2013 Nursing Annual Report
Nurses Leading Change, Transforming Care: Our Nurses’ Story
Contents 1
Message from Children’s National’s Vice President & Chief Nursing Officer
2
About Children’s National & Division of Nursing Demographics
3
Nursing Awards & Recognitions
7
Transformational Leadership
10 Structural Empowerment 12 Exemplary Professional Practice 15 New Knowledge, Innovations & Improvements 18 Empirical Outcomes
A Message from Children’s National’s
Vice President & Chief Nursing Officer Children’s National Health System boasts a professional nursing workforce dedicated to the improvement of the health of children and their families through the provision of preventative, excellent, innovative, and specialty nursing care. An environment of shared decisionmaking and support for clinical nurses as leaders throughout the organization encourages and empowers nurses to advance the art and science of nursing while practicing to their full extent. The Division of Nursing supports nurses to achieve higher levels of education and academic progression. Many of Children’s National’s clinical nurses possess advanced education degrees as well as extensive professional certifications in the field of specialized pediatric care.
Nurses lead improvements in safe, high quality patient care, and their efforts have been recognized by numerous national awards.
Nurses lead improvements in safe, high quality patient care, and their efforts have been recognized by numerous national awards. Through collaboration and mutual respect, nurses partner with physicians as a valued member of the healthcare team in patient care, quality improvement, and in redesigning care to meet the needs of patients and families and the demands of future healthcare reform. Effective workforce planning in Nursing ensures that programs are in place to support clinical nurses in achieving high quality and safe patient care outcomes. Through the application and evaluation of a comprehensive professional practice model, this annual report tells ‘Our Nurses’ Story’ and showcases nurses at Children’s National as they establish a foundation to lead and transform care for patients and families, achieve professional mastery, demonstrate exemplary patient care, and excel in nursing research and innovation toward the advancement of pediatric nursing.
Linda Talley, MS, BSN, RN, NE-BC Vice President and Chief Nursing Officer
Cover photo: Sarah Carruth, BSN, RN, CPN; 7 East Medical Care Unit.
Children’s National
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About Children’s National
About the Nurses at Children’s National
• Has grown from a 12-bed facility
• Total Number of Nurses...................................................................1738
in 1871, to an integrated healthcare
.
– Full-time..........................................................................................1367
system with 303 licensed beds;
.
– Part-time........................................................................................... 252
• Serves over 400,000 children
• Per-diem.................................................................................................... 119
annually in the ambulatory setting;
• Turnover Rate (average).................................................................... 13%
• Is among only 7 percent of hospitals
• Nurse Vacancy Rate (average)...................................................... 2.7%
nationwide to achieve Magnet® designation, the highest level of recognition for nursing; • Has received the Beacon Award for Excellence from the American Association of Critical-Care Nurses for three Intensive Care Units (Cardiac, Pediatric, and Neonatal); and • Has been awarded the highest recognition, Accreditation with Distinction, as an American
• Nurse Tenure (average length of employment)............................................ 7 years • New Nurse Hires (full- and part-time)........................................ 200 • Combined Bachelor, Master, or Doctorate in Nursing.....................................................................84% • Bachelor’s Degree in Nursing.........................................................64% • Master’s Degree in Nursing.............................................................. 19% • Doctorate Degree....................................................................................1% • Certified by a nationally or
Nurses Credentialing Center (ANCC)
internationally recognized
Provider Unit.
professional organization.................................................................42%
(January 1, 2013-December 31, 2013)
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2013 Nursing Annual Report
Children’s National Nursing Awards
2013 National Magnet Nurse of the Year®
For the Children’s National Congenital Heart Disease Screening
Elizabeth Bradshaw-
of several publications on this topic and recently co-authored
Program Elizabeth coordinated research efforts for the use of newborn pulse oximetry screening for critical congenital heart disease (CCHD). She is a frequent guest speaker and an author new recommendations published for CCHD screening of all
Mikula, MSN, RN, CPN Former Clinical Program Manager/Clinical
newborns (Martin, G. R., Beekman, R. H., Mikula, E. B, et al (2013). Implementing recommended screening for critical congenital heart disease. Pediatrics, 132(1), e185-e192.
Program Coordinator, Cardiac Research
This is the second consecutive year a Children’s National nurse has been given this honor. In 2012 Kathy Ann Sheehy,
Elizabeth Bradshaw-
MSN, APRN, PCNS-BC, RN-BC; Interim Director, Advanced
Mikula, MSN, RN, CPN
Practice Nursing, and Director of Program Development and
received the 2013 Kathy Ann Sheehy (left) and Elizabeth Bradshaw-Mikula (right).
Implementation, Pain Medicine, received the National Magnet
National Magnet Nurse
Nurse of the Year® award in New Knowledge, Innovations, and
of the Year® award in
Improvements. These awards are presented annually by the
Empirical Outcomes. “Elizabeth is a strong advocate for the
American Nurses Credentialing Center (ANCC) and recognize
nursing profession and for advancing the health and wellbeing of children everywhere,” said Linda Talley, MS, BSN, RN, NE-BC, Vice President and Chief Nursing Officer. “Her research and leadership on behalf of pediatric nurses has sparked a
outstanding contributions by clinical nurses in Magnet® designated hospitals. ANCC, a subsidiary of the American Nurses Association, provides individuals and organizations throughout the nursing profession with resources to achieve
worldwide advocacy campaign for the health screening of
practice excellence. n
infants for congenital heart disease at the earliest possible stages of life.”
