Jefferson Health New Jersey 2018 Annual Nursing Report

Jefferson Health – New Jersey
2018 Nursing Annual Report

CONTENTS

1 A Message from the Chief Nurse Executive

TRANSFORMATIONAL LEADERSHIP
2 Nurse-SafeTM Program – Addressing Workplace Violence
3 Developing Leadership Skills Through Shared Governance

STRUCTURAL EMPOWERMENT
4 The Journey to Magnet®
8 Giving Clinical Nurses a Voice in Workplace Environment and Staffing
9 Community Outreach – Veterans Haven Endeavor
10 Nurses Supporting Nurses
10 Awards and Recognition
12 The Pursuit of Excellence: Nursing Certification
13 The Pursuit of Excellence: Increasing BSN Nurses

EXEMPLARY PROFESSIONAL PRACTICE
14 Leading the Way in Fall Reduction – TIPS
15 Facilitating Patient Needs Through Interprofessional Complex Care Consults
16 Benefits of Professional Organization Membership – Self-Extubation QI Project
17 Scholarly Activities

NEW KNOWLEDGE/INNOVATIONS/IMPROVEMENTS
20 Researching Factors that Influence the Pursuit of an Advanced Practice Nurse Degree
21 Improving the Work Environment Through Clinical Nurse Involvement
22 Current Table of Projects
24 Improving Throughput Using An Innovative Transfer Center Approach

A Message from the
Chief Nurse Executive

2018 proved to be a hallmark year for the Jefferson Health –
New Jersey’s (JHNJ) Department of Nursing. In August, we received
our first Magnet® Recognition Designation, considered the gold
standard for nursing excellence. The “Journey to Magnet” brings
clinical excellence and an engaged workforce. Magnet standards
are rigorous and they demand continual improvement. Our Shared
Governance model has provided us with the framework to promote
shared decision-making and a Magnet culture.

An organization that believes in the Magnet journey sees value in
creating a healthy work environment (HWE). Nursing Leadership’s
role is to provide direction in the development and fostering of a
HWE for clinical nurses, setting the stage to sustain it. To accomplish
this task, the administrative team must
commit to using evidence-based practice
to lead change through collaboration and
partnership with nurse leaders, clinical
nurses, and all disciplines.

Throughout the 2018 Annual Nursing
Report, you will find examples of how we value a healthy work
environment and promote clinical excellence. To the Magnet nurses,
thank you for all you do to provide a healthy environment for your
patients and each other.

Helene Burns, DNP, RN, NEA-BC
Chief Nurse Executive

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TRANSFORMATIONAL LEADERSHIP

Nurse-Safe™ Program – Addressing Workplace Violence

Workplace violence has In 2018, at the recommendation During the two-hour class,
become a national issue of the interdisciplinary Work- staff engaged in hands-on
and one that has affected place Violence Committee, training, practicing effective
staff at Jefferson Health – Jefferson Health – New escape techniques to
New Jersey. Workplace Jersey hospital administrators address potential situations,
violence consists of physically and nurse leaders funded a ranging from patients
and psychologically damaging program endorsed by the grabbing a staff person’s
actions that occur in the American Nurses Association, wrist, to patients choking a
workplace or while on duty. called Nurse-SafeTM by CDT staff member. The instructors
Training, Inc. also showed protection
There have been incidences measures for two items that
where we have witnessed Classes for Emergency staff members routinely carry
patients and visitors verbally Department staff and on them: ID badges and pens.
and/or physically assault inpatient nursing staff
staff. Each episode of were offered from June The class’s final 30 minutes
violence takes a team effort to September 2018. The focused on effective verbal
to address the violator and focus of the class was de-escalation techniques
support employees. effective evasive/escape and recognizing patient
maneuvers to promote behaviors indicating an
both staff and patient safety. immediate potential for
violence. The final teaching
points were the use of
physical evasion and verbal
de-escalation techniques,
applicable to staff in both
their work and personal lives.

When Phase One of the
Nurse-Safe classes was
completed in September
2018, more than 1,000 staff
members had attended.
Training will resume for
additional staff in 2019.

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NURSING LIGHTS THE WAY

Developing Leadership Skills Through Shared Governance

The beauty of Shared NURSE EXECUTIVE SAFETY AND NURSING WORKFORCE PRACTICE COUNCIL
Governance is that clinical COUNCIL QUALITY COUNCIL ENVIRONMENT AND
nurses share in decisions STAFFING COUNCIL Service Line Committees
that allow them to thrive Clinical Nurse Dermal Defense Committee Peer Review Committee
each day. Peer leadership Recognition Committee Falls Committee Strategies for Shiftwork Safety Suicide Prevention Committee
is essential in shared and Wellness Committee
governance. ADVANCED PROFESSIONAL
PRACTICE NURSE • UNIT COUNCNURSEILS • UNIT COUNCILS • UNIT COUNCILS • UNITCOUNCILS • UNI DEVELOPMENT
The Informatics Committee COORDINATING
has strived to mirror the COUNCIL COUNCIL COUNCIL
shared governance model,
completing 90% of (yearly) T COUNCILS • UNIT COUNCILS • UNIT COUNCILS
goals over the past three
years. These goals have been EBP NIGHT SHIFT INFORMATICS MAGNET NURSE
achieved because members RESEARCH (1 PER CAMPUS) COUNCIL AMBASSADOR LEADER
made the decision to become COUNCIL COUNCIL
clinical leaders, taking an COUNCIL
active role in becoming
ambassadors for Informatics. and became educators in Research findings were
As end users, members have teaching the documentation presented at one of the
been an integral part of and nursing orientation monthly meetings, and a
Soarian® improvements, and classes. The Informatics decision was made to pursue
have made recommendations Committee gives nurses the expanding the committee to
and tested workflows prior opportunity to participate a council. The proposal was
to new documentation in decision-making for presented at the Coordinating
going live. clinical documentation, while Council, and a unanimous
understanding the process vote elevated Informatics
Members are leaders in clinical and importance of proper to a council. This newly
areas, allowing them to be a clinical documentation. established council is just one
resource for other clinicians, example of shared governance
and providing feedback Last year, there was a at its best. Clinical nurses
concerning documentation discussion about the are taking leadership roles,
issues. They have developed difference between a becoming engaged, and
and facilitated the Informatics committee and a council. moving the organization
Skills Fair, instructed unit Members did not understand forward in innovative ways.
secretaries with service provider why Informatics was a
workspace competencies, committee and not a council.
Therefore, the committee
decided to create a workgroup
to research their differences,
and the benefits of becoming
a council.

