The AAMC Nursing Blog

Archive for June, 2010

Climbin' the Ladder: the OR team celebrates with C.J. and Gerianne

The Professional Development Committee set out to develop a clinical ladder that honors the expertise of nurses who make a difference at the bedside and recognize those who show leadership on a daily basis within their unit and the facility.

It is an honor for the Professional Development Committee to announce the name of AAMC’s Nursing Clinical Ladder: C.A.R.E – Clinical Advancement to Reach Excellence. Thanks, Melissa McCoy, RN, of the Flex Unit, for your creativity in naming the Ladder. 

On May 27, we had our first Board Review Appointments. The day went off without a hitch (that is, if you ignore the 10 minute fire alarm drill that began as the first applicant entered the room—what an ice breaker).

It was a monumental day. We laughed and we cried—and I am not talking about the applicants. Our nurses did such a tremendous job presenting all of their hard work that they had the board members in tears!

The Professional Development Committee would like to congratulate our first group of Ladder appointees: Cheryl Briggs, Stephanie Dolle, Gerianne Fraddosio, Jennifer Herzig, Carrie Jackson, Maria Reinitz, and C.J. Rovaldi. You all should be very proud of the work you have done.

We would like to especially thank all of our Board Review Members for being such an asset to the new Clinical Ladder.

Thank you, also, to all of the folks who are so actively engaged in enhancing the care of our patients and documenting their own professional development.

For all of you eager nurses who are ready to participate in Clinical Advancement to Reach Excellence, look for additional Board Review dates in the upcoming months. For any questions, please contact Clinical Education and Professional Development. We look forward to hearing from future applicants. 

-Jamie Cinotti (Dotson), BSN, RN

You walk into your patient’s room to talk to him about his lab results. He is being treated for lung cancer and has had several admissions over the last few months. He asks a lot of specific questions about his labs and plan of care. As you carefully answer his questions, he pulls out an iPhone. “Hold on,” he says, “I need to Tweet this.”

You walk out to the nurses’ station. There’s been a call out for tonight. The charge nurse goes online and posts the open shift on the unit’s Facebook page. Within a few minutes, a coworker responds that she can cover the shift.  

Before making an appointment with a fertility doctor, your friend and her husband check out several of the many “rate your doctor” websites to find who has the highest rankings in their area. After reading several reviews about a particular physician who is rated high in bedside manner with a courteous staff, they call to make an appointment.

A friend of mine recently had major surgery to remove a large abdominal cyst. She posted details about her recovery—and pictures of her healing  scars—on my Facebook page, wondering if I thought the wound was healing properly.

These are just a few examples of the way technology is changing the culture of healthcare. Don’t believe it? Well, you are reading the Nursing Blog right now.

Recent statistics show that over 60% of adults seek health information on the internet. Many patients, like the man admitted for cancer in the first scenario, use social media to communicate with their family and friends—and save making multiple phone calls or emails. Some nurses use social media like Twitter to educate the public and promote health and wellness.

Technology has given us the opportunity to share as much as we want about our medical experiences, knowledge, and personal health issues with the world—or our 500 Facebook friends.  

Do you Facebook, Twitter, or blog? How do you see technology and social media changing your nursing practice?

Sometimes the little things can make all the difference. If you’ve ever had someone hold a door for you when you’ve had an armful of groceries, you know this to be true.

Welcome Hourly Rounds. Just a little thing—something you are probably already doing—that will make a big impact on our patients. How? In addition to preventing falls, research indicates that hourly rounding increases patient satisfaction and decreases the use of call bell requests.  

All inpatient ACP units, as well as the ED, Observation Unit and Women’s Surgical Unit will participate in this initiative. Hourly rounding will be performed by a nurse or PCT every hour during the day and evening shifts, as well as every two hours during the night shifts. In recognition of the importance of uninterrupted sleep, sleeping patients will not be awakened.

Attention will be focused on the four P’s: pain, peripheral IV, potty, and positioning. Rounds will also include an introduction of the nurse or PCT to the patient, as well as an environmental assessment.

To ensure that this new practice is standardized, a script has been developed to serve as a guide for communication between the staff member, patient and family, and staff will be competencied in this new practice.

