Letter from the Chief Nursing Executive - Medical City … Letter from the Chief Nursing Executive...

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Letter from the Chief Nursing Executive

As my second year as Chief Nursing Executive for our Division closes and I look back over the tremendous accomplishments made by our nurses and caregivers throughout the past year, I could not be more proud. I am delighted to share with you this year’s Nursing Annual Report. In it, you will find powerful evidence of our strong and vibrant culture of nursing excellence.

Our nurses continue to make amazing mission-driven innovations in patient care, demonstrating repeatedly their dedication to the care and improvement of human life. In what I believe is directly correlated, our employee engagement was number one in HCA for the second year in a row this year. This is a measure of the joy and meaning derived from our work. Be sure to spot the many quotes from our nurses in this report regarding finding joy in their work, the theme for this year’s Annual Report.

Throughout the year, nurses across our hospital system continued to integrate with one another, form new working relationships with counterparts from our various settings, learn from one another, network and share best practices. We were therefore poised for our momentous strategic change announced on November 18, 2016: the introduction of a new common brand for our entire Dallas-Fort Worth healthcare organization (pictured on front cover).

Healthcare excellence now goes by one name: Medical City Healthcare! Now, with our new brand, our community recognizes that all 13 of our hospitals, seven provider-based emergency rooms, 11 ambulatory surgery centers, 34 urgent care centers, 14,000 employees, 7,000 physicians and 6,000 nurses are all part of Medical City Healthcare.

The delivery of healthcare is evolving rapidly in our country, and nurses are leading change and advancing health. Medical City Healthcare nurses are developing new models of care to meet the needs of our patients. Whether carefully assessing their patients for subtle changes in condition, leveraging technology, innovating for greater effectiveness, navigating their patients’ courses of care, preventing readmissions, developing their own leadership expertise, conducting research, presenting at national conferences or volunteering in their community, Medical City Healthcare nurses are known for their special brand of compassion.

As you review our Nursing Annual Report, you will see how this exquisite compassion, defined by the ability to connect through human caring, along with expertise and interprofessional collaboration, allow us to deliver on our promise to our patients for excellence always in Medical City Healthcare. I am honored to serve in my role and grateful for our many nursing heroes and their colleagues who find joy in providing world-class patient care. I hope you will enjoy getting to know more about them and that you will share in my sense of pride. Welcome to Medical City Healthcare!

Sincerely,

Carol Gregory, MSN, MBA, RN, NEA-BC Chief Nursing Executive

INTRODUCTION

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Letter from the President

Nurses are the fabric of our hospitals, weaving together leading-edge medicine and dedication to the highest standards and compassionate care. Patients and family members often describe your healing influence as the human connection that differentiates and comforts during the most frightening of experiences.

As we look back on 2016, the results of your exceptional caring and competence are apparent across our organization. Our physicians speak highly of your impact and have again expressed increased satisfaction with nursing care. The North Texas division also achieved the highest employee engagement results in the company

for the second year in a row, reinforcing the satisfaction and pride you derive from your important work.

Your ongoing contributions in clinical quality and unparalleled patient experience have resulted in another year of expansion and achievement for Medical City Healthcare. The newly

opened Medical City Frisco immediately exceeded all expectations for growth. Medical City Denton was redesignated as a Magnet facility, and Medical City Plano will attain

status as a Level 1 Trauma Center in 2017. Most important, your commitment to excellence always has saved even more lives through our sepsis, CAUTI and

CLABSI reduction successes.

Under the direction of Chief Nursing Executive Carol Gregory, our culture of nursing excellence continues to shine, encouraging knowledge-sharing and collaboration for the benefit of all the patients we serve and creating new opportunities for nurses throughout our division.

As President of Medical City Healthcare, I am proud of our commitment to excellence always, to which nursing excellence is the foundation. Thank you for your dedication to a calling that makes a meaningful difference in countless lives every day.

Sincerely,

Erol R. Akdamar President

INTRODUCTION

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Nursing by the Numbers - 2016

Medical City Healthcare Nurses by the NumbersTotal number of nurses 6,000Average nurse tenure 6.9 yearsPercent of nurses with BSNs 65%Percent of all nurses with professional certification 28%# Certification reimbursements in 2016 981# Nurses who received career enhancement awards 1,602Total dollars given for career enhancements $1.2MTotal dollars given for tuition reimbursement $2MTotal dollars spent on nursing capital purchases $5.7M

Editorial Board

Carol Gregory, MSN, MBA, RN, NEA-BC

Sandy Haire, DNP, MHA, RN, NEA-BC, FACHE

Zach Mueller, DNP, RN, NEA-BC

Cassidi Roberts, MSN, RN, CEN

INTRODUCTION

“Nursing is THE differentiator for HCA”

– Sam Hazen, HCA President

& COO

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TRANSFORMATIONAL LEADERSHIPMeet the CNOs of Medical City Healthcare

Angie Buckmeier, MHA, BSN, RN Medical City Children’s Hospital

H. A. Trey Caraway, III, MBA, BSN, RN Medical City Las Colinas

Sandi Gill, MHA, BSN, RN, NEA-BC, CNMLMedical City Frisco

Sandy Haire, DNP, MHA, RN, NEA-BC, FACHE Medical City Plano

Brandy Farrer, MSN, RN, NEA-BC Medical City Lewisville

“We are privileged to lead change and advance

health by inspiring passionate professional practice for every patient every time.”

- CNO Credo

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Judi Messer, MSN, RN, NEA-BC Cathy McLaughlin, MSN, BSHM, RN, ONC Zach Mueller, DNP, RN, NEA-BC Medical City Alliance Medical City Arlington Medical City Dallas & Medical City Children’s Hospital

Lynn O’Neill, MBA, BSN, RN, NEA-BC, FACHE Cathy Pierce, MS, RNS Tracey Smithson, MSN, RN, NEA-BC Medical City Fort Worth Interim CNO, OUMC Medical City North Hills

Cassidi Roberts, MSN, RN, CEN Nicki Roderman, DNP, RN, CCRN, CNR Pam Whitley, MSN, RN Medical City McKinney Medical City Denton Medical City Green Oaks Hospital

TRANSFORMATIONAL LEADERSHIPMeet the CNOs of Medical City Healthcare (cont.)

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In 2015 when Carol Gregory began her role as the first division Chief Nursing Executive, she asked each of the Chief Nursing Officers to identify their personal mission statements. The model below represents those sentiments that serve to drive the passion for excellence and strategic thinking of the CNOs across Medical City Healthcare. In their entirety, they represent a holistic view of our transformational leadership.

During an off-site retreat, the model of the personal missions was revealed and a credo developed from the combined themes. Agendas for each monthly meeting of the CNO Council since 2015 have contained both the credo as well as the Medical City Healthcare Mission. Both serve to underscore the mission-driven work of the nursing executive team as they build a culture of nursing excellence.

TRANSFORMATIONAL LEADERSHIPMeet the CNOs of Medical City Healthcare (cont.)

Build strategic

interprofessional relationships

Inspire effective

communication

Make a palpable, positive

difference in the lives of

others

Work with patient-centered

teams

Serve as a catalyst for

caring

Teach the “why”

Not be associated

with anything that is not

great

Live, laugh, love

& pursue lifelong learning

Focus on the synergy & collective wisdom of

teams

Live & lead with integrity,

transparency & servanthood

Enhance a culture of

caring from the HEART

Improve outcomes through

exemplary professional

practice

Never quit

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TRANSFORMATIONAL LEADERSHIPMagnet® Journey

As the highest and most prestigious designation for nursing excellence, Magnet Recognition is a highly sought-after honor achieved by only 8 percent of hospitals across the globe. The designation, conferred by the American Nurses Credentialing Center (ANCC), is awarded for nursing excellence, quality care and innovation in nursing practice. The achievement comes only after a rigorous journey that demands excellence in nursing-sensitive quality measures and a strong culture reflective of all components of the Magnet Model. The model includes Structural Empowerment, New Knowledge, Innovations and Improvements, Exemplary Professional Practice, Transformational Leadership and Empirical Outcomes, all in the context of Global Issues in Nursing and Health Care. Only those hospitals that show evidence of all aspects of the model are firmly in place can receive Magnet Recognition. The mission of ANCC, which is a subsidiary of the American Nurses Association (ANA), is to promote excellence in nursing and healthcare globally through credentialing programs.

This year Medical City Denton was proudly and deservedly redesignated as a Magnet facility. Nicki Roderman, DNP, CCRN, CNR, Chief Nursing Officer for Medical City Denton, noted that: “It has been four years since our initial designation, and through continued improvement in outcomes, advancement in nursing practice and implementation of evidence-based care, we were able to demonstrate our excellent hospital.”

© 2013 American Nurses Credentialing Center. All rights reserved. Reproduced with the permission of the American Nurses Credentialing Center.

5 Medical City Healthcare Magnet Hospitals

“The joy I get is the interaction I have with

my patients. I enjoy seeing them feel better.”

- Barb Moreland, MSN, RN Behavioral Health

Services

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TRANSFORMATIONAL LEADERSHIPMagnet® Journey (cont.)

Pictured from left to right seated: Michelle Yeatts, Magnet Coordinator; Nicki Roderman, CNO; Georgette Calm, Education Director. Standing: Steve Edgar, CEO; Dean Miller, ACNO; Lori Carson, Consultant

Dean Miller, Associate Chief Nursing Officer for Medical City Denton, said, “This has certainly been an amazing journey … and one we will never forget.”

Because nursing is not practiced in a silo, a Magnet designation is also reflective of teamwork across the entire organization. The consistent commitment to the care and improvement of human life at Medical City Denton was rewarded with what is considered the gold standard for quality care and was cause for great celebration.

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As Barbara Shaw-Harris, BSN, RN, Medical City Denton Same-Day Surgery, noted, “Seeing all departments working together and building for the future allows us to move mountains. We have, and we will continue to do so. This is what makes us great and allows us to deliver excellence in care always.”

Medical City Healthcare now has five Magnet® - recognized hospitals, including:

Two additional hospitals within Medical City Healthcare are currently designated as Pathways to Excellence®. This designation reflects a firm culture of support for nurses and is also awarded by the ANCC. The organizational credential recognizes healthcare facilities that have created positive work environments where nurses can flourish. Current Pathways to Excellence hospitals are:

TRANSFORMATIONAL LEADERSHIPMagnet® Journey (cont.)

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TRANSFORMATIONAL LEADERSHIPMajor Milestones - 2016

GROWTH/EXPANSION

Medical City Frisco opened its doors as an HCA facility.

Medical City Healthcare opened its Simulation Center in the Resource Center.

Medical City Dallas and Medical City Children’s Hospital participated in an iMobile pilot.

Medical City Plano completed a survey for a Level I Trauma Center designation by the American College of Surgeons with no deficiencies.

EXTERNAL RECOGNITION

Medical City Denton achieved a Magnet® re-designation by the American Nurses Credentialing Center.

Medical City McKinney and Medical City Lewisville received The Leapfrog Group Top General Hospital Award.

Medical City ER Flower Mound Provider-based ED received a Lantern Award from the Emergency Nurses Association.

Medical City Children’s Hospital received the Texas Hospital Association Award for Excellence in Community Service.

Medical City Plano received the Sarah Cannon Complex GI Center of Excellence Award, the first in the nation.

Medical City Dallas received the Silver Award in resuscitation from the American Heart Association.

Medical City Denton achieved year-over-year improvements in the AHRQ Survey on patient safety.

Medical City Lewisville was featured in the winter edition of the HCA Clinical Excellence publication on it’s first-time Magnet® designation in 2015.

Medical City McKinney RN Martha Langham was awarded as a finalist for the HCA Frist Humanitarian Award.

Medical City Flower Mound ED received a Guardian of Excellence Award from Press Ganey.

Medical City Fort Worth RNs Megan Gallegos and Shawn Lewis received the HCA Innovator’s Award.

Medical City Denton and Medical City McKinney received CMS recognition as Best in Nation for ED Wait Times for under four minutes from April 2015-March 2016.

Medical City North Hills received the Gold Seal of Approval Certificate of Distinction by The Joint Commission for their sepsis management.

Medical City Alliance received the Studer Group Award for Excellence in Outpatient Satisfaction.

CASCADING EXPERTISE

Medical City North Hills was featured in an Advisory Board Company publication on its program for successfully reducing Sepsis.

Medical City Healthcare presented a poster on its Nursing/IT&S Partnership at the national Studer Conference: What’s Right in Healthcare.

Medical City Dallas had a podium presentation on Social Media in Healthcare at the national Magnet Conference.

Medical City Lewisville presented on its pain management success on the HCA American Group CNO Network Conference Call series.

Medical City Alliance presented on its OP patient satisfaction on the HCA Drop-In Call series.

Medical City Fort Worth presented at the HCA Clinical Services Summit on its success in CLABSI reduction.

Medical City Fort Worth was featured in the spring edition of the HCA Clinical Excellence publication on its ED Concierge Program.

Medical City Dallas and Medical City Children’s Hospital were featured on the HCA CNO Call for their Nurse-Physician Collaborative Committees.

ACCREDITATION

Medical City McKinney was recognized by The Joint Commission for it’s outstanding Accreditation Survey.

Medical City Lewisville received Accreditation from the Commission on Cancer (CoC) with commendations in five areas including oncology nursing care.

Medical City McKinney received disease-specific recertification in Hip and Knee from The Joint Commission with no deficiencies.

ACADEMIC PARTNERSHIP

Medical City Plano partnered with Texas Woman’s University for the first Academic Partnership Cohort in Medical City Healthcare.

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TRANSFORMATIONAL LEADERSHIPNurses on BoardsAs the most trusted profession and heart of healthcare, nursing is helping to transform healthcare across our nation. A National Coalition of the American Academy of Nursing, the American Nurses Association and the American Nurses Foundation launched an effort in 2014 to place 10,000 nurses on governing boards by 2020. Many Medical City Healthcare nurses lend their expertise in their communities or in their professional organizations by serving as board members, including the following:

NAME FACILITY BOARD

James Allard, MSN, RN, NEA-BC

Medical City Dallas NTONE Board of DirectorsLegal Hospice of TexasWorkplace Advocacy Committee for TNA

Amy Atnip, MSN, RN Medical City Plano NCTTRAC Board of Directors - SecretaryMarci Ayers, MSN, RN, CSRN, RN-BC, CNE

Medical City Healthcare International Advocacy Council for Livingstone University in Mbale, Uganda

Susan Bedwell, MS, APRN, CCNS-N

OU Medical Center AACN APRN Item Writing Committee, Peace Lutheran Executive Board

Monica Bildner, MLS, BSN, CPN

Medical City Dallas Fortis College Advisory Board

Mira Brown, BS, BSN, RN, CWCN, WOCN

Medical City Denton United Way Denton – Veterans CourtUnited Way Denton – Mental Health Court

Page Brown, MSN, RN Medical City Lewisville President – Academy of Medical Surgical Nurses, North Texas Chapter 205Megan Brunson, MSN, RN, CNL, CCRN-CSC

Medical City Dallas AACN - Director

Kyle Bryan, MSN, RN, NEA-BC

Medical City Lewisville Lewisville Chamber of Commerce

Angie Buckmeier, MHA, BSN, RN

Medical City Children’s MCCH Family Advisory BoardWesley Matthews Driven 2 Greatness Board

Trey Caraway, MBA, BSN, RN

Medical City Las Colinas Medical City Las Colinas Board of Trustees – Voting Member

Lew Wyman-Collins, BSN, RN

Medical City Lewisville Hemophilia Federation of America Advisory Board

Sherry Cusumano, RN, MS, LCDC

Medical City Green Oaks Hospital

National Alliance on Mental Illness (NAMI) – Dallas Chapter President, Texas NAMI Board & Chair of Public Policy Committee for Texas Chapter

Deborah Echtenkamp, APRN, RN, MSN, CPON

Medical City Dallas Camp iHope Foundation - President

Brandy Farrer, MSN, RN, NEA-BC

Medical City Lewisville Medical City Lewisville Board of Trustees – Voting MemberHCA Medication Management Advisory BoardHCA Professional Practice Nursing Strategic WorkgroupSpecial Abilities of North Texas Board of TrusteesPediPlace – Clinical Operations Board

Jeanne Farmer, DHSc, BSN, RN

Medical City Plano Collin County Adult Clinic Board

Gary Fullerton, MBA, RN, FACHE, NEA-BC

Medical City Lewisville Denton County Behavioral Health Board

Laura Garner, RN Medical City Plano ABA Aftercare Reintegration CommitteeEmily Gentry, BSN, RN, OCN

Medical City Healthcare AONN Leadership Council

Sandi Gill, MHA, BSN, RN, NEA-BC

Medical City Plano City House Board

53 Medical City Healthcare Nurses on Boards

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Carol Gregory, MSN, MBA, RN, NEA-BC

Medical City Healthcare DFWHC Foundation BoardDFWHC Foundation Healthcare Workforce Center Advisory Board Medical City Community Advisory BoardVNA Advisory BoardHCA CNO CouncilHCA Leadership Institute Advisory BoardHCA Nursing Professional Practice Strategic Workgroup Co-ChairMedical City Healthcare Nursing Professional Practice Governance Board AdvisorNorth Texas Consortium of Academia and Practice Partners

Sandy Haire, DNP, MHA, RN, NEA-BC, FACHE

Medical City Plano MCP Board of Trustees – Voting MemberTONE Board of DirectorsDFW Great 100 BoardTNA Texas TeamCollin County Children’s Advocacy Center Plano Chamber of Commerce Board of DirectorsHCA People/Professional Practice Nursing Strategic Workgroup

Margaret Elaine Haxton, MS, APRN-CCNS

OU Medical Center Oklahoma Board of Nursing – Advance Practice Council AANN – Stroke Focus Group ChairOACNS – President ElectOANN Board

Michelle Hooks, MSN, RN, TCRN

Medical City Plano Collin College EMS Advisory BoardCollin County Sexual Assault Response Team Board (SART).

