TL8 The CNO uses various methods to communicate, be visible, and be accessible to nurses throughout the organization. Choose two of the three below:
| Provide one example, with supporting evidence, of communication between the clinical nurses(s) and the CNO that led to a change in the nurse practice environment. |
OR
| Provide one example, with supporting evidence, of communication between the clinical nurses(s) and the CNO that led to a change in the patient experience. |
OR
Provide one example, with supporting evidence, of communication between the clinical nurse(s) and the CNO that influenced a change in nursing practice.
Example 1 – Communication that Led to a Change in the Nurse Practice Environment
NAME OF INITIATIVE
Admitting Non-Scholar Employees into the Versant Program
BACKGROUND AND PURPOSE
Methods Used by CNO to Promote Visibility, Accessibility and Communication
Chief Nursing Officer and Vice President Gail Gordon, RN utilized several methods to promote visibility, accessibility and communication among her nurses. In addition to her open-door policy, Gordon has scheduled meetings with new hires during their First 90-days in the organization. (TL8 01 90-Day Meeting Log) This is an important touch point to gather their impression of the organization under fresh eyes, capitalize on best practices from their previous organization, and identify opportunity areas. Gordon attends hospital-wide shared governance meetings and various teams and forums participated in by clinical nurses where she gets first-hand information on clinical nurses’ opinions and suggestions. Additionally, Gordon conducts intentional rounding for outcomes (TL8 02 Rounding Schedule) to harvest valuable information especially from clinical nurses and other direct care staff who are at the front line. To supplement the regularly-scheduled rounding, Gordon also conducts the “Roundtable with Gail”. The Magnet Designation department coordinates with Gordon’s executive assistant in scheduling her visit during the last 15-minutes of the department’s staff meeting. The Magnet Designation department puts out a flyer 1 month before the scheduled meeting together with the “Ask Gail” box where staff can put in questions for Gail to address during the session. The department’s nursing leaders are not present during these meetings to promote candid participation and discussion among the staff. Gordon rotates her visits among the 9 nursing departments throughout the year.
Communication between Clinical Nurses and CNO
In April 2013, Gordon was scheduled to visit 3 South, a medical-surgical/telemetry/orthopedic department. Prior to the meeting she received 7 anonymous questions in the “Ask Gail” box. Two of the questions pertained to staff’s concern about their colleague Charles Juste, RN, as follows:
- “We have a care partner (CP), Charles Juste, who went to school to become a RN. He was not a scholar and cannot get a job here. Can something be considered for these staff who are trying to better themselves? Charles is an excellent employee who already knows the culture. I would like to see some type of program developed for these employees, thanks.”
- “We are motivated to continue our education which is great. On the other hand, we have CPs which have gotten their license as a RN but are not offered a job. These CPs know the regulations and ropes. Yet investment is given to people who are from the outside in. Why not keep our own and help climb the ladder of success? Encourage and support our own.”
The Patient Care Leadership Council (PCLC) consisting of CNOs from various hospitals had previously established the offer criteria for accepting applicants into the Versant program which prioritized nurses who are enrolled in the onsite scholars program. This placed existing employees who obtained their RN degrees outside of the scholars program towards the bottom of the hierarchy.
Gordon addressed the clinical nurses’ above concerns during her roundtable discussion in 3 South on April 2013. (TL8 03 South Meeting Minutes and Sign-in Sheet 4/22/13)
METHODS AND APPROACH
In May 2013, Gordon took this input back to PCLC which resulted in the reevaluation of the Versant program offer criteria and subsequent revision as follows: (TL8 04 PCLC minutes 5/16/13)
- BSN (Bachelors of Science in Nursing) scholars
- ADN (Associates Degree in Nursing) scholars
- BSN employees
- ADN employees
- Executive referrals
PARTICIPANTS
Name/Credentials |
Title |
Department |
Role |
3 South Nurses |
Clinical Nurses |
3 South |
Provided input to CNO |
Gail Gordon, MSN, RN, NEA-BC |
Chief Nursing Officer and Vice President |
Nursing Administration |
Solicited clinical nurses input on practice environment and brought it to PCLC |
PCLC |
Chief Nursing Officers from across the system |
Nursing Administration |
Revised Versant offer criteria |
Randy Garcia |
Administrative Assistant |
Magnet Designation |
Oversaw the roundtable scheduling and process |
OUTCOMES
Change in the Nurse Practice Environment
The 3 South nurses received Gordon’s update on the revised criteria favorably. As a result of the new guidelines, Patient Care Manager Linda Simpson, RN, was able to hire Charles Juste, RN, and put him through the Versant program. Juste is currently working night shift in 3 South. Additionally, 5 more existing employees who got their RN outside of the scholars program were on boarded:
- Jocelyn Pierre, RN – MS5
- Georgina Wilson, RN – Perinatal Services
- Fabiana Trujillo, RN – Surgical Services
- Edgar Miranda, RN – ED
- Narai Martinez, RN - PCU
This change, brought about through clinical nurses’ input, improved the nurses’ practice environment by providing job and retention opportunities to existing employees who are already well versed with the organization’s culture. The 3 South staff also appreciated the time that Gordon took out of her hectic schedule to visit them as evidenced by the high scores she received from the feedback survey.
