, from left, Helen Maysonette, RN, and Barry Owen, RN, BSN, CCRN, team leader on the CVICU, go over objectives for the day; bottom, from left, Juby Sunny, RN, BSN, Sara Martin, RN, BSN, and Carol Helms, nurse extern, discuss a patient’s care in the CVICU.

CPNP-AC

Tamara Cooper, RN, BSN

Leslie Lewis, RN, MSN, CCRN, FP-C

Marilyn Cox, RN, MSN, CNS, CDE

Kim Miller, RN, MS, CPNP

Jaunita Dale, PhD, RN, CPNP

Sara Moore, RN, MSN, PNP-AC, APRN-BC

Valarie Eichler, RN, MSN, CCRN, PNP-AC, CPNP-PC

Rodica Pop, RN, MSN

Debra Eshelman, RN, MSN, CPNP

Lori Vinson, RN

Mary Glazier, RN, MSN, CPNP, CPNP-PC

Susan Washington-St.Claire, RN

Evelyn Torres, RN, MSN, CCRC

Tanja Hoffman, RN, MSN

Stephanie Woods, RN, MSN, PhD

Robin Landgraf, RN, MSN, CPNP-PC

Charles Wyatt, RN, MSN, CPNP

Judy LeFlore, PhD, RNC, NNP, CPNP-PC,

Community Involvement | 2007 Nursing Annual Report | Children’s Medical Center

37

227 NURSES AT CHILDREN’S ARE INVOLVED IN COMMUNITY SERVICES, ACTIVITIES AND VOLUNTEERING.

Community Involvement Beneficiaries Heart to Heart Fun Walk Volunteer

Mission Trips

Children’s Parade

Arboretum Volunteer

Children’s Barnyard

Pregnancy Center Volunteer

Junior League

Camp Directors, Volunteers and Nurses

Chair of Nurses Advisory Council

Girl Scouts of America

Special Olympics Volunteer

Boy Scouts of America

School Presentations

Church health fairs and camps

Substitute Teacher and Tutoring

Board members of various foundations and organizations

Medical Reserve Corps Volunteer Habitat for Humanity

Dallas City Medical Corps Volunteer

Epilepsy Support Group Coordinator

Cub Scouts

Neonatal Resuscitation Program Instructor

PTA

Guest Lecturers/Speakers

City of Dallas Volunteer

American Red Cross

Soccer Coach

American Heart Association

School Nurse Volunteer and Workshops

Make-A-Wish Foundation

Food Pantry

Sierra Club

Assistant Scout Master Camps

Above left, Saramma Isaac, RN, BSN, a nurse on C7, during a teaching visit to a boys’ orphanage in India while she was on an autumn mission trip; above, Virginia Bledsoe, RN, MSN, MBA, CPON, hematology-oncology clinical educator, enjoys fishing at Camp John Marc with Braden Eary.

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Children’s Medical Center | 2007 Nursing Annual Report | Community Involvement

“The goal of our efforts of compassion in medical missions is to provide health care to people in needy areas throughout our world. I am motivated to bring both physical and spiritual wellness to patients we are privileged to aid. I feel very humbled by the experience.” – SARAMMA ISAAC, RN, BSN

Participating Nurses Lori Allen, RN, BSN, CCRN Tasha Barksdale, RN

Kim Miller, RN, MSN, CPNP

Tami Beaudin, RN, BSN

Melissa Miller, RN, BSN

Virginia Bledsoe, RN, MSN, MBA, CPON

Lisa Milonovich, RN, MSN, PCCNP, CPNP-AC, CCRN

Angie Burris, RN, BSN, CDE Cherly Butler, RN, BSN Brad Cook, RN, BSN Amanda Dean, RN, BSN

Top, Debbie Robertson, RN, BSN, from the Hand Clinic, goes over the consent form for an influenza vaccination with mother Kandace Stidham, and grandmother Linda Rowe holding 2-month-old Amira Mabee during the three-day Boo Flu Clinic; bottom, Kathy Harper, RN, MBA, project director for Facility Planning and Design, at the annual Neiman Marcus Adolphus Children’s Parade, her 20th year of volunteering for the event.

Kathleen McHugh-Burton, RN, MSN, MBA, PNP-BC, PNP-AC, CNS, IBLCE

Ellie Doolin, RN, BSN Johnnie Fairman, RN, BSN Don Fowler, LVN Maegan Gaither, RN, BSN Cecilia Gladbach, RN, BSN, CPON Jordan Howard, RN, BSN Mary Hunchik, RN Rebecca Janis, RN, CPN Julie Jenkins, RN, BSN Diane Kim Jernigan, RN, BSN Mariamma Joseph, RN, CNN Kelly Lautzenheiser, RN, MSN, CPNP Sharon Lemley, RN, RN, C, AEC Karen Linder, RN, BSN, CDE Kristina Long, RN, CPN Marsha MacKenzie, RN, MS, CDE Jennifer Marshall, RN Juana Martinez, RN

Laura Moore, RN Sarah Muzzy, RN Melissa Myers, RN, MSN, FNP-C Jim Penn, RN, MSN Dewan Perry, RN, BSN, MS Debbie Robertson, RN, BSN Pat Satterwhite, RN, BSN, CPON Corianna Seelig, RN, BSN Christine Seibert-Oropeza, RN, BSN Elizabeth Shull, RN, BSN Joanna Spahis, RN, MSN, CNS, APNG Susan Sparks, RN, BSN Kate Stejskal, RN Sarah Svoboda, RN, BSN Haridas Thankappan, RN, BSN, CNN Preethy Vargheese, RN, BSN Jamie Wacassay, RN, BSN, CDE Christine Wagner, RN, MSN, CPNP Bonita Williams, RN, MSN, PNP-BC Victoria Williams, RN Nicole Woolen, RN, BSN

