AACN News—June 2008—Association News
Vol. 25, No. 6, JUNE 2008
2008 Is a Record-setting Year for NTI
For the first time in AACN history, attendance at the National Teaching Institute & Critical Care Exhibition last month topped 9,200—an outstanding accomplishment in any given year but a real coup for the inaugural NTI in Chicago.
Attendees packed General Sessions, educational courses, special events and the Critical Care Exposition during the conference May 3-8 at the new McCormick Place West. They networked, laughed a lot, made new friends, learned ways to enhance their practice, found new career opportunities and were inspired to confidently move forward in their personal and professional lives.
The experience laid the foundation for another
successful NTI May 16-21, 2009, in New Orleans, La.
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New AACN Web Site Makes Access to Resources Easier
Check out AACN’s redesigned Web site – www.aacn.org. We’ve taken our already rich content, added to it and reorganized it into packages that cater to both general and specialized interests.
The redesign is part of AACN’s ongoing efforts to put the high-quality resources you need at your fingertips – in the most accessible, easy-to-find format possible. This is a result of feedback from members and other visitors about ways to make the site easier to navigate and more user-friendly. Our goal is to enhance your ability to provide excellent care by providing access to timely information in a timely manner.
Now, content is organized by specific audience groups so that you can go directly to role-specific information. The updated navigation is more intuitive, requiring less of your valuable time to locate resources. Whether you are new to acute and critical care or experienced in our specialty, whether you are at the bedside or in a leadership role, we want to strengthen our connection with you in this and every other way possible.
As you explore this new Web site, please let us know what you think. We want to know what works better for you or how we can still improve this online experience to support the critical work you do every day.
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Scene and Heard
Our Voice in the Media
AJN Career Guide 2008 – “Finding the Job That’s Right for You” referenced the Beacon Award, including the standards of excellence categories. “Look for Magnet or Beacon facilities as you search for new positions. Organizations that have maintained their status demonstrate a commitment to excellence.”
Nurse.com (Jan. 14, 2008) – “Managing to Keep Patients Healthier.” “Nurses using disease management programs can help certain types of patients reduce hospital stays and costs, according to a recent study.” The article, titled “Chronically Critically Ill Patients: Health-Related Quality of Life and Resource Use After a Disease Management Intervention,” appeared in the September 2007 issue of American Journal of Critical Care.
Nursing Spectrum – D.C. (Jan. 14, 2008) – “Lighting the Way for ICUs: The American Association of Critical-Care Nurses announces its Beacon Award winners” dedicated a full page to the title with a picture of a lighthouse. Becky Pierce, RN, assistant administrator for patient care services at Harborview Medical, Seattle, said, “The components of what the application puts you through are positive. We’ve had a huge surge in the number of people that are certified in critical care as a result of this.” Kimberly Kotora, RN, head nurse manager, Medical ICU, University Hospitals Case Medical Center, Cleveland, said, “Applying for Beacon has been the ICU’s template for creating a healthy work environment and raising the bar every year.”
Medical News Today (Jan. 29, 2008) – “ACNM Supports Study of Effectiveness and Outcomes of Care of Advanced Practice Nursing.” This project will “produce an assessment or meta-analysis of existing research on care delivered by advanced practice nurses (APNs).” AACN is one of the nursing organizations contributing to this project.
Tradeshow Week (Jan. 28, 2008) – “IAEE Says No to Drugs.” “The Intl. Assn. of Exhibitions and Events has adopted a policy aimed at achieving drug-free workplaces in the exhibitions and events industry … When Randy Bauler, corporate relations and exhibits director for AACN, assumed the 2008 IAEE chairmanship at the Expo! Expo! in Las Vegas in December, he named as one of his top priorities raising awareness of this issue.”
Nursing News (Winter 2008) – “Notes from Joan” indicated that Charity Providence Hospitals in Columbia, S.C. has received a grant that “will provide the funds necessary to implement the AACN Synergy Model, a system that links clinical practice with patient outcomes … The two units that have been selected to pilot the Synergy Model are 6 Tower and 4 East. These changes will ultimately take place throughout the hospitals.”
NurseZone.com (Jan. 2008) – “Specialty Spotlight: All About Progressive Care/Telemetry Nursing.” Mary Pat Aust, RN, MS, AACN clinical practice specialist, was interviewed for this article. When asked what advice she would give a new graduate interested in telemetry nursing, she added, “I would also encourage them to join a professional organization such as AACN and take advantage of all the resources available through that organization.”
Kansas City Nursing News (Jan. 2, 2008) – “KU Hospital MICU Wins Beacon Award.” “The process is a really good self-evaluation of your unit, whether or not you get the award,” said Akiko Kubo, RN, BSN, unit educator of the MICU at the University of Kansas Hospital. “Tammy Peterman, COO, CNO, points to the impact of this award on nurse recruitment. Many potential hospital employees look for hospitals that have received Magnet designation and/or a Beacon Award. ‘There was a lot of excitement generated and a lot of pride to be able to tell friends and family members. I believe that, to be honored this way, is very humbling.’ ”
Nursing Economics (Jan. 1, 2008) – “The AACN Synergy Model for Patient Care: A Nursing Model as a Force of Magnetism.” “AACN’s Synergy Model for Patient Care describes nursing practice based on eight patient characteristics, and also describes eight nurse competencies … Synergy results when the needs and characteristics of the patient, clinical unit or system are matched with a nurse’s competencies … The Synergy Model is an excellent framework to organize the work of patient care throughout the healthcare system … It can be used in various ways and provides a comprehensive framework for assuring success in building a philosophy that supports the Forces of Magnetism.”
Our Voice at the Table
John Dixon, RN, MSN, former AACN board member, attended the ANA’s Congress on Nursing Practice and Economics as AACN’s organizational liaison. He also serves as co-chair of a task force charged with revising and updating ANA’s Social Policy Statement for Nursing.
Janice Wojcik, RN, MSN, CCRN, APRN-BC, AACN board member, presented “Healthy Work Environments: A Journey to Excellence” at the Delaware Nurses Association Spring Conference in Dover, Del. The conference focused on advocacy, research, leadership and peer review as foundational elements in a culture of nursing excellence.
Beth Martin, RN, MSN, CCNS, ACNP, AACN Certification Corporation chair-elect, presented “EOL Care in the ICU” for AACN’s Heart of the Piedmont Chapter in High Point, N.C.
Dave Hanson, RN, MSN, CCRN, CNS, AACN president, delivered the keynote address “Reclaiming Our Priorities” at the Mountain to Sound AACN Chapter Hot Topics in Critical Care Conference, in Renton, Wash. Hanson and chapter board members toured numerous nursing units at area hospitals to meet with staff nurses and nursing leaders to promote the Beacon Award for Critical Care Excellence.
