MAYO CLINIC IN ARIZONA Department of Nursing of Nursing Demographics Clinical RN % Type of Degree 268 ... AGCNS-BC transitioned into new nursing leadership roles. ... and inter-professional

Mayo Clinic in Arizona

DEPARTMENT OF NURSING

2017 Annual Report

| DEPARTMENT OF NURSING 2

A MESSAGE FROM THE ARIZONA CHIEF NURSING OFFICER

Dear Nursing Colleagues,

We have much to celebrate this year in the Arizona Department of Nursing. Every day we partner with members of the healthcare team in caring for patients. We are positioned for growth, progress and development as evidenced by the significant accomplishments we made in 2017, including our recent Magnet® designation.

As I reflect over the past year, I am grateful for the significant strides we have made in patient experience, quality improvement, evidence-based practice, employee health and organizational safety. All of these elements are part of the blue print for a Magnet designation and are necessary for us to continue to provide world class nursing care.

As we look to the year ahead, our deep, rich history will continue to guide our priorities. In the coming months we will focus on the Plummer Project as we prepare for the transition from Cerner to the Epic electronic health record. This institution-wide project is the largest ever undertaken by Mayo Clinic and due to the magnitude of its impact, the Epic implementation and providing high quality care for our patients during the transition must be our 2018 priority.

The success of Mayo Clinic would not be possible without your dedication and skill. Keeping our patients at the center of all we do is a hallmark of Mayo Clinic nursing and a trademark of our staff. Take time to congratulate your colleagues on their accomplishments. Your boundless compassion and interdisciplinary collaboration continue to generate positive feedback and meaningful innovation. Thank you for the excellent care, flexibility, and support you provide every day to our patients, to each other and to our community.

Sincerely,

Teresa L. Connolly, DNP, RN, NEA-BC, FACHE Chief Nursing Officer Chair, Mayo Clinic in Arizona Department of Nursing

A MESSAGE FROM MAYO CLINIC CHIEF NURSING OFFICER

Let’s take this opportunity to reflect on—and celebrate—the accomplishments of the past year and look forward to what’s ahead.

What a historic year 2017 was for Arizona Nursing! The year you achieved Magnet designation—the highest international recognition an organization can receive for nursing excellence. Such well-deserved recognition—congratulations! Each of you should take great pride in this accomplishment, as it required everyone’s effort, working together, whether it was preparing for the visit, talking with an appraiser, or providing patient care so that others could be available. It was truly a team effort!

Magnet designation recognizes your professional excellence and your high standard of patient care. And speaking of patient care, Arizona continues to lead all of Mayo Nursing in patient experience scores, another example of your nursing excellence.

Your accomplishments help to continue to define and elevate professional nursing at Mayo Clinic, and demonstrate nursing’s contributions to our organizational priorities. Your active engagement and participation are key. Thank you for your active involvement in the practice, education and research shields, the multi-disciplinary groups you participate in, and the effort you put forth every day to make certain our patients receive the best possible care.

The year ahead will be another historic one as we complete our transition to Epic, the single largest project ever undertaken by Mayo Clinic. As your participation and involvement increase, I want you to know how grateful I am for your dedication, commitment and discretionary effort, all while making sure our patients continue to be well cared for. Our transition to Epic will take resilience and the support of one other. Patience will be important—we’ll all be learning together. With our collective talent and commitment, I know we will be successful.

Sincerely,

Pamela O. Johnson, MS, RN, NEA-BC, FAAN Mayo Clinic Chief Nursing Officer Chair, Mayo Clinic in Rochester Department of Nursing

32017 ANNUAL REPORT |

4 | DEPARTMENT OF NURSING

1821

1753

68 42.3Average RN Workforce age in years

75% of RNs with a BSN or higher degree

7.03 Average length of service in years

2017 DEPARTMENT OF NURSING DEMOGRAPHICS

TOTAL # NURSES 1467 1601 1750 1821

TOTAL RNS 1419 1546 1679 1753

TOTAL LPNS 48 55 71 68

YEAR 2014 2015 2016 2017

Total Nurses

Registered Nurses

Licensed Practical Nurse

Department of Nursing Professional Practice Model

Pivotal communicator

Navigator

Teacher

Transformational leader

Caringhealer

Vigilant guardian

Evidence-based practice

Professionalenvironment

Continuity of care

RN accountability

Problem solver

Patient-Nurse

Relationship-BasedCare

Core Values

Mayo Clinic Nursing Professional Practice Model


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TRANSFORMATIONAL LEADERSHIP

Magnet 2017 – It’s all about the Journey

The Department of Nursing experienced a historical moment in December as we gathered to hear the outcome of our Magnet journey. Over the last four years, we aligned the way we work with the Magnet standards which provided us the structure needed to support a culture of nursing excellence. What is nursing excellence? It is nurses engaged in an environment that promotes personal and professional growth which leads to positive patient outcomes. As we worked toward designation, we focused on sustainable projects and programs that supported this culture. As we celebrate our designation, let us reflect on what has changed over the past four years to get us to where we are today.

A journey takes us to our destination but it does not mean the expedition has come to an end. Over the next four years, our nursing practice and professional environment will undergo continuous transformation and renewal. This will require energy, engagement, creativity, and innovation. Each of us has a responsibility to be transformational leaders. As we celebrate, let us not forget how far we have come and how far we have to go. Nursing excellence needs continuous cultivation and support. We challenge each of you to think about your role in sustaining a Magnet culture. Congratulations on a job well done and we look forward to continuing the journey with all of you to achieve the next designation.

Professional Practice Model – In 2014, we launched our revised Professional Practice Model that depicts roles and core values of nurses.

2014

Nurses participating in Evidence-Based Practice, Quality, and Research – Nurses are disseminating their work both internally and externally through posters, presentations and publications.

