Float Brochures (2024)-Completed
Problem/Rationale: Our unit was having a lot of float pool personnel coming to our unit. As a former float pool RN, I knew how difficult it was to stay in the know of what initiatives and requirements of various departments. It was also difficult to identify my resources and remember all of the door codes. There was a float brochure that the unit had prior to my arrival, however, it was pretty much directed to only nurses and did not contain a lot of valuable information. Additionally, our staff were getting sent down to the ED to care for overflow patients and the brochure that was provided was extremely out of date, was never readily available to them, and contained limited information. Leaving my staff frustrated and feeling unsupported.
Plan: To make a float brochure for the unit, one directed to the RNs and their responsibilities, and another directed to the PCAs containing their responsibilities. Contact information for the charge nurse, resource nurse, and the entire leadership team was also provided so the float pool personnel felt that they had someone in Leadership they could turn to. I also made a map of the unit so that float staff could refer to it if they were looking for a specific room. For the ED overflow, feedback was obtained by the bedside staff regarding what information they feel they need to function safely. I had both staff and the ED Leadership team review the current flyer that was made by the ED Leadership team, asking if the information that is provided is relevant and up to date. I created a brochure with the combined feedback.
Outcome: Float pool staff were interviewed intermittently to determine if they found the information in the brochure helpful and relevant. The float pool employees provided only positive feedback and found the brochure very helpful. For the ED Float Brochure, after having my staff review and approve the information, the brochure was presented to the ED manager and Senior Director who gave approval. I interviewed my staff, and they said that the information that was provided was very benefcial.
Plan: To make a float brochure for the unit, one directed to the RNs and their responsibilities, and another directed to the PCAs containing their responsibilities. Contact information for the charge nurse, resource nurse, and the entire leadership team was also provided so the float pool personnel felt that they had someone in Leadership they could turn to. I also made a map of the unit so that float staff could refer to it if they were looking for a specific room. For the ED overflow, feedback was obtained by the bedside staff regarding what information they feel they need to function safely. I had both staff and the ED Leadership team review the current flyer that was made by the ED Leadership team, asking if the information that is provided is relevant and up to date. I created a brochure with the combined feedback.
Outcome: Float pool staff were interviewed intermittently to determine if they found the information in the brochure helpful and relevant. The float pool employees provided only positive feedback and found the brochure very helpful. For the ED Float Brochure, after having my staff review and approve the information, the brochure was presented to the ED manager and Senior Director who gave approval. I interviewed my staff, and they said that the information that was provided was very benefcial.
Charge Nurse Standard Work (2024)-Completed
Problem/Rationale: Upon arriving to the unit, the charge nurses were completing all of their documentation on paper. There was a huge binder where these documents were stored. Often times there were papers lost or piling up. I also noticed that the Leadership team would not know about issues or concerns with patients or staffing unless one of the charge nurses sent us an email. This led to many follow ups with staff, often times several days after the event and by then the nurse may have forgotten pertinent information. Leadership also needs to report out at the beginning of the shift census, staffing, safety concerns, central lines/foleys, etc. The charge nurses were having to write all this information down before 0900, and sometimes they simply did not have the time to get us all the information.
Plan: Move the charge page to a Teams Page. Within this page, common documents would be stored, updated information was posted, and a new end of shift report was developed for the Charge Nurse, Resource Nurse, and Clerk. The Clerk would upload all the documents that we need to store (i.e. the assignment sheet at the end of the shift) so that they could be accessed in one excel sheet.
Outcome: The workflow for the Charge Nurses became very streamlined and efficient. Allowing for more time to focus on assigning patients, breaking RNs for lunch, and helping the staff. The end of shift report keeps the Leadership Team afloat with any issues that may occur during the shift if we are not present. Included on the Charge end of shift report was everything that is needed for the safety call that the Leaders report out on, so the Charge Nurse is not needing to frantically collect that information. Additionally, the Resource and Charge end of shift report has a question regarding recognition of staff so that we can ensure that staff are being recognized for their hard work. I was involved in a rapid improvement initiative that required data collection; I added it to the charge end of shift report so that I have quick access to the data that I needed to report out on.