Exhibit TL8a: 3 South Roundtable with Gail Feedback Survey
Analysis: Above graph shows that the 3 South clinical nurses and staff received the CNO roundtable session favorably.
Summary Attachments/Hyperlinks/Evidences
TL8 01 90-Day Meeting Log
TL8 02 Rounding Schedule
TL8 03 South Meeting Minutes and Sign-in Sheet 4/22/13
TL8 04 PCLC minutes 5/16/13
Exhibit TL8a: 3 South Roundtable with Gail Feedback Survey
Example 2 – Communication that Led to a Change in the Patient Experience
NAME OF INITIATIVE
Patient Food requests
BACKGROUND AND PURPOSE
Methods Used by CNO to Promote Visibility, Accessibility and Communication
In May 2013, Chief Nursing Officer and Vice President Gail Gordon, RN conducted her “Roundtable with Gail” in the Perinatal Services department. During this session, Gail attended the last 15 minutes of their staff meeting. In order to encourage honest feedback from the clinical nurses and staff, department nurse leaders were not present. Thus, no minutes were taken during this portion of the meeting except for Gordon’s rounding log which she used to take notes. The clinical nurses in the Mother/Baby Unit (MBU) brought to her attention an issue they were experiencing with the patients’ food.
Communication between Clinical Nurse and CNO
During this forum, the clinical nurses informed Gordon that there was not enough patient food readily accessible at night. They articulated to her that during the night, many of the post partum patients complained of feeling hungry. (TL8 05 Rounding Log and Staff Meeting Sign-in Sheets) The nurses attributed this to the physical demands associated with the labor and delivery process. Additionally, the department was in the process of transitioning from the traditional post partum/nursery model to the couplet care delivery model which went live in February 2013. As a result of this initiative, the clinical nurses had seen an increase in the number of breast feeding mothers, who required 500 more calories per day. Incidentally, when Gordon assumed the role of administrator on-call (AOC) on June 2nd, 2013, she received similar comments from the clinical nurses in MBU during her rounds.
METHODS AND APPROACH
The next day, Gordon provided the feedback to Perinatal Services Director Jan Weatherspoon, RN. Weatherspoon thanked Gordon for the feedback and for rounding in her department which was very well received by the staff. (TL8 06 Thank You Email from Weatherspoon) Weatherspoon then arranged a meeting with Gordon, Food Services Director Zeke Perez, and Clinical Nutrition Services Manager Lizanette Fratecelli on June 2013. (TL8 07 Meeting Minutes 6/13/13) Their goal was to afford a consistent delivery of well-balanced and nutritious evening snacks to post-partum mothers, thus, maintaining patients' satisfaction on “quality of food”. They came up with an action plan of providing a snack box. It would consist of a sandwich, yogurt, and fruit delivered to each patient together with their evening trays. The team quickly acted on this and implemented it on July 1st, 2013. Additionally, Gordon invited Perez to speak at the Nursing Leadership Meeting (NLC) in October 2013 as a follow-up. Perez spoke to the nursing leaders about the importance of having adequate food par levels in the pantry especially at night to meet patients’ needs. (TL8 08 NLC Meeting Minutes 10/18/13)
PARTICIPANTS
Name/Credentials |
Title |
Department |
Role |
Janice Moitt, RN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Angela Saxton, RN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Mayra Moreno, BSN, RN, RNC-LRN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Vicki Brawner-Flatt, RN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Gary Frey, RN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Edelmys Mederos, BSN, RN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Maria Garcia, RN, RNC-LRN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Beth Diaz, RN, RNC |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Kelly Goldman, BSN, RN, CMSRN |
Clinical Nurses |
Perinatal Services |
Communicated to CNO patient concerns |
Gail Gordon, MSN, RN, NEA-BC |
Chief Nursing Officer and Vice President |
Administration |
Obtained clinical nurse input and participated in the action planning |
Jan Weatherspoon, MSN, RN, NEA-BC |
Prenatal Services |
Prenatal Services |
Developed and implemented the action plan |
Zeke Perez |
Director |
Food Services |
Developed and implemented the action plan |
Lizanette Fratecelli, RD |
Clinical Nutrition Services Manager |
Food Services |
Developed and implemented the action plan |
OUTCOMES
Change in the Patient Experience
Since the change was implemented as a result of clinical nurses’ communication with Gordon, there have been no further anecdotal complaints of being hungry from the patients. Additionally, the Food Services department made slight modifications to the snack box and changed the yogurt and fruit to chips based on the patients' feedback.
Exhibit TL8b: Homestead Hospital Post Partum Quality of Food Percentile Rank
Analysis: There have not been any dips in MBU’s patient satisfaction on “quality of food” since the implementation of the snack box.
Summary Attachments/Hyperlinks/Evidences
TL8 05 Rounding Log and Staff Meeting Sign-in Sheets
TL8 06 Thank You Email from Weatherspoon
TL8 07 Meeting Minutes 6/13/13
TL8 08 NLC Meeting Minutes 10/18/13
Exhibit TL8b: Homestead Hospital Post Partum Quality of Food Percentile Rank
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