The mission and vision of Sparrow Nursing directly reflects and supports the strategic priorities of the hospital. Sparrow's vision is to be recognized as a national leader in quality and patient experience. Our nursing mission—to provide high-quality nursing care utilizing the Transformational Model of Professional Practice—enables Sparrow to be successful in both mission and vision.
Sparrow's Chief Nurising Officer and Vice President of Nursing participate in establishing the hospital's strategic objectives that strongly support the hospital's Mission and Vision.
A strategic plan for nursing was developed utilizing the five pillars of People, Service, Quality, Resources and Growth. Nurses at every level had input and impact on outcomes through our shared decision-making model of Nursing Councils and Committees. This aggressive plan was implemented in the first quarter of 2011.
In March 2011, the Nurse Coordinating Council—comprised of front-line nurses from various units, Vice President of Nursing Carol Dwyer, and Chief Nursing Officer Elizabeth Henry—came together with the Manager and Director nurse mentors from each Nursing Council. The Nurse Coordinating Council determined the focus of work of each Nursing Council in support of the Strategic Plan for the coming year. Each council selected specific goals to guide them throughout 2011. The 2012 State of Nursing Annual Meeting highlighted and celebrated the accomplishments of the Nursing Council and those goals accomplished by individual units. A sampling of their accomplishments follows:
Unit Goals Accomplished
- Implementation of Joint Camp
- Development and initiation of a Pediatric Family Advisory Council
- Pediatric Palliative Care Team and Home Hospice
- Organizational achievement of 7 of 10 HCAHPS Domains at or above Goal
- Support professional nursing certification
- Direct care nurses 13.9% (2010) " 20.7% (2011)
- 25 nurses attended conferences supported by the Sue Tadgerson Education fund:
- AONE Annual Meeting
- AACN Progressive Care Pathways Conference
- Critical Care Nursing Conference (NTI)
- Michigan Society of Gastroenterology Nurses and Associates Regional Conference
- Pediatric Critical Care Conference
- Survivorship Issues in Cancer Care
- ANCC Conference
- Facilitated the use of the Critical Thinking Toolkit
- Back to School Education Open House—promoting Higher Education
- Supported plan for early mobility of all patients in the Critical Care and Surgical Specialties Unit to improve outcomes and decrease length of stay
- Collaborated with pharmacy to improve the timing of antibiotics, improving the workflow for nurses in the care of patients
- Evaluated the SBAR Handoff Tool utilization to insure safe hand-offs
- Evaluated the Suicide and Self-Harm Policy (Administrative Policy) to help protect our patients
- Approved the implementation of the IM SAFE falls scale for pediatric patients to improve patient safety
- Supported the 7 Foster team in TCAB initiatives with supplies at the bedside, decreasing the number of steps an RN takes by 2.9 miles per 12 hour shift
- Supported the 7 Foster TCAB initiative to create the Admission Buddy System, decreasing by 30 minutes on average
- Supported the implementation of the MEWS tool (Modified Early Warning System) on Med Surg and Stepdown Units
- Supported Evidence-Based Practice in the following:
- IV policy: Adult and Pediatric TKO rates
- Daily weight and lab record
- Patient consent
- Refined the Nursing Excellence Award criteria
- Developed a communication process for best practices within the Quality Council matter expert presentations
- Implemented thank you cards—recognizing units for their quality work
- Expanded Quality Council representation
- Participated in a Journal Club
- March 17, 2011, Greater Lansing Community Research Day hosted by Sparrow
- Evidence Based Fellows explored exciting projects:
- Kim Harr, RN, and Erin Darnell, BSN, RN, "Does alternative and complementary therapy reduce anxiety and increase comfort when incorporated into the treatment plan for pediatric patients?"
- Bethann Conn, BSN, RN, and Kelli Isrealson Brown, MSN, RN, "Designing a tool and resource for nurses to use on how to deal with difficult families"
- Oct. 21, 2011, Second Annual Nursing Research Symposium, with visiting Professor Dr. Kathleen Bobay from Marquette University
- Deb Schutte, PhD, RN, from MSU College of Nursing began working as our Nursing Research Consultant in September
- Eleven research proposals presented to the council for discussion and approval
Center for Care Innovation and Transformation
Transforming Care at the Bedside (TCAB) is a national initiative sponsored by the Robert Wood Johnson Foundation (RWJF) whose goal is to address quality of care on medical surgical units. The program is designed to engage leaders at all levels of the organization while focusing on the work of one unit. American Organization of Nurse Executives (AONE) received a grant to work with RWJF "Aligning Forces for Quality" project in changing TCAB to the Center for Care Innovation and Transformation (CCIT). In fall 2011, Sparrow's Medical Intermediate Care Unit joined the AONE collaborative for CCIT. The project addressed these focus areas:
- Improve the quality and safety of patient care on medical surgical units
- Increase the vitality and retention of nurses
- Engage and improve patient's and family member's experience of care
- Improve the effectiveness of the entire care team
- Identify leadership development for the future
- Design the patient care delivery model for the future
- Create healthful practice environments that recruit and retain a robust workforce
CCIT serves as a laboratory to create the skill set needed for all of us to be the designers of new care delivery models. The Medical Intermediate Care Unit learned new tools to identify innovation among the team. They brainstormed 459 different ideas to improve their unit design and workflow. Initiatives the team developed through the PDCA model include:
- Supplies at the bedside: Decreased the steps required to care for a patient by 2.9 miles per caregiver per day, or 18,890 miles a year! This mileage would equal travel to Charleston, S.C. and back.