Research | 2007 Nursing Annual Report | Children’s Medical Center

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77 NURSES AT CHILDREN’S ARE INVOLVED IN RESEARCH EFFORTS. 46 OF THOSE NURSES LED RESEARCH STUDIES. Research Heather Paterson, RN, MSN, CPNP, CPNP-PC, CCRN

Tracine Adame, RN, BSN

Linda Grande, RN, MSN, CPNP-PC

Sally Adams, MS, RN, CPNP

Karen Gregory, RN, MSN, CNS, APRN-BC

Mindi Anderson, RN, MSN, PNP

Heather Grein, RN, MSN, PNP-AC, CPNP

Kathryn Pecenka-Johnson, RN, MS, CPN

Marcie Baldwin, RN, BSN, CCRN

Cathie Guzzetta, RN, PhD, AHN-BC, FAAN

Dewan Perry, RN, BSN, MS

Maria Bisceglia, RN, MSN, CPNP

Katherine Hammond, RN, MSN, CPNP, CPNP-AC

Lynn Pittsinger, RN, MSN, CPNP

Margaret Bray, RN, BSN

Christina Hauck-Harrington, RN, MSN, CPNP-PC

Tammy Robertson, RN, MSN, APRN-BC, CPNP-AC

Linda Buckins, RN, MSN, FNP-C

Heidi Haynes, RN, MS, CPNP

Joseph Sabella, RN, PhD

Angie Burris, RN, BSN, CDE

Tanja Hoffman, RN, MSN

Shari Scott, RN, MS, LMFT, LPC

Sally Carmen, RN, MSN, CPNP

Amy Holland, RN, MSN, CPNP

Shannon Self, RN, BSN

Joe Cavender, RN, MSN, CPNP-PC

Julie Jenkins, RN, BSN

Elizabeth Shull, RN, BSN

Lynn Chase, RN, BSN, CCRN

Kim Jernigan, RN, BSN

Isabelle Sjoberg, RN, BSN

Paige Clancy, RN, MSN, FNP

Mary Kistner, RN, BSN

Cathey Staab, RN, RN-C

Kimberly Clark, RN, BSN, CCRN

James Knapp, RN, MSN, CPNP-AC, APRN-BC

Lisa Thompson, RN, MSN, CPNP, PNP-AC

Lynn Clark, RN, MS, RN-C, CPNP-PC, CPMN

Judy LeFlore, PhD, RNC, NNP, CPNP-PC, CPNP-AC

Lori Thornton, RN, MSN, FNP-C Evelyn Torres, RN, MSN, CCRC

Sharon Lemley, RN, RNC, AE-C

Olivia Torres, RN, BSN, CCRC

Deborah Boger, RN, MSN Kimberly Bookout, RN, MSN, CPNP, CWOCN

Cindy Cochran, MSN, RN, CPNP Judy Conedera, RN, MSN, RN-BC

Rodica Pop, RN, MSN

Leslie Lewis, RN, BSN, CCRN, FP-C

Brenda Urbanczyk, RN, BSN

Kathleen Corcoran, RN, MS, CPNP-PC, PNP-AC

Karen Linder, RN, BSN, CDE

Preethy Varghese, RN, BSN

Karissa Luckett, RN, BSN, MSW, AE-C

Christina Villaneuva, RN, BS Christina Villanueva, RN, BSN

Michelle Copeland, RN, MS, CNPD

Tina Costa, RN

Linda Madden, RN, MSN, CPNP

Melanie Coursey, RN, BSN

Janice Mangurten, RN, CCRN, CEN

Jamie Wacasey, RN, BSN, CDE

Shellye Crawford, RN, MSN, CPNP

Renee Manworren, RN, MSN, CNS, RN,C

Juanita Dale, PhD, RN, CPNP

Jennifer Marshall, RN

Bonita Williams (Conley), RN, MSN, PNP-BC, APRN-BC

Barbara Drews, RN, MS, CPNP

Deborah McElroy, RN, BSN

Patricia Williamson, RN, MSN, CPNP-PC

Debra Eshelman, RN, MSN, CPNP

Kim McHard, RN, MSN, CPNP-PC

Amy Wilson, RN, BSN

Scotti Floyd-Edgar, RN, BSN

Kim Miller, RN, MS, CPNP

Andrea Windich-Biermeier, RN, CPON

Dorothy Foglia, RN, MS, PhD, CCRN

Lisa Milonovich, RN, MSN, PCCNP, CPNP-AC, CCRN

Charles Wyatt, RN, MSN, CPNP

Shirley Montanye, RN, CCRC

Fiker Zeray, RN, MSN, CPNP

Lisa Gatica, RN, BSN, CPN Celilia Gladbach, RN, BSN, CPON Cindy Godley, RN Ann Gosdin, RN, MS, CPNP Russell Graham, RN, BSN, CPN

Gloria Young, RN, BSN, CDE

Sara Moore, RN, MSN, PNP-AC, APRN-BC Jill Mraz, RN, BSN Patricia Newcomb, PhD, RN, CPNP

Please note: Lists may not be all-inclusive.

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