Plan: Move the charge page to a Teams Page. Within this page, common documents would be stored, updated information was posted, and a new end of shift report was developed for the Charge Nurse, Resource Nurse, and Clerk. The Clerk would upload all the documents that we need to store (i.e. the assignment sheet at the end of the shift) so that they could be accessed in one excel sheet.
Outcome: The workflow for the Charge Nurses became very streamlined and efficient. Allowing for more time to focus on assigning patients, breaking RNs for lunch, and helping the staff. The end of shift report keeps the Leadership Team afloat with any issues that may occur during the shift if we are not present. Included on the Charge end of shift report was everything that is needed for the safety call that the Leaders report out on, so the Charge Nurse is not needing to frantically collect that information. Additionally, the Resource and Charge end of shift report has a question regarding recognition of staff so that we can ensure that staff are being recognized for their hard work. I was involved in a rapid improvement initiative that required data collection; I added it to the charge end of shift report so that I have quick access to the data that I needed to report out on.
Door Signage (2023)-Completed
Problem/Rationale: Staff were creating door signs due to difficulty locating door signs. Handmade door signs have an unprofessional appearance.
Plan: I interviewed staff to see what door signs they needed. I then created two designs of each sign they needed and presented the options at UPC for staff to vote on. Signs were made the size of a postcard, printed, laminated, magnets attached, and organized in a box with dry erase markers for quick and easy access.
Outcome: There have not been anymore handmade signs placed on the patient doors, giving the unit a more professional appearance. Making the signs the size of a postcard allowed the use of multiple signs and the door would not look cluttered. Allowing the staff to vote on which design sign they wanted gave the staff a say in the signage they use and therefore higher likelihood of using the new door signs.
Plan: I interviewed staff to see what door signs they needed. I then created two designs of each sign they needed and presented the options at UPC for staff to vote on. Signs were made the size of a postcard, printed, laminated, magnets attached, and organized in a box with dry erase markers for quick and easy access.
Outcome: There have not been anymore handmade signs placed on the patient doors, giving the unit a more professional appearance. Making the signs the size of a postcard allowed the use of multiple signs and the door would not look cluttered. Allowing the staff to vote on which design sign they wanted gave the staff a say in the signage they use and therefore higher likelihood of using the new door signs.
Onboarding Standard-Work (2023)-Completed
Problem:
Our department was onboarding a large volume of new employees. There did not seem to be a consistency in an onboarding process among the Leads (Supervisors) nor was there an obvious standard process for onboarding. Orientation schedules for new hires were being obtained 2-4 weeks prior to start date, leading to several changes in several documents when orientation was delayed or changed by the new employee. Orientation for even experienced RNs were 6 weeks all on day shift (even if employee applied for night shift position), which was taxing on departmental resources and staff capable of precepting new hires. Welcome Days were often scheduled last minute, making it difficult to arrange someone within Leadership to provide the Welcome Day to new hires. No process in place if orientation needed to be extended. Finally, no process in place to ensure new hire competencies were completed 90-days from hire date.
Rationale:
Plan:
Expected Outcome:
Our department was onboarding a large volume of new employees. There did not seem to be a consistency in an onboarding process among the Leads (Supervisors) nor was there an obvious standard process for onboarding. Orientation schedules for new hires were being obtained 2-4 weeks prior to start date, leading to several changes in several documents when orientation was delayed or changed by the new employee. Orientation for even experienced RNs were 6 weeks all on day shift (even if employee applied for night shift position), which was taxing on departmental resources and staff capable of precepting new hires. Welcome Days were often scheduled last minute, making it difficult to arrange someone within Leadership to provide the Welcome Day to new hires. No process in place if orientation needed to be extended. Finally, no process in place to ensure new hire competencies were completed 90-days from hire date.
Rationale:
- The onboarding process is the new hire's first impression of the organization. Lack of consistency and organization during the onboarding process can lead to widely varying experiences and therefore widely varying first impressions.