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STRUCTURAL EMPOWERMENT

The Journey to Magnet® Recognition

On January 31, 2014, more the foundation of our nursing were established and
than 50 clinical nurses and practice. The Shared functioning by September,
nursing leaders gathered in Governance group developed with system core councils
a room to explore nursing a plan to transform nursing in place by year’s end. The
at Jefferson Health – New from a hierarchical structure foundation for excellence
Jersey (then Kennedy), taking to a decentralized, shared had been established.
the first steps on our four- decision-making process.
year journey to Magnet. This Increased nurse engagement
workshop discussed nursing Lastly, the Professional in decision-making, improved
theorists, care delivery models, Practice Model group interprofessional collaboration,
our philosophy of nursing; our finalized the professional and a healthy work environment
mission, vision, and values; practice model – our became initiatives in 2015.
and shared governance. Nursing Lantern. At the
From these preliminary talks, April 2014 Nursing Leadership This was reflected in the
a draft of the first professional Academy, each group Press Ganey Workforce
practice model evolved. presented its work, which Engagement & Nursing
was received with over- Excellence survey, completed
Energized from this whelming excitement. the following year. The
exhilarating day, three work survey’s results exceeded the
groups began to define The summer of 2014 brought Magnet benchmark in 5 out
nursing. The Nursing Theorist nurses education about the of 7 categories established
group selected Jean Watson, “Journey to Excellence,” by the American Nurses
Florence Nightingale, and and introduced them to the Credentialing Center (ANCC),
relationship-based care as groups’ work. Unit councils as shown in Table 1.

Table 1: Press Ganey Workplace Engagement & Nursing Excellence Survey

ANCC Category Percentage of Work Units
Above the National

Nursing Excellence Mean

Fundamentals of Quality Nursing Care 66.67%
Leadership Access and Responsiveness 61.90%
61.90%
Professional Development 57.14%
Autonomy 52.38%
50.00%
Adequacy of Resources & Staffing 45.24%
RN-to-RN Teamwork and Collaboration

Interprofessional Relationships

Note: numbers shown in green exceed the national benchmark.

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NURSING LIGHTS THE WAY

Completion of two research The Magnet Program summation, we were
studies that took place in Office notified us on May 10, advised of our strengths and
2016 would become part of 2018, that we had achieved a opportunities, and that we
our Magnet document. This threshold score that allowed had zero deficiencies. This was
was a journey milestone, as us to move on to the next a positive and empowering
one of the projects had been step — a site visit to verify, experience.
completed by a clinical nurse clarify, and amplify the nursing
as a result of an observation she excellence, as described in On August 15, 2018, all our
had made related to outcomes the document. hard work paid off with a call
on her medical-surgical unit. from the Magnet Commission,
It was apparent that a Magnet Thanks to the efforts of the announcing that it unanimously
culture was taking root. Magnet Ambassador Council, voted to award Magnet
our nurses were ready for this recognition to Jefferson
In late December 2016, site visit. Council members Health – New Jersey. What
the Magnet application was worked tirelessly with units a great moment of pride and
submitted to ANCC. Less than to establish Magnet boards, validation for everyone, to be
four weeks later, we were “brag books,” and a comfort the first hospital in Camden
advised that the application level in interacting with and Gloucester counties to
had been accepted. appraisers. On the day of achieve such recognition!
the visit — June 27 — there You may ask, ‘What’s next? ...
With excitement, formed was enthusiasm, mixed with the journey continues.
workgroups began to pull anticipation. The energy
together the “stories” outlining became palpable as the days We will never stop striving
how we met each of the 49 continued, and each session to be better for our patients,
standards. On August 1, 2017, concluded. Jefferson Health our associates, and our
our Magnet document was – New Jersey nurses were community – and look
submitted for review. “high-fiving” in the halls, and forward to what the future
their pride was visible. At the will bring.
conclusion of the visit, in the

5

STRUCTURAL EMPOWERMENT

6

NURSING LIGHTS THE WAY

7

STRUCTURAL EMPOWERMENT

Giving Clinical Nurses a Voice in
Workplace Environment and Staffing

The Nursing Workplace Environment • Authentic Leadership: Nurse leaders must

and Staffing Council (NWESC) started as a fully embrace the imperative of a healthy work

Staffing Committee in 2016. A broader scope environment, authentically live it, and engage

was identified and the committee expanded others in its achievement (AACN, 2018).

to a Council, with the purpose of addressing

the workplace environment, in addition to The sessions not only educated committee

staffing. The Council, facilitated by Chief members on these key concepts, they also

Nurse Executive Helene Burns, adopted the provided a valuable networking experience.

Standards for Establishing and Sustaining Participants identified communication

Healthy Work Environments model from the skills, critical conversations, and budgeting

American Association of Critical-Care Nurses information as extremely enlightening. An

(AACN) as guiding principles. “aha” moment came to many while learning

about Full-time Equivalents (FTEs) and Hours

In October 2017, the Council began meeting Per Patient Day (HPPD).

with four other NJ hospital staffing councils

as an initiative of the Organization of Nurse The NY Organization of Nurse Executives

Leaders, New Jersey (ONL-NJ). Based on the and Leaders (NYONEL) invited the NJ

AACN model, a teaching program was created. NWESC to speak at their Safe Staffing

The program was divided into three education Summit in September 2018. They were

sessions, covering the following standards: interested in learning about ONL-NJ’s Safe

Staffing initiative. Council Co-Chair and

• Skilled Communication: Nurses must be Stratford clinical nurse Amelia Skelly, along

as proficient in communication skills as with Maria Brennan, CNO of Our Lady of

they are in clinical skills. Lourdes Health System, and Susan Cholewka,

• True Collaboration: Nurses must be relentless Executive Director of ONL-NJ, presented

in pursuing and fostering true collaboration. the overview of how the ONL-NJ started the

• Effective Decision-Making: Nurses must NWESC program, and how it has expanded

be valued and committed partners in making to include nine more hospitals.

policy, directing and evaluating clinical care,

and leading organizational operations. Amelia spoke from the heart, expressing how

• Appropriate Staffing: Staffing must ensure this council has provided clinical nurses with

the effective match between patient needs insight into the intricacies of staffing and the

and nurse competencies. ability to discuss staffing with nursing leaders

• Meaningful Recognition: Nurses must be and be part of the decision-making process.

recognized, and must recognize others,

for the value each brings to the work of

the organization.

