geisinger magnet application

QUALITY SECUR ING THE LEGACY INNOVATION

GEIS INGER MEDIC AL CENTERFORCE 3

Introduction

Leadership style, relationships with others, and communication are essential elements in achievingorganizational goals.

Sue Hallick, CNO, consistently focuses the leadership team and hospital council staff on the “big picture.”She expects staff at all levels and their leaders to gain perspective from professional organizations andcredentialing bodies so that Geisinger Medical Center’s healthcare providers fulfill their founder’s directiveto “Make my hospital right. Make it the best.”

Abigail Geisinger’s visionary philosophy lifts the careers of nurses beyond the day-to-day operations andinto the future.This is accomplished routinely and consistently through open discussions and open-endedquestions in both formal and informal settings. Leaders and staff at all levels regularly converse with Sueregarding the internal and external environment of nursing at GMC. Many staff suggestions from thesediscussions are incorporated into GMC’s Nursing Vision document.

Effective communication to and from a large number of employees is a challenge for any organization.GMC meets this challenge through a matrix of hospital councils and a flat, well-defined managementstructure.

Communications that start at the CNO and executive level are shared with the inpatient andoutpatient management teams. Solid processes are in place to disperse information throughout everylevel of nursing. Because GMC does not have multiple layers of management, information flows quicklyand easily–from the CNO through her direct reports and then directly to the staff nurses, educators, andsupport staff. Concurrently, the council structure provides information that moves in the oppositedirection–from staff nurses, educators, and support staff directly to Sue. Sue attends all council meetingsto share information downward and receive information upward from council members.These councilmembers are charged with taking information back to their colleagues. Council leaders easily shareinformation with each other because the nursing council structure provides such an effective opportunityfor information exchange.Verbal communication through these avenues is supplemented throughnumerous written and electronic formats to reinforce and ensure that communication touches eachemployee in every department and every staff.

Visibility is a key characteristic of the transformational leader—the foundation of leadership behavior atGMC. Nurse leaders are visible in the hospital and in their designated units every day. It is a routinefunction and part of the GMC culture because the leaders’ span of control allows them accessibility tobuild the strong relationships needed to be successful leaders.

QUALITY • SECURING THE LEGACY • INNOVATIONQUAL ITY SECUR ING THE LEGACY INNOVATION F3-1


EVIDENCE 1Describe the CNO’s leadership style and give at least two (2) examples related to thecomponents referenced above.

eadership is the art of getting someone to do something you want done because he/she wants todo it. It is a way to get things done to a standard and quality above their norm and doing itwillingly1. Leadership is a dynamic relationship between the leader and the follower who share a

common purpose. When dealing with change, the leader influences followers to move to a higher level ofmotivation to affect real change. Leadership is a process that involves inspiring, motivating, and influencingpeople. Sue Hallick, Geisinger Medical Center’s CNO, possesses these very important leadershipcharacteristics. She is a dynamic leader with many years of experience.

Because of her interest in steadily improving her ownperformance, Sue participated in a 360-degree evaluation severalyears ago. This evaluation involved a written self-assessment aswell as feedback in such areas as communication, leadership, andapproachability from her peers and staff. The documents werethen scored, analyzed, and presented to her. They listed herstrengths and opportunities for improvement so Sue was able tounderstand and use her strengths to their best advantage andwork on areas where she might improve. Feedback from her peersand direct reports are incorporated in her ongoing performanceappraisals.

Sue felt that the 360-degree evaluation was such a valuableexperience that she requested that Associate Vice PresidentsDenise Beechay and Crystal Muthler also complete a 360-degreeevaluation. She has also encouraged a few of the operationsmanagers to do the same.

Sue is a transformational leader. Transformational leaders guide their followers in the direction of established goals. As atransformational leader, Sue inspires her followers to transcendtheir own interests for the good of the organization as our system grows and heads in new and challengingdirections. As changes occur, Sue instills confidence and commitment in her managers and staff. She servesas a role model and is actively involved as a coach, advisor, and educator. She provides positivereinforcement to the nurse managers and staff as they adapt to a constantly changing healthcareenvironment. The three stories that follow reflect that commitment.

L

“Leadership is adynamic relationship

between the leader andthe follower who share a

common purpose.”

1 Kostelnikov,Vadim (2007), Effective Leadership, http://www.1000ventures.com/business_guide/crosscuttings/leadership_main.html

QUALITY SECUR ING THE LEGACY INNOVATION F3-2


STORY: MOVING AHEAD

Transformational leaders guide their followers in the direction of established goals.

An example of Sue’s leadership philosophy can be found in the presentation she gives on the NursingService Line to the Geisinger Board, nursing councils, and at other leadership and nursing forums (3:1:A;see also FORCE 1, EVIDENCE 1).

3:1:A



Sue recognized that the reason many nurses leave their employers is a poor relationship with their managers. Because of this, Sue has set the bar high for her management staff. She has developedexpectations for performance, fiscal accountability, and leadership. Leadership expectations include positiveattitudes, creative problem solving, quick test-of-change thinking, skill in communication, and data-drivendecision making (3:1:B).

Sue decreased the span of control for nurse managers to afford these managers time to devote to the unitand increase their visibility by staff. The number of managers increased from 11 to 17 so that (with a fewexceptions) each manager is responsible for only one unit. The change was made to enable the managers toeffectively mentor their staff and build strong, high-performing teams.

3:1:B

PERFORMANCE APPRAISAL GRID

Operations Manager, Nursing Date:

Key Elements 7 UN NI ME EE TIMELINE OUTCOME

FISCAL RESPONSIBILITY 9

HPPD (Paid Total) target met YTD 11

SLHO % YTD 12




Supplies within budget 13

Manpower within budget 14

Dollars 15

FTEs (Total costs within budget) 16

LEADERSHIP 20

Strategic planning for unit development 21

Magnet Force of Magnetism Cochair activities: 22

1. Meet established timeline markers 23

2. Collect and/or submit documents as required 24

Mentor Team Coordinators with growth and 25

development, problem solving, and communication 26

Lead staff through constant change 27

Support risk-taking ideas 28

ACCOUNTABILITY 32

Day-to-day operations: 33

1. Drives retention/recruitment strategy 34

2. % RN and LPN vacancy rate/unit 35

3. Manages care delivery process 36

a. Skill mix 37

b. RN-to-patient ratios 38

Drives compliance with standards of care 39

Patient Satisfaction: 40

1. Press Ganey results within 90th percentile 41

2. Service standards are complete and active 42

COMMUNICATION 45

Employee: 47

1. Holds at least six unit meetings each year 48

2. Day-to-day communication methodology 49understood by all employees

Keeps the Leadership Team informed 50

Ensures professional positive inter- and intra- 51departmental communication

JOINT COMMISSION/DOH REGULATORY STANDARDS 55

Documentation within compliance: 57

1. Develop unit processes that will 58produce steady results

a. Seclusion/restraint in accordance 59with hospital standard

b. Pain assessment in accordance 60with hospital standard

Environmental needs are within compliance 61

Process to ensure compliance of all standards is active 62

Accrues staff competency: 63

1. Performance evaluations completed on time 64

2. Annual staff competencies completed 65




QUALITY/SAFETY 68

Evidence of a patient safety culture: 69

1. Review process in place on each unit 70

2. Quarterly updates to CNO 71

Prevention of falls: 72

1. Review unit % of compliance with current policy 73

Pneumococcal and influenza vaccine process: 74

1. Staff awareness and compliance 75

Adverse drug events: 76

1. Staff aware of policy and follow practice to report 77

Rapid Response Team: 78

1. Staff awareness 79

Staff aware of ORYX measures and accountability to process 80

EDUCATION

Staff Education: 85

1. Setting performance standards with annual competencies 86

2. Support attendance at inservices, conferences, etc. 87

3. Set annual educational credit requirements 88

4. CEP have active role in staff education 89

5. Assist staff with professional career planning 90

Goal: Staff verbalizes educational needs are met 91

Individual Education: 92

1. Develop individual educational goals 93

2. Professional organization membership 94

PROFESSIONAL PRACTICE ENVIRONMENT 98

Unit Councils: 100

1. Identify council members and chairs 101

2. Unit Assessment 102

3. Identify key elements and develop timeline 103

4. Engage staff in problem solving; develop Unit Story 104

Evidence-based practice and research: 105

1. Best Practice benchmarks 106

2. Review of literature-based practice changes 107

3. Quick test of change 108

4. EB Practice changes 109

5. Nursing research conducted on unit 110

Professionalism of Staff: 111

1. Unit appearance and pride 112

2. Core values for nursing integrated 113

3. Staff expectation: professional organizations 114and certifications

4. Nurse satisfaction scores (NDNQI) 115

5. Plan to improve patient satisfaction 116

Staff collaboration process with: 117




1. Other nursing units 118

2. Other healthcare professionals 119

3. Physicians 120

Goal: Promote staff involvement and awareness of 121collaborative practice

STORY: THE DIFFICULT CHOICE

As a transformational leader, Sue Hallick inspires her followers to transcend their own interests for the good ofthe organization as our system grows and heads in new and challenging directions. She helps the nursing staffdeal with change; adapting is one of our core concepts in accordance with Roy’s Adaptation Model.

Sue Ruckle, RN, the long-time operations manager of surgical unit BP5, died after a long and brave battlewith cancer. She possessed excellent leadership skills, and her interpersonal skills were top-notch. She wasviewed as a dedicated GMC employee, serving the system for thirty years. She was a true nurse and apatient advocate. To the BP5 nursing staff, the thought of trying to replace Sue seemed nearly impossibleand appeared to be a long and difficult process.

Three internal nurse candidates were considered for the open operations manager position. With SueHallick’s support, the staff began the interview process. Resumes of the candidates were posted on the unitfor the staff to review. Sue requested staff (of all levels) to participate in the interview process. Several staffmembers volunteered and, together, the staff submitted a list of questions for the interviews.

After the first round of interviews was complete, the staff did not feel that any of the candidates couldreplace Sue. Sue Hallick met with the staff representatives participating in the interviews to obtain theirfeedback and help them through this difficult process. She asked the staff to rank the candidates but,according to Mary Ann Ebert, interim team coordinator, “they could not rank any.”

Sue then did her magic. She helped the staff accept Sue Ruckle’s death, but acknowledged that no personwould fully replace her. She helped the staff realize they needed to adapt and pick the best person to leadthem into the future. She provided leadership in helping the interview team see the strengths andweaknesses of each candidate. Through this process, Sue helped them identify the top two candidates andopen a discussion among the unit’s staff. The staff was able to understand their need to adapt and acceptthis as an opportunity for change. Each of the remaining two candidates spent a four-hour block of time onthe unit to allow the staff to assess each candidate’s fit with the unit.

After the second round of interviews, Sue and the staff nurses came together for another group meeting.They discussed the benefits of each candidate and worked to identify the best fit for the unit.

OUTCOME

Securing the legacy is a strong theme throughout Geisinger Medical Center. The idea of having ahomegrown leader who had risen through the ranks appealed to the group. Sue pointed out that manyhomegrown leaders have worked out well. Sue herself began her career at GMC as a staff nurse and theinterview group had the utmost respect for her. Sue also helped the staff realize that they would have an



important role in the development of this new manager. Sue’s role in this process proved vital in steeringthe group to their final decision. With Sue’s assistance, support, and expertise, the group made their finaldecision as to who would serve as operations manager.

Cheryl Examitas, RN, was chosen as the new leader. She is currently in the process of transitioning, andthings are looking brighter for the unit. As Mary Ann Ebert, RN, team coordinator states, “Sue Hallickhelped us to see this candidate’s potential.” Charity Whitmire, BP5 staff nurse, adds, “I think Cheryl isgoing to do just fine. We will get to know each other and help each other.”

Joan Mervine, RN, CNE, indicates, “I know Cheryl from some of the courses I have taught. She has alot of exciting new ideas, and her critical care background is a positive attribute.”

Janice Kozloski, BP5 nursing assistant, says, “It will be a little rough at first getting used to someone new, but Sue Hallick helped us move on and realize we need to work with Cheryl. Things are going towork out.”

PERSPECTIVES FROM TWO MANAGERS

Two managers—Crystal Muthler, RN, AVP, and Bonnie Patterson, RN, the CNO’s operations manager—were also involved in the selection process and have shared their opinions about Sue’s role in this process.

The mournful passing of a beloved nurse manager recently became testament to GMC’s philosophy ofgrowing its own leaders and stands as evidence in this force.

One of Susan’s closest allies during her tenure at Geisinger Medical Center was Bonnie Patterson, RN (anoperations manager). The pair were friends since the days when both worked together in the GMC’sRecovery Room (surgical suite). “I was comfortable and familiar to the staff because I had covered for Susanwhen she was well and then when her health was failing,” Bonnie recalls. “So I was brought in by ourCNO to work temporarily with the staff to help them with the healing process after the loss of their leaderand to help them select a new manager.”

“Selecting a new manager would be difficult, but the CNO was determined to actively involve all of thestaff in the selection no matter how long the process took,” Bonnie recounts. “Sue was terrific in workingwith the staff and leading open and honest communication about what the team was looking for in a newleader,” remembers Crystal Muthler, RN, a GMC associate vice president. Crystal was also involved in theselection process. “The staff was mourning. I think they felt left behind in a sense when Susan died,although they did recognize that they needed to pick up the pieces and move forward.”

The nurse manager position was posted internally, and many applicants stepped forward, but none fromBP5. Much as they wanted a leader like Susan, the nurse who rose to the top in the interview process was ayoung critical care nurse who had no experience in orthopaedics.

Crystal said that she, the CNO, and the staff met to talk frankly about the important qualities theywanted in a new leader. “There was no coercion or pressure to hurry the process,” Crystal says. “SueHallick, our CNO, explained that we would continue looking until we found the right person. Sue’sphilosophy was that it had to be the right fit for the staff, no matter how long the search took.”

“By the end of the first long meeting, the team had decided they were looking for someone who couldkeep the unit moving in a positive direction. They would choose strong leadership skills over orthopaedicexperience if the candidate had the right qualities.”



“Sue’s crucial conversation with the staff opened their minds and changed their mindset so they couldseparate the person from the position,” Bonnie says. Of all the applicants, one candidate—Cheryl Examitas,RN—had the strongest leadership skills. Cheryl was welcomed as BP5’s new manager on April 15, 2007.

“During the interview process, Cheryl spent the day on the unit wearing scrubs and getting to knoweveryone,” Bonnie explains. “It was clear to everyone that, as a critical care nurse, she could bring adifferent perspective to the unit and new qualities that could enrich the staff.”

Cheryl dove right into her work. Bonnie reports, “One of the things that she did almost immediately wasto provide an opportunity for the medical-surgical nurses to become certified in Advanced Cardiac LifeSupport. Doing so created a better level of patient care. For the staff, Cheryl found a way to accommodateeveryone’s desired shift schedule, adding a 12-hour rotation if requested.

“This wasn’t easy to accomplish, but the staff had wanted this type of flexibility in their schedules foryears,” Bonnie recalls. “Cheryl found a way to get it done and it really did improve the quality of life foreach staff member. Staff satisfaction and patient satisfaction continues to be exceptionally high” (3:1:C).

3:1:C

EVIDENCE 1: SOURCES OF EVIDENCE

3:1:A Slides from Nursing Vision Presentation

3:1:B Performance Appraisal Grid for Managers

3:1:C NDNQI: Quality of Nursing Leadership (BP5)

NDNQI Quality of Nursing Leadershipfor BP5

4

BP5 National Rate

3

2

1

02006 2007

GMC Rate4 = highest0 = lowest



EVIDENCE 2Provide examples of effective and ineffective leadership-style outcomes and follow-up action asappropriate.

he effectiveness of the leadership style at Geisinger Medical Center is reflected in the NDNQIQuality of Nursing Leadership data.

STORY: WHAT HAPPENED? A SUCCESS STORY

At times even an expert manager with years of experience can revert to an ineffective management style.This can occur for many reasons, but the story here is how one manager was helped to regain credibilityand effectiveness with her staff. This story is one of discovery, growth, and success.

CNO Sue Hallick’s open communication style enabled staff to discuss concerns with her. In thisparticular case, these talks revealed dissatisfaction with a staff ’s manager. That manager was Linda Miller,RN, a long-term, well-respected manager who was responsible for three nursing units. With an extremelyheavy workload, she did not notice the staff ’s increasing dissatisfaction.

As Sue Hallick was making rounds on the nursing units, the staff revealed their concerns to her. Some ofthese issues included the decreased visibility of their manager, poor (or lack of ) communication, and lack ofattention to details important to the staff (such as shift scheduling). In addition to what Sue heard onrounds, the staff expressed concerns directly to her through Emails. Sue also noticed that there was anexodus of team coordinators from these units.

Sue realized that this manager needed help to regain the credibility and effectiveness she had lost. Shemet with Linda and expressed her concern regarding the staff ’s comments. Linda was willing to accept Sue’sguidance and, together with Crystal Muthler (AVP), developed an action and performance improvement

NDNQI Quality of Nursing Leadershipfor Geisinger

4

National

3

12006 2007

GMC Rate

2

high

low

T



plan. This plan addressed communication, visibility, mentoring, and staffing issues. Work had begun on thejourney back to credibility.

OUTCOME

Linda has regained her effectiveness and credibility. Her span of control has been decreased from three totwo units. Linda continues to meet routinely in follow-up meetings with Sue and Crystal. Sue keeps incontact with the staff nurses from both of Linda’s units as well. She has been happy to see the improvement.

The overall average nurse satisfaction scores from the NDNQI RN Satisfaction Survey have increased onLinda’s units from 45.61 in 2005 to 49.93 in 2006 and 50.60 in 2007. Another positive outcome is thatLinda has developed strong team coordinators who work well together.

Comments from the staff reflect that Linda is back on track and they are back to being a strong team.Beth Brening, RN, staff nurse on CH2 states, “Things are going pretty well on our unit now. Linda is sucha good manager. Things are always up and down depending on how busy we are and how staffing is, butwe are OK.”

Sevasty Chamberis, RN, staff nurse on CH3 also states, “The busy pace of our unit can [at times] put astrain on all of us. I have worked with Linda for a long time and wouldn’t want to work anywhere else.”

Date: 3/30/2007 5:21:01 P.M.

Subject: Re: Linda Miller

Terri,

I just wanted to let someone know how wonderful Linda has been to work with. She has been extremely supportive of me both in mywork and in my personal life since I’ve been in this position. She always makes herself available to meet with me and offers to help meeven before I can ask.

I just thought that someone should know! Share this with whomever you see fit.

Thanks Terri!

Emily Mowery, RN

CNE, CH2, and CH3

Linda stated that “this experience made me stop and take a good look at my performance. It has helpedme put things into perspective.” She indicated that she has been able to be more visible for the staff sinceshe is down to two units. She also has increased the number of team coordinators available on the off shiftsto help lead the staff.



STORY: A NEW LEADER

Every new manager needs to establish strong relationships with staff, physicians, and patients. An excellentexample of new effective leadership is Joyce Keister, RN, the new nurse coordinator of the OrthopaedicAmbulatory Care Clinic.

Joyce took over the nurse coordinator role in the orthopaedic clinic, an extremely busy clinic with largepatient volumes. Joyce had been working in the clinic as a staff nurse before assuming her role ascoordinator. She viewed this new role as an opportunity to grow professionally and a chance to improvepatient outcomes. Joyce was a credible leader because she has an orthopaedic background and she hadestablished relationships with the clinic staff by working there. Joyce was also familiar with the orthopaedicdoctors who can be challenging at times.

Soon after Joyce started as coordinator, CNO Sue Hallick, during one of her routine Quality Rounds,identified some concerns in the clinic related to survey readiness expectations and patient safety. Severalissues were causing these concerns:

• Due to large patient volumes, patients arriving for appointments had to wait in long lines beforesigning in for their appointment.

• Staff had the wrong documentation tool for monitoring medication refrigerator temperatures.• Doctors were not using the electronic health record (EPIC®) for prescription refills.• There was no bathroom in the back of the clinic for patients to use while waiting for their

physician. • The medication reconciliation process was inconsistent.• Medication storage and security practices needed to be improved.• Handwashing practices and equipment cleaning and storage needed to be improved.

As Joyce began her role as coordinator, Diane Engelhart, RN, nurse coordinator for the Urology Clinic,served as her mentor. Mike Enriquiz, the operations manager for the Orthopaedic Clinic, was also verysupportive. Because Mike has a business background and Joyce has a nursing background, they make agood management team.

NDNQI Job Satisfactionfor Children’s 2 and Children’s 3 (combined average)

60%

CH2/CH3 Combined

40%

0%2005 2006

GMC Rate

20%

National

2007



OUTCOMES

Sue met with Joyce to provide guidance and mentoring. Joyce was empowered after their interactions andbegan to make changes she felt were necessary. She instituted daily rounds and, while on those rounds,asked staff for input. She worked with the staff to make sure that they introduced themselves by name andtitle to all patients when beginning their interactions. Joyce set up a number system so arriving patientscould be seated and then called by number when it was their turn to sign in. This helped alleviate the longlines at sign-in and increased patient satisfaction. Joyce also worked with the Facilities Department to havea bathroom installed in the back of the clinic.

To address the regulatory issues, Joyce instituted the proper refrigerator logs. She worked with the doctorsto stress the importance of using EPIC to renew prescriptions. She moved the printers out of the hallwaysto protect patient confidentiality.

Joyce worked with Crystal Muthler, AVP, to define Career Enhancement Program (CEP) roles for theRN, LPN, and clinic technician. She also created the position of triage nurse to answer emergencyquestions and address postoperative patients’ inquiries. She set up monthly department meetings to discussissues and staff concerns.

Joyce also contacted Pat Campbell, RN, Infectious Disease (ID) nurse director, to conduct ID rounds through the clinic to assure the safest environment. She had Avagard handwashing systems installed in thehallways, revamped the entire equipment cleaning process, and obtained storage carts for needles andsyringes.

Since Joyce has instituted changes in this clinic, patient satisfaction scores have improved. Staffsatisfaction has also improved .

The following are testimonials from staff on Joyce’s integration into her new management role: • Clinic desk clerk: “Joyce is more visible. She has helped patient flow tremendously by implementing

the number system. Patients no longer have to wait in long lines to check in. She helps staff withworkload whenever possible.”

• Rita Mirello, LPN: “Joyce is very helpful. She takes time for us and listens to our concerns. If youare having a problem, she is there to help you find the best solution. She works to help solve familyand patient concerns.”

NDNQI Job Satisfactionfor Orthopaedics (Surgical Outpatient)

80%

Ortho

60%

20%

0%2006 2007

GMC

40%

National



• Shawn Meighan, RN: “Joyce helps in the clinic if it is busy. Joyce is pleasant. She has done a goodjob improving MD/nurse relationships. She has done really well since she started in her role. Icannot say enough good things about her.”

• Kevin Tersavage, cast technician: “Joyce is very fair; she knows what it is like to have worked her wayup. There is more bonding between staff, like a family now. She is always willing to help. She is thebest thing that has happened to this clinic.”

During the last performance improvement audit there was a 90- to 94-percent compliance withmedication reconciliation.

Joyce’s future goals include the development of a spine coordinator nurse position. This nurse will workclosely with patients with spinal injuries. Joyce continues to work with the staff to provide a safeenvironment for patients and improve patient outcomes.

Medication Reconciliation Audits: Orthopaedic Clinic

100%

0%12/2006 8/20076/2007

90%80%70%60%50%40%30%20%10%

Patient Satisfaction Scores: Orthopaedic Clinic

2006** 7/1/06 - 12/31/06 2007** 1/1/07 - 6/30/07

Overall Rating80%

Care Received Likely to Return

2006* 1/1/06 - 6/30/06

81%82%83%84%85%86%87%88%89%90%91%92%93%94%95%



EVIDENCE 3 Provide examples of how direct-care nurses’ feedback is used in organizational decision making.

urses are involved in organizational decision making by participating in hospital and unit-based councils and numerous task forces or committees related to almost every aspect of theorganization. Input from direct-care nurses, especially with regard to point-of-service and staff

issues, is valued by the organization.

AVENUES OF COMMUNICATION The most common way for direct-care nurses to provide input or feedback is through the SharedGovernance Councils and other committees. Nurses from inpatient and outpatient areas are represented on the shared governance councils and various other committees (3:3:A).