- By Leadership initiating contact with the new hire and also providing the Welcome Day, this sets the tone and trusting/mentoring rapport between the new hire and their direct supervisor.
- Experienced Nursing Assistants and RNs were given 6 orientation shifts, night shift was given the option to begin orientation on nights or they could have one week of orientation on day shift and one week on night shift. This would balance the load of new hires between shifts requiring orientation and also decrease cost and overtaxing of resources.
- Failure to complete new hire competencies can lead to organizational fallouts during Joint Commission surveys and other state/federal regulatory surveys that may ask to review personnel files.
Plan:
- Collaborating with department educator, hospital senior directors, department leadership team, I created Standard Work to address all issues mentioned above which would provide consistency and organization throughout the onboarding process from the time the offer is extended to the applicant to the 90-day competency review and completion.
- A checklist was created to ensure that all tasks and milestones were being met throughout the onboarding process.
- Orientation schedules were created during the Welcome Day so that the Lead can review the schedule to see which preceptors are available on which days and fewer changes by new hire will be requested in the short amount of time.
- Welcome Days were to be scheduled with new hire on a day that the Lead was available.
- New hires were to be met with by their direct supervisor to determine if more orientation was needed, review competency binder, and touch base with the preceptor to review competencies that were incomplete.
- Lead to schedule a 30-Day from hire meeting with the new hire, to determine if they needed any additional support and to review competency completion status.
- Educator to meet with the new hire between 60-90 days from date of hire to complete competencies and complete employee file.
Expected Outcome:
- Consistent onboarding for every new hire, every time.
- Creating new hires orientation schedule will lead to less schedule changes and therefore less confusion and opportunities for error by Leads and preceptors. Preceptors will know when they are precepting, therefore increasing their job satisfaction within that role.
- Less utilization of department resources and education budget by decreasing orientation time for experienced hires.
- More interaction between Leadership team and employees to ensure all their needs are met and they are receiving all the support they need.
- Ensuring completion of new hire files and competencies within a reasonable timeframe of 90-Days.
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Telemetry Process Improvement (2023)-Completed and Ongoing
Problem:
I had recognized that patients were being transferred frequently to the ICU for cardiac arrhythmias such as afib RVR and hypertensive crises, both which could be corrected with IV push beta blockers, antiarrhythmics, and/or antihypertensives. IV hydralazine and IV metoprolol were only allowed to be administered IVPB and transfused over 30-60 minutes. Expressed to our department leadership and hospital executive team the need to allow the RNs on our unit to push cardiac medications to prevent transferring of patients to our ICU for conditions that can be quickly corrected with IV push medications. However, there was a lack of a sense of urgency in the bedside staff when tele techs would call staff with issues. Additionally, tele techs were being forced to listen to incessant monitor alarms for 12 hours.
Rationale:
Plan:
Outcome: There was significant improvement in RN and NA response times and adherence to the chain of notification by tele techs. Improvement initiative and results were presented to Sharp’s Alarm Management Committee who planned to rollout our new tele process to the remaining Sharp hospitals.
I had recognized that patients were being transferred frequently to the ICU for cardiac arrhythmias such as afib RVR and hypertensive crises, both which could be corrected with IV push beta blockers, antiarrhythmics, and/or antihypertensives. IV hydralazine and IV metoprolol were only allowed to be administered IVPB and transfused over 30-60 minutes. Expressed to our department leadership and hospital executive team the need to allow the RNs on our unit to push cardiac medications to prevent transferring of patients to our ICU for conditions that can be quickly corrected with IV push medications. However, there was a lack of a sense of urgency in the bedside staff when tele techs would call staff with issues. Additionally, tele techs were being forced to listen to incessant monitor alarms for 12 hours.
Rationale:
- Transferring patients to higher levels of care for conditions that are easily and quickly treatable leads to higher costs for the patient, strain on staff and resources, as well as patient dissatisfaction.
- In order to safely push IV cardiac medications, RNs need to have a sense of urgency regarding changes in cardiac rhythms or inability for tele tech to monitor due to batteries/leads needing replacement.
