Magnet Recognition Program® Request for Additional Documentation
Homestead Hospital
Homestead, FL
MGN20140102
TL5 Nurse leaders lead effectively through change.
TL5a: Provide one example, with supporting evidence, of the strategies used by nurse leaders to successfully guide nurses through unplanned change.
The initiative that was described was planned, organized and implemented over a span of six months; therefore, it did not describe an unplanned change example.
Provide one example, with supporting evidence, of the strategies used by nurse leaders to successfully guide nurses through unplanned change.
______________________________________________________________________
A new example is provided below.
Unplanned Change
NAME OF INITIATIVE
Ebola Preparedness
BACKGROUND AND PURPOSE
In September of 2014, Ebola became a national threat to the country when the first case was confirmed in the United States (U.S.). Specifically, as healthcare workers, nurses needed to address this immediately in order to ensure the safety of the public as well as that of the staff who would be caring for these patients. Ebola Virus Disease is a disease in humans and nonhuman primates caused by 5 virus species, 4 of which cause diseases in humans. An epidemic in Western Africa was caused by the most virulent species. Transmission is through unprotected direct contact with blood, body fluids, and organs/tissues of infected persons or animals. The virus can also spread through contact with contaminated objects. The dried virus can survive on surfaces for several hours and up to several days at room temperature in fluids. However, the Ebola virus is killed with hospital grade disinfectant, such as household bleach. The incubation period from exposure to when signs and symptoms appear is from 2-21 days, averaging 8-10 days. To date there is no FDA-approved vaccine or medicine available for the treatment of Ebola. Supportive measures, such as intravenous fluids; replacing electrolytes; and supplemental oxygenation, if used early, can improve the chance of survival. Knowing the infectious nature of Ebola, Homestead Hospital nurse leaders gave it their immediate attention.
METHODS AND APPROACH
The Centers for Disease Control and Prevention (CDC) confirmed the first U.S. case of Ebola in Dallas, Texas on September 30th, 2014. Two days after the first confirmed case was announced Chief Nursing Officer and Vice President Gail Gordon, RN, communicated to nurse leaders the guidelines set forth by the corporate office based on CDC recommendations for the care of Ebola patients. The focus was directed towards the Emergency Department (ED) and the Intensive Care Unit (ICU). As a result, Specialty Nursing Services Assistant Vice President Ana Cabrera, ARNP (nurse leader), together with ED Director Sherine Craig, RN (nurse leader), coordinated the communication to the nursing staff. Cabrera conducted a meeting with other nursing leaders on the focus areas in October 2nd, 2014, to delegate roles, responsibilities and tasks. (TL5 01a Ebola Preparation Meeting Minutes 10/2/14) Each member was expected to participate in regular briefings and provide updates as requested by the corporate offices.
The ED already had several members who had Emergency Response Training (ERT) and were ready and willing to take on the additional responsibility to train the remaining ED staff. The same approach undertaken for other emergency responses was used to address Ebola. In October 10th, 2014, Craig led her team through an ED strategic planning meeting regarding the care of Ebola patients. ED Clinical Nurse Educator Bettina Laier, RN, ED Patient Care Supervisor Andrew Seaman, RN, and Clinical Nurse Denishia Dozier, RN were the ED team leaders who coordinated training and education. ED Patient Care Supervisors, with the support of Laier, Seaman and Dozier, led daily shift huddles that included reminders and Q&A sessions. Craig also covered the same information in her monthly staff meetings (TL5 02a ED Strategic Planning Meeting Minutes 10/10/2014 and Staff Meeting Minutes 10/25/14)
Under the direction of Cabrera, ICU/PCU Patient Care Manager Leslie Everett, RN and Clinical Nurse Specialist Rosemary Lee, ARNP, were assigned to coordinate education and training for the remaining staff (i.e. ICU, OR, Imaging, Respiratory). Everett and Lee first attended a corporate training session before educating the staff. Once they felt competent to proceed, they conducted the training and competency validation of the direct care staff. As staff was trained, an ongoing list was kept by the respective department’s patient care supervisor. Some direct care staff in the ED and ICU volunteered to be the first ones to care for these patients.
This was a very intense and emotionally charged period for the staff. To allay everyone’s fear and apprehension, Infection Control Manager Wendy Rey, RN, who was the resident expert on Ebola took the lead in sending out regular updates based on the latest guidelines, as changes were happening on a daily basis. She continually relayed information either via email or by morning huddles to the leaders as she received it from the corporate office, the CDC and the local health department. She also facilitated hospital and nursing leadership attendance to meetings with the CDC and the Department of Health via national webinars and telephone conferences. Additionally, she frequently rounded on the units and distributed posters on how to properly identify patients. She provided bedside clinical staff with checklists and guidelines including step-by-step pictures of how to properly don and doff personal protective equipment (PPE). She posted notices and alerts of signs and symptoms in public areas. Beginning October 24th, 2014, Rey conducted 9 Q&A sessions at various times for all hospital staff over a 10-day period due to ongoing concerns regarding Ebola.
On October 16th, 2014, Homestead Hospital received 3 patients through the ED suspected of Ebola. Leaders and frontline staff activated the Ebola plan. Coincidentally, Cabrera was the Administrator-on-Call that day and coordinated activities in the ED along with Rey, ED Medical Director Otto Vega, MD, Vice President of Operations Kenneth Spell, patient care house supervisors and the direct care staff. While the patients were being evaluated in the ED, Everett worked closely with Safety/Security Manager Ellen Sordo, RN and the Engineering Department to finish construction of the ICU anteroom in preparation of caring for the suspected Ebola patients. Fortunately, all 3 patients tested negative for Ebola.
