It is my pleasure to present the 2016 Northwest Community Healthcare Nursing Annual Report. With more than 1,200 nurses, all of them committed to transform patient care through exemplary professional practice — believe in making a difference every day in the lives of our patients and their families.
Throughout the past year, we’ve seen countless examples of NCH employees making a difference in the lives of others — within our walls and beyond. From enhancing our clinical care team model thru innovative work in care coordination for the complex patient across the care continuum, from saving lives to preparing parents to care for their newborns — our nurses are continually reaching new heights in patient-centered care.
As a Magnet designated organization, Northwest Community Healthcare is infused with a culture that brings out the best in our staff and offers the highest quality care for our patients and their families. Our work is driven by our commitment to lifelong learning, improving practice, collaborative decision making, patient and staff safety, and the delivery of patient- and family-centered care. We have worked hard to create a supportive, professional practice environment so that the nurses, and the entire NCH team can do what is best — provide exceptional patient care.
Thank you for being part of this community of dedicated caregivers. Together, we are undoubtedly making a significant difference in the lives of others.
Kimberly A. Nagy, R.N., MSN, NEA-BC
Executive Vice President, Patient Services
Chief Nursing Officer
We would like to extend our deepest appreciation to our nurses for the special way they deliver compassionate high quality care to our community. The care they provide allows Northwest Community Healthcare (NCH) to be an organization that makes a difference to the families we serve.
The commitment and dedication to the patient experience is exemplified by being recognized as a Magnet Organization for three consecutive periods.
This achievement can only be accomplished through clinical excellence and passion. This is critical in NCH’s mission “to improve the health of the communities we serve and to meet individuals healthcare needs.”
President and CEO
Partnership with Linden Oaks has brought active change and growth for the nurses in Behavioral Health (BH). 2016 saw the opening of a 20-bed Generations program unit, a residential addictions treatment program, and an intake department. The additions led to the onboarding of over 100 new employees to support the new care areas.
The staff recognized the need to develop two new roles on the care team: lead nurse and lead case manager. Also recognized was the need for integrated behavioral health care plans, which were built into the EMR to support care across the BH continuum. To further support quality across departments, specialty policies and procedures for each area were reviewed and updated. One key area of quality improvement focused on the reduction of restraint use. The restraint audit process was optimized, and enhanced restraint training was provided for all staff. As a result, the departments demonstrated a 78 percent decrease in restraint use from the previous year.
Nurses in Health Information Management led changes to support clinical documentation improvement. The nurses’ understanding and experience in care provision is essential in chart review to ensure accuracy in documenting care and diagnostic-related groups. Huron software was implemented in 2016; the program ensures that provided care is captured in the electronic medical record. The nurses participated in six weeks of classroom and hands-on education prior to roll out of the program.
The team sends out “Weekly Tips to Physicians/Providers” to support accurate documentation. Nurses monitor various metrics to demonstrate their department’s performance. The department exceeded six of seven goals for FY2016. Goals include case mix index, query rate, physician response rate, physician agree rate, and patient record review. Results for the fiscal year included 39 percent query rate (goal 30-40 percent), 94.5 percent physician response rate (goal >80 percent), and 90.8 percent patient records review (goal >80 percent).
NCH’s professional practice received significant support in 2016 as a result of the NCH Foundation’s 19th Annual Golf Classic. Golfers and sponsors donated more than $441,000 for nursing development. In 2016, over $100,000 of additional donations were directed to support nursing development. NCH is committed to advancing the knowledge of its more than 1,000 nurses to provide the highest value in areas of quality, safety and cost to those we serve.
Proceeds from the golf classic help NCH provide opportunities for nurses to pursue additional education, achieve specialized nursing certification and participate in research studies. The funds also offset costs of nurses attending and presenting at national and international conferences on innovation, safety and best practices.
In June 2016, members of the Clinical Nurse Leadership Council (CNLC) were provided contact hours as Helen Poole, M.P.H., B.S.N., of the Gobel Group presented Nurses' Role in Philanthropy.
The presentation provided insight to the relationship between gratitude and giving and focused on the important role of nurses in fostering philanthropic growth.
