Detroit Receiving Hospital

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					                    Force 4
                  Volume 1

Personnel Policies
    & Procedures

       Salaries and benefits are
  characterized as competitive.
  Rotating shifts are minimized
       and creative and flexible
      staffing models are used.
  Personnel policies are created
    with staff involvement, and
  significant administrative and
            clinical promotional
            opportunities exist.
                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

Magnet Force 4: Personnel Policies & Procedures

Salaries and benefits are characterized as competitive. Rotating shifts are
minimized and creative and flexible staffing models are used. Personnel policies
are created with staff involvement, and significant administrative and clinical
promotional opportunities exist.

   We have previously discussed the overarching system-wide processes that guide policy,
                                            compensation and other personnel functions. The
 DRH and its staff are partners in
 creating a compassionate, caring           DMC defines the broader structure and the site
 and productive work environment.
 Common beliefs and values help
                                            applies that structure to their patient population and
 DRH chart its course and provide           organization culture. In today’s highly competitive
 direction to its health care delivery
 team. Personnel policies and               employment arena, employers like DMC/DRH are
 procedures serve as guidelines for
 the uniform and consistent                 finding ways to differentiate themselves from other
 administration of personnel policy.        hospitals throughout southeast Michigan. The DMC
 The policies and procedures are
 based on sound management                  compensation program is defined at the system level
 principles and appropriate human
 resource practices, including              and is designed to attract and retain talented,
 clarifying the rights and
                                            committed employees and to encourage professional
 responsibilities of both DRH and its
 employees. DRH pledges to                  growth. The program is based on a compensation
 provide fair employment practices,
 good working conditions and                philosophy that defines the objectives of pay focusing
 opportunities for career
 development. Likewise, DRH                 on competitive salaries and benefits, internal
 expects its employees to be                equity/fairness, job evaluation/analysis, job status
 committed, to give their best effort
 and to treat each other and                (wage and hour exemption) and compliance with laws
 patients with respect and dignity.
                                            and regulations. DRH also offers various programs to
help qualifying employees meet their personal and professional responsibilities, including
flexible staffing models that promote work life balance.

   The following story illustrates one nurse’s process in choosing DRH as her employer of
          In 2005, I was employed at another nearby hospital system and was quite unhappy with
          my job. I wanted to expand my nursing knowledge and experience. I needed a job in a
          stimulating environment that challenged me, ignited my professional drive, advanced my
          practice at the bedside and offered support toward higher education.

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                                             Force 4: Personnel Policies and Procedures

                      After soliciting advice from several nursing colleagues about a
                      best-in-class hospital, they recommended Detroit Receiving. They
                      said DRH has an outstanding reputation as being a great place to
                      work with highly qualified management and staff that work as a
                      team to provide exceptional patient care.

                      I began working at DRH on December 13, 2005. At DRH, I found
                      exactly what I was looking for in an employer -- flexible work
                      schedules, continuing education, numerous growth opportunities
                      and much, much more.”

DRH offers staff nurses an opportunity to express their opinions and make
recommendations on how to improve units to enhance patient and job satisfaction.

I am currently at level 4 in the promoting excellence (PE) program. Although PE
requires establishing measurable goals to improve professional development and
outcomes, I plan to stay and build my career through higher education with support from
my management.”

Laura Suelzle, RN
4 years at DRH

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                                                       Force 4: Personnel Policies and Procedures

SOE 1: Describe the formal and informal performance appraisal processes used in
the organization, including self–appraisal, peer review, and 360° evaluation (as
appropriate) for nurses at all levels in the organization.

       The standards of professional performance for the DCN by ANA are: “the nurse
evaluates one’s own nursing practice in relation to professional practice standards and relevant
statutes and regulations” ANA Nursing Scope and Standards of Practice (2004). At DRH,
performance appraisals provide an effective and engaging way to influence and evaluate the
work performance of all employees. Clear job expectations and responsibilities are established
in relation to organizational goals and objectives. An ongoing dialogue of planning, feedback
and evaluation are some of the methods used to help employees achieve performance goals.
DRH uses the concept of “group practice” for performance appraisal of nurses. Group practice
means nurses use and adhere to the same standards and principles, in other words DRH nurses
practice as “one” collaborative group to ensure compassionate care experiences for patients.
Group practice also reflects the process of shared decision-making to define standards of
practice. The performance appraisal process provides an opportunity for staff to pause and
examine their progress in achieving nursing excellence.

       Staff nurses at DRH are formally evaluated annually according to the performance
appraisal process, which is a dynamic two-way interactive process designed for and by the
professional nurse. For the staff nurse, this process has been named ‘Promoting Excellence’.
Managers begin this annual process to allow for time to have performance conferences and agree
upon subsequent year goals . They submit the result of the performance appraisal to Human
Resources annually by July 1st. Performance increases are given during the first pay period in
September of the current year. The nurse’s unit manager determines the increases based on
mutual agreement of attainment of performance goals and years of nursing experience. These
criteria, reviewed annually, are determined by a team from DMC Wage and Compensation, PNC
staff at both site and DMC levels and representatives of each site who are unit level leadership.
The levels of achievement are labeled by levels ranging from 1-10.

       All new-hire RN’s are evaluated initially at the end of their orientation period. This
evaluation consists of a discussion among the nurse, preceptor, and clinical nurse manager.

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During this discussion, achievement of competency, responsibilities and professional nursing
goals are identified. Consecutive evaluations then take place annually.

           As stated, the performance appraisal for staff nurses is called “Promoting Excellence”
(PE). PE requires each nurse to set performance goals with the unit leadership and together, they
continually strive to attain the goals. The development of the PE process occurred in 2005 and
was a yearlong process. A design group consisting of nurse leaders and PNC developed the PE.
The group selected five domains of nursing practice for assessment, including customer service,
patient care, communication, teamwork/leadership, and professional practice. Today the
process is well articulated and embedded in the culture of DRH. There are ten levels for each
domain, and each level requires a nurse to master specific performance objectives and behaviors.
The domains and anchors for each level are outlined below:

Customer Service
           Nurses at DRH are committed to creating new customer experiences for all patients and
families who enter through our doors. The levels and domains outlined for nurses are in Table
4.1a. In this PE category are the guidelines for achieving excellence in customer service. They
are as follows.
Table 4.1a
Levels 1and 2        Uses basic customer service standards in interactions with patients, families and staff
Level 3              Consistently incorporates all elements of customer service
                     Competent in basic service recovery
Level 4                Able to respond to concerns and issues in an accepting manner
                       Able to implement service recovery in most situations
Level 5                Assesses patient and family expectations as basis for plan of care
                       Views staff from other departments as internal customers and adheres to customer service
Level 6                Able to adjust plan of care to accommodate special or personal needs
                       Able to resolve increasingly complex concerns/conflicts
Level 7                Anticipates and plans for periods of increased stress for patients and families
                       Assists less experienced staff with service recovery
Level 8                Coaches staff when lapses in customer service standards are observed
                       Advocates for customer needs with support departments
Level 9                Provides exemplary customer service despite challenging unit events
                       Is sought by less experienced staff for help in problem-solving customer service issues
Level 10               Role model for customer service excellence
                       Seeks opportunities to mentor staff to improve customer service skills

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Patient Care
           Through the principles of Swanson’s Caring Model, nurses at DRH create intentional,
therapeutic relationships to deliver exceptional patient care. Table 4.1b shows the levels and
domains that guide decision-making and interventions facilitated by Swanson’s vision of care.
Table 4.1b
Levels 1and 2        Provides safe patient care in accordance with policy and standards.
                     Recognizes when help is needed and seeks appropriate assistance.
                     Recognizes and responds to obvious changes in patient status.
Level 3                Makes routine decisions without help
                       Requires direct support for unfamiliar conditions, treatments or diagnoses.
                       Demonstrates proficiency in unit specific interventions and skills.
                       Verbalizes knowledge of and is compliant with regulatory agency standards.
Level 4              Considers secondary diagnoses when making decisions.
                     Consults with more experienced staff when unfamiliar conditions or treatments arise.
                      Follows through on advice with increasing independence.
                     Begins to recognize potential impact of changes in patient status.
Level 5              Attains full proficiency in unit specific interventions and skill.
                     Requires help infrequently for complex situations or rapid changes in environment.
                     Includes patient and family perspectives when making decisions
                     Recognizes and responds to early indicators of change in patient condition.
Level 6              Provides support to less experienced staff as requested.
                     Requires help only in extreme/critical situations.
                     Seeks multiple sources of data/information to support decision-making.
                     Recognizes and responds to subtle changes in patient condition.
Level 7              Assesses skill levels of less experienced staff and offers guidance
                     Anticipates need for and obtains resources for changing patient needs.
                     Recognizes potentially incompatible interventions and initiates actions to resolve.
                     Recognizes and prioritizes responses to multiple changes in patient condition.
Level 8              Develops creative ways to implement interventions in challenging situations.
                     Consults colleagues and manager regarding unusual strategies or situations.
                     Recognizes and prioritizes responses to condition changes in multiple patients.
Level 9              Consulted by other staff for alternative interventions in complex situations.
                     Makes complex decisions involving multiple and/or conflicting patient care priorities.
                     Anticipates potential problems and takes action to prevent or decrease impact on patient.
Level 10             Provides expert care for a group of complex patients despite occurrence of unexpected unit
                     Clearly differentiates between decisions within nursing scope of practice and those requiring
                      multidisciplinary collaboration.
                     Plans for potential problems and arranges for appropriate resources and support.

           Great care has been taken to ensure the voice of nurses at all levels is heard and
operationalized through the shared decision-making process. Nurses are encouraged to

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                                                                Force 4: Personnel Policies and Procedures

communicate openly and directly. Table 4.1c shows the levels and domains providing direction
for nursing communication.
Table 4.1c
Levels 1and 2        Communicates emergency situations immediately
                     Describes situations accurately
                     Documents findings and care plan in accordance with guidelines
Level 3              Communicates changes in patient condition with medical staff in a timely, accurate and
                      efficient manner
                     Documentation includes patient response to interventions
Level 4              Demonstrates ability to address patient care and treatment issues in an effective and efficient
                      manner in order to achieve desired outcomes
                     Documentation includes clear and precise objectives related to the treatment plan
                     Uses planned outcomes and nursing judgment related to patient, family and significant
                      others physical, psychological and spiritual needs
Level 5              Adjusts communication priorities in response to emergencies
                     Suggests improvements
                     Documentation reflects collaboration with the multidisciplinary team
                     Able to communicate unit activities to peers and stakeholders
Level 6              Able to sort communication priorities quickly and accurately
                     Documentation outlines the advanced stages of illness and progress toward desired
                     Collaborates within multidisciplinary team and is viewed as a resource
Level 7              Communicates concerns relating to plan of care assertively
                     Documents rapid changes in clinical outcomes that impact LOS
                     Makes members of the multidisciplinary team aware of potentially incongruent goals/plans
                     Maintains optimal levels of communication within the department and with other
                      departments to coordinate patient care delivery
Level 8              Able to facilitate problem solving and conflict resolution within multidisciplinary team
                     Communicates issues with potential to impact patient care delivery through chain of
Level 9              Communicates strategies to improve practice with designated decision-making group
                     Uses critical thinking skills to serve as a resource to peers and stakeholders to facilitate
                      discharge planning and decrease LOS
                     Seeks out problems and concerns from customers, stakeholders, coworkers and supervisors
                      to enhance practice and enhance patient outcomes
Level 10             Participates in formal and informal forums to identify and resolve clinical practice and unit
                      operational issues
                     Able to share expertise and knowledge in a broad range of cases involving the
                      multidisciplinary team
                     Viewed as credible in practice with an enhanced ability to coordinate multiple aspects of

           DRH encourages and rewards leadership from all nurses within the hospital. Teamwork
is manifest through nurses who have a deep and longstanding commitment to collaboration. The
categories for teamwork and leadership are as follows.

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Table 4.1d
Levels 1and 2        Delegates correctly to other team members
                     Works cooperatively, assists other team members when asked
Level 3                Supervises ancillary staff at a beginner level
                       Demonstrates increasing awareness of overall unit and co-worker needs
                       Needs assistance to determine priorities among conflicting demands on time
Level 4                Demonstrates the value of team work by:
                                   o Supervises ancillary staff. Requires assistance when confronted with complex
                                   o Offers assistance to co-workers to promote team function
                                   o Feedback received supports that the team values contributions
Level 5                Supervises ancillary staff effectively. (This is required; not allowed for NA.)
                       Knows scope of practice of team members
                       Able to perform in charge nurse role, delegating in accordance with scope of practice
                       Advances defined patient outcomes
                       Takes an active role in seeking clarification, verifying information and communicating
                        accurately to control/dispel rumors
Level 6                Initiates and shares goals with team to enhance cooperation
                       Delegates efficiently and effectively to team members with multiple roles
                       Acts as a resource person, problem-solver and troubleshooter
                       Supports other charge nurses when not assigned to charge duty by role modeling exemplary
Level 7                Acts as a clinical role model
                       Improves team function and skills of others by assessing strengths and deficits among team
                        members and taking these into account when making assignments and providing support
                       Proactively works to resolve staffing issues
                       Maintains a positive focus despite adverse conditions, and encourages others to do the same
Level 8                Mentors others based on assessment of strengths and needs
                       Teaches others to match priority with situation
                       Responds consistently in complex situations
Level 9              Considers unit PI goals when delegating and coordinating activities of the care team
                     Trains staff for unit leadership and acts as resource for them
                     Intervenes and problem-solves when interpersonal conflicts arise between peers.
                     Anticipates and participates with shift leader, charge nurse, and management in staffing,
                      quality improvement, customer satisfaction
Level 10             Shares team building best practices with other units or sites
                     Leads well in complex, rapidly changing situations
                     Mentors less experienced staff in developing and maintaining mature, respectful
                      relationships with peers

Professional Practice
           The tenants of Professional practice form the underpinnings of nursing at DRH. The
following Table 4.1e depicts the levels and domains for this category.
Table 4.1e
Levels 1and 2          Accepts constructive feedback from manager and coworkers
                       Implements evidence-based practice changes as directed
                       Has completed diversity training
                       Participates in self-appraisal of performance
                       Aware of what PNC and nurse practice council is. (Shared governance and unit

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Level 3       Knowledgeable about quality indicators for unit/service.
              Is knowledgeable of professional organization, and published standards
              Incorporates feedback from manager and coworkers in daily practice
              Patient’s cultural needs are assessed and addressed
              Relates to co-workers in a manner that is consistent with cultural diversity values
              Maintains awareness of PNC and nurse practice forum
Level 4       Gains additional knowledge by completing at least one educational offering relating to
               clinical specialty. (Can be completed by reading an article, attending in-house inservice,
               outside offering, etc.)
              Participates in peer review process
              Supports student clinical experiences. (For MN's. may include participating in student
              Recognizes ethical issues and initiates established process for resolution.
              Seeks and gives information to PNC
Level 5     Gains additional knowledge by completing at least 2 educational offerings related to clinical
            Supports evidence-based practice among staff. (Follows new practice guidelines.)
            Shares ideas, suggestions and solutions with unit management/CNS, PNC and nurse practice
Level 6     Gains additional knowledge by completing at least 2 educational offerings, one of which
             includes evidence-based practice recommendations
            Supports staff participation in educational offerings. (Covering for staff to attend,
             encouraging staff attendance.)
            Encourages adherence to evidence-based practice changes among team members
            Communicates openly and collegially with manager and CNS's
Level 7     In addition to level 6 requirements, prepares a summary of the evidence-based practice
             offering for staff (i.e., handout)
            Incorporates evidence-based practice principles in own daily practice
            Continuously and accurately evaluates own performance and makes appropriate adjustments
            Participates in the development of unit priorities (i.e., resource allocation, safety, practice,
             effectiveness, and budget development) in accordance with professional practice
Level 8     In addition to level 7 requirements, prepares an educational offering: journal club, poster or
             case review for unit. (Disseminates the information.)
            Actively supports implementation of evidence-based practice. (Beyond your own scope;
             leading the charge.)
            Participates in the development of unit priorities (i.e., resource allocation, safety, practice,
             effectiveness, and budget development) in accordance with professional practice
Level 9     In addition to level 8, one of the educational offerings completed must relate to the
             professional practice environment. (i.e., staff development, retention, leadership, ethics, etc.
            Provides suggestions/plans for unit/hospital staff development, retention, leadership or other
             practice environment improvements
            Seeks out written resources, which may include published research to guide problem solving
             when confronted with practice or operational challenges
            Takes an active role in the implementation of practice and operational changes
            Participates in the development of unit priorities (i.e., resource allocation, safety, practice,
             effectiveness, and budget development) considering staff skills, clinical issues, and
             budgetary responsibility
Level 10    In addition to level 9, assists another (can be different discipline) in preparing his/her
             educational offering or share offering beyond the scope of own unit
            Participates in unit council or staff meetings to evaluate the practice setting and collaborates
             with decision-making body to promote optimization

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                                                             Force 4: Personnel Policies and Procedures

                  Participates in an ongoing PI initiative – may lead or be part of a team
                  Identifies and takes action to remove barriers to evidence-based practice

       The primary rationale for implementing PE was to provide oversight and uniform
guidelines for the determination of compensation across all eight DMC hospitals.. PE also
helped to eliminate the dissatisfaction of compensation compression among staff. Compression
consisted of clustering salaries around the same point without respect to years of experience.
Compression typically affected staff nurses with one to three years of experience, causing the
beginning salary range to overlap with the range for new hires. This resulted in a new hire
starting with a higher salary than a nurse with one or two years of experience. The PE model
rewards nurses for achieving the objectives and behaviors of each domain. (attachment, 4.1a,
Promoting Excellence Performance Criteria, p. 12)

       Additionally, a staff nurse suggested the concept of peer evaluation -- another example of
shared decision-making within DRH. Annually, the nurse submits the names of five colleagues
to complete peer evaluations. The selected colleagues complete a peer assessment attesting that
the nurse has achieved the next PE practice level. (attachment 4.1b, Promoting Excellence Peer
Assessment, p. 14) The manager provides the employee with the self–evaluation tool
(attachment 4.1c, Promoting Excellence Self Assessment, p. 15), and completes the manager
evaluation (Attachment 4.1d, Promoting Excellence Manager Assessment, p. 16). After the peer
and self evaluations have been completed, the manager meets with the nurse to review the
feedback. At this review session, the manager and nurse mutually determine if the nurse has
successfully demonstrated the objectives and behaviors for the appropriate level, and next year’s
goals are developed. Ultimately, PE puts the nurse in charge of his/her professional career path.
By collaborating with the unit director, nurses determine their current and/or next level of
performance and corresponding compensation level.

       Informal and anecdotal feedback about the performance of a staff nurse contributes to the
overall performance appraisal. This feedback is received in several ways. Sometimes a nurse is
mentioned in a patient survey, which is recognized through verbal acknowledgment by their
manager. Letters are forwarded to corporate human resources for placement in the nurse’s

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personnel file, and are occasionally published in the Receiving Rap, the hospitals internal
employee newsletter. Spot Awards can also be given to employees who exemplify exceptional
performance in patient care, family interaction, project completion, and other achievements.
Spot Awards are part of a formal recognition program based on a human resources policy. This
is an ongoing form of recognition that is presented throughout the year “on the spot” to all
employees. Spot Awards consist of movie tickets, department store and restaurant gift cards, and
other gifts.
        I would like to present a spot award to Lisa Haener RN for her positive team attitude and
        commitment to patient care on 7-12-08. Lisa had already worked several shifts this
        week, however, Lisa willingly volunteered to stay over an additional 4 hours today (7p-
        11p) just so that her co-workers would not have to work short staffed with 18 patients.
        Lisa stated, "It's busy up here, and if there isn't going to be a third nurse until 11pm, then
        I will stay over until they come." Lisa's positive team spirit is one of many reasons why I
        appreciate Lisa and why she will always be an asset to this health care organization.
        Please acknowledge her with a spot award. Thank you.

        Charmaine Bond RN, BSN
        Nursing Administrative Supervisor
        7 ½ years at DRH

        A Support with Action Team (SWAT) staff nurse volunteered to assist in the ED caring
for patients who were awaiting inpatient admission. Her contribution was acknowledged
publicly with a Spot Award. She responded with the following thank you note:
        I just want to thank the Nursing Department for acknowledging and awarding me with
        tickets to the concert on Wednesday. I also want to take the time to thank Charmaine
        Bond, Nurse Supervisor, Tiffani Brazelton, Lead Nurse, ED, Leticia Owens, Staff Nurse
        and Gary the RT on midnights. We all worked together that night and successfully
        transferred five patients out of the module. They were supportive and treated me with
        respect. Leticia Owens worked in the OCU and provided much needed assistance to
        transfer patients out. I appreciated all of their help.
        Thank you,
        Rashonda McGee, RN
        Staff Nurse, SWAT
        3 years at DRH

        The formal performance appraisal process for nurse leaders and APNs is a 360◦ four-step
process. The first step is for the nurse leader to complete a self-evaluation, which includes
(attachment 4.1e, Pay Decision Summary and Competency Validation Form, p. 19) three
domains. They are:

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   1) Job duty performance
   2) Customer satisfaction
   3) Work group interaction behaviors and documentation of attainment of previous year’s

       The second step involves identifying customer stakeholders to provide input into the
evaluation. This input is shared by completing a customer/stakeholder form, which is distributed
by the nurse being evaluated to five peers of their choice. Once the stakeholder completes the
form, it is then given to the nurse’s immediate supervisor for tallying of scores and evaluation
completion. The third step includes developing individual performance goals for the upcoming
year. Individual nursing leaders develop a personal performance action plan and meet
individually with the CNO. Meeting with the CNO affords nursing leaders an opportunity to
discuss results produced, plans for professional growth and formulation of the next year’s goals.
The fourth step involves the CNO completing an evaluation of the nurse leader. This evaluation
incorporates the leader’s self–evaluation, customer and stakeholder input, and achievement of
goals and objectives from the previous year. The 360◦ evaluation process is also used for the
CNO. The Chief Nurse, Ms. Hinton, identifies minimally 5 customers and stakeholders,
including physicians and directors from Patient Care Services (PCS).

       This highly engaging and collaborative appraisal process helps to define the objectives
and guiding principles that recognize and reward the individual and team performance of nurses
at DRH.

