Nursing Annual Report 2024 | Sailing Towards Magnet Mastery

Exemplary Professional Practice
Exemplary Professional Practice

Exemplary Professional Practice Nursing Award: Elzbieta Kowalska, Medical Unit

Elzbieta Kowalska, Medical Unit

Whether she is in the role of charge nurse, break nurse, preceptor or direct care nurse, Ela is a model of patient-centered care. In her role as a Unit Partnership (UPC) chair, she has increased the membership of 2C's UPC from seven representatives to 12 to enhance diversity and inclusion. Ela is a big proponent of the Age Friendly designation as part of her advocacy for elderly patients.

See video of all nominees >

Professional Practice Model

Professional Practice Model

El Camino Health's nursing professional practice model (PPM) emphasizes the patient being at the center of all care. These are the other key components of the model:

Caring and Family — words chosen by our nurses that reflect their practice.

Excellence — refers to the goal to deliver the highest quality care to patients.

Community — represents the hospital's history as a community-built organization and its future — broadening delivery of care across the continuum.

Compassion — describes how our nurses deliver care.

Science and Innovation — reflect our legacy as the first hospital in the world to implement an Electronic Medical Record in 1971, and our culture of supporting nursing innovation through the Nursing Research Council.

Patient Care Team — captures the collaborative nature of care at El Camino Health.

Four key aspects of care enclose the labyrinth: Preventative, Restorative, Psychological-Spiritual, and Growth-Collaboration-Education.

Sustainability Council: Leading Change at El Camino Health

The Sustainability Council is a new, nurse-led, shared governance council at El Camino Health. Rooted in El Camino Health's values of innovation, stewardship, and interdisciplinary collaboration, this council is committed to fostering sustainable healthcare practices that advance the wellness of our patients, co-workers, community, and environment.

As nurses, advocating for sustainable practices aligns with our professional values and ethics, empowering us to lead by example in promoting environmental sustainability. Recognizing the necessity for a collaborative effort, the Sustainability Council is comprised of interdisciplinary membership, including representatives from multiple nursing units at both campuses as well as in-patient and out-patient, nutrition services, environmental services, supply and purchasing, respiratory services, information technologies, and marketing.

We aim to cultivate champions who will drive cultural change around sustainability within our organization. By empowering individuals to become advocates for environmental stewardship, we foster a collective commitment to creating a more sustainable future. We are already seeing this as the Sustainability Council reps have returned to their units and have started unit-based Green Teams on CCU, PCU, Labor and Delivery, and Endoscopy.

Acute Rehab Unit Photo Booth Celebrates Patient Successes

Acute Rehab Unit Photo Booth Celebrates Patient Successes

Patient with family member celebrating discharge from Acute Rehabilitation

When a patient is discharged from the Acute Rehabilitation Unit on the Los Gatos Campus-or “Bootcamp with Love” as the team calls it, it’s a major accomplishment. Discharge is an exciting moment that acknowledges the hard work and skilled care of the patient, family, and medial team. Currently, the Acute Rehabilitation Center has a “bell” that the patients ring to celebrate their departure. Whenever the bell is rung, any staff in the nearby area will clap and celebrate with the patient, regardless of whether they were on the patient’s medical team or not. Many patients and families also like to take pictures to commemorate the occasion.

To enhance the patient’s experience, the Acute Rehabilitation Center created a Discharge Photo Booth where patients, families and the medical team can take these commemorative photos. The booth was the summer project of a college intern, Cassie Chou, who secured grant funding from the El Camino Health Foundation and built the booth herself. Along with being a fun final activity, the Rehab Center team believes these photos further highlight the magnitude of the patient’s accomplishment. As part of the discharge process, not only does the patient use the “bell” to announce his/her departure from the rehab unit, but the next stop is also the photo booth for the patient’s family member to utilize their smart phone device to capture the image of the patient celebrating their milestone. The photo is kept as a fond memory and is typically shared by family members on social media. The photo booth has contributed to the success of the rehab unit achieving our likelihood to recommend a GOAL rate of 96.5% since the DC photo booth launched in August of 2023.

Pre-Admission Services Showcasing their Success

Pre-Admission Services Department (PAS)

PAS team members

The Pre-Admission Services Department (PAS) was established in April 2019. Currently, the team includes 10 RNs, 3 coordinators, the Peri-Anesthesia Manager, Assistant Clinical Manager and Director of Anesthesia. Pre op surgical and procedure patients were called by pre op nurses a few days before their procedure to gather health information. The hospital saw same day cancellations greater than 30-45 every month. The organization saw a need to better prepare patients for their patients and The Pre-Admission Services unit was created to medically optimize patients, reduce same-day cancellations, enhance recovery, and reduce surgical site infections.

Patients are contacted by coordinators to schedule a PAS call, where RNs gather patient’s health history, reconcile medications, and go over important pre- and post-operative instructions, including the Enhanced Recovery after Surgery (ERAS) program. Updates and changes in patient condition are documented in Epic. Any patient concerns are addressed with Charge nurses, management, and Anesthesia at daily huddles. Additionally, PAS RNs reach out to surgeons and patient’s medical team members (PCP, Cardiologists, Endocrinologists, and Pulmonologists etc.) to ensure medical optimization is achieved pre-operatively.

