Notable Nursing
Spring 2012 | A Publication For Nurses By Nurses
Feature Stories
Nurses Aiding
Nurses
Support from Peers and Mentors
Helps Nurses Advance Their
Education – p. 01
Shared Governance: Sharing Tools to
Extend Its Impact – p. 06
Evolving Retention Efforts Benefit New
Hires and Leaders Alike – p. 12
Cancer Institute Initiative Taps
Teamwork to Enhance Patient
Experience – p. 16
Also Inside
Becoming a Newborn-Friendly
Hospital – p. 04
Fostering Best Practices in Vascular
Access – p. 08
Nursing Innovations in the Neuro ICU
– p. 10, p. 11
Research Results – p. 19, p. 22
The Stanley Shalom Zielony Institute for Nursing Excellence
The Stanley Shalom Zielony Institute for Nursing Excellence
clevelandclinic.org /notable
Table of Contents
Nurses Aiding Nurses
p. 06 Shared Governance: Model for
Inclusive Decision-Making
Expands in Reach and Impact
p. 12 Beyond Recruitment: Evolving
Strategies to Engage and
Retain Nurses
p. 16 Taussig’s Responsiveness
Project: Tapping Teamwork
and Accountability to Improve
Patient Experience
Other Feature Articles
p. 04 Becoming Baby-Friendly: How
Lakewood Hospital Earned
a Coveted Designation for
Newborn Care
p. 08 Changing Vascular Access
Culture Through Knowledge
and Empowerment
p. 18 Using Core Measures to
“Be Remarkable”
p. 20 How to Write the Perfect
Abstract
News in Neurology
2
p. 10 Breaking New Ground:
Nurse Introduces Mobility
Protocol to Neuro ICU
p. 11 Detecting Delirium in the
Neuro ICU
Research
p. 19 Assessing Education Needs of
Asthma and COPD Patients in
the ED
p. 22 Study Gauges Consistency in
CLABSI Classification
Departments
p. 23 Nurses of Note
p. 26 Awards
Cleveland Clinic’s Nursing Institute
is known as The Stanley Shalom
Zielony Institute for Nursing
Excellence in recognition of Mr.
Stanley Zielony’s generous gifts
to advance nursing education,
informatics, research and clinical
practice at Cleveland Clinic.
Nurses from all of Cleveland Clinic’s
system hospitals and family health
centers compose The Stanley
Shalom Zielony Institute for Nursing
Excellence. For a listing of all
locations, visit clevelandclinic.org.
Dear Colleagues and Friends,
Nurses are the largest sector of healthcare providers in the United States, with
RNs alone accounting for more than 2.6 million healthcare jobs, according to the
federal Bureau of Labor Statistics.1 With nurses’ influence poised to increase upon
fuller implementation of the Affordable Care Act in 2014, we are looking ahead
toward attention to primary care, prevention, career training and expanded nurse
education. Changes in how care is provided — and by whom — are progressing
rapidly. The challenge to nurses will be how fast they can acclimate and thrive in
this evolving environment. There are many calls for action, and nurses are facing
the future with a unified spirit dedicated to making a difference.
Nurses have been central to Cleveland Clinic from its beginnings over 90 years
ago. Today, nurses at Cleveland Clinic reflect a united vision for the future of
healthcare. Our nurses — more than 11,000 strong — are establishing
themselves as equal partners and collaborators in comprehensive healthcare.
Their growth is demonstrated by involvement in leadership and pursuit of additional certifications and advanced degrees. Nursing growth promotes career
opportunities that were not available previously. Today, nurses can choose among
a diversity of roles — acute or ambulatory care providers, educators, quality experts, managers and advanced practice nursing providers, to name just a few —
across many specialties. Broadening nursing opportunities under the Affordable
Care Act will make our world-class organization both stronger and more nimble.
In this issue of Notable Nursing, we share some ways in which our nurses
support, encourage and empower one another to enhance care while furthering
their profession. We include stories on promoting the advancement of nurse
education, heightening bedside practice and decision-making, facilitating open
communication between nurses and leadership, and providing systemwide
initiatives that improve quality measures and patient satisfaction. Nurses at
Cleveland Clinic are a strong voice that speaks to tomorrow’s healthcare reality.
The Zielony Nursing Institute is proud of our collaborative spirit and dedication
to excellence. Our exceptional programming and innovations that support the
broad scope of our nurses’ lives are examples of our commitment to deliver on the
promise of world-class care. I hope you enjoy reading
about the advances we make each day in nursing.
Professional Development
Gets Personal:
Nurses Share How and
Why They’re Advancing
Their Education
The challenges are substantial:
Increase the share of nurses
with a baccalaureate degree
to 80 percent by 2020, and
double the number of nurses
with a doctorate by that same
year. These recommended
goals from the 2010 Institute
of Medicine (IOM) report, The
Future of Nursing, are ones that
Cleveland Clinic takes seriously.
Meeting these goals calls for
commitment at the institutional
level as well as vision and
Sarah Sinclair, MBA, BSN, RN, FACHE
Executive Chief Nursing Officer
Stanley Shalom Zielony Chair for Nursing
Advancement
Chair, The Stanley Shalom Zielony Institute for
Nursing Excellence
determination from individual
nurses. This special report
profiles four Cleveland Clinic
nurses who are advancing their
education amid everyday career
and life challenges — often with
1.Registered Nurses. In: Occupational Outlook Handbook, 2010-11
Edition. Washington, DC: Bureau of Labor Statistics. Available at:
http://www.bls.gov/oco/ocos083.htm. Accessed February 13, 2012.
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Cleveland Clinic is proud to support the Forest
Stewardship Council. FSC certification helps ensure
that the world’s forests are managed in a positive
manner: environmentally, socially and economically.
COVER STORY
p. 01 Professional Development Gets
Personal: Nurses Share How
and Why They’re Advancing
Their Education
216.448.1039 Notable Nursing Spring 2012
some help from fellow nurses.
1
The Stanley Shalom Zielony Institute for Nursing Excellence
COVER STORY
“I can’t believe I’m doing this.” That’s what Donna Rittenberger, RN, CGRN, first thought as she entered her BSN
program early in 2011. After all, she had been a nurse since
earning an ADN in 1983, became certified in her specialty
in 1994 and assumed increasing responsibility throughout
her career, rising to her current position as Nurse Manager,
Digestive Health, at Hillcrest Hospital in 2000.
“A part of me felt, ‘After almost 30 years of practice, what
could I gain from this?’” Rittenberger says.
2
After a short while in the program, however, she was wishing
she had gone back to school many years earlier. “It’s been
really good for me,” Rittenberger explains. “I’ve found a lot of
pleasure in learning things I hadn’t expected to. For example,
my courses in business communication and finance have been
very helpful in my role as a nursing leader.”
She’s found it so fulfilling that she plans to continue on in an
MSN program after she earns her BSN, which she’s on track to
complete later this year.
Rittenberger’s experiences are exactly what Cleveland Clinic
aims to foster in the wake of the 2010 IOM report. “We’re
making it a goal to get 80 percent of nurses to the BSN level
going forward,” says Sarah Sinclair, MBA, BSN, RN, FACHE,
Executive Chief Nursing Officer and Chair of the Stanley
Shalom Zielony Institute for Nursing Excellence. “We’ll do it in
a reasonable time frame to give an opportunity to everybody
who is committed to earning that degree.”
Many motivations
In Rittenberger’s case, the impetus for advancing her education
was an upcoming Magnet Recognition Program® requirement
for all nurse managers to have a degree in nursing at the baccalaureate level or higher.
For other nurses, the initial motivation to pursue further education came from within or from colleagues and mentors. “I
knew I wanted to advance my degree in a way that would
use my strengths and interests,” says Esther Bernhofer, BSN,
Jennifer Van Dyk, DNP student:
“The DNP program has helped
me start seeing myself as a global
healthcare leader. I’ve started to
think about mundane observations
around patient care on a larger
scale, as potential research projects
that could have broad impact.”
PhD(c), RN-BC, a Nursing Education Specialist on Cleveland
Clinic’s main campus who is near completion of a five-year
BSN-to-PhD program. She initially looked into MSN programs,
but when she expressed an interest in ultimately completing
research and teaching in her specialty, pain management, she
was told she would benefit from a PhD.
“I thought, ‘I can’t do that — a PhD is beyond me,’” Bernhofer
says. But a doctoral-prepared senior nurse researcher colleague
convinced her otherwise and encouraged her to apply. “The
message I received from my colleagues and managers here
was, ‘You can do it — go for it. What can we do to help?’ That
was very encouraging.”
For Chad Hollis, BSN, RN, who is pursuing an MSN to become
a nurse practitioner (NP), it was the NPs and physician assistants who work with him on the vascular surgery floor at
Cleveland Clinic’s main campus who spurred him on. “They
told me about NP programs and always helpfully challenged
me on the floors about how to handle different clinical situations rather than just telling me what to do,” he says. That
broadened his perspective on patient care and lit the spark to
pursue training to take on greater clinical responsibility.
Common challenges, differing solutions
Despite the many motivations, taking on a multiyear school
commitment while holding down a demanding clinical job is
not easy. Time management is the overriding challenge.
“Balancing priorities can become incredibly hectic,” says
Jennifer Van Dyk, MSN, RN, Nurse Manager, Orthopaedics,
Lakewood Hospital, who is halfway through a doctor of nursing
practice (DNP) program.
That’s especially the case for nurses with big family commitments. Van Dyk, the mother of a newborn, says the time demands have simply forced her to quickly develop strict organizational skills. “I’ve also become better at accepting help — at
home, work, wherever,” she explains. “Getting to know myself
and being honest about what I can and cannot do has been
important.”
216.448.1039 Notable Nursing Spring 2012
Chad Hollis, MSN-NP student:
“My return to school has caused
me to be less task-oriented.
Instead of focusing just on the
here and now, I try to step back
and really get the whole picture
of what’s been going on with
the patient.”