Dave Ungurean, VP Corporate Fundraising, and Kathleen Grummel, Director of Development, spoke about their roles at NCH and their experiences working at the Foundation. Information was provided for members to assist patients who express desire to support nursing through outreach to the NCH Foundation. They provided an instructional handout for members to disseminate to their respective staffs on how to notify Foundation staff of a grateful patient in the EMR. Handouts “Help Us Thank Patients and Families Who Support NCH” and “A Nurse’s Role Partnering in Philanthropy” also were provided.
NCH nurses participate in philanthropy through giving. The CNLC in collaboration with the Patient Care Leadership Council (PCLC) supports semi-annual drives. Members of the councils facilitate departmental giving to benefit local organizations. In 2016, NCH’s Emergency Department and the Arlington Heights Senior Center were supported.
Nurses also support philanthropy through their professional organizations. One example is NCH’s Day Surgery Center (DSC). Nurses Lorena Manalansan, B.S.N., CAPA; Sue Nolan, B.S.N., CAPA; Gina Jablenski, R.N., CAPA; and Cheryl Ioakimidis, B.S.N., served on the planning committee for the Illinois Society of Perianesthesia Nurses’ (ILSPAN) annual Spring Conference.
In addition to providing education for perianesthesia nurses, ILSPAN sponsors a charitable organization each year. The 2016 planning committee selected the local Women in Need Growing Stronger (WINGS) as the recipient. Fifteen NCH nurses attended the event and the DSC donated gift baskets to raffle. Over $500 was contributed to WINGS. Additionally, participants donated a large number of toys, non-perishable food, books and household items.
Recognizing opportunity for improvement in care team collaboration, the Cardiac Renal department developed “The A-Team” concept. Based on results of their 2015 National Database of Nursing Quality Indicators (NDNQI) Nurse Satisfaction Survey, all department staff attended team building sessions in April. Communication was a primary focus to impact teamwork positively, and staff identified their goal to increase collaboration and role clarity.
Nurses and patient care technicians/unit secretaries from each shift were selected by staff to represent the department. Those individuals met to brainstorm and identify key values and behaviors representative of high performing teams. The group also reviewed job descriptions for each role to support understanding and standardization of roles. The A-Team Agreement was created and presented at a unit meeting in June, outlining expected values and behaviors. All staff signed the agreement demonstrating commitment to the unit and team.
The group’s work included integrating a team huddle on each shift. The brief huddle gathers the entire team to discuss patients who potentially could require extra care, identify staff needing support for high acuity patients, and review the staffing plan for the shift.
Staff feedback has been positive. The unit’s goal is to ensure safe, reliable, high quality care for their patients as evidenced by improved patient satisfaction survey results. Nursing satisfaction survey results will demonstrate improved RN-to-RN collaboration. The team has seen initial improvement in their patient satisfaction and nursing satisfaction survey results and continues their work to drive improved outcomes.
The annual Nursing Awards at NCH are based on the American Nurses Association Standards of Professional Nursing Practice and presented during Nurses’ Week celebrations. Awardees were honored at a ceremony followed by a reception.
Nurses were nominated by peers for recognition as exemplifying one of the 10 standards. Additional awards recognize the APN/Educator of the Year, Manager of the Year, and Nurse of the Year. Nominations highlight numerous examples of exceptional nursing practice and leadership. Congratulations to these exemplary nurses!
The NCH DAISY Award program recognizes nurses who demonstrate exemplary clinical skills and offer compassionate care to patients. Nominations are submitted by patients and their families. Nominations may also be submitted by nursing colleagues and other disciplines to recognize nurses who demonstrate extraordinary collaboration and teamwork.
Each month typically has 80 – 100 nominations submitted. These are blinded and sent to the Professional Nursing Recognition Council which votes to select one nominee to be honored as that month’s NCH DAISY Nurse.
NCH has partnered with the DAISY Foundation to offer these awards since 2011. Each honoree receives a DAISY Award pin and hand-carved statue titled A Healer’s Touch. The DAISY honoree and all DAISY nominees are posted on nch.org and on the DAISY page of the NCH intranet. They also are highlighted on flyers in the Oasis cafeteria. The honoree’s unit displays the DAISY Award banner announcing the recognition.
Learn more about the NCH DAISY Award program.
2016 saw the Medical Pulmonary Unit roll out Preference Aligned Communication and Treatment (PACT); a three-year project aimed at changing the culture around advanced care planning during hospitalization. PACT is a state wide initiative aimed at ensuring the patient receives care aligned with their personal healthcare goals and wishes. This is accomplished through patient screening and ongoing conversations with patients that have chronic diseases and their families. These conversations support nurses in communicating patient care preferences; the information is shared with healthcare teams across all levels of care.
