2010 NURSING ANNUAL REPORT by fdh56iuoui




Transformational Leadership

Structural Empowerment and Teamwork

Exemplary Professional Practice

New Knowledge and Innovation

Empirical Quality Results

                                  2010 NURSING ANNUAL REPORT   1

How we relate to each other, our patients and our community.

Relationship-Based Care

Nursing at Tallahassee Memorial has adopted a model of care that provides a framework for providing excellent care through collaborative

relationships. Relationship-based care takes place in a caring and healing environment organized around the needs and priorities of the patients and

their families who are the center of the care team. This report highlights many examples of how our colleagues have developed strong collaborative

relationships in order to achieve outstanding patient care and advance nursing practice at TMH.

               Tallahassee memorial HealthCare
               2010 NURSING ANNUAL REPORT

               Transformational Leadership
        2      Leading the Way in Our Vision for World Class Health Care
        4      Giving Every Nurse a Voice through Shared Governance

               Structural Empowerment and Teamwork
        6      Creating New Ways to Get Patients
               to the Right Place at the Right Time
        8      Reaching Out to Our Community
       10      Providing Resources for Professional Nursing Practice
       11      Developing Collaborative Relationships to Improve Patient Care

               Exemplary Professional Practice
       12      Bringing New Technology to Heart Attack Patients
       14      Pushing the System to Improve Patient Care
       16      Recognizing Nurses Who Achieve Professional Advancement

               New Knowledge & Innovation
       18      Using Evidence-Based Practice to Help Diabetes Patients
       20      Finding a New Way to Minimize the Pain of an Injection for Kids
       22      Supporting Nurse Scholars
       24      Spreading the Word about New Knowledge

               Empirical Quality Results
       26      Keeping an Eye on our Progress

The 2010 Nursing Annual Report is produced by the Nursing and Public Relations
Departments of Tallahassee Memorial HealthCare, 1300 Miccosukee Road,
Tallahassee, FL 32308. Phone (850) 431-1155.

                                      Nurses Are Leaders in Our Pursuit
                                      Of RECOGNIzED WORLD CLASS HEALTH CARE

                                      Dear TMH Friends & Colleagues:

                                      As Tallahassee Memorial HealthCare continues working toward Magnet™ recognition,
                                      I’d like to congratulate our nurses for the progress made during 2010. Clearly, nurses
                                      throughout the organization are making vital contributions as we pursue our vision of
                                      being a recognized world-class community health care system.

                                      Tallahassee Memorial has experienced many successes during the past year. As you
                                      review this annual report, you will learn how nurses have contributed significantly to
                                      these successes through their work as compassionate healers, progressive educators,
                                      innovative researchers, continuous learners, creative thinkers, valued collaborators,
                                      involved decision makers and passionate leaders. These qualities exemplify the
                                      highly skilled professional nursing practice that has developed at TMH. In my view,
                                      TMH nurses combine the art and the science of their profession and contribute to a
                                      healthy environment for our patients and our colleagues.

                                      As we look forward to a new year of challenges and opportunities, I urge our nurses, and indeed, all of our colleagues to continue
                                      the good work that has been started. Know that your efforts not only strengthen our organization, but give us the privilege of
                                      providing the best experience possible for the patients we serve.


                                      G. Mark O’Bryant
                                      President & CEO

                              2   2010 NURSING ANNUAL REPORT
                                                                                                                                                       TRANSfORmATIONAL LEADERSHIP
                                                                Nursing Excellence
                                                                CONTINUES TO UNfOLD AT TmH
                                                                I am pleased to welcome you to the 2010 Nursing Annual Report. There
                                                                have been many successes during the past year and it is a privilege to
                                                                describe the efforts that TMH nurses and their colleagues have put
                                                                forth to create the outcomes that have occurred. The successes will
                                                                be profiled within the framework of the American Nurses Credentialing
                                                                Center’s Magnet™ Model but will be shared via stories of the relationships
                                                                between nurses, patients, peers and colleagues across TMH and across our

                                                                 I would like to commend you, our nurses, for strengthening our organization
                                                                 through relentless pursuit of nursing excellence. You have continually
                                                                 advanced the professionalism and image of nursing. You have organized
                                                                 and participated in sound decision making, supported by science, evidence
                                                                 and experience. You have managed our resources through stewardship.
                                                                 You have maintained a focus on improving communication, systems and
processes to enhance the quality of care we provide for our patients. We continue to strive to ensure every patient and family member truly
feels that we care and that our passion is for service.

You will read about your amazing year. You will be touched by stories that you didn’t know existed in your midst. Each of you has helped to
advance the mission and vision of Tallahassee Memorial. Be proud and accept my gratitude for your dedication and excellence.


Barbara Gill MacArthur, RN, MN, FAAN
Vice President & Chief Nursing Officer

                                                                                                                      2010 NURSING ANNUAL REPORT   3

                                      THE COOrdiNATiNg COuNCiL iNCLudEs THE CHAirs Of EACH Of THE fivE sHArEd gOvErNANCE COuNCiLs (Quality, Education,
                                      Practice, Management and research & Evidence-Based Practice Advancement) as well as other TMH nursing leaders. Pictured here are
                                      members (front to back) Jessica Bahorski, ArNP, MsN, Leslie Hancock, rN, MN, susan King, ArNP, MsN, and Norman Pasley, rN, MsN.
                                      (Not all Council members are included.)

                                      The Quest for mAGNET RECOGNITION
                                      Tallahassee Memorial is pursuing Magnet ™ recognition, a designation         Magnet hospitals are known across the country as being the place
                                      conferred by the American Nurses Credentialing Center (ANCC)                 where the best nurses practice. Research has indicated that the time
                                      when a health care organization has demonstrated that it provides            spent on the journey to Magnet recognition strengthens the quality of
                                      an environment of excellence in nursing care. Achieving Magnet               nursing practice and patient care.
                                      recognition requires successfully completing a rigorous multi-year
                                      process that qualifies the organization for submission of an application.    The Five Magnet Model Components
                                      The decision to pursue Magnet recognition represents a major                 •   Transformational Leadership
                                                                                                                   •   Structural Empowerment
                                      commitment by the organization. It communicates that we place the
                                                                                                                   •   Exemplary Professional Practice
                                      highest priority on providing quality care for our patients and a positive
                                                                                                                   •   New Knowledge, Innovation & Improvements
                                      proactive environment for our colleagues.
                                                                                                                   •   Empirical Quality Results

                              4   2010 NURSING ANNUAL REPORT
                                                                                                                                                                    TRANSfORmATIONAL LEADERSHIP
                                                 shared governance
                                                 The Voice of NursiNg aT TMh
                                                 Message from Sheri Cook, RN
                                                 Chair of the Shared Governance Coordinating Council

                                                 WhaT IS ShaREd GovERNaNCE?
                                                  1   It is the nurse’s voice being heard at every level throughout the organization.
                                                  2   It is about relationships.
                                                  3   It is making every nurse the “best in role” through this collaborative effort.

