October 21, 2014

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By Lori Armstrong

As a nursing community, our thoughts are with both Nina Pham and Amber Vinson, the two nurses in Dallas who contracted Ebola after caring for a patient who died from this disease after returning from Liberia. These two new cases are the first confirmed transmissions of Ebola in the United States.

Nurses play such a critical role in the care of every patient. The treatment provided in situations such as these highlights the amazing work of nurses and the inseparable link between outstanding nursing care and patient care outcomes.

Ebola is a serious illness, and as a nurse myself, I understand and share the concerns that nurses and health care providers across the country have about Ebola. Texas Children’s is committed to providing the very best care to patients with suspected or confirmed Ebola while ensuring the safety of our caregivers. Nursing leaders are partnering with Infection Control and our physician colleagues to ensure the best protocols and procedures are in place, and I am confident that Texas Children’s Hospital is prepared.

Since suspected Ebola patients will be cared for by the nurses and physicians in the Emergency Centers, Pediatric ICUs, the Women’s Assessment Center, and in the Labor and Delivery Unit, it is unlikely that many of you will come in contact with an Ebola patient at the hospital. However, for those who may care for these patients, extensive training is being provided. We are so thankful to our dedicated colleagues in these areas for their participation in all the training and preparation that is ongoing.

We will support and protect our health care team

While caring for our patients remains our focus at Texas Children’s, we are also intensely focused on protecting our physicians, nurses and staff. Keeping each one of you safe as you care for these patients means that we will provide you with state-of-the-art personal protective equipment (PPE), extensive training and education in the use of PPE, and ongoing communication.

Personal protective equipment such as impervious jumpsuits or gowns, gloves, eye protection, facemasks and shoe covers are readily available and frontline employees are being trained on the proper use of this isolation equipment. We will use PPE practice drills as well as simulation to ensure competency of all employees who will be providing direct care to these patients.

Education and communication is of utmost importance, and we are doing everything possible to stay up to date with the latest information and share it with those who will be directly responsible for these patients’ care. As new information becomes available, leaders will work to quickly understand any new recommendations, make changes and communicate those changes to you.

Our preparedness has been tested

As mentioned, designated teams are in place and I am confident we are taking the right precautions to be prepared should an Ebola patient arrive at Texas Children’s. Two weeks ago when a patient who returned from Sierra Leone presented at our West Camus Emergency Center with a fever, the patient was immediately isolated and subsequently transferred to the PICU. The appropriate teams were notified and protocols were followed.

Our staff was ready and performed flawlessly. They were careful, deliberate and efficient, and the right care was provided. The patient was discharged several days later after a negative Ebola test. The entire leadership team and I are so proud of the way this team provided expert care and executed all of the appropriate protocols while supporting the patient, patient’s family and each other.

This is reassurance that we are well prepared to care for patients with Ebola.

We will keep you thoroughly informed

As professional nurses, I encourage all of you to stay up to date on the latest Ebola information we are sharing regarding our response and readiness.

Please check Connect regularly. You can also visit the external Connect news site at www.texaschildrensnews.org anytime. We also will continue posting information here on our Voice of Nursing blog. And as always, your nursing leaders and I are here to support each and every one of you and answer any questions you may have about our preparations.

The voice of nursing is especially critical during our preparation and planning for patients with Ebola. Therefore, your input, suggestions, questions and feedback are welcomed and appreciated. You will continue to play a vital role in the coming days, weeks and months.

I am honored to work among such compassionate, dedicated nurses. I have never been prouder of our team for taking such great measures to care for patients who need us most. You inspire me to be a better nurse and a better leader.

October 14, 2014

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They say everything’s bigger in Texas and we definitely represented our state well at the national nursing Magnet® conference in Dallas last week. More than 7,000 nurses and nursing executives from top hospitals came to celebrate Magnet Recognition® and gathered to share evidence-based practices. Amongst them were a group of 52 Texas Children’s nurses and nurse leaders. It was an honor to represent the incredible nursing team at Texas Children’s and a truly inspirational experience.

This year’s conference was my third and I had the great pleasure of presenting along with my colleague Jackie Ward, RN Asst. Vice President of Nursing. Our presentation, “A framework for leadership development and succession planning” was amongst four podium presentations and three poster presentations by nurses and leaders from Texas Children’s. This was our chance to shine and present to the other hospitals what our nursing team has been doing to improve outcomes and reach for excellence in nursing care. It was amazing to see so many hospitals that are striving for nursing excellence in one place. There were nurses from all over the world focused on improving outcomes and achieving Magnet® status. We also had a specific pediatric session where all the pediatric hospitals came together to discuss how to achieve positive outcomes within pediatric subspecialties.

