Provide one example, with supporting evidence, of communication between the clinical nurse(s) and the CNO that led to a change in the nurse practice environment.
OR
Provide one example, with supporting evidence, of communication between the clinical nurse(s) and the CNO that led to a change in the patient experience.
Provide one example, with supporting evidence, of communication between the clinical nurse(s) and the CNO that influenced a change in nursing practice.
Hazel Robertshaw, VP Patient Care Service/CNO uses multiple strategies to enhance communication with nurses throughout the organization. These strategies include:
As the CNO, Hazel plays a key role in fostering open communication horizontally and vertically to facilitate effective decision-making among all stakeholders. The levels of nursing at Thompson include the Executive Nursing Team (CNO, nurse managers, supervisors, the CNLs, the Nursing Informatics Specialist and the patient educator).
The CNO meets with the nursing directors and the her other direct reports on a monthly basis and more frequently as needed. In these meetings, team members discuss progress towards goals identified on their operations plans and any barriers to implementation. Strategies are discussed to enhance progress towards goal achievement. Personal and professional development plans are also discussed as applicable.
Shared Governance is the main vehicle for ensuring that all levels of nurses are involved in decision making at Thompson. In our nursing shared governance structure, the Nursing Practice Council facilitates the implementation of shared governance decisions. Nursing Practice Council membership includes clinical nurses, nursing directors, the Clinical Nurse Leaders, Informatics Nurse Specialist, Clinical Educator/Magnet Project Director and the CNO. All levels of nursing are represented on this council and this facilitates allocation of the human, fiscal and technology resources needed to support collective council decisions.
In addition to Shared Governance activities, Hazel rounds on the units on a regular basis. As part of the Executive team commitment she rounds in the evenings regularly and one weekend shift every 5-6 weeks to ensure that she is visible and available to staff working the off shifts, as do all members of the Executive Team. These rounds have been helpful in identifying issues that occur out of normal working hours. The executive team members discuss these findings on a regular basis and where necessary action plans are formulated to improve the working environment for the nurses and others.
Hazel rounds informally on a regular basis. She touches base with the clinical nurses and patient care technicians to elicit any concerns they may have regarding their practice or patients.
As a result of her open communication style, issues are raised and solutions identified that affect all areas of nursing practice.
Example 1- Change in nurse practice environment as a result of clinical nurse communication with the CNO
Mirroring the Pyxis in the Emergency Department
One evening while rounding in the Emergency Department, Hazel was approached by Mary Jane (MJ) O'Neill, RN, about a challenge that she had identified. She explained that the Emergency Department has two PYXIS machines; one behind A pod and one behind B pod. (there are 4 pods in the Emergency Department and each one has 6 rooms. A and B pods are staff 24 hours per day; C and D pod are flexibly staffed to meet changes in volume). MJ explained to Hazel that there were different drugs contained in each machine and it was not uncommon for the nurses to have to go from one machine to the other to get all the medications for one patient. She had heard that on the medical surgical floors the PYXIS had been "mirrored" to have all medications available in each location. She asked Hazel if it would be possible to make this happen for the Emergency Department.
Hazel discussed the feasibility with Robert Locke, MS, RPh, Director of Pharmacy and the wheels were set in motion for the change to take place. This was a complex process that required additional funding and a new contract with Carefusion, the PYXIS vendor. The contract was signed in July 2013 and the machines were installed later in the year.
The majority of medications are now available in both PYXIS machines and this makes the work environment more efficient for the nurses working in the Emergency Department
Exhibit TL8.1 Excerpts from the emails between pharmacy, nursing and the CNO regarding the ED Pyxis machines.
From: Mary O'Neill
Sent: Tuesday, July 23, 2013 8:59 PM
To: Renee Thomas
Subject: RE: Pyxis
Awesome. I just opened up my email to send you a note about it and voila… your message was there. So these will be mirror images?
Thanks MJ
From: Renee Thomas
Sent: Tuesday, July 23, 2013 11:46 AM
To: Mary O'Neill
Cc: Stephanie Bavis
Mary – I just wanted to let you know that a contract was just signed for new ED machines! We should be receiving them sometime in late August. They would then go live sometime in September! Hooray!
