Sentara Martha Jefferson Nursing Annual Report 2019

PROFESSIONAL DEVELOPMENTPROFESSIONAL DEVELOPMENTEndoscopy:Laura Marino, MSN, RN, AGACNP-BCKiley Bailey, MSN, RN, RNC-OBPalliative Care:Layne Brophy, BSN, RN, CGRNEdie Markowski, BSN, RN, CCRNAdrianna Chapman, BSN, RN, C-EFMAurora Durkee-Warren, RN, RN-BCKarron Good, RN, CGRNBoyce McClennan, BSN, RN, CCRNStephanie Dennis-Bowers, RN, RNC-OBPeggy Bishop, MSN, RN, AANP, ACHPNSara Morris, BSN, RN, CMSRNElizabeth Eldredge, BSN, RN, CLDEmily Peterson, BSN, RN, PCCNSharon Fickley, MSN, RN, RNC-OB, C-EFM,CNLInfusion Center:Hollis Campbell, BSN, RN, OCNKristin Rubenoff, BSN, RN, CCRNPatricia Kearns, RN, OCNIntegrated Care Management:Veronica Bernacchi, BSN, RN, PCNVictor Somers, RN, CCRNJennifer Gaines, MSN, RN, CHSEMichelle Harper, BSN, RN, RN-BCAmanda Harrison, BSN, RN, C-EFMJennifer Johnson, BSN, RN, CNORMike Nelson, BSN, RN, OCNHilda Taylor, DNP, RN, CCRN, PCCN,CNLChristine Hibbert, RN, RNC-OBKathryn Jones, BSN, RN, RN-BCDanielle Schrader, BSN, RN, OCNTenaya Thurston, RN, PCCN, NREMT-PAdelle Karaca, BSN, RN, RNC-LRNSusan Lebeis, RN, BA, CCMBrandi Teel, RN, OCNEmergency Department:Esther Lozano, RN, IBCLCPatra Reed, DNP, RN, CNML, CCCTMMedical Oncology/Cancer Services:Samantha Carter, BSN, RN, EMT-BPenny Merrel, BSN, RN, IBCLCGreg Ford, BSN, MA, NHDP-BCAllyson Michaels, MSN, RN, IBCLCPatient Safety & Quality:Brandy Maxton, RN, OCNMichele Bascle, BSN, RN, OCNCornell 2:Melinda Schmidt, RN, CMSRNJanelle Gorski, MSN, RN, ANP-BC,AOCNPDeborah Brown, BSN, RN, RN-BC, GRNShaela Shifflett, RN, CMSRNJean Jun, DNP, MSN, RN, FNP-CErin Muller, BSN, RN, RNC-OB, IBCLCJulie Drexler, RN, RN-BC, GRNStacey Williams, BSN, RN, RN-BCGerald Perry, RN, NREMT-PKatherine Rainey, BSN, RN, IBCLCOutpatient Surgery Center:Laura Trissel, DNP, RN, AGACNP-BC,AOCNPLindsey Fletcher, BSN, RN, RN-BC, GRNObservation:Anne Roane, MSN, RN, FNP-CLaura Salvatierra, BSN, RN, CLDDawn Haasnoot, MSN, RN, RN-BC, CAPACarrie Thompson, BSN, RN, NREMT-PBethany Shaffer, BSN, RN, CLDDebra Rose, RN, RNC-OBRomantha Turner-Miller, BSN, RN,CENElaine Shinsky, BSN, RN, RNC-OB, EFM-CPatricia Sawyer, BSN, RN, CNORGabrielle Smith, BSN, RN, RNC-OBRobin Workman, BSN, RN, CMSRNFree-Standing ED:Samantha Spiker, BSN, RN, RNC-LRNRobert Kirk, BSN, RN, CENKristin Von Thelen, BSN, RN, RNC-OBMary Beth Revak, BSN, RN, OCNCornell 1:Dana Graves, BSN, RN, PCCNLyndsey Schaffer, BSN, RN, PCCNRyan Thompson, MSN, RN, CNLWendel 2:Teresa Brock, BSN, RN, ONCJenna Masten, BSN, RN, RN-BCShaune McKinnon, MSN, RN, PMHNP-BCShannon Welch, BSN, RN, ONC10 / NURSING ANNUAL REPORT 2019Karina Guinn, BSN, RN-BC, GRNLauren Longenecker, BSN, RN, RN-BC,GRNKeith Martin, RN, CMSRN, GRNStephanie Riordan, BSN, RN, RN-BCTamara Talley, BSN, RN, CPNDavid White, BSN, RN, CMSRNKable Pluger, RN, RN-BC, GRNWendel 1:Patricia Scott, BSN, RN, RN-BC, GRNAmanda Beuttenmuller, BSN, RN, CCRNBrittany Shifflett, BSN, RN, NREMT-BDanine Stoner, RN, RN-BC, GRNEmily Brady, MSN, RN, CNLSurgical Program Development:Rosemary Watson, BSN, RN, PCCNMeredith White, BSN, RN, RN-BC, GRNAmber Campos, BSN, RN, CCRNAbigail Zuehlke, BSN, RN, CRNIConnie Summy, BSN, RN, ONCCornell 3:Rebekah Critzer, RN, CCRNEbony Lindsay, BSN, RN, CMSRNSusan Loomis, RN, PCCNNina Dennis, BSN, RN, CCRNKathleen Ellis, RN, CCRNJennifer Kilel, DNP, RN, CCRNWendel 3:Crystal Adcock, BSN, RN, RNC-OB,C-EFMChristi Hankle, MSN, RN, RN-BC, CNRNPatient Educator:Whitney Digney, M.Ed, BSN, RN, CMSRNN U R S I N G A N N U A L R E P O R T 2 0 1 98 / 1 1