2015 Strategic Plan – In 2015, we implemented the Department of Nursing Areas of Emphasis. This helped us align our work with the organizations’ goals.

2017 Organizational Structure – In 2017, the Department of Nursing organizational structure was updated with alignment of clinical practices across the continuum.

Advance Education – The Department of Nursing increased the number of bachelors and masters prepared nurses through hiring and promoting continuing education.

Structural Empowerment – Professional governance has expanded through Unit Based Teams to include additional ambulatory and procedural settings.

Certified Nurses – We have had a steady increase in certi�ed nurses and have surpassed annual targets.

Nurses Report to Nursing – In 2013, nurses in ambulatory and procedural areas transitioned to reporting to the Chief Nursing Of�cer, an important component of our governance structure.

2013


Healthy Nurse, Healthy Nation™

Studies conducted through the American Nurses Association (ANA) have shown that nurses have poorer health habits and a higher level of stress compared to the average American. The ANA created the Healthy Nurse, Healthy Nation initiative that includes the Grand Challenge survey to help nurses’ identify areas for improvement in their overall wellness and monthly topics to tackle specific wellness issues. Eileen Reali, RN-BC, heard about the initiative at a conference and approached Chief Nursing Officer, Teresa Connolly, DNP, RN, NEA-BC, FACHE, to involve Mayo Clinic Arizona and encourage nurses to take the time to focus on their own health in order to better influence the health of others. With leadership support from Teresa and Nurse Administrator Kathleen Matson, DHA, MSN, NE-BC, Mayo Clinic Arizona became a Premier Partner with the ANA in the Healthy Nurse, Healthy Nation Grand Challenge. Eileen, along with Jayne Debrular, MSN, RN; Candy Boyes, RN, CWON; and Jasmine Bhatti, RN, formed a workgroup that presented the Healthy Nurse, Healthy Nation Grand Challenge to multiple departments and at events throughout 2017.

In addition to recruiting for the Grand Challenge, clinical nurses involved with the initiative created and facilitated a series of educational and physical activities that promoted healthy living and improving health for the community at large. The workgroup partnered with Employee Wellness to facilitate healthy living behaviors, supporting themes each month that influence the health and well-being of employees. The workgroup set goals to increase nurse wellness champions within the organization and utilized the Healthy Nurse, Healthy Nation program to educate nurses on maintaining and improving their own health and well-being.

As a Premier Partner with the ANA, Mayo Clinic Arizona has access to health survey data from staff and has used the data to help focus future seminars on areas where there is a need for change. Future surveys will be used to measure outcomes on the workgroups efforts and look for improvement in the health of Mayo Clinic Arizona nurses. So far, there are 337 nurses from Mayo Clinic Arizona participating in the Grand Challenge and the workgroup plans to increase that number in 2018.


Department of Nursing Areas of Emphasis in Support of the Strategic Plan

Strategic planning is how organizations set priorities, focus energy, resources and ensure that everyone is working toward common goals. The Mayo Clinic strategic plan is guided by our mission, vision, primary and core values. In March 2017, Teresa Connolly, DNP, RN, NEA-BC, FACHE, invited Subcommittee Chairs, Unit Based Team Chairs and Magnet Champions to collaborate with Nurse Leaders to align the work that nurses do with the organizations strategic priorities.

The first aim of this event was to validate the Department of Nursing priorities identified in the plan. The second aim was to develop tactics to further advance the identified priorities. Participants were divided into small groups focusing on each component of the Areas of Emphasis document. For example, one group concentrated on the statement from the document, “Develop Nurse Leaders at all Levels.” The group focused their conversation around formal mentorship, advancing certifications and promoting lifelong learning.

Participant Carrie Karlene, BSN, RN, Apheresis Team Lead and Magnet Champion, described the experience as both enlightening and invigorating. “It confirmed how the strategic plan applies to nurses as contributing individuals, which feeds into our unit plan and goals and

ultimately supports Mayo Clinic. Small groups, including diverse individuals from a multitude of settings, gave valuable input on how to positively advance nursing practice. The revised Areas of Emphasis in support of the strategic plan makes our supporting tactics comprehensible and helps to create a renewed sense of active engagement. Personally, I was honored and grateful to be a part the event and thoroughly enjoyed the collaboration of everyone involved.”

Participant Pam Silva, BSN, RN, Clinical Nurse and Magnet Champion, described her experience saying, “it allowed a think tank moment with nurses from various backgrounds that captured different perspectives quickly, efficiently and organically. The small groups were less formal and allowed for a comfortable exchange of experiences and discussion. I think this is a great way to cast a wide net rather than using a fishing pole to accomplish the task.”

The outcome of the event was a refreshed Department of Nursing Areas of Emphasis document that will guide us toward improving patient safety and quality outcomes. The updated goals and graphic will be disseminated in early 2018.

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Deliver Highest-Value Care toBe Most Trusted and Affordable

Nurse Sensitive Quality OutcomesNDNQI RN Satisfaction ResultsPatient Satisfaction, Patient Experience ResultsCore Measure Outcomes

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Support Nursing Recruitment and Retention EffortsDevelop Nurse Leaders at all levels ( Succession Planning, Mentoring, Professional Development, Education, Certification)Foster a Safe and Secure Environment

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Promote Healthy Nurse Healthy Nation initiativesDevelop a strategy to use social media for internal communicationEPIC Implementation & Optimization

Achieve Staffing to Workload Metrics (+/- 1% recommended)Reduce staff patient handling injuriesReduce staff harm from violent patient events

Facilitate a culture of Evidence-Based PracticeFormulate and align Nursing Research to support the organizations priorities (Cancer, Cardiovascular, Transplant, Neuroscience, Center for the Science of Healthcare Delivery).