Hanson gave the keynote, “Reclaiming Our Priorities,” at the South Bay Chapter Certification Celebration Dinner in San Jose, Calif. He also attended the Houston Gulf Coast Chapter’s 2008 Presidential Gala and kicked off the evening program with his “Reclaiming Our Priorities” keynote address.
Caryl Goodyear-Bruch, RN, PhD, AACN president-elect, attended the 34th Annual Midwest Conference, sponsored by the Northwest Chicago Area Chapter. She presented “Reclaiming Our Priorities: Assuring Safety With the Power of Nursing” as the keynote speech and a breakout session, “Assuring Accuracy in Hemodynamic Monitoring.” Former AACN board member Suzanne Burns, RN, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP, presented a mastery session on “Pulmonary Pearls,” and former AACN board member Tom Ahrens, RN, DNS, CCNS, CS, FAAN, spoke on “Moving Clinical Education Into the 21st Century” and “Advances in Hemodynamic Monitoring.” Beth Hammer, RN, MSN, APRN-BC, AACN board member, also attended, as well as Joy Speciale, RN, MBA, AACN/CCRN ambassador, and Jenny Zaker, RN, APRN, MEd, RN-C, who are both active on the NWCAC Board of Directors.
Dixon presented the keynote address at Clarian Health’s 21st Annual Cardiovascular Nursing Seminar in Indianapolis, Ind. His lecture, “Skilled Communication: Do You Hear What I Hear?” focused on Skilled Communication, the first HWE standard.
Dixon spoke at the preconference for the Odyssey on Critical Care Conference in Richmond, Va., sponsored by Virginia Commonwealth University Health System Education & Professional Development and the Greater Richmond Area Chapter of AACN. He presented “Assassins in the Workplace: Meet the Healthy Work Environment Standards” and “The Synergy Model: How to Make It Part of Your Daily Practice.”
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Submit Research and Creative Solutions Poster Abstracts for NTI 2009
Are you interested in sharing your findings from a clinical research study/project or the creative way in which you have successfully addressed clinical issues in your unit? Do you like to talk to your colleagues about ways they can incorporate evidence-based data into their practice? Do you like to connect with other colleagues who have the same research interests and/or clinical issues as you? Of course you do! Here is your chance to have an impact by sharing your knowledge and expertise with other acute and critical care nurses.
You are invited to submit an abstract to be considered for a poster presentation at the 36th annual National Teaching Institute & Critical Care Exposition, May 16-21, 2009 in New Orleans, La. Submissions are being accepted for consideration from July 1 to Oct. 1, 2008. Application guidelines and instructions are available on the AACN Web site; www.aacn.org > Conferences/Exhibits > Abstract Submission.
Once received, the poster abstracts go through a blind review and selection process. After the selections have been made, poster abstract submitters will be notified of the status of their abstract. Poster abstracts presenters receive a $75 reduction in NTI registration. One discount is available for each selected abstract.
From the selected research abstracts, four will receive the Research Abstract Award, which recognizes individuals whose abstracts reflect outstanding original work, replication research or research utilization. Award recipients will discuss their findings at an oral research presentation at NTI, and they also receive $1,500 toward NTI expenses.
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Membership Campaign Springs Forward in Apri
The month of April brought showers of new members to AACN through the latest Member-Get-A-Member campaign, “I Can Make a Difference.” During the month, 291 individuals and chapters recruited 711 new members for a total to date of 4,617 new members recruited by 1,031 individuals and chapters.
407 new members recruited by 163 individuals
304 new members recruited by 128 chapters
In individual recruiting for the month, perennial “member-getter” Ann Brorsen, RN, MSN, CCRN, CEN, of Sun City, Calif., led the way with 27 new members recruited. Also with good showings for the month were Lucille Hicks, RN, BS, CCRN, of St. Louis, Mo. (19); Lisamae Williams, RN, BS, BSN, CCRN, of Homestead, Fla. (13); Kathleen Richuso, RN, MSN, RN-BC, of Chapel Hill, N.C. and Crystal Logsdon, RN, MSN, CCRN, of Savannah, Ga. (11); and Lisa Markham, RN, ADN, of Piedmont, Mo. and Suzanne Rzeszutko-Heslop, RN, CCRN, TNS, of Alsip, Ill. (10).
Still in the campaign lead to date with 62 new members recruited is Lorraine Fields, RN, CNS, MSN, BSc, CCRN, CNRN, APN, of Uniontown, Ohio. In second place overall is Kathleen Richuso, RN, MSN, RN-BC, of Chapel Hill, N.C. with 39. Following close behind in third place is Mary Holtschneider, RN, BSN, MPA, RN-BC, of Durham, N.C. with 38.
In chapter recruiting for the month of April, the Greater Cincinnati Chapter was responsible for 15 new members joining the AACN family. This puts them into third place overall in the campaign with 49. In second place for the month with 14 was the Greater East Texas Chapter. With 12 members recruited in the month, the Houston Gulf Coast Chapter solidified its overall lead, which now stands at 89 new members recruited.
The “I Can Make a Difference” MGAM campaign began Sept. 1, 2007 and will continue through Aug. 31, 2008. Participation offers the opportunity for recruiters to receive valuable rewards, including a $1,500 American Express gift check that will be awarded to the top individual recruiter. Members who recruit more than 20 new members by campaign end will be entered into a random drawing for a $1,000 American Express gift check, those who recruit 10-19 new members by campaign end will be entered into a random drawing for a $750 American Express gift check, and anyone who recruits 1-9 new members by campaign end will be entered into a random drawing for a $500 American Express gift check.
After recruiting their first five new members, participants will receive a $25 gift certificate toward AACN products and services, and $50 after recruiting a total of 10 new members.
In addition, individuals who recruit at least one new member in a campaign month will be entered into a drawing for a $100 American Express gift check. Kathleen Richuso, RN, MSN, RN-BC, of Chapel Hill, N.C. won the gift check for April.
The overall top-recruiting chapter by campaign end will be awarded a $1,500 honorarium check toward the chapter treasury. Recruiting chapters will also be entered into a random drawing at campaign end for an honorarium check toward their chapter treasury: If they recruit more than 20 new members by campaign end, chapters are eligible for a $1,000 honorarium check, 10-19 new members recruited by campaign end, they are eligible for a $750 honorarium check, and with 1-9 new members recruited by campaign end, chapters are eligible for a $500 honorarium check.
In addition, chapters are eligible for monthly drawings for a free NTI registration any month they recruit a new member. The winner for April was the First Coast Chapter in Jacksonville. Fla.
To see the full list of recruiters and their totals visit the AACN Web site at www.aacn.org > Membership.
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Members on the Move
Chris Angelucci, RN, CCRN, RRT, BSHA, was named district clinical specialist for KCI – Therapeutic Support Systems, Southeast U.S. territory.