PROFESSIONAL DEVELOPMENTPROFESSIONAL DEVELOPMENTSharon “JJ” Peacock, BSN, RN, RN-BCCharles Sauls, MSN, RN, FNP-CMAPPJudy Kauffman, DNP, MSN, RN, CNNMAPP is Sentara Martha JeffersonHospital’s clinical ladder program.Nurses start at level I and progressup to level V. Financial incentivesare provided to nurses at each leveland for maintenance within levels.The MAPP levels are a reflectionof 4 nursing competencies: clinicalpractice, education, leadership, andevidence based practice. The MAPPlevels are:Imelda Solis, RN, RN-BCAdministration/NursingAdministration:Johnsa Morris, MBA, MHA, BSN, NEA-BCAmy Black, DNP, RN, NEA-BCAllison Crawford, MSN, RN, CRNILaura Decker, BSN, MSHA, RN, NEA-BCAbby Denby, MSN, RN, NE-BCPASS:Practices/Hospitalist Group:Courtney Lambert, MSN, RN, NE-BCClin 1 – NoviceMary Huff, BSN, RN, RN-BCElaine Alpern, MSN, RN, A-GNPKelly Via, MSN, RN, RN-BCClin 2 – Advanced BeginnerSenior Services:Caroline Brand, MSN, RN, CCRN,AGACNP-BCBeth Vitolo, BSN, RN, NREMT-BClin 3 – ExperiencedJessica Cooper, BSN, RN, OCNBarrie Carveth, MSN, RN, FNP-CNursing Education:Elizabeth Driscoll, MSN, RN, BC-ADMMina Ford, MSN, RN, RN-BC, AOCNSGina Gilmore, MSN, RN, CCRNAmanda Deinlein, MSN, RN, RN-BC,PCCN-KJennifer Hall, MSN, RN, CEN, AGACNPBCAshley Mangum, MSN, RN, CNL,CCRN-KGenevieve Harway MSN, RN, AANPCPResearch Coordinator:Kathryn Reid, PhD, RN, FNP-CAngie Honeycutt, MSN, RN, ONC, FNP-CJessica Kenty, MSN, RN, NP-CNicole Lepsch, MSN, RN, FNP-CCommunity Health:Elizabeth Lawwill, MSN, RN, FNP-C,CMSRNSetour Dillard, BSN, RN, OCNBarbara Martin, BSN, RN, CDE, WHCNPMatthew Mildonian, MSN, RN, FNP-C1 2 / N U R S I N G A N N U A L R E P O R T 2 0 1 98Clin 4 – ProficientClin 5 – ExpertNursing seeking to climb to ormaintain a level of Clin 3 or higher,are required to submit a writtennarrative describing an example oftheir clinical practice as part of theMAPP packet requirements. Thiswritten narrative is known as anexemplar and highlights some ofthe MAPP nurses’ most memorableclinical experiences. Heather Noble,BSN, RN, CAPA shared a powerfulexemplar reflecting his experienceas a nurse in the PACU.MAPP Exemplar, Heather NobleBeing a Post Anesthesia Care Unit(PACU) nurse requires a special setof skills. PACU is truly a specialty ofits own, with this comes patients ofall types. Some postoperative patientswake up crying and some wake upviolent.Mrs X was an elective surgicalpatient who was having surgery forcontinuing back issues.Post-extubation, the anesthesiologistgave bedside report that included anylines, drains, advanced airways, pastmedical history, the medications givenduring the procedure, allergies, andany other pertinent information. Shehad a bone graft placed during surgerythat was compressing her Iliac veinand would need to be possibly takenout. She also had foreign body bonefragments in her retroperitoneum dueto a fragile lumbar bone that wouldpossibly need to be removed. Reportof these complications turned myassessment of the patient to be morecirculation and neuro related. As withany back surgery, it was important toassess every 15 minutes for any changein the patient neuro assessment. Anychange could be due to increasingpressure from the bone graft. ThisHeather Noble, BSN, RN, CAPAwould be an emergent surgery thatwould be an immediate return tothe OR rather than the currentadmission to PACU for reassessment.Circulation was also a huge factor forthis patient. She was at an extremelyhigh risk of passing a clot due to beingpostoperative and also because she didnot have much blood flow space forblood to pass by the bone graft thatwas being compressed. I assumed shewould need a computed tomography(CT) scan to further assess her currentcondition. I immediately called theCT tech to see if there was time toget her in for the scan stat, and I wastold yes. I notified the physician thatCT was ready to go if he wanted itperformed. He had me enter a verbalorder and I brought the patient up tothe CT suite. While transporting theNURSING ANNUAL REPORT 2019 / 13