Shared Governance is the voice of nursing at Tallahassee Memorial                  Role modeling and mentoring of rising leaders occurs. Alignment
Hospital. “The appropriate use of voice is, therefore, not a threat either to      of nursing with the TMH strategic plan, via this group, provides the
nurses or to nursing. Silence is the threat to nursing. Nursing recognition        opportunity to make progress toward becoming a recognized world-
hinges on individual nurses using their voice.” (Bruesh, 2006, p. 29)              class hospital with MagnetTM recognition. As the co-chair, along with
                                                                                   the Chief Nursing Officer, of the Coordinating Council, I interface
As we have seen again and again, we are using our collective voice to
                                                                                   both vertically and horizontally with colleagues, and I am present
directly affect our patients’ outcomes with best practices in care. On
                                                                                   at meetings with members of the Board of Directors. The Shared
every nursing unit there are education, practice, quality and research
                                                                                   Governance model clearly provides representation to and from nursing
teams. These unit-based teams are led by nurses who are directly
                                                                                   throughout the organization.
involved in patient care and have chosen to join these teams to
improve processes and measurable outcomes. Each nursing unit elects                Shared Governance is about collaboration. Being elected to represent
representatives to hospital-wide councils that address concerns and                the best in nursing is an honor and a reminder of the value of
formulate strategies for improvement and the application of evidence-              relationships. We are called to lead, teach and advocate for our
based practices throughout TMH.                                                    patients and our communities. As we serve, we must obtain the best
                                                                                   tools and information available. Then, our patients will receive the
Each of the house-wide councils is led by an elected chair, who serves
                                                                                   best of care as we work together. Collectively we are stronger, smarter
as a member of the Coordinating Council. The Coordinating Council is
                                                                                   and superior. Thanks to all who give us the opportunity to grow,
more than a representative body carrying forward the voice of nursing.
                                                                                   becoming better and wiser nurses in this process.
The Council is about relationships. The Coordinating Council includes
the Vice President/Chief Nursing Officer, the Executive Director of                Bruesh, B., Gordon, S. (2006) From Silence to Voice, what nurses know
Nursing Operations, the Directors of Nursing Practice and Clinical                 and must communicate to the public, ILR Press London.
Education, and the Magnet Program Manager.

                                                                                                                                   2010 NURSING ANNUAL REPORT   5

                                           duriNg A dAiLy BEd HuddLE, nursing leaders utilize an electronic
                                           system to determine the status of every patient in the hospital
                                           in order to help with timely placement of newly arriving patients.
                                    6   2010 NURSING ANNUAL REPORT
                                                                                                                                                                           STRUCTURAL EmPOWERmENT & TEAmWORK
smooth operators
The Many Components of Nursing Operations Help Keep Patient Care on Track at TMH
On average, Tallahassee Memorial Hospital sees 400-600 patients per day.           who make our hospital’s electronic tools effective. “Our colleagues did an
Getting each of those patients to the right place and making sure every area       outstanding job of adapting to this change,” she commends.
of the hospital is staffed with enough nurses to provide care is a big job.
                                                                                   In addition to making use of these technological advancements, TMH
Fortunately, strong leadership, advanced technology and a cooperative              colleagues have an active and vital role in shaping our hospital’s Nursing
team of nursing colleagues enable our hospital to meet the challenge every         Operations. Each month, an interdisciplinary team called the house-wide
day. The term “Nursing Operations” encompasses the wide range of people,           Patient Flow Committee meets to review systems and data and determine
programs and protocols involved in this task.                                      where improvements can be made. In September 2009, TMH developed
                                                                                   a shared staffing policy that eases patient flow by identifying nurses who

Over the years, our system of Nursing Operations has undergone many                have the ability to work in multiple units.
changes, creating marked improvements in the efficiency and level of care
our hospital provides. Norman Pasley, RN, MSN, Director of Patient Flow,
cites the implementation of electronic tools as the greatest improvements          Electronic tools promote clinical
in patient flow he has observed during his time at TMH. “Electronic tools          readiness by helping our nurses to
promote clinical readiness by helping our nurses to plan and prepare,” he
says. “When a patient is discharged or transferred to the proper setting faster,   plan and prepare. — Norman Pasley, RN, MSN
patient satisfaction improves.”
                                                                                   This policy delineates all nursing competencies and the units where
OptiLinkTM is an automated tool that helps manage scheduling, and                  specialized care takes place. By identifying competencies among nursing
TeleTracking is a collection of electronic tools designed to manage patient        staff, we determine which nurses are eligible to work in units outside of
traffic and bed allocation within the hospital. While TMH began utilizing          their home units. This way, when one unit is “surging” in patient volume or
electronic tools as early as 2002, the most recent addition is an electronic       has a staff member call out sick, a nurse from another unit can help to fill in
Bed Board acquired in April 2009.                                                  those gaps.
Prior to the Bed Board, phone calls were made to a number of hospital              Ultimately, the many components of Nursing Operations, now located in a
units every time a patient needed to be assigned to a bed. Now, colleagues         centralized area, converge to help our staff provide the highest quality of
in the Patient Placement department can view the status of all the beds in         care for our patients. Streamlining our methods of operation in order to
the hospital on a flat screen television set. Based on the information they        deliver this quality of care is a process that involves many people including
observe, they can assign patients to available beds electronically. The system     nursing supervisors, the central staffing office, float pool colleagues, the
then automatically notifies nursing units of pending arrivals via pager.           patient transportation department, and our patient placement staff. As
This process has markedly decreased the number of phone calls needed to            our team continues to work cohesively, and technology steadily improves,
make bed assignments and has resulted in a 60% reduction in the time it            Nursing Operations will also continue to strengthen our ability to care for
takes to get a patient placed on the appropriate nursing unit.                     patients.

“We use our resources better than we ever used to. This isn’t just a tool. We      “We’re right up there with any hospital, but we’re implementing the
changed our whole process. Now we can be prepared and proactive. We can            methods to be among the best,” says Norman. “It is just a matter of
plan,” says Lori Knarr, RN, MS, and Executive Director of Nursing Operations.      continuing to secure the tools and technology to deliver world-class care.”

While Lori recognizes the significant role of technology in improving
Nursing Operations, she is also quick to point out that it is TMH colleagues
                                                                                                                                          2010 NURSING ANNUAL REPORT   7

                                           TMH Nurses
                                           reach ouT To The coMMuNiTY
                                            The dedication of TMH nurses extends beyond the hospital’s walls with our colleagues volunteering their time to dozens of not-for-profit organizations
                                            throughout the year in order to help improve the health of our community. It is with pride that we acknowledge some of the volunteer activities that our
                                            nurses participated in during 2010.

                                            Automated External Defibrillator training for state park employees                  Influenza Clinic for Imagine School at Evening Rose
                                            Automated External Defibrillator training at a local church                         Leon County Annual Health Fair
                                            Alzheimer’s Project at a local church                                               Leon County Emergency Medical Services Kids Fair
                                            American Cancer Society Relay For Life                                              Making Strides Against Breast Cancer Walk
                                            American Heart Association Walk                                                     March of Dimes Walk
                                            Backstage RN for drama production at a local high school                            MRSA presentation at a local church
                                            Bowling for Diabetes fund-raiser                                                    NAMI (National Alliance on Mental Illness) Walk
                                            Boy Scouts of America                                                               Nurse coordinator at the Florida Camp for Children and Youth with Diabetes
                                            Camp nurse at Florida Bible Camp                                                    Pregnancy Help Center
                                            Cardiovascular disease presentation at a local church                               Preschool health habits presentation at a local school
                                            Clinic nurse at Boy scout Camp Wallwood                                             Project Graduation with local high school
                                            Community health fair for Big Bend Black Nurses Association                         Ride for Hope to benefit Tallahassee Memorial Cancer Center
                                            Community outreach at Temple Maintenance, a local church                            Tallahassee Tennis Challenger to benefit the Vogter Neuro ICU
                                            Disaster relief with the Florida Baptist Association
                                            First aid responder at youth camp
                                            Forget Me Not Walk for Alzheimer Disease
                                            Healthy Living Team, Elder Care Program

                                    8   2010 NURSING ANNUAL REPORT
                                                                                                    STRUCTURAL EmPOWERmENT & TEAmWORK
  called their team the Heart Bypassers raised money for the American
  Heart Association’s 2010 Heart Walk. Pictured are: Alyssa Litton, rN,
        danielle verity, rN, Kelly Wiley, certified surgical technologist,
     and Tricia folsom, rN, BsN. (Not all team members are pictured.)
                                                                   2010 NURSING ANNUAL REPORT   9

