2009 Annual Nursing Report

The 2009 Princeton HealthCare System Annual Nursing Report celebrates the many impressive accomplishments of our nursing staff. As the articles that follow illustrate, our commitment to providing “Excellence Every Day” has inspired us to achieve great results for our patients. Within these pages you will find stories highlighting our transformational leadership, exemplary professional practice, structural empowerment, new knowledge, innovations and improvements, and empirical quality outcomes.

Guided by a clear mission, vision and core values, the PHCS nursing staff impacts our organization

and community through an established learning environment, collaborative practice, and a model

of “Shared Governance,” giving direct care providers a voice in the practice of professional nursing.

Through the use of this model, quality patient care is assured, and we can focus our practice on

establishing caring relationships with our patients and their families.

PHCS President and CEO, Barry

Rabner, and the entire senior executive

team join me in congratulating

the Princeton HealthCare System

nursing staff on their remarkable

accomplishments and vision for the

future. While this annual report marks

a special opportunity to recognize our

nursing staff’s commitment to caring,

teamwork and nursing excellence, it is

the continued praise and recognition

from the patients we serve that

speaks the loudest.

Dr. Susan G. Lorenz, DrNP, RN, NEC-BC

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Nursing Leaders

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Princeton HealthCare Systems’ Certified Nurses

Board Certification of Nurses plays an increasingly important role in the assurance of high standards of care for patients and their loved ones.

J7Jennifer AllenEileen Aneskewich Michelle BasiloneDaphne Berei Clare Chang Leslie FeldmanConnie Gong Qinghe Jiang Kelly Lacava Robin Luco Denise McGinley Amy Miller Sheenamol Nair Myanh Nguyen Olubukola Osinowo April Seifert Humility Sumayang Elaine Tarnofsky Eva Treder Hong Yan

J6 Susan AndersonSusan GreenanSusan Jafar Ann Laughlin Barbara Reese Kathleen Ryan Maria Stout

B5Donna Covin Kathleen Seneca

ICU/CCULorna Barron Mayda Federovitch Charles Gallagher Jennifer Mac Jason Ou Megan PerdoniKristen Peterson Mindy Tanpiengco Janet Viscomi

LDRPChristine Anobile Stacy Booher Beth Brogan Barbara Demetrician Esta Desa Margaret Deysher Pam Ellet Carol Fabian Katie Faul Claire Fazio Sheri Glanding Barbara KettererKaren KraehnbuehlKelly Lamonica Miriam LecureauxYufung LuPatsy Mather G. Ann McGuireMelissa Parker-Combes Dawn Rittley Neydin Rivera Nicole Rook Kim Vu Jung Yun

SCNKate Faul Maria GouldBarbara HeruskaKimberly HoganMargarita LimDonna Seitz Grace Shah Bella Edessa Somera

EndoscopyNoreen Darbenzio Donna Eicke Lynne Forester Colleen Haraz Sau Jung Vicki Meisel Ellen Rodriguez Karen Zipper

ORJoan Boczany Jennifer Bousenberry Bihju BrodyKatie Conrad Alison Fuhr Gail Haftel Sharon Hamilton Helene Herbert Joy Hubbard Ann KingPatricia Lum Susan Macera Fe Moreo Lori Mozenter Janet NapolitanoKiersten Scully Patricia Soto Josephine Waseleski Eugene Yap

PACUSusan Ayres Debra Brian-Taft Loretta Chipin Danielle Daab Eileen Devlin Marylou Gaffney Beth List Mary Maguire Diane Willan

B2Veronica Amegavluie Inez Brandon Stella Chang Allysone Freda Liya Gu Murielle Jeanty Miran Kim Wendy Luca Monica Lyle Judy Mariani Jennifer Neumann Adena Romeo Nandy Singh Lee Welser

Infusion Room Elizabeth Beckett Jordana Leblanc Lori Anne Leonardi Barbara Pevahouse Linda Powel

Acute RehabJoan Aprigilano Fran Nawn Mary Ann Protz

PEDSLynda Proto Griselda Quia

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EDULydia Pitonyak

EDJeannie Arena Robin Boyer David Clark Richard HarrisMark Mackavanagh Maureen McAteerKristen Montefusco Lori Sletta Christine Wiggins Regina Zupanc Float Team NursesDebra Davies Maria Hevery Melissa Lagrotta Carol Schwab Toni Cranmer

Cardiac & Pulmonary RehabNancy Alpaugh Mary Ricci Sally Stout Loretta Voorhees

Cardiac Catheterization LabAllison Yiacas

Community EducationKaren Davison Laura Lettbetter Elsa NegrinJoy Rees Karen Rust

Department of EducationCarolynn Bitzer Geri Karpiscak Patricia Lum Melinda Petillo Department of Medicine/Cancer ProgramMary Bracke Ellen Land

Diabetes Management ProgramDebbie Brown-Kuhn Sheila Handel Nancy Rhodes

HomeCarePatricia Anene Lilia Barrias Tina Berger Christine Diaz Maureen Jarzyk Karen Kraenbuehl Monica Lyle Naomi McCarty Susan Mikolon Sheryl Moncrief Cynthia Raymond Imelda Remolado Teresa Scott Maryanne Sheerin Joy Weinberg Ellen Williams Judith Wilson Barbara Yost Sandra Young

Infection ControlKathleen Hill Information TechnologySusan Sunyak Interventional RadiologyVida Kaplan MerwickRashmi Seghal

Nursing AdministrationKaryn Book Barbara Christiano Paula Davis Rebecca Doherty Sandy Evanko Denise Kurtz Jennifer LaFavers-HollanderSusan Lorenz Carolyn Schlesier

Occupational HealthMaureen Abbott Barbara Koprowski Barbara Goldfluss Brenda Lay PelkaColleen Rossi

Outpatient ClinicAnn Marie Maldarelli Jeanette Levin Maureen McSorley Teri Nachtman Karen O’Brien Lee Ann Popovich Karen Rossi Joan Saccenti Laura Snare Mary Ellen Spencer

Pain ManagementCarol Burns Diane Foreman Ann Perry Donna Post Performance ImprovementLynn BennettKathleen Rauch Princeton HouseLisa JohnsonGary SnydermanColleen Toler

