CEDARS-SINAINURSING ANNUAL REPORT
2016
Cedars-Sinai Nursing Annual Report 20162 |
December 22, 2016
Reflecting on our 2016 journey, it’s clear that our progress and accomplishments were driven by the extraordinary teamwork, collaboration and dedication of our nurses. We faced many challenges together, including frequent volume surge in the census, CS-Link™ 2015 go-live and optimization, bar coding for blood administration, ventilation system duct cleaning of multiple units and the need to rapidly open additional spaces for patient care. Yet through it all, each of you demonstrated personal strength, perseverance and dedication to see us through in our unending quest to deliver exceptional, safe, quality, person-centered care.
During this year, we developed the 2016–2020 nursing strategic plan and developed a schematic to depict our goals: safe, quality care; improving the patient experience; value and efficiency; evidence-based practice and research; transformational leadership and education development; philanthropy and community services, which all lead to our nurses’ engagement for excellence in human caring.
In transformational leadership and educational development, more than 50 percent of the staff advanced to CNIII. Cedars-Sinai nurses advanced their professional development in many organizational development courses as well as nurse residency, the Rising Stars curriculum, the Emerging Leader Program (and several participated in the AONE manager and director fellowships); and six nurses were selected as Brawerman PhD scholars. We also developed the onboarding transition program for new Advanced Practice Nurses.
Research has demonstrated that nurses engaged in continual learning and with a BSN plus specialty certification have better patient outcomes. Our goals were to achieve 80 percent BSN and specialty certification by 2020. We achieve 80 percent specialty certification this year, and 85 percent have at least a BSN, with 14 percent having a master’s in nursing!
We continue to strive to improve our patient experience with increased emphasis on courtesy and respect, discharge education, and listening and verbalization to the patient when we are checking their identification for safe medication administration.
Thank you for the Human Caring you exhibit each day. You are greatly appreciated for your work each and every day.
Sincerely,
Linda Burnes Bolton, DrPH, RN, FAANChief Nurse Executive and Vice President of NursingJames R. Klinenberg, MD and Lynne Klinenberg Linkin Chair in Nursing
CEDARS-SINAI NURSING
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 3
CEDARS-SINAI NURSING
OUR VALUES
Our values are the guiding principles for all that we do, shaping our interactions with those whom we are privileged to serve.
Advocacy — Assuring that the voice of each patient is heard and respected. Standing up for the right thinking, right action, and right practice for our patients and families, for each other and for our institution.
Global Awareness — Viewing healthcare from both a macro and micro perspective, with an understanding of how the profession of nursing “fits” into the ever-changing healthcare environment.
Courage — Acting boldly on the strength of our convictions, advocating for our patients, our colleagues and ourselves in both clinical and administrative settings, even in difficult circumstances.
Inclusion — Valuing each patient and each member of our team as individuals with different origins, different perspectives, who share common goals of doing the right thing.
These values are unique to Nursing at Cedars-Sinai, but we still incorporate Cedars-Sinai’s Core Values into our practice.
Additional Cedars-Sinai Values:
• Integrity
• Compassion
• Excellence
• Innovation
• Stewardship
• Teamwork & Collaboration
• Respect & Diversity
OUR PHILOSOPHY
Nursing is committed to, and accountable for, safe, professional practice as evidenced by consistent utilization of the nursing process, inter-professional collaboration with our colleagues and achievement of quality outcomes. We are advocates for people by promoting the delivery of the right care at the right time.
We practice human caring. We listen to our patients and their loved ones, and we place them at the center of all planning and decision-making. We meet each person where they are in the moment. We connect with each person by valuing their unique needs, spiritual beliefs and personal choices. We seek to earn each person’s trust at all times.
We pursue and apply new knowledge, evidence-based practice, and models of care as a means of providing services that exceed expectations. We utilize research as the basis for our practice. We engage in continuous quality improvement. We embrace new technologies to promote the delivery of care. We are cognizant of the total cost of care, and we engage the initiative to enhance value. We work to improve the health of our community.
OUR PROFESSIONAL PRACTICE MODEL
The Cedars-Sinai Nursing Professional Practice Model is a dynamic process that integrates our philosophy of Education & Development, Research as Evidence-Based Practice, Quality-Safety Practices & Outcomes, and Community with our vision, mission and values that guide and support the delivery of person-centered care.
OUR VISION
Excellence in Human Caring
OUR MISSION
Cedars-Sinai Nursing is committed to leadership and excellence in delivering quality, compassionate, value-added, person-centered care. We are committed to continuous education and science as the foundation for improving our practice and enhancing our work environment.
Cedars-Sinai Nursing Annual Report 20164 |
CEDARS-SINAI PROFESSIONAL PRACTICE MODEL
EXCELLENCE IN HUMAN CARING
N
ew K
now
ledg
e, In
novations
Structural Empowerm
ent
Exem
plary Professional Practice Transformatio
nal L
eade
rshi
p
St
Pro
fess
iona
lism
ssio
naOre
m’s
Nursin
g P
rofe
s
Orreem
’sNur
sin
Theory
O
Philanthropy
ctice
A
dvo
cacy
ofes A
G
lobal
Ad
voca
cy
Globbaal
Awar
enes
s
Ex
Safe,
al
Saafe,
Quality Carers
hip
Development pDDevelo
Leadership &
nsformatio
nal L
eade
rrsh
velopmentInclusion
Tr
IIn
Courag
e
ew Evidence-Driven Practice
Kno
wle
dge,
Innovation
EEvidenP
Vision &
e Drivenctice
nce-DriVision
&
Philosophy
nsns
n&
hhyy
Eng
agem
ent
Person,Family andCommunity
Remember that the “person” is always at the heart of what we do, and that the Person, Family and Community does not just represent the patients that we care for but also represents our own selves, colleagues, families and communities. Care and respect yourself and one another!
