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Increasing the Number of Certified Nurses In PACU
ASPAN NATIONAL CONFERENCE ABSTRACTS Nursing. In the perioperative setting we have implemented the (CSL) Clinical Staff Leader Model. This model was created to foster greater support and professional development for the clinical staff at Vanderbilt. The ratio of clinical staff to each CSL was lowered and has increased the value of the clinical staff’s individualized support through their assigned CSL. This new model was implemented in response to years of Nursing surveys that the clinical staff wished to have a closer professional relationship with management, a more valued evaluation process, and a chain of command that would ensure better outcomes for their work environment. This is possible for the CSL team who now weekly work 2 clinical days in staffing with the team and 2 designated administrative days to support the team. This model also supported the Manager in having more dedicated time to round and concentrate on process improvement versus evaluating staff. Objectives of Project: The highlighted goal is the improvement of staff satisfaction and professional growth through the comparison of the nursing quality survey (pre-CSL & post-CSL implementation). Process of Implementation: To prepare for the change, clinical staff leaders go through intensive coaching sessions to learn how to apply leadership lessons to real-life situations. Administrative coaches are provided to each unit’s new leadership team and meet weekly for a 90 day period to discuss tactics and unit/ hospital based philosophies to guide and manage the team. Statement of Successful Practice: Empowering leaders and staff to provide input into decision-making and in their professional growth/ nursing practice. Success is also maintained through recognizing achievements, rewarding/ recognizing, and improving retainment. Ultimately, in the HR/PACU units at Vanderbilt, we hope to have the bottom line proof of success, strength, and stability, come from the encouragement of “Team Spirit”. This will ensure buy-in from staff on our future endeavors and give the team the opportunity to be truly invested in problemsolving and decision-making at the unit and enterprise levels. Implications for Advancing the Practice of Perianesthesia Nursing: This model will strengthen our facilities Magnet designation, the professional clinical ladder, EBP, and leadership guidance in professional organization membership.
MEETING THEM AT THE DOOR: ENSURING A SAFE SURGICAL EXPERIENCE FOR THE COMPLEX PEDIATRIC PATIENT BY DESIGNING AND IMPLEMENTING THE ROLE OF THE PRE-OP CLINIC RESOURCE NURSE Team Leader: Mary E. Reak, RN, MSN, CPAN Gillette Children’s Specialty Healthcare, St. Paul, Minnesota Team Members: Katherine Houle, RN, MSN, CPAN, Cheryl Tveit, RN, MSN, CAPA, Cassie Kosson, RN, CPAN, Janel Olson, RN, CAPA Background Information: Our complex pediatric patients frequently arrive for surgery with an extensive list of comorbidities. The Anesthesia group for our facility has developed a list of patient conditions (“anesthesia alerts”) for which additional information/orders are required (such as medication weans, anticoagulant adjustments, seizure disorders, ketogenic diet management and apnea evaluation) pre-operatively to assure patient safety and coordinate therapies. Historically this list of anesthesia alerts was completed by a clinic nurse. Unfortu-
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nately, there were many gaps in the data collection and the incomplete alerts were frequently passed on to the pre-op nurses for follow up, often necessitating additional phone calls to families and potentially delaying crucial interventions. Objectives of Project: Our objective in the design and development of the Pre-Op Clinic Resource Nurse role was to efficiently address all anesthesia alerts, ensuring timely interventions preoperatively and assuring patient safety, ultimately improving patient satisfaction. Process of Implementation: An eight week pilot program was conducted, placing a pre-op nurse in the clinic to complete anesthesia alerts for all patients for whom surgery orders were completed. The pre-op nurse also had the opportunity to complete pre-op teaching during this visit and begin the process of care coordination. Statement of Successful Practice: Upon completion of our pilot, multiple safety improvements were noted. No surgical orders arrived in the pre-op office with incomplete anesthesia alerts, compared to a 20% return prior to the pilot. Medication weans and lab orders were addressed with providers in person while reviewing the medical history. Patients with cardiac issues, MDROs, difficult airways, s/p organ transplantation, risk of malignant hyperthermia and hematological concerns were further evaluated, past medical records obtained and plans put in place for a safe surgical experience. Physicians and clinic nurses responded positively to the new role in terms of patient safety, patient satisfaction and workflow efficiency. Implications for Advancing the Practice of Perianesthesia Nursing: Evaluation post the pilot program was overwhelmingly positive and the recommendation was made to create a permanent Pre-op Clinic Resource Nurse Position. This role is now a full time position ensuring the streamlined, efficient, safe preparation of our patients for surgery.