                                                                                           Page 11
Promoting Excellence Performance Criteria Attachment 4.1a

                                                 Page 12
Promoting Excellence Performance Criteria Attachment 4.1a

                                                 Page 13
Promoting Excellence Peer Assessment Attachment 4.1b

                                            Page 14
Promoting Excellence Self Assessment Attachment 4.1c

                                            Page 15
Promoting Excellence Managerm Assessment Attachment 4.1d

                                                Page 16
Promoting Excellence Manager Assessment Attachment 4.1d

                                               Page 17
Promoting Excellence Manager Assessment Attachment 4.1d

                                               Page 18
Pay Decision Summary and Competency Validation Form Attachment 4.1e

                                                           Page 19
Pay Decision Summary and Competency Validation Form Attachment 4.1e

                                                           Page 20
Pay Decision Summary and Competency Validation Form Attachment 4.1e

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SOE 2: Provide examples of how workplace advocacy policies and processes
safeguard employee rights and promote a safe and healthy work environment.

       Workplace advocacy is defined by the ANA as an “array of activities which are initiated
to address the many and varied employment and workplace challenges nurses face on a daily
basis.” ANA Board of Directors (1991.) Retrieved January 1, 2009 from

       DRH has integrated systems that address workplace advocacy, employee rights and
safety. DRH is firmly committed to practices that generate safe and healthy workplace actions,
conditions and procedures. These practices are aimed at reducing and eliminating work-related
hazards and enhancing health promotion. The hospital is dedicated to the prevention of all
occupational illnesses and injuries resulting from infectious disease, chemicals, biological or
radioactive hazards in the workplace. Examples of initiatives that safeguard employees’ rights,
create a healthy work environment, and facilitate safety include reducing exposure to pathogens,
leadership rounds, and the employee assistance program, and other employee health and wellness

Reducing Pathogen Exposure
       Infection control education is provided annually to all health care employees on topics
such as blood borne pathogens, tuberculosis, and latex sensitivity. DRH also has an annual
policy requiring the testing of all employees, physicians and students for tuberculosis. Infection
control policies are presented through the required Net Learning module in accordance with
OSHA and CDC guidelines, as well as internal policies.

       Employee safety, specifically the prevention of blood and body fluid exposures (BBFE),
is a high priority at DRH. In 2001, OSHA published the final rule on “Occupational Exposure to
Bloodborne Pathogens: Needlesticks and Other Sharps Injuries”. The bloodborne pathogens
standard was revised to conform to the federal Needle Stick Safety and Prevention Act.
Provisions of the rule include:
      Requiring exposure control plans that reflect how employers implement new
       developments in control technology.

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      Mandating employers to solicit input from employees responsible for direct patient care
       in the identification, evaluation, and selection of engineering and work practice controls.
       In order to comply with the standards, the DMC established a Safer Sharps Committee.
The purpose of the committee is to review safety sharps devices on the market and complete
product evaluations of selected devices. Staff nurses had the opportunity to evaluate safety
products in their clinical setting and provide input in the product selection. At DRH, the BBFE
Prevention Task Force has oversight of the evaluation process. An example of safety needle
product evaluation included the Twinpak™ Dual Cannula Device with attached blunt fill and
safety needles; staff nurses in anesthesia, PACU, 4Q SICU and ED, evaluated The Twinpak™
device. The device helped to streamline IV insertion by reducing the number of individual
pieces, thus, making the process easier and safer for nurses. Staff nurses in the ED and some on
nursing units also evaluated various safety needles used for injections. Ultimately, a safety
needle product was chosen for implementation across the DMC and at DRH. The safety needle
product created a 35% reduction of BBFEs related to the use of a needle as the device implicated
in an exposure. For 2008, we maintained a 0.8-1.6% rate and 1.2% mean average per 1,000
patient days of BBFEs at DRH. These raw numbers reflect benchmark data for DRH
(attachment 4.2a, DRH Blood and Body Fluid Exposures p 29). Currently, there is no national
benchmark target for BBFE’s per 1,000 patient days, however, we are less than our 2007 BBFE
rates. So, as we compare our 2008 rates to 2007, our mean average score of 1.2% is notably an
improved score.

       The BBFE policy (1 CLN 010) outlines the care provided to health care workers post
exposure. This is a critical time for the staff to seek treatment and counseling. Although DRH
has instituted a needle-less system to increase safety and reduce injuries, exposure to blood borne
pathogens and needle stick incidents may still occur in the workplace. Informed consent is
required for post-exposure testing, treatment and follow-up with occupational health services.
The employee’s confidentiality and rights are safeguarded during this process. (attachment 4.2b
1 CLN 010 Post-exposure chemoprophylaxis policy, p.30)

Leadership Rounding
       Leadership rounding includes regularly scheduled rounds conducted by DRH leaders.
The monthly rounds focus on employee’s perception of patient and workplace safety. Leadership

                                                                                           Page 23
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

analyzes issues and reports them to the Leadership Performance Improvement Coordinating
Committee (LPICC) quarterly. It is expected that all employee safety concerns are handled on
discovery, and actions plans are included in the performance improvement report. As a result of
leadership rounding, additional shuttle buses were added in January 2008 to increase route
frequency for staff transport to and from the parking areas during peak work hours. (attachment
4.2c, DRH Canfield Parking Lot Express Shuttle Email p. 31)

Employee Assistance Program (EAP)
       Working daily in a trauma hospital may bring stress to many of the staff. The experience
of supporting patients and families through catastrophic injury, illnesses, and sometimes death,
can prove to be very difficult emotionally. This fast-paced world of trauma/emergency care,
coupled with external pressures, also can be challenging to manage. DRH offers an Employee
Assistance Program (EAP) as a resource. The EAP assists employees and their families during
difficult times through telephone interventions, counseling, education, referrals, mediation,
support and advocacy (Policy 1 HR 513). The EAP is a confidential program in accordance with
applicable state and federal laws. While not designed to provide long-term therapy, this service
assists employees with short-term therapy that can transition into other forms of care. EAP is
also engaged at the unit level to provide assessment and action planning with groups of
employees. Nursing workgroups at DRH have used the EAP to resolve team disagreements,
facilitate interpersonal communication, and promote inclusion of a team member’s viewpoints.
The EAP has proven to be a valuable resource for DRH employees (attachment 4.2d, Employee
Assistance Program, p. 32).

Ensuring A Safe and Healthy Work Environment

       DRH recognizes the importance of ensuring a healthy and safe work environment. Each
year, the Epidemiology Department, in conjunction with DMC Occupational Health Services,
launches an annual influenza vaccination program for all interested employees, medical and
clinical staff, students and volunteers. Coordinators of the program follow the planning methods
recommended by the CDC and promotional activities provided by the American Association of
Occupational Health Nurses, as well as the Association of Occupational Health Professionals.
The program used several strategies to increase participation including on-site clinics, articles in

                                                                                            Page 24
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

the Receiving Rap, the hospital’s employee newsletter, as well as periodic communications in the
DMC Enews, flyers and email are used to inform the staff about the annual program. We
deputized roving flu vaccinators during November and December. Many DRH employees
voluntarily received a flu shot during the 2008 campaign (Attachment 4.2e, Employee Flu
Vaccination email, p. 33).

         The following narrative published in the DMC eNews by a DRH nurse, illustrates the
openness of our culture and the care and concern that nurses have for their patients and each

         I‘d like to share my further insight as to how much the flu vaccine truly impacts our
         environment. I have Rheumatoid. I now receive a weekly injection called Enbrel. While it
         has been a huge blessing to have been placed on this medication, as it has made a huge
         improvement in my quality of life, I had to weigh out the risks and benefits of
         compromising my immune system in order to obtain relief. I went for relief, as well as
         improving my chances of keeping my joints healthy.

         Here is the point....I may be standing next to you in the cafeteria and you have no idea
         that I'm on such a medication that decreases my ability to fight off all infections and
         viruses. I appear healthy; however, I can become very sick much easier than most folks
         my age. No one would ever know this unless I shared it with you. Those of you who
         receive the flu vaccine help me to stay healthy!! You put me at much less risk to get sick
         without even realizing it!!! For that, I say "thank you"!!! I thought it would be nice to
         thank those who help without even realizing it.

         One more thing....for those who think that the flu vaccine will "give you the flu", despite
         my situation, I have received my vaccine. I have a compromised immune system, however
         I took the chance. Let's all become silent partners in keeping our patients and each other
         healthier this season. Thank you!!!!

         Nicole Ouellette RN, BSN
         Manager 6A, University Health Center, Orthopedic Clinic
         2.5 years at DRH

New Hire Physicals:

         To comply with federal and state regulations, DRH conducts pre-employment physical
examinations on individuals who enter the final stages of a hiring agreement. During the
evaluations, all new hire candidates are questioned about their health behaviors such as nutrition
and exercise, use of tobacco and/or alcohol, and vaccination history. If an individual is identified
as a smoker, the nurse provides interventions such as a smoking cessation kit. New hires and

                                                                                             Page 25
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

employees with alcohol or substance abuse problems may be referred to the EAP after
undergoing preliminary drug and alcohol screening. The individual is informed that their
employment offer is contingent upon a negative drug screen at the new hire physical.
Additionally, new hires are educated about the need for protection against communicable
diseases such as Hepatitis B, Influenza, Tetanus, Diphtheria and Pertussis, Varicella, as well as
the Measles, Mumps and Rubella. This screening, education and referral are conducted by the
RN’s in the DMC Occupational Health clinic. Last year in 2008, the department immunized
5188 people against Hepatitis B, Tdap, MMR and Varicella.
       Nurses in the Occupational Health Clinic conduct screenings, education and referrals for
communicable diseases. The clinic also educates employees about health issues, promotes
healthy behaviors and encourages safe work practices.

Workplace Violence Prevention

       DRH has a comprehensive plan for the management and prevention of workplace
violence that is implemented through the Workplace Violence Assessment Team. This
information is available online in our DMC policies intranet website. Incidents and potential
incidents are reported to the employee’s Supervisor and hospital Security. All attempts are made
to defuse the situation quickly and safely. Following a minor incident of violence, Human
Resources conducts an employee fitness-for-duty assessment, contacts Security for appropriate
discipline, or the employee is referred to Occupational Health Services or Emergency
Department for help. For more severe violations and incidents, comprehensive investigations are
conducted, and depending on the outcome, corrective actions are taken. In addition, a complete
incident report form is submitted to the Workplace Violence Assessment Team (WVAT).
(attachment 4.2f, Policy 1 HR 507 & appendix A p. 34)

Sexual Harassment

       DRH is committed to ensuring a workplace free from verbal or physical conduct that
threatens, harasses, disrupts or interferes with the work performance of another employee.
Additionally, the hospital also prohibits creating an offensive, hostile or intimidating
environment. DRH offers ongoing education of other policies such as Sexual Harassment thru

                                                                                           Page 26
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

Net Learning. This is the internal hospital educational web-based competency course
(attachment 4.2g, Policy 1 HR 511 and 1 CG 018, p. 35)

Lateral Violence Prevention

       The Life Stress Center at DRH serves people whose problems and reactions to life are
interfering with enjoyment of their social, work, family, or educational life. It is staffed by three
psychologists and they offer a variety of psychological treatments that are tailored to meet the
individual’s needs. In addition, they provided crisis counseling & debriefings for employees
who have had workplace experiences that have been disturbing to them. Employees are referred
by a Supervisor to avert work violence or after an incidence may have already occurred
(attachment 4.2h, Life Stress Pamphlet, p. 36)

Personal Workplace Safety

Vehicle Safety Tips
       These are Simple tips to help protect your vehicle and your belongings. These tips are
communicated electronically via email to a ZZ-DRH Everyone & ZZ-DRH Management team
distribution list. In addition, they are communicated in the bi-weekly hospital newsletter
(attachment 4.2i, Vehicle Safety Tips email, p. 37)

Security Safety Briefings
       These are presented during New Hire DRH employee orientation & thru briefings on
demand to nursing units and any other hospital area. Lonnie Paige, Operations Manager of
DRH/DMC Security, discusses safety measures to ensure a safe and secure environment for the
hospital staff. Any DMC staff may call the department and request a safety briefing.

Internal & External Hospital Security Escorts
       Security provides escorts throughout the hospital campus 24 hours a day, 7 days a week
to all staff members who need an escort. In 2008 there were 7,286 employees escorted. Officer
Lonnie Paige compiles monthly confidential security run data reports and then provides a year-
end summary report for the nursing staff.

                                                                                             Page 27
                                                                      Detroit Receiving Hospital
                                                      Force 4: Personnel Policies and Procedures

Crime Prevention
       The security department at DRH interacts with Wayne State security police, Detroit
police Department, and Veterans Federal. This information sharing allows the security
department to become aware of any crime occurring within 8 square miles.

Health and Wellness
       Obesity and physical inactivity are two of the most common health problems. To
encourage employees to live a healthier lifestyle, DRH has partnered with our affiliated DMC
hospitals to ensure that our employees have the opportunity to participate in health and wellness
programs. In 2008, weight-watchers-at work and fitness and yoga classes were offered to
increase opportunities for all employees to make healthy lifestyle changes. (attachment 4.2j,
Enews announcement, p. 38 )
       The “Take me to Receiving” environment is one, which fulfills the employee’s right to a
safe workplace, and promotes physical and psychological safety for the staff. When the work
environment is as predictably safe as the environment is at DRH, employees are able to provide
the appropriate focus on patient care.

                                                                                          Page 28
                                                                   DETROIT RECEIVING HOSPITAL
                                                                 BLOOD AND BODY FLUID EXPOSURES



                PER 1,000 PATIENT DAYS

                                               Jan-08   Feb-08    Mar-08   Apr-08   May-08    Jun-08      Jul-08    Aug-08      Sep-08     Oct-08     Nov-08     Dec-08
                             DRH RATE           0.8      1.2       1.1      1.0      1.4        1.1        0.8        1.3         1.6        1.6        1.4           0.9
                             DRH YTD MEAN       1.2      1.2       1.2      1.2      1.2        1.2        1.2        1.2         1.2        1.2        1.2           1.2
                             DRH LCL            0.9      0.9       0.9      0.9      0.9        0.9        0.9        0.9         0.9        0.9        0.9           0.9
                             DRH UCL            1.5      1.5       1.5      1.5      1.5        1.5        1.5        1.5         1.5        1.5        1.5           1.5

          This is a confidential professional/peer review & quality improvement document of the DMC. It is protected from disclosure pursuant to one or more of the
          provisions of MCL 331.531, MCL 331.533, MCL 333.20175, MCL 333.21513, MCL 333.21515, & MCL 330.1143a and other state and federal laws.
          Unauthorized disclosure or duplication is absolutely prohibited.

Page 29
                                                                                                                                                                            DRH Blood and Body Fluid Exposure Data Attachment 4.2a
                                                          Post Exposure Prophylaxis Policy Attachment 4.2b

Title:            Post Exposure Prophylaxis                                      Page 1 of 8
Policy No:        1 CLN 010                                                      Effective Date: 01/09/08

To standardize medical care following a Blood or Bodily Fluid Exposure (BBFE).

All Exposed Individuals (as defined below) who present for post-exposure management of BBFEs.

Exposed Individual - for the purpose of this policy, an exposed individual shall refer to any individual
occupationally exposed to blood or bodily fluid of another individual.

BBFE (Blood or Bodily Fluid Exposure) - Any percutaneous (puncture or cut through skin), mucosal (e.g. eyes or
mouth) or non-intact dermal (e.g. abraded skin, chapped skin or dermatitis) exposure to blood or a potentially
infectious bodily fluid of another individual (“source”).

HBV – Hepatitis B Virus

HCV – Hepatitis C Virus

HIV – Human Immunodeficiency Virus

Potentially Infectious Material - Blood, tissue, visibly bloody fluids, semen, vaginal secretions, cerebrospinal fluid,
synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, amniotic fluid and inflammatory exudates are
considered potentially infectious materials for HIV, HBV and HCV. Materials which are not considered potentially
infectious for HIV, HBV and HCV include feces, urine, nasal secretions, saliva, sputum, sweat, tears and vomitus,
unless these materials are visibly bloody.

1. Upon presentation for post-exposure management of a BBFE, the risk of exposure will be assessed
considering the nature and severity of the exposure and the risk level of the source of the blood or bodily fluid.
The exposed individual will be appropriately counseled, with care provided according to CDC guidelines and
current medical practices, and shall be offered post-exposure prophylaxis if clinically indicated.

2. Attempts will be made to rapidly identify and test the source patient for HIV, HBV and HCV. If HIV positive,
attempts will be made to determine the history of antiretroviral drug treatment and/or prior genotypic antiretroviral
resistance testing (GART).

3. Baseline testing of the exposed individual will be performed for HIV, HBV and HCV. DMC healthcare workers
found to be infected with any of these agents will be subject to the DMC HIV/HBV/HCV Infected Healthcare
Worker Policy (1 CLN 023). Those found to be infected on baseline will be referred to their personal physician for

4. Informed consent will be obtained prior to testing or treatment. For HIV testing, this will include a specific HIV
test consent form. In the case of the source individual who is a hospital patient, the consent to
treatment/admission at the DMC fulfills the need for the specific HIV test consent.

5. An infectious disease consultation and/or second level counseling by an infectious disease expert shall be
arranged whenever indicated.

1. All DMC employees with BBFEs must complete an incident report and report to their designated DMC OHS
clinic (or clinic/emergency department providing back up coverage for DMC OHS after hours) for post-exposure

Sponsor: DMC Infection Control committee
                                                                                                            Page 30
                                          DRH Canfield Parking Lot Express Shuttle email Attachment 4.2c
Brown, Ken (DRH)
From:                        Dawkins, Jeffrey H.
Sent:                        Thursday, January 03, 2008 5:57 PM
To:                          ZZ-DRH Management Team
Cc:                          Nelson, Shaun(Parking)
Subject:                     DRH Canfield Parking Lot Express Shuttle

Importance:                  High

Please be advised that a DRH Canfield Parking Lot Express Shuttle service has been
made available for employees with parking assignments in that location. The program has been
implemented on a trial basis.

The DRH Canfield Parking Lot Express Shuttle is available in the morning, Monday-
Friday, 6:00AM - 9:00AM. The shuttle stop is located at the CANFIELD PARKING LOT
CROSSWALK (Canfield Ave.) and will travel to the HOSPITAL ENTRANCE.

The DRH Canfield Parking Lot Express Shuttle is available in the afternoon, Monday-
Friday, 3:00PM - 6:00PM. The shuttle stop is located at the HOSPITAL ENTRANCE and will travel

The shuttle is marked DRH EXPRESS.

Please let your staff know this service is available.

I would be happy to answer any questions.


Jeff Dawkins
Chief Operating Officer
Detroit Receiving Hospital
Office: (313) 745-3104
Fax: (313) 745-4472


                                                                                                Page 31
                                                           Employee Assistance Program Attachment 4.2d

Title:          Employee Assistance Program                                     Page 1 of 2
Policy No:      1 HR 513                                                        Effective Date: July 1, 2007

To describe the Employee Assistance Program’s practices, definitions, procedures and responsibilities to the
organization as a workplace resource designed for resolution of personal concerns before they begin to impact
job performance.

The Employee Assistance Program provides confidential professional counseling services to all DMC
employees and their immediate families.

It is the policy of the Employee Assistance Program to provide professional counseling and referral services to
employees and members of their immediate families who encounter personal and/or job related problems.

The Employee Assistance Program (EAP) is the DMC’s workplace resource designed to assist in the
identification and resolution of productivity problems associated with employees impaired by personal concerns
including, but not limited to: health, marital, family, financial, alcohol, drug, legal, emotional, stress or other
personal concerns which may adversely affect employee job performance.

Employees are encouraged to resolve their personal problems through the EAP before the problem begins to
affect job performance. Participation in the EAP is voluntary.


1. The mission of the DMC-EAP is to assist employees and their immediate families who are experiencing
   anxiety, depression, marital or family problems, alcohol or substance abuse, legal matters, or financial
   difficulties. The EAP assists employees and their families during difficult times through telephone
   interventions, one on one counseling, education, referrals, mediation, support and advocacy.

2. The counseling of employees and their immediate family members in the EAP will be held in strictest
   confidence in accordance with applicable state and federal law. The Detroit Medical Center shall not have
   access to any identifying data on who has utilized or is involved with the EAP, without written authorization
   of the individual.

3. Involvement in the EAP will not be a factor for consideration in the employee’s performance evaluation.

4. The DMC recognizes that problems related to alcohol and other chemical dependence are treatable
   illnesses and will be dealt with as such.

5. The core activities of EAP includes (1) management consultation to identify problems in the workplace and
    plan interventions and training; (2) individual and family problem-assessment, counseling and coaching
    services; (3) referrals for appropriate diagnosis, treatment and assistance; (4)community networking to
    facilitate linkages between workplace and community resources which provide such services;(5) follow-up
    services to insure employee access and satisfaction; (6) critical incident debriefing to assist employees in
    dealing with trauma that occurs within the workplace.

6. If the supervisor suspects that an employee’s unsatisfactory job performance may be caused by personal
     problems, the supervisor is encouraged to remind the employee EAP is available.

7. Any costs for therapy or other services recommended by the EAP will be subject to current health insurance
    coverage or will be the responsibility of the employee.

Sponsor: Human Resources
                                                                                                         Page 32
Employee Flu Vaccine email Attachment 4.2e

                                  Page 33
                                                Prevention of Workplace Violence Policy Attachment 4.2f

Title:          Prevention of Workplace Violence                                Page 1 of 6
Policy No:      1 HR 507                                                        Effective Date: May 1, 2008

To provide for a workplace free of violence through a comprehensive plan of management and prevention.

Violence, harassment, intimidation, threats and other disruptive behavior that occurs at any Detroit Medical
Center facility or property, or which occurs during the course of an employee’s work related activities on behalf of
the DMC.

See Glossary of Terms

The Detroit Medical Center’s focus is on the prevention of violence through existing safety and educational
measures, employee awareness, and support of the EAP Program. The DMC promotes a positive culture of
respect, and zero tolerance for abuse and violence.

There will be no retaliation or reprisal against any individual who, in “good faith,” complains of, reports or
participates in the investigation of an occurrence of violence. Any employee who willfully and knowingly falsely
reports an incident of violence will be subject to disciplinary action.

The terms of this policy shall apply unless such terms are in a contract to which The Detroit Medical Center, or
one of its covered operating units, is a signatory. In such cases, the applicable conditions of the contract shall
govern for employees covered by that contract, and such provisions will take precedence over this policy.


     a. Violence by an employee is a serious form of misconduct that will not be tolerated and for which an
        employee may be disciplined up to and including termination of employment. The DMC reserves the
        right, as deemed necessary and appropriate in its sole opinion, to assist in the bringing of criminal
        charges or criminal prosecution of employees and non-employees who violate this policy by engaging in
        workplace violence.

     b. All employees are required to report to their supervisor, or other levels of management, any act of
        violence or threatening behavior committed in the workplace, on DMC property or while engaged in work
        related activities. All reported incidents will be investigated.

     c.   During the investigation, management will make every reasonable effort to protect the identity of the
          employee making the report. However, if the incident is substantiated, confidentiality may no longer be

2.   VIOLENCE PREVENTION: The Detroit Medical Center requires training for all employees regarding
     violence prevention. Each regional unit will ensure that such training takes place.


     a. Reporting known incidents of violence is mandatory. Failure to report such incidents is a work rule
        infraction subject to disciplinary action. An employee is similarly encouraged to notify supervision of
        potential workplace violence which could occur as the result of a domestic dispute, involving either the
        employee or a co-worker, which could be carried into the workplace.