Giuseppina (Pina) Violano, MS, RN-BC, CCRN, accepted a position as injury prevention coordinator at Yale-New Haven (Conn.) Hospital’s Trauma, Surgical Critical Care & Surgical Emergencies Department. She is also a recipient of the “20 Noteworthy Women Award” from the New Haven Business Times.
Patricia Bradshaw, RN, MS, CEN, CCRN, CCNS, Major, United States Air Force, was selected for promotion to the rank of lieutenant colonel two years early. She was also chosen to pursue Air Force-sponsored, full-time PhD nursing studies beginning in Fall 2008.
Brant Russell, RN, MSN, MBA, is the new system director of Emergency & Trauma Services at Summa Health System, Ohio.
Debra Douglas, RN, MSN, CNA, was appointed chief nursing officer/senior vice president for patient services at Our Lady of Fatima Hospital, a division of St. Joseph Health Services of Rhode Island.
Paul Read, RN, was promoted to vice president and will continue in his role of chief nursing executive at Springhill Medical Center, Mobile, Ala.
Hollynn Lobsiger, RN, ADN, was appointed manager of the progressive care unit at the Heart Center, St. Francis Hospital & Health Centers, Ind.
Lynne LaCourse, RN, ADN, AA, was promoted to director of the surgical unit and infection control at St. Cloud Regional Medical Center, St. Cloud, Fla.
Marguerite Rodgers Kinney, RN, DNSc, was inducted into the Alabama Nursing Hall of Fame. At a dinner in her honor, she was praised for her accomplishments as a nurse educator and for her leadership at AACN.
Susan K.B. Jones, RN, CNS, MS, CCRN, CCNS, received the 2007 Clinical Nurse Specialist of the Year Award from the National Association of Clinical Nurse Specialists.
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Monthly Super Savers
AACN’s monthly Super Savers offer you specific catalog resources at discounted prices. The following Super Saver prices are valid through July 31, 2008. All orders must be postmarked by July 31 to be eligible for the Super Saver price. Check this column monthly for additional values that will enhance your nursing practice.
Influencer...The Power to Change Anything (#120650)
From the best-selling authors who taught the world how to have crucial conversations comes “Influencer,” a thought-provoking book that combines the remarkable insights of behavioral scientists and business leaders with the astonishing stories of high-powered influencers from all walks of life. You'll be taught each and every step of the influence process – including robust strategies for making change inevitable in your personal life, your professional life and your world.
Regular Price: Member $23.70, Nonmember $24.95
Super Saver Price: Member $20.50, Nonmember $22.50
What You Accept is What You Teach (#128664)
“What You Accept is What You Teach” is the perfect “how-to” guide for navigating the maze of challenging employee communication and performance problems. It is an excellent resource for developing a healthy culture of accountability and improved employee performance.
Regular Price: Member $15.20, Nonmember $16.00
Super Saver Price: Member $12.95, Nonmember $14.50
Relationship-Based Care Field Guide (#130602)
Written as a field guide, this book will inspire those who are working on the critical relationships that deliver superior care. “Relationship-Based Care Field Guide” gives readers a sense of what it’s like to be part of an organization that never stops evolving. Long after relationship-based care is alive and thriving in your organization, it will continue to grow and change. This book is an essential resource, no matter where you are in your professional journey.
Regular Price: Member $94.05, Nonmember $99
Super Saver Price: Member $86.50, Nonmember $93
AACN Advanced Critical Care Nursing:
A Comprehensive Resource for Advanced Practice Nurses
The new “AACN Advanced Critical Care Nursing,” edited by Karen K. Carlson, provides an in-depth, evidence-based reference to enhance your advanced practice. This valuable resource offers beyond-the-basics information to help you sharpen and maintain your critical thinking skills, accurately interpret monitoring and support devices, and plan appropriate, evidence-based interventions.
• Specific, detailed guidance for critical care
• Evidence-based knowledge to support best practices
• Time-saving, at-a-glance features
• Multidisciplinary plans of care
• Complex, unfolding case studies
Order your copy (Product #128250) today from AACN’s Online Bookstore. (Price: Member $94.05, Nonmember $99.95)
Place your order today1www.aacn.org/bookstore
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AACN Members Share Insight at Annual Forum
AACN celebrated a year of successes as members gathered for the annual AACN Membership Open Forum during NTI 2008 in Chicago last month. For the second year, the meeting followed a small group discussion format in which attendees responded to a set of questions:
• What does AACN do best to support you in your professional work?
• What can AACN do differently to better support you professionally?
• If AACN could do one thing to delight you as a member, what would it be?
AACN President Dave Hanson stressed that feedback to questions such as these are central in shaping the association’s future and helping AACN to continue to provide the resources acute and critical care nurses need to deliver safe, quality care to patients and patients’ families.
Before the discussion got under way, Hanson briefly outlined the accomplishments of the past year, including the granting of unlimited free CE credits for AACN members. Other accomplishments were highlighted in a printed handout distributed to attendees. Included was the launch of a redesigned AACN Web site, one of the areas cited most by members at last year’s forum with respect to what they would like to see improved.
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Is Your Unit a Beacon of Excellence?
The AACN Beacon Award for Critical Care Excellence shines national recognition on units that attain high standards for quality, exceptional care of patients, and healthy, humane and healing work environments.
The Web-based application process asks you to evaluate your critical care unit in six areas:
• Recruitment and retention
• Education, training and mentoring
• Evidence-based practices
• Patient outcomes
• Healing environments
• Leadership and organizational ethics
Applications, which may be submitted at any time, are evaluated on a quarterly basis. Awards are granted twice a year. The application fee is $1,000 per unit.
For more information, visit the AACN Web site at www.aacn.org
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2007 AACN Excellent Nurse Manager Award
Celeste R. Perrin, RN, BSN
Sentara Norfolk General Hospital, Norfolk, VA
The staff in the CCU at Sentara Norfolk General Hospital admitted a 76-year-old gentleman we will call Mr. W. He had bypass surgery and was admitted to the CCU for the third time in his postoperative course, due to congestive heart failure and respiratory arrest. He was intubated, on a ventilator, very confused and combative.
Mr. W was well known to the staff and within three days, had been extubated. The surgeon insisted Mr. W remain in the CCU despite his near readiness to be transferred. Celeste knew the astute assessment skills of her staff, and their attentiveness to Mr. W.’s respiratory care helped him remain free from congestive heart failure and pulmonary edema. She knew we needed to help him become stronger by getting him moving so he could begin to tolerate position changes, increase overall strength and remain extubated.