PROFESSIONAL DEVELOPMENTPROFESSIONAL DEVELOPMENTMAPPExemplar, Heather Noble (continued)patient, who was still quite sedated,we explained where we were goingand why. She agreed and within afew seconds was back asleep. UsuallyI would give a patient some versedto have the CT done if they had anyanxiety or inability to hold still whileit was being performed. For thispatient it was pertinent to have the CTperformed without any medicationsthat could mask new occurringneurovascular issues. The scan wascompleted with her still sleeping andwas conclusive that she would need tobe assessed by another surgeon whocould fix the iliac vein compression.The next surgery would require twosurgeons and it needed to happen assoon as possible.The patient began to ask about herhusband in the waiting room. Shewas worried he would be upset andwouldn’t know where she was or whatwas going on. I reassured her thathe had been updated by the surgeonand asked if she would like for him tocome back to the PACU and sit withher until she was able to go back intothe operating room. She began to getteary eyed and said yes. After having14 / NURSING ANNUAL REPORT 2019her husband with her, he not onlyhelped calm the patient, but also kepther mind off of the pain, just as I hadpredicted. Distraction alone can helppain immensely. Once the husbandwas with the patient, the primarysurgeon updated both on the need togo back to the OR and why. They bothunderstood and were in agreement.The husband was able to say hisgoodbyes for now and I escortedhim back into the waiting room. Ithen asked the patient how she wasfeeling and offered to answer anyadditional questions she may have.She began to cry and grabbed myhand. She explained how it had beena long day and she was worried aboutwhether she would wake up after thissecond round of anesthesia. I assuredher that it was essential to have thecompression fixed and that I would bewaiting for her in the PACU just likethe first wake up. Her vital signs werestable and she had done very well inthe postoperative period even withsome severe surgical complications.She said the encouragement made herfeel better and she held my hand untilthe operating room nurses came in toget her.The second surgery was about 2 hourslong. I was there to help wake her upand control her pain postoperatively.She did great!This patient’s care was extremelyorganized and our team was readyfor anything that may happen atany moment despite the tone ofthe situation. Being a PACU nurseprepares you for critical situationsthat may occur at any moment. Thecollaboration between the surgeons,nurse and anesthesia is alwaysencouraged and in this situation it wasconfirmed by the handoff of care at thebedside, the suggestion to lower theamount of narcotics postoperativelypending the next surgery, and byconfirming when to start the Heparindrip. Evaluation was shown in theassessment and reassessment of theblood pressure and pain. I appliedclinical judgment while hangingHeparin which is not a commonmedication administered in the PACU,giving pain meds when needed, andwhen deciding the appropriate timeto extubate. Clinical judgment is notlimited to that. It is constantly in theback of my head. Does the patientneed a simple mask or a Bipap? Willone more dose of pain medicinecause her to not breathe? If she stopsbreathing do I have my suppliesnearby to support her airway? Whatis my plan if she clots where thecompression is occurring? Do I havethe physicians contact information?These are questions I was constantlyreviewing and assessing for whilecompleting tasks. These answers canconstantly change as the patient’sstatus changes. While moving thepatient to have a CT completed, Ieducated the patient on why this wasneeded and how they would do it.Education was given to the patientregarding pain medications whengetting them and why they needed tobe temporarily stopped. She was alsoprovided verbal education regardingwhy she needed to have a new IVline for Heparin and repeat surgery.Caring was used when holding thepatient’s hand and offering a listeningear and encouragement prior toheading back to the OR for thesecond surgery. Not only was havingthe husband back with the patient acaring gesture for the patient, but alsofor comfort of the husband.Caring for PACU patients is a passionthat requires a special skill set that isnot acquired easily. Each patient isdifferent and for this reason PACUnurses are well rounded and havestrong clinical skills. I truly believethe PACU is a place that patients feelcompletely vulnerable and have nocontrol of their actions. I strive to bethe PACU nurse that provides thesepatients the safety and security theyneed and deserve.NURSING ANNUAL REPORT 2019 / 15