Sponsor: HR
                                                                                                          Page 34
                                                                     Sexual Harassment Policy Attachment 4.2g

Title:             Sexual Harassment Policy                                       Page 1 of 4
Policy No:         1 HR 511 and 1 CG 018                                          Effective Date: April 13, 2008

To establish guidelines to ensure a work environment free from sexual harassment and to provide a mechanism
for assisting individuals who believe that they have been subjected to harassment in contradiction to this policy.

All employees of The Detroit Medical Center (“The DMC”) and its subsidiaries, as well as students, medical and
house staff, visitors, patients, vendors, agents, and persons affiliated with The DMC.

The following examples may represent sexual harassment if the behavior is unwelcomed:

A.       Overt Actions

         1. Unwanted, unsolicited, or offensive sexual advances, requests for sexual favors, and other verbal,
            visual, and/or physical conduct of a sexual nature constitute sexual harassment when:

              a. Submission to or rejection of such conduct is made either explicitly or implicitly a term or condition
                 of an individual’s employment.
              b. Submission to or rejection of such conduct or communication by an individual is used as a basis
                 for decisions affecting employment, promotion, transfer, selection for training, or performance
              c.   Such conduct or communication has the purpose or effect of substantially or unreasonably
                   interfering with an individuals work performance or creating an intimidating, hostile, or offensive
                   work environment.

         2. The definition of sexual harassment applies equally to females and males. Both males and females
            can be victims of sexual harassment, and both males and females can be perpetrators of sexual

B.       Sexually Hostile Environment

         1.        Sexual harassment includes behavior, which may create a hostile or offensive work environment.
                   A hostile work environment is an environment in which harassment is so persistent that it
                   substantially or unreasonably alters the terms and conditions of employment.

         2.        Behavior that is of a sexual nature and interferes with an individual’s work performance may
                   constitute a sexually hostile or offensive work environment. While the following list is not
                   exhaustive, it can or should be used as a guide to identify inappropriate behavior:

                   a. Sexual propositions, invitations, or other pressures for sex;
                   b. Jokes of a sexual nature;
                   c.   Suggestive or offensive remarks;
                   d. Displaying pictures, posters, or cartoons of a sexual nature;
                   e. Displaying pornographic materials;
                   f.   Sexually derogatory sounds and comments;
                   g. Whistling in a suggestive manner;
                   h. Unwelcome patting, pinching, or touching;

Sponsor: Stanton M. Beatty, Corp. Audit & Compliance
                                                                                                              Page 35
Life Stress Center Pamphlet Attachment 4.2h

                                   Page 36
Vehicle Safety Tips email Attachment 4.2i

                                 Page 37
                                                                        Wellness Program Enews Attachment 4.2j

Employee Wellness Programs

Register now through Friday for fun fitness classes, yoga, hustle and more
                             Harper/Hutzel Health Amenities Program's fall wellness classes
                             begin the 2nd week in October. Register now through Friday. There
                             are some exciting new classes being offered during the week and on
                             Saturdays. Classes include hustle lessons, African dance, Yoga,
                             belly dance and Zumba. These classes are full of energy and fun.
                             Schedule of classes is as follows:

                           Yoga: Mondays 5:30-6:30 p.m.
                           Belly Dance: Tuesdays 5:30-6:30 p.m. / Saturdays 2:30 - 3:30 p.m.
African Dance: Tuesdays 5:30-6:30 p.m.
Zumba: Wednesdays 5:30-6:30 p.m. / Saturdays 11a.m.-12 p.m.
Hustle Lessons: Thursdays 5:30-7:30 p.m./Saturdays 12:30-2 p.m.

Weight Watchers' -The "At Work" Program at RIM
Weight Watchers at RIM is starting a new 12 week program. Registration will be held Thursday,
Sept. 27 from 11:30 a.m. to 12:30 p.m. in the basement auditorium at the Rehabilitation Institute
of Michigan (RIM). At least 15 paid members are needed to hold the program.

The cost is $135 (Bring proof of insurance to obtain this discount rate.) Weight Watchers
Headquarters is offering a special rate of $25 for HAP members only. Proof of HAP insurance is
required. The sessions start at 11:30 a.m., Thursday Oct. 4, in the basement auditorium and will
run every Thursday for 12 weeks. If you have questions, please contact Regina Floyd via e-mail
or 745-3503.

                                                                                                      Page 38
                                                                                      Detroit Receiving Hospital
                                                                      Force 4: Personnel Policies and Procedures

SOE 3: Describe how staffing plans and practices are consistent with The ANA
Principles of Nurse Staffing.

       DRH’s staffing practices are based on the commitment to incorporate the ANA Principles
of Nurse Staffing into resource planning. One of DRH’s most valued resources is its nursing
staff, who delivers care to our patients. As part of our professional ethical accountability to the
citizen public, DRH and its nursing leadership assures appropriate numbers and competent staff
to provide care. Several sources are used to determine appropriate staffing, including the average
daily census, patient needs, patient population, staff competencies and experience. The DRH
budget is projected based upon the staffing plan. DRH staffing plans and practices reflect the
ANA Principles and address three planning dimensions for the funding of staff. The dimensions

       a. Patient Care Unit – The patient mix (critical, elderly, mobility) and unit logistics are
          considered when developing the staffing plan. Application of this principle is
          discussed in detail on the next page.
       b. Staffing – Staff competency, professional and non-professional mix, years of
          experience, tenure (on the unit) are all considered when planning for daily staffing.
          For example, a nurse trained in hydrotherapy must be assigned to the Burn Unit during
          each shift.
       c. Organizational Factors - There is a systematic process for credentialing agency nurses.
          Sitters are available to monitor the psychologically compromised individual.

    Figure 4.1 illustrates the staff planning and budgeting cycle overview process and addresses
ongoing and annual evaluation of staffing adequacy.

                                                             Daily via staff nurse staffing
   Master Budget               Implementation                and scheduling committee
    and Staffing               Resource                     Bi–weekly via unit director
        Plan                   allocation                    and nursing finance
                               Clinical                     Staffing effectiveness
                               judgment                      measures

                   Data compiled quarterly to review for trending
                    and utilized in analysis for next budget cycle

Fig. 4.1: Staffing Planning and Budget Cycle Overview Incorporating Input from
all levels of staff

                                                                                                        Page 39
                                                                           Detroit Receiving Hospital
                                                           Force 4: Personnel Policies and Procedures

       At DRH, the Plan for Provision of Care is integral to the annual budgeting process. The
Plan for Provision of Care is a review of the scope of services provided at DRH and includes
budgetary assumptions related to patient volume, core staffing, staffing matrix, and patient acuity
(OOD 15, Plan for Provision of Care, p. ). The plan defines the budget development process,
staffing and scheduling.

       All nursing units complete their own work schedules and information is entered into
OneStaff® (McKesson, Inc., Alpharetta, GA), a staffing and scheduling electronic system. This
system provides the hospital with centralized knowledge of staffing resources on a shift-to-shift
basis. At the unit level charge nurses are accountable for utilizing clinical judgment to assess unit
activity (patient needs) and required staff competencies and to assign staff appropriate for the
clinical circumstances.

        The following table illustrates how staffing plans and practices at DRH are consistent
with the ANA Principles for Nurse Staffing. Four of our major patient care areas are
highlighted-- critical care, psychiatry, acute care and the emergency department. The elements
and content contained within the 3 columns are considered when developing plans and are
incorporated into daily staffing decisions. The principles are carried out throughout the hospital.
                                              Principles of Nurse Staffing
Unit                   Unit Related                  Staff Related          Organization Related
Critical Care    5 Intensive Care Units,       General:                    Competency
                 with 8-14 staffed beds         Annual critical care        Critical care policies
                 per unit.                       education and skills         define competency,
                  Burns = 6 staffed beds       Unit specific                patient flow, orientation,
                  SICU/Trauma = 10              competencies                 preceptor preparation, and
                   staffed beds                 Preceptors                   standards of practice.
                  Coronary Care Unit = 10     Level of experience          Supplemental Staff
                   beds                         Novice to Expert            Approved overtime
                  Medical ICU = 10 staffed    Education and                 DRH Float Pool of Nurses
                   beds                        Preparation                   Agency
                  Neurotrauma ICU = 8          Critical Care Registered   Professional & Non-
                   staffed beds                  Nurse (CCRN)               Professional Support
                 Contextual Issues              Trauma Nurse Core          Services:
                  Contained units, horse        Curriculum (TNCC)           Clinical Pharmacy
                   shoe design, central         Advanced Trauma Life         Consultant
                   monitoring capacity for       Support (ATLS)              Respiratory Therapy
                   vital signs, hard wired      Advanced Cardiac Life       Physical Medicine &

                                                                                                  Page 40
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

                                           Principles of Nurse Staffing
Unit               Unit Related                   Staff Related         Organization Related
                for monitoring                Support (ACLS)                Rehabilitation (PMR)
                ventriculostomy, IA          Advanced Burn Support        Dietary
                Balloon Pumps,                Life (ABLS)                  Chaplain
                Continuous Renal            Language Capacity              Social Work (placement,
                Replacement Therapy,         Primarily English             guardianship, family
                PA Catheters, etc.)           speaking with translation     issues)
             Patient Population:              services available as        Case Management
              Acute, critically ill          needed                       Laboratory
               (sudden onset, trauma)       Tenure                         Housekeeping
              Hemodynamically               1 – 20+ years                Transportation
               unstable                     Non-Professional              Information
              Age range; adolescent to                                   Technology
                                            Assistive Staff
                                             Patient Care Associate       Electronic medical record
              Culturally diverse (see                                      (EMR)
               OOD 1)                         (PCA)
                                             Student Nurse Associate      Clinical Information
              Scheduled and emergent                                       System (CIS)
               diagnostic procedures for      (SNA)
                                             Student Nurse Externs        Email accounts for all
               which patient is                                             nurses
               transported by RN & RT         (SNE)
                                             Patient Care Unit Clerk      Wireless internet
               transport team                                              Net Learning
              Approximately 80%              (PUC)
                                             Patient Service Associate   Support in Ethical
               occupancy rate
              Family and caregiver           (PSA)                       decision-making
               may also require support     Quality Initiatives            Palliative Care Service
              Spiritual Care may be         Institute for Healthcare     Consults to Ethics
               needed due to the crisis       Improvement (IHI) ICU         Committee
              Potentially impaired           Bundles
               communication related to      Keystone Initiatives
               LOC or maintenance of            o CLBSI
               ventilation                      o UTI
              Pain Management                  o VAP
              Other specific needs:         Pressure Ulcer
                 o Hydrotherapy              Patient Falls
                 o Extensive wound          Interdisciplinary and
                   dressings &              Collaborative activities
                   debridement               High level of Control
                 o Organ procurement          over practice
                                             High level of
                                              Collaboration with
                                              medical staff
                                             Multidisciplinary rounds,
                                              Rehabilitation for
                                              transfer, Safety &
                                              environment rounds,
                                              Critical Care Practice
Psychiatry   2 Patient Care Units,          General:                      Competency
             with 19-22 staffed beds         Annual psychiatric           Psychiatric policies define
             per unit.                        education and skills          competency, patient flow,
              2R; Crisis Center             Unit specific                 orientation, preceptor
               (emergent)                     competencies                  preparation, and standards

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                                                                         Detroit Receiving Hospital
                                                         Force 4: Personnel Policies and Procedures

                                            Principles of Nurse Staffing
Unit               Unit Related                    Staff Related         Organization Related
              3Q; Inpatient Unit                o Management of               of practice.
              5V; 3 leased beds                   disruptive patients     Supplemental Staff
             Contextual Issues                   o Psychiatric             (same as Critical Care)
              2R; locked, adult unit              medications
                o all patients visible           o Physical management
                  from the central nurses        o Medical codes           Professional & Non-
                  station                        o Recipient Rights        Professional Support
                o 2 quiet rooms              Level of experience           Services:
                o private patient             Novice to Expert               Dietary
                  interview room             Education and                    Chaplain
              3Q: inpatient locked          Preparation                      Social Work
               adult unit                     Psychiatric Nursing            Occupational Therapist
                o individual private           Certification                  Case Management
                  patient rooms flow                                          Housekeeping
                  around a central
                                             Language Capacity                Transportation
                  nursing station in a        Primarily English
                  circular pattern             speaking with translation
                                               services available as
                                                                           Cross-training for
                o common patient                                           psychiatric units.
                  rooms include dining         needed
                  room, multipurpose         Tenure
                  room, and PT/OT             5—30+ years                 Managed Care
                  room.                      Non-Professional              Physician Network
              5V; inpatient locked          Assistive Staff
               adult unit                     Mental Health Technician
                o 3 beds leased from           (MHT)
                  Wayne State                 Patient Care Unit Clerk
                  University                   (PUC)
             Patient Population:              Patient Service Associate
              Acute behavioral health         (PSA)
               with co morbidities           Quality Initiatives
              Stabilization of medical       Restraint and Seclusion
               profile                        Assaultive Behavior
              Age range; adult only          Patient Satisfaction
              Initial treatment for         Interdisciplinary and
              Intake to community
                                             Collaborative activities
               mental health                  Michigan Department of
              Patient needs;                  Community Health visit
              Medical referrals and           for licensure (defines
               care                            conditions for licensure
              Shelter, food, safety           for mental health
              Referral for substance          treatment.
              Insurance
              Social staff issues
                 Family dynamics
                 Child care referrals
              Legal processing
                 Guardianship
                 Petitions

Acute Care   9 Acute care units with 6-20    Level of Experience           Effective and efficient

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                                                                  Detroit Receiving Hospital
                                                  Force 4: Personnel Policies and Procedures

                                     Principles of Nurse Staffing
Unit          Unit Related                  Staff Related          Organization Related
       RN staffed beds                Novice to expert            support services
       4LM-ORTH/TRAUMA                1-30+ years                   Policies define competencies
       1:6-7nurse patient ratio       Education and Preparation     Patient care policies
       4N-OBSERVATION 1:4              Annual skills               Supplemental Staff with
       nurse patient ratio               competency including       agency
       4U-                               online modules             Float pool and/or approved
       STROKE/TELEMETRY                Med/surgical                overtime
       1:5 nurse patient ratio           certification              Safety and Risk
       4V-                             Nurses Improving            Management (SRM)
       STROKE/TELEMETRY                  Care for Health system
       1:5 nurse patient ratio           Elders (NICHE)             Professional and non-
       5 LM-MEDICINE                   Preceptors
       1:6-7 nurse patient ratio       Unit population specific
                                                                    professional support
       5N BENIGN                         competency and cross       services
       HEMATOLOGY 1:5                    training
       5U-ACUTE CARE FOR               Telemetry and stroke           Transportation
       ELDERLY                           training                      Environmental services
       (ACE) 1:5                       Pain management                Dietary
       5P-Ortho, neurology,            Chemotherapy                   Lab services
       Urology 1:3                       management training           Chaplain
                                       Wound care                     Social work for
       Care Team includes             Control over Practice             discharge, placement or
                                                                        family issues
       Clinical Manager               Performance                      Transportation
       RN                                                              Social worker
                                      Improvement (PI)                 Respiratory therapy
       Patient Care Associate          Nurse sensitive
       (PCA)                                                           Pharmacy services
                                        indicators such as falls,
       Patient service Associate        pressure ulcers, skin and
       (PSA)                            wound team staffing
                                                                    Information technology
       Patient Unit clerk (PUC)         effectiveness
       Number of patients                                            Electronic medical
       9O %Occupancy                                                  record (EMR)
       Acutely ill to pre and post
                                      Activities that add to         Clinical Information
       surgical                       the body of nursing             system (CIS)
                                      knowledge                      Email
       Contextual Issues               Unit and hospital level      Inter/intranet
       Units above are designed in      professional nurse
       the shape of horseshoe or U      councils                    Support in ethical
       shaped with nursing station     Journal club                decision making
       centrally located in the        Poster presentations        Palliative care service
       center.                         Safety and                  Consults to Ethics
       Each unit has a supply area      Environmental rounds        Committee
       that is maintained at           Practice group
       predetermined and regularly     Collaboration with
       monitored levels or pars         medical staff and APNs
       which may increase or
       decrease based on nurse
       demand or need.

       Patient population
           Patient population for

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                                                                          Detroit Receiving Hospital
                                                          Force 4: Personnel Policies and Procedures

                                             Principles of Nurse Staffing
Unit               Unit Related                     Staff Related         Organization Related
                 all acute care units
                 include individuals
                 ranging from late
                 adolescence to elderly

             Some top diagnoses
              Pancreatitis
              Asthma
              Pneumonia
              Cellulitis
              CHF
             Culturally diverse
             Sickle Cell
             Acutely ill
             Comorbidities with psych

             Social Supports
             Spiritual Care
             Pain Management
             Family support
             Translator assistance

             Multiple diagnostic
             procedures in appropriate
             areas of hospital transported
             by transportation department

Emergency    Level 1 Trauma                   General                     General nursing policies
Department   Approximately 110,000                                        Tier 2 ED policies
             patients in 2008                 3-day general orientation   Management Operating
(ED)         250-300 visits daily             1-day EMR                   Directives (MOD)
                                              5 day Emergency Nursing     Nursing Action Protocol
             Total 79 beds                    Association didactic
                                              1 day clinical competency   Professional
              16 beds Transitional care      1 day ED process
               unit (TCU)
                                                                          Supplemental services
                                              GN has 8 weeks with         (same as critical care)
              Walk in clinic 11 beds         preceptor
              6 individual Modules           RN has 6 weeks with
              40 beds                        preceptor
                                                                          Support Services
              Resuscitation 3 beds                                        SRM
                                              Tenure                       ED Jonah
             Patient population               1-30+                        Social worker for
             From Trauma to critical and                                    placement, insurance
             urgent                                                        Clinical Resource
                                              Education and                 Management
             Stat laboratory                  preparation                  Communication Center
                                               Certified emergency        Helps with facilitating
             Predesignated for any              nurse (CEN)
             presiding or visiting                                          transfers, taking

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                                                                           Detroit Receiving Hospital
                                                           Force 4: Personnel Policies and Procedures

                                             Principles of Nurse Staffing
Unit                  Unit Related                  Staff Related         Organization Related
                dignitary care                 ACLS                           ambulance calls, collect
                 Pancreatitis                 TNCC                           information prior to
                 Asthma                       NIMS 100/700 General           patient arrival by radio
                 Pneumonia                     practioners                   Respiratory therapy 24/7
                 Cellulitis                   NIMS 100/200/700              Region 2 South Hazmat
                 CHF                                                         Blood bank
                 Psychosis                   Language capabilities           Pharmacy
                Culturally diverse            same as critical care           Project Assistant for
                Homeless                                                       Rapid HIV testing
                Sickle Cell                   Quality initiatives             Stat lab
                Elderly                        Heart Failure
                Acutely ill                    Pneumonia
                Co-morbid diagnoses with       Acute Myocardial
                psych issues                    Infarction

                                              Activities that add to
                Care Team includes
                                              the body of nursing
                5 Clinical Coordinators       knowledge
                RN                             ED specific and hospital
                PCA                             NPC
                PSA                            Journal Club
                SNA                            Poster presentation
                Emergency Medical
                Technician (EMT)
                2 Licensed Practical Nurse
                ED transporter

                Contextual Issues
                 6 modules with
                  individual nurse work
                  station and treatment
                 designated physician
                  work stations
                 ED dedicated pharmacy
                 ED radiology

       The Benign Hematology Unit (BHU) is a specific unit example of application of the
ANA Staffing Principles and demonstrates how the data in the table above is translated into

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

Patient Care Unit Related
       The Benign Hematology Unit (BHU) is open to a census of 10 patients. BHU has a
combination of patients consisting of inpatients, as well as patients admitted for Day Treatment.
Patients may be admitted to Day Treatment as an alternative outpatient venue for patients
requiring blood transfusion, medication infusion/chemotherapy, pain management and research
diagnostic testing. For inpatients, BHU provides an area for maximum specialized surveillance
and support of vital function for patients with acute episodes of pain. In general, these patients
require much higher dosages of pain medication and combination of medications in order to
manage their pain effectively.

Patients with the following diagnoses are suitable for admission to the inpatient unit:
    Sickle Cell Disease
    Thrombocytopenia
    Thalassemia
    Clotting Disorders
    Microangiopathic Hemolytic Anemia
    Hemolytic Anemia, with or without fever, or renal dysfunction in a patient with no other
     reason for these findings

       Patients are primarily located in private and semi-private rooms in immediate proximity
to the nursing stations. Staff nurses have easy access to computers for documentation purposes.
A centralized call-light system is in place so that the nurse or PCA can respond in a timely
manner to care needs of the patient.

       Patients may range in age from adolescent to seniors. Many of the patients with sickle
cell disease are transitioning into the adult population from Children’s Hospital of Michigan, a
sister DMC facility. The average length of stay for inpatients varies from 3.5 to 5 days. Patients
requiring higher intensity of care are transferred to the Medical Intensive Care unit.

       Patients admitted to the Day Treatment services (as an alternative for outpatient care)
typically require blood transfusions, medication infusions/chemotherapy, pain management and
research diagnostic testing. The average time for an episode of care for patients admitted for

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                                                                        Detroit Receiving Hospital
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Day Treatment services is four to five hours. Patients are generally admitted to the inpatient unit
if their problem is not resolved by 5 p.m.

Staff Related
       When the unit was designed, the team made a decision about the staffing model. The
model consisted of Registered Nurses (RN), Patient care associates (PCA), Social Worker (SW),
and a patient unit clerk (PUC). We felt that it was essential that the model was one that was rich
with staff nurses. Therefore, we determined that the nurse: patient ratio would be 1:3. We knew
based on the data we had gathered about the benign hematology patient population that the staff
nurse role was crucial to planning, coordinating and implementing care for these patients. Also,
given the complexity of these patients related to their pain management, psychosocial needs, and
family dynamics we made the decision that at least 80% of the staff nurses had to be

       The next challenge was to recruit experienced nurses to become part of the care team that
were willing to take care of patients that had a reputation of being complex. We decided that
would recruit from other acute care units within DRH. Since we were recruiting from within,
Tommye Hinton, CNO supported hiring contract agency to support staffing on the units that
were giving resources to the Benign Hematology unit. This tactic facilitated the ability of DRH
staff who were interested in learning new skills to be able to transfer to the unit, Contract agency
nurses allowed support for patient care on other units until those nurses who were transferring
could be replaced. There were 2 nurses recruited from the Medical Intensive Care units, 4 nurses
came from medical surgical units, and 1 nurse with experience working with patients with sickle
cell came from our sister hospital Rehabilitation Center of Detroit. Only 2 of the 9 nurses were
inexperienced nurses.