In order to determine the effectiveness of this proactive nursing intervention, the occurrence of falls, hospital acquired pressure ulcers, and peripheral IV infiltration will be measured on all participating units. The level of patient satisfaction related to call bells, response of nurses, and pain management will also be measured.

Hourly Rounds will kick off on Tuesday, July 6. Look for additional information on the cafeteria bulletin board, during the upcoming Traveling Coffee Cart, and at the bus stops. Please feel free to contact Ann Marie Pessagno at apessagno@aahs.org Cathaleen Ley at cley@aahs.org directly with any questions.

Thanks to the Falls Committee and Unit-Based Nursing Quality Councils for their work in implementing this EBP intervention at AAMC.

The “little things” we do can have a big impact on our patients and their families. What are some other proactive interventions that make a difference on your unit?

-Cathaleen Ley, PhD, APRN, BC

I don’t get teary-eyed very easily, but there is something about a Fourth of July celebration that does me in. Maybe it’s the patriotic music paired with an incredible fireworks display, or maybe it’s the way people come together to celebrate our many freedoms during a time of war. Cap that off with the look of wonder on my little boy’s face as he gazes up into the sky—I’m done for.  

The must be hundreds of locations to celebrate the Fourth of July this year, but everyone seems to flock to the same crowded places. This year, consider checking out some of these lesser known locations. As a true fireworks enthusiast, I may hit a couple of them. See you there…

Rock Hall Harbor – If you live on the Eastern Shore or have a boat, go to Rock Hall. Rural area = darker skies = brighter fireworks! This show kicks off at 9 p.m. on July 3.

Oregon Ridge in Cockeysville- If you love music—specifically the Baltimore Symphony Orchestra jamming to Tchaikovsky’s 1812 Overture, Sousa’s Stars and Stripes Forever, and the national anthem—you must check out this show. Bring a blanket and a picnic basket. Gates open at 5 p.m., fireworks begin at 8 p.m. on both July 3 and 4.

Chesapeake Maritime Museum in St. Michaels – Watch the St. Michaels fireworks display over the Miles River while listening to the jazzy, big band sounds of The Rhythm Doctors. July 3 from 7 -10 p.m.

Downtown Annapolis – an “old-fashioned Fourth of July celebration” including a parade, fireworks over the harbor, and a performance by the USNA Band. The best viewing areas include public spaces Northeast of the Severn River, along the Naval Academy Bridge, any of the street-end parks facing Spa Creek, and aboard a boat in the Annapolis harbor. Festivities will be held on July 4: the parade begins at 6 p.m., concert 8 p.m., and fireworks at 9:15 p.m.

AAMC Nurses, where are you celebrating this year?

-Monica Mewshaw

We think so! And in an effort to inspire our community’s young people to consider a career in health care, AAMC started the High School Health Care Exploration program. Two years later, this “summer camp” fills up months in advance. It’s attendees, in many case, go on to declare college majors in nursing, pre-med, physical therapy, and the sciences.

This month, 12 students from area high schools attended the four-day program, providing them with a first hand, behind-the-scenes look at health care career options.

During the camp, the high schoolers were CPR certified, practiced basic assessment skills in our simulation lab, toured the ED, learned about helicopter transport and spent time with AAMC staff on several units.

We asked them to tell us more about what they enjoyed the most about the High School Health Care Exploration Program:

I came to this program most excited for Mother/Baby and discovered that I really enjoyed different things from each department.” –Meagan Ingley

When I first started this program, I wanted to do physical therapy and sports medicine. After today, I am more interested in working with the EMS unit and in the ER. Whichever medical profession I choose, I want to make sure I make a positive impact on someone’s life…It is good to see people who love their job because it makes me more confident (in choosing) a profession.” –Mitchell Flores

The reason I am participating in the AAMC High School Health Care Exploration Program is because I want to pursue a career in the medical field, specifically as a neurosurgeon…I have been able to witness what large roles each specific job plays and how important each and every single one of them is.” –Darby DeStefano

My passion is neonatal care…Every baby deserves tender loving care, especially preemies, and that is what I wish to give them.” –Alaysa Pizarro