Radiology/Radiation OncologyCindy AstaCathy Kyne Surgery CenterDiane BrewerToni BrushnahanJanet Donnelly Christine FaustTerri FinkChris Hicks Laurie Kopanyi Cheryl KotarskiJane Platt Patricia RogersLinda Vasquez Anissa Viterito

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J7April Seifert BSN

B5Lisa Davis MSNLauren Firman NY Times Nurse of the Year Finalist Nathalie Georges MSN

ENDOTrina Brinkley MSN

ORAnn King AORN Princeton Chapter 3109 PresidentPatricia Lum AORN Princeton Chapter 3109 Vice PresidentEileen Snyder AORN Princeton Chapter 3109 Treasurer and BSNPatricia Soto AORN Princeton Chapter 3109 SecretarySharon Hamilton MSN

PACUDebra Brian-Taft BSN

B2/Infusion RoomElizabeth Beckett Mercer County Oncology Nursing Society President Wendy Luca Mercer County Oncology Nursing Society Treasurer and MSN Monica Lyle Mercer County Oncology Nursing Society Vice-President Adena Romeo Mercer County Oncology Nursing Society Secretary

EDUCatherine Hegedus Princeton Health Commission Member/Princeton Alcohol & Drug Alliance Liason

MerwickClaire Smith MSN

Princeton HouseLisa Johnson BSN

Diabetes ManagementNancy Rhodes Chronic Diabetes Advisory Council Member, NJSDOH & Senior Services Member, Diabetes & Chronic Disease Prevention & Control Program Member, Garden State Association of Diabetes Educators (GSADE) Executive Board Member, Website Administrator, Co-Chair of Annual Meeting, Chair of Nominating Committee

Home CareCarol Blount Contributor to Suzanne Gordon’s new book titled When Chicken Soup Isn’t Enough: Stories of Nurses Standing Up for Themselves, Their Patients, and Their Professions

Nursing Achievements

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Employing Evidence-Based Intervention to Reduce Interruptions by the Nurse During Medication AdministrationJune 2009: Organization of Nurse Executives, New Jersey Annual Research Day, New Jersey Hospital Association, Princeton, NJPresenter: Kathleen Seneca, MSN, RN, CNL BC, Clinical Nurse Leader, Telemetry

Experienced: But Not on a Dragon BoatJuly 2009: National Nurse Staff Development Organization National Convention, San Diego, CAPresenters: Carolynn Bitzer, MSN, RN, APN, BC, FNP, CS, Clinical Nurse Educator, Medical-Surgical and Pediatrics Kathleen Ryan, BSN, RN-C, Nurse Manager, J6

Interdisciplinary Interventional RoundsJuly 2009: Clinical Nurse Leader Leadership and Innovation Symposium, Portland, ORPresenters: Donna Covin, RN, MSN, CNL, Clinical Nurse Leader, ICU/CCU/IMCU Kathleen Seneca, MSN, RN, CNL BC, Clinical Nurse Leader, Telemetry

Beginning a Lean Journey: Emergency Department ThroughputSeptember 2009: Nursing Management Conference, Chicago, ILPresenters: David Clark, RN, CSSGB, Manager, Emergency Department Jennifer LaFavers, RN-BC, CSSGB, Manager, Nursing Resources Pamela Neuman, BS, Staffing Coordinator

Car Seat Tolerance TestSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJPresenter: Judith Miller, BSN, RN, Staff Nurse, Special Care Nursery

The Development of a Sleep Protocol to Promote an Enhanced Healing EnvironmentSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJ (Abstract and poster accepted at Nurses Improving Care for Healthsystem Elders (NICHE) Conference, April 2010, Baltimore, MD)Presenter: Christine Andreyko, RN, BSN, PCCN, GRN, Staff Nurse, Telemetry

EB Approach to the Stryker Infusion PumpSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJPresenter: Barbara Reese, BSN, RN, ONC, Assistant Nurse Manager, J6

Employing Evidence-Based Intervention to Reduce Interruptions by the Nurse During Medication AdministrationSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJPresenter: Kathleen Seneca, MSN, RN, CNL BC, Clinical Nurse Leader, Telemetry

Poster Presentations—2009

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Experienced: But Not on a Dragon Boat September 2009: Nursing Management Conference, Chicago, ILPresenter: Kathleen Ryan, BSN, RN-C, Nurse Manager, J6

Febrile Neutropenia: Evidence-Based PracticeSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJ (Poster accepted at 35th Oncology Nursing Congress, May 2010, San Diego, CA)Presenters: Inez Brandon, BSN, RN, OCN, CHPN, Assistant Nurse Manager, B2 Oncology Lee Wesler, BSN, RN, OCN, Assistant Nurse Manager, B2 Oncology Jordana LeBlanc, BS, RN, OCN, Staff Nurse, B2 Oncology Monica Lyle, BS, RN, OCN, Staff Nurse, B2 Oncology Jennifer Neumann, BS, RN, OCN, Staff Nurse, B2 Oncology Wendy Lucas, MSN, RN, OCN, Nurse Manager, B2 Oncology Carolynn Bitzer, MSN, RN, APN, BC, FNP, CS, Clinical Nurse Educator, Medical-Surgical and Pediatrics

Improving DVT and PE Prevention for Surgical PatientsSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJPresenters: Eileen Snyder, RN, CONR, Staff Nurse, Surgical Services/OR Mollie Nutkiewicz, RN, BSN, Staff Nurse, Surgical Services/OR

Refining the Patient Room: The Live Patient Mock UpSeptember 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJ (Accepted for presentation at Pebble Project—Center for Health Design Conference, April 2010, Philadelphia, PA) (Abstract and poster accepted at Nurses Improving Care for Healthsystem Elders (NICHE Conference, April 2010, Baltimore, MD)Presenter: Susan Lorenz, DrNP, NEC-BC, RN, Chief Nursing Officer

What is the Gold Standard for an IV in an Eating Disorder Patient?September 2009: Fifth Annual Research Day, Poster Presentation, UMCP, Princeton, NJPresenter: Terri Voigtsberger, RN, Staff Nurse, EDU

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Publications—2009

Karyn Book, MSN, RN, CLSSYB, Professional Practice Coordinator, published an article in Nursing Management titled “C.O.M.E. be a Nurse Manager.”

