News from the Johns Hopkins Hospital Department of Nursing, Johns Hopkins Bayview Medical Center, and Howard County General Hospital (a member of Johns Hopkins Medicine) A Foot in the Door
Lifting the Haze
Stable Staffing in an Unstable Economy
The Patient Comes First
Staying Motivated Beyond the First Step
Gatorade, Free of Charge
Noted With Pride
Teaming UP
Staying Put
The recession won’t last forever, nor will the hospital’s nonexistent vacancy rate, says Karen Haller, PhD, RN, vice president for nursing and patient care services. Even in the current downturn jobs exist, Haller says, but nurses won’t have their pick. Her mantra for one and all: “Get your foot in the door.”
For new nursing graduates, the recession means that they are going to have to look harder, longer, and maybe cast their nets wider when hunting for a job, says Haller.
 Throughout the hospital, important allies are finding ways to employ as many new nurses as possible. Nursing leadership, for example, revised a rule to allow grads with Certified Nursing Assistant (CNA) credentials to keep the clinical associate jobs they held as students while waiting for RN jobs to open up.
Karen Davis, MSN ’94, nursing director for the Department of Medicine, took advantage of the rule change to hire several new grads in CNA positions so they’ll be in line for part-time RN openings. “They’re already here, and can transfer over time into RN positions,” Davis says. “That way it’s seamless.”
The revised policy allowed Allison Murter, MSN ’04, RN, nurse manager for the bone marrow transplant unit on Weinberg 5B, to offer a CNA job to Pete Meagher, an eager new nursing graduate. She reached him in Boston where he was interviewing at another hospital. Pete said, “I’m coming back; I’ll take it,” Murter recalls.
Meagher has already passed the nursing board exams, but started work as a CNA on June 1. “He was holding out for this unit which was phenomenal and makes me very proud,” Murter says. She has also hired another grad in a CNA position who is preparing for her boards.
The new Oncology Functional Unit Nurse Team, established by Suzanne Cowperthwaite, MSN ’08, RN, is a flexible team willing to cover weekend shifts as well as for sick calls and medical leaves of absence on oncology inpatient and outpatient units. The team frees up other nursing staff to precept novices, says the assistant director of nursing in the department of oncology.
“We love to hire nursing students we know and have been on our units,” Cowperthwaite says. “You know what they’re capable of, and they can have an easier transition into the role.”
Another job creation strategy requires a “divide and multiply” approach. “Every time I get a resignation now, I take that position and cut it in half and make it into two part-time positions,” says Joan Diamond, MSN, RN, a nurse manager in obstetrics. That way, “the nurses get their foot in the door and there are always opportunities for overtime,” Diamond says. “I want to support as many new grads as I can.”
Sherri Jones, MSN ’09, RN, coordinator of nursing programs for the department of surgery, and nurse managers remained committed to new grads although all positions were filled throughout the department. “We decided, ‘Let’s continue to finish interviewing and ask grads if they’d like to be a part of a waitlist.’” Jones and her colleagues drafted a letter to the select few who made the waitlist promising to stay in touch.
The waitlist has been a good confidence builder, Jones says. “We built a lot of trust, and the interviewees felt wanted.”
And sooner than Jones anticipated, the waitlist came in handy: “Come to find out, about four units have had openings.” —Stephanie Shapiro
She and Billing are quick to point out that palliative care does not equal hospice care, a common misconception among patients and clinicians alike. "Palliative care is about empowering patients and their families with knowledge, so they are informed and able to determine their goals of care," she explains, recalling a case where both the palliative care team and the patient's doctors recommended hospice as the best choice. The patient, however, wished to continue chemotherapy. Respecting and supporting that decision and managing the physical symptoms or side effects of chemotherapy became the team's goal. "It is not only about end-of-life issues, it is about quality of life and how to live better with cancer," says Billing. When Karin Taylor, a clinical nurse specialist in Child and Adolescent Psychiatric and Mental Health, came to work in the Department of Psychiatry in the mid-1980s, she remembers walking off the elevator and into “a haze of smoke.”