       The PCA was included as part of the staffing model to support the nurses with the care
related to phlebotomy and comfort measures for these patients. The PCA transferred from the
Cardiac Care unit. She had excellent phlebotomy skills. Given the psychosocial needs of these
patients, we made the decision to have a Social Worker as part of the care team. The Social
Worker’s role would be vital in assessing the psychosocial needs of these patients and providing

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

linkage to community resources. The Social Worker that was hired had previous clinical
expertise with patients having these disease processes and psychosocial challenges.

       Finally, the PUC role was needed to receive visitors, phone calls, direct requests for
information, answer call lights and assist in the anticipation and communication of the patient,
family or visitor needs. The PUC transferred from the Medical Intensive care unit. She brought
to the team her wealth of knowledge in interacting with family members.

       The BHU staff nurse appropriately delegates aspects of nursing care and supervises the
care delivery of all non-licensed personnel. All nurses working in the BHU have successfully
completed the DMC Benign Hematology course, have PCA pump certification and 3 nurses on
day shift have completed chemotherapy certification. The PCAs also have been trained in
generic procedures such as IV start and phlebotomy, and EKG.

       Appropriate staffing levels are determined by the number and care intensity of patients
and by our core staffing demands. Staffing plans have been developed for the BHU based on
average daily census, nursing skill mix and NHPPD. Incorporating intensity of required care
with the staffing grid guides staffing plans.

       Patient need is the primary driver of staffing. Any staffing variances are addressed either
by unit management or the Administrative Supervisors. Supplemental staffing resources include
DRH pool, overtime, contingent staff, and transfer of staff between units, external agency or
additional hours by part-time personnel.

       Staffing effectiveness indicators are reviewed to trend data relating to patient impact from
staffing levels and competence. These indicators are:
          Adverse medication events
          Patient satisfaction
          Nurse satisfaction

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

        Competency is maintained through an annual skills day. In-services and continuing
education is offered throughout the year by the Nursing Education department. Unit based in-
services are done by experienced nursing staff based upon needs assessment. Staff can also meet
educational needs by access to the Intranet and Internet. Resources available to staff to assist in
meeting educational needs are the Educator, Nurse Practitioner, and Clinical Manager, unit
preceptors, clinical pharmacist and physicians.

        Collaboration between all members of the health care team is required, including the
admitting physicians, subspecialty consultants, hospital-based physicians, physicians-in-training
and support disciplines; including pharmacy, respiratory therapy, and social worker. Bi-weekly
there is an interdisciplinary meeting to discuss care related to in-patient, Day Treatment and in
the out-patient setting. Medical rounds are attended by medical director/designee, fellows,
residents, staff nurses, APN, pharmacist, respiratory therapist, and the dietician. The plan of care
is discussed collaboratively with all involved disciplines.

Organization Related
   1. Nursing staff must have adequate knowledge and are competent about medication
        administration and certified using the PCA pump and PCA buttons.
   2. The nurses had to be knowledgeable about the psychosocial needs and disease process of
        these patients in order to enact the five basic processes of the caring model.
   3. Nurses had to be certified to administer chemotherapy
   4.   PCA staff needed expert skills in phlebotomy

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                                                                        Detroit Receiving Hospital
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SOE 4. Describe how the organization fosters a nondiscriminatory climate in which
care is delivered in a manner that is sensitive to diversity.

        At DRH, we believe that different cultures, different experiences and different
perspectives create an opportunity for an inclusive atmosphere that provides compassionate care
to all patient populations. We hold the rich diversity of our staff and our patients as a gift from
which we learn and all benefit. A non–discriminatory environment ensures alignment and
appreciation of diversity throughout all levels of the organization. Diversity is reflected in the
DRH mission and the nursing blueprint for care as providing high quality services to patients
without regard to religious, racial, ethnic identification or economic status. At DRH and its
system leader the DMC, diversity is viewed from three aspects:

       VALUE: Difference is welcomed and viewed positively.
       CULTURAL NORM: Different perspectives, skills and experiences are valued.
        Leadership practices and organizational systems exist that fully utilize our diverse
    ▪   BUSINESS STRATEGY: Diversity contributes to our overall business success.

        DRH supports and maintain a work environment that embraces the similarities and
differences of our employees and patients, in an atmosphere of mutual respect and cooperation.

Staff Diversity Education
       At DRH, we provide various educational opportunities for our staff to foster and
encourage a non-discriminatory environment. Training is designed to make staff culturally
aware and recognize & respect cultural differences when delivering care to patients. Throughout
November 2008, a 15-minute film titled, “Dignity and Respect: Showing Our Patients Cultural
Sensitivity” was made available for all staff, including but not limited to, physicians, nurses,
patient care/support associates, patient unit coordinators, and executive and management teams
(attachment 4.4a, Dignity and Respect Video Flyer, p. 57). All patient care leaders are required
to complete a three-hour diversity training program entitled “Diversity As An Ongoing Journey”
(Attachment 4.4b, Diversity Training Program Objectives, p. 58). Additionally, all new nurses

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

must complete a module on diversity as a part of the new hire orientation. (Attachment 4.4c,
New Employee Orientation Customer Service, p. 59)

       Tenured staff have many opportunities throughout each year to take advantage of cultural
competence training. In addition, cultural competency is a component of the formal performance
appraisal for nurses at all levels. This is demonstrated as a professional practice expectation for
the DCN at level three and beyond.

       During 2008, DRH’s Diversity Council offered several in-services that center on
understanding and respecting other cultures, including the Taste of Filipino Culture, Canadian
Cultural Appreciation Day, and Changing Cultural Misconceptions (attachment 4.4d, Diversity
Flyers, p. 61)

Culturally Sensitive, Patient-Focused Care

       DRH also recognizes the importance of diversity application through the EMR and
patient care delivery. During a patient admission, the nurse completes the adult admission
history, which includes an assessment of cultural or spiritual practices that may impact care.
Patients are asked about cultural practices, which may influence pain management, use of blood
and blood products, eating preferences, and end-of-life considerations. The patient preferences
are included in the plan of care, see figure 4.4a. Other considerations include religious practices,
pastoral care or spiritual advisor needs.
        I was taking care of a strict Muslim family and I wanted to make sure that I adhered to
       the no pork restrictions, which were requested to me by the family. They stated that the
       patient has a severe reaction to pork. While reviewing the patient’s medications I quickly
       learned that she was ordered a dose of Heparin, which is made out of a pork base.
       Therefore, I called the physician and asked if he could discontinue the Heparin and
       replace it with Lovenox. I came back to the room and explained to the family that we
       have made notation of the pork restrictions in the patients chart and will closely follow
       these orders. Afterwards the family and patient were pleased.

       Nikenge Scales-Fowler RN, BSN, CCRN
       4Q Staff Nurse
       12 years at DRH

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                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

Figure 1.4a. EMR Screen Shot.

Staff assignments are sensitive to the requests and needs of patients. For example, in certain
cultures, it is not appropriate for men to be involved in the care of females. Therefore, staffing
assignments attempt to be congruent with this patient need.

       There was a Muslim family that did not want a male RN taking care of a female patient.
       On this particular day, I was the charge nurse and we had an all male staff working for
       the shift. So after learning about this family’s request during shift change, I immediately
       called our sister unit (4T burn trauma ICU) and arranged for a swap between a female
       and male RN to take place. In addition, for the next 3 days I reviewed the schedule and
       pre-assigned a female RN to that patient. The family was relieved afterwards.

       Donna Pappas RN, BSN, CCRN
       4Q Staff Nurse
       25 years at DRH

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                                                                         Detroit Receiving Hospital
                                                         Force 4: Personnel Policies and Procedures

Each nursing leader is expected to promote diversity by modeling behaviors that correspond with
the values of inclusion and creating and open, supportive and responsive care delivery practice
environment in which differences are valued and accepted. This is modeled daily at DRH. It is
woven into the fabric of what we do.

       In 2008, respirator fit testing became an annual requirement for employees required to
       wear an N-95 respirator. Individuals with facial hair are not allowed to wear the mask
       because it prevents it from sealing. If an employee is unable to undergo fit testing, they
       cannot care for patients in respiratory isolation. Due to religious beliefs, many men are
       unable to shave and when performing the screening for this testing, staff must be
       culturally sensitive. It is important that staff not judge the employee and assume that the
       employee does not want to comply with the testing or does not want to wear the
       respirator so they do not have to care for isolation patients. It is important that staff
       performing the fit testing conduct the screening in a way that demonstrates cultural

       Pat Goins RN, BSN
       Manager Occupational Health Services
       15 years at DRH

As part of an academic medical center, DRH provides training to physicians and other clinicians
from countries around the world. Rev. Debra Dove, Department of Spiritual Care, provides
cultural and spiritual assistance to clinicians, if needed. She also provides social, spiritual, and
interventions for patients, families and employees. The department provides “culturally
competent care with a deep respect for each person’s faith and spiritually,” according to
Reverend Dove, Hospital Chaplain. Below she explains the lessons learned during her tenure at

       In my role as a hospital chaplain, I have worked with people from many different
       religions, races, and ethnic groups for over 20 years. I have found that the foundational
       grounding of all people is we are more alike than different. We may have different
       cultural nuances, but we all look for the same things. We all need love, understanding,
       respect and life without fear. I do recognize there are varying cultural nuances that are
       important to people from the diverse population that we serve at DRH. In engaging with
       these individuals, I ask what is important to them, what I can do to assist them or provide
       resources that may be helpful during their time of need.

       One patient that comes to mind is a female patient who was dying from liver cancer. I
       believe she was of the Catholic faith. She asked me what she could expect in her course of

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                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

       dying. I told her I could tell her of what I’d read, and then asked her what she had been
       experiencing in her transition. At that point, she became the teacher and I the student as
       she told me what she had been experiencing and we shared her journey together.

       Each patient teaches me something everyday. I remember a young man who was gay
       who came in through the ED and went into the crisis center after trying to kill himself.
       His spiritual self was in doubt because of his being gay and he was very depressed and
       suicidal. (He needed to be reassured that he was still a child of God and God was a
       loving God). He was very reassured after our conversation of his spirituality and given
       information of follow up after discharge.

       Then there are the many families who need hope, encouragement and comfort while their
       loved one is receiving care within our hospital. Having a loved one sick or injured is
       physically and emotionally taxing for families. I help them deal and cope with the
       situation. I let them know I am able to contact their minister or a member of their faith to
       come and provide support. I have been on the battlefield for my Lord for many, many

       The nursing staff and I work closely together here providing culturally competent care --
       they are my eyes and ears. I believe Swanson’s Caring Model embodies spiritual
       concepts. It helps us all to see care doesn’t have a color. You don’t have to speak a
       person’s language to communicate with them. We just have to care for one another.

Diversity Resources for Patient Care Delivery
       DRH provides translations for nearly 100 languages and dialects. Staff can call an
interpreter 24/7 and have translation of health information provided for patients, families and
staff. Staff also has access to a link on the DMC intraweb that allows them to print out patient
care instructions and medications in Spanish.

       There are multiple American Sign Language resources available. Deaf, Hearing & Sign
language Inc., provides daytime, weekend, holidays and after hour services provided to patient
and family members who are deaf and hearing impaired. In addition, DRH provides amplified
telephone headsets for hearing impaired patients and a telecommunications device for the deaf as
needed (attachment 4.4e, Interpreter Information Sheet, p. 63).

       Furthermore, the rich diversity of DRH’s patient population creates an environment
where the uniqueness of every individual is integrated into his or her plan of care. DRH nurses
recognize that each person has unique health problems, family situations, and cultural-language

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                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

dynamics that require treating patients not just medically, but also individually and emotionally.
As mentioned above, nurses utilize many resources to bring cultural and language support
services directly to the bedside. For example, to address the cultural and language needs of
patients and families, staff nurses work with nurse educators to assemble an ad-hoc team of
hospital staff interpreters for emergent needs. DRH nurses rely on these language interpretation
services to ensure two-way communication throughout the care process. In the narrative below
a nurse practitioner explains how an interpreter helped a deaf and hearing-impaired family
member understand the dying process for a loved one.

       In September of last year, a 70-year-old elderly man was admitted to our unit, 5T, after
       suffering a devastating stroke. He had a fairly large family consisting of a second wife
       and four adult children. His wife, who had power of attorney, informed us of his decision
       to withhold life support if he had no chance of surviving his illness. The interpersonal
       relationships within the family, including the patient and his wife, seemed to be somewhat
       strained. Adding to this family dynamic was the challenge of communicating with his
       daughter who was deaf and hearing impaired. As a nurse, I provide care to patients and
       emotional support to family members. I also recognize, anticipate and respond to the
       needs of individuals entrusted with my care. Upon learning about his daughter’s
       impairment, I contacted a sign language interpreter in anticipation of her arrival.
       Through my training as a nurse, I have learned that you need to make eye contact with a
       person who is hearing impaired. So, I knew how important it was to provide her with a
       sign-language interpreter. Through the interpreter, we were able to explain her father’s
       condition, his prognosis and his advanced directives. She was very supportive of the
       whole plan of care, and just stated she did not want him to suffer or have any pain. The
       interpreter stayed with the daughter throughout the dying process and remained for
       several hours after in case the daughter needed additional support. Providing a way for
       this family member to communicate and understand gave her a voice during the end-of-
       life process.

       Julie Walsh, RN, MSN, APN-BC
       Palliative Care
       6 years at DRH

Spanish Classes
       In an effort to assists with understanding and communicating with Spanish speaking
patients, families and staff, the DAC has recently instituted learning resources to teach nursing
and other patient care staff basic language techniques. The resources enable staff to better
communicate important health and medical information to Spanish speaking patients and their

                                                                                           Page 55
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

       In keeping with DRH’s mission, the purpose of the Diversity Action Council is to
develop and maintain an environment in which we embrace the similarities and differences of all
in an atmosphere of mutual respect and cooperation (Attachment 4.4f, Diversity Mission
Brochure, p. 64).

       DRH creates programs that are sensitive to diversity and display an organizational
commitment to care for people from all walks of life.

                                                                                          Page 56
Dignity and Respect Video Flyer Attachment 4.4a

                                       Page 57
Diversity Training Program Objectives Attachment 4.4b

                                             Page 58
New Employee Orientation Customer Service Attachment 4.4c

                                                 Page 59
New Employee Orientation Customer Service Attachment 4.4c

                                                 Page 60
      Canadian Culture Appreciation Flyer Attachment 4.4d


               APPRECIATION DAY

  Presented by The DRH Diversity Council

•Canadian food at the DRH cafeteria
•Canadian Fact Game
•Videos of Canadian Culture
•Information on Canadian Culture

  Wednesday, January 16, 2008
  12:00 P.M.- 2:00 P.M.
  Cafeteria Entrance

                                                 Page 61
                                  International Inclusion Day Flyer Attachment 4.4d


                  International Inclusion Day:
       Changing Cultural Misconceptions

    Presented by DRH Diversity Council and
             International Services

                       BROWN BAG PRESENTATION
      Discussion of myths and truths about different cultures.

                           Panel Speakers
             Rev. Debra Dove, Coordinator of Spiritual Care, DRH

   Dr. Basem Qusous – Executive Director, Arabic American Friendship Center

                 Ian Widd - International Services Coordinator

              Robert Wamack, Principal of Crockett Middle School

      Moderator: Jan Toles - DRH Council Member and END Technologist

                                Monday, November 17, 2008
                                    12:00 - 1:00 P.M.
                                        Crockett A

                                                                           Page 62
                                                                                          Translator Tip Sheet Attachment 4.4e

                                          TRANSLATOR TIP SHEET
                                                            INTERNAL RESOURCES:
Employee Interpreter/Translator:
   Consult the internal resource list for physicians or employees who may provide the requested service. Contact and obtain permission from the
   employee’s immediate supervisor if services are required during regularly scheduled working hours. Whenever internal resources are used,
   you must: Fax completed *Request for Translation/Interpreter Services form to Patient/Guest Relations at (313) 993-8664.

    If assistance is required, contact:
    Monday-Friday (8:00am – 4:30pm)                  Patient/Guest Relations                 745-3495
    Weekends/After hours/Holidays                    Security                                745-3325
                                                     Emergency Dept.                         745-3356
                                                    Nursing Administration                  Pager #9860

Telecommunication Device for the Deaf (TDD):
     Equipment and the logbooks are available in Nursing Administration. Patient care areas may sign out equipment for patient use and are
     responsible for securing the device and returning clean equipment to Nursing Administration.

                                                         EXTERNAL RESOURCES:
    The Unit/Clinic Department arranges and authorizes service via the companies listed
    below. When the unit completes arrangements, fax completed *Request for Translation/Interpreter Services form to Patient/Guest
    Relations at (313) 993-8664.

      1. On-line interpreters:     Interpreter by phone >100 languages/dialects available
          24 hour number           866-588-4655. Follow on-line instructions (client ID #4201)

         2.    Multi-Language Inc.         Scheduled appointments – usually requires 24 hour notice
               24 hour number                       734-513-0886. Follow on-line instructions
               Weekends/After hours                 734-564-1180

     1. Deaf Can
        Daytime                               248-332-3331
        Weekend/After hours/Holidays 248-523-1998 (emergency pager)

         2.   Deaf Options
              Daytime                                313-961-8120
              Weekend/After hours/Holidays           Message only

         3.    Deaf, Hearing & Sign Language, Inc. (DHSL)
              Daytime                              313-596-6032
              Weekends/After hours/Holidays        313-952-3050

         4.   Connections for Deaf Citizens (CDC)
              Daytime                             313-875-4970
              Weekends/after hours/Holidays       313-333-4977

         *The requesting area’s cost center is charged for all translation/ interpreter services.

          >Requests for Translation/Interpreter forms are available online
           in the translation/interpreter policy DRH-ADM 8102 (Tier 3)

                                                                                                                      Patient/Guest Relations
                                                                                                                                January 2009

                                                                                                                                  Page 63
                                                                          Diversity Mission Brochure Attachment 4.4f


            M. Cristina Ramirez – Chair
                                                                      DRH DIVERSITY ACTION
                     Jeff Dawkins                                           COUNCIL
                      Debra Dove
                   LaToyia Johnson
                     Felimar Latif
                   Brenda Lawrence                                          “Diversity is in our History.
                   Jacqueline Lyons                                       Our Strength is in Our Diversity”
                      Teresa Ruiz                                             (Quote from the DMC Diversity Council)

                     Megan Smith
                     Sylvia Taylor
                    Janenetta Toles
                     Kristin Upton

Email M. Cristina Ramirez at
OR CALL 745-493

                                                                          Monthly meetings on the second Friday
                                                                          of the month from 12 – 1 P.M., Third
                                                                          Floor 3H.20

                                                            -Two members participate in the planning committee for
                                                            Diversity Appreciation Day

             CALENDAR OF ACTIVITIES 2008                          DRH DIVERSITY COUNCIL MISSION
Quarterly Activities                                               In support of the Detroit Medical Center's Diversity
                                                                   Council’s mission, our goal is to develop and maintain
Black History Month – February/08                                  an environment in which we embrace the similarities and
                                                                   differences of all in an atmosphere of mutual respect and
Participation in Michigan Walk2gether May/08                       cooperation.

Latino Cultures Appreciation Day – September/08                    GOALS:

International Tolerance Day – November/08                              Increase staff awareness and acceptance of diversity
                                                                      in the workplace.

Other Activities                                                      Develop activities that highlight Detroit Receiving’s
                                                                      diversity, where our staff can feel included and
- Participation in Martin Luther King celebration in                  recognized.
collaboration with Spiritual Care
                                                                      Tailor diversity activities and training to the needs of
- Chair represents DRH’s Council at the DMC Diversity                 DRH
Council meetings
                                                                      Increase Diversity Council’s visibility in DRH.
-   Participation in the planning committee for Diversity
    Appreciation Day                                                  Consolidate the Diversity Council at DRH
-   Volunteer in activities planned by the DMC DAC


                                                                        Monthly meetings on the second Friday of the
                                                                        month from 12 – 1 P.M., Third Floor 3H.20

                                                                                                                                 Page 64
                                                                         Detroit Receiving Hospital
                                                         Force 4: Personnel Policies and Procedures

SOE 5: Provide examples of how the organization addresses workforce diversity.

“In diversity, there is beauty and there is strength.”
Maya Angelou,
Inaugural Poet, Writer, Educator, Historian, Author, Civil Rights Activist

       DRH’s vision for diversity is based on developing and maintaining an inclusive
environment that values and encourages the contributions of all employees and honors the
unique attributes of individuals. These attributes may, include race, gender, culture, ethnicity,
nationality, age, sexual orientation, disability, education, religion, life experiences and beliefs.

       The vision for including also means understanding, communicating and valuing
differences that enable staff to provide each other with learning that might not otherwise be
realized. DRH is dedicated to building a workforce that reflects diverse cultures, demonstrates
cultural competence and appreciates differences. We believe that such a culture creates an
environment wherein the very best care can be provided to patients and families. (Attachment
4.5a, Policy 2PBN 029, p. 69).

       Following are several programs that highlight and evidence our commitment to
workforce diversity:

Diversity Action Council
       DRH’s overwhelming support of inclusiveness was spearheaded by the DMC’s
commitment to diversity with the formation of a DMC-wide strategy by senior leadership to
create a more diverse workforce. This strategy resulted in a Diversity Action Council (DAC) at
each hospital to provide direction and ensure alignment of diversity activities at every institution.

       The purpose of the DAC is to develop and maintain an environment in which we embrace
the similarities and differences of all, in an atmosphere of mutual respect and cooperation. It is
comprised of employees who reflect diverse positions, backgrounds, and thinking. The DAC
meets monthly on the second Friday of the month from noon to 1p.m, and meetings are open to

                                                                                               Page 65
                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

all non-committee members who want to attend. Cristina M. Ramirez, Ph.D., clinical
psychologist, chairs the DRH DAC.

       The following employees serve on the Council:

          Jeffrey Dawkins, COO
          Debra Dove, Spiritual Care Coordinator, Pastoral Care
          LaToyia Johnson
          Felimar Latif, RN, Staff Nurse, 4L/M/N/5P
          Brenda Lawrence, RN, Quality Department
          Jacqueline Lyons, Surgical Technician
          Cristina Ramirez, Ph.D., Chair
          Teresa Ruiz
          Megan Smith, Data Analyst, Clinical Transformation
          Sylvia Taylor, Manager, Central Sterile Processing, Co-Chair
          Janenetta Toles
          Kristin Upton, RN, Staff Nurse, 4U/4V

       Members of the DRH DAC are available to individual employees or staff members who
wish to voice concerns or problems regarding racial, ethnic, religious or other diversity issues in
our workplace.