Angela Champion, BSN, RN, Staff Nurse, J6, published an article in Plastic Surgical Nursing titled “Motivating Factors for Seeking Cosmetic Surgery: A Synthesis of Literature.”

Carol Hanselman, RN, Staff Nurse, Telemetry, published an article in Global Public Health titled “Increasing Primary Health Care Through Nurse Entrepreneurs: A Pilot Program in Burundi.”

Kathy Rauch, BSN, RN, CPHQ, Director, CCOPA & Risk Management, published an article in Journal for Healthcare Quality titled “Excellence in Action: Developing and Implementing a Fall Prevention Program.”

Claire Smith, MSN, RN, CNL, CRRN, Assistant Director of Nursing, Merwick Care Center, published an article in PADONA CEU titled “Conflict Resolution in the Long-Term Care Setting.”

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UMCP Implements Shared GovernanceanceThe Shared Governance Model developed for University Medical Center at Princeton’s Nursing Department in January 2009, was designed to improve patient care by providing nurses at all levels an opportunity for meaningful input into key decisions impacting nursing practice and administrative policy and procedure. By empowering the nursing staff, Shared Governance provides a catalyst for improving nursing practice, professional development, work environment, and staff satisfaction.

The guiding principles of Shared Governance, as developed by the UMCP Nursing Board in 2009, include: a unified vision, a unified voice, developing and improving best practice and collaborative efforts between leadership and staff.

Both staff nurses and nurse leaders play key roles in the Shared Governance Model, focusing on the following responsibilities:n Leaders must believe in the judgment and expertise of the staff because they are the providers that best understand the issues affecting patient care delivery.n Leaders must articulate the vision for the department and support and allow others to make decisions related to patient care delivery service, educational needs, and professional growth.

n Staff nurses must be committed and flexible in participating in the process and driving success.n Staff nurses must serve as the key component in developing a Shared Governance Model and seeing it through to the development of councils.

Hospital-based and unit-based councils were formed in the fall of 2008 to assist in identifying issues within the Nursing Department and collaboratively deciding on solutions. They include: Executive Council, Performance Improvement Council (with a SWAT Subcommittee and Falls Subcommittee), Staff Nurse Advisory Council, Clinical Practice Council (with a Policy and Procedure Subcommittee and an Information Technology Nursing Subcommittee), Professional Development Council (with a Nursing Newsletter Subcommittee, Recruitment and Retention Subcommittee and Nursing Recognition Subcommittee), Research Council, and Nursing Board Council. In addition, each area is represented by a unit-based council, including the outpatient areas.

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2009 Shared Governance Accomplishments

n Chairs and Co-chairs were mentored by their advisors, Susan Lorenz, RN, DrNP, CNAA-BC, Vice President of Patient Care Services and Chief Nursing Officer; Barbara Christiano, MS, RN, BSN-BC, Director of Nursing; Geri Karpiscak, MSN, RN, Director of Professional Practice, Education and Customer Service; Kathleen Ryan, BSN, RN-C, Nurse Manager, J6; Kathleen Seneca, MSN, RN, CNL BC, Clinical Nurse Leader, Telemetry; and Karyn Book, MSN, RN, CLSSGB, Professional Practice Coordinator, Nursing Administration. They were educated on how to conduct a meeting with their peers, develop agendas, write meeting minutes, and communicate with their councils between meetings.

n All council members were introduced to Robert’s Rules for the Shared Governance Model, as well as the bylaws developed by the Magnet Champions, who were comorised of members selcted from each department.

n The Reseach Council adopted The Iowa Model of Evidence-based Practice as a Research Utilization Model was adopted to guide research at UMCP.

n The fifth Annual Research Day was held Sept. 16, 2009, focusing on Advancing Evidence-Based Research and featuring guest speakers as well as presentations from five UMCP nurses.

n A total of eight projects — six with posters accepted at national conferences, three resulting in pending policy change — were completed in 2009.

n Nursing Matters now has a research column and three research columns ran in 2009.

n The 6th annual Research Day was planned for Sept. 21, 2010, with the focus of Transforming Care at the Bedside.

n The weekend policy within the Nursing Department was revised.

n A comprehensive review and development of action plans was undertaken related to the Nurse Engagement Survey.

n Assistance was provided in the selection of the nurse call system and the Nurse Server design for the new hospital.

n Over 200 nurses achieved their certification and were recognized on March 18, 2009.

n During the week of May 3, 2009, National Nurses Week, nurses across PHCS were celebrated.

n Nurses nominated and recognized their peers across the system for nursing excellence during the Nurses Week Awards Ceremony.

n An initiative was spearheaded to promote nursing professional development by adding degrees and certifications on ID badges for nurses across PHCS.

n The abundance of community outreach efforts by PHCS nurses was recognized through the suggestion of the Professional Development Council.

n Outpatient Council held its first Outpatient Fair highlighting the departments and available services. All employees and visitors were welcome to attend.

n Staff nurses participated in interpreting Performance Improvement dashboards and communicating the information to their peers through their unit-based councils.

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LDRPThe LDRP adopted the GE Centricity Perinatal System, training close to 200 staff nurses, OB providers, pediatricians, and anesthesiologists, and becoming almost completely paperless. The only paper forms now in use are consent forms, a pioneering effort for University Medical Center at Princeton. The Staff Nurse Advisory Council has been working on policies and bringing best practice guidelines into current practice. Of note is the bilirubin screening for all infants prior to discharge. LDRP purchased transcutaneous bilirubin meters, which provide a noninvasive means to measure jaundice in newborns, preventing painful heel sticks and catching hyperbilirubinemia earlier, resulting in prompt treatment.

B2The Unit-Based Research Council wrote an abstract that was selected as a poster presentation titled Febrile Neutropenia: Spread the Word! at the Annual Oncology Congress, which was held in San Diego.