3:3:A

SHARED GOVERNANCE COUNCILS

NURSING RESEARCH COUNCIL

Terri Bickert, MSN, RN, CNA-BC Deb Stayer, RN,Director of Magnet and Nursing Education Clinical Nurse Educator (PICU)

Mary Ann Bloskey, RN, MSN, MHA, Margaret West, RN, MSN, DNSc,Center for Health Research Assistant Dean,Thomas Jefferson University

Pat Campbell, RN, MSN, Lori Lauver, RN, MSN, PhDDirector of Infection Control Assistant Professor,Thomas Jefferson University

Cindy Matzko, RN, MSN, APRN, BC, CCRC Deb Wantz, MSN, RN, CCSN, CCRC,Rheumatology Clinical Nurse Specialist and Certified Clinical Nurse Specialist, Heart Failure SectionResearch Coordinator Department of Cardiology

Sheila Hartung, PhD (BU) Marylee Scholtis, RN

Deb Zimmerman, RN, Cardiology Jody Bachman, RNClinical Nurse Educator (OB/GYN)

NDNQI Decision Making

3

2.9

2.7

2.52006 2007

2.8

GMC National

2.6

N



Robin Steimling, RN,Clinical Nurse Educator (BP6/BP7)

NURSING RETENTION AND COMMUNICATION COUNCIL

INPATIENT STAFF NURSES OUTPATIENT CLINIC NURSES

Beyer, Melissa, RN (CH2) Bidelspach, Lisa, LPN (Eye Clinic)

Brink, Janice, RN, BSN, CEP (NICU) Corrigan, Sandy, RN (GIM)

Brokenshire, Judy, RN, CMSRN (BP6) Fulmer, Sherri, RN (Dialysis)

Chamberis, Sevasty, RN (CH3) Gaugler, Jatina, RN–Staff Nurse (Pain Therapy)

Evans, Sarah, RN (BP5) Heath, Sally, RN (PSC)

Grunden, Marie, LPN (AGP5) Ikeler, Kristen, RN, BSN (OCN Knapper Clinic)

Harris, Danielle, RN (AICU) Jones, Carol, RN,Team Coordinator (Emergency Department)

Henrie, Sandra, RN (BP8–alternate) Madden,Tracey, RN (I&O)

Heuermann, Jane, RN (AGP2) Moore, Janet, RN (Orthopaedics)

Hons, Sara, RN, BSN (Labor & Delivery) Ney, April, LPN (Sunbury Women’s Health)

Intintolo, Joan, RN–Staff Nurse (BP7) Reichenbach,Teresa, RN (Dermatology)

Karnes, Pamela, RN (AGP5) Sekulski, Connie, RN (I.V.Therapy)

King, Megan, RN (WP1) Strzempek, Lynda, RN (Radiation)

Kleman, Cheryl, RN, CEP (PACU) Shotwell, Betsy, RN (Emergency Department)

Lerch, Lyndsey, RN–Staff Nurse (AGP5) Worhach, Stephanie, RNC, CBC, CCE, CLSS–Team Leader (OB/GYN)

Lines, Red, RN (Life Flight®) Wright, Christianne, RN–Staff Nurse (I&O)

Lizardi, Lynn Ann, RN (SCU3) Yocum, Kay, RN (Endoscopy)

Long, Mary Ellen, RN, CCRN (PICU)

Mattis, Deb, LPN (BP2) OTHERS

Michael, Nicole, RN/CEP (AGP4) Danilowicz, Gerri Ann, RN–Clinical Nurse Educator (SCU4)

Nariskus, Kristy, RN (OR) Gordon, Nancy, RN, CNC–Clinical Nurse Educator (ED)

Newsome,Vanessa, RN (NICU–alternate) Horan, Kate, RN, Clinical Nurse Educator (OR)

Peterman, Elizabeth, RN, BSN (CCU) Hallick, Sue, RN, CNO–Nursing Leadership

Provow, Amanda, RN (OR—alternate) Marks, Jami, RN–Advisor, Operations Manager (Inpatient OB/GYN)

Reiner, Amy, RN (CCU) Endress, Steve, RN, Flight Nurse, Life Flight (Cochair)

Smoyer, Karen, RN, CEP (BP8) Varano,Tess, RN–Cochair (AGP4)

Spatzer, Barbara, RN (AICU) Botella, Judy, RN–Supervisor

Spickard, Sandra, RN (MSF) Clutcher, Kathy, RN–Nurse Recruiter

Strunk, Lori, RN (AGP4) Curtin, Colleen, RN–Nurse Recruiter

Swartzentruber, R. Elaine, RN–Staff Nurse (Cancer Center) Gibson, Eileen, RN (IT)

Thomas, Elizabeth, RN Hoffman, Lynn, LPN (GHP-QI)

Wallish, Mary, RN (CCF) Lamont, Susan, RN (Human Resources)

Wemple, Jennifer, RN, BSN (SCU4) Merrill, Michele, RN (Vitaline)

Wonlschlegel, Mandy–Extern (BP5) Miller, Becky, RN (Human Resources)

Zimmerman, Rebecca, RN (BP5) Miller, Cindy, RN (Human Resources)

Petrovich, Susan, RN (QI)

Schoch, Michelle, RN (QI–alternate)

Young, LaVera, RN (Neuro Services Line)

CLINICAL PRACTICE

Jody Bachman, BSN–CNE (NICU) Lisa McGinty, RN–Staff Nurse (I&O)



Melania Balzer, BSN–Staff Nurse (OR) Judy Malatesta, RN–Staff Nurse (CICU)

Carol Bettleyon, RN–Clinic Nurse (EHS) Dave Mensch, RN–Staff Nurse (BP2)

Candace Bossler, RN–Staff Nurse (SCU3) Darlene Mensinger, RN–Staff Nurse (NICU)

Ann Bower, RN–Staff Nurse (BP7) Joan Mervine, RN–CNE (BP5 and BP6)

Sue Brown, RN–Patient Ed (Pt. Safety) Emily Mowry, BSN–CNE (CH2 andCH3)

Vicki Cragle, RN–Staff Nurse (CICU) Tracey Nicholas, BSN (PI)

Joan Callahan, BSN–Staff Nurse (PACU) Sharon Novak BSN (IFD)

Donna Deitz, RN–Clinic Nurse (Hematology/Oncology) Devon Orner, BSN–Staff Nurse (OB)

Tracey Eddinger, BSN–Staff Nurse (AGP5) Bonnie Patterson, RN–Operations Manager (AGP5 and I.V.Therapy)

Eileen Gibson, RN–Clinic Nurse (Urology) Kathy Politis, RN–Staff Nurse (AGP4)

Jason General, BSN–Staff Nurse (NICU) Linda Rea, RN–Staff Nurse (PICU)

Kathie Green, RN–Staff Nurse (BP5) Carol Rudy, RN–Clinic Nurse (Preadmission Testing)

Sue Hallick, RN, BSN, CNO Tonya Sellard, RN (Leave)–Staff Nurse (SCU4)

Krissy Haulman, RN–Staff Nurse (AGP2) Stacie Semborski, RN–Staff Nurse (Pediatric Sedation Team)

Sabrina Heddings, RN–Staff Nurse (SCU4) Ann Shaffer, RN–Staff Nurse (ED)

Kristin Hogan, BSN–Staff Nurse (BP2) Renee Smith, BSN–CNE (PACU)

Carol Hughes, RN–Staff Nurse (AGP4) Jody Snyder, BSN–Clinic Nurse (Endoscopy)

Jackie Janovich, RN–Staff Nurse (BP6) Hope Spigelmyer, RN–Staff Nurse (CCF)

Katie Jones, RN–Staff Nurse (AICU) Deb Stayer, MSN–CNE (PICU)

Holly Kasper, RN–Staff Nurse (CH2) Robin Steimling, RN–CNE (BP7 and BP8)

Mary Kleiner, BSN–Clinic Nurse (OB) Dennis Tanner, RN–CNE (BP2)

Carol Krohn, RN–Clinic Nurse (OPH) Mike Treese, BSN–Staff Nurse (MSF)

John Krohn, RRT–Staff RRT (RCS) Deb Watkins, RN–Clinic Nurse (Foss 7)

Barb Knowlton, RN–CNE (I.V.Therapy) Jenifer Wemple, BSN–Clinic Nurse (SCU4)

Adrienne Lonczynski, BSN–Staff Nurse (BP8) Ann Wilver, RN–Clinic Nurse (Foss 6)

Rene McCloskey, RN–CNE (EPIC, PI) Jessica Yancoskie, BSN–Staff Nurse (AICU)

PERFORMANCE IMPROVEMENT

Staff Nurse/Clinic Nurse Representatives

Abram, Georgette, RN (CICU) McElroy, Amanda, RN, BSN (PICU)

Baney,Virginia, RN (AGP5) Miller, Cindy, RN (SCU4)

Blessing, Antionette, RN (I&O) Nuemeister, M. Jean, RN (AGP4)

Bogart,Tiffany, RN (AGP5) Phelps, Sheila, RN (CICU)

Bower, Gail, RN, OCN–Hematology/Oncology Clinic Reinard, Cindy, RN (BP6)

Cicero, Shirley, RN (BP2) Rezykowski, Stacy, RN (BP7)

Cochran, Mary Jo, RN (BP8) Scheller, Ashley, RN, BSN (Labor & Delivery)

Dennen, Maureen, RN (AGP4) Schieber, Pam, RN (AGP2)

DePoe, Ann, RN (CCF) Sellard,Tanya, RN (SCU3)

Derr, Charity, RN (BP5) Skocik, Lenore, RN (NICU)

Gerringer, Melanie, RN (BP7) Snyder, Deb, RN, CPON (F3/F6)

Gelbaugh, Diane, RN (Pre-surgery Center) St. Clair, Deanna, RN (AGP4)

Harter, Kate, RN (Labor & Delivery) Witt, Barbara, RN (OR)

Hartzel, Sue, LPN (MSF) Yankoskie, Jessica, RN (AICU)

Hogan, Kristin, RN (BP2) Yost, Marianna, LPN (MSF)

Houseknecht, Melissa, RN (Labor & Delivery) Zechman, Deb, RN (MSF)



Janovich, Jacqueline, RN, ASN, CMSRN (BP6) Ziller, Melissa, RN (WHC)

Kieffer, Jan, RN (Periop Area)

Kister, Nicole, RN (CH3) Ad Hoc Members

Loeffler, Kim, RN (ED) Aukamp, Greg, RN (Respiratory Therapy)

Bowman, Ann Marie, RN (Infection Control)

Chairman Kutza, Joey, RN (Life Flight)

Breining, Bethann, RN (CH2) Nicholas,Tracey, RN (PI)

McCloskey, Rene, RN–Clinical Nurse Educator Vought, Cindy, RN (EPIC Inpatient)

Mensch, Deb, RN–Operations Manager

Administrative Support

Hallick, Sue, RN, CNO–Nursing Leadership

Bickert,Terri, RN–Director of Magnet and Nursing Education

Direct-care nurses can also talk directly to Sue Hallick at the councils or through Sue’s frequent rounds topatient care areas. Sue and other nursing leaders are also visible and accessible to staff. Staff can offerfeedback on every aspect of the organization—from patient care to employee issues. They can also contactSue through her Email or beeper.

EXAMPLE: CLINICAL PRACTICE COUNCIL

The Clinical Practice Council contributed to the organizational Patient Identification Policy and Procedurethat was developed to cover both the inpatient and outpatient areas (3:3:B).

3:3:B

NURSING PROCEDURE MANUALPOLICY 10.3SECTION: PROVISION OF CARE, TREATMENT, AND SERVICESTITLE: PATIENT IDENTIFICATION (INPATIENT AND OUTPATIENT)

PURPOSE

The Patient Identification policy establishes guidelines to accurately identify every patient at all times with all patient encounters.

PERSONS AFFECTED

All hospital personnel.

POLICY

The policy of Patient Identification is to ensure:

• The Geisinger Medical Center staff shall adhere to the statues of the federal government, Commonwealth, Joint Commission,DOH, Geisinger Medical Center, and other regulatory bodies.

DEFINITIONS

Not applicable



RESPONSIBILITIES

All hospital personnel are responsible for identifying every patient.

EQUIPMENT/SUPPLIES

Color-coded bands—Red Name Alert Stickers and Signs

PROCEDURE

1. All staff will identify patients in the patient care setting using a minimum of two unique patient identifiers:

Primary Identifiers:

a. Full name

b. Date of birth (month/day/year)

c. Medical record number

d. Trauma name and number

Secondary Identifiers:

a. Patient’s social security number

b. Patient’s telephone number

c. Patient’s address

2. These two unique identifiers must be used, and match, whenever the staff is:

a. Taking lab samples from the patient (blood, urine, culture, tissue, and fluids). Prior to taking lab specimens, two identifiersmust match the patient armband, each specimen label, and each request form. Circle or highlight the name on each label toensure all labels have the same patient name.This will serve as documentation that the patient armband, each specimenlabel, and each request form was checked prior to taking the lab sample. Each specimen label should be dated and have thetech code of the staff member collecting the specimen. Refer to Phlebotomy Procedure.

b. Administering any medications

c. Administering any blood product

d. Starting I.V.s

e. Performing any procedures or treatments

f. Sending patient off unit for tests—The RN or LPN will document in the medical record verification of patient identificationand correct diagnostic test by initialing the physician order prior to sending the patient off the unit for the test.* In an emergency or life threatening situation, the diagnostic test may be performed without adherence to theserequirements.

g. Transferring a patient, following a procedure or surgery, discharge, and when replacing identification bands.

h. On the Behavioral Health Unit, an individual’s photograph may be placed in the Kardex and may be used for purposes ofvisual identification by staff.

3. Patient must wear identification band during entire inpatient hospital stay (see Color Coded Patient Identification Bands).

4. If identification band is removed for any reason (such as I.V. lines or surgery), the identification band must be replaced as soonas possible or before leaving current location/department.The nurse assigned to the patient is responsible for replacement ofthe armband.

5. If patient has an armband with a temporary name and medical record number (Trauma), once the patient is identified and hasa band with full name, medical record number, and full date of birth available, do not remove the temporary band. Keepboth bands on throughout admission.

6. If patient expires, leave the identification band in place.

7. If patient is coherent, ask patient to state full name and full birth date (Month/Day/Year), and compare this information to thepatient’s armband and request form/computer label(s).

8. Never use patient's room number as an identifier.

9. Never state patient’s name and ask patient to confirm it.

10. Same name alert:



a. Place red name alert sticker on blue addressograph plate, census boards, spine of medical record.

b. Whenever possible, separate same name patients geographically or by nursing teams.

11. For all operative and other invasive procedures, refer to the Correct Site, Procedure and Person Surgery/Procedure(Guidelines for Assuring), located in the Patient Care Manual, Policy 904.

12. If applying identification band on patient, check the patient’s full name and medical record number and date of birth, with themedical record prior to placing identification on patient. At bedside, verify information with the patient, having patient statetheir full name and medical record number. If patient is unable to state medical record number, ask patient to state full date ofbirth (Month/Day/Year). Once identification is verified, apply band to patient’s wrist or ankle (infant’s ankle).

13. If patient cannot communicate (infants, language barriers, cognitive impairments, sedated, unconscious), ask family member orattendant to verify the patient’s identity. Use trauma name and number, or if identification band is on patient, checkinformation against identification band.

14. When rooming all patients in the Outpatient setting, the clinic nurse or the medical assistant will state, “As part our patientsafety efforts and to assure proper identification, please state your full name and date of birth.” *

15. The clinic nurse or medical assistant will verify and document the verbal response with the patient medical record informationand then place the patient in the exam room.

16. In cases where conscious sedation is used or an invasive procedure is performed, it is recommended that a patientidentification band is applied to the patient and that the band is used for patient identification.

* In the event that the patient is unable to participate in identifying himself/herself, a reliable caregiver should be asked thisquestion.

Several online manuals are filled with policies and procedures that demonstrate direct-care nurses’ inputin organizational decision making. A sample of the extensive list of policies and procedures developed byand for direct-care nurses include:

• Patient Identification (Revised)• Medication Reconciliation (Revised)• Standardized Approach to Handoff Communication (New)• Continuous Pulse Oximetry Monitoring (New)• Protocol for Specialty Beds (Revised)• Nasogastric Insertion/Removal (New)• Adult Gastric Feeding (New)• Ankle/Brachial Index (New) • Restraint/Seclusion Policy (New)• Irrigation of Apheresis Catheter (New)• Fem-O-Stop (New)• Airway Suction-Pediatrics (New)• EKG (Revised)• Pleural Catheter Drainage System (New)• Safeguard—The Pressure-Assisted Dressing (New)• Medication Administration—EPIC (New)• Blanket and Fluid Monitoring (New)• Bed Zeroing—Versa Care Bed (New)• Insulin Storage and Administration on Patient Care Units (Revised) • Personal Alarm (New)



EXAMPLE: DECISIONS MADE BY UNIT COUNCILSUNIT COUNCIL AND MANAGER STAFF DECISION MAKING

BP5 Advisory—Unit Practice Council and Move lab slips to other side of counter.Cheryl Examitas, RN Patients transported to gym and back by unit staff rather than transporters.

Move staff lounge to a larger area and staff involved in all decisions—color, layout,and equipment.

BP6 Advisory—Unit Practice Council Started the process of using Memory Boxes; group developed the practice for unit.and Michele Long, RN Requested increase in barichairs—purchased.

BP7 Advisory—Unit Practice Council and Employee “Coin Recognition” program developed.Peter Price, RN Reorganized supply room.

Developed competency fair with CNE and CEPs.Requested door for med room so can lock and decrease distractions.

BP8 Advisory—Unit Practice Council and Staff requested an open full-time LPN position be converted to 0.5 LPN and a Michele Long, RN 0.5 NA positions.

AGP2 Unit Staff and Dee Hollenbach, RN In transition to new manager: developing new councils; suggestion box put up; headsetsfor desk clerks purchased; changed time of NA shift to accommodate vital signs better ;more to come.

AGP4 Unit Practice Council and Belongings sheet process changed to increase documentation.Phyllis Knorr, RN Determined how to assign the third NA on each shift.

Creating a med room at request of staff—increase safety.

AGP5 All for Five—Unit Practice Council Hook outside of rooms to hang lab coats when patient is in isolation.and Bonnie Patterson, RN Standardize stocking cart.

(I.V.Team—LED head lamps for I.V. insertions)

BP2 Safety Council and Deb Ulrich, RN Change process for handing out patient belongings; remove boxes of gloves from patient rooms; provider must carry pair ; change time laundry and shower open.

Nurse Executive Council Develop NA role new to unit; staffing and scheduling policies; interviewing new candidates.

Conference Council All requests for conference go through them and are approved by them. Schedule and guidelines established.

AICU Unit Practice and Angelo Venditti, RN Insulin protocol rounded to nearest whole number to decrease potential for error.Color code admission system to communicate attending doctor.Staff lounge being moved to other space to enable window per staff request.Turn volume with set standard parameters

CICU Unit Practice Council Noise Reduction Task Force formed by council—implemented several techniques:and Deb Mensch, RN white noise, signs to remind quiet zone, pad tube system, and more.

Discovered an I.V. line separator; requested pharmacy to use larger labels and print on I.V. bags to decrease error/respond to aging nurse population.

SCU3 Advisory—Unit Practice Council and Standardized isolation carts on unit.Kim Kuhn, RN Hooks and shelves for equipment requested.

New scheduling pattern for 8- and 12-hour shifts (more days in a row).Lock certain supplies on weekend when they appear to be hard to find.

SCU4 Advisory—Unit Practice Council and Portable phones purchased for patients to communicate with families.Dawn Troutman, RN Move fax machines and rearrange desk area to increase efficiency.

New staff lounge—all aspects decided by staff: how, what is in it, no phone or computer wanted in there.

CH2 Advisory—Unit Practice Council Started to assign lunch groups and set up guidelines to decrease interruptions.and Linda Miller, RN Visitation guidelines reviewed.

Safety issues related to communication discussed.

CH3 Advisory – Unit Practice Council List of medications requiring vital sign checks developed and in med room; combinedand Linda Miller, RN to meet every other month with CH2; revising the visitation guidelines.

NICU Maureen Lloyd, RN, and Clinical “Glitches” board to give insight to help everyone on staff practices; booklets for Care Team parents and visitors developed.Renovation Group Number and type of monitors, capital items, and other equipment needed.



UNIT COUNCIL AND MANAGER STAFF DECISION MAKING

PICU Unit Practice Council Unit ground rules.and Maureen Lloyd, RN Several requests for new equipment done, refrigerator, phones, computers, patient care

items.Patient/family call backs.

WLL Bereavement Council and Requested room for “demise” cases to allow a private experience, needed supplies.(OB/GYN) Jami Marks, RN

Advisory—Unit Practice Council Mission and vision for unit revised.Visitation guidelines revised.

ED Education Council and Memory Boxes instituted in ED;Charmaine Tetkoski, RN Blue fall signs used throughout hospital; CEP group redesigned orientation process.

PACU Unit Practice and Education Team Requested door applied to break room; due to other construction—requested keys to Cindy Bird, RN come in through front door during off hours; an emergency exit is being installed;

“grease” board kept in waiting room for family to track patient in OR themselves.

OR OR Workgroup and Hang brackets for clamps; hooks on doors for isolation signs; laser goggle designated Deb Strausser, RN and hook to keep; flip binders with phone numbers in each room.

When issues need to be addressed or a proposed change needs feedback, Sue Hallick and the othernursing leaders listen to what staff nurses have to say. When an issue needs to be resolved, the leadersconsult the staff. Some of these issues have included practice issues, communication failures, and retentionissues. Although direct-care nurses have direct access to Sue, they also share input and feedback with theircoworkers and unit managers, either one-to-one, through unit councils, or through unit meetings (3:3:Cand 3:3:D).

3:3:C

SCU3 TEAM PRACTICE COUNCIL MINUTES9/13/07

DIRECT-CARE PROVIDER COUNCIL MEMBERS:

Melissa Shambach, RN—Team Coordinator Martha Downs, RN—Team Coordinator Candace Bossler, RN—CEP

Tonya Sellard, RN—CEP Gavin Claycomb, RN Wendy Onvsconage, RN—CEP

Bethann Herriman, NA Lori Valentine, RN, CCRN

OLD BUSINESS

Tonya Sellard, RN, CEP, presented the council with the Geisinger job descriptions for the nurse extern. As a reminder to everyone,the extern has similar responsibilities to a nursing assistant.

There was a revision of the unit council teams.

Taping of report is not permitted. If you have any questions about a certain situation see the charge nurse.

Revision of the titration book continues to be in progress by Candy.

Isolation cart par items are going to be looked at and revised by Beth Herriman, NA, and Gavin Claycomb, RN.

Please remember not to take the Hemacult and Gastrocult developers into the Isolation rooms. Have someone place a drop onthe card or take a few drops in a medicine cup into the room.

Just a quick reminder that it is not necessary to check the pH levels on a corflo.

There is going to be a trial on the Nov. 11th – Dec. 8th schedule. Full-time employees are who this is going to affect.We are goingto trial three 12-hours shifts one week and three 12-hours and an 8-hour shift another week. If you think about it, it will eliminate



one full shift that you need to come to work. It will also make it easier for those of you who like to do overtime. It was discussedand decided that although you will work overtime by four hours one week, you will not receive the bonus and the week that youwork the 12 hrs you would have to work four hours beyond your shifts in order to get overtime but you will get the bonus. In theend it all works out.We also talked about putting that date in the book the week you do the extra eight, and we figured out thatin order to put a date in the book you have to work beyond the hours that you are scheduled.

NEW BUSINESS

Weekend position call-ins were discussed. It was decided that if on a Saturday or Sunday a person who works perm. weekendscalls in, it will be made up on a Friday.Therefore on the next schedule, they will need to work three Fridays.

Vacations for weekend positions were also discussed. If a perm. weekend person is scheduled for vacation the same weekend as anonperm. weekend person on the opposite shift, you will both get the weekend off. If a day-shift and a nightshift perm. weekendput in for the same weekend, they will both be permitted to be off.Two perm. weekend people who are on the same shift will notbe permitted to be off together; the person with the most seniority gets the weekend off. This is all permitted that staffing allots it;otherwise you will need to find someone to work for you.

Reinforcement was made on the fact that if you call in the day before or the day after your scheduled holiday to be off, you willnot get paid for the holiday.

Any changes on the schedule that are going to be made need to go through the team coordinators.

Scheduling guidelines were discussed and more will be coming on that.There is going to be a subcommittee consisting of MarthaDowns, RN, Missy Shambach, RN, and Candy Bossler, RN, who are going to look over the guidelines.

The nightshift holiday pay was discussed, and we just want to make sure that you night-shifters are aware that you will now be paidfor 12 hours of holiday time for working the night before the holiday starting at 1900.

There is going to be a new contract form coming around the corner. If you void a contract, be aware that you will not be able tocontract the next schedule, and it will be up to Missy Shambach, RN, and Martha Downs, RN, if you will be able to contract afterthat.

We are looking into preparing an equipment box that will be for emergencies; it will consist of extra cables, BP cuffs, etc.Thesesupplies will be locked, and you will need to go to the charge nurse to get the key in order to use these supplies.There will be asign-out sheet so we know when to replace what is used.

Charge nurses, please be aware that you need to sign when the line cart is restocked.

Gavin Claycomb, RN, and Tonya Sellard, RN, were elected to replace Mike Beaver, RN, in designing the SCU web site.

Gavin Claycomb, RN, is going to join the scheduling committee.

Candy Bossler, RN, is going to look and revise the critical care nursing guidelines pamphlet and make it more SCU friendly.

A Christmas party is going to be planned. Look for the sign-up sheet in the lounge.We are going to plan the party during theweek so that everyone will have a chance to come.We will keep you informed on more details as the time nears.Tonya is going tobe looking into locations.

Gavin Claycomb, RN, and Gordan Cole, RN, CNE, were elected to work on a packet to give to patient's families so that they canfind their way around.

Issues and concerns with EMAR and CPOE were discussed. For the first two weeks, superusers will be available to help and willnot be counted in the numbers. At this time, we will not run short.

There was discussion on the role of the nursing assistant in SCU. It was decided that we are going to do a week trial with thenursing assistant doing Q2 hour vitals and urine outs and putting them into the computer. Beth and Tonya are going to look intofiguring out guidelines when the nurse needs to be told right away if there is a problem.

We are going to hire four new nursing assistants.The positions will be posted soon.There will be two D/N, one nighter, and oneD/E. Beth Herriman, NA, is going to work on an orientation packet for the nursing assistant.There is going to be a change in thatnursing assistants are going to be crossed-trained as unit secretaries.The orientation is going to be increased to 10 weeks becauseof this.

Week 1 General orientation

Week 2 Spend a week with a nurse (learn how to do general care of patients)

Weeks 3-4 Spend with the nursing assistant

Weeks 5-8 Desk

Weeks 9-12 Back with nursing assistantGordon Cole RN, CNE, gave a proposed orientation packet for new nurses.



3:3:D

STAFF MEETING MINUTESSCU4

DIRECT-CARE STAFF NURSE

ATTENDEES:

Sept 6, 2007 Sept 17, 2007

Denae Cole, RN Donna Plotts, LPN

Christy Muthchler, RN

Sabrina Heddings, RN

Melanie Feick, RN

Bonnie Caratetter, RN

Marcy Lutz, RN

Heather Yost, RN

Mary Bosco, UDC

Beth Snyder, UDC

Kim Castillo, RN

STAFFING

We are in the process of hiring two new NA for D/E. Jobs have been offered. I will keep you updated on our progress. Four of ournew RNs will be off orientation starting in October. All our new approved positions are posted.

NDNQI

Benchmarks reviewed for staffing levels. Discussed ways to meet our staffing needs with staff participation.

INFECTION CONTROL

Reviewed handwashing before and after entering the rooms.

There is to be no food or drinks at the desk. Drinks were found at the desk during ID rounds. Individuals will be addressed.

Reviewed C-diff isolation and the need to wash your hands and not use Avagard because it is ineffective.There is a green sign thatneeds to be placed outside C-diff rooms so everyone knows to wash hands.

Outside shampoo or soap discussion with staff. Team decided we should use shampoo provided by hospital to limit outsideinfection possibility. Please use what is provided by the hospital.

RESTRAINTS/VO/TO

Restraints audits reviewed and need to have order match nursing charting reviewed.When someone gets OOB we need a dcorder for rails and when they get back to bed we need a reorder of rails. So if we take anything off or add anything, the order needsto match what we are doing and the time we are doing it. Any questions see Dawn or Sabrina.

We did not have one care plan when our restraints were audited by PI. Everyone is responsible for checking the restraint careplans when you have someone in restraints.

We only missed one Q2 hour documentation. Continue to match your charting to the physician orders.When ever you dc, start,or change what you are using, there needs to be an order in the chart that matches what you did at the same time you did it.

Daily restraint audits are continuing and we are doing well. Remember any time four gates are up, this is a restraint and requires anorder. No exceptions.

Our VO order audit was 100% in all areas. Keep up the good work.



MAGNET

Magnet work is continuing. More info as it becomes available.

POLICY CHANGES

There is a new policy for the COURDE Cath placement. Please review the education in the staff bathroom. See Gerri with anyquestions.

EDUCATIONAL ISSUES

All education classes are cancelled the first two weeks we implement EPIC OCT 14th–Oct 28th.This is in an effort to have all ofour resources available for the EMAR and CPOE

PATIENT SATISFACTION

Rounds are continuing in the unit. Noise at the desk is an issue with some patients. Be aware that our voices carry. Noinappropriate conversations at the desk; those patients and others can hear.