INCREASING THE NUMBER OF CERTIFIED NURSES IN PACU Team Leaders: Brenda Moore, BSN, RN, CAPA, Kim Sheffield, BSN, RN, CPAN UF Health Shands, Gainesville, Florida Team Members: Susan Harris, BSN, RN, CPAN, Lauren Kennedy, BSN, RN, CPAN, CCRN, Colleen Anderson, BSN, RN, CPAN, Sarah Levy, BSN, RN, Gillian Louissant, BSN, RN
Background Information: Current evidence shows that specialty nursing certification provides the following benefits:
Promotes excellent patient care Improves patient safety and outcomes Increases nurse satisfaction Provides a sense of empowerment Increases level of competence Enhances interdisciplinary collaboration Demonstrates leadership
As a Magnet Hospital, we recognize that promoting professional development, such as increasing the number of certified nurses, is part of the Structural Empowerment component of Magnet hospitals. Our organization’s FY15 goal is for 38% of eligible nurses to obtain certification in their specialty area. As of October 2013, the PACU department’s number was a dismally
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low 14.8% certified nurses. We determined that an action plan was necessary to accomplish the goal. Objectives of Project: Recognizing the many benefits of increasing the number of certified nurses, our objective was to offer education, mentoring, and support to meet unit and hospital goals. Process of Implementation: A PACU Certification Pit Crew was organized to evaluate staff needs and develop an action plan to meet this goal. An action plan was implemented to educate staff of the benefits of certification. A Survey Monkey was utilized to assess learning needs. Barriers, such as a lack of study time, expense, and fear of failure were identified. Encouragement and recommendations were offered to overcome these barriers. The certification pit crew provided ongoing educational resources, study tools, and group practice exams. Posters were used within the department to share education, sign-up & testing dates, review courses, and ongoing measurement of goal achievements. Additionally, a “need to know” certification education was added to the unit’s monthly newsletter. Statement of Successful Practice: As of October 2014, the PACU certification rate is up to 36.9%. We anticipate reaching the hospital goal of 38% by the end of 2015. Implications for Advancing the Practice of Perianesthesia Nursing: The Certification Pit Crew has been instrumental in increasing the number of certified nurses in the PACU. Providing peer level support, leadership, and mentoring were influential methods in obtaining this goal.
MATURE NURSE RETENTION SURVEY PROJECT Team Leader: Dawn Davison, MSN, RN, CPAN Advocate Good Samaritan Hospital, Downers Grove, Illinois
Background Information: Research defines the “mature nurse” as any nurse over the age of 45. Forty-one percent of nurses are 50 years or older, with 82% of this subgroup anticipating retirement in the next decade. The average age of the perioperative nurse is 52. Objectives of Project: The purpose of the MNRS Project is to determine the needs of this population at Good Samaritan Hospital, present results to Nursing Leadership, and provide strategies and recommendations related to retention. Process of Implementation: The project utilized an existing survey created by a nurse leader with permission from the author. The survey was posted on-line and available to 365 nurses meeting criteria with 183 responding. This created a robust survey response rate of 50%. Information collected included demographics such as age, practice area, role, years in nursing, current employer, and intent to remain with employer. Nurses were asked to rank the following six categories related to mature nurse retention: scheduling flexibility, ergonomics and environment, technology, redesigned role, benefit and retirement plans, and recognition. There was also an area to free text responses related to stress and retention. Statement of Successful Practice: The findings of the study, which suggest that increased patient acuity accompanied by increased nursing workload attribute significantly to dissatisfaction in the workforce of the mature nurse were identified via the free text responses. Results were presented to Nursing Leadership, Vice-President of Human Resources,
ASPAN NATIONAL CONFERENCE ABSTRACTS and reviewed by the Nurse Executive Committee for use in strategic planning. The poster was also presented at the Advocate Nursing Research Symposium and received the People’s Choice Award. Implications for Advancing the Practice of Perianesthesia Nursing: Nurses identified in free text responses that increased patient acuity and nursing workload are the top priorities in maintaining the mature nurse. These are new findings not addressed in the original survey. As the nursing population ages, especially in the perianesthesia area which includes a large number of mature nurses, strategies need to be implemented to retain this subgroup of nurses.