The patients smoked everywhere except in bed. The nurses, including Taylor, a clinical specialist on Meyer 3, also smoked.
Over the decades, the air has cleared on Meyer units as cigarette breaks were gradually restricted. And in February of this year, all of Meyer went smoke-free, courtesy of a campaign spearheaded by Taylor.
“We are doing the patients a horrible disservice by not educating them about the damage caused by tobacco,” says Taylor, who kicked the habit 20 years ago. “For too long in psychiatry, there was the thought, ‘Oh, gosh, these people have lost so much in their lives; we don’t want to take this away from them.’”
 But permitting patients momentary relief has long-term disadvantages. Psychiatric patients die 25 years earlier than the general population as a result of medical complications, many of them related to smoking, Taylor says. While primarily a health measure, the ban also eliminated the possibility of violent responses from patients denied daily cigarette breaks granted to others.
Before the smoking ban took effect, Taylor and colleagues led education efforts for staff and patients. Concerns expressed in focus groups that the tobacco prohibition would be unfair or incite violence were allayed. The department’s patient education committee and smoking task force also made sure that admission order sets would provide patients with adequate nicotine patches and gum. Nurses were also encouraged to provide plenty of hard candy, fruit, music, stress balls, and fresh air breaks to help patients cope with withdrawal.
With the imminent smoking ban in the Meyer 1 courtyard and pending legislation to ban smoking on sidewalks around hospitals in Baltimore City, the hospital can look to Psychiatry’s example, says Judith Rohde, ScD, RN, Director of Nursing for Neurosciences and Psychiatry. —Stephanie Shapiro
 | Karen Haller |
When this year’s graduating class first entered nursing school, confidence was high. The chronic global nursing shortage promised jobs, flexibility, competitive salaries, and benefits to newly minted RNs. Then the recession hit.
In my 21 years at The Johns Hopkins Hospital, I have never seen turnover as low as it has been this year: Less than seven percent in the first nine months of fiscal year 2009, compared to 12 percent the previous year. For the month of May alone, the turnover was less than one percent.
Though the numbers are stunning, they illustrate a familiar pattern: When the economy contracts, nurses stay put to offset household income losses. When the economy is flush, nurses are apt to work fewer hours, accept promotions, or relocate when a spouse takes a new job.
Faced with these new economic challenges, nursing leadership and nurse managers throughout the hospital are devising thrifty and creative ways to avert layoffs and employ as many new nurses as possible.
We have curtailed several premium-pay programs for a savings of $6 million—that translates to 60 nurses who were able to keep their jobs this year. A similar program at the Johns Hopkins Bayview Medical Center saved $3 million and 30 nursing jobs. Neither I nor the nursing directors will receive pay raises this year. The goal, of course, is to hit that balance between saving money right now and preserving what programs we need when the economy improves.
This period of recession and retrenchment offers us opportunities. We’re fully staffed, and can now re-direct the energy we’ve been pouring into recruitment these past years. We can shift our resources into stabilizing programs, making quality improvements, and developing new leadership among our ranks. It’s a welcome time of stable staffing. —Karen Haller, PhD, RN, FAAN
VP of Nursing and Patient Care Services, Johns Hopkins Hospital
Over the years, Osler 8 nurse manager Sandra Garlic, BSN, grew weary of losing reliable clinical associates because they felt undervalued and overworked. “I’ve seen some excellent CAs come and go on my unit because of their frustrations and not having enough of a voice in decisions,” Garlic says.
As Johns Hopkins nurses increasingly manage computerized records and medication administration, clinical associates have taken on more responsibility at the bedside. It is the CAs who place and remove straight catheters, change dressings, draw blood, take vital signs, administer EKGs and glucometer finger sticks, and frequently are the first to note changes in a patient’s baseline status.