PROFESSIONAL DEVELOPMENTPROFESSIONAL DEVELOPMENTMAPPIn 2019, the following nurses participated in the MAPP program as a Clinician 3 or higher.Clinician III:Dannette McGeeJessica FoxRoy G. TomlinJoy P. RossonKelly RitzHeather P. KunkLucie LaFontaineStacey L. WilliamsKarron GoodSusan BrandtSusan BarnardCamry LeakeAmy BowmanJennifer GainesElizabeth M. BrooksKable PlugerSamantha SpikerAmy L. BrownAllyson M. MichaelsNina DennisCrystal AdcockSarah Garmey,Jacqueline ConnerPatricia SawyerMike William BannisterPaula AlbertsKathy L. KrevanskyKristin Von ThelenSamantha G. LevelRebekah Seay CritzerEmily PetersonHeather NobleShaela ShifflettKendall CrusseKevin ProctorLisa SmithLori BurnettAurora Durkee-WarrenShane SimsGabriel H. HendersonPatricia KearnsSarah SilvermanErin KinseyBrandy MaxtonSamantha SznajderEsther LozanoSusan WheelerLinda WhiteAna Karina GuinnAllison E. WoodsideClinician IV:Paula M. PippinKathleen EllisJosh LandisVanessa LawsonFrank SignorettiShawna StokesRoben L. BoydAmber EanesJoshua MohrCarla MorrisRegina PerkinsTamsey Dillenbeck16 / NURSING ANNUAL REPORT 2019Tammie W. SmithCourtney KimbleMichelle SacreShannon WelchEtta C. ToliverHeidi Wolfe EnglishLaura T. MathenyStacey RiccardiMichele BascleGabrielle SmithCary SquireTamara Talley (Gentry)Kait YoungRebecca (Becca) HooverHeidi AndersonCrystal A. RoweAmy C. BrownClinician V:Sara S. MorrisVictoria MelanderBarbara PetrellaJessica L. CooperBrittany DrumhellerDeborah A. BrownElaine C. ShinskyMarcia D. ArnoldKathryn H. ButlerLila J. SmithNURSING ANNUAL REPORT 2019 / 17

PROFESSIONAL DEVELOPMENTPROFESSIONAL PRACTICESHIP ProgramMissionVisionValuesIn 2019, SMJH launched a Student Healthcare Internship Program (SHIP), an early workforce recruitment initiative offered forsenior nursing students completing their last two semesters of an accredited nursing program. SHIP provides aspiring nursesunique opportunities to earn premium pay while working in our acute care facility as student nurses.Workforce89MAPP participants183Scholarships awarded to dateNRP graduates35.3%SpecialtyCertified2384.7%BSNor higher ORhave a contractto do so68.8%BSNor higherdegree**Percentage ofeligible nurses:nurses with 2or more yearsof serviceSentara HealthcareSentara NursingWe improve health every day.We improve health every daythrough nursing excellence.To be the healthcare choice of thecommunities we serve.To create an environment ofhealth and healing.People, Quality, Patient Safety, Service & IntegritySentara Healthcare’s Philosophyof Nursing outlines the beliefsthat help to support the overallmission and vision.We believe:18 / NURSING ANNUAL REPORT 2019 Our work is built on a foundation ofsafety and accountability. We seek to create the best possibleexperience of caring and healing forour patients, families and caregivers. As nurses, we influence care throughevidence-based practice and shareddecision making, and throughcollaboration, coordination, andinnovation we accomplish positivepatient outcomes.NURSING ANNUAL REPORT 2019 / 19