During the conference, talk of Ebola was rampant, as Dallas is the site for treating an Ebola patient. I toured Children’s Medical Center Dallas Hospital, and was asked screening questions related to international travel. During the conference, we discussed our plans for Ebola screening, and Texas Children’s is right in line with other hospitals in preparations.

The theme of this year’s conference, “think big, go magnet,” went hand-in-hand with our state’s larger than life mentality. It was an opportunity to share great ideas and be inspired to do big things to improve patient care through nursing. We were especially proud to represent Texas Children’s as our own neonatologist and star of TLC’s The Little Couple, Dr. Jennifer Arnold kicked off the conference as the keynote speaker. Dr. Arnold gave an inspirational talk highlighting the strong partnerships between nursing and physicians in planning and coordinating patient care.

It wasn’t all business at this conference. One of my favorite moments of the trip was a pizza night for Texas Children’s nursing staff where we got to kick back, relax and have some fun getting to know the other nurses better. After a week away from the hospital, I am happy and excited to bring back everything I learned to share with the rest of my team and really put best practices to use here. The Magnet® conference is a chance to be reminded of how important of a role you play in the patients’ lives. You walk away proud to be a nurse, inspired to do great things, and pumped about the Magnet program®.

October 7, 2014

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“I’m ecstatic to introduce to you our Voice of Nursing blog,” said Lori Armstrong, chief nursing officer.

As the largest segment of the Texas Children’s workforce, the nurses are the heart and soul of this organization. You are at the bedside of the children and women who trust their care to us. You truly make a difference in the outcomes of our patients.

Through the reinvention of nursing, we have taken many steps toward helping our nursing staff be the strongest it can be. At 2,500 strong, I truly believe we are the best we’ve ever been. You now have access to better education, you have more colleagues to help with the incredible patient volumes, and your nurse leaders are now closer to the unit to help meet your needs. Our nurses are more qualified than ever to care for the increasingly complex cases we see each day.

Together, we do tremendous work here, and this blog is a place for Nursing to shine. It’s a tool to: communicate about new, successful approaches to patient care; share advice about things that have made a difference in your career; or tell us about a patient who has changed the way you care for others. The Voice of Nursing is a place for you to share your stories. These stories may give you ideas for implementing successful practices in your own units, or they may just help you get through a rough day at work. This is your space to inspire other nurses and share our successes with colleagues across the organization.

I hope you find this blog informative and inspirational, but more than anything, I hope it starts an open conversation between all of us. You will hear from me, and I hope to hear from you.

So let’s get started!

Jump to areas of interest. On the right-hand side, you will find the strategic areas the blog will address. You can use these tabs to go back to stories that may interest you and read what your colleagues have shared in the past.

Connect and comment. Below each post you’ll find room to comment. I encourage you to leave your thoughts after each blog that inspires you. I encourage open feedback that’s also courteous and respectful.

Make sure to write to me as well.

Subscribe. There is a button on the column to the right of the page which gives you the option to subscribe. When you subscribe, you’ll receive the new blog posts in your email inbox once a week. I highly encourage it!

I’m so excited about the Voice of Nursing. This is our space for your voice – let’s start the conversation.

September 30, 2014

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“Today was a banner day at Texas Children’s,” said Chief Quality Officer Dr. Angelo Giardino. “We have figured something out.”

Giardino, who attended the debrief of a two-day nursing care delivery summit, said he was hopeful for what the future of nursing at Texas Children’s has in store. The two-day summit brought together more than 60 frontline nurses, nursing leaders, representatives from human resources and leaders from across the organization. The frontline staff made a huge impact on the summit by bringing their ideas from the bedside to the leaders and investing in the re-design. The intent of gathering this particular group was to generate ideas, share concerns and form suggestions about the way nursing care is delivered by our 2,500 nurses.

“We felt the support of our leadership and other disciplines,” said Clinical Specialist Joellan Mullen. “They recognized the importance of the role of the nurse in patient care and quality outcomes.”

The strategy was to form groups that would then visit an area of the hospital unfamiliar to them. The groups each captured a day in the life of a nurse in order to determine the best strategy to improve the role of the nurses in that unit. By identifying challenges, they were able to understand what stands in the way of delivering the best possible care. Challenges included the need for better collaboration between the physicians and nurses during rounds, cluttered work spaces, a lack of standardization in pods, struggles with translation services, juggling the many duties of a nurse and role confusion.