OR The Operating Room staff has made tremendous strides in becoming more “green.” The first initiative was to reduce red bag waste. The staff has successfully reduced red bag waste by only putting “contaminated” items in the bags. After several months of changing past practices and old habits, recycling was instituted in the OR. All non-contaminated plastics (numbers one through six); aluminum; glass; and cardboard are now recycled, reducing clear bag waste. The next phase of the OR green initiative is to introduce specialty packs to decrease the amount of unneeded supplies being opened. The OR is also planning to start a recycling program for blue sterile wrap, which contributes to approximately 50 percent of the clear bag waste.

EDUThe Eating Disorder Unit is working on an interdisciplinary research project that will follow patient outcomes after discharge from the inpatient program. The Unit-Based Clinical Practice Council nurses joined forces with several EDU therapists, a mental health associate, and a nutritionist to begin the collaborative project. The unit hopes to have a sample of 150-200 patient outcomes over a two-year period. EDU is in the early stages of research, and is currently critiquing articles for its literature review. The unit will begin to track possible contributing factors to recurrence or relapse of patients, as well as how long they maintain recovery. The EDU hopes to be able to contribute to the relatively small amount of research that has been done regarding eating disorder patient outcomes.

Unit-Based Councils Activities Report

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SCN The SCN Unit-Based PI and Research Committee members, in collaboration with a CHOP neonatologist, revised the Car Seats, Monitoring of Premature and Low Birth Weight Infants Policy. The policy has been approved and is currently in use.

OutpatientAs an initiative for the Magnet Outpatient Council, members identified a need for increased awareness of University Medical Center at Princeton’s Outpatient Services. Since there have been a number of new outpatient programs established at UMCP, both staff and community education was necessary.

Council members opted to hold an intradepartmental OP Services Fair on Sept. 29, 2009, in Ground Floor Conference Rooms A & B. Outpatient departments were invited to participate, and those expressing an interest in participating were given guidance on how to showcase their services at the fair. This included staff biographies, poster presentations of services, and pamphlets and educational tools, along with giveaways, generous raffle prizes, and refreshments. Exchanging information regarding their specific services was freely discussed among the fair participants. The outcome exceeded expectations. Attendance by employees, as well as the community, was heavy. Feedback was extremely positive, and it was apparent that considerable information about UMCP Outpatient Services was disseminated.

During the post-fair discussion held during the Magnet OP Council meeting in October 2009, the decision was made to host at least one OP Services Fair each year, expanded to include OP departments that did not participate in the first event. Improvements in publicity and room arrangement were also discussed.

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Nursing Research Council Formed

Though still in its infancy, several notable research projects were already flourishing by the end of the first year. Seven projects were being led by staff nurses, five with posters accepted to national conferences, and three involving pending policy change.

The first step in creating a culture of research was to assess the current culture. Council members created a survey to assess their colleagues’ awareness of council activities and nurse-led projects within the institution, visibility of research, as well as interest. With baseline information obtained, the council initiated an awareness campaign, including monthly Research Council educational displays and email communication regarding the council.

The Shared Governance based Nursing Research Council was formed in 2009 and has already

evolved into a passionate group representing both inpatient and outpatient units. The purpose of

the Research Council is to educate and mentor nurses and nursing students in their understanding

of clinical research and evidence-based practice. Assists to facilitate the integration of research in

the clinical setting, translate evidence based practice into clinical practice and facilitate conducting

nursing research. Integrating research into practice, and as a result transforming care at the bedside,

is the ultimate goal of nursing research.

The first task at hand was “to encourage and facilitate education on research and evidence-based practice through conferences, journal club meetings, Research Day, and other educational offerings.” In 2009, the council also adopted the Iowa Model of Evidence-Based Practice as its research utilization model to guide practice, and meetings, as well as conferences, provided continued education to members. The Organization of Nurse Executives of New Jersey (ONE) NJ Seventh Annual Research Day and the 2009 ANCC (American Nurses Credentialing Center) Magnet Conference provided educational opportunities to some members, who then brought newly acquired knowledge back to share with their fellow council members.

Since its inception, attendance at council meetings has increased, and to raise awareness throughout Princeton HealthCare System Research Council updates are provided at staff meetings, and the council maintains a standing column, Research Matters, in the Nursing Matters newsletter. Promotion of education related to research, a continuing goal from 2009, is ongoing. Education is now a standing agenda item at every Research Council meeting; topics include the Iowa Model, research terminology, and research critique. The council is planning to extend education to their colleagues through in-services and traveling posters highlighting projects, and plans for Research Council bulletin boards, traveling posters and monthly research facts are underway to improve visibility.

Audrey Amir, BSN, RN, PCCN

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Research Day 2009 Focuses on Advancing Evidenced-based Research

The University Medical Center at Princeton hosted its fifth annual Research Day for Princeton

HealthCare System on Sept. 16, 2009. A total of 65 nurses had the opportunity to hear national,

regional and local speakers share their expertise on nursing research and evidence-based practice

(EBP). Nurses from UMCP exhibited 16 posters highlighting their research and EBP projects.

Louise Yorke, PHCS Medical Librarian, demonstrated how to access our library database for those

researching future projects.

Sheryl Smolensky, RN, Clinical Researcher, UMCP Cancer Program, began the day outlining the evolution of research and the use of human subjects, including landmark legislation that evolved to protect the rights of research subjects. She explained the implementation of the Internal Review Board (IRB), which reviews, approves, and monitors all studies involving human subjects, as well as the process for obtaining IRB approval. She concluded with an explanation of the four phases of clinical trials, protocols for clinical studies, and schedules required for validation.

Audrey Amir, RN, Staff Nurse, Telemetry, presented the Iowa Model for nursing research. This was the research model selected this year by the Nursing Research Council. She demonstrated the use of the Iowa Model tools to guide ongoing nursing research and EBP projects at PHCS.

Susan Fowler, Manager of Clinical Nursing Research at VNA of Central Jersey, shared keys to success for EBP projects and nursing research. She encouraged nurses to use the art and science of nursing practice to guide future nursing research. She demonstrated the formulation of a PICO (Population, Intervention, Comparison, Outcomes) question to develop research projects, explained how to utilize levels of evidence in research, and discussed the difference between nursing research and EBP projects.

