Provide one example, with supporting evidence, of nurses' participation in a professional development activity that demonstrated an improvement in knowledge, skills, and/or practices for professional registered nurses. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
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Provide one example, with supporting evidence, of nurses' participation in a professional development activity that was associated with an improvement in a patient care outcome. Supporting evidence must be submitted in the form of a graph with a data table that clearly displays the data.
Example One: Participation in a professional development activity that demonstrated an improvement in knowledge, skills, and/or practices for professional registered nurses.
Background FF Thompson Hospital is a Pennsylvania State Nurses Association (PSNA) continuing education provider which allows the organization to create either hospital or unit-specific continuing education units (CEU’s) and offer them to the nursing staff free of charge. The CEUs can be designed in a multitude of ways, providing flexible education for day, night, evening, part time, and per diem nurses, increasing their knowledge base, skills, and practice related to their specific unit. Some examples of the opportunities offered to the nursing staff include: Grand Rounds, Preceptor Courses, BLS, ACLS, Stroke Training, CMS Core Measures, and Care of the Orthopedic Patient. Utilizing the PSNA CEU process, FF Thompson Hospital can provide continuing professional development activities that provide active participation and promote lifelong education to the nursing staff. Providing continuing professional development adds to nurses' core and experimental learning processes, and ultimately provide an increase in patient safety. An example of a professional activity that resulted in an improvement in knowledge and skills is evidenced by the Telemetry Course that is offered within the hospital. Problem An educational assessment survey in 2010 that 78% of nurses on 2 West were not telemetry credentialed. This put a strain on the charge nurses who were constantly watching the telemetry monitors, and made taking scheduled breaks difficult, as there were not enough telemetry competent staff to safely monitor the patients. With the onboarding of the new nurse educator in 2011, Adrian Hordon, MSN RN, created a new Basic Dysrhythmia/Telemetry Course that combined the use of computer modules, videos, moderate fidelity simulation, and hands-on skills stations to increase the nurses knowledge base regarding dysrhythmias. As an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (PSNA), the course provided the nurse 15.6 CEUs upon successful completion, which entails a written test worth 206.5 points, and a live rhythm identification simulation which requires the nurse to correctly identify 15/15 common and potentially lethal arrhythmias. It was identified through the educational assessment survey that the 16 hour course would be best attended by breaking the course out over four weeks, four hours each week. Goal Statement Increase the number of credentialed telemetry-eligible registered nurses on 2 West and 3 West to 75% by 2013 Participants Adrian Hordon, MSN RN, Clinical Nurse Educator and Magnet Project Director, Nursing Administration, Patient Care Services
March 2011 Catherine Heeb, RN, Clinical Nurse 2 West Medical Surgical Unit, Department of Nursing Christopher Tavano, RN, Clinical Nurse 2 West Medical Surgical Unit, Department of Nursing Deborah Jones, BSN, RNC-OB, C-EFM, PLNC, Director of Obstetrical Nursing, Nursing Administration, Patient Care Services Kimberly Campbell, RN, Clinical Nurse, 2 West Medical Unit, Department of Nursing Megan Didas, BSN, RN, Emergency Department, Department of Nursing Melanie Martin, BSN, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Stephanie Friel, RN, Charge Clinical Nurse, 3 East Surgical Unit, Department of Nursing Stephanie K. Lipp, RN, Clinical Nurse, 3 East Surgical Unit,Department of Nursing Tina Hopkins, BSN, RN, Clinical Nurse, 3 East Surgical Unit, Department of Nursing July 2011 David Wasson, Patient Care Tech (PCT), Emergency Department, Department of Nursing Amber Fulmer, BSN, RN, Charge Clinical Nurse, 3 West Medical Unit, Department of Nursing Jonathan Borisuk, RN, Clinical Nurse 2 West Medical Surgical Unit, Department of Nursing Ragan Stevens, RN, SANE, Clinical Nurse, 3 West Medical Unit, Department of Nursing Sherman Curry, PCT, 3 East Medical Surgical Unit, Department of Nursing Tiffany Shantz, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Whitney Barrett, BSN, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing April 2012 Connie Kraft, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Emily Georger, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Gail Dickinson, Respiratory Therapist, Respiratory Therapy, Department of Nursing