(The High School Health Care Exploration Program) has solidified that I am really considering a health care path. Even though I am unsure of exactly what I would like to do.” –Carly Campbell

My goal is to become a registered nurse in a hospital, hopefully an obstetric or labor and delivery nurse. I came to this camp to experience the atmosphere of a hospital to see if it is really where I see myself someday. So far, I like everything about it!” –Cassidy Sullivan

I love it! I hope one day to become a Pediatric Nurse Practitioner.” –Hannah Pajak

Since I was seven years old, I have always known I wanted to be a doctor. At the time, it sounded like any other kid’s dream, but as I got older and really committed myself to the idea, I realized how determined I was to fulfill it…At this point in time, I’m considering working in pediatric oncology and hopefully my week at AAMC can help me achieve that.” –Carolyn Murphy

What about you? Why did you choose a profession in health care? Tell us about it here.

The hallways in the basement of the ACP are clean and bright, but somewhat bare.

Jackie Sachs was a Language Arts teacher who went through chemotherapy here at AAMC. She noted how “dismal” the “tunnel to chemo”—the basement of the Donner and Acute Care Pavilions—looked as she was being wheeled over for her treatments.

Even though she suffered from the side effects of chemo—nausea, hair and weight loss, as well as lethargy and fatigue—she had a vision. She wanted to brighten up the place.

“She and I scribbled notes on the back of a hospital menu, hashing out ideas of scenes to paint on the tunnel walls. We divided them into themes such as Broadway musicals, seasons of the year and nursery rhymes. We thought how painting the walls would bring a little beauty to the patients and the staff who traveled through the tunnels,” says Jackie’s daughter, Deborah Love.

After Jackie passed away, Deborah formed Tunnels of Love. She enlisted the aid of Laquel Ling, an art teacher at Magothy River Middle School, and her student volunteers to fulfill her mother’s dream.

After the Tunnels of Love team finishes, the walls are bright and cheery.

The first mural, “The Impossible Dream,” is complete and can be enjoyed by those who pass through the tunnels in the basement of the Acute Care Pavillion.

Thank you, Jackie Sachs and all those at Tunnels of Love, for a wonderful legacy.

-Debra Keane, RN

For the past ten years, Jan Campbell, RN, has been a part-time staff nurse in AAMC’s Edwards Operating Room. She also serves as the 2^nd Vice President of the United States Naval Academy (USNA) Women’s Club. Over the past several months, Jan has been influential in helping to raise almost $15,000 through this organization, the proceeds of which have gone to support military families.

As a Navy wife and mom, Jan is especially dedicated to raising funds to support the Fisher House Foundation, an organization that provides United States Armed Forces and their families’ comfortable temporary lodging when a military member or dependent requires specialized or extended medical care.

Fisher House facilities enable families to stay together while a loved one is undergoing long-term treatment. They are close in proximity to military hospitals—a sort of “home away from home.” Currently in the U.S., there are 45 Fisher Houses on 18 military bases and 15 on VA centers.

One of Bethesda Naval Hospital's Fisher Houses

This temporary lodging concept for military families began in 1990 and nationally has offered more than 3 million days of free lodging to more than 120,000 families (a savings of about $15 million in lodging, food, and transportation). The average length of stay is 15 days; average stay for combat casualties 60-75 days. Families who stay at Fisher house do not pay. Fees at Navy, Army, and Air Force Fisher Houses are underwritten by The Fisher House Foundation (FHF)—a not-for-profit organization that builds new houses and assists in the coordination of both private and public support for their homes.

We at AAMC are proud to have Jan on our staff and are grateful for her support of the Fisher House Project.

What about the rest of our staff? What cause are you most devoted to and why? Let us know here.

-Amy Kohler, RN

“Oh my! This is hard!” exclaimed a student who came through the recent AAMC Nursing Institute course, Introduction to Perioperative Nursing course.

This two-credit elective provides Anne Arundel Community College nursing students with theoretical and clinical experience in the perioperative setting. Specifically, the role of a perioperative nurse is explored during 18 hours of didactic and 40 hours of hands-on clinical time.

As always, the students were blown away at the level of teamwork and knowledge demonstrated by the staff in Surgical Services.

