TL - Transformational Leadership

TL4EO: Describe and demonstrate one (1) CNO-influenced organization-wide change.


Example: EMR Problem List: a CNO influenced organization-wide change was not demonstrated:

  • The initiative was focused on change within nursing, not organization-wide.
  • The pre data (critical care division) was not the same as the post data (all of nursing).

Provide pre and post initiative data is similar and that demonstrates impact at the organizational level.


Provide a new example from the time period of April, 2010 to July, 2013.


  • New Example Provided

Organizational Wide Go- Green Campaign

Purpose and Background:

Rita Smith DNP, RN, NEA-BC, CNO continuously strives to create an environment conducive to healing while also reducing environmental risk and contaminants. In 2009, Dr. Smith began an organization wide campaign to transform JCMC into an organization that focused on environmental welfare by implementing systems and processes to foster a “green living” culture. She initially began this movement with Steven Mosser, than Vice President of Facilities. At this time the JCMC was renegotiating the contract with the current waste disposal company. She collaborated with Mr. Mosser throughout the bidding process in order to ensure that the next contracted company would assist us in accomplishing the goal of “going green” and energy conservation. She finally succeeded in 2011 with the contracting of Stericycle.

Dr. Smith, in 2010, established and led a multidisciplinary task force, which would later be referred to as the “Green Team.” The primary focus of this team was to evaluate and implement environmental best practices to improve sustainability in key areas such as waste and risk compliance, management of multiple waste streams, efficient energy usage, safer chemicals, and efficient use of resources. Data collected on the various initiatives implemented in 2010 was used as baseline data to project goals for the following years (2011-present).

Key Problems Identified:

  • No process established at JCMC to recycle plastic, glass, metal and paper
  • No process established to recycle and reprocess items in the OR
  • High cost of municipal and regulated medical waste disposal
  • Need to increase regulatory compliance with disposal of hazardous medications


  • Increase the number of initiatives to reduce environmental waste and promote a “go green culture”
    • Reduce amount of regulated trash to achieve best practice and/or industry standards
    • Increase organization-wide recycling
    • Meet or exceed best practice and/or industry average for disposal of regulated medical waste
    • Increase the amount estimated waste diverted from landfills
  • Increase organization wide cost savings from baseline and sustain over 3 years



Methods or Approach:

Under the direction of Dr. Smith, the interdisciplinary “Green Team” met monthly to prioritize and strategize the implementation of various initiatives to promote waste reduction and cost savings. As initiatives were introduced and implemented, individual task forces were developed. These teams presented their progress to the “Interdisciplinary Green Team” on a monthly basis. Dr. Smith assumed accountability for each of these initiatives and continued to inspire and motivate team members to consider and implement additional projects.

Initiatives & Timeline:

Initiatives & Timeline 

Below is a summary of each project that has been ongoing from 2009 to present:

Solvent Recycler

Early in 2009, under the leadership of Dr. Smith, the laboratory had concerns regarding the cost of disposal of their hazardous chemicals, for example, xylene, alcohol and formalin. They contacted a company called CBG Biotech in order to purchase a recycler which would enable them to reuse their hazardous chemicals. The goal was to reduce solvent purchases and costs relevant to waste disposal, handling and storage costs. Because of this process the laboratory is able to recover and reuse 90%-95% of these chemicals. A task force was assembled that included Dr. Smith, Ribhia Abedhady, Director of the Laboratory and Arlene Richman Account Manager of CBG Biotech. The initial cost for purchase of the recycling equipment was: $24,510.00. See below for the Return on Investment:

Annual Cost Savings of the Recycling of Chemicals in the Laboratory 

This results in an Average Monthly Savings of $4,521.00 which is ongoing from the inception of the recycling program. The Return on Investment occurred in 5.4 months after purchase of the recycling machine.

Energy Efficient Lighting

Early in the “Go Green” initiative, Dr. Smith investigated the option of improving lighting efficiency throughout the hospital. In 2010, the Green Team explored commercially available, cost effective lighting technologies that offer the best opportunities to achieve high energy savings and reduce hospital costs. In January 2010 all of the lighting fixtures were retrofitted with high efficiency electronic ballast bulbs. In addition, occupancy sensors with digital timers were installed in spaces that are frequently unoccupied such as restrooms and mechanical rooms. These sensors will cause dimmers and lights to shut off after five minutes of no occupancy. The installation of the new lighting in the mechanical rooms on the 1st and 3rd floors contributed to 35,100 kW-hr and $4,684 of annual energy savings per year. Since this initiative began a total of $19,472 has been saved.

Medical Equipment Reprocessing

In 2010, the interdisciplinary Green Team led by Dr. Smith explored utilizing a reprocessing approach to conserve valuable healthcare resources, reduce medical waste, and reduce equipment cost. Reprocessing includes converting single use devices into reusable devices that cost about 50% less than the cost of a new device. These reprocessed items are FDA regulated to ensure high quality standards. The medical equipment reprocessing task force comprised of members from Cardiac Catheterization Laboratory, operating room and gastrointestinal laboratory worked diligently since its inception in 2010 to improve and expand this service. For additional information please refer to EP7EO, and EP7EO – Supplemental. A table summarizing the results is listed below.