Sharon Ingram, MSN, MHA, RN, CIC

Medical City North Hills DFWHC Foundation Patient Safety and Quality Committee

Becky Jones, MSN, RN, CCRN

Medical City Denton HCA Critical Care Nursing Committee

Leonard Keesee, RN, LCDC, NCAC II

Medical City Green Oaks Hospital

National Alliance on Mental Illness Board, Advisory Committee for TPAPN, Advocate Advisory Committee Chair for TPAPN

Joe-ell Lohrman, MSN, RN, TCRN

Medical City Plano Texas Trauma Coordinators Forum Board of Directors

Clint Magee, MBA, RN Medical City Alliance Keller Chamber of Commerce Board of DirectorsSteven McCraw, MBA, BSN, RN

Medical City McKinney – Stonebridge PBED

Prosper Chamber of Commerce

Cathy McLaughlin, MSN, BSHM, RN, OCN

Medical City Arlington American Cancer Society, Texas Chapter

Judi Messer, MSN, RN, NEA-BC

Medical City Alliance Northwest Education Foundation BoardNorthwest Education Foundation Strategic Planning Board - ChairHCA Operations Nursing Strategic Workgroup

Kammie Monarch, MSN, RN, JD

OU Medical Center OU College of Nursing Curriculum CommitteeNursing Networks, LLCOU College of Nursing Community Advisory Board

Zach Mueller, DNP, RN, NEA-BC

Medical City Dallas MCDH Board of Trustees – Voting MemberPediPlace Board of Directors – SecretaryHCA Leadership Nursing Strategic Workgroup

Mandy Nelson, MS, APRN-CNS, ACNS-BC

OU Medical Center Oklahoma Board of Nursing – APRN representative on the Board

Lynn O’Neill, RN, MBA, NEA-BC, FACHE

Medical City Fort Worth HCA Operations Nursing Strategic Workgroup

Deborah Parris, DNP, APRN, PCNS-BC

OU Medical Center Covenant Life Assembly Board

TRANSFORMATIONAL LEADERSHIPNurses on Boards (cont.)

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Carla Rider, MS, MBA, RNC-LRN

Medical City Plano March of Dimes Advocacy and Government AffairsState of Texas NTTRAC, Perinatal Committee Voting MemberSigma Theta Tau International Chair Lead National Faculty Maternal-Child Health Nurse Leadership AcademyMaternal Mortality and Morbidity Task Force, State of Texas Perinatal Quality Collaborative

Ginny Robinson, BSN, RN Medical City Plano Journey of Hope, Grief Support CenterUnited Way Community Impact Grants Panel (Substance Abuse) – Co-Chair

Nicki Roderman, DNP, RN, CCRN, CNR

Medical City Denton North Central Texas College Board – VP of Denton CountyHCA Professional Practice Nursing Strategic Workgroup

JD Romero, RN Medical City Alliance ENAInstitute for Quality, Safety & Injury Prevention

Rhonda Ross, MSN, RN Medical City Denton Children’s Advocacy BoardNancy Routly, RN Medical City North Hills North Texas Chapter of Risk Management Association Board - PresidentTricia Scott, MS, RN, FACHE

Medical City Healthcare DFW Hospital Council Workforce Planning BoardCollin College Advisory BoardEl Centro College Advisory BoardNorth Texas Consortium of Academia & Practice Partners

Cathleen Shellnutt, MSN, RN, AGNS-BC, CGRN

Medical City Plano TCU Graduate Faculty Advisory BoardSGNA Junior Editor

Tabitha South, MSN, RN NE-BC

Medical City Plano HCA Medical Surgical Nursing Committee

Tom Tierney, BSN, RN Medical City Dallas TXENA – DirectorTCENA – Immediate Past President

Sue Vanek, MSN, RN Medical City Plano ABA National Burn Repository Advisory Committee ABA Burn Center Disaster Planning Special Interest GroupSouthern Region Burn Centers – Disaster Representative

Amy Yazbeck, MBA, RN Parrallon Supply Chain Solutions

DFW Hospital Council NTHIQ Collaborative

Janice Wierzbicki, MHA, BSN, RN

Medical City Healthcare DFWHC Post-Acute Care Council

Jessica Wilson, MSN, RN, CCRN

Medical City Plano HCA Critical Care Advisory Board

Joyce Winbush, BSN, RNC, CMSRN

Medical City Dallas North Texas Chapter of AMSN Board

Denise Zimmerman, RN Medical City Alliance ANA BoardANA NICU Nurse Toolkit Group – LeadAcademy of Neonatal Nursing Board

TRANSFORMATIONAL LEADERSHIPNurses on Boards (cont.)

“When someone comes through our doors, they are not just a face or a name.” – Bow Beckett, RN, BSN

Ortho/Surg/ Trauma, Medical City

McKinney

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TRANSFORMATIONAL LEADERSHIPNursing Executive Development

Adding ACNOs

As a part of succession planning for nursing leaders within Medical City Healthcare, new assistant CNO positions were added at nine of our hospitals within the last two years. ACNOs within our division include:

Medical City Arlington Ginny Johnson, MBA, BSN, RNC-NIC, NEA-BCMedical City Denton Dean Miller, MSN, RNMedical City Dallas and Medical City Children’s Hospital

Katie Bruels, MSN, RN

Medical City Fort Worth Megan Gallegos, MSN, RN, BSMedical City Green Oaks Hospital Russell Reed, BSN, RNMedical City Las Colinas Kim Petty, MSN, RNMedical City Lewisville Kyle Bryan, MSN, RN, NEA-BC, CCRNMedical City McKinney John Summers, MA, BSN, RN, CPPSMedical City North Hills Sharon Ingram, MSN, MHA, RN, CICMedical City Plano Tabitha South, MSN, RN, NEA-BC

Nursing Executive Succession Planning Summit

This year a Nursing Executive Succession Planning Summit was sponsored by Carol Gregory, CNE, with the help of Rowena Yates, Director of Leadership and Organizational Development. Thirty-three nursing leaders were in attendance. Speakers from within the community, division and company spoke to the audience about the career progression into nursing executive roles. A panel discussion was held by CNOs from across Medical City Healthcare as to the challenges and rewards of their roles.

HCA Executive Development Program

HCA as a company is known for its commitment to developing leaders. As noted on the ATLAS web site, HCA’s Leadership Development Institute has a number of signature programs, such as the Executive Development Program (EDP). The program is designed purposefully for preparing leaders for hospital executive roles, such as CNO, COO or CFO. The EDP curriculum is:

“Designed to provide a wide variety of opportunities for participants to network, gain necessary experiences and increase their exposure to other facilities and divisions. Educational content leverages leadership development best practices by partnering with Harvard Business Publishing. Participants are selected based on Talent Review results as individuals with the potential to fill one of these roles successfully, and asked by leadership to apply.”

This year, two of our assistant CNOs were selected to participate in the CNO development program. Kim Petty from Medical City Las Colinas and Dean Miller from Medical City Denton following a rigorous interview process were each selected to attend the program in preparation for future CNO roles. Congratulations to Kim and Dean.

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Division Investment in Nursing Professional Development – Multiyear

2014 2015 2016Charge Nurse Certification

Participation NA NA 1097

HCA Director Development 0 3 2HCA CNO Development 2 0 2RN Residency Program 152 344 518

Emerging Leaders Program (Nurses) 15 24 23

Nursing Executive Succession Summit NA NA 33

Serving as Preceptors for Master’s Degree StudentsMany nursing executives within Medical City Healthcare devote their time to support others as preceptors when nurses are seeking advanced nursing education. Pictured here is Lynn O’Neill, CNO, at Medical City Fort Worth, who served as preceptor to Jason Smith, MSN, RN, CNOR. Jason now serves as OR director for Medical City Fort Worth and is a recent Emerging Leaders graduate.

TRANSFORMATIONAL LEADERSHIPNursing Executive Development (cont.) Read what the program has meant to them:

“The Executive Development Program has truly shown me the incredible emphasis that our leaders in HCA place on developing the next generation of leaders. No other organization could rival this amount of time, resources and attention to leadership development.”

“The Executive Development program has provided an invaluable opportunity to gain firsthand, critical insights into the HCA Corporation. Being able to hear HCA’s president and other corporate executives not only discuss the “business of healthcare,” but also passionately discuss the mission and vision of HCA and the importance of keeping the patients at the center of all that we do, reaffirmed for me that this is definitely the company in which I want to be a leader of healthcare for the future.”

Dean Miller, MSN, RN ACNO, Medical City Denton

Kimberley Petty, MSN, RN ACNO, Medical City Las Colinas

“If your actions inspire others to dream more,

learn more, do more and become more, you

are a leader.” - John Quincy Adams

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TRANSFORMATIONAL LEADERSHIP2016 Charge Nurse Certificate Program

HCA’s Leadership Institute recognizes that our people are our most vital asset. Knowing that front-line leaders are key to our success, a commitment was made to deploy a formal HCA Charge Nurse Leadership development program across the company.

In 2014-2015, Carol Gregory, CNE, Medical City Healthcare, was part of an enterprisewide task force that provided guidance and expertise to build a suite of training courses specifically for HCA charge nurses. The three overarching objectives for the program were to:

• Increase leadership and management capabilities

• Build critical knowledge and thinking skills for the changing healthcare industry

• Create a culture of nursing leadership best practices across HCA

As a result, current nurses with varying amounts of charge experience, may now acquire a Charge Nurse Leadership Certificate through the program. As an added bonus, 32.5 hours of continuing education credit may be obtained.

The nine four-hour sessions include:

• Leadership Fundamentals• Supervisory Skills• Critical Thinking• Crucial Conversations for Charge Nurses• Coaching for Excellence• Leading Change in a Dynamic Climate• Patient Experience at HCA• Understanding Productivity and Business Acumen• HCA Vitals for Charge Nurses

(.5-hour online session)

In January 2016, Medical City Healthcare began offering Leadership Fundamentals, Supervisory Skills, Critical Thinking and Crucial Conversations for Charge Nurses. With strong CNO support from each facility, over 124 nurses attended all four sessions in 2016, with each course averaging 300 participants. In 2017, Coaching for Excellence and Leading Change will be added to the training options, providing two additional courses in the Charge Nurse Leadership development program. See below for graph and course description details:

Charge Nurse Leadership Certificate

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Recognizing the gap in tools, training and support for front-line leaders, several years ago, Carlene Headley-Obansa, MSN, RN, PCCN, NEA-BC, Director, Inpatient Services, instituted a Clinical Supervisor Leadership Development (CSLD) program at Medical City McKinney. The investment is one hour per month of activities ranging from team-building exercises, fostering positive relationships, learning about unit productivity, employment laws, nurse leader rounding (NLR), validations and post-NLR coaching. Senior leaders have joined the meeting on occasion to provide inspiration and encouragement.

The CSLD brings consistency to leadership across departments. This leadership collaboration provides a forum where department best practices are shared to achieve organizational goals. At least one clinical supervisor is recognized each session. The organization has benefited from breakdown of departmental barriers, which were a problem prior to the CSLD. The front-line leaders have since built strong, professional relationships, a success factor for patient throughput.

High-level leader collaboration is now part of the culture at Medical City McKinney and will continue to play a pivotal role in improving quality and patient care outcomes. Medical City McKinney was recognized as one of the Top Performers during its Joint Commission Survey in 2016 as well as in the most recent Leapfrog Hospital Survey. CSLD plays a role in the hospital’s success.

The following are testimonials from a sampling of the clinical supervisors who have been the beneficiaries of Carlene’s vision:

“It was one of the most beneficial decisions ever made for the clinical supervisors who are on the frontline and run the units to come together and get to know each other as leaders. It helped me become knowledgeable about the mission of our hospital, productivity, patient throughput, expectations and, moreover, led me to a completely different level of nurse leader rounding that is more effective and meaningful.” – Bindu Devasia, RN, PCU

“… We get to share our experiences and use them to move forward. It’s nice to hear other people’s opinions or suggestions, which can be beneficial to our units as well.” – Anabelle Chan, RN, 4C

“I have learned that leadership does not come easily to most people. The skill can be learned when taught by knowledgeable and experienced leaders. You know you are on the right track when your team begins working together as a cohesive unit and then new leaders emerge in their own right.” – Linda Fortner, RN, Psych

Carlene Headley-Obansa, MSN, RN, PCCN, NEA-BC, presenting

Clinical Supervisor Ron Wilson, RN, with a Recognition Award

Ann Dutez, RN, ED Night Clinical Supervisor (third from right), receiving a Recognition Award

with her ED night crew

TRANSFORMATIONAL LEADERSHIPClinical Supervisor Leadership Development

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Medical-Surgical Nursing Council

The Council of Med-Surg leaders continued to meet for its second year in 2016. Tabitha South, MSN, RN, NE-BC, Director for med-surg and oncology at Medical City Plano continued to serve as chairperson. Their priorities were to increase the number of Unit of Distinction honorees, partner with the North Texas AMSN Chapter and expand interdisciplinary collaboration. Accomplishments included sharing best practices on a PCT handoff communication tool, HCAHPS and certification.

Subcommittee work resulted in technology upgrades and kit bundling for supply scanning, sharing BCMA successes, a staffing to patient needs pilot at Medical City Fort Worth and Medical City Denton, and the development of a lead tech role at Medical City Las Colinas and Medical City McKinney. Review of vital signs technology was accomplished at Medical City McKinney and Medical City Plano. The committee also shared employee engagement wins and opportunities from across the division.

IT partner rounds continued in 2016 as a result of the 2015 survey conducted by IT with med-surg leaders. In 2016, the council sponsored a panel presentation by HealthTrust. Quarterly follow-up meetings with the council are now in place.

Medical City Healthcare was the No. 1 division for representation at the annual Academy of Medical Surgical Nursing Conference held in Washington, D.C., on September 29-October 2, 2016.

STRUCTURAL EMPOWERMENTMedical City Healthcare Nursing Councils

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Critical Care Nursing Council

In its inaugural year, leaders from across Medical City Healthcare came together in 2016 to form the Critical Care Nursing Council. Becky Jones, MSN, RN, CCRN, Critical Care Director for Medical City Denton, serves as chairperson. The following are their 2016 accomplishments:

• Collaboration through NTX Division email group for survey readiness and sharing best practices

• Ventilator optimization including data drill down and documentation changes leading to better integrity for vent days

• IV pump conversion collaboration

• Best practice sharing on the NG Residency Program, Mug Shots and multidisciplinary rounding tools

• HCA Critical Care Advisory Council roll-out of Units of Distinction program and Specialty Certification program

• Collaboration with Intensivist Council

Goals for 2017 include:

• Critical Care Units of Distinction

• Ventilator optimization

• Collaboration with Intensivist Council

• Research project

STRUCTURAL EMPOWERMENTMedical City Healthcare Nursing Councils (cont.)

“It’s an honor to do patients’ stem cell transplants, it’s such an important

day, it means a new chance at life, or as many patients may call it a rebirth.”

– Karen Mihdawi, BSN, RN, BMTCN, Medical City Dallas Stem Cell

Transplant Unit, McKinney

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STRUCTURAL EMPOWERMENTNursing Professional Practice Governance Board (PPGB)

Rapid Response Team (RRT)Medical City Dallas is the first HCA facility in the North Texas Division (NTD) to have a dedicated full-time Rapid Response Team. The RRT is composed of critical care nurses with several years of experience in healthcare including first responder, emergency medicine and several ICU specialties. The team was recently recognized by the Code Blue committee for its help in implementing the most up-to-date recommendations from the American Heart Association during codes. The combined efforts helped Medical City Dallas receive the Silver award in resuscitation from the American Heart Association, making it one of five hospitals in the state of Texas and the only hospital in Dallas-Fort Worth to receive this award.