NEW STAFF/EXTERNS/ETC

Steve Thomas starts 9/17 /07 as our new UCA.Welcome Steve. He will be full-time D/E.

OTHER HOUSEKEEPING

COWS, better known as computers on wheels, need to be kept in the patient’s room and plugged in.They cannot be in the halls.The computer on the wall by 15 needs to have its keyboard flipped up when it is not in use.

Review of harassment policy. GMC has a no tolerance harassment policy 310 in the HR manual. Harassment definition wasreviewed and the GMC policy discussed. Any questions or concerns see Dawn.

Alarms in the unit are to be on at all times. Changes made to the alarms need to ordered by the attending service. Any attempt toturn off alarms or muffle them will not be tolerated and will result in disciplinary action.

On Nov. 12, 2007, GMC is going tobacco-free.There are a number of programs to assist any staff who needs help to quit. SeeConnections for details.

Submitted by Dawn Troutman, Ops Manager, SCU4

EXAMPLE: EQUIPMENT PURCHASED AS A RESULT OF STAFF FEEDBACK

Managers also meet with Sue Hallick to share staff nurse suggestions and feedback. Direct-care nurses haveprovided feedback to management on the acquisition of direct-care equipment. Management presented thisfeedback from their reporting units at a manager’s meeting and set priorities for department-specificpurchases (3:3:E).

3:3:E

GEISINGER MEDICAL CENTER EQUIPMENT REQUESTS BY STAFF FOR MINOR EQUIPMENT FY07

UNIT PRIORITY ITEM UNIT PRIORITY ITEM

BP5 7 Thermometer BP8 3 Suction regulators

BP5 9 Desk chairs BP7 6 Dinamap blood pressure machine



UNIT PRIORITY ITEM UNIT PRIORITY ITEM

BP5 2 Dopplers BP7 7 Suction regulators

BP5 3 Pulse ox AGP4 1 Telemetry transmitters

BP5 8 Bladder scan AGP4 2 Patient recliners

BP5 10 Stretchers AGP2 1 Bariatric chair

AGP5 1 Medication lockers AGP2 Patient lift

AGP5 3 Dopplers BP2 4 Geri chairs

AGP5 6 Shower stretcher AICU 4 Family chairs

BP6 1 Bari chairs SCU3 2 Triple pumps

BP6 2 Patient chairs SCU3 4 Percussors

BP6 4 Pulse ox CCU 2 Fluid warmer ranger

BP8 1 Refrigerator CCU 6 Hillrom transfer chair

EXAMPLE: STRATEGIC STAFFING INCENTIVE (SSI)

Another avenue for direct-care nurses to provide feedback is through meetings held by the CNO (SueHallick, RN), the associate vice presidents (Crystal Muthler, RN, and Denise Beechay, RN), and the nursemanagers.

Direct-care nurses met with Sue, Crystal, Denise, and several managers to come up with a plan to addressstaffing issues. The staff and managers were challenged to develop a plan in their unit-based councils thatwould encourage voluntary overtime. Additionally, a workgroup of direct-care nurses and managersdeveloped a departmental plan that provides a monetary bonus for volunteering to cover unit staffingneeds. It was implemented initially in 2005 and is revised at least every year (3:3:F).

3:3:F

GEISINGER MEDICAL CENTERINPATIENT NURSINGBASIC, PRESCHEDULED AVAILABILITY AND COMMITTED CORESTRATEGIC STAFFING INCENTIVE (SSI)REVISED: AUGUST 29, 2007

INTRODUCTION

The Geisinger Medical Center Inpatient Nursing Strategic Staffing Incentive (SSI) is designed to provide incentive compensation forkey inpatient employees.The purpose of the plan is:

A. To recognize and reward staff for the commitment to patient care during periods of high census and resource shortages.

B. To financially compensate staff for prescheduling additional or extra hours in advance.

C. To enable staff to maintain control of when the extra hours are worked, benefiting the employee and department staffingneeds.

D. To increase staff ’s voluntary participation in preplanning to meet staffing needs.

E. To promote a more even distribution of extra hours among staff members, meet core staffing needs on units, and eliminatemandatory overtime.

I. DEFINITIONS

A. When used in this Plan Document, the terms below are defined as follows:

1. “SSI” means this incentive plan in its entirety, including amendments, rules, and regulations adopted pursuant hereto.



2. “Incentive” means a positive motivational influence—an additional payment as a means of rewarding increased cooperationand commitment to patient care.

3. “Employer” means Geisinger Medical Center.

4. “Geisinger” means Geisinger Health System.

5. “Voluntary time” means time that is preplanned or agreed upon prior to the end of the employee’s scheduled shift.

6. “Basic SSI” means Basic Strategic Staffing Incentive, an incentive paid to eligible inpatient staff that voluntarily preplan or agreeto work additional hours within the designated time window as defined above.

7. “Prescheduled Availability Premium” means a lump sum premium paid to eligible individuals willing to make themselvesavailable for a minimum number of time blocks per schedule on a preplanned basis to staff unexpected shortages on adesignated inpatient unit.

8. “Committed Core Premium” means a lump sum premium paid on a per-schedule basis to eligible individuals willing to fill aminimum requirement of core time blocks per scheduled on a preplanned basis.

II. IMPLEMENTATION CRITERIA

A. The SSI will be implemented based on one or more of the criteria stated below with the Chief Administrative Office—GMC/System Chief Nursing Officer and Human Resources approval.

1. Above budget patient volumes

2. 10% or greater direct patient care provider vacancy rate (includes staff on leaves of absence)

3. For emergency staffing situations other than listed above at the discretion of nursing leadership.

III. BASIC STRATEGIC STAFFING INCENTIVE

A. To qualify for the Basic SSI, the eligible employee must volunteer to work additional or extra hours for a designated inpatient-nursing unit. An employee from another department is eligible for the incentive as long as the extra hours worked are on adesignated inpatient unit.

B. All levels of nonexempt, budgeted personnel working on a designated inpatient unit are eligible for the incentive.

C. A minimum block of two hours must be scheduled voluntarily as defined in Section II.

D. Rates are as follows:

1. RN—$45.00 for every two-hour block of additional hours worked on a voluntary basis.

2. LPN, Paramedic (ED), Surgical Tech—$30.00 for every two-hour block of additional hours worked on a voluntary basis.

3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR, CSR Technician I, CSRTechnician II, Lead CSR Technician—$22.50 for every two-hour block of additional hours worked on a voluntary basis.

E. Only VOLUNTARY time as defined will be eligible for the incentive. If additional time is not prescheduled, the employee mustdeclare his/her intent to stay prior to the end of his/her scheduled shift.

F. Only two-hour increments or more will be counted toward the incentive, with the exception of the Women’s Pavilion,Surgical Suite, ETU, Foss 8, and Emergency Room, where one-hour increments or greater will be counted.

G. Only extra hours for staffing purposes related to direct patient care will be counted toward the incentive.

H. Flex Pool employees are eligible for the Basic SSI if a scheduled shift of eight hours or more is extended.

I. Committed Flex Pool employees are eligible for the Basic SSI if a scheduled shift of eight hours or more is extended or theemployee works above their scheduled committed hours.

J. Additional hours worked as a result of switching shifts with another employee are not eligible.The incentive only applies tothose hours scheduled to staff unexpected shortages on a designated inpatient unit.

IV. PRESCHEDULED AVAILABILITY PREMIUM*

A. All Basic SSI guidelines apply.

B. The Prescheduled Availability Premium is a lump sum premium (in addition to the Basic SSI) to be paid in the pay periodfollowing the end of each schedule period to an employee who preschedules availability for a minimum of six 4-hour blocks inaddition to his/her regular work schedule.



C. The premium will be paid regardless of whether the employee is activated at the following rate:

1. RN—$120.00 per schedule

2. LPN, Paramedic (ER), Surgical Tech—$90.00 per schedule

3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR—$60.00 per schedule

D. Prescheduled availability must be scheduled in a 4-hour block.

E. Should an employee who has committed to prescheduled availability refuse to work a prescheduled block, the premium in itsentirety will be forfeited.

F. Should an employee who has committed to prescheduled availability call in at any time during the schedule period withoutmaking up the time within the schedule period, the premium in its entirety will be forfeited.

V. COMMITTED CORE PREMIUM*

A. All Basic SSI guidelines apply.

B. The Committed Core Premium is a lump sum premium (in addition to the Basic SSI) to be paid in the pay period followingthe end of each schedule period to an employee who commits to covering a minimum of eight 4-hour core blocks within theschedule, in addition to his/her regular work schedule.

C. The premium will be paid regardless of whether the employee is activated at the following rate:

1. RN—$240.00 per schedule

2. LPN, Paramedic (ER), Surgical Tech—$180.00 per schedule

3. Unit Desk Clerk, Nursing Assistant, Staffing Specialist, Equipment Tech-OR, Support Associate-OR—$120.00 per schedule

D. Committed core coverage must be scheduled in a 4-hour block.

E. An employee who enrolls in the Committed Core Premium program may be reassigned to another unit per Patient CareManual Policy #328,Temporary Reassignment of Nursing Personnel; however, the employee may be offered the opportunityto reschedule core commitment time on their home unit within the current schedule period.

F. Rescheduled time is at the discretion of the time-scheduling committee or the unit manager.

G. Should an employee who enrolls in the Committed Core Premium program refuse to work a scheduled committed coreblock or call in at any time during the schedule period without making up the time within the schedule period, the premiumin its entirety will be forfeited.

1. An employee who calls in during the schedule period must contact his/her manager to schedule an appropriate make-upday. Make-up days are not eligible for Basic Strategic Staffing Incentive payment.

H. Individuals who enroll in the Committed Core Premium program and meet the requirements outlined in Sections B, D, and Ewill not be required to stay unexpectedly for that schedule period.

*Prescheduled Availability and Committed Core Premium enrollment may be limited based on the needs of the unit.

VI. GENERAL PROVISIONS

A. This Plan may be amended, modified, or terminated with or without notice to participants at the discretion of the ChiefAdministrative Office—GMC/System Chief Nursing Officer Geisinger Health System or the Human Resources Department.

B. A participant forfeits all rights to the incentives payable under the SSI if, prior to the payment of the award, the participantparticipates in behavior or misconduct that results in a formal performance improvement plan being issued.

C. In the event of the death of an active participant, any earned incentive will be paid to the participant’s beneficiary asdesignated in the employee record.

In 2007, the workgroup that included staff nurses and managers was reconvened and worked with GenaMaize, a member of the Finance Department. The goal of the group was to revise the plan to improvenurse satisfaction and maintain quality. The NDNQI scores on overtime reflect our ongoing efforts(3:3:G).



3:3:G

UNIT RNS WORKING EXTRA HOURS% of Unit % of Unit RNs Reporting Working Extra Hours, Reason Given Mean Change

RNs Reporting in Unit Overtime They Did During Past Year

Not Work % Extra Money % Unit Busy % Unit % Staff % RequiredExtra Short-staffed Pressure

-1=decreased0=unchanged+1=increased

Average of All Comparison Hospitals 20 19 18 26 1 6 0.23

Average of all units in Hospital 13 21 13 22 2 16 0.56

Adult Critical Care 20 31 12 28 1 3 0.31

AICU—Shock/Trauma 9 45 9 28 0 4 0.64

CICU—Cardiac—50150001 4 30 16 32 0 16 0.81

Adult Step-down 25 30 10 27 1 3 0.27

SCU3—Special Care Unit 16 28 0 28 4 16 0.96

SCU4—Special Care Unit 17 43 9 17 0 0 0.47

Adult Medical-Surgical 24 24 11 29 1 3 0.25

AGP4—Telemetry 21 24 14 31 0 7 -0.12

AGP5—Cardiopulmonary 20 14 11 29 9 6 0.46

BP5—Bone and Joint Care 24 6 6 24 0 29 0.79

BP6—Surgical—50010012 10 10 5 55 0 15 0.50

BP7—Medical/General 8 33 8 25 0 17 0.48

Average of All Comparison Hospitals 20 19 18 26 1 6 0.23

Average of all units in Hospital 13 21 13 22 2 16 0.56

BP8—Hematology/Oncology 15 8 15 46 8 8 -0.08

AGP2—Medical-Surgical 13 20 13 27 13 7 0.58

Obstetrics 18 18 22 28 1 7 0.29

(LDRP)—50550001 5 10 10 13 0 45 0.77

Neonate 17 19 23 27 2 8 0.28

NICU—Neonatal—50400010 8 15 15 32 5 23 0.96

Pediatrics 24 20 18 29 1 4 0.21

CH2—Infant/Toddler—50400070 0 17 6 28 0 39 0.88

CH3—School-age Medical-Surgical 5 19 0 62 5 10 0.85

PICU—Pediatric—50400050 18 5 5 23 5 41 1.00

Psychiatry 22 15 14 36 2 4 0.17

BP2—Psych—50070001 15 30 20 20 5 10 0.50

Surgical Services 14 11 25 22 1 12 0.20

In and Out 20 10 10 30 5 20 0.67

Operating Room 23 16 13 18 7 18 0.93

Periop 16 28 4 24 4 24 0.57

Rehabilitation 23 15 13 35 2 3 0.14

Emergency 16 34 12 31 1 2 0.38

Emergency Department 14 39 11 28 0 3 0.69

Ambulatory Care 23 8 24 18 1 5 0.18

Cards & CT Surgery Outpatient Clinic 33 29 13 4 0 8 0.57



% of Unit % of Unit RNs Reporting Working Extra Hours, Reason Given Mean ChangeRNs Reporting in Unit Overtime

They Did During Past YearNot Work % Extra Money % Unit Busy % Unit % Staff % Required

Extra Short-staffed Pressure

-1=decreased0=unchanged+1=increased

Foss 3 and 6 Pediatrics 17 8 0 0 0 8 0.45

Hem/Onc Clinic 33 27 20 0 0 13 -0.23

Medical Outpatient 25 17 21 8 0 0 0.39

Surgical Outpatient 16 3 33 12 0 22 0.43

Women's Health Outpatient Clinic 13 33 20 13 7 7 0.42

Interventional Labs 15 11 27 21 1 10 0.15

Dialysis 0 0 67 17 0 17 0.67

Endoscopy 0 6 19 0 0 50 0.93

Comparison data are not provided for this unit type category because the wide variety of units included invalidates its use forcomparison purposes.

Clinical Nurse Educators 5 32 21 5 0 0 0.14

CRNA 0 25 0 0 0 42 0.67

Flex RN 11 17 17 44 11 0 0.53

Floats 9 18 9 23 0 32 0.90

I.V.Team 15 46 15 15 0 0 -0.08

Life Flight 10 35 15 25 0 0 0.33

Sue Bennett, RN, a direct-care nurse on the Hematology/Oncology unit (BP8), indicated, “I think thatthe SSI has helped to increase the amount of time people volunteer to help the unit. It is a fair way to dealwith staffing issues. I actually look forward to being able to pick up the hours when it suits me and myfamily.”

The SSI encourages more staff to work extra hours voluntarily, thus providing adequate staffing required for high quality, safe patient care. And employees feel a greater level of appreciation from themanagement team.

GMC Nursing Overtime Incentive Comparison

$6,000,000

2006

$5,000,000

$4,000,000

$3,000,000

$2,000,000

$1,000,000

$02007 2008

2006 2007 2008



EXAMPLE: INFLUENCE OUTSIDE OF NURSING

Direct-care nurses also have input that influences organizational decision making outside of the NursingDepartment on issues that impact patient care. Some of these issues include:

• EPIC (Electronic charting system)—Nurses assisted in developing the screens and the process ofdocumentation for our electronic health record (EHR). These nurses are active in all phases ofdevelopment and system rollout (3:3:H).

3:3:H

GEISINGER HEALTH SYSTEMCONSOLIDATED CONTROL TEAM MEETING MINUTES

Meeting Minutes: May 22, 2007

PRESENT

GMC: Bernie Aurand, RN, direct-care BP7; Jody Bachman, RN, CNE, NICU; Gordon Cole, RN, CNE, SCU3; Carol Hughes, RN,direct-care AGP4; Kristin Hogan, RN, direct-care BP2; Alan Huntington, EPIC programmer; Lani Kishbaugh; Melissa Kratzer, RN,direct-care medical-surgical float; Joan Mervine, RN, CNE, BP5; Emily Mowry, RN, CNE, CH2/CH3;Tracey Nicholas; Sharon Novack;Debbie Stayer ; Dawn Troutman;Tami Underhill; Alice Wilson; David Wolf, RRT, Respiratory Therapy; Cassandra Bell, EPIC; MelissaEick, EPIC; Meredith Fowler, BP2, EPIC; Cindy Vought; Joanne Williams.

GWV: Deb Tykosh, Crystal Hritzik, Louise Jenkins

NOTE TYPES

• Cindy: It has been decided the PROGRESS tab will be for physicians only and the INITIAL ASSESS tab will be changed toNURSING post CPOE go-live.

• Group discussed if they want different note types under the NURSING tab; example:Telephone Contact, Initial Assessment,Nursing Progress Notes, Nurse Specialist Notes, Social Services.

• Group decided three types of notes (Nursing Progress Notes, Initial Assessment and Telephone Contact) would be listedunder the NURSING tab.

• Question was asked if the fast note will work with this set-up. Melissa will investigate.

• Question asked: How will Nutrition and Physical Therapy report their initial assessment? They are currently using the INITIALASSESS tab. Cindy will check with Wanda to find out which non-nursing groups are using the INITIAL ASSESS tab.They willneed to decide where they will document their initial assessment

FLOW SHEET GROUP 500021 (PERIPHERAL NERVE BLOCK) STATUS ROW ADDITION

• Cindy asked the group if “capped” could be added to the status row as a selection under Group 500021—Peripheral NerveBlock.The Epidural group already has “capped” as a selection.

• Group approved adding “capped” to Peripheral Nerve Block group.

MED HISTORY

• Joan Mervine addressed group on behalf of the Med Recon team regarding the Medication History.

• Cindy told the group the Periop Nurses, PEDS, BP2, and L&D nurses are for the most part updating the Med Recon in EPICand doing it on paper.

• Lori reminded the group that they previously decided against using the Med Reconciliation in EPIC because the nurses wouldhave to double document (EPIC and paper) until CPOE/EMAR goes live and paper is eliminated. She also had a concern thatif we decided to use EPIC Med Reconciliation, we could not get the nurses trained before Joint Commission arrived oncampus. (See 4/10/07 minutes where the group agreed not to add to navigator for adult world.)



• Joan asked if updating med list in EPIC was not an option, could they view the ED meds.This would help nurses whencommunicating with patients about their preadmission meds. Melissa showed the group the Med Documentation Report inthe Admission Navigator.The title of the report has been changed to “Update Prior to Admit Med.”

• Group decided it was okay to add “Med Documentation” report to Admission Navigator for viewing by the rest of the adultworld. Melissa will add it to navigator next week.

POST-FALL GROUP EVALUATION

• Joanne asked the group if they have frequent documentation under the Post-Fall Group. If so, do they need a reminder flag?

• Gordon reported the policy would be reviewed in July and advised against making any changes at this time.We don’t want tostart something that will have to be retired.

EMAR SUPER USER TRAINING QUESTIONS

• Joanne went over several questions that were asked at the EMAR super user training, but it was decided by the group thatthis was not the time or place to review them.

• A comment was made that the super user questions are not getting answered.

• Joanne said she would look into it.

NEXT MEETING

• June 12, 2007

• 1:30 p.m.–3:00 p.m.

• Bush 3

Cassandra BellInpatient EPIC Team

NURSE ADMIT WORKFLOW 4/24/2007

Nurse enters patient’s chart in EPIC

Access the Nurse Admit fromthe Action Menu

Patient Arrives to Inpatient floor



Nurse can update/edit theAllergies for the patient

Nurse selects if a line is availablefor a Nurse Draw (labs)

Nurse selects flow sheet link to be taken to the FlowSheet Activity and selects the appropriate flow sheet to

complete from under the Chevron dropdown



Nurse selects and completes the appropriate AdmitDatabase flow sheet



FLOW SHEET COMPLEX CHANGES FOR 4/24/2007

Due to a policychange, the NGTPlacement List will

reflect the neworder with

additional choices.

Ostomy will sit on theIntegumentary flow

sheet as before but nowit will be duplicatable soyou are able to bring in

another group andrename it.

TURN AND REPOSITION CHANGE

The Turn/Reposition row will be versionedand Rotobed will be added as an option.



The wording was changed toreflect the highlighted

section below.

PATIENT EDUCATION FLOW SHEET CHANGES

A new LDA group is available forthe I.V. Management Flow Sheet

called Midline Catheter.



• Equipment and supplies—Nurses have input into the type of equipment and supplies that arebeing considered for purchase through the Clinical Use Evaluation (CUE) Committee. Thesenurses help to test them and make the final selection (3:3:I).

3:3:I

GEISINGER HEALTH SYSTEMCLINICAL USE EVALUATION COMMITTEEMEETING MINUTES: 4/26/07LOCATION: GWV VMB VIDEO CONFERENCE ROOMGMC VIDEO CONFERENCE ROOM—HOSPITAL 3TIME: 1 P.M. CLINICAL USE EVALUATION ATTENDANCE RECORD

CALENDAR YEAR 2007

Members April

J. Bachman, RN (D), CME X

P. Baylor, RN (D), Risk Management EA



Members April

C. Bird, RN (D), operations manager X

T. Bower, RN (CP), operations manager UA

C. Day, RN (W), direct-care nurse X

S Heppding, RN (W), direct-care nurse EA

L. Kasper, RN (W), direct-care nurse EA

B. Knowlton, RN (D), CNE X

J. Kopec, RN (W), direct-care nurse X

K. Linn (D), Purchasing X

G. Maize (D), Finance X

B. Mullay, RN (W), operations manager EA

B. Patterson, RN (D), operations manager X

B. Rice, RN (W), operations manager EA

G. Rittle, RN (D), direct-care nurse, ED EA

B. Rohrer, RN (D), direct-care nurse, Peds X

B. Rozycki, RN (W), direct-care nurse, ICU X

J. Santo, RN (W), direct-care nurse, ICU X

D. Stump, RN (D), direct-care nurse, Anesthesia X

R.Tronsue (GSWB) X

L. Kearney, RN (D), purchasing (Facilitator) X

UA–Unexcused Absence X–Attended–No Meeting EA–Excused AbsenceTD–Technical Difficulties N/A–Not a member

REVIEW AND APPROVAL OF MINUTES

Minutes of 3/22/07 corrected and approved.

OLD BUSINESS

THERMOMETERS

Welch Allyn Core Tympanic Thermometers have been approved for use at all sites except Outpatient Peds (need reading in oralmode).Thermometers can be ordered now. The order from all three hospitals will be submitted at once.

I.V. LABELING TAGS

All hospitals will use the color-coded tags on tubing with the name of the day of the week, as when to change I.V. (same as GWV’s tags).

Conclusion/Action: GWV to send sample. Policy to be changed as to tag tubing, the day I.V. is to be changed and describing tags.

I.V. PUMP UPDATE

Updates on pumps will be done sometime in June. All Pharmacies will be involved with adding upgrade and revising the GuardianDrug Library. GWV getting 20 single channel loaners and 20 poles until new exchange completed.

Conclusion/Action: Other facilities will look into loaners.

NEW BUSINESS

ENEMA BAG KIT

All hospitals will be using the same Enema Kit with a hanging plastic bag instead of a plastic bucket.

Conclusion/Action: More cost saving.



BARIATRIC BEDPAN

Identified as a need by GMC and GWV. Holds 2 qts. of liquid and 1000 lbs of weight.

Conclusion/Action: First check with present vendor to see if they have such item. If not, get cost from new vendor.

LATEX CATHETERS

At Children’s Hospital, have straight catheter kits with red rubber latex catheters and Foley insert kits with latex catheters.The redrubber catheters are also used for suctioning children.This poses a potential problem for exposure to latex allergic reactions toboth patient and care provider.

Conclusion/Action: B. Rohrer to check with present company (Bard) to see if they have non-latex products. GWV to check withBonnie Rice to see if there is a problem at GWV.

NEXT MEETING: JUNE 2007

Belt restraints to be addressed.

STAFF NURSE RECOMMENDATIONS FOR CUE

I.V. tubing labeling GMC converted to the system process for labeling I.V. tubing to indicate tubing change dates.This change also improved SCS production time because the staff does not have to place the label on the I.V. bag.

No rinse shampoo caps Per a nursing request, sourced and obtained a product to aid with cleansing patient’s hair to cut down buckets, trays, and shampoo to one item.

Disposable BP cuffs Per a nursing request that expressed the need to house disposable cuffs for patients in isolation, this was done in accordance with Infection Control to assist with decreasing the incidence of transferring isolation particles.

Mouth care kits To assist with decreasing VAPs in accordance with clinical effectiveness and Saving 100,000 Lives Campaign initiatives, nurses worked with AICU staff to select the best products to accomplish this.To date, it has been effective (per Lani Kishbaugh).

Endure body wash and lotion In conjunction with Infection Control, nurses requested a product to help decrease the microorganism growth on skin to decrease hospital-acquired infections.

Vest restraints Removed vest restraints per Joint Commission recommendation and replaced with restraints that were approved by Nursing.

Patient admission kits Developed an understanding of what Nursing needs from an admission kit and what is the most cost effective to provide. A mini-workgroup worked with a major assist from AVP Denise Beechay to review withNursing the need to assess each patient before giving them a kit and to establish a basic kit so that individualnursing floors do not need to make their own. Savings derived from this effort will be determined.

Central line bundle kit Worked in conjunction with clinical effectiveness as part of the Saving 100,000 Lives Campaign.

Thermal to bath blanket This conversion is in process, savings to be announced next month.and disposable towels in the ED


3:3:A Shared Governance Council Rosters

3:3:B Nursing Procedure Manual—Patient Identification Policy (developed by Nursing Practice Council)

3:3:C Unit Council Minutes (SCU3)

3:3:D Staff Meeting Minutes (SCU4)

3:3:E Equipment Requests by Staff for Minor Equipment

3:3:F Strategic Staffing Incentive (SSI)

3:3:G NDNQI: Unit RNs Working Extra Hours

3:3:H EPIC Consolidated Control Team Minutes

3:3:I CUE Meeting Minutes



EVIDENCE 4 Describe mechanisms or processes that create a practice environment that fosters horizontaland vertical communication between nurses at all levels throughout the organization.

EXAMPLE: HOSPITAL-BASED SHARED GOVERNANCE COUNCILS

The shared governance model creates an environment of open communication between staff nurses,advanced practice nurses, nurse managers, and administration. Vertical communication occurs when a staff nurse communicates directly to a manager or to Sue Hallick, our CNO. Horizontal communicationoccurs among peers. Working together on policies, projects, or practice-related problem solving fosterscommunication between nurses from all departments throughout the organization regardless of their level.The familiarity gained from working together on the councils enhances inter-unit interactions as well.