Celeste empowered the multidisciplinary team in the CCU to devise a plan of care with the physician to assist Mr. W. to remain in the ICU for the time he needed to become stronger and prevent another readmission to the ICU. She collaborated with both the step-down unit manager and other ICU managers to plan a method for us to handle other ICU admissions and allow Mr. W. to remain in the CCU until he was physically able to tolerate the move to the step-down unit.
In conclusion, Celeste has created an environment of professionalism in the CCU. She has encouraged collaborative problem solving not only with her ICU staff, but also with the multidisciplinary team that includes respiratory therapy, pharmacy, nutrition, physical therapy, pastoral care, physician and step-down staff. She has been a transformational leader by empowering staff to communicate clearly and be accountable for solving problems. Finally, she has addressed obstacles to success and seen them as opportunities to make better outcomes happen.
Robyn L. Bushinski, RN, BA, PHN, MA
University of Minnesota Medical Center-Fairview, Saint Paul, MN
I am surrounded by extraordinary individuals who are as committed and passionate about providing the very best care to patients and their families as I am … we share this vision of excellence. This commitment and passion ties us together with challenges and dynamic change in a complex environment.
My role in providing support and leadership in this MICU was recently quoted by my longtime friend and mentor, Ann Gengler, as: “She has the innate ability to inspire, challenge and provide the support needed to allow individuals to do their best.” Additionally, “she is dedicated to helping her staff and unit develop by encouraging focus on individuals’ strengths and how they complement others’ strengths.”
I believe nurse managers must help people recognize their own talents. We are not as aware of our abilities as we should be. To do what we are capable of, we must be aware of our abilities. Only then will we be able to do what we are truly capable of … and that can be incredibly empowering!
Understanding the MICU and making time to strategize is one of the challenges that I have become capable of. Determining what has been important to staff – historically, today and in the future – continues to inform my decisions. I have involved staff in more decisions over time … they have become capable in this regard as well. Eliciting their ideas and sharing the links that I see have enabled staff to build upon their perspectives and engage each other in that same dialogue toward informed decision making. The team building and support for thoughtful decisions has engaged staff to a significant level. This engagement can be seen in the true dedication to serving our patient population that I see from staff day-after-day. They are the true inspiration!
Cheryl Johnson Smith, MS, RN
Integris Baptist Medical Center, Oklahoma City, OK
Cheryl Smith is the clinical director for the transplant ICU at Integris Baptist Medical Center. The unit motto is, “Our patients come first,” and our goal is to provide outstanding care to patients and families. To do this, Cheryl incorporates staff input into every avenue. We are encouraged to write down suggestions for change and improvement. Cheryl takes these suggestions to the appropriate committee for review. She has supported the staff to become involved in committees throughout the hospital. These staff members become the communication conduit between our unit and other areas of the hospital.
Cheryl was instrumental in establishing the Evidence Based Practice and Research Council at our hospital. She challenges staff to question practice and provides resources for them to find the answers.
Cheryl has an open door policy with the staff, her colleagues, patients and families. She often asks our staff about their career goals to gain insight into how to best mentor and grow our staff. She believes that her job is to help staff find their niche in nursing, even if that results in them moving into positions in other clinical departments.
As chair of the Integris Baptist Magnet Steering Committee, Cheryl is in charge of the hospital’s drive for Magnet recognition. She often asks staff to consider how they contribute to making our unit and hospital a great place to work.
Cheryl adamantly believes that her job is to take care of the staff so that they may take care of the patients. She says the bedside nurses are the experts and that she is there to support them in their jobs. The day-to-day activities involved with running a unit can often be overwhelming. Cheryl has a way of making it seem easy, and she is always there to lend a helping hand.
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2007 AACN Community Service Award
Intensive Care Unit
Riverside Methodist Hospital, Columbus, OH
• Provided needy families of patients donated personal care items and clothing
• Provided school supplies for underprivileged children
• Participated in citywide events such as Project Feed, Multiple Sclerosis Walk and UW Community Care Day
• Donated items to the Riverside Sewing Guild such as baby blankets and grief blankets
• Adopted both children and elderly at Christmas time; this year they adopted the United Methodist Children’s Home as well as 11 residents of a local nursing home. They also provided a Christmas party, toys and games for the children of the Marsh Run Apartments.
• Raised enough money for a patient and his family (victims of Hurricane Katrina) to outfit an apartment. This family will always remember how this caring staff reached out to them in their time of need. In a thank you note, the family wrote, “It’s people like you who renew our faith in humanity.”
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2007 AACN Media Award
Organ Donor Council
Clarian Health Partners Methodist Hospital, Indianapolis, IN
Our institution’s Organ Donor Council began in September 2004. We had four key objectives: to increase organ donation, to increase staff knowledge of organ donation, to avoid and prevent missed opportunities for organ donation, and to create an atmosphere of making things work out for potential donor families and the intended recipients.
The council’s goal was to produce a video to communicate our message. We wanted our colleagues and co-workers to talk about how organ donation had touched their lives, to promote increased communication and accountability across the system, to promote the early referral process and to change the culture across the hospital. We needed to partner with an expert for a project such as this! We contacted the Informatics Department at a university in the metropolitan area to inquire about whether someone would be interested in designing, directing and producing the video. Three students and their professor teamed with the Donor Council to make our team’s vision a reality.
“Your Name is Miracle” was first shown in January 2006 to more than 150 healthcare workers from across Indiana. In addition, the video has been shown to various groups at our institution; key concepts are discussed in nursing orientation; and it is available on our intranet and the institution’s Web page.
The relationship between the Indiana Organ Procurement Organization (IOPO) and our institution has been enhanced tremendously; other hospitals and the lay public have shared the impact the video’s message has had on them; and a missed referral is no longer viewed as a failure but as an opportunity for improvement. Allowing families to make informed decisions for organ donation in a nonthreatening environment has become our major objective. The “Your Name is Miracle” video continues to assist us on our journey to eradicate the wait anyone has for a life-saving organ.
Marketing and Communications Department
University of Virginia Health System, Charlottesville, VA
The University of Virginia (UVA) Health System, a Magnet hospital, is recognized as one of the nation’s top hospitals and a leader among academic medical centers. This reputation is built by the UVA staff with their commitment to care, healing and building a better future. An impressive corporate communications campaign was launched in 2006 to celebrate the unique and valuable contributions made by the nurses of UVA and to honor the important role of each hospital employee. The publicity campaign involved two core messages: “We recognize our Everday Heroes: the Nurses of UVA” and “Leading the Way with ….” Content development was guided by a strategic partnership between the leaders of Marketing and Nursing. Nurses featured in the campaign represented a variety of clinical settings, ages, gender, tenure, ethnicities, community contributions and backgrounds. Nurses were supported with time away from their clinical responsibilities for the photo shoots. Candid photos reflected the personalities of featured employees. A stealth installation of 14 large banners, suspended from lobby ceilings, and 195 mounted hallway placards took place on a weekend to launch the 2006 Week of the Nurse and National Hospital Week. A slide show of the campaign images was displayed on large, flat-screen TVs in hospital cafeterias and on the UVA Health System Intranet. The campaign also included radio spots, newspaper ads, features in professional and lay journals and, most surprising, large placards on city buses! This campaign has resulted in a boost in morale and employee conviviality. Its success was born in the effective working relationship established by Nursing and Marketing.
