Norton Hospital working together

Norton Hospital’s nursing team accepted the challenge in 2016 to create a culture of working together. “Together” became nursing’s theme.

 

Together means staff members go beyond their day-to-day interactions to get work done. Together includes delivering patient care in concert with the patients and their families. During Norton Hospital’s journey to creating a positive culture, some significant improvements were realized for patients and the patient care delivery teams.

 

Working together, we addressed safety and quality in several ways

  • Dee Jones, MSN, and Nena Hoenck, MSN, addressed advanced nursing practice, creating models to improve safety. Jones’ model focuses on care within the Intensive Care Unit, ensuring an intensivist is in place 24/7. Nurse practitioners take on that role when physicians are unavailable. Hoenck’s model focuses on inpatient care and calls for nurse practitioners to round on patients in transition and respond to rapids and codes.
  • Working together through interdisciplinary rounds, teams have been able to significantly reduce central line infections and urinary catheter infections. Bedside nurse practitioners, nurse managers and assistant nurse managers  working with staff have been key in getting results.
  • Norton Hospital assisted in establishing a new sentinel event process. The new process has resulted in a safer environment, with an increase in the number of good catches and reporting of safety events. There has been a 27 percent reduction in serious safety events.
  • Bedside nurses have improved the implementation of bedside medication verification and bedside shift reporting. Norton Hospital nurses are demonstrating excellence in each of these areas.
  • Norton Hospital also received awards for best practices in resuscitation efforts from the American Heart Association’s “Get With the Guidelines” program.

 

Working together, we became friendlier

  • Electronic rounding has been incorporated into each nurse leader’s routine, resulting in nurses and nurse leaders being more visible. This process has led to patients and families recognizing the friendliness of their care teams. Patient experience scores are higher. They have exceeded the 2016 goals and are expected to exceed the same goals in 2017.
  • Jené Kendall, MSN, system sepsis team leader, took the initiative to meet with local emergency medical services (EMS) providers. In these meetings, Kendall successfully engaged EMS in the process of identifying sepsis symptoms in the field. Kendall’s efforts resulted in a closer relationship with EMS, which values and uses her expertise to enhance skill sets within the EMS community.

 

Working together, we became more efficient, creating convenience for patients

  • Norton Hospital led the way in developing transportation options for patients discharged from the hospital and Emergency Department. The team, led by the Clinical Effectiveness department, resulted in the creation of a bus token program.
  • Abby Bahe, MSN, implemented comfort carts for Norton Hospital patients, creating an environment of service and convenience and promoting a holistic approach to care. Patients have access to aromatherapy, music and personal care items via the cart.
  • Norton Hospital worked to make it easier to get a bed within the Norton Healthcare system by establishing a patient flow committee. The committee evaluated convenience and timeliness of processes related to patient admission, such as time from order written until time admitted, time for registration, and time for test results. The committee’s efforts have resulted in Norton Hospital being the leader in accepting patient referrals from outlying facilities.
  • The surgical team, by working together with surgeons and staff, surpassed all metrics recorded in the past five years, thereby improving efficiency and increasing the availability of surgical suites to accommodate growth.
  • A comprehensive unit-based safety program team (CUSP) was created as a framework to support a culture of safety. (The team focused on communication, teamwork, leadership and evidence-based practice). One of the goals was to have zero central line-associated bloodstream infections (CLABSI). The team’s strategy for reaching that goal focused on bundle compliance, vein preservation, interdisciplinary rounds, a vascular access algorithm and central venous line de-escalation. The result was a 59 percent reduction in CLABSI. See the table to the right.

 

Norton Healthcare Institute for Nursing

Norton Healthcare Institute for Nursing was born out of a committee established by Tracy E. Williams, DNP, R.N., senior vice president and system chief nursing officer, in 2008. Its purpose was to centralize nursing core orientation across the Norton Healthcare system, including at Norton Brownsboro Hospital, which was about to open. It was expected that more than 400 new Norton Brownsboro employees would need to go through orientation. The Institute for Nursing was conceptualized to be the formative structure for the professional growth of Norton Healthcare’s nurses. It started with four centers, all of which remain today: the Center for Research; Center for Professional Development; Center for Nursing Practice; and Center for Outreach.