“What I need from each of you is to be patient and hopeful,” said Chief Nursing Officer Lori Armstrong who listened to all of the reports.

It was a chance for not only Armstrong, but other leaders, including representatives from Human Resource,s to hear the needs of this dynamic group of employees at Texas Children’s and how their work can greatly impact patient outcomes. The three main overarching goals that were determined as a result of the summit are:

  1. Bring the RN closer to the bedside
  2. Ensure that the right discipline has the right responsibilities
  3. Ensure that there are no gaps in supplies, equipment or services needed to deliver care

“The Summit reinforced Texas Children’s commitment to empower the nursing staff to advocate for safe care for ALL patients by focusing on the right task done at the right time, by the right person,” said Patient Care Manager Tina Babb. “The Summit showed that Texas Children’s is committed to the future of nursing, health care, and our patients.”

As a result of the summit, an executive summary has been developed, a governance structure has been established with an executive steering committee, project steering team and work teams. The committee will begin meeting this fall and teams will kick off their work in January.

“What we learned from the summit was what action needs to be taken immediately to help our nurses deliver the best possible care to every patient,” Armstrong said.

September 3, 2014

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10 West Tower, the epilepsy monitoring unit, recently celebrated 365 days without a hospital acquired pressure ulcer and kept achieving their goals making it now to 445 days without one. It was a team effort which helped improve patient care and outcomes for those who are receiving EEG or electroencephalography monitoring.

Top six ways EMU reached 445 without a HAPU:

  • Process and Practice modifications were implemented with the EMU patients, the techs received skills competency training
  • EMU nurses perform a skin assessment prior to the techs placing the EEG leads on every EMU patient and after the leads are removed
  • The patient is prepped with a less abrasive solution and the patient head is no longer wrapped
  • Use of disposable leads
  • Collodion TM-soaked gauze is applied to the top of the lead over the skin and dried in place.
  • Gel electrodes are utilized for the cheeks due to the sensitivity of this area.

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Nurses perform skin assessments twice a shift during prolonged EEG monitoring and at the completion of the study, which include tests for blanching and checking skin integrity. If there is an abnormal finding in the skin assessment, the physician is notified to consider removal of leads, and a referral to a wound care specialist is made.

August 19, 2014
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Dr. Milton Finegold (right), chief emeritus, Department of Texas Children’s Pathology, congratulates Finegold Award recipients Cherish Sullivan (from left), daughter of Yovaletta Sullivan, Labor and Delivery; Kayla Evans, daughter of Danyalle Evans, Nursing Float Pool; and Paolo De Jesus, son of Ruby De Jesus, 10 WT/Neurology/Neurosurgery/Epilepsy Monitoring Unit.

Finegold established the scholarship in 1985 in memory of his wife, Joan, a nurse, to help the children of Texas Children’s registered nurses fulfill their educational goals. The applicant (registered nurse) must be an employee of Texas Children’s for a minimum of two years on or before May 1 of the year of application.

July 15, 2014

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With the national and local demand for Acute Care Pediatric Nurse Practitioners, Texas Children’s and Texas Tech University have entered into a partnership agreement that supports faculty roles for APRNs, Priscila Reid MS, RN, FNP, CPNP-AC and Julie Kuzin, MSN RN CPNP-PC/AC. Students will enter the program this fall and will benefit from the expertise of these two APRNs that are dedicated to patients and families at Texas Children’s through advancing nursing education and training.

AC-PNPs practice in a variety of settings not only in the hospital’s intensive care and subspecialty units, they extend their practice to the community in caring for the technology dependent child and the chronically ill child with special needs. Historically, the hospital has relied on an abundance of residents to staff the 24/7 units. The shortage of residents and the mandate to reduce resident work hours from the Accreditation Council for Graduate Medical Education (ACGME) has led many hospitals to rely on acute care nurse practitioner to provide quality patient care. With the shift in the model of using more acute care PNPs, the need for education and training has increased.

The partnership between Texas Tech University Health Science Center and Texas Children’s Hospital allows for Reid and Kuzin to have a paid faculty position with the university while still spending half of their time in the patient care setting at the hospital. We believe that this partnership will strengthen the recruitment of AC-PNPs at Texas Children’s.

“We are positioning Texas Children’s to step into the 21st Century to make a difference in patient outcomes by ‘advancing nursing practice through advanced practice nursing,” said Elizabeth “Charley” Elliott, director of advanced practice providers.
The courses will officially begin in the fall.