A team of PACT champions was created, including clinical nurses, nurse educators, chaplains, and Clinical Care Coordinators (C3s). The Information Technology department supported the project and built the PACT Trigger Tool into the admission navigator in the EMR.
On average, 30 percent of the unit’s patient population triggers positive, indicating follow up with a PACT conversation. Since implementation, the unit has demonstrated 96 percent performance in documenting the patient’s goals and wishes learned through the PACT conversation. The PACT initiative has heightened nurses’ and physicians’ awareness of the importance of end-of-life care planning and the value effective communication contributes to care across the continuum. The initiative has enhanced nurse - physician communication and collaboration, and the unit has improved their overall patient satisfaction scores. PACT has expanded to the Oncology Unit with plans to expand the program to other units.
Day Surgery Center nurses developed a surgical services pediatrics task force in November, 2015. This interdisciplinary team implemented several initiatives in early 2016 to benefit pediatric patients and their families. A preoperative pediatric tour is offered now for patients four years and older. This service has helped decrease patient anxiety on the day of their procedure.
Pediatric patients also are provided an opportunity to create drawings which are posted as art on a highly visible wall in the unit. Additionally, in September they began providing iPads to patients while in the preoperative area; children are able to play games to fill their pre-procedure time. Success of their work is evidenced by improved outcomes for ‘Nurses courtesy toward family’ in the department’s patient satisfaction surveys.
In addition to patient satisfaction, patient safety is a key priority for the team which undertook an initiative related to pediatric post-operative medication orders. Nurses on the interdisciplinary team partnered with anesthesiologists, pharmacy and the EMR Orders team to integrate tightened guidelines for titration of pediatric sedative and pain medications within the EMR. Guidelines were disseminated for integration into practice in other departments providing pediatric patient care.
Led by Lisa Consolazio, B.S.N., R.N., CHPN, the Inpatient Oncology Unit focused on decreasing the incidence of Central Line Associated Blood Stream Infections (CLABSI). Their patients not only have a higher percentage of central lines than most other inpatient units, but often are immunocompromised, placing this vulnerable population at a greater risk for potential infection. The unit’s CLABSI prevention focused on daily central line rounding and compliance with chlorhexidine (CHG) bathing.
The daily line rounds include a physical inspection of the integrity of each central line dressing, the presence of the CHG disc over the line site, the presence of alcohol impregnated caps on all IV ports and documentation of the CHG bath. Immediately following rounds, real time feedback is provided to RNs and Patient Care Techs, further reinforcing the rationale and benefits for compliance with this evidence-based protocol.
To further augment daily rounding, additional components of Consolazio’s Clinical Resource Nurse IV (CRN) project included targeted education to reinforce the principles and rationale for meticulous central line care and CHG bathing, and enhanced staff awareness of unit performance data. CLABSI incidence and CHG compliance data is posted monthly on the unit’s Service Excellence Board and the data is sent to all nurses via email, with recognition for the improved outcome.
Their data reflects a 75 percent decrease in CLABSIs in 2016, with only one occurrence (compared to four CLABSIs in 2015). Daily CHG bathing rates demonstrate 92.8 percent compliance as compared with a 65.5 percent rate in 2015.
Nurses from Women’s and Infants’ Services focused on quality improvement in 2016, implementing a project focused on improving patient satisfaction. In August, unit champions piloted integration of teachback methodology in combination with a post-partum roadmap tool. Teachback provides seamless, individualized, patient-centric education and promotes collaborative dialogue between nurses and patients. Improved patient satisfaction was demonstrated by an increase in the unit’s scores for the indicator “Instructions for care at home.” Following implementation the unit achieved a score of 92.5 percent, meeting their goal of one to two percent improvement and outperforming the national benchmark. The unit’s goal for 2017 is top quartile performance for this indicator.
The nursing team also developed a program supporting alignment with the American Academy of Pediatrics’ gold standard target for exclusive breastfeeding during the first six months of life. In March, the unit implemented “Quiet Time” each day, a part of “Gentle Transitions” initiatives. The unit had previously implemented other Gentle Transitions initiatives, skin-to-skin and timed initial bathing of newborns after birth. These initiatives provide bonding times for the new family and integrated best practices to support development of mother-baby dyads. Evidence supports these practices to improve bonding, newborn physiologic stability, and improved breastfeeding rates. Following the addition of quiet time, the unit demonstrated a 10 percent increase in exclusive breastfeeding at three months post-implementation.
