Glossary
TL - Transformational Leadership

TL7: Advocacy and Influence-Describe and demonstrate how nurse leaders value, encourage, recognize/reward, and implement innovation.

Nurse leaders at Jersey City Medical Center value, encourage, recognize/reward, and implement innovation in a variety of ways. The value we place on innovation is demonstrated through its inclusion as one of our strategic goals of the Division of Nursing. Our strategic goal states that “we will develop and implement innovations that foster top decile performance on all nurse sensitive quality indicators and patient satisfaction.”

Innovation is encouraged through participation in our Shared Governance process. Nurses are able to participate on committees interdisciplinary, departmental and unit-based. These committees establish goals and objectives that ultimately advance excellence across the organization. Creative approaches are encouraged in order to accomplish these goals. One issue arose between the Critical Care Unit and the Medical-Surgical Units. The concern was with the administration of the Pneumococcal vaccine. The issue was that the Critical Care nurses were unable to administer the vaccine on a regular basis because some patients were unable to consent. They would then be transferred to a Medical-Surgical Unit and subsequently be discharged without the necessary vaccine. This raised much concern among all the staff nurses. A Professional Practice Ad Hoc Council meeting was arranged to discuss and strategize on methodologies to resolve this issue. Nurses involved in this session included (see below):

TL7-Table 1 

Twenty-five nurses hospital-wide attended this Ad-Hoc meeting and decided that they would note on the Medical Record that the vaccine was not given and continue to “hand-off” this information at every shift and to the unit that the patient is transferred to in order to ensure compliance. The discharging unit will perform a full assessment prior to the patient being discharged. All the nurses who attended this session were in agreement with this course of action.

Another way that innovation is encouraged is through nurse’s participation in the DMAIC taskforces. Through these performance improvement groups, nurses and their colleagues from other disciplines seek creative solutions to advance our organizations overall strategic goal. One such project is Obstetric Adverse Events. Nurses involved in this project are Rachele Dalalian RNC, CLNC, Performance Improvement Specialist, Lillian Reyes BS, RN Manager of Mother-Child Health, and Randa Francis, MSN, CNM, WHCNP-BC, Perinatal Nurse Educator. This project incorporates the elective induction bundle, and a reduction of the primary C-Section rate. Accomplishments included an increase from 91% compliance with the bundles to 100% between 2011 and 2012, and a decrease in the primary C-Section rate from 32% to 25.5% (average for 4 months 22%).

TL7-Table 1 

A key way that innovation is recognized and rewarded is through the creative efforts of our Clinical Nurse Leaders (CNL). This fairly new role insures that clinical excellence and evidence-based practice are delivered at the bedside. They work closely with patients and their families and develop and review population-based care protocols, standards and practice guidelines. Claudia Garzon-Rivera MSN, RN, CNL, CCRN and Mabel LaForgia MSN, RN, CNL, CCRN were concerned about Congestive Heart Failure readmissions and the lack of an adequate teaching tool for patients. Ms. LaForgia and Ms. Garzon-Rivera in conjunction with Sandy Liu Pharm D and Nan Rao Pharm D developed an educational book for patients Appendix TL7-A. The book included issues that nurses wanted to prepare the patients for on discharge. The book used very simple language and includes heart failure zones, nutrition facts, sample menus, a monthly weight chart, medication tracker, a description of the heart failure medicines, important facts about medicines and a list of web sites if patients want more information.

Another way that innovation is recognized and rewarded is through the Nurse Excellence Awards. These awards are categorized to be in alignment with the magnet nursing model. Nominees have to demonstrate these qualities in their professional practice:

Rita Smith DNP, RN, NEA-BC, CNO and Michele Dickerson MSN-ED, RN, NEA-NIC, Educator NICU Transformational Leadership, New Knowledge, Innovations and Improvements, Exemplary Professional Practice, Structural Empowerment and Empirical Outcomes. The award in 2011 was presented to Michelle Dickerson MSN, RN, RNC-NIC nurse educator in the NICU for New Knowledge, Innovations and Improvements. She won this award based on the innovation of implementing Newborn Resuscitation Program review classes and education workshops for the nursing staff. This actually included mock code classes. She also instituted S.T.A.B.L.E (Sugar and Safe Care, Temperature, Airway, Blood Pressure,Lab work and Emotional support for the family) which is a neonatal post-resuscitation and pre-transport stabilization education program.Ms. Dickerson made S.T.A.B.L.E. a standard certification as opposed to being optional.

Rita Smith DNP, RN, NEA-BC, CNO and Michele Dickerson MSN-ED, RN, NEA-NIC, Educator NICU

She is also in the process of preparing courses on a regular basis that focus on developmental care and facilitates “Preemie for a day.” Preemie for a Day is an interactive, multi-sensory program that helps caregivers understand the NICU experience of preterm infants. Participants not only learn and discuss ways to improve the care and outcomes of the NICU patient, but also experience the reasons for approaching care in a developmentally supportive manner.