 

Since its beginning, Norton Healthcare Institute for Nursing has sponsored the following major developments:

  • Development and implementation of the Professional Practice Model
  • Implementation of the Competency Model, including the online documentation of competencies
  • Implementation of the Research Model and the Evidence-based Practice Model
  • Implementation of preceptor classes
  • Development and revision of core nursing and core pateint care associate (PCA) orientations, including evening, weekend and online options
  • Implementation of the PCA class for inexperienced PCAs; this followed a two-year collaborative partnership with Spalding University on a clinical and didactic PCA program
  • Development and implementation of the Norton Academy at Jeffersonville High School for  juniors and seniors interested in pursuing a career in the health field
  • Development, implementation and revisions of the critical care orientation and advanced courses, and the Surgical Services orientation and classes
  • Development and implementation of the Nursing Residency Program for new graduate registered nurses to assist in transition from the student role to point of care nurse
  • Development and implementation of the Nurse Extern/Apprenticeship Program – SNAP
  • Provision of support and resources to Norton Healthcare affiliate facilities
  • Development and implementation of the sexual assault nurse examiner (SANE) program at each Norton Healthcare Emergency Department
  • Coordination of American Heart Association courses across the system
  • Coordinator and provider of American Nurses Credentialing Center- and Kentucky Board of Nursing-approved programs for the awarding of continuing education credits
  • Development and implementation of the Sterile Processing Tech Program at Prosser Academy
  • Achievement of center of excellence by the National League of Nursing after having been an institute for only three years, and the fourth health care facility in the nation to receive that recognition. The institute has applied for redesignation as a center of excellence in 2017.

The Top 10 Transformational Initiatives for Norton Healthcare Nursing

  • Implementation of the Swanson's Theory of Caring as the foundational model for nursing practice
  • Implementation of the Professional Practice Model
  • Implementation of the Competency Model, the Research Model and the Evidence-based Practice Model
  • Implementation of the Practice Governance Structure
  • Remote patient management
  • Strategic partnerships to foster academic progression:
  • University of Kentucky BSN to DNP program
  • University of Kentucky MSN to DNP program for Leadership
  • Western Kentucky University MSN to DNP Program
  • Spalding University MSN to DNP Program
  • Bellarmine University RN to BSN Program
  • Galen College of Nursing BSN Program
  • Role of the advanced practice registered nurse
  • Strategic 20/20 vision for nursing
  • Nursing residency program
  • Nurse extern/SNAP program

 

Key partnerships between Norton Healthcare nursing and others that are driving collaborative research and care initiatives:

  • University of Louisville endowed chair for research
  • Bellarmine University
  • University of Kentucky
  • Galen College of Nursing
  • Spalding University
  • Rush University
  • Western Kentucky University
  • Norton Academy
  • Office of Workforce Development
  • Human Resources
  • Norton University

Norton Cancer Institute: A decade of progressive
care by advanced practice registered nurses

Advanced practice registered nurses are regarded as vital members of the health care workforce. They are providing care in the United States more than ever, with the number doubling over the past 10 years from approximately 106,000 in 2004 to 220,000 at the end of 2016.

 

Advanced practice registered nurses deliver autonomous patient-centered care that is efficient and cost-effective. They are an integral part of multidisciplinary cancer care, supporting quality-of-care improvements and mitigating oncology workforce shortages.

 

At Norton Cancer Institute, the number of advanced practice registered nurses increased from five in 2007 to 25 by the end of 2015. More than half of these providers have earned a specialty oncology certification: six are advanced oncology-certified nurse practitioners, two are advanced oncology-certified nurse specialists and seven have earned oncology-certified nurse designation.

 

These areas at Norton Cancer Institute are supported by nurse practitioners:

  • All facets of oncology care in the clinics and area hospitals
  • Behavioral oncology
  • Clinical trials/research
  • Infusion centers
  • Multidisciplinary clinics/tumor boards
  • Prompt Care Clinic open until 8 p.m.
  • Survivorship
  • Weekend inpatient care

 

Advanced practice registered nurses will support these future Norton Cancer Institute programs:

  • Survivorship Program expansion
  • Additional Prompt Care Clinic sites with extended hours
  • Sickle cell program
  • Centralized telephone triage center
  • Expanded advanced practice registered nurse oncology orientation program

 

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