2012 UNC Nursing Annual Report 1

2012

Fiscal Year Nursing Annual Report

UNC HOSPITALS | DIVISION OF NURSING



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4 LETTER FROM DR. TONGES
6 TRANSFORMATIONAL LEADERSHIP 16 NURSING STAFF PROFILE
Janice Galloway
Jeff Strickler & David Witek
18 NEW KNOWLEDGE, INNOVATION
8 NURSING STAFF PROFILE & IMPROVEMENTS
Diane Schroeher, Paul Zarick & John Zarick Nicoleta Constantin

10 STRUCTURAL EMPOWERMENT 20 THE EVOLUTION OF NURSING
Wade Mauser 22 NURSING STAFF RECOGNITION

12 NURSING STAFF PROFILE AWARD WINNERS
Teresa Holt
26 PROFESSIONAL ACCOMPLISHMENTS
14 EXEMPLARY PROFESSIONAL PRACTICE
Emily Moody

CONTENTS

Mary Tonges, PhD, RN, NEA-BC, FAAN | Senior Vice President, Chief Nursing Officer

and Associate Dean for UNC Health Care in the School of Nursing.

Dear Colleagues and Friends, communicate the great success of shared governance and

It is with great pleasure and structural empowerment of nurses in our organization.
pride that I share Nursing In May we launched our on-site NAII program and will
highlights for this year. have the capacity for 120 participants per year — a terrific
As you view this annual opportunity for our Nursing Assistants that I am so glad we
report, you will see the are doing.

strong commitment of the SERVICE
University of North Carolina
Medical Center to the art We have continued to have very high HCAHPS scores and
and science of nursing. I based on these scores, we’ve been ranked #1 in the country
think we all recognize that these are turbulent times for for overall patient centeredness by the University Health
health care, and I recently read a quote from Alfred North System Consortium.

Whitehead, an English philosopher, that is very applicable The Inpatient Experience Team launched three great
to our current work, “The art of progress is to preserve order programs for our patients this year – the Monday night
amid change, and to preserve change amid order.” The high dinners for families and visitors of patients in Memorial
points of this year’s work can be summarized as follows. Hospital, foot care provided by our team of Certified Foot

PEOPLE Care Nurses and most recently, beauty and barber services.

UNC Hospitals was recognized, and we celebrated at the At the unit level, SICU received the ANCC Beacon Award
National Magnet Conference in Baltimore in October, 2011. this year meaning that we now have 3 Beacon Awards –
Of the over 1,000 abstracts submitted, three from UNCH CTICU, CICU and SICU. Congratulations! Not to mention
were chosen for poster presentations. The topics ranged that CICU has gone over 3 years without a VAP. Actually,
from “Aspiring Nurse Leaders” to “VADs from Acute Care to there has only been one case of VAP in the last 5 years.
Rehab” and “S.A.G.E. Nurses.” Dean Kristen Swanson and I Quite impressive.

were honored to be invited to give a podium presentation on QUALITY
“Translating Caring Theory into Practice.”
On the NDNQI quality measures, 78% of units
The Professional Development Council has been doing a outperformed the national benchmark for skin, 82% for
lot of great work to further increase our NDNQI nursing restraints and 77% for falls. We are contributing heavily to
job satisfaction scores. They’ve collected and are sharing the hospitals’ success in meeting or exceeding Blue Cross/
“Bright Ideas” from units that outperformed the national Blue Shield and Employee Incentive Program Quality Goals.
benchmarks in 5 of the 5 categories. The Diversity Council Nursing should be especially proud of reducing CAUTIs per
created a Shared Governance Day to celebrate and 1,000 patient days to .73 as compared to a goal of .76.

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FROM THE DESK OF DR. MARY TONGES