Direct-care nurses serve on various Nursing Department councils. They share their opinions on thebenefits that these experiences provide:

• Nursing Clinical Practice Committee Cochair Mike Treese, RN, float/staff nurse:“As a float, I see a lot in the inpatient areas, but the Clinical Practice Council brings togetherinpatient and outpatient staff, managers, and representatives from other nursing councils. Throughmy council work, I am able to see the wide impact nursing issues have on the various specialties inand out of the hospital setting” (3:4:A).

CLINICAL PRACTICE COMMITTEE MEMBERS 2007

Charlene Anselmo, RN Women’s Health Pavilion Staff Nurse

Jody Bachman, BSN NICU Nurse Educator

Melania Balzer, BSN Operating Room Staff Nurse

Patricia Baylor, RN Employee Health Services Clinic Nurse

Carol Bettyleyon, RN Radiation Oncology Clinic Nurse

Candice Bossler, RN Special Care Unit 3 Staff Nurse

Ann Bower, RN BP7 Staff Nurse

E. Sue Brown, MSN Patient Safety Patient Education

Joan Callahan, BSN PACU Staff Nurse

Donna Dietz, RN Hematology/Oncology Clinic Nurse

Tracey Eddinger, BSN AGP5 Staff Nurse

Cathy Eyer, RN Women’s Health Pavilion Nurse Educator

Eileen Gibson, RN Urology Clinic Clinic Nurse

Sheila Clark, RN BP5 Staff Nurse

Sue Hallick, MS, BSN Nursing CNO

Sabrina Heddings, RN Special Care Unit 4 Staff Nurse

Carol Hughes, RN AGP4 Staff Nurse

Dianne Nestor, RN BP6 Staff Nurse

Dorothy Johnson, BSN CH3 Staff Nurse

Katie Jones, RN AICU Staff Nurse

Holly Kasper, RN CH2 Staff Nurse

Barbara Knowlton, RN I.V.Therapy Nurse Educator



Carol Krohn, RN Eye Clinic Clinic Nurse

John Krohn, RRT Respiratory Therapy Staff RRT

Juna Lewis, RN AGP5 Staff Nurse

Adrienne Lonczynski, BSN BP8 Staff Nurse

Judy Malatesta, RN CICU Staff Nurse

Devon Manney, BSN OB/GYN Staff Nurse

Lisa McGinty, RN I&O Surgery Staff Nurse

David Mensch, RN BP2 Staff Nurse

Darlene Mensinger, RN NICU Staff Nurse

Joan Mervine, RN BP5, BP6 Nurse Educator

Emily Mowry, BSN Children’s Hospital 2 & 3 Nurse Educator

Polly Muthler, RN AGP2 Staff Nurse

Tracey Nicholas, BSN Performance Improvement GMC Campus

Sharon Novac, BSN Infectious Disease GMC Campus

Jeanne Perch, RN Pain Therapy Clinic Nurse

Bonnie Patterson, RN AGP5 & I.V.Therapy Operations Manager

Vicki Patterson-Cragle, RN CICU Staff Nurse

Kathy Politis, RN AGP4 Staff Nurse

Linda Rea, RN PICU Staff Nurse

Tonya Sellard, RN Special Care Unit 4 Staff Nurse

Stacie Semborski, RN Pediatric Sedation Team Staff Nurse

Anne Shaffer, RN Emergency Department Staff Nurse

Renee Smith, BSN PACU Nurse Educator

Jody Snyder, BSN Endoscopy Clinic Nurse

Hope Spigelmyer, RN Critical Care Float Pool Staff Nurse

Deb Stayer, MSN PICU Nurse Educator

Robin Steimling, RN BP7 & BP8 Nurse Educator

Dennis Tanner, BS, RN BP2 Nurse Educator

Michael Treese, BSN Medical-Surgical Float Pool Staff Nurse

Timothy Troxell, LPN BP6 Staff Nurse

Deb Watkins, LPN Foss Clinic Clinic Nurse

Jenifer Wemple, BSN Special Care Unit 4 Clinic Nurse

Ann Wilver, RN Foss 6 Clinic Nurse

Jessica Yancaskie, BSN AICU Staff Nurse

3:4:A

GEISINGER MEDICAL CENTERNURSING CLINICAL PRACTICE COUNCIL MINUTESDATE: JULY 10, 2007TIME: 0700 – 1100TEAM MEMBERS

KEY: X–PRESENT E–EXCUSED A–ABSENT

Charlene Anselmo, RN X Lisa McGinty, RN

X Jody Bachman, BSN X Judy Malatesta, RN



Melania Balzer, BSN Dave Mensch, RN

Patricia Baylor, RN X Darlene Mensinger, RN

Carol Bettleyon, RN Joan Mervine, RN

Candace Bossler, RN Emily Mowry, BSN

X Ann Bower, RN Tracey Nicholas, BSN

Sue Brown, RN Sharon Novak, BSN

Vicki Cragle, RN X Devon Manney, BSN

X Joan Callahan, BSN X Bonnie Patterson, RN

X Donna Deitz, RN X Jean Perch, RN

X Tracey Eddinger, BSN X Kathy Politis, RN

X Eileen Gibson, RN X Linda Rea, RN

Dorothy Johnson, RN

X Sue Hallick, BSN X Tonya Sellard, RN

Sabrina Heddings, RN Stacie Semborski, RN

X Ann Shaffer, RN

Carol Hughes, RN Renee Smith, BSN

Jody Snyder, BSN

X Dorothy Johnson, RN X Hope Spigelmyer, RN

X Katie Jones, RN Deb Stayer, MSN

Holly Kasper, RN X Robin Steimling, RN

X Carol Krohn, RN Dennis Tanner, RN

X John Krohn, RRT X Mike Treese, BSN

X Barb Knowlton, RN Deb Watkins, RN

X Juna Lewis, RN Jenifer Wemple, BSN

X Adrienne Lonczynski, BSN Ann Wilver, RN

Rene McCloskey, RN Jessica Yancoskie, BSN

Polly Muthler, RN X Sheila Clark, RN

Diane Nester, RN Tim Troxell, LPN

Facilitators: Barb Knowlton, Mike TreeseMinute Taker: Chris WhitmireGuest(s):

CALL TO ORDER

Meeting called to order at 0700.

APPROVAL OF MINUTES

The minutes were approved as submitted.

ANNOUNCEMENTS

ADULT ECMO

The policy is not quite done and will be tabled until next meeting. A policy for the Rotobed was passed out for group to review.Please make changes that may be needed. Changes will be made and brought back to the group for approval.



VISUAL CHECKS

Visual checks documentation in EPIC has been revised to include sleeping and breathing. Skin warm has been removed. Touch hasalso been removed due to patients reporting being awakened when touched in the middle of the night. Check unit policies tomake sure the changes are done regarding the visual check policy.

RESTRAINT POLICY

Clarification is needed.When a patient has restraints in bed then is transferred to a chair, does the restraint order need to berewritten for the chair and again when the patient is returned to bed. A meeting will be held next week to work on clarification.

CATHETER TIPPED SYRINGES

Catheter tips syringes can be left at bedside according to DOH.You cannot leave any syringe that a needle can be attached to atthe bedside.

CONTINUOUS PULSE OX MONITORING

Bonnie will report at the next meeting.

NEW MEMBER

Sheila Clark will replace Kathie Green from BP5.

A Life Flight representative will be joining the group in the future.

UMBRIAC CLAMP/JUDY MALATESTA

A clamp (Umbriac Clamp) invented by a Geisinger employee to be used when transporting a patient with multiple I.V. drips thatneed to be infusing constantly.The clamp is put on a pole for transport and is unclamped from the pole once in the room. In useCICU right now but will be hospital-wide eventually.

SITE MARKING FOR SURGERY

Physicians will now have to start marking their own surgical sites prior to surgery. It was the responsibility of the nurses previously.Information to follow. Lisa McGinty will forward the information to Barb who will forward it to the group.

MEDIPORTS®/DONNA DIETZ

Staff should be encouraged to use the Mediport for blood or I.V.s if the patient has one. Barb suggested the incidents be reportedto the unit managers so they can be addressed.

Clarification is needed to see if it is perceived or a real issue.Tracking should be done to try to clear up the issues. Donna will dosome tracking to clarify issues.

ASSESSMENTS

Patient assessments are good for 12 hours. If you work 12-hour shifts it is fine, but if you work 16 hours you must assess thepatient after 12 hours.

I.V. IG POLICY

The I.V. IG Policy is located in the Nursing Procedure Manual online. It is Policy 59A.

ADMINISTRATIVE UPDATE

JOINT COMMISSION

Sue Hallick talked to the group regarding the Joint Commission visit. She explained the process and told the group how long theywould spend in the hospital each day. She told the group they want to talk to the nurses and not the managers.



The employee picnic will be held as scheduled.We will know by Friday their recommendations. Sue will get that out immediately

INCENTIVES

Sue told the group overtime incentives are being revised. Considering lowering the hours worked for the core incentive. Alsobeing considered is a special incentive for weekend and off-shift hours.

PARKING ISSUES

Currently, security staff has other added responsibilities and cannot always take people to the North Zone parking lot when shiftsend later in the evening. Sue will talk to Scott Bitting regarding the situation.There were also concerns regarding lighting and thebushes and weeds on the walk to the parking lot.

NEW RESEARCH NURSE

Our PhD nurse, Dr. Adele Spegman, will start July 16, 2007. She will work part-time for Nursing and part-time for the ResearchCenter. She will bring the nursing component into the studies.

NURSING VISION

Sue will go over the Nursing Vision at an upcoming meeting.

VACANT NURSING POSITIONS

Sue shared vacancy and turnover rates for nursing nationwide, at GMC, and at GWV.

THOMAS JEFFERSON

Thomas Jefferson will have 50 graduates for the next semester. Five people have been accepted into the doctorate program forThomas Jefferson.

MAGNET UPDATE

Sue talked to the group regarding Magnet. Groups are gathering information, and we have a person helping the group with writingthe stories. She explained the process so far, and Terri will continue to keep the group updated.The Conceptual Framework will bediscussed at a future meeting.

TERRI’S MAGNET UPDATE

Hard work is being done and we are on track for April 2, 2008 document submission.

Magnet excitement for this July will be done at the Employee Picnic. August will be Rita’s Ice.

Conceptual Framework is a big topic.There will be discussion on how to continue to incorporate it into the practice todemonstrate how the process is done at Geisinger.

Survey forms done at your evaluation are being turned in to Magnet. It is important to demonstrate how the nurses are involvedwith the community. Please let the Magnet groups know when an employee wins a reward regarding their community service.

Employees receiving certifications are growing.We are above average on medical-surgical certifications. Keep up the good work.

CEUs FOR LICENSE RENEWAL

State board has passed the process regarding the need for a minimum of 30 CEUs to renew your license. It will begin with the2008 renewal year.Terri will keep the staff informed regarding the free CEUs.The information is on the Nurse Channel for all toaccess.

The state has not clarified the type of CEUs that will be acceptable.There have been recommendations on the acceptableprograms, but clarification will come.

Terri told the group to check with Judy Shipe regarding the CME classes and the possibility of getting PSNA credits for theprograms.



Turn programs in to Nursing Education, Chris Whitmire 01-51, to get credit on your transcripts.

The monthly Growing Up, etc., articles will go into the GOALS program in the future.When you take the class and complete it willgo on your transcript automatically.

The OR Trauma is in GOALS and when completed goes to you transcript automatically.

PEARLS

There is an online program called Pearls. It can be accessed for a variety of topics that offer CEUs.Terri will send it to BarbKnowlton to send out to the group for all nursing staff.Terri will be sending it to GWV for their use also.

Please submit the Pearls certificate with a sign-in sheet to get credit on your transcript.

NURSING RESEARCH

Terri spoke about the new research nurse. She will be visiting the Clinical Practice group in the future.

RESTRAINTS

Terri told the group that DOH thought we needed to improve our process with restraints.They think that we are overly strictwith ourselves. Sue spoke to the DOH to figure out the process we need to go through. Hopefully by Monday we will haveapproval and things will not change.

“Behavioral” and “nonbehavioral” have changed to “violent” and “nonviolent.”

It relates to the people who know they are intending to harm you and ones who are not aware because of extenuating factorssuch as drugs, etc.

Location does not distinguish the differences in patients. It is the diagnosis and the way they are being treated.

The new process and reeducation will be done starting next week and will have to be done by August 1, 2007.

URINARY INFECTION COMMITTEE

Diane visited the group previously and took concerns from the group back to the committee.

In some areas in the hospital, nurses are inserting the Coude catheter. In the past, placement of this catheter was a physicianresponsibility. It is important to educate staff in the use of the catheter in the future.

ADJOURNMENT

Adjournment at 11:00.

MINUTES APPROVED BY:

Barb Knowlton, RN

• Nursing Retention and Communication Council (NRCC) Cochair Tess Varano, RN, staff nurse, AGP4:“The members of the NRCC have an eight-hour meeting once a month that allows not only aforum to bounce ideas off each other but a comfort zone for addressing concerns to our CNO.Having nurses on the committee that represent the pediatric, ED, intensive care, medical-surgicalspecialties also gives the committee and its members unique insight to further address retentionand communication issues.”

• Steve Endress, RN, staff nurse, Life Flight: “Working together during council meetings allows nurses from all levels to have the opportunity tocommunicate effectively and to collectively work as a team to enhance the overall function of eachnursing unit and the nursing department as a whole. The NRCC council is a collective group of



nurses, a well rounded team formulated to maintain open communication, enhance the nursingpractice, and promote the nursing image throughout the Geisinger system” (3:4:B).

3:4:B

GEISINGER HEALTH SYSTEMRETENTION AND COMMUNICATION COMMITTEEMEETING MINUTESTHURSDAY, SEPTEMBER 27, 2007, 0700-1530LOCATION: ANESTHESIA CLASSROOM

Attendance

KEY: X–PRESENT E–EXCUSED A–ABSENT R = REPRESENTED

INPATIENT NURSING INPATIENT NURSING CONT. OUTPATIENT NURSING CONT

Beyer, Melissa, RN—CH2 (NWM) Spatzer, Barbara, RN, AICU (HWE) X Wright, Christianne, RN,Staff Nurse—I&O

Brink, Janice, RN, BSN, CEP—NICU (PS) X Spickard, Sandra, RN, MSF (NWM) Yocum, Kay, RN, Endoscopy (PS)

X Brokenshire, Judy, RN, CMSRN—BP6 (NWM) Strunk, Lori, AGP4 NURSING LEADERSHIP

X Chamberis, Sevasty, RN, CH3 (HWE) X Swartzentruber, R. Elaine, RN X Hallick, Sue, RN, CNOStaff Nurse, Cancer Center

Evans, Sarah, RN, BP5 Thomas, Elizabeth X Marks, Jami, RN—Advisor,Ops Mgr—Inpatient OB/GYN

X Grunden, Marie, LPN, AGP5 (HWE) Wallish, Mary, RN, CCF (PS) X Endress, Steve, RN, Flight Nurse,Life Flight, Cochair

Harris, Danielle, RN, AICU Wemple, Jennifer, RN, BSN, SCU4 (PS) E Varano,Tess, RN, cochair,AGP4 (HWE)

Henrie, Sandra, RN, BP8 (alternate) Wonlschlegel, Mandy, Extern, BP5 CLINIC NURSE EDUCATORS

Heuermann, Jane, RN, AGP2 Zimmerman, Rebecca, BP5 X Danilowicz, Gerri Ann, RN,Clinical Nurse Educator, SCU4

Hons, Sara, RN, BSN— OUTPATIENT NURSING X Gordon, Nancy, RN, CNCLabor & Delivery (PS) Clinical Nurse Educator, ED

Intintolo, Joan, RN, Staff Nurse, BP7 X Bidelspach, Lisa, LPN X Horan, Kate, RN, Clinical Nurse Eye Clinic (NWM) Educator, OR

Karnes, Pamela, RN, AGP5 Corrigan, Sandy, RN, GIM OTHER

X King, Megan, RN,WP1 (PS) Fulmer, Sherri, RN, Dialysis (NWM) Botella, Judy, RN, Supervisor

X Kleman, Cheryl, RN, CEP, PACU (NWM) X Gaugler, Jatina, RN, Staff E Clutcher, Kathy, RN,Nurse—Pain Therapy (NWM) Nurse Recruiter

X Lerch, Lyndsey, RN, AGP5— X Heath, Sally, RN, PSC (NWM) Curtin, Colleen—Nurse RecruiterStaff Nurse (HWE)

Lines, Red, RN, Life Flight X Ikeler, Kristen, RN, BSN, OCN Gibson, Eileen, RN, ITKnapper Clinic (HWE)

Lizardi, Lynn Ann, RN, SCU3 (HWE) X Jones, Carol, RN,Team Coord. E Hoffman, Lynn, LPN, GHP—Emergency Department QI (PS)

E Long, Mary Ellen, RN, CCRN, PICU Madden,Tracey, RN, Lamont, Susan, RN, HumanStaff Nurse—I&O (NWM) Resources

E Mattis, Deb, LPN, BP2 Moore, Janet, RN, Orthopaedics Merrill, Michele, RN ,Vitaline

Michael, Nicole, RN—RN/CEP, AGP4 (HWE) Ney, April, LPN, Sunbury Women’s Miller, Becky, Human ResourcesHealth (PS)



INPATIENT NURSING INPATIENT NURSING CONT. OUTPATIENT NURSING CONT

Mutchler, Christy, RN, AGP4

Nariskus, Kristy, RN, OR Reichenbach,Teresa, Dermatology Miller, Cindy, Human Resources

Newsome,Vanessa, RN—NICU X Sekulski, Connie, RN, I.V.Therapy (HWE) Petrovich, Susan, QI(alternate) (PS)

X Peterman, Elizabeth, RN, BSN, CCU Schoch, Michelle, QI (alternate)

Provow, Amanda, OR (alternate for OR) Strzempek, Lynda, RN, Radiation Young, LaVera, Neuro Services Line

Reiner, Amy, RN, CCU Shotwell, Betsy, RN—ER

Smoyer, Karen RN, CEP—BP8 (PS) X Worhach, Stephanie, RNC, CBC,CCE, CLSS, OB/GYN Team Leader (PS)

PS = Patient Satisfaction HWE = Healthy Work Environment NWM = Nurses Week/Magnet

PATIENT SATISFACTION SUBCOMMITTEE

Present: April Ney, LPN (Sunbury OB/GYN); Sara Hons, RN (L&D); Jenifer Wemple, RN (SCU4); Rebecca Zimmerman, RN (BP5);Megan King, RN Chair (Perinatal Edu);Vanesse Newsome, RN (NICU); Steve Endress, RN (Life Flight); Michelle Schoch (GHP);Stephanie Worhach, RN (OB/GYN GMC); Jane Heuermann (GP2).

Guests: Deb Strouse (Scheduling Services); Ruth Carawan (Scheduling Services); Carol Hardee (CareLink).

Meeting called to order at 7:05 a.m. Representatives from CareLink educated the committee on the IVR (Interactive VoiceResponse) system, which guides the user through the Geisinger system.The system has many capabilities to phone tree the clientto the correct department and is also programmed to recognize clients that may mispronounce names or departments. CareLinkis open 7:00 a.m. to 9:00 p.m., seven days a week, closing for Christmas.They handle about 130,000 calls per month with 80schedulers that are mostly at the Wessner Building in Danville and in Glenmaura in the Northeast.The system is continuallyimproving primarily by suggestions from clients.This meeting allowed us as patient advocates to get a better understanding of ourappointment system.

The poster and bookmark project are with Marketing, and a proof will be coming next week before going to print.This will bedistributed as soon as it is received from Marketing—please get your comments back ASAP when you receive it. A journal articlereview was submitted by Rebecca Zimerman (BP5). Her article reviewed the correlation of patient satisfaction with patienteducation and pain control. She reviewed the standards of care for her floor (Orthopaedics) and the patient education that isdone for joint replacements and the interdisciplinary approach to patient education and the high level of patient satisfaction in that population.There is increasing use of peripheral nerve blocks that allow patients to have a greater level of comfort in theimmediate postoperative period. In addition, her floor has pictures and explanations for patients and families in common areas for education.

Steve Endress impressed upon the committee to remind our fellow employees to consider taking time to nominate a worthyemployee for Employee of the Month. For the entire Geisinger Medical Center hub, only six employees were nominated for thismonth’s consideration. Being recognized by your fellow employees is a significant employee satisfier. Employee of the Month is opento all employees—please look around not just your unit but all those you interact with to find someone that deserves recognition.It was suggested we have a “Kudos” section in E-Connections to recognize fellow departments, nurses, units, coworkers—this will betaken to Public Relations to get their feedback (great suggestion!). A field trip was initiated for the last 45 minutes of the meeting –everyone was asked to walk around the hospital and simply observe coworkers, keeping the “ten foot rule” in mind—the ten-footrule says anyone—employees, patients, or families—within 10 feet should be greeted with either a smile, a nod, or a hello and alsowatch for people that may need help finding their way, getting their food, etc. Committee members returned with their reportsand were generally surprised at the lack of acknowledgment of the people that surround us. It is suggested to see if you can findone person in your department to work on implementing the 10-foot rule, and see if we can get it to multiply. Jane Heuermannreported that a Patient Satisfaction Committee was being formed on her unit after she approached her operations manager whothought this was a good idea—great work Jane! October meeting will not be held due to EPIC rollout of CPOE/EMAR. Novembermeeting will be Tuesday, November 20, at 7:00 a.m. in the Anesthesia Conference Room. If you have not brought a journal articleon patient satisfaction, please bring one to share at the November meeting.The guest speaker will be Randy Hutchison, and we willshare the results of our field trip and get feedback on any changes noted. Megan W King, RN, BSN

Chair, Patient Satisfaction Subcommittee



HEALTHY WORK ENVIRONMENT SUBCOMMITTEE

The Healthy Work Environment group decided to have posters created to get the word out since communication is the biggestissue whether verbal or nonverbal.The group is looking to have a vendor visit GMC for technique training; a proposal is beingsubmitted to Administration for approval of funds.The subgroup has employed Terri Bickert for guidance to move forward with thisinitiative.You can expect to see posters in November.

NURSES WEEK AND MAGNET SUBCOMMITTEE

Judy Brokenshire gave an update on Nurses Week 2008 and upcoming Magnet events.

Nurses Week 2008: Nominations for Nurse Excellence awards will open December 1st. Nominees will receive their nominationprinted on parchment paper. Flex staff will be included in the categories; they will not be singled out as in the past. Anyone wishingto nominate someone for the Nightingale Award can submit his or her requests to Judy Brokenshire or Nancy Gordon.

Sunday, May 4th—Remembrance Ceremony

Monday, May 5th—Nurse Excellence Awards

Tuesday, May 6th—Infection Control Conference and Poster Contest

Wednesday, May 7th—Speaker (considering different options for speakers)

Thursday, May 8th—Certification Dinner

Friday, May 9th—Care for the Caregiver Day

Suggested themes from GMC: “Geisinger Nurses—The Driving Force of Excellence” and “Geisinger Nurses—Making it the Best!”

Gift ideas: Fleece blankets or auto visors

Magnet Excitement: October NRCC meeting and Magnet events have been canceled due to the EPIC implementation go-live onOctober 15th. November 19th will be the 3rd annual Turkey Bowl at 5 p.m. in the Hemelright Auditorium. All units are encouragedto participate by entering a team.Teams may consist of four individuals (units may have more than one team), but all teams areencouraged to bring along their cheerleaders. Start thinking about your team costume. December will be the annual distribution ofthe nursing calendars and a Christmas luncheon for the NRCC representatives (details forthcoming).

WOUND VAC PRESENTATION

KCI representatives were on hand to give a Wound Vac presentation during lunch. Some of the clinical nurse educators joined thepresentation and enjoyed lunch with the NRCC members.

GUESTS

Diane Harlow, Employee Health;Terri Bickert, Magnet Program; Randi Hutchison, Patient Satisfaction; Sue Hallick, CNO; JenniferBoxer, PR & Marketing.

APPROVAL OF MINUTES

The August 28, 2007 meeting minutes were approved as submitted.

DIANE HARLOW, EMPLOYEE HEALTH—SMOKE FREE ENVIRONMENT

Effective November 15th, Geisinger will be a smoke-free campus. Diane Harlow from Employee Health attended the NRCCmeeting to address any questions the group may have on what can be expected and what Geisinger is doing to assist employees.A decision was made by senior leadership to have no tobacco products on health system property.Visit the Wellness site on theGeisinger InfoWeb for more details. (PowerPoint presentation attached).

TERRI BICKERT, MAGNET UPDATES

RN Satisfaction Survey: Currently at 88% completion; looking to meet or exceed last year’s response rate of 92%.Winners of thoseunits reaching 100% completion are I.V.Team (<25 group); BP7 (>25 group); CCU (>50 group).There are many units at 100%completion; however, other groups have extremely low completion rates.Terri commended Lisa Bidelspach and the otheroutpatient representatives for the wonderful job they did encouraging outpatient areas to complete the survey.Terri reviewedsome of the changes for next year’s survey, including clearer communication of eligibility requirements, eligibility of nondirect patientcare staff taking the survey, and unlicensed staff survey questions.



Magnet Update: Seven forces are near completion; seven forces to go. October 15th is the deadline for all information to besubmitted. Currently, we are in the proof-gathering stage, but we need nurse stories. Please call or Email Terri with your spiritual,specific stories, or good deed stories. Magnet is also looking for examples of time-off requests/approvals and how nurses areinvolved in the scheduling process (time off for classes, meetings, schedule adjustments, etc.). Mock surveys will be conducted in thefuture to simulate what the actual Magnet survey will be like.Terri has been meeting with Magnet partners to educate them onwhat Magnet is and what it can mean for them. Partners are providing examples of their collaboration with nurses. PharmacyWeek is the same week as Hospital Quality Week; activities are being planned. EPIC Go-Live: Scheduled for Monday, October15th. During our last EPIC rollout, patient satisfaction scores dropped at the same time we were submitting the first Magnetdocument.Terri urged the group not to let the frustrations affect the wonderful patient care they provide. A suggestion was madeto have posters on the units notifying patients of the EPIC implementation and to “please bear with us during this time of change.”

GROUP DISCUSSION

Heart Walk Update: Connie Sekulski thanked NRCC members who participated in the Heart Walk; the group raisedapproximately $1,400.

Volunteers: Roxie Shrawder is requesting volunteers for two upcoming events, the Milton High School Career Fair (11/1/07) andthe Girl Scouts of America need a nurse to help them obtain the Nurse Exploration patch.

OMNI Survey: The OMNI Survey for Employee Satisfaction results were recently released. Results have been given to managersfor development of action plans for improvement. Once the results are published and action plans developed, common trends willbe addressed. NRCC has been invited to participate in this initiative. General OMNI information is available on the InfoWeb foremployees.