Children’s National nurses receive the National Magnet Nurse of the Year® Award for two consecutive years.
Children’s National
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Children’s National In 2013 the following Children’s National nurses were recipients of the daisy award: • Jillian Rekart, BSN, RN, CPN; Surgical Care Unit • Susan Stanley, MSN, RN; Former Director, Nursing Systems • Katelyn Snyder, RN, CPN; 7 East Medical Care Unit • Kathleen Barner, BS, RN;
DAISY Award Winners The DAISY Foundation was founded by Bonnie and Mark Barnes- the parents of J. Patrick Barnes who died at age 33 due to complications of Idiopathic Thrombocytopenic Purpura (ITP). The family created the international DAISY Award for Extraordinary Nurses as a means to honor nurses across the globe for excellence in caring for patients and families.
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7 East Medical Care Unit
The 2013 Association of Pediatric Hematology/Oncology Nurses Casey Hooke Distinguished Service Award Deborah Freiburg, MS, BSN, RN Director, Medical Nursing and Patient and Family Education Program The Association of Pediatric Hematology/Oncology Nurses (APHON) presented Deborah Freiburg, MS, BSN, RN with the 2013 Casey Hooke Distinguished Service Award for excellence in service and leadership. Deborah has been a true advocate in pediatric hematology/oncology nursing for
Deborah Freiburg
over 20 years. Deborah is a founding member of the local APHON chapter, served as national Board of Directors’ Treasurer
(2006- 2012), participated on key APHON committees, presented at conferences, and provides ongoing mentorship to nurse members. Deborah’s colleagues declare her greatest talent is building relationships to promote nursing and professionalism. APHON is the leading professional organization in its specialty dedicated to promoting optimal nursing care for children, adolescents, and young adults with cancer and blood disorders by defining high standards of practice and interprofessional care. This award was established in Hooke’s name to celebrate his leadership as President during a difficult period in the organization’s history.
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2013 Nursing Annual Report
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The Association of Pediatric Hematology/ Oncology Nurses honors a Children’s National nurse for dedication and leadership.
Nursing Awards
The Washingtonian 2013 Excellence in Nursing Awards Out of hundreds of nominations, Washingtonian magazine selected ten extraordinary individuals for contributions in the field of nursing for the annual Washingtonian Excellence in Nursing Award. Two Children’s National nurses received this award: • Christy Baxter, MSN, MHA. RN, CPN; Clinical Manager, Pain Medicine • Lindsey Kennedy, BSN, RN, CPHON; RN II, Hematology/Oncology/Bone Marrow Transplant Unit Christy was honored for her commitment to exceptional nursing care, team collaboration, and innovation in the art and science of nursing—bringing exciting technological advances to her young patients. Her work in Children’s National Pain Medicine clinic focuses on minimizing and eliminating pain for the nation’s children. Lindsey was recognized for her deep understanding of complex disease processes, treatment, comfort, and caring for children with life-threatening cancer and blood disorder diagnoses. Her work demonstrates a unique level of compassion for patients and families facing extremely difficult circumstances.
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Christy Baxter (left) and Lindsey Kennedy (right).
Children’s National’s 2013 Nurses Week Celebration Children’s National celebrated Nurses’ Week May 5th – 10th. The weeklong event was sponsored by the System-level Shared Nursing Leadership Professional Development Council to honor and recognize all nurses within the organization. The council sponsored special guest speakers of the nationally renowned American Nurse Project. Special events included activities in support of the Endowed Chair for Nursing Research donors, Annual Celebration of Scholarly Writing for nurse authors, Leadership Rounds in honor of clinical nursing, and the Annual Children’s National Nurses’ Week Awards Ceremony.
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Colleen E. Whitmore, MSN, FNP, RN; Director of Nursing Services, Children’s School Services (left) and Barbara Scott, MSN, RN-BC, NE-BC; Vice President of Children’s School Services during the Nurses’ Week Awards Ceremony (right).
Children’s National
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Children’s National Nursing Awards
American Nurse Project The American Nurse Project, by photographer and award-winning filmmaker Carolyn Jones, tells the personal stories of 75 nurses from across the United States and gives voice to millions of women and men who play an important, every day role, integral to America’s healthcare system. The American Nurse introduces to the community at large a broad spectrum of nurses from big cities to small towns, tiny clinics to mega-hospitals, and many locations in between. Thanks to peer nominations the following four Children’s National nurses are featured in The American Nurse: •D elores Crowder, BA, RN; Community School Nurse; Children’s School Services •J essica Graef, MSN, RN, CNL, CPHON; RNII; Hematology/Oncology/Bone Marrow Transplant Unit •C hristine Guelcher, MS, APRN, PNP-BC; Advanced Practice Nurse Practitioner; Hematology/Oncology Unit •R osemary Livingston, BSN, RN; RN II; Heart and Kidney Unit Children’s National is proud to be the only freestanding pediatric hospital whose nurses are featured in The American Nurse Project. The website and book recognize and represent the outstanding contributions of the professional nurse throughout the nation.
