TL - Transformational Leadership

TL2: How nurses at every level-CNO, nurse administrators, and direct-care nurses-advocate for resources, including fiscal and technology resources, to support unit/division goals.

The Chief Nursing Officer, Rita Smith DNP, RN, NEA-BC, as well as the entire leadership team are strong advocates for nursing. Staff members are encouraged to lobby for resources necessary to ensure that their units are functioning efficiently. Shared Governance is the structure that fosters the teamwork, communication and autonomy that are necessary in order to carry-out decisions/recommendations. Issues are initially discussed in the individual Unit Practice Councils (UPCs). Staff nurses utilize this forum to suggest operational improvements for their unit. These issues may either be resolved at the unit level or they may be referred upward to one of the major councils for discussion. Council Chairs meet quarterly with the CNO to report/discuss issues relevant to their individual councils. The CNO also frequently connects and communicates with Divisional Directors, Nurse Managers, Educators and Clinical Nurse Leaders. The CNO conducts unit rounds so that she can assess problems/issues directly. She may attend unit staff meetings when invited and conducts Town Hall Meetings on a quarterly basis. During these sessions, staffing needs, equipment needs and process issues are discussed. She insures that these meetings are held on every shift so that she receives a broad perspective on problems.

This communication network connects all levels of nurses and improves clinical decision-making. Our nurses are empowered to use their clinical expertise in order to sustain their nursing practice.

Example of a Director of Nursing advocating for resources on the Labor and Delivery Unit

The Labor and Delivery Unit were utilizing the GE Centricity Perinatal computer system for fetal tracings. Documentation and archive capabilities, however, were not part of the system. Cheryl Owens DNP(c), RN, CNOR Director for the Mother/Child Health Division recognized the need for an upgraded system as part of the perinatal safety initiative. Ms. Owens participated in the Information Technology (IT) Steering Committee as well as the Perinatal Safety Committee and provided them with information on a system upgrade which included the costs involved as well as a justification. Both committees supported the project, pending approval from senior administration. Ms. Owens emphasized the safety aspects of implementing such as system, such as, remote observation, efficient documentation and alerts and reminders of site-specific protocols. Ms. Owens continued to lobby for the upgrade, until in early 2010 when it was approved. She then collaborated with the Department Chief of Service and formed an interdisciplinary task force to address the issue. The team consisted of:

TL2-Table 1

A Project Tracker database was developed in collaboration with Centricity. The Tracker listed tasks, priorities, and due dates in order to keep the team on target. Appendix TL2-A In February of 2011 two of the nursing staff, Andrea DiRubba BSN, RN and Sharon Williams BSN, RN, were selected for extensive training in Chicago to become Master Trainers for the upgraded Perinatal Centricity program. In March, four (4) hour training sessions were offered to all clinical/medical and clerical staff. A team of supervisors were formed as a resource for the transition. In April, the Labor and Delivery Department went live with all admissions after 8:00 PM. The implementation phase was flawlessly executed with support from IT and Nursing Appendix TL2-B.

Example of the CNO advocating for resources on Units

Rita Smith DNP, RN, CNO began a process of evaluating a patient education system which can be used by nurses as an educational tool and that patients and their families can continue to access at home after discharge. The system that she determined would be most beneficial was the EMMI Solution. The objectives of obtaining this solution are:

  1. Prepare patients for surgery and for their hospital stay
  2. Educate patients about chronic illnesses
  3. Provide a resource for patients and their families to access post-discharge from home.

Projected areas where EMMI will help are outlined on the Table below:

TL2-Table 2

This system is able to prescribe education on patient’s treatments and needs, contains interactive educational modules, can be e-mailed or forwarded to their own physician’s offices or a panel of physicians can answer questions the patients or their families may have. The patients receive nearly “real” time feedback. The goal of obtaining this system is to increase patient satisfaction and provide communication between the patient and the medical/surgical team. Patient’s can become informed prior to admission and can more readily participate in their care.

Ms. Smith collaborated with Brenda Hall MSN, RN Senior Vice President of Safety and Quality to obtain this resource.