A task force was created in 2015 to reimagine our vision, mission, values and philosophy. From this, our Professional Practice Model was developed to give a visual description of these elements and show how we deliver care specific to our practice and our strategic plan. This is then enveloped in the four components of a Magnet organization. Approval was sought through the divisional and unit councils, and final approval was given through the Nurse Coordinating Council in December 2015.
EXCELLENCE IN HUMAN CARING
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 5
Nurses advance their field by initiating and participating in the research, development and implementation of innovations in care delivery.
Validates that all nurses are encouraged to utilize
and participate in decision-making
structures to initiate or
influence their practice environment
CEDARS-SINAI PROFESSIONAL PRACTICE MODEL EXAMINED
OUR STRATEGIC GOALS Give Us Purpose
PERSON, FAMILY AND COMMUNITY
OUR NURSING VALUES Drive Us Forward
PERSON, FAMILY AND COMMUNITY
OUR PRACTICE The Makings of a Cedars-Sinai Nurse
THE MAGNET MODEL COMPONENTS
These are our guiding principles for all that we do!
They help us to achieve our quadruple aim of exceptional OUTCOMES, exceptional STAFF and
PATIENT EXPERIENCES, at the BEST VALUE!
As engaged professionals, we can promote the return to self-care for our patients
and the community in which we serve!
Exemplifies the innovative work of nurses within the full scope of their professional practice
Demonstrates innovative
and effective nursing
leadership strategies and
their outcomes
Inspire us to deliver the best care for our patients in the best environment for nursing!
PERSON, FAMILY AND COMMUNITY
Reach for Our VisionEXCELLENCE IN HUMAN CARING
Our desire to achieve Excellence in Human Caring with every person, every time!
PERSON, FAMILY AND COMMUNITY
PERSON, FAMILY AND COMMUNITY
Cedars-Sinai Nursing Annual Report 20166 |
CEDARS-SINAI NURSING STRATEGIC PLAN
Quadruple aim of achieving exceptional OUTCOMES, exception STAFF and PATIENT EXPERIENCES, at the best VALUE
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 7
CEDARS-SINAI NURSING STRATEGIC PLAN FY16–20
EX
CE
PT
ION
AL
O
UT
CO
ME
S:
QU
AL
ITY
(9
0%
OR
B
ET
TE
R)
EX
CE
PT
ION
AL
P
AT
IEN
T A
ND
F
AM
ILY
E
XP
ER
IEN
CE
(M
EA
SU
RE
D B
Y
HC
AH
PS
>7
5%
)
HO
W O
FT
EN
D
ID N
UR
SE
S:
VA
LU
E A
ND
E
FF
ICIE
NC
Y
(ME
AS
UR
ED
<
LO
S, C
OS
T/P
AT
IEN
T D
AY
)
EN
GA
GE
ME
NT
IN
E
BP
AN
D
RE
SE
AR
CH
WIT
H
AP
PL
ICA
TIO
N T
O
PR
AC
TIC
E
ED
UC
AT
ION
P
AT
HW
AY
FO
R
TR
AN
SF
OR
MA
TIO
NA
L
LE
AD
ER
SH
IP A
ND
P
RA
CT
ICE
INC
RE
AS
ED
P
HIL
AN
TH
RO
PY
A
ND
C
OM
MU
NIT
Y
SE
RV
ICE
NS
I exc
ee
ds
me
an
Nat
ion
al b
en
chm
ark
Ed
uca
tio
n/
Info
rmat
ion
:
Exp
lain
th
ing
s in
a
way
yo
u c
ou
ld
un
de
rsta
nd
?
LO
S, d
isch
arg
ed
b
y 11
am; m
axim
ize
pat
ien
t fl
ow
All
staf
f in
volv
ed
E
BP
an
d
ach
ieve
me
nt
no
ted
in
an
nu
al e
valu
atio
n
>5
0%
nu
rse
s C
N I
II
or
eq
uiv
ale
nt;
rev
ise
and
sta
nd
ard
ize
CN
III
p
roce
ss
>%
nu
rsin
g
staf
f d
on
atio
n
op
po
rtu
nit
ies
Re
alia
bili
ty in
N
urs
ing
’s s
tan
dar
d-
ize
d p
roto
cols
(p
reve
nti
on
CA
UT
I, V
AP
, CL
AB
SI,
Fra
ilty,
H
AP
U, F
alls
)
Ph
ysic
al C
om
fort
:
Do
eve
ryth
ing
to
h
elp
wit
h p
ain?
Re
du
ce t
ota
l co
st/p
atie
nt
and
exp
and
p
op
ula
tio
n h
eal
th
en
rollm
en
t
>#
of
po
diu
m a
nd
ab
stra
ct a
cce
pte
d
to c
on
fere
nce
s;
>#
pu
blic
atio
ns;
al
l pro
ject
s n
ote
d in
R
ese
arch
Re
gis
try
Cu
ltu
re o
f te
amw
ork
, in
clu
seiv
en
ess
an
d in
cre
ase
em
oti
on
al
inte
llig
en
ce;
me
asu
red
by
nu
rse
en
gag
em
en
t >7
5%
$ in
en
do
wm
en
t
Incr
eas
ed
d
ocu
me
nta
tio
n a
nd
d
ecr
eas
ed
use
of
rest
rain
ts m
eas
ure
d
by
CA
LN
OC
me
an
Pat
ien
t P
refe
ren
ce:
Lis
ten
ed
car
efu
lly
to y
ou
?
Tre
at y
ou
wit
h
cou
rte
sy a
nd
re
spe
ct?