With its inaugural meeting held in January of 2017, Medical City Healthcare now has a venue for front-line decision-making regarding nursing professional practice across the division. Forty-five members attended the first meeting led by Carol Gregory, CNE, and Executive Champions Tracey Smithson, CNO, Medical City North Hills; Zach Mueller, CNO, Medical City Dallas and Medical City Children’s Hospital; and Megan Gallegos, ACNO, Medical City Fort Worth.

Michelle Yeatts, MSN, RN-BC, CEN, Magnet Program Manager, Medical City Denton, has been named as chairperson. Molly Ricker, BSN, RN, BMTCN, Clinical Education Specialist in Oncology at Medical City Dallas has been named as co-chair and JoLynn Howland, BSN, RN-BC, AE-C, Employee Health/Injury Coordinator for Medical City Alliance, has been named as secretary.

Members reported viewing the PPGB as an important and welcomed addition to shared leadership across Medical City Healthcare. An ice breaker activity lead by Tracey Smithson helped participants to become familiar with one another. Also discussed was the board’s charter, preference regarding sections to include in a division-wide discharge folder, and plans for tele-nursing within Medical City Healthcare.

Nursing Professional Practice Governance Board Inaugural Meeting January 2017

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Appearance StandardsIn preparation for the introduction of the new Medical City Healthcare brand, a division policy was written to create a new uniform standard for clinical staff. Scrubs are now color-coded by specialty with the same designated color used at all facilities within Medical City Healthcare. Uniforms are embroidered with the new Medical City logo. The new uniforms are scheduled to roll out in April 2017.

Questions regarding the prohibition of nail polish remained after the division policy was introduced. At Medical City Dallas, members of the Standards of Nursing Practice Council (SONPC) shared leadership committee conducted an integrative review of the literature using PUBMed, CINAHL, and the Cochrane Database. After an exhaustive review of the literature, it was conclusive that well-manicured nails (non-gel) pose no safety risk to patients. This ability to align evidence with practice produced an avenue for personal expression important for nurses and clinical personnel. SONPC members voted to recommend a policy change allowing unchipped, non-acrylic polished nails. The CNO Council approved this recommendation and the policy was revised accordingly. Feedback has been overwhelmingly positive on this success of shared leadership.

STRUCTURAL EMPOWERMENT

Nurses Leading Change

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STRUCTURAL EMPOWERMENTWhite Rose CeremonyThe Shared Governance Professional Development Council at Oklahoma University Medical Center adopted a ceremony to honor deceased RNs. The Kansas State Nurses Association first developed the White Rose Ceremony in 2015. Its use is encouraged by the American Nurses Association. Over the past year, two nurses from Oklahoma University Medical Center passed away. Nurses were able to honor each of them at their funerals following the loss of their nursing colleagues.

In addition to the tribute paid, a poem entitled “She Was There,” written by Duane Jaeger, MSN, RN in 2004 is traditionally read during the ceremony. A white rose is placed with the nurse after reading the phrase: “We honor you this day and give you a white rose to symbolize our honor and appreciation for being our nursing colleague.”

In June 2016, this practice was shared with the CNO Council by Toni Steele, VP, Nursing Operations at Oklahoma University Medical Center. Shortly thereafter, following the untimely death of a nurse from the PICU, Medical City Dallas and Medical City Children’s Hospital nurses were able to honor the nurse with the White Rose Ceremony.

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GLOBAL ISSUES IN NURSING & HEALTHCAREAIDET with an A.C.C.E.N.T.: International Nurse Connect

Nurses from diverse global backgrounds are an integral part of the nursing workforce within Medical City Healthcare. The stakes are high in hospital settings; miscommunication can be life-threatening and mutual understanding is paramount. Accented speech can present communication challenges and pose barriers to enculturating comfortably into new practice settings in a foreign country. Bias and/or misunderstanding may result in the individual being misperceived as lacking in knowledge. If nurses fail to successfully narrate their interventions, a gap in essential patient knowledge may occur.

At Medical City Healthcare, such barriers to effective communication with patients, co-workers and physicians have been overcome as a result of an innovative approach to learning and support. As a part of nursing orientation at the division level, a facilitated networking session is afforded new and tenured nurses from foreign countries.

The class has been successfully facilitated by a communications expert and a foreign-born nurse for the past two years. Participants quickly recognize the value placed on what is brought by nurses from various cultural backgrounds to our work setting. Participant reviews have been outstanding.

In recognition of increasing globalization of our workforce and as a part of a comprehensive leadership approach to creating a culture of inclusivity, this tactic has helped reduce year-over-year RN turnover and increase both RN and physician satisfaction across the division. Nurses from 63 foreign countries covering six continents have been among the participants! Recently, an American-born nurse in nursing orientation took advantage of the class herself. The response in a note she sent to Marci Ayers following the experience speaks to the success of the class and its wider applicability:

“ ... I wanted to say how impacted I was with the AIDET with an A.C.C.E.N.T class … When you mentioned that sometimes foreign-born nurses feel that we American-born nurses are excluding and

sometimes distanced from them at work, it really hit home with me. Being born and raised in Texas, I thought you nailed it on the head when you explained that sometimes it is because we feel intimidated … and not able to relate to cultural differences as they can … I felt intimidated and hesitant to come because I didn’t know how I would be perceived, being that I am not a foreign-born nurse. But wow, I am so happy that I came. For once, I was the minority sitting in that class, and it was a very humbling experience.

I gained so much insight from all of the stories and was impacted greatly by hearing the personal experiences that everyone had. I also was able to learn from the scenarios shared and feel so much more knowledgeable regarding how to manage and communicate when cultural barriers

present themselves. I just wanted to share my thoughts about the course because I didn’t have the words to share this at the end of class. I wanted to thank you (and the class) for greatly impacting and touching my nursing heart.”

God bless people like you, Alyssa (Allie) Wentzel, RN

“I’ve been a nurse in the US

for many years and I have never experienced anything like this class.

Thank you.”

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GLOBAL ISSUES IN NURSING & HEALTHCARESolidarity in the Face of a Hate CrimeThe shooting at a nightclub in Orlando in June 2016 was the deadliest mass shooting in the United States by a single shooter and the deadliest terrorist attack in the U.S. since the September 11 attacks in 2001. At Medical City Dallas and Medical City Children’s Hospital, staff members were moved to reach out to the Orlando community and to the healthcare providers who cared for the victims of the shooting following this horrific event. In a showing of solidarity, a letter and video were sent by CNO Zach Mueller to Joyce Willis, MSN, RN, NEA-BC, CNO at Orlando Regional Medical Center. Pictures of signed posters reflecting the staff’s deep compassion and heartfelt empathy were included.

Medical City Dallas and Medical City Children’s Hospital demonstrating solidarity

“I think a great part of my work is educating our

patients and families so that they can have the very best outcomes

possible. That is when I know I have made a difference.” –

Evangeline Quilantang, RN, DSU, Medical City McKinney

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GLOBAL ISSUES IN NURSING & HEALTHCAREInternational OutreachNurses from across Medical City Healthcare participate in mission trips and other humanitarian efforts outside the United States. Here are some examples:

Martha Langham, RN Executive Director of Process Improvement Medical City McKinney

Martha was a finalist for the 2017 HCA Frist Humanitarian Award. Among the many reasons for the award is the work she and her husband do in restricted-access countries. They were instrumental in building and supporting a school for children whose goal is to develop leaders.

Charlaine Crocker, MSN, RN, CNOR, RNFA Director of Surgical Services Medical City Las Colinas

With over 30 years of surgical services nursing, Charlaine sets high standards for her staff, which they willingly seek to attain. She also embarks yearly on mission trips to Guatemala, donating her time and surgical skills to assist physicians performing surgeries for those who would otherwise not receive them. Her devotion to serving others has inspired those in the community, as she has organized a local group to quilt blankets and has worked with vendor groups to donate supplies to send to Guatemala.

Theresa Beebe, RN Charge Nurse Medical City Lewisville

Theresa came to work at Medical City Lewisville immediately after her military service in an Afghanistan military field hospital. Her enthusiasm and expertise has been exhibited in her performance in her charge nurse role, while volunteering with a mobile medical Unit and on an emergency medical task force.

Bataan Memorial Death March

Last weekend, White Sands Missile Range hosted the Bataan Memorial Death March on the 75th anniversary of the largest surrender of forces in U.S. history. Over 150 clinical and logistical volunteers erected a field hospital to take care of the military and civilian participants. There was record attendance (7,200) and record heat (91 degrees) for this year’s event. In all, 596 patients were cared for. From our field hospital, we treated four STEMI, two stroke and three major heat exhaustion patients who all had to be transferred to a tertiary facility. Hundreds of others were treated for foot injuries, dehydration and exposure injuries and were discharged home to recover.

The logistics team members who deployed were:

Brian Firebaugh, Medical City ArlingtonChris Kellen, Medical City McKinneySteve Palmer, Medical City Las Colinas

The clinical team members were:

Dr. Sharon Malone, QuestcareKen Carpenter, Medical City PlanoMichelle Hooks, Medical City PlanoKim Adams, Medical City PlanoMike Thornton, Medical City PlanoKara Adams, Medical City Las ColinasJenny Johnson, Medical City Las ColinasJacob Johnson, Division

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSResearch and Evidence-Based PracticeNurses throughout Medical City Healthcare are contributing to the nursing body of knowledge by conducting research or leading evidence-based practice initiatives. The following a sampling of such studies conducted or extended in 2016.

PCOR-ICU Collaborative

The Intensive Care Unit at Medical City North Hills was one of 50 hospitals chosen from across the country to participate in the Society of Critical Care Medicine Patient-Centered Outcomes Research-Intensive Care Unit, or PCOR-ICU. This research collaborative is focused on improving patient and family-centered care outcomes, as well as the experience of critically ill patients and families. Medical City North Hills hopes to positively impact patient and family experiences in our Intensive Care Unit by introducing pet therapy and music therapy. This Research Collaborative will help build partnerships between our Intensive Care Unit staff and our patients and families. Cilia Beach, BSN, RN, PCCN, assistant director of critical care, and Shannon Croft, MA, BSN, RN, director of education, presented their implementation plan at Northern Illinois University for this collaborative research study.

Cilia Beach, BSN, RN, PCCN Shannon Croft, MA, BSN, RN

Cue-Based Feeding in the NICU and Dr. Brown’s Bottles

Historically in NICUs across the country, the feeding methods utilized were volume driven. New research points to utilizing cue-based feeding as a more developmentally appropriate approach for feeding infants in the NICU. Cue-based feeding looks directly at the infant’s cues to determine if it will be an appropriate and safe time to initiate a feeding. Micha Clark, Speech Therapist, was asked to assist the Medical City Lewisville NICU staff in developing a cue-based feeding program. Assessment of cues occurs throughout the feeding attempt to determine whether the feeding continues to be safe and developmentally appropriate.

Together with NICU Educator Traci Richards, Micha worked with the NICU staff to determine the best ways to implement these changes. Micha presented education regarding cue-based feeding in a staff meeting and created a bulletin board in the NICU with information for staff to view. She also created a visual aid that can be utilized by staff members and patients’ families (see Cue Stoplight below). All staff members within the NICU completed a cue-based feeding competency. Additionally, Micha provided one-on-one education to staff members and education regarding feeding techniques and cues.

Micha also researched and brought forward a new product to be utilized for safe and appropriate feeding for infants in the NICU. This product was Dr. Brown’s Premature Baby Bottles. Micha worked with Hannah Barnett, BSN, RN, RNC-NIC, NICU manager, and supply chain to obtain this product and implement its use in the NICU. Micha provided education to the staff and patients’ families for appropriate use and cleaning of the product. The implementations of both cue-based feeding and the Dr. Brown’s Bottles have contributed to more developmentally appropriate feeding methods within NICU.

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSResearch and Evidence-Based Practice (cont.)

Interrelationships of Compassion Fatigue, Job Satisfaction-Life Balance Activities in Oncology Nurses

Beth Barnhouse, BSN, RN, OCN, Manager of Oncology for Medical City Dallas teamed up with Research Nurse Becky Spencer, PhD, RN, IBCLC, to assess the presence of compassion fatigue among nurses working in oncology at Medical City Dallas and examine the relationships among compassion fatigue, job satisfaction and life balance. She was also interested in whether participation in self-care activities moderates the relationship of compassion fatigue and job satisfaction. Compassion fatigue can result in physical symptoms including fatigue, headaches, sleep disturbances, appetite changes, hypertension, cognitive and emotional symptoms such as decreased concentration, apathy, anxiety, irritability and depression. Survey tools included the ProQOL, Nursing Work Index Revised scale and Life Balance Inventory scale. Sixty nurses participated in the study by completing all three surveys.

Findings concluded that life balance appears to moderate the relationship between burnout and job satisfaction among this nursing population but not the relationship between secondary traumatic stress and job satisfaction. Secondary traumatic stress and burnout may require different prevention and management strategies to effectively combat compassion fatigue. Recommendations include designing and testing interventions to help nurses achieve better life balance to improve burnout rates and job satisfaction and conducting more research on factors related to secondary traumatic stress.

”Compassion fatigue is characterized by physical,

spiritual and emotional exhaustion caused by witnessing

trauma and suffering.”

Beth Barnhouse was recognized for her research on compassion fatigue

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSResearch and Evidence-Based Practice (cont.)

Skin-to-skin in the Operating Room

A tradition of separation of mother and baby after cesarean section birth persists in many hospitals. The evidence shows that keeping a mother and newborn together after cesarean section birth promotes family-centered care and increases satisfaction regarding the birth experience.

Paula Hanna, BSN, RNC-MNN, IBCLC, ICCE, RCL, lactation coordinator, applied and was accepted as a TCU fellow and set out to make this birth experience a reality for moms at Medical City Lewisville through an evidence-based practice project. She enlisted the help of the mother/baby staff, unit manager and director. She met with the obstetric staff at a department meeting and the head of anesthesia in January 2015. Together they all worked to create the process for skin-to-skin contact in the labor and delivery operating room.

In March 2015, this process change was implemented. With the mother’s permission, each stable newborn greater than 37 weeks’ gestation with an Apgar score of at least 8 at five minutes of life was placed on the mother’s chest wearing a diaper and hat. Newborns were covered with warm blankets and remained skin-to-skin until completion of surgery just prior to the mother’s transport to the recovery room.

The goal of this project initially was to assess overall maternal satisfaction with the birth experience when new mothers were able to experience skin-to-skin contact in the operating room. Due to the overwhelming improvement in the satisfaction scores, this process has now become standard practice at Medical City Lewisville. Maternal satisfaction scores increased from 78 percent to 98 percent between March 2015 and July 2015.

The standard of care for the healthy full-term baby born via an uncomplicated cesarean section should be to place the newborn skin-to-skin as soon as possible following delivery. By making this standard practice, new families will experience a birth rather than just an operation.

This process improvement change, which has been sustained throughout 2016 as well, has been so important because it has affected the way patients view their birth. We have had many mothers write and email to share how, this experience changed their lives. Family-centered care, has been promoted through this successful initiative.

“When the nurses asked if I wanted skin-to-skin time, I actually started crying because, deep down, I wanted that experience so badly. Being immobile on the OR table and hearing my baby cry for the first time left me in a state of helplessness, and having the nurses keep me a part of my baby’s birth was amazing. Being able to see her and actually touch her was the highlight of the entire experience, and I actually felt myself relax once I had her on me.”

Lateral Violence – Does It Exist and if So How Does It Affect the Work Environment?

In 2016, a survey was conducted of nurses from main EDs and provider-based EDs to answer the question: To what extent do nurses in Medical City Healthcare and the Oklahoma City market EDs experience lateral violence and how does it impact their work environment and patient care? Lateral violence is also known as bullying and was measured by using the John Hopkins Disruptive Behavior tool. The survey was completed by 384 (75%) of the 511 eligible nurses.

0%

20%

40%

60%

80%

100%

120%

Before S-T-S After S-T-S

OverallSatisfaction

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSResearch and Evidence-Based Practice (cont.)Analysis of the data suggests that there are differences in the types of, triggers for, response to, and effects of lateral violence – these differences depend on whether the nurse was full time or PRN, was experienced or less experienced, the hospital setting, the frequency in which lateral violence was experienced, whether the lateral violence resulted in a near-miss/harm to the patient, and most dramatically by whether the lateral violence made the nurse consider moving departments or resigning. A zero-tolerance culture is recommended to reduce the impact of lateral violence.

Measuring QT Intervals

Cardiac patients continuously have their electrical activity of their hearts monitored. This is known as an electrocardiogram, or EKG. One small portion of the EKG is referred to as the “QT interval.” This often underrecognized measurement indicates the heart’s ability to contract and completely relax before needing to contract again. If this interval is prolonged, or in other words, if it takes the heart too long to relax, the patient is considered high risk for developing a lethal heart rhythm, which may possibly lead to death. Adverse effects of a plethora of medications on the QT interval are a well-studied phenomenon.

Assessing and monitoring the QT Interval is essential in early detection and can possibly lead to an action that can reduce the risk of developing these deadly rhythms.