Reference
American Association of Critical-Care Nurses (AACN), (2018). AACN Standards for Establishing and Sustaining Healthy Work Environments:
A Journey to Excellence. Retrieved from http://ajcc.aacnjournals.org/content/14/3/187.full

8

NURSING LIGHTS THE WAY

Community Outreach – Veterans Haven Endeavor

The U.S. Department of Veterans educate veterans on topics for the veterans; these items
Affairs (VA) says about 11% of the related to health and wellness were collected from all Jefferson
adult homeless population in (e.g., basic hygiene and self- (NJ) campuses. Lastly, the
America is comprised of veterans. care). Through collaboration Winslow Township Democrats
The VA has many benefits and with multiple Jefferson Health made a monetary donation
services to assist homeless departments, a plan emerged used to purchase many items
veterans; however, not all for this service project. presented to the veterans.
receive the resources needed
to successfully transition back Using the common denominator The luncheon was an enormous
into the community. of food — which can bring success and helped launch the
people and cultures together — partnership between Jefferson
This is why strong, diverse social a special veterans luncheon was and Veterans Haven. Project
support networks and effective planned. Aramark Food Services Lead and Clinical Nurse Carlos
community outreach programs generously volunteered to provide Vascos is currently in discussions
are indispensable. Nurses at a BBQ for Veterans Haven. with area utility companies to find
the Jefferson Surgery Center in a path that would pre-approve
Washington Township reached Jefferson Surgery Center Veterans Haven residents for
out to Veterans Haven, a South purchased personal care items energy assistance when they
Jersey-based transitional housing for the veterans. These items move back into the community.
program for homeless veterans were packaged in gift bags and
to offer their support. presented during the event. In the coming months, Jefferson
Other donated items were will provide health and wellness
Veterans Haven focuses on used as raffle prizes. education for Veterans Haven
treatment, self-reclamation, residents. In collaboration with
and community reintegration. In addition, an online, internal Winslow Township’s governing
During discussions, it became request went out, asking for body, this initiative offers support
clear there was a need to donations of household items for displaced, at-risk veterans.

9

STRUCTURAL EMPOWERMENT

Nurses Awards & Recognition
Supporting
Nurses ‘Power of One’ Award Winners - 2018
Clinical Nurses
In April 2018, the Coordinating Ruth Duma, BSN, RN, RN-BC, CMSRN – Cherry Hill T1
Council voted to hold a fundraiser Patricia DeAngelis, BSN, RN, CCRN – Stratford ICU
for Nurses House, Inc., a national Iwona Soloff, BSN, RN – Washington Township MS3
organization dedicated to helping Susan Saporito, BSN, RN, ONC – Cancer Center
RNs in need. Nurses House offers
assistance with housing and Nurse Leader
medical expenses for nurses who Jean Faubell, BSN, RN, RN-BC, CMSRN – Nursing Informatics
are seriously ill, injured, disabled,
or facing other dire circumstances. Clinical Associates
This worthy organization had been Kayan Maxam, Patient Care Technician – Cherry Hill T1
identified the previous year by Jessica Stewart, Unit Secretary – Stratford 4 East/West/ACE
Jefferson Stratford Hospital PACU Elizabeth Peifer-Wodarczyk, Patient Care Technician –
clinical nurse Nancy Demarino. In Washington Township MS1
the true spirit of community service, Lauren Mastripolito, Patient Care Technician –
Nancy held an individual campaign Washington Township Outpatient Dialysis
to raise money, selling $1 paper
dolphins with the (contributor’s ) DAISY Award Honorees
name, which were displayed in 4th Quarter 2017
the hospital lobby during National Laura Lanzelotti, BSN, RN, Clinical Nurse – CH – T3
Nurses Week. Regina Siegfried, BSN, RN, Clinical Nurse – WT - ICU
Kristen Doerrmann, BSN, RN, Clinical Nurse – ST - ACE

The Coordinating Council set 1st Quarter 2018
up a donation page on the Nurses Jill Reilly, BSN, RN, RNC-OB, EFM-C, Clinical Nurse –
House website. A modest goal of WT – L&D
$750 was set, and to our delight, Kevin Grannan, BSN, RN, Clinical Nurse – CH – T2
donations came in, one after Christine Crankshaw, RN, CMSRN, Clinical Nurse –
another! The campaign raised ST – Medical Surgical
$2,012, a 168% increase over the
goal. The spirit of community 2nd Quarter 2018
outreach is strong within our Maggie Mae Yacobacci, RN, CMSRN – CH ICU
Magnet® organization! Amy Smith, BSN, RN – ST 4 East
Mary Meyers, BSN, RN – WT MS3

3rd Quarter 2018
Janice Penn, BSN, RN, CMSRN – CH T1
Joseph Fratanduono, BSN, RN, RN-BC, CMSRN –
ST 4 East