Others have overcome the time demands of work and school in
more concrete ways. For Rittenberger, the flexibility of her online BSN program has made all the difference. “The availability
of online degree programs changes the equation for a lot of
people, especially those with family commitments,” she says.
Hollis finds the availability of on-site courses to be key. Thanks
to a collaborative effort between Cleveland Clinic and Kent
State University in Kent, Ohio, he is able to attend his weekly
classes on Cleveland Clinic’s main campus. “That makes the
program really convenient,” he says. “I only have to travel to
Kent, Ohio, a handful of times.”
A clear role for institutional support
All nurses profiled here mentioned Cleveland Clinic’s generous tuition support as an important factor in their decision to
further their schooling. “It’s a huge help,” says Van Dyk. “I
couldn’t be doing this without it.” Even those who say they’d
probably be pursuing their degree anyway add that the tuition
support is helping them earn it much faster.
Institutional support manifests in other ways as well. “The
Nursing Institute has put a lot of importance on professional
development and furthering our education,” observes Van Dyk.
“There’s a general aura of support.” Rittenberger says she has
“complete support” from her leadership: “They are very connected with my goal and want to see me succeed.” Hollis says
his floor is flexible about solving scheduling challenges that
come up for him around final exams. ”That makes it less of a
struggle,” he notes.
For Bernhofer, who started at Cleveland Clinic in 2005 after
decades working in home care and community hospitals, institutional support came in less tangible ways. “When I arrived
and saw all that was happening at Cleveland Clinic — the
complexity of the cases, the way everyone worked, all the resources here — it opened my eyes to professional possibilities I
didn’t even know I had before,” she says. “That’s a lot of what
motivated me and what supports me today.”
Esther Bernhofer, PhD(c) student:
“Continuing my education gives me
access to people and practices I
otherwise wouldn’t have. I’m exposed
to and interact with experts in pain
management and nursing research
that will contribute immensely to
how I do my research.”
COVER STORY
Donna Rittenberger,
BSN student: “Going
back to school has
really helped me define
the more difficult
aspects of my job as a
nursing leader.”
clevelandclinic.org /notable
Educational infectiousness
Mentoring is another common form of institutional support, but
more notable is how quickly nurse scholars become mentors to
their fellow caregivers who may be considering advanced nursing education.
“My going back to school has had an impact on some nurses
who report to me,” says Rittenberger, explaining that one has
since begun further nursing education and two others are seriously considering it. “I’ve played a role in showing them that
learning is fun and that if I can still do it at my age, they certainly can too.”
Van Dyk has seen similar trends among some LPNs and RNs
who report to her. She also reports a community of “peer mentors” among the 10 or so Cleveland Clinic nurses who are
currently enrolled in the same DNP program that she is. “We
spend a lot of time supporting each other, providing resources
to each other and networking. All of us are very focused on
becoming mentors to future DNPs down the road.”
Words of advice
There are recurring themes in the advice these nurses have for
others considering following their path: Take it one step at a
time. Seek out available resources. Keep your eye on the goal.
“Just start talking to people in the educational programs you’re
thinking of,” Bernhofer counsels. “Let them know your story,
your interests and your needs. The nursing educators out there
are really interested in helping you make your dreams come
true.”
“Be aware that many options are now available to meet your
schedule and lifestyle,” advises Rittenberger. “There are online
programs, on-site courses and classes for night-shift workers.”
“Start with one class, one semester — everybody can take one
class,” Van Dyk says. “And use the resources available to you,
be they tuition support, manager encouragement or assistance
from co-workers and family. Don’t be afraid to ask for help.”
Email comments to [email protected].
3
The Stanley Shalom Zielony Institute for Nursing Excellence
clevelandclinic.org /notable
216.448.1039 Notable Nursing Spring 2012
Becoming Baby-Friendly:
How Lakewood Hospital
Earned a Coveted Designation
for Newborn Care
Lakewood Hospital adopted The Joint Commission’s
Perinatal Care Core Measure on Exclusive Breast Milk
Feeding in 2010, according to Coe Bell, BSN, RN, IBCLC,
Manager for Perinatal Education. “This quality measure
helps us assess the percentage of babies we deliver who
leave our hospital having been exclusively breastfed,”
Bell says. “Exclusive breastfeeding is important because
babies who receive only breast milk in their first days of life
are more likely to be breastfed longer.” She adds that the
American Academy of Pediatrics recommends exclusive
breastfeeding through the first six months of life, and
breastfeeding along with complementary foods through the
first year.
Many changes, one goal
4
Cleveland Clinic’s Lakewood Hospital was designated a Baby-Friendly Hospital in March 2012.
The hospital worked for more than five years toward gaining the designation from Baby-Friendly
USA as part of the Baby-Friendly Hospital Initiative (BFHI), a global program sponsored by the
World Health Organization and the United Nations Children’s Fund (UNICEF).
The BFHI encourages and recognizes hospitals and birthing
centers that offer an optimal level of care for infant feeding.
Since its launch in 1991, the BFHI has assisted hospitals
in giving mothers the information, confidence and skills
needed to successfully start and continue breastfeeding
their babies (or to feed them formula safely) and has
provided special recognition to hospitals that do so. BabyFriendly USA is the nonprofit national authority for the
BFHI in the United States.
UNICEF states that a hospital can be designated BabyFriendly “when it does not accept free or low-cost breast
milk substitutes, feeding bottles or [artificial nipples], and
has implemented 10 specific steps to support successful
breastfeeding.” These 10 steps are provided on the UNICEF
website at unicef.org/programme/breastfeeding/baby.
htm#10.
“There is strong evidence to support breastfeeding as a
best practice,” says Joyce Arand, MS, CNS, RNC, NEA-BC,
Director of Nursing for Women and Children, Lakewood
Hospital and Fairview Hospital. Compliance with the BFHI
is endorsed by many professional health organizations,
including the Association of Women’s Health, Obstetric and
Neonatal Nurses; the American Congress of Obstetricians
and Gynecologists; and the American Academy of
Pediatrics. It is also endorsed by the Centers for Disease
Control and Prevention, the National Institutes of Health
and the U.S. Surgeon General.
To promote and support exclusive breastfeeding, the
hospital has instituted the following:
Skin-to-skin care immediately after birth, if possible. The
mother (or father, in some cases) is given the naked baby
immediately after birth. She holds the baby “skin-to-skin”
on her bare chest for an hour or more. Traditional weighing
and measuring of the baby by nursing staff is delayed until
after the initial feeding is completed. Immediate skin-toskin care has been shown to cause the mother’s temperature to rise to warm the baby, and it also helps regulate the
baby’s heart rate and breathing, which better enables the
baby to self-latch for breastfeeding.
Rooming-in. Lakewood Hospital’s birthing center has
private rooms in which a mother labors, delivers and
recovers in the same space. After delivery, the baby stays
in the room with the mother and family, and the time that
the baby is out of the room is kept to a minimum. This
arrangement promotes family bonding, helps parents learn
to care for their infant while expert care is close by and helps
facilitate breastfeeding on demand.
Breastfeeding education and support. Classes led by
international board-certified lactation consultants (IBCLCs)
are available to pregnant women for teaching the basics
and importance of breastfeeding. Hands-on support and
education are available to new mothers while they are
in the birthing center, and outpatient lactation support
groups and help lines are available to mothers once they are
discharged from the hospital.
Removal of items that do not support breastfeeding.
Although the hospital is prepared with formula for mothers
who make an informed decision to formula feed, it is not
automatically offered. Also, the gift shop does not carry any
bottles or items with nipples, such as pacifiers.
“We try to remove as many barriers to breastfeeding as
possible,” Barabach says. “It is still the mother’s choice
whether to breastfeed, but we want to make sure it is an
informed choice.” She notes that about 75 to 80 percent
of new mothers leave Lakewood Hospital exclusively
breastfeeding their babies.
Email comments to [email protected].
Of the more than 15,000 hospitals and maternity facilities
around the world that have been granted Baby-Friendly
designation, 135 are in the United States (as of press time).
Of these, Lakewood Hospital is only the fourth in Ohio and
the first in Northeast Ohio.
A team effort
“It took a real team effort to make this happen,” says Lynn
Barabach (photo above), MSN, RNC, Nurse Manager, Birthing Center and Teen Health Center, Lakewood Hospital.
“We worked as a system to make evidence-based maternity
care practice changes across the Cleveland Clinic birthing
centers. We changed policies and educated our nurses and
providers. We also educated our support staff so they would
understand if a patient were to ask them about something
related to breastfeeding.”
Other System
Hospitals Are on
Baby-Friendly
Path
In addition to Lakewood
Hospital, several other
hospitals in Cleveland Clinic
health system — Fairview,
Hillcrest and Medina — offer
birthing services and have
been preparing to meet
the requirements for BabyFriendly designation.
Fairview Hospital adopted
The Joint Commission’s
Perinatal Care Core Measure
on Exclusive Breast Milk
Feeding in April 2010 and has
been working toward BabyFriendly designation for the
past five years. At press time,
the hospital was scheduled
to have an April 2012 on-site
assessment by Baby-Friendly
USA, one of the final steps
in the process to obtain
designation.
Hillcrest Hospital has been
fulfilling requirements to
become designated BabyFriendly and has an on-site
assessment scheduled for
May 2012.
Medina Hospital has begun
the process to pursue BabyFriendly designation. Its
goal is to have an on-site
assessment planned by the
fourth quarter of 2012 or
the first quarter of 2013.
5
The Stanley Shalom Zielony Institute for Nursing Excellence
clevelandclinic.org /notable
216.448.1039 Notable Nursing Spring 2012
“A healthcare facility would most likely have difficulty
achieving Magnet recognition without the concept of
shared governance fully integrated throughout.”
Monica Weber, MSN, RN, CNS-BC, CIC
Shared Governance
Model for Inclusive Decision-Making
Expands in Reach and Impact
Since shared governance was implemented by nurses at Cleveland Clinic’s main campus 11 years ago,
it has grown to include all regional hospitals within the health system. Now best practices that were
fostered by the model are increasingly having an impact throughout Cleveland Clinic and beyond.