At Medical City Lewisville, measuring the QT interval was the critical care unit policy, but actual practice was inconsistent. EKGs were measured on paper and stored in the paper chart, which was cumbersome and inefficient. Calculating the measurement in relation to the patient’s heart rate required using a somewhat complicated equation (involving square roots!). Needless to say, this made the measurement, calculation and results that could be reported and tracked nearly impossible!

In 2015, the Critical Care Professional Practice Council envisioned a screen that combined both the current paper documentation and the desired information for QT measurement. They enlisted the help of Clinical Analyst Michael Munoz, who developed a link from Meditech to another internal program set up to do the necessary square-root-corrected calculation. ICU Nurse Kimberly Zurek and Critical Care Educator Laura Woodward ensured that staff were educated and that the new Meditech screens were tested (again and again, with many revisions). Pre-data was collected and in mid-2016, the new intervention went live.

One month of data was collected and it was found that out of 3,923 documentations, only 65 percent were “normal” measurements, almost 28 percent were “moderately prolonged” and nearly 8 percent of all readings were “severely” or “dangerously prolonged.” It was also noted that before the implementation, only 19 percent of nursing staff said they had ever noted a prolonged QT interval and had reported it to a provider in the previous year. As a result of the new documentation system, in just one month, that number increased to 84 percent. Even more important, 41 percent of nurses said they had seen a positive outcome for a patient as a direct result of the communication of a dangerous severely prolonged QT interval to a provider.

Kim Zurek, TCU Fellow Winner

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Research and Evidence- Based Practice (cont.)Heads Up: Design and Implementation of a Nurse-Driven Head Strike Protocol in the Medical City Plano Emergency Department Improves Patient Outcomes

Patients treated after establishing the Medical City Plano head strike protocol were more likely to have trauma activation, receive expeditious initiation of reversal agents and

survive their head injury for patients taking anticoagulants. Studies have previously reported improvements in rapid reversal and mortality after similar protocols were implemented, but generally limited the population to those on warfarin or anticoagulants only.

This comprehensive, nurse-driven reversal protocol presents an algorithm for managing patients with suspected traumatic ICH taking any pre-injury blood thinners, allowing ownership by the nursing staff to ensure there are no

delays in initiating blood products. This protocol may be particularly salient with the aging of the trauma population and parallel increase in use of blood thinners. Sharon Wacht, RN, CEN, will be presenting the abstract as a podium presentation at the 2017 Annual Conference of the Society of Trauma Nurses. Previously, Sharon presented a poster at the 2015 North Texas Division Research and Evidence-Based Practice Day and the Trauma Centers Association of America’s Annual Conference in Louisville Kentucky.

NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS

10th Annual Research/EBP Day

Over 190 people were in attendance at the Annual Research Day for Medical City Healthcare held in August 2016 at the Grand Theater at Medical City Lewisville. Chief Nursing Executive, Patient Safety Officer, and Senior VP for HCA Jane Englebright, PhD, RN, CENP, FAAN, was the keynote speaker. Dr. Englebright spoke on the subject of The Big Data Revolution. Joseph Zerwekh, PhD, Clinical Research Director for Medical City Dallas spoke on the subject of the IRB and its role in nursing research. Medical City Dallas librarian, Hema Sawhney, MLS, spoke on library and reference services. Nicki Roderman, DNP, RN, CNO, Medical City Denton, and Sandy Haire, DNP, RN, Medical City Plano, provided executive oversight for the Research Committee, which sponsored the event.

Jane Englebright, Joyce Carver, Sandy Haire and Nicki Roderman at 10th Annual Research Day

64.4 percent of the participants indicated they intend to make practice changes as a result of their learnings. Participant ratings also included:

Completely Almost CompletelyContent was relevant to learning outcomes. 89.7% 10.3% --Learning outcomes were met through my participation. 87.1% 11.8% 1.2%

Teaching methods and strategies were effective. 99.2% 11.8% --

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Research and Evidence Based Practice (cont.)

Podium presentations included:

• “Reducing Falls Using a Mini-Cog Tool” - Jeanne Farmer, DHSc, BSN, RN, Medical City Plano

• “Skin to Skin in the OR: A Family Centered Cesarean” - Paula Hanna, BSN, RN, IBCLC, Medical City Lewisville

• “Two Tiered Code Stroke Activation” - Crystal Perry, MSN, RN, CEN, Medical City Denton

• “Lateral Violence in the ED: Impact on Nurses and Patients” - Melissa Schilling, MSN, RN, CEN, Medical City Plano

• “NLP Software Used in Discovery of Incidental Lung Cancers” - Gigi Smith, RN, Medical City Plano

• “Reducing Blood Culture Contamination Rates in the ER” - Sara King, BSN, RN, CEN, Medical City Denton

• “Can Adding a CNL to an Inpatient Oncology Unit Improve Quality Outcomes and Patient Satisfaction?” - Kelly Cole, MSN, RN, OCN, CNL, Medical City Dallas

• “Interrelationships of Compassion Fatigue, Job Satisfaction and Life Balance Activities in Oncology Nurses” - Mary Elizabeth Barnhouse, BSN, RN, OCN, Medical City Dallas

• “Effectiveness of Hourly Rounding on Fall Rates” - Tim Rabb, DC, RN, BSN, Medical City Fort Worth

• “Innovating for Orientation Efficiency” - Jency Abraham, BSN, RN, CMSRN and Beatrice Ngo Bisombi, RN, Medical City Las Colinas

• “A Randomized Controlled Trial of Oral vs IV Administration of Nonnarcotic Analgesia Protocol Following Pediatric Craniosynostosis Corrections on Nausea and Vomiting Rates” - Kanayla Ditthakasem, MSN, RN, CCRP, Medical City Children’s Hospital


11 Podium Presentations

48 Posters

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Research and Evidence Based Practice (cont.)Poster presentations included:

Medical City Denton

Laura Johnson, BSN, RN, CMSRN Improving HCAHPS Scores in Pain Management

Tami Bristow, MSN, RN, CPCN Advanced Directives and Medical POAKristina Boyer, BSN, RN Reducing Turnover Times in the Operating Room

Medical City Lewisville

Kimberly Zurek, BSN, RN, CCRN The Short & Skinny About Prolonged QT: Identifying Patients At Risk for Fatal Arrhythmias

Rita Whitney, MSN, APRN, FNP-BC, CWOCN, CWS

In ICU Patients, Does the Use of a Sacral Foam Dressing Decrease the Number of HAPUs on the Sacrum?

Debbie Walser, BSN, RNC “The Gift of Time” Perinatal Palliative Care

Medical City Arlington

Thomas Dombrowsky, PhD, RN Engagement With Activity and Functional Status Among Older AdultsShereida Fontenot, RN CAUTI PreventionJennifer Box, BSN, RN Increasing the Use of Peanut Balls During Labor

Medical City McKinney

Debra L. Miller, BMOS, MSN, RN-BC, CCNR-K

Meditech Interactive Learning Series - Med-Surg

Debra L. Miller, BMOS, MSN, RN-BC, CCNR-K

Meditech Interactive Learning Series - Critical Care

Medical City Dallas

Deborah Bryson, RN, IBCLC Becky Spencer, PhD, RN, IBCLC

Exclusive Breastfeeding Rates and Implementation of Delayed Newborn Baths

Orpheulia Davis, RN, MSN, BMTCN Betsy Blunk, RN, BSN, CHTC Tamara Loos, PhD Tonya Cox, BSN, RN, OCN

Analysis of Spectra Optia MNC Procedures: Reviewing Data to Improve Process Performance

Alex Murphy Jenna Stembridge Taylor Coocnce

Chemotherapy Supportive Care Guidelines

Hena George, RN, BSN Oncology Patient Safety Strategy: Offering Toileting Assistance During Nursing Hourly Rounding

Ashley Evenson, RN, BSN, OCN To Polish or Not to Polish: A Shared Governance Council Review of the Literature

Oklahoma University Medical Center – Edmond

Darrin Nobis, RN, MSN Call Light Escalation Plan: A Care-giver Driven Effort to Improve Call-Light Responsiveness and Patient Satisfaction

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Oklahoma University Medical Center

Rhonda Farris, MSN, RN Catherine Grossinger BSN

Acute Ischemic Strokes and the Clot Buster

The Children’s Center at OU Medical Center

Deborah A. Parris, MS, APRN, PCNS-BC Stephanie Montgomery, RRT-NPS, AE-C

Development of an Interdisciplinary Team for the Initiation of High-Flow Nasal Cannula

Medical City Children’s Hospital

Kanlaya Ditthakasem, MNS, RN, CCRP Deformational Plagiocephaly: A Systematic Review

Kanlaya Ditthakasem, MNS, RN, CCRP Apert, Crouzon and Pfeiffer Syndromes: What Pediatric Nurses Need to Know

Kanlaya Ditthakasem, MNS, RN, CCRP Parental Information, Knowledge and Understanding of the Importance of Tummy Time for Preventing Deformational Plagiocephaly: A Survey

Jennifer Shelby, RN, BSN, CCRN Pediatric Chest Tube Guidelines

Medical City Plano

Mary Bailie, BSN, MBA, RN, CPHQ, HACP Use of New Method for Localization and Excision of Nonpalpable Breast Lesions Improves the Patient Experience and Improves Operational Efficiency for the OR

Medical City North Hills

Ann King, PT Incidence of DVT in Post Op Total Knee and Hip Patients Without Using TED Hose

Rebecca Scott Thorough Discharge Teaching = Happy Patients and PhysiciansAshley Thomas Improvement in Assessment and Management of Pain in Non-English-Speaking

Patients

Medical City Fort Worth

Amanda Rowlett, RN Ben D’Amico, RN

Effectiveness of Daily CHG Bathing in Reducing Hospital-Acquired Infections

Jennifer Rice, BSN, RN, CPAN, CAPA Susan Setterlund, MSN, RN, CCM, NEA-BC Eve Sheppard, BSN, RN, CCM

Washing Away Surgical-Site Infections: Plaza’s Comprehensive Preoperative Surgical Cleaning Kit

Kelly Talbert, BSN, RN-BC IV Insertion and Perceived Pain ReductionWhitney Mick, RN, ASN Shelby Burkhart, RN, BSN

Point of Care Testing

Mathew Judy, RN Katie Mummert, RN Meagan Longley, RN Amelia Billings, RN

Controlling CAUTIs in the ER

Christina Intharansy, RN Cindy Garcia, RN Kara Przybyla, RN Samantha Ray, RN Linda Thun, RN

Key Words at Key Times

Halley Sinclair, MSN, RN-BC, CBN Bariatric Surgery Support Group: Strategies to Increase Participation


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Technology

Partnering for Patient-Centered Care

Since the inception of the IT/Nursing Partner Focus Rounds in 2016, 373 rounds were completed in both the Oklahoma University Markets and Medical City Healthcare settings. With these partner rounds, the following actions were taken in support of nursing efficiency and patient care excellence:

Actions #s# PCs Evaluated 8,936Keyboards Replaced 416Mice Replaced 405Tap-n-Go Readers/Badge Enrollment 366SSO Software Deployed 375Monitors Replaced 83Mouse Pads Replaced 81Printers/MedComm (mapped, labeled, cleaned) 1,002cTracker 282Kronos Time Clocks 159Scanners (upgraded, cleaned, replaced) 2,794Phones Replaced/Checked 343Phone Cords Replaced 81Number of Clinicians Trained on Systems 193Cable Management/PC Labeling 476Number of Physicians Trained on Systems 102Number of Patient Room PCs cleaned 1093Validate Neuron Functionality 616Number of Carts Cleaned 272

In addition, many technical and application efforts assisting nurses have occurred through the efforts of our IT&S partners throughout 2016. A sampling of just a few of these include:

• Innovation Challenge for Consult-a-Nurse Tele-Nursing

• Core Measure Documentation Updates

• EBCD Pre-Work

• Hardware Deployment

• Multiple Meditech Software Upgrades

• Applications or Systems Deployment

o GE Carescape

o Carepoint for EDs

o iMobile, including Hill-Rom integrations and cell tower upgrades

o MyCare

o Vitals Plus

o BloodTrack

o WoundExpert

o ePrescribe

o HIE Clinical Viewer

o TeleNICU

o Teletracking

o ViSiMobile

• Reporting and Analytical Tools

o Meditech handoff reports for ED to inpatient units

o Falls and CAUTI Teradata

o VSee for Shift Report

o Power PI for NLR, HR and PVCs

With this focus on patient care, IT&S personnel have found their work to be more satisfying, and valuable nursing time has been saved in support of patient-centered care.

“The smiles and belly laughs that I see from the children that I take care of overshadow all of

the sadness that we see.” – Claudia Sebastian, BSN, RN, CPN, Medical City Children’s

Hospital Float Pool


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Presentations and Publications

Presentations

Nurses within Medical City Healthcare have been leading change and advancing health by way of sharing their knowledge and expertise in presentations at national conferences again this year. Some of these have included:

• Medical City Fort Worth’s nurse Eve Sheppard, BSN, RN, CCM gave a presentation at the HCA 2016 Clinical Excellence Summit in Nashville. Her presentation was entitled: “Approach to Impacting Hospital Acquired Conditions in CLABSI.”

Clay Franklin, CEO, and Eve Sheppard, ICP

• Medical City Dallas nurse Nenita Cuellar, BSN, RN, CNN, presented her abstract at the Annual Dialysis Conference February 27-March 1, 2016, in Seattle, Washington. Her presentation was entitled “Pre-sternal Peritoneal Dialysis Catheter an Access of Choice: A Tale of Two Patients.”

• Medical City Dallas nurses Orpheulia Davis, MSN, RN, BMTCN; Betsy Blunk, BSN, RN, CHTC; Tamara Loos, PhD; and Tonya Cox, BSN, RN, OCN presented at the BMT Tandem meeting on February 18-22, 2016 in Honolulu, Hawaii. Their presentation was entitled “Analysis of Spectra Optia MNC Procedures: Reviewing Data to Improve Process Performance.”

• Medical City Plano nurse Sharon Wacht, RN, CEN, is scheduled to present at the 2017 Annual Conference of the Society of Trauma Nurses in St. Louis, Missouri held April 5-8, 2017. Her presentation is entitled “Heads Up: Design and Implementation of a Nurse-Driven Head Strike Protocol in the Medical City Plano Emergency Department Improves Patient Outcomes.”

• Medical City Children’s Hospital nurses Janie Garza, BSN, RN, CCRN; Emily Williams, MSN, RN, CCRN, Kathy Drescher, DNP, APRN, CNS-CC, CPNP, CNML, and Angie Buckmeier, MHA, BSN, RN, presented at the 2016 ANCC National Magnet Conference in Orlando, Florida held October 5-7, 2016. Their presentation was entitled “Leveraging Social Media to Transform Care Delivery: The Good, the Bad and the Ugly.”


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Janie Garza, Director; Angie Buckmeier, CNO; and Emily Williams, Manager

• Medical City Healthcare CNE, Carol Gregory, MSN, RN, MBA, NEA-BC, and CIO, Leah Miller presented a poster at the Studer Group annual What’s Right in Healthcare conference held in Chicago August 2-4, 2016. The poster was entitled “Patients are at the Heart of IT&S and Nursing Partner Rounds.”

Carol Gregory, CNE and Leah Miller, CIO

Presentations and Publications (cont.)

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• Medical City Las Colinas’ nurse Ron Samuel, MSN, RN presented at the AONE Conference on March 29-April 1, 2017, in Baltimore Maryland. His presentation was entitled “Sustaining Workforces: An Accumulation of Nurse Leaders’ Strategies.”

• Medical City Dallas, Medical City Las Colinas and Medical City Healthcare nurses Kathy Walton, BSN, MBA, Bea Bisombi, BSN, RN, Marci Ayers, MSN, RN, CMSRN, RN-BC, CNE and Carol Gregory, MSN, RN, MBA, NEA-BC, presented at the AONE Conference March 29-April 1, 2017, in Baltimore, Maryland. Their presentation was entitled “Effective Communication for a Global Workforce.”

Publications

Megan Gallegos, MSN, BS, RN, and Shawn Lewis, RN, from Medical City Fort Worth, published an article in the January 2017 Advance for Nursing entitled “Emergency Department Concierge.”

Carol Gregory, MSN, RN, MBA, NEA-BC, CNE, for Medical City Healthcare, published an article in the July 2016 Advance for Nursing entitled “Inter-professional Collaboration Creates IT Rounding.”

2016 APHON Counts Writing Award

Kamela (Kammie) Tessitori-Lancaster, BSN, RN, CPON, from Medical City Children’s Hospital, was awarded the 2016 APHON Counts Writing Award for her article entitled “My Most Memorable Case: Intuition Doesn’t Lie.” The article was published in the Spring, 2016 issue of APHON Counts. The organization developed the award to recognize Association of Pediatric Hematology/Oncology Nurses (APHON) members for a published manuscript. The writing award was presented during the annual conference in Indianapolis, Indiana.