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NURSING LIGHTS THE WAY

BEE Award Honorees March of Dimes
4th Quarter 2017 ‘Nurse of the Year’ 2018
Mary Hughes – Monitor Tech – CH – T3 Category: NICU
Susan Abel – PCT – WT – MS4 Deborah Keller, BSN, RN, RN-C – Recipient
Kathryn Montesinos – CNA – Health Care Center
Gabrielle Bottini – PCT – CH – T2 Category: Adult Health
Desiree Calalo – PCT – CH – T3 Angelina McCurdy, MSN, RN, APN, CMSRN
Stephanie Washington – PCT – ST 2 East – Recipient
Maureen Bailey – Staffing Coordinator – CH James Hillis, MHA, BSN, RN, CCRN – Finalist
Justin Ardito – Occupational Therapist– WT Christine Levin, BSN, RN, CMSRN – Nominee
Kenneth Burt – Physical Therapist– Homecare Carol Strosser, BSN, RN, PCCN – Nominee
Amanda Sannelli, RN – Nominee
1st Quarter 2018
Marvin Brown – Environmental Services Category: ‘Rising Star’
Associate – CH Catherine Boiler, RN – Nominee
Helaine DiFranceisco – Surgical Technician – Gabby Umosella, BSN, RN – Nominee
Surgical Center
Shannon Faulls – PCT – CH – T3 Category: Nurse Educator
Rafia Qureshi – PCT – CH – T3 Paula Greenbaum, MSN, RN, CMSRN, RN-BC
Nicole Robinson Thomas – Guest Services – Nominee
Coordinator – WT
Category: Nurse Leader
2nd Quarter 2018 Tracey Dzierzgowski, BSN, NE-BC – Nominee
Steven Foster – Nutrition Services Associate – WT
Denise Powell – Nutrition Services Associate – CH Organization of Nurse Leaders
Cheriann Young – Pharmacy Technician – CH New Jersey 2018
Margaret Santiago – Environmental Services Category: Divisional Leader
Associate – CH Elaine Joyce, MSN, RN, CNOR, CRNFA
Marvin Brown – Environmental Services Associate – Nominee
– CH
Alexis DeRosa – Patient Care Technician – CH – T1
Margaret Pine – Patient Care Technician – WT – MS1
Thomas Mattson – Lead Construction Specialist - WT
Lisa Rotella – Outpatient Imagining - WT

3rd Quarter 2018
Kay Pai – Patient Care Technician – CH – T1
Robert Gordon – Mental Health Technician III –
CH – West Pavilion
Valerie Lambert – Environmental Services
Associate – ST
Janiva Richardson – CNA – Health Care Center
Tanya Maddox – CNA – Health Care Center

11

STRUCTURAL EMPOWERMENT

The Pursuit of Excellence: Nursing Certification

The nursing profession requires a commitment to lifelong learning. All graduate
nurses take the National Council Licensure Examination (NCLEX) in order to
become licensed to practice.

This license represents entry-level competence. The Institute of Medicine (IOM), in
its “To Err is Human” report, recommends that heath professional licensing bodies
implement periodic reexaminations. Certification exams provide a way to meet the
IOM recommendation; it validates the nurses’ competence and growth beyond novice
practice. Benefits of certification include: improved patient outcomes, increased
nurse satisfaction, an environment of professionalism, and a culture of retention
(AACN, 2018).

Over the past four years, nurses at Jefferson Health - New Jersey have been
empowered to pursue certification through organizational assistance with
educational preparation, financial support, and bonuses paid annually for up to
two certifications. Certification has grown by 15%, and we are on track to meet
our current goal of 42% certified nurses by 2021.

Percent of Certified Nurses

50% 2014 2015 2016 2017 2018
45% 23.88% 29.50% 36.50% 37.80% 39.40%
40%
35%
30%
25%
20%
15%
10%

% Certified

Reference
American Association of Critica-Care Nurses, (2018). Certification benefits patients, employers, and nurses. Retrieved from
https://www.aacn.org/certification/value-of-certification-resource-center/nurse-certification-benefits-patients-employers-and-nurses.

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NURSING LIGHTS THE WAY

The Pursuit of Excellence: Increasing BSN Nurses

As a result of the changing complexity of nursing, However, any candidate hired without a BSN
the Institute of Medicine (IOM) issued “The Future would be required to obtain the degree within
of Nursing” report, outlining a key directive that the three years of hire as a condition of employment.
basic education level of entry into practice should All new-to-practice hires would be required to
be a Bachelor of Science in Nursing (BSN) degree. have the BSN degree upon hire, as well as all
management positions. As a result, new hires with
Given there are currently multiple educational a BSN increased by 16% in one year. In addition to
pathways leading to a license to practice, the tuition reimbursement, the following incentives
recommendation was made for organizations to were established to encourage current associates
increase the percentage of nurses with a BSN to to return to school to earn a BSN:
80% by 2020.
• Financial bonus tied to the exemplary and mentor
This became a priority in the Jefferson Health – levels in the Clinical Advancement Program, which
New Jersey Nursing Strategic Plan, and in 2014, reward earned degrees, and pursuit of degrees.
multiple strategies were identified and put into • Increased academic partnership to streamline
place to increase the percentage of BSN nurses — the pursuit of education.
which at that time was only 52.12%. • Implementation of a nursing scholarship program.

It was determined that two simultaneous Data is collected semi-annually during the second
initiatives would be needed: one for new hires, and fourth quarters of the year. As of the fourth
and one for current associates. A decision was quarter of 2018, there were 71.8% nurses at BSN
made to continue to hire experienced candidates level or higher, exceeding our year-end goal
that share the Jefferson values, with or without of 70%. It is expected that the organization will
a BSN degree. reach the IOM recommendation of 80% by 2020.

Percent BSN or Higher Nursing Degree

80% Q3 Q1 Q3 Q1 Q3 Q1 Q3 Q1 Q3
75% 2014 2015 2015 2016 2016 2017 2017 2018 2018
70% 52.12% 71.80%
65% 55.90% 58.32% 60.62% 62.33% 64.11% 67.58% 71.06%
60%
55%
50%
45%
40%
35%
30%
25%
20%
15%
10%

% BSN or Higher
Nursing Degree

13

EXEMPLARY PROFESSIONAL PRACTICE

Leading the Way in Falls Reduction - TIPS

In late May 2017, the multidisciplinary Falls During the pilot, unit-based process audits
Committee engaged in a Fall Prevention were conducted, as well as audits by the Falls
Collaborative with the New Jersey Hospital Committee members. Patient fall data was
Association (NJHA). Several members of the monitored through the safety event reporting
Falls Committee attended the workshop in system. Weekly team huddles were initiated
Princeton, and were introduced to the and held through conference calls. The pilot
evidence-based Fall TIPS (Tailored units were able to share positive stories,
Interventions for Patient Safety) program. identify barriers, and discuss lessons learned.