Parking: A survey on the current parking situation is available online for all employees to take. Survey ends October 5th.

No Meeting: The October NRCC Meeting is being canceled due to the EPIC go-live and the need to have all staff on the unitsduring this transition. EMAR: All paper information will be transferred to electronic information by midnight 10/14/07. Superuserswill be available 24/7 on the unit, and they will not be counted in the staffing numbers. Nurse shadowing will also be an option forthose who may need additional help. Help will continue to be available through December with a command center in theHemelright Auditorium.The first two weeks of implementation will be critical. Nurses are encouraged to support each otherthrough this implementation period to ensure quality and safe patient care.

RANDI HUTCHISON, PATIENT SATISFACTION

After a brief introduction, Randi broke the committee into several different groups. Individuals within the groups were asked toreflect on difficult situations they’ve encountered and how they handled the situation. After a few minutes, the groups citeddifferent scenarios, how they handled them, and how they can improve their handling techniques. Randi provided some very helpfultips on dealing with irate patients/families, etc.

UPDATES FROM SUE HALLICK

Subcommittees: Gave their updates to Sue. See specific subgroup reports above.

RN Satisfaction Survey: Terri Bickert covered; see notes above.

Parking Survey: Sue encouraged the NRCC to complete the online survey about the current parking situation here at Geisingerand provide their suggestions for improvement. Follow-up communication will be published on anticipated changes based on theoutcome of the survey.

SSI Trial: A three-month incentive trial will begin for RNs who volunteer during the weekend hours. Check with your unit managerfor detailed information on SSI.

Supplemental Education Funds: the Board has not yet reviewed this incentive plan.This will be readdressed in December, and Suewill report the outcome to NRCC.There are no sign-on bonuses at this time. Sue asked the group for suggestions on educationopportunities and how to use the money appropriately.

OMNI Survey: Sue reported that the OMNI Survey feedback sessions are in progress.

Nursing Strategic Plan and Vision: Sue has been presenting the Nursing Strategic Plan and Nursing Vision to all newly hired nurses.

EPIC: October 15th go-live date. Sue assured the group that there will be adequate staffing during this time of transition.

NRCC Meetings: Sue asked the group to provide feedback on her role in this committee, her attendance at these meetings, andthe information she provides. She stressed if urgent issues come up that may need to be addressed more frequently than onceeach month at the NRCC meetings, please contact her directly for guidance. Sue recognized the high stress levels that all nurseswork under and the importance of everyone’s efforts. She thanked the group for their input and all their hard work.



JEN BOXER, PR AND MARKETING—UPDATES

Jennifer gave the group a quick update on the following items:

• Healthcare Quality Week

• Online Parking Survey

• 2nd Quarter 2007 NDNQI Certification—GMC ranks higher than national average

• HWE Posters—out and in circulation

• Pt. Satisfaction: Poster and bookmarks in proofing stage

• Nurse News: in final production phase

• Nursing annual report: still being revised

• ED Nurses Week October 7 – 13th

• Nurses Week gifts: anticipate $5 each in 2008; Jen Boxer to order gifts; group recommended auto visors.

NEXT MEETING

Tuesday, November 20th, in the Anesthesia Conference Room after subgroup meetings

ADJOURN

The meeting adjourned at 3:30 p.m.

REMINDERS

OCTOBER: The NRCC meeting and Magnet Excitement event for October are being canceled due to the EPIC implementation.Hospital Quality Week will proceed as planned.

NOVEMBER: The Turkey Bowl will be Monday, November 19th at 5 p.m. in the Hemelright Auditorium.The November NRCCmeeting will be held on Tuesday, November 20th (changed due to the Thanksgiving holiday).

Respectfully submitted,Kelly HockenbroughAdministrative AssistantMagnet Program, Nursing Education and Nursing Research

• Nursing Services Quality Performance Improvement Council (NSQPI) Cochair Beth Breining, RN,staff nurse, CH3: “Working together with the members of NSQPI, as well as nurse practice and Recruitment andRetention (R&R), gives the entire Nursing Department an added sense of cohesiveness. Thisnetworking gives you many resources for whatever problems or challenges you may encounter. Thisyear, with all the changes and improvements that we have embraced on NSQPI, has opened somany doors to go forth with improvements based on the data we have collected. The added helpthat we received from Scott Berry’s group with the Geisinger Quality Institute (GQI) short coursewas also very beneficial in giving us the tools and skills needed to enhance our reports. All of this,of course, is to ensure quality care for our patients. That’s the reason we are all here” (3:4:C).



3:4:C

GEISINGER HEALTH SYSTEMNURSING SERVICE QUALITY PERFORMANCE IMPROVEMENT COUNCIL MINUTESWEDNESDAY, JULY 18, 2007; 0700 A.M.–1530 P.M.

KEY: X–PRESENT E–EXCUSED A–ABSENT

Nursing Leadership Chairs Staff Nurses (Inpt) Staff Nurses (Outpt)

X Hallick, Sue, CNO X Breining, Beth, RN, CPN, CEP X Baney,Virginia, LPN A Bower, Gail, RN,ONC

X Bickert,Terri, RN, MSN X Englehardt, Diane, RN, CNC X Buck, Robin, RN X Brown, Ryan, RN

X Muthler, Crystal, RN, AVP X McCloskey, Rene, RN, CNE, MS X Cicero, Shirley, BSN, ANC, CEP X Gelbaugh, Diane, RN

X Mensch, Deb, RN, BSN, MHSA X Cochran, Mary Jo, RN X Huber, Mary Ann, RN

X DePoe, RN, CCRN X Moore, Janet, RN, BSN

X Derr, Charity, RN, BSN, ONC X Nagy, Sandra, RN, BSN

A Gerringer, Melanie, RN X Pearse, Sandy, RN

X Harter, Kate, RN X Persing, Karen, RN

A Hartzel, Sue, LPN X Sim, Julia, RN

A Herrold,Teri, RN X Snyder, Deb, RN,CPON

A Homan, Amanda, RN, CEP A Sokol, Kristi, RN

A Jones, Katie, RN X Umbriac, Mary Susan,RN

AD HOC Ancillary A Kieffer, Jan, RN X Weber, Eileen, RN,CNC

E Bowman, Ann Marie, RN X Aukamp, Greg, RRT A Kister, Nicole, RN A Zarick,Terry, RNRN, BSN

X Nicholas,Tracey, RN, BSN X Kutza, Joey, NREMT-P, CEP A Leitzel, Deb, RN, AD A Ziller, Melissa, RN

E Vought, Cindy, RN X Loeffler, Kim, RN, CEN, CEP

X McElroy, Amanda, RN, BSN

X Meredith, Jane, RN, CCRN, CAPA

X Miller, Cindy, RN, BSN

X Phelps, Sheila, RN

X Reinard, Cindy, CMSRN

Alternates Guests A Schieber, Pam, RN

E Abram, Georgette, X George,Vicky, RN A Seidel,Terri, RNRN, BSN ANCC Consultant

E Houseknecht, Melissa, RN X Sellard,Tonya, RN, CEP

E Rezykowski, Stacy, RN X Sitler,Tiffany, RN, CMSRNBSN, CEP

E Scheller, Ashley, RN X Skocik, Lenore, RNC

X St.Clair, Deanna, RN, AD

X Witt, Barbara, RN, CEP

CALL TO ORDER

Rene McCloskey called the July 18th meeting of the NSQPI Council to order at 0700 a.m.




The minutes from the June 20th meeting were approved.

NURSING SERVICE SHORT COURSE GQI POSTER BOARD PRESENTATIONS

Rene started the meeting by welcoming the new outpatient and inpatient members. Everyone stood and introduced themselves.The council members along with some managers and guests enjoyed breakfast and conversation about all the different posterboard presentations.

MANAGERS PRESENT

• Linda Miller

• Bonnie Patterson

• Maureen Lloyd

*Scott Berry and Janet Comrey were unable to attend, due to being at GWV for the day.

CONCEPTUAL MODEL

Rene handed out a paper on the Nursing Conceptual Model.This is going to be a contest. Every week, Rene will send informationvia Email about the conceptual model.There will be a test at our next meeting and if you receive an A on this test, you will receivea prize.The prize will be meal tickets.

Action: Send out Conception Model information by Friday the 27th. Person Resp. Rene McCloskey

JOINT COMMISSION RESULTS

Deb Mensch talked about the Joint Commission survey. Deb congratulated everyone on a job well done. “Lego’s—we start outbuilding small, but we continue to build to bigger and better things.” Keep up the momentum! Deb will get in contact with PublicRelations about the placement of our poster boards throughout the hospital.

Sue Hallick said this was one of the best surveys at GMC.The Joint Commission was impressed with all staff, pride, level ofacceptability.There was an air of professionalism.The staff was superb.The data walls were great. At the leadership session, thequestion was asked, “Tell us how they (staff) did this?” Sue thanked and congratulated everyone, and said that we could not havehad a better survey. Sue took time to look at and have discussion with all council members on their poster boards.

• Crystal Muthler was in attendance.

• Vicky George talked about the Magnet Program.

THE INPATIENT COUNCIL WAS DISMISSED TO DO THEIR AUDITING. THE INPATIENT COUNCIL WILLRECONVENE AT 2:00 P.M.

OUTPATIENT COUNCIL

Rene welcomes all outpatient members.The outpatient council is meeting to be introduced to all NSQPI information.There weresix new members at this meeting.We are very happy they are involved in this committee.There are 14 total outpatient membersat this time.We are acting like a Magnet team.

OUTPATIENT RECEIVED:

• NSQPI Handbook

• The web site (NSQPI) shown

• GQI Short Course Handout

• Data board

If you need information posted to the web site, please contact Sharon and she will make sure the information gets put on the website.

• [email protected] (Sharon’s Email)



Rene showed everyone how to log on to SharePoint and how to upload files. If anyone has a problem or needs assistance, contactRene, and she will meet with you personally at your convenience.

• [email protected] (Rene’s Email)

Indicator calendars:

• All members need to develop an Indicator calendar by the next meeting. Instructions were given during the meeting. If you arein a unique area and need an audit form specifically for your area, let Rene know and she will make one to meet your needs.

The three audits that need to be done next month:

• Hand hygiene

• Patient identification

• Handoff

Action: Indicator calendars due Person Resp. All Outpatient Council Members

THE OUTPATIENT COUNCIL WAS DISMISSED AND THE INPATIENT COUNCIL HAS RECONVENED AT 2:00 P.M.

INPATIENT COUNCIL

Rene reviewed the SharePoint process with all inpatient council members. All were in agreement after reviewing the Falls Policythat an extra line with Y/N needs to be added to the question “Is armband on?”

All members need to check with managers to see who is responsible for auditing the Restraint Action Plan. Audits need to be inby the end of each month. Rene is also working with Pat Campbell on a solution for Life Flight and the use of Avagard.TonyaSellard and Cindy Miller had some suggestions on making auditing a quicker and easier process.They did the auditing together withone looking at the charts and the other writing the information down.They completed three audits each in less than a half anhour.Tonya and Cindy both agreed if you are able to have someone help you, this is a nice and easy process.

Action: All members need to check with managers Person Resp. All Inpatient Council Membersto see who is responsible for auditing the Restraint Action Plan.

NEXT MEETING

The next meeting for NSQPI is on August 15th at the Research Building Multipurpose Room.The Computer Lab has beenreserved for NSQPI members for only the meetings that are held in the Research Building from 1:00 to 3:30 p.m.

ADJOURN

The meeting was adjourned at 3:20 p.m.

Respectfully submitted,Sharon RabbNursing Education

• Research Cochair Deb Stayer, RN, clinical nurse educator, PICU: “I participate in many hospital and unit-based councils. It does not matter what a person’s level is,we all work together to get the job done. Better patient care is always at the center. Being involvedin decisions and professional activities that have a positive impact on nursing is very gratifying”(3:3:D).



3:4:D

GEISINGER HEALTH SYSTEMNURSING RESEARCH COUNCIL MINUTESOCTOBER 8, 2007LOCATION: INTERMEDIATE ROOM #4 CENTER FOR RESEARCH2:00 – 3:00 P.M.

KEY: X–PRESENT E–EXCUSED A–ABSENT G–GUEST

X Terri Bickert, MSN, RN, CNA-BC E Deb Stayer, RN, Clinical Nurse Educator (PICU)Director of Magnet & Nursing Education

X Mary Ann Bloskey, RN, MSN, MHA X Margaret West, RN, MSN, DNSc Assistant Dean,Center for Health Research Thomas Jefferson University

E Pat Campbell, RN, MSN, Director of E Lori Lauver, RN, MSN, PhD, Assistant Professor,Infection Control Thomas Jefferson University

E Cindy Matzko, RN, MSN, APRN, BC, CCRC E Marylee Scholtis, RNRheumatology Clinical Nurse Specialist and Certified Research Coordinator

X Deb Wantz, MSN, RN, CCSN, CCRC X Adele Spegman, RN, PhD, Director, Institute on Nursing ExcellenceClinical Nurse Specialist, Heart Failure SectionDepartment of Cardiology

E Sheila Hartung, PhD (BU) A Amy Birrane, CRC

X Deb Zimmerman, RN, Cardiology

X Robin Steimling, RN

Clinical Nurse Educator, BP6/BP7

E Jody Bachman, RN Clinical Nurse Educator, OB/GYN

CALL TO ORDER

Terri Bickert called the meeting to order at 2:10 p.m.

ANNOUNCEMENT

Terri Bickert announced her resignation from the Nursing Research Council effective with this meeting. Dr. Adele Spegman willlead the group through nursing research.Terri will be available to the council as an ad-hoc member and as necessary for guidancethrough the transitional period.

Terri thanked the group for the assistance with this council as she pointed out the value in each member and what they have tooffer this council.

NURSING RESEARCH CONFERENCE

Reminder about the conference “Current Issues in Clinical Research” being held at the Split Rock Resort on October 26th.

Registration is around 100, and you can still register through the CME office if you’d like to attend.The conference will featuremany speakers, including Janet Boyce from the Children’s Hospital of Philadelphia and many others.

RESEARCH STUDIES

Dr. Spegman reviewed the following research studies and their progress-to-date: Anderer study, Donna Fick study request,Treesestudy, CICU/HAM data collection study pre- and post-construction.

REVIEW OF COUNCIL

Dr. Spegman spoke with the group about what the council has done in the past, the status of some research projects that were



requested but no outcomes reported, the RN Satisfaction Survey, and the need for IRB approval, and evidence-based practice.TheNRC bylaws were also reviewed, including how the online requests are initiated with NRC mentor involvement. Dr. Spegmanrecommended adding Claire Huntington to the council as an ad-hoc member to access her resources and knowledge base.

NRC SUBGROUP

Dr. Spegman presented council with the idea of developing a subgroup of the NRC to facilitate EBP training using clinical nurseeducators to teach our nurses. A training process will need to be developed, and NRC will serve as experts on the EBP.

NEXT MEETING

The next meeting of the Nursing Research Council will be on Monday, November 19th at 2 p.m. in the Jones Library on FossClinic 7.

ADJOURN

The meeting adjourned at 3:00 p.m.

Respectfully submitted,Kelly HockenbroughAdministrative AssistantMagnet Program

• Administrative/Operations Managers Council Chair Peter Price, RN, medical-surgical manager, BP7: “I feel comfortable talking or approaching anyone regardless of their level in the organization.Working together to improve processes or our work environment is everyone’s goal” (3:4:E).

3:4:E

GEISINGER MEDICAL CENTER INPATIENT/OUTPATIENT OPERATIONS MANAGERS MEETING MINUTESWEDNESDAY, SEPTEMBER 12, 20072:00 P.M.NURSING EDUCATION CENTER ROOM 2

KEY: X–PRESENT E–EXCUSED A–ABSENT G–GUEST

MEMBERS

Anderer,Tammy, MSN, CRNP X Morgan, Marsha, RNDirector, Best Practices, Comm. Practices Ops. Mgr., Ophthalmology Amb Care Fac

X Basinger, Mark, LCSW X Muthler, Crystal, RN, BSNOps. Mgr., Psych AVP, Nursing Services

X Bastian, Catherine, MA, RD, LDN Myers, Donna, RNOps. Mgr., Clinical Nutrition Services Ops. Mgr., Cardiovascular Medicine

X Beechay, Denise, RN, MHA, CHE Naugle, Lori, RNAVP, Nursing Services Clinical Nurse Coord., Pre-surgery Center

Bickert,Terri, MSN, RN, CNA-BC Ososkie, Nancy, RNDirector, Magnet/Nursing Education Ops. Director., Pediatric Specialities

X Bird, Cindy, RN, BSN Parnell, ClaudeOps. Mgr., Periop/In & Out Surgery Ops. Mgr., System Therapeutics



Cook, Pamela X Patterson, Bonnie, RNOps. Mgr., Division of Medicine Ops.Mgr., AGP5 and I.V.Therapy

Enriquez, Michael, MHA, FACHE Payne, Brenda Ops. Director, Orthopaedics Team Leader, MRI

X Examitas, Cheryl, RN Pogge, Caroline, MHAOps. Mgr., BP5 Ops. Mgr., Neuroscience

Faden,Valerie Jean Potsko, Kerri, RNProject Mgr., Scheduling Services Ops. Mgr., Hematology/Oncology

Fegley,Wendy, LPN Price, Peter, RNOps. Mgr., Shamokin/Selinsgrove Clinics Ops. Mgr., BP7

X Fifield, Cheryl, MBA, MT Richer, Arthur, CRNA, MSOps. Director, Lab Divisional Chief Nurse Anesthetist

X Frye, Susan, MBA Rittle, George, RNOps. Mgr., CV and Vascular Surgery Team Leader, ED

X Graham, Marlair, RN Rubenstein, Linda, RNClinical Nurse Coord., Pain Medicine Clinic Coord., Pediatric Specialities

X Hallick, Susan, RN, BSN, MHA Sanders, DebraCAO-GMC, System CNO Ops. Director,Transplant Surgery

Hardee-Swank, Carol Shrawder, Roxie, RN, BSN, MS, CHCRDirector, Scheduling Services HR Manager, Recruitment

Hartranft, Carol X Sim, Julia, RNData Support Analyst

Hendricks, Daniel X Singer, Scott, RRTOps. Mgr., Dental Med/ENT/Urology Ops. Mgr.

X Henninger, Deb, RN, BSN, CCRC X Sledgen, Marie, RNOps. Mgr., Clinical Trials Office Chest Pain Center

Hoffman, Dawn Snyder, Kyle, MHAOps. Director, General and Plastic Surgery

Hoffman, Janice, MHA X Strausser, Deb, RNOps. Director, Anesthesia/Pain Mgmt. Ops. Mgr., OR

X Hollenbach, Dee, RN Tetkoskie, Charmaine, RNOps. Mgr., AGP2 Ops. Director, ED and Life Flight

Keifer, Lisa Thomas, DaveOps. Mgr., Radiation Oncology Clinic Coordinator, CVTS

X Kemberling, Sharon, RN, BSN X Troutman, Dawn, RN, BSN, CCRNOps. Mgr., Pt. Placement/Transfer Center Ops. Mgr., SCU4

Kieselhorst, Kessey, MPA, RD X Ulrich, Debra, RN, CDirector, Regulatory PI Ops. Mgr., BP2

Knorr, Phyllis, RN Venditti, Angelo, RNOps. Mgr., AGP4, MSFP, CCFP Ops. Mgr., AICU, AICU South, RT

X Kuhn, Kim, RN, BSN X Wargo, Christina, RN, MSNOps. Mgr., SCU3, Staffing Office Director,Trauma Program

X Lloyd, Maureen, RNC Wary, Andrea, RN, BSN, M.EdOps. Mgr., NICU, PICU, CH Floats Ops. Mgr., OB/GYN Dept-CP Clinics

X Long, Michele, RN, BSN, OCN West, Margaret, DNSc, RNOps. Mgr., BP6, BP8 Asst. Dean/Assoc. Prof,TJU

X Marks, Jamie, RN Wintersteen, Kim, RNOps. Mgr., IP, OB/GYN Director, OSW

Martz, Linda Lee, RNC, CCRN Woll, Michael, BSTeam Coordinator, NICU Ops. Mgr., Division of Medicine (GIM)



X McDermott, Betsy, RNN, OCN Womer, Sally, RTClinical Nurse Coord., Hematology/Oncology Radiology Coordinator of Quality Improvement and

Business Development

X McFadden, Ann, RN Janine Alexis, GuestOps. Mgr., OB/GYN

Mensch, Debra, RN, BSN, MHSA Diane S. Harlow, GuestOps. Mgr., CICU, Flex Pool

X Miller, Linda, RN, BSN X Kim Tokar for Deb SandersOps. Mgr., CH2, CH3

X Miller, Lynn, CAO-GMC

OMNI SURVEY

Wenda Hartzel provided the group with information to use in connection with upcoming OMNI survey meetings with staff. Shestressed the importance of adequate preparation, which includes setting your goals (be realistic) and understanding your group,what matters to them, and what they are likely to focus on. Don’t forget to consider the tone you would like to set (more of a“town hall” discussion as opposed to a debate).

Before the meetings, everyone should remember to center themselves and focus on what needs to be accomplished. Express yoursense of welcome by arriving before everyone else, preparing the room physically and symbolically, and greeting each person with asmile as they arrive.

During the meeting, make sure to secure a safe emotional environment for everyone, including you. Establish the ground rules,designate someone to record information, start with the positives, and then generate solutions for each area of challenge.Wendaprovided some hints to enhance success.

Let people know they are being heard! Be honest about what we can and cannot do. Plan a follow-up meeting, if necessary. Holdpeople accountable for timelines and make sure action plans get to the right people.

The group thanked Wenda for her presentation. Handouts were available.

TOBACCO-FREE INITIATIVE

Diane Harlow, director of the Wellness Program, distributed the manager tool and cards to give to employees and patients.TheTobacco-free Policy is in final stage now—actually going to Executive Leadership tomorrow. Efforts are being made to spread theword now about not allowing smoking on Geisinger-owned or leased properties. Signage indicating intent is up now and will bereplaced with permanent signage. Diane requested that everyone go to the Geisinger Wellness section of the InfoWeb foradditional information. Messages are also going out with patient appointments.We may also look at our external web site and localmedia to get the word out.There are several programs being offered to help people quit smoking.We have a Quit and Winprogram that offers prizes, reduced prices on medications to help with smoking cessation, etc. Diane provided copies of theEmployee Tool Kit, which does include some role playing suggestions.

As of November 15, the smoking huts will disappear. Every other major health system locally, with the exception of theBloomsburg Hospital, will be going tobacco-free.

Packets of information were available for everyone to utilize.

MAGNET UPDATE/EDUCATION UPDATE

Terri Bickert provided an education update for the group. CPR/BLS certifications—Nursing Education has started offering morecourses and we have increased the number of staff that can attend. On the Nurse Channel, continuing education is explained onthe InfoWeb. As part of new employee orientation, nurses are able to view “The Vision for Nursing” hosted by Sue Hallick, DeniseBeechay, and Crystal Muthler.

Satisfaction surveys are ongoing.Tickets to the Bloomsburg Fair and meal tickets are being offered for survey participation.

NEW PHYSICIAN ORIENTATION

Lynn explained that Dr. Stephen Pierdon and Cynthia Bagwell have put together a draft that Lynn distributed. Kate Fleetwood willbe sending this out electronically for review and comment. Please direct your comments to Dr. Pierdon and/or Cynthia.

Lynn also discussed Midas reporting. She stressed the importance of quality discussions happening in all department meetings. Lynn



will distribute a listing for assigning individuals to access the reports. Responses should be directed to Karen McKinley with theindividual’s name.

There being no further business, the meeting was adjourned at 3:00 p.m.

Judy Rohland, Recording Secretary

Note:This information is not intended to serve as formal minutes, but rather provide a listing of issues discussed as information andany follow up for those who were unable to attend.

All of these councils make decisions that impact hospital care. Policies may be changed, and nurses areempowered to make the changes that impact their work area and improve patient care at the bedside.Nurses at all levels communicate with one another on these councils and bring information back to theirnursing units.

In addition to the horizontal and vertical communication that occurs through these councils, Sue has anopen-door policy that allows direct-care nurses to talk with her easily. All nursing leaders emulate thispractice to enable information to flow in both directions and among all levels.

EXAMPLE: UNIT-BASED COUNCILS

A mutual exchange and sharing of information about experiences and common work problems—usuallyamong peers—occurs in unit-based councils or meetings. A unit council committee consists of unit staff, alllevels of nursing, and unit desk clerks. Unit council meetings are scheduled on a routine basis, usuallymonthly, throughout the year. The meeting agenda includes topics relevant to the unit. Ideas are shared andexamined, priorities are set and action plans implemented. Many positive changes originate at unit councilmeetings.

One example of a change that occurred on BP6 was shared by Judy Brokenshire, RN, staff nurse. As aresult of a suggestion made by the unit practice council, the Unit Practice (Advisory) Council developed anEmployee Appreciation Box. Staff members are encouraged to vote for a peer who they feel has gone aboveand beyond their expected duty. At the end of each month when votes are counted, an Employee of theMonth is identified. A designated bulletin board on the unit displays the current Employee of the Month.It includes pictures of the employee and some of their favorite things (family, pets, hobbies, etc.). Theemployee of the month is congratulated at a monthly lunch celebration. Staff share by bringing in treats.Being aware of the nurses’ needs enhances working conditions within a unit. Appreciation shown to nursingstaff is relevant in creating an environment conducive to high-quality, safe patient care (3:4:F).



3:4:F

GEISINGER HEALTH SYSTEMADVISORY COUNCIL (PRACTICE COUNCIL)MINUTES: SEPTEMBER 25, 2007LOCATION: BP6 WORK ROOM

MEMBERS

Present:

Cindy Reinard, RN—CEP

Eileen King, LPN

Lori Wetzel, NA—CEP

Kim Nuss, UDC—CEP

Patti Spotts, RN—CEP

CALL TO ORDER

Meeting was called to order at 0700.


The council reviewed the minutes from the last meeting.

OLD BUSINESS

1. There will be shoe covers on the unit for the staff to use for isolation rooms.

Employee of theMonth bulletinboard



2. Crystal Light is on the Stage I diet.

3. Cell phone reminder—DO NOT use cell phones for making calls and text messaging. It is a distraction and interrupts thework flow. Names will be turned in to Elaine and Michele.

4. Respiratory tubing needs to be changed every 24 hours and done on evening shift.

5. Coude catheters are now in par.

NEW BUSINESS

1. When ostomy supplies are ordered, please take them into the patient’s room; do not leave at the desk.

2. We made up laminated cards with most important phone numbers to be given to our new hires.

3. Gastric bypass abdominal binders need to be put in the patient’s room. Lately they have been misplaced.

4. Anyone interested in being a member of the Advisory Council for 2008 needs to contact Elaine via Email.

5. The time schedule is posted for four weeks in advance, which should be ample time to fill in your time.

REMINDERS

1. As a reminder, it is everyone’s responsibility to see if your coworkers need help. Please, if you are not busy, assist yourcoworkers.We ALL need to be team players.Work as a TEAM.