       The following message appeared in DRH’s employee newsletter, Receiving Rap:
       A message from the DRH Diversity Action Council
       September 2008

       As employees and staff at Detroit Receiving Hospital and University Health Center, we
       function in a wonderfully diverse workplace. Many racial, ethnic, and religious groups
       are represented here as members of the Receiving family. Supported at the executive level
       of the DMC and Receiving, programs are in place, which demonstrate a commitment to
       diversity. Our organization also has policies in place to insure a workplace free of fear,
       discrimination and bias. Detroit Receiving’s Diversity Action Council is an example of
       our leadership’s commitment to celebrate and embrace diversity. Receiving’s Diversity
       Action Council is composed of a variety of staff members who have received training
       from The National Conference for Community and Justice (NCCJ) in a program titled
       "Different People…Common Ground,” which provides a framework for groups to
       explore, discover and develop new insights about diversity. Since 2002, Receiving’s
       Council has been facilitating this program at the departmental level. Many of our staff
       have participated in and completed the Different People…Common Ground awareness
       program. And on behalf of all them, be part of the fiber that keeps our work environment

                                                                                            Page 66
                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

       healthy, warm and inviting to all. Participate in a diversity awareness session if you
       haven’t already done so.

    The DRH council members are actively involved in diversity education, sponsoring many
events, seminars and observances that communicate the importance of a respectful work
environment (see attachment 4.4f).

       I was encouraged to attend a DAC meeting by a council member. So, I did. After
       attending, I found the work of the council to be very focused and committed on activities
       to raise awareness about cultural diversity in the workforce. I am Philippine and I
       thought about what value I could bring to the council, so I decided to become a member.
       Henceforth, Philippino Day was created in June 2008. A lot of work went into planning
       this day, and I was the primary lead. On Philippino Day, there were philipino entrees
       served in the cafeteria, music, videos, as well as arts & crafts. Everyone enjoyed this
       event and said it was very effective in raising awareness of the philipino culture.

       Felimar Latif, RN
       Staff Nurse, 4L/M/N/5P
       6 years at DRH
       4 years as a DAC member

Annual Martin Luther King Celebration & Black History Month
       Every year in the month of January, DRH honors the memory of Reverend Dr. Martin
Luther King, Jr., by holding an observance celebration. The program is organized by members
of the DAC, and includes an optional prayer service in the hospital chapel for staff to hear
pastoral care read a passage of inspiration, speak about his legacies and offer a closing prayer.
This year’s theme, titled “Change, Diversity and Unity” featured FOX 2 News Reporter Lee
Thomas as the keynote speaker. In addition to the presentation, there was a performance by the
Hindu Temple Rhythms Dance Company (attachment 4.5b, Black History Month Flyer, p. 70).

Latino Culture Appreciation Day
       Latino Culture Appreciation Day is celebrated every September at DRH. This event is
open to all employees, patients and families. Organized by the DAC, the day features Latin-
inspired arts and crafts, music and traditional cuisine served in the cafeteria. The event also
recognizes Latino employees, and invites residents from the community to speak about their
culture and traditions. (attachment 4.5c, Latino Culture Day Flyer, p. 72)

                                                                                             Page 67
                                                                      Detroit Receiving Hospital
                                                      Force 4: Personnel Policies and Procedures

Diversity Appreciation Day
       This is an annual event to recognize cultural diversity at DRH. In October 2008, the
theme was “Learning from the Past, Building Future Challenges in Healthcare.” The goal of the
presentation was for participants to understand how current views on diversity are shaped by
past, individual, social and community experiences and how to use these experiences to prepare
for future challenges in healthcare.

Diversity Competency Training
        All new employees of DRH are required to complete a Net Learning customer service
module that includes diversity content. A score of 80% is required and if not achieved the
employee must repeat the module. Several policies and procedures also reflect workplace
diversity. The affirmative action policy (1 HR 106) supports DRH’s commitment to affirmative
action and equal opportunity employment. Briefly the policy states, DRH is an equal opportunity
employer that treats all employees equally in an environment free of intimidation, harassment
and discrimination. (Attachment 4.5d, Affirmative Action Policy, p. 73) Tenured employees
receive access to a culturally competence video or attend various educational sessions throughout
the year.
       DRH is committed to creating a diverse workforce that reflects the diversity of our
geographical location. To ensure our commitment, our nurse recruitment representative attends
job fairs which are sponsored by various minority organizations such as the Arab American
Nurses Association and the National Association for the Advancement of Colored People
(NAACP). We participated in the NAACP job fair held March 2009.

                                                                                          Page 68
                                                        Multicultural Diverse Needs Policy Attachment 4.5a

Title:          Multicultural Diverse Needs                                     Page 1 of 1
Policy No:      2 PBN 029                                                       Effective Date: 06/30/2008

To establish a consistent framework for assuring that all patients are treated with dignity and respect regardless of
race, creed, gender, national origin, or economic status by assuring that staff members are educated about the
multicultural needs of persons served.

Department of Psychiatry and Neurosciences Personnel and Medical Staff.


The Department of Psychiatry and Neurosciences in the Detroit Medical Center will ensure that all multicultural
issues affecting patients and their families will be considered when formulating and implementing the plan of
service and providing education.

1.    All staff will be provided with orientation and ongoing educational training related to the treatment needs
      of a multicultural and economically disadvantaged population.

2.      The need for specialized care related to cultural background, e.g. dietary requirements, use of interpreter
        services, etc. will be identified during the initial assessment and included in the plan of service.

3.      Staff will assess the patient’s level of understanding of the proposed course of treatment, make
        accommodations for cultural background and financial status during treatment planning and throughout
        the course of treatment, and will appropriately address and document related questions and/or concerns.

4.      Efforts will be made to accommodate the cultural needs of patients except when such accommodations
        interfere with the safety of the patient and/or the milieu.

5.      Efforts will be made to secure appropriate services to economically disadvantaged individuals as

6.      In the event that a patient or family member believes that the patient’s cultural needs are not being
        adequately met or addressed, he/she will be encouraged to confer with the treatment team and/or the
        Recipient Rights office for resolution.

7.      Appropriate interpreter/translator services will be secured as feasible, initially and throughout treatment.

The Chief Nursing Officer and the Specialist in Chief, Psychiatry, have overall responsibility and authority for
administration of all policies, procedures, and guidelines related to Psychiatric/Behavioral Health Care patient
care policies.


________________________________________________                            __________________________
Chief Nursing Officer                                                       Date

________________________________________________                            __________________________
Sponsor: PBN Committee
                                                                                                           Page 69
                            DRH Diversity Action Council Members

                            M. Cristina Ramirez – Chair
                                        Harry Capps
                                      Jeffrey Dawkins
                                        Felimar Latif
                                    Brenda Lawrence
                                     Jacqueline Lyons
          Celebrates                     Teresa Ruiz
                                        Kim Schafer
                                        Megan Smith
                                        Sylvia Taylor
                                          Jan Toles
                                       Kristin Upton

                                   Mission Statement:

                          In keeping with the DMC's mission, the
                       purpose of the Diversity Action Council is to
                         develop and maintain an environment in
                           which we embrace the similarities and
                       differences of all in an atmosphere of mutual
                                 respect and cooperation.

Page 70
                                                                       Black History Month Flyer Attachment 4.5b

          Welcome:         M. Cristina Ramirez                 Thank you to all those who made this
                                                                        program possible
          Presentation:    The Historic “Detroit Colored
                           Women’s Club”                    Chichita Young
                           Chichita Young                  Larry Campbell
                           President of the Detroit        Janet Young, Source Booksellers
                           Association of Women's Club     Jeffrey Dawkins
                                                           Maxine Pritchett
          Reflection:     Larry Campbell                   DRH Diversity Action Council Members
                          Director of Environmental        DRH Audiovisual Department
                          Services                         DRH Environmental Services
                                                           DRH Marketing Department

                                                           Look for other programs organized by the
                                                           Diversity Action Council in the near future.

Page 71
                                                                                                          Black History Month Flyer Attachment 4.5b
                                   Latino Cultures Flyer Attachment 4.5c


                      APPRECIATION DAY

               Presented by The DRH Diversity Council

    Wednesday,          •Singing by “Cantico de la Mujer
September 24, 2008      Latina”
11:00 AM.-2:00 P.M.     •Crafts for sale
   DRH Cafeteria        •Videos of Latin America
                        •Information on
                         Latino/Hispanic Cultures
                        •Latin American food at the
                         DRH cafeteria

                                                                Page 72
          Title:          Affirmative Action – Equal Employment Opportunity              Page 1 of 5                          Title:          Affirmative Action – Equal Employment Opportunity                  Page 2 of 5
          Policy No:      1 HR 106                                                       Effective Date: May 1, 2008          Policy No:      1 HR 106                                                           Effective Date: May 1, 2008

          To demonstrate The Detroit Medical Center's commitment to Affirmative Action/Equal Employment Opportunity                Minority: Any person classified as Black, Hispanic, Asian or Pacific Islander, American Indian or Alaskan
          by clarifying the conditions, procedures, and responsibilities governing equal employment opportunity and                Native or other individual designated as minority by the Equal Employment Opportunity Commission and/or
          affirmative action programs within covered operating units.                                                              Title VII of the Civil Rights Act of 1964.

          SCOPE                                                                                                               POLICY
          This policy applies to all employees of The Detroit Medical Center (DMC) (excluding joint ventures / affiliates     The Detroit Medical Center provides and promotes equal employment opportunity to all persons, without regard
          and other DMC entities as may from time to time be deemed appropriate).                                             to race, color, sex, age, religion, national origin, weight, height, marital status, disability, status as a Vietnam-era
                                                                                                                              or special disabled veteran or sexual preference. Within the provisions of applicable laws, equal employment
          Employees covered by a union contract should refer to the collective bargaining agreement. This policy applies      opportunity will be provided in all employment practices as well as all other terms and conditions of employment.
          to union employees except to the extent the policy conflicts with the applicable collective bargaining agreement,   Employees of the Detroit Medical Center are prohibited from engaging in any employment practices that are
          in which case the provisions of the collective bargaining agreement on that subject will control.                   prohibited by law and are contrary to the intent of this policy.

          DEFINITIONS                                                                                                         The definitions and procedures enumerated previously shall apply unless such procedure is specified in a
          See Glossary of Terms (1 HR 006)                                                                                    contract to which a covered operating unit is a signatory. In such cases, the terms of the contract shall govern
              Applicant                                                                                                       for employees covered by that contract and such terms will take precedence over this policy.
              DMC Healthcare System
              Covered Organization                                                                                            PROVISIONS

               Affirmative Action Plan and Program (AAP): A written program, meeting the requirements of 41 CFR Parts         1.   AFFIRMATIVE ACTION PLAN AND PROGRAM:
               60-1 and 60-2 which annually details an action-oriented set of activities to achieve equal employment
               opportunity and the inclusion of minorities and females in the work place. The AAP includes an analysis of          a. Any entity in which the DMC has 50% or more ownership shall be required to have an Affirmative
               the workforce, comparison of minority and female utilization to relevant labor markets, identifies under-              Action Plan and Program as mandated by Executive Order 11246 (as amended).
               representation of minorities and/or females in the internal workforce and provides for actions to attempt to
               increase the representation of minorities and/or females in workforce areas where under-representation              b. Each operating unit will develop annually an Affirmative Action Plan and Program and schedule for
               exists.                                                                                                                attaining defined minority and female employment goals. The program and schedule will be reviewed
                                                                                                                                      and approved by the Vice President of Human Resources.
               Adverse Impact: Is a series of calculations that measure selection rates in employment decisions. Adverse
               impact occurs when the selection rates for females, minorities or other protected groups are substantially     2. HUMAN RESOURCES PRACTICES:
               different from, or less than, the rates for males, non-minorities or other non-protected groups.
                                                                                                                                   a. Covered organizations will continually scrutinize their employment practices in order to prevent
               Bona Fide Occupational Qualification (BFOQ): An exception permitted under Section 703(e) of Title VII of               unlawful discrimination. Sources of unlawful discrimination as best can be determined will be
               the Civil Rights Act of 1964, which allows an employer to hire on the basis of certain characteristics (e.g.           eliminated.
               religion, sex, national origin) that would otherwise be unlawful. The necessity for such BFOQs must be
               demonstrated as related to a verifiable, business need and is reasonably necessary to the normal
                                                                                                                                   b. All employment advertising will include a statement reflecting the DMC’s commitment to equal
               operation of that business.
                                                                                                                                      employment. The DMC Director Employment and Workforce Transitions (or designee) is available to
                                                                                                                                      review an entity's advertising materials/programs upon request.
               Human Resources Practices: Human Resources policies, practices, procedures or programs that pertain
                                                                                                                                   c.   All public and private employment sources utilized by a covered operating unit will be advised of the
               a. Recruitment, hiring and placement                                                                                     DMC's equal employment opportunity policy. No recruitment source will be utilized if it functions in a
                                                                                                                                        manner contrary to the objective/intent of this policy.
               b. Employee advancement (promotions) and job retention
                                                                                                                                   d. Wherever possible, covered operating units will utilize public and private employment sources of
               c.   Training and education                                                                                            qualified minority applicants to assist in filling job vacancies. The DMC Director of Employment and
                                                                                                                                      Workforce Transitions (or designee) will be available to coordinate and provide assistance for such
               d.   Terminations                                                                                                      activities upon request.

               e.   Disciplines

               f. Payment of wages, merit programs, and participation in employer sponsored benefit programs                  3.   THE DMC AFFIRMATIVE ACTION EMPLOYMENT ADVISORY COMMITTEE (AA/EAC):
               g. Layoffs and recalls

          Sponsor: HR                                                                                                         Sponsor: HR

Page 73
                                                                                                                                                                                                                                                         Affirmative Action Policy Attachment 4.5d
          Title:          Affirmative Action – Equal Employment Opportunity               Page 3 of 5                         Title:         Affirmative Action – Equal Employment Opportunity                Page 4 of 5
          Policy No:      1 HR 106                                                        Effective Date: May 1, 2008         Policy No:     1 HR 106                                                         Effective Date: May 1, 2008

               a. The Detroit Medical Center will periodically convene the Advisory Committee whose functions are as                   1.   Assist in problem identification and in the attainment of unit goals and objectives.
                                                                                                                                       2.   Participate in local minority organizations and/or community ethnic groups as feasible.
                   1)    Develop recommendations regarding Affirmative Action matters for presentation to appropriate
                         management committees/councils.                                                                               3.   Discuss the Affirmative Action Plan and Program with employees to be certain that employees are
                                                                                                                                            aware of the operating unit's EEO policy and Affirmative Action Plan and Program.
                   2)   Disseminate information/strategies pertaining to Affirmative Action related issues.
                                                                                                                                       4.   Review the qualifications of external applicants and internal employees to be sure that minorities,
                   3)   Review the status of an operating unit’s Affirmative Action activities.                                             females, the disabled, veterans and other protected classes are given full opportunities for
                                                                                                                                            transfer and promotion.
               b. The Advisory Committee membership will include the President of each operating unit or designee, Sr.
                  Vice President Corporate Affairs, Vice President Human Resources, Director of Employment and                         5.   Assist in the identification of sources of qualified minority, female, disabled, veteran and other
                  Workforce Transitions, and the EEO Planning Specialist. The DMC Vice President of Human                                   protected class applicants for use by covered operating units and refer candidates as appropriate.
                  Resources or designee will chair the committee.
                                                                                                                                  c.   It will be the responsibility of the Human Resources Department to:
                                                                                                                                       1.   Ensure adherence to the provisions of this policy and develop any written administrative
               a. Employee complaints of unlawful discrimination will be addressed as follows:                                              procedures and forms as necessary in order to execute the provisions of this policy and promote
                                                                                                                                            its usage.
                   1)   Internal Complaints: the Human Resources Department will process Internal complaints of
                        unlawful discrimination. Internal complaints will follow the DMC Employee Problem                              2.   Communicate to department heads, supervisors and employees both the existence and
                        Solving/Appeals Process.                                                                                            objective/intent of this policy as well as the procedures for implementation.

                   2)   External Complaints: External complaints of unlawful discrimination filed by applicants or                     3.   Inform the DMC Vice President of Human Resources (or designee) of any employee charges of
                        employees as well as the organizational responses, will be processed by and responded to in                         unlawful discrimination and any minority employment audits conducted by external agencies.
                        writing by the Human Resources Department.
                                                                                                                                       4.   Develop written programs that promote minority, female and other protected class employment
               b. Any employee who intentionally engages in unlawful discrimination will be subject to disciplinary action,                 and foster an atmosphere of equal employment opportunity.
                  up to and including discharge.
                                                                                                                                       5.   Monitor progress toward attainment of minority, female and other protected class employment
          5.   RESPONSIBILITIES:                                                                                                            goals and periodically report results to the senior vice president and other management staff.

               a. The DMC Vice President of Human Resources or designee in conjunction with the operating unit                         6.   Act as central repository for documentation pertaining to complaints of unlawful discrimination as
                   executive staff will:                                                                                                    well as any external agency audits.

                   1.   Develop policy statements, affirmative action plans and internal and external communication                    7.   Ensure the business necessity for any BFOQ is documented.
                                                                                                                                       8.   Audit compliance with the provisions and intent of this policy.
                   2.   Assist in problem identification.
                                                                                                                                       9.   Notify DMC President/CEO if an Affirmative Action Program is required.
                   3.   Assist management in resolving EEO problems and goal establishment.
                                                                                                                                  d. It will be the responsibility of each covered operating unit President and Senior Vice President (or
                   4.   Design and implement audit and reporting systems that will measure the effectiveness of the                  designee) to:
                        Affirmative Action Plan and indicate needs for remedial action. Determine the degree to which
                        goals and objectives have been attained.                                                                       1.   Ensure organizational support for minority employment goals.

                  5. Serve as a liaison between community based minority and female organizations, organizations for                   2.   Monitor organization progress toward goal attainment and take remedial action as needed.
                        the disabled and covered veterans and community action groups concerned with the employment
                        opportunities of minorities, females, the disabled and veterans.                                               3.   Monitor overall program compliance.
                  6. Keep management informed of the latest EEO developments.
               b. It will be the responsibility of the Operating Unit’s Supervisors and Managers to:

          Sponsor: HR                                                                                                         Sponsor: HR

Page 74
                                                                                                                                                                                                                                                  Affirmative Action Policy Attachment 4.5d
          Title:         Affirmative Action – Equal Employment Opportunity              Page 5 of 5
          Policy No:     1 HR 106                                                       Effective Date: May 1, 2008

              e. It will be the ultimate responsibility of the President/Chief Executive Officer to ensure compliance with
                 the Executive Order Program. The President/Chief Executive Officer will:

                  1.    Review and approve Detroit Medical Center employment goals.

          Requests for exceptions to this policy are to be submitted to the senior executive of the appropriate operating
          unit for decision. This person must secure the concurrence of the senior executive of Human Resources prior to
          finalizing the decision.

          REVIEW DATE
          May 2011

          1 HR 106 May 2005

          Please check one:
          This policy is: New    Reviewed       Revised         Deleted Policy(ies)


          Sponsor: HR

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                                                                                                                             Affirmative Action Policy Attachment 4.5d
                                                                                   Detroit Receiving Hospital
                                                                   Force 4: Personnel Policies and Procedures

SOE 6: Describe the organization’s nursing recruitment and retention programs
and responses to ongoing challenges in the marketplace.

  I knew I wanted to work in critical           Nurses today have many choices -- more than ever before
  care, but always thought I would go
  into cardiac care. After my student     in the history of nursing. DRH’s reputation for excellence
  experience, I realized I enjoyed        and workforce stability has sustained the hospital’s
  working with neuro patients, and I
  really liked the staff as well. They    employment level over the years. Today, however, employers
  were supportive and
  knowledgeable.                          like DRH must respond quickly to marketplace demands to
  Sheri Frank                             attract and retain top nursing talent. This requires ongoing re-
  9 years at DRH
  (Hired in May 1999 after spending       evaluation, re-engineering and revitalization of personnel
  senior semester working with 5T         policies that provide fast and flexible strategies for nursing

2008-2009 DRH Staff Nurse Recruitment Plan
    The Table below describes the 2008 DRH Staff Nurse Recruitment Plan that was developed
in collaboration with members from the DRH Recruitment & Retention (R&R) committee.
Suggested Tactic             DRH Strategy                      Assigned to:               Status
Develop Acute Care theme     1.   Identify logo                C. Bradley, Nurse          Q2 2008 (completed)
for recruitment              2.   Identify slogan              Recruiter
                                                               B. Poindexter, Director
Direct Mailer                1.   Highlight medical-           C. Bradley                 Q2 2008 (completed)
                                  surgical positions
                             2.   Target tri-county zip
SICU/Surgical Acute Care     1.   Leave ICU job postings       S. Bennett, Adm Director   Q3 2008 ( Ongoing)
Interview Team                    up during entire             B. Poindexter
                                  interview process            C. Bradley
                             2.   SICU and Surgical
                                  Acute Care Directors
                                  interview entire
                                  candidate pool together
                             3.   Extend job offer for 2
                                  unit position
                                  alternatives for
                                  candidate to chose
                                  from, or offer best fit of
                                  2 units
                             4.   Consider posting 2
                                  additional FTEs in
                                  SICU as acute care
Utilize SNA as Staff         1.   Utilize higher               Management Team            Q1 2008 (completed)

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Suggested Tactic              DRH Strategy                     Assigned to:             Status
Nurse Pipeline                    concentration of SNAs
                                  in surgical acute care
                              2. Provide monthly
                                  opportunities for SNA
                                  to work 1:1 with Staff
Employee Referral             1. Continue system-wide          Nurse Recruitment        Q1 (ongoing)
Campaign                          3k referral bonus for        Management Team
                                  acute care
                              2. Re-evaluate for
                                  effectiveness in 60
                              3. Distribute referral
                                  bonus fliers on the
                                  inpatient units
Ongoing assessment of         Reassess number of               C. Bradley               Q1 (ongoing)
Progress toward goal          openings and communicate
                              to management every 2
Psychiatric Services: Goal:   1. Cancel requisitions >6        C. Moore, Director       Q3 2008 (completed)
Reduce Service Vacancy            months old and replace       C. Bradley
Rate to 5%                        with new
                              2. Contact old applicants
                                  regarding current
                                  position interest
                              3. Set goal of 48hr TAT
                                  from application to
                                  initial candidate contact
                              4. Broadcast email on
                                  Nurse Icon
                              5. Post staff nurse
                                  position on Career
                                  Builder job board
                              6. Present 15 minute
                                  presentation at DMC
                                  SNE party in August
                              7. Repeat presentation for
                                  OU and WSU
                                  students/fall term

Operating Room: Fill all      1.   Set goal of 48hr TAT        K. Crawforth, Director   Q3 2008 (completed)
vacant positions                   from applicant to initial   C.Bradley
                                   candidate contact
                              2.   Re-evaluate need for
                                   further additional
                                   tactics after 30 days
                              3.   Increase SNAs in
Job Fair                      1.   Mailer and Newspaper        C. Bradley               Q2 (completed)
Goal: Fill all vacant              Advertisement               All DRH Managers         Repeat in 2009
positions                     2.   DRH Managers will           R&R committee
                                   conduct on-site             DCNs

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                                                                         Detroit Receiving Hospital
                                                         Force 4: Personnel Policies and Procedures

       This is a dynamic plan owned by all. The strategies are evaluated in an ongoing manner
by the R & R committee and Nurse Leadership. Metrics used to evaluate success are hiring
numbers, vacancy rate (evaluated monthly) , SNA utilization ( assessed via the caregiver
summary reports monthly and year-to-date). Currently, DRH has a nurse vacancy rate of 5.9 %
contrasted with the national average vacancy rate of 8.5% (AHA 2006). In light of the national
nursing shortage, projected statewide increase in demand for nurses, and DRH’s close proximity
to other health care systems, the hospital has capitalized on using the popularity of the hospital
for clinical nurse training as a pipeline-priming tactic for graduate and staff nurse recruitment.
DRH is known for its clinical excellence and nurses seeking experience in Emergency and
Critical Care come to the hospital as a preferred employer. DRH sponsors nursing students from
colleges and universities throughout the Metro Detroit area, who also seek clinical placement at
our facility to gain exposure to the complex patients the hospital is recognized for treating.
Students request placement at DRH and have found it to be an ideal environment for a broad
exposure to learning experiences and collaborative teams in a teaching environment. Designated
staff nurse preceptors serve as ambassadors to ensure that students receive mentoring and site-
based resource support during their clinical experiences. Nineteen (19) designated staff nurses
support the role of staff nurse preceptor for new staff and students at DRH. Collectively, these
staff nurses have trained over 200 new employees and provided guidance and support to over 25
student nurse clinical placement groups between January 2006 and December 2008.