Achieve Mission-AdvancingFinancial Performance

Transform the Practice

Achieve Magnet® DesignationPromote Care Across the ContinuumEnhance Patient Experience (Intentional Rounding, Leadership Rounding, Practice Optimization, Connected Care)Advancing Practice Convergence(Policies/Procedures/Guidelines, EPIC)

Achieve Operational Excellence

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Participate in Centers of Excellence Initiatives (Contractor & Payer Relations)Participate in Mayo Clinic Care NetworkSupport Competitive Market Plan

Generate Ongoing Demand

Invest in Talent and Technology

Outperform the national benchmarks for the following:

PEOP

LEPR

OCES

SES

OUTC

OMES

INNOVATE

OBJE

CTIV

ES

EXECUTE GROW

Arizona Department of Nursing Areas of Emphasis in Support of the Mayo Clinic Strategic Plan


STRUCTURAL EMPOWERMENT

2017 Department of Nursing Initiatives

Video Monitoring Program – Remote video monitoring allows patients to be observed via real-time video sent to a command station over a secure wireless network.

FEB

Short Stay Observation Unit Opening

MAR Care Across the Continuum – Care across the Continuum workgroups bring teams together with the goal of enhancing the patient experience by developing interventions that will impact patient outcomes and increase patient satisfaction. This provides the opportunity to ensure the patient has a �rm understanding of their plan of care and empowers them to fully participate in that plan.

Lippincott – Lippincott Procedures, an evidence-based repository of nursing procedures that standardizes care, saves time and streamlines work�ows bringing evidence-based practice to the bedside. Lippincott Procedures assists in practice convergence for Mayo Clinic nurses.

OCT

My Nursing Website – Department of Nursing resources and documents reside in the My Nursing website allowing nurses at all sites to access content through one portal, facilitating collaboration and convergence.

DON Reorganization – Arizona Department of Nursing transformed its leadership organization structure to align specialty practices under a single nurse administrator, reinforcing caring for patients across the continuum.

NOV

Magnet – Magnet designation was achieved through the hard work, dedication and collaboration of nurses and interdisciplinary colleagues.

DEC

Plummer – The Mayo Clinic Health System-Wisconsin sites implemented the EPIC health record in July, followed by Mayo Clinic Health System-Minnesota in November. In Arizona, we continue efforts toward the implementation of a single integrated health record anticipating October 2018 Go Live.

JUL &NOV 2018


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New to Arizona: Mayo Clinic’s Pain Rehabilitation Center

The literature states the United States opioid epidemic continues to climb sharply, as demonstrated by an increase in deaths related to prescription opioids. The phenomenal successes of Comprehensive Pain Rehabilitation programs across the enterprise provided a foundation for the opening of an Arizona treatment program. Arizona’s objective was to create a comprehensive and sustainable rehabilitative treatment program to drastically reduce opioid use while improving perceived quality of life for participants with chronic pain.

Pain Rehabilitation Center (PRC) nurses initiate the patient admission process and establish a patient-centered relationship; they are committed to listening to patient concerns and incorporate these concerns into the plan of care. The PRC nurses encompass all the characteristics that make up the nursing professional practice model with an emphasis on being vigilant guardians, pivotal communicators and transformational leaders. They demonstrate this by being culturally competent, utilizing a holistic approach and facilitating classroom participation throughout the program. The nurses play a pivotal role by developing and reinforcing patient coping skills and address patient needs across the continuum.

The Core components of the PRC program include:

PRC Core Components

Medicationmanagement &chemical health

education

Stressmanagement &

relaxationtechniques

Physical therapy

Occupationaltherapy

Group therapy

Sleep

Biofeedback


Department of Nursing Subcommittee Accomplishments

Subcommittee Overview

The Arizona nursing subcommittee structure provides an opportunity for clinical nurses to be involved in shared decision-making about clinical practice, quality improvement, staff and professional development, research and evidence-based practice. Each subcommittee has their own charge and functions. In this publication, the subcommittees highlight a few of their 2017 accomplishments.

Note: Magnet readiness was a priority for all subcommittees.

Nursing Practice Subcommittee

• Supported leadership succession planning

– 2017 membership included 62% clinical RNs (up from 53% in 2016 and 34% in 2015)

– Expanded nursing roles represented to include two LPNs and a CRNA; increased ratio of ambulatory to inpatient clinical nurses

– Encouraged clinical nurse involvement in nursing practice subcommittee presentations with clinical nurses assisting with 73% of presentations for appropriate agenda topics

• Provided approval for best practices

– Central line dressing and product change

– Tracheostomy pressure injury prevention interventions for all inpatient tracheostomy patients

– Two RN skin assessment for all inpatient units and skin care resource guide

– RN hypertensive visits in ambulatory care to standardize blood pressure measurement

• Supported the Plummer project by recommending a definition of “per unit routine”, providing input on usage of symptom based order sets, and ongoing project updates.

• Defined, clarified, and developed a resource guideline to assist nurses with patients with patio privileges

• Endorsed and provided recommendations for nursing practice improvements and protocols including:

– Graduated compression stocking measurement standards

– Autonomic dysreflexia workflow

– ICU noise reduction

– Nurse-initiated immunization protocol for ambulatory care

– Hyperkalemia power plan

• Participated and supported efforts to improve pain medication ordering and administration practices

Nursing Quality Subcommittee

• Engaged unit/department staff in Magnet readiness, preparing them to speak about quality initiatives. Discussed innovative strategies to engage nurses in articulating their expertise related to nursing quality.

• Guided nurses to integrate Nursing Professional Practice Model and Arizona Department of Nursing Areas of Emphasis into Nursing Quality Subcommittee.

• Analyzed and disseminated inpatient and ambulatory nursing quality data to enhance collaboration and continuity of care.

• Analyzed fall and fall injury data with a focus on preventing falls with injury.

