SE - Structural Empowerment

SE11EO-Commitment to Community Involvement: Describe and demonstrate the result(s) of the affiliations with schools of nursing, consortiums, or community outreach programs described in SE11.

Nurse Residency Program

Nurses are integral parts of the healthcare delivery system, as they are front-line personnel with intimate access to patients. Given the current climate of healthcare, it is imperative that nurses are given the opportunity to develop the skills necessary to deliver safe and effective care in an environment that fosters learning and professional growth. A collaborative effort between the University of Medicine and Dentistry of New Jersey (UMDNJ) and Jersey City Medical Center led to the development of a Nurse Residency program for nurses who graduated within the last 12 months.

Graduate nurses who are interested in the Nurse Residency Program, apply with the University of Medicine and Dentistry of New Jersey. A fee is charged to the individuals entering this program specially designed to assist new and recent graduates make a smooth transition into nursing practice. The Professional Development Education Department, in collaboration with the Nurse Managers from Nurse Resident accommodating units, conducts interviews with the prospective Nurse Resident. Nurse Residents are placed in their primary unit of interest as frequently as possible. Nurse Residents are given the opportunity to work one on one with an experienced nurse preceptor for four months. A total of 24 hours per week is dedicated to safely managing a full patient load in an acute care setting with the assistance of a specially trained dedicated preceptor. Structured weekly goals and skills checklists are utilized and maintained to ensure residents are meeting their objectives. Weekly didactic sessions are provided to enhance their clinical experiences and assist in developing the judgment, skill and knowledge needed to enter the workforce. (Please see Reference SE11EO-A to view the Nurse Residency Program Outline). Topics related to quality and safety of patient care such as evidence-based practice, national patient safety goals, pressure ulcer and fall prevention, palliative care, etc. are presented weekly. In addition, the graduate nurse obtains certificates in phlebotomy, EKG interpretation, ACLS, and advanced stethoscope skills. Other benefits include job placement assistance, and interviewing tips.

Each nurse resident is also provided an experienced nurse mentor to guide him or her through the process. They are also given shadowing opportunities in different specialty areas such as the emergency department, cardiac catheterization lab, renal dialysis, endoscopy etc. The patient care units that have provided Nurse Residents the opportunity to learn include all the Medical/Surgical Units, Telemetry/Pulmonary Unit, Critical Care Division, Mother Baby Unit, and the Emergency Department.

JCMC is committed to providing nurses with the knowledge and experience needed to successfully enter the nursing workforce. Nursing leadership at JCMC believes that sound practices must be developed to ensure the safe transition and retention of new nurses into the nursing profession. In addition to providing a service to the newly graduate nurses in our community, the organization also benefits by potentially hiring employees trained and enculturated in the facility. Currently, the Nurse Residency program has been very successful in providing educational support and clinical experiences to 25 newly graduated nurses. For more information and supporting information regarding the nurse residency program please see SE11.

SE11EO-Table 1

Reducing CHF Readmissions Collaborative

Jersey City Medical center is focused on increasing quality of healthcare to improve outcomes in heart failure
Reducing CHF Readmissions Collaborative

patients. This can only be accomplished if nursing and the interdisciplinary team play an active role in the implementation of evidence based approaches to decrease congestive heart failure (CHF) readmission rates. In 2009 it was identified that baseline rates for all cause readmissions of patient diagnosed with CHF was 31%. Consequently, JCMC joined a nation wide collaborative with the Institute for Healthcare Improvement (IHI). The goal was to achieve a 20% reduction in readmission rates by September 2010 through partnership with the community of Jersey City. This collaborative approach focused on interventions to:

  • Improve core discharge planning and the transition process out of the hospital
  • Improve transitions and care coordination between care settings
  • Enhance coaching, education and support for self management

Using the methods expressed in the IHI How to Guide: Creating an Ideal Transition Home, the team focused on the four key changes to create an ideal transition home for patients of JCMC. These changes included:

  1. Performing enhanced admission assessment for post-hospital needs
  2. Provide effective teaching and enhanced Learning
  3. Conduct real time patient and family centered hand-off communication
  4. Ensure post hospital care follow up