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Photos © “The American Nurse: Photographs and Interviews by Carolyn Jones
2013 Nurses’ Week Awards Winners Transformational Leadership
Professional Practice
Develops and conveys a strong vision, philosophy, practice
Displays a conceptual framework for nurses, nursing care, and
model, strategic and quality plan:
interprofessional patient care:
• Katuan Davis, BSN, RN, CPN; Clinical Supervisor; Children’s
• Megan Kretzschmar, MSN, RN, CPN; RN II; 6 East, Intestinal
National Specialists of Virginia • Mary Anne Hilliard, Esq., BSN, CPHRM; Chief Risk Counsel
• Joellen Gormsen, BSN, RN; RN II; Neuroscience Unit
• Rosie Santos, BSN, RN-BC, CPN; RN II; Post Anesthesia
• Alison Goradia, BS, RN, CPN; RN II; Hematology/Oncology/
Care Unit
Bone Marrow Transplant Unit
Structural Empowerment
New Knowledge, Innovations & Improvements
Promotes self-governance, shared decision-making, and
Integrates evidence-based practice and research in clinical care:
processes for standards of practice, relationships within the
• Eileen Walters, BSN, RN, CPN, CPHON; Nurse Navigator;
organization and among community organizations: • Colleen E. Whitmore, MSN, FNP, RN; Director, Nursing Services; Children’s School Services • Rose Szeles, MSN, RN, NE-BC; Director, Nursing; Hematology/Oncology
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Rehab Unit
2013 Nursing Annual Report
Surgery Adminstration • Javan Ngaii, BSN, RN, CPN, CNRN; Shift Coordinator; Neuroscience Unit • Kevin Wilson, BS, RN; RN II; Emergency Medicine Trama Center/United Medical Center
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Transformational Leadership Guided by our transformational leader, Vice President and Chief Nursing Officer, Linda Talley, nurses within the Division of Nursing continue to move the professional practice of nursing at Children’s National to the forefront with a strong mission and vision.
Children’s National Shared Nursing Leadership
Nursing Mission Statement The Children’s National Nursing mission is to provide nursing care that creates improved health for the children of the world and their families through the provision of excellent nursing care. We advance these efforts through CARE: Care, Advocacy, Research and Education in partnership with patients, families, colleagues, and the community at large.
Nursing Vision Statement
Clinical Improvement & Nursing Research Council (CINRC)
PRACTICE COUNCIL
• Reviews and makes recommendations related to issues of quality, performance improvement, evidence-based practice, and research in nursing
• Evaluates and integrates unitbased practice and evidencebased research to ensure excellence in nursing care
• Serves as a conduit for nursing quality and research between the organizational level and clinical nurses through programs such as: Nursing Sensitive Indicator (NSI) kudos, Child’s Voice patient satisfaction project, research protocol review, quality data tracking and strategy with clinical area Culture of Nursing Excellence (CONE) teams
The Children’s National Nursing vision is to be the leading national and international pediatric hospital of choice and to provide innovative solutions to pediatric care and patient safety within a fiscally accountable environment. Children and their families participate in creating a healthy environment from birth to adulthood in a setting of
Subcommittees: Nursing Quality Committee (NQC)
collaborative patient and family-centered care. Children’s National Health System is considered the premiere destination for evidence-based pediatric nursing practice in an environment of shared nursing leadership and collaboration
Nursing Research Advisory Council (NRAC)
across the continuum.
Professional Development Council
Nursing leadership aligns nursing goals and initiatives with
• Offers opportunity for greater involvement in Shared Nursing Leadership
the overall Children’s National strategic plan to promote the
• Provides input in nursing professional development planning
profession of nursing, promote practice consistency, and
• Initiatives include Nurse’s Day, Patient Support Technician Day, Nursing Grand Rounds, Peer Review
resource allocation across the organization. In response to the Institute of Medicine’s 2010 report, “The
Subcommittees: Nursing Clinical Ladder Mentoring Program
Future of Nursing: Leading Change, Advancing Health” the Division of Nursing created the Department of Advanced
• Promotes nursing standards through evidence-based practice
Subcommittees: Safe Nursing Practice Comfort Team Innovation COUNCIL • Initiates improvements and advancements for the benefit of our patients, families, and staff • Projects include Daisy Award, Nursing Nomination Advisory Committee, RN Communication Project, Environmental Sustainability Subcommittees: Informatics and Technology RESOURCE COUNCIL • Collaborates with the nurse executive team to establish priorities for human and fiscal resources • Enhances recruitment and retention strategies in nursing • Initiatives include BearBuddies, Float Pool development, Nurse Ambassador Program, BEAR LIVING: A Resource Guide for Children’s National Nurses Subcommittees: Patient/Family Education Council Autism Awareness Team
. . . Continued on p. 8
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Transformational Leadership
Practice Nursing at Children’s National with the objectives:
unexpected increases in patient volume and/or acuity, while
to strengthen Advance Practice Registered Nurses’ (APRN)
also preserving fiscal accountability. Workforce improvements
practice foundations; decrease turnover; and create
focused on the following:
organizational awareness of the quality and efficiency afforded by APRNs. The number of APRNs at Children’s National expanded with an 81 percent growth over four years (20102013) with the on-boarding of approximately 60 new nurse practitioners (NPs) in the past
An environment of shared decision-making and professional engagement achieves low vacancy and turnover rates.