       Based on their positive clinical experiences, nursing students who have been trained by
our staff nurses typically join the staff after graduation. Many of them cite the exposure they
received during their clinical rotations in the main OR, burn center hydrotherapy and hyperbaric
areas as major factors for selecting DRH. Clinical groups placed within the hospital are
welcomed to participate in staff continuing education opportunities such as case studies, the
annual Detroit Trauma Symposium and grand rounds. Additionally, recruitment pizza parties are
held for the clinical groups so that the staff nurses, nursing leadership and recruitment team can
make the students feel welcome. The nurse recruiter is accessible to the students for career
counseling, and the facility provides nurse-shadowing experiences. The shadowing experience
enables a student nurse to stay with a staff nurse for a day to get a firsthand look at the job

                                                                                              Page 78
                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

responsibilities. (Attachment 4.6a, Job Shadowing Program, p. 86) Each graduating student
receives career counseling, which greatly influences graduate nurse transition experiences and
retention at the facility.

Nursing Student Pizza Parties
        The purpose of the Nursing Student Pizza parties is to have an informal luncheon session
with students who have or will be completing clinical rotations. This gives them an opportunity
to dialogue with the nurse recruiter about employment opportunities for SNA positions and
Graduate nurse openings depending on their graduation date. During these sessions, the nurse
recruiter Cheryl Bradley explains the employment process and the various employment options.
This pizza party is not only about employment but also provides an educational opportunity for
both DRH and the student. DRH also provides a guest nurse speaker, or a nurse educator to
discuss specific topics followed by a questions and answer period. Usually, a nurse director or
clinical nurse manager will dialogue with the student about their experiences on the various
units. Frequently, the nurse recruiter and students will take their “pizza party on the road” and
go to various colleges and universities with pizza, gifts and information.
Nursing Student Pizza Party scheduled events as follows:

   Date                University / College                   Time              Attendance
5/07/2008      Davenport University                    10:00am – 12:00pm        10 students
7/21/2008      Student Nurse Extern graduation         10:00am – 2:00pm         5 students
8/14/2008      Davenport University                    12:00pm – 1:30pm         8 students
9/25/2008      Oakland Community College               12:00pm - 1:30pm         8 students
11/26/2008     Oakland Community College               11:00am –12:00pm         8 students
12/4/2008      Wayne State University                  12:00pm – 1:30pm         8 students
12/5/2008      Oakland Community College               12:00pm – 2:00pm         15 students

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                                                         Force 4: Personnel Policies and Procedures

The following table illustrates our 2008 involvement with multiple university programs and the
number of students in clinical rotations at DRH.

Table 4.6a: 2008 DRH Clinical Student Nurse Placement by School

             University                 # Clin. Groups     # of Students    Class Level of Students
Wayne State University                        18                144        Soph, Junior, Senior
Davenport University                           5                 40        Junior, Senior
Wayne County Community College                 8                 72        1st/2nd yr
University of Detroit Mercy                    2                 14        Accelerated program
Oakland Community College                      8                 63        1st/2nd yr
Baker College                                  3                 20
Schoolcraft College                            1                  8
Henry Ford Community College                   3                 24        1st/2nd yr
Saginaw Valley State, UDM,                    n/a                51        Precepted Seniors
Oakland University, Eastern
Michigan University
Total                                         48               436

Student Nurse Extern Program
       In addition to educational experiences, DRH offers two distinct types of entry-level
employment opportunities for nurses. The DRH Student Nurse Extern Program is a temporary,
full-time assignment lasting from June 5 through July 21, 2008. The purpose of the Extern
program is to establish a close connection with interested students that can then be leveraged into
employment following graduation. These programs are considered best practice because they
enable engagement between the student and unit. During the summer months in 2008, we hired
five nursing students that had completed their medical/surgical clinical rotations as a student
nurse extern. This program offers BSN nursing students the opportunity to work side-by side
with an experienced staff nurse throughout the summer. This experience exposes the student to
advanced bedside clinical skills, fundamentals of patient care, and the overall responsibilities of
a staff nurse. Based on the positive feedback, the program was expanded. After the summer
externship has ended, students can continue working as a student nurse associate (SNA) while
completing their nursing program. On July 21, 2008, DRH re-hired the four participants into a
student nurse associate position. (Attachment 4.6b, Student Nurse Extern Job Posting
Summary, p. 87)

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                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

Student Nurse Associate Employment (SNA)
          The second entry-level employment opportunity at DRH is the SNA. These hired
employees attend nursing school and concurrently train as nursing students on the unit. SNA’s
serve as valued members of the PCS support staff team. The SNA works under the supervision
of a registered nurse who delegates tasks based upon patient needs and SNA skills and abilities.
In 2008, there were 30 SNAs employed at DRH. Students in their junior and senior year of a
nursing program can utilize the SNA role for their emergence into the nursing career path,
allowing them to become more comfortable working in the hospital environment, and giving
them the opportunity to develop a sense of belonging within the organization that promotes
retention after graduation. Approximately 80% of the SNAs who worked at DRH in 2008
became employed as staff nurses after graduation (Attachment 4.6c, Student Nursing
Opportunities at the DMC, p. 88) and. DRH’s strong support and development of the student
nurse provides staff nurse retention value to our organization as well. Ms. Hinton has
established as a goal with the Directors increasing the total number of SNAs from 30 to 40 for
2009. Relationships with the nursing students afford the experienced staff nurse mutual gain by
providing the opportunity to mentor those entering the profession of nursing while receiving the
support needed to ensure the delivery of quality patient care.

       I was not sure if I wanted to come here at first, but working on 5T (Neurotrauma ICU) as
       an SNA really helped me decide. I liked the atmosphere and the sense of team. I feel
       challenged. I see nurses who have been here several years that are still learning new
       things and that is part of the attraction – always learning something. There is a lot of
       support for new nurses. There’s always someone you can go to.”

       Kris Klumpenhouwer, RN
       Staff Nurse, 5T, NeuroIntensive Care
       6 years at DRH

       Our “Hire 100” Nurses Campaign has become one of our major hiring efforts for nursing
at DRH. This year the event occurred April 14, 2008 through June 20, 2008.

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                                                                         Detroit Receiving Hospital
                                                         Force 4: Personnel Policies and Procedures

         Each year the Detroit Medical Center exceeds the system hiring goals. The primary
focus on the Hire 100 initiative is to attract new staff to areas in the Detroit Medical Center
(DMC) that have the greatest vacancy. For the 2008 campaign, the Nurse recruiters, VPs of
Patient Care and the PNC recommended specific incentives to be used at their sites that they
expect will be useful in attracting new staff.

         These incentives support recruitment and retention tactics that are part of the DMC
Patient Care Services Strategic Plan. This plan will benefit both new staff and current staff and
those areas which have had critical staffing needs for experienced staff. For some sites that have
critical staffing issues, to offset tuition costs for new graduates or to stipend experienced RN’s
who commit to working in those areas. Our staff was very supportive of an incentive, which
benefited both the new nurse preceptor and the unit mentor that worked with the new nurse
during his/her first year. This specific incentive was experienced as a retention tactic and
recognition for experienced staff and benefits those who spend so much time and energy working
with new employees.

The hire 100 list for 2008 to date is as follows:
NAME                                      DATE OF HIRE    JOB TITLE          UNIT          JOB TYPE
Christina Collins                           4/27/2008        RN                4T             .9
Sandy Pope                                  4/27/2008        RN                4V            cont
Andrea Blaies                               5/16/2008        RN                5R             .9
Sherry Renee                                5/16/2008        GN                5R             .9
Carol Blair                                 6/16/2008        GN                5T             .9
Joshua Olson                                5/16/2008        GN                4Q             .9
Shelia Berg                                 5/16/2008        RN                5R             .9
Rachel Zuniga                               5/16/2008        GN               5M              FT
Janice Rodrique                             5/16/2008        RN                5P             FT
Rexiena Holder                              5/16/2008        RN                4Q             .9
Angela Woodley-Williams                     5/25/2008        RN                5Q             .9
Nancy Gayer                                 6/01/2008        RN           Pre-adm test        FT
Almeta Jackson                              6/01/2008        RN                5N             FT
Hermeneglido Malabed                        6/01/2008        RN                5N             FT
Valisa Jordan                               6/01/2008        RN                5N             FT
Yolanda McIntyre                            5/26/2008        RN                5N             FT
Gillam Q'Vadis                              5/20/2008        RN                5N             .9
Som-Clyde Montenegro                        5/20/2008        RN                5N             FT
Heather Baur                                5/16/2008        GN                4N             FT
Charmaine Farrugia                          5/19/2008        RN             IV team          cont
Colleen Hall                                5/16/2008        GN               5M              FT
Denise Petersimes                           5/16/2008        RN           Pre-adm test        FT
Sheila Henry                                5/13/2008        RN                5Q             .9

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

NAME                                DATE OF HIRE         JOB TITLE           UNIT          JOB TYPE
Toleka Taylor                         5/16/2008             RN                4N              FT
Sandra Duncan                         6/01/2008             RN                5N              FT
Renee Tucker                          6/13/2008             GN                5M              FT
Gwendolyn Riddick                     6/13/2008             RN                3Q             PT4

DRH hired 27 nursed during the 2008 campaign. Since the inception of the DMC Hire 100
Nurses program, each year, we have continued to increase the number of nurses employed at

Employee Referral Bonus Program
       The employee referral bonus program encourages DRH employees, and particularly staff
nurses, to recruit additional staff nurses to the hospital and DMC. The DRH nurse becomes
engaged in active recruitment for the hospital, and is utilized to identify nursing colleagues who
would make great team members and co-workers, and exhibit professional behaviors that support
the mission and customer service standards of the organization. The referral bonus award
payment amount varies from $3,000 to $5,000 depending on the recruitment demand for a
particular specialty area, and requires that the hiring nurse and the referring employee stay at the
DMC for a full year to maintain payment eligibility. In this respect, the referral bonus program is
utilized as a tactic to both recruit and retain staff (Attachment 4.6d, DMC Employee Referral
Award Flyer, p. 89).

Tuition Assistance Program
    The Tuition Assistance program is a recruitment tool used to attract experienced nurses to
DRH who are interested in continuing their education to obtain a higher degree. The program
offers up to $15,000 in tuition support to RNs willing to commit to 3 years of employment with
the DMC after graduating. LPNs who want to return to school can also take advantage of this
program to receive $5,000 in tuition support to obtain an associate’s degree in nursing, and may
continue in the program to work toward earning a BSN degree. BSN prepared nurses are eligible
to utilize this program to receive up to $24,000 in support to continue their education in a CRNA
career track. The Educational Tuition Assistance program is both a recruitment and retention
tactic for the hospital because it promotes the professional development of the nurse, provides

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                                                                        Detroit Receiving Hospital
                                                        Force 4: Personnel Policies and Procedures

financial resource support of continuing education of the nurse, and secures a future work
commitment from the employee within the hospital (Attachment 4.6e, Tuition assistance policy
& guidelines, p. 90).

Flexible Scheduling
    A third tactic used at DRH to attract the experienced RN to the facility is the advertising and
promotion of flexible scheduling alternatives. Unit-based staff nurse self-scheduling is promoted
throughout the hospital. Some of the scheduling options provided to accommodate nurses with
limited work availability are 3-twelve hour shifts per week and receive full-time benefit
privileges, flex shifts with non-traditional start times, four-hour scheduling block alternatives,
per diem contract and weekend cadre contract packages, and limited commitment sixteen hour
per month casual contingent employment (Attachment 4.6f, Detroit News ad highlighting
flexible scheduling, p. 92).

As a director, it is my belief, that nurses are more content when they are able to have a schedule,
inclusive of shift preference, that supports their personal and educational needs. As in many
other units, the staff nurses do self-scheduling and balance the schedule. In the SICU, staff
nurses do not rotate to another shift unless it is required to meet the patients’ needs due to
inappropriate mix of experienced nurses, nurses on medical leaves of absence, or unequal
number of requests to work a particular shift. The nurses themselves define the length of time for
rotation. It may vary from 2 weeks to 3 months. What is important is that the nurses decide this
process and I support their decisions. There are a core number of nurses who are not required
to rotate shifts. Nurses that are required to rotate are those that are clearly not intending to be a
part of the SICU team for more than 2 years. After 1 ½ years of experience, these nurses have
applied and been accepted into a CRNA program. Their time on the unit is approximately 2
years. All staff supports this arrangement.

Sue Ellen Bennett, RN, MSN
Administrative Director Patient Services & Director SICU
18 years at DRH

    Other recruitment programs in place are aimed to attract the experienced nurse and maintain
a balanced level of experience within the staff nurse workforce. This is accomplished through
DRH and DMC advertising in professional nursing journals and newspapers, participation in
local job fairs and professional conferences, and website advertising. The Nurse Recruitment
Division recognizes every DMC Staff Nurse as a member of the organization’s recruitment team,
and has found that peer contact and interaction at recruitment functions is invaluable to

                                                                                             Page 84
                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

presenting a realistic portrait of what the nurse practice environment of the organization has to
Ongoing Challenges
         The greatest ongoing challenge that we face at DRH is the recruitment of graduate
nurses, as we are competing with other health systems. The way we keep a competitive
advantage, is that we have ongoing clinical placement relationships with multiple universities as
mentioned in table4.6a, and through our ongoing employment of SNA’s. In 2008, this
recruitment strategy has resulted in an 80% retention rate of SNA’s upon nursing school
graduation. In 2008, we implemented the Alliance for Clinical Excellence (ACE) software. This
software enables DRH to put our clinical placement availability on line so that schools outside of
the immediate Detroit area can still take advantage of clinical opportunities. As a result, we have
increased the number of clinical students from 120 in winter 2008 to168 in winter 2009.

                                                                                           Page 85
Job Shadowing Program Attachment 4.6a

                             Page 86
                                         JOB POSTING SUMMARY                                                                                                  JOB POSTING SUMMARY
           Title:                    Student Nurse Extern                                                                       Title:                    Student Nurse Extern
           Page 1 of 2                Job Code:             5NA86               Date:              April 12, 2005               Page 2 of 2                 Job Code:               5NA86                 Date:             April 12, 2005

                                                                                                                               7. Visual acuity and manual dexterity.
          Summary Description                                                                                                  8. Demonstrates willingness to make a meaningful contribution to the work environment as evidenced
                                                                                                                                  through behavior and attitude.

          The Student Nurse Extern (SNE) is a member of the patient care services team with primary responsibilities            Patient Age Statement                           Applies:              X           Does not Apply:
          for technical, multi-skilled direct and indirect patient care activities. The SNE is assigned to work under the
          supervision of a registered nurse who delegates tasks based upon patient needs and SNE skills and
          abilities. The SNE will report all deviations from expected patient parameters to the registered nurse. It is
                                                                                                                                ___ Employees with Patient Contact
          recognized that specific patient care tasks may vary widely in type and frequency from unit to unit or across         Based on observation, demonstrated knowledge and skills necessary to provide care appropriate to the age of the
          service lines, based on the nature of the patient population being served. Therefore, individual units, or            patients serviced on assigned unit(s). Demonstrated knowledge includes principles of growth and development over
          service lines, may appropriately add to or delete from the duties defined in the Student Nurse Extern job             each patient's life span. Provides care needed as described in department policies and procedures.
          description when approved by nursing administration. The goal of this position is to build on academic
          experiences of the student by providing practical application of skills and critical thinking.                        _X__ Nursing/Patient Care
                                                                                                                                Based on observation, demonstrated knowledge and skills necessary to provide care appropriate to the ages of the
          NOTE: This job is flat-rated and assigned to pay grade 866 in the Temporary Exception Range Hourly                    patients serviced on assigned unit(s). Demonstrated knowledge includes principles of growth and development over
          (TER) pay structure. The rate paid is based on external market rates paid and internal equity with the                each patient’s life span. Possesses ability to assess data reflective of each patient's status and interprets appropriate
          Student Nurse Associate and Student Nurse Intern pay rates. Typically, this position is 8-weeks long during           information needed to identify each patient's age-specific requirements. Provides care needed as described in
          the summer months.                                                                                                    department policies and procedures.

                                                                                                                                Working                 Ability to work productively and effectively within a complex environment, handle
                                                                                                                                Conditions:             multiple/changing priorities and deal with stresses associated with a patient care
          Minimum Qualifications                                                                                                                        environment such as emergencies, time pressures, varying patient
                                                                                                                                                        emotions/attitudes/conditions, etc.

          1. Currently working on a Bachelor of Science degree in Nursing (BSN).                                                                        Patient care environment with minimal exposure to infectious diseases and hazards
                                                                                                                                                        from cleaning solutions and disinfectants when using universal precautions. Provides
          2. A junior or senior level college/university BSN student in good standing.                                                                  care needed as described in the department's policies and procedures.

          Skills Required                                                                                                       Reporting               Clinical Manager, Manager and/or Director – Patient Services
                                                                                                                                Pay Grade:              866
          1. Good analytical and observational problem-solving skills.
          2. Mathematical ability to perform calculations such as addition, subtraction, multiplication and division etc.       Hourly/Salaried:
          3. Ability to adapt to new technologies used in the work environment.
                                                                                                                                Job Family:             X    Clerical/Technical                   Leadership
          4. A high level of interpersonal and verbal skill and team work commitment in order to effectively function                                        Professional/Administrative          Union
             as a team member in support of all services delivered on the patient unit and to effectively communicate
             with patients, their families and other hospital personnel to address customer needs.
                                                                                                                               Please note that the primary purpose of this job posting summary is to set a rate of pay for this job
          5. Good reading, writing and comprehension skills in order to understand effectively communicate and                 classification. Only those duties and responsibilities necessary for proper job evaluation and labor market
             contribute to procedures, processes, orders, methods and standards.                                               analysis have been included. Other duties and responsibilities will be assigned by the supervisor.
          6. Physical ability to regularly (80-90% of work time) walk and stand; lift soiled linens and move equipment
             as necessary; assist patients in repositioning, bed to stretcher transferring, basic activities of daily living
             and maintenance locomotion requiring lifting (very heavy 60+ pounds), bending, pulling, pushing,
             standing and walking.

                                                                  1                                                                                                                        2
          Student Nurse Extern_5NA86_04-05.doc                                      Date Printed: 02/13/2009 7:29 AM           Student Nurse Extern_5NA86_04-05.doc                                          Date Printed: 02/13/2009 7:29 AM

Page 87
                                                                                                                                                                                                                                                            Student Nurse Extern Job Posting Summary Attachment 4.6b
Student Nursing Opportunities Attachment 4.6c

                                     Page 88
DMC Employee Referral Award Flyer Attachment 4.6d

                                         Page 89
          Title:          Educational Assistance Program – Standard                         Page 1 of 4                        Title:            Educational Assistance Program – Standard                      Page 2 of 4
          Policy No:      1 HR 401                                                          Effective Date: December 1, 2008   Policy No:        1 HR 401                                                       Effective Date: December 1, 2008

          OBJECTIVE                                                                                                                c.   Educational assistance monies shall not exceed a maximum of $1600.00 reimbursement per calendar
          To provide financial assistance to employees who are enrolled in approved educational programs.                               year for any eligible employee.

          SCOPE                                                                                                                                                Benefit Status             Maximum Educational Assistance
          This policy applies to all hourly and salaried employees of the Detroit Medical Center (excluding joint                                                      1                           $1,600.00
          ventures/affiliates and other DMC entities as may from time to time be deemed appropriate).                                                                  2                           $1,360.00
                                                                                                                                                                       3                           $1,040.00
          DEFINITIONS                                                                                                                                                  4                           $ 800.00
          See Glossary of Terms for: Employee Benefit Status, Final Warning, Reemployment, Reinstatement
                                                                                                                                                                  Contingent                        $      -
          Employees are encouraged to enhance their skills in areas that are beneficial to the DMC. Within budgetary               d. Educational assistance monies will be provided to cover expenses associated with base tuition costs
          constraints, educational assistance will be granted in accordance with the provisions contained herein.                     (other expenses, e.g., fees, books are not covered).
                                                                                                                                   e. Within budgetary constraints, one hundred percent (100%) of the educational assistance will be paid
          This policy, in combination with 1 HR 402, constitutes the DMC educational assistance program within the                    upon presentation of proof of payment.
          definition of IRC Section 127.
                                                                                                                                   f.   All courses must be scheduled outside of regularly scheduled work hours.
          Employees covered by a union contract should refer to the collective bargaining agreement. This policy applies to        g. An employee who intentionally falsifies or misrepresents educational documentation/requests will be
          union employees except to the extent the policy conflicts with the applicable collective bargaining agreement, in           subject to disciplinary action up to and including termination and will be permanently excluded from any
          which case the provisions of the collective bargaining agreement on that subject will control.                              future participation in the DMC educational assistance program.