The goal of TIPS is to prevent patient falls Patients and visitors reported that the colorful
by translating an individual patient’s fall risk poster at the bedside provided a better
assessment into a decision-support intervention understanding of how to partner with the
that communicates fall risk status, and creates staff to support the fall prevention plan.
a tailored, evidence-based plan accessible Opportunities to improve included: engaging
to all care team members — including the the patients and families in fall risk assessment
patient and family. During the workshop, the and care planning, location of posters at the
team was instructed to create a timeline for patient’s bedside, process for patients not
implementation, which outlined the steps identified as high fall risk, cleaning processes,
toward piloting the TIPS program. This timeline and posters in different languages.
became the step-by-step journey to trialing
an evidence-based patient safety initiative. Upon conclusion of the pilot, a decrease
in both falls and falls with injury rates was
The team first had to gain support from the Falls observed. The Fall Committee recommended
Committee, along with nursing and hospital a system-wide roll-out of the TIPS program
leadership; all parties offered unanimous and and received support from the Chief Nurse
overwhelming support. An implementation Executive Helene Burns. Next steps include
team was formed and pilot units were selected. obtaining TIPS resources, revising the current
TIPS bedside posters were developed, and staff policy, aligning electronic documentation,
education was provided through computer- and providing education to clinical staff.
based learning (CBL). Pre-data was evaluated The goal is for system-wide implementation
and a go-live date was selected. in 2019.

TIPS Pilot Unit Fall Rates TIPS Pilot Unit Injury Fall Rates

5Total Fall Rate Per 1
1,000 Patient Days
Total Injury Fall Rate PerPre-DataPost-DataPre-Data Post-Data
1,000 Patient Days
4

3 Intervention Intervention
2

1

0 Q3 Q1 Q2 Q3 Q4 0 Q3 Q1 Q2 Q3 Q4
2017 2018 2018 2018 2018 2017 2018 2018 2018 2018
Pilot Unit 2.79 1.62 1.39 1.50 2.57 Pilot Unit 0.74 0.36 0.52 0.17 0.18
Injury Fall Rates Injury Fall Rates

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NURSING LIGHTS THE WAY

Facilitating Patient Needs Through
Interprofesssional Complex Care Consults

A Root Cause Analysis meeting is conducted
after a medical error occurs to enable an
interdisciplinary team to explore reasons for
the error, and determine ways to prevent a
reoccurance.

As Jefferson Health – New Jersey moves
into its “High Reliability Organization” status,
we talk about “chasing zero” – meaning zero
preventable harm to patients.

According to The Joint Commission, an Complex patients are those requiring
estimated 80% of medical errors occur frequent admission or re-admission to the
because of miscommunication between ED or hospital; elderly and frail; frail, but
caregivers (Joint Commission Perspectives®, not elderly; multiple and/or key chronic
August 2012, Volume 32, Issue 8). Gaps in conditions; and/or suffer from behavioral
communication increase patient safety risk. health/or chemical dependency. The Complex
And the most vulnerable patient is the one Consultation Team includes, but is not
with complex healthcare needs. limited to: medical staff, nursing, behavioral
health team, case management, social services,
In 2017, Chief Nurse Executive Helene Burns; and other appropriate support services.
Chief Medical Officer Dr. Tim Dombrowski;
and Kim Hoffman, Corporate Director of Any care provider can call the hospital
Patient Safety & Risk Management; began operator and request a “Complex Care
searching literature for how hospitals Consultation.” Within 24 hours, the CNE
addressed complex patient care that requires or CMO facilitates a virtual meeting via
frequent communication among care providers. conference call with all the caregivers,
Most of the literature spoke about training including medical staff on a case.
medical staff to care for complex patients.
Since its inception and throughout 2018,
Procedures for better communication among “Complex Care Consultations” occur at
care providers are often labeled “inter- least once a week among the hospitals.
disciplinary rounds,” which are challenging The process has improved communication
to conduct on a typical medical/surgical unit. among care providers and enhanced the
The CNE and CMO drafted a new policy/ individualized patient plan of care.
procedure titled “Complex Care Consultation.”
This policy provides inter-professional expertise,
care coordination, and improved team
communication early in the complex patient’s
presentation to ensure effective communication
and coordinated care planning.

15

EXEMPLARY PROFESSIONAL PRACTICE

Benefits of Professional Organization Membership –
Self-Extubation QI Project

Clinical nurses are encouraged to become members of their specialty nursing organizations
as a way to bring best practice ideas to Jefferson Health – New Jersey. Two nurses in the
Cherry Hill ICU – Janice Coffey, BSN, RN, and Mario Battista, RN, CCRN – did just that to
address an increasing incidence of patient self-extubation.

As members of the Critical Care Service Line and Unit Council, Janice and Mario were
aware of the increasing numbers of ventilated patients that were self-extubating. As
members of the American Association of Critical Care Nurses, both receive the American
Journal of Critical Care and read an article addressing risk factors in self-extubations.

They brought this information to the Unit Council, leading to the development of an
assessment tool to be used after all self-extubations. As a result, the main risk factor
identified for the patient population was active weaning from the ventilator. A new process
for increased surveillance and monitoring during the weaning process was initiated, after
which, self-extubations decreased dramatically.

Nurses are lifelong learners. Professional organizations are one way of keeping up with
current practice and promoting positive outcomes for all.

20% Pre-Data CH-ICU Self-Extubation Rate
18%
16% Self-Extubation Rate Post-Data
14%
12% Intervention
10%
8% Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3
6% 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018
4% 12.53% 11.15% 15.50% 3/361 12.40% 4.39% 4.96% 0.00% 8.93% 4.59%
2/403 0/332 3/336 2/436
2%
0%

CH-ICU Self-
Extubation Rate

Self-Extubation/Vent Days 6/479 3/269 6/387 4/399 3/242 1/228

Reference
Centers for Disease Control (CDC). 2016. Heart failure fact sheet. Retrieved from https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_heart_failure.htm

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NURSING LIGHTS THE WAY

Nursing Scholarly Activities

Jefferson Health – New Jersey nurses are encouraged to participate in scholarly activities,
including submitting abstracts for poster and podium presentation; submitting manuscripts for
public presentation; and participating in evidence-based practice projects and nursing research.

