Notable Nursing: Update, February 2013

Nurses Learn from Real-Life Patient Scenarios

“The demons are coming! They’re getting me!” Those disturbing lines–part of a simulated 911 call–kicked off the general session of the 17th Annual Critical Nurse Symposium sponsored by Cleveland Clinic’s Fairview Hospital last fall. The session featured a dramatized patient scenario, following a woman from her frantic call, to her ambulance ride, emergency department visit, ICU stay and eventual discharge. Nearly 100 critical care nurses in attendance directed the care shown on stage using an audience response system.

“We wanted to think outside the box and employ experiential learning,” says Nichole Kelsey, BSN, RN, Clinical Instructor at Cleveland Clinic. “When you create an experience around a learning objective, it gives adults a frame of reference to remember the information.” The audience answered six multiple-choice questions using hand-held clickers. The first question came after the emergency call, when the patient provided her background history in a short aside to the audience, then asked, “What do you think is wrong with me?”

Follow-up questions asked about use of restraints and sedation for the patient, who had ingested bath salts—a family of designer drugs. The interactive session relayed important information about bath salts, the Richmond Agitation Sedation Scale (RASS), the teach-back method and more.

“I can sit through classes and remember a little bit,” says Scott Linebaugh, BSN, RN, Nurse Manager of the ICU at Cleveland Clinic’s Hillcrest Hospital. “But I remember every detail of interactive sessions like the bath salt scenario.” Linebaugh attended the symposium with four nurses from his unit.

Breakout sessions at the Critical Nurse Symposium were also interactive. Six included hands-on patient scenarios using human patient simulation mannequins with realistic pulmonary, cardiovascular, metabolic and neurologic systems.

“We really wanted to make this an event every attendee would remember,” says Kelsey. “I truly believe we accomplished that.”

The Path to Excellence at One Community Hospital

In December, Cleveland Clinic’s South Pointe Hospital achieved the Pathway to Excellence® designation from the American Nurses Credentialing Center, becoming one of just two hospitals in Ohio to earn the distinction. Cleveland Clinic’s Lakewood Hospital was recognized for its positive practice environment in 2010.

“When we achieved this designation, our bedside nurses all felt so rewarded and recognized,” says Barbara Elliott, MSN, RN, Nursing Quality Coordinator at South Pointe Hospital. “It shows that what nurses do every day–the quality, teamwork and compassion–is valued.”

Healthcare organizations seeking the designation must meet 12 practice standards essential to an ideal nursing environment and undergo a thorough review process by the Commission on Pathway to Excellence. The standards stress a safe work environment, nursing orientation programs, professional development opportunities and more.

South Pointe Hospital received exemplar recognition for Practice Standard No. 8: “Nurses are recognized for achievements.” In 2009, the hospital’s Recruitment, Retention & Recognition Shared Governance Committee instituted a Rookie Nurse Breakfast to recognize nurses with one year of experience or less. “That first year of nursing can be tough,” says Elliott. “We want to support new nurses.”

A big part of earning the designation was completion of the required online survey by the hospital’s 420 nurses. “What we included in the documentation tells our story, but if scores from the online survey didn’t verify what we wrote, we wouldn’t have earned Pathway designation,” Elliott explains.

Prior to earning its designation, South Pointe Hospital spent one year preparing and pulling evidence together and another year writing documentation. Elliott offers three tips for hospitals seeking the designation:

  1. Get buy-in from leadership. It’s an investment of time and money, so management must support the project. South Pointe Hospital had outstanding support from Sheila Miller, MBA, MSN, RN, Chief Nursing Officer, and Kiran Rai MSN, RN NE-BC, Director of Nursing.
  2. Create Pathway to Excellence teams. To facilitate the project South Pointe Hospital implemented a steering committee and Pathway teams for all 12 standards.
  3. Prepare staff nurses. “We had to educate our nurses about Pathway to Excellence, what the standards mean and how they achieve these standards every day,” says Elliott. The hospital used a multi-faceted approach to educate nurses. Methods included an online module as well as face-to-face meetings led by Pathway to Excellence teams with all units and shifts. “It was extremely important for us to get to every single nurse and explain what the designation means to them,” says Elliott.

The work paid off. Says Elliott, “The most impressive outcome we’ve realized from this achievement is that the dedication and compassion our nurses live every day in their practice is outwardly demonstrated to all members of the profession, patients, families and the community.”

Nursing Research on the Rise at Euclid Hospital

In 2009, Cleveland Clinic’s Euclid Hospital formed a Research and Evidence Based Practice Council for nursing professionals. “We wanted to develop a professional culture for nurses and provide an understanding of what research and evidence-based practice entails,” says Vickie Gardner, BSN, RN, Coordinator, Nursing Quality & Accreditation at Euclid Hospital. “Research is important because it empowers nurses to understand their practice and question the unknown. It compels nurses to ask, ‘Is this really a best practice, or is there a better way?’”

The council’s 12 members–including frontline and outpatient nurses, a nurse practitioner and a pharmacist–meet monthly. Last year, Jeanne Sorrell, PhD, RNPH, Senior Nurse Researcher from Cleveland Clinic’s Main Campus, joined the council as a liaison to provide guidance. In its short history, the Research and Evidence Based Practice Council has made quite an impact. Here are a few of its accomplishments:

  • Educational Workshops—In 2012, the council held two four-hour workshops introducing nurses to research. Guest speakers shared how to formulate a research question, develop research project proposals, translate evidence, use research software and more. Approximately 20 nurses attended each workshop and received CEUs for the sessions. “Feedback was positive,” says Gardner. “Nurses felt the topics were relevant to their practice and helped guide them on how to start their own projects.”
  • Research Projects—In the past 18 months, nurses at Euclid Hospital have implemented six IRB-approved research projects. Topics range from nursing compliance with Foley catheter securement devices to factors associated with venous thromboembolism in critical care and surgical patients. The most recent undertaking, examining quality care for older adults in acute care settings, is the hospital’s first qualitative research project with a nurse as primary investigator.
  • National Conference Participation—Euclid Hospital nurses are gaining national recognition for their efforts. A poster presentation was on display at the 8th Annual Conference of the American Association of Heart Failure Nurses last June in Chicago, and an abstract was accepted to the upcoming 12th National Conference on Anticoagulant Therapy in Phoenix.

“We are constantly amazed at council meetings,” says Gardner. “We had no idea nurses were doing this kind of work, and they do it every day. It’s exciting to see!”