APHON Editor-in-Chief Kaye Schmidt (left) presents award to Kamela Tessitori-Lancaster

NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSPresentations and Publications (cont.)

“We all have to work as a team, and I get a lot of joy

from forming these relationships, especially with my coworkers.”

– Sharon Clevenger, RN, Medical City Arlington

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In an effort to smooth the transition into practice for the new professional nurse, Medical City Healthcare offers a yearlong residency to our new graduates. In addition to working side by side with a preceptor in the early weeks of orientation, the opportunity for networking, facilitated learning and ongoing support are key components of the program.

Medical City Lewisville was the first hospital in the Medical City Healthcare division to implement the Nurse Residency Program, now a standard throughout the division. The first cohort started in February 2013. Since that time, eight cohorts, totaling 65 nurse residents creating 26 evidence based professional practice presentations, have taken place. This initiative has resulted in improved changes in nursing practice. The 2016 evidence-based practice projects included presentations on:

• Palliative Care

• Educational Tablets in the ED

• Hand-washing Initiatives

• Pain in Labor

• PCU Nursing Acuity Tool

• Belmont Rapid Infuser Training in the ED

Allison Gilbert, BSN, RN, July 2016 Graduate Cohort No. 8, presents her EBP project at graduation.

Medical City Healthcare Nurse Residency Program

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Medical City Healthcare Nurse Residency Program (cont.)The 12-month comprehensive evidence-based residency curriculum includes a wide variety of topics designed to not only provide the basic support needed but also to help develop the knowledge, skills and abilities of the first-year nurse. Some of the topics utilized in this program are listed below:

• Developing Critical-Thinking Skills• Utilizing the Transition to Practice Model• Attending Monthly Facilitator-Guided

Debriefing Sessions• Meeting Regularly With Management• Providing Formal and Informal

Constructive Feedback• Implementing Evidence-based Projects • Providing Leadership and Professional

Development Opportunities• Offering Networking Opportunities With Other

Nurse Residents.

A remarkable benefit of the Nurse Residency Program is the trending decrease in first-year new nurse overall turnover since its inception. By offering this evidence-based program, we provide new nurses not only with the tools to help them navigate through the complexities of working in a hospital setting during that critical first year of nursing, but also the skills to be strong advocates for their patients. Nurse residency programs make a difference.

An important goal of Medical City Lewisville’s Nurse Residency Program is to provide the support and training needed to positively impact not only patient outcomes but also our new nurses’ transitions into what will ideally become a lifelong journey of pursuing nursing to its fullest potential.

Sarah Miller, BSN, RN, July 2016 Graduate from Cohort No. 8, summed up her experience with the program by commenting, “The Nurse Residency Program gave me the confidence I needed to care for my patients. It made me comfortable in my role as a nurse.”

Medical Center Denton also has a well-established Nurse Residency Program that has drastically reduced first-year turnover. The hospital was recently recognized as having the lowest RN turnover in the entire American Group within HCA. A special part of Medical City Denton’s graduation ceremony is when the CNO reads testimonials from managers about individual residents who have been assets to the organization.

Nicki Roderman, CNO for Medical City Denton at Residency Graduation

Evidence-based practice projects are presented as either a poster or podium presentation as a component of successful completion of the residency. As an example, the Short Report was designed to improve the handout between ED and inpatient units at Medical City Denton.

Not all the activities associated with the Residency program are scholarly. There is also plenty of time to get to know


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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSMedical City Healthcare Nurse Residency Program (cont.)Not all the activities with the residency program are scholarly. There is also plenty of time to get to know one another and enjoy each other’s company.

In 2017, HCA will introduce the HCA Nurse Residency Program for new nurses in all 169 HCA hospitals. A tool kit and curriculum will be available for every hospital across the company. See what Dr. Jane Englebright, CNE for HCA, says about the new program.

Happy Hour for new graduate residents at


Nurse interns at Medical City Lewisville

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSTexas 2-Step Program

The Texas 2-Step Program is a distance learning program in which current employees within Medical City Healthcare have the opportunity to obtain their associate degree in nursing. The employee must meet rigorous requirements to be admitted to the program. Once they are admitted, Medical City Healthcare pays tuition, fees, books and uniforms up front in exchange for a two-year commitment to work full time as an RN.

The first class graduated in May 2010, and since then over 300 nurses have been added to the nursing workforce in Medical City Healthcare. Initially the program was funded by a two-year Texas Workforce Commission grant. During the height of the nursing shortage, distance learning was identified as a way to increase the number of students a community college could graduate. The program is provided through a partnership with two local community colleges. The colleges provide the lecture portion via state-of-the-art video conferencing equipment in a classroom at the hospital, and Medical City Healthcare provides the clinical faculty.

Tricia Scott, MS, RN, FACHE, serves as the director for the program. The hospitals provide seven master’s-prepared clinical faculty who take a personal interest in the students. The program not only provides the hospitals with dedicated high-quality nursing staff, but it truly changes lives. Tricia states that this program is very meaningful to all involved, and it could not be done without the support of senior leadership.

The first step is earning the associate degree in nursing, then obtaining a Bachelor of Science in nursing after passing boards – hence the name for the Texas 2-Step Program. The learning doesn’t stop there. Many graduates have gone on to be leaders in the hospitals. Texas 2-Step is an example of Medical City Healthcare investing in its people by helping them grow in their careers.

300 Texas 2-Step Medical City Healthcare Graduates

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Chantall Bontemps-Christian, MSN, RN, RNC-OB

Gary Huey, MSN, RN-BC

Kristen Lynch, MSN, MBA, RN-BC

Debra Mezo, MSN, RNC-OB

Claudia Morales, MSN, RN, CMSRN

Jennifer Mundine, EdD, RN, CNE

Suzanne Wetmore, MSN, RN-BC

Tricia Scott, MS, RN, FACHE

Texas 2-Step Program (cont.)

Clinical faculty include:

“The joy of nursing is caring with heart.”

– Nancy Escandor, RN, Medical City Arlington

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTSPromoting Specialty CertificationIn 2014, the emergency department at Medical City Lewisville hired a new educator. One of the educator’s long-term goals was to increase and maintain a high rate of certified nurses within the ED. In 2014, combining Certified Emergency Nurses and Certified Pediatric Emergency Nurses, our department was only 7 percent certified. The educator started a multilayer approach to tackle this opportunity.

One of the main barriers the educator identified was the cost of the review books. To eliminate this barrier, the educator purchased five CEN and five CPEN review books with the ED budget. For anyone who was serious about becoming certified, these review books were numbered and rented out like library books for 10 weeks at a time. The rental program gave the nurses opportunity to study without the burden of purchasing a book.

The second barrier the educator identified was the crippling test anxiety so many ED nurses suffered from when considering taking a certification exam. The educator developed a fun, innovative solution to this problem called The Weekly Top 5. The Weekly Top 5 is a five-question quiz she sent via Survey Monkey to the staff each week. The surveys also contained at least two questions a week from either the CEN or CPEN review books as well as questions on trauma, geriatric, stroke and septic patient scenarios. The nurses who answered 90 percent of all the quizzes correctly by the end of the month received a $10 Starbucks

gift card. Nurses who participated in all the weekly surveys received a hospital cafeteria meal card. In the first month, 87 percent of the staff were completing the Weekly Top 5 surveys. The nurses were studying CEN/CPEN questions without the pressure of taking a quiz while at the same time boosting their confidence in their knowledge level.

The third tactic the educator used to increase the certification rates was to use the Emergency Nurse Pediatric Course (ENPC) as a study booster for the CPEN. Our facility set an ambitious goal of getting 100 percent of the ED nurses in the ENPC class by the end of 2016. ENPC is a two-day course that covers very similar curriculum to the CPEN exam. The facility already had a goal of sending 100 percent of their ED nurses to this class, so the educator capitalized on this and marketed the mandatory ENPC class as a two-day CPEN review course. The educator had tremendous success with this strategy, and six nurses passed the CPEN when they took it within two weeks of the ENPC.

As of January 2017, 21 nurses have completed CEN, CPEN or both, bringing our department certification rates to 50 percent. Currently, all review books are checked out, and four nurses plan to sit for the exam by the end of the month.

Medical City Lewisville currently outpaces other hospitals in Dallas-Fort Worth with a 48 percent certification rate among all nurses on staff. The ED program has contributed to the hospital’s success.

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EMPIRICAL OUTCOMES - EXCEPTIONAL CLINICAL QUALITY

Falls Prevention ProgramThe Division Fall Committee, formed in 2014 at the request of the CNO Council to review fall occurrences and share best practices from hospitals with ZERO falls with injury, has been instrumental in fall prevention throughout Medical City Healthcare. The Joint Commission considers an injury-related fall to be a never event and CMS will not reimburse for fall-related costs. Based on its data analysis and review of the literature, the committee revised the existing policy in Q216. The new inpatient guidelines concentrate on preventing injurious falls. Each hospital established a multidisciplinary team focused on policy implementation and falls prevention. Hospitals throughout the division adopted more than 20 best practice interventions over the course of the year.

The most significant change is that now all inpatients are considered to be at risk for falls. Regardless of the department location, patients have universal fall prevention interventions provided. Nurses now perform a fall-risk assessment that includes a risk for injury assessment on admission during each shift, upon transfer and with any change in status. We evaluate a patient’s ABC’S: A: Age >70, B: Bone disorders, C: Coagulation therapy and S: Indicating a recent surgery.

A Age > 70B Bone DisordersC Coagulation TherapyS Recent Surgery

Yellow socks, signage and armbands identify patients as a universal fall risk, and red socks and signage communicate risk for Injury. This improves awareness of the patient’s status among all care providers. Moving patients closer to the nurses’ station, increasing use of bed exit alarms and encouraging comprehensive patient and family education are safety tactics for patients at risk for injury. Purposeful hourly rounds, individualized toileting plans, careful medication reviews and use of a sitter if indicated are also key.

One of the many important changes implemented this year is the regular use of gait belts with assisted transfers and ambulation. We purchased high-quality gait belts and placed them visibly in each patient room. Moreover, clinical personnel received hands-on training for the gait belts, Posey chair alarms and bed alarm techniques. Continued competency validation and quarterly in-services help ensure proper use and help maintain a culture of safety for all.

In the event of a fall, we perform an immediate multidisciplinary post-fall huddle and a Friday Fall Review that look at the root cause and analysis for each incident. We continue to measure our outcomes, track data and evaluate trends monthly at the Division Falls Committee. These innovative prevention approaches have resulted in a reduction of falls with injuries and demonstrate our promise to our patients to deliver safe, patient-centered care throughout Medical City Healthcare.

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Falls Prevention Program (cont.)Three hospitals have had ZERO falls resulting in injuries for six consecutive quarters.

Because of the focus we place on patient safety and the dedication of our Medical City Healthcare staff, falls that result in injury have dropped significantly.

Medical City Healthcare Falls with Injury

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Nursing-Sensitive Quality Indicators

CLABSI Prevention

Central-line-associated blood stream infection (CLABSI) prevention is a critical component of our Nursing Services Strategic Plan in Medical City Healthcare. As we work hard to protect our patients, we have implemented tactics such as daily central line rounds, multidisciplinary ICU rounds, removal of central lines as a standard when transferring out of the ICU, vigilant catheter and dressing care, and precluding blood culture draws from central lines. As a result, in 2016 we experienced a 28 percent reduction in CLABSIs over the prior year. Four of our hospitals have been completely CLABSI-free for six quarters!

“Knowing that women will not always remember the names of their nurses but they

always remember how they were treated and felt, it brings joy to

me to be told that I helped make their experience a good one”

– Angie McNally, RNC, OB, L&D, Medical City Dallas

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Nursing-Sensitive Quality Indicators

CAUTI Prevention

The nursing-sensitive quality indicator of Catheter Associated Urinary Tract Infections (CAUTI) is one with which Medical City Healthcare nurses have made great strides. The Joint Commission has included in the National Patient Safety Goals the prevention of CAUTIs through the implementation of evidence-based practices. As we work diligently to protect our patients, we have implemented tactics such as daily Foley rounds, avoidance of insertions under emergent conditions, frequent peri-care and Foley care using CHG, early removal and avoidance of indwelling urinary catheter use whenever possible. Foleys are removed using a nurse-driven Foley removal protocol, which the medical staff has fully endorsed in each of our settings. With the help of our supply chain, we also changed our catheter supplies to the Bard SureStep catheter kit. The kit facilitates the nurse’s ability to insert a Foley using aseptic technique. As a result, in 2016 we experienced a 30 percent reduction in CAUTIs over prior year. Six of our hospitals have been completely CAUTI-free for six quarters!

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Sepsis ManagementSepsis remains the number-one reason for hospital mortality across the nation. More than 258,000 lives are lost to sepsis each year, ranking it as the third leading cause of death in the U.S. (after heart disease and cancer), according to data from the Centers for Disease Control and Prevention (CDC).

Medical City Healthcare has focused on early recognition and goal-directed therapy. In addition to having a sepsis coordinator in each facility, this year we rolled out the concept of having sepsis champions on each unit on each shift. Champions were provided with extensive education and training to assist with early recognition. Because of the combined efforts for continual improvement by physicians, clinicians and executives, Medical City Healthcare was able to reduce our severe sepsis mortality in our patient population by 5 percent over the prior year. An example of the work underway, is that noted at Medical City North Hills below.

Medical City North Hills Sepsis Program Accomplishments

The sepsis program at Medical City North Hills has made vast improvements in 2016, earning The Joint Commission’s Gold Seal of Approval® for Sepsis Management Certification. The Gold Seal of Approval® is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care.

Dorie Murray, RN, sepsis coordinator at Medical City North Hills, has led many new sepsis initiatives to drive best practices; ultimately, this has decreased our hospital sepsis mortality rate from 10 percent to 6 percent this year. An increase of 122 percent in our “Code Sepsis” activations has driven this success. This outcome was the result of collaborative efforts between Medical City North Hills and our community partnerships with EMS activations of the code in the field.

The impressive reductions in septic shock mortality and increases in bundle utilization made by the Medical City North Hills team were published by the Advisory Board. These results and best practices were shared nationally through this Advisory Board publication of research in collaboration with Crimson.

Medical City Healthcare Overall Sepsis Mortality Was Reduced By 20% Year Over Year.

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Nursing Data PortalAs a support to nursing leaders, HCA has taken a significant step forward in the area of data analytics for nursing. In 2016, the Nursing Data Portal was unveiled. The portal is a tool that brings together multiple metrics onto a single site for use in data-driven decision-making related to running a nursing unit. Now, nursing leaders need not search through multiple reports to understand their progress with such levers as productivity, quality, nursing turnover and patient experience. As leaders are becoming more comfortable with the tool, they are finding that the ability to drill into data to the unit level and even to the level of the clinician helps them identify gaps and improve their service. The Nursing Data Portal is one more example of the depth of resources brought to bear within the HCA enterprise to support patient care and accelerate performance.

A sample unit snapshot of the Nursing Data Portal below reflects the variety of metrics available for real-time analysis. In Medical City Healthcare, each facility has identified an expert who is providing coaching to peers to optimize the portal’s use. Data is refreshed monthly and displayed using a point system with weighted values. Progress is part of the monthly discussion with the leader’s CNO for removing barriers if they exist.

“Joy is a state of mind

and an orientation of the heart.”

– Kim Jobe, RN, Intensive Care Unit, Medical City Denton

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The Leapfrog Group Top General Hospital AwardWhat a privilege it is to serve our patients with the highest quality of care. The Leapfrog Group Hospital Survey compares hospital performance on national standards of patient safety, quality, efficiency and management structures that prevent errors, providing the most comprehensive picture of how patients fare at individual institutions. The data collected also enable hospitals to benchmark their progress toward Leapfrog’s standards and measure the care they deliver. “We set the toughest standards in the industry so hospitals that excel at Leapfrog deserve the finest recognition we can give them,” said Leah Binder, president and CEO of The Leapfrog Group. Medical City McKinney and Medical City Lewisville were two out of five hospitals in Texas among nine hospitals in HCA to receive the Top General Hospital Award.

Medical City McKinney Quality Leaders receive Leapfrog Top General Hospital Award

The Joint Commission Best PracticesThe Joint Commission holds a summation conference with HCA following each year’s accreditation surveys. During the summation, best practices from across the company are recognized. Recognition was received by hospitals within Medical City Healthcare and the Oklahoma City market. The Joint Commission recognitions of best practices included the following:

• Medical City McKinney for its RRT RAPID STEPPS flip booklet for staff education.

• Medical City McKinney for its lab/pharmacy decision support program for antibiotic stewardship.

• Oklahoma University Medical Center for its Fire Alarm Device Inventory Change Form utilized for fire safety.

• Medical City Las Colinas for its patient ID sticker used on IV tubing in the OR.

• Medical City Las Colinas for its “Dany Dollars” staff recognition program.