2. Please remember to document patient education daily and PRN.

STAR OF THE MONTH

Congratulations to Mary Aigler for being “Star of the Month” for October 2007. Date for a party will be announced.

NEXT MEETING

The Advisory Council’s next meeting will be December 5, 2007.

Respectfully submitted,Lori WetzelBP610/10/2007

EXAMPLE: ADMINISTRATIVE COUNCILS

Operations managers from both the inpatient and outpatient areas also have an avenue for horizontalcommunication. They meet monthly to discuss issues related to the medical center and to work onsolutions to mutual problems. The forums and administrative committees provide a mechanism for bothhorizontal and vertical communication. Direct-care nurses also serve on administrative committees, such asthe Critical Care Administrative Committee, the CPR Committee, and the Trauma Committees. Theyprovide each committee with staff input and feedback and bring back information to share with the staff(3:4:G).



GEISINGER MEDICAL CENTERDANVILLE, PENNSYLVANIACPR COMMITTEE ROSTER 2007

PHYSICIAN AND NURSE MEMBERS

Michelle Thompson, MD, Chairman Timothy Vollmer, MD,Vice Chairman Cathy Knight, RN, Secretary Internal Medicine—Peds Emergency Medicine Clinical Nurse Educator

Isabelle Amarose, RN, Staff Jody Bachman, RN, Clinical Dylan Birkett, MD, AnesthesiologyNurse, CICU Nurse Educator NICU

Judy Botella, RN, Nursing Supervisor Nancy Braham, RRT, Respiratory Cindy Derk, RN, Nursing SupervisorCare Services

Sara Field, RN, Staff Nurse, AGP5 Scott Girard, DO, Chief Resident Dante Grassi, PharmD, System Therapeutics

Marilyn Haupt, MD, Critical Care Medicine Emily Mowery, RN, Clinical Nurse Maria Latovich, RN, Staff Nurse, AGP5Educator, Children’s Hospital 2 & 3

Nancy Nuss, RN, Blood Conservation Jess Oren, MD, Cardiology Peter Price, RN, Operations Manager BP7

Juan Salgado, MD, Chief Resident John Shultz, RN, Staff Nurse, AGP4 Debbie Stayer, RN, Clinical Nurse Educator, PICU

Kimberly Wilson, RN, Clinical Nurse Educator, AGP5

CONSULTANTS

Barbara Brown, RPh, System Therapeutics Susan Hallick, RN, CNO Nancy Gordon, RN, Clinical Nurse Educator, Emergency Department

Joan Mervine, RN, Clinical Nurse EducatorBP5 & BP6

MCPDP175.DOC Revised: January 2004 Revised: February 2006

Revised: July 2003 Revised: March 2004 Reviewed: February 2007

Revised: December 2003 Revised: January 2005 Revised: July 2007

3:4:G

GEISINGER MEDICAL CENTERDANVILLE, PENNSYLVANIACPR COMMITTEE MEETING MINUTESAPRIL 25, 2007; 1230–1400 HOURSNEC/ROOM 203

MEMBER

Present Excused

X Amarose, Isabelle, RN

Birkett, Dylan, MD X Latovich, Maria, RN, CMSRN

Botella, Judy, RN X Mervine, Joan, RNC

Braham, Nancy, RRT Nuss, Nancy, RN, CCRN

X Derk, Cindy, RN, CCRN Oren, Jess, MD

X Field, Sara, RN X Price, Peter, RN, CMSRN



Gordon, Nancy, RN, BSN Shellenberger, Matthew, DO

Grassi, Dante, RPh X Shultz, John, RN, BSN

Haupt, Marilyn, MD X Thompson, Michelle, MD

X JWCH CNE: Bachman, Jody Vollmer,Timothy, MD RNC, BSN Mowry, Emily, RN, BSNStayer, Debra, RN, MSN, CCRN

X Knight, Cathy, RN, Presiding

Guest Recorder: Chris Whitmire, Secretary

OLD BUSINESS

APPROVAL OF MINUTES

Minutes from the January 24, 2007, were approved as written.

LIFEPAK 20S AND LIFEPAK 500S

The upgrades to the Lifepak 500 AEDs will be completed within the next week per Tom Berns, Clinical Engineering.

Lifepak 20s updates were not available yet.

New Medtronic Representative. Problems with FDA and no new Lifepaks can be shipped.

PENDING.

TRIAL WITH FIBEROPTIC LARYNGOSCOPE BLADES

The trials with the fiberoptic blades are continuing.There are stocking supplies on the trial floors.The switch in code carts mayoccur after the start of the fiscal year if all goes well.

REPLACEMENT OF WOODEN INTUBATION BOXES

The boxes have been pulled from the areas that do not need them.

UNITS

Cathy asked the group if boxes could be removed from areas within the hospital.The boxes will stay in the areas without codecarts.

ANNUAL REVIEW AND REVISION OF EMERGENCY EQUIPMENT CONTENTS

The Intubation Box Checklist was reviewed to see what needs to be kept and what will be taken out of the boxes. Cathy gave alist of suggested revisions and a discussion followed.

Children’s 2 & 3 should reflect the boxes for PICU.

The group made suggestions of the supplies that could be removed.

Include everything except the items kept in the Children’s Hospital units.

NEW BUSINESS

HEART CODE ACLS—AVAILABILITY OF NEW CD

The new CDs arrived Monday and Emails were sent out regarding their arrival.

Your BLS must be done first.The CDs have been made available to RNs this year. Gordon Cole came up with a policy to guidepeople.

Please encourage people to do the CD since there is such a backlog with the regular classes.

REMOVAL OF CODE CART FROM PULMONARY FUNCTION LAB

The cart will go back into the code cart exchange system.They will move to Woodbine Lane and will not need the cart.

Cathy told the group they are looking for safety mechanisms for the code carts. It was questioned if the central line kit on the



code cart could be taken out as we now have a central line cart available for all areas.

It was suggested education be done regarding the central line cart locations. It was also suggested that an attached form be placedon the code carts.

Cathy will check on the location of the central line carts. No changes will be made until after Joint Commission is done.

MEETING ADJOURNMENT

The meeting adjourned at 1320 hours.

NEXT CPR COMMITTEE MEETING

The next meeting will be held on July 25, 2007, from 1230 to 1330 hours. Location will be the CCU Conference Room.

APPROVED BY

Cathy Knight, RN

PEER REVIEW GENERATED DOCUMENT SOLELY FOR THE QUALITY IMPROVEMENT PURPOSES PURSUANT TO 63P.S.425.1ETSEQ and MCARE-NOT FOR REDISTRIBUTION OUTSIDE THE SYSTEM'S PEER REVIEW

EXAMPLE: ORGANIZATIONAL COMMUNICATION

Several channels for organizational communication are available. The Nurse Channel (the nursing page onthe GMC Intranet) is a common method to communicate throughout the Nursing Department. Thequarterly publication of NursesNews is another means of communication to nurses of all levels (3:4:H).



3:4:H



The Connections newsletter, a hospital-wide publication, is distributed to all employees (3:4:I).

3:4:I




3:4:A Nursing Clinical Practice Council Meeting Minutes

3:4:B Retention and Communication Committee Meeting Minutes

3:4:C Nursing Service Quality Performance Improvement Council Meeting Minutes

3:4:D Nursing Research Council Meeting Minutes

3:4:E Inpatient/Outpatient Operations Manager Meeting Minutes

3:4:F BP6 Advisory Council Meeting Minutes

3:4:G Cardiopulmonary Resuscitation Committee Meeting Minutes

3.4.H NursesNews, Quarterly Nursing Newsletter

3:4:I Connections, Hospital-wide Newsletter



EVIDENCE 5 Provide examples of how direct-care nurses initiate change to improve patient care, nursingpractice, and/or the work environment.

taff nurses are clearly at the frontline in patient care. They see issues firsthand and have the primeopportunity to consider solutions to problems. When staff nurses are encouraged to plan andimplement their ideas, practice is improved and patient care is provided in a safer, more effective

manner. Geisinger Medical Center can offer several examples of this care concept.

EXAMPLE: THE PATIENT RESTRAINT DILEMMA—NURSING PRACTICE AND IMPROVED CARE

Patients often get restless and confused. When this happens, they can cause self-harm by falling out of bedor pulling out an I.V. line or catheter. In the past, the solution to this problem has been to restrain thepatient. However, in today’s healthcare environment, this is not the preferred method. So how do nursesdeal with this dilemma?

On nursing unit AGP4, staff nurses developed a policy for “Least Restrictive Methods Utilized beforeApplying Restraints.” Phyllis Knorr, RN, AGP4’s operations manager, turned to her Nursing PracticeCouncil to identify a way to reduce the need for restraints on the unit. The Unit Practice Council, led byCarol Hughes, RN, a staff nurse on the unit, developed their new practice (3:5:A).

3:5:A

GEISINGER HEALTH SYSTEMAGP4 UNIT PRACTICE COUNCIL MINUTES: 7/26/07CCU CONFERENCE ROOM

MEMBERS

Barry Tempesco, RN,TC; Carol Hughes, RN; Ruthann Urban, UDC; Kathy Newcomb, NA

CALL TO ORDER

0700


Yes

OLD BUSINESS

We will be addressing the staff regarding use of the sliding scale insulin. If you haven’t been approached by someone already, pleaserespond to Tera’s Email.We will address this at our next meeting.

NEW BUSINESS

The telemetry strips and trends will be moved up behind the med sheets in the mini charts.This was suggested by Dr. Harrison.He felt the only information in the mini charts that pertained to the physicians were the med sheets and telemetry strips and itwould be nice if they were together.

S



The insulin drip policy will be posted in the dictation room for the doctors to review.

We are in the process of devising a policy for AGP4 on using the least restrictive method for restraints.

1. Anticipate toileting and hydration needs, pain management, provide ambulation opportunities, reorient patient to environment,turn and reposition, offer reading material, reduce sensory level, provide patient safety booklet.

2. Find out what your patient’s bedtime routine is.What are their preferences? What is calming to the patient?

3. Involve family, and let them stay with patients when able.

4. Use bed alarms.

5. Utilize the Companion Program for neurology, vascular, and trauma patients.

6. Utilize high visibility beds (8 total).

7. Put the patient on 1:1 nursing care.

When a patient has a restraint on or 4 side rails please put it on the report sheet.This is very important because starting August 1(next Wednesday) management will be auditing 5 patients per week for the next 3 months. It will be the responsibility of thecharge nurse on days, evenings, and nights at the beginning of each shift to print a report sheet for the 60s and 70s and place itthe filing cabinet by the charge nurse.There will be a tab put in that will say report sheets restraint audits.Thank you for your help.

Please remember to stamp the back of all forms that are part of the patient’s medical record.This needs to be done even if thereisn’t a box on the back of the paper.They are scanned at medical records and it poses a problem if they are not stamped.

Please keep up the good work on the unit. Just because Joint Commission was here, we don’t want to get back into any badhabits; for example: food and drinks at the desk, clutter in the hallways, remember good handwashing, keep top of med carts cleanand free of meds, keep medication cabinet locked at all times, return stretchers to where they came from, and remember to logout of EPIC!

When stocking the rooms, please place only 10 blue pads and 10 attends per Phyllis.We are wasting a lot because they are beingthrown away when a patient is discharged.

Try using the bed alarms more frequently.We may be able to prevent falls!

Christmas Party Updates:

It will be December 29 at the Front Street Station.We booked a DJ with Karaoke.We will be bringing our own desserts again.Wediscussed having a $10 gift exchange.We will provide food for evening shift but we will have those scheduled bring their owndesserts.We have $433 left in the bank. More to come!

NEXT MEETING

8/23/07

ADJOURN

1100

Respectfully submitted,Carol Hughes, RN

OUTCOMES

The Least Restrictive Restraint practice has been adopted by the staff and is now in use. Use of restraintshas decreased.

LEAST RESTRICTIVE RESTRAINT PRACTICE

Steps all staff will try and also document before asking physician for restraint order:

1. Anticipate toileting/hydration needs, pain management, provide ambulation opportunities, reorient patient to environment,turn and reposition, offer reading material, reduce sensory overload, provide patient safety booklet.

2. Find out your patient’s bedtime routine.What is their preference? What is calming to the patient?



3. Involve family, and allow them to stay with the patient when able.

4. Utilize bed alarms.

5. Utilize the Companion Program for patients on the services the program is covering. (Neurology,Vascular, and Trauma, atpresent).

6. Utilize high visibility beds.

7. Discuss 1:1 nursing care with physician.

Devised by: AGP4 Unit Practice Council, 7/26/07

EXAMPLE: NURSES INITIATE CHANGE—WORK ENVIRONMENT

Lynn Fait, RN and ED team coordinator, and Brian Evans, RN, staff nurse, were very concerned about thepatient flow in the ED and the resources available when high patient census results in lack of beds to admitpatients in the hospital. When ED patients cannot get an available hospital bed, the ED can become aninpatient holding area—while still having to function in its role as an ED. Lynn and Brian considered thisproblem and worked with the ED Quality Improvement Team to develop a real-time intervention thatmatched the ED service demand to available resources. They also worked with senior leadership to developa plan to facilitate ED improvements.

Direct-care nurses involved in the process included Lynn Fait, RN; Brian Evans, RN; Kim Loeffler, RN;and Blanche Zawatski, RN. Leaders involved included Charmaine Tetkoskie, RN and director ofEmergency Services; Denise Beechay, RN and associate vice president of Nursing; Sharon Kemberling, RNand coordinator of Patient Placement; and Dr. Joseph Bisordi, GMC’s medical director. Scott Berry of theDepartment of Clinical Effectiveness also helped assess the problem and evaluate possible solutions. Theprocedure that resulted from their efforts facilitated communication between staff physicians and ED nursesso that everyone would be aware of the status of the ED census and when to accept ED-to-ED transfer



patients. This ED status is updated (at a minimum) every two hours. The decision to change the status isbased on real-time ED and hospital capacity. The status changes are communicated to the department by acolor-coded sign (Demand/Capacity Codes) mounted in the front of the ED.

Colors on the sign indicate the following status:• Green: Accept • Yellow: Accept• Orange: All nontrauma pediatric patients should be sent to Knapper Clinic (when open) if

declared medically stable after a pediatric screening by a triage physician.• Red: ED-to-ED transfers will not be accepted with the exception of all 911 calls, Level I cardiac

patients, trauma patients, and all patients who present directly to the ED. If a patient is declined, an Email is to be sent to the director of Emergency Services and the coordinator

of Patient Placement stating the patient’s name, diagnosis, and referring hospital. The requesting facility’sphone call is transferred to the Transfer Center for follow-up (3:5:B).

3:5:B



OUTCOME

Since the ED Demand Capacity Grid has been developed, communication between the ED staff and EDcharge nurse has improved. The ED nurses have a greater sense of control over their working environment.It has also encouraged a multidisciplinary approach to communication among doctors, nurses,administrative supervisors, and patient placement staff each working to provide the best patient outcome.

NDNQI RN Satisfaction SurveyED Nurse Practice Environment & MD Relationship Score

National ED Nurse - MD Relationship Mean PES Score

2006 2007

ED Nurse - MD Relationship

0

National Mean PES Score

1

2

3

4

poor

excellent

Time to Admission: ED

Intervention7/06-6/07 7/07-8/077/05-6/06

0

Ho

urs

1

2

3

4

5

6

7

8

9

10



EXAMPLE: PATIENT COMPANION PROGRAM—IMPROVED PATIENT CARE

There are times during a patient’s hospitalization when constant monitoring may be needed to assure safety.Several nurses recognized this need and made a commitment to finding a method to improve patient care.Using staff feedback, a team of nursing leaders was assembled to develop a Companion Program (3:5:C)that healthcare teams could use when a patient is identified by direct-care nurses as needing constantobservation.

PATIENT COMPANION WORKGROUP

Bonnie Patterson, RN, operations manager AGP5

Peter Price, RN, operations manager BP7

Robin Steimling, RN, CNE BP7, BP8

Kim Kuhn, RN, operations manager SCU3

Rachel Arduini Administration

Susan Standish Wallace, RN Care Management

Dawn Troutman, RN, operations manager SCU4

Dee Hollenbach, RN, operations manager AGP2

Rene McCloskey, RN Nurse Informatics

Lori Cole RN, team coordinator AGP5

Kelly Klinger, RN Nursing Supervisor

Cindy Derk, RN Nursing Supervisor

Judy Botella, RN Nursing Supervisor

Hospital administration was very supportive of this idea and challenged the team to develop an inclusiveplan to provide a safe environment, companionship, and supportive care to patients requiring ongoingobservation.

The team developed the following plan of action:• Assessment: The team assessed the needs of the patients who required constant supervision to

provide a safe and supportive environment.• Planning: First, evaluation of the current process of care and the types of patients who would

benefit from this service was carried out. This plan would initially be available only for certainidentified services and then later expanded to include all service lines. The Companion Programwas initially provided to neurology, neurosurgery, trauma surgery, hematology/oncology, andmedicine services (upon physician orders). We expect to add services (such as cardiology) to thecomplement. At the start of the program, a flow included identifying whether the patient was onthe eligible service line and met the criteria for the program. If so, the nurse would check with thestaffing office to see if a companion was available. The companion would then report to thestaffing office and be assigned to the program’s patient. The patient’s need for a companion is evaluated every shift and the process repeats itself, as indicated. If there is no companionavailable, the staff evaluates the need for a safety watch, special room placement, and/or additionalnursing staff.



OUTCOME

The Companion Program has been very successful. Patients who would have been considered in need of ahigh visibility bed may now be in rooms away from the nurses’ station since a companion is assigned at thepatient’s bedside. Families welcome the program knowing that a companion will be with their loved onethroughout the shifts and will keep the floor nurses aware of the patient’s needs.

A patient and family program satisfaction survey is used to evaluate the program’s effectiveness. Thissurvey includes questions regarding the helpfulness and friendliness of the companion and whether or notthey met the patient’s personal needs. It also asks about how visitors were treated and overall satisfactionwith the Companion Program.

Family/Patient Satisfaction Survey: Companion Program

0

Mea

n S

core

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

Helpful/Friendly

Met PersonalNeeds

Attitude TimelyResponse

TreatedWell

OverallSatisfaction



3:5:C




3:5:A AGP4 Unit Practice Council Meeting Minutes

3:5:B Emergency Department Demand Capacity Codes

3:5:C Patient Companion Brochure



EVIDENCE 6 Provide examples of how direct-care nurses’ feedback is used by nurse leaders to makechanges to improve patient care, nursing practice, and/or the work environment.

LISTENING TO EACH OTHERurse leaders and direct-care nurses work together to make Geisinger Medical Center the bestplace to work and to receive care. We listen to each other and try different ways to improvepatient care and nursing practice. In addition to sharing ideas in one-to-one interactions, nursesin lead and direct-care roles share ideas during council meetings and unit meetings. The table

below lists a few examples of feedback from unit direct-care nurses that was put into action by the nurse leader.

DIRECT-CARE STAFF FEEDBACK AND OUTCOMES

UNIT Operations Manager STAFF Feedback from Unit meetings OUTCOME

BP5 Cheryl Examitas, RN Request an increase in the number of 12-hour Implemented through shared scheduling processshift positions available *Improved work environment

BP6 Michele Long, RN Request an increase in the number of 12-hour Implemented through shared scheduling processshifts positions available * Improved work environment

BP7 Peter Price, RN Request purchase of a bladder scanner Purchased *Improved patient care and nursing practice

BP8 Michele Long, RN Request for preprinted assignment sheets Implemented through Unit Practice Councilbe instituted on unit *Improved nursing practice

AGP2 Deb Ulrich, RN Employee Suggestion Box needed to enable Implemented and staff determined where on unit it “on the spot” record of ideas was to be located

*Improved work environment

AGP4 Phyllis Knorr, RN Changes in scheduling to increase flexibility in Implemented through Shared Scheduling Councilresponse to nurses needs process; leader and staff worked together to revise

guidelines *Improved work environment

AGP5 Bonnie Patterson, RN Staff recognition for ongoing excellent Implemented “Blue Moon Award” through the All for performance in patient care and Five Council (AGP5 Unit Practice Council) contribution to unit *Improved work environment

BP2 Deb Ulrich, RN Request patient shower Renovations done*Improved patient care

AICU Angelo Venditti, RN Create an employee needs list to capture ideas Implemented by Unit Council; list reviewed weekly by to improve unit and patient care staff member before sending to management

*Improved work environment and patient care

CICU Deb Mensch, RN Staff interested in finding another way to Implemented through shared scheduling processschedule for holidays and vacations * Improved work environment

SCU3 Kim Kuhn, RN Request bladder scanner to decrease need for Purchased; CEP Team provided education on new repeat straight cath of neuro patients equipment

*Improved patient care and nursing practice

SCU4 Dawn Troutman, RN Staff voiced need for increased staffing due to After receiving approval, manager hired two agency increased census and acuity personnel


CH2 Linda Miller, RN Request for more axillary thermometers Purchased*Improved patient care

CH3 Linda Miller, RN More triple channel pumps Purchased*Improved patient care

N



UNIT Operations Manager STAFF Feedback from Unit meetings OUTCOME

NICU Maureen Lloyd, RN Needed more infant swings Purchased*Improved patient care

PICU Maureen Lloyd, RN Return to shared scheduling process with Implemented; interested staff beginning to develop this change in leadership guidelines and process


WLL Jami Marks, RN More thermometers needed Purchased one for each roomOB/GYN *Improved patient care

ER Charmaine Tetkoski, RN New triage process Implemented through CEP council and nurse educator*Improved patient care and nursing practice

PACU Cindy Bird, RN Request for increase in number of 12-hour Implemented through shared scheduling processshifts to be available *Improved work environment

OR Deb Strausser, RN Supply carts need to be restocked in afternoon Implemented *Improved work environment

Outpatient managers listen to suggestions from clinic direct-care nurses as well. The table below lists a fewexamples.

OUTPATIENT STAFF FEEDBACK AND OUTCOMES

CLINIC MANAGER STAFF INPUT from unit meetings OUTCOME

Foss 2 Psychiatry Mark Basinger Creation of depression privacy Effective flow for screening patient in a primary care setting;care screening all screening is triaged by one person

*Improved patient care and nursing practice

Pre-surgery Center Janice Hoffman Development of a new clinic Decrease appointment time from 90 minutes to 60 minutesflow process *Improved patient care

Pain Therapy Janice Hoffman Redesign for staff and patient Shared process with staff and leaderscheduling *Improved work environment, patient care, and nursing

practice

Gastroenterology/ Scott Singer Saltines and soda after endoscopy ImplementedNephrology *Improved patient care

Urology Dan Hendrick Communication from nurse to Implementation of a Blue Note Providers on what patient needs *Improved patient care are for each Office Visit

Women’s Outpatient Ann McFadden, RN The creation of an EPIC Staff and providers worked with EPIC team to develop newdocumentation encounter with an order setsinpatient consult *Improved patient care

Hematology/ Keri Potsko, RN Clinic triage checklist Developed by staff nurses Oncology *Improved patient care and nursing practice

Rheumatology Pam Cook Need to improve the Instituted a process for PPD/adult immunizations prior to documentation of adult the start of biologic medicationsimmunizations

GMC’s nursing leadership has always been open to feedback. According to Kristen Ikeler, RN, a clinicnurse from the Hematology/Oncology Clinic, “Management regularly seeks items for unit meeting agendasand ways to improve patient care.”



Staff members are encouraged to help in problem solving at unit meetings. Working together to improvepatient care is the standard.

EXEMPLAR:A NEW WAY

Staff nurses are encouraged to offer their input to nurse leaders on ideas for creating effective changes inpatient care, nursing practice, and the work environments. The following example of this practice wasevident in the Operating Room (OR).

For many years, nurses working in the OR worked traditional eight-hour shifts. They were also requiredto be trained to work in all types of surgical settings. This antiquated practice had a considerable impact onnurse job satisfaction and retention of employees. The turnover rate in the OR in 2006 indicated that theOR’s work environment and staffing practices were in need of change.

GEISINGER HEALTH SYSTEM 2006-07 OR TURNOVER TRENDING ANALYSIS

FY 2007 Voluntary Total Turnover % Total1st Qtr 2nd Qtr 3rd Qtr 4th Qtr YTD

AU-02000155090010 2.48% 1.55% 3.76% 1.54% 9.33%

AU-02000155090030 5.41% 2.78% 0.00% 0.00% 8.19%

AU-02000155090050 0.00% 0.00% 0.00% 0.00% 0.00%

Overall OR Totals 2.55% 1.48% 2.44% 0.98% 7.45%

GEISINGER HEALTH SYSTEM 2007-08 OR TURNOVER TRENDING ANALYSIS

FY 2008 Voluntary Total Turnover % Total1st Qtr 2nd Qtr 3rd Qtr 4th Qtr YTD

AU-02000155090010 3.08% 3.08%

AU-02000155090030 2.04% 2.04%

AU-02000155090050 0.00% 0.00%

Overall OR Totals 2.33% 2.33%

Staff Nurse Deb Strausser, RN, had a vision for a concept that she thought could enhance thedepartment’s working conditions. Her idea incorporated POD nursing to enable flexible scheduling withinthe OR. POD nursing incorporates certain surgical specialties into one group with nurses assigned to aparticular surgical group. The term POD is not an acronym; it relates to the concept of “streamlining orgrouping.”

After talking to her manager, Deb presented the idea to Crystal Muthler, RN, associate vice president ofNursing and director of the Surgical Suite. Crystal was very receptive to this new model. She took thepresentation to CNO Sue Hallick who also supported it and helped to make the vision a reality. Suerequested budget approval from the Executive Leadership Team to transform the requested changes intopractice (3:6:A).



3:6:A

POD KICK-OFF MEETING MINUTES JANUARY 9, 2006

Present

M. Renner, ST B.Witt. RN

Judy Bowersox, RN G. Edwards (Herrold), RN,Team Coordinator

J. Sheridan, RN,Team Coordinator D. Decker, ST

S. Carnish, RN S. Pritchard, RN,Team Coordinator

D. Strausser, RN,Team Coordinator D. Rider, RN,Team Coordinator

MEETING

The kick-off meeting was started by discussing the concerns members brought from the general staff.The following questions arelisted with the discussion that each question brought forth.

Q. What advantages would POD nursing have over the current structure of teams?

Discussion: Scheduling and assignments could be more manageable in smaller PODs than the current structure where the scheduleand assignment is working with a large volume of staff and individual needs of services are often compromised.

Q. Why not free up team coordinators completely to have them manage their current teams and not be staffing rooms at all?

Discussion: POD management structure is design to have the POD leaders still with the service 50 to 60 percent of the time,giving them contact with their service to still remain the hands-on expert and resource for the POD members. POD coordinatorswould be an additional layer of management that would manage schedule, assignments, and vacation and personal time requests inaddition to the usual managerial duties, such as budget and operational issues.