Renee Thomas, RPH
Pharmacy Operations Manager
Thompson Health
350 Parrish Street
Canandaigua, NY 14424
Office (585) 396-6752
Cell (585) 919-9807
Sent: Tuesday, April 30, 2013 9:35 AM
We are in the “midst” of signing a new contract with Pyxis with URMC which will save us $$ in 2014. When that is signed, we will work on getting equipment early.
Sent: Friday, April 26, 2013 5:45 PM
Hi Renee,
Just checking in to see how things are looking for the new pixis for the ED. What I am hearing through the grapevine is encouraging. What do you know? Thanks MJ
Sent: Tuesday, March 26, 2013 3:31 PM
Subject: Pyxis
Mary :
Pyxis rep came in and gave us price on new machines that would hold over 500 meds per side at additional cost of $1000 per month. (We currently have #575 meds with approx. #500 needing mirrored). We could easily mirror the machines if they are exactly the same and held more meds.
Dept (585) 396-6750
Cell (585) 512-0063
Sent: Tuesday, March 26, 2013 10:06 AM
To: Hazel P. Robertshaw
Subject: RE: CareFusion/Pyxis quote for ED.
Hazel :
Will save time, energy, work for ED NSG. We will also be able to increase stock for ED so nurses and supervisors don’t have to run around after hours to pull things from other areas (that then do not get charged). RT meds can be separate (per JCAHO guidelines) and more narcs can be placed in larger cubbies, thereby decreasing tech time filling machines. We have proven on the floors how mirroring has improved work flow. We have also proved that when meds are not available, there is higher risk that pts do not receive the meds they need in a time, and med therapy is delayed until pt reaches floor.
We will eventually be changing over machines within a year for new upgrade. Getting a new configuration and having ED reconfigured correctly now will save time next year.
Pyxis profile is strictly a safety measure since ED does not look at orders before they give med. If it is not on profile, then they would question if the order is still active, or was it discontinued?
P Please consider the environment before you print this e-mail
From: Robert J. Locke
Sent: Monday, March 25, 2013 1:05 PM
To: Hazel P. Robertshaw; Thomas Everetts
Cc: Renee Thomas
Subject: FW: CareFusion/Pyxis quote for ED.
To the question of maximizing the ED PYXIS units, Margie has offered the following configuration change. This would allow for mirroring and increasing capacity. If we want to “PROFILE” these units it would be an additional $200+ / month.
Returned / forwarded by:
Bob Locke, R.Ph., MS
Director of Pharmacy
ThompsonHealth 585-396-6754
Example 2-Change in nursing practice as a result of clinical nurse communication with the CNO.
New safer insulin syringes
Needle stick injuries can have significant consequences for nurses. It is essential that organizations employ strategies for reducing the potential risk of these types of injury. FF Thompson Hospital has used safety devices on all syringes, IV catheters and butterfly venous access devices for many years. In 2014 we had two needles stick injuries as a result of the use of insulin syringes. As the CNO, Hazel was very concerned with this trend. At the monthly Nursing Practice Council, Hazel shared her concern with the nursing team. One of the nurses, Katherine Wethington, RN, CMSRN, identified that the design of the current insulin syringe did not include an adequate safety device (see Exhibit TL8.2). The matter was taken to the Value Analysis Team for discussion and exploration of different, safer equipment (see Exhibit TL8.3).
New insulin syringes were subsequently identified, trialed and are now in use across the organization. The new syringes have an integral safety device to prevent injury. Since implementation there have been no further insulin syringe needle stick injuries.
Exhibit TL8.2 Minutes from February Nursing Practice Council
2.
CNO/Director Discussion/Round Table/Miscellaneous
Hazel noted that there was an increase in needle sticks year to date
Hazel stated that this needed to be presented to the Value Analysis Team for further discussion and identification of alternate products.
Exhibit TL8.3 Value Analysis Team minutes
VAT Meeting Minutes.pdf