Mountain States Health Alliance Forces of Magnetism:

Celebrating our Strengths

 Force 1: Quality of Nursing Leadership

• Oncology Nursing Society – involvement of JCMC
• Nursing Leadership Academies
• Strong emphasis on certification (Orthopedic, Med-Surg, Oncology, OR, PACU, ED Critical Care, etc.)
• Unit meeting minutes reflect pillars and organizational Quality Measures

 Force 2: Organizational Structure

• Partnership – use of Mountain States Perioperative Council, Practice Council, Front line staff, Front line staff decision making
• Partnership with Rehab and JCMC
• Recognition that nursing covers many areas – involvement of all parties, not just nursing zones

 Force 3: Management Style

• TCAB
• Shared governance model
• VAP rounds, PICC rounds, Assistant Clinical Leaders
• Niswonger Children’s Hospital facility activation/planning teams
• SSU meetings (monthly) – leadership present as well as other departments
• Nurse Residency, Nurse Intern classes, Advisory Board, Senior Management Students

 Force 4: Personnel Policies and Program

• HR focus groups
• Certification
• Orientation program for new Team Members
• Smart Square
• Cross-trained staff for Women’s/Children’s competencies
• BEST program
• Clinical policy and procedures committee
• 30-60-90 review new hire (to start)
• Synergy model as basis for BEST Nurse Program used in critical care course
• Core staffing model based on facility needs (criteria for ICU/PCU/Med Surg staffing)

 Force 5: Professional Models of Care

• 2600 and monitor station – self scheduling (staggered)
• AICU – self scheduling
• Flex scheduling in joint center based on OR schedule/LOS
• Use of LPNs in NICU & CWH
• Jean Watson’s Caring Theory
• ED Flexible schedules for school, staggered shift for flow of patients

 Force 6: Quality of Care

• Quality awards support all the work directed
• Implemented Q1 rounding
• Literature search required for policies & procedures
• Research and EVP
• IRB through ETSU
• TIPS (TN Intervention for Pregnant Smokers) CWH
• CSR/Tracers
• Research Council
• Universal Protocol
• Vermont Oxford Database– NICU
• Surviving Sepsis Team
• 5400 Vent rounds (interdisciplinary)
• Direct Admit CAP team
• implementation of H Works project team – admissions
• Bariatric Center of Excellence
• Central Line
• ETSU CON faculty partnering with Team Members regarding research projects and are members of Research
• Mobility efforts in ICU/VAP prevention and pressure ulcers – additional bedside staff to help move initiative
• Research conference, 3rd annual — Newly formed research department
• Electronic database subscriptions and Internet access at the bedside

• Rapid Response Team—Quality Award 2007
• Nurse based urinary catheter elimination
• Trauma program
• Staff hourly rounding
• No pass call light zones (2200 & 2400)
• NaviCare to regulate patient flow
• CSR/tracers
• Direct admit CAP team
• Multidisciplinary rounds on ventilator patients – 5400
• APACHE database for ICU
• Clinical policies and procedures committee
• Massive transfusion policy – ED
• Chest pain and stroke center development and implementation
• Advancement Education for Ortho/Neuro/Trauma
• Work with pre-hospital to improve/identify special patient groups (Sepsis, TBI, Arrest, Trauma Protocol)
• Universal Protocol – initial implementation in the OR – now going house-wide

• Palliative Care Team
• ICU clinical educator CNS for SSUs
• Provide evidence-based reference to improve practice and collaborative between disciplines
• Promotion for APNs/CNS for consultation and front line nurse support
• Mountain States Perioperative Council, which includes experts from all facilities and bases decisions on JC and AORN guidelines/standards

• Nurse-driven – surviving sepsis – glucose control – ISTAT – Rapid Response – VAP – CLBSI – ICU – Hospital-wide – TCAB
• Immunization Protocol, CAP
• Practice/Quality Councils
• Bed placement and staffing office
• Nursing Quality Awards
• Evidence-Based Practice

• Stroke Education for community and outlying agencies
• Reach to Recovery
• Relationships
• HRC, Wellness Center
• Parental outreach programs
• Cardiac Rehab offering free classes
• Komen activities
• Relay for Life
• Pre/post op classes and support groups for gastric bypass
• AHA heart walk
• Women’s Heart Initiatives
• Safe Kids Coalition
• ED/Trauma
• TVC – program partnership/Joint Replacement Center (Pre-op class, Hip/Knee pain classes, etc.)
• Work with local schools – nursing, paramedic, med school, respiratory with clinical experience and teaching in the OR
• Children’s Hospital programs – education at health fairs/in schools, etc. CPS
• MOD collaboration/team walks/support groups, health watch news programs

• Injury prevention programs – trauma services
• Exit care discharge instructions
• Pre-op open heart class offered to the community
• Nurse education "traveling cart" to reduce time nurse has to leave the bedside
• Nurse Intern Program
• Specific nurse residency program development (NICU, Pediatrics/PICU/ obstetrics)
• Joint/spine community education programs
• Child passenger safety
• Prenatal education
• Bariatric community forums
• Use of other CNS, educators to in-service for presentations at Regional and National Conferences
• Departmental In-service
• Preceptor Development
• Certification promotion for population specific education (NRP, PALS, CCRN, AWONNFM)

• CEO Monday Letter recognition
• CNS contribution to clinical initiatives/outcomes
• QS – CWH
• Promotion of nurses into leadership roles
• "Thank you for being a nurse" commercials
• Bereavement Packet – CWH, NICU
• Caring model/anticipate need for patient centered care
• Assistance and resources to help publish our accomplishments
• Opportunity – establish "nursing excellence" award to recognize and promote excellent nurses
• Team Member monthly recognition and role expander for various nursing positions

• ICU multidisciplinary daily goal rounding
• Interdisciplinary Fall Team
• Traumatic Brain Injury Workgroup (multi-disciplinary)
• NICU FAP & PICC rounds
• Falls Task Force
• Quarterly AICU/NICU/PICU critical care meeting and discussions of integration
• Nurse/anesthesia/CRNA/surgeon joint meeting to express goals
• Stroke rounding – multidisciplinary – requirements for critical stroke program
• Referral feedback form, CWH, NICU, Pediatrics, PICU
• IHI Perinatal Project (Quality Award)
• Bimonthly NICU interdisciplinary meetings for overall patient population care/process
• ED multidisciplinary team meetings (Nursing and both physician groups)
• Multidisciplinary facilitation of process change to increase patient safety through standardization of pediatric crash carts
• Bimonthly NICU interdisciplinary meetings for overall patient population care/process

• MSHA University
• Leadership Academy
• Nurse Residency Program Tuition Reimbursement
• Nurses serving as clinical faculty
• Promotion of courses listed
• Nurse intern programs
• Advisory Board
• Certification reviews
• Local ADRA chapter participation
• Records in TEDS
• Paper rosters
• Oncology services – Chemotherapy & Biotherapy class – National standards, endorsed by ONS
• Specialty courses: Critical Care, Progressive Care, I, IV, Trauma courses, TNCC, ENPC, ATEN, ITLS, Pediatric ITLS