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2007 AACN Mentoring Award
Gwendolyn Smith, RN, MSN
The Medical Center of Central Georgia, Macon, GA
There are few nurses who will end their careers and touch as many lives as Gwen Smith. Gwen has been a nurse for almost 30 years, transitioning from staff nurse to director of the Critical Care Center. At our hospital alone, there are 16 nurses in leadership roles as a direct result of her mentoring abilities, including nurse directors, educators, vice presidents, organizational leaders, professors of nursing and advanced practice nurses. Gwen embodies what it means to be a mentor; she holds you accountable, she encourages, she gives advice and support, she helps you to see your vision, she celebrates your achievements and, most of all, she leads by example.
Gwen was my preceptor when I was a new graduate 24 years ago. I remember being nervous and afraid, but Gwen put me at ease. I thought Gwen was brilliant and I wanted to be as smart and as good as she. Twenty years later, as the new director of the PICU, I asked Gwen to mentor me again. Gwen provided me with budget guidance and help in handling difficult physician and staff issues. Gwen also helped with a tough ethical situation in the PICU. She attended the family conference, listened to the concerns of the PICU staff and desires of the family, and provided a neutral viewpoint. Her presence and guidance were helpful and reassuring to all parties involved.
During our Nurse Week Celebration, in a packed auditorium, Gwen was named outstanding mentor, receiving a standing ovation. In her humble spirit, she was completely taken by surprise. She said she just wanted to make a difference and had no idea that she was impacting her peers in this way. Gwen is a shining example of what is good and right. I can’t think of anyone else who exemplifies mentoring more than Gwen.
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2007 AACN Excellence in Leadership Award
Deborah B. Hobson, BSN
Johns Hopkins Hospital, Baltimore, MD
For the past 26 years, I have worked in the surgical ICU at Johns Hopkins Hospital. My first safety project involved the elimination of catheter-related bloodstream infections (BSI). Taking care of an acute septic patient, I realized I wanted to improve the quality of care our patients receive. In reviewing the evidence for best practice, we started with good hand-washing, sterile barrier precautions and use of chlorhexidine prep. I designed the “line cart,” which contains all supplies needed to maintain central-line placement compliance. Development of a care team checklist empowers nurses to ensure all safety initiatives are observed. Implementation of these safety initiatives has decreased our BSI rates from 19.7/catheter days to 0/catheter days (the SICU has not had a catheter-related BSI in the past 19 months). We call this our CR-BSI Bundle, which is now being used by other healthcare providers nationally as well as internationally. Being known as “the change agent” for the SICU, I have led the following projects: Medication Reconciliation, Ventilator Bundle, Tight Glucose Control, DVT Prevention, Surgical Site Infection, Heparin Protocol and Sepsis Bundle.
Leading these ongoing safety initiatives has challenged me as a bedside nurse to continue to seek opportunities for improved patient care. Despite the risk of introducing new concepts to staff members, the success of my outcomes continues to keep me motivated. I am now the project manager for several safety collaboratives throughout the hospital and look forward to providing the best for every patient who passes through Johns Hopkins Hospital. When I started my nursing career, my perception was to take care of patients. However, now with my nursing experience, my goal is to provide every patient in every hospital the care they deserve. I truly believe that one person can make a difference!
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2007 Datascope-AACN Excellence in Collaboration Multidisciplinary Award
Surgical Intensive Care Unit
Rochester General Hospital, Rochester, NY
Our multidisciplinary team was greatly inspired by the widely published, evidence-based research that spoke to the need for multiprofessional teams that addressed patient safety on a consistent basis. The surgical intensive care unit at Rochester General Hospital multidisciplinary team consists of an intensivist, a midlevel staff of physician assistants, nurse manager, nursing staff, clinical resource educator, pharmacist, dietician, respiratory therapy, social work and pastoral care. Our team has used a unique collaborative approach to ensuring excellence in care, a healthy work environment and, ultimately, improved patient outcomes. We did so by creating a “Daily Patient Care Goals” sheet that used a consistent formal process to address many of the patient safety concepts. The development of the goal sheet was in line with some of the IHI 100K Lives campaign strategies, which relied heavily on evidence-based practice. Specifically, the goal sheet addresses many of the high-risk clinical concerns, including central line infection, deep vein thrombosis and gastric GI ulcer prophylaxis, ventilator-associated pneumonia and hyperglycemia.
With the enhanced environment of safety, came a cascade of benefits for patients and staff, creating a culture of collegiality and excellence in care. The use of the patient-care goal sheet has reaffirmed a deep commitment to improving the care of our patients in the SICU. With the aid of our patient-care goal sheet, our multidisciplinary teams believe that we have provided the highest quality of care and created an environment steeped in excellence and improved patient outcomes.
Rapid Response Team
University of Kentucky Hospital, Lexington, KY
In November 2004, the University of Kentucky SWAT team (a nursing resource team) was approached to rethink its mission and develop a rapid response model. After reviewing data from the UHC Failure to Rescue benchmarking project and IHI’s Saving 100,000 Lives Campaign, we began to formulate a vision. Our team of eight critical care nurses quickly identified the need to recognize the early signs of clinical decline. Representatives from other disciplines joined our team and together, we developed appropriate ways to intervene. We proactively rounded on patients at high risk of decline and those transferring out of the ICU. We designed an educational plan that identified our goals for the acute care staff and physicians, including early warning signs of decline and the SBAR technique. SBAR is a tool used for communicating patient information among healthcare teams. Our project went live in February 2005. Since then, our acute care cardiac arrests have decreased by 15%. We make rounds on approximately 350 ICU transfers and high-acuity floor patients each month. We are also called to assess between 75 and 100 patients who are declining clinically, approximately 45% of whom remain in the acute care setting with RRT intervention.
We continue to gather data on all patients we see to help create a predictive model for patient decline. From this, we hope to develop protocols and increase process improvement. In a recent survey of nurses and physicians, RRT had a greater than 90% satisfaction rate.
The University of Kentucky RRT has been very successful. We attribute our success to the overwhelming support of our administrative leaders and colleagues. The Datascope Excellence in Multidisciplinary Team Collaboration Award embodies all the values and goals that our team has strived for and succeed in achieving.