• Medical City Children’s Hospital for its NICU tracheostomy teaching tool and checklist.

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EMPIRICAL OUTCOMES - UNPARALLELED PATIENT EXPERIENCE

HCAHPSThe patient’s experience of care is unique and individualized to each person we are privileged to serve. The nursing bundle, consisting of nurse leader rounding, hourly rounding and post discharge calls together help to ensure an overall positive patient experience. Monitored regularly and trended quarterly, nurses within Medical City Healthcare use the data as reported by patients to continually improve their services. This year all three of the metrics within the bundle have gradually increased.

Evidence-Based Leadership

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HCAHPS (Cont.)

As Lyn Ketelsen, MHA, RN, VP for patient experience for HCA, notes, and as documented in the literature, that the correlation with those patients who report having been visited by a nursing leader during their stay and the patients’ overall rating of their hospital stay is very high. Nurse leaders have been working diligently on improving their effectiveness with nurse leader rounds under the guidance of Denise Dwight, division VP for patient experience, and the CNO Council. Using skill labs, validation schedules and coaching feedback, nurse leaders have been perfecting the ability to meaningfully round on their patients with compassion and efficiency. The work is paying off, as can be seen in the chart below.

Quarter for quarter, more and more patients rate their hospital experience at the highest possible level.

Committed to Care

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Nurse Leader Boot CampMedical City Healthcare offers a quarterly Leadership Development Institute (LDI) for all managers and above. Over 700 leaders come together each quarter for two days of learning, networking and sharpening their skills, particularly around the subject of the patient experience. At the November 3-4, 2016 LDI, Denise Dwight, VP for patient experience, and Carol Gregory, CNE, sponsored a boot camp as a breakout training session for nurse leaders. The session entitled “Nursing Bundle Boot Camp: Building a Culture of Nursing Excellence for the Patient Experience,” was devoted to building skill around nursing leader rounds and its impact on culture. Over 300 nursing leaders heard from peers on their best practices. They also spent time role-playing to reinforce skills for effective nurse leader rounds.

Peer presentations included:

• Care Transitions: Mary Williams, Manager 6th Floor, Medical City North Hills

• Care Transitions: Jenifer Jones, Orthopedics Manager, Medical City Denton

• Overall Rating: Tracy Guzardo, Manager OB/GYN, Medical City Lewisville

• Overall Rating: Dawn Kleckner, Manager Gynecology/Oncology, Medical City Dallas

• Nurse Communication: Summer Hughes, Manager of Women’s, Medical City Alliance

• Doctor Communication: Brandon Prunty, Manager 7E, Medical City Fort Worth

• ED NLRs: Michelle Hooks, Medical City Plano

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more

harm than any exertion.” – Florence Nightingale

300 Nurse Leaders Attended

Boot Camp

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Communication BoardsTo support bedside nurses in bundling their care and reinforcing their communication with patients, families and other caregivers, nurses within Medical City Healthcare redesigned the patient communication boards. Now with our new brand, we will have a uniform look to our communication boards throughout our division.

The boards are being ordered now and include a Spanish version on the reverse side of the insert. Standard templates have been designed by service line for inpatients, ED, women’s services, NICU and rehab.

Inpatient Communication Board

ED Communication Board

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The Voice of our PatientsWe regularly receive feedback from our patients through emails, recognition cards and HCAHPS survey verbatims. Here are a few of the messages we received in 2016 describing their memorable experiences.

What Our Patients Tell Us About Medical City Healthcare Nurses


OBST – “I really enjoyed Lisa. She was very caring.”

4N – “Simon was the best.”

1E – “Dana was on key. She was very caring, and I just loved her. She was a great nurse.”

Grand Prairie ED – “Melissa was very sweet.”

Medical City Dallas and Medical City Children’s

9N – “Beverly and Natalie were excellent nurses.”

6E – “Elsey was a very professional yet personal, compassionate person.”

6E - “Bridgette did a wonderful job.”

7S – “Dee was a wonderful nurse.”

ED – “Sara, Lane and Efy were friendly, smiley and made my son feel at ease.”

Medical City Denton

ED - “Amanda was wonderful.”

ED - “Jason was awesome.”

ED - “I felt Jamie really cared.”

6th – “My husband loved it when Vinh was on duty.”

6th – “Alex needs to be cloned.”

3W - “Jeff was honest and answered every question.”


6E – “6th floor E has an awesome nursing staff.”

Medical City Las Colinas

MST – “Alissa, the charge nurse was amazing.”

PCU – “One nurse specifically stood out. Her name was Raquel.”

Medical City Lewisville

ED – “Billie was very professional.”

ED – “Connie was great.”

Medical City McKinney

ED - “Alex listened to my concerns and made sure we were as comfortable as possible.”

Stonebridge ED – “Nurse Amy was amazing, and Matai was calm and soothing.”

Medical City Plano

NUR6 – “Kendall was a super nurse. I couldn’t have asked for better.”

Oklahoma University Medical Center and Oklahoma University Medical Center Children’s

U4E/U4W – “Stacy was absolutely amazing.”

NICU – “Brooke was wonderful to me and my family.”

Medical City Frisco

Post-op – “Sandi reassured us that I would receive personable care and attention.”


6th – “Patty was above outstanding. I don’t think a relative could have been more attentive.”

ICU – “Dakota hit it out of the park with her excellent care.”

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Going the Extra Mile for an Exceptional Patient Experience Creates Joy

Medical City Alliance

“As a nuclear medicine nurse, I had a patient who was coming in for a Lexiscan stress test. When she arrived, I noticed that she looked like she was not feeling well. While checking her vitals, I noted that her blood sugar was low and her blood pressure was high. After probing deeper, the patient shared with me that she had not taken her heart medication for 36 hours due to the fasting requirement. We moved forward with performing the test, but I made a point to check her vitals once again following the test. Sure enough, just as I had noticed prior to the test, her blood pressure was still elevated and her blood sugar was low. Despite the fact that this particular test typically only takes about 10 minutes to complete, I simply did not feel comfortable sending her home with low blood sugar and high blood pressure, especially since she had come to the appointment alone. I encouraged her to test herself when she got home and I would follow up with a call. Despite the fact that we had her blood sugar safely elevated when she left, it was once again low when she got home. I encouraged her to contact her primary care physician or come into the ER to be rechecked. She promised she would. Turns out, she did reach out to her primary care physician and there was an issue that required treatment. She was so touched by the care I took to ensure her safety, she wrote a beautiful letter, which I now hang in my locker to remind me of our responsibility to our patients. Each patient is unique and each requires a unique a high-level of care.”

Medical City Denton

“Shulee Smith went above and beyond for her patient who passed away on Monday night in our unit. She found out he loved making birdhouses, so to cheer him up she made him a birdhouse and gave it to him Sunday night. She told me he asked her to leave his light on so he could look at it through the night. She is a great nurse, and we are lucky to have her.” – Nichole Schmidt, BSN, RN


“During a PCM call, I spoke to a patient about his discharge instructions and filling prescriptions. The patient reported that he had trouble getting one of his prescriptions filled. I learned that he did not have an appointment scheduled within the next week and also learned that the prescription was for diabetic medications, so I got his pharmacy information and contacted the pharmacist to learn what was preventing his scripts from being filled. It turned out they needed clarification on whether or not he needed test strips in addition to the glucometer. After the miscommunication was resolved, the pharmacist assured me that she would get the prescriptions filled and inform the patient when they would be ready. I followed up with the patient and let him know to expect a call from them. He was very appreciative and happy about the speed in which the matter was addressed.” – Jason Cochran, RN, PCU


“One of our patients had been admitted through the ER for a GI bleed and was receiving care on the Med-Surg floor. Her physician called for a colonoscopy, so she was asked to finish a bowel prep. I went to help transport the patient down to imaging from the 3rd floor and realized that she had not even started the bowel prep. When I asked her why, she told me that she could not drink it, that it was too harsh, and there was no way she could ever finish the 1000 cc’s in the bottle. Instead of becoming frustrated or worrying about other things I needed to be doing, I simply sat down and started to talk with her. I quickly realized that she was there alone and had no family to speak of to visit or encourage her. She was afraid, lonely and confused, and clearly me spending some time with her was what she needed. The bedside nurse was also very thankful given how busy the floor was and the demands on her time. So I sat with her and encouraged her to finish the bowel prep, breaking it into smaller amounts that were easier for her to finish. I also helped her to the bedside commode as needed until the entire bowel prep was finished. Since so many of us have support networks at home, we sometimes forget that our patients do not always have that same support network in place. During my time with her, I developed a special connection. We bonded in that moment, and I think of her often when caring for our patients. Sometimes slowing down and just listening is the best medicine for our patients.”

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Going the Extra Mile for an Exceptional Patient Experience Creates Joy (cont.)


“When a patient presented s/p fall at an Alzheimer’s facility with a head laceration, her head and neck were scanned and her laceration repaired. She was then released and able to return to the facility. The next day Cathy Hamilton, RN, did a post-visit phone call with the patient’s husband who stated his wife did not want to get out of bed, which was unusual. She advised him to bring her back to the ER. She did come back and was diagnosed with and admitted for a pelvic fracture.”


“One of our patients was recently diagnosed with a terminal bone cancer. I was sitting with her shortly after she had received the news, and she was sad, scared and confused. As we sat there and talked about her life, I encouraged her to make a bucket list of things she wanted to do before she passed. The very first thing on her list was to enjoy a giant seafood feast, complete with crab legs, shrimp and all of the sides. As I went to bed that night, I thought of that patient and how much she had touched me earlier that day. When I woke the next morning, she was still on my mind, so I decided to do something about it! I had that day off from work, so I decided to go to Pappadeaux, purchase lunch for my new friend and bring it to the hospital so we could enjoy a meal together. To my surprise, once Pappadeaux learned what I was doing, they volunteered to donate the meal. I brought the meal up to the hospital, and the patient, her husband and other family members were all moved to tears. In fact, the local FOX affiliate and hospital administration heard about it and we were on the news, and a video was even made to highlight the story. As I mentioned in the video, sometimes we are called to not just care for our patients and their physical needs, but the needs of their heart and soul as well. This was one of those times, and I feel so blessed to have been a part of this incredible experience.”


“My first contact with Damita Ware, RN, was when she started work at Medical City North Hills as a concierge at the front lobby. From the moment I met her, I knew she had a heart to serve. Damita always had a smile, a touch and a warm and friendly greeting. She has a BS in business management and an MBA, but I knew that her heart was at the bedside, so she enrolled in nursing school as a second career and attained her BSN.

She began working on the PCU unit but still noted that something was missing in her heart. During a ‘Chat with the CNO,’ she shared that her passion was for the elderly and mental illness. I suggested she shadow a shift in our Geriatric Behavioral Unit. She found her calling and transferred to the GBU, where she has blossomed. She delivers exceptional, quality care every day with great kindness and understanding toward patients, families, co-workers and all with whom she comes in contact. Her calm, quiet and gentle spirit resonates with the patient population. We are so pleased that she followed her heart.” – Tracey Smithson, CNO


“The patient experience is a priority at Medical City Arlington’s ER since we see an average of 195 patients each day. As a team, we are focusing on the helpfulness of the first person the patient meets as well as on a quality nurse leader round. Recently during rounds, I spoke with a mother who had arrived in the ER in a panic after tripping and falling while carrying her son. The first person with whom she came in contact, was Jason Maxtin, our medic at the front desk. She stated Jason remained so calm and reassuring that she was able to calm down. After her interaction with Jason, she said she knew she had brought her son to the right place. I was proud to see what a difference our staff can make in the patient’s overall care.” – Gary Busby, RN, ED Manager

Medical City Denton

“We recently had a patient in the ICU expire. When I walked into the room, her two small dogs were in bed with her. She has had these beloved pets 13 years. Of course, the shot records were brought in to the unit. Dr. Iyer and Ashley, RN, arranged for the pets to come be with their mother one last time. The pets were with her when she passed away. I was moved to tears when Nicole, RN, asked me to pronounce, and I walked in to see this last wish carried out … It’s great to know we have nurses and physicians who care enough to make our patients’ last wishes come true.” – Sheri Mason Hagler, BSN, RN, CCRN, House Supervisor


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Going the Extra Mile for an Exceptional Patient Experience Creates Joy (cont.)


“The oncology nurses at Medical City Arlington are resilient, forward-thinkers, strong, nurturing and above all compassionate.” A patient’s last dying wish was to see his first grandchild. Nurses Virgil, Sarah, Kasie, Elizabeth, Carolyn, Susan Esperanza and Crystabelle along with Drs. Derrick Nguyen and Darren Nelson worked diligently, offering all their medical and nursing support, along with prayers and tears with the family, in hopes that this wish could be fulfilled, despite his rapidly deteriorating condition. Six days after the baby was born, his daughter was able to travel from Arizona to Texas and introduced his first grandson to their patient. The patient passed away three days later. – Crystabelle Ferim, BSN, RN, Oncology Program Director, and Kasie Dixon, RN, Oncology Unit Manager

“When you are able to send a patient to surgery with a

smile on their face, and their family is calm and comfortable, you know

you have had a positive influence on them, and that is why we do what

we do …to make a difference in the lives we touch.”

– Pamela Davies, RN, DSU, Medical City McKinney

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EMPIRICAL OUTCOMES - CONSISTENT EARNINGS OUT-PERFORMANCE

RN Recruitment and Retention

Improving Selection

Estimates of the cost of turnover for a single RN as reported in the literature can range anywhere from $50,000 to $100,000 depending on the specialty. At Medical City Healthcare, RN turnover is considered a sentinel event. Leaders are coached on creating a working environment where every RN can flourish.

Medical City Healthcare CNOs analyzed all RN voluntary turnovers over a two-year period to ascertain if the selection process could be improved. RN resignations were categorized as to whether they were unpreventable, whether additional measures could have been taken to prevent the resignation or whether adjustments to the selection process may have been beneficial.

Peer interviewing is now the standard for bringing nurses into our setting. Peers from the department and, when possible, from the shift the individual will work are involved in panel interviews. The candidate is appraised using behavioral interviewing with special attention paid to fit for the specialty and to the culture of the organization. Realistic job previews are provided. Staff deployed multiple strategies to ensure the new employee is welcomed and enculturated into the unit and the organization so that they have a sense of pride in their employment and experience joy in their work as rapidly as possible. CNOs now have personal touch points with new employees in a number of venues.

In 2016, voluntary RN turnover was reduced by 7 percent. Estimated cost savings associated with an improved selection process were annualized at almost $1M based on improvements seen in the second half of 2016. By strengthening the selection process and continuing to create a healthy work environment, the percent of voluntary resignations that occurred for unpreventable reasons (spouse job transfer, family illness, etc.) rose by 11 percent.

RN Engagement

An annual employee satisfaction survey is conducted in order to give a voice to employees and continually improve our healthy work environment. We were proud to learn that for the second year in a row, Medical City Healthcare was ranked No. 1 in HCA for our employee engagement. HCA determines this metric by calculating the ratio of highly engaged nurses to those who are disengaged in their workplace. The RN engagement ratio has continued to climb for the past three consecutive years, indicating the value placed on creating a working environment throughout the division where professional nurses can flourish. This assessment is an important indicator, that helps drive RN recruitment and retention.

Percent of voluntary RN resignations that were unpreventable

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EMPIRICAL OUTCOMES - CONSISTENT EARNINGS OUT-PERFORMANCE

Recruitment and Retention (cont.)

Attracting Traveling Nurses

Nurses have options. Research shows that the number-one reason for turnover in all industries is dissatisfaction with one’s immediate supervisor. Nurses outside of Medical

City Healthcare who come to us as travelers may have chosen a traveling assignment because they hadn’t yet found a nursing culture in which they wanted to work permanently. Our nursing leaders on the other hand have had success in attracting traveling nurses to come to work for Medical City Healthcare permanently.

In our organization, travelers are treated like family. Leaders establish a personal connection with them just as they do with their permanent staff and help them have a sense of belonging. Recently, nursing leaders were recognized and thanked by their CNOs for creating a working environment that attracts and retains traveling nurses.

Pictured from left to right: Carol Gregory, CNE; Tracey Smithson, CNO, Medical City North Hills; Eunice Valai, Asst Director, Medical City North Hills; Cathy McLaughlin, CNO, Medical City Arlington; Zach Mueller, CNO, Medical City Dallas; Nicie Taylor, Manager, Medical City Dallas; Kevin Inderhees, Admin Director, Medical City Fort Worth; Christy Coyle, Director, Medical City Fort Worth; Shawn Lewis, Manager, Medical City Fort Worth; Tracey Guzzardo, Manager, Medical City Lewisville; Brandy Farrer, CNO, Medical City Lewisville; Lynn O’Neill, CNO, Medical City Fort Worth; Liz Rock, Director, Medical City Denton; Nicki Roderman, CNO, Medical City Denton.