                                           Nursing Resource Center
                                           Named for former TMH Chief Nursing Officer
                                           In July 2010, approximately 100 people gathered at TMH to pay tribute to
                                           former Chief Nursing Officer, Joan Futch, at a ceremony to name the Nursing
                                           Resource Center in her honor. Joan, who was present at the ceremony,
                                           passed away in March 2011.
                                           Joan Futch, RN, BSN, MSHA, began working as a staff nurse at TMH in
                                           1969. As a result of her outstanding performance and professionalism, she
                                           progressed through the organization to Senior Vice President for Nursing
                                           Administration & Chief Nursing Officer in 1986 and held that position until
                                           her retirement in 2001.
                                           The Joan R. Futch Nursing Resource Center helps advance the nursing
                                           profession at TMH by promoting the continuous learning necessary to
                                           provide the very best of care to our patients and families. It is an educational
                                           environment where nurses can network, conduct literature searches of
                                           current publications and research findings, and consult with Roxanne Hauber,
                                           RN, PhD., a faculty member of the Florida State University College of Nursing
                                           and the first nurse researcher for the Nurse Scientist Scholar Program at
                                           Tallahassee Memorial. (See related article on page 22.)
                                           Joan stated during the ceremony, “I am proud to have been given the
                                           opportunity to serve at TMH for so many decades. We accomplished much
                                           while I was here, but there is still much to be done. I have seen what is
                                           occurring with nursing practice at TMH today and I salute the nurses and the
                                           leadership at TMH responsible for this. Please use this resource center to
                                           keep up the good work.”
                                           As a further tribute to Joan, the TMH Foundation has established the Joan R.       disPLAyiNg THE PLAQuE uNvEiLEd AT THE dEdiCATiON Of
                                           Futch Nursing Resource Fund for continuing education, travel, equipment and        THE JOAN r. fuTCH rEsOurCE CENTEr ON JuLy 18, 2010
                                           other endeavors and acquisitions that will assist nurses in meeting present        are: (left to right) Paula fortunas, President and Chief Executive
                                           and future challenges. For donation information, visit                             Officer of the TMH foundation, Joan futch, rN, former TMH Chief
                                           www.tmhfoundation.org or call (850) 431-5389.                                      Nursing Officer, and Barbara MacArthur, rN, MN, fAAN, current
                                                                                                                              TMH vice President/Chief Nursing Officer.

                                    10   2010 NURSING ANNUAL REPORT
                                                                                                                                                                   STRUCTURAL EmPOWERmENT & TEAmWORK
collaborative relationships
advance Patient care
Just as it takes a village to raise a child, nurses at Tallahassee
Memorial know that their work is enhanced and supported
by their colleagues from many different disciplines within
the organization. These collaborative working relationships
are based on the premise that all members of the healthcare
team make essential and meaningful contributions in the
achievement of clinical outcomes. “If it is one of us, it is all of
us,” states Barbara MacArthur, Vice President/Chief Nursing
To recognize these relationships, the Nursing Departments
salutes a group of “Featured Colleagues” in each issue of
its monthly employee newsletter called Pulse. Sometimes,
the group of “Featured Colleagues” includes nurses and
sometimes it does not, but the “Featured Colleagues” are
always valued members of the health care team at TMH.                 CiNdy ALLEN ANd TiM fOrTuNAs ArE PArT Of THE PATiENT AdvOCACy
One such group is the Patient Advocacy Department. Some of            TEAM that interacts with nurses and other TMH colleagues to enhance the experi-
their activities include:                                             ence of patients and family members at the hospital.
n   Visiting patients on the inpatient units.
n   Researching and providing appropriate information to patients and families.
n   Supporting families in crisis during medical emergencies and in ongoing hospitalization.
n   Partnering with staff to resolve concerns voiced by patients, improve communications and help meet non-clinical patient and family
n   Providing information to out-of- town friends and family members about hotels, meals and transportation.
n   Handing out patient safety information and supplying personal items.
n   Recognizing patients who celebrate their birthdays while hospitalized.

                                                                                                                                 2010 NURSING ANNUAL REPORT   11
                                         TMH Nurses Lead the Way
                                         With cooL New Technology
                                         In August 2009, TMH became the first hospital in the Big Bend to          Russ Marsh, 59, a local man who has made a full recovery after being
                                         implement the use of therapeutic hypothermia treatment for heart          treated at TMH for a heart attack last year. “I think cooling therapy is
                                         attack victims. The lifesaving treatment lowers body temperature          a great thing based on the wonders it has done for us,” says his wife
                                         in order to preserve brain function following cardiac arrest, and our     Diane. “I don’t think he would be the way he is now if TMH hadn’t
                                         nurses were directly responsible for bringing this technology to TMH.     used this technology,” she adds.

                                         Ally Fields, RN, BSN was serving as Assistant Nurse Manager in the        Approximately 2-3 patients are being treated with therapeutic
                                         Bixler Emergency Center when she first learned of the treatment and       hypothermia per month at TMH. Usually the therapy is initiated in the
                                         contacted Benjamin Abella, MD, of the University of Pennsylvania,         Emergency Center, Diagnostic and Interventional Suite (Cath Lab) or

                                         a national leader in resuscitation research.                              Cardiac Intensive Care Unit (CICU). Regardless of where the treatment
                                                                                                                   is initiated, therapeutic hypothermia care continues as the patient
                                         There’s always an environment of caution                                  progresses through many units within the hospital, and successful
                                         when you start a new therapy, but now                                     treatment is made possible by the joint efforts of many colleagues.
                                         we are seeing the neurological benefits                                   “This is a really strong collaboration between our physicians and our
                                         for our patients.         —Ally Fields, RN, BSN                           nurses,” commends Ally.

                                         Dr. Abella readily collaborated with Fields, and another nursing          The latest undertaking of Ally and the TMH team, has been involving
                                         colleague, Terri Repasky, RN, MSN, in order to create a cooling           local paramedics and the Leon County Emergency Medical Services
                                         treatment protocol for TMH. Ultimately, nurses developed a thorough       in this lifesaving therapy by providing education. TMH nurses are
                                         and highly effective protocol, and now all TMH critical care nurses—      more than willing to share their skills, knowledge and commitment to
                                         just over 100 individuals—have been educated in cooling therapy.          health and positive outcomes with our community via this therapeutic
                                         Over the past year and a half, the program has grown exponentially,       advancement.
                                         reaching success rates equivalent to or greater than many institutions
                                                                                                                   Ally, who now works as a nurse in the Cardiovascular Medical-Surgical
                                         across the nation. “There’s always an environment of caution when
                                                                                                                   Intensive Care Unit, connects her passion for therapeutic hypothermia
                                         you start a new therapy, but now we are seeing the neurological
                                                                                                                   treatment to the painful experience of losing her father to cardiac
                                         benefits for our patients,” says Ally. “Bringing this technology to the
                                                                                                                   arrest when she was a teenager. “He would have survived if not for
                                         area is just one more example of the world-class care we provide at
                                                                                                                   the loss of brain function,” she says. “I’ve always wanted to help
                                                                                                                   prevent others from going through what my family went through.”
                                         Many cardiac arrest patients who might have otherwise died or
                                                                                                                   The adoption of therapeutic hypothermia treatment at TMH is a
                                         experienced severe neurological outcomes have been able to return
                                                                                                                   testament to the vision and dedication of our nurses, as well as the
                                         to their normal lives thanks to this treatment. One such patient is
                                                                                                                   strong support of our physicians and colleagues.