Q. Are their models to help with the transition?

Discussion:Yes, the models show that this process must be staff-driven and governed. POD must balance the work.The PODsmust have similar services.

Q. Suggested PODs

Discussion:Talked about how PODs are designed in other institutions that volume of work and block time must be considered.This led to a discussion of possible PODs. Deb Struasser agreed to Email each committee member samples of block time.K.Walley will also send each member information on average number of rooms running by day of the week and time of day data from Jan–Oct 2005.

Next meeting was scheduled for January 23. K.Walley is looking for possible time to meet sooner if possible.

The process of change began in November 2005 and was fully initiated by August 2006. The idea wastaken out to the staff in unit meetings to gain feedback and identify a group to help work out the details.Several nurses and a surgical technician volunteered to help. Volunteers included Carla Travelpiece, RN,CNE; Kate Horan, RN, CEP; Diane Rider, RN, team leader; Barb Witt, RN; CEP staff nurses; andMelissa Renner, surgical technician. An extensive process of garnering information from the Association ofPerioperative Registered Nurses followed. Other activities included talking with the staff and physiciansthroughout the OR and soliciting buy-in and ideas on how to best group the surgical specialties.



Team coordinator positions were created for each newly created POD in the OR. Nurses expressed aninterest in the POD they wanted to be assigned to according to the surgical specialty. Flexible hours, suchas 10- or 12-hour shifts and varying start times, made it possible for nurses to adapt their schedules to meetthe department’s needs as well as the needs of their own personal lives (3:6:B).

3:6:B

GEISINGER HEALTH SYSTEMDIVISION OF SURGERYUNIT MEETINGMARCH 22, 2006OR LOUNGE6:45AM–2:00 P.M.

PRESENT

RN–REGISTERED NURSE; ST–SURG TECH; TC–TEAM COORDINATOR

Lowell Adams, RN; Melania Balzer, RN; Heather Barkasy, ST; Linda Barrick, ST; Nancy Bowen, ST; Judy Bowersox, RN; Mike Brezgel,RN; Michelle Brown, RN; Sharon Carnish, RN; Kathy Connaghan, RN; Grace Covington, ST; Sue Crouser, ST; Deb Decker, ST; MikeDennen, ST; Denise Derr, ST; Deb Disabella, RN; Deb Donahue, RN,TC;Tami Dunbar, ST; Jamie Fetterolf, RN; Melissa Fisher, ST;Janice Flory, RN; Jodie Frasch, RN; Linda Frazier, RN,TC; Janice Garinger, ST; Jenelle Garinger, ST; Sue Gearhart, RN; Susan Hargraves,RN;Wendie Hess, RN,TC; Robert Hollenbach, ST; Michael Horan, ST;Tammy Hurst, RN; Deanna Ikeler, RN; Fran Kase, RN,TC;Heather Killian, ST; Coty Kimball, ST; Anne Kulick, RN,TC; Michelle Lindenmuth, RN; Patrick Masters, ST; Kim McCaffery, RN; BradyMcGee, RN; Deb Miller, RN; Jennifer Miller, RN; Ginger Mott, RN; Zachary Moyer, ST; Kimberly Mylet, RN; Kristy Nariskus, RN; LedellNeufer, RN;Tammy Noss, RN; Constance Polomski, ST; Amy Reamer, ST; Melissa Renner, ST; Diane Rider, RN,TC; Jake Sheridan, RN;Michele Shulski, RN,TC; Pauline Stine, ST; Mary Stratton Curtis, RN;Victoria Szot, RN; Stacey Taylor, RN; Barb Witt, RN; BonnieYagle, ST; Pam Zurick, RN

OPEN POSITIONS

• RN-7

• Support associate vacancies–

9 to 5:30 p.m. position open



Robert Miller, a temp, started March 15th.

New temp starting on 3/16/06. His name is Larry Witmer.

Temp starting Friday 3/17/06. His name is Phillip Parker.

CSR—CENSITRAC (JOAN COREY SPOKE IN THE P.M. ONLY)

• Joan presented the live Censitrac information via PowerPoint.This showed the staff how inaccurate scanning has been. ALLtrays need to be scanned at every point of departure from each area.

• Censitrac is only as good as the staff who complies.

• Accurate tracking is a necessity for instrument inventory.

• Clipboard placed in PAR room; please place sticker on board with a note where the instrument was taken to if you do nothave time to scan yourself.

MAGNET

• Thank you for participating in the Magnet Pep Rally on Tuesday, March 14.Jamie Fetterolf and daughter MakenzieStacey Taylor



Heather KillianKim McCafferyNancy SalwockiCarla TravelpieceBarb Witt

• A good time was had by all.

TEAM RECOGNITION

• Please congratulate the General Surgery Team.They have been recognized by the hospital with the Bariatric Service ExcellenceAward.

NEW REGISTRIES

• Barb Devlin presented the new OR Registries. All of anesthesia charges have been taken off.The registry will stay in thepatient’s chart.This will be implemented on April 3, 2006.

COMMITTEE ANNOUNCEMENTS

a. OR Workgroup—

1.Workgroup welcomes Michelle Brown, RN, to the committee. She will be replacing Donna Lindemuth, RN.Thank youDonna for all of your dedication to this committee and service to the OR.

2. Price is right—Wide safety strap-$95, Linda Frazier, RN-am, Sue Hargraves, RN-pm.

3. Wish List of Duties that can be assigned during slow periods has been given to each charge nurse including weekendsand night shift.

4. ROSE Award—to be announced April 5.

5. Remember to sign up for adopt-a-room.

6. Stocking room inservice on April 5 with workgroup and IMAs.

7. We plan to purchase a digital camera in the near future.

8. Twenty new suction adapters were marked and put in service.

9. Next project: Designing a new booklet that will be placed by each addressograph and at desk of infrequent/special labrequest with brief synopsis of test and a sample lab request form; anticipate completion ASAP. Any usual or infrequentlab request, please see workgroup with suggestions.

10. Avagard and glove box holders as requested by staff have been placed in the CSR Satellite area.

b. Time Committee—See the attached Holiday Guidelines—Anne Kulick, RN

• All staff must sign up in Martha and Marsha’s office.

c. Performance Improvement/QI–Barb Witt, RN

1. Please make sure your patient has an ID band on when they are leaving the OR.

2. There was a low compliance for labeling of medications and/or solutions taken out of the original contain. Please labeleverything.

3. All clocks on the walls are synchronized house-wide. Please use them for documenting times on the pink sheet andregistry.

d. Policy and Procedure Review Committee

• Allograft Policy—Policy complete; the yellow logbooks are on order. After they arrive we will implement and review thepolicy.This is only human or animal tissue.

• Ortho and CV will maintain their own yellow binders.

e. CEPs—No updates

f. Retention Committee—March meeting was cancelled. If anyone has any issues they would like brought up, please see one ofthe members of the committee.

• The Hospital Retention Committee is having a jelly bean counting contest.

g. OR Relations—The form to report an OR relations issue is now at the control area. Upon completion of the form it may



be turned in to operations director, team coordinator, or charge nurse.The committee will now meet on a quarterly basis;next meeting in June.

h. Clinical Nurse Educators—New hospital uniform regulations policy has been revised and should be enforced. It can befound online under Manuals, Patient Care, Policy 307.

• There are three trauma binders with articles in the lounge on the windowsill. One is pediatric, one is adult, and one isgeriatric.The adult binder has two different articles, with two separate sign-in sheets and different tests (tabs areseparating everything). By reading and completing the tests for theses four articles, your trauma education hours will becomplete for the year 2006.

• The gold sign-in sheets and tests will be collected monthly. Please sign your initials and date on the gold sheet and placethe completed test in the back inside cover of the binder.

i. Latex—List of products containing latex has been updated; the format will be different.The list will be on the latex-freecarts.

POD NURSING

• Interviews are underway for POD coordinators.

• OR staff survey will be done pre-POD and then after implementation.

• Several physicians have given positive feedback about the planned change.

• Staff should continue to decide which POD they want to participate in; selections are ongoing.

OUTCOME

In 2007, nurses in each POD are engaged and committed to making their group work well. These changesgreatly improve the working environment and the nurses’ perception of having a good day overall.


3:6:A POD Kick-off Meeting Minutes, January 2006

3:6:B Division of Surgery Unit Meeting Minutes, March 2006

Overall Had a Good Day ScoreGMC OR

GMC Score National Score

2005 2006

Had a Good Day

1

2

3

4

5

2007



EVIDENCE 7Describe how nursing leaders are visible and accessible to direct-care nurses.

eisinger Medical Center nursing leaders (administrators and managers) demonstrate visibility andaccessibility. Visibility refers to the physical presence of the nursing leader in patient care areas.Accessibility is how open the nursing leaders are to being approached by direct-care nurses. The

Nursing Department has an open-door policy that enables staff to approach them at any time.

Operations managers interact with their staff in a variety of ways, including during unit staff and unitcouncil meetings and through one-on-one interactions by phone, beeper, or Email. Unit meetings offerattendees an opportunity to discuss the impact of policy changes on the organization, the department, andtheir unit. The unit councils provide opportunities for staff and managers to work together on issues thatwill benefit nursing practice, patient care, and the overall work environment.

SPAN OF CONTROLIn the early 1990s, hospitals all over the country were forced to make organizational changes to stayfinancially solvent. These changes were evident in nursing departments where managers were spread across a number of nursing units. At GMC, managers were responsible for two or more nursing units, whichdrastically decreased their visibility and accessibility to staff. Here are some accounts in the nurse managers’own words.

GNDNQI Nurse Satisfaction Survey: Manager’s Ability,

Leadership, and Support of Nurses

3.5

2006

1

0.5

2007

GMC National

0

4

2.5

3

1.5

2



• Terri Bickert, MSN, RN, former manager of AICU, CICU, SCU4, AGP4, and AGP5:“Having multiple units was very challenging. It was a different kind of busy from having one unit.Splitting time every day between meetings and several high profile units was challenging. It washard to move beyond day-to-day operations, to look at the unit vision and how to move theretogether with the staff. Implementing Shared Governance Councils and strong assistant managerswas my key to success. The thing I enjoy most about leadership is guiding and mentoring staff. Attimes that was very hard when priorities were focused on day-to-day operations. Looking back, it isamazing we got through it.”

• Bonnie Patterson, RN, formerly operations manager of AGP5, I.V. Therapy, and BP7; presentlyoperations manager of AGP5 and I.V. Therapy:“Each nursing unit is unique, so even though they may have similar functions and responsibilities,their operational needs are very different. As a manager, I found that I needed to understand thestrengths and weaknesses of each area and the staff working in those areas in order to best supporttheir needs. I also found that it was not beneficial to make comparisons between the units orassume that because a process was successful in one unit it would be successful in the other. Eachunit had its own culture and personality, and I had to use different approaches to similar situationsbecause of these differences. I had to learn to balance time spent with staff and make sure that eacharea’s priorities were addressed as each area felt they needed to be. I was fortunate in that each unittook its turn having a crisis; only occasionally were the units in crisis at the same time. When thishappened, I really needed to depend on the staff and team coordinators to help with the supportand follow-through necessary to resolve their issues.”

As the new millennium began, new nursing leadership assumed control of GMC’s nursing services. A number of new initiatives were undertaken stressing the importance of visibility, accessibility, and

GMC nursemanager with staff nurses



accountability. Sue Hallick, RN, CNO, identified the need to adjust the span of control for her team ofinpatient operations managers to facilitate the Nursing Department’s success. In 2001, Sue began increasingthe number of managers. They grew from nine in 2000 to 17 by 2007. The outpatient areas followed Sue’sexample and also increased their number of outpatient operations managers and clinical team leaders.

NUMBER OF OPERATIONS MANAGERS

2000 2002 2005 2007

Inpatient 9 11 15 17

Outpatient 10 14 16 18

This change in span of control has enabled managers to stay aware of day-to-day activities occurring onthe unit, making sure patient flow is smooth and staffing is sufficient for demand. In addition to spendingtime on the unit, managers answer questions, address concerns, and solve problems. The operationsmanagers or their team coordinators make patient rounds several times a week to ensure quality care andfollow-up on identified issues.

The reduced span of control has enabled the nursing leaders to coach and mentor nurses to grow anddevelop professionally. Unit-based councils are more productive, and operations managers have staffengaged in unit operations. There are still challenges day-to-day, but the staff and manager work as a teamto find solutions (3:7:A).

3:7:A

OUTPATIENT MANAGERS LIST COMPARISON

GMC 2003 GMC 2007Department Name Name

Division of Medicine Susan Frye Susan Frye

Kim Rankin Jan Hoffman

Sandy Whitmire Donna Myers

Scott Singer Scott Singer

Kerri Potsko Kerri Potsko

Mike Woll

Pam Cook

Division of Surgery Becky Ruckno Mike Enriquez

Jill Leiby Marsha Morgan

Scott Gulliver Caroline Pogge

Pat Campbell Dan Hendricks

Chris Wargo Chris Wargo

Deb Sanders

Kyle Snyder



GMC 2003 GMC 2007Department Name Name

OB/Women’s Claire Varney Anne McFadden

Psychiatry George Godlewski Mark Bassinger

Pediatrics Nancy Ososkie Nancy Ososkie

Donna Lapchak Donna Lapchak

OUTCOMEThis increase in the number of front-line managers has decreased their span of control and has allowedthem to be more accessible and visible to staff. They can be on their units or clinics daily and are availableto meet informally to discuss staff concerns and suggestions. They are also available to make patient roundsand can address issues in a timely manner.

• Dee Hollenbach, RN and a new manager in 2007:“I cannot even imagine having more than one unit. I am on the unit every day and staff membersknow that they can approach me at any time. I am busy selecting a new team coordinator andworking with the staff to determine our direction. I think working together is the only way.”

• Michelle Long, RN, manager of BP8, and new manager of BP6: “I have had councils on BP8 for some time and am enjoying getting things going on BP6. Thenurses have so many good ideas that are really making a difference in our unit and patient care.”

• Charmaine Tetkoskie, RN and long-term director of Emergency Services: “The ED staff is the greatest. They have had Shared Governance Councils for so long that it is justpart of who we are. The senior staff shows the newer ones how to make things happen. It reallymakes things better for me, too. The nurses on the councils are problem solvers, and I rely on themto keep improving patient care and ED flow.”

• Marsha Morgan, RN and manager of the Ophthalmology Clinic: “I rely on my staff to keep the clinic running smoothly. I have experienced nurses who do what isneeded to make sure the patients are cared for properly. I don’t know what I would do withoutthem.”

STAFF NURSE PERCEPTIONSWhen nurses were asked about their perception of the visibility and accessibility of nursing leadership, theirresponses were very positive. Here are just a few examples.

• Judy Malatesta, RN and CICU staff nurse CEP:“I have been an employee at GMC for 30 years and have seen many managers come and go. Forthe most part, I have been very fortunate to have had managers who care about the staff and thepatients. Management has always been positive and supportive and shown that it cares.”

• Deb Mattis, LPN, BP2 Psychiatry:“Now that our manager has only one unit, we get to see her every day.”

• Tonya Sellard, RN, staff nurse SCU3:“I feel I can talk to my manager about anything. She is very open to discussing my concerns.”



• Ann Bower, RN, staff nurse BP7:“We really appreciate it when our manager comes out to pitch in when the unit is extremely busy.”

• Tracey Eddinger, RN, staff nurse AGP5:“I don’t know how she does it, but she seems to be here all the time, helping us all the time.”

• Lisa Bidelspach, LPN, clinic nurse, Ophthalmology Clinic:“Marsha is great to work with. This clinic is so busy and fast moving. Marsha used to be a staffnurse here, too, so she knows what we are going through and how to help us. I know I can go toher anytime to talk about what is going on.”

• Stephanie Worhach, RN, clinic nurse, Women’s Clinic: “Women’s Clinic is a great place to work. Ann is such a positive manager. She is committed tohelping us make this the best clinic. She asks us for our opinions and I feel she is veryapproachable. I am very lucky.”

A VISIBLE AND ACCESSIBLE CNOCNO Sue Hallick routinely attends meetings of the Shared Governance Council where she conveys animage that is approachable and open to communication. She and the staff discuss current events as well asissues arising on their respective work units. Nurses throughout the organization are able to meet one-on-one with Sue whenever needed.

Sue leads by example and is visible and accessible to her management staff. It is not unusual for her tostop by a manager’s office and ask how things are going. She attends their management meetings and guidesand supports them as they deal with the day-to-day operations of their units.

Sue leads by example by being visible and accessible to direct-care providers. Beyond her interactions atthe Shared Governance Council meetings, she schedules rounds on all three shifts and during weekends andholidays. This provides her an opportunity to interact with nursing staff on the units and to support the24/7 operation of the department.

CNO’S SCHEDULE FOR ROUNDS

Wednesday, July 5, 2006 3:00 – 5:00 p.m. Danville Campus

Thursday, July 6, 2006 3:00 – 5:00 p.m. GWV

Tuesday, July 18, 2006 3:00 – 4:00 p.m. Danville w/Admin Resident

Wednesday, August 2, 2006 1:00 – 3:00 p.m. Danville

Thursday, August 10, 2006 9:30 – 11:00 a.m. GWV w/Dr. Steele

Wednesday, August 16, 2006 4:00 – 5:00 p.m. Danville

Thursday, August 17, 2006 2:30 – 3:30 p.m. Danville w/Dr. Bisordi

Friday, August 25, 2006 3:00 – 5:00 p.m. Danville

Wednesday, September 6, 2006 1:00 – 3:00 p.m. Danville

Friday, September 15, 2006 1:00 – 3:00 p.m. Danville

Monday, October 2, 2006 2:00 – 3:30 p.m. Danville w/Dr. Steele/AVPs

Tuesday, October 17, 2006 7:00 – 8:00 a.m. Danville

Wednesday, October 25, 2006 6:00 – 8:00 a.m. Danville w/AVPs

Wednesday, October 25, 2006 2:00 – 3:00 p.m. Danville

Thursday, October 26, 2006 11:00 a.m. – 12:00 p.m. Danville



Wednesday, November 22, 2006 2:00 – 3:00 p.m. Danville w/Wade/Bisordi/Miller/Beechay

Thursday, November 23, 2006 All Day Rounds Danville—Thanksgiving Rounds

Wednesday, November 29, 2006 1:00 – 2:00 p.m. Danville w/Wade/Bisordi/Miller/Beechay

Wednesday, December 6, 2006 3:00 – 5:00 p.m. Outpatient Surgery—Woodbine Lane

Wednesday, December 13, 2006 10:00 a.m. – 12:00 p.m. Danville

Wednesday, January 3, 2007 8:00 – 10:00 a.m. Danville

Monday, January 8, 2007 2:00 – 4:00 p.m. Danville

Friday, January 12, 2007 2:00 – 4:00 p.m. Danville w/AVPs

Wednesday, January 17, 2007 2:00 – 4:00 p.m. Danville

Friday, January 19, 2007 10:00 a.m. – 12:00 Noon Danville

Tuesday, January 23, 2007 1:00 – 3:00 p.m. Danville

Thursday, January 25, 2007 3:00 – 5:00 p.m. Danville

Thursday, February 1, 2007 10:00 a.m. – 12:00 Noon Danville

Wednesday, February 7, 2007 1:00 – 3:00 p.m. Danville

Friday, February 9, 2007 9:00 – 11:00 a.m. Danville


Thursday, February 22, 2007 2:00 – 3:00 p.m. Danville

Monday, February 26, 2007 3:00 – 5:00 p.m. Danville


Friday, March 2, 2007 8:30 – 10:30 a.m. Danville

Monday, March 5, 2007 2:00 – 4:00 p.m. Danville

Wednesday, March 7, 2007 9:00 – 11:00 a.m. Danville

Thursday, March 8, 2007 1:00 – 4:00 p.m. GWV

Friday, March 16, 2007 1:30 – 3:30 p.m. Danville w/AVPs

Tuesday, March 20, 2007 1:30 – 5:30 p.m. GSWB

Wednesday, March 21, 2007 3:00 – 5:00 p.m. Danville w/AVPs

Monday, March 26, 2007 1:30 – 3:30 p.m. Danville

Friday, March 30, 2007 10:30 a.m. – 12:30 p.m. Danville

Wednesday, April 18, 2007 9:00 – 11:00 a.m. Danville

Thursday, April 19, 2007 7:00 a.m. – 2:00 p.m. GWV and GSWB

Friday, April 20, 2007 2:00 – 4:00 p.m. Danville

Tuesday, April 24, 2007 8:30 – 9:30 a.m. Danville w/AVPs

Wednesday, April 25, 2007 3:00 – 5:00 p.m. Danville w/AVPs

Friday, April 27, 2007 3:00 – 5:00 p.m. Danville

Monday, May 1, 2007 9:00 – 11:00 a.m. Danville w/AVPs

Tuesday, May 2, 2007 9:00 – 11:00 a.m. Danville

Monday, May 7, 2007 2:00 – 5:00 p.m. Nurses Week Rounds—Danville

Wednesday, May 9, 2007 3:00 – 5:00 p.m. Nurses Week Rounds—Danville

Thursday, May 10, 2007 7:30 – 10:30 a.m. Nurses Week Rounds—Danville

Wednesday, May 23, 2007 2:00 – 3:00 p.m. Danville

Friday, May 25, 2007 1:00 – 3:00 p.m. Danville

Wednesday, May 30, 2007 10:00 a.m. – 12:00 p.m. Danville

Thursday, May 31, 2007 7:00 – 10:00 a.m. Danville

Friday, June 1, 2007 9:00 – 10:00 a.m. Danville

Tuesday, June 5, 2007 2:00 – 4:00 p.m. Danville





Tuesday, June 26, 2007 2:00 – 4:00 p.m. Outpatient Surgery Center—Woodbine Lane

Wednesday, June 27, 2007 10:30 – 12:00 Noon Danville

July 6, 2007 Quality Rounds 8:45 a.m. – 11: 45 a.m.

July 26, 2007 Quality Rounds 11:30 a.m. – 1:30 p.m.

August 14, 2007 Quality Rounds 9:30 a.m. – 1:00 p.m.



August 31, 2007 Quality Rounds 2:00 p.m. – 5:00 p.m.

September 3, 2007 Quality Rounds 2:00 p.m. – 5:00 p.m.

September 7, 2207 Quality Rounds 11:00 a.m. – 1:00 p.m.

September 11, 2007 Quality Rounds 3:30 p.m. – 5:00 p.m.

September 18, 2007 Quality Rounds 11:00 a.m. – 1:00 p.m.

October 5, 2007 Quality Rounds 11:00 a.m. – 1:00 p.m.

October 15, 2007 Quality Rounds 7:00 a.m. – 10:00 a.m.

October 19, 2007 Quality Rounds 9:00 a.m. – 10:30 a.m./1:00 p.m. – 3:00 p.m.

October 24, 2007 Quality Rounds 3:30 p.m. – 5:00 p.m.

October 31, 2007 Quality Rounds 3:30p.m. – 5:00 p.m.

November 2, 2007 Quality Rounds 11:00 a.m. – 1:00 p.m.

November 5, 2007 Quality Rounds 2:30 p.m. – 4:30 p.m.

November 6, 2007 Quality Rounds 9:00 a.m. – 11:00 a.m.

November 22, 2007 Quality Rounds 7:00 p.m. – 12:00 p.m.

December 7, 2007 Quality Rounds 3:00 p.m. – 5:00 p.m.

December 21, 2007 Quality Rounds 12:00 p.m. – 2:30 p.m.

December 27, 2007 Quality Rounds 7:00 a.m. – 9:00 a.m.

If Sue hears that a unit may be going through a difficult time, she makes sure to visit the unit frequently.During her rounds, she engages the staff, asking them about how their day is going and how their familiesare doing, letting the staff know she cares. Sue has been at Geisinger for more than 20 years and knowsmany staff members.

One example of why the staff respects her as a visible and accessible leader is demonstrated in this story.It occurred a year ago, close to Christmas. One of the staff nurses received a paycheck that was short ofmoney. The error, according to Geisinger policy, was too small to be corrected before the nurse’s nextpaycheck. This nurse was very stressed because she planned to use her paycheck to finish buying herchildren’s Christmas presents. The operations manager tried to help but the amount was not large enoughto warrant a special check. Taking a suggestion from one of her colleagues, Wendy Potter, RN, staff nurse,called Sue and explained the situation and the steps that had been taken in an attempt to resolve the payrollerror. Sue was able to have a corrected check issued to the nurse. Sue listened and took the time to help,which meant a lot to Wendy and her coworkers.


3:7:A Outpatient Managers List Comparison, 2003 and 2007

[Terri: Is this the correct time?]



EVIDENCE 8Provide examples of mentoring and succession planning by and for nurse leaders and direct-care nurses.

ne of the Nursing Department’s primary goals is to secure the legacy of its founder, AbigailGeisinger. It was Abigail Geisinger’s directive when she founded the hospital in 1915 to “Makemy hospital right. Make it the best,” that has formed the basis for Geisinger’s nursing vision.

One component of making Geisinger the best is its success in retaining strong professionals, which is due(in part) to its commitment to fostering professional growth. More than 41 percent of Geisinger’s nursingworkforce has 10 or more years of tenure in our organization. Geisinger is committed to “growing ourown,” which means that we believe in and recognize the potential for advancement and professionaldevelopment of our staff. We believe that offering these opportunities plays a role in retaining quality staff.

To that end, a mentorship program was developed several years ago (3:8:A). Its goal is to recognizeindividuals who engage in mentoring behaviors by offering them additional tools (knowledge) to enhancetheir performance. The program is available for those individuals who show mentoring potential. Thementorship program debuted with a large kick-off attended by all managers, team coordinators, and clinicalnurse educators. It is now offered routinely.

3:8:A

MENTORSHIP PROGRAM 2007

February 2 0730 – 1030

May 1 1200 – 1500

August 3 0730 – 1030

November 19 1200 – 1500

Location:

Nursing Education Center

Room 201, Second Floor

COURSE DESCRIPTION

The Mentor Class is a 3-hour program designed to assist nurses to develop their mentoring skills to the fullest. Any nurse who wantsto become a mentor on their units is encouraged to attend. CEPs who have accepted the “mentor” role are encouraged to attend.

Among topics to be included:

• Difference between preceptors and mentors

• Characteristics of mentors

• How to get started

If you have any questions on whether this program is for you, please discuss this with your Clinical Nurse Educator (CNE).