6
Shared governance is an organizational model for health
systems that empowers nurses to have a voice in decisionmaking on policies and standards surrounding quality of care
and their professional practice. It is based on a number of core
principles:
“Shared governance allows front-line staff to get involved in
decision-making,” Lahl says. “It is a part of their practice
they can control. They have valuable input to give related to
processes, systems and structures that affect patient care as
well as teamwork and coordination of care.”
• Partnership among healthcare providers and between
providers and patients
A tool kit to spread best practices
• Equal focus on services, patients and staff
• Accountability and willingness to invest in decision-making
• Ownership of contributions to healthcare decision-making
The biggest impact shared governance has had at Cleveland
Clinic is in giving staff nurses the opportunity to get involved in
projects to improve quality measures and patient satisfaction,
according to Meredith Lahl, MSN, PCNS-BC, PNP-BC, CPON,
Senior Director of Advanced Practice Nursing. All nurses are
contributing to those two overall goals, she says.
Lahl chaired the Shared Governance Coordinating Council from
2006 through 2011. The Coordinating Council is the main body
in the shared governance structure on Cleveland Clinic’s main
campus and oversees and links all the individual councils from
across main campus. It also has begun to integrate councils
from the regional hospitals in Cleveland Clinic health system.
As the shared governance model has grown and spread across
the health system, a tool kit available on the intranet site of
the Cleveland Clinic Zielony Nursing Institute has facilitated
standardization of shared governance processes and procedures
used on Cleveland Clinic’s main campus. The tool kit simplifies
the process for nurses to start up a council or get involved in an
existing one. It provides information on what shared governance
is, how to start a council, how to recruit members, and the nuts
and bolts of setting up a meeting.
The site is also a place where nurses can share information
about projects they are working on to improve quality and
patient satisfaction. “Through the site, one unit can see what
another unit is doing, which makes it easy to pilot or replicate
programs in different areas,” Lahl says. Some successful
shared governance projects have been extended across a
“Shared governance allows front-line staff
to get involved in decision-making; it is a
part of their practice they can control.”
Meredith Lahl, MSN, PCNS-BC, PNP-BC, CPON
hospital or the entire health system. For instance, Cleveland
Clinic’s Hillcrest Hospital submitted a poster in 2011 on a
best practice for timely symptom recognition and evidencebased one-hour benchmark antibiotic administration to patients
presenting with febrile neutropenia. The practice is currently
being implemented systemwide.
Conference in October 2011 on using Shared Governance Day
to highlight quality improvement across a multihospital health
system. Many participants asked them to share some of the
tools they presented, with the most-requested tool being the
scoring matrix used to judge poster presentations for Shared
Governance Day.
Shared Governance Day: A showcase for successes
Enduring and broadening impact
Shared Governance Day is a key annual event that began in
2007 as a venue for promoting nursing professional practice
and shared governance within Cleveland Clinic. Through its
design using professional poster presentations, unit- and
hospital-specific successes and best practices are highlighted
and discussed among attendees. The fifth annual Shared
Governance Day was held in November 2011 at Cleveland
Clinic’s main campus, Euclid Hospital and Lakewood Hospital.
It was the second time the event included the entire health
system, and its focus was on quality improvement. Eighty-five
posters were presented.
Lahl notes that the influence of Shared Governance Day posters
is extending beyond the Zielony Nursing Institute to other areas
within Cleveland Clinic. For example, the Quality & Patient
Safety Institute and the Office of Patient Experience have each
displayed nurses’ posters at their own conferences. Moreover,
some nurses have begun submitting their posters to national,
regional and state conferences and to the American Nurses
Association’s National Database of Nursing Quality Indicators.
“The posters are a good way for front-line staff to be recognized,” Lahl says. “Staff are proud of quality improvement or
other accomplishments and the positive effect their outcomes
may have on patient care.” The posters are available all day
for review and evaluation and are later uploaded to the Zielony
Nursing Institute’s intranet site. Poster evaluation consists of
rating each poster on five criteria for a total of 20 points. Teams
completing highly rated work are recognized formally and their
work is shared widely.
Lahl and Monica Weber, MSN, RN, CNS-BC, CIC, Patient Safety
Officer/Magnet Program Manager, gave a joint presentation at the
American Nurses Credentialing Center (ANCC) National Magnet
Shared Governance Day in 2011 included participation by
Cleveland Clinic Florida, whose nurses submitted eight posters.
In fact, one of the posters from the Florida hospital, on a
program that resulted in a significant reduction in pressure
ulcer rates in the ICU, won an award. “Our staff was quite
happy to participate, and our chief nursing officer was very
supportive,” says Raquel Bryan, MHA, MPH, BSN, RN, CVN,
Nursing Quality Coordinator, who traveled to Ohio to represent
the Florida hospital. She adds that Cleveland Clinic Florida
plans to participate again in 2012 and hopes to host the event
in Florida someday.
Deb Solomon, MSN, RN, ACNS, BC, current Chair of the Shared
Governance Coordinating Council, says Shared Governance Day
“really energizes” nurses. “Nurses are embracing the event
7
The Stanley Shalom Zielony Institute for Nursing Excellence
Shared Governance
continued
and look forward to actively participating,” she
adds. Solomon, who is charged with coordinating
Shared Governance Day in November 2012,
says she already has quite a few hospitals in the
system volunteering to host it. Nursing support
testifies to the systemwide interest in the event
and the opportunity it affords to highlight quality
improvement projects that focus on outcomes of
nurse decision-making using the shared governance
management model.
Commonalities with Magnet criteria
8
Cleveland Clinic’s main campus achieved Magnet
recognition in 2003 and was redesignated a Magnet
hospital in 2008; Cleveland Clinic’s Fairview Hospital
was granted Magnet recognition in 2009. Weber says
that while the ANCC’s Magnet Recognition Program®
does not specifically require that shared governance
be in place, a healthcare facility would most likely
have difficulty achieving Magnet recognition without
full integration of the concept of shared governance.
The Magnet application manual, Weber says,
defines shared leadership/participative decisionmaking as “a model in which nurses are formally
organized to make decisions about clinical practice
standards, quality improvement, staff and professional development, and research.” As part of applying or reapplying for Magnet recognition, healthcare
facilities must demonstrate that they reflect and
embody that model.
clevelandclinic.org /notable
Changing Vascular Access
Culture Through Knowledge
and Empowerment
For many nurses, knowledge and experience
gained through systematic training in vascular
access is nonexistent or limited throughout
their education and career. Yet more than
7 million central venous access devices and
160 million peripheral intravenous catheters
are placed each year in the United States.1
This sheer volume presents many challenges
for care, particularly in the area of central lineassociated bloodstream infection (CLABSI)
prevention. Nurses at Cleveland Clinic are
embracing the challenges of healthcareacquired infections through a unique program
aimed at increasing knowledge of best
practices in vascular access.
216.448.1039 Notable Nursing Spring 2012
V ascular
A ccess
R esource
to take the course. Over 500 nurses throughout Cleveland
Clinic health system have completed the program, with 120seat sessions filling in less than a week. And the training is
making an impact.
“Our program allows participants to ask questions and
apply evidence-based knowledge through hands-on
competency stations,” says Nichole Kelsey, BSN, RN,
Clinical Instructor, Nursing Education. “After completing
the VARN program, participants leave with a comprehensive
body of knowledge of vascular access nursing that empowers
their everyday abilities.”
A focus on detail informed by big-picture thinking
Knowledge is power
1.Richardson DK. Vascular access nursing — practice,
standards of care, and strategies to prevent infection:
a review of flushing solutions and injection caps
(part 3 of a 3-part series). J Assoc Vasc Access.
2007;12:74-84.
The VARN education program empowers bedside nurses by
giving them the authority, knowledge and skills to facilitate
best practice in vascular access, according to Chris Thomas,
MSN, CNP, VA-BC, Manager, Vascular Access Services, Fairview Hospital. “Most of our participants were not taught any
of this knowledge in nursing school, yet they are the most
liable for vascular access complications,” explains Thomas,
who has been teaching the VARN program since its first
class in November 2010. “There are hundreds of programs
that speak to educating nurses on vascular access, but
we have something special that is raising the attention of
vascular access specialists nationwide. We thought our approach would encourage nurses to take the lead in managing vascular access care needs, but we had no idea it would
be this successful, to the point that physicians are asking for
VARNs specifically.”
Chris Thomas, MSN, CNP, VA-BC
program
The Vascular Access Resource Nurse (VARN) program is a
systemwide effort led by a multidisciplinary team composed
of a vascular access specialist, a CLABSI prevention educator, an infection control preventionist, nurse managers
and other nurse educators from four of Cleveland Clinic’s
regional hospitals. The intensive eight-hour education program begins with a four-hour didactic section focused on
nurse empowerment and broad vascular access evidencebased knowledge. Following the didactic section are five
30-minute hands-on, one-on-one workshops that focus on
practical application of instruction related to central line
dressing change, port access, central line removal, central
line blood draws, occlusion treatments and assessment and
treatment of extravasation.
Reference:
Email comments to [email protected].
N urse
As experts of vascular access, Kelsey and Thomas are committed to spreading the message of the VARN program.
Increasing local attention to the VARN program has been
paralleled by increases in the number of nurses desiring
“Due to the VARN educational program, we have 65 nurses
who are championing this cause,” notes Alina Zakrocki,
BSN, RN, Infection Preventionist, Lakewood Hospital.
“I see how empowered they feel discussing central lines
with physicians — they have the knowledge to collaborate
with them about removing a femoral vein line quickly or
discussing why it should not be placed at all. The program
promotes team communication and collaboration, and we
saw a reduction in CLABSIs in 2011.”