three years. Through effective interprofessional collaboration Nursing along with physicians, medical staff office, and Human Resources created 21 new NP positions. In addition, there are 26 independently-run NP outpatient clinics affiliated with Children’s National. Children’s National Shared Nursing Leadership engages and empowers nurses to partner in decisionmaking, implementation, and
evaluation of the art and science of nursing. Shared Nursing Leadership promotes a culture of accountability where each clinical nurse’s participation contributes to improvements in overall performance. The goal is to achieve excellence in professional practice and patient and family-centered care in support of the strategic goals of Children’s National. Through Transformational Leadership the Division of Nursing has reached major accomplishments by sustaining improvements related to workforce outcomes in 2013. Nearly ten years ago Nursing achieved a drastic reduction in vacancy, turnover, and use of contract nursing through an enhanced recruitment and retention campaign. The campaign objectives included: providing high quality and safe patient care; providing a high level of care satisfaction; increasing morale and satisfaction among nurses; and ability to safely care for
• Use of trended data, vacancy, and turnover rates by nurses to formulate staffing plans and advocate for resources; • Clinical nurse participation in staffing and scheduling practices to meet growing volume and acuity of patients; • Staffing and scheduling plans according to principles that address number of patients, acuity, the care environment, available technology, expertise, skill mix, ancillary personnel, and contributing factors affecting patient care; • Nursing leadership rounds with clinical nurses to review staffing, scheduling, and resource needs; • Collaboration of clinical nurses and the Department of Nurse Recruitment through shared decision-making for recruitment and retention planning; and • Resources for all newly hired nurses such as the Bear Living guide and Bear Buddy program to enhance their social onboarding, integration, and work-life balance. Nurses effectively confront the demands of healthcare today and the future through comprehensive workforce planning. Nurses possess the skills and knowledge to think critically about the current environment and healthcare reform, budget and workforce management, and leadership accountability through the following activities: • Budget Boot Camp programs; • Workforce Management programs; • Chief Nursing Officer Dashboard Meetings; • Nursing Leadership Retreats; and • Scheduling and Staffing sessions. In the past year the Division of Nursing demonstrated effective workforce education and successful programs in sustaining these achieved outcomes. Children’s National Nursing maintains a stable turnover rate between 12% and 13% from 2012- 2013 and boasts a reduced vacancy rate from 5.9% in 2012 to 2.7% in 2013.
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Photo pg 9: Calvin Burke, AD, RN; Crisis Nurse (left) and Jigisha Patel, BSN, RN; Cardiac Intensive Care Unit (right). 8
2013 Nursing Annual Report
Children’s National
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Structural Empowerment Children’s National’s Division of Nursing is committed to lifelong learning and provides exceptional resources to advance skills, earn academic degrees, and achieve certification. The Division of Nursing set a goal for 80% of all nurses to have earned a Bachelor’s Degree in Nursing (BSN) or higher by January 2015. As of December 2013 84% of all nurses have a BSN or higher nursing degree. Mastery of skills, knowledge, and abilities is validated through
Our Magnet® Champions lead outreach activities in the
specialty nursing certification which brings added value to our
community throughout the year and for the past three years
patients, nursing, and the organization. Nursing set a goal to
have partnered with children’s hospitals across the country to
increase professional nursing certifications by 5% over a two-
conduct a Cereal Drive. The Cereal Drive provides nutritional
year period (2011- 2013) and exceeded this goal in January
support during the summer session to students who normally
2013 with the achievement of 42% of all Children’s National
receive breakfast at school school and may go without food
nurses holding certification.
in the summer. Donations are collected throughout the organization to provide cereal to local children and their
The Nursing Education and Professional Development
families to promote proper nutrition, healthy eating, and well-
Department partners with 56 universities, community colleges,
being of lower-income area residents. In 2013 the Magnet®
and vocational education centers. Nurses entering practice
Champions collected over 9,000 servings of cereal.
for the first time are often challenged with the transition from education into practice. Through the Pediatric Nurse
Magnet® Champions also lead the Back to School and
Residency Program, Children’s National supports new graduate
Holiday Drives for the St. Ann’s Center for Children, Youth,
clinical nurses to develop pediatric nursing skills through
and Families. These programs collect back to school items for
specialized education and orientation. In 2013, 200 new nurse
financially disadvantaged youth residing at the St. Ann’s Center
hires completed the program and also implemented capstone
and provide needed items and gifts for families during the
evidence-based projects on their unit/departments which
holiday season.
positively impacted patient care outcomes. Structural Empowerment is demonstrated through clinical In advancing technology and providing resources to increase
nurse engagement and empowerment. Through the
learning, Nursing implemented RNsConnect as an online
implementation of a cutting-edge, state-of-the-art Board of
learning tool for nurses. It provides an opportunity for nurses
Visitors (BOV) Simulation Program, nurse and interprofessional
to obtain training and link to peers virtually without limitation
learning in a real-time clinical environment has flourished in
to time or location. As healthcare continues to change,
2013. Clinical simulation provides interactive, real-life patient
RNsConnect provides a platform to adapt to changes through
care scenarios designed to reflect what nurses encounter in
an innovative environment of online learning, training, and
the hospital environment. It provides active learning, increases
connecting. Nurses can search, upload, and access education
motivation, enhances information retention, and hardwires
and training and connect through a virtual environment
critical elements of patient safety, quality care, and service
to share ideas about the current healthcare landscape and
excellence. Simulation helps nurses, physicians, and team
changes.
members reflect on care demonstrated and develop critical thinking skills during just-in-time learning. The Program affords unit/department educators to further:
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2013 Nursing Annual Report
Karen Bellasis, AD, RN; Acute Care Float Pool (left) and Heather Gray, AD, RN-BC; Hematology/Oncology (right).