De
cre
ase
d
trav
ele
r an
d
ove
rtim
e %
b
y d
ecr
eas
ing
va
can
cy a
nd
st
affi
ng
fo
r LO
A
Sp
read
be
st
pra
ctic
es:
C
C d
elir
ium
stu
dy
; im
pac
t o
f n
urs
e re
sid
en
cy p
rog
ram
; fr
ailt
y re
sear
ch
% c
ert
ific
atio
n in
cre
ase
pe
r u
nit
to
80
% e
ligib
le$
en
do
we
d c
hai
r
VP
Nu
rsin
g
Incr
eas
ed
Ala
ris
pu
mp
inte
gra
tio
n in
P
ed
s an
d O
nco
log
y (s
can
nin
g r
ate
97
%
adu
lts)
Re
spo
nsi
ven
ess
:
Go
t h
elp
as
soo
n a
s yo
u w
ante
d?
Incr
eas
e re
ten
tio
n
of
top
tal
en
t;
coac
h a
t al
l le
vels
; su
cce
ssio
n
pla
nn
ing
Pla
n o
f ca
re a
nd
d
isch
arg
e p
lan
nin
g
in C
S-L
ink;
exp
and
d
eci
sio
n s
up
po
rt
in E
HR
%B
SN
an
d %
MS
N;
= 8
0%
by
20
20
(6
5%
B
SN
; 15
% B
SN
/MS
N);
6
en
rolle
d P
hD
p
rog
ram
$ e
nd
ow
ed
ch
air
rese
arch
Co
nti
nu
al r
eg
ula
tory
re
adin
ess
wit
h
inte
gra
ted
lear
nin
g
fro
m t
race
rs
Pat
ien
t/F
am
ily
Ed
uca
tio
n:
Sys
tem
wid
e im
pro
vem
en
ts
LE
AN
Six
Sig
ma
curr
icu
lum
fo
r n
urs
e le
ade
rs a
nd
e
du
cato
rs
Est
ablis
h r
ese
arch
fe
llow
s p
rog
ram
w
ith
pai
d r
ele
ase
tim
e
>S
imu
lati
on
an
d
e-l
ear
nin
g; c
om
pet
en
cy
veri
fica
tio
n
Incr
eas
ed
nu
mb
er
of
com
mu
nit
y vo
lun
tee
r o
pp
ort
un
itie
s
Acc
ompl
ishe
d in
FY
16P
rogr
essi
ng(A
ppro
ved
NC
C 6
/18/
2015
aft
er m
odifi
cati
ons f
or d
ivis
ion
prac
tice
coun
cils
)
Cedars-Sinai Nursing Annual Report 20168 |
GOALS AND ACCOMPLISHMENTS
GOALS FY16 ACCOMPLISHMENTS FY17 STRATEGIES
1
Exceptional Outcomes: Quality 90% or better
Cedars-Sinai continued to perform above the 90th percentile in safe quality care with all nurse sensitive indicators below the CALNOC mean
Continue exceptional performance in Safe, Quality Care
2
Exceptional Patient and Family Experience: measured by HCAHPS > 75% for pain management, nurse responsiveness, listening, courtesy & respect, patient/family understanding discharge education
Above the benchmark at 50% for pain and responsiveness and improving in listening, courtesy and respect and discharge education
Expand patient family involvement in nursing/patient/family councils; expand rollout of CS-Link MyChart; continue IPE role modeling and simulation training
3
Value and Efficiency: measured by length of stay (LOS), cost per patient day and unplanned overtime
Value and Efficiency: Improvements in discharging patients earlier and decreasing length of stay but reimbursement for care is less; fill vacancies and retain excellent staff and decrease unplanned overtime
Increase efficiency of earlier discharge and POCR rounds; increase specialty training classes for perioperative, critical care, ED and L&D and APN; fill vacancies; decrease use of travelers and overtime
4
Engagement in EBP and Research with Application to Practice
More clinical nurses are participating in abstract submissions and publications. November 2015 CS-Link optimization streamlined admission documentation and discharge education documentation; second research scientist hired
Continue increase clinical nurses’ involvement in EBP, submission of abstracts, presentations and publications. Establish research fellow programs with paid release time
5
Education Pathway for Transformational Leadership and Practice
Some units below orginaizational level but at Organization level eligible CN III at 53%; 75% specialty certification and 80% minimum BSN and 70% engagement on nurse satisfaction
At unit level >50% nurses CN III; 80% engagement score on nurse satisfaction; continue education programs at all levels
6
Increased Philanthropy and Community Service
Collaboration wtih Community Relations to establish additional endowments for nursing and community volunteer opportunities increased; Funded grant for spread of Frailty program; 86 community programs held and 750 nursing students from 18 affiliated schools had clinical placement and preceptors
Move from collaboration to attainment of additional funding for Nursing endowments and CS nurses donating to endowed chair; expand available number of preceptors for students, nurse residents and new staff
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 9
2016 NURSING CHARACTERISTICS
CHARACTERISTICS OF MAGNET ORGANIZATIONS
2016 MAGNET ORGANIZATIONS*
CEDARS-SINAI 2016
RN turnover 12 % 6%
Average # years employment 10 years 9.5 years
% of leaders with graduate degrees 60%84% in nursing plus
9% MBA, MHA
% of direct care nurses with BSN 59% 71%
% associate degree nursing 38.5% 14%
% Master’s degree direct care nurses 4% 14%
% Leaders with certification 60% 92%
% direct care nurses with certification 35% 80%
* Source Average Magnet Organizations Characteristics, ANCC website: wwwnursecredentialing.org updated November 2016
MAGNET REDESIGNATION PROCESS
• What is Magnet? A designation granted by the American Nurses Credentialing Center (ANCC) for nursing excellence, quality patient care and innovations in nursing practice and an engaged nursing staff.
• The nation’s highest honor for “Excellence in Nursing and quality patient care.”
• Cedars-Sinai was designated a Magnet organization in 2000 and is applying for a fifth designation September 2017 when we will submit our evidence collected from October 2013–September 2017. The appraisers will read and score our document and a site visit will be scheduled in four to six months.