As use of central catheters and intravenous lines increases
due to high acuity, focus on the care surrounding their use
needs to remain a high priority. Emphasis on details such
as scrubbing for 30 seconds with chlorhexidine prior to
line placement provides course participants with basic care
details and expands their base of knowledge so they can
offer better options for patients, says Zakrocki.
Karen Theodore, RN, Clinical Instructor, Medina Hospital,
agrees. “As nurses, we perform many tasks routinely, but do
we really think about why we do them?” she asks. “When
completing vascular access audits each month, we ask ourselves if we are doing all we can to prevent CLABSIs. The
VARN program causes a lot of excitement. Nurses have new
knowledge and incorporate it into practice.”
As the program expands, its fundamental message remains
clear: Education and practical training on best practices in
vascular access are not just for new nurses or nurse managers — they are for everyone involved in the daily care of
patients requiring a central line. “Administrative support
for nurses to become a VARN is given at every level of leadership,” says Thomas. “Each day we ask how we can change
the culture in a way that encourages our colleagues to share
their knowledge and assertively apply their knowledge and
skills to improve patient outcomes. The VARN program
helps nurses make the Zielony Nursing Institute’s vision
and mission a reality.”
Email comments to [email protected].
9
Breaking New Ground:
Nurse Introduces Mobility
Protocol to Neuro ICU
Protocol empowers nurses to help uniquely
challenged patients return to mobility more quickly.
When Malissa Mulkey, MSN, CCRN, CCNS, started working
in the neurological ICU at Cleveland Clinic’s main campus
more than two years ago, she wanted to get her patients moving. “I thought we weren’t doing enough to promote early
movement,” says Mulkey, a clinical nurse specialist who
also cares for patients in the neurological step-down unit.
10
Early mobility is important in neurological ICU patients for
the same reasons it is in other populations: to reduce the
risk of hospital-acquired conditions such as pressure ulcers,
to avoid prolonged length of stay due to weakness and
deconditioning, and to lessen patients’ rehabilitation needs
after discharge. These benefits fueled Mulkey’s interest in
mobility, yet when she searched for early mobility protocols
in the literature, she found none that were amenable to
patients treated in the neurological ICU.
More
Moves
Toward
Mobility
The protocol has been complemented by a number of other recent mobilitypromoting changes to the neurological ICU. More physical and occupational
therapists have been added, with some dedicated solely to the unit. Specially
designed chairs with fold-down arms have been introduced. Portable lifts are
available with disposable slings, and bed features make it easier to get patients
out of bed regardless of their weight or physical handicaps. Unit nurses have
been trained by physical and occupational therapists to use the chairs and new
bed features and were offered additional instruction in body mechanics.
clevelandclinic.org /notable
Mulkey found that neurological ICU patients were excluded
from studies of early mobilization. “Nurses may be less
comfortable getting these patients out of bed, given their
medical diagnoses and unique needs and challenges,
including confusion,” she observes.
Undaunted, Mulkey decided to adapt early mobility protocols from the literature to accommodate patients in a
neurological ICU environment. After gaining support from
ICU leaders and other ICU clinical nurse specialists, she
authored an early mobility protocol specifically for patients
treated in the neurological ICU. It was implemented in the
neurological ICU on Cleveland Clinic’s main campus in late
February 2012.
Once the physician writes an “activity as tolerated” order
for a patient, nurses are charged with facilitating early
mobility. The protocol leads nurses to advance patients
through increasing degrees of mobility. It begins with steps
like elevating the head of the bed by 30 degrees, turning
and repositioning, and range-of-motion exercises, and
it continues through steps such as weight bearing and
standing or walking in the hallway. Criteria guide nurses
on when to initiate and when to proceed to the next step;
exclusion criteria are also included.
Nurses use their clinical judgment and the patient’s
response to mobility to advance through the protocol. Thus,
patients can make progress without needing to wait for a
new order before moving to the next step.
A designated nurse representative is temporarily assigned
to a unit for several hours a day to encourage progression of
patients through the protocol, to help with documentation
and to provide assistance with the physical aspects of
mobility promotion.
“The traditional thinking has been, ‘We can’t move these
patients — they’re too sick,’” says Victoria Rhoades, BSN,
RN, CCRN, Nurse Manager, Neurological ICU. “The mobility
protocol aims to start these patients’ recovery as soon as
possible because that will improve their outcomes. We look
for even small increments of movement early on, and then
help patients progress as far as they can before they go to
the regular floor.”
Mulkey’s ultimate goal reaches even beyond that point.
“Most of our patients have been going from the hospital to
some type of rehabilitation center, not directly home,” she
says. “I want to see if we can change that.”
Email comments to [email protected].
216.448.1039 Notable Nursing Spring 2012
Detecting
Delirium in the
Neuro ICU
Despite being a neurological condition, delirium has not
traditionally been monitored for in neurological ICUs
across the nation even though it is widely assessed in other
critical care settings. That’s because its symptoms closely
resemble those of many potentially lethal neurological
conditions, including vasospasm, cerebral edema,
meningitis and encephalopathy, according to Kate Klein,
MS, ACNP-BC, RN, CCRN. “The fear is that if we call these
symptoms delirium early on, we might miss — or mistreat
— a life-threatening condition,” explains Klein, who works
as a nurse practitioner in neurological ICUs at Cleveland
Clinic’s main campus.
Nevertheless, early identification and treatment of delirium
in neurological ICU patients matters. The longer these
patients remain in a state of delirium, the harder it is for
them to emerge from it, and the worse their long-term
outcomes are. “If we can detect delirium early, we can use
pharmacologic and nonpharmacologic interventions to
help resolve this transient neurologic derangement and
help patients recover faster,” Klein says. “It’s about not
looking at patients solely in the short term, which used to be
the prime focus in critical care, but doing more to prevent
morbidity in the longer term — getting patients home, back
to work, back to their daily activities.”
Delirium also matters because it affects 30 to 80 percent
of ICU patients and is a major driver of ICU costs, Klein
notes. These and other factors spurred a growing interest in
assessing for delirium in critically ill patients with primary
neurological injuries. The need for assessment generated
the desire to validate a tool for use in the neurological ICU.
Interest has focused on two instruments that are wellvalidated in other ICU settings:
The Confusion Assessment Method for the ICU (CAMICU), designed from the DSM-IV criteria for delirium,
assesses for fluctuations in mental status, inattention,
Nurses champion efforts to monitor
for delirium in a setting where it has
largely been neglected — and where it
can prove particularly damaging.
News in Neurology
News in Neurology
The Stanley Shalom Zielony Institute for Nursing Excellence
level of consciousness and disorganized thinking. It can be
administered in approximately five minutes by the bedside
nurse.
The Intensive Care Delirium Screening Checklist, an eightitem checklist of delirium characteristics based on DSM-IV
criteria for delirium. It is completed by the bedside nurse
as part of daily charting over the course of at least an eighthour period.
Klein and other nursing colleagues are currently investigating whether either of these tools or the neurointensivist’s
subjective impression can be validated for use in the neurological ICU.
Until an instrument is validated in this setting, Klein and
her colleagues focus on what they can do at the bedside to
mitigate suspected delirium in their patients. “The goal is
to help patients recover from their injury and provide necessary treatment, which often involves simply normalizing
their day,” she says. This is done by frequent orientation to
surroundings, date and time. Also, getting patients moving
as early as possible, having them sit in a chair so they can
better interact during family visits, and facing them toward
the window so they can see if it is day or night can be highly
beneficial in promoting clear, organized thinking.
Reassurance also is key. “We tell patients that delirium is
common in this setting and that delusional thoughts are
not unexpected,” she adds. Klein is hopeful about prospects
for identifying the best monitoring tool and ultimately
the most effective treatments. “People are using the word
‘delirium’ in this setting now. That’s a recent development.
There’s a growing appreciation of how damaging delirium
can be in patients with critical illness and how changes in
the early phases of care can improve these patients’ longterm outcomes.”
Email comments to [email protected].
11
The Stanley Shalom Zielony Institute for Nursing Excellence
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216.448.1039 Notable Nursing Spring 2012
Beyond Recruitment:
12
Evolving Strategies
to Engage and
Retain Nurses
An optimal patient experience requires an
engaged nursing staff. With a national nursing
shortage and a high rate of nurse turnover within
hospitals (12.7 percent in Ohio), achieving the
ideal level of engagement can be daunting.
Leaders in Cleveland Clinic’s Stanley Shalom
Zielony Institute for Nursing Excellence have
risen to the challenge of engaging quality
nursing staff by embarking on a long-term
initiative focused on recruitment and retention.
13
The Stanley Shalom Zielony Institute for Nursing Excellence
“You’re no longer a faceless
executive tucked away in an
office somewhere.”
Kerry Major, MSN, RN, Chief Nursing
Officer, Cleveland Clinic Florida
The retention portion of the initiative, which kicked off
in January 2012, aims to facilitate open communication
between Nursing Leadership and new Zielony Nursing
Institute employees, with the goal of maintaining a strong
nursing staff that will enjoy productive and successful careers
at Cleveland Clinic.
14
To support this effort, Sarah Sinclair, MBA, BSN, RN,
FACHE, Executive Chief Nursing Officer and Chair of the
Zielony Nursing Institute, has assembled a 45-person
multidisciplinary committee that includes nurse managers,
chief nursing officers (CNOs), associate chief nursing officers
(ACNOs) and representatives from finance, human resources
and marketing communications. As part of the initiative,
committee members are personally spending time with new
nursing hires throughout the health system. The informal,
casual meetings are designed “to give the committee
members the opportunity to learn about each person’s new
hire experience, inquire about any needs or questions they
may have and further help welcome them to their new roles,”
Sinclair explains. Team members ask new hires if they have
any suggestions for the orientation process and how they feel
they have been able to acclimate themselves to their jobs.
Also, Sinclair is encouraging individual hospitals in Cleveland
Clinic health system to begin or continue their own recruitment
and retention initiatives under the direction of their CNOs.