• Improved RN accountability through continued development and presentation of nursing quality projects with a goal of at least one presentation per quarter.

• Supported and provided communication regarding Enterprise initiatives.


Nursing Research Subcommittee

• Increased clinical nurse membership to over 50%

• Increased attendance by 27% at the Nursing Research and Evidence Based Practice Festival.

– 29 poster presentations

– 14 podium presentations

– 175 attendees

• Increased publications by 15% from 2016 (n=13) to 2017 (n=15)

• Funded three evidence-based practice projects:

– 2 West Approach to Address Nutritional Interventions for Hospital Acquired Pressure Injury Prevention (Lead: Shae Miller, RN BSN) Small Grant Award

– Physician-Nurse Rounding (Lead: Danielle Walpole, BSN, RN) Small Grant Award

– Non-Medication Interventions for Reducing Pain and Anxiety During Analgesic Infiltration of the Skin (Lead: Jessica Snyder, RN) small grant award

• Funded two research projects:

– Mayo Clinic Arizona Department of Nursing: Preferred Learning Styles and Correlation of Learning Styles with Outcomes, Safety, and Service Variables (PI: Kara Mangold, DNP, RN, ) internal award

– Efficacy of Ambulating Heart Failure Patients with Pulmonary Artery Catheters While Awaiting Heart Transplantation or Left Ventricular Assist Device (LVAD) Insertion to Reduce Postoperative Length of Stay (PI: Amanda Stumpf, BSN, RN) small grant award

• One external grant application submitted in 2017

Nursing Education Subcommittee

• Endorsed educational initiatives including:

– Redesign of the Team Leader Development program, New Employee General Orientation and Preceptor Development course for ambulatory and inpatient nursing staff.

– Nurse Residency Program:

- Total hired into the program in 2017 = 66

- Completion of program = 91% (Feb 2017 cohort).

• Expanded Mayo Clinic Continuing Nursing Education Provider unit across the organization with 37 courses provided and 354 ANCC contact hours offered.

• Infused the Department of Nursing Areas of Emphasis in support of the Mayo Clinic Strategic Plan and the Department of Nursing Professional Practice Model in all educational initiatives.

• Coordinated the Nursing Education Conference, “The Nursing Effect: Leading from the Front Line of Change.” 126 attended.

– Pre-conference offered which emphasized professional development opportunities within the organization

– Conference incorporated concepts from the Healthy Nurse, Healthy Nation initiative and plenary session topics included therapeutic sense of self, finding humor in the workplace, patient mobilization, pressure injury recognition and prevention, violence in healthcare and unraveling the mystery surrounding research.

• Oversaw Mayo-affiliated student nursing programs with rotations from 14 colleges and universities as well as placement for observational experiences.

• Subcommittee members developed, coordinated and/or endorsed educational initiatives. Some examples include:

– Nursing Education Subcommittee member retreat (inaugural event)

– Thrombo-Embolic Deterrent hose measurement

– Two RN skin assessment

– Tiered skills acquisition model

– Clinical program initiatives – Video Monitoring Program, Controlled Substance Waste Process

400

800

1,200

600

1,000

2014 20162015 2017

839870

1,076 1,050

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Year*placements include clinical rotations, observations, practicum placements and precepting students

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Mountain Park

Mayo Clinic in Arizona supports multiple organizations through monetary, medical supplies and equipment donations as well as coordinating physician and allied health volunteers to provide health services. Mountain Park Health Center is a non-profit Community Health Center whose goal is to provide affordable healthcare for the community through the Patient Centered Medical Home model.

This collaboration has been in place since 2013 to provide breast cancer screening through the Breast Health for Life program. Our organization supports this community healthcare outreach by providing mammography machines, radiologist time and nursing consultation. Mountain Park in collaboration with Mayo was awarded a Susan G. Komen® grant to treat breast cancer patients identified through the Breast Health for Life Program. After Mayo Clinic provides the breast cancer treatment, Mountain Park provides the follow up care for breast cancer survivors.

In 2016, Mountain Park identified a need for further education and support for their staff to continue to provide appropriate breast cancer survivor care. Noël Arring, DNP, RN, OCN, Program Manager for Nursing Research was contacted by community

relations and the Hematology/Oncology Department to help address Mountain Park’s identified needs. Noël’s doctorate work focused on population health management for cancer survivors. Noël and the Mountain Park Cancer Screening Manager met to clarify Mountain Park’s needs and agreed to start with the development of survivorship care plans.

In 2017, the care plans for cancer survivors were delivered at Mountain Park. Processes were established to ensure automatic survivorship resources for future Mountain Park patients. Noël continues to be available for consultation and regularly meets with Mountain Park to help identify and address their cancer survivorship needs.

Paradise Valley Unified School District Collaboration

Mayo Clinic Arizona partners with the Paradise Valley Unified School District (PVUSD) to provide patient care shadowing opportunities, including classroom and work-based learning experiences, for high school students interested in a healthcare career. This partnership began in 2002 when Nursing Education Specialists’ (NESs) reached out to form a Future Nurses of America club at local high schools to get students interested in a nursing career. The partnership has since expanded to a Health

Care Academy (HCA), which includes exploring nursing and other clinical allied health professions.

The NES in coordination with the HCA faculty identifies clinical experiences for the high school students. These students have the opportunity to experience the scope of nursing practice in the inpatient, emergency department, care management, ambulatory infusion center, pain clinic, pre-operative evaluation clinic and endoscopy environments.