• Identify gaps in the environment, work-flow processes, and/or training;
Clinical Simulation provides nurses an interactive and reallife learning experience that enhances knowledge, skills, communication, teamwork, patient safety, and outcomes.
•S hare findings and recommendations with leaders to enhance a safe environment; • F acilitate richer understanding of specific patient conditions; •E nhance individual decision-making skills. •A llow nurses to critically analyze their own actions and critique the clinical decisions of others; and •P romote closed-loop communication within clinical teams. By providing patient care scenarios founded on real events, clinical nurses have the opportunity to improve care based on simulated learning. Improvements in 2013 include the following: • Increased patient safety by adding oxygen and suction equipment to clinic exam rooms; • Improved teamwork, communication, and use of shared mental models among clinicians participating in interprofessional simulations; •E levated clinical nurse knowledge and skills; •E ffective cardiac compressions, bag-mask ventilation, use of a code cart, and defibrillators; • Improved emergency interventions prior to arrival of code team; •M odified Pediatric Early Warning Score (MPEWs) to insure timely escalation of care; and • Timely and accurate trauma assessments. Overall, the Simulation Program enhances teamwork, communication, high quality, safe care, and practices among Children’s National’s expert healthcare teams.
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Exemplary Professional Practice Our Care Delivery System is Patient and Family-Centered Care and defined as a collaboration of the patient, family, and healthcare team that places a priority on the strengths, needs, and desires of the patient and family to optimize health and wellness. Patient and Family-Centered Care is central to the Nursing Professional Practice Model which provides the framework for overall excellence in the delivery of quality patient care and outcomes. Key components within the model are Patient and FamilyCentered Care, Professional Development, Shared Nursing Leadership, EvidenceBased Nursing, and Partners in Care.
Children’s National Health System Division of Nursing Professional Practice Model
To support Exemplary Professional Practice the Pathways to Nursing Care Excellence Fellowship was created to advance Nursing in exceeding desired care outcomes. As the demands for safety and quality in healthcare increase, quality improvement strategies play a role in supporting the patient experience and outcomes of the organization. This one-year fellowship for clinical nurses addresses challenges
Guided by Exemplary Professional Practice the Division of
in nurse-sensitive indicators by providing each nurse with
Nursing has improved patient care outcomes through nurse-
essential information about quality improvement strategies
sensitive, quality improvement measures using evidence-
and opportunities to lead new approaches. The Fellowship
based practice. A system-wide Pressure Ulcer Program was
supports clinical nurse autonomy in identifying, planning,
developed to decrease the number and grade of hospital-
implementing, and sustaining care improvements in their
acquired pressure ulcers through use of National Database
work settings.
of Nursing Quality Indicators (NDNQI) metrics. These metrics examine the number of patients with Stages 1
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The Fellowship consists of didactic presentations, group work
through 4, as well as un-staged and deep tissue injury
focused on concept application, clinical time on the unit,
hospital-acquired ulcers. The Program includes two full
follow-up reflection on work progress, and collaboration with
prevalence studies per quarter along with an educational
faculty and unit leadership. In 2012- 2013 ten nurse fellows
offering for approximately 50 unit-based clinical nurses
completed the fellowship resulting in the implementation of
who have advanced skills in prevention and management.
nine quality improvement projects. (details on page 13)
These nurses in collaboration with a dedicated wound care
2013 Nursing Annual Report
Pathways to Nursing Care Excellence Fellowship – Quality Improvement Project Implementations
Preventing Harm from IV Infiltrates
Improving Patient Satisfaction During the
Debbie Haddon, BSN, RN; Clinical Supervisor;
Pre-Operative Screening
Central Nursing Resources
Layla San Martin, BSN, RN, CPN; RN III; Ambulatory Surgery Center
Rounding with a Purpose Allison Armstrong, BSN, RN, CPN;
Rounding with a Purpose
Clinical Instructor; 7 East Medical Care Unit
Erin Younger, BSN, RN; Shift Coordinator; Hematology/Oncology/Bone Marrow
Comfort Campaign: Targeted Interventions
Transplant Unit
to Reduce IV Pain/Anxiety Emily Dorosz, BSN, RN; Clinical Instructor;
30-second Approach to Improve
Emergency Medical Trauma Center
Patient Satisfaction Hannah Greenlick-Michals MPIA/ESD,
I CARE – Using Real-time Feedback to
BSN,RN,CPN,CNRN; Surgical Airway and
Improve Patient Satisfaction
Tracheostomy Professional Practice Specialist
Tina Humbel, MSN/MHA, RN-BC, CPN, CCRN; Staff Development Specialist
Skin Time Out Raven Wiggins, BSN, RN; RN II; Surgical
Use of Comfort Measures During Allergy Testing
Care Unit
Amanda Troger, BSN, RN; RN II; Allergy Clinic Preventing EEG-related Pressure Ulcers Javan Ngaii, BSN, RN, CNRN, CPN; Shift Coordinator; Neuroscience Unit
nurse (Clinical Nurse Specialist), and the quality leaders
• Conducting monthly tracer audits and unit-based
from the Department of Nursing Research and Quality
Root Cause Analyses related to pressure ulcers;
Outcomes, implemented interventions for pressure ulcer
• Implementing the “Cushion & Protect” campaign to
prevention, prevalence and grade reduction by 2013.