                                  12   2010 NURSING ANNUAL REPORT
                                                                                 EXEmPLARY PROfESSIONAL PRACTICE
ALLy fiELds, rN, BsN, WAs iNsTruMENTAL in bringing therapeutic
hypothermia treatment to TMH, a technology that helps preserve brain
                    function in certain types of heart attack victims.
                                               2010 NURSING ANNUAL REPORT   13

                                         Clinical specialists: Advanced Practice Nurses Who
                                         Push the system to improve Patient care
                                         Most people know what a nurse practitioner is. The same can be said          technology. Once a final selection was made, a whole host of changes
                                         for nurse midwives and nurse anesthetists. But when people hear the          had to occur, involving many different departments, to prepare TMH
                                         title “clinical specialist,” they look confused and ask “what do you do,     for the introduction of smart pumps. Policies and procedures had to
                                         exactly?”                                                                    be written to reflect new science and technology. Physician order set
                                                                                                                      changes and education for approximately 925 nurses took place. The
                                         Kathy Barnett, RN, MSN, Pain Management Clinical Specialist at TMH,
                                                                                                                      education was accomplished with the assistance of the TMH Clinical
                                         understands the confusion. “We wear many hats, and cover a lot
                                                                                                                      Education faculty and utilized web-based learning and hands-on
                                         of territory,” Kathy explains. Clinical specialists are registered nurses
                                                                                                                      competency validation. Kathy also communicated with the Pharmacy
                                         with an advanced degree who serve as clinical experts, educators,

                                                                                                                      & Therapeutics Committee of the Medical Staff who provided input to
                                         researchers, consultants and managers in their area of expertise.
                                         Currently TMH is home to five of them (in pain management,
                                         emergency, cardiovascular, pediatrics and maternal-child). On any
                                                                                                                      after implementation, I went out and
                                         given day, you might find a clinical specialist at a patient’s bedside, in   talked to users about smart pumps and
                                         the classroom, in a committee meeting or online reviewing the latest         heard only three things: It’s so much easier.
                                         research on a patient care issue. “Our job is to push the system to          It’s so much better. It’s so much safer.
                                         improve patient care in our specialty, and that can take us in a lot                                                      — Kathy Barnett, RN, MSN
                                         of directions.”
                                                                                                                      establish safe, effective drug dosage libraries that were programmed
                                         A significant contribution by a clinical specialist at TMH was the           into the pumps. Implementation occurred in March 2009 and went
                                         advent of ‘smart’ pump technology for the IV administration of patient       off without a hitch. Kathy adds, “After implementation, I went out and
                                         controlled analgesia (PCA). By keeping eyes and ears on evidence-            talked to users about smart pumps and heard only three things: ‘It’s so
                                         based practices, it became apparent that smart pumps were totally            much easier. It’s so much better. It’s so much safer.’ That tells me that
                                         in keeping with TMH’s vision of providing recognized world-class             we did a good job planning. We chose a good product, we anticipated
                                         health care. Kathy gathered the evidence and then worked through             potential problems upfront, and we listened to our staff all along
                                         administrative channels to create a business plan for how the pumps          the way.” Over the last year, additional applications and uses of the
                                         would benefit the organization and the patients that it serves. Dollars      technology have been added.
                                         were allocated through the organization-wide capital equipment
                                                                                                                      Today, the built-in safeguards of smart pump technology have
                                         budgeting process.
                                                                                                                      dramatically increased patient safety at TMH, virtually eliminating PCA
                                         “Then we had to move from vision to reality,” Kathy says. Onsite             programming errors. This fact never fails to make Kathy smile. “That
                                         demonstrations of the pumps available on the market took place to            alone is worth its weight in gold,” she says.
                                         garner input from the clinical, bedside nurses who would use the

                                  14   2010 NURSING ANNUAL REPORT
                                                                                                    EXEmPLARY PROfESSIONAL PRACTICE
           CLiNiCAL sPECiALisT KATHy BArNETT, rN, Ms, (middle) worked with colleagues
             in many different disciplines at TMH to implement smart pump technology for iv
administration of patient controlled analgesia (PCA) for pain management. she is pictured here
      with Hematologist/Oncologist Tim Broeseker, Md, and iT Project Manager Walt Colville.15
                                                                       2010 NURSING ANNUAL REPORT

                                          Nursing advancement at TMh
                                         TMH actively supports nursing advancement by recognizing and rewarding achievement through education differentials, certification
                                         differentials and a professional development compensation system. Currently, more than 200 nurses hold one or more specialty nursing
                                         certifications or advanced practice licensure.

                                          Advanced Registered        Certified Nurse Midwife      Certified Case Manager       Smith, Sharon              O’Neill, Shannon
                                          Nurse Practitioner         Canter, Margaret             Flores, Leann                Stadler, Patti             Perny, Cynthia
                                          Bahorski, Jessica          Gurniak, Miriam              Harper, Marilyn              Stallard, Jacqueline       Pope Jr, Stevey
                                          Benham, Nancy              Hartley, Kathy               Kelly, Kris                  Townley, Amy               Roddenberry, Becton
                                          Bruner, Teressa            McKeon, Kathleen             Petersen, Margaret           Varella, Debra             Stadler, Patti
                                          Chamberlain, Melissa       Ruscher, Donna               Williams, Jacqueline         Weeks, Barbara             Stoltzfus, Esther
                                          Doheny, Laura              Stroh, Heather                                            Williams, Marylu
                                          Earp, Jaibun                                            Certified Critical Care RN                              Certified
                                          Epley, Deanna              Clinical Nurse Specialist    Akkarappuram, Anto           Certified Diabetes         Gastroenterology RN
                                          Evans, Cyndi               Florence, Donna              Ashley, James                Educator                   Baker, Ann-Marie
                                          Godbey, Joyce              McGowan-Repasky, Terri       Baker, Colleen               Fevrier, Linda             Dewar, Adele
                                          Griffin Jimmie             Schall, Mary Beth            Berry, Ivette                Mitchell, Adela            Fletcher, Phyllis.
                                          Griffin, Judy                                           Brown, Laura                                            Hammond, Jeanette
                                          Heburn, Donna              Clinical Specialist          Burtch, Mary                 Certified Dialysis Nurse   Hancock, Leslee
                                          Jones, Faith               Bahorski, Jessica            Cantrell, Kristin            Culbertson, Kathy          NeSmith, Darinda
                                          King, Susan                Barnett, Kathleen            Cenedella, Nancy             Harris, Linda
                                          Kleynen, Judy              Hubmann, Monica              Chason, Kelly                Parker, Judith             Certified HIPAA
                                          Lammert, Cartier           Lee , Kathy                  Cochran, Maria               Unglaub, Vanessa           Privacy Expert
                                          Louvaris, Kathy            Nicoll, Deborah              Cochran, Tommy                                          Dykes, Kelly
                                          Marky, Angie                                            Collins, Amanda              Certified
                                          Moore, Vivian              Certified Ambulatory         Fields, Ally                 Emergency Nurse            Certified Hospice
                                          Nash, Beth                 Care Nurse                   Forrest, Linda               Aggabao, Gloria            & Palliative Care Nurse
                                          Pallentino, Julia          Atteberry, Mary              Griscom, Wendy               Barton, Cheryl             Grischy, Sandy
                                          Patterson, Kathy           Cooper, Claudia              Harrison, Lesley             Cook, Sheri
                                          Pedersen, Debra            Copeland, Deborah            Jordan, Elizabeth            Doud, Victoria             Certified in Infection
                                          Randall, Sara              Dodson, Barbara              Loftis, Darlene              Fields, Jennifer           Prevention and Control
                                          Spells, Melanie            Hatcher, Patricia            Matyjaszek, Jeremy           Godwin, Joni               Benham, Nancy
                                          Steele, Lynn               Jubinsky, Christine          Mavridoglou, Petros          Hadden, Kelli              Kelly, Wallace
                                          Stevens, Michelle          Turner, Julie                McDonald, Erica              Hedrick, Jayne
                                          Whaley, Quandra            Wester, Julia                O’Neill-Wann, Robin          Kelly, Cynthia             Certified Inpatient
                                          Wilson, Irene              Whittington, London          Patterson, Kathryn           McCallister, Debra         OB Nurse
                                                                     Wright, Margaret             Plasay, Rebecca              McGowan-Repasky, Terri     Amirzadeh Asl, Parivash
                                                                                                  Sapp, Johnnie                Meals, Kimberly            Bailey, Laurentina