To disseminate their outcomes, the nurses submitted abstracts which were accepted for presentation at the 2017 March of Dimes Annual Perinatal Nursing Conference. Posters related to the unit’s work include Teachback and Roadmap: Bridging the Gap to Discharge and The Impact of the Gentle Transition Initiatives on Exclusive Breastfeeding Rates.
Next steps include re-evaluation of the teachback/road map process and Gentle Transitions initiatives to ensure continued improvement with the goal to achieve top quartile performance.
Consideration of clinical efficiency and care coordination resulted in a nurse-led initiative to develop clinical pathways for post-operative care of complex surgical patients on the Post-Surgical Unit. The pathway integrates evidence-based practice to enhance efficiencies, decreasing length of stay (LOS) for this patient population. The pathways outline detailed plans for expected patient outcomes, promoting optimal recovery. A key aspect of the initiative standardized patient hand-off to ensure patient goals for the day aligned with their pathway.
Following an extensive review of the literature, nurses recognized opportunity to decrease LOS, and developed the interprofessional Pancreas and Colon Post-Surgical Care Optimization Council. Nurse-led, the team created post-surgical pathways addressing activity progression, post-surgical diet and pain management. Interventions included an innovative approach: gum chewing. Interdisciplinary rounds were implemented; discussion included plan of care, quality measures, LOS, and discharge plans. The team’s goal was to decrease LOS for these complex patients to the Medicare standard of 10.5 days. The team anticipated a related increase in patient satisfaction scores.
Pre-data LOS for this patient population was 16.5 days. Improvement was realized quickly in the quarter subsequent to the initiative with LOS decreased to 13.79 days. Year-end data reflects 11.19 days, a decrease of 32 percent from baseline.
Mimi Malesky, B.S.N., R.N., CNML; Sandy Heyboer, M.S.N., R.N.-BC, and Kathleen Didier, R.N.-BC, were selected for a podium presentation at the 2017 National Magnet Conference to disseminate the unit’s exceptional work and outcomes. The conference hosts over 9,500 nurses worldwide.
See Our Patient Experience Reports
2016 Nurse Satisfaction Results
Julia Knight, M.S.N., APN, ACNS-BC; Cindy Ruiz, M.S.N., APN-CNS, CCRN, Silos to Superstars, Successful Advancement of the Clinical Practice Innovations Council (CPIC). National Association of Clinical Nurse Specialists, Atlanta, GA
Diane Ryzner, M.S.N., APN-CNS, OCNS-C, Transition to Practice. APN Boot Camp – Illinois Society for Advanced Practice Nursing, Olivet Nazarene University (April); Northern Illinois University (April); Loyola University (November)
Cindy Ruiz, M.S.N., APN-CNS, CCRN, Do you know the Quality of Your CPR? National Association of Clinical Nurse Specialists, Atlanta, GA
Cindy Ruiz, M.S.N., APN-CNS, CCRN, Do you know the Quality of Your CPR? American Association of Critical Care Nurses National Teaching Institute, Houston, TX
Cindy Ruiz, M.S.N., APN-CNS, CCRN, Quality Improvement Using CPR Feedback Tools. In-Hospital Cardiac Arrest Outcomes Symposium, Durham, NC
Cindy Ruiz, M.S.N., APN-CNS, CCRN Mock Codes: Building a Championship Team! In-Hospital Cardiac Arrest Outcomes Symposium, Durham, NC
Josephine Smudde, M.S.N., OCN; Karen Ottaviano, B.S.N., OCN; Catherine Johnson, B.S.N., Nurse Led Multiprofessional Team to Improve Adherence to Treatment for Patients with Head and Neck Cancer Receiving Radiation in a Community Hospital. American Society for Radiation Oncology (ASTRO) Head and Neck Cancer Symposium, Scottsdale AZ