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2007 Datascope-AACN Excellence in
Collaboration Nurse to Administration Award
Critical Care Team
Doctors Hospital Ohio Health, Columbus, OH
During 2005, the critical care team faced many challenges, including participating in the OhioHealth Critical Care Fellowship Program and implementing a bar code medication administration system, an intensivist program and an eICU. These efforts were impeded by a 24% RN turnover. Additionally, the unit was a site for preceptor-guided experiences, though graduates consistently selected other sites for permanent placement.
Our dedicated nurses were not willing to accept this as status quo and enlisted Human Resources to conduct focus groups and evaluate the annual employee opinion survey to determine the root causes of the increased turnover. They learned that floating to cover shortages on other units was a major source of dissatisfaction.
The team members developed a request for a “closed ICU” with voluntary floating. They developed measurable goals and indicators of success to assure a win-win for staff and the organization by establishing baseline measures for quality of worklife and financial performance, a trial period and evaluating results. Since the initial pilot, some changes have been made to include floating to step-down units only, with staff contributing to orientation plans and ongoing dialogue to improve both the staff and patient experience.
This engaged staff was also willing to demonstrate the value of their model in measurable terms. The results included a reduction in turnover from 24% to 3.7%, a cost saving of $500,000 per year, and a decrease in agency utilization from 18% of hours worked to only 2%, saving $50,000 per year. On the annual employee opinion survey job satisfaction was 18% favorable to the nation, and peer work relationships were 20% favorable. Physician satisfaction with nursing care improved from the 67th to the 87th percentile on a national survey in March 2006, and inpatient patient satisfaction with nursing care is at the 97th percentile in the Press Ganey database.
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2007 Datascope-AACN Excellence in
Collaboration Nurse to Family Award
Medical Respiratory Intensive Care Unit
St. Luke’s Medical Center, Milwaukee, WI
This award demonstrates what it means to be a team and what it takes to pull together to provide excellent nursing care. The medical respiratory ICU (MRICU) is always striving to provide top quality and best-practice nursing care.
In attempt to save a patient’s life, we all assume roles without delegation. In addition to working toward saving a patient’s life, we are providing coping support to our families. This is a very emotional and terrifying time for our family members. We believe in promoting a sense of security to our family members by assuring them that we are doing everything possible. We also encourage their presence so they are able to see everything that is being done to save their loved one’s life. This provides a sense of peace and comfort in the end-of-life experience.
In the MRICU, we provide care to a variety of medical and surgical patients. We encourage primary nursing to ensure that the best care possible is delivered and received. It is imperative that we keep an open line of communication among nurses, MDs, family, and other disciplines involved in our patient care. We take part in daily Outcome Facilitation Team meetings where we meet with all disciplines and discuss the medical, social and emotional aspects of our patients to collaborate and individualize patient care.
The MRICU is well respected and known for its excellent nursing care. It is through collaboration, compassion, teamwork and education that we have set such high nursing standards in our unit. We strive to deliver top-quality nursing care.
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2007 Excellence in Clinical Practice/Non-Traditional Setting Award
Billy J. Gilliland, ASN, RN
Princeton Baptist Medical Center, Birmingham, AL
As a young adult, I left rural Alabama and saw the world through travel experiences as a Navy corpsman. These experiences taught me that people, regardless of their culture, ethnicity or geographic location, need the interventions and insights of caring nurses. One of the purposes of my life has been to lead efforts to improve the health of my community, region and the world. This aim has been pursued through the support of my family, hospital, church and the local AACN chapter.
My daily efforts are focused locally. As an outreach of our church, I manage a food bank. I also volunteer to perform health screenings and evaluations at Drummond Coal Mines. My acute care facility is located in a distressed urban neighborhood. The managers of our acute care facility contribute through construction work, serving as readers and resources to the local schools, and lobbying for healthcare access for the uninsured. My local AACN chapter helps our schools in this area by obtaining supplies like toothbrushes, Band-Aids, over-the-counter medicines and small Christmas presents for the school nurse to distribute.
At the regional level, I am in a group that takes a healthcare van to the Black Belt of Alabama. This outreach uses rural churches so that patients without access to care or financial resources can have their wounds cleaned and evaluated, education relevant to prevention of hypertension and diabetes, and health screenings.
My community also encompasses the world. I have traveled to Africa and Central America as part of a medical mission’s team. The needs there are basic; however, by providing nutrition and simple medical care, these communities are able to continue their existence. My time in these regions has opened my eyes to populations that have so little but are grateful and gracious.
Lynne Nevers-Hoeft, RN, BSN, CCRN
Aurora St. Luke’s Medical Center, Milwaukee, WI
Critical care has expanded beyond the traditional setting, thus requiring critical care nurses to work in nontraditional areas such as emergency rooms, catheter labs, operating rooms and even home healthcare. However, another area of nursing practice utilizes critical care nurses to provide uninterrupted care along the continuum in an effort to improve patient care outcomes. This area is hyperbaric medicine.
For those not familiar with hyperbaric medicine, hyperbaric oxygen (HBO) is used to treat a variety of critical illnesses such as arterial gas embolism, carbon monoxide poisoning, gas gangrene, necrotizing fasciitis and acute arterial insufficiency/crush injuries. These patients are often intubated, have numerous lines including arterial, Swan and central, and may require ongoing fluid resuscitation and inotropic support. This “ICU” is in a confined area, separated from the outside world by 6 inches of steel. The patient receives 100% oxygen while in a pressurized environment to assist with treatment of the illness. The goal is for the patient to receive uninterrupted care while meeting the standards of the ICU and HBO. Therefore, the nurse must demonstrate competence in both areas.
Scott, a 34-year-old healthy male, developed a rapidly spreading necrotizing fasciitis in his L-chest (B-hemolytic Strep). As the on-call RN for HBO, I was called in to dive with Scott his first time. He was very ill and in need of a great deal of coordination for HBO, medical and nursing care. His intensivist, the HBO team and I worked together to coordinate his care. I treated Scott many times in HBO and provided both physical care and psychological support to him and his family in the medical-respiratory ICU where I have been employed full time for 28 years.
Scott did survive and recovered after many reconstructive surgeries and returned to his same active lifestyle.
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2007 Datascope-AACN Excellence in Collaboration Nurse to Physician Award
Intensive Care Unit
Kaiser Sunnyside Medical Center, Clackamas, OR
In my seven years as a CCNS in my current unit, I have experienced the best nurse-physician collaborative partnership of my career.
The development of our Mild Therapeutic Hypothermia for patients following cardiac arrest is an example. Research was presented to our nurses that mild hypothermia following cardiac arrest improved neurological outcome. The medical director and I presented this to the nursing partnership council, and they supported the concept. The medical director and I developed a procedure, guidelines, order sets and quick-start directions. We partnered to educate the ICU and ED nursing staffs, cardiology, ICU and ED physicians, and internists/hospitalists. We implemented our program as the AHA added recommendations to resuscitation guidelines for this therapy.
