FALL 2008
FALL
Sacred Encounters
Sacred Encounters
INSIDE THIS ISSUE:
>A Student Once Again
by CNO Katie Skelton
>Healthiest
Communities
> Growth
> Perfect Care
EDITORIAL BOARD:
Patti Aubé
Carmen Ferrell
Stacey Fischer
Sheila Holliday
Cathy Semar
Joanne Stermer
A nursing narrative By DENISE BOYD, R.N., BSN, OCN, CNIV
When I first started in Oncology, one of the first things I learned from the
nurses was don’t get too attached to the patients. Having come from an
orthopedic unit where the average length of stay was two to three days, this was
never an issue. In Oncology it is much different. Patients stay in the hospital for
two to three weeks at a time and you have a chance to get to know them and
their families very well. I’d like to tell you that after nine years I always keep to
that rule, but there are some patients you just connect with.
Y. was one of those patients. When he was first diagnosed with acute
myelogenous leukemia (AML) he had lots of visitors. Most of his family lived in Korea but he had
many friends who would come visit him on a consistent basis. He was a typical 24-year-old. He
always wanted things his way, thought that everything we did inconvenienced him, and wanted
things done five minutes ago. He complained that he was bored every time he was in the hospital.
He spent most of the day on his computer emailing friends, watching movies or shopping on
ebay (which he loved). He even got upset at me one day during multidisciplinary rounds because
someone outbid him on an ebay item while the team was talking with him. Although I was his
bedside nurse many times, I would get to know a different side of Y. on the days I wasn’t doing
patient care.
Every Wednesday I sit in an office and work on projects for the floor. The office door is always
open and one Wednesday Y. came in, sat down, and started talking with me. At first I thought he
came in that day because his computer was broken, but as time went on this became a constant
thing. Some days our conversation consisted of small talk. Other days we spoke about his plan of
care and treatment. As time went on he really grew on me. I enjoyed his company and liked to joke
around with him. I felt fortunate to have the opportunity to get to know him.
Y. went through a couple cycles of chemotherapy and was in and out of the hospital.
Unfortunately, his leukemia was not responding to chemotherapy. He was eventually transferred to
the ICU for respiratory distress and intubated for a month. I remember thinking I would never get my
work done with Y. in the office. Now I was feeling guilty for not cherishing that time. I tried to visit Y
every time I was working, but it was hard for me to see him intubated and sedated.
Y.’s white count eventually did come up and they were able to extubate him and transfer him
back to our unit. During the next several weeks his condition improved. It was great, but short
lived. Chemotherapy did not work and there was nothing else we could do for him. He told me he
was afraid to die, but knew his time was near. I told him it was okay to be afraid, but he would
be in a better place. I told him don’t worry, heaven has ebay! He laughed. After that he told me
he wanted to go home. I spoke with the physician and we set a plan to get him home. The day we
discharged him he gave me a hug and thanked me for being his friend.
When he came in for transfusions he looked happy. Then, after being off work a couple of days I
returned to find Y. was admitted DNAR (do not attempt resuscitation). He was not verbally responsive
but could weakly grasp my hand. I sat with him for awhile. A couple hours later his nurse called me
back into the room when Y. had taken his last breath. Ironically it was a Wednesday.
A Student
Once Again
I had an incredible opportunity in
July to spend a week as a student,
as a Fellow, on a site visit for the
American Nurses Credentialing Center Magnet Appraiser
program. I was paired with three other very experienced
appraisers and was fortunate to have a wonderful mentor.
We visited a great organization with multiple campuses
and many talented people.
Seeing through the lens of a student’s eye is a great
opportunity. It’s a chance to revisit things you think you
know. It’s a chance to clarify, to expand, to delve into a
subject that you may never have explored before. It’s a
chance to ask, and to be open to new ideas, concepts and
ways of doing things. It’s a chance to grow!
I learned and relearned a few key points that I would
like to share with you from my student experience as an
appraiser for Magnet.
1.Do your homework. There is nothing like being well
prepared! It doesn’t matter whether you are the teacher
or the student on this one. There is no substitute for
preparation.