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EXEMPLARY PROFESSIONAL PRACTICE

Advanced Practice Nursing Across Medical City Healthcare, advanced practice registered nurses (APRNs) hold many unique roles, which contribute to leading change and advancing health for our system. They provide a level of nursing expertise and exquisite competence that serves our patients in important ways. They also provide resources, consultation and role modeling for our bedside nursing staff.

Featuring a small sampling of representatives from a variety of APRN roles helps pay tribute to all the APRNs across our division who are engaging in exemplary professional practice every day.

Allison Butler, RN, CMSRN, MSN, FNP-BC Orthopedic Program Coordinator, Medical City McKinney

Allison has held the role of Orthopedic Program Coordinator and Orthopedic Nurse Practitioner for Medical City McKinney for the past four years during which time the hospital has seen improvement in patient outcomes; patient, staff and surgeon satisfaction; and improved cost containment in all of her orthopedic programs.

Allison spends most of her time teaching preoperative joint replacement classes, rounding on

postoperative patients and clearing patients for surgery for the orthopedic surgical team. She can also often be seen in the emergency department consulting for fractures, traumas and non-healing wounds with bone involvement. She then quickly relays this information to the surgeons, and together they develop and implement a plan of care. This approach expedites patient care and allows the on-call surgeon to continue seeing patients or surgical procedures. Allison’s communication also offers great peace of mind to patients and families.

Because of the improvements in Medical City McKinney’s orthopedic program and the trust developed between Allison and the surgeons, orthopedic volume has grown 42 percent in the last year. Dr. Charles Toulson, Chief of Orthopedic Surgery, Medical City McKinney, had this to say:

“Allison is a major component of Medical City McKinney’s total hip and total knee replacement program. With her excellent clinical skills and passion for patient care, our surgeons consider her an equal member of our orthopedic surgical team. As a Joint Commission surveyor, she brings an incredible resource to our team. She ensures that we are using the most current evidence based practices to ensure the greatest outcomes for our patients. She is reliable, hardworking and resourceful. I am glad she is on my team.”

Her collaboration with the orthopedic team paired with improved outcomes and decreased complications has also contributed to two more orthopedic surgeons now routinely performing surgeries at MCM on a regular basis.

Not only has Allison been an incredible asset in patient care, her dedication to collecting data and process improvement has vastly

improved the program overall. This program has seen a decrease in blood utilization to near zero, zero total joint replacement-associated infections in the year 2016 and a significant decrease in overall orthopedic complications. The results of Medical City McKinney’s most recent Joint Commission survey for Total Hip and Total Knee certification was zero deficiencies. Allison has accepted an interim position with Joint Commission as a surveyor for Orthopedic Certification programs.

Because of Allison’s relationship with the staff on the orthopedic unit, pain management and the discharge process have also improved. Sarah Jaquay, orthopedic RN, said:

“Allison is easily accessible and always responds. I feel she listens to patients’ and nurses’ concerns and is open to nursing input, which ultimately improves the patient experience and outcomes. This makes our lives as nurses much easier.”

Mandy Nelson, APRN, MSN, CNS Oklahoma University Medical Center

As the clinical nurse specialist for the largest service line at Oklahoma University Medical Center, Mandy Nelson is dedicated to improving patient outcomes by implementing quality improvement plans that meet organizational goals of reducing healthcare-associated infections. She has a master’s degree from

Improving Outcomes

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Ball State University and is currently completing her Doctor of Nursing Practice at Chamberlain College of Nursing. Mandy identified the need for improvement in stroke educational awareness for Comprehensive Stroke Certification (CSC) and developed nursing and physician education and competencies consistent with CSC requirements.

Additionally, she collaborated with physicians to develop critical care stroke order sets and protocols utilizing evidence-based practice guidelines. In May 2013, she was recognized for her work to improve the care of the stroke patient as OU Medical Center received certification as a Comprehensive Stroke Center.

Mandy has also completed an evidence-based CAUTI improvement initiative, including a literature review and gap analysis to identify gaps in practice and opportunities for improvement, which substantially decreased catheter-associated infections (CAUTI). Her work was recognized as a best practice by the Oklahoma Hospital Association HEN Clinical Improvement Advisors during an OU Medical Center site visit in reducing CAUTI in August 2014.

Mandy has collaborated with nurses and physicians to analyze sepsis-related mortality and develop interventions for improvement. In conjunction with fellow colleagues, an adult sepsis algorithm was developed to identify, stratify and provide early intervention for sepsis patients. In March 2013, she was selected to present the successful sepsis algorithm development and implementation at the National

Association of Clinical Nurse Specialists annual conference.

Mandy represents all APRNs in Oklahoma after being appointed by Governor Mary Fallin as the Advanced Practice Nurse representative on the Oklahoma Board of Nursing.

Cara Guthrie-Chur, MSN, RM, AGACNP-BC, CCRN Neuro Acute, NP, Medical City Fort Worth

Why I love my role as a Neuro Acute NP:

“Challenges, intrigue, rewards and a wonderful group of nurse, physician and ancillary colleagues! Patients experiencing stroke and other acute neurological conditions do not always present with a clear reason for their neurological event. Critical thinking and anticipatory guidance are mandatory.

While outcomes despite the best possible care can sometimes be unfortunate, I also get to participate in many amazing successes. Seeing former patients walk through the door

smiling and reporting a satisfying functional recovery is one of the best possible rewards! Likewise, working with compassionate, respectful colleagues who genuinely value neuroscience and clinical excellence is a huge motivator.’

Deborah Parris, DP, MS, APRN, PCNS-C Oklahoma University Medical Center Children’s Hospital

Deborah Parris is a Pediatric Clinical Nurse Specialist at The Children’s Hospital in Oklahoma City. Deborah completed her master’s degree at The University of Oklahoma College of Nursing with a focus in parent child nursing in the CNS track and a doctorate in nursing practice from Chamberlain College of Nursing. Deborah’s scholarly work focused on the implementation of a nurse focused screening for the early identification and treatment of sepsis in the pediatric patient. This screening has been incorporated into the electronic nursing documentation for patients from the Emergency Department through the Pediatric Intensive Care Unit.

EXEMPLARY PROFESSIONAL PRACTICEAdvance Practice Nursing (cont.)

Improving Care Locally and Nationally

Promoting Functional Recovery

Early Identification of Pediatric Sepsis

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Deborah utilizes her clinical and professional skills to support the intradisciplinary team in improving the quality of care provided to pediatric patients and families. Deborah provides system level support as the mentor to the Evidence Based Practice Committee, chair of the Advanced Practice Professional Council and co-chair of Nursing Professional Practice Review.

Rita Whitney, MSN, APRN, FNP-BC, CWOCN, CWS Wound Care Nurse, Medical City Plano

With a passion for wound/ostomy care, Rita serves as a preceptor to nurses throughout Medical City Healthcare to help them obtain Wound Care certification. She evaluates and treats patients while striving to make a difference with each encounter. Rita founded and facilitates an Ostomy Support Group for the local community. Participants have noted that Rita helped them reclaim their self-worth and well-being in their new life with a colostomy.

She is a strong proponent of advanced education. While working full time as a Wound Care Nurse and caring for

her family, she obtained her Nurse Practitioner license and is now pursuing her Doctor of Nursing Practice. She has served as a mentor for two terms assisting TCU Evidence Based Fellows to complete their scholarly projects.

During ICU daily rounds, physicians and nurses seek her expertise when making critical decisions for patients with wounds and pressure ulcers. Rita presented a poster on ulcer prevention at the 2016 Annual Research/EBP Day. She is the author of a quarterly Wound Care Education Newsletter designed to keep staff abreast of the latest evidence based practice. When asked recently what keeps her so motivated, Rita replied, “Always the patients!”

Kathy Drescher, DNP, APRN, CNS-CC, CPNP, CNML Director/Nurse Practitioner, Congenital Heart and ECMO Program - Medical City Children’s Hospital

Dr. Kathy Drescher is an Advanced Practice nurse who consistently demonstrates the highest level of excellence in her practice setting. Her nursing career spans more than 30 years in which she has dedicated countless hours to her passion of

providing the highest quality of life to children born with congenital cardiac anomalies.

Her research manifested new evidence related to the efficacy of Blake drains versus traditional Trocar chest tubes in pediatric cardiothoracic surgical patients by reducing tissue erosion, pain, increasing patient mobility and decreasing cost.

It was Kathy’s vision and passion for family-centered care that pioneered innovations such as collaborative rounding, nurse-led bedside presentation, family presence during rounds and resuscitation efforts, and bedside high-fidelity simulation in the congenital heart unit.

Reflecting on Kathy’s performance, Dr. Eric Mendeloff, Director of Pediatric Cardiothoracic Surgery, states:

“Dr. Drescher has been a passionate and integral member of our congenital heart team who has played a central role in helping continuously raise the bar on all facets of care for our complex congenital heart babies and their families.”

Kathy has been a three-time podium presenter at the ANCC Magnet® conference. She served on the Magnet abstract review committee for two consecutive years.

A recent occurrence illustrates this APRN’s true connection to her purpose. The mother of a patient with a severe congenital anomaly had not had an opportunity to see her baby before he was taken to the operating room. All those around the mother were busily informing her of the baby’s diagnosis and outcome probabilities. Kathy paused as she intuitively saw the mother’s true need and took the time to describe the baby’s features: “His eyes are blue, his hair is red, he is so beautiful.” The mother later recounted that this simple act of kindness and compassion was exactly what she needed in that moment.


Ostomy Support

Driving Excellence with Congenital

Anomalies

Advance Practice Nursing (cont.)

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EXEMPLARY PROFESSIONAL PRACTICEInterprofessional Collaboration

Sarah Cannon Center of Excellence

Medical City Plano is the first HCA hospital in the nation to be designated a Sarah Cannon Center of Excellence. This distinction signifies a fully integrated approach to cancer care, bringing together essential components of clinical quality to improve outcomes for cancer patients. A Sarah Cannon Center of Excellence provides a multidisciplinary approach to treatment, including physician leadership, the use of leading-edge technology, highly skilled oncology nurses and a nurse navigation program that ensures a constant point of contact from the moment of diagnosis through therapy and beyond.

Accredited through the American College of Surgeons Commission on Cancer, Medical City Plano’s oncology service includes a team composed of highly skilled medical professionals who collaborate to provide patients and their families with education, support, advocacy and excellent care throughout their cancer journey.

On Friday, September 16, 2016, Sarah Cannon leaders, including Fred LaMaistre, MD, Senior Vice President, Sarah Cannon Market Operations and Physician-in-Chief of Blood Cancers, and Dr. Howard “Skip” Burris, III, President, Clinical Operations and Chief Medical Officer made the presentation to Medical City Plano recognizing this honor.

Compassionate Colleague Recognition

Recognition of physicians by their nurse colleagues, and vice versa, is an integral part of the culture at Medical City McKinney. Quarterly, a Compassionate Caregiver Award is conferred by Nursing Services to an outstanding physician and posted on the hospital’s social media site. Amanda Faggart, Women’s Services Director, sent this message to CNO Cassidi Roberts.

“An environment of mutual respect is critical for the workforce to find joy and

meaning in work.” – Through the Eyes of the Workforce: Creating Joy, Meaning and

Safe Healthcare. Lucian Leape Institute,

2013

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Interprofessional Collaboration (cont.)“Dr. Rajala just called to let me know how much he appreciated the award again. He said it was the nicest thing anyone has done for him in 36 years and that he is getting cards in the mail from patients congratulating him and people all over the community wishing him congrats. Thanks for getting this started – the docs really appreciate the recognition.”

The following is a message received by Cassidi describing the recognition by a physician for his nurse colleagues:

“I want to tell you about something that happened at 4 a.m. bed board the other night. I asked Dr. Corcoran to come in and meet the clinical supervisors. When he came in, I introduced him and then introduced each of my peers by name and their floor. Then Dr. Corcoran talked to them and praised them for enduring the hard shifts and called them an extension of the ER team. He praised them, and it was very genuine and, my goodness, it was such a smashing hit! The group just glowed under the praise and truly felt part of the team. In turn, Dr. Corcoran understood that these were the nurses who carried out the next phase of care. One team! – Ann Dutze, ER Night Clinical Supervisor

Nurse Physician Collaborative Committees

At Medical City Dallas front-line nurses meet with physicians within their service lines to collaborate on improving patient care. This four-year tradition was “borrowed” from Cedars-Sinai after having heard it described as the next level of shared leadership during the 2012 Magnet® Conference. A standardized action plan template (see below) with assigned accountabilities is used, both as the meeting agenda and to track follow-up after each meeting.

Initiatives Completion Goal Responsibility/Owner Status Metrics I. Resources/Staffing

1. Improve department turnover Ongoing Jennifer L./Teresa S.

8 new staff hired since July. Current positions open: 3 RNs EP, 1 tech IC - no movement for EP,

tech position posted 10/11 .Nicole W. interviewed for FT EP position by leadership and staff (conversion from traveler to FT). Multitask

postion, Ozzie, began on 11/11.

Annualized Turnover <10%;

Currently = 13.7%

2. Implement Cath Lab Coordinator position November 2013 Teresa S.

Currently covered by Teresa, interviews 10/21. Roma and Melissa M. being considered.

Qualities looking for: respected, autonomous, resil ient, educated, have clear expectations, and communicate well with staff; must have abil ity to schedule rooms to meet MD needs. Roma A.

offered position and accepted. Orienting to role and supporting transition. Support from staff

and physicians has been positive.

3. Implement EP Coordinator position January 2014 Teresa S. Began rotation of role 10/7/13 q2weeks with Jennifer M. first rotation

4. Acquire dedicated phone for EP and Cath Lab coordinators January 2014 Teresa S./Jennifer L.

Teresa currently taking calls for Cath Lab until position hired; request made for EP coord phone

to be rotated until position hired. EP phone obtained from IT & S

5. Re-implement Board Runner role December 2013 Unit Practice Council Develop Gold Standard duties. Roma A. has transitioned to role. COMPLETE

6. Recruit experienced staff ongoing Unit interview panel and leadership Continue to partner with recruiting for qualified applicants

II. Education/Staff Development

1. Reevaluate orientation process In development Jennifer L./Teresa S./Staff Under way, will add to UPC agenda next month

Cath Lab Collaborative


Cath Lab Collaborative

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EXEMPLARY PROFESSIONAL PRACTICEInterprofessional Collaboration (cont.)Collaborative committees are in place for neurosciences, cardiac catheterization lab, oncology, ED, pediatrics, NICU, PICU and congenital heart surgery services. Committee successes have included:

• Criteria for adding RN and/or PCA resources based on acuity (neuro)• Staff education by physicians on unit (neuro)• Standardized handoff Kardex with audits by nursing leaders (neuro)• Charge nurse walking rounds (neuro)• Joint NIH/neuro assessments at bedside shift report (neuro)• Dedicated mobile phone line for coordinators (cath lab)• Physical plant refresh of staff lounge, physician consult room, lockers and bathrooms (cath lab)• New staffing matrix (ED)• Purchase of new walkie-talkies (ED)• Implement flow coordinator role to increase physician-staff communication (ED)• Designate dedicated NICU educator, chiefly to support interns and night shifts (NICU)• Hiring of additional specialized PT/OT staff to support increased census (NICU)• Purchase of new task chairs (NICU)• Purchase of new oto/ophthalmoscopes (NICU)• Implementation of cue-based feeding education program (NICU)• Increased traveler orientation (NICU)• Senior leader recognition of milestones, e.g. 300 days CLABSI-free celebration (NICU)• Night bed huddle and rounding by physicians (PICU)• Development of bulletin boards highlighting new staff and recognitions (multiple)• Hiring and training of additional staff (all).

“Joy and meaning in work refers to the sort of reinforcing

engagement that occurs in a positive, supportive and

constructive care environment.” – Jonathan Perlin, MD, PhD,

MSHA, MACP, FACCMI, President, Clinical Services and

Chief Medical Officer, HCA

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EXEMPLARY PROFESSIONAL PRACTICEPhysician Prescriptions

What Physicians Say About Medical City Healthcare Nurses

Nurses and doctors work side by side throughout our organization and are dedicated to the interprofessional collaboration so critical to a world-class patient care environment. As the Institute of Medicine has noted in its Future of Nursing Report published in 2010:

“No single profession, working alone, can meet the complex needs of patients and communities. Nurses should continue to develop skills and competencies in leadership and innovation and collaborate with other professionals in healthcare delivery and health system redesign.”

This year during the annual physician satisfaction survey, the number of physicians in our division who rated their “perceptions of nursing care” as excellent was the highest yet. The survey findings resulted in a percentile ranking of 88.3rd compared to the national database. This is as compared to the previous year of a percentile ranking of 87.7th. The division saw a significant increase in physician satisfaction based on “Place to Practice” as well, ranking as the second highest division in HCA. Clearly, Medical City Healthcare

physicians appreciate the collaboration they have with their nursing colleagues and once again recognize their important contributions to optimal patient outcomes.