Maintaining patients at 33 degrees centigrade was difficult; however, nursing continues to champion the program. They have seen surprising outcomes and aggressively identify potential candidates and advocate for this therapy.
We have worked together to streamline the process. The medical director and I tracked outcomes and presented at the citywide critical care conference. This program was the first in the city, and we have shared our experience locally and nationally. Many hospitals in our region now have a similar program. Many patients we treated do not receive care in our system. We carefully explained to families this strange treatment. Patients and families have expressed gratitude for this novel therapy. Nursing staff satisfaction is high. The support tools make the process easier, and it is rewarding to be able to do something beneficial to improve neurological outcomes instead of waiting for patients to wake up.
We have worked on many projects and initiatives with the same spirit of collaboration. Our nursing and physician staff finds this relationship rewarding and beneficial to patient outcomes.
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2007 3M Health Care AACN Excellence in Clinical Practice Award
Alana J. Coleman, RN, BSN, CCRN
Children’s Hospital of Pittsburgh, Pittsburgh, PA
I have been a neonatal intensive care nurse for seven years. During that time, I have cared for many critically ill infants diagnosed with congenital diaphragmatic hernia (CDH). There was, however, one particular infant that challenged my perspective and impacted my nursing career.
When the infant was admitted, his father informed me upon admission that his son was going to die. He had researched CDH and discovered a physician with the highest published success rate. Unfortunately, the physician lived thousands of miles away. Days later the father’s declaration proved true.
Devastated by a sense of loss, I decided to research and contact the physician about whom the father had boasted. I then initiated meetings with the directors of neonatology and pediatric surgery at my hospital. In preparation for these meetings, I educated and armed myself with as much knowledge as I could about the physician’s entailed gentle ventilation, permissive hypercapnea and delayed surgery approach. I researched and dissected pieces of innovative information on this evidence-based approach from all over the U.S., Canada and Sweden, and became even more convinced of its success. My hard work paid off. I was able to convince the directors that our existing CDH protocol needed updating. I was granted a quality improvement project regarding CDH patients treated at our institution. It involved collecting, assessing, organizing and dissecting various data representing these patients. Months later, I presented the results to a group of professionals from neonatology and surgery. The presentation was successful, and there was a synchronized agreement to change the protocol.
A multidisciplinary team of intensive care professionals formed to officially change the protocol. After an informative lecture from the grandfather of gentle ventilation himself and countless meetings, our new protocol emerged.
Today, I continue to monitor, assess, teach and evaluate this protocol. More importantly, I continue to witness its rising success.
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2007 AACN Excellence in Caring Practices Award in Honor of John Wilson Rodgers
Norine O’Malley-Simmler, RN, BSN
Massachusetts General Hospital, Boston, MA
An hour before Mrs. T.’s life support was to be withdrawn, I entered her room to find an emotional scenario. Her family was begging her for guidance about what she wanted to do. As I approached Mrs. T., I took a deep breath and slowly explained what a tracheostomy would involve and what removing the endotracheal tube would mean. I explained that, if she chose to remove the endotracheal tube, I would do everything I could to make her comfortable. She mouthed the words to me, “I need more time, I need more time.” Mrs. T was not ready to leave her family.
On December 23, after careful planning, our team placed Mrs. T. on a stretcher to begin her last journey home. I had the privilege of accompanying her, at her request. Upon arrival, her daughter and grandson greeted her. We placed her in her own bed, surrounded by holiday decorations and her favorite things.
Each family member went into Mrs. T.’s room to spend time with her during her last few hours at home. Mr. T. lay down with her and read her a poem he had written. Her Dalmatian licked her face, and her cat curled up next to her. Mrs. T.’s grandson kissed her on the cheek. Then she shared some private moments with her daughter.
After two hours, it was time to return to the hospital. I knew Mrs. T. had needed this time to spend at home with her family and pets. As I was leaving, she looked up at me the same way she had when she indicated she needed more time and said, “Thank you.” Mrs. T. was ready. She passed away peacefully the following day, on Christmas Eve.
Michelle Chapman, RN
Mission Hospital Regional Medical Center, Mission Viejo, CA
SF, a single healthy mother of an 8-year-old boy, arrived at our hospital with a fatal aneurysm. She quickly progressed to brain death. I notified her parents, and then spent the next few hours caring for SF.
Before meeting SF’s family, I drew in a deep breath and asked God for support. The first person to catch my attention was a strong, elderly gentlemen holding tightly to a tiny hand. I introduced myself as SF’s nurse. Matthew, SF’s son, immediately wanted to know if his “mommy” was still sleeping. I explained that she looked like she was asleep and may look different because she was hooked up to a lot of tubes.
Matthew looked concerned, but not frightened. Once at her bedside, I realized how unaware he was of the gravity of the situation.
Later, with the support of family and staff, Matthew received the news of his mother’s death. Matthew told his grandmother that he wanted to see his “mommy” again. Upon entering SF’s room, Matthew immediately approached the bed. He then turned to me and asked if he could get in bed with his “mommy.” I did not try to hide my tears as I placed him next to her. It took Matthew only a few short minutes to find that familiar place between his mother’s neck and shoulder in which to lay his head.
Matthew left the hospital that day without his mother, but instead with a Teddy bear with an attached ribbon that secured a lock of his mother’s hair. I left that day with the perspective that only those who work on the other side of the automatic swinging doors can fully embrace. This was yet another day in the life of a nurse.
Laura Stephens, RN
The Medical Center of Central Georgia, Macon, GA
Patient advocacy is at the core of Laura Stephen’s practice. Mr. D. experienced extensive spinal trauma from an accident in his home. Despite interventions, Mr. D. experienced complication after complication. Laura developed a strong bond with the patient’s wife. As the patient’s outlook became more dismal, Laura honestly explained to the wife clinical signs and symptoms indicating that interventions were no longer working. The wife began to rely on Laura for her support and explanations. Laura also explained options as the patient approached the end of his life. Laura encouraged the family to consider what they knew the patient would want. Ultimately, the family decided to change Mr. D.’s code status. Laura advocated for the code status change with the physician who was initially reluctant, as he believed that the patient might still have “a chance.” Laura was patient but persistent in explaining why the family desired the status change.
As Mr. D.’s condition continued to deteriorate, the family decided to move to a palliative focus of care. Laura again advocated for Mr. D. and family with the physicians. The family decided to discontinue mechanical ventilation and other supportive treatment. The wife was emotional and felt she was unable to stay at the patient’s bedside; however, she did not want Mr. D. to be alone. The entire family asked Laura to stay with Mr. D. as he passed. Even though Laura was not assigned to Mr. D. that day, she held Mr. D.’s hand as he passed away.