Casual conversations benefit new hires and leaders alike
Two of those CNOs — Kerry Major, MSN, RN, of Cleveland
Clinic Florida, and Kelly Hancock, MSN, RN, NE-BC, of
Cleveland Clinic’s main campus — offer new staff regular
opportunities to meet with them personally and talk casually
and candidly about their experiences as new employees.
Major meets with new employees 90 days after their hire
in an informal gathering each quarter dubbed “Koffee with
Kerry.” Between 50 and 75 percent of nursing employees
hired in the previous quarter typically attend these events, in
which Major and a human resources representative sit down
clevelandclinic.org /notable
and have coffee and conversation with the new hires. In
addition to nurses, all new personnel additions to the nursing
staff, including administrative employees, are invited.
Major began hosting her coffee events more than a year ago
and says they help to “break down the barrier” between herself
as CNO and her employees because the events give them the
opportunity to get to know each other. “My employees are not
afraid to approach me or give me feedback later because I met
them early on in an informal setting,” she says. “When you
break that barrier, your employees are much more amenable
to talking to you. You’re no longer a faceless executive tucked
away in an office somewhere.”
Among the issues discussed is the effectiveness of the
onboarding process and orientation programs. Major makes
an effort to find out if these programs were meaningful to the
new hires by asking open-ended questions. She makes notes
and gives feedback to the appropriate people, who may be
directors, human resource managers or staff development
personnel. As a result of comments from the conversations
thus far, Major and her staff have made adjustments to
the department-specific orientation program and improved
the individual nurse coaching program. “This is really
the best way to enhance your programs and get valuable
feedback,” she says. “It’s a nice way to open the lines of
communication.”
Hancock agrees. She has been holding regular lunches with
her nursing staff since she became CNO of Cleveland Clinic’s
main campus in July 2011. Her program, called “Chief
Conversations,” is an informal way for her to recognize her
staff’s accomplishments and for them to tell her what’s on
their minds. “This has been a great opportunity for me in my
new role,” Hancock says. “I’ve learned a lot, and it has really
helped to guide my strategy for new initiatives and changes in
current processes and programs.”
She speaks to her new hires as a group during their orientation and then reconnects with them at the Chief Conversations lunches, which are offered to all nursing employees. The
lunches, which are held on main campus, are limited to 15 to
20 staff members in order to “accommodate a meaningful dialogue.” Hancock says some “great conversations” have taken
place at the meetings and some ideas have been implemented
as a result. One suggestion regarding peer interviewing was
passed on to the directors and has been implemented for all
nurses on main campus. Hancock says she has received much
positive feedback on the Chief Conversations program and
plans to continue it.
216.448.1039 Notable Nursing Spring 2012
First two weeks are critical
The first two weeks on the job are a key time to engage
nurses, according to Deb Small, MSN, RN, NE-BC, who is
CNO of Cleveland Clinic’s Fairview Hospital. Within that
time frame, new nurses generally undergo a Performance
Based Development System test to assess their on-the-job
skills and critical thinking. That test, Small says, can be very
intimidating, and nurses may need extra support to help them
through this potentially tough time.
“In the first few weeks, along with getting nurses oriented
clinically, alleviating fears and intimidation is really
important,” Small says. “We spend that time getting new
nurses adjusted to the culture here, getting their questions
answered and doing what it takes to create a good job
environment for them.” Each new hire is given a coach to
whom his or her schedule is matched, and the two work
together to help the new hire hone skills on a structured skill
set list. The new hire also goes through an orientation process
designed specifically for him or her.
At 45 and 90 days, the nurse manager and the coach meet
with the new hires to find out how they are doing and what
they need help with. Depending on which unit they work
for, new hires may also spend a day with members of case
management, pharmacy, phlebotomy or other areas, as part
of the orientation process. Small says Fairview Hospital may
eventually offer new hires a morning coffee program in which
they can get together with other new hires to exchange ideas
and information and gain support.
Retention efforts will continue to unfold
Under the leadership of CNO Dawn Bailey, BSN, RN,
MAOM, Cleveland Clinic’s Euclid Hospital recently began
implementing a plan to more closely address new nurse
retention and turnover. One part of Bailey’s plan was an
enhancement of her weekly staff rounding processes.
Bailey holds informal meetings with all nursing new hires
“The first two weeks in
the job are a key time to
engage nurses.”
Deb Small, MSN, RN, NE-BC, Chief
Nursing Officer, Fairview Hospital
in the hospital at their 30-day mark. She asks them a
short list of key questions to ensure that she’s aware of the
main elements of their satisfaction with their onboarding
experience, orientation, relationship with their coach, and
overall reception in the workplace.
“We believe our nurses need to see and feel support from
nursing administration,” Bailey says. “Nursing Leadership
needs to be sure they are meeting expectations of our newly
hired staff. To that end, my team of nursing directors will be
helping me to keep in contact with these new employees at
60, 90 and 120 days.”
Another major focus for Bailey’s team is retention of older
nurses. Euclid Hospital has highly tenured nursing and
support staff, Bailey says, with a large number of RNs and
LPNs poised to retire within five years. “We need to be
creative and proactive in developing alternative shifts and
roles that are less physically taxing on our older nurses.
Alternative shifts will allow us to retain experienced
nurses’ vast knowledge base and expertise in the practice
environment,” she says, adding that she’s begun preliminary
discussions with human resources on initiatives in this area.
Ultimately, a bundled approach with attention to ongoing twoway communication, collaboration between leadership and
new nurses, and a focus that includes meeting individual needs
may be the best approach for engaging and retaining nurses.
Email comments to [email protected].
“Nursing Leadership needs to be
sure they are meeting expectations
of our newly hired staff.”
Dawn Bailey, BSN, RN, MAOM,
Chief Nursing Officer, Euclid Hospital
15
The Stanley Shalom Zielony Institute for Nursing Excellence
clevelandclinic.org /notable
216.448.1039 Notable Nursing Spring 2012
Taussig’s Responsiveness Project:
Seven Improvement Targets of
Tapping Teamwork and Accountability
to Improve Patient Experience
Taussig’s Responsiveness Project
Providing world-class cancer care can be demanding. With more than 46,000 inpatients treated at
Cleveland Clinic’s Taussig Cancer Institute in 2010 alone, Cancer Institute nurses understand this all
too well. Despite competing demands and priorities of patient care, nurse leaders and staff throughout
the Cancer Institute foster a supportive culture. They are aware of patients’ individual needs and
believe that caregiver teamwork enhances their ability to be optimally responsive to patients.
The Taussig Cancer Institute team implemented improvements in 17 areas targeting
people, processes and technology. Examples
include:
• Improved patient communication
regarding responsiveness expectations
and commitment, including health
unit coordinator introductions and
postdischarge letters from nurse
managers
• Increased problem-solving
16
The Cancer Institute’s efforts along these lines, dubbed
Taussig’s Responsiveness Project, were initiated with the
purpose of meeting inpatients’ needs quickly and effectively. The project was implemented in July 2011 and uses
a systematic patient-centered improvement approach (see
box for themes related to 17 improvements that target
people, processes and technology). The project has measurable targets and expectations aimed at the primary project
goal of delivering outstanding call-light responsiveness and
improving patient satisfaction.
“Our focus is multifaceted and includes setting the expectations and creating a culture of teamwork, leadership and
accountability, as well as establishing targets for responding to patients’ needs and leveraging our technology,” says
Julie Fetto, MBA, BSN, RN, CHPN, OCN, Nursing Director,
Taussig Cancer Institute. “The comprehensive approach,
which includes sustaining our improvements through
audits of the metrics and continuous feedback to the team,
has been fundamental to our success.”
Fueling success through teamwork
Creating a plan to elevate overall responsiveness to patients’
needs across the Cancer Institute’s 103 beds in four units
required a holistic, comprehensive approach involving all
caregivers, including nurse managers, staff nurses and
nursing assistants.
Left to Right: Patti
Akins, BSN, RN,
OCN; Anne Fitz,
RN, MBA, CHPN
(in white); and
Stephanie Walker,
BSN, RN
“Based on the breadth of factors that touch responsiveness, we had to evaluate the current state across all aspects
of the institute, not just individual pieces,” explains Henry
Buccella, Senior Director of Continuous Improvement for
the Cancer Institute. “For 10 weeks after implementation,
Julie Fetto and I rounded for an hour every week with a
process scorecard to engage and involve all employees. We
found that tapping into the capabilities of the health unit
coordinators (HUCs) in regard to communications, accountability and urgency was a huge component of the project,
in addition to better utilizing technology within our patient
call-light communication system.”
A Responsiveness Project team worked closely with the
HUCs to ensure they understood how important their roles
were to quality patient care and patient satisfaction, define
standard work expectations and priorities, and develop
their role as champions of customer service. Ongoing support of the new initiative was achieved by identifying staff
that had the most impact on process expectations and
engaging them in developing solutions, according to Patti
Akins, BSN, RN, OCN, Nurse Manager of the Bone Marrow
Transplant and Leukemia Units. “It all goes back to everyone being here for the patient and ultimately how we can
make the hospital experience better for them,” Akins says.
To do this, the project team reviewed the HUCs’ job
description. “We recognized that they played a huge role in
overall responsiveness to patient needs and nurse-patient
frequency and effectiveness through
problem-solving huddles for daily
“abnormalities” (tracked via newly
created process scorecards)
• Reduced risk through development and
implementation of backup procedures
for when a health unit coordinator is not
available
• Increased urgency by defining/
implementing an escalation process for
over-target call times
• Better use of technology by changing
critical call-light communication system
settings to support best practices
• Better support of caregivers through
creation of a support responsibility
matrix for hardware, software, settings
problems and needed reports
• More consistent visibility of RN/PCNA
location and availability through
tracking proper locator use and recommunication as needed
communication to meet those needs,” says Anne Fitz, RN,
MBA, CHPN, Nurse Manager, Harry R. Horvitz Center for
Palliative Medicine at the Cancer Institute. “By making
HUCs ambassadors of each unit, we empowered them to be
in charge of navigating the patients’ call lights and requests
to the front desks. Support from nursing leadership ensured
that HUCs had a direct voice with nurses regarding patients’
requests.”