all services (Physicians, Nurse Practitioners, Nurses,
These interventions included:
Respiratory Therapists, Orthopedic Technicians);
• Establishing an in-house web page with educational
• Making specialty wound and skin products available
resources, algorithms, protocols, skin care guidelines,
on units;
and specialty unit initiatives;
• Establishing wound and skin standards in a patient’s
• Developing a 24/7 pressure ulcer expert list posted
plan of care and nursing practice guidelines;
in the Central Staffing Office as a resource for clinical
• Forming a collaboration between Wound & Skin
nurses;
Advanced Practice Nursing, Nursing Quality, Patient Safety, and Performance Improvement Departments;
. . . Continued on p. 14
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Exemplary Professional Practice
• Revising specialty-bed algorithm with a new bed for high risk patients; • Updating, re-evaluating, and summarizing current literature on pressure ulcers; • Implementing electronic health record documentation enhancements; and • Developing specific education for clinical nurses, to collaborate with the Respiratory Services, Department and vendor to prevent respiratory device-related pressure ulcers. Clinical nurses contribute patient population- specific knowledge for prevention and create significant improvements in our pressure ulcer prevalence. Of the 13 inpatient units tracking and trending hospital-acquired pressure ulcers, 90 percent of the units were below available national benchmarks during the last two calendar years (2012 – 2013) and teams have significantly reduced the number of Stage 3 and above hospitalacquired pressure ulcers over the last two calendar years.
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2013 Nursing Annual Report
Children’s National nurses achieve a significant reduction in the prevalence of hospital-acquired pressure ulcers compared to national benchmarks.
New Knowledge, Innovations & Improvements The Division of Nursing is committed to advancing pediatric care through innovative research and to bringing these innovations to the bedside. Guided by the Department of Nursing Research and Quality Outcomes, our nurses are engaged in nursing research, making discoveries of their own, and are on the frontline putting these discoveries into practice.
Children’s National Nurse Scholars
The Department of Nursing Research and Quality Outcomes
scientists, faculty, research nurses, clinical nurses, educators,
provides research mentorship and support for nurses to
and administrators who provide oversight for the conduct
develop, expand, and advance nursing research studies
of nursing research to ensure scientific merit, feasibility, and
through individual appointments, monthly open office
compliance with governing agencies in protection of human
hours, and group learning activities guided by a Nursing
subjects within all studies. This past year, the committee
Research Activity Development Program. The program
reviewed 14 unique protocols. Of the IRB-approved nurse
includes a Saturday Scholars’ Program and monthly Doctoral
led studies, nine have extramural funding with NIH (National
Nursing Support Group for all interested nurses. In support
Institutes of Health) as the most frequent source. Across 28
of the theme ‘Dissemination of New Knowledge’, Nursing
studies, ten different study designs are used, including six
promotes ‘Doctoral Celebrations’ for each nurse completing
intervention protocols and ten of the 28 studies have reached
a doctorate in nursing practice (DNP), a doctoral degree in
the stage of publication of findings.
philosophy (PhD), or other doctoral degree. Since January 2012, six celebrations have been sponsored whereby the nurse
In 2013 Children’s National nurses disseminated findings
presents his/her research or capstone project as a means to
through abstracts, posters, presentations, and publications
disseminate New Knowledge.
in the advancement of scientific evidence, literature, and in translating New Knowledge. A formal method used to
The Nursing Research Advisory Committee within Shared
translate new knowledge is a focus on celebrating scholarly
Nursing Leadership is responsible for review and approval
writing which is of the mindset that purposeful nursing
of all nursing research protocols before submission to the
action includes continually examining our practice to identify
Institutional Review Board (IRB). Membership includes nursing
opportunities for improvement. Scholarly practice also
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New Knowledge, Innovations & Improvements
includes implementing
The 18 authors included:
strategies to
Elizabeth Bradshaw Mikula, MSN, RN, CPN, Former Clinical
achieve improved
Program Manager/Clinical Program Coordinator, Cardiac Research
care outcomes for patients, families, and communities and sharing outcomes
Advanced Practice Nursing Suzanne Feetham, PhD, RN, FAAN, Nurse Research Consultant
through various means
Chris Guelcher, MS, APRN, PNP-BC, Pediatric Nurse Practitioner
such as published
Celia Henderson, BSN, RN, CDE, CPT, Clinical Instructor
nursing care journals. In May 2013 an inaugural Celebration of Scholarly Writing in
Ginikanwa Ukpabi, MPH, MSN, FNPBC; Occupational Health (left) and Leilani Wagner, MSN, FNP-BC; Occupational Health (right) as authors honored at the Celebration of Scholarly Writing.