Example of a Nurse Manager advocating for resources on a Medical/Surgical Unit

The nurse’s on 7 East Medical-Surgical Unit discussed a patient care issue in their Unit Practice Council (UPC) involving patients who were admitted late in the afternoon or evening. The nurses were unable to obtain food for these patients as the Dietary Department was not a twenty-four hour operation. Nourishments were brought to the floor during the day, however, they were limited to sandwiches and juice, and they frequently ran out of food during the course of the day. The nurses on this unit

approached Clare Cinelli BSN, RN Nurse Manager of 7 East and 7 West (Medical-Surgical Units). Ms. Cinelli met with the staff to discuss their options. Ms. Cinelli arranged a meeting with Rita Smith DNP, RN, NEA-BC, CNO and Robert Ashe, Director of Dietary to discuss a plan. A determination was made that a vending machine that distributed a choice of healthy foods would be made available to the unit. The vending machine is stocked on a daily basis by Food Services and contains a variety of choices, for example, salads with beef, chicken or turkey, yogurt, fresh fruit, canned soups and coffee. The nurses are provided with tokens in order to gain access to the food. The nurses on this unit are pleased to have a methodology whereby they can provide needed food to their patients.

Example of a staff nurse advocating for resources in the Operating Room

In the Operating Room many pneumatic instruments are used to drill and saw through bone. During an oral-maxillofacial (OMF) procedure, the drill that they were using was overheating and becoming warm in the physicians hands. The back-up drill was obtained in order to complete the procedure. The dysfunctional drill was taken to the Sterile Processing Department (SPD) with a note identifying it as in “need of repair.” The Operating Room Materials Manager was also notified that a new drill could possibly be

needed, as it had a history of recent repairs. The Materials Manager determined, after reviewing the repair history, that the purchase of a new drill was needed. He discussed it with the Nurse Manager, Kelly Loo BSN, RN, CGRNA and they determined that a new replacement drill would be purchased. The Purchasing Department thought that a repair contract was a better possibility and posed that issue to OR management. When this was discussed with the staff, they believed that the purchase of the equipment was a better choice and they took this issue back to their Unit Practice Council (UPC). Diane Finklestein BSN, RN and Elise Rivera BSN, RN determined that they would lobby administration for the purchase of this equipment. Their major concern was the safety of their patients. Also, since the drill was used for orthopedics as well, they feared there would be a conflict of equipment at times. They went back to their Nurse Manager and voiced their concerns. They also participated in a Town Hall Meeting with Rita Smith DNP, RN, NEA-BC, CNO and mentioned this issue. Ms. Smith, in turn, reviewed this with the respective managers and it was determined to present this issue to the Operating Room Committee. Kelly Loo BSN, CGRNA, RN, Nurse Manager and Cheryl Owens DNP(c), CNOR, RN, Director of Nursing presented this issue and the committee decided that a new drill would be purchased. Appendix TL2-C

Example of Nurse Educator advocating for resources in the Newborn Intensive Care Unit

After taking a tour of the Newborn Intensive Care Unit (NICU) Marie Guarini Mangin, the sister of U.S. Representative Frank Guarini, determined to make a contribution to this unit. She was motivated by the fact that her son had been born prematurely and spent time being cared for in the NICU. She was moved by the Medical Center’s most fragile patients and was determined to contribute to their development. The NICU staff, led by then Nurse Manager Juanyetta Harris MSN, RN and Michele Dickerson BSN, RN, RNC-NIC, Nurse Educator swung into action to determine how best to utilize the donation. Ms. Dickerson researched the potential benefits of the Giraffe Omnibed and its need in the NICU.

This incubator is designed to promote the growth and stability of the smallest newborns in the NICU. It controls heat, humidity, oxygen, light and noise. Bi-directional air flow through double walls provides a thermal environment; an air curtain prevents heat loss when either door is open. It also contains a Whisper Quiet mode to reduce noise and create a soothing environment. A large hood surface promotes x-ray clarity and visibility. The design also allows for easy access for parents to sit comfortably with the infants for skin-to-skin care. Ms. Dickerson worked tirelessly providing information to the physicians, the Foundation, to Ms. Smith and to the nursing staff. Her hard work was rewarded when the gift was indeed utilized to purchase the Giraffe Omnibed. The organization has even leased two more Giraffes as a result of the positive results experienced with the donated giraffe.

The neonatal intensive care unit for Jersey City Medical Center was named yesterday for Marie Guarini Mangin, center. She is joined by her brother, former U.S. Rep. Frank Guarini, far left; Jersey City Medical Center CEO and President Joseph Scott, far right; her children and their spouses.

The neonatal intensive care unit for Jersey City Medical Center was named yesterday for Marie Guarini Mangin, center. She is joined by her brother, former U.S. Rep. Frank Guarini, far left; Jersey City Medical Center CEO and President Joseph Scott, far right; her children and their spouses.