I was assigned to the inpatient neurology unit; I fell in love with the dedication and passion of each one of the nurses and staff. While I was in this unit, I feel like my brain grew because of the knowledge I gained. Seeing all of the equipment on these patients took some time to get used to. It was interesting to hear everyone’s story on why they were admitted and the challenges they face. I love this rotation and cannot wait for the next one!– PV student

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Tulsi Rounds

The End of Life Care Project Workgroup sought to implement a multidisciplinary forum which would provide staff with a safe, comfortable setting to discuss difficult emotional and social issues encountered in the work environment. Tulsi Rounds focus on the human dimension of health care whereas traditional rounds which focus on the patient, diagnosis and plan of care. Tulsi gives caregivers the opportunity to share their experiences, thoughts and feelings on thought-provoking topics based on actual experiences. The program promotes empathy, resiliency, compassion and provides hope for the staff.

Tulsi Rounds are not intended to review medical decision-making or to identify potential care issues. Tulsi is a facilitator-led support for all members of the healthcare team to talk about end of life patients and work through the grieving process with other colleagues. The format provides a chance to reflect, share challenges and successes, and support one another in ways not otherwise possible in a fast-paced work environment. Through Relationship-Based Care, care is organized based on the needs of the patient and family. Principles of patient and family-centered care include respect and dignity, information sharing, participation and collaboration. Respecting patient and family choices and developing a meaningful relationship can be challenging to the clinical caregiver and the dilemma is often at the heart of discussions in Tulsi, which offers a way to recognize and work through such conflict.

Tulsi rounds are available to all staff at Mayo Clinic in Arizona, with sessions being held quarterly on both the Phoenix and Scottsdale campuses. The following grid indicates the number of attendees per session since the implementation of Tulsi Rounds in October 2016.

10/25/16 PHOENIX CAMPUS 86

54 1/31/17 PHOENIX CAMPUS

52 4/26/17 PHOENIX CAMPUS

20 2/2/17 SCOTTSDALE CAMPUS

33 5/4/17 SCOTTSDALE CAMPUS

TULSI ATTENDEES

What a great event that was. I don’t think anyone felt uncomfortable in the environment and I’m sure many left feeling somewhat more whole simply by virtue of being there. I hope there are many more Tulsi Rounds to come.– Tulsi participant

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Nurses Influence Transplant Center Success

The Transplant Center RN Care Coordinator team is composed of many different roles that impact patient care, quality outcomes and supports Achieving Operational Excellence. From the time the transplant recipient is referred, the nursing team begins vigilant oversight of the patient through three roles: Pre-Transplant, Procurement and Post-Transplant RN Care Coordinators.

Pre-Transplant RN Care Coordinator teams ensure that the patient meets the regulatory and clinical requirements to be safely listed and transplanted. They are responsible for education, monitoring evaluation results, participating in the Selection Committee and listing the patient.

In 2017, 1,200 patients were followed through evaluation, 1,058 were presented at Selection Committee, and 696 were ultimately added to various waitlists.

2,500

2,000

1,500

1,000

500

02014 2015 2016 2017

1836 1850

1272

9601116

595473

2007

1373

11611077

725

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2275

1637

12001058

696

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10791025

585

364

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SelectionWaitlist AdditionsTotal Transplants

1,000

800

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400

200

0Heart Liver Kidney

MCA Actual

National Median

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11371

921

260

2014-2017 Aggregate Transplant Volumes

Wait List Volumes

As of December 31, 2017 the various RN Coordinator Teams were actively managing 1070 waitlisted patients.

The Procurement RN Coordinator team is responsible for reviewing all deceased kidney, liver, and pancreas organ offers, their diligence and assessment skills have positively impacted organ selection resulting in Mayo Clinic Arizona accepting organs that other centers across the country do not. Current National Scientific Registry of Transplant Recipients data shows that Mayo Clinic Arizona is 209% more likely to accept a kidney offer than national practice and 701% more likely to accept hard to place kidneys.


The Procurement RN Coordinator team has had the same positive impact on liver offers. Mayo Clinic Arizona is 312% more likely to accept a liver offer than national practice and 1302% more likely to accept hard to place livers.

In 2017, Mayo Clinic Arizona performed 54 living donor kidney transplants and screened an average of 112 donors per month.

The Post-RN Coordinator team is responsible for ensuring the patient is prepared for discharge. In 2017, the Post-Transplant RN Teams educated 521 newly transplanted recipients. Their role in discharge includes:

• Proposing all transplant related prescriptions and arranging follow up appointments

• Educate the recipient and caregiver regarding medications, symptomology, post-transplant process prior to discharge

• Attending inpatient rounds to participate in the plan of care

The team has been able to accomplish these duties while achieving a median length of stay that is well below the national average.

0.1Lower Higher

Offer Acceptance Overall Kidney

AZMC

0.4 2.5 10 0.1Lower Higher

Offer Acceptance Hard to Place Kidney

NationalAverage

NationalAverage

AZMC

0.4 2.5 10

0.1Lower Higher

Offer Acceptance Overall Liver

AZMC


Offer Acceptance Hard to Place Liver

NationalAverage

NationalAverage

AZMC

0.4 2.5 10

0.1Lower Higher

Offer Acceptance Overall Kidney

AZMC


Offer Acceptance Hard to Place Kidney

NationalAverage

NationalAverage

AZMC

0.4 2.5 10

0.1Lower Higher

Offer Acceptance Overall Liver

AZMC


Offer Acceptance Hard to Place Liver

NationalAverage

NationalAverage

AZMC

0.4 2.5 10

Median Length of Stay

Without our 37 RN Care Coordinators and the large multidisciplinary team, we would not be able to be successful in giving the gift of life to over 500 patients every year.

20

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0Heart Liver Kidney

NationalMCA GoalMCA Actual

Day

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16

13

1110

76

5

23

SRTR 1 Year Survival

The multidisciplinary team monitors recipients closely to ensure a successful post-transplant course. This success is evident in the National Scientific Registry of Transplant Recipients (SRTR) one year survival rate.