                                  16   2010 NURSING ANNUAL REPORT
                                                                                                                                               EXEmPLARY PROfESSIONAL PRACTICE
Brannen, Nancy             Manzo, Girlie          Picklesimer, Diana          Lewis, Nancy                 Minimum Data Set
Cao, Kimberly              Powell, Angela         Russell, Linda              Lonkani, Sharon              /PPS/RAI
Chaney, Traci              Robinson, Lydia        Sowell, Cheryl              Newman, Katie                Hevner, Mylinda
Dewit, Sharon              Smith, Deborah         Sutton, Karen               Taylor, Sonseria             Wilson, Faye
Kelly, Victoria            Tomberlin, Herbert     Swoboda, Debora             Whitaker, Linda
Kirkland, Stephanie        Williams, Tarika       Tricquet, Pamela                                         Nurse Executive
Marcinowski, Kendra                               White, Anne                 Certified Radiologic Nurse   Lyon, Freda
McGee, Eileen              Certified Neonatal                                 Ward, Ashley                 Knarr, Lori
Nichols, Paula             Intensive Care Nurse   Certified Pediatric Nurse                                Pasley, Norman
Roberts, Erin              Bloyd, Kim             Buser, Eileen               Certified Rehab RN
Rohe, Karen                Booker, Cynthia        English, Ashley             Evans, Shiela                Nursing Professional
Tiller, Heidi              Driver, Emily          Gatlin, Sherry              Williams, Jacqueline         Development
                           Forbes, Stacie         Glady, Robin                                             Maxwell, Karen
Certified Lactation        Glombowski, Kathy      Lewis, Suzanne              Certified RN
Consultant                 Merritt, Deborah       Long, Monique               Assessment Coordinator       Oncology Certified Nurse
Chavers, Heidi             Schrader, Petrea       Marr, Denise                Wilson, Faye                 Carson, Jessica
Comer, Christina           Spataro, Sharon        Paterniti, Crystal                                       Garrigan, Annette
Frazier, Shelly            Stevens, Teresa        Pierce, Karen               Certified RN, Infusion       Marky, Angela
Goodson, Angela            Tucker, Monica         Ranner, Donna               Hoch, Nora                   Michaels, Joanne
Miller, Elizabeth          White, Lalania         Reiser, Linda                                            Murphy, Frances
                           Zampino, Sheryl        Williams, Louisa            Certified Sexual Assault     Robertson, Christina
Certified Maternal                                                            Nurse Examiner               Taylor, Dreama
Newborn Nurse              Certified              Certified                   Walker, Kathy                Van Winkle, Shannon
Brock, Mary                Neuroscience RN        Post Anesthesia Nurse
Dixon, Sandra              Howard, Meredith       Brown, Gail                 Certified - Wound Care
Johnson, Jennifer          Schremser, Christie    Brown, Madelyn              Moran, Gisela                Progressive Care
Katz, Linda                Soike, Kevin M.        McCarthy, Kate                                           Certified RN
Peterson, Tasha            Teems, Nancy                                       Certified Wound Ostomy       Barden, Leanne
                                                  Certified Professional in   Nurse                        Cain, Grace
Certified Med-Surg Nurse   Certified Nurse        Health Care Quality         Payne, Jennifer              Corbin, Keith
Asis-Cruz, Katherine       Operating Room         Monica Ford-Green                                        Gaden, Karen
Banes-Egina, Mary Jane     Barfield, LeeAnn                                   Lamaze Certified             Holland, Diana
Baptista, Girlie           Blanton, Jane          Certified Psychiatric/      Childbirth Educator          Paulett, Christina
Buckhalter, Harriet        Coldwell, Angie        Mental Health Nurse         Tafuri, Kathleen             Reynolds, Julie
Burnett, Rebecca           Duckett, Faith         Baillargeon-Chaloux,                                     Shipp, Kimberly
Cooper, Barbara            Folsom, Patricia       Donna                       Medical-Surgical RN,         Solis, Sharon
Deabler, Susan             Howes, Kathy           Baker, Shirlene             Board-Certified              Wiler, Zahma
Groce-Madison, Mary        Ingram, Sharon         Bowles, Pamela              Groce-Madison, Mary
Hamilton, Pamela           Jackson, Sharon        Carter, Sandra
Higham, Sandra             Johnson, Joyce         Chambers, Linda
Linsagan, Nell Jasmine     Linton, Alyssa         DeCastro, Arlene

                                                                                                             2010 NURSING ANNUAL REPORT   17

                              AdELA MiTCHELL, rN, Of THE TALLAHAssEE MEMOriAL
                              diABETEs CENTEr shows Heath Plair of Port st. Joe how
                              an insulin pump works. Adela completed an Evidence-Based
                              Practice (EPB) study that compared the effectiveness
                              of insulin pump therapy and multiple injections
                              for controlling blood sugars in pediatric
                              diabetes patients.
                             18   2010 NURSING ANNUAL REPORT
                                                                                                                                                                            NEW KNOWLEDGE & INNOvATION
Diabetes Nurse finds Answers to Questions
About Effectiveness of insulin Pump Therapy using Evidence-Based Practice
Adela Mitchell, RN, spends her days as a certified diabetes educator at the       After an exhaustive search of research databases, Adela found seven
Tallahassee Memorial Diabetes Center providing care, education and support        studies that met her criteria. The research criteria were: good design,
to adults and children with diabetes and their families. One of the common        more randomized studies, population with patients that were between
questions she is asked by parents of children with type 1 diabetes is, “Would     the ages of 1 and 21 years, and research not conducted by companies that
we be able to control our child’s blood sugar better with an insulin pump         manufactured insulin pumps.
than with injections?”
                                                                                  After evaluating and synthesizing the data, Adela was able to summarize her
“There are pros and cons to insulin pump therapy” explains Adela. “It does        findings:
allow a lot more flexibility with meals and snacks, but some children do not
like to be attached to it all the time. Most children on insulin pumps like the
                                                                                  n   A1C levels (a measurement of a person’s average blood sugar levels over a
fact that they do not have to take several injections a day, but the insertion        period of months), was lower (better) for insulin pumps in only one short
sets have to be changed every three days and they can get clogged at times.           study. Longer studies showed no significant difference.
It’s not for everyone, so when parents ask if they should get a pump, I want      n   Three of the studies showed less episodes of severe hypoglycemia (low
to provide an appropriate answer.”                                                    blood sugar) in those with insulin pumps, but the consensus was that
Until she went through Evidence-Based Practice (EBP) Mentor training                  more controlled studies were needed.
at Tallahassee Memorial, Adela would cite her personal observations,              n   One study showed a higher rate of diabetic ketoacidosis (DKA) or
information she learned at conferences or articles she had read. The EBP              increased ketone production with insulin pumps, but none that required
Mentor training she participated in during 2010 showed her a new way to               hospitalization, while another study showed significantly lower episodes
answer this question. It showed her how to find, synthesize and evaluate              of DKA with insulin pumps. The conclusion was that more randomized
research findings to answer clinical questions with more confidence.                  studies are needed.
Adela and 13 TMH nurses met approximately twice a month over the                  n   Insulin pumps were associated with increased treatment satisfaction
course of a year and learned how to apply the steps involved in evidence-             and quality of life in all studies except one, which reported no significant
based practice. They also learned how to implement results within the                 difference.
organizational framework of TMH. In addition, the nurses began working on
evidence-based projects in their specific area of specialization.                 Adela has shared her results with the other diabetes educators at the
                                                                                  Diabetes Center, as well as the local pediatric endocrinologists, and she is
“The steps of evidence-based practice include: identifying the idea or            now armed with evidenced-based information she can share with parents.
question, searching the available evidence, evaluating the evidence and then      She feels good knowing that what she learned through EBP Mentoring is
determining how to implement the findings, “ explains Jessica Bahorski,           benefiting her own patients and the local diabetes community.
ARNP, MSN, the Clinical Specialist in the Pediatric Department at TMH who
helped lead the EBP mentoring sessions.                                           “The EBP Mentor training was a really good learning experience,” Adela says.
                                                                                  “It definitely changed the way I see and research things. It showed me how
Adela’s question was: How is diabetes management affected when children           to look beyond my own experiences, identify appropriate research studies
with diabetes use insulin pump therapy instead of multiple daily injections?      and use the evidence to provide the best care I can.”