• If the site visit is successful, the Magnet commission will designate Cedars-Sinai for a fifth Magnet-recognized organization for another four years.
Cedars-Sinai Nursing Annual Report 201610 |
TRANSFORMATIONAL LEADERSHIP
Today’s health care environment requires a new way of thinking, being and providing care. Cedars-Sinai nurses are empowered to think outside the box and drive transformational change. As a result, Cedars-Sinai remains strong and well positioned for the future. Research has demonstrated that nurses with a BSN degree and certification have better patient outcomes. “The Future of Nursing” report advocated that 80 percent of nurses have a BSN by 2020. Cedars-Sinai Nurses achieved and exceeded that level in 2016!
Graph showing 2014–2016 CS RN Education level
Cedars-Sinai Nurse Education Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
01
21
78
2
18
80
1
14
85
2014 2015 2016
Cedars-Sinai Eligible Nurse Certification Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
0
79 77 80
2014 2015 2016
Goal: 80% Certification by 2020
Goal: 80% Certification by 2020
DN 1 2 1
ADN 21 18 14
BSN/MSN 78 80 85
BSN 65 68 71
MSN 13 12 14
Goal: 80% BSN/MSN Certification by 20/20
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 11
CEDARS-SINAI LEADERSHIP DEVELOPMENT PROGRAMS
Transformational leadership and educational development are a key component of the Cedars-Sinai strategic plan.
LEADERSHIP LEVEL
CORE EDUCATION ADDITIONAL EDUCATION
CNI12-month nurse residency
transition programCrucial Conversations
CNII Preceptor program Crucial accountability; InsideOut coaching
CNIII Charge nurse courseRising Stars program; Emotional Intelligence;
Diversity workshop; project management
CNIV Project management Advisory Board leadership courses
Assistant Nurse Manager
Emerging leaderAdvisory Board leadership courses and
Organizational Development courses (OD)
Associate Director
Semiannual nursing leadership workshop
Advisory Board, OD leadership courses; AONE manager fellowship
Executive Director
Semiannual nursing leadership workshop
Advisory Board, OD leadership, AONE Director fellowship,
Annual professional meetings
Executive CNOC-Suite leadership meetings,
PEAC strategic planningAdvisory Board, AONE system and
CNO workshops, professional meetings
Evidence-based practice and research shows an engaged nursing staff with a good working environment has better patient outcomes and more retention of nursing staff.
Cedars-Sinai Nursing Annual Report 201612 |
NURSE ENGAGEMENT SURVEY
RN Satisfaction/Engagement 2016 and percentage of units better than benchmark
89% Participation
Professional Development
Leadership Responsiveness
Interprofessional Relationships
Adequate Resources &
Staffing
CS 90% 97% 80% 89%
The nurse engagement survey questions that comprise the category
MAGNET CATEGORY ENGAGEMENT QUESTION DRIVERS
PROFESSIONAL DEVELOPMENT
I know what is required to perform my job.
I have helpful discussions with manager on career.
Receive regular feedback on my performance.
Training & development helped me improve.
Received effective on-the-job training.
Most recent performance review helped me improve.
LEADERSHIP & RESPONSIVENESS
My CNO is a visible advocate for nursing.
Hospital administration follows through on nurse suggestions for improvement.
My manager is open and responsive to staff input.
INTERPROFESSIONAL RELATIONSHIPS
Abusive behavior is not tolerated.
I have good personal relationships with coworkers.
I receive support from employees in my unit to help me succeed in my work.
My coworkers do a good job.
ADEQUATE RESOURCES AND STAFFING
My organization supports employee safety.
I have a manageable workload.
Organization does a good job selecting and implementing new technologies to support my work.
My unit has enough staff.
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 13
STRUCTURAL EMPOWERMENT
The Nursing Strategic Plan provides the framework for continuous quality improvement. The plan challenges to develop new ways of thinking and delivering care, to blend the art and science of nursing with transformational leadership style, and provide the best possible outcomes for our person-centered care across the continuum of care. This comprises shared decision-making as well as recognition and awards.
2016 NURSING AWARDS AND RECOGNITION
Recognition of nurses at all levels is a key component to the culture of excellence at Cedars-Sinai. Recognition promotes empowerment, involvement and continuous improvement.
Zifkin Nurses of the Year: Marie Fe White, MSN, RN, ACNP, FNP and Karen Silva, PhD, MSN, RN-BC
Transformational Leadership: Joan Dawson, MSN, RN, CNOR, NEA-BC
Structural Empowerment: Maureen Davis, MSN, RN-BC
New Knowledge and Innovations: Cecille Pallagao, BSN, RN, CNOR
Exemplary Professional Practice: Barbara Fields, BSN, RN-BC
Empirical Outcomes: Norma Viverous, MSN, MPH, RN-BC
Ralph Parsons Nursing Excellence: Emily Gray, MSN, CMSRN
Elliott Blinderman Neurosurgical Scholarship: Joy Sarsoza, BSN, CMSRN
K. Black Neurosurgical Excellence: Michelle Medley, BSN, RN, CCRN
Nursing Informatics Excellence: Erin Carr, BSN, RN, OCN & Ellen Shukhman, BSN, RN-BC
Tower Urology: Carmencita Rue, BSN, RN, CNOR
Lilian Klapper RN Orthopedic: Shu-Tyng Chang, BSN, RN, ONC
Dorskind Oncology: Jennifer White-Geller, MSN, RN, ONS
Dorskind Woman’s Health: Mykel LeCheminant, MSN, RN-C
Dorskind Community Health: Haesook Kim, MSN, RN-BC
Helping Hand: Nicole Schwartz, AD, RNC-OB
Cedars-Sinai Nursing Annual Report 201614 |
SHARED GOVERNANCE MODEL
Cedars-Sinai’s shared decision-making foundation is at the unit practice level. After ideas are tried and adopted, they are spread to the divisional clinical practice council. Monthly recommendations from the divisional clinical practice council are brought to the Nursing Coordinating council — which is comprised of divisional directors, co-chairs of divisional councils and CNO — where recommendations are adopted across the organization for nursing.