          PROVISIONS                                                                                                               h. The amount of educational assistance will be reduced by the amount of monies received or to be
          1. ELIGIBILITY:                                                                                                             received from other sources (e.g. scholarships, grants, veteran’s benefits, or stipends and so forth).
             a. Be a full-time or part time status employee.                                                                          Employees are required to divulge monies received from any other source at the time of application, any
                                                                                                                                      time during participation or at the time of reimbursement.
              b. Be on the active payroll at the beginning and completion date of the educational program, except as
                 referenced in provision 3.c.                                                                                      i.   When limited educational assistance monies are available, a department may prioritize the approval of
                                                                                                                                        eligible coursework. Such priority may take place as follows:
              c.   Not have received a second level discipline, or higher, within six (6) months or one (1) year for final
                   warning prior to application for tuition assistance or any time during approved coursework.                          1. Benefit to the employee’s department.
              d. Have acceptable performance as defined by the employer-of-record prior to and during approved                          2. Career path enhancement outside the employee’s department, but within the employee’s operating
                 coursework.                                                                                                                unit and defined as a market sensitive job.
              e. The educational program, including on-line offerings, provided by an accredited college/school for which               3. Career path enhancement outside of the employee’s department/operating unit, but within the Detroit
                 the employee is applying must meet one or more of the following criteria:                                                  Medical Center.
                           i. Assist an employee to maintain or improve work performance in his/her current job
                              classification.                                                                                           Approval of coursework in this case will be administered consistently for like job titles in the same
                                                                                                                                        department during a given budget period.
                           ii. Be required in order for an employee to retain his/her job classification, salary level or      3. PAYMENT OF EDUCATIONAL ASSISTANCE MONIES:
                              employment.                                                                                         a. In order to receive reimbursement for an approved educational program, the employee must:

                                                                    OR                                                                  i. Provide both satisfactory proof of completion of the approved education program and documentation
                           iii. Help prepare an employee for a career path within the department, operating unit or the DMC.               pertaining to the paid cost/fee for the approved educational program. Satisfactory completion (for the
                                                                                                                                           purposes of this policy) of an approved course may be one of the following:
                           iv. Be taken at the direction of an employee’s supervisor.                                                        a) Minimum letter grade of “C” or equivalent for undergraduate coursework; minimum letter grade of
                                                                                                                                                “B” or equivalent for graduate coursework.
             a. Forms and forms process instructions are available on the DMC intranet via the following path: DMC                           b) “Pass” in a pass/fail course.
                intranet / Human Resources / HR Forms / Tuition Benefit Forms: Tuition (Education) Assistance.                               c) Certification and or licensure or equivalent document of successful course completion.

              b. Application for educational assistance must be approved by the employee’s current manager before the
                 beginning of the educational program and after the completion of the educational program. These                        ii. Submit an application for reimbursement no later than sixty (60) days following the completion of
                 approvals must be obtained before submission for reimbursement.                                                            coursework.
          Sponsor: HR                                                                                                          Sponsor: HR

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                                                                                                                                                                                                                                                    Tuition Assistance Policy & Guidelines Attachment 4.6e
          Title:            Educational Assistance Program – Standard                        Page 3 of 4                              Title:         Educational Assistance Program – Standard                       Page 4 of 4
          Policy No:        1 HR 401                                                         Effective Date: December 1, 2008         Policy No:     1 HR 401                                                        Effective Date: December 1, 2008

                                                                                                                                      5. RESPONSIBILITIES:
              b. Intra-system Employee Movement
                                                                                                                                          It will be the responsibility of the Human Resources Department, in collaboration with the Tax and Payroll
                   i. It will be the responsibility of the employee to disclose their current participation in the program to their       Services Department as well as other significant stakeholders to:
                      potential new manager, prior to the time that the offer is made.
                                                                                                                                          a. Audit compliance with the provisions and intent of this policy.
                   ii. An employee who is enrolled, or who is currently attending, approved coursework at the time of
                       transfer, will be allowed to complete the course and receive educational assistance provided that
                                                                                                                                          b. Develop any administrative procedures and forms as necessary in order to execute the provisions of this
                       coursework was previously approved, and that the employee meets all other eligibility criteria.
                       Payment will be the responsibility of the new department.
                   iii. The employee must provide documentation that the coursework was both eligible and approved for                    c. Communicate to department heads, supervisors, and employees both the existence of this policy and the
                        reimbursement at the sending operating unit.                                                                         procedures for implementation.
                   iv. The employee must certify that he/she was not previously reimbursed for the coursework.                        ADMINISTRATIVE RESPONSIBILITY
                   v. Approval and/or reimbursement of additional coursework, following intra-system movement will be                 Requests for exceptions to this policy are to be submitted to the senior executive of the appropriate operating unit
                      based on the criteria contained herein.                                                                         for decision. This person must secure the concurrence of the senior executive of Human Resources prior to
                                                                                                                                      finalizing the decision.
              c.   An employee will become immediately ineligible for educational assistance if the employee:

                   i.    Terminates DMC employment prior to completing approved coursework.                                           APPROVAL SIGNATURE (S)
                   ii.   Fails to satisfactorily complete approved coursework.
                   iii. Is on a leave of absence (LOA) during the coursework, unless reviewed and approved by department
                        director in consultation with Human Resources.                                                                Corporate Vice President, Human Resources                                          Date
                   iv. Falsifies or misrepresents any documentation/request for educational assistance. Employee will be
                       subject to disciplinary action up to and including termination and will be permanently excluded from
                       any future participation in the DMC educational assistance program.

              d. Repayment of tuition monies to the DMC for termination of employment or falsification:                               Executive Vice President/Chief Operating Officer                           Date
                 i. Management will notify the Payroll Department immediately of the termination of an employee who
                    received enhanced tuition assistance monies. In addition, management will submit timely termination
                    paperwork to ensure all systems accurately reflect employment status.                                             REVIEW DATE
                                                                                                                                      December 2011
                   ii. If an employee voluntarily or involuntarily terminates (excluding layoff) for any reason, within twelve
                        (12) months of a reimbursed educational program, the DMC shall reserve the right to deduct                    SUPERSEDES
                        reimbursement monies from the employee’s final paycheck(s). Such deduction will be equivalent to:             1 HR 401 EFFECTIVE DATE: FEBRUARY 15, 2008
                        One hundred percent (100%) of the amount paid or the maximums allowed by state or federal law, if
                        termination occurs within six (6) months of reimbursement or fifty percent (50%) of the amount paid, if       KEY SEARCH W ORDS: Educational Programs, College Degree, Tuition Assistance
                        termination occurs between six (6) and twelve (12) months of reimbursement.
                                                                                                                                      Please check one:
                   iii. If an employee falsifies or misrepresents any documentation/request pertaining to an approved                 This policy is: †New     †Reviewed       6 Revised        † Deleted Policy(ies)
                         educational program the employee will be required to repay any educational assistance monies
                         received for that program.                                                                                     THERE MAY BE NO EXCEPTION TO THIS POLICY WHERE SUCH EXCEPTION IS A VIOLATION OF LAW
          4. TAXATION:                                                                                                                     This policy may be revised or revoked at any time by the DMC without prior notice to employees.
                Any educational assistance provided by this policy, in combination with policy 1 HR 402, in excess of
                $5250 in a calendar year is taxable and subject to withholding of federal, state, and city income taxes,
                and social security and Medicare taxes.

                   Any future changes to the maximum dollar amount excludable, as well as any changes to other provisions
                   of Section 127, will cause the provisions of this program to be changed in a like manner.

          Sponsor: HR                                                                                                                 Sponsor: HR

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                                                                                                                                                                                                                                                             Tuition Assistance Policy & Guidelines Attachment 4.6e
Detroit News AD Attachment 4.6f

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SOE 7: Provide action plans developed with direct care nurse input/ involvement
to address variation in unit—or service-based turnover and vacancy rates.

       Through our shared governance structure—unit based councils, R& R committee and
leadership council—direct care nurses provide their knowledge and input to develop action plans
that address challenges and enhance nursing practice. The following examples are offered:

4Q Surgical Intensive Care Unit (SICU)
       The surgical intensive care unit (SICU) has regularly reported higher turnover rates than
other units within the hospital. Analysis of the data revealed that a large percentage of this
turnover was due to nurses leaving the unit to begin a master’s program in anesthesia. A unit-
based plan was developed to address this issue that included ensuring replacement of staff nurses
prior to the nurses leaving for school. The SICU nurses found the value in this predictable
turnover and began to see the increase in hiring not only as a response to turnover, but as a
retention tool for the nurses remaining. The SICU nursing staff has a distinct privilege of
providing many nurses with a solid knowledge foundation, critical thinking and quality clinical
practice skills. This unit attracts nurses who want to gain valuable, challenging experiences that
will successfully lead to their acceptance into a CRNA program. The nurses on 4Q are known for
being highly motivated, self-directed, compassionate and extremely committed to providing
evidence-based practice. They have an intense eagerness to learn, experience, and apply
knowledge to direct patient care because 67% of the staff nurses in the SICU are presently
enrolled in higher education. Eleven out of 18 (61%) of the staff nurses are currently completing
courses that support a CRNA program acceptance. Although, these nurses are moving on to
pursue advanced degrees, they still remain employees within the DMC system. Last year in
2008, when two nurses left 4Q, they both received jobs within the DMC. Both nurses went over
to Harper University Hospital; one received a CRNA position and the other a Nurse Practitioner

       The 4Q action plan follows in table 4.7. The plan is evaluated each year to determine its
effectiveness in responding to the turnover while clearly communicating the rationale for nurse
departures to preserve morale on the unit. For instance, each new critical care nurse is assigned
two preceptors. This strategy creates a “win-win” situation for both parties. With two preceptors,

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the added responsibility of teaching is minimized. This provides much needed down time for the
preceptors allowing them to “just care for the patients”.

Table 4.7: 2008-2009 SICU (4Q) Action Plan in Response to Predictable Unit Turnover

Action                          Accountability     Date         Communication/Feedback
Recruit New Nurses              Cheryl Bradley,    Ongoing      Each year March – May, added
                                Nurse Recruiter,                emphasis in preparation for exits.
                                Unit Nurses &                   Nurses leave for CRNA school in
                                Unit Management                 September of each year
Hire Nurses (over the number    Director           May of       Establish expectations that nurses who
anticipated to exit unit each                      each year    are on the CRNA track may be
year)                                                           expected to rotate shifts.
Evaluate and restructure the    Unit Management    Ongoing      Allows nurses to be paired by
nurse preceptorship role and                                    experience and interest and relieves
selection                                                       the continuous preceptor ships of
                                                                nurses who are leaving.
Assign new hires to 2           Unit Management    Upon hire    The added responsibility of teaching is
preceptors                                                      minimized
Continue to make self-          Unit Management    Ongoing      Gives nurses a feeling of autonomy
scheduling a priority                                           and flexibility.

Action Plan to address General Vacancies

        Strategies to address recruitment of agency nurses to practice as staff nurses at DRH were
developed and implemented by Aileen Petrozzi, RN, BS, were successful. As of January 2009, a
total of eight agency nurses were hired to join the DRH in-house pool.

Goal: Continue to recruit experienced nurses to the in-house nursing pool, 2008-2009
1. Actively work with DRH recruiter.
2. Recruit the agency nurse that comes to work frequently at DRH through various approaches
    and methodologies; make them feel valued even though they are not permanent staff.
1. Place the requisitions in web hire for the amount of staff needed/projected to recruit.
2. Meet and greet all agency employees the first day they arrive.
       Supply orientation folder with explanations on how DRH works
       Provide parking and badge information

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      Supply in house pool manager phone number in case a problem develops that cannot be
       resolved with unit or supervisor on duty.
      Make agency staff feel like a DRH employee by giving them Nurses’ Week gifts
      Provide agency employees with the available options related to working at DRH,
       example: Per diem three- $38.00/hr
      When feedback is received about the employee from the unit, communicate the
       information to the agency.
      Keep them updated by sharing all new processes and policies.
      Provide an “open door” policy to answers questions and concerns.

Staff Nurse Turnover/Vacancy Action Plan for Nursing Units 4U, 4V, and 5R and
Emergency Department

4U/4V Medical Surgical:
      The new generation of graduate nurses are seeking employment in several specialty
areas, including critical care, medical, surgical, cardiac, pediatrics and emergency medicine just
to name a few. Develop a campaign that be used during the interview process that presents the
benefit of working within the Medical-Surgical environment. Nurses are however free to select
their specialty of choice consistent with vacancies.

5R Critical Care:
      Nurses interested in critical care are educated about the specialized critical care units
during the interview process. Nurses not interested in the MICU are given the option of working
in burn trauma ICU, neurotrauma ICU or SICU. For nurses requiring SICU experience to enter
the anesthesia program, assistance is provided.

Emergency Department(ED):

       As a Level One Trauma Center that treats over 80,000 patients a year in the ED, new
nurses working in the department typically stay for at least 2 years before transferring into
another area such as critical care. Many use the ED as an entry into anesthesia, or they seek
employment at a less challenging ED.

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       The following action plan was developed to address the turnover/vacancy rate in med-
surg, critical care and the ED using the best practices for nursing. It was created to maintain a
consistent number of students on the units to fill staff nurse vacancies twice a year.

Action #1: Hire student nurses on each of the units with high vacancy rates such as 4V, 4U,
5R and ED.

In this region, student nurses graduate in May and December. If they are hired six months to a
year before graduating, they are able to fill open positions. Management teams will collaborate
with nurse recruitment to assess vacancies. In 2008, there were ten vacancies in the ED, two
vacancies on 4U/4V and two vacancies on 5R.

EMR trained
Familiar with departmental policies and procedures
Familiar with periods of “overwhelming busy” periods
Awareness of patient types and needs
Familiar with the nursing units’ standard of practices
Transition to staff nurse role is easier
Professional relationships are developed with staff and management team

Action #2: Participate in the training of student nurses from various colleges and
Staff nurses from each unit act as preceptors for student nurses’ clinical rotation. The student
must work the schedule of the preceptor because they are not accompanied by their clinical
instructor. Students complete various hours of clinical experience per semester. For the
traditional nursing program, students are placed on different units for clinical experience.

Action #3: Recommend and promote the employee referral bonus program.
This program provides a monetary reward for referring a nurse to DRH. Employees receive
$3000 for each nurse hired and employed for one year.

Advantage: Each unit will encourage their staff to refer nurses to DRH for employment.

Action #4: Staff Nurse/Manager participation in recruitment job fairs.
Staff nurses from 4U, 4V, 5R, and the ED are active members of the Recruitment and Retention
Committee. Committee members attend job fairs at the colleges and universities. Additionally
they participate in the interviewing process for new nurses.

                                             Fall 2008
Oakland University:
Hrs required:      Dates:

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 Student         Preceptor Name              Shift         Unit Description               Management Contact
  Name                                                     Preceptor contact

              Geraldine Yopp, BSN            Days
   Early                                                           Director: Monica Marshall
                                                         ED: Level One Trauma                  313-745-3112
                Kristina Trupiano,           days        Emergency Department        Clinical Manger: Debra Gallivan-
 Sarkozy               BSN                              313 966-0705                              Heroux
                                                                    313 993-2547

                                                       Fall 2008
Saginaw Valley State University:
Hrs required: 172     Dates: 8/25-12/13/08
 Student       Preceptor Name          Shift              Unit Description                Management Contact
  Name                                                Preceptor contact number

Jennifer       Kim VanDeede            Days          4V 20 bed                         Director: Barbara Poindexter
Vigneron                        Medical/Surgical/Neurological             313 745-3116
                                                     313 7453034                            Clinical Manager:
                                                                                       Harjeet Singh: 313 7453595
  Jenny        Melissa Merlker         Days          ED – Level 1 Trauma               Executive Director: Monica
  Mars                        313 966-0705                                Marshall
                                                                                         Clinical Manager: Debra
                                                                                      Gallivan-Heroux 313 993-0024
                                                                                      Clinical Nurse Preceptor: Alita
                                                                                               313 745-7174

                                                     Winter 2008

Eastern Michigan University 475 1/7/08 – 4/21/08
100 hrs required   BSN Required
Student     Preceptor                Unit/                    Unit Description              Management Contact
 Name         Name                   Shift                Preceptor contact number

              Kim                    4U/V
           Vandeneede                Days
                                                         4U 18 bed                        Director Barbara Poindexter
                                                         Medical/Surgical/Neurological           313 745-3116
                                                         *Certified Stroke Center 313          Clinical Manager:
           Sharita Harris          4U/V                  745-3034                          Harjeet Singh: 313 745-
                            Afternoons/midnights         4V 20 bed Medical/Surgical                  33595
                                                         313 745-3082

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                                             Winter 2008

Oakland University NRS 473/485 1/8/08 – 4/15/08
170 hrs required BSN preferred Instructor Kelly Berishaj : 586 260-2862

 Student       Preceptor Name        Shift       Unit Description           Management Contact
  Name                                           Preceptor contact

  Briggs,       Leona Claxton      ED Days      Level One Trauma          Director: Monica Marshall
  Jamie                                        Emergency Department              313-745-3112
Neugebauer,     Melissa Merkler    ED Days        313 966-0705         Clinical Manger: Debra Gallivan-
 Christina                                                                          Heroux
                                                                                 313 993-2547

                                             Summer 2008

Davenport University: Additional DRH Preceptors
90 hrs required May 4-Aug. 2
 Student       Preceptor Name       Shift        Unit Description           Management Contact
  Name                                           Preceptor contact

              Melissa McKinney      Days       4U/V Med-surg (stroke    Director: Barbara Poindexter
                        center, neurology,             313 745-3116
                313 745-3034                          surgery)         Clinical Manager: Harjeet Singh
                                                                                313 745-3595

                                             Winter 2008

University of Detroit Mercy NUR 498 473 1/7/08 – 3/15/08
120 hrs required
 Student       Preceptor Name       Shift        Unit Description           Management Contact
  Name                                           Preceptor contact

Melanundra       Sonia Dallas      5R 7A-7P    12 bed Medical ICU          Director Annette Marsh
 Williams                                                  313 745-2880
                                                                              Clinical Manager:
                                                                         Vivian Henry: 313 745-3237

   Scott            Ron Tyra       ED Days      Level One Trauma          Director: Monica Marshall
 Brownlee                 Emergency Department              313-745-3112
  Maggie        Geraldine Yopp     ED Days        313 966-0705         Clinical Manger: Debra Gallivan-
  Butzu                                                       Heroux
  Sandra       Kristina Trupiano   ED Days                                       313 993-2547

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                             DRH STUDENT PLACEMENT BY UNIT
                                    Spring/Summer 2008
  UNIT   MONDAY             TUESDAY        WEDNESDAY            THURSDAY   FRIDAY     SAT      SUN
 4U, 4V                       WCCC            WCCC
                              4P-10P          4P-10P
                            3/10-5/5/08     3/10-5/5/08


                             DRH STUDENT PLACEMENT BY UNIT
                                       Winter 2008

     UNIT             MONDAY              TUESDAY       WEDNESDAY          THURSDAY          FRIDAY
                                                ACUTE CARE
      4U             WSU 3010             WSU 3020                          WSU 3010        WSU 3020
      4V              1/7-3/7/08           1/7-3/7/08                       1/7-3/7/08      1/7-3/7/08
                        7A-2P                7A-2P                            7A-2P           7A-2P
                     Kowalewski           Kowalewski                           TBD             TBD

                       WCCC                 WCCC
                       4P-10P               4P-10P
                     1/14-3/4/08          1/14-3/4/08
                     3/10-5/5/08          3/10-5/5/08
                                              CRITICAL CARE

                                              Winter 2008

University of Detroit Mercy NUR 498 473 1/7/08 – 3/15/08
120 hrs required
 Student        Preceptor         Shift          Unit Description            Management Contact
  Name            Name                       Preceptor contact number

                                 5R 7A-    12 bed Medical ICU                Director Annette Marsh
                                   7P                                             313 745-2880
                                                                                Clinical Manager:
                                                                           Vivian Henry: 313 745-3237

                                            Level One Trauma Emergency     Director: Monica Marshall
            Geraldine Yopp         ED               Department                   313-745-3112
            Days            313 966-0705             Clinical Manger: Debra
                                                                                 313 993-2547

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                                          Winter 2008
Saginaw Valley State University
Hours required:                      BSN required             Dates:
       Faculty Ava Lewis

  Student       Preceptor Name    Shift         Unit Description             Management Contact
   Name                                     Preceptor contact number

   SVSU         Kim Vandeneede    4U/V
        Days    4U 18 bed                              Director 4U/V:
   Beth                                   Medical/Surgical/Neurological        Barbara Poindexter
 Butterfield                              *Certified Stroke Center 313            313 745-3116
                                          745-3034                             Clinical Manager:
                                          4V 20 bed Medical/Surgical      Harjeet Singh: 313 745-33595
                                          313 745-3082

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SOE 8: Provide examples of how direct care nurses participate in recruitment and
retention activities.

        Recruitment and retention activities involve not only nursing management teams, but also
direct care nurses in order to strengthen the workforce and reduce nurse turnover at DRH. It is
imperative that direct care nurses partner with the DRH R&R Committee so they may speak to
others about the joy of their practice and encourage potential nurse candidates to become a part
of our health system.

DRH Recruitment/Retention Committee
        The DRH Recruitment and Retention (DRH R/R) committee was established as a
subcommittee of the DMC's R/R (DMC R/R) committee. Its purpose is to address trends in
recruitment, develop plans to promote retention and provide a venue for staff input into these
activities that consider the DRH culture and practice environment. The committee is facilitated
by two nursing directors, and a staff nurse chair, Floddie James RN, MSN. The DRH Nurse
Recruiter is a member of the committee and shares monthly updates on upcoming recruitment
and retention activities, including any job fairs scheduled. This committee tracks staff nurse
turnover and exit interview data across the system, they also identify trends in data and make
improvements to senior leadership. Members of the R&R Committee are responsible for
planning and implementing recruitment and retention activities. Some examples of how direct
care nurses participated in recruitment and retention activities for the year of 2008 are:
          Implementation of the Daisy Award Program at DRH and creation of the Daisy
           Award Nomination form
          Creation and design of the Daisy Award on DMC's Employee Intraweb
          Development and planning for the Implementation of "Tea for Senior Staff Nurses"
          Creation of Daisy Award & Magnet Display boards on all Nursing Units

        I became a member of the DRH R/R committee in 2008. One reason that I continue to
        work at DRH is because I enjoy working for my management team and I have a lot of
        autonomy over my practice. Also, my clinical manager Delphin encourages my
        professional development as a nurse. Nurses are the best recruiters of nurses and being
        a member of this committee has encouraged me to recruit and retain others on my unit. I
        motivated a recent graduate nurse on my unit, Theona Hindmon, to understand that
        persistence will pay off.