- Tele Techs need a chain of notification with established timeframes for escalation so if issues are not addressed, they know who to contact next and when they need to escalate.
- Tele techs listening to alarms nonstop for 12 hours will lead to alarm fatigue and risk of missing serious arrhythmias.
Plan:
- New tele process created to establish a chain of notification including timeframes of when notifications need to be escalated.
- Tele techs kept a call log each shift of every call made, I then consolidated that data in the call logs to identify opportunities for improvement and where to focus the education to be given.
- I presented education to both our Unit Practice Counsel and to our tele techs which included percentage of fallouts by bedside staff and by tele techs individually which was further broken down into specific fallouts, events of potential patient harm, suggestions on how to prevent further fallouts, etc. I also included the results in the monthly newsletter and added a one different suggestion on how to prevent fallouts each week in our shift huddles.
- I met with each of the tele techs, face to face and one on one to review the chain of notification in detail with them, plan moving forward, education presented at their meeting (poor turnout to meeting to present education and fallouts), and the tele techs signed an agreement that I reviewed the chain of notification with them, they understand the chain of notification, and they agreed to follow the chain of notification and escalation for every patient, every time.
- After education was rolled out, another round of tracking phone calls in a call log was completed and I reanalyzing data in the call logs. Bedside staff was followed up in real time one on one of any identified fallouts and the tele techs were followed up with weekly via email of any fallouts.
Outcome: There was significant improvement in RN and NA response times and adherence to the chain of notification by tele techs. Improvement initiative and results were presented to Sharp’s Alarm Management Committee who planned to rollout our new tele process to the remaining Sharp hospitals.
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Post-Op Bariatric Surgery Brochure (2022)-Unable to rollout due to inability to obtain surgeon support
Problem:
Working with bariatric patients throughout my career, I understood the importance of accurate intake tracking/documentation and reinforcement of diet education after surgery to ensure patient is safe for discharge. I recognized that there was a knowledge gap in not only our RNs but with patient’s as well. Intake was not well tracked, not tracked consistently, or tracked at all. Patient’s had obvious gaps in knowledge regarding how much clear liquids they were allowed to drink, how often they should attempt to drink, or even a true understanding of what their diet restrictions were immediately post operatively and after discharging.
Rationale:
Plan:
Outcome: Unfortunately, when the finalized brochure was presented to the Bariatric Committee, the same surgeon wanted to have their name and contact information placed on the brochure. Surgeon moved up the chain of command up to the CEO who reinforced this policy. Attempts were made to compromise with surgeon by placing slits for business cards, however, continued to refuse approval of the brochure. After a year of working on the brochure and attempting to compromise with surgeon, brochure unable to obtain Bariatric committee and surgeon approval and was unable to be sent to print. Alternatively, I am working on creating a tool that will be strictly used as a nursing tool and patients will not be able to take the tool home with them, and therefore will not require approval by the Bariatric Committee or surgeons.
Working with bariatric patients throughout my career, I understood the importance of accurate intake tracking/documentation and reinforcement of diet education after surgery to ensure patient is safe for discharge. I recognized that there was a knowledge gap in not only our RNs but with patient’s as well. Intake was not well tracked, not tracked consistently, or tracked at all. Patient’s had obvious gaps in knowledge regarding how much clear liquids they were allowed to drink, how often they should attempt to drink, or even a true understanding of what their diet restrictions were immediately post operatively and after discharging.
Rationale:
- Failure to track intake could lead to failure to identify diet intolerance and therefore lead to unsafe discharge of patient and potential for hospital readmission for dehydration, perforation, or other post-operative complications.
- Failure to assess for understanding of diet restrictions received prior to surgery and reinforcement of that education post-operatively could lead to post-operative complications between discharge and their 2 week follow up with their bariatric dietitian.
Plan:
- Brochure developed that included intake tracking and IS usage using check boxes, giving some accountability and responsibility to the patient and allow for verification of intake by comparing number of medicine cups to check marks on brochure; a menu of clear liquid options available on the unit, and basic education on dietary restrictions and things to avoid (i.e. straws) post-operatively. (Brochure rough draft I created prior to going to marketing can be seen below).