Enhanced admission assessments involve family caregivers and community providers as full partners in discharge planning and predicting home needs. In order to anticipate our community needs the Nurse Case Managers were instrumental in performing enhanced admission assessments on patients admitted with CHF. Using focused question they uncovered patient’s unmet needs and determined that most patients were aware of their diet and need to follow up with MD, but most did not understand the significance of daily weights and need to report them to the physician. The CHF enhanced assessment questions are the following:

  • Why do you think you ended up sick enough to be hospitalized?
  • What do you typically eat for all meals?
  • What did you eat for dinner last night?
  • Do you have a scale and a calendar? How often do you use them? If not what is preventing you to use them?
  • When were you last scheduled to see your doctor? Did you make it to the appointment? Did you make it to the appointment?
  • Did you fill all of your prescriptions? If not what prevented you from doing so? How do you know when to take your pills?
  • Were there any reasons that kept you from taking your pills?

It was also determined that most of them did not own scales. This led to collaboration between nurses and case managers during interdisciplinary rounds to communicate and develop a plan to meet patients’ educational needs and garner the resources necessary. In addition Nancy Floom LSCW, secured $1,800 from Target and our Liberty Health Foundation for scales for those who could not afford them.

Providing effective teaching and enhanced learning to meet the needs of our community was essential to preventing CHF readmissions. The patient education process and tools were customized by the team to meet the needs of our patients, family caregivers, and community providers. The “teach back”, an evidence based method, was adopted and implemented house wide for all patients admitted or with a diagnosis of CHF. The “teach back” method is a way for nurses to verify that what they explained to the patient was clearly understood. After education is provided the patient is asked to confirm their understanding by verbalizing or demonstrating their knowledge. A form was developed to record the patients’ responses to ensure continuity and follow up by all nursing providers. The nurses trialed this method using the CHF color zones (See Appendix SE11EO-A1 and SE11EO-A2). The CHF color zones is a one page tool that uses the colors of a stoplight, green, yellow, and red, to guide patient in managing their CHF symptoms. For each zone the tool provide signs and symptoms and specific instructions for managing the condition including when to seek emergency medial assistance. The nurses on the telemetry unit and cardiac step-down trialed this new process on 50% of all patients identified as having CHF. Both patients and nurses reported positive results and the process was implemented house wide. Evaluation of the process revealed that 81% of patients receiving the “teach back” method with the CHF zone were able to verbalize understanding of CHF teaching. Some learning deficits identified during the education process was a 19% error rate regarding when to call the physician regarding the 3-5 pound weight gain, the ability to recall the name of their “water pills”, and dietary needs. This information led to the development of the CHF booklet titled “Living with Heart Failure: A guide for a healthy heart” by the Clinical Nurse Leaders in collaboration with Sandy Liu Pharm D. For more information on the CHF booklet please refer to Appendix TL7-A. To ensure continuity all of these tools were provided to the neighboring nursing homes, clinics, and doctors’ offices.

The process of conducting real-time patient and family centered handoff communication and ensuring post hospital care follow up was an essential process to ensure that the same standards of care applied when transitioning from unit to unit and from the hospital to the long term care facilities or home. The team invited key nursing leaders from neighboring long term care facilities and medical clinics to participate in the collaborative meeting to identify improvement strategies to prevent CHF readmissions during the transition process. Key Opportunities for improvement and strategies were identified and implemented

SE11EO-Table 2

Leigh Bailey MSW, LSCW, Director of Case Management spearheaded this multidisciplinary team attended by team members listed below:

SE11EO-Table 3

By including the patient, families, and caregiver in the education, transition, and discharge process and ensuring that they fully understand the diagnosis, plan of care, and follow up care with the physician the nurses and the interdisciplinary team at JCMC positively decreased the CHF readmission rates in 2010. Since then JCMC has applied these methods to other diagnosis, such as Acute Myocardial Infarct and Pneumonia.

CHF readmission Collaborative Project Sept. 09 - Dec. 10