Gretchen Brandon MSN, APRN, NNP-BC, NE-BC, Former Director,
Pamela S. Hinds, PhD, RN, FAAN, Director, Department of Nursing Research and Quality Outcomes and Associate Director, Center for Translational Science
Nursing was created
Susan Keller, MLS, Health Sciences Librarian
to annually recognize
Katherine Patterson Kelly, PhD, RN, Nurse Scientist
scholarly writing by nurses during Nurses’ Week. The event
Valere Lemon, MBA, RN, Project Coordinator, Center for Pediatric Informatics
honored 18 authors of
Johanna Menard BSN, RN, CPN, Research Nurse Coordinator
25 scholarly articles
Jeanne Pettinichi, BSN, RN, CPEN, CPN, Clinical Instructor
published in the
Simmy Randhawa DNP, MBA, MS, RN, NE-BC, CPN, Director,
previous year by having each Nursing scholar introduce his/ her publication, a synopsis of the publication, acknowledge co-authors, and present a signed copy of the publication to Vice President and Chief Nursing Officer, Linda Talley. At the conclusion of the celebration, nursing scholars were
Nursing Education, Professional Development, Parish Nursing and BOV Simulation Program Kathy Ann Sheehy, MSN, APRN, PCNS-BC, RN-BC, Clinical Nurse Specialist
presented with a feather quill pen which symbolizes harmony
May-Britt Sten, MSN, RN-BC, Director, Performance Improvement
in purpose and excellence as well as echoes the use of quill
Connie Trexler, RN, CPN, Clinical Resource Nurse Program
pens by Supreme Court justices to sign opinions.
Manager Ginikanwa Ukpabi, MPH, MSN, FNP-BC, Advanced Practice Nurse Practitioner Leilani Wagner, MSN, FNP-BC, Advanced Practice
The Division of Nursing supports 28 nurse-led Institutional Review Board (IRB) approved research studies.
Nurse Practitioner Anne Watson, PhD, BSN, RN, Research Nurse Coordinator n
Photo pg 17: Nicole Herberger, BSN, RN, CCRN; CICU and Amanda Hackney, BSN, RN, CCRN, RN-BC; CICU. 16
2013 Nursing Annual Report
Children’s National
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Empirical Outcomes Empirical Outcomes are the strongest indicator of excellence and define the strength of systems and processes within an organization. Through Empirical Outcomes nurses at Children’s National are making significant impacts to improve patient care, the work environment, organizational performance, and outcomes for our patients and families. Within each of the four components- Transformational Leadership, Structural Improvement, Exemplary Professional Practice, and New Knowledge, the work of our nurses is linked to the achievement of outcomes. Numerous publications by nurses within the Division of Nursing are just one example of Empirical Outcomes at Children’s National.
Nursing Publications Berger, J. T., Sten, M. B., & Stockwell, D. C. (2012). Patient
Gillespie, G.L., Hounchell, M., Pettinichi, J., Mattei, J. & Rose,
handoffs: Delivering content efficiently and effectively is
L. (2012). Caring in pediatric emergency nursing. Research and
not enough. The International Journal of Risk and Safety in
Theory for Nursing Practice, 26(3), 216-232.
Medicine, 24(4), 201-205.
Guelcher, C. (2012). Inhibitor development. In Nursing Working
Bradshaw, E. A., Cuzzi, S., Kiernan, S. C., Nagel, N., Becker,
Group (EDs), Nurses’ Guide to Bleeding Disorders. National
J. A., & Martin, G. R. (2012). Feasibility of implementing
Hemophilia Foundation.
pulse oximetry screening for congenital heart disease in a
Harden, B. W., Martin, G. R., Bradshaw, E. A. (2012). False-
community hospital. Journal of Perinatology, 32(9), 710-715.
Negative Pulse Oximetry Screening for Critical Congenital
Bradshaw, E. A., & Martin, G. R. (2012). Screening for critical
Health Disease: The Case for Parent Education. Pediatric
congenital heart disease: advancing detection in the newborn.
Cardiology, 34(7), 1736-1738.
Current Opinion in Pediatrics, 24(5), 603-608.
Hinds, P. S., Oakes, L. L, Hicks J., Powell, B., Srivastava, D. K.,
DeSalvo, D. J., Greenberg, L. W., Henderson, C. L., & Cogen,
Baker, J. N., Spunt, S. L., West, N. K., Furman, W. L. (2012).
F. R. (2012). A Learner-Centered Diabetes Management
Parent Parent-Clinician Communication Intervention during
Curriculum Reducing resident errors on an inpatient diabetes
End-of-Life Decision Making for Children with Incurable
pathway. Diabetes Care, 35(11), 2188-2193.
Cancer. Journal of Palliative Medicine, 15(8), 916-922.
Fair, C., Wiener, L., Zadeh, S., Albright, J., Mellins, C. A., Mancilla,
Hinds, P. S., Nuss, S. L., Ruccione, K. S., Withycombe, J. S.,
M., Tepper, V., Trexler, C., Purdy, J., Osherow, J., Lovelace, S.,&
Jacobs, S., DeLuca,H., Faulkner, C., Liu, Y., Cheng, Y. I., Gross, H.