Support included a kickoff retreat. Nursing management
used survey and focus group feedback from all HUCs to
develop and strategize the best implementation plan.
Once an implementation plan was drafted, the management team involved the HUCs in a retreat in addition to
communicating the process, priorities and standard work
improvement protocol. HUCs took the lead in accelerating
the culture shift by promoting customer service, communication, teamwork, urgency and accountability. Leadership
supported enhanced HUC visibility by recognizing good
performance and offering coaching as needed.
“There is real-time accountability for the HUCs to answer
patient calls within one minute and pass the request on
to someone to meet the patient’s needs as quickly as possible,” says Kathy Day, BSN, RN, OCN, Nurse Manager,
Medical Oncology.
Turnaround in patient satisfaction
Before the Responsiveness Project was implemented,
the Cancer Institute’s Hospital Consumer Assessment of
Healthcare Providers and Systems (HCAHPS) patient satisfaction scores were below the target range. Following implementation, the institute attained four months of sustained
performance above 70 percent (73 percent represents the
90th percentile).
“The Cancer Institute’s patient satisfaction scores were in
the middle of the pack comparatively across the system,”
says Buccella. “We wanted to focus this pilot project on the
institute and hit the ball out of the park. Our scores show
that we’re doing it.”
The role of rounding
Day credits purposeful hourly rounding, an initiative
launched by Cleveland Clinic’s Stanley Shalom Zielony
Institute for Nursing Excellence in 2010, as a primary
component of the project’s success. Nurse managers systemwide were trained on key hourly rounding behaviors,
including introduction (telling the patient your name and
role); addressing the “four P’s” (pain, position, potty [toilet
needs] and possessions/personal items); explaining the
17
The Stanley Shalom Zielony Institute for Nursing Excellence
purpose of rounding and when you or others will return;
and documenting the rounding. The goal is for nurses to
make rounding “purposeful” every time. Nurses engage in
a connecting moment with the patient at the end of each
hourly visit to ensure that all needs are met.
Each day’s rounding activity is tracked as nurses sign a
24-hour log at the patient’s bedside. Real-time information
is also reviewed through the call-light system, which Day
reviews weekly to address any gaps in care. “Review of our
2011 data shows purposeful hourly rounding decreased the
number of call lights by 50 percent,” she says.
clevelandclinic.org /notable
The Responsiveness Project’s comprehensive focus is a
win-win for patients and all caregivers involved. By readily
meeting patients’ needs, the project reduces stress on the
floor for the nursing staff. Further, reduced stress raises
job satisfaction and fosters camaraderie, according to Fitz.
“Although we’re not perfect and we continue to work each
day on improvements, the movement to improve patient
satisfaction is in place,” Fitz says. “We know that sustaining
this is a daily effort, yet I feel it’s becoming ingrained in the
culture. It’s still a huge amount of work, but it’s not as hard
as it used to be because everyone knows that they are being
supported.”
Email comments to [email protected].
of taking care of each patient the best way possible, we are
inclusive of all potential needs. Currently, we are ahead of the
curve on including Joint Commission-required measurement
changes and additions, such as the pneumonia measures that
were added in January 2012.”
18
Using Core Measures
to “Be Remarkable”
It’s been 25 years since The Joint Commission (formerly Joint
Commission on Accreditation of Healthcare Organizations)
announced its intentions to standardize core performance
measures into its accreditation process. Core measures,
which are always evolving, are now often regarded only for
their ties to reimbursement and not their original intent of
implementing evidence-based practice to improve patient
care, according to Nancy DeWalt, RN, Nurse Manager,
Progressive Care Unit, Cleveland Clinic’s Hillcrest Hospital.
DeWalt is the driving force behind Hillcrest’s “Be Remarkable”
program, an initiative created to elevate clinical care. The program uses a core measure flow sheet to gauge the application
and assessment of quality discharge measures for five medical
conditions or areas (congestive heart failure, acute myocardial
infarction, pneumonia, stroke and surgical care safety) and to
instill the importance of improving patient satisfaction.
“For each of my 50 staff on the heart unit to ‘be remarkable,’
they must apply all measures to every patient throughout each
shift, regardless of the diagnosis,” explains DeWalt. “By using
a flow sheet, we take a comprehensive approach to tracking
congestive heart failure, acute myocardial infarction, pneumonia, stroke and surgical care improvement. To meet our priority
The impetus for the Be Remarkable program, implemented in
June 2011, is to instill pride in the delivery of care. Organized
through a unit practice council, the program is guided by a
group of charge nurses who are champions for the cause.
Through presentations, ongoing education and patient education fliers, staff reinforce the key principles of core measures
and the importance of overall patient satisfaction that results
from their attention to care.
“Regardless of core measures and the Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS)
scores, nurses should all want to be remarkable,” says DeWalt.
“As a unit, we evaluate ourselves on how well we meet the
needs of our patients and we strive to leave a positive lasting
memory with each patient and family member. By utilizing our
program’s flow sheet and patient education tools as a guide,
we are reminded that each of us is the first line of patient
satisfaction.”
The program is making a difference across the hospital, with
nursing assistants and health unit coordinators being trained
to use the Be Remarkable approach. “We have gone 374
days without a catheter-associated urinary tract infection and
have not had any core measures below expectations in more
than five months,” DeWalt says. “Also, our patient satisfaction
scores have doubled and are still climbing.”
Email comments to [email protected].
216.448.1039 Notable Nursing Spring 2012
Assessing Education Needs of
Asthma and COPD Patients in the ED
The volume of patients who present to emergency departments (EDs) with asthma or chronic obstructive pulmonary
disease (COPD) is high. Cleveland Clinic ED nurses were prompted to wonder if they could better target educational
efforts to patients’ information needs to reduce future ED use for these chronic, manageable conditions.
“We weren’t sure whether patients were
coming to the ED for asthma/COPD
because they lacked knowledge about
managing their condition or because of
other factors,” says Robbie Dixon, RN,
an ED nurse at Cleveland Clinic’s main
campus.
Although numerous tools are available
in the literature for assessing patients’
educational needs about asthma and
COPD, Dixon and her colleagues found
no studies that used available tools in the
ED setting.
So they developed and conducted a
cross-sectional, correlational study using
survey methods to assess the information needs of patients treated in the ED
for asthma or COPD and to determine
if patient characteristics were associated with information needs about these
conditions.
The questionnaire
Dixon and colleagues modified the Lung
Information Needs Questionnaire (LINQ),
a validated tool designed to measure
patients’ need for information about their
respiratory disease. They used the LINQ’s
16 questions that gauge patient knowledge across six domains:
• Disease knowledge
• Medications
• Self-management
• Diet
• Exercise
• Smoking
The questionnaire includes four demographic questions; however, to determine
which factors might be associated with
patients’ levels of information needs, the
researchers added eight additional patient
characteristic questions.
They administered the questionnaire
to patients aged 13 to 90 years who
presented with asthma or COPD exacerbations at two EDs in Cleveland Clinic
health system (a tertiary care urban ED
and a suburban community ED) from
mid-2009 to mid-2011. Patients who
participated were sufficiently alert and
aware, and had at least one other ED
visit for asthma or COPD in the prior year.
Low to moderate information
care provider (PCP) had lower overall
information needs, as did patients with
higher incomes.
When results were analyzed by individual
knowledge domains, information needs
were significantly associated with at least
one patient characteristic for all domains
but one — exercise. The two characteristics most frequently associated with level
of information needs in specific domains
were whether patients lived alone and
whether patients had a PCP. Living alone
correlated with greater information needs
regarding medications, self-management
and smoking. Not having a PCP correlated with greater information needs
about medications and smoking.
needs revealed
Future steps
More than 150 patients completed the
questionnaire. “The total LINQ scores
showed that patients had low to moderate information needs based on the
domains studied and in the overall score,
reflecting some gaps in information
needed to provide optimal self-care,”
explains Dixon.
“In light of these findings, we need to do
a better job getting patients to schedule an appointment with a PCP before
they leave the ED, since having a PCP
correlates with better overall information levels,” says co-investigator Nancy
M. Albert, PhD, CCNS, CHFN, CCRN,
NE-BC, Senior Director of Nursing
Research and Innovation. “Income level
and living alone are nonmodifiable characteristics that have important effects on
information needs. Although we cannot
alter patient income or their status of
living alone, we can create processes and
systems that encourage patients to seek
care from a PCP and have their knowledge needs met outside the ED setting.”
Patients’ needs were greatest for information on diet and disease knowledge.
Information needs levels were lower for
exercise, smoking, medications and selfmanagement, but information need gaps
were present for all domains.
In analysis of patient characteristics, only
two factors were associated with total
LINQ scores: patients who had a primary
Email comments to [email protected].
19
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216.448.1039 Notable Nursing Spring 2012
How to Write the
Perfect Abstract
Writing an abstract is a craft that nurses are wise
to master if they aim to be influential clinicians,
researchers, administrators or educators. As with
any craft, practice — guided by sound principles —
is the key to mastery.
Typical Anatomy of a
Structured Abstract
The abstract is a concise synopsis or representation of a
research or clinical project, and is often required as part of
a manuscript or presentation submission. “The successful abstract provides an overview of your work and offers
enough detail to demonstrate the work’s importance,” says
Nancy M. Albert, PhD, CCNS, CHFN, CCRN, NE-BC, Senior
Director of Nursing Research and Innovation at Cleveland
Clinic.
20
Abstracts of manuscripts should provide enough detail
(together with article keywords) to help readers and
database searchers determine if the full manuscript
will meet their knowledge needs, Albert notes. For a
presentation, an abstract is the basis on which meeting
organizers decide whether to accept the abstract’s author
as an oral or poster presenter.
Structured or unstructured?
Abstracts may be structured (with section headings) or
unstructured (without headings), depending on the requirements of the targeted journal or requesting organization.