Nurse-physician collaboration continued formally this year with our program of dyad rounding in our Medical Surgical Units with multidisciplinary rounding in ICUs and through a variety of nurse-physician collaborative committees underway in a variety of specialties. Nurses at all levels pride themselves on these important working relationships with their physicians.

When asked, here is what physicians across Medical City Healthcare say about the nurses with whom they work:

“From the CNO level down, the group of nurses at Medical City McKinney is unparalleled. In 15 years I’ve never been as blessed as I am now to work with a group of professionals so dedicated to compassionate and quality healthcare. What sets them apart is their sense of ownership of patient care, their dedication to teamwork and the mutual respect between the providers and the nursing team.” – Scott Corcoran, MD, ED Medical Director, Medical City McKinney

“It’s a pleasure to work with wonderful nurses who always communicate well, and provide excellent patient care.” – Nikhil Bhayani, MD, FIDSA, Infectious Diseases, Medical City North Hills

“… There have been multiple changes that have been required in order to progress from a community hospital to a Level 1 Trauma Center. I was always able to count on the nurse leaders and bedside nurses to implement new programs in order to move us forward as a trauma center. It is my pleasure to work alongside the hard-working, dedicated nursing staff ...” – Matt Carrick, MD, Trauma Medical Director, Medical City Plano

“The ED staff at Medical City Frisco has the most engaged nurses I have seen. They really have taken ownership of the Emergency Department, which will lead to great patient care as our volume grows. I am proud to be a part of this team.” – Nicole Rodgers, MD, ED Medical Director, Medical City Frisco

“Over 25 years, I’ve had the great good fortune of working with thousands of gifted nurses. The pinnacle of that experience is shown by the amazing nurses at Medical City Children’s Hospital. They embrace each patient and their families, bringing to bear the full science and art of compassionate nursing care.” – Red Starks, MD, Pediatric Anesthesiologist, Medical City Children’s Hospital

“As a new CMO, it’s been a pleasure to meet the Medical City family of nurses, and I am overjoyed to find them so dedicated to their patients. It is my job to make sure that they have the voice they need to provide the highest quality and safest care available today. Together, we can make the journey to zero harm a short and fruitful trip.” – Eric Benink, MD, Chief Medical Officer, Medical City Arlington

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EXEMPLARY PROFESSIONAL PRACTICEPhysician Prescriptions (cont.)“The nursing staff of Medical City North Hills is like a large family. They are here to help and provide quality care to their “family members.” – Dale Brancel, MD, General Surgeon, Medical City North Hills

“During the first 15 years of my career, I worked for the Parkland, Methodist and Baylor systems. Then 22 years ago, I began practicing in HCA hospitals: first Lewisville, then Medical City and finally Medical City McKinney. The reason I prefer HCA over the others is because at each facility there is a culture of teamwork between the physicians and nurses. I found this to be particularly true at Medical City McKinney, where I am now in my 20th year of practicing and 13th year of serving as a member of the hospital board. HCA promotes a true sense of teamwork throughout the organization, which creates a great work environment. This in turn has created lifelong friendships and a wonderful lifestyle. Only one of my original nurses is still working with me, but with the addition of new faces, the team has become better than ever. – Tim Hartman, DO, FACEP, Medical Director, Stonebridge PBED, Medical City McKinney

“The nurses at Medical City Lewisville are vital to the care of our patients. They are passionate, caring and hardworking. It is always a pleasure to work with them.” – Farrah Paracha, MD, Hospitalist, Medical City Lewisville

“The OR is the best in the areas. I can do twice as many cases at Frisco as I can elsewhere. Great team effort and morale … Turnover times have been excellent. The floor/ICU nurses have all been very attentive and helpful. They call for appropriate questions and have been very helpful with patients and providing assistance with reinforcing discharge instructions.” – Rob Dickerman, DO, Neurosurgeon, Medical City Frisco

“I like working in a place with such a great team environment. The nurses are such great advocates for the patients.” – BreeAnna Gibson, MD, OB/GYN, OU Medical System

“The teamwork exhibited [last week] to help resuscitate a hemorrhaging patient in the MICU was outstanding, well-coordinated and controlled. I have worked in many ICUs and I could tell the RNs had excellent rapport with each other.” – Nilesh Dave, MD, Intensivist, Medical City Dallas

“The nurses at Medical City Frisco strive to provide the highest quality care possible. They utilize all resources at their disposal to aid the patient in their recovery. They are one of the hardest working nursing teams in DFW.” – Ricky R. Kalra, MD, Neurosurgeon, Medical City Frisco

“The nurses are always willing to help. Their kindness and compassion exceeds expectations. I enjoy working at this hospital in large part due to the quality of nursing care, and my patients always report a wonderful nursing experience.” – Melissa Kinney, MD, Breast Surgeon, Medical City Lewisville

“The nurses are responsive and always helpful.” – Robert Lynn Cash, MD, Pulmonologist, Medical City North Hills

“Our nurses go the extra mile to deliver great care to our patients.” – John McDonald, MD, Pathologist & Chief Medical Officer, Medical City North Hills

“The children of Oklahoma are fortunate to have a group of highly skilled and dedicated PICU nurses to take care of them. Their passion and commitment to the care of our critically ill children is exemplary.” – Harold Burkhart, MD, Chief of Thoracic and Cardiovascular Surgery, OU Medical System

“The nurses at Grand Prairie are highly trained emergency nurses whose professionalism is second to

none. What really sets our nurses apart is their high level of empathy and compassion they give to each and every patient that comes through those ER doors. It is a pleasure to work side by side with each one of them” – Trent Boyko, MD, ED Physician, Medical City ER Grand Prairie

“The nurses at Medical City McKinney do an amazing job of providing excellent care to my patients, and they are truly a joy to work with. They acknowledge the fact that I have a very busy solo obstetric practice and do what they can to manage my patients so that I get the most out of my day. In the past year, I delivered over 400 babies at Medical City McKinney and am amazed that my office was very rarely interrupted. I feel like I have the nurses and other staff at Medical City McKinney to thank for that.” – Bruce Rajala, DO, OB/GYN, Medical City McKinney

“The nurses prove the plain and simple mantra: Caring is the essence of nursing.” – Sujatha Krishnan, MD Infectious Diseases, Medical City Lewisville

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Physician Prescriptions (cont.)“This quote about nurses has been much harder to write than I thought it would be. Not because there is too little to say, but because there is too much to say. To summarize the admiration I have for the nursing staff at Medical City Plano is almost impossible. They are, without a doubt, the strength and soul of the ICU. Their strength holds the ICU together. When the day becomes chaotic, stressful and sometimes overpowering, I have relied on the ICU nurses to lean on, to hold on to, to look up to. When the day becomes emotional, when I’m close to giving up, I feed off of the spiritual strength of the work ethic and drive of [the] nurses.

I feed off their drive to, beyond all else, simply do the right thing with the gifts given.

Several months ago we took care of a middle-aged patient with extreme multisystem organ failure … The room was filled with machines and a RotoProne bed. In the middle of the night and into the early morning, we fought to keep that patient alive, at times with four nurses in one of the smallest rooms we have. Doubts of hopelessness came into my very exhausted mind. I couldn’t think beyond to the next step. I wasn’t sure if there was a next step. I wasn’t sure if I had pushed enough.

When the patient finally succumbed and there was that calm after the storm is when I came across one of the most powerful, symbolic and indelible moments of my career at Plano. The patient’s nurse who had

fought all night — taken every order regardless of how sometimes futile it may have been, pushed their physical capabilities — slumped against and then slid down the wall in the hallway, crouched in blue scrubs stained from sweat, blood and an exhausting night, hands on head. Every once in a while, another nurse would come by and clasp [the nurse] on the shoulder.

It was at that moment I realized several things: 1) Nurses give all, and they are underappreciated for it. 2) I took the easy way to medical care and went to medical school. 3) When you think you’re giving everything for that patient, there is a nurse giving more. 4) I am lucky, blessed and honored to work with the ICU nurses at MCP.” – Scott Van Poppel, MD, Medical Director Intensivist, Medical City Plano

Nursing ExcellenceAll across Medical City Healthcare, every day nurses perform extraordinary acts of compassion, exemplify their dedication and deliver lifesaving and life enhancing care. In 2016, many were recognized in various ways for their excellence always in the care and improvement of human life.

Martha Langham, RN, Medical City McKinney, HCA Frist Humanitarian Award Finalist

Certified nurses celebration at Medical City Plano

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Nursing Excellence (cont.)

DAISY Award® For Extraordinary Nurses

Elizabeth Grant, RN, NCIU, Medical City Arlington, receives The DAISY Award

Oklahoma University Medical Center Procedural Nurse Patricia Powell, RN, Stephenson Cancer Center, receives The DAISY Award

Oklahoma University Medical Center Children’s Hospital Nurse Kristen Wright, RN, ICU East, receives The DAISY Award


Rosanne Wheatfall, RN, Medical City Arlington, receives DAISY Award

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ENA Lantern Award

The Emergency Nurses Association 2016 Lantern Award recognizes a select group of ERs that exemplify exceptional practice and innovative performance in the core areas of leadership, practice, education, advocacy and research. Medical City Flower Mound provider-based ER is one of only 11 hospital ERs nationwide to receive the Lantern Award this year and among only a handful to have received it twice! “Our dedicated staff goes above and beyond every day to ensure patients receive the quality experience they deserve,” says Sharn Barbarin, Medical City Lewisville CEO (pictured on right).

Health Care Heroes

A project to rehabilitate an elderly patient’s home after he had been robbed, beaten and hospitalized was spearheaded by CNO Lynn O’Neill and Linda Hastings from Medical City Fort Worth. They received the Fort Worth Business Press Health Care Heroes Award for their extraordinary humanitarianism.

Linda Hastings and Lynn O’Neill

HCA Innovators Award

Shawn Lewis, RN and Megan Gallegos, RN win the 2016 HCA Innovators Award

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EXEMPLARY PROFESSIONAL PRACTICENursing Excellence (cont.)

Extreme Nursing

Quarterly, the CNO Council sponsors a recognition ceremony for exceptional nursing care.

Laura Rampy, RN and Ron Samuel, RN, from Medical City Las Colinas were recognized for resuscitating a runner who collapsed following a half-marathon

Over 55 Celebration Dinner

A dinner is held every six months in the spring and fall with nurses who are over age 55 at Medical City Fort Worth. The purpose of the dinner is to appreciate them and see what can be done to keep them at the bedside.

55+ dinner attendees at Medical City Fort Worth

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Top Female Executive Award

Angie Buckmeier, MHA, BSN, RN, CNO for Medical City Children’s Hospital, won the 2017 Addison Top Female Executive Award.


“We see miracles happen. We see children on the brink of

death, and we see them get better. I am surrounded by amazing

nurses who are not just my co-workers, they are my family.” – Rachel Eudey, RN, OUMC

Children’s Hospital

Nurses Week celebration, Medical City Plano Physician’s Choice Award, Medical City Arlington

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Medical City Healthcare 2016 DFW Great 100 Nurses

The 2016 winners of the DFW Great 100 Nurses were honored in April at the Morton H. Meyerson Symphony Center. Sixteen Medical City Healthcare highly deserving nurses Medical City Healthcare were selected out of the 600 nominated from across the Dallas-Fort Worth area for this prestigious honor.

The Great 100 Nurses of the Dallas-Fort Worth is an annual tradition dating back to 1991 when 100 nurses were selected for their excellence in the art and science of nursing. Nominations can be made by co-workers, physicians, patients or family members and are blinded as to the nominee’s organization. Congratulations to the following winners for 2016!

Heather Boyd Stephanie McDonald LaShay Powell Kelsey Vinson

Medical City Alliance Amber Reyna

Medical City Green Oaks Pam Whitley

Medical City Fort Worth Diana Nguyen

Medical City Healthcare Joyce Carver

Medical City Children’s Hospital

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Medical City Dallas

Kelly Cole Nenita Cuellar Carolyn Schaefer

Medical City Las Colinas

Bea Ngo Bisombi Kim Petty

Medical City Lewisville Kyle Bryan

Medical City McKinney John Summers

Medical City Plano Sandi Gill


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Winners were selected for being role models, leaders, community servants, compassionate caregivers and significant contributors to the nursing profession. The event is a time of great joy and celebration as well as an opportunity to raise funds for nursing scholarships.

Pictured from left to right: In the front row are Kelly Cole, Carolyn Schaefer, Amber Reyna, Nenita Cuellar, and Kelsey Vinson. From left to right in the second row are Bea Ngo Bisombi, Kim Petty and Sandi Gill. In the third row are Kyle Bryan and John Summers.

“My joy in nursing comes in part from the trust that

is placed in me by my coworkers and patients.” – Maryann Holbrook,

RN, PACU, Medical City McKinney

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The nomination process for the 2017 Great 100 Award began as the year was ending. Nominations from each of the Medical City Healthcare hospitals included:

Medical City Alliance: Melinda Bales, Kim Beeler, Staci Birman, Courtney Blevins, Jordan Henderson, Angie Junker, Nelson Martinez, Stacey Miller, Casey Northup, Laura Ramirez, Diane Richey, Denise Scurlock, Keri Spillman, Kim Stephens, Wendy Whitford, Stephanie West.

Medical City Arlington: Elizabeth Grant, Jane Maza.

Medical City Children’s Hospital: Kamela Lancaster, Emily Williams

Medical City Dallas: Kara Eastom, Hisayo Pelton, Rick Reddick, Eric Rodriguez, Jenna Taylor

Medical City Denton: Melanie Hardy, Cindy Lang, Dean Miller, Amber Parman, Crystal Perry, Liz Rock, Rhonda Ross, Joanie Sackett, Anne Van Dyke, and Michelle Yeatts.

Medical City Fort Worth: Kevin Inderhees, Jennifer Rice, Alis Walton and Sandy Viall.

Medical City Green Oaks: Ester Atuchukwu, Dusty Cornelius, Mary Herald, Lea Hilton, Tykita Jones, Diane Oatridge, Joan Patty, Missy Pepin, Emily Zimmerman.

Medical City Healthcare: Rowena Yates

Medical City Las Colinas: Jency Abraham, Kara Adams, Beatrice Ngo Bisombi, Charlaine Crocker, Kimberly Petty, Laura Rampley, Ron Samuel, Ryan Schirato, Tina Sturgill, Araceli Wilson.

Medical City Lewisville: Brittni Barnhardt, Laurie Beall, Theresa Beebe, Shanna Boettcher, Jamie Hancock, Paula Hannah, Jonathan Kim, Kathy Lock, Anna Ounanian, Adam Whitman, Rita Whitney, Laura Woodward, Jennifer Wootoon.

Medical City McKinney: Brenda Cannedy, Ann Dutze, Amanda Faggart, Carlene Headley-Obansa, Gary Huey, Edward Lee, Mark Lisonbee, Mike Mixon, Laura Nix, Cassidi Roberts.

Medical City North Hills: Celia Beach, Kim Beauchamp, Laura Burch, Phillip Fabian, Cherry Gardner, Amanda Gatlin, William Harn, Lizzie Howard, Sharon Ingram, Cynthia Kell, Crystal Lewis, Kirk Lyman, Scott Muchow, Dorrie Murray, Sandy Routly, Tracey Smithson, Carleen Stout, Monte Sutton, Emily Taton, Patty Teichmann, Denise Torres, Eunice Valai, Damia Ware, Jodi Webster, Morgan Williams.

Medical City Plano: Lizy Abraham, Michelle Hooks, April Kimbell, Stephanie Koonz, Tabitha South.


Congratulations to our 2016 winners and to all our nominees for 2017!

Medical City Healthcare nurses excel in the traits required for this tremendous honor and distinction. Medical City Healthcare nurses exemplify role modeling, leadership, community service, and compassionate caregiving. They are making significant contributions within their profession and across our organization.


“I find joy during the care [of patients] because when you care for a patient you will now always be a part of that patient’s life and they will also always be

a part of my life.” – Iris Escario, RN,


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“My joy is having the autonomy to use my nursing judgment in numerous situations which allows

me the ability to see the difference I make in a patient’s life whether it be physically, spiritually or emotionally. Knowing that together in nursing we are able to provide the community safe and

patient centered care. We work as nurses because we have a calling for this profession. The quality of care I deliver, my principles and values do not turn

off at the end of the shift when I walk out the door. They are with me at all times, wherever I am. Having worked here for 37 years I can honestly state that

I have come full circle with my nursing career. HCA has allowed me to fulfill every dream I have wanted in nursing. They have helped me grow in many ways

and achieve heights I never thought were possible. At Medical City Denton, our administrative team is our foundation and it is solid. I see great things

happening in our future. Seeing all departments working together, and building for the future, allows us to move mountains and we have

and we will continue to do so. This is what makes us great and allows us to deliver excellence in care always.”

– Barbara Shaw-Harris, BSN, RN, Same Day Surgery, Medical City Denton

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