Kapetanovic, S. (2013). Reproductive health decision-making
E., Wang, J., DeWalt, D. A. (2013). PROMIS pediatric measures
in perinatally HIV-infected adolescents and young adults.
in pediatric oncology: Valid and clinically feasible indicators
Maternal and Child Health Journal, 17(5), 797-808.
of patient_reported outcomes. Pediatric Blood & Cancer, 60(3),
Gao, W., Yuan, C., Wang, J., Du, J., Wu, H., Qian, X., & Hinds,
402-408.
P. S. (2013). A Chinese Version of the City of Hope Quality
Hinds, P. S., Feetham, S. L, Kelly, K. P., Nolan, M. T. (2012).
of Life–Ostomy Questionnaire: Validity and Reliability
“The Family Factor” Knowledge Needed in Oncology
Assessment. Cancer Nursing, 36(1), 41-51.
Research. Cancer Nursing, 35(1), 1-2.
Photo pg 19: Violet Uttaro, BSN, RN (left) and Laura Rogers, BSN, RN, CCRN (right), Neonatal Intensive Care Unit. 18
2013 Nursing Annual Report
Kahalley, L. S., Wilson, S. J., Tyc, V. L., Conklin, H. M., Hudson, M. M., Wu, S., Xiong, X., Stancel, H. H., & Hinds, P. S. (2013). Are the psychological needs of adolescent survivors of pediatric cancer adequately identified and treated?. Psycho-Oncology, 22(2), 447-458. Lemon, V., Stockwell, D.C. (2012). Automated detection of adverse events in children. Pediatric Clinics of North America, 59(6), 1269-1278. Kahalley, L. S., Robinson, L. A., Tyc, V. L., Hudson, M. M., Leisenring, W., Stratton, K., Mertens, A. C., Zeltzer, L., Robison, L. L., Hinds, P.S. (2012). Risk factors among adolescent survivors of childhood cancer: A report from the Childhood Cancer Survivor Study. Pediatric Blood & Cancer, 58(3): 428-434. Martin, G. R., Bradshaw, E. A. (2012). Sensitivity of pulse oximetry for detection of critical congenital heart defects in newborn infants higher than that of antenatal ultrasound with few false positives. Evidence Based Medicine, ebmed-2011. October, T., Watson, A., Hinds, P. S. (2013). Characteristics of Family Conferences at the Bedside Versus the Conference Room in Pediatric Critical Care*. Pediatric Critical Care Medicine, 14(3), e135-e142. Parsons, S., Fairclough, D. L., Wang, J., Hinds, P. S. (2012). Comparing longitudinal assessments of quality of life by patient and parent in newly diagnosed children with cancer: the value of both raters’ perspectives. Quality of Life Research, 21(5), 915-923. Pentz, R. D., Pelletier, W., Alderfer, M. A., Stegenga, K., Fairclough, D. L., Hinds, P. S. (2012). Shared decision-making in pediatric allogeneic blood and marrow transplantation: what if there is no decision to make? The Oncologist, 17(6), 881-885. Randhawa S. (2012). Using the Transtheoretical Model for outcome evaluation in continuing education. Journal of Continuing Education in Nursing, 43(4), 148. Raphel, S., & Sheehy, K. (2012). Chapter 29 Partnership for Success in Mental Health Policy. In Yearwood, E., Pearson, G., & Newland, J. (Eds.), Child & Adolescent Behavioral Health: A Resource for Advanced Practice Psychiatric and Primary Care Practitioners in Nursing. West Sussex, UK: Wiley-Blackwell. Reilly, B.K., Brandon, G., Shah, R., Preciado, D., Zalzal, G. (2012). The role of advanced practice providers in pediatric otolaryngology academic practices. International Journal of Pediatric Otorhinolaryngology, 77(1), 36-40. Stewart, J., Grimm, K. P., & Kelly, K. P. (2012). Making the Right Decision for My Child With Cancer: The Parental Imperative. Cancer Nursing, 35(6), 419-428. Wagner, L., Ukpabi, G., Keller, S. (2012). A unique partnership of occupational health nurses and librarians: Promoting employee health by walking the path of wellness together. Journal of the Association of Occupational Health Professionals in Healthcare, 28. Williams, P. D., Williams, A. R., Kelly, K. P., Dobos, C., Gieseking, A., Connor, R., Ridder, L., Potter, N., Del Favero, D. (2012). A Symptom Checklist for Children With Cancer: The Therapy-Related Symptom Checklist–Children. Cancer Nursing, 35(2), 89-98.
Children’s National
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2013 Nursing Annual Report
The 2013 Nursing Annual Report is published by the Department of Professional Nursing Practice. Children’s National Health System 111 Michigan Ave NW Washington, DC 20010-2970 www.ChildrensNational.org
Design Central, Inc. Graphic Design
Photo: Jessica Stafford, MSN, BSN, PNP, Hematology/Oncology/Bone Marrow Transplant Unit.
Copyright © 2014 by Children’s National Health System. All rights reserved. The bear logo, Dr. Bear, and Children’s National Health System are registered trademarks. The names of the other organizations within the Children’s National Health System are service marks of Children’s National Health System and/or its affiliates. Children’s is a member of the Children’s Miracle Network. Children’s National does not discriminate on any grounds prohibited by applicable law, including race, color, religion, age, sex, national origin or ancestry, sexual orientation, marital status, status as a disabled or Vietnam veteran or as a qualified disabled individual.