The following list recognizes New Jersey-based associates involved in such projects from December 2017
to November 2018.

Poster Presentations Cindy Hou, DO, MA, MBA, FACOI, FACP; Nikunj
Vyas, Pharm. D. BCPS; and Marianne Kraemer,
American Nursing Informatics Association (ANIA) BSN, RN, MPA, Ed. M, CENP, CCRN-K
National Conference, Orlando, FL, May 10-12,
2018: Using an Interactive Informatics Skills Fair American Psychiatric Nurses Association
to Validate Informatics RN Competencies Conference, Colmbus , OH, October 24-27, 2018:
Dana Byrd, MSN, RN, CCRN; Gwen Heaney- Quality Improvement in PMH Clinical Practicum:
Cutts, MSN, RN; Eleanor Lazar, BSN, RN, PCCN, Utilizing Standardized Tools to Identify Change
CMSRN; and Khainde Williams, MSN, RN, RN-BC Kathleen Clark, PhD, RN, PMHCNS-BC

Organization of Nurse Leaders (ONL) Research Podium Presentations
Day, Princeton, NJ, June 6, 2018: Enhancing
the Management of the Behavioral Health Hold Organization of Nurse Leaders’ New Jersey
Patient in the Emergency Department Nurse Leader Nursing Workplace Environment
Jennifer Clendining, BSN, RN, CEN, CPEN; and & Staffing Council Education Session, Princeton,
Connie Bowen, DNP, RN, APN-C, CCNS, CCRN, NJ, February 23, 2018: True Collaboration
CEN, CPEN Helene M. Burns, MSN, RN, NEA-BC

Association of Professionals in Infection New Jersey State Nurses Association (NJSNA)
Control (APIC) 45th Annual Conference, Region One Meeting, Morristown Medical
Minneapolis, MN, June 13-15, 2018: Center, Morristown, NJ, March 24, 2018:
The Missing Link with a Path Less Traveled: Violence in the Workplace: One Hospital’s
Incorporating an Aggressive Nursing Strategy Perspective
in Antimicrobial Stewardship Helene M. Burns, MSN, RN, NEA-BC
Donna Cybulski, MSN, RN, CCRN; David
Condolucci, DO, MACOI; Cindy Hou, DO, Oncology Nursing Society (ONS) 43rd Annual
MA, MBA, FACOI; Marianne Kraemer, BSN, Congress, Washington, D.C., May 17-20, 2018:
RN, MPA, Ed. M, CENP, CCRN-K; and Nikunj Creation of a Multidisciplinary Lung Nodule
Vyas, Pharm. D. BCPS Center: An Innovative Care Model for High Risk
Lung Nodules
Infectious Disease Society of America Michele E. Gaguski, MSN, RN, AOCN, CHPN,
National Conference, San Francisco, CA, NE-BC, APN-C; Sandra Murray, RN, OCN,
October 3-7, 2018: ONN-CG, CTTS; and Robert Davis, MBA
Implementation and Three-year Results
of Antimicrobial Stewardship Program in a 17
Three Hospital Community Health System

EXEMPLARY PROFESSIONAL PRACTICE

Podium Presentations AANN (American Association of Neuroscience
Nurses) Philadelphia Chapter, 42nd Annual Fall
Jefferson NJ Community Health Fair, Cherry Fling, Philadelphia, PA, October 25, 2018:
Hill, NJ, August 25, 2018: Sudden Cardiac Reflections on over 50 years of Practice in
Arrest and Hands-Only Bystander CPR Neurosurgery: A Conversation with the
Maureen Green, BSN, RN, CEN, CPEN, TCRN Simeone Institute of Neurosurgery Staff
Cheryl Rosselli, MSN, RN, CNRN; Bynum, J.,
Nursing Workplace Environment & Staffing RN, CRNFA; Krajewski, B., BS, CRNP, CNRN;
Council Education Session, Princeton, NJ, and Simeone, F.A., MD, FAANS(L), FACS
September 14, 2018: Research on Healthy
Work Environment Penn Medicine Nursing Research Conference,
Helene M. Burns, DNP, RN, NEA-BC; and Philadelphia, PA, November 7, 2018:
Birkenstock, K. Executive Support for Nursing Research:
CNO Panel Discussion
Healthcare Facilities Symposium & Expo, Helene M. Burns, DNP, RN, NEA-BC;
Austin, TX, October 9, 2018: Conley, M.; Coladonato, A.; and Wadsworth, B.
Room with a View: How Staff Engagement
Led to a Shared Vision of the Future Webinar Presentations
Helene M. Burns, DNP, RN, NEA-BC;
Lisa Dutterer, CAO; Feldman, G., EDAC, CLGB, Lippincott Webinar Series 2018, January
LEED Green Associate; and Palmer, M., AIA, 2018: Lippincott Users Group: Lippincott has
LEED AP BD+C, CLGB brought the Sizzle to Kennedy Health
Gwen Heaney-Cutts, MSN, RN; and Coleen
Organization of Nurse Leaders’ New Jersey Nilsen, MS
Nurse Leader & Emerging Nurse Leader
Conference, Princeton, NJ, October 11, 2018: National HINN Leadership & Partnership for
True Collaboration & Authentic Leadership in Patients (PfP), February 1, 2018: Pacing Event
a Healthy Work Environment Webinar on Falls Prevention NJ
Helene M. Burns, DNP, RN, NEA-BC Helene Burns MSN, RN, NEA-BC; and
Michelle Colbert, MSN, RN, CPPS

Sepsis Alliance Webinar October 2018:
Sepsis: Across the Continuum of Care:
Integration of Infection Control and
Antimicrobial Stewardship with Sepsis Initiatives
Cindy Hou, DO, MA, MBA, FACOI; and
Marianne Kraemer, BSN, RN, MPA, Ed. M,
CENP, CCRN-K