What’s more, experienced CAs stand ready to help new nurses. “I may not be an RN, but I’ve been in codes,” says Theresa Toppin, a CA in Weinberg. “I will be at your back when a code happens, even if you don’t know what’s going on or this is the first code you participate in. I’m strong enough to be behind you so that your patient won’t know that this is the first code you ever participated in.”
Despite the wealth of experience and support Toppin and other clinical associates contributed to a unit, they were often left out of daily reports and their opinions were frequently ignored. Nor were CAs equipped to lobby on their own behalf.
 | April Rufus, a clinical associate on Osler 8, helped develop a protocol and visual aid for novices learning how to suction patients. |
Through a host of initiatives, nurse managers and their colleagues throughout Johns Hopkins have enlisted the clinical associates in a campaign to boost their confidence and stature in the workplace. It is a continuing effort that demands new protocols, as well as mutual respect, essential to teamwork. The solution is not “just putting tools in place that mandate what’s going to happen,” stresses Pat Sullivan, MS, RN ’77, a nurse manager on Meyer 3. “It’s changing the culture.” When CAs from Osler 8, Meyer 8, and Nelson 7 gather for meetings of the SOARING program, the proceedings begin with I Believe I Can Fly, the group’s theme song. In 2002, Garlic established SOARING, based on the principles of Success, Ownership, Accountability, Respect/Responsibility, Independence, iNtegrity, and Growth. At these meetings, Garlic and hospital nurse educator Margo Preston Scott, MSN, RN, cover the basics of conflict resolution, communication strategies, prioritizing, how to avoid chronic absenteeism, and other skills. Once SOARING launched, Scott took the lead, preparing lesson plans, giving presentations and inviting guest speakers. Increasingly, Garlic and Scott have given CAs the floor to make presentations as well. “Sandra and I want this to be their meeting and to feel good they’ve been at SOARING even if there’s tough stuff to talk about,” Scott says.
Garlic, who will receive her MSN from Johns Hopkins University School of Nursing in December, and Scott advocate on the behalf of CAs with nursing staff, while also urging them to solve problems on their own. Program participants recognize that “they’re the best advocates for themselves,” Garlic says. “Now, nurses respect their opinions, because they’ve learned what a CA can do and listen to them.”
Motivated by new-found confidence, Christine Wilson and April Rufus, both CAs on Osler 8, developed a protocol and visual aid for novices learning how to suction patients. After approval by Garlic, the protocol was introduced to the unit during an in-service training by Wilson and Rufus. Without SOARING, “We probably would have discussed the suction protocol among ourselves [and left it at that],” says Wilson, who is enrolled in an RN program at the Community College of Baltimore County.
Though skeptical at first, Phyllis Oseni, another CA on Osler 8, found that participation in SOARING paid off in very practical ways. “We did a skit one time about how your tone is if you ask somebody to help you,” Oseni says. “A week later, I really needed some help moving a patient, and another CA said she was busy. I thought about the skit, and I didn’t get mad, even though that person could have helped.”
Recently, a second SOARING program launched for CAs on CMSC 9, Nelson 8 and Osler 5. “I would love to see it go hospital-wide,” Garlic says. Meanwhile, a systems analysis told Sullivan, Meyer 3 nurse manager, that poor communication between nurses and CAs assigned to observe high-risk patients jeopardized everyone’s safety.
Clinical associates on Meyer 3 often spend most of their shift observing and interacting with patients at risk for suicide. And yet, Sullivan says, “They’re not used to contributing in rounds, because they have felt like nobody’s listening to them. Some of it is self-perception, not believing they’re important. We try to bring them in and support their efforts.”
Sheila T. Johnson, a CA for 21 years, helped to revise a patient report sheet to en-sure critical information is updated shift to shift based on behavioral observations made by CAs. Johnson contributed to the effort as a member of a multidisciplinary task force that included Sullivan, nurse clinicians Karin Taylor, PMHCNS-BC and Elizabeth Scala, IIE- PACE, as well as a PI team leader and attending physician.