PROFESSIONAL PRACTICEPROFESSIONAL PRACTICEPosters and PresentationsYearAuthor/AuthorsSubject TitlePlace of PresentationNational (N), Regional (R), orLocal (L)HospitalAffiliationBuilt and Natural EnvironmentBarriers and Facilitators toPhysical Activity in CancerSurvivors Living in Rural,Suburban and Small UrbanNeighborhoodsOncology Nursing ForumSMJHEvaluation of 12-WeekShelf Life of Patient-ReadyEndoscopesSociety of Gastroenterology Nursesand AssociatesPublications2019Pam B. DeGuzman, Crystal Chu,Jess Keim-MalpassMarch/Valerie Lacey, Karron Good,April 2019 Chris Toliver, Shirley Jenkins,Pam DeGuzmanOncol Nurs Forum. 2019 Sep 1;46(5):545-555. doi: 10.1188/19.ONF.545-555SMJHGastroenterol Nurs. 2019 Mar/Apr;42(2):159-164. doi: 10.1097/SGA.0000000000000364.Posters2/20/2019 Ashley Mangum, MSN, RN, CNL,CCRN-K and Pam DeGuzman, PhD,RN, CNLImproving Nursing Knowledge CNL Summit; Tampa, Florida (N)to Prevent Catheter-AssociatedUrinary Tract InfectionsSMJH1/25/2019 Allyson Michaels. MSN, RN, IBCLCDextrose Gel: An EBP ProjectUniversity of Virginia School ofNursing (L)SMJH2/20/2019 Pam Baker DeGuzman, PhD, RN, CNLFinding Your Voice For SafePatient CareCNL Summit; Tampa Florida (N)SMJHPresentations20 / NURSING ANNUAL REPORT 2019NURSING ANNUAL REPORT 2019 / 21

PROFESSIONAL PRACTICEPROFESSIONAL PRACTICEShared GovernanceShared Governance examples (continued)Our Shared Governance Academy was held in December. We had two sessions this year: Shared Governance 101 and SharedGovernance Pro.Cornell 1Wendel 2 In an effort to strengthen our awareness and engagement in Shared Governance throughout the hospital, each unit isscheduled to report out at a Nursing Leadership meeting. The unit manager and chair or other staff member from the unitcouncil are asked to share what they were working on and allow for 2-way interaction, feedback, and guidance. This hasproven to be a beneficial process for both Nursing Leadership and the unit councils to share in order to better understand thework being done in those councils.Some examples of the work done in our Shared Governancecouncils in 2019 include:Infusion Center/Medical Oncology Quick Visits to improve patientexperience and care deliveryIncrease rate of BSN or higherdegree for staffImprove patient satisfactionChemo Verification – chart auditsto ensure a checklist of verificationsis completed prior to administeringchemo. Follow up is done withthe nursing staff when verificationis found to not have beendocumented.Increase rate of nurses withspecialty certification Wendel 1 Staff morale – Employee of theMonth and team outingsNCP and RN teamwork–implemented a morning huddlebetween the RN and NCP tofacilitate better communication22 / NURSING ANNUAL REPORT 2019Worked to decrease HAPIs andCLABSIsIV pump storageDeveloped a new design for anICU-specific whiteboardImplemented use of the HighReliability Board including aProject Tracker spreadsheetCornell 3 Morning rounds for managerand charge nurse so that nursescan focus on medicationadministration and assessmentsDeveloped clear role expectationsfor AA, RN, NCP, Charge/UCEmployee of the MonthMonthly birthday celebrationsfor staff CAUTI Stand-down toreduce HAIsImprove patient satisfaction – earplugs and sleep masks for patientsProfessional Development Worked to develop handouts withtop 3-4 certifications for each unitChanged Graduation andCertification celebrations toquarterly as part of NursingLeadership instead of annually formore timely recognition of staffachievementsHelped to implement RN EventPeer Review at SMJHAdmit Recovery Cornell 2 Patient satisfaction – provide warmwashcloths to each patient firstthing in the morning Educate staff for transition toIntermediate Care UnitPatient Satisfaction improvements Hourly Rounds signs were hung ineach room and the “Commitmentto our Patients” cards and aletter from Nurse Manager weredistributed to each patient Implement text communicationwith family members waiting insurgical loungeCreate a unit reference book foreducation/documentationHold Quarterly Education –Bladder Bash and Central LineDanceSMJH Nurses Recognized atVNF Gala:On September 21st, the Virginia Nurses

1 / NURSING ANNUAL REPORT 2019 SENTARA MARTHA JEFFERSON NURSING ANNUAL REPORT 2019. 2 / NURSING ANNUAL REPORT 2019 NURSING ANNUAL REPORT 2019 / 3 Johnsa Greene-Morris, MBA, MHA, BSN, RN, NE-BC . related to healthcare-associated infection prevention, serving as a resource to team members, and providing peer-to-peer coaching. The team met monthly