90

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80

50

60

Heart Liver Kidney

Pat

ient

Sur

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)

National Expected MCA Actual

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97.86

92.33 92.9094.90

97.36 96.7396.98

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EXEMPLARY PROFESSIONAL PRACTICE

Quality Improvement: Kidney Transplant Selection to Listing

In 2016, the Transplant Center averaged 73 days from the organ Selection Conference to Listing and Transplant Coordinators spent an average of 22.5 hours per week managing patients who have been “Approved Pending.” “Approved Pending” refers to patients being approved from the Selection Conference with pending medical or psychosocial aspects needing resolution. Collaboration between Pre Kidney Transplant Coordinators, providers and administrative leadership resulted in the development of a Quality Improvement project to reduce

the average Selection to Listing time by 75% and reduce the “Approved Pending” labor hours by 85% in 2017.

Based on data, nurses took initiative to make changes in support of the strategic goals of the Transplant Department. Approval was received to change the process to take patients to Selection Conference for a decision of candidacy only when they are medically and psychosocially approved. The process change afforded more time for nurse transplant coordinators to work with patients, overall improving the flow of evaluation to Listing.

Improving Hypertension Control

The Arrowhead Primary Care East team identified an opportunity to improve the hypertension control rate of their patients as measured by the Population Health Practice Management Tool (PMT). An interdisciplinary team was formed with the goal to improve the hypertension control rate as measured by the PMT from 51% to 65% over a four month period. This was to be accomplished without a negative effect on patient quality data and staff satisfaction. As part of the quality improvement steps, process mapping was utilized to determine problem areas and identify opportunities for intervention. Interventions included team educational meetings, methods to address patients no longer receiving primary care at Arrowhead, standardization of blood pressure measurement and follow up, and review of AskMayoExpert guidelines for hypertension treatment.

Throughout the four month project timeline, hypertension control rates improved each month with a final value in August 2017 of 69.67%, exceeding the goal of 65%.

A control plan was established with plans to disperse this information to other health care teams. RN scope of practice was optimized during this project. Follow up visits for patients with uncontrolled hypertension are now routinely scheduled for RN visits to recheck blood pressure, discuss home medications, medication compliance, blood pressure measurement technique, and lifestyle modification.

Nurses acted as pivotal communicators in providing insight into the current workflow, as problem solvers while exploring creative solutions for improvement and as teachers when educating the interdisciplinary team on proper technique for blood pressure measurement. The nurses’ collective voice of a caring healer emphasized the importance of accurate blood pressure measurement and evidence-based hypertension treatment to achieve optimum patient wellbeing.

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Baseline2016

Improve2017

Improve2017

Reduced75%

4

Reduced85%


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Care Across the Continuum

Care Across the Continuum (CAC) workgroups bring teams together, both nursing and interdisciplinary groups, to support the patient as they interact with different members of our healthcare team by addressing gaps in collaboration across the care continuum. The goal is to enhance the patient experience and develop interventions that will impact patient outcomes, increase patient satisfaction and improve quality care.

One example of the work being done by the Urology CAC workgroup was the development a pre-surgical patient education program to better prepare the patient for the hospital and post-hospital experience. This provides the patient with a firm understanding of the post-surgical plan of care and helps set realistic expectations that will empower them with the knowledge they need to fully participate in their recovery.

Initial CAC Workgroups

Bone Marrow

Transplant

Orthopedics

ENTColorectal

Neurology/Neurosurgery

Urology

Mayo Clinic Employee Resource Groups (MERGs)

The Mayo Clinic Employee Resource Groups (MERG) act as a vital link allowing employees to celebrate diversity in their work environment. There are various MERGs that celebrate a wide variety of diversity, from cultural or ethnic backgrounds to interest groups, all with the goal of increasing inclusivity. While MERGs are created around a specific group, such as the lesbian, gay, bisexual, transgender, intersex (LGBTI) community or African Descendants, they seek to be welcoming of all who wish to celebrate diversity. MERGs provide a great opportunity for employees to get involved on a volunteer basis, affecting change within the organization by supporting modifications in practice that increase our inclusivity for employee and patients, and represent Mayo Clinic externally to the community.

Nursing, as the largest profession in the organization, plays a huge role in MERGs – from nurse executives who act as Executive Sponsors for MERG groups to numerous nurses who are active in both leadership and membership roles. Amstrong Gutierrez, BSN, RN,

CCTC, Secretary of the LGBTI MERG notes, “Getting involved in a MERG allowed me to help bring more visibility to diversity at Mayo. It has also offered me a way to meet many of my fellow co-workers and give back in the community.” Creating this sense of inclusivity is a primary goal of the MERG groups. Michael Escarte, RN commented, “I decided to participate in the group to allow myself to be surrounded by people of similar cultural backgrounds and get an idea of how their experiences have been within the organization. It also gives me the opportunity to network and meet people in different roles that I would otherwise not have the chance to meet.” MERGs also provide opportunities for individuals to develop new skills through networking with other members on initiatives that support diversity.

My experience in this CAC has been very eye opening about the patient experience in other care areas besides inpatient. I think that nurses having a better understanding of the information patients receive across multiple environments underscores the importance of a singular collaborative approach across the continuum of care. – Devin Maierhofer BSN, RN

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Pressure Injury Prevention Strategies

Hospital-acquired pressure injuries (HAPIs) are serious complications that can lead to increased medical costs, length of stay, pain, infection and potential death. Evidence supports thorough skin assessments for all patients on an ongoing basis and that double check systems for nursing procedures can reduce errors and omissions. Skin is typically assessed during the nursing assessment and risk for pressure injury is determined using the Braden scale. Despite this practice, the number of pressure related injuries continued to be greater than expected. In early 2017, the inpatient unit-based chairs committee set forth to determine if the addition of a second RN performing frequent skin assessments would decrease the number of HAPIs.