Shared Governance Principles are:
Role of CPC
• Focuses activities to achieve the following outcomes:
• Increased number of BSN and certified staff
• Reduction in turnover; increased retention of new hires
• Active and ongoing peer review process
• Implementation/spread of TCAB process improvements
• Designs and implements best practice care standards and processes.
• Supports and fosters clinical decision-making at the point of service.
• Proposes and reviews clinical policies and nursing practice standards.
• Coordinates efforts and recommendations/proposals of the Unit Practice Councils to ensure consistency, complete communication and implementation.
• Recommends resources that support and facilitate nursing clinical practice.
CPC Disseminates information to UPCs for discussion
About best practices in Peer Review, Professional Advancement, retention of employees
Conduct to and from UPCs
To insure all information reaches UPC’s for discussion and feedback to CPC as needed
UPCs directs information to CPC for discussion
About best practices in Peer Review, Professional Advancement, retention of employees and other feedback as evolves
Information flow between UPC and CPC
Clinical Practice Council
NMs & UPC Chairs
Unit Practice Councils
Origin: 3/2007Rev: 2/2010; 12/2014
Information flow between UPC and CPC
Clinical Practice Council
NMs & UPC Chairs
Unit Practice Councils
• Information sharing
• Ideas generation for performance improvement
• Consensus building
• Individual responsibility
• Team accountability
Unit practice councils comprise the following reporting workgroups: peer review, MD-RN collaborative, education, regulatory preparation, community service, recruitment & retention, professional advancement, EBP, continuing education and patient acuity classification.
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 15
EXEMPLARY PROFESSIONAL PRACTICE
At Cedars-Sinai, we’re committed to offering excellent safe, quality care to each person we serve. Below are our Nursing Sensitive indicators for Hospital-Acquired Pressure Ulcers (HAPU stage 2 plus); Falls With Injury; Catheter-Associated Urine Tract Infections (CAUTI) and Central Line-Associated Blood Stream Infections (CLABSI), Stroke Measures and administration of pain medications in the Emergency Department within 60 minutes. For Stroke Measures, we are better than the benchmark 100 percent of the time for eight quarters as well as for administration of pain medication within 60 minutes in the Emergency Department, which is the ambulatory measure we are using. This data is for Quarter 1, 2014 to Quarter 4, 2015. We will be adding the latest two quarters of data (Quarters 1 and 2 of 2016) to this report before submitting in September 2017.
DIVISION UNIT NAME HAPU 2+FALLS
INJURYCLABSI CAUTI
Critical Care ICU/NSICU 8SCCT 7/8 7/8 4/8 2/8
MICU/RICU 7SCCT 4/8 7/8 7/8 3/8
SICU 5SCCT 6/8 6/8 7/8 6/6
CICU 4SCCT 8/8 7/8 6/8 2/8
CSICU 6SCCT 1/8 7/8 8/8 6/8
Med/Surg Aids/Idc/Hosp – 4SE 7/8 7/8 6/8 --
Gyn/Onc Cre 3SW/3SE–MED Closed Closed Closed --
Med-Surg 4NW 1/7 6/8 6/8 --
Med-Surg Care 7SE 8/8 8/8 7/8 --
Med-Surg Care 8North 7/8 8/8 8/8 --
Med-Teach 5SE 4/8 7/8 4/8 --
Med-Teach 5SW 4/7 6/8 7/8 --
Med-Teaching Care 6SW 7/7 5/7 5/7 --
Med/Surg Care 8South 8/8 8/8 6/8 --
Oncology 4SW 8/8 8/8 6/8 --
Ortho Care 7North 4/8 8/8 6/8 --
Universal Unit 3SCCT 5/8 7/8 8/8 --
Stepdown CHF/Heart Failure 6SE 6/8 7/8 6/8 --
Med-Surg Care 6NW 6/8 7/8 5/8 --
Step Down 6NE 4/8 8/8 6/8 --
5NE 6/8 7/8 6/8 --
5NW 8/8 7/8 5/8 --
WP NICU 8/8 8/8 6/8 --
PICU – 4SCCT 6/6 8/8 7/8 8/8
Pediatric Med/Surg 4North 8/8 7/8 7/8 --
Rehab Acute Rehab 7SW 8/8 6/8 7/8 6/8
L&D L&D 8/8 8/8 8/8 --
Post-Partum 3NW 8/8 8/8 8/8 --
Nursery 3 Nursery 8/8 8/8 8/8 --
Cedars-Sinai Nursing Annual Report 201616 |
EXEMPLARY PROFESSIONAL PRACTICE
Overall Patient Satisfaction for tracking and evaluating of patient experience as measured by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a public reporting tool that assess major areas of hospital performance that is compared to the patients’ perspective of how they perceived their care. Performance measure captured are for questions related to pain management, nurse responsiveness, patient engagement/patient-centered care, nurse treatment with courtesy and respect. Historically, we have done well in helping patients with their pain and responsiveness. In the last year, we have significantly improved in courtesy and respect, patient engagement and patient-centered care and medication safety. We have opportunities for improvement in listening, discharge education, continuity of care and patient education.
Pain ManagementDuring hospital stay, how often did hospital staff do everything they could to help with your pain?
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 78.7 80.3 81.5 79.5 78.4 81.3 80.3 80.6 8/8
B/M 77.5 77.1 76.5 76.4 77.1 77.1 77.1 76.8
ResponsivenessHow often did you get help getting to the bathroom or using bedpan as soon as you wanted?
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 65.8 67.5 65.6 69.4 67.9 66.7 71.2 71.0 8/8
B/M 63.5 63.2 61.7 62.2 62.5 62.9 63.3 63.3
Courtesy and RespectDuring this hospital stay, how often did nurses treat you with courtesy and respect?