Most structured abstracts typically have five section
headings (see sidebar), but the number and heading names
may vary according to the criteria of a specific journal or
requesting organization, the type of work being presented
(quality improvement, innovation or research) and whether
the intent is for an article or a presentation. For instance,
standard section headings are more applicable to research
studies and systematic reviews than to case studies or
reports of quality improvement initiatives or innovative
projects.
Background or Introduction. This section tells readers
why they should care about your work. It should be
short (a single sentence, if possible) and identify a
specific gap in knowledge about your topic. The aim
is to hook readers and persuade them to read on.
Objectives or Purpose. This is a statement of
how your work will address the problem or gap in
knowledge identified in the previous section. Once
this purpose is set forth, the remaining sections
should stay on topic and align with it.
Methods. This portion should be detailed enough to
let readers understand how your project was carried
out and gauge its rigor. For research projects, it
typically touches on the setting, sample, research
design, measurement/instrumentation, and data
collection and analysis. Even for reports of different
types of projects, such as a quality improvement
initiative or a systematic literature review, the focus
should be on how the project was designed and
measured to fulfill its purpose, not on the process of
how you made the project happen.
Results. This section reports specific results for the
major end points mentioned in the Methods section.
This section is often the longest, and it needs to be
structured to provide key points about the project’s
aim, question or purpose. For research abstracts,
report p values when significant and when space
allows. Also, a table or figure, if easy to read, can
trump text, so use one of these visual methods to
show some results when allowed.
Conclusion. This is a summary of results. It should
be focused specifically on addressing the project’s
purpose or objectives. If the word count allows, it
may also touch on implications of your findings or
future research needs.
Unstructured abstracts should cover all the same elements
that structured abstracts do, and in the same order. Using
transition language like “In conclusion,” or “The purpose
of this study was” can help readers quickly navigate through
an unstructured abstract. Unstructured abstracts often
have tighter word limits than their structured counterparts
do. When the maximum word count is low (50–100 words),
minimize all abstract content except the Results section so
that you focus on what the reader wants to learn most.
Just as important are the things to avoid:
Do’s and don’ts of abstract writing
Don’t ignore the requesting organization’s submission
guidelines on matters like font size and type; character
or word limit; rules surrounding the title (such as use
of question vs. statement formats); use of symbols,
abbreviations, headings and uncommon acronyms; and
submission of only completed research or project work.
“Failure to follow submission guidelines may prompt
reviewers to give an abstract a lower rating score even
if the ‘content’ is compelling,” Albert explains. “Also,
reviewers may consider poor grammar or content flow to be
a surrogate for low-quality work and may be more likely to
reject your work or only approve for poster presentation if
the acceptance process is competitive.”
Albert has a number of tips for nurses looking to establish
or sharpen their abstract-writing skills and boost their
chances of having abstracts accepted at meetings.
Key points to remember when preparing an abstract
include:
Know your audience. For instance, if the intended audience
is clinicians, the Conclusion section should not focus on
next steps that are of limited importance to clinicians.
When writing the Results and Conclusion sections, take
care to be accurate when discussing data assumptions. Do
not state significance when it was not found. Make sure your
ideas are sequenced correctly so readers can follow your
thought process.
Pay attention to spelling, grammar and sentence structure.
Use full sentences and review for sentence logic and length,
wordiness, passive voice and formatting. Not only will your
points be clearer and more compelling, but mistakes in
these areas can be a turnoff to some editors and abstract
judges.
Keep the title concise. “Long titles can be distracting,”
Albert warns. “The title should hook the reader while still
being specific to the theme of the abstract.”
Never introduce new concepts in the Results or Conclusion
sections that were not mentioned in earlier sections.
Don’t sweat the word count too much at first. “My
philosophy is to get the key messages on paper, no matter
the word count,” Albert explains. “If I then need to delete
some words, I can look for content that’s less important and
start cutting, perhaps by shortening the Background and
Purpose sections or removing some detail from Methods.”
Albert’s concluding advice is to set aside your completed
abstract for a day or two and then reread it before
submitting. “I’ll usually notice a few opportunities for
improvement that were not so obvious earlier,” she says.
“This is also a good time to make sure the content flows well
and hangs together from section to section.”
One more tip: Keep at it. “As with all writing, practice leads
to improvement!” Albert says.
Email comments to [email protected].
Free CME Webcast on Writing for Publication
In addition to this abstract-writing advice, Nancy Albert offers
detailed guidance on writing for publication more broadly in a free
90-minute webcast, “Three Phases of Writing for Publication,”
available at clevelandclinic.org/NursingCMEPublication.
21
The Stanley Shalom Zielony Institute for Nursing Excellence
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Nurses of Note
Study Gauges
Consistency
in CLABSI
Classification
Increased focus on central line-associated bloodstream infections (CLABSI) led Cleveland Clinic
infection prevention nurses to study consistency in applying the CLABSI definition.
22
Reducing CLABSI has become a growing priority for infection prevention. It is important for infection prevention
teams to reliably and consistently classify CLABSI so that
nursing units are aware of their true rates of occurrence and
can better promote patient safety interventions.
Promising levels of reliability
“CLABSI are considered preventable, so they are starting
to be factored into healthcare quality indicators and
reimbursement,” says Megan DiGiorgio, MSN, RN, CIC,
of the Department of Infection Prevention at Cleveland
Clinic’s main campus. “As bedside caregivers are asked to
review infections to determine how they could have been
prevented, we need to ensure consistency in applying the
definition of CLABSI.”
DiGiorgio and her colleagues are pleased with the results of
their study, which they are preparing for publication. “The
level of inter-rater reliability that we found is higher than
the levels reported in many studies of inter-rater reliability
of different infections in other clinical settings,” DiGiorgio
explains. She adds, however, that few existing studies of
inter-rater reliability of CLABSI classification based on
current CDC definitions were available for comparison.
The challenge of classification
The findings highlight the challenge of applying the CLABSI
definition in a complex clinical setting, DiGiorgio says.
That is not always an easy task. While her department
follows the Centers for Disease Control and Prevention
(CDC) definition for CLABSI, DiGiorgio says the definition
does not always reflect clinical presentation of the patient.
That’s particularly the case in special populations, such as
hematology-oncology patients, since the CLABSI definition
was developed primarily with medical or surgical patients
in mind.
To examine their department’s consistency in defining
CLABSI, DiGiorgio and her fellow infection preventionists
conducted a descriptive, correlational, cross-sectional
study in which they randomly selected two blood cultures
each day from all positive cultures drawn from hospitalized
patients at Cleveland Clinic’s main campus. Each blood
culture was evaluated for CLABSI separately by two infection
prevention nurses randomly selected from an overall team
of eight infection prevention nurses who participated in the
study. The aim was to determine the inter-rater reliability
of CLABSI classification for each specimen. Blood cultures
were evaluated each day for nearly four months to achieve
the 165 cultures needed for adequate statistical power.
In this study, DiGiorgio and her research team also collected
data on some characteristics of infection prevention nurses
to examine factors associated with CLABSI inter-rater
reliability. Nurse characteristics (for example, length of
time as an RN, length of time in current job, certification in
infection prevention and other factors) were not associated
with consistency in classifying CLABSI between two raters.
These results indicate that orientation and ongoing team
communication about issues affecting optimal CLABSI
classification are being addressed in a way that promotes
consistency in carrying out classification procedures.
DiGiorgio hopes this study may spur other hospitals to
consider similar investigations. “It provided an opportunity
to examine a facet of our daily work,” she notes. “We hope
to encourage others to explore research opportunities in
their work. That’s what we did, and it served as a valuable
learning tool for our department.”
Email comments to [email protected].
Kathy Burns, MSN, RN,
ACNS-BC, CEN, has a number
of “firsts” to be proud of. She
recently became the first — and
only — clinical nurse specialist at Cleveland Clinic’s Medina
Hospital, where she has worked
for the past 17 years.
She also led the hospital on its journey to becoming the first
and only hospital in its county to be certified as a Primary
Stroke Center by The Joint Commission. The certification,
which came in December 2011 as a result of Burns’ leadership over the previous year and a half, is a “huge benefit to the
community,” she says. Burns coordinated the stroke program
and led the team that educated hospital staff on the signs
of stroke, treatment options, risk factors and care of stroke
patients in preparation for The Joint Commission survey. As
Stroke Coordinator for Medina Hospital, Burns continues to
provide education on stroke not only to her colleagues but also
to patients and the surrounding community.
Burns’ successes also include chairing the Central LineAssociated Bloodstream Infection Team at Medina Hospital.
Under her leadership, the team worked to decrease the incidence of central line infections in patients in the ICU. Medina
Hospital won national recognition for this initiative from the
U.S. Department of Health and Human Services in May 2011.
Burns, her husband and their two sons have been actively
involved in Boy Scouts of America for the past 12 years. In
2005, Burns volunteered as a nurse for the National Boy Scout
Jamboree in Virginia, an event that draws about 40,000 Boy
Scouts every four years for 10 days of physical challenges. In
2009, she was asked to serve as the first Chief Nurse/Deputy
Chief Medical Officer for Nursing for the Jamboree. In that role,
Burns developed educational programs, supervised staffing
for 20 medical facilities and worked on logistics and disaster
planning for Jamboree Medical Services. She and her staff also
were responsible for teaching the medical team to use the electronic medical record.
Burns has been asked to repeat her service in that role for the
2013 National Jamboree. She also was appointed to serve
on the National Health and Safety Council for the Boy Scouts
of America — another first, as no nurse had previously been
named to serve on this national committee.
During the 2009 National Jamboree, Burns led a research
study to determine if there was a relationship between weight
and the severity of injury in adolescent males participating in
the Jamboree. Results of this research helped guide participant
requirements for the 2013 Jamboree and were published in
Journal of Pediatric Nursing in November 2011.