                                                                                                                                          2010 NURSING ANNUAL REPORT   19
                                                                AfTEr LEArNiNg ABOuT “Buzzy”
                                                                     AT A NursiNg CONfErENCE,
                                                                 donna ranner, rN, of the Pediatric
                                                               department, brought this kid-friendly
                                                                     device that minimizes the pain
                                                                      of needle sticks back to TMH.
                                                                           she is pictured here with
                                                                       shelby sloan of Tallahassee.

                             20   2010 NURSING ANNUAL REPORT
                                                                                                                                                               NEW KNOWLEDGE & INNOvATION
creates a Buzz in the TMh Pediatric unit
At the Society of Pediatric Nurses Conference last year, Donna Ranner, RN, Certified Pediatric        The science Behind Buzzy
Nurse (CPN), discovered Buzzy®, a cute, kid-friendly device that reduces the pain of needle pricks.   Buzzy® is based on the Gate Control
Invented by a physician and mother, the vibrating plastic bumblebee with ice pack wings helps
minimize discomfort and create a distraction during children’s shots.                                 Theory of Pain, a concept introduced
                                                                                                      by Ronald melzack and Patrick Wall
Donna is Chair of the Pediatric Nursing Department’s Research and Evidence-Based Shared
                                                                                                      in the 1960s. The theory proposes
Governance team. Together, the team, which also includes Catherine Hanks, RN, CPN, Becky
Robertson, RN, Betsy Stoutamire, RN and Nique Long, RN, CPN, decided to test the unusual              that pain signals can be blocked from
gadget. They used Buzzy on about 20 patients to see what the patients, parents and nurses             entering the brain if alternate sensations
                                                                                                      travel the same neurological pathway
One of these parents was Kristen Sloan who brought her 9 year-old daughter Shelby to TMH              simultaneously.
when she began having symptoms of a ruptured appendix. After being admitted to the hospital,
Shelby needed an IV but was very frightened.                                                          The idea is that heat, cold, pressure or
                                                                                                      vibration applied to a mild injury can
“Shelby was terrified of getting an IV,” remembers Kristen, who says her daughter became even
                                                                                                      diminish pain by occupying the
more upset when she learned she would also need to have blood drawn. At this point, a TMH
colleague brought in Buzzy.                                                                           sensory nerves. This theory
                                                                                                      is applied in many
With her attention focused on the fun gadget, Shelby’s fears subsided, allowing her nurses to
administer care in a supportive and compassionate way. Kristen says she would definitely request      common responses
Buzzy again for her daughter, as well as recommend it to other parents of young children. “It         to pain, such
really helped to keep her mind off of the needle,” she said.                                          as running a
Other parents who witnessed Buzzy in action were equally impressed, commenting, “Really               burn under cold
loved Buzzy, —He’s a big help,” and, “Loved Buzzy. My child didn’t want to give him back!”            water or applying
With such positive feedback, TMH quickly integrated Buzzy into children’s care in the Pediatric       pressure to a
Unit, Pediatric Intensive Care Unit and Kid’s Korner. Now, our nurses’ goal is to determine the       bumped elbow.
best techniques for utilizing the device. In December 2010, the team decided to embark on a
research study using Buzzy. This new study will compare the effectiveness of Buzzy with and
without his ice pack wings, as well as with a topical numbing cream.

                                                                                                                             2010 NURSING ANNUAL REPORT   21

                                    TmH Nurses Get Care Down to a Science
                                    Nurse scientist scholar Program facilitates Nursing Practice improvement
                                    Through Evidence-Based Practice and research

                                    Evidence-Based Medicine (EBM) aims to apply evidence gained from the          Since the inception of the Nurse Scientist Scholar Program in 2009, TMH
                                    scientific method to clinical decision making. Examples of EBM can be         nurses have engaged in a number of valuable research and evidence-
                                    traced as far back as ancient Greece. However, it was only in the 20th        based projects. Examples of some recent and ongoing projects include
                                    century that the concept evolved to impact almost all fields of health care   the following:
                                    and policy.
                                                                                                                  n   Kathy Barnett, RN, MSN, a clinical specialist, is leading an evidence-
                                    The modern day era of EBM began in the 1970s and has become the                   based practice project conceived by the nursing staff of the
                                    predominant approach to improving health care and patient outcomes.               Postoperative Care Unit and aimed at improving their patients’ post-
                                    Subsequently, nursing began to transition to Evidence-Based Practice              operative experience and pain management through pre-operative
                                    (EBP), most notably through the work of Bernadette Melnyk and Ellen               patient education.
                                    Fineout-Overholt. Nursing involvement in EBP and research aimed
                                    at continuously improving nursing care is an essential component of
                                                                                                                  n   donna Florence, RN, MS, a clinical nurse specialist, is facilitating a team
                                    achieving MagnetTM recognition, a goal TMH has set out to achieve.                from the Family Care Unit focused on mitigating an uncomfortable side
                                                                                                                      effect of an epidural medication often experienced by patients.
                                    Roxanne Hauber, RN, PhD., a faculty member of the Florida State
                                    University College of Nursing, is the first nurse researcher for the Nurse
                                                                                                                  n   donna Ranner, RN, a certified pediatric nurse, and Jessica Bahorski,
                                    Scientist Scholar Program at Tallahassee Memorial. A partnership                  RN, MSN, a clinical specialist, are leading a team of Pediatric
                                    between TMH and the FSU College of Nursing, the program was                       Department nurses and are developing a research study to investigate
                                    established through the Florida State University and TMH foundations.             what interventions are most effective for decreasing pain and distress
                                    “This collaborative initiative creates a culture of inquiry between the two       associated with giving children IVs.
                                    institutions, fostering the development of nursing unit-based research        n   adela Mitchell, RN, a certified diabetes educator, completed an EBP
                                    and evidenced-based projects,” says Paula Fortunas, President and Chief           project to discover best practices related to helping children with type I
                                    Executive Officer of the TMH Foundation.                                          diabetes and their families make decisions about how to manage their
                                    “My job here is to facilitate the nursing staff at all levels to take             insulin administration.
                                    ownership of and improve nursing practice through the use of best             n   Joann Green, RN, MSN, a clinical education coordinator, is
                                    evidence and when needed, the development of new knowledge,” says                 implementing an EBP based program focused on the nurses who serve
                                    Dr. Hauber.                                                                       as clinical preceptors for new TMH colleagues. Using evidence to guide
                                    Working with Dr. Hauber to further this goal is a team of advanced                the educational preparation for preceptors as well as providing support
                                    practice nurses and research council members. These nurses focus                  to the preceptors, best practices have been established for the unit
                                    on gaining the skills needed to access evidence and answer clinical               specific orientation process.