A nursing workgroup was created utilizing representatives from wound ostomy service team, wound ostomy resource team, clinical nurses, informatics, education, quality, clinical nurse specialists and leadership to develop a pilot study. The intermediate care unit was selected for the pilot due the mixed acuity patient population and HAPI quality data.

The pilot program was conducted February-April 2017 and included the following interventions:

• Education regarding complete skin assessment, pressure injury prevention strategies and expectations

• Bedside tools in each patient room to help guide assessments

• Workflows and resources to assist with time management and compliance

• A script to help educate patients on importance of shift to shift skin assessments in preventing skin injury

• Increased rounds and collaboration between RN’s and Wound, Ostomy and Continence RN’s.

Due to positive results from the pilot phase, the 2 RN Skin Assessment practice was initiated on all inpatient units in August 2017. Consultations to the wound ostomy team increased, demonstrating an improved awareness of skin concerns, leading to early intervention and prevention resulting in the continued decline of HAPI’s.

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The number of Hospital Acquired Pressure Injuries dramatically decreased from 4 in January (pre-intervention) to 2 during the pilot time frame.

Practice continued after pilot with zero Hospital Acquired Pressure Injuries in months of May and June 2017.


NEW KNOWLEDGE AND INNOVATION

Cerumen Clinic

Cerumen (earwax) removal and wound assessment has been well established within the RN’s scope of practice. Cerumen removal with microscope and dry-suction equipment (microsuction) is cited in the literature as a safer method as compared to the traditional ear lavage method. A process improvement initiative was developed that educated Ambulatory Otolaryngology RNs, Olivia Aniche, RN, and Kathryn Sutton, RN, to support a cerumen removal clinic using microsuction. Historically, Physician Assistants performed this procedure for all patients in the Department of Otolaryngology. This increased patient access to appointments and improved department staff satisfaction. The initiative also aimed to increase revenue capture, decrease costs, improve patient satisfaction and promote autonomy of practice as RNs work to the top of their scope.

Katie Dozbaba MSN, RN, CMSRN, Ambulatory Otolaryngology Nurse Manager and Jennifer Ernst, MSN, MS, APRN, GCNS-BC, Clinical Nurse Specialist, demonstrated transformational leadership by advocating for nursing to develop the clinic. They gained

stakeholder support within the department to empower nurses through the process. The initiative establishes new knowledge, innovations and improvements as the use of microsuction for cerumen removal is a new practice for nurses at Mayo Clinic Arizona. Microsuction cerumen removal is not within the standard education preparation for nurses, evidence from the literature and expert clinicians were used to develop the nursing procedure and education. Interdisciplinary collaboration with providers was instrumental in ensuring competency validation through supervised practice. This project was a perfect blend of using evidence-based practice to drive quality improvement for the department.

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Preoperative Ambulation of Patients with Pulmonary Artery Catheters

Nursing staff within the progressive cardiac care unit (PCCU) conducted a research project to demonstrate that ambulating patients with a pulmonary artery catheter (PAC) in place is effective in reducing post-operative inpatient length of stay after heart transplant or left ventricular assist device (LVAD) implantation. Patients with pulmonary artery catheters had previously been restricted to bedrest or very limited mobility due to the perceived risk of catheter-associated complications. A professional standard of practice for ambulating patients with pulmonary artery catheters did not exist, so the project was intended to provide a model for other institutions considering a practice change. In 2014, PCCU nurses began ambulating these patients in order to maintain their physical conditioning and improve patient satisfaction. A retrospective study of patients (2007-2014 without ambulation; 2014-present with ambulation) was conducted to demonstrate that ambulation of patients with a PAC is not only safe and effective, but also contributes to improved post-surgical outcomes. The impact of pre-operative ambulation with a PAC on post-operative length of stay (LOS) in comparison to previous patients that were maintained on bedrest was tracked and measured in terms of post-operative days spent in ICU and PCCU. A review of data

indicated there was a clinically significant decrease in LOS post-operatively between the patients who were maintained on bedrest pre-operatively and those that were ambulated despite a longer preoperative LOS. There was an average ICU LOS decrease of 2.5 days and an average PCCU LOS decrease of four days post-operatively. The decreased LOS also led to a reduced financial and resource burden, with an estimated savings of $24,000/patient. Additionally, patients with a PAC who were ambulated demonstrated no additional risk of adverse events compared to those on bedrest, greatly impacting patient satisfaction and quality of life.

Participation in the study supported the nurses’ roles of transformational leader, problem solver and vigilant guardian, empowering them to achieve a higher standard of professional practice for this specialty patient population by furthering their leadership skills and advocating for patients. Nurses also presented the results at both local and regional conferences, and are in the process of writing a manuscript with the goal of publication. The intent is for the work to transform the standard of practice for this patient population and inspire others to conduct their own nursing research in order to further the profession of nursing.

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Innovative Assessment and Intervention for Diabetic Foot Ulcers

Delayed healing of wounds increases patient distress and discomfort and increases the risk of complications and healthcare costs. Early assessment of diabetic foot ulcerations (DFUs) favors planned actions of the healthcare team, especially the implementation of measures to promote prompt intervention. Nursing staff within the Department of Orthopedics conducted a pilot study to assist patients with self-care and improve communication between the patient and provider.

The pilot study focused on the effect of RN facilitated patient-centered education to increase patient adherence with routine foot care and decrease reported DFUs. Nurses hypothesized that using standardized patient-centered education and implementing digital photography home assessments, will increase adherence with foot self-care and decrease the number of DFUs. Patients were instructed to take digital photos of their DFU and send them to the healthcare team for review and recommended potential interventions. The prompt response enhances the patient/caregiver and healthcare team experience by improving communication, building trust and aiding in communication between specialties.

Using current technologies such as smartphones, digital imagery, and integrated electronic health records, there is potential for adaptation of this pilot research to other specialty practices. The role of digital imagery in patient-directed reporting and communication supports the advanced use of technology and has the potential to change the way healthcare is delivered.