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NURSING LIGHTS THE WAY

Publications Evidence-Based Projects,
Performance Improvement
Hou, C., Davila, S., Rava, L., & Kraemer, M. and Nursing Research
(2018). A statewide antimicrobial stewardship
collaborative: Findings in the first year, American March 2018: The Chief Nursing Officer’s
Journal of Infection Control 46(6): 21-22. Role for a Healthy Work Environment
Cindy Hou, DO, MA, MBA, FACOI; and Marianne Helene M. Burns, MSN, RN, NEA-BC
Kraemer, BSN, RN, MPA, Ed. M, CENP, CCRN-K
September 2018: Understanding the
Burns, H.M., Zedreck Gonzalez, J. F, Hoffmann, Experience of Clinical Nurses’ Involvement
R.L., & Fulginiti, S. (2018). The CNO’s role in Decisions About a Healthy Work Environment
in a healthy work environment, Nursing and Staffing: A Pilot Study
Management, 49(10): 22–28, doi: 10.1097/01. Helene M. Burns, DNP, RN, NEA-BC;
NUMA.0000546200.94337.06 de Cordova, P.B.; Johansen, M.; and Weaver, S.
Helene M. Burns, DNP, RN, NEA-BC; and
Susan Fulginiti, DNP, NE-BC, RN-BC Addiction Recovery Coach Referrals from the
ED: Does CARGE-AID Make a Difference?”
Gaguski, M.E., George, K., Bruce, S.D., Brucker, Julie Daly, MSN, APN, NP-C, BCEN
E., Leija, C., LeFebvre, K., & Thompson Mackey,
H. (2017). Oncology nurse generalist Opioid Crisis: ED Clinician Knowledge of
competencies: Oncology Nursing Society’s Epidemic, and Prescription Drug Monitoring
imitative to establish best practice, Clinical Wanda Nocella, MSN, RN, FNP-BC
Journal of Oncology Nursing, 21(6), 679-687.
Michele E. Gaguski, MSN, RN, AOCN, CHPN, Safe Sleep Practices in the Neonatal
NE-BC, APN-C; Kim George, MSN, APRN, Intensive Care Unit (NICU)
ACNS-BC, OCN; Susan D. Bruce, MSN, RN, Deborah Keller, BSN, RN, RNC
OCN, AOCNS; Edie Brucker, MSN, MPH,
AGPCNP-BC; Carol Leija, MSN, RN, OCN; Door to EKG
Kristine LeFebvre, MSN, RN, AOCN; and Barbara Lamaina, BSN, RN, CEN
Heather Thompson Mackey, RN, MSN,
ANP-BC, AOCN Structured Teaching Plan for Nurses
of CHF Patients
Shoba Mathews, DNP, RN, FNP-BC, CCRN,
PCCN, CMSRN

19

NEW KNOWLEDGE, INNOVATIONS, & IMPROVEMENTS

Researching Factors that Influence the Pursuit
of an Advanced Practice Nurse Degree

This past year, six members of the Advanced Increased psychological demands, lower
Practice Nurse (APN) Council worked together autonomy, long hours, and lack of support
to develop and implement a research project. from peers and supervisors, can lead to job
The project’s purpose was to determine what dissatisfaction, and, in turn, an intention to
factors appeared to influence a nurse’s decision leave nursing (Han et al., 2015). Recruitment
to pursue an APN degree. and retention of nurses is essential (Chan et al.,
2013; Steege & Rainbow, 2017). The demand for
There is limited to no literature specific to this nurse anesthetists, nurse midwives, and nurse
research question; however, this information practitioners is expected to grow as much as
could assist with nurse recruitment and retention. 31% from 2014 to 2024 (US Department of Labor
It is expected that the nursing shortage will [USDL], 2015). This increase relates to the need
continue to grow as baby boomers age, and for preventative care, healthcare legislation,
the demand for healthcare continues to rise and aging baby boomers (USDL, 2015).
(American Association of Colleges of Nurses,
2017). With this in mind, there will be an The hypothesis for the research project is that
increasing need for both Registered Nurses the RN clinical setting is a predominant factor
(RNs) and APNs. associated with pursuing an APN degree.
Researchers believe that knowing these factors
There are many factors that contribute to may assist with focusing efforts for recruitment
the nursing shortage, beyond the aging to APN degree programs, as well as retention
nursing workforce and the faculty vacancies of our nurses.
in nursing programs, which limit access.
(Carnivale, Smith & Gluish, 2015). Many The research consisted of a survey sent out to
nurses are leaving, or intend to leave, their all employed Jefferson Health – New Jersey RNs.
current nursing position or the profession We are currently working with a statistician to
for various reasons (Chan et al., 2013; Han, interpret the data received and determine if
Trinkoff & Gurses, 2015). further surveying is required, prior to releasing
the results. We anticipate disseminating our
final findings in the first quarter of 2019.

Reference
American Association of Colleges of Nursing (2017). Retrieved February 8, 2017, from http://www.aacn.nche.edu/education-resources/
aprn-consensus-process

Carnevale, A., Smith, N., & Gulish, A. (2015). Nursing supply and demand through 2020. Georgetown University: Center on Education and
the Workforce. Retrieved February 8, 2017, from https://cew.georgetown.edu/wp-content/uploads/Nursing-Supply-Final.pdf.

Chan, Z., Tam, W., Lung, M., Wong, W., & Chau, C. (2013). A systematic literature review of nurse shortage and the intention to leave.
Journal of Nursing Management, 21, 605–613.

Han, K., Trinkoff, A., & Gurses, A. (2015). Work-related factors, job satisfaction and intent to leave the current job among United States
nurses. Journal of Clinical Nursing. 24(21-22). 3224-3232.

Steege, L.M. & Rainbow, J.G. (2017). Fatigue in hospital nurses: ‘Supernurse’ culture is a barrier to addressing problems: A qualitative
interview study. International Journal of Nursing Studies, 67, 20-28.

