Below are the finalists in the Management category for the Nursing Spectrum 2009 Nursing Excellence awards. A recognition gala is planned for May 6 at the Sheraton Society Hill in Philadelphia.
Lori Betts, RN, BSN, CPN
Nurse Manager, 2A
Nemours/Alfred I. duPont Hospital for Children
Betts took on a challenge many experienced nurse leaders might have declined. The nurses on her new unit were unhappy, the nursing vacancy rate was high, physicians were frustrated and had outbursts of anger, and patients reported low satisfaction with the care provided. Over the past five years, Betts has lifted this unit to one of the best functioning units in the hospital. The most recent patient satisfaction and NDNQI scores ranked it at the top of the hospital and at the top of like units across the nation.
Currently, more than 60 of the nurses on this unit hold a BSN or higher degree, and now zero hours are supplied by agency nurses. Betts also leads by example. When she embraced nursing certification for her unit, she immediately took the necessary steps to become certified herself. For several quarters in a row in 2008, patients and families ranked this unit in the 95th percentile for patient satisfaction. Under Betts leadership, the unit implemented family-centered rounds that include the entire patient care team and the family. She is a strong advocate for her staff, while at the same time keeping what’s best in mind for the patients and families their unit serves.
Elizabeth Mil, RN, MA
Director, Critical Care Services
Capital Health System
Mils journey in nursing began in her native land of the Philippines.
After coming to the U.S. in the 1980s, Mil worked as a staff nurse and quickly was promoted to assistant nurse manager. During a brief period, she was required by immigration laws to return to the Philippines then re-emigrate to the U.S. through Florida. Her desire to promote forward movement in nursing was undaunted. After two years, she returned to her current employer and resumed her quest, this time as a critical care nurse. Mil remained connected to her roots in the Philippines and became the founder of the Pioneer Wesleyan University Nursing Organization in 1990, holding the position of president for four years. There are now five chapters in the U.S. and two in Europe. When the current nursing shortage became reality, the nominee sought and secured support from her healthcare organizations board of directors, the U.S. Department of Immigration, and the Philippine government to establish a program for the active recruitment of Filipino nurses. Rigid criteria were developed by Mil that went beyond the immigration requirements so only the cream of the crop would be hired through this collaborative approach to recruitment. The nominee has since been requested to present the recruitment program at several venues, including the Texas Asian Nurses Association. Nursing in at least two countries has experienced and/or recognized the impact of her endeavors.
In 2008, she received the Outstanding Alumni Award from Wesleyan University in the Philippines. Mil has presented posters on BIS Monitoring and CPOE, and podium presentations on CPOE locally and in New York City. She also is a student pursuing a doctoral degree, with a plan to graduate in 2010.
As a director of critical care services, she is responsible for the management of the critical care units and serves as liaison between the units, other disciplines, and hospital administration. She also has played a vital role in the achievement of Magnet designation for the healthcare insitutions.
Mil developed the internship program for telemetry, which consists of didactic and clinical experience components. The program has since been expanded to include the newly hired nurses for ICU, CCU, and the emergency departments.
In consideration of the high incidence of stroke in the surrounding communities, Mil launched a community education program for the stroke-prone population. She has engaged the public relations department in arranging for billboards, radio and TV interviews, often writing what is presented.
Christine Muldoon, RN, BSN
Thomas Jefferson University Hospital
Muldoon has taken on a huge commitment as acting nurse manager for the oncology unit and invests 100% of her time, energy, and heart in this position. Muldoon takes the time to listen to her staff no matter how busy she is, and she made a significant sacrifice in forgoing her service as a bedside nurse, something she truly loved, when she took on the permanent position of charge RN and then the position of acting nurse manager. Muldoon was instrumental in the implementation of the Caring Tray, with juice, fruit, crackers, light sandwiches, and other snacks to be delivered to patients family members during particularly stressful times, such as a new diagnosis or poor prognosis.
It was a way for nurses to show their support and concern. She has made great strides in improving staff morale by identifying issues of concern, and working with staff to come up with practical solutions. For example, Muldoon empowered the facilitys unit-based committees to take control of their work environment through measures such as implementing self-scheduling, administering a survey for schedule satisfaction, and providing increased decision-making opportunities for Professional Development Committee members.