CONNECTING THE DOTS: PROFESSIONAL DEVELOPMENT FOR NOVICE PACU NURSES Team Leaders: Staci Eguia, MSN, RN, CCRN, Cori Kopecky, MSN, RN, OCN University of Texas at MD Anderson Cancer Center, Houston, Texas Team Members: Elsy Puthenparampil, MSN, RN, CPAN, Jenise Rice, MSN, RN, CPAN
Background Information: During nursing orientation in PACU, nurses are provided an extensive orientation with weekly goals and unit based objectives. However, direct observation of these nurses (RN’s ranging from novice to expert) indicated disconnect between nursing theory and clinical practice. An orientation process survey was provided to 15 nurses in PACU to assess the efficiency of orientation and to identify additional learning needs. The survey and direct clinical orientation of new hires identified a need for further education to alleviate disconnect in the “how” and “why”. “Connecting the Dots” (a one day course focused on caring for the post anesthesia patient) was developed to aggregate PACU nurses orientation, theory, and clinical knowledge. Objectives of Project: The purpose was to improve the orientation process for an inexperienced PACU nurse through a one day course that focused on PACU based didactic and skill session. Process of Implementation: Based on the new employee orientation needs assessment, and direct clinical observation of the new PACU nurses; we developed “Connecting the Dots” one day program. The program focused on didactic and skill validation required caring for high acuity patients in the PACU including ventilator management, flap assessment, hemodynamic monitoring, malignant hyperthermia, and recovery scores. Formative and summative assessments were done to evaluate the effectiveness of the program. Post Assessment results indicate a 20% increase in assessment and nursing interventions based on course content. Statement of Successful Practice: Implementation of “Connecting the Dots” a program for novice PACU nurses to aggregate and “connect” both clinical and theoretical nursing will assist in decreasing knowledge deficits and enhance professional development. Implications for Advancing the Practice of Perianesthesia Nursing: This project improved the professional development of novice PACU nurses and standard of care for patients in the high acuity post-operative recovery period.