Although the course is designed to attract students into the periop specialty, they will be able to utilize their new skills–such as aseptic technique, surgical conscience, patient safety, the role of different team members, and hand off communication–in any nursing setting.

According to Margaret Saul, RN, CNOR, clinical educator in the OR, “The transformation in the knowledge gained by the students during the course is nothing short of amazing!”

In fact, this course has been so successful that other hospitals are seeking opportunities to offer the same type of program in their community.

The students asked that we convey their deepest, most heartfelt thanks to our staff for welcoming them and teaching them about what you do to help the people of our community stay healthy and well.

-Denise Schmitt, MS, BSN, RN, CEN

During a phone survey process to measure patient satisfaction, the very last question asked is: “Thinking of this visit, what one thing could the emergency department have done better?” Upon their consent, the patient’s comments are recorded. 

Below, in their own words, are some of the wonderful things our patients are saying about AAMC’s ED team:

I just want to thank the Anne Arundel Medical Center for treating my son. You took very good care of him and he was very satisfied with the radiology and the nurse that came in and both doctors, the triage doctor and the doctor that actually seen him…so you guys did a great job!”

 Actually, there’s nothing that I think they could’ve done any better. They actually went above and beyond my expectations for our little girl whenever we took her there. They took their time with her and they made sure she got medication which helped bring her temperature down and they were just really, really good and they were very courteous to us.”

I was impressed by their courtesy and their decency and their accuracy…and I pray to God to continue to give them the long strength to be able to do their job in very humble and decent manners.”

As far as anything you could do better, I don’t think there’s anything you can really do better. The ER is sort of a miracle place anyhow. I’m a retired policeman, I’ve been to many ER’s and I gotta say, it was–for being some place you really don’t want to go–it was not really traumatic being in there. Everybody was helpful and concerned. I was pleasantly surprised.”

Ah, summer in Annapolis. You know it has officially started when you smell those steamed crabs, smothered with Old Bay, or take that first leisurely evening stroll down at the Annapolis docks. But what’s really going to get summer going? The eagerly anticipated 3rd annual AAMC Nursing Strategic Planning Retreat, that’s what!

The retreat is being held on Fri., June 11. An interdisciplinary team of AAMC staff members will focus on what we’ve been up to and where we are going, with a huge spotlight on patient- and family-centered care. More to come on that soon! In the meantime, here are your monthly NSP initiative updates.

Professional Development                                                     

• The first eight applicants completed their Board of Review on May 27!
• Reminder to those who occupied a CNII position in the old ladder: if you are pursuing a Level II on the revised ladder please make plans to schedule a Board Review. The application should be sent to Clinical Education and Professional Development;
• Be on the lookout for the new policy regarding the ladder, slated for final approval in June.

NIC

• Preparing to start training nurses on Chart Review. Smart Alecs to work with nurses on their units to do Tracers in preparation for our upcoming Joint Commission visit;
• Working on recommendations for appropriate places within the record to properly document care given to patients.  For example: standardizing pain reassessment documentation;
• Creating priorities for Hot lists for the upcoming JCAHO visit, as well those for ALEC. Hot lists are being gathered from many different councils and committees and will be used to compile a list of high priorities to work on as an organization.

Communication                                                                           

• Pushed out about 50 blog updates over the last four months! Will continue to build content and promote AAMC Nursing.
• Acted as communication consultant for other initiatives and departments;
• Researching build for AAMC Nursing smartphone “app.”

Care Delivery Model                                                      

• Working to support units in the promotion of patient- and family-centered care. Just to mention a few: the CCU is receiving much positive feedback from their newly initiated Family Rounding, PACU in the Edwards Surgical Pavilion is trialing family visitation with success.

Staffing & Scheduling                                                            

• Revised nine existing policies and developed one new policy: Floating to Another Unit;
• Reviewed all policies with Professional Nursing Council, Nursing Operations Leadership Council, Chief Nurse Executive, Human Resources Partners;
• Developed master list of organizational staffing and scheduling policies.
• Future Plans: Move reviewed policies through hospital approval structure;  Continue work on policy revisions from organizational master list; Incorporate Flexible Pool and CPT staffing into Tiered Pool Staffing Policy NAD11.1.09