Designated by her peers as one of the unit’s “lead CAs,” Johnson now works hand in hand with the charge nurse, participating in daily milieu rounds and reports. “To know you’re being heard and something’s being done about what you’re saying makes you feel like you’re really part of the team,” she says. Marian Richardson, MSN, RN, AOCN, a nurse manager in the Department of Radiation Oncology, has always valued the role played by the CAs throughout Weinberg and sought ways to build upon their enthusiasm.
When communication faltered between nurses and clinical associates in various Weinberg departments, experienced CA Roslyn Watson approached Richardson with a plan to hold educational seminars for her peers.
“I just saw what was needed on the floors,” Watson says. “Talking to Marian, I knew the nurses and CAs needed to be a team and that’s my goal, to make all of us a team.”
Richardson readily agreed to support Watson’s efforts, which began with building morale among her peers. “The CAs play a vital role in the functioning of our clinics,” Richardson says. “We wanted to recognize their contribution and provide educational meetings to enhance their skills.”
In less than a year, Watson and a committee of other experienced clinical associates have established a monthly series of seminars where CAs learn communication and coping skills, participate in training programs and receive information about educational opportunities. Last October, Weinberg clinician associates also held the first “CA Week,” complete with health screenings, massages, and guest speakers.
“Basically, our whole idea for this program is that the patient comes first,” Watson says. “No matter how hard the job is, the patient comes first. And everyone’s going to be a patient one day.” —Stephanie Shapiro
The nurses who lead the First Step Day Program on Meyer 2 understand that treating a patient’s addiction is only part of the journey toward recovery. The 12-year-old program also provides comprehensive health care and psychiatric treatment—a multi-pronged approach rarely found in other day hospital programs.
What sets First Step apart even further is the attention the staff—nurses, therapist, and outreach workers—pays to the needs of patients as they complete the program and transition back into the community. By helping clients procure birth certificates Medicare, food stamps, and other necessities, the nurses go beyond the call of duty to make sure that each patient is discharged with a social safety net.
The team of six has also built a strong relationship with the housing facilities where First Step patients live, often advising dorm supervisors on medical concerns. “It’s not just a 12-hour a day program,” says Debbie Ekonomides, RN, who often takes those late-night calls from dorm supervisors seeking guidance. “We work around the clock.”
To be admitted to First Step, patients, referred by consultation services on all medical floors, must demonstrate motivation for recovery. They typically remain in the program for up to 28 days, but First Step nurses follow up as patients graduate to the Program for Alcoholism and Other Drug Dependencies.
When alumni return for Monday meetings, still clean 18 months out, the First Step team’s 24/7 effort is rewarded. Those visits, says program coordinator Patti Burgee, RNC, CARN, “keep us motivated.” —Stephanie Shapiro
When Renay Tyler, MSN ’05, ACNP, CNSN, RN, and her husband John got out a map and drew a circle through all points within a two-hour radius of Towson, they were contemplating convenient locations for a weekend retreat.
“If we’re going to buy another property, it should be something that we can enjoy and afford,” said Tyler to her husband. She wasn’t exactly looking for a second job.
 Within that circle, though, was a charming variety store on milepost 76.5 of the C&O Canal National Historical Park. The store, attached to an old cabin, was for sale. Both Renay, an assistant director of nursing for advanced practice in the Department of Surgery, and John, an administrator with the Veteran’s Administration, were plenty busy during the week. Still, the shop, for 40 years a popular stop for towpath travelers and boaters, beckoned.
In 2006, the Tylers bought Barron’s Store at Snyder’s Landing, near Sharpsburg, MD. The couple’s decision to keep the store open and fix the property pleased original proprietor Lee Barron who was nearing 80 and ready to retire.
Now, on weekends from spring through fall, the Tylers continue the Barron’s tradition. “We sell cold drinks, granola bars, penny candy, and we have ice cream,” says Renay Tyler. Enrolled in the new doctor of nursing practice (DNP) program at the Johns Hopkins University School of Nursing, she does homework and works on performance appraisals during lulls in business.