- Presented brochure to management and hospital executives who liked the idea. Suggested reaching out to Bariatric Nutritionist to review content included in brochure regarding diet and restrictions and have her bring to the Bariatric Committee for approval and then my management team would present to Hospital CFO for approval to move forward.
- CFO approved brochure and asked that it be brought to marketing department to create a brochure that is on brand with other brochures. Approved in Bariatric Committee, after surgeon request to have their name on the brochure was denied because Sharp does not allow this sort of personalization on hospital specific education material, and this would lead to confusion since there are several bariatric surgeons. .
- Bariatric Nutritionist and I worked with marketing for about 8 months developing the bariatric brochure, after I finalized how I wanted the brochure to look, Bariatric Nutritionist presented the finalized brochure to the Bariatric Committee.
Outcome: Unfortunately, when the finalized brochure was presented to the Bariatric Committee, the same surgeon wanted to have their name and contact information placed on the brochure. Surgeon moved up the chain of command up to the CEO who reinforced this policy. Attempts were made to compromise with surgeon by placing slits for business cards, however, continued to refuse approval of the brochure. After a year of working on the brochure and attempting to compromise with surgeon, brochure unable to obtain Bariatric committee and surgeon approval and was unable to be sent to print. Alternatively, I am working on creating a tool that will be strictly used as a nursing tool and patients will not be able to take the tool home with them, and therefore will not require approval by the Bariatric Committee or surgeons.
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Teams Resource Page (2022)-Completed and Ongoing
Problem: New hires were given binders during their Welcome Day that contained printed resources and all the required competencies. Nursing binders were 5”, 3-ring binders that contained outdated information, unnecessary tests that were not required by Sharp, and difficult to find resources when looking for them. The binders were being stored in the break room and not being referred to after orientation, often containing incomplete competencies. Binders were very overwhelming for new hires.
Rationale:
Plan:
Outcome: Binders were able to be significantly reduced and only contained the clinical pathway, competencies, and tests. Staff enjoy the newsletter and keeps them afloat with departmental and systemwide news, in September, the Bariatric Coordinator will begin having a "guest writer column" so that they can relay process updates and education pertaining to Bariatric patients on a monthly basis. Staff are using the resources in the files frequently and I have even had SRN staff, ALs, and other departments we often collaborate with to be added to our page so they can access the resources and newsletters as well. Night shift staff are utilizing the chat in Teams for shift swaps, allowing myself and the other night shift Lead to see employees agreeing to swap and updating ANSOS.
Rationale:
- Binders contained so much information and was difficult to find resources if looking for them, so staff were not using them.
- Printed resources become outdated and if a staff member did refer to the information in the binders, they could be referring to processes that have been updated.
- Due to the large amount of paperwork in the binders, it was easy to overlook required competencies.
- Binders were very large and taking up a lot of space in the breakroom.
- The cost of purchasing binders, paper, ink, and the cost of man hours to assemble binders was wasteful.
Plan:
- I created a Teams page that contained an extensive number of resources for RNs, NAs, and Tele Techs/Unit Clerks.
- Policies/Procedures and other documents that change often were uploaded as links so that employee would only see the most up-to-date information. Out of date material is easily removed to reduce confusion.
- In addition to the Resources, on the team’s home page, I post a newsletter that I create monthly, there is a picture gallery of the staff having fun at work or doing work-related activities, a section where I type up staff recognitions for staff mentioned in our unit’s charge shift report and the Administrative Liaison’s shift report, self-schedule calendar, and countdown timers for compliance requirements.
- Created tags for both Day Shift and Night Shift RNs, NAs, Tele techs/Unit clerks so if they wish to reach out to staff to swap shifts, they can put the tag in a chat and then all employees in their role and shift can receive a notification on the Teams App on their cellphones, allowing them to respond right then and their supervisor will be able to see the exchange and swap the shifts in ANSOS.