The day ended with a presentation by Aline Holmes, RN, APNC, MSN, Senior Vice President of Clinical Affairs and Director of the Institute for Quality and Patient Safety at the New Jersey Hospital Association, emphasizing the ongoing need for nursing research.

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Nursing Matters Newsletter Launched

Nursing Matters was launched as a quarterly newsletter published by and for the nurses at Princeton HealthCare System. The Newsletter Committee consists of nurses from throughout PHCS, and reports to the Chief Editor and the Professional Development Committee. The publication highlights individual nursing accomplishments throughout PHCS, as well as unit- and system-wide initiatives. Recurring columns include “Research Matters,” submitted by the Nursing Research Committee; “It’s Our Niche,” submitted by the NICHE Committee; “Between the Stacks,” submitted by Louise Yorke, Medical Librarian; and a message from Susan Lorenz, RN, DrNP, CNAA-BC, Vice President of Patient Care Services and Chief Nursing Officer.

Nursing Grand Rounds Begin

Nursing Grand Rounds began as an annual event at Princeton HealthCare System in 2009, showcasing nursing’s role in providing comprehensive and holistic care. The program’s objective is to present a complex patient case in a formal lecture-style setting by nursing staff members who provided direct care for the patient and his or her family. Each nurse speaks about the patient and the challenges and successes involved in his or her care. The program provides a forum for an open dialogue to share information and enhance clinical reasoning skills. All speakers and planners adhere to the American Nurses Credentialing Center Commission on Accreditation standards, and continuing education credit is awarded to participants. Patients are de-identified with strict adherence to protection of spatient privacy.

Pictured left to right:Sandy Mariani, MSN, RN

Carolynn Bitzer, MSN, RN, APN, BC, FNP, CS

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Date Topic Credits

January 5 Cardiovascular Drug Pearls 1.0

January 20 Basic EKG Class 7.5

January 21 Hot Topics in Cardiology 7.0

February 26 Advances in Surgical Nursing 5.0

March 10 Pediatric Code Review 2.0

March 14 Bariatric Continuing Education Series 10.0

April 15 Preceptor Workshop 4.0

April 28-29 Pediatric Assessment Course 11.0

May 5-6 Shared Governance 1.0

May 12 Pediatric Code Review 2.0

May 28 Oncology Nurses Education Program 3.5

June 10-11 ANCC Gerontologic Certification Review Course 13.0

June 15 EEG Review 1.0

June 17 Skin and Wound Update Day 6.5

June 30 Nursing Grand Rounds 1.0

July 16 Parkinson’s: Comprehensive Review 2.75

July 24 Review of Non-Invasive Ventilation 1.0

September 8 Pediatric Assessment Review for the ED Nurse 4.0

September 8 Interventional Pain Medicine 1.0

September 14 Pediatric EKG & Respiratory Review 1.5

September 14 Preceptor Meeting-Providing Constructive Feedback 0.5

September 16 5th Annual Research Day 5.0

September 17 What’s New in Pain Management Medication 1.0

October 29 Orthopedic Day 6.0

Total CEUs Offered 98.3 Credits

Continuing Education Credits Offered, 2009

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CHOP Newborn and Pediatric Care Introduced

The Children’s Hospital of Pennsylvania (CHOP) Newborn and Pediatric Care was introduced at University Medical Center at Princeton in July 2009, resulting in the Pediatric Department’s continued growth in patient volume and the quality and expertise of care provided by the Pediatric Nursing staff. The department participates in bimonthly mock codes with the Emergency Department, and has taken on the task of standardizing the pediatric code carts throughout the hospital and in the Pediatric Clinic.

The Pediatric Nursing staff has continued to enhance their knowledge of topics such as autism and SIDS through guest speakers, seminars and continuing education programs. All of the nurses have completed competencies on the treatment of hyperbilirubinemia, respiratory illnesses, and sepsis workups. The prior experiences of the nursing staff have proven invaluable in the development of policies and procedures for the growing department. All of the nurses participate in a Shared Governance Committee, and some have traveled to CHOP for education on the special needs of children with gluten intolerance. This education has resulted in the reevaluation of the way care is provided to this growing population.

The department was completely renovated in December 2009, providing a warm, inviting atmosphere where pediatric patients can heal, and their families can be comfortable. New cribs with vinyl tops keep climbing children safe and are esthetically pleasing as well. The playroom is home to a large selection of donated books, board games, and a mobile Wii station to entertain the children as they recover.

Highlights at a Glance

n Eight UMCP nurses went to CHOP for three weeks of clinical shadowing rotation and nearly a dozen nurses went to Bristol Myers Squibb Children’s Hospital (BMSCH) at Robert Wood Johnson for clinical shadowing.

n A two-day pediatric care course was held at UMCP for new nurses and those in need of a pediatrics refresher.

n Monthly Pediatric Nurses meetings were held with an education component, and monthly pediatric services meetings were held for management, educators, and administrators.

n OR/PACU/AM Admissions pediatric education was held.

n A child life specialist from Bristol Myers Squibb Children’s Hospital (BMSCH) provided lectures for clinical and non-clinical staff on interacting with the pediatric population.

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Experimental Research of an Inpatient Room Mock-up: From Mock-up to ModelIn 2005, University Medical Center at Princeton joined the Pebble Project, an initiative created by the Center for Healthcare Design to assist healthcare facilities in creating evidence-based designs to promote healing. As a Pebble Project participant, UMCP is the first hospital in the nation to build a model room that will be used to treat patients prior to its replication in the new hospital. In 2009, the Robert Wood Johnson Foundation awarded Princeton HealthCare System a $2.8 million grant to assist in the collection and dissemination of research data and ultimate construction of the rooms in the new hospital.

Phase 1 of the project was considered the learning laboratory. Nearly 700 staff members, visitors, and patients provided input that resulted in over 200 changes in the room concept before a mock-up was construction. Once the mock-up room was fully functional and ready for simulation testing, a variety of guests spent the night and provided feedback concerning various aspects of the design.