And in some ways, Tyler’s weekend job is not unlike her weekday job. In both, “I’m engaged in meeting people and finding some common ground, whether it’s a customer or a colleague,” she says. “It’s more than just selling a soda and more than just giving a performance appraisal.”
Occasionally, Tyler’s nursing skills come to the rescue. “We’ve had a few kids who spin out over their handlebars and cases of dehydration when it’s unseasonably warm,” Tyler says. Those patients get a Gatorade, free of charge. —Stephanie Shapiro Mary Ellen Wilson was awarded the “Maryland ACEP Emergency Nurse of the Year Award.” Margo Preston Scott, MSN, RN, Nurse Educator (GRAD YEAR) was nominated for recognition as a “Trailblazer” by the Associated Black Charities. She was nominated by Morton M. Lapides, Jr., School President of the itWORKS Learning Center, Inc. Jaimie Stafford, RN, represented Johns Hopkins Nursing in the Hugh O’Brien Youth Leadership Program (HOBY), where she discussed the rewards of a nursing career with sophomore high-school students. The event was held at St. Mary’s College over Memorial Day Weekend. Nurses Week Awards Kelly Caslin, BSN, RN and Neysa Ernst BSN, RN of Osler 4 received The Linda Arenth Award for Innovation in Service Excellence for initiating “Frequent Vitals” at the weekly staff meetings to review their patient satisfaction scores and target areas for improvement.  Aiko Kodaira, RN, MS, OCN; Mikaela Olsen, RN, MS, OCN; Judith Karp, MD; Rajashree Pakala, RD; Kathy Piercy, RD; Karen Mackey, BSN, RN; Kelsey Oveson, BA; Frances Chandler, MSN, RN; and Meghan Lopez, MSNc, RN received the The Shirley Sohmer Research Award for their study, “The Determination of the Most Appropriate Diet in Leukemia Patients Receiving AcD-Ac Consolidation Chemotherapy” in which they evaluated the diet protocol that has been used for 20 years at the Kimmel Cancer Center at Johns Hopkins.
Dawn Luzetsky, MSN, RN; Nancy Stanley, RN; Annette Perschke MSN, RN, CRRN; E. Robert Feroli, PharmD, FASHP; and Peter Doyle, PhD also received the The Shirley Sohmer Research Award for “Examining and Reducing Distractions and Interruptions During Medication Administration: A Translation Study.”
The Nursing Publication Award was given to Sandi Dearholt, MS, RN; Kathleen White, PhD, RN, NEA-BC; Robin Newhouse, PhD, RN, NEA-BC, CNOR; and Linda Pugh, PhD, RNC, FAAN; Stephanie Poe, MScN, RN for the publication, “Educational Strategies to Develop Evidence-Based Practice Mentors.”
The Pediatric IV Response Team of Radiology Nurses was given the Nursing Excellence Award. The team, consisting of Ron Langlotz, BSN, RN; Kristina Hoerl BSN, RN; Ron Wardrope RN; Joan Ulatowski BSN, RN; Melody Corbin, Clinical Technician, helped with difficult pediatric IV insertions and mentored other staff to become experts. Their efforts led to a significant decrease in the number of pediatric outpatient cases that were canceled or rescheduled and an increase in patient satisfaction scores. Lori Van Gosen, MSN, RN, a Pediatric NCIII on the Vascular Access Team, was awarded this year’s Evidence-Based Practice Fellowship. Journal Articles American Society for PeriAnesthesia Nurses (ASPAN) Safety Tool Kit, 2009
Dina A. Krenzischek, Pamela Windle, Maureen Iacono, Jennifer Allen, Tanya Spiering, Theresa Clifford, Becki Hoyle, Chris Price, Cindy Ladner Breast Cancer Research and Treatment
“Promoter Hypermethylation in Sentinel Lymph Nodes as a Marker for Breast Cancer Recurrence”