Outcome: Binders were able to be significantly reduced and only contained the clinical pathway, competencies, and tests. Staff enjoy the newsletter and keeps them afloat with departmental and systemwide news, in September, the Bariatric Coordinator will begin having a "guest writer column" so that they can relay process updates and education pertaining to Bariatric patients on a monthly basis. Staff are using the resources in the files frequently and I have even had SRN staff, ALs, and other departments we often collaborate with to be added to our page so they can access the resources and newsletters as well. Night shift staff are utilizing the chat in Teams for shift swaps, allowing myself and the other night shift Lead to see employees agreeing to swap and updating ANSOS.
*Names are blocked out for privacy*
PCA Preceptorship Program (2022)-Pending Senior Director Approval as of July 2022
Problem:
Our PCAs orient on 5 different units over 5 shifts. Often times their Competency Forms and Department Orientation Checklists are incomplete leading to more time when Leaders meet with them to review their competency forms . In addition, sometimes our new employees receive below par orientation on one or more of their orientation shifts.
Rationale:
Our PCAs orient on 5 different units over 5 shifts. Often times their Competency Forms and Department Orientation Checklists are incomplete leading to more time when Leaders meet with them to review their competency forms . In addition, sometimes our new employees receive below par orientation on one or more of their orientation shifts.
Rationale:
- By allowing our PCAs to be Preceptors and orient our new PCAs, we can train our Preceptors how to complete the documentation in its entirety
- We can establish specific orientation requirements such as showing them where the Pharmacy and Blood Bank are
- Preceptors can make the new hires aware of our expectations, such as entering time edits into Kronos when there is an error on their timecard and approving their timecards biweekly
- Give new PCAs someone to turn to outside of Leadership when they have questions and when they need a mentor.
- Reach out to our to our PCAs to see if they are interested in precepting new hires, they must not have received corrective action in the past year, be rated as effective or higher on the previous years evaluations, reliable, and have good attendance.
- Partner with Leadership of 2 departments in Chula Vista and 2 Departments in San Diego. We will pre-book our preceptors to their unit on days they will be precepting our new hires and update the shift label in Kronos so that both the department and the preceptor are aware that they will be orienting. The unit Leaders will make charge RNs aware that when they see these specific PCAs assigned to the unit, they can not be pulled to be a sitter/CO and they cannot be floated to another unit.
- When meeting with new hires and deciding on what days they wish to orient, we will coordinate their orientation days based on the schedules of our preceptors.
- Competency and Department Orientation Checklists will be fully or mostly completed prior to the new PCA meeting with Leadership to review.
- New PCAs will receive a good and thorough orientation on the units.
- New Float Pool PCAs will meet other Float Pool PCAs and give them an opportunity to develop work relationships with their coworkers which will make them feel as though they have additional support outside of Leadership.
- By making some of our PCAs Preceptors, this will give them an opportunity to become mentors to fellow PCAs, give them a sense of value and worth with these additional responsibilities, as well as positively impact their Yearly Evaluations.
Site-Based Float Pool Teams Resource Page (2021)-HR and Senior Director Approved, Pending Manager Announcement to Department as of July 2022
Problem:
Rationale:
Plan:
Expected Outcome:
- Due to the size of our department (over 250 employees), our primary methods of communication of essential information have been via email and individual text messaging. We have found that most employees do not check their emails on a regular basis and so Leadership also has to individually text our employees which is time consuming.
- If staff need to swap a shift with employees, they must reach out to their coworkers via email and employees are not regularly checking their emails so they do not see the requests, leading to more requests from employees to Leadership for schedule changes. The distribution email also includes both NOC and AM shifts, so often times someone will agree to swap a shift and then realize that it is for the opposite shift and decline the swap.
- When reviewing competencies, any skills not experienced during orientation shifts, we print out resources for them. Leading to high paper and ink waste.
- Employees are frequently asking for the same forms, phone numbers, and other various resources. Sometimes sending them multiple times to the same employee. This can be time consuming for Leaders looking for all of the forms, phone numbers, and resources to send to employees.
Rationale:
- The Teams app can be downloaded to employee's phones. This will allow better communication between Leadership and staff regarding important information.