US Department of Labor. (2015). Nurse anesthetists, nurse midwives, and nurse practitioners. (2015). Retrieved February 10, 2017, from
https://www.bls.gov/ooh/healthcare/nurse-anesthetists-nurse-midwives-and-nurse-practitioners.htm#tab-6

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NURSING LIGHTS THE WAY

Improving the Work Environment
Through Clinical Nurse Involvement

In 2015, Chief Nurse Executive Helene Burns Beginning in Q4 of 2017, Jefferson Health –
introduced a new committee to our then- New Jersey became one of the five pilot
Kennedy Nursing Shared Governance Model hospitals in the state participating in a
known as the “Staffing Committee.” research study: Understanding the
Experience of Clinical Nurses’ Involvement
Clinical nurses were invited to join the in Decisions About a Healthy Work
committee, which Helene chaired. Its purpose Environment and Staffing: A Pilot Study.
was to provide a forum for nursing leadership
to share information on nursing budgets, Members of the council participated in a
vacancy rates, turnover rates, recruitment quantitative and qualitative research study
strategies, comparisons of nurse-to-patient aimed at understanding more about how
ratios in our region, and local/national nurse nurses – including clinical nurses and nurse
staffing trends. managers/leaders – understand the healthy
work environment and nurse staffing.
As the committee evolved, its focus turned
to looking at adequate staffing and Research questions that guided this study
improvements to the work environment. were: (1) What is the experience of clinical
In 2017, the committee became a core nurses’ involvement in decisions about a
council in shared governance and was healthy work environment and staffing,
renamed the “Nursing Work Environment (2) What are nurse leaders’ and clinical
and Staffing Council (NWESC).” The council’s nurses’ perspective of a healthy work
goal is now to provide a formal collaborative environment and staffing?, – and (3)
structure that gives clinical staff nurses a What are nurse leaders’ and clinical nurses’
respected voice in determining human and perspective of staffing committees and
environmental resources needed to provide how staffing committees contribute to
the best patient care. The Strategies for a healthy work environment? The study
Shiftwork Safety & Wellness Committee was completed late in 2018 and will be
was formed to offer classes about disseminated early in 2019.
shiftwork safety to all Jefferson Health –
New Jersey staff.

21

NEW KNOWLEDGE, INNOVATIONS, & IMPROVEMENTS

ANCC Research Studies – June 2018

Research IRB Date Study Date Study
Study Title Review Type Approved Status Completed

Factors that Influence Exempt 6/9/2017 Ongoing
a Nurse’s Decision to
Pursue an Advanced
Practice Nursing Degree

The Breakdown in Sepsis: Exempt 8/21/2017 Complete 6/22/2018
the Link Between Skin
Failure and Sepsis

Understanding Clinical Expedited 8/31/2017 Ongoing
Nurses’ Involvement
in Decisions for Healthy
Work Environment

Opioid Crisis: ED Clinician Exempt 3/16/2018 Complete 8/28/2018
Knowledge on Epidemic,
Rx Drug Monitoring

Statistical Analysis Expedited 5/25/2018 Ongoing
of Vein Diameter in
Patients Requiring
Upper Arm Access

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NURSING LIGHTS THE WAY

Study Scope Study Types

Nurse PI, Co-PI, Role(s) of Credentials Internal to a Single
&/or Site PI Nurse(s) Organization
Multiple Organizations
within a System
Independent Organizations
Collaboratively
Replication
Qualitative
Quantitative

Constance Bowen PI DNP, RN, APN-C
Rosemary Serock Co-PI MSN, APN, NP-C
Julie Daly Co-PI MSN, APN, NP-C
Noreen Loreto-Santos Co-PI MSN, APN, ACNP-AG, FNP-BC
Gwyn Parris-Atwell Co-PI MSN, RN, APN-C

Patricia Zielinski PI BSN, RN, WCC
Sherry Grillo Co-PI RN, WCC
Deborah Sloan Co-PI RN, WCC, OMS

Helene Burns PI MSN, RN, NEA-BC
Mary L. Johansen Co-PI PhD, NE-BC

Wanda Nocella PI MSN, RN, FNP-BC
Connie Bowen Co-PI DNP, RN, APN-C

Danielle Shontz PI BSN, RN
Kerri Swipes Co-PI BSN, RN
Herb Schoener Co-PI BSN, RN
Kelly Wright Co-PI BSN, RN
Debashis Kushary Co-PI PhD

23

NEW KNOWLEDGE, INNOVATIONS, & IMPROVEMENTS

Improving Throughput Using an Innovative
Transfer Center Approach

Effective, efficient patient throughput is vital to quality care and satisfaction.
Though an Enterprise project to blend best practices, we have had the pleasure
to work within the Jefferson Health system to integrate Jefferson Health – New
Jersey with Thomas Jefferson University Hospital (TJUH) and its affiliates. The
assigned project included the Patient Flow Management Center (PFMC) and the
bed management build of EPIC. This opportunity proved more than we could
have ever imagined.
Jefferson Health – New Jersey was received and welcomed into the Jefferson family
by some of the most professional, hardworking individuals. The PFMC consists of
environmental services, internal transport, bed management, support, and leadership
to our group. We also are being integrated into the EPIC team. We were surprised to
see the dedication and level of knowledge of this team, which welcomed us, providing
the education and tools needed to become very patient-centric.
The build is growing seamlessly. This team also has supported us in preparation for
the Jefferson Health – New Jersey task force for patient flow. We have held two
meetings, to date, with our team to discuss building beds and their attributes into the
EPIC system. The teams, which are engaged and work very well together, include:
PFMC, EPIC, and individuals who are topic experts within the New Jersey campuses.
General Electric was contracted to realign the PFMC to include a data component
for the Enterprise, and clinical pathways through our “Wall of Analytics” creation.
This integration is truly a wonderful and educational experience that will harmonize
the various components of our health system into ONE JEFFERSON, while improving
throughput and the patient experience across the enterprise.

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NURSING LIGHTS THE WAY

Contributors

Executive Editors
Helene Burns, DNP, RN, NEA-BC

Chief Nurse Executive

Kim Packer, MS, BSN, RN, NEA-BC
Corporate Director, Clinical Excellence

Managing Editor
Nicole Pensiero

Corporate Director, Communications

Contributing Writers
Dana Byrd, MSN, RN, CCRN

Clinical Nurse

Amelia Skelly, BSN, RN, CMSRN, CNOR
Clinical Nurse

Carlos Vascos, BSN, RN
Clinical Nurse

Michelle Colbert, MSN, RN, CPPS
Manager, Patient Safety & Risk

Julie Daly, DNP, RN, APN, NP-C
Nurse Practitioner

Patricia Madden, MSN, RN, CCTM
Corporate Director, Nursing

Danielle Shontz, BSN, RN, VA-BC, CEN
Clinical Nurse

KennedyIsJefferson.org