Hetty Carraway, Shelun Wang, Amanda Blackford, Mingzho Guo, Penny Powers, Stacie Jeter, Nancy Davidson, Pedram Argani, Kyle Terrell, James Herman, Julie Lange [March 2009] Breast Care
“Invasive Lobular Carcinoma of the Male Breast: A Rare Histology in an Uncommon Disease”
Susanne Briest, Russell Vang, Kyle Terrell, Leisha Emens, Julie Lange [February 2009] Frontiers of Health Services Management
“Sealing the Cracks, Not Falling Through: Using Handoffs to Improve Patient Care”
Paine, L and Millman, A. [Spring 2009] Gastroenterology Nursing
“Confocal Laser Endomicroscopy: in Vivo Endoscopic Tissue Analysis”
Christine Smith, Jeanette Ogilvie, Laurie McClelland [September 2008] Issues in Mental Health Nursing
“Crisis Prevention Management: A Program to Reduce the Use of Seclusion and Restraint in an Inpatient Mental Health Setting”
Maureen Lewis, Karin Taylor, Joyce Parks [March 2009] Journal of Nursing Care Quality
“Evaluation of Quality Improve-ment Initiative in Pediatric Oncology: Implementation of Aggressive Hydration Protocol”
Lisa Fratino, Denise Daniel, Kenneth Cohen, Allen Chen [April-June, 2009] Journal of PeriAnesthesia Nursing
“Pharmacotherapy for Acute Pain: Implications for Practice”
Dina Krenzischek, Colleen Dunwoody, Rosemary Polomano, James Ruthwell [February 2008] Journal of PeriAnesthesia Nursing
“ASPAN’s Delphi Study on National Research: Priorities for Perianesthesia Nurses in the United States”
Myrna Mamaril, Jacqueline Ross, Ellen L Poole, Joni M Brady, Theresa Clifford
[February 2009] OR Nurse
“The SGAP flap for the Postmastectomy Patient”
Frances Bayne, Courtney Edwards, Svetlana Filer
[May 2009] Patient Safety
“A Novel Process for Introducing a New Intraoperative Program: A Multidisciplinary Paradigm for Mitigating Hazards and Improving Patient Safety”
Jose Rodriguez-Paz, Lynette Mark, Kurt Herzer, James Michelson, Kelly Grogan, Joseph Herman, David Hunt, Linda Wardlow, Elwood Armour, Peter Pronovost [January 2009] Book Publications
Chemotherapy and Biotherapy Guidelines and Recommendations for Practice, 3rd Ed.
Polovich, M, Whitford, JM, Olsen, M (Eds.).
Pittsburgh: Oncology Nursing Society [2009]
Hopkins Nursing Contributors: Joanne Finley, MiKaela Olsen, Brenda K. Shelton, Janice L. Skinner Critical Care Nursing, North American Edition A Holistic Approach 9th Ed.
“The Critically Ill Pregnant Patient”
Cathy Maiolatesi [December 2008] Current Cancer Therapeutics, 5th Ed.
Ettinger, DS, Donehower, RC, Olsen, M and RN Schwartz (Eds).
Hopkins Nursing Contributors: Joanne Finley, MiKaela Olsen, Janet R. Walczak [2009] PeriAnesthesia Nursing Core Curriculum
Chapter 8
Elsevier Health Sciences, 2009
Dina A. Krenzischek
A new, interdisciplinary OB Stat Team at Howard County General Hospital is engaging in intensive drills to help avert and respond to issues that may arise during pregnancy, childbirth, and puerperium.
“The biggest benefit of having such a team is the comfort level of the staff and physicians,” said Digna Wheatley, MHA, RN, Risk Manager at Howard County. Introduced in January 2009, the OB Stat Team went live after conducting a series of four drills over the course of three months. “By practicing the skills necessary for difficult situations early on, they can truly be ready in an emergency.”
 The OB Stat Team provides early intervention and stabilization for obstetrical emergencies throughout the hospital. Subdivided into teams Alpha and Bravo, the Team responds quickly, arriving on location in five minutes or less when an emergency situation arises.