MEETING THEM AT THE DOOR: ENSURING A SAFE SURGICAL EXPERIENCE FOR THE COMPLEX PEDIATRIC PATIENT BY DESIGNING AND IMPLEMENTING THE ROLE OF THE PRE-OP CLINIC RESOURCE NURSE Team Leader: Mary E. Reak, RN, MSN, CPAN Gillette Children’s Specialty Healthcare, St. Paul, Minnesota Team Members: Katherine Houle, RN, MSN, CPAN, Cheryl Tveit, RN, MSN, CAPA, Cassie Kosson, RN, CPAN, Janel Olson, RN, CAPA Background Information: Our complex pediatric patients frequently arrive for surgery with an extensive list of comorbidities. The Anesthesia group for our facility has developed a list of patient conditions (“anesthesia alerts”) for which additional information/orders are required (such as medication weans, anticoagulant adjustments, seizure disorders, ketogenic diet management and apnea evaluation) pre-operatively to assure patient safety and coordinate therapies. Historically this list of anesthesia alerts was completed by a clinic nurse. Unfortu-
e27
nately, there were many gaps in the data collection and the incomplete alerts were frequently passed on to the pre-op nurses for follow up, often necessitating additional phone calls to families and potentially delaying crucial interventions. Objectives of Project: Our objective in the design and development of the Pre-Op Clinic Resource Nurse role was to efficiently address all anesthesia alerts, ensuring timely interventions preoperatively and assuring patient safety, ultimately improving patient satisfaction. Process of Implementation: An eight week pilot program was conducted, placing a pre-op nurse in the clinic to complete anesthesia alerts for all patients for whom surgery orders were completed. The pre-op nurse also had the opportunity to complete pre-op teaching during this visit and begin the process of care coordination. Statement of Successful Practice: Upon completion of our pilot, multiple safety improvements were noted. No surgical orders arrived in the pre-op office with incomplete anesthesia alerts, compared to a 20% return prior to the pilot. Medication weans and lab orders were addressed with providers in person while reviewing the medical history. Patients with cardiac issues, MDROs, difficult airways, s/p organ transplantation, risk of malignant hyperthermia and hematological concerns were further evaluated, past medical records obtained and plans put in place for a safe surgical experience. Physicians and clinic nurses responded positively to the new role in terms of patient safety, patient satisfaction and workflow efficiency. Implications for Advancing the Practice of Perianesthesia Nursing: Evaluation post the pilot program was overwhelmingly positive and the recommendation was made to create a permanent Pre-op Clinic Resource Nurse Position. This role is now a full time position ensuring the streamlined, efficient, safe preparation of our patients for surgery.
INCREASING THE NUMBER OF CERTIFIED NURSES IN PACU Team Leaders: Brenda Moore, BSN, RN, CAPA, Kim Sheffield, BSN, RN, CPAN UF Health Shands, Gainesville, Florida Team Members: Susan Harris, BSN, RN, CPAN, Lauren Kennedy, BSN, RN, CPAN, CCRN, Colleen Anderson, BSN, RN, CPAN, Sarah Levy, BSN, RN, Gillian Louissant, BSN, RN
Background Information: Current evidence shows that specialty nursing certification provides the following benefits:
Promotes excellent patient care Improves patient safety and outcomes Increases nurse satisfaction Provides a sense of empowerment Increases level of competence Enhances interdisciplinary collaboration Demonstrates leadership
As a Magnet Hospital, we recognize that promoting professional development, such as increasing the number of certified nurses, is part of the Structural Empowerment component of Magnet hospitals. Our organization’s FY15 goal is for 38% of eligible nurses to obtain certification in their specialty area. As of October 2013, the PACU department’s number was a dismally
e28
low 14.8% certified nurses. We determined that an action plan was necessary to accomplish the goal. Objectives of Project: Recognizing the many benefits of increasing the number of certified nurses, our objective was to offer education, mentoring, and support to meet unit and hospital goals. Process of Implementation: A PACU Certification Pit Crew was organized to evaluate staff needs and develop an action plan to meet this goal. An action plan was implemented to educate staff of the benefits of certification. A Survey Monkey was utilized to assess learning needs. Barriers, such as a lack of study time, expense, and fear of failure were identified. Encouragement and recommendations were offered to overcome these barriers. The certification pit crew provided ongoing educational resources, study tools, and group practice exams. Posters were used within the department to share education, sign-up & testing dates, review courses, and ongoing measurement of goal achievements. Additionally, a “need to know” certification education was added to the unit’s monthly newsletter. Statement of Successful Practice: As of October 2014, the PACU certification rate is up to 36.9%. We anticipate reaching the hospital goal of 38% by the end of 2015. Implications for Advancing the Practice of Perianesthesia Nursing: The Certification Pit Crew has been instrumental in increasing the number of certified nurses in the PACU. Providing peer level support, leadership, and mentoring were influential methods in obtaining this goal.