This event provided the opportunity for the organization to put into action the Ebola preparedness plan. Thereafter, Cabrera led a debriefing session with the interprofessional team and key stakeholders. The team identified areas of strengths and opportunities. Cabrera assigned follow-up action items on identified issues. (TL5 03a Ebola Debriefing Minutes 10/16/14) The very next day on October 17th, 2014, the corporate office planned an unannounced system-wide drill involving Ebola patients. Homestead Hospital staff performed exceptionally well due to steps that were taken to prepare for such an event including those of the day prior. Craig has previously made this suggestion to Rey, Sordo and Gordon, who in turn communicated the need for a hospital-wide drill to the corporate office. (TL5 04a Email from Craig 10/9/14) Additionally, on November 18th, 2014, Craig also coordinated an Ebola drill including Miami-Dade Fire Rescue. Sordo submitted action reports to the Emergency Management Committee after the drills.
Perinatal Services Director Jan Weatherspoon, RN (nurse leader), had voiced her concerns regarding the care of the obstetrical (OB) patient and potential newborn. Several communications occurred at the corporate level to attempt to address these concerns. After a potential Ebola patient presented to the ED and was taken directly to the OB department, the nursing staff felt uneasy about the process that was in place. With much debate due to lack of evidence and guidelines to support the care of this patient population, Cabrera met with the leadership team of the Perinatal Services on October 21st, 2014 to devise a plan in the event a case should occur. The group decided that the OB patient would remain in the ICU and support would be provided as needed by the OB patient care supervisor. At the conclusion of the meeting, OB Patient Care Supervisor Julie Brandt, RN, sent an email, on behalf of the leadership team, to the Perinatal Services staff to inform them of the recommendation. Lee together with Perinatal Services Clinical Nurse Educator Linda Johnson, ARNP provided training and education to the OB staff.
Strategies Used by Nurse Leaders
In summary, the strategies used by nurse leaders to successfully guide nurses during an unplanned change included:
- Spearheading the Ebola preparation activities.
- Delegating roles, responsibilities and task.
- Coordinating the communication flow from the corporate, CDC and local health department offices to the staff.
- Assuring availability of facilities, PPE and supplies to properly care for Ebola patients.
- Organizing staff education and competency validation.
- Developing and updating Ebola guidelines, as needed.
- Evaluating the effectiveness of Ebola plan through drills and debriefing sessions.
PARTICIPANTS
The following individuals were involved in carrying out this unplanned change ( with nurse leaders’ name highlighted):
Name/Credential |
Title |
Department |
Role |
Ana Cabrera, DNP, ARNP, ACNP-BC, NEA-BC |
AVP Nursing (ED, ICU/ PCU, Surgical Services, Perinatal Services) |
Nursing Administration |
Coordinated meetings and preparedness; led debriefing post event |
Sherine Craig, MSN, RN, CNML |
Director |
Emergency Department |
Spearheaded ED preparedness |
Jan Weatherspoon, MSN, RN, NEA-BC |
Director |
Perinatal Services |
Develop guidelines for OB |
Gail Gordon, MSN, RN, NEA-BC |
Chief Nursing Officer and Vice-President |
Administration |
Acted as liaison between Homestead Hospital and the Corporate office |
Leslie Everett, BSN, RN, CCRN |
Manager |
ICU/ PCU |
Ensured preparedness of ICU and ancillary staff. |
Wendy Lopez, RN, ICP |
Manager |
Infection Control |
Facilitated hospital-wide/corporate communication and education |
Ellen Sordo, MN, RN |
Manager |
Safety/ Security |
Chair of Hospital Wide Emergency Preparedness Committee |
OUTCOMES
By December 2014, the following had been accomplished:
- ED had trained 143 nurses and ED technicians while ICU had trained 33/35 nurses;
- Guidelines and protocols (TL5 05a Ebola Plan, original and updated versions) were established and in place; and
- All departments had the equipment they needed to care for an Ebola patient.
Through, the monthly Emergency Management Committee meeting, ongoing recommendations and communication continued. The Emergency Management Committee recommended the establishment of an interprofessional Ebola subcommittee, which held its first meeting in December 2014. In February 2015, the Emergency Management Committee endorsed the Ebola Subcommittee to the Department of Nursing Services. The following month, Gordon communicated with Cabrera, Craig and Everett the need to address ongoing training and education. Gordon designated Craig to take the lead for ongoing Ebola readiness. This included ensuring that orientation, training, competencies, supplies and equipment are available for the direct care staff.
In May 2015, the team involved in the Ebola preparation had the honor of receiving the Kaizen Award. Kaizen is a Japanese word that means “change for the betterment”. The Kaizen Award is a strategy that reinforces the continuous improvement initiative in the Baptist Health “Good to Great” philosophy. The purpose of the award is to foster, recognize and reward innovation, collaboration and enterprise-wide execution of major strategic and operational initiative.
Exhibit TL5aa: Gordon presenting the Kaizen certificates to the winners. (Pictured below from left to right: Craig, Everett, Rey, Gordon, Cabrera and Sordo.)
Summary Attachments/Hyperlinks/Evidences
TL5 01a Ebola Preparation Meeting Minutes 10/2/14
TL5 02a ED Strategic Planning Meeting Minutes 10/10/2014 and Staff Meeting Minutes 10/25/14
TL5 03a Ebola Debriefing Minutes 10/16/14
TL5 04a Email from Craig 10/9/14
TL5 05a Ebola Plan, original and updated versions
Exhibit TL5aa: Gordon presenting the Kaizen certificates to the winners.