As the primary RN in the diabetic foot care clinic and the leader of this study, I was able to coordinate the patient’s care with the different medical and surgical specialties, such as Endocrinology, Primary Care, Plastic Surgery (wound care) and Orthopedics.– Annie Manuel, MSN, RN

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Innovative Approach to Nursing Learning Needs Assessment

Today’s complex health care environment demands a comprehensive approach to assessing practice gaps and subsequently identifying learning needs of professional nurses. Emerging technologies, data inundation and a shifting demographic challenged the Nursing Education Subcommittee to endorse a multifaceted approach conducting a learning needs assessment. In collaboration with Nursing Research Subcommittee, a validated tool to identify preferred learning styles was identified. The Index of Learning Styles questionnaire was offered to nurses at all levels of the organization and resulted in a 67% response rate. The Index of Learning Style results supported learning activities that incorporate visual and sensing modalities.

Additionally, the Department of Nursing’s Shared Governance Committee structure was engaged to inform and prioritize topic areas. Data was collected from various internal sources (e.g., committees, strategic plan) and external sources (e.g., accreditation and regulatory trends, American Nurses Association, Arizona State Board of Nursing, professional organizations). This data was used to identify priority topics for education.

The information about preferred learning styles was coupled with identified topics to drive innovation in preparing professional development opportunities. In 2017, initiatives included: Magnet Ignite, a gaming based educational approach to building confidence and competence for Magnet recognition designation; central venous catheter education rounds at the point of care with hands-on use of actual equipment; and incorporation of active and visual learning techniques at the Annual Nursing Conference. Planned 2018 endeavors include a focus on Evidence-Based Practice through the implementation of journal clubs and the Department of Nursing Education Fair.

The team’s comprehensive approach to assessing practice gaps and identifying learning needs has led to innovation in education delivery, as well as prudent and meaningful use of resources. This work is being shared externally at the Western Institute of Nursing, American Organization of Nurse Executives, the Medical Library Association Conferences, as well as through journal publication.


Academic Appointments

AWARDS AND RECOGNITION

Assistant Professor, Nursing

Instructor, Nursing

Marie (Jay) J. Maningo-Salinas, PhD, MSN, RN, NE-BC

Eva M. Boldea MSN, RN, ACNS-BC

Eryn M. Draganski MS, MSN, RN, AGCNS-BC

Danielle M. Roth MSN, RN, CMSRN

Kristin M. Altman MSN, RN, OCN

Trisha L. Deason MHA, MSN, RN, NE-BC

Kimberly K. Howard MSN, RN, CNOR, CRNFA

Cindy A. Chambers MSN, APRN, ACNS-BC

Richard Fleeger MSN, RN, CSSM

Laurie H. Schellbach MBA, RN

Kimberly A. Valentine MSN, RN

Sue M. Weinhold MSN, RN, CCTC

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Community and Service Recognition Awards

The following allied health employees were recognized for providing outstanding service to patients, co-workers and clients within the internal and external Mayo Clinic community.

Michael B. O’Sullivan, M.D., Award for Excellence in Clinical Nursing

Due to the generosity of Charles and Rowena Simberg, benefactors, for the past 17 years, Mayo Clinic proudly recognizes clinical nursing excellence in honor of Michael B. O’Sullivan, M.D. The 2017 recipients are:

Inpatient/Acute Care: Catherine Rodrigue, MSN, RN, CNOR; Surgical Services

Ambulatory Care: Shannon Long, RN, CCTC; Solid Organ Transplant

Individual Award for Service Excellence

Jennifer M. Sweilem, RN, CHPN

Team Award for Service Excellence: End of Life Care Workgroup

Team Leaders:

• Tom Fitch, MD

• Susan Launder, MSN, RN, OCN

Team members:

• Doralyn Costello, MSN, RN, OCN

• Katie Drewelow, MSN, RN

• Melania Flores, MSN, RN

• Meagan Gruwell, RN

• Megan Lopez, RN

• Jill Lovill, MSW, LMSW

• Charles Manak, MD

• Heather Manion, MSN, RN, CCTC

• Valerie Nies, RN

• Joan Ralph Webber, APRN, CNS, MSN

• Ayan Sen, MD

• Travis Shelton, PharmD

• Jill Wade, RN

• Judy Whitman, MSN, RN, CCRN-K

FRIDAY, OCTOBER 6, 2017

SERVICE RECOGNITION

Honoring Your Service on the Staff of Mayo Clinic

2017


2017 Research and Evidence Based Practice Festival

First Place Award:

Efficacy of Ambulating Heart Failure Patients with Pulmonary Artery Catheters (PAC) While Awaiting Heart Transplantation or Left Ventricular Assist Device (LVAD) Insertion to Reduce Postoperative Length of Stay

• Amanda Stumpf, BSN, RN, PCCN

• Nicole Magrosky, RN

• Andrew Talamantes, BSN, RN, PCCN

Second Place Award:

Help Us Support Healing (H.U.S.H.)

• Christina Frantz, BSN, RN, CMSRN

• Jennifer Pekor, BSN, RN

• Kamryn Dembski, BSN, RN

• Leigh Hartig, BSN, RN

Third Place Award:

2nd RN Skin Assessment

• Candy Boyes, BSN, RN-BC

• Jane Sederstrom, APRN, MSN, AGCNS-BC, CCRN

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Poster Presentations 175 Podium

Presentations29 14 Attendees (27% increase over 2016)

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2017 DON National or International Presentations

National or International Presentations

Publications

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MAYO CLINIC IN ARIZONA Department of Nursing of Nursing Demographics Clinical RN % Type of Degree 268 ... AGCNS-BC transitioned into new nursing leadership roles. ... and inter-professional