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 84.1 85.3 84.3 85.4 85.5 84.2 85.6 85.9 7/8
B/M 84.3 84.2 84.2 83.8 84.3 83.9 83.9 84.1
Patient Engagement/Patient-Centered CareWhen I left the hospital, I clearly understood the purpose for taking each medication.
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 64.7 64.1 65.5 63.1 64.3 65.6 65.2 67 8/8
B/M 62.2 63 62.3 61.8 62.7 63 63.5 63
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 17
EXEMPLARY PROFESSIONAL PRACTICE
Patient Engagement/Patient-Centered CareDuring the hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left.
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 47.7 48.4 50.7 48.1 48.9 45.2 48.8 48.3 7/8
B/M 45.3 44.7 43.8 44.1 45.9 46 46.2 46.6
SafetyDuring this hospital stay, before giving you any new medicine, how often did the hospital staff ask you about your allergies or other medications you may have been taking?
Q Q2 FY ’15
Q3 FY ’15
Q4 FY ’15
Q1 FY ’16
Q2 FY ’16
Q3 FY ’16
Q4 FY ’16
Q1 FY ’17
Outcome
C/S 81.9 79.2 80.5 81.7 80.2 80.3 81.5 81.0 5/8
BM 79.6 79.6 79.2 80.3 80.4 80.2 80.6 81.1
Cedars-Sinai Nursing Annual Report 201618 |
NEW KNOWLEDGE AND INNOVATIONS
Through new knowledge and research, the Nursing Department has made remarkable progress in improving the nursing care, enhancing patient experience and improving patient outcomes. Limited list of nursing staff publications and presentations external to Cedars-Sinai include:
Published Articles in 2016
Gray, EA, Santiago, L, Dimalanta, MI, Maxton, J, Aronow, HU (2016). Discharge by 11am: The Significance of Discharge Planning. MEDSURG Nursing, 25 (6), 381-384.
Marion McRae, MSCN, ACNP-BC, CCRN: The Role of the Cardiovascular Genetics Counselor in Cardiovascular Team, section ACC
Marion McRae, Alice Chan, A. Lee, R. Hulett, Bernice Coleman. Team-Based Learning improves Nurses’ Knowledge of Cardiac Surgical Resuscitation. Dimensions in Critical Care. 36 (1): 60-67.
Bernice Coleman, et al. Advanced Nursing Practice and Research Contributions to Precision Medicine. Nursing Outlook, Mar-Apr 2016; 64(2): 117-123
Coleman, et al. Racial and Ethnic Disparities in Outcomes after Heart Transplantation: A systematic review of contributing factors and future directions to close the gap. The Journal of Heart and Lung Transplantation, Oct 2016
Naomi Tashman, BSN, ONC, WCC and Sarah Low, MSN, OCN, CMSRN, Improving Hospital Acquired Pressure Ulcer Prevention on an Orthopedic Unit, MedSurg Matters, August 2016; 25(4): 4-7
Noonan, K, Miceli, Ts, Managan, P, and Rome, S. Multiple Myeloma Treatment Options for Newly Diagnosed, Relapsed and Refractory Disease. Journal of the Advanced Practitioner in Oncology, Vol 7, suppl1, March 2016, 83-96.
Williams J. Katapodi, M, Starkweather, A, Bedzek, L, Cashion, A, Coleman, B; Advanced Nursing Practice and Research Contributions to Precision Medicine. Nursing Outlook. 64:117-123.
Podium Presentations in 2016
“Watching TV in the Hospital: Enhancing Heart Failure Education,” Barbara Fields, 2016 Association for Nursing Professional Development, Pittsburg, PA, July 2016
“Managing Side Effects,” Sandra Rome, International Myeloma Foundational Regional Community Workshop, San Francisco, CA, May 3, 2016
“90 Seconds of Focused Team Conversation to Reduce LOS and Address the Triple Aim,” Mary Reyes-Gonzales & William Stanford, MD, AONE, Fort Worth, TX, March 31, 2016
“Inherent Challenges of Managing the Dually Diagnosed Patient in an Acute Medical Environment,” Karen Silva, Sigma Theta Tau NU MU chapter, CSULA, Los Angeles, CA, November 2016
“Forensic Nursing: Possibilities and Challenges,” Karen Silva, Hospital De Clinicas de Sao Paulo, Brazil, August 31, 2016
“Mapping an Innovative Future: Seamless Progression to BSN,” Keith Hoshal, 2016 Magnet Conference, Orlando, FL, Oct. 6, 2016
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 19
NEW KNOWLEDGE AND INNOVATIONS
Poster Presentations in 2016
“Power to the CP: Empowering Clinical Partners through Stroke Education,” Laurie Paletz, Pamela Moore, Nili Steiner, International Stroke Conference, Los Angeles, CA, Feb. 2016
“Closing the Gap: A Customized Hospital Centric Trauma Orientation to Increase Documentation Compliance and Trauma Nurse Comfort Using High Fidelity Simulation,” Greg Eichelzer, MSN, RN, CEN and Donovan Steward, MSN, RN, CEN at the Society of Trauma Nurses National Conference, Anaheim, CA, March 2016
“Swallow Screens in the ED: A Hard Act to Follow,” Greg Eichelzer, MSN, RN, CEN, and Laurie Paletz, BSN, RN, SCRN at EPIC Group Meeting, Verona, WI, April 2016
“Who Ya Gonna Call?,” Marilyn Shirk, MN, RN, CNS-BC at Annual International Society of Psychiatric-Mental Health Nurses, Minneapolis, MN, April 2016
Cedars-Sinai Nursing Annual Report 201620 |
NURSING SPECIALTY CERTIFICATIONS
It has become an expectation at Cedars-Sinai that when you are eligible, you obtain specialty certification. Eighty percent of the eligible nurses at Cedars-Sinai have obtained their certification, a necessary step in advancing to CNIII.