Medical Equipment Reprocessing 

Integrated Waste Stream Management

In 2011, a heightened focus was placed on environmental safety, best practices, waste compliance and the management of multiple waste systems at JCMC. Dr. Rita Smith assembled the Green Team for a brainstorming session to determine what issues would be addressed. Dr. Smith’s major concern focused on the necessity of a hospital wide culture change and the implementation of methods to achieve that goal. The Team, directed by Dr. Smith, determined to collaborate with a corporate partner in order to assist with the development of a comprehensive program. Stericycle was contracted with the following goals: focus on the correct disposal of biohazard materials, waste segregation and regulated medical waste by type. The three waste streams to be addressed are Municipal Solid Waste (MSW) which incorporates ordinary trash, Recycling Program (Rcy) and Regulated Medical Waste (RMW) Complete reports of compliance findings are distributed to senior leadership and reviewed with the Infection Control Nurse, Victoria DeChirico MSN, RN, CIC.

In 2011, Problems included the improper segregation of medical waste and the lack of correct recycling. Dr. Smith spearheaded the following interventions:

  • The placement of proper receptacles house-wide for the recycling of plastic and paper. These devices were placed in high occupancy areas, for example in lounges and patient waiting areas. They also placed “desk-top” cardboard recycling containers to ensure that receptacles would be accessible and convenient to everyone
  • Massive education house-wide to include all nursing staff as well as all environmental personnel. This education highlighted the importance of the restriction of items to be placed in regulated medical waste. Environmental staff was educated on how to handle the RMW containers following disposal

The table below demonstrates environmental diversions from landfill, the amount in pounds of waste generated, and the cost savings resulting from proper waste disposal:

Integrated Waste Stream Management 

Pharmacy Waste Management program

In June of 2011, Dr. Smith initiated a meeting with Stericycle representatives, Michael Curci Pharm-D, Maura Donohue BSN, RN Nursing Education Specialist, and Maria DeVivo Pharmacist to institute a pharmaceutical waste management program in order to be compliant with recent legal mandates.

The pharmaceutical program outlined a method to classify and dispose of medications using a safe and systematic method. The system included the use of varied colored containers that are dependant on whether the disposed item is a hazardous, sharp, or regulated waste in accordance with the Resource Conservation and Recovery Act (RCRA). All patient care areas were provided with three containers, two black and one blue.

The waste management process begins in the pharmacy with the proper coding of each pharmaceutical dispensed to the patient care units. The coding involves the pharmacy placing a sticker on each item to insure proper disposal once the medication is on the units. If an item from the Pharmacy does not contain a waste code it defaults to the blue container (non-RCRA). Certain items were identified to be sent back to the pharmacy for proper disposal.

In June of 2011 a train the trainer program was instituted in order to educate Pharmacy, Environmental Services, Managers, Clinicians and all nursing units. The overall impact of this training had a positive effect and reinforced the proper disposal of all pharmaceuticals. Waste segregation compliance is assessed biannually and education is reinforced as needed.


Chris Amato, BSN, RN, CEN, A staff nurse from the Emergency Department presented the use of a macerator as an environmental green initiative for the ED. Rita Smith was extremely supportive and guided Ms. Amato in the evaluation and ultimate purchase of this equipment. She also guided Ms Amato in the development of a business plan to present to Value Analysis for approval. A task force was established with the main goal of changing the current practice of using plastic bedpans, wash basins, and urinals to a single use pulp disposal system. This system improves infection control standards while providing a more eco-friendly system of human waste management. The taskforce members included Dr. Smith, Chris Amato BSN, RN, CEN, Staff RN, Ed Hvitfelt, Director of Purchasing and Erin Salmond Manager of Critical Care.

After a thorough evaluation of the product and a review of potential return on investment, the first macerator was installed in the ED in August of 2012. Please refer to TL2 – supplemental for additional information. This initiative successfully reduced cross contamination and improved infection control practices by reducing the exposure of the nursing staff to human waste. Therefore, in April of 2012, two additional macerators were installed in the Intensive Care unit. Although the cost of usage in the ICU is greater, due to this being a single use product, versus a multi use product, Dr. Smith felt it was important to expand this to the ICU as an infection control safety measure. A table summarizing the results of this initiative is displayed below.

Integrated Waste Stream Management 

Integrated Waste Stream Management 

Other “Go Green” Initiatives

During the post intervention period, Dr. Smith has promoted and organized many other initiatives that encourage a “green living culture” among employees, patients and visitors

Integrated Waste Stream Management 

Organizational Wide Outcomes:

Integrated Waste Stream Management 

Analysis of Baseline Data

In 2010, there were only three major green initiatives. These initiatives included the solvent recycler, energy light efficiency and medical equipment reprocessing. These three initiatives produced a total of $235,540 in annual savings, 35,100kW-hr in energy savings and 6,206lb of waste diverted from landfills.

Post Intervention Data

This data reveals how the “Green Team” led by Dr. Smith made substantial investments to transform JCMC into a workplace that is healthier, safe, and environmentally sustainable. As a result of the “Green Teams” work on these projects, Jersey City Medical Center received the Environmental Quality Award from the New Jersey Business & Industry Association on October 16, 2013. The below table demonstrates achievement of established goals set forth by Dr. Smith.

Integrated Waste Stream Management