Phase 2, the semi-immersive or simulation phase, is presently underway. Using the model room, simulations will identify any potential problems during events such as code blues, patient falls, and medication administration. The model room will be viewed against a comparable private room on J6 in these simulations, and will be evaluated both quantitatively and qualitatively for efficiency of space, use of patient care equipment, ability to maintain safe standards of care and caregiver comfort with procedures.

Phase 3 will involve the use of real patients and real patient scenarios to ultimately determine the best use of space, equipment, and safe care of patients, their caregivers, and the healthcare team. The final phase will be completed at the new hospital, to provide the ultimate assessment of the new room in the new hospital setting.

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NICHE: The ACE Nursing Unit: Meeting the Needs of Older Adults As a result of its commitment to redefining care for every patient, University Medical Center at Princeton (UMCP) was one of the first hospitals in the state to open an Acute Care of the Elderly (ACE) Unit. The highly specialized and progressive ACE Unit at UMCP, which opened January 2008, is specifically designed to enhance the care provided to elderly patients. The unit’s mission is to help older patients heal while maximizing their ability to retain their strength and mobility.

An exceptional team of healthcare professionals provides care in UMCP’s ACE Unit, including a board certified geriatrician medical director, and nurses specially trained to improve the care of hospitalized individuals age 65 and over. Each nurse working on J7, which houses the ACE Unit, has received 16 hours of geriatric-specific education. All nursing assistants have received eight hours of related training. The team is also led by the NICHE Coordinator and Nurse Manager.

The results are impressive. ACE units nationwide have been shown to reduce the length of a hospital stay, better preserve a patient’s ability to function normally, and increase patient satisfaction. The UMCP’s ACE Unit is one of many initiatives under the umbrella of the national Nurses Improving the Care of Healthsystem Elders (NICHE) Program, which aims to provide exemplary care to all older adults in healthcare settings. In the spring of 2008, UMCP became a designated NICHE site, an affiliation that highlights the dedication of the healthcare system’s nurses to improving care for geriatric patients.

Special features of the ACE Unit include:n Low beds to prevent falls.n Pressure-relieving mattresses to provide greater comfort, each equipped with a built-in scale to monitor weight.n Wall surfaces and door frames highlighted with contrasting colors to enhance depth perception in older adults. n Signs and display boards with larger than normal type to promote readability.

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J6: Transforming Care at the Bedside In July 2009, UMCP’s J6 Post-Surgical Unit was chosen to participate in the Transforming Care at the Bedside (TCAB) Program along with 50 other hospitals nationwide. The Institute for Healthcare Improvement, in partnership with The Robert Wood Johnson Foundation, launched this comprehensive effort to improve bedside care. The TCAB initiative is a framework for change, focused on improving care on medical/surgical units and built around several main categories, including patient centeredness, honoring the whole patient, patient safety, efficiency care processes and staff vitality.

Several staff members attended education sessions at the National TCAB Conference in Chicago in September 2009, and then returned to J6 to educate the entire staff. As a result, on Sept. 28, 2009, J6 held its first “Deep Dive” session to identify changes needed to improve care. Deep Dive is a brainstorming technique used to enable staff to verbalize and identify processes in need of change. During this four-hour session staff members broke into small groups and began brainstorming. Later, they clustered together common themes — for example equipment and supplies, staffing documentation and work flow — to gain a clearer picture of the proposed areas in need of change.

The staff, along with the J6 TCAB team, then began a quick process of testing each proposal and either adapting, abandoning or adopting it into the work environment. Some of the proposals that have been successful and/or are being improved upon include: post-op admission/discharge nurses who report to the unit at 11 a.m. and are responsible for all post-operative patients, admissions and discharges; identifying staff assignment acuity levels and placing visual markers on the J6 bed-board; placing welcome letters in patient rooms and family waiting areas; and bedside reporting, where nurses complete their hand-off communications to their shift replacement at the bedside, with patient/family involvement.

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Christine Andreyko, RN, BSN, PCCN, GRN, Staff Nurse, Telemetry

Nursing is about making a difference in other people’s lives, and through the Leadership Succession Training Program I am able to have an even larger impact. Through the guidance of my mentor, Daphne Berei, BSN, CNA, Nurse Manager, J7, I am able to help plan the transformation of the Geriatric Emergency Department to provide improved care for the elderly on admission to the Emergency Department. With goals set in place and the encouragement of my mentor, I achieved my GRN certification and had a poster abstract accepted at a national conference. It has been rewarding to collaborate

with other members at UMCP and be entrusted to initiate certain tasks during the process.

Nursing Leadership Succession Planning Program Launched The Nursing Leadership Succession Training Program at University Medical Center at Princeton (UMCP) was developed to provide a mechanism by which UMCP nurses would have the opportunity to be mentored into leadership roles in nursing. This program is part of the on-going commitment of the Senior Management Team to retain and promote nursing staff. In 2009, four staff RNs — Christine Andreyko, Inez Brandon, Linnea Gilmour and Lopa Patel — were selected from a group of applicants to participate in the first succession planning program. Their selection was based on work history, letters of recommendation and a personal essay. Their training began in November 2009, at the Aspiring Nurse Leaders four-day training program offered by the American Organization of Nurse Executives (AONE). Each participant was partnered with a mentor, and has been working with their mentor on an organizational project.

The following are thoughts from each of the four participants on their experience to date:

Inez Brandon, BSN, RN, OCN, CHPN, Assistant Nurse Manager, B2

The Leadership Succession Training Program has been a very interesting and eye-opening experience for me. Working with Susan Lorenz, RN, DrNP, CNAA-BC, Chief Nursing Officer, on the Model Room Project has provided me with a wide range of experiences in nursing leadership, as well as evidence-based healthcare design research. We have been working with a variety of contractors to develop the best patient room possible, based on evidence. We are currently working on phase two of Dr. Lorenz’s research project, where we are looking at the room from the perspective of staff as well as visitors. We have invited VIPs from the area to spend a night in the model room and provide their feedback. We also attended a Pebble Project Conference sponsored by the Center for Healthcare Design. The conference highlighted hospitals from around the world that are working on evidence-based healthcare design. Included

in the presentation was our own Dr. Lorenz, discussing our new hospital under construction in Plainsboro.