MATURE NURSE RETENTION SURVEY PROJECT Team Leader: Dawn Davison, MSN, RN, CPAN Advocate Good Samaritan Hospital, Downers Grove, Illinois
Background Information: Research defines the “mature nurse” as any nurse over the age of 45. Forty-one percent of nurses are 50 years or older, with 82% of this subgroup anticipating retirement in the next decade. The average age of the perioperative nurse is 52. Objectives of Project: The purpose of the MNRS Project is to determine the needs of this population at Good Samaritan Hospital, present results to Nursing Leadership, and provide strategies and recommendations related to retention. Process of Implementation: The project utilized an existing survey created by a nurse leader with permission from the author. The survey was posted on-line and available to 365 nurses meeting criteria with 183 responding. This created a robust survey response rate of 50%. Information collected included demographics such as age, practice area, role, years in nursing, current employer, and intent to remain with employer. Nurses were asked to rank the following six categories related to mature nurse retention: scheduling flexibility, ergonomics and environment, technology, redesigned role, benefit and retirement plans, and recognition. There was also an area to free text responses related to stress and retention. Statement of Successful Practice: The findings of the study, which suggest that increased patient acuity accompanied by increased nursing workload attribute significantly to dissatisfaction in the workforce of the mature nurse were identified via the free text responses. Results were presented to Nursing Leadership, Vice-President of Human Resources,
ASPAN NATIONAL CONFERENCE ABSTRACTS and reviewed by the Nurse Executive Committee for use in strategic planning. The poster was also presented at the Advocate Nursing Research Symposium and received the People’s Choice Award. Implications for Advancing the Practice of Perianesthesia Nursing: Nurses identified in free text responses that increased patient acuity and nursing workload are the top priorities in maintaining the mature nurse. These are new findings not addressed in the original survey. As the nursing population ages, especially in the perianesthesia area which includes a large number of mature nurses, strategies need to be implemented to retain this subgroup of nurses.
CONNECTING THE DOTS: PROFESSIONAL DEVELOPMENT FOR NOVICE PACU NURSES Team Leaders: Staci Eguia, MSN, RN, CCRN, Cori Kopecky, MSN, RN, OCN University of Texas at MD Anderson Cancer Center, Houston, Texas Team Members: Elsy Puthenparampil, MSN, RN, CPAN, Jenise Rice, MSN, RN, CPAN
Background Information: During nursing orientation in PACU, nurses are provided an extensive orientation with weekly goals and unit based objectives. However, direct observation of these nurses (RN’s ranging from novice to expert) indicated disconnect between nursing theory and clinical practice. An orientation process survey was provided to 15 nurses in PACU to assess the efficiency of orientation and to identify additional learning needs. The survey and direct clinical orientation of new hires identified a need for further education to alleviate disconnect in the “how” and “why”. “Connecting the Dots” (a one day course focused on caring for the post anesthesia patient) was developed to aggregate PACU nurses orientation, theory, and clinical knowledge. Objectives of Project: The purpose was to improve the orientation process for an inexperienced PACU nurse through a one day course that focused on PACU based didactic and skill session. Process of Implementation: Based on the new employee orientation needs assessment, and direct clinical observation of the new PACU nurses; we developed “Connecting the Dots” one day program. The program focused on didactic and skill validation required caring for high acuity patients in the PACU including ventilator management, flap assessment, hemodynamic monitoring, malignant hyperthermia, and recovery scores. Formative and summative assessments were done to evaluate the effectiveness of the program. Post Assessment results indicate a 20% increase in assessment and nursing interventions based on course content. Statement of Successful Practice: Implementation of “Connecting the Dots” a program for novice PACU nurses to aggregate and “connect” both clinical and theoretical nursing will assist in decreasing knowledge deficits and enhance professional development. Implications for Advancing the Practice of Perianesthesia Nursing: This project improved the professional development of novice PACU nurses and standard of care for patients in the high acuity post-operative recovery period.