Jennifer Michaud, RN, Clinical Nurse, 2 West, Medical Surgical Unit, Department of Nursing Laura Hampton, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Lisa Gaby, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Marilyn Schlehr, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Stacy Smith, BSN, Clinical Nurse,2 West Medical Surgical Unit, Department of Nursing Suzanne Holtz, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing
July 2012
Jaime Rosman, PCT, 3 West Medical Unit, Department of Nursing Tree Otero, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Mike Maslanik, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Susan McCormick, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Sandra Phelps, Cardiology Technician, Cardiology, Department of Nursing October 2012 Catherine Henry, RN, Clinical Nurse,3 West Medical Unit, Department of Nursing Janelle Stratton, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Lisa Gaby, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Megan Blums, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Nicole Simon, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Mark Herdman, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing February 2013 Amanda Castle, RN, Clinical Nurse, Emergency Department, Department of Nursing Austin Hagel, Cardiology Technician, Cardiology, Department of Nursing Elke Mayer, Cardiology Technician, Cardiology, Department of Nursing Juliane Shafer, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Melissa Mandurano, PCT, Emergency Department, Department of Nursing Thomas Everetts, BSN, RN, Director of Emergency Nursing, Nursing Administration, Patient Care Services
October 2013 Annmarie Lippa, BSN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Brandon Jackel, RN, Clinical Nurse, 2 West Medical Surgical Unit Department of Nursing Christine Lyon, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Emily Upham, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Frances Barber, PCT, Emergency Department, Department of Nursing Jeremy Herniman, Physical Therapist, Sports Medicine Kelly Thorla, RN, Clinical Nurse, 2 West Medical Surgical Unit Department of Nursing Khristeen Sproul, RN, Clinical Nurse, Emergency Department, Department of Nursing Lauren Baker, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Madelyn Houghtaling, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Meggin Duchesneau, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Michele Vonglis, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Peter Leboo, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Samantha Letendre, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Tammie Capriotti, RN, Clinical Nurse, 2 West Medical Surgical Unit, Department of Nursing Tammy Ruckle, RN, Clinical Nurse, 3 West Medical Unit, Department of Nursing May 2014 Alexandra Libby, BSN, Clinical Nurse, 3 West Medical Unit, Department of Nursing Christina Meissel, RN, Clinical Nurse, 2 West Medical Surgical, Unit Department of Nursing Jim Busch, RN, Clinical Nurse, Intensive Care Unit (ICU), Department of Nursing Lorene Martin, RN, Clinical Nurse, ICU, Department of Nursing Sarah Reinhardt, RN, Clinical Nurse, 3 East Medical Surgical Unit, Department of Nursing Stacey Krossber, RN, Clinical Nurse, 2 West Medical Surgical Unit Department of Nursing Outcome In 2011, 13 RNs completed the four-day comprehensive course, with a 100% pass rate. On post-course surveys, 92% of those that completed the course felt confident they could recognize lethal arrhythmias, 85% felt they could identify a change in a patient’s rhythm, providing increased nursing knowledge and quicker response time to a change in patient condition related to telemetry readings. With the success of the telemetry course, the number of RNs working on telemetry units to complete the training in 2012 increased to 50% (2 west) and 77% (3 West) and 2013 increased to 79% (2 West) and 81% (3 West) respectively, with a goal of 100% eligible nurses credentialed in 2014. The popularity of the Telemetry Course grew, and many nurses on non-telemetry units attended the course before taking ACLS to better understand the functionality of the heart and rhythm identification. Many unlicensed assistive personnel (UAPs) enrolled in RN programs also attended the course to gain a better understanding of the conductive pathway of the heart. For any new RN hired into the ED, ICU, or Telemetry unit, it is now a requirement to complete the telemetry course that is offered biannually within six months of hire.