Muldoon assisted with the development of the Multicultural Diversity Nurse Resource Group by supporting and encouraging staff nurses on our unit to take on the role of chairperson. She also was critical in the units development of the Caring Committee, whose members send sympathy cards to patients families upon the death of their loved ones. Sharing her significant clinical experience, Muldoon teaches a chemotherapy and biotherapy course. Advancing the practice of nursing, she facilitated the professional staffs ability to attend the recent Oncology Nursing Societys National Congress in Philadelphia. Through her efforts, nearly 75% of the staff was provided the opportunity to attend the event.
Christine Ranjo, RN, BSN, NE-BC
Hospital of the University of Pennsylvania
As nurse manager for a progressive CICU, Ranjo has demonstrated high standards for quality patient outcomes and collegiality.
The unit was established in July 2004 when it was necessary to increase capacity for inpatient care to accommodate a growing number of patients requiring intensive and often extended cardiac care. Ranjo was highly influential in designing the workplace environment, expanding the front-line care workforce, and cultivating effective partnerships with physicians and other healthcare professionals to effectively and safely meet patient care demands. She also worked on plans for the recent expansion from 30 to 48 beds. She is highly regarded by her peers, staff, hospital and nurse administrators, physicians, and other professionals for her leadership acumen, and respected for her resolve in undertaking numerous challenges and devotion to patients, all for quality patient care. Her unit sustained the second-lowest turnover rate in medical nursing, 1.7% year to date, with a zero vacancy rate.
She is first and foremost an experienced bedside nurse with excellent clinical decision-making as well as patient and family relationship skills.
One coworker said Ranjo was visible to her staff and especially shined during codes when her experience helped the patients and provided a confidence boost to less experienced nurses. She often took these stressful situations and turned them into teaching opportunities by asking questions and giving helpful hints.
Ranjos leadership has helped the unit rank second in mean overall patient satisfaction.
She engaged staff in conducting journal clubs to offer 12 CEUs per year.
If clinical nurses need help, she is there. One RN said Ranjo helped her transfer a patient so the bed could be turned over quickly for a critically ill patient. Another time, she covered patients while the RN was busy with a critically ill patient.
Another nurse said when a young man that nurses on the unit had cared for over several years died, Ranjo provided extra staff and drove nursess, four at a time, to stay for a half hour at the funeral. The deceased patients mother felt that her son had made a difference to each of us, and Ranjo made that possible.
Patricia Sanchez, RN
Nurse Manager, Medical Acute Care Unit
South Jersey Healthcare
Since accepting the position of manager of the 37-bed medical acute care unit in 2006, Sanchez has improved patient care outcomes, increased patient and staff satisfaction, and has made a substantial impact on the fiscal stewardship of the organization. With data showing a rising fall rate on the unit, Sanchez established and mentored a staff nurse-driven task force to address patient falls and fall prevention. Realizing the responsibilities staff nurses have and the limited personnel available, Sanchez developed a new position, the Safety Aid, utilizing existing staff who focus exclusively on patient safety.
Through data analysis and staff input, Sanchez realized many falls were related to the patients perceptions that they were inconveniencing the nurse or were not in need of assistance to ambulate, despite the new environment, medications, and instructions given. The Safety Aids position focuses on relationship and trust building with patients, so they can feel their safety is a priority and can initiate and accept assistance. The fall rate on the unit has decreased by 66%. She also developed and mentored a new role to care for peritoneal dialysis patients, the PD champion. This program resulted in a decreased length of stay for these patients, a decrease in the recidivism rate of PD patients, an increase in patient satisfaction, and a decrease in the fiscal impact of PD care. By thinking outside the box, Sanchez has extended the concept of ICU rounding to patient satisfaction rounds, which pairs nurses and ancillary staff with a patient relations specialist to round daily on every patient. This program has met with an unexpected level of success and is now campus-wide. It will be extended to the other campuses in the near future.
The nominee also developed the Ticket to Ride program, which requires all staff transporting patients to various diagnostic tests and therapies to have a document that verifies the patient and the test/therapy, the department, the fall risk, and any necessary isolation precautions. This form is brought by the transport staff to the nurse caring for the patient for review and signature before the patient is released. The nurse also is responsible for reviewing this information with the patient for validation. The transport staff then presents this ticket to ride to the receiving staff for review and signature. In this way, all staff caring for the individual patient is aware of his or her needs, so the staff members are able to provide the best possible car. This program began as a pilot on the unit and was rapidly rolled out system-wide.
One coworker describes Sanchez as the Pied Piper of SJH. When she is on a task force or committee, everyone wants to be a part of it.