Many thanks to the Quality Council and to each of you. • November 2011: 7 bed Admissions Unit opened on the
ground floor of NS
The most recent good news is that our nosocomial pressure
ulcer rate is 2.7 (on a base of 478 patients). This is down from • January 2012: 10 bed ADU reopened on 4 West to
3.2 in February and our lowest since December, 2010 when the accommodate very high census
rate was 2.2. What is especially good about these results is the
fact that for the first time Stage 1’s were included in the survey INNOVATION
in accordance with new National Database for Nursing Quality
Indicators. It’s great to see this reduction and a real credit to the Through the work of the Clinical Documentation
work of the Skin Committee and Resource Nurses. Implementation Committee, we can now extract pain
assessment data from eChart, and falls documentation flows
FINANCE to PORS. We’re on track to begin using electronic Medication
Administration Records (MARs) in the coming year.
We don’t always talk as much about finance but we all know
how critical it is. As they say, “no margin, no mission,” meaning The Perinatal Depression Unit is the first of its kind in the
that unless we are paid more than we spend, we will not have nation.
the resources needed to fulfill our mission, especially our
commitment to care for the people of NC regardless of ability The Research Council initiated the first Beckton Dickinson
to pay. As the largest division in an enterprise in which at Nursing Research Fellowships, and the Professional Practice
least 50+ percent of costs are salaries, nursing’s financial Council developed and implemented nurse-driven protocols/
performance is critical to hospital success. Share in my pride order sets to facilitate the practice of nursing to its fullest scope.
about the following measures of our resource stewardship:
On 4 Anderson North, our Innovations Unit, the Carolina Care
• The ratio of actual to budgeted expenses in nursing has Partners in Practice care delivery model has been fully and
decreased 7.7% over the last 3 years very successfully implemented. NAII skills on this unit have
been expanded to include changing appliances for established
• Expenses as a percent of revenue have improved by 3.7% ostomies, priming central line tubing and initiating the
over the past 3 years. Admission Assessment by collecting data.

Quality with economy — it doesn’t get better than that! All of which leads me to paraphrase Dennis Waitley: “UNCHC
Nursing has all the reason in the world to achieve our greatest
GROWTH dreams - imagination plus innovation equals realization.” You
ARE the Power of Nursing!
We continued to grow in Fiscal Year 2011-2012:
• July 2011: NCCH, added 10 basinets Sincerely,
• August 2011: 5 bed Perinatal Depressions Unit opened

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ERs are
designed for a

24 hourless-than
experience

Responding &
Redirecting

Jeff Strickler, MA, RN, CNE, CEN, CFN | Director of Emergency Services
David Witek, MSN, RN, CEN, Nurse Manager | Behavioral Health Emergency Department

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When decreased funding for mental health care Emergency
began in the 2000’s, increasing numbers of mental Department.
health patients, with increasingly acute needs, began However, Jeff
arriving at a steady pace in emergency rooms all initiated some
over the country. Emergency Services Director for very unique and beneficial features for this patient
UNC Hospitals, Jeff Strickler, responded with a population.
recommendation to implement the approach some
other hospitals were using, called a Behavioral Health

TRANSFORMATIONAL LEADERSHIP

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John Zarick has been a nurse at UNC Hospitals UNCH. She has 34 years of experience, much of it in
(UNCH) since Fall of 2012. That makes him a new pediatrics.
nurse. At least a new nurse here. In fact, John has
33 years of nursing experience with most of it in And that’s not all. Paul Zarick, John and Diane’s
elder son, works at UNCH in the Pediatric Intensive
Pediatrics. Care Unit, and Andy, their younger son, recently
received his degree in Nursing. What is his specialty?
But there is more to this You guessed it - he too, has a love for, and works in,
story. John’s wife, Diane pediatrics.
Schroeher, is also a nurse at

Diane Schroeher, BSN, RN, Clinical Nurse II
Paul Zarick, RN, Clinical Nurse II | John Zarick, RN, Clinical Nurse II

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83

years

of combined
nursing

experience.

A Family Tradition

NURSING STAFF PROFILE

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Staff nurses
can influence
decision making
within the UNC

“family.”

Bringing More Voices
to the Table

Wade Mauser, BSN, RN, CEN, Clinical Nurse III | Emergency Department

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In retrospect, Wade Mauser now sees why he lacked believes that raising awareness about an increasingly
passion about his previous career as an accountant – diverse patient population is essential for nurses to
he wasn’t able to touch people’s lives at a point of crisis provide the highest quality care possible.
and really make a difference for them like he wanted.
Since his move into nursing seven years ago, he has
worked in the Emergency Department, where his
love for helping others has given rise to a new passion
– working on the Nursing Diversity Council. Wade

STRUCTURAL EMPOWERMENT

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Somewhere between skeptical and scared is where me while I was
Teresa Holt found herself last year when, during studying,” Teresa
what she thought was a routine job evaluation, her explains, after
nurse manager told her that she had secured a place months of getting up
for Teresa in the NA II Training Program. “I couldn’t at 4:00 am to read
believe it!” Teresa said. “I wanted something better and prepare for classes and tests. After successfully
for myself for so long, but thought it was too late in completing 80 hours of classroom instruction and 80
my life to go back to school.” “I made sure I sat on the hours of clinical experience, she enthusiastically says
front row in class, and I told my family not to bother “I accomplished something big!”