Another key way that innovations are implemented occurs in the Intensive Care Unit (ICU). The ICU was covered by Intensivists ten (10) hours per day. Although they were constantly available for consultation, they were not on-site 24/7. The remaining time, evening and night hours, nurses worked closely with the residents. The ICU nurses became concerned that there was a break-down in the flow of communication and decision-making between patient care and the physician. This problem was discussed with Christina Simeone BSN, RN Nurse Manager of the Critical Care Division. Ms. Simeone and her charge nurses determined that a Skype report would be appropriate. They determined that by using this methodology the Intensivists could actually be present and view the patients during the rounding process. They related this innovation to Rita Smith CNO who discussed this idea with the Chief Information Officer (CIO), Stephen Li. The CIO purchased the necessary equipment on a mobile cart for the unit to use. The ICU team next discussed this issue with Risk Management to ascertain that they would not be violating any HIPPA initiatives. It was determined that since the physicians already had access to the patient records, no HIPPA codes would be violated. This process provides continuity of patient care and provides security to the nursing staff, particularly when making decisions to triage the patients out of the unit.

The Clinical Ladder is another way that innovations are recognized and rewarded. Nurses are financially rewarded as they advance on the clinical ladder. Their advancement depends on a variety of criteria, for example, degrees attained and/or certifications attained, membership in a professional organization and community involvement to name a few. All members of the clinical ladder must submit a project that is beneficial to their unit and that requires some statistical information. Many of these projects are innovative. One project undertaken by Rosanna Vales BSN, RN, staff nurse on the inpatient Behavioral Health Unit, assembled a team and developed a quarterly nursing newsletter. The first edition of the newsletter highlights nursing’s accomplishments, international missions, case management and behavioral health. Nurse’s photographs and poster presentations are featured Appendix TL7-B.

Transforming Care at the Bedside (TCAB) is another way that nurse leaders encourage innovation. TCAB engages frontline staff and unit managers to spearhead change. Ideas for transforming change come from nurses and other care team members who spend time with the patients and their families. These teams identify where change is needed, suggest and test potential solutions and decide whether those solutions should be implemented. Nurses on 6 West, Medical-Surgical Unit, collaborated to develop a portable rapid response kit to be used during rapid response calls. They identified an issue, that when a rapid response was called, they would frequently not have all the items needed when the team arrived. The nurses involved included: Amelia Blanco BSN, RN, RNC, Marba Babour MSN, RN, Khushbu Desai BSN, RN and Concordia Meglioranza BSN, RN, RNC. The kit includes materials such as specimen tubes, angio-catheters, respiratory equipment and lubricants/ointments. The kit has been successfully used and is much more efficient than opening the code cart.

Exemplar

“One of my goals, when I assumed the role of Nurse Educator in Mother/Child Health (MCH), was to establish a perinatal simulation laboratory. The division already owned a high fidelity doll that can simulate many human obstetrical and neonatal scenarios. The

ultimate goal is for nurses and physicians to improve teamwork and communication through simulation of high risk, low frequency scenarios that will decrease maternal and infant mortality. I presented my plan to the leadership team, Lillian Reyes BS, RN, Nurse Manager, Cheryl Owens DNP(c), RN, CNOR Director of Nursing and Rita Smith

DNP, RN, NEA-BC Chief Nursing Officer. This team was very supportive and encouraged me to proceed with my plan. It was suggested that I integrate this simulation lab with the already functioning EMS simulation center. They had an additional room available that I am able to wire and convert to a perinatal lab. I obtained a quotation for customizing the room which was for $17,000.00. I appealed to the Hudson County Perinatal Consortium for some funding to assist me in this venture. They provided me with $1300.00 towards this project with the proviso that this would become a regional simulation laboratory. The Finance Department assisted me in the development of a business plan in order to obtain approval from senior management for the additional funds necessary to implement my plan. The support and encouragement that I received from the leadership team was instrumental in moving this project forward. I believe that it will provide a valuable service to perinatal areas within the entire region.” ( Submitted by Randa Francis CNM, RN, WHCNP Nurse Educator Women-Child Health)

Another way that innovation is encouraged occurred between the Intensive Care Unit and the Organ Donor Council and was recently implemented. The idea was to construct a memorial wall commemorating our organ donors. Nursing representation on the council included: Cristina Simeone BSN, RN Nurse Manager of Cardiac Care Unit, Jessica Walsh MSN, RN, CNL, Nurse Manager of the SICU, and Christine Pangilinon BSN, RN staff nurse in the SICU. Zadith Colon MPH, CPTC, the Hospital

Services Manager of the New Jersey Sharing Network approached Mr. Joe Scott CEO and President of Liberty Health in order to gain support for the project. The Planning Team consisted of Christine Pangilinan BSN, RN, Zadith Colon MPH, CPTC, and Tammy Pfeifle, Director of Volunteer Services.

Wall of HeroesThe Planning Team determined that the “Wall of Heroes” would be placed outside the operating room and across from the Intensive Care Unit. Christine Pangilinan BSN, RN submitted several designs for the wall which were then brought to the vendor to initiate. It was determined by the Committee, that pictures of the donors would be carefully framed and placed on the wall with the inscription: “In their final hours, they gave a lifetime.” Letters from donor recipient’s family members also adorn the wall, thanking the donor and their families for their extraordinary gifts. Many of the letters are from children. A commemorative quilt also serves as a reminder of loved-ones lost. The original dedication of the wall was on August 18, 2010 when 25 donors were honored. The wall has been rededicated two more times, May 20, 2011 to honor 10 additional donors and on April 26, 2012 to honor four more donors. A ceremony is held at the Medical Center and family members and recipients are asked to speak.

Many family members visit our “wall” and are inspired by the courage, hope and love portrayed there. It is a lasting tribute to our heroes and their families.