TO REGISTER

Online Patient Care Services Speed Schedule

or call Chris Whitmire (570) 214-9205

PROGRAM CONTENT QUESTIONS

Any Clinical Nurse Educator, Nursing Education

O



GEISINGER HEALTH SYSTEMGEISINGER MEDICAL CENTERDANVILLE, PENNSYLVANIAEDUCATION RESOURCES PROGRAM RECORD

Program date: ______________

Participant: _______________

Date attended: _________

CONTACT HOURS

General Topic: 3.3

Age-specific topic:

Pediatric Hours (0 – 17 yr old) ______

Adult Hours (18 – 54 yr old) _____

Geriatric Hours (55 yr old and >) _____

Verifying signature: ______________________

PROGRAM NUMBER: 20686PROGRAM TYPE: CLTPROGRAM TITLE: MENTORING

EDUCATION RESOURCES ASSOCIATE:

Jody Bachman, RN

Gerri Ann Danoliwicz, RN

Judy Shipe, RN

SPEAKER(S)

Jody Bachman, RN

Gerri Ann Danoliwicz, RN

Judy Shipe, RN

INTENDED AUDIENCE

CEP staff and others who are interested in becoming mentors

STATEMENT OF NEED

Please check one: *

Reg. Agency Trauma Orientation QI X Provider credit

Other—check all that apply:

Pt. Pop. Advances Staff Request Management Request



OBJECTIVES

At the conclusion of the program, the participant will:

1. Discuss the role of the mentor.

2. Identify the differences between a mentor and a preceptor.

3. Review the foundation and framework of mentoring.

4. Describe the importance of developing goals—short and long term—for both the mentor and mentee.

5. Discuss barriers to mentoring and methods to overcome them.

6. Identify the benefits to mentoring from a personal and organizational perspective.

OUTLINE OF CLASS CONTENT (INCLUDE THE USE OF ANY SLIDES, OVERHEAD TRANSPARENCIES, HANDOUTS, ETC.)

I. Introduction and Overview

II. What is mentoring?

A. Definitions

B. Mentor vs. preceptor

C. Characteristics

D. Survey

III. Theories/Foundations

A. Stage/phase

B. Novice to expert

C. Adult learning

IV. Personal development plan

V. Barriers and methods to overcome

A. Separation of roles

B. Lack of support

C. Time

D. Poor communication

E. Toxic mentors

F. Limited availability of qualified persons

G. Mismatching of mentor/novice

VI. Benefits

VII. Ongoing process

A. Preventing burnout

B. Evaluation

C. Documentation

D. Socialization

MENTOR ROLE IN CAREER ENHANCEMENT PROGRAM (CEP)Many years ago, when the Clinical Ladder Program evolved into the Career Enhancement Program (CEP),one of the roles that the staff nurses felt needed to be developed was that of a mentor. Typically, staff wouldseek out specific nurses on each unit with their clinical questions or when they needed a shoulder to leanon. The new role emerged from these discussions—the CEP mentor.

The CEP mentor is a person who takes on additional responsibilities on the unit to help new nursestransition into their roles and to help other coworkers through their day-to-day struggles.



CAREER ENHANCEMENT PROGRAM (CEP) MENTOR ROLE CHARACTERISTICS

The mentor:The purpose of this role is to provide support and encouragement to new members of the unit staff. A mentor should beapproachable and encouraging. A mentor should be a positive role model.This would include being up-to-date on all unit-requirededucation, inservices, and promoting upcoming training. Mentors should demonstrate positive conflict resolution tactics andpromote unit cohesiveness.They should be committed to continuing education themselves.

Characteristics of a CEP mentor include:

• Provides primary support for new staff on unit

• Serves as a resource/preceptor on the unit

• Ensures completion of required orientation paperwork

• Monitors orientees’ progression through the initial six months of employment

• Works with unit manager/clinical nurse educator to review/revise orientation program

• Serves as a resource person to staff serving in preceptor role

• Reviews orientees’ progress weekly with clinical nurse educator

• Precepts the orientee >50 percent of the time during the orientation period

• Serves as backup preceptor for other unit orientees

The following list includes many examples of how securing the legacy through mentoring and successionplanning of leadership has worked at GMC.

MENTORING AND SUCCESSION PLANNING EXAMPLES

MENTEE: FORMER POSITION MENTOR MENTEE: NEW POSITION

Denise Beechay, RN Sue Hallick, RN, CNO AVP, NursingOperations Manager, AICU

Crystal Muthler, RN Sue Hallick, RN, CNO AVP, Surgical Suite and NursingOperations Manager, SCU, Float Pool

Phyllis Knorr, RN Terri Bickert, RN, Operations Operations Manager, AGP4Administrative Team Coordinator, AGP4 Manager, AGP4

Peter Price, RN Bonnie Patterson, RN, Operations Operations Manager, BP7Administrative Team Coordinator, BP7 Manager, BP7 and AGP5

Angelo Venditti, RN Denise Beechay, RN Operations Manager, AICUAdministrative Team Coordinator, AICU Operations Manager, AICU

Charity Derr, RN Joan Mervine, RN CEP, BP5Staff Nurse, BP5 Clinical Nurse Educator

Kimme Duffy, RN Linda Miller, RN Administrative Team Coordinator, CH2 and CH3Team Coordinator, CH2 and CH3 Operations Manager, CH2 and CH3

Kerri Potsko, RN Cindy Vought, RN, Ops Mgr Operations Manager, Hematology/Oncology ClinicTeam Leader, Hematology/Oncology Clinic BP8, Hematology/Oncology Clinic

Michelle Long, RN,Team Coordinator, BP8 Cindy Vought, RN Operations Manger, BP8 and BP6Operations Manager, BP8

Judy Brokenshire, RN, Staff Nurse, BP6 Joan Mervine, RN, CEP, BP6Clinical Nurse Educator

Heidi Cole, RN, Staff Nurse, CH2 Chris Raup, RN, Administrative Team Team CoordinatorCoordinator, CH2 and CH3



MENTEE: FORMER POSITION MENTOR MENTEE: NEW POSITION

Jeanette Rowello, RN, Staff Nurse, AICU Angelo Venditti, RN Team CoordinatorOperations Manager, AICU

Rene McCloskey, RN, CEP Staff Nurse, AGP5 Judy Haines, RN Clinical Nurse Educator, BP7Nurse Educator, AGP4 and AGP5

Renee Smith, RN, CEP, PACU Carla Travelpiece, RN Nurse Educator, PACUNurse Educator, OR

Cheryl Examitas, RN,Team Coordinator, AICU Angelo Venditti, RN Operations Manager, BP5Operations Manager, AICU

Dee Hollenbach, RN.Team Coordinator, AGP2 Deb Ulrich, RN Operations Manager, AGP2Operations Manager, BP2 and AGP2

Jami Marks, RN, Nursing Supervisor Sue Hallick, RN, CNO Operations Manager,WLL

Andrea Wary, RN,Team Coordinator, Ann McFaddin, RN,Operations Operations Manager,Women’s Outpatient Manager,Women’s Outpatient Women’s Community Practice sites

CLINICAL NURSE EDUCATORS AS MENTORS

UNIT MENTOR MENTEE

CICU Artman, Susan, RN Jim O’Connell, RN, staff nurse

NICU Bachman, Jody, RN Janice Brink, RN, staff nurse

SCU3 Cole, Gordon, RN Candy Bossler, RN, staff nurse

SCU4, Critical Care Floats Danilowicz, Gerri Ann, RN Jennifer Wemple, RN, staff nurse

ED, Life Flight, Radiology Gordon, Nancy, RN Kim Loeffler, RN, staff nurse

AGP4 Haines, Judy, RN Carol Hughes, RN, staff nurse

OR Horan, Kate, RN Sherry Bottiger, RN

ICU Kishbaugh, Lani, RN Alex Brock, RN

Generalist Knight, Cathy, RN Alice Kuznicki, RN

I.V.Therapy Knowlton, Barb, RN Sue Ridall, RN

BP5/BP6 Mervine, Joan, RN Cindy Rinard, RN

CH2/CH3 Mowry, Emily, RN Melissa Narcavage, RN

Periop, I&O, Pre-surgery Smith, Renee, RN

BP7 Steimling, Robin, RN Kristi Sands, RN

AGP2 Underhill,Tami, RN Sharon Sudol, RN

WHP Wilson, Alice, RN Cathy Eyer, RN

NURSING LEADERSHIP: MENTORING AND SUCCESSION PLANNINGSuccession planning establishes a process that recruits employees, develops their skills and abilities, andprepares them for advancement. In the past, succession planning across the country typically targeted onlykey leadership positions. In today’s organizations, it includes key positions in a variety of job categories.With the move to flattened management structures, succession planning provides replacement insurancewhen key people leave an organization. It is important that potential successors are identified early andgiven appropriate training so that when the time comes they can move into more senior roles. Theexpectation of mentoring and succession planning is built into many job descriptions (3:8:B and 3:8:C).With good succession planning, employees are ready for new leadership roles and can step up when aposition becomes available.



3:8:B

GEISINGER MEDICAL CENTERDEPARTMENT OF HUMAN RESOURCESJOB DESCRIPTION

TITLE: Inpatient Nursing Operations Manager

FAMILY/GRADE: 67 Managerial/10 JOB CODE: 2215

BARGAINING UNIT: No FLSA: Exempt

DEPARTMENT: Nursing LOCATION: GMC Campus

JOB SUMMARY

Manages nursing personnel and daily operational-related activities. Leads NSG team for assigned units with responsibility for alloperational functions of the team.Works in partnership with the Medical Director/Physician Liaison of the inpatient unit to provideadministrative and medical staff support to the operations of the inpatient unit.

Responsible for developing and initiating improvements in the organization and delivery of high quality, cost effective patient care.Duties and responsibilities will include supporting the vision, mission, and goals of the NSG Department and the organization.Responsible for nursing clinical practice, budgetary personnel activities, regulatory activities associated with the unit and the clinicaldepartment, and the implementation and continuing support of EMR.

Reports directly to the Chief Nursing Officer and is matrixed to the Department Service Line leaders (Vice President and Chair)as appropriate.

MAJOR DUTIES AND RESPONSIBILITIES

*A. Leadership:

1. Demonstrates characteristics and behaviors necessary to assure employee understanding and acceptance of the nursing andsystem driving strategies.

2. Effectively communicates the NSG and the organization’s vision, goals, and initiatives at the unit/department level.

3. Effectively incorporates goals, vision, and initiatives into unit/department plans.

4. Participates effectively as a member of departmental/divisional/regional leadership teams.

5. Facilitates team-based problem solving within and between departments.

6. Develops, implements, and audits all departmental policies and procedures.

7. Develops an effective working relationship with the Medical Director/Physician Liaison of the inpatient unit.

8. Develops positive and proactive employee relations.

*B. Human Resource Management:

1. Recruits, interviews, and hires applicants.

2. Participates in recruitment and retention process for all team members.

3. Accountable for staffing, vacation scheduling, cross-training activities, etc. with other team leaders as needed and/or required.

4. Maintains accurate payroll timesheets of staff.

5. Coordinates performance evaluation process for all team members.

6. Collaborates with Human Resource Generalist regarding employee performance improvement planning.

7. Develops, implements, and revises nursing retention strategies on an ongoing basis.

*C. Strategic Planning/Implementation:

1. Develops and participates in the design and implementation of all strategic operational plans.

2. Anticipates, evaluates, and appropriately responds to changes in the healthcare environment.

3. Develops capital, clinical, financial, HR, IS quality, and service plans.



4. Develops business plans identifying opportunities for new technology and anticipates future needs for personnel andequipment.

5. Monitors progress of goals and impact of respective plans.

6. Develops marketing strategies for the unit/department.

*D. Financial Performance:

1. Demonstrates accountability for continuously improving the work unit, department, division, and system by developingperformance expectations and goals that focus on service, quality, and cost.

2. Communicates a clear description of performance expectations and goals to employees, encouraging and supporting theirparticipation and accountability.

3. Establishes and adjusts hours-per-patient-day (HPPD) for assigned units based on national benchmarks.

4. Develops, implements, and achieves budgets, which attain unit, division, and system goals.

5. Reviews reports to monitor all revenue and expense impacting activities.

6. Develops and implements operational contingency plans as financial needs arise.

7. Educates employees in the need to develop a cost-conscious approach to quality care and/or service delivery.

*E. Service/Patient/Customer Satisfaction:

1. Develops and promotes service standards that foster a customer-sensitive environment, using a proactive approach.

2. Measures performance against standards and seeks team commitment to exceed standards.

3. Resolves patient and customer-related issues in a timely manner.

*F. Risk Management:

1. Assists in dealing with risk management issues.

2. Assists in development and implementation of department PI plan.

3. Ensures all incidents, serious events, and sentinel events are reported to PI and addressed in a timely manner.

4. Proactively reviews the units/systems exposure to develop educational activities for employees/associates that will reduceliability.

5. Coordinates and communicates safety standards and processes.

6. Assists and maintains regulatory compliance.

*G. Care Management System:

1. Works closely with care management to facilitate maximization of clinical pathways and case management system.

2. Assists in the implementation of organizational care management activities.

3. Works with appropriate personnel to ensure compliance with regulatory agencies.

*H. Education/Coaching:

1. Facilitates continuing education and research opportunities for employees, self, and community to support growth andenhance the contribution to Geisinger Health System.

2. Utilizes leadership concepts to effectively facilitate team building by serving as a mentor, and teacher.

3. Collaborates with Clinical Nurse Educators to develop employee orientation, continuing education, and competencies.

I. Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified toperform.

*Denotes essential job functions.



SKILLS AND ABILITIES

Demonstrates successful nursing resource management and team coordinator development.

Demonstrates budget management skills.

Demonstrates successful recruitment and retention policies, medical staff and employee relations, and an educational program thatensures clinical competence.

EDUCATION AND/OR EXPERIENCE

RN presently licensed or eligible for licensure in Pennsylvania required.

Bachelor’s degree in related field required. Master’s degree in Nursing, in Healthcare Administration, or related field preferred.

BSN or commitment to obtain BSN required.

Minimum five years line management experience in a healthcare setting required.

Management experience in an academic medical center or integrated healthcare delivery system preferred.

WORKING CONDITIONS/PHYSICAL DEMANDS

Work is typically performed in a clinical environment.

The specific statements shown in each section of this description are not intended to be all-inclusive.They represent typicalelements considered necessary to successfully perform the job.

REVISIONS:

Devised: 7/06*

3:8:C

GEISINGER HEALTH SYSTEMDEPARTMENT OF HUMAN RESOURCESJOB DESCRIPTION

TITLE: RN-Inpatient CEP

FAMILY/GRADE: 77 Inpatient RN-Licensed / 02 JOB CODE: 4623

BARGAINING UNIT: No FLSA: Nonexempt

DEPARTMENT: Nursing LOCATION: GMC Campus

JOB SUMMARY

Responsible for all aspects of the RN Inpatient position, including assessment, evaluation, and coordination of care (see PositionDescription, RN Inpatient). Performs additional duties under the following possible domains: Mentor, Educational Liaison,Performance Improvement Coordinator, Clinical Coordinator. Each of the above domains carries with them additionalresponsibilities as defined in the nursing Career Enhancement Program.

Commitment to community service is encouraged and supported by the Geisinger Health System.


1. Performs all aspects of the RN Inpatient Position Description (see Position Description, RN Inpatient).

2. Satisfactorily completes all aspects of the domain selected in the Career Enhancement Program (mentor, education,performance improvement, clinical coordinator).

3. Submits necessary documentation to operations manager of performance in the Career Enhancement Program prior toperformance evaluation.



4. Meets and follows the division’s and organization’s established Service Standards.

5. Performs other duties as required or assigned by emergency or other operational reasons for which the employee is qualifiedto perform.


Demonstrates good organizational skills and effective communication skills.

Demonstrates consistently excellent clinical nursing skills, knowledge, judgment, and leadership in an independent environment.

Demonstrates the ability to work independently as well as in team environment.

Demonstrates ability to meet the requirements of the specific domain in the Nursing Career Enhancement Program.

Demonstrates ability to meet the requirements of the specific domains renewal process to retain this position (see Nursing CareerEnhancement Model).


Valid RN License in Pennsylvania required.

Minimum one-year experience in the unit required.

Satisfactory performance appraisal required (not in the active disciplinary process).

Completion of introductory period in the hospital prior to application required.


Work is typically performed in a clinical environment.


REVISIONS:

Revised: 11/07

Revised: 9/06

Devised: 6/03

EXAMPLE: MENTORING AN ASSOCIATE VICE PRESIDENT

CNO Sue Hallick appointed two new associate vice presidents (AVPs). She had begun mentoring CrystalMuthler ten years earlier when Sue was an operations manager and Crystal was an administrativesupervisor. Sue saw Crystal’s potential and began to teach and guide her while giving her opportunities togrow and develop. Sue’s protégé continued to shine—first as an operations manager, then a director—andnow as an AVP.

Sue values Crystal’s ability as a mentor so much that it is part of Crystal’s role to mentor the operationsmanagers.

According to Crystal, “Assuming an executive role on the nursing management team was both a growthopportunity and a new challenge for me. I had spent the previous fifteen years as a member of the nursingmanagement team, filling operational roles. My strength was identifying areas of weakness and findingsolutions to them. I believe that Sue had thoughts of an advanced role for me when, with her guidance, Ibecame the clinical director of the Surgical Suite. As clinical director, I was challenged with many issues inareas other than nursing and had to hone my negotiating skills. As an AVP, Sue has taught me to ‘paint the



picture’ in order to convey a broader message, increase understanding of issues, and to gain groupconsensus” (3:8:D).

3:8:D

GEISINGER MEDICAL CENTERDEPARTMENT OF HUMAN RESOURCESJOB DESCRIPTION

TITLE: Associate Vice President, Nursing Services, GMC JOB CODE: 1052

FAMILY/GRADE: 99/8 FLSA: Exempt

DEPARTMENT: Nursing Service Line LOCATION: GMC Campus

JOB SUMMARY

Responsible for overseeing the operational activities of the nursing services GMC campus as directed by the Chief Nursing Officer.Manages assigned personnel daily operations and related activity in conjunction with the direct operational leadership teams inassigned areas. Duties and responsibilities will include supporting the operations manager teams and department service lineswhich interface with nursing services and the overall system Nursing Service Line strategy. Assists in the oversight of all nursingclinical practice, employee relations issues, budgetary process, and associated regulatory activities, quality, and safety of nursingpractice on that campus.

Performs all duties to promote and lead the highest level of patient care and maximum patient satisfaction.

Reports directly to the Chief Nursing Officer.Works in conjunction with Service Line.


Leadership:

1. Demonstrates characteristics and behaviors necessary to assure employee understanding and acceptance of the systemdriving strategies.

2. Effectively communicates vision, goals, and initiatives at the Nursing Department unit level.

3. Effectively incorporates goals, vision, and initiatives into unit/department plans.

4. Participates effectively as a member of committees and departmental and divisional leadership teams.

5. Facilitates team-based problem solving within and between departments.

6. Leads the process to build a nursing leadership “bench” to assure leadership accountability is achieved and maintained.

7. Is a key role model and mentor for new nursing leaders within the Nursing Department at GMC.

EDUCATION/COACHING/CAREER ENHANCEMENT

1. Facilitates continuing education and research opportunities for employees, self, and community to support growth andenhance the contribution to Geisinger Health System.

2. Utilizes team building concepts to effectively empower team members by serving as a mentor, teacher, and coach.

3. Assures educational needs of all staff and leaders are addressed and met.

EMPLOYEE MANAGEMENT

1. Facilitates development, maintenance, and success of unit teams via mentoring of unit leaders and support of the NursingDepartment philosophy.

2. Provides feedback to team regarding performance and job-related issues.

3. Enhances skills of team members, such as decision making, problem solving, conflict resolution, human resource management,communication, and leadership.



SERVICE/QUALITY/COST

1. Demonstrates and establishes accountability for continuously improving the work unit, department, division, and system bydeveloping performance expectations and goals that focus on service, quality, and cost.

2. Communicates a clear description of performance expectations and goals to employees, encouraging and supporting theirparticipation.

3. Establishes appropriate benchmarks and directs action plans to address out-of-benchmark performance in conjunction withthe Chief Nursing Officer.

PATIENT/CUSTOMER SATISFACTION

1. Develops and promotes service standards which foster a customer-sensitive environment.

2. Measures performance against standards and seeks team commitment to exceed standards.

3. Facilitates staff ’s management of patients and customer-related issues.

RISK MANAGEMENT

1. Collaborates with the Chief Nursing Officer, Medical Director, and medical staff on issues of patient care and nursing/physicianstandards.

2. Works with the team coordinators and operations managers to influence and share accountability for utilization managementand cost-effective outcomes.

3. Proactively reviews the units/systems exposure to develop educational activities for employees/associates which will reduceliability.

STRATEGIC PLANNING/IMPLEMENTATION

1. Anticipates problems/risks and supports change.

2. Effectively adjusts plans.

3. Develops and implements departmental and divisional program planning.

4. Develops capital, financial, human resource quality, and service plans.

5. Implements plans through team-based empowerment.

FINANCIAL PERFORMANCE

1. Assists in the oversight of the GMC nursing budget in conjunction with the Chief Nursing Officer and financial liaison.

UTILIZATION MANAGEMENT

1. Facilitates business and clinical decision-making issues involved in materials procurement and usage.

2. Monitors and maintains cost-effective utilization of resource.

3. Works in conjunction with Material Management to oversee materials resource utilization.

PATIENT SAFETY IMPROVEMENT

1. Ensures that the patient safety improvement and management program will be given high priority and will support theprogram.

a. Ensures that sufficient time is available for staff participation in patient safety activities at both the department andorganizational level.

b. Ensures that staff attends all required patient safety education programs.

Performs duties as required or assigned by emergency or other operational reasons for which the employee is qualified toperform.




Demonstrated positive employee relations, staffing effectiveness, and resource management.

Must possess successful conflict resolution abilities and budget management skills.


Current RN license or eligible for licensure in Pennsylvania required. Bachelor's Degree in related field required.

Master’s Degree in healthcare administration or related field required or commitment to obtain.

Minimum of 5 to 8 years line management experience in a healthcare setting required.

Management experience in an academic medical center or integrated healthcare delivery system preferred.


Work is typically performed in a clinical/office environment.


EXAMPLE: A SECOND AVP

A similar situation occurred with the second AVP, Denise Beechay, who started as an administrativesupervisor and interacted with Sue Hallick on a daily basis. It quickly became clear that the two sharedmany common interests and Sue was committed to helping Denise grow professionally. She offered Deniseopportunities to increase her experience as an operations manager, then as a director, and now as AVP. BothAVPs credit Sue as being an integral part of their professional growth.

EXAMPLE: AN OPERATIONS MANAGER’S ACCOUNT

Ann McFaddin, RN, (operations manager of Women’s Outpatient) tells her story about her mentoringexperiences: “The growth and development of people is the highest calling of leadership. Being a part of theWomen’s Service Line team has, for me, been a time of growth and development as a manager. I steppedinto the role of an operations manager after being a team leader for numerous years. My mentor to the roleof team leader was the outgoing operations manager, Claire Varney, a fellow RN. She saw potential in staffand sought ways to develop those who showed energy and a desire to excel. Claire taught me a great dealabout handling daily operations and increasing patient and staff satisfaction. Before her retirement, Claireopened my eyes to the aspect of management. As one of the operations managers of Women’s Health, I usethe skills she taught me on a daily basis.

“During the past year, I have learned a set of new skills. Our leader is Ruth Nolan, RN and vice presidentof the Women’s Service Line. I have great admiration for her. Ruth accepted this position in February 2006.She was new to Geisinger, but you would not know that by talking with her. She quickly learned thedynamics of the system and has taught us something new on a daily basis. Her philosophy aboutdeveloping others is ‘I can contribute a small amount, but what the team can contribute is much more.’

“Ruth promotes a collegial atmosphere characterized by the entire team’s consideration and respect forone another. Each member of the team is valuable. Our strengths are recognized and acknowledged. Ruthasks our opinion on many operational issues and processes all our options. We process the positive and



negative issues and formulate an action plan. The team is unique in its design, the vice president andoperations manager are both RNs. It allows us to look at the clinical side of an issue as well as theoperational impact.

“With the knowledge and building blocks I obtained, I was able to create a plan for the team leaders inmy units. I began with four clinical team leaders, a lead ultrasound technician, and a team leader for thesupport staff. The year has seen much growth and development as we learn how to interact with oneanother and learn our roles. Together, we designed a plan for the team leader’s development that includedbiweekly meetings to allow me to provide the tools for success. Developing others in the team andempowering them to their full potential is very important to me. Formulating councils within thedepartment has been very rewarding as I observed the staff becoming involved in process and flows that willultimately improve the safety and satisfaction of staff and patients. Encouraging the staff to bring theirthoughts and ideas to the table improves daily operations.”

MENTORING DIRECT-CARE NURSESMentoring and succession planning at GMC is not limited to the leadership staff. It occurs throughout alllevels of nurses.

EXAMPLE: RAISING INTEREST IN CERTIFICATION

Joan Mervine, RN, clinical nurse educator, has worked with two surgical units for five years and has workedhard to gain the unit staff ’s trust and confidence. She has mentored a number of nurses over the years, butone in particular—Charity Derr, RN—stands out. Charity works as a staff nurse on BP5 Orthopaedics. AsJoan began to interact with the staff, Charity’s interest began to grow. Joan guided Charity’s progress andinvolvement. Charity became engaged in unit activities, in the Career Enhancement Program, and in one ofthe nursing department councils (NSQPI). Charity is active on this council and represents her unit well.She has become a unit leader and continues to take on more responsibilities. Through her mentoringefforts, Joan raised the interest of other staff nurses in obtaining medical-surgical certification. Charity wasone of the first to take the challenge and now she, too, leads the charge for other qualified nurses on herunit to do the same.

CERTIFIED NURSES ON BP5

Joan Mervine, RN Medical-Surgical Certification

Bonnie McWilliams, RN Orthopaedic Nurse Certification

Sheila Zanella, RN Orthopaedic Nurse Certification

Carol Payne, RN Orthopaedic Nurse Certification

EXAMPLE: STAFF-TO-STAFF MENTORING

Experienced nurses also mentor newer, less experienced nurses. The process often benefits both participantsmore than either one anticipated. Ann Keilbasa, RN, one of the more experienced nurses in the Cardiac



Intensive Care Unit, noticed that a new graduate—Ann Reiner, RN, who was just out of orientation—wasstruggling. Ann took Amy under her wing and offered her help and guidance. Ann would check in withAmy when they worked the same shift, making sure Amy understood her assignment and was adapting tothe intense environment.

Ann also intervened when other staff members were with the new nurse, encouraging them to help Amylearn. Now Amy is an experienced critical care nurse. She credits Ann with helping her survive those firstfew months and values her support and guidance. Amy still occasionally seeks out Ann for guidance. Theyhave developed a long-lasting and trusting relationship.


3:8:A Mentorship Program

3:8:B Job Description Reflecting Mentoring Role: Inpatient Nursing Operations Managers

3:8:C Job Description Reflecting Mentoring Role: RN Inpatient-CEP

3:8:D Job Description Reflecting Mentoring Role: Associate Vice President

geisinger magnet application

Documents

hospital council staff

council leaders

andsupport staff

staff suggestions

nursing council structure

successful leaders

nurse leaders

council members