Teresa Holt, NAII | 6 Children’s

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BigThis is really
to me

A Change is Going to
Do Me Good

NURSING STAFF PROFILE

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It’s in

heartevery nurse’s
to care and be
empathetic

Peer Visits Bring
Perspective & Positivity

Emily Moody, RN-BC, Clinical Nurse II | 5 Anderson

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Nurses on 5 Anderson care for many patients, both researching similar programs already in existence
pre and post-operatively, who are facing the loss of around the country, and within other departments
a limb. Emily Moody was aware of the deep sense at UNC Hospitals, Emily worked closely with Jill
of loss many of these patients were experiencing Barum from the Physical Medicine and Rehabilitation
Department to identify and train a group of mentors –
and wanted to find a way individuals who have also lost a limb and want to visit
to meet their emotional with amputee patients to share real-life stories while
needs, so she created the providing hope, and sometimes just listening.
peer mentoring program
for amputee patients. After

EXEMPLARY PROFESSIONAL PRACTICE

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Retirement often yields visions of a future filled with current role as a Rapid Response
the freedom to do anything one chooses, including the Consult Nurse — one she loves
option not to work again. Janice Galloway retired after because she gets to give back all
nearly four decades of nursing, but UNC Hospitals she has learned over the years.
lured her back with a newly created position — one When asked what qualities she
specifically designed with Janice’s wealth of experience would look for in a candidate for her position, she
and knowledge in mind. listed flexibility, experience, maturity, thoughtfulness,
being well-rounded and easy to talk with. We couldn’t
And looking back on her various roles, she now sees have said it better.
how everything that came before has led her to her

Janice Galloway, RN, CCRN, CFCN, | Rapid Response Consult Nurse, Adult Transport Team

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Everything I’ve

38 ydeoanerfosr
has led
to this role.

A Good Fit

NURSING STAFF PROFILE

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Apply

the scientific

findprocess to
answers

Asking the Right
Questions

Nicoleta Constantin, PhD, RN, Clinical Nurse III | 6 Children’s

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After obtaining a nursing degree and It currently calls for venipuncture even though these
working with pediatric patients on patients already have central lines in place.
6 Children’s, Nicoleta Constantin’s
previous experience as a PhD researcher
in Biochemistry has come back into play
for her. In 2013, she and her nursing peers will begin
data collection to evaluate the protocol used for
obtaining antibiotic levels with cystic fibrosis patients.

NEW KNOWLEDGE, INNOVATION
AND IMPROVEMENTS

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The Evolution of Nursing

Helena Kyle, RN, supervisor for the Department of Surgery Mary Tonges, PhD, RN, senior vice president and chief nursing
nursing units in the late 1960s and 1970s, exemplified the role officer of UNC Hospitals.
nurses have played throughout the history of UNC Health Care.
Helena was a pioneer of nursing initiatives at UNC Hospitals INNOVATIONS IN CARE
and recognized the need to extend nursing care to patients at DELIVERY
home at a time when home health agencies were not available
and public health nurses were limited. Helena passionately From the beginning, nurses have led the way in groundbreaking
recruited registered nurses, licensed practical nurses and changes at UNC Hospitals. For example, the first documented
nursing assistants to work on their days off to care for and teach intensive care unit (ICU) opened at UNC Hospitals in 1953
families to care for patients in their homes. UNC Hospitals’ spurred by increasing complexity of care required during the
nurses, like Helena, have been instrumental in fulfilling an polio epidemic. Spearheaded by Ethel Harrison, RN, a nursing
supervisor, the ICU made it possible to aggregate the sickest
array of roles and patients in one area and demonstrated nurses’ dedication to
implementing innovation and improvements in the delivery of quality care.
initiatives that
have revolutionized Two decades later, in 1974, critically-ill patients were cared for
nursing care locally by an exclusively RN staff and self-governed by a triad system
and nationally. composed of a hospital administrator, physician and nurse
responsible and accountable for decision making at the clinical
While nursing care service level ― revolutionary concepts at UNC Hospitals and
nationally at that time.
has evolved during
Nurses continually develop and implement programs designed
the past 60 years, to improve patient care. “Nurses play a central role in fulfilling
our Commitment to Caring,” says Dr. Tonges. “We are
commitment to leaders and members of the Commitment to Caring teams,
including Inpatient Experience, Standards and Measurement,
exemplary care has Communication and others.”

always been the focus MO VI NG THE P RO FESSI O N
FORWARD
at UNC Health Care.
As the N.C. Memorial Hospital expanded to become UNC
Nurses’ influence Hospitals in 1989 and continued to grow, nurses also saw

has expanded and

extended into other

realms of care

North Carolina Collection, Univ. of N.C. Library at Chapel Hill delivery. “Nurses are

influential members

of the UNC Hospitals’ clinical and administrative teams and

play an active role in numerous decision-making forums,” says

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