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       Diane Reed RN, BSN
       Staff Nurse 5U and member of DRH Recruitment and Retention Committee
       15 Years at DRH

The Daisy Award for Extraordinary Nurses
       DRH is proud to be a DAISY Award Hospital Partner. R&R chair Floddie James RN,
MSN of surgical units 4L/M/N/5P is the coordinator of this quarterly event. The Daisy Award is
a nationwide program that rewards and celebrates the extraordinary clinical skill and
compassionate care given by nurses everyday. Patients, visitors, physicians or employees may
nominate a deserving nurse by completing a nomination form and submitting it to the nominee's
manager by the 15th of every February, May, August & November. Every quarter, at DRH,
special honor and recognition is given to a staff RN. Recipients receive a Daisy Award
Certificate, Sculpture, pin and a special public ceremony which takes place on the unit of the
selected winner. Staff may view the actual presentation of the Daisy Award on the DMC
Intranet. (Attachment 4.8a, DRH Recruitment and Retention Committee 2008 Achievements, p.

Tea for Senior Staff Nurses
       This is an opportunity to recognize and listen to the concerns of senior staff direct care
nurses who have accrued many years of longevity at DRH. This idea was created by staff nurses
and the meetings occur quarterly with the CNO. In this meeting, nurses discuss team initiatives
to improve the work environment, staffing, and retention of senior staff. The goals of this direct
care nurse-driven initiative are to increase retention and nurse satisfaction among the senior
nurses at DRH. (Attachment 4.8a)

Breakfast with Tommye
       This is a special invitation to attend a one-hour casual breakfast in the DRH cafeteria
with the CNO Tommye Hinton of Patient Care Services. This initiative began in 2008 and the
focus of this breakfast is for the new hire graduate nurses to share their thoughts about
employment at DRH. This invite is exclusive to graduate nurses only who have successfully
passed their 120 day orientation period and will now enter the PE program. In addition, this is an
opportunity to congratulate and welcome the new graduate nurses who have passed their

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NCLEX exam and are now Registered Staff Nurses on their respective units. We have
successfully held three breakfasts, and staff nurses have enjoyed this opportunity (attachment
4.8b, Breakfast with Tommye invitation, p. 107).

Save a Valued Employee (S.A.V.E.)
       In an effort to reduce voluntary turnover at the hospital sites, members of the DMC
Recruitment and Retention Committee developed a subcommittee called S.A.V.E. This acronym
stands for “Save a Valued Employee”, and the goal of the subcommittee is to reduce staff nurse
turnover within the organization. S.A.V. E. team representatives can be contacted by other staff
nurses, preceptors, or members of nursing management if they are aware of a staff nurse who is
expressing dissatisfaction or having difficulties in his or her work environment. The S.A.V.E.
representative for the hospital has been deputized with the authority to identify the concerns of
the employee, and make whatever reasonable changes are necessary that will result in a more
positive work environment for that staff nurse and retain him or her within the organization.
Interventions by the S.A.V.E. team in the past have included changing an employee’s shift,
assigned unit, and DMC hospital site of employment.

       Here is one example of how one DRH nurse was retained through the efforts of the
S.A.V.E. team:
       A staff nurse hired into the burn unit at DRH whose previous nursing experience was
       working in long term care. She had a positive attitude and provided exceptional care to
       the patients, but was unsuccessful in passing the required online critical care examination
       necessary to continue working in the burn specialty area. This nurse was contacted by
       her nurse recruiter and DRH S.A.V.E. team representative Cheryl Bradley, Nurse
       Recruiter, to discuss other opportunities she might want to consider. Through
       communication with unit directors over the two areas, Ms. Bradley was able to retain this
       nurse at DRH by facilitating her transfer to the 4U medical-surgical unit. The nurse has
       been working on 4U since February of 2007, and is much happier in the fit of her new

Nursing Open House
       An example of a larger recruitment event planned with input from the entire DRH R&R
committee in April 2008 was the Nursing Employment Open House. The Open House was
arranged so that applicants could receive information about employment opportunities, view the

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facility, tour the unit(s) and discuss career opportunities, goals and objectives. The committee
handled all decisions made regarding the event, including mailer design and content, menu
planning, and location. Staff nurses and managers were present at the event to speak with
potential employees and conduct interviews. In addition, direct care nurses Sonya Dallas
RN,BSN Staff nurse preceptor 5R and Alita Pitogo, RN, Staff nurse preceptor for the ED, were
two of the staff nurses who interviewed potential nurse job candidates and provided unit tours
during the event (Attachment 4.8c, Nursing Open House Newspaper ad, p. 108 and attachment
4.8d Nursing Open House Flyer, p. 109)

Hospital Week and National Nurses Day
       In 2008, leadership decided to rename Nurses’ Week to Hospital Week in order to give
recognition to all disciplines during the same time once a year. However, May 6 is National
Nurses day and the events during this week have continued to be a huge success for DRH and
very appreciated by the nurses. (Attachment 4.8e, DMC Enews Announcement, p. 110)

       Corporate resources are utilized to ensure the week is filled with recognition,
appreciation, and fun for the entire hospital. One highlight of the Hospital Week festivities is an
8-hour corporate sponsored conference coordinated by the DMC nursing education division that
features a national speaker (attachment 4.8f, Nurses week conference attendees, p. 113). Staff
nurses rotate their attendance at this annual conference to be sure that every year all staff is
presented with an opportunity to participate. In addition, last year on May 5, 2008, the patient
care services division and the department of nurse recruitment sponsored a 2008 DMC Nursing
Excellence Luncheon (attachment 4.8g, Nursing Excellence Luncheon Flyer, p. 114).

       A DMC-level R&R committee task force subgroup is formed annually to support the site-
based planning and communication for Nurse and PCA Week. Task force members serve as the
panel that manages the annual selection of the DMC Nurses and PCAs of the Year. The selected
DRH Nurse of the Year winner for 2008 was 4U/ Clinical Transformation Specialist – Pamela
Haddox, RN BSN, and the DRH PCA of the Year was Liana Allen from a medical-surgical unit.
Nurse’s Week is kicked off with a corporate sponsored thank you luncheon for the DMC Nurse
of the Year winners, figure 4.8a. In preparation, nursing peers wrap gifts and prepare thank you

                                                                                             Page 104
                                                                       Detroit Receiving Hospital
                                                       Force 4: Personnel Policies and Procedures

cards, send out luncheon invitations, and help decorate the restaurant where the event is held.
The DMC Nursing Leadership Team and the DMC CNO, CEO and chief business officer extend
their personal thanks to the Nurses of the Year winners through their presence at this event. The
theme for this year’s luncheon was butterflies, which was selected to represent the clinical
transformation the organization has gone through over the past year during the implementation
of the electronic medical record and our journey toward recognition for nursing excellence.

       Figure 4.8a DMC Nurses of the Year; DRH Nurse of the Year Pam Haddox back row 4th
       from left.

                                                                                           Page 105
                                  DRH Recruitment and Retention Committee 2008 Achievements Attachment 4.8a

                                                                        R&R Committee                                                             2008 R&R
DRH Nurse Recruitment and                                   In a round table                   •      Review statistical        During the year of 2008, the R&R Committee implemented the
Retention Committee                                            setting:                               data related to the       •   Met with the Director of Transportation to improve the shuttle
                                                                                                      nursing retention             service
                                                            • R&R members
                                                                                                                                •   Developed strategies to improve safety for all staff members
                                                               discuss ideas and                      rate                          parking in the parking lots
                                                               strategies to retain            •      Create ways for           •   Implementation of the DAISY Award at DRH
                                                                                                                                •   Created the DAISY Award’s nomination form
                                                               staff nurses                           nurses to voice           •   Provided access to the Daisy Award on the DMC intraweb’s
                                                            • Develop and                             concerns/                     site
                                                                                                                                •   Met with the Associate VP of Nursing to implement a “Tea for
                                                               implement                              satisfaction in a             the Senior/Seasonal Nurses” in 2009
                                                               incentives that will                   positive manner           •   Plan to implement “Daisy Award & Magnet Boards” on all
                                                                                                                                    Nursing Unit’s/Pods
                                                               attract new nurses
                        fj 01/11/2009               1                                 fj 01/11/2009                         2                                        fj 01/11/2009                       3

                                                                        DAISY Award’s                                           2008 Daisy Award Winners
    DAISY Award Foundation                                              Nomination Form                                           “Extraordinary Nurses”
   Information regarding
    the DAISY Award’s
    foundation can be
    accessed on the DMC/
    DRH intraweb or
                                                               The DAISY Award nomination form can be
                                                                downloaded @, click on “Nursing”
   Selection of the DAISY                                      and “DAISY award”
    Award’s Extraordinary                                      Deadline for submitting the nomination form is the
    nurse is done quarterly                                     15th of February, May, August, & November
                            fj 01/11/2009               4                             01/11/2009                            5                         Ron Tyler, RN, ED, Kim Van Deede, RN, 4V &         6
                                                                                                                                                                  Sonja Dallas, RN 5R

             DAISY Award                                    “Tea for Senior Staff Nurses”                                         DAISY/ Magnet Boards

                                                            Purpose:                                                                                                          Purpose
                                                                                                                                                                              •  Provide updated
                                                             Listen to concerns
                                                                                                                                                                                 information re: the
                                                              of Nurses                                                                                                          DAISY Foundation
                                                             Allow nurses an                                                                                                 •  Provide information re:
                                                                                                                                                                                 our “Journey to
                                                              opportunity to be                                                                                                  Magnet Status”
   A special thanks to Ms. Tommy Arnold-Hinton,
    Associate VP of Nursing, Ms. Patricia Natale, CNO,        heard                                                                                                           •  Nurses will have an
    DMC and Mr. Jeff Dawkins, Chief Operating Officer,       Retention &                                                                                                        opportunity to display
    for their ongoing support for the DAISY Award at          Satisfaction                                                                                                       what he or she is
    DRH.                                                                                                                                                                         doing on the unit

                            01/11/2009                  7                             01/11/2009                            8                                        01/11/2009                          9

                                                                                                                                                                                                   Page 106
                                                     Breakfast With Tommye Attachment 4.8b

To: Angela Larry
    19954 Burgess Street
    Detroit Michigan, 48219

Dear Angela:

This is a special invitation to attend a “Breakfast with Tommye”.

We would like to congratulate all Graduate Nurses that have passed the NCLEX exam
and are Staff Nurses and all Staff Nurses that have been successfully added to the P.E.
Program at Detroit Receiving Hospital. This is an opportunity for you to meet with
Tommye Hinton-Arnold, Associate Vice President of Patient Care Services at DRH for a
one-hour casual breakfast, to share your thoughts and insight about employment at
Detroit Receiving Hospital.

The breakfast will be held at Detroit Receiving Hospital Cafeteria Conference Room on
December 17th from 7:30am – 8:30am.

If you are scheduled to work, we will advise your supervisor/managers of this invitation
in order to release you from work during that time so that you can participate and attend.

Please RSVP at 313-578-3033, El Wardlow or Monica Bryant. We look forward to
hearing from you.


Cheryl A. Bradley, Nursing Recruiter
Nursing Administration, 3rd Floor
313-966-0956 phone
313-745-3637 fax email address

                                                                                       Page 107
Nursing Open House Newspaper Ad Attachment 4.8c

                                      Page 108
Nursing Open House Flyer Attachment 4.8d

                               Page 109
           Message                                                                                               Page 1 of 6   Message                                                                                               Page 2 of 6

                                                                                                                                            Nurses Week 2008: Click Here for A Message from Mike Duggan
            Brown, Ken (DRH)
                                                                                                                                Scroll through this Special Edition of eNews to see the people, places and events for Nurses Week
             From:     Bond, Charmaine
             Sent:     Saturday, January 31, 2009 11:37 AM
             To:                                                                                                                          Nurse to Nurse- A Reflection
             Subject: FW: Special Edition Nurses Week 2008                                                                     Dear Mr. Duggan,
                                                                                                                                  I am writing this letter to share with you what I'm sure you already know, that the Detroit Medical Center
                                                                                                                               employs the brightest and best of the nursing profession.
           -----Original Message-----                                                                                             I was admitted into Harper University Hospital on March 22, 2007. On March 23rd I underwent emergency
           From: ENews                                                                                                         surgery. From the time that I entered in to the emergency room until discharge I was treated wonderfully.
           Sent: Monday, May 05, 2008 13:57                                                                                       I know that we have just celebrated nurse's week, but it goes without saying nurses are the unsung
                                                                                                                               heroes of Hospitals. I had the pleasure of having the most compassionate, respectful and professional
           To: ENews
                                                                                                                               nurses that I have ever met take care of me. The entire 6 ICU nursing staff was awesome.
           Subject: Special Edition Nurses Week 2008                                                                              I would especially like to mention Cynthia McGhee, Jillian Grant, and Darlene Herbert. During the period
                                                                                                                               after my surgery, they were very informative, attentive, knowledgeable and caring. It goes without saying
                                                                                                                               their presence made the difference during my stay. I would also like to thank Rob (The Swat Nurse), who
                                                                                                                               traveled with me to all of my procedures and, explained everything so thoroughly and held my hand thru the
                                                                                                                               rough parts.
                                                                                                                                  As you venture toward Magnet status, if these nurses are representative of your nursing force I doubt you
                                                                                                                               have nothing but success. --Sincerely, Angela Allen, RN, BSN, CCRN, TNCC, Critical Care Staff Nurse
                                                                                                                               Detroit Recieving Hospital

                                                                                                                               Congratulations to the 2008 DMC Nurses of the Year!
                                                                                                                               It is with great pride that the DMC announces the winners of the 2008 DMC Nurse of the Year awards.
                                                                                                                               Recipients of this award are selected by a DMC registered nurse peer review panel, and are recognized for
                                                                                                                               Staff Nurse clinical nursing excellence, and their overall valued contributions to the DMC and the
                                                                                                                               community. These individuals will be honored at a recognition lunch reception at Atlas Bistro on May 5th,
                                                                                                                               and at the DMC Nurses' Week conference at the Atheneum Hotel on May 8th.

                                                                                                                               The winners are:

           Monday, May 5, 2008

                     Celebrating National Nurses Week:
                               May 6- 12, 2008

                       Happy Nurses Week to Nurses Everywhere
             Monday, May 5, the Detroit Medical Center kicks of their celebration of National Nurses Week, which is
           nationally recognized May 6-12 of every year. In honor of the dedication, commitment, and tireless effort of
           the nearly 2.9 million registered nurses nationwide who promote and maintain the health of this nation, the
            Detroit Medical Center is proud to recognize registered nurses within our organization and throughout the
                                        country, for the quality care they provide every day.

           2/13/2009                                                                                                           2/13/2009

Page 110
                                                                                                                                                                                                                                                   DMC eNews Nurses Week Announcement Attachment 4.8e
           Message                                                                                            Page 3 of 6   Message                                                                   Page 4 of 6

                                                                                                                            DRH-Pain & the Addicted Patient In-service 1 p.m., 5P-19 (free CEU)
                                                                                                                            DMC-Nightingale Award Reception-Troy

                                                                                                                            Friday, May 9th
                                                                                                                            HUH/HWH-Hospital Nurse of the Year Reception 1:30 pm HUH Kresge Aud
                                                                                                                            SGH-Hospital Nurse of the Year Bar-B-Q Lunch Reception-courtyard
                                                                                                                            RIM-Nurse Nacho Social

                                                                                                                            Monday, May 12th
                                                                                                                            SGH- Florence Nightingale Birthday Cake Celebration 2 p.m. - 4 p.m.,
                                                                                                                            10 p.m. - 12 a.m.

                                                                                                                            All Week
                                                                                                                            DMC Nurses' Week portfolio & Glamour Shot gift certificate distribution
                                                                                                                            WDVD Nurse Thank You Radio Announcements from Mike Duggan, CEO
                                                                                                                            Show your badge/ID at any Cinnabon location for a free Cinnabon

                                                                                                                            The Faces of Nursing in and around the DMC

           Site-based events are planned throughout the week to celebrate Nurses Week. Request a full schedule from
           your Nursing Office, Nurses Week representative, or Supervisor so you don't miss out on an opportunity for
           fun or professional enrichment. Here are a few highlights for the week:

           Monday, May 5th
           DMC-Nursing Excellence Thank You Luncheon
           RIM-Cake and Punch Reception
           HVSH-Breakfast 7 a.m.-9 a.m.-Cafeteria, Body Shop pampering, Free Ice Cream Bars
           HUH/HWH-Ice Cream Bars 12 p.m.-3 p.m. Hospitality Suite #4
           SGH- DJ and Magician 2 p.m.-8 p.m. Surgical Lounge Courtyard

           Tuesday, May 6th
           DRH-Tube Feeding In-service 12 p.m., 5P-19 (free CEU)
           HVSH- WDVD Live broadcast 6:30 a.m.-10 a.m. North Orchard Entrance
           MIOSH-WDVD Live broadcast 11:30 a.m.-1:30 p.m.
           HUH/HWH-5 minute chair massages 3A Murphy Classroom 12 p.m.

           Wednesday, May 7th
           RIM-Giving Back to the Community Day (Crockett High School presentation on the profession of nursing)
           DRH-Satin Hands Nursing Hand Massages
           CHM-WOMC live broadcast 6 a.m.-10 a.m.-Cafeteria

           Thursday, May 8th
           DMC-Nurses' Week Conference-Creating a Positive Workplace-Atheneum Hotel (pre-registration required)
           CHM-Life Uniform sale 7 a.m.-5 p.m. Classroom 2 & 3

           2/13/2009                                                                                                        2/13/2009

Page 111
                                                                                                                                                                                                                    DMC eNews Nurses Week Announcement Attachment 4.8e
           Message                                                                                             Page 5 of 6   Message                                                                                                 Page 6 of 6

                                                                                                                             Education and Research:
                                                                                                                             Nancy Gibbs-DRH

                                                                                                                             Runner Up:
                                                                                                                             Advanced Practice Category:
                                                                                                                             Linda Schrettner Miller-HVSH

                                                                                                                             DMC Nominees:
                                                                                                                             Xiaojie An-RIM
                                                                                                                             Nancy Barnai-MIOSH
                                                                                                                             Sue-Ellen Bennett-DRH
                                                                                                                             Cheryl Casico-DRH
                                                                                                                             Patricia Dodge-HWH
                                                                                                                             Corrine Hamstra- HUH
                                                                                                                             Kathleen McLaughlin-HWH
                                                                                                                             Donna Pappas-DRH
                                                                                                                             Teodora Pontaoe-HUH
                                                                                                                             Vernessa Salkic-RIM
                                                                                                                             Sylvia Van der Koy Kempl-DRH

                                                                                                                             Hutzel Hospital RN Nominated for People's Choice Award
                                                                                                                             Congratulations to Delicia Shimkoski, RN, BSN, IBCLC, Coordinator Childbirth Education/Lactation
                                                                                                                             Consultant at Hutzel Women's Hospital for her nomination for the 2008 Oakland University School of
                                                                                                                             Nursing People's Choice Award. The People's Choice Award was established to acknowledge and thank an
                                                                                                                             "Everyday Nursing Hero" who has greatly impacted the life of a patient. Delicia will be invited to attend the
                                                                                                                             Nightingale award ceremony at the San Marino Club on May 8th, where the recipient of the award will be

                                                                                                                             Every DMC RN is an integral part of what makes us a healthcare organization of which we can be proud. It
                                                                                                                             is diversity, collaboration (whether your nursing contribution is at the patient bedside, providing leadership,
                                                                                                                             or educating others), and your commitment to giving the best to the patients and each other that make DMC
                                                                                                                             a great place to be.

                                                                                                                                     Thank you for your Caring, Commitment, and Compassion, and Happy Nurses Week!

           Congratulations to DMC Nightingale Award Nominees & Winners
           The Oakland University Nightingale Awards for Nursing were created to honor dedicated nurse
           professionals from throughout the state of Michigan. This is the 20th anniversary of the award celebration,
           whose nominees are selected through peer submissions, and winners are chosen by a designated
           colleague selection committee. This year the DMC is proud to congratulate 15 of our nurses as nominees for
           an award, resulting in 3 DMC Nightingale Award recipients and 1 runner-up, including an organizational
           sweep of the Staff Nurse Practice category. Over 700 healthcare professionals will be in attendance at the
           Nightingale reception celebration held on May 8th at the San Marino Club in Troy. Financial support
           obtained from event attendance will raise money for scholarships for Oakland University nursing students,
           as well as provide Oakland University with updated training equipment and technology resources for their
           nursing program.

           Award Winners:
           Staff Nurse Practice Category:
           Melissa Mayes-HVSH
           Mary Ellen Zajac-CHM

           2/13/2009                                                                                                         2/13/2009

Page 112
                                                                                                                                                                                                                                                   DMC eNews Nurses Week Announcement Attachment 4.8e
                                  Nurse's Week Conference Attendees Attachment 4.8f

                  2008 Nurses Week Conference Attendees
                  A Positive Workplace: It’s in Your Hands
                       Speaker: Jo Manion, RN, PhD
                                  47 Total

Gwendolyn Fields                       Myrna De Los Reyes
Gloria Garrett                         Esther Rogers
Christina Gravalese                    Jane Serra
Sandy Hagen                            Harjeet Singh
Tommye Hinton                          Janise Watkins
Leslie Johnson                         Jacqueline Williams
Elena Laboga                           Connie Tucker
Lolita Martin                          Sylvia VanderKooy
Robin Mazur
Nikenge Fowler
Debbie Gallivan-Herroux
Jennifer Gray
Pamela Haddox
Bettie Hines
Leslie Jackson
Gloria Jordan
Kris Klupenhouwer
Sharon Lowry
Patricia Natale
Taessa Malone-Carter
Randy Nixon
Donna Pappas
Scarlet Patrick
Camille Pavlak
Karen Pole-Klupenhouwer
Cedric Pugh
Patricia Randall
Kathleen Scherer
Althea Seaborn
Lisa Steinhilb
Estella Armstrong
Markyta Armstrong-Goldman
Anne Balarezo
Beverly Baul
Leticia Boulasan
Katherine Butler
Mae Butler
Sandi Caban
Mike Canete

                                                                          Page 113
                            Nursing Excellence Flyer Attachment 4.8g

NURSES: Making a Difference Every Day !

      The Patient Care Services Division

   and Department of Nurse Recruitment

  request the honor of your presence at the


              Monday, May 5 th

             From 12:00-2:00 PM


             Atlas Global Bistro

      3111 Woodward Ave, Detroit MI

            Northwest corner of

       Charlotte and Woodward Ave

    (2-3 Blocks South of Orchestra Place)

    Gated Parking available on Charlotte

                                                           Page 114