                             22   2010 NURSING ANNUAL REPORT
                                                                                                                                                                NEW KNOWLEDGE & INNOvATION
n   deb Nicoll, RN, MSN, a clinical specialist, and Susan King, ARNP, MSN,   rOxANNE HAuBEr, rN, Phd, is a faculty member at the fsu College
    Director of Clinical and Patient Education, have facilitated a multi-    of Nursing and the first nurse researcher for the Nurse scientist scholar
    disciplinary EBP based project on Glycemic Control. This project         Program at Tallahassee Memorial, a partnership between TMH and the
    addresses the management of hyperglycemia in adult inpatients            fsu College of Nursing, which was established through the TMH and
    at TMH.                                                                  fsu foundations.

With each of these projects, TMH nurses make discoveries that directly
                                                                             practice. “The movement toward Magnet status has a strong focus
improve care for our patients. Their involvement in improving patient
                                                                             on the role of the nurse in improving practice, which translates into
care through the application of evidence and research helps establish
                                                                             improved patient outcomes,” points out Dr. Hauber.
a nursing culture worthy of Magnet recognition, an award given by the
American Nurses’ Credentialing Center (ANCC) that signifies quality
patient care, nursing excellence, and innovations in professional nursing

                                                                                                                              2010 NURSING ANNUAL REPORT   23

                                    Publications and Presentations
                                    Information is best when it is shared; best practices can benefit more than the original source and one of the highest levels of responsibility for the
                                    nursing professional is to disseminate what is learned and discovered. TMH nurses are involved in sharing their work through both publications and
                                    presentations. Examples of this work are listed below and illustrate the wide variety of topics being addressed at TMH.

                                    PuBLICaTIoNS                                                                  PRESENTaTIoNS

                                    CEN Review Manual.                                                            Building an organ donor Program:
                                    Fourth edition (2009).                                                        how to, What to and What do You Need?
                                    Terri Repasky, RN, MSN, CEN, EMT-P (contributor)                              National Association of Organ Procurement Organizations National
                                                                                                                  Conference. Miami, Florida (August 2010)
                                    developing Processes to Enhance Multidisciplinary Care.                       Barbara Gill MacArthur, RN, MN, FAAN; Christy Corbitt, RN, CPTC
                                    Oncology Issues, Nov/Dec 2010.                                                EBP in the Real World.
                                    Anne Hatcher, RN (contributor)                                                11th Annual EBP Conference 2010 Preconference Workshop, Glendale,
                                                                                                                  Arizona (2010).
                                    Insulin Pump Therapy versus Injection for adolescents with diabetes.          Robin Kretschman, RN, MSN, NEA-BC
                                    Diabetes Research and Clinical Practice, Volume 89, Issue 2, (August 2010).
                                                                                                                  Implementation of an organ donation Collaborative Team
                                    Adela Mitchell, RN, CDE                                                       at Tallahassee Memorial hospital.
                                                                                                                  Lifequest Organ Recovery Services Regional Conference. Pensacola,
                                    outcome Management Matters.                                                   Florida (2010)
                                    Nursing Management , 41(8): 13-16 (2010)                                      Barbara Gill MacArthur, RN, MN, FAAN
                                    Robin Kretschman, RN, MSN, NEA-BC
                                                                                                                  Pain Management in orthopedic Patients.
                                    Radiation Therapy Skin Guidelines: Management by Condition.                   Orthopedic Nurse Association Annual Conference (May 2009)
                                    Revised, 2010.                                                                Kathy Barnett, RN, MSN; Milt Dahl, RN, MS
                                    Anne Hatcher, RN (contributor)                                                The Relationship between BodySize, Risk Perception of developing
                                                                                                                  Type 2 diabetes and Likelihood of Lifestyle Behavior Change
                                    Sheehy’s Emergency Nursing Principles and Practice.                           among african american Women.
                                    Sixth Edition, (2010)                                                         National Association of African American Studies National Association
                                    Terri Repasky, RN, BSN, CEN, EMT-P (contributor)                              of Hispanic & Latino Studies National Association of Native American
                                                                                                                  Studies International Association of Asian Studies (NAAAS & Affiliates)
                                                                                                                  Conference. Baton Rouge, Louisiana (February 2010)
                                    Temperature Measurement in Pediatrics: a Comparison                           Brenda Owusu, RN, MSN, ANP-BC
                                    of the Rectal Method versus Temporal artery Method.
                                    Journal of Pediatric Nursing (Published on line, 2011)                        how We Make the System Work for You at the 2010 Southeast Cerner
                                    Jessica Bahorski, RN, MSN, PNP-BC; Terri Repasky, RN, MSN, CEN, EMT-P;        Regional User Group Meeting in Tampa Florida, April, 2010
                                    Donna Ranner, RN, CPN; Ally Fields, RN, BSN, CEN,; Michelle Jackson, BS,      Allison Mars, RN BSN, and Francesca Holladay, RN, BSN
                                    CCLS: Lucy Moultry, RN; Karen Pierce RN-BC; Mary Sandell, RN, MAdEd.
                                                                                                                  Creating a Culture of Falls Prevention
                                                                                                                  Florida Organization of Nurse Executives Conference, 2009
                                                                                                                  Patty Esher, RN, MHA, BSN

                             24   2010 NURSING ANNUAL REPORT
                                                                                                                                                             NEW KNOWLEDGE & INNOvATION
Research and Evidence-Based Practice studies
Nursing research fosters professional development and advances nursing science. We are proud to report that TMH had many
research studies underway with nurses serving as principle investigators or co-investigators, including 47 active studies, 18
completed studies and 14 studies led by nurses, which are listed below.

The TrialNet Natural history Study of the development of Type I            hospital Elder Life Program (hELP) Version 3: May 30, 2008
diabetes, Protocol, TN-01, Version: Feb. 15, 2007                          Kenneth V. Brummel-Smith, MD; Lisa Granville, MD; Nick Nelson, MD;
Larry C. Deeb, MD; Adela Mitchell, RN, CDE                                 Christopher Dunlap, MD; Kasinal Cashe White, RN, BSN, MSN;
                                                                           Kym Holcomb, BSW
human Papillomavirus acceptability vaccine among a Rural Sample of
Women over 16 Years                                                        a Comparison of the Effectiveness of a Standard Log Book versus the
Laura Davis, RN                                                            Internet or voice Recognition System When Monitoring Pregnant
                                                                           Women with Gestational diabetes
CREaTE II: Building Telehealth home Care Systems for older adults          Larry Deeb, MD; Kim Rohrbacher, RN
Neil Charness, PhD; Ryan Yordon; Dawn Smith, RD, CDE;
Linda L. Fevrier, BSN, CDE; Ryan Best                                      The Effect of Nursing on NICu (Neonatal Intensive Care unit)
                                                                           Patient outcomes
Evidence-based Practice Implementation Scale                               Deborah Merritt, RNC, BSN
Robin Kretschman, RN, MSN
                                                                           New Nurse Residency-an Evidence Based approach
Evidence-based Practice Beliefs Scale                                      Alice Nied, RN, MSN, NEA-BC
Robin Kretschman, RN, MSN
                                                                           a Comparative Study of a Non-invasive Temperature device versus
organizational Culture & Readiness for System-Wide Integration             an Invasive Temperature device in Pediatric Patients in an Emergency
of Evidenced-based Practice Survey                                         Center and Inpatient Pediatric unit
Robin Kretschman, RN, MSN                                                  Terri Repasky, RN, MSN, CEN; Michelle Jackson, BS, CCLS; Jessica
                                                                           Bahorski, ARNP-C; MSN; Ally Fields, RN, BSN; Lucy Moultry, RN; Karen
                                                                           Pierce, RNC; Donna Ranner, RNC; Mary Sandell, RN, MAdEd
NICa Compliance Study
Arthur Clements, MD; Erin Schleicher; Colleen Killian

hIv-aIdS Coordination of Care Research
Norman Pasley, RN, BSN

                                                                                                                           2010 NURSING ANNUAL REPORT   25

                                   NursEs frOM THE CArdiOvAsCuLAr LAB are among
                                   those whose units scored high in nursing satisfaction.
                                   seated: rhonnie schaeffer, rN, BsN. standing (left to right)                    mean Change in Quality of Care Over Past Year
                                   sherry McBride, rN, BsN, Patty Brown, rN, BsN, Barbara
                                   Hurlston, rN, and Mary Ann valentine rN.