Data Requirements
Example Two:
Professional Development activity to improve patient outcomes
Background: Our Professional Practice model is the Synergy model of care. Synergy is based on the premise that the characteristics of the patient and the nurse unite to create a synergistic relationship that results in optimal patient outcomes. Professional development activities associated with the Professional Practice model include clinical inquiry, collaboration, facilitation of learning and systems thinking. In the Synergy model, each patient is unique and brings a set of characteristics to each health care situation.
• Stability • Complexity • Vulnerability • Predictability • Resiliency • Participation in decision-making • Participation in care • Resource availability
The nursing components of Synergy are:
• Clinical judgment • Clinical Inquiry • Caring practices • Advocacy/moral agency • Facilitation of learning • Collaboration • Systems thinking
Patient safety initiatives and Hospital Acquired Infections (HAI) are tracked and trended monthly through our Quality and Safety Committee. If fall-outs are identified action planning takes place outside of these meetings in the area the issue is identified is occurring with appropriate feedback. Problem Central line associated blood stream infections (CLABSI) occurs when bacteria enters the blood through a central line catheter. 41,000 CLABSI occur every year (CDC 2011) and can cost as much as $40,000 per incident (Leap Frog Group 2011). With an associated mortality of 12-25% (CDC MMWR 3/2011). In the 4th quarter 2012 and 1st quarter 2013 3 West, a Telemetry/primarily Medical floor had 3 CLABSIs. In the previous 14 months they had not had any. Through a collaboration with Infection Prevention a Root Cause Analysis was completed and interventions were put into place. Goal Statement Reduction in the rate of CLABSI to 0%. This was strategically in-line with Thompson Health's goal of zero Hospital Acquired Infections.
Data was obtained through Infection Prevention surveillance and data submission through NDNQI. Data requirements Participants Kathy Wethington, RN, CMSRN, Clinical Nurse, 3 West, Medical Surgical Unit, Department of Nursing Kiera Kuhn, MS-HQS BSN, RN, Director of Quality, Safety and Utilization Management, Patient Safety Officer, Quality Department Gloria Carr, MSN, RN, CIC, RN-BC, Director of Infection Control and Emergency Preparedness, System Administration Amber Fulmer, BSN, RN-BC, Charge Nurse 3 West, Medical Surgical Unit, Department of Nursing Jessica Schojan, RN, Charge Nurse 3 West, Medical Surgical Unit, Department of Nursing Elizabeth Alexander, MSN, RN, CN-E, Director of Medical Surgical Nursing, Patient Care Services Interventions: A Root Cause Analysis was conducted in the 1st Quarter 2013 and several areas of improvement were identified. One PICC line was left in for 28 days with no reassessment if the line needed to be continued. Furthermore, there were opportunities identified regarding proper hygiene and better documentation of central line care. Also, there was confusion from the nursing staff (RN's and PCT's) as to what constitutes a central line. The following interventions were put into place in the 2nd Quarter 2013:
Exhibit SE4EO.3
SE4EO, Clinical Care Station.png
Outcome Since the above interventions were put into place 3 West has gone 5 quarters with no CLABSI. There are regular audits of the documentation to ensure ongoing compliance and daily the number of central lines is reviewed by the clinical nurse and Charge Nurse to identify potential patients whose central lines can be discontinued. Nurses are also encouraged to review the Weekly Harm Report that is sent out through hospital-wide email to show transparency of nursing efforts to prevent hospital-accumulated infection (Exhibit SE4EO.3)
Exhibit SE4EO.1
Exhibit SE4EO.1 Central Line In Use.pdf
Exhibit SE4EO.2
Exhibit SE4EO.3 Exhibit SE4EO.3 Weekly Harm Report 8-15-14 with Year-To-Date Data