The staff of the neuro ICU was thanked in Mr. D.’s obituary for excellence during his hospitalization. But, Laura was mentioned by name! This was a special tribute to a nurse who took the time to show caring and compassion to a patient and family in crisis.
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2007 Baxter-AACN Excellence in Patient Safety Award
IV Drips Safety Team
University of Pittsburgh Medical Center Presbyterian, Pittsburgh, PA
A standardized concentration infusion list developed in 1990 to minimize concentration differences, define maximum concentrations and provide safe dosages had grown to 45 drugs. However, over a 13-month period, nine adverse drug events (ADEs) involving concentration changes were reported at the University of Pittsburgh Medical Center-Presbyterian, a tertiary-care center (136 ICU beds) with a diverse patient population, multiple levels of care and varying needs. To address this issue, an interdisciplinary group was assembled to reduce ADEs related to drug infusion concentrations.
The group split into two teams to facilitate work. A developmental team (pharmacists and physicians) reviewed ADEs, revised the list to reflect best practice and facilitated approval from safety and QI committees. An implementation team (nursing, pharmacy and information specialists) approved the drug list, provided education and facilitated implementation.
Audits of current practice by the developmental team revealed: 1) moderate compliance with the standard list and frequent use of multiple “standard” concentrations, 2) increased medication errors after “requested” concentration changes secondary to failure to adjust infusion rates and 3) problems related to order changes and lack of communicating the changes. Redesign included reducing: 1) the ability to have multiple “standard” concentrations for the same drug (16 to two) and 2) inability to change concentrations without physician order.
The implementation team created teaching tools, updated online resources and educated staff. New infusion concentrations and lists were dispensed on the go-live date, and team members rounded to provide support and reduce error potential during the 72-hour implementation period.
Prescribing compliance with standard concentrations improved from 55% to 95% and ADEs related to drip concentrations were eliminated. Our team is confident that application of these practice changes will result in sustained safety and quality care for our patients. Further, the standard list has been adopted at our five electronic-health-record-affiliated hospitals and is planned for system-wide implementation later this year.
MICU and CCU Team
Allegheny General Hospital, Pittsburgh, PA
July 2003 began a new way of looking at central line infections in MICU and CCU. Nursing directors, educators and physicians formed a team with staff nurses and infection control to address this issue. It was decided that no infection was acceptable. Statistics and graphs sanitized the issue, and every infection was a life-threatening occurrence. In the beginning, there were 19 central line infections in one year, including one death. Infections were reduced by 90% within three months. Now, an infection is a rarity that initiates an immediate investigation into possible causes, and processes are reassessed. Instead of a 1-in-25 chance of getting an infection, it is down to 1 in 527.
Toyota Production System principles, learned through a collaborative with the Pittsburgh Regional Healthcare Initiative, were used to analyze the current state and define and refine processes. We found that practice varied between practitioners for insertion, care and documentation, and supplies were not easily accessible. Best practice was reviewed and ideas were taken from all levels of staff to change practice.
Dressing and line insertion kit packaging was changed to include all necessary supplies and a chart sticker for documentation. All residents and nurses were required to complete educational learning modules developed to present necessary information. The nurses were given the authority and responsibility to guard against infection by ensuring practice was followed. “Is this line really necessary?” is frequently asked, and femoral and rewiring of lines are avoided.
A breach in practice leads to stopping procedures by the nurses, our guardians for patient safety. Our team continues to reinforce a no-blame atmosphere and a culture of safety conducting real-time analysis and changes as needed.
ICU Multidisciplinary Team
The Valley Hospital, Ridgewood, NJ
At Valley Hospital in Ridgewood, NJ, a postoperative patient was admitted to the ICU. Her nurse related to the collaborative team that the patient barely slept the night before due to severe pain and nausea. Pastoral care suggested a trial of massage therapy. The respiratory therapists changed their schedule for chest physiotherapy to the afternoon. Dietary suggested enrolling the patient in the “ginger” study. The pharmacist suggested antibiotic dose modification based on renal function. In only five minutes, the team adjusted the plan of care to meet the patient’s specific needs.
In early 2005, a goal was established to reduce mortality, morbidity, and length of stay, and to improve patient safety in the ICU by ensuring compliance with nationally accepted guidelines. Reduction of ventilator-associated pneumonias (VAPs) and blood stream infections (BSIs) were targeted. A multidisciplinary team consisting of an intensivist, the team leader (nurse manager), critical care nurses and representatives from pharmacy, respiratory therapy, nutrition, physical therapy, case management, social services and pastoral care was formed. Daily goals are established for each patient. Optimal patient safety is ensured by strict adherence to established protocols.
Since its inception, this collaborative approach in The Valley Hospital ICU has had significant success. BSIs have been reduced significantly. There have been no VAPs for 15 months. ICU mortality and length of stay have decreased. The collaborative approach has fostered open dialogue among the various members of the team. Each member feels empowered by contributing to the health of the patient. Daily review has led to familiarity with best care practices. As the complexity of medical illnesses and treatments increases, optimal patient safety is increasingly dependent on the collaboration of the patient’s team. The whole is truly greater than the sum of the parts.
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2007 AACN Excellence in Caring Practices Award in Honor of John Wilson Rodgers
Jennifer Michele Maddox, RN, BSN
University of Virginia Health System, Charlottesville, VA
Just weeks earlier, J.E. had been a normal 16-year-old. Then, a visit to the pediatrician for frequent headaches led to a diagnosis of medulloblastoma, an aggressive brain tumor. J.E.’s tumor was resected, but he developed elevated intracranial pressures (ICP) and meningitis several days later and was transferred to the neuroscience ICU (NICU).
On admission to the NICU, J.E. opened his eyes and occasionally blinked to command, but the rest of his body had no movement or response to pain. Throughout J.E.’s stay in the ICU, I treated him as if he were completely aware, explaining his care, playing music and often talking to him about girls and cars. I was always very honest with J.E.’s parents, and they trusted me.
As time passed and his exam did not improve, J.E.’s parents faced tough decisions. Although we all knew J.E.’s tumors would eventually take his life, his parents decided to proceed with the tracheostomy and tube feeding in hopes of getting him well enough to receive radiation therapy. Most of the healthcare team felt that J.E.’s parents made the wrong decisions, and that J.E. should be allowed to die. My thoughts were, “If his family could have this much faith, then so can I.” We can never say what choices we would make until we are put in that position.
Once off the ventilator, J.E. was moved to our neuro intermediate unit, then to rehab and ultimately home. J.E. started talking and moving his arms and legs. I actually got to talk to J.E. on the phone. I admire his parents for not giving up on him even though most wanted to. I was an advocate by supporting and educating J.E.’s family, communicating assertively with the healthcare team and providing expert clinical care.
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