                                   RN Satisfaction Propels


                                   Improvements in Quality of Care                                        0.2
                                   Nursing satisfaction at TMH is measured using the National Database         0

                                   for Nursing Quality Indicators (NDNQI) survey tools. This year, 784    -0.2
                                   of our registered nursing colleagues who provide direct care for our   -0.4
                                   patients participated in the survey along with 136,000 peers from
                                   hospitals across the country. The practice environment was evaluated
                                   by 90% of those eligible to participate, far exceeding the national    -0.8

                                   participation rate of 65%. This strong level of response provides       -1

                                   invaluable input as we strategically progress in nursing at TMH.                                2006            2007           2008            2009            2010
                                                                                                                                               -1 = Detoriated   0 = No change   +1 = Improved

                                                                                                                         Average of all units at TMH                All comparison units in all comparison hospitals

                            26   2010 NURSING ANNUAL REPORT
                   4           Practice Environment Scale mean Scores

                                                                                                                                                                                                     EmPIRICAL QUALITY RESULTS














                                      Nurse              Nursing             Nurse Manager               Staffing and               Collegial            Mean PES
                                  Participation        Foundations          Ability, Leadership,          Resource             Nurse-Physician          Score
                                   in Hospital          for Quality            and Support                Adequacy                Relations
                                      Affairs              of Care                of Nurses

                                Average of all units at TMH                   Average of all comparison units                          Average of all comparison units
                                                                              in all hospitals                                         in teaching facilities

The Results
RN satisfaction at TMH out-performs the national average in every category.                         leadership and support of nurses; staffing and resource adequacy; and collegial
This includes job enjoyment scores and the mean change in quality of care over                      nurse-physician relations.
the past year.                                                                                      The NDNQI Survey is a valuable tool that benchmarks hospitals with like
RN Satisfaction at TMH also out-performed the national average in every                             hospitals and each unit with like units across the country. The consistent
category that contributes to the practice environment scale: nurse participation                    improvement in the practice environment that has been seen in each area
in hospital affairs; nursing foundations for quality of care; Nurse Manager ability,                reflects the improvements in quality of care that have been seen at TMH.

                                                                                                                                                                   2010 NURSING ANNUAL REPORT   27

                                   Tracking Empirical Results Helps Improve Quality at TmH
                                   TMH Nursing colleagues recognize that nationally benchmarked data can be used to help improve the quality of patient care we provide
                                   and the environment in which nursing is practiced.
                                   Nursing-sensitive indicators reflect the structure, process and outcomes of nursing care provided at the bedside. To provide a comparison,
                                   TMH is a member of the National Database of Nursing Quality Indicators® (NDNQI), a proprietary database of the American Nurses
                                   Association that collects and evaluates unit-specific nurse-sensitive data from over 1,700 hospitals. These unit-level comparative data
                                   reports are used for quality improvement projects.
                                   As a member of the NDNQI, Tallahassee Memorial also has the opportunity to participate in an annual RN survey, which alternates its focus
                                   from year to year between job satisfaction and the practice environment. (See article on previous page.)

                                       RN JOB PLANS                                     JOB EmPLOYmENT SCALE T-SCORE                                  PERCENT Of PATIENTS WITH HOSPITAL
                                       % Remaining on Same Unit for Next Year           <40=low satisfaction 40-60=moderate satisfaction > 60= high   ACQUIRED PRESSURE ULCERS
                                       100%                                              70                                                           10%
                                       90%                                                                                                             8%
                                       80%                                                                                                             6%
                                                                                         50                                                            5%
                                       70%                                                                                                             4%
                                       60%                                                                                                             2%
                                       50%                                               30                                                            0%
                                                                                                                                                             1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
                                              2007     2008             2009   2010              2007          2008             2009      2010              2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010
                                                     TMH      NATIONAL MEAN                                 TMH       NATIONAL MEAN
                                                                                                                                                                       TMH     MED-SURG COMPARISON GROUP

                            28   2010 NURSING ANNUAL REPORT
                                                                                                                                                                                                                                                                                  EmPIRICAL QUALITY RESULTS
INJURY fALLS per                                                                                      CATHETER-ASSOCIATED UTIs fOR                                        CENTRAL LINE-ASSOCIATED BLOOD-
1000 PATIENT DAYS                                                                                     ADULT & PEDIATRIC ICUs                                              STREAm INfECTIONS for ADULT & PICUs
2.00                                                                                                  6.0                                                                 3.0
                                                                                              GOOD                                                            GOOD                                                                                                    GOOD
                                                                                                      5.0                                                                 2.5
                                                                                                      4.0                                                                 2.0
1.00                                                                                                  3.0                                                                 1.5
                                                                                                      2.0                                                                 1.0
                                                                                                      1.0                                                                 0.5
0.00                                                                                                  0.0                                                                 0.0
       1/14 2/14 3/14 4/14 5/14 6/14 7/14 8/14 9/14 10/14 11/14 12/14                                        1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q                                  1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
                                                                                                            2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010          2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010
                          TMH            NDNQI MED-SURG MEAN                                                               TMH     NHSN COMPARISON GROUP                                            TMH            NHSN COMPARISON GROUP

CENTRAL LINE-ASSOCIATED BLOOD-                                                                        vENTILATOR-ASSOCIATED PNEUmONIA                                     vENTILATOR-ASSOCIATED PNEUmONIA
STREAm INfECTIONS fOR NICU                                                                            fOR ADULT & PEDIATRIC ICUs                                          fOR NEONATAL ICU
16.0                                                                                                                                                                      14.0
                                                                                               GOOD   6.0                                                                                                                                                             GOOD
14.0                                                                                                                                                                      12.0
12.0                                                                                                  5.0
10.0                                                                                                  4.0
                                                                                                      3.0                                                                  6.0
                                                                                                      2.0                                                                  4.0
 2.0                                                                                                  1.0                                                                  2.0

 0.0                                                                                                                                                                       0.0
         1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
                                                                                                      0.0                                                                         1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q
        2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010                                          1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q 1Q 2Q 3Q 4Q                                 2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010
                                                                                                            2008 2008 2008 2008 2009 2009 2009 2009 2010 2010 2010 2010
                             TMH            NHSN COMPARISON GROUP                                                                                                                                    TMH            NHSN COMPARISON GROUP
                                                                                                                           TMH     NHSN COMPARISON GROUP
                  Note: NHSN Pooled Mean for birth-weight category<750g used as comparison.                                                                                               Note: NHSN Pooled Mean for birth-weight category<750g used as comparison.

                                                                                                                                                                                                                          2010 NURSING ANNUAL REPORT                         29
              The region’s first Certified Stroke Center and only state designated
              Brain & Spinal Cord Injury Center.
              An Accredited Chest Pain Center with Percutaneous Coronary
              The Big Bend area’s only accredited community hospital
              cancer program, affiliated with the Moffitt Cancer Center.
              The only birth facility in the Big Bend equipped to care for high-
              risk moms and critically ill babies.
              A State Designated Level II Trauma Center.
              Offering a wide range of minimally invasive surgeries including
              da Vinci® robotic surgery and single-incision procedures.
              The region’s only Neurological, Pediatric and Level III Neonatal
              Intensive Care Units.
              First hospital in the country to be recognized by the American
              Psychological Association as a Psychologically Healthy Workplace.
              Winner of the National Research Corporation’s Consumer Choice
www.TMH.org   Award for the sixth year in a row.

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