Team Alpha, paged for most OB emergencies, is comprised of a labor and delivery charge nurse, anesthesiologist, obstetrician, obstetrical technician, pharmacist, unit secretary, respiratory therapist, lab personnel, and security. A chaplain is also part of the team, acting as a liaison between the patient’s family and the team itself.
For life-threatening emergencies involving antepartum/postpartum hemorrhaging, the Bravo Team is called. The group includes members of the Alpha Team plus eight additional staff, including a second anesthesiologist, neonatologist, pathologist, and Gyn/Oncologist.
Since going live, the team has answered six calls, and each emergency is another learning experience. For example, when the team recently received a call that a woman was going into labor in the lobby, they raced down the stairs to meet her—only to discover that the mother had been placed on an elevator going the opposite direction.
Such instances are documented by the primary staff nurse in both the medical record and OB Stat Team record. The charge nurse then completes a summary report to be reviewed in a later debriefing session.
“When reviewing the performance, we try to stay positive,” says Ellen Thompson, MS,BSN, RNC-OB, OB Clinical Education Program Manger. “We ask ‘What did we do well?’ and ‘How could we improve communication?’” By reassessing past situations and holding followup drills every six months, the team constantly strives for improvement and preparedness for the next obstacle ahead.
“Through the collaboration efforts of various disciplines, the team will have the resources necessary to overcome numerous obstacles,” said Judy Brown, MAS, RN, Senior Vice President of Outcomes Management at Howard County. “Every group has a role and we all move in concert.” —David Biglari
Maintaining a consistent nursing staff is essential to providing high quality patient care. But in recent years, Maryland hospital units suffered from high nursing turnover rates. At the Johns Hopkins Bayview Medical Center’s Surgical Intensive Care Unit (SICU), the turnover rate reached 35 percent in 2005.
In January 2008, the Maryland Hospital Association (MHA) responded with the creation of the Nursing Retention Collaborative, an 18-month project spanning 26 hospitals, designed to help reduce voluntary turnover to five percent or less on an ongoing basis.
Carol Miller, RN, BSN, CCRN, patient care manager of the Bayview SICU, had just started her new position when she was asked to manage and organize her unit’s participation in this new collaborative.
“It was a lot of work,” Miller recalls, “and a lot of data collecting.”
Miller distributed surveys to the nurses in SICU to help assess qualitative performance. Unlike previous surveys, which ranked satisfaction on a “1–5” scale, nurses were asked to write narratives describing the nursing environment on their unit—what worked, what didn’t work, what they liked, and what needed improvement.
 It didn’t take long for Miller to see a common thread in the survey responses: SICU nurses needed to improve their communication with one another.
“We started off putting an easel in the break room, where people could leave positive comments at the end of their shift,” Miller said. “Unfortunately, people were writing comments about the messes people were leaving behind, and so on.”
To better communicate about staff responsibilities, one of the charge nurses developed a room check sheet that covered the bare essentials of what needed to be done at the end of each shift. The checklist worked so well, it was shared with other units in the hospital.
In light of the success of the checklist, a daily goal sheet was developed and filled out by the charge nurse as a way of measuring whether the unit was meeting its goals. It too was adopted by other units.
The room checklist and daily goal sheets were a good first step. But another reason staff turnover was high, accord-ing to Advanced Clinical Nurse (ACN) for Education Lynda Hodges, RN, BSN, CCRN, was personality conflicts.
“There were a lot of assumptions being made due to a lack of communication,” Hodges said. “Everyone seemed to be on the defensive because of a look, or something that was said and taken the wrong way.”
Communication sessions, led by human resource representatives, offered insight into effective com-munication methods and conflict management.
“We learned about constructive feedback, and that it’s okay to disagree, but more importantly, how to come to a resolution,” Miller said. “It was well-received.”
The result? Fewer complaints about communication styles, high SICU scores on the Safety Attitude Questionnaire (SAQ), and zero catheter associated bloodstream infections for the past 16 months. To date, the SICU turnover rate has dropped from 27 percent in 2008 to 18.4 percent. —Jonathan Eichberger |