- Fall Bundle: This initiative pushed the easy button for supplies to be in one package for a patient who is high risk for a fall. Pre-bundle compliance with total fall bundle was less than 60 percent on high risk fall patients. Post-bundle compliance with fall bundle was 98 percent after supplies were consolidated.
- Admission Buddy:Created a process that two caregivers admit a patient. Each caregiver has assigned tasks to complete. This initiative decreased admission time for a patient from 65 minutes on average to 40 minutes per admission.
- Portable X-Ray Project: Defined criteria of patients who warrant portable chest x-rays. Decreased the number of portable x-rays on 7Foster from 11 per week to 4.5 times per week.
- Team Boards: Developed pet and family boards to better know our peers.
Advocacy and Influence
Several of our Nursing Leaders participated in the Michigan Organization of Nurse Executive's Advocacy Day. These Nurses were able to interact with our state legislators and discuss with them issues related to nursing in Michigan. After their day at the Capitol the information learned and tactics developed were shared at the Nurse Leadership Council.
Chief Nursing Office Elizabeth Henry, and Vice President of Nursing Carol Dwyer, have ensured that nursing interests are represented in the development of Sparrow's
iSparrow Electronic Medical Record project. The selection of a Clinical Director over the iSparrow project was strongly influenced through the advocacy of Ms. Henry and Ms. Dwyer through the selection of a nurse to fill this important leadership position.
Ms. Henry participated on the Michigan Statewide Task Force for Nursing Practice to define and transform nursing practice in Michigan through 2011. The work of this group was completed and their recommendations forwarded to the Governor of Michigan in early 2012. This work, if adopted by the Legislature, will allow nurses to practice to the full extent of their education and competencies. Staff nurses participated in forums to voice and influence change that will shape nursing practice for years to come.
Ms. Dwyer completed her 2nd term on AONE's Strategic Planning Committee. On this national team, she advocated for nursing to be an integral voice in healthcare reform.
Ms. Dwyer serves as a mentor to the frontline RN Caregivers on the Coordinating Council, meeting with them monthly to guide, encourage, and inspire. Ms. Dwyer developed our RN-to-BSN program white paper and advocated for our Professional Advancement System, which was established in July 2011.
As our senior leaders in Nursing, Ms. Dwyer and Ms. Henry represent and advocate for Nursing as members of Board Quality, President's Advisory Council, Quality Pillar and Service Pillar.
Visibility, Accessibility and Communication
Nurse leader rounding at Sparrow is not limited to interacting daily with patients. Nurse leaders round on each of their Caregivers in a formal way at least four times per year. This interaction allows the nurse leader to provide one-to-one coaching and mentoring for each caregiver. In addition, nurse managers have open door policies that make it easy to access them throughout the shift. Service line directors are also visible on their units while rounding on patients, interacting with staff, and holding "meet and greets" or open forums.
Chief Nursing Officer Elizabeth Henry and Vice President of Nursing Carol Dwyer each make weekly rounds on the units. During these rounds they reward and recognize staff, validate that processes are implemented, share priorities, and answer questions. In addition, Ms. Henry holds monthly open forums that are open for any Caregiver to attend.
Increased Participation in the NDNQI RN Survey
Participation in the NDNQI RN Survey has increased every year with 82 percent participation at Sparrow Hospital and 91 percent participation at St. Lawrence. Nursing Practice Environment is defined as the organizational characteristics of a work setting that facilitate or constrain professional nursing practice. The Practice Environment consists of the following subscales: Nurse Participation in Hospital Affairs, Nursing Foundations for Quality Care, Nurse Manager Ability, Leadership & Support of Nurses, Staffing and Resource Adequacy, and Collegial Nurse Physician Relations. Both campuses scored fairly close to the benchmarks with Sparrow Hospital ranging within .01 to .19 from the mean and five variables less than the benchmark. St. Lawrence scored within .01 to .08 of the mean with three variables less than the benchmark for All Hospital Mean.
Patient Care Services NDNQI Patient Practice