2.Each of us has a responsibility to be informed and
knowledgeable about our work and our practice
environment.
3.Magnet Designation is all about robust Nursing
Excellence: excellence in practice, in development of
people, in research, in relationships. Don’t confuse
Magnet with Six Sigma or Lean or Core Measures or PI.
Magnet is Nursing Excellence in practice.
4.The bedside nurse is the key to Nursing Excellence in
practice. Leaders can foster its development but it’s the
day nurse and night nurse at the bedside that make it a
reality for the patient.
My student experience made me even more proud to come
home and be a part of such a great nursing team here
at SJO. Thanks to each of you for making our practice
environment what it is – excellent!
Katie Skelton R.N., CNAA, BC
Vice President of Patient Care Services
Chief Nursing Officer
Growth
Growth
Nursing Communications: Synched & Linked
To all of you who completed the nursing communications surveys inserted
in the last issue of this newsletter, Thank You! Your strong participation
was and will be very helpful in the St. Joseph Hospital Nursing
Communications Council’s efforts to relay what is happening in our nursing
practice. As we build on best communication practices for the future, it is
encouraging to see survey results showing a solid majority of SJH nurses
feel informed and satisfied with nursing communications.
“Issues and trends impacting nurses” was the number-one selection to the
question, “What information interests you the most?” The Communications
Council has been researching how best to provide that information, and wants
you to be aware of an excellent source of nursing issues and trends. SJH
Medical Librarian Julie Smith has created an award-winning blog called “Show
Me the Evidence,” located on our hospital website, www.sjo.org/Employment/
NursingExcellence. Please stop by and check it out!
Top responses to the question, “What information would you like to see on
the hospital website?” were “Specific accomplishments of SJH nurses,”
“Nursing Council Highlights” and “Past issues of SJH Nursing: Excellence
in Action.” You’ll now find all of these items on the website.
We’re always listening for suggestions on how to enhance nursing
communications. We welcome your emails to our Communications Council
co-chairs at [email protected] or [email protected].
Pumping Up the Volume
New statistics reported by the Office of Statewide Health Planning and
Development (OSHPD) show that St. Joseph Hospital now ranks first in
Orange County and third in the state of California for surgical volume.
There were 26,791 surgeries performed here in 2007. This represents
a 3.4 percent increase over the previous year, when St. Joseph Hospital
ranked fourth in the state for number of surgeries.
Again this past year, St. Joseph Hospital ranked first in Orange County for
Emergency Department volume with 92,775 visits, and CV Bypass Surgery,
with 375 CV bypass surgeries for children and adults.
SJH Bucks Nursing Shortage Trends
The vast majority of California hospitals face serious challenges finding
nurses - a problem that’s only getting worse as more nurses retire and
change jobs. Although hospitals currently face a nurse shortage averaging
nine percent, the shortage could grow to 30 percent by 2020, according to
the American Association of Colleges of Nursing.
Fortunately, St. Joseph Hospital nurses are bucking those trends. Waiting
lists have been compiled for several nursing units, including Main OR,
Surgery Center, Cath Lab, Endoscopy, Interventional Radiology, Heart
Center, Orthopedics, Labor and Delivery, Mother/Baby and Critical Care.
The turnover rate here for RNs decreased in FY07 to seven percent,
and continues to be well below the state average of 14 percent. Nursing
Leadership Team (NLT) members have averaged 10+ years with St. Joseph
Hospital. To read their reasons for joining the team and staying, visit www.
sjo.org/Employment/Nursing_Excellence/Meet_Our_Nursing_Team.
Still, St. Joseph Hospital continues to grow and hire experienced nurses in
key areas. Through October 6, 2008, employees referring a candidate who
is hired can receive a referral bonus of up to $5,000. Find opportunities at
www.sjo.org/Employment/Search_Jobs.
Healthiest
Healthiest
Communities
Communities
Upcoming Events
Employee Partners BBQ
September 17, 10:30 a.m. – 2 p.m.
in the Sisters’ Garden; 10 p.m. – 2 a.m.
for the night shift in the Café
MASH-style Marathon Aid —These nurses were among the 175 St. Joseph Hospital employees volunteering for medical duty at the August 31 Disney Half Marathon. St. Joseph Hospital
was the exclusive medical sponsor of the event. With more than 13,000 marathon participants, the crew kept busy handing out bandages, ice and Tylenol as well as administering I.V.
fluids and defibrillation from three medical tents along the course.