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Lopa Patel, RN, ANCC, Assistant Nurse Manager, J6

Harvey S. Stone said, “The Growth and Development of people is the highest calling of leadership.” I believe this is the foundation of the Leadership Succession Training Program. I have been given the opportunity to work alongside some of the most educated people in this facility, as well as being mentored by one of the nursing directors. Thus far this program has given me insight into which path I would like to pursue in nursing. I now have the privilege to be mentored by the director of education, Geri Karpiscak, MSN, RN, who has helped provide me with opportunities so that I can achieve my goal of being involved in nursing education, among other exciting projects. When I first was picked for this program, I had a clouded view of what I wanted to do with my career, but now that we are more than halfway through the program I have a clearer view of where I see myself five years from now. With the leadership and guidance this program provides, nurses on all levels

can aspire to be better, develop their skills, generate stronger teamwork and improve the manner in which nursing care is delivered.

Linnea Gilmour, BSN, RN, Staff Nurse, J6

The Leadership Succession Training Program has provided me a unique opportunity to work closely with many leaders throughout the organization. In particular, the mentorship component of this program has provided me a resource, coach, teacher, and advisor. Karyn Book, MSN, RN, CLSSGB, Professional Practice Coordinator, Nursing Administration, has included me in different projects that have generated a greater understanding for the organizational structure and financial components of the hospital budget. As an integral part of the In-Quality Staffing Project, an initiative through Caldwell Butler and Associates, the process of determining the number of work units per staff or unit on an hour-to-hour basis was both educational and challenging. For example, a result of this project revealed specific times to decrease the appropriate staff as the census decreased, while still providing quality care. I was able to facilitate a department meeting, develop different tracking tools, evaluate results, and present our findings. Throughout this process, I received constructive criticism, which has strengthened my abilities to succeed in these tasks in the future. In addition, my mentor has encouraged me to continue to pursue my short- and long-term goals by researching and discussing areas of interest. For this reason, I began my master’s degree in Nursing Administration this summer. More importantly, this mentorship has further enhanced my desire to pursue a career in leadership.

The Leadership Succession Training Program will continue through the fall of 2010, and has provided a variety of leadership training opportunities.

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Clinical Nurse Leader Program Advances

The University Medical Center at Princeton (UMCP) participated in a national pilot program with 90 educational institutions (five in New Jersey) and 190 medical facilities (21 in New Jersey) launched by the American Association of Colleges of Nursing in 2005. The program partnered healthcare providers with educational institutions in the development and education of future nursing leaders. Partnering with The College of New Jersey (TCNJ),

two UMCP candidates graduated from the Masters of Science in Nursing program in 2007, obtaining their

Clinical Nurse Leader (CNL) certification. The CNL position was launched on Telemetry in June 2007 with the guidance of the Director of Nursing Education and the support of the Vice President of Nursing. It is now in place in ICU/CCU/IMCU as well, with RNs from J6, B2 and J7 currently enrolled in the program.

CNLs are dedicated to promoting patient safety, providing clinical expertise at the bedside, promoting evidence-based practice, and laterally integrating multidisciplinary care for patients. Aligning with national efforts of the Institute for Healthcare Improvement, American Nurses Association and the Joint Commission, CNLs continually focus on quality initiatives, multidisciplinary collaboration, improving system functioning, and eliminating waste. They are unit-based champions for organizational efforts to achieve compliance with publically reported performance data, such as Leapfrog Core Measures.

At UMCP, CNL collaboration with Performance Improvement led to intensive education of nursing staff and development of a concurrent review team to ensure compliance with Cardiac

Core Measures. CNL recruitment of a physician champion facilitated physician education and compliance to these protocols.

Collaboration with Nursing Informatics facilitated the hardwiring of Core Measure compliance into computer documentation. CNL

attention to Nursing Sensitive Indicators allows them to become unit-based drivers of organizational initiatives such as the Falling Star

Program, Hourly Rounding with a Purpose, and Skin Care Rounds. Their intense efforts to educate and support nursing staff through the

Kathleen H. Seneca, MSN, RN, CNL, BCDonna S. Covin, MSN, RN, CNL

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implementation of these initiatives have enabled the success of these programs with measurable outcomes such as a reduction in the number of falls, reduction in the development of pressure ulcers, and reduction in the use of restraints on Telemetry. Efforts to better manage pain and to improve communication with patients regarding their plan of care has led to improved scores on UMCP’s Press Ganey Survey.

At UMCP, CNL clinical support and education of staff nurses has identified opportunities for improvements in the orientation process for new nurses on Telemetry. CNLs developed a didactic orientation program that ensures consistent knowledge transfer and skill development during the orientation process. Preceptors and new nurses now have a toolkit of policy and best practice references to ensure consistent transfer of knowledge, development of critical thinking, and initiation into organizational values and philosophy.

The program has enabled new nurses to complete orientation feeling confident, competent and prepared for independent practice. Nursing staff retention has improved significantly, confidence of both new and experienced nurses has increased, and orientation expenditures have decreased.

CNLs have presented the success of this program at two national conferences, one in October 2009 and the other in January 2010, and the template for orientation has been adopted throughout the hospital for unit-specific modifications based on each unit’s patient population. This program realized an initial annual savings of $41, 000 in extended orientation costs, and eliminated the $50,000-70,000 loss per nurse turnover. An unexpected benefit of this program has been increased physician confidence in the clinical competence of the nursing staff. Three preceptors on the Telemetry staff have been elected Chair or Co-Chair of Magnet Councils, and nine Telemetry nurses earned their Progressive Care Nurse certification this year.

Support of nursing leadership has been invaluable to the establishment and ongoing success of the CNL role at PHCS. New candidates have been identified for fall 2010 admission, and two candidates are currently in the Master of Science in Nursing program, Clinical Nurse Leader Tract. These two candidates are Juliet Puorro and Inez Brandon. Current CNLs Donna Covin and Kathleen Seneca serve as preceptors for CNL students from TCNJ and teach as adjunct faculty at the college. As a result, Donna Covin received the distinguished honor of being a finalist for the Tri-State Regional Nursing Spectrum Awards this spring and the UMCP Nursing Excellence Award for Leadership was awarded to Kathleen Seneca.

