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
 Force 7: Quality Improvement
  • 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
 Force 8: Consultation & Resource
  • 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
 Force 9: Autonomy
  • 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
 Force 10: Community & the Healthcare Organization
  • 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
 Force 11: Nurses as Teachers
  • 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)
 Force 12: Image of Nursing
  • 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
 Force 13: Interdisciplinary Relationships
  • 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
 Force 14: Professional Development
  • 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