Free Surgical Interventions
for Orange County’s Poor
Healthiest Communities
Takes Flight
St. Joseph Hospital’s Outpatient Surgery
Center is providing 16 free surgeries
to area residents in need on Saturday,
September 13. St. Joseph Hospital will
partner with the nonprofit Access OC to
host a day of low-risk outpatient surgeries
for low-income and uninsured patients.
Nurses from St. Joseph Hospital often go
above and beyond in volunteering their
skills for community care. For instance,
this past summer James Pham, R.N.,
Emergency Department, and Laura
Vicuna, R.N., Outpatient Pavilion Pre-op,
traveled over 7,500 miles to improve the
health of communities in North Vietnam.
A variety of surgical needs are addressed
through the program. Cases typically range
from hernia repairs and cyst removals to
cataract removals, tonsillectomies, repairs
of torn ligaments and muscles, breast
biopsies and gynecologic procedures.
All of the procedures include pre- and
post-operative care, medications and lab
testing.
An entire team of volunteers, including
physicians, nurses and many others,
donate their skills and time to this local
program. Without their help, many of
these less fortunate men and women
would end up in emergency rooms with a
more severe illness. In all likelihood they
would endure additional months or years
without receiving relief or an opportunity
to be productive and pain free.
Referrals to the program come through
the Coalition of Orange County Community Clinics, comprised of 44 local
clinics, including St. Joseph Hospital’s La
Amistad Family Health Center. For more
information on Access OC’s program visit
www.AccessOC.org.
This was Laura’s first medical missions
trip. “I really enjoyed the experience, and
it was a beautiful country,” she reported.
“We had two teams, one in the field and
the hospital surgical team. I worked in
the field, taking histories with the help of
an interpreter. We also had a chance to
tour the hospital. In this culture, nurses
don’t have much autonomy. The nurses
primarily assist the physicians. It seemed
strange to me to see two family members
sharing a patient’s bed, but families are
there to be the main caretakers.”
For James, the Good Samaritan Medical
Missions trip took him back to the country
of his birth, which he left in 1989 at the
age of 14. “We went to areas far from
major hospitals, where many people who
worked in the rice fields every day had
never seen a doctor. We would take those
requiring surgery back to the hospital. I was
impressed by how many people we were
able to operate on. We performed 46 cases,
from removing spleens, goiters and uterine
fibroids to correcting orthopedic issues,”
said James, who helped triage the patients.
Employee Wellness Fair “Wellness Matters”
September 24, 7 a.m. – 2 p.m.
On the grass between the Sister Francis
Dunn building and the parking structure
Stop by for resources on financial, spiritual,
emotional, physical and social health.
Race for the Cure
Sunday, September 28 at Fashion Island,
Newport Beach
To participate on the team from The Center
for Cancer Prevention and Treatment at
St. Joseph Hospital call Sheree Simpson
at (714) 771-8843.
Celebration 2008!
Saturday, October 4, 6 – 11 p.m.
At the Hilton Anaheim
Call (714) 771-8211 for tickets and
information.
Evidence Based Approaches in the
Diagnosis & Treatment of Stroke
October 10, 8 a.m. - 4 p.m.
Mother Louis Room, St. Joseph Hospital
Call (714) 771-8044 for registration
information.
ANCC National Magnet Conference
October 15 – 17, Salt Lake City, Utah
SJO Magnet representatives will receive the
most current information on the new Magnet
model, patient safety, collaborative research,
staffing excellence and leadership practices.
Cultural Discovery Fair
October 22, 11:30 a.m. – 3 p.m.
On the grass between the Sister Francis
Dunn building and the parking structure.
Fair-goers will be treated to “tastes” of the
countries represented while learning about
healthcare traditions.
Check Your Insides Out:
Preventing Colorectal Cancer
October 22, 4 - 8 p.m.