Certification graph from 2014–2016 for direct care nurses
Cedars-Sinai Nurse Education Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
01
21
78
2
18
80
1
14
85
2014 2015 2016
Cedars-Sinai Eligible Nurse Certification Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
0
79 77 80
2014 2015 2016
Goal: 80% Certification by 2020
Goal: 80% Certification by 2020
Certification 79 77 80
Cedars-Sinai Nurse Education Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
01
21
78
2
18
80
1
14
85
2014 2015 2016
Cedars-Sinai Eligible Nurse Certification Rates, 2014–2016
% o
f R
Ns
90
80
70
60
50
40
30
20
10
0
79 77 80
2014 2015 2016
Goal: 80% Certification by 2020
Goal: 80% Certification by 2020
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 21
Jerome Codilla, CNIII BSN, RN, PCCN
Mayette David, CNIII: BSN, RN, CCRN
Seng Eap, CNIII BSN, RN, CCRN
Marielle Garalza, BSN, RN, CMSRN
Jacqueline Jones, BSN, RN, CMSRN
Jonvee Manzon, BSN, RNC-NIC
Tu Tran BSN, RN, CPN
Bradley Bliss, BSN, RN, CPAN
Mayette Davis, RN, CCRN
Tessie Hernandes, MSN, RN, CCRN
Michael Russo, BSN, RNC-NIC
Annette Robinson, BSN, RN, CPN
Kenneth Brooks, RN, CPAN
Lisa Dugger, MSN, RN, ACNS-BC, CDE
Haley DePalma, BSN, RN, CEN
Samantha Cutidioc, BSN, RN, CMSRN
Alexandra Reed, BSN, RN, CMSRN
Crystal Ramos, BSN, RN, CMSRN
Rosemary Onwuka, MSN, RN-BC
Manisha Ati, BSN, RN, CNOR
Anna Gallagher, BSN, RN, CNOR
Tara Watson, BSN, RN, CNOR
Nicole Landon, BSN, RN, CNOR
Alex Borys, BSN, RN, CNOR
Traci Ginsberg, BSN, RN, PCCN
Mark Rue, BSN, RN, PCCN
Brian Zunner, MS, RN, APHN-BC
Sofia Nava, BSN, RN, CCRN
Rebecca Ely, MSN, RN, CCRN
Ariela Kauffman, BSN, RN-BC
Miriam Daniel-John, MSN, RN, CMSRN
Linda Lamendola, BSN, RN, CMSRN
Gal Kotlow, BSN, RN, CMSRN
Alex Rector, MSN, RN, CCRN
Jina Kim, BSN, RN, CEN
Ryan Hodges, MSN, RN, CEN
Jeanette Horible, BSN, RN, CMSRN
Bjorn Inductivo, BSN, RN, CMSRN
Judy Esqueda, MSN, RNC-NIC
Kim McGroarty, BSN, RN, CPEN
Ellen Mack, MN, RNC, CPHQ
Laurie Marquez, BSN, RN, PCCN
Fawzi Homsi, BSN, RN, PCCN
Jeffrey Lopez, BSN, RN, PCCN
Jeremiah Burton-Blankenship, BSN, RN, PCCN
Emily Leach, MSN, RN, SCRN
Brian Gombodorj, BSN, RN-BC
Sylvia Estrada, MSN, DNP, MSHCM, CBCN, CBEC
Sherry Goldman, MSN, NP, CBCN, CBEC
Amanda Crick, MSN, ANP, CBCN, CBEC
CEDARS-SINAI NURSES OBTAINING CERTIFICATION IN 2016:
Cedars-Sinai Nursing Annual Report 201622 |
CERTIFICATIONS (continued)
Justin Munar, RN, CCRN
Molly Davis, BSN, RN, CMSRN
Marie De Austria, BSN, RN, CMSRN
Isabelle Mishaw, MSN, RN, CMSRN
Cris Sideno, BSN, RN, CMSRN
Melani Lim, BSN, RN, OCN
Daniel Schiesaro, BSN, RN, PCCN
Shiela Mariano, MSN, RN, CCRN
Kariz Anasco, RN, CCRN
Thanhan Tran, BSN, RN, CMSRN
Oscar Abarca, RN CMSRN
Frances Leong, MSN, RN, CMSRN
Kristen Carlos, BSN, RN, PCCN
Bridget McLoughlin, MSN, RN, CCTC
Janet Toledo, BSN, RN-BC
Paidamwoyo Tswakanyi, BSN, RN-BC
Roland Hemmings, BSN, RN, CCRN
Jayne Cortez, BSN, RN, CCRN
Angelita Ulan, BSN, RN, CMSRN
Aileen Espiritu, BSN, RN-BC
Alena Johantgen, BSN, RN, CPN
Naomi Jean-Baptiste, BSN, RN, PCCN
Anna Puhky, BSN, RN, CCTC
Natalie Robinson, BSN, RN-BC, CCTC
Robin Mulvaney, BSN, RN, CCRN
Karina Finkelshteyn, BSN, RN, CCRN
Marilou Paraiso, BSN, RN, CCRN
Olena Svetlov, MSN, RN, CNS, CCRN
Rajinder Gandhi, RN, CMSRN, PCCN
Jillian Beekman, BSN, RN-BC
Christine Hardy, MSN, RN, CCRN
Joy Gerales, RN, PCCN
Emily Gaddam, BSN, RN, CIC
Julieta Mijares, RN, CMSRN
Marie De Austria BSN, RN, CMSRN
Kamillia Dela Paz, BSN, RN, CMSRN
Hillary Lachoff, BSN, RN, CMSRN
Michael Deleon, BSN, RN, CMSRN
Angelita Ulan, BSN, RN, CMSRN
Amerine Bailey, BSN, RN, CMSRN
Nkechi Perkins, MSN, RN-BC
Olga Shichko, BSN, RN-BC
Jocelyn Perkins, BSN, RN, PCCN
Lauren Pellegrini, BSN, RN-BC
Ria Aldanese, BSN, RN-BC
Anna Pantoja, RN, CCRN
Alicia Fox, BSN, RN, CHFN
Vanessa Frigillana, BSN, RN, CMSRN
Jeanette Munden, BSN, RN, CMSRN
Amanda Kuehl, BSN, RN, CMSRN
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 23