- Shift swap requests can be sent via chat which can put a notification on the app, allowing more peer seeing the requests.
- By adding resources that correlate with the competency checklists, we can review them with employees on the Teams Page and then it will be there for the employee at any time, and decreasing paper and ink usage.
- By having the phone numbers, forms, and resources in one easily accessible place for employees to retrieve, Leadership will receive fewer emails, phone calls, and texts requesting this information. Freeing up more time for Leaders to focus on other tasks.
Plan:
- Develop a Teams Page that is specifically for our staff.
- Include links to the important websites such as Kronos, LMS, ReadySet and Scripps interweb
- Make a list of important telephone numbers we are often asked for
- Put the self-scheduling calendar on the page for employees so everyone will see when the schedule opens, closes, and posts
- Include a countdown timer for important compliance deadlines
- Upload an abundance of resources and policies that mirror every skill on both PCA and RN competency forms, including RN specialties, so that if any competencies they may not experienced. Additional resources to be uploaded as well, including various helpful policies, information and required forms for LOAs, Kronos user guides, HR resources, etc.
- Create tags for both Day Shift and Night Shift PCAs and RNs so if they wish to reach out to staff to swap shifts, they can put the tag in a chat and then all employees in their role and shift can receive a notification on the Teams App on their cellphones, allowing them to respond right then and their supervisor will be able to see the exchange and swap the shifts in Kronos.
- Make monthly newsletters to include on the page, include important compliance information and deadlines, recognition of employees, welcome new employees to the team, etc.
Expected Outcome:
- Better communication and distribution of information between Leadership and employees.
- Better access of readily available resources for employees so that they are not depending on our office hours to receive requested resources.
- Employees able to swap shifts easier and quicker to their fellow coworkers
- Less waste of office supplies since resources are available on the Teams Page and can be printed at home.
Badge Buddies (2021)- Completed
- Our PCAs go to 20 different units and our RNs go to 15 different units. They expressed that they have a challenging time remembering door codes for each of the units, which units have the night shift RN do the morning glucose checks, and the charge nurse’s numbers.
- I created 3 different badge buddies:
- One had all of the door codes for each unit, which units require the NOC RN to obtain the morning blood sugar, and the charge nurse’s numbers for both Mercy San Diego and Mercy Chula Vista.
- One had pertinent phone numbers for Mercy San Diego (i.e. Telemetry Room, department’s nursing station numbers, etc.) and a Fahrenheit/Celsius conversion table.
- One had pertinent phone numbers for Mercy Chula Vista and a QTc measurement chart.
- One had all of the door codes for each unit, which units require the NOC RN to obtain the morning blood sugar, and the charge nurse’s numbers for both Mercy San Diego and Mercy Chula Vista.
Toiletry Distribution (2020)-Completed
When the pandemic first started, I had a serious exposure my second day caring for a Covid patient. The Operation Supervisor had to come up to the unit, place me in a bunny suit, and bring me to the OR showers. I had no makeup remover, conditioner, or brush. All I had was the surgical scrub soap, the soap we supply to patients, and a soft bristle brush. I have hair that goes past my lower back, without conditioner, it tangles. So in my moment of immense terror, I also had to sit with this soft bristled brush and brush the knots out of my hair for 45 minutes before putting on surgical scrubs and going back to work.
I thought to myself, wouldn't it be nice to just have little toiletry packs for the staff that are exposed or even just for staff who would like to shower prior to going home to their loved ones after caring for Covid patients? Just a tiny bit of comfort for them during a scary time. So I reached out to my community, Coronado, and the response was more than I could ever expected. I managed to collect enough travel sized toiletries to make 180 kits which I was able to distribute to all 5 of the hospitals.
Scripps Communication Department was kind enough to announce the delivery of the toiletry kits to the hospitals in the Covid Update Newsletter.
I thought to myself, wouldn't it be nice to just have little toiletry packs for the staff that are exposed or even just for staff who would like to shower prior to going home to their loved ones after caring for Covid patients? Just a tiny bit of comfort for them during a scary time. So I reached out to my community, Coronado, and the response was more than I could ever expected. I managed to collect enough travel sized toiletries to make 180 kits which I was able to distribute to all 5 of the hospitals.