Juliet Puorro, BSN, RNInez Brandon, RN, BSN, OCN, CHPN

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Princeton HomeCare Services Initiates New Services

Palliative Care

Princeton HomeCare Services initiated palliative care services in June 2009, and introduced the new treatment option to the community through a series of presentations. In the first six months, over 60 patients coping with major, life-limiting illnesses were served.

The service offers individuals on homecare the psychosocial, spiritual and nursing expertise of a specially trained palliative care team. The goals of intervention are pain control, symptom management, quality of life enhancement, and spiritual-emotional comfort for patients and their primary caregivers. Under the physicians’ orders, team members treat symptoms, address end-of-life issues, and perform or instruct families in intravenous therapy. Team members are trained in IV therapy, chemo administration, advanced symptom management, end-of-life care, and care coordination with Hospice and community programs. The team is also comfortable discussing the preparation of a living will, advance funeral planning, and community resource options. Each patient’s needs are continuously reassessed, and all treatment options are explored and evaluated in the context of the patient’s goals, values and symptoms.

Many patients receive therapies at home, such as chemotherapy, total parenteral nutrition (TPN), and intravenous pain management therapy, but in-patient services are available for treatments that cannot be provided in the home. All palliative care patients receive nursing care, and may receive social work and chaplain services upon request. Other services are available when ordered by a physician, including home health aides, dieticians, pharmacist’s consultations and rehabilitation services.

Palliative care may be offered concurrently with “curative” therapies, and is not restricted to the end of a person’s life or to those enrolled in Hospice. Patients may choose to seek any treatment options available to them, and continue to use their existing health insurance plans during treatment. Potential palliative care patients may demonstrate: cancer diagnosis with metastases (METs), weight loss, repeated admissions to the hospital and deteriorating condition, loss of activities of daily living and significant effort to leave home, and end stages of a chronic condition such as MS, Alzheimer’s disease, or Parkinson’s disease.

Hospice

In 2009, the Hospice Team initiated the use of Complementary Alternative Medicine (CAM) treatments in coordination with its team of Hospice volunteers.

Professional staff and volunteers, under the direction of members of the nursing and physician staff, are trained to provide bedside yoga, massage therapy, aroma therapy, music thantology, art therapy, and other forms of CAM. This program has been well-received by patients and families, who must request CAM treatment before it can be provided.

While traditional medical treatments are effective for patients’ symptoms, many individuals request alternative therapies and respond positively to CAM care for the relief of physical and emotional pain or stress, resulting in an improved quality of life.

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Princeton House Behavioral Health Expands ECT

For many years, electroconvulsive therapy (ECT) was performed at University Medical Center at Princeton’s Surgical Services, but a growing need for the treatment resulted in a move to Princeton House Behavioral Health in 2006. In 2009, the Princeton House ETC Suite performed 2,065 treatments on both inpatients and outpatients, up from 1,630 in 2006.

ECT has been proven to be a safe, effective lifesaving treatment alternative for certain mental health disorders, including severe depression accompanied with psychosis, suicidal intent or refusal to eat or perform activities of daily living; medication-resistant mania and bipolar disorders; and severe schizophrenia; as well as for patients suffering from severe motor issues related to Parkinson’s disease. According to the Mayo Clinic, ECT has a higher success rate for severe depression than any other form of treatment, and has demonstrated rapid improvement when compared to medications alone. ECT is recognized to be safe for patients, who in addition have a variety of medical conditions, including heart, lung, kidney, and liver diseases.

Advancements in the delivery of ECT have resulted in patients experiencing little or no physical discomfort or cognitive affects, and improved patient outcomes. Each patient has a consultation with a specially trained ECT psychiatrist, an individualized education session with a specially trained ECT nurse, and an anesthesia consultation. Patient care is delivered by a highly trained medical team including critical care-trained or PACU-trained nurses holding current Advance Cardiac Life Support (ACLS) certification. All nursing care is administered in accordance with the American Society of PeriAnesthesia Nurses Association guidelines and may include pre-op, intra-procedural and critical care; PACU; patient advocacy and patient education.

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Surgical Services Advances Through AORN

AORN Chapter Formed

In April 2009, following a nine-month process that involved developing objectives, bylaws, and a membership roster, the surgical department was recognized as Chapter 3109, an official chapter of the national/international Association of Perioperative Registered Nurses (AORN). The officers include Ann King, MSN, CNOR, President; Patricia Lum, RN, BSHA, CNOR, Vice President; Eileen Snyder, RN, CNOR, Secretary; and Patricia Soto, RN, Treasurer.

In its first year, the chapter grew to 14 members, and began offering educational meetings complete with CEUs. The chapter looks forward to sending delegates to the national conference, which will be held in Philadelphia, PA, in March 2011.

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Perioperative 101 Program Launched

In 2007, University Medical Center at Princeton’s Surgical Services launched the AORN Perioperative 101 Program, through a licensure from the Association of Perioperative Registered Nurses. The web-based program offers selected nurses an opportunity to learn the perioperative nurse role through an eight-month education and orientation program. Since 2008, four courses have been provided and nine nurses have completed training, with the earliest participants now acting as team leaders.

The first seven weeks of the program focuses on classroom didactic sessions with the Perioperative Educator facilitating the program. After successfully completing this portion of the program, nurses move into the clinical area and are mentored and precepted with the experienced Perioperative Nurse. This clinical experience includes the circulating role, as well as the scrub role in all the specialty areas. The nurse orientee also rotates through other perioperative areas to receive a well-rounded orientation. These areas include the PACU, AM Admission, Anesthesia and Central Processing departments. The on-call requirement is introduced during the orientation period and includes “Buddy Call,” an on-call experience that prepares the nurse, who will provide patient care in urgent and emergency situation when she is in charge. A number of “Buddy Calls” are provided to the orientee under the supervision of an experienced Perioperative Nurse. When the orientation is completed, the nurses join the surgical team with the full responsibilities of a Perioperative Nurse.

Due to the substantial commitment of time and resources required for the program, participants are required to make a two-year employment commitment to UMCP.

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Redefining Care.