Mary Noonen, BSN, RN, BC, is
a clinical instructor in the Nursing
Education Department and certified in nursing professional development. She is a firm believer in
continuing to challenge oneself
throughout one’s nursing career.
“Nursing is continual growth,” she says. “You can become an
expert in an area, but there is always room to grow.” She practices what she preaches by getting involved in nursing projects
and activities that allow her to stretch beyond her clinical
instructor role.
For example, last year Noonen was asked by nursing leadership to represent Cleveland Clinic’s South Pointe Hospital on
the systemwide nursing research council. She embraced the
opportunity and is really enjoying it. “I am a novice researcher,”
she notes. “But you have to grow to become an effective
instructor and presenter. It was a wonderful opportunity to be
asked to join this council.”
As a result of her appointment to the council, Noonen helped
coordinate various educational opportunities with regard to
conducting nursing research for internal Nursing Education
Department staff as well as hospitalwide staff. She reports
information she gleans from the research council at each staff
meeting and regularly reminds her colleagues to consider
research and evidence-based practices whenever possible.
As a clinical instructor, Noonen is based at South Pointe
Hospital, but she travels throughout Cleveland Clinic health
system to teach. She has helped roll out several “just-in-time”
educational in-services for various nursing units. These include
the development of online modules and floor instruction on
topics including malignant hyperthermia, an agitation sedation
scale and dofetilide protocols. Noonen also teaches basic and
advanced life support as well as pediatric advanced life support classes and serves on the orientation team charged with
nurse onboarding.
23
The Stanley Shalom Zielony Institute for Nursing Excellence
NurseS of Note
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216.448.1039 Notable Nursing Spring 2012
continued
Executive Editor
Noonen received the 2011 Excellence in Nursing Education–
East Region Award as part of Cleveland Clinic’s annual Nursing
Excellence Awards. Her award was based on nominations she
received from peers recognizing her excellence and expertise
related to education of nursing staff. Numerous staff members
from across the health system nominated Noonen for her many
contributions.
“This is an extraordinary honor,” she says. “I am blessed to
work with phenomenal co-workers. Everyone wants to deliver a
high-quality product, which keeps the bar high for everyone.”
Noonen, who is pursuing her MSN degree, has worked at
Cleveland Clinic since 1993. When a back injury forced her
to give up bedside nursing, she was naturally drawn to the
Nursing Education Department. “I’m very happy being a clinical instructor,” Noonen says. “The beauty of this job is the
variety of things I can be involved in.”
She adds that she has been fortunate to have had very
good mentors who have “ignited my love of nursing.” She
encourages new nurses to seek out good mentors as well. “You
can’t quit learning,” Noonen says. “You have to keep asking
questions.”
24
Anne Vanderbilt, MSN, CNS,
CNP, is passionate about the
geriatric patients she works with
on a daily basis. She has spent
the past 11 years at Cleveland
Clinic’s main campus caring for
them, educating them and her
colleagues, and conducting
research on issues affecting this “especially vulnerable group.”
“These patients need and deserve dedicated and highly trained
skilled providers,” she says.
Vanderbilt believes that most nurses who specialize in geriatrics do so because of a personal experience. And she is no different. Her inspiration was her grandmother, to whom she was
very close. She was involved in her grandmother’s care and
saw her through a serious illness. Vanderbilt’s mother was a
nurse as well who cared for patients in a nursing home.
Vanderbilt’s current work at Cleveland Clinic involves spending half of her time in the Nursing Education and Professional
Practice Development Department, where she develops educational programs for her fellow nurses and other healthcare
professionals and conducts research. She spends the other half
of her time working with outpatient geriatric patients.
“I like the balance of research, education and clinical practice,”
she says. “It’s exciting to impact patients and the profession of
nursing on many different levels.”
In late 2011, Vanderbilt partnered with a physical therapist
to address a chief issue in older adults — falls. Together they
developed a specialty falls clinic in which they work with older
adults in the community who are at risk for falls. Through the
clinic, which is offered a few times a month, Vanderbilt and
her partner provide an interdisciplinary evaluation of each
person, which includes a review of their medications and an
assessment of their strength and physical abilities. Based on
this information, they offer recommendations on how each
person can minimize his or her fall risk.
Vanderbilt also works to educate her colleagues by coordinating
and teaching the Geriatric Resource Nurse Program — a model
of care for hospitalized older adults that is recognized as a best
practice by the Nurses Improving Care for Healthsystem Elders
(NICHE) program, of which Cleveland Clinic is a member.
Through NICHE, Cleveland Clinic was invited to participate in
a federally funded investigation along with 11 other hospitals
to study catheter-associated urinary tract infections (CAUTIs)
and practices surrounding catheter use. Vanderbilt was chosen
to be the principal investigator for Cleveland Clinic in the
18-month study, which began in 2010. Because CAUTIs
are now considered a quality measure, there is “now much
more awareness of appropriate catheter use and duration,”
Vanderbilt says. “Urinary catheters used to be thought of as
benign devices of convenience but now are viewed more as an
intervention with benefits and risks.”
Vanderbilt was the principal investigator on a study Cleveland
Clinic main campus nurses conducted independently in 2005
on urinary catheters. She is also involved in a research study of
known risk factors for delirium in patients undergoing elective
orthopaedic surgery.
Maryann Yavor, MSN, RN, is
known at Cleveland Clinic’s
Hillcrest Hospital for her motto:
“It’s all about the babies.” As
Nurse Manager of the Neonatal
Intensive Care Unit (NICU) there,
Yavor says that she and her staff
of 95 all naturally feel this way.
“No matter what decision is made, every decision hinges on
what’s best for the babies,” she says.
This is tangibly evident in the newly renovated NICU at
Hillcrest. The new unit, which opened in November 2010,
features 24 private rooms and a host of amenities that facilitate the family-centered care that Yavor and her team believe
is so important.
While plans were being made for the renovation of the unit,
Yavor made sure that her team had the opportunity to contribute their ideas and suggestions.
“Through shared governance, all nurses had the opportunity
to focus on what they thought was most important,” she says.
“They all came together and contributed ideas. I respected
their opinions and listened to all of them.”
She led the team in giving opinions and feedback on what the
new NICU should be. Spearheading this process is one of the
things she is most proud of in her 30-plus years on the unit.
She has been the nurse manager for six years.
“I truly believe in lateral leadership — the sharing of ideas,”
Yavor says.
Her team is very close despite more than doubling in staff size
to accommodate expansion of the unit. She says the focus was
on hiring nurses with experience to staff the unit, but she also
hired new graduates who shared her team’s passion.
Nancy Albert, PhD, CCNS, CHFN,
CCRN, NE-BC, FAHA, FCCM senior Director, Nursing Research and
innovation
Address comments on Notable Nursing
to Nancy Albert, [email protected].
Editorial Board
Catherina Chang-Martinez, MSN, ARNP
Continuing Education & Staff Development
Cleveland Clinic Florida
Sue Collier, MSN, RN, BA
Chief Nursing Officer, Hillcrest hospital
Christine Dalpiaz, MSN, RN
Nursing Education, Euclid Hospital
Joan Kavanagh, MSN, RN
Associate Chief Nursing Officer
Molly Loney, MSN, RN, AOCN
Nursing Administration, Hillcrest Hospital
Mary Beth Modic, MSN, RN, CDE
Nursing Education, main campus
Ingrid Muir, BSN, RN
Nursing Director, Medicine and
Endocrinology & Metabolism Institutes,
main campus
Shirley Mutryn, BSN, RN
Nursing Education, Marymount Hospital
Ann Roach, MSN, RNC
With the renovation of the unit, Hillcrest’s NICU also transitioned from a Level II to a Level III facility — a big jump in
critical care that presented a positive professional challenge to
her staff. The change to a private room setting also required
flexibility from her staff, as they were used to seeing each other
and communicating in one main NICU room. But with the
constant use of personal hands-free communications technology, her nurses are able to communicate with each other just
as quickly and are now comfortable in the private room setting,
which is ultimately advantageous to the babies.
Women’s and Children’s Services,
Lakewood Hospital
Yavor encourages her staff to attend national conferences and
supports them in developing and attending local neonatal nursing education days to promote advancement of knowledge in
the neonatal nursing specialty.
Amy Buskey-Wood
Under Yavor’s leadership, daily rounding on the unit has grown
to include individual teams that involve pharmacists, social
workers, physicians, nurses, and occupational, physical and
respiratory therapists.
Mandy Barney
“We are successful because we are a multidisciplinary team,”
she says. “We believe that neonatology is a team sport.
Everyone, including the parents, has input on the baby’s care
for the day.”
Christine Staviscak, BSN, RN
Nursing Education, Lakewood Hospital
Claudia Straub, MSN, RN, BC
Nursing Education, main campus
Linnea VanBlarcum, MSN, RN, ACNS-BC
Patient Care Services, Lutheran Hospital
Glenn Campbell
Managing Editor
Art Director
Photography
tom merce, don gerda, Willie McAllister,
Ken baehr, mike wilkes, Toni greaves,
Russell Lee
Marketing Manager
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25
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Cleveland Clinic (main campus) | Fairview Hospital
Awards
lakewood Hospital
Katherine Hoercher, RN, FAHA, and Deborah Klein,
MSN, RN, APRN-BC, CCRN, FAHA, were elected to
Fellowship in the American Heart Association. They were
recognized at the American Heart Association Scientific
Sessions in November 2011.
Cara Berg, BS, RN, WHNP-BC, SANE-A, received the
Lewis Barbato Award for Outstanding Student Service from
the American College Health Association in June 2011.
The award honors one student annually who has made
major contributions to college health. Berg, who is a nurse
at Cleveland Clinic’s Hillcrest Hospital, is pursuing a doctor
of nursing practice (DNP) degree.
Correction: In the listing of 2011 Nursing Hall of Fame award
Nell Hancin, LPN | Children’s Hospital for
Rehabilitation, Shaker Campus
winners in our Fall 2011 issue, we left out one of the winners.
Our apologies to Nell Hancin, LPN.