With a “Drive to Excellence,” administration and staff at St. Barnabas Hospital in the Bronx have introduced patient-centered nursing initiatives over the past nine months that focus on improving patient care and core measure outcomes as well as patient satisfaction.
“We have a focus on partnerships in everything we do here at the facility,” said Ann Marie McDonald, RN, EdD (c), CEN, director of nursing professionalism and quality. “We partner with our patients, their families, other members of the interdisciplinary team, our nurse colleagues and with students who come to St. Barnabas for clinical rotations.”
“Our patients are faced with many challenges. Given our collaborative rapport with nursing administration, we believe that we are taking more ownership in what we do as registered nurses for our patients and for our practice,” said Marcia Butler-Hurlington, RN, BSN, MSN, senior nurse in pediatrics.
As nurses and administration discuss issues and concerns with one another, they have developed a “green, yellow and red light” approach to the process. If the idea or suggestion the employee offers is something that can be developed or incorporated, it is given a green light; a work in progress is given a yellow light; and if the issue is something that cannot be implemented at that particular time, it is given a red light.
Using the Baptist Leadership Group model, senior leadership instituted and participate in inclusive town hall meetings, leadership rounding, labor management meetings and interdisciplinary committees. “Engaging our staff in the process is most important to the senior leadership team. We are able to get our message out and everyone has a voice,” said Denise Richardson, RN, MSN, vice president and CNO at St. Barnabas. “Communication and collaboration with our labor partners is vital and key to affect change.”
Early in the year, RN directors met individually with their staff to talk about staff progress and how the directors can help them in their practice and work environment. For example, after nurses identified a patient safety issue in the ICU, six cameras were installed to monitor patients even more closely.Denise Richardson, RN, vice president and CNO, left, and Marcia Butler-Hurlington, RN, senior nurse, pediatrics, right, meet with Nurse.coms Eileen P. Williamson, RN, senior vice president and CNE, at a roundtable.
“We want our processes to have structure and focus,” said Rory Sweeny McGovern, RN, EdD, director of nursing education and professional development. “We want to hear about the issues and we want everyone to be involved in what we need to change or improve.”
With the multidisciplinary team in attendance, daily white board rounds are conducted on every unit each day, in which the patients care and discharge plan is discussed.
“We use SBAR, which focuses on situation, background, assessment and recommendation, as our communication model because it is clear, concise and makes for a much safer approach to patient care,” said Arlene Laidlaw, RN, BSN, labor and delivery staff nurse. The SBAR approach will be rolled out to the entire hospital soon.
Serving as visual cues, colored magnets on the whiteboard indicate various aspects of the patients condition. “For example, a purple magnet indicates that the patients discharge is scheduled for the next day, and reminds the team to complete paperwork, disseminate 24-hour discharge notices, provide education, administer appropriate vaccines and arrange or schedule transportation,” said Lilian Habana, RN, BSN, MS, geriatrics nurse manager.
Core measures for acute myocardial infarction, congestive heart failure, pneumonia, stroke and surgical site infections also are indicated by specific colors, and services that are required by the patient after discharge, such as shelter needs and RN services are documented on the board. “During rounding, the entire team caring for the patient shares information about the patient and every discipline has an equal voice,” said Mimi Nacario, RN, MA, CCRN, NP-BC, senior nurse in the ICU, who is leading an initiative to incorporate order sets in electronic medical records.In front of the nursing dashboard on the center for aging and rehab excellence unit, which indicates performance improvement in people, quality, service and finance, are, from left, Marcia Butler-Hurlington, RN, senior staff nurse, detox/pediatrics; Lilian Habana, RN, nurse manager, geriatrics; Bridget Cristy, nursing attendant, medical and center for aging and rehab excellence unit; Mimi Nacario, RN, senior staff nurse, ICU; and Ann Marie McDonald, RN, director of nursing professionalism and quality.
With the ICU staff exploring the possibility of working toward a Beacon award, nurses being trained as preceptors and a cultural diversity team instituting programs for patients, families and staff, St. Barnabas drive to excellence continues to expand.
“I promote an open-door policy because it is important that I hear from our nurses about what is working and what is not. All creative recommendations are encouraged and entertained,” Richardson said. “Although the healthcare system provides us with many challenges, we remain optimistic and focused.”