Scripps Communication Department was kind enough to announce the delivery of the toiletry kits to the hospitals in the Covid Update Newsletter.
Blood Sugar Check Packets (2020)- Comleted
- While working on the Covid Dedicated Unit, we did not want to bring the entire glucose check supply box into the rooms, so nurses were grabbing handfuls of supplies and bringing them into the room. This led to a high wastage of supplies.
- I bought small sealable plastic bags from Amazon, I placed an alcohol swab, two lancets, and a small piece of gauze in the packets.
- I also made copies of the barcode on the strips container and placed them in a bag with the corresponding container so that the nurses could take a strip from the container and a copy of the barcode to that container rather than taking entire containers into the room.
New Grad Nurse Orientation Model (2015)-Completed
- In Florida, New Grad nurses were oriented by starting them with 1 of the patients of the 6-7 patient assignment and the Preceptor would take the other patients. I found this let to little oversight of the New Grad and little knowledge of the care provided throughout the shift, which eventually led to a delay in recognition of a patient deterioration and an RRT initiation. I also noticed that they struggled tremendously moving beyond 4 patients.
- I trialed a new way of orienting my New Grads by assigning them a task each week for the entire patient assignment.
- Week 1: Shadow myself, get checked off on blood draws, etc. I also arranged for them to spend an 8-hour shift in Preop to do nothing but start IVs.
- Week 2: Assessments which I would perform alongside them.
- Week 3: Assessments and charting of assessments.
- Week 4 & 5: Assessments, charting, PRN medication pass + charting
- Week 6 & 7: Assessments, charting, PRN Meds + charting and beginning of shift med pass
- Week 8, 9, & 10: Assessments, charting, PRN & Scheduled Meds
- Week 11 & 12: Total care of entire team including discharging and admitting of patients
- Week 1: Shadow myself, get checked off on blood draws, etc. I also arranged for them to spend an 8-hour shift in Preop to do nothing but start IVs.
- This led to better oversight of New Grad, easier transitions from skill to skill in comparison to patient to patient.
- This eventually led to a unit wide change to how New Grad RNs were being oriented and when more than one RN precepted the same New Grad, they would know where the New Grad was in their orientation.
Education Presentations to Ortho NPC (2014-2015)- Completed
After I transferred to Ortho, I noticed there seemed to be a gap in knowledge related to Chest Tube maintenance and NG Tube Insertion and Maintenance. Below is the chest tube presentation I created and presented to our NPC.
Colorectal Patient Brochure (2013)- Completed
- While caring for my Postop Colorectal patients, I noticed that every single patient asked the exact same questions: “When will this tube in my nose come out?” “When can I eat?” “How am I supposed to have a bowel movement if I do not eat?” “I just had surgery a few hours ago! What do you mean I need to get up and walk?” There were high patient noncompliance rates with postop ambulation, delayed removal of NG Tubes, and unrealistic pain management goals.
- I was Vice-President of our Nurse Practice Counsel and therefore needed to attend Unit Triade Meetings (the unit manager, a physician representative, and the President and Vice-President of the unit’s Nurse Practice Counsel met monthly to discuss any concerns that any of us had from a management, physician, and nursing standpoint). I brought this up in our monthly Triad Meeting and recommended we create a brochure for all the Colon & Rectal Clinic of Orlando (CRC) patients during their preop appointment.
- The Nurse Practice counsel collaborated with the CRC surgeons on what to include in the brochure then I utilized my Microsoft Office skills to create the brochure. The brochure included answers to the frequently asked questions that patient’s ask postoperatively, what to expect preop, intraop, and postop, and our expectations of them once admitted to the floor. Once approved by the Nurse Practice Counsel, Management, and the surgeons of the CRC, we made copies and the surgeons had them stocked in the exam rooms.
- This led to a better understanding by patients on what to expect after surgery, why we were asking them to so soon after surgery, and improved patient compliance leading to fewer postop complications and a decrease in prolonged hospitalizations.