Provide one example, with supporting evidence, of a nurse leader's advocacy that resulted in the allocation of resources to support an organizational goal. AND Provide one example, with supporting evidence of a clinical nurse's (or clinical nurses') advocacy that resulted in the allocation of resources to support nursing unit goal.
Example 1 Critical Care Nursing Director advocates for a change to the Electronic Health Record
Nursing leaders at FF Thompson develop goals at departmental level based on the System Strategic Goals and Objectives. The resources necessary to achieve goals are frequently evaluated and nurse leaders advocate for specific changes in resources needed to attain their goals. This ongoing evaluation includes feedback from clinical nurses and other members of the healthcare team.
The strategic plan sets forth the organizational goals.
Goals:
The quality goal has an objective:
Exhibit TL2.1
Exhibit TL2.1 Strategic Plan.pdf
The front door to the organization is the Emergency Department for over 80% of our patients and this department has been tasked with improving the "front end" processes for patient flow. In the summer of 2012 the electronic medical record vendor changed to McKesson Paragon. This change was necessary for the organization to meet the requirements set forth in the American Recovery and Reinvestment Act 2009 which included the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH sets forth the criteria necessary to meet specific targets, known as Meaningful Use criteria. The McKesson Paragon suite did not include an Emergency Department specific module although at the time of purchase it was expected that this module would be available in the near future. The Emergency Department was therefore not able to fully transition to the new electronic medical record (EMR). A compromise was reached whereby the patient would be registered in Paragon and nurses enter their medications, allergies, past medical history and initial vital signs into this system. The providers would use computer provider order entry (CPOE) via McKesson Webstation for Physicians. The remainder of the emergency department documentation would stay in T-System, the existing electronic record.
On October 30th, 2013, a meeting was held to review the risks and benefits of either system when used alone in the Emergency Department. This meeting included nursing and provider leadership from the Emergency Department, the IT department, and Nursing Informatics.
A presentation was made to the executive team on November 11th, 2013. Nursing and provider leadership was present to support and advocate for the decision to use T-System as the primary EMR for the Emergency Department. After discussion about flow of patients, patient safety, and associate satisfaction, it was determined to go forward with T-System as the primary EMR for the Emergency Department pending approval by the clinical nursing staff as well as clinical providers. On November 20th, 2013 an online webinar was organized by Emergency Nursing Leadership for T-System to demonstrate the features and capabilities of the latest version of the product. Staff had the opportunity to ask questions about the product and see the possible uses for the Emergency Department. A similar evaluation was asked of from McKesson, but they did not have the availability to provide this. A decision matrix was handed out to the staff to evaluate both a T-System solution and a McKesson solution. The clinical staff overwhelmingly confirmed leadership's decision to use T-System. To accomplish this transition, a full time clinical nurse was allocated to the project from February 2014 through the end of the project to work on development and testing of the T-System. Her clinical hours were filled by the use of per diem nurses while she was allocated to this project. The final implementation of the project has occurred in two phases, the first was an upgrade to the latest version of T-system and this took place on July 14, 2014 and the final piece is the implementation of CPOE through T-System and this occurred on September 9th, 2014.
Example 2 Clinical Nurse advocates for additional equipment to support Core Measures VTE prophylaxis for Stroke patients
In 2013 an increased focus on the inpatient nursing units involved VTE prophylaxis, especially in the care of stroke patients. This conforms to established best practice, and is tracked and trended through core measures. Concurrently, the average daily census on the medical/surgical units was increasing. As a result, the inpatient units did not have an adequate number of pumps for the Sequential Compression Devices (SCDs).
In a June 2013 staff meeting, the staff nurses raised the issue of the inadequate number of pumps. The Director of Medical-Surgical Nursing, Elizabeth Alexander, MS, RN, CN-E agreed to follow-up and garner more pumps.
Materials Management Director Thomas Weibel was engaged to discuss the availability of additional product. The trialing of a new SCD product was discussed. Meetings were held with the vendor and in September of 2013 a trial of the new pump was held. Overall feedback from the staff was positive and the decision to change vendors was made. Based on the increase in inpatient census the number of pumps was increased from 50 to 75.
The process for storing and cleaning the pumps was also evaluated. Previously, the pumps were cleaned in Sterile Reprocessing and stored in Surgical Services where they were available for post-operative patients. After hours they were not easily accessible to the inpatient units, resulting in decreased compliance with the core measure. Going forward, the pumps were assigned to each unit based on need, and were cleaned on the unit after each patient use.
Since the changes have been made, compliance with core measures has improved and associates no longer need to spend time searching for equipment.