CERTIFICATIONS (continued)
Kimberly Geraldez, MSN, RN, CMSRN
Tiffany Romero, BSN, RN-BC
Elitzafan Ebrahimdoost, BSN, RN-BC
Sheri McIntosh, MSN, RN-BC
Cenon Abesa, BSN, RN, CPN
Jennifer Blaney, MSN, RN, CPN
Jennifer Underhill, MSN, CCRN, CPN
Simona Campa, BSN, RN, PCCN
Tiffany Daun, BSN, RN, CCTC
Gideon Alcala, BSN, RN-C California State University, Fullerton
Denise Levesque, BSN, RN-BC Western Governors University (WGU)
Tsehay Sintayehu, BSN, RN-C, WGU
Tracey Constable, BSN, RN, OCN University of Phoenix
Janet Chaidez, BSN, RN-BC California State University, Los Angeles (CSULA)
Amber Hinson, BSN, RN, CAPA WGU
Mariam Kyababchyan, BSN, RN University of Phoenix
Janice Ritchie, RN-BC, WGU
Denise Levesque, BSN, RNC-MNN, WGU
Analisa Traba, BSN, RN; WGU
Laura Fellman, BSN, RN-C; WGU
Michael Gifford, BSN, RN-C; WGU
Jennifer Leroux, BSN, RN, CCRN; WGU
George Halab, BSN, RN-C; WGU
Crystal Gonzales, BSN, RN, CMSRN; WGU.
Ernest Johann Mitra, BSN, RN-C; WGU
BSN
Mylissa Mitchell MSN, RN, CPAN from University of Phoenix
Daniel Elinskas, MSN, RN, CAPA from University of Texas
Marie Kreisman, MSN, RN, CAPU from Western Governors University (WGU)
Michelle Onyemachi Chukwu, MSN, RN, CPAN, WGU
Ella Michaelian, MSN, RN-BC
Ashken Galstyan, MSN, RN-BC
Jae Chung, MSN, RN, CMSRN, Azusa Pacific University
Bhargavi Simhadri, MSN, RN, CMSRN, WGU
Ariel Morejon, MSN, RN-C, WGU
Robert Viana, MSN, RN-BC St Mary’s University
Miya Han, MSN, RN, PCCN, CSULA
MSN
Cedars-Sinai Nursing Annual Report 201624 |
CERTIFICATIONS (continued)
Lauren Wilstein, MSN, RN, ACNP; UCLA
Rotch Delos Santos, MSN, RN, CCRN; WGU
Amy Matsuo, MSN, RN-BC; WGU
Rosalind Tu, MSN, RN-BC; WGU
Michele Rivera, MSN, RN-C; WGU
Amanda Williams; MSN, RN-C, WGU
Lilian Cruz, MSN, RN-C; WGU
Kimberly Geraldez, MSN, RN, CMSRN, ANP from Azusa Pacific
Sherie McIntosh, MSN, RN, CMSRN, University of Phoenix
Lilian Cruz, MSN, RN-C
Cedars-Sinai nurses who advanced their educational degrees in 2016 to BSN and MSN. Cedars-Sinai continues to provide critical pipeline loans for nursing education of $5,250 per year (January to December) and $600 per year for continuing education or certification assistance.
Cedars-Sinai celebrating National Nurse Certification Day
Cedars-Sinai Nursing Annual Report 2016
©2017 CEDARS-SINAI
| 25
A number of Cedars-Sinai nurses have received awards or participated on state and national boards, contributing their expertise.
2016 RECOGNITION PROFESSIONAL ORGANIZATIONS
Editors: Jane Swanson, PhD, RN, NEA-BC, FAAN, Sarah Stepien, MSN, MPH, RN-BC, Leslie Reed 12-22-2016
Lina Lapid, MSN, RN, CPAN White House Millennium Council Award from Philippine Heritage Institute International
Jeffrey Bergen, MSN, RN, CPHAQ election to board of directors of Vascular Birthmarks Foundation 2015-2017
Sylvia Estrada, DNP, MSN, MSHCM, WHNP-BC, CBCN, CCRP appointed to 2016 board of American Organization of Nurse Executives for a one-year term
Giancarlo Lyle-Edrosolo, DNP, RN, NE-BVC, CCRN-CMC also appointed to AONE Board for a two-year term
Linda Burnes Bolton, DrPH, ScD, RN, FAAN 2016 AONE Prism Diversity Award
Margo Minissian, MSN, ACNP, CLS, AACC, FAHA received Distinguished Associate of the American College of Cardiology award at 65th annual meeting
Naomi Tashman, BSN, RN, ONC received National Association of Orthopedic Nurse Practice Award 2015–16 at national meeting, Orlando, Florida
Millicent de Jesus, reappointment to editorial committee of Academy of Medical-Surgical Nurses journal MEDSURG Nursing, 2016–2018
Bernice Coleman, PhD, RN, APN delivered the commencement address for Yale School of Nursing, May 2016
Linda Burnes Bolton, DrPH, RN, FAAN American Academy Nursing Living Legend, October 2016
Linda Burnes Bolton, DrPH, RN, FAAN was promoted to System Chief Nursing Executive and Vice President of Nursing; also endowed with the inaugural James R. Klinenberg, MD and Lynne Klinenberg Linkin Chair in Nursing