Carrie Burkhart, M.S.N., CEN, Workplace Violence: De-escalation Strategies. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Leslie Collins, M.S.N., APN, CCRN-CSC, CCNS, Cardiac Surgery First 24: Preoperative and Intraoperative Management. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Leslie Collins, M.S.N., APN, CCRN-CSC, CCNS, Cardiac Surgery First 24: CABG Surgery. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Leslie Collins, M.S.N., APN, CCRN-CSC, CCNS, Cardiac Surgery First 24: Valve Surgery. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Leslie Collins, M.S.N., APN, CCRN-CSC, CCNS, Cardiac Surgery First 24: Ascending Aortic Dissection and RV Tear. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Leslie Collins, M.S.N., APN, CCRN-CSC, CCNS, Transitional Care: Cardiac Surgery in the 21st Century. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Karen Kotz, Ph.D., APN, with Tell, D., Mathews, H. & Witek Janusek, L. Social Support Buffers The Effect of Maternal Childhood Adversity on Neonatal Outcomes. 30th Annual Loyola University Chicago Ruth K. Palmer Research Symposium, Building Opportunities: Using Data Science to Improve Population Health Outcomes, Chicago, IL
Karen Kotz, Ph.D., APN, with Tell, D., Mathews, H., & Witek Janusek, L. Childhood Adversity Influences Depressive Risk and Elevated TNF Alpha During Pregnancy, Impacting Birth Outcomes. Southern Wisconsin Association of Neonatal Nurses (SWANN) 3rd Annual Conference, Creating a Culture of Compassion, Waukesha, WI
Karen Kotz, Ph.D., APN, with Tell, D., Mathews, H., & Witek Janusek, L. Impact of Maternal Childhood Adversity on the Psycho-Neuroendocrine-Inflammatory Profile During A Normal Low-Risk Pregnancy. Southern Wisconsin Association of Neonatal Nurses (SWANN) 3rd Annual Conference, Creating a Culture of Compassion, Waukesha, WI
Karen Kotz, Ph.D., APN, with Tell, D., Mathews, H., & Witek Janusek, L. Social Support Buffers the Impact of Maternal Childhood Adversity on Neonatal Outcomes. Midwest Nursing Research Society 40th Annual Research Conference: 40 Years of Advancing Nursing Science, Improving Practice and Enhancing Health Outcomes, Milwaukee, WI
Connie Mattera, M.S., R.N., Cardiac arrest management. Cobleskill EMS Conference, New York, NY
Connie Mattera, M.S., R.N., Pediatric Trauma More than Band-aids and Backboards. Cobleskill EMS Conference, New York, NY
Connie Mattera, M.S., R.N., EMS Changes & Challenges. Wisconsin State EMS Conference, Milwaukee, WI
Connie Mattera, M.S., R.N., Lesson Planning. Wisconsin State EMS Conference, Milwaukee, WI
Connie Mattera, M.S., R.N., What’s Hot & Not in Trauma. Wisconsin State EMS Conference, Milwaukee, WI
Connie Mattera, M.S., R.N., What’s Hot & Not in Trauma. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Connie Mattera, M.S., R.N., Fluids & Electrolytes. American Association of Critical Care Nurses Midwest Conference, Itasca, IL
Connie Mattera, M.S., R.N., Traumatic Brain Injury. Greater Buffalo EMS Conference. Buffalo, NY
Connie Mattera, M.S., R.N., Oral Maxillofacial trauma. Greater Buffalo EMS Conference. Buffalo, NY
Connie Mattera, M.S., R.N., Musculoskeletal trauma. Greater Buffalo EMS Conference. Buffalo, NY
Connie Mattera, M.S., R.N., Diabetes. Colorado State EMS Conference, Keystone, CO
Connie Mattera, M.S., R.N., OB Complications. Colorado State EMS Conference, Keystone, CO
Connie Mattera, M.S., R.N., Heart Failure. Colorado State EMS Conference, Keystone, CO
Cindy Ruiz, M.S.N., APN-CNS, CCRN, “Patient on the precipice. Can he survive aortic dissection?” (2017). American Nurse Today, 12(1), p. 24.
Kimberly Nagy, MSN, RN, NEA-BC, Chief Nursing Officer
Claudia Ronayne, MSN, RN, Executive Director Professional Practice – Clinical Care Transformation & Integration
Vicky Goeddeke, MS, BSN, RN, NEA-BC, Nursing Excellence Manager
Sandra Heyboer, MSN, RN-BC
Diane Ryzner, MSN, APN-CNS, OCNS-C