Featuring lectures and CoCo the colossal
colon at The Center for Cancer Prevention
and Treatment. To register call
(714) 633-DOCS (3627).
Perfect
Care
Perfect
Care
Have you thought about what it means to provide Perfect Care and
how you contribute to this strategic goal of the hospital?
St. Joseph Hospital has
four major outcome
goals for fiscal years
2008-2012.
Our areas of focus are:
1 Sacred Encounters
2 Healthiest Communities
3 Growth
4 Perfect Care
What is Perfect Care?
Perfect Care means every patient will receive the right
care, at the right time, in the right setting. As a nurse,
you have a huge impact on achieving this goal. You
are the patient’s advocate who insists the right care is
provided each and every time. It is through our hard
work and dedication to our patients that we get closer to
our goal of Perfect Care every day.
Other aspects of Perfect Care include a commitment to
availability of publicly reported data, standardization,
evidence-based medicine, a system-wide performance
improvement competency and methodology, and a
culture of safety.
The goals of Perfect Care are zero preventable deaths,
injuries or adverse events, and exceptional performance
in five focused conditions. These conditions represent
large numbers of patients and the strategies for care
are supported by evidence-based medicine. These five
conditions are: Acute Myocardial Infarction (AMI),
Congestive Heart Failure (CHF), Community Acquired
Pneumonia (CAP), Coronary Artery Bypass Graft (CABG),
Surgical Care Improvement Project (SCIP), and Total
Joint Replacement (TJR). As evidence becomes available,
the care required in these populations changes. Staff is
expected to know the quality indicators (interventions) for
each condition and know when to apply them.
How do we keep up with evidence-based care to our patients?
The Perfect Care Checklist (PC Checklist) was created
by nurses to support the delivery of evidence-based
care throughout the patient’s entire stay. When
utilized, the patient can receive the right care, at
the right time, in the right situation - thus, Perfect
Care. The PC Checklist has been employed housewide
since early 2007 to help us do the right thing for our
patients. The format, indicator wording and method
of documentation are all based on nursing staff input.
Nursing simply needs to remember to use the PC
Checklist with every patient, any time any kind of
report is given.
Why is the PC Checklist sometimes on green paper and
sometimes on yellow paper?
The color of the PC Checklist changes with each revision as a visual clue to know there is something new on
the tool. The PC Checklist is revised when there is evidence to change the interventions for the five focused
conditions or at nursing request. Nursing Leadership
Team is integral in making revisions to the PC Checklist
based on bedside nurses’ input. Do you have some suggestions? Please let your manager know!
What happens to the PC Checklist after the patient
is discharged?
The PC Checklist is not part of the patient record.
It is sent to Quality Management upon completion
and maintained for six months. If failures to provide
Perfect Care (evidence-based care) are identified, the
PC Checklist is reconciled with the patient record to
determine where/how the failure occurred. Nurses and
physicians are coached as needed.
Do you know how your floor is doing in Perfect Care?
Have you seen the graphs in your department (Nursing
Dashboards and Clinical Excellence run charts for
AMI, CHF, CAP, CABG, SCIP, TJR)? These graphs are
a great, measurable indicator of how your floor is doing
to provide Perfect Care.
Is it possible to see how we compare to other facilities in
providing evidence-based care?
Yes. St. Joseph Hospital’s performance is publicly
reportable, and your patient care contributes to this
overall performance. If you are interested in how we
compare to other hospitals, check out these websites:
• hospitalcompare.hhs.gov
• calhospitalcompare.org
• qualitycheck.org
How do we keep improving at St. Joseph Hospital and
reach our goal of Perfect Care?
• Be aware of what your patients need and make sure
they receive it prior to leaving the hospital
• C
ommunicate to the next provider of care during
shift change (or change in level of care) all items
that are needed
• Follow through with items needed
• Continue a culture of performance improvement
• Continue being the patient advocate
Thank you for all you do to make St. Joseph Hospital
an exceptional place to receive care in Orange County!
Carla Wilson, RN, BSN, PHN
Clinical Outcomes Coordinator, Quality Management
www.sjo.org