The PAS team strives to call all OR patients for both campuses and MV endoscopy, Willow Outpatient, and Cath Lab patients. Additionally, PAS RNs teach the weekly joint replacement classes on the Mountain View campus. In these classes, PAS RNs address how joint replacement patients can prepare for their surgery and what to expect at home. Education on pain management and recognition (and prevention) of common post-operative complications are also discussed.

Same day cancellations have reduced to 5-10 a month in the enterprise since the initiation of the program. Most of the current cancellations are due to skin issues that a phone call cannot fully assess.

The PAS Department is proud of the work they have done and showcased the department’s success at the 42nd Annual American Society of Perianesthesia Nurses conference in April 2023 and at the North Bay Health QI/EBP/Research Conference in October 2023.

Implementation of a Dynamic Nursing Workload Acuity System at El Camino Health

It is a regulatory requirement for hospitals to have a patient classification system, which is a rating of how much nursing care a patient requires. To meet this requirement, El Camino Health designed the NIM (Nursing Intensity Measurement) scoring system over 30 years ago.

The shortcomings of NIM included requiring manual entry of the score twice a shift, and the nurses often relied on their subjective opinion to determine the score rather than utilizing the objective criteria defined in the system. This commonly resulted in an entire unit of patients being rated with very similar acuity scores, which did not capture the true nursing workload of the individual patients.

The Direct Care Informatics Council, comprised of nurses and IT analysts, evaluated, and approved the implementation of the automated nursing workload acuity system embedded within Epic, our electronic health record. The team spent 6 months customizing the system and validating over 180 rules related to documentation including orders, assessments, medications, and wounds to accurately reflect the unique nature of individual patient workload. This was followed by a phased role out over 2 months, completed in May 2023.

This new nursing workload acuity system provides an objective method to capture accurate nursing workload acuity scores by utilizing patient data recorded in Epic.  This provides a valuable tool for charge nurses to create balanced patient assignments for experienced nurses as well as provide appropriate assignments to new graduate nurses to support their learning without overwhelming them. The added benefit of automated entry rather than manual entry saved 1,256,000 clicks per year, the equivalent of saving 349 nursing hours per year.

Mother Baby Unit: Sunshine Committee

The Sunshine Committee was organized to help boost staff morale, teamwork and to foster camaraderie across the department. The Sunshine Committee promotes the Magnet Component of Exemplary Professional Practice to ensure the quality of care provided and safety of patients remains top priority. Committee leadership roles rotate among general members. Notably all members enthusiastically contribute to organizing and promoting social events and employee well-being programs.

Since the beginning of the committee there have been a wide variety of activities and events. The implementation of the New Hire Wall of Fame was a big hit with staff and a great way to learn about new team members. The Summer BBQ for staff and family as well as the Spring Fling Dinner and Dance were two main events that were overwhelmingly positive. Since the inception of the Sunshine committee, the department Patient Perception of Nurse Communication scores have improved, currently placing them in the 92nd percentile. Spending time together both inside and outside of work has been a positive experience.

Los Gatos ICU Unit Partnership Council (UPC) Giving Tree

Los Gatos ICU Unit Partnership Council (UPC) Giving Tree

After the stress of the pandemic and higher-than-ever patient acuity in Los Gatos, the UPC in the ICU felt that morale was low and needed a boost. The council decided to create their "Adopt-a-Family Holiday Tree" for the second year in a row. Partnering with the Bill Wilson Center, which serves children, young adults, and families in Santa Clara County, the LGICU UPC team chose families to “adopt” for the holiday season. While specific details are withheld, they were given information on age, gender, and items from the individual family member's wish list. For example, “Mom/aged 35 wants bed-in-a-box," "Brother/aged 15 wants tennis shoes, sized 10," or "Sister/aged 6 months, needs diapers and wipes." The items were separated, attached to ornaments, and decorated on the felt tree in the LGICU breakroom. The staff could select an ornament with item descriptions to purchase for the family members. The feedback was profoundly positive. The staff enjoyed purchasing the specific items for their "adopted" family member. Aligning with El Camino Health’s practice model of community involvement, this activity gave back to those in need in Santa Clara County and served to boost spirits and morale among staff during the holidays.

2B Embracing a New Workflow

Pre-Op/Short Stay affectionately known as 2B has gone through some changes and the team has risen to the occasion.

Pre-Op/Short Stay

Pre-Op/Short Stay team members

The unit is now technically three units in one, pre op, phase two recovery for surgical patients and the procedure area for Cath Lab and interventional radiology patients.

Until a couple of years ago, the unit did not recover post-intervention patients. These patients were sent to inpatient telemetry unit to recover and then discharged the next day.

With the creation of a procedure only side, separating the procedure patients from surgical patients, as well as initiation of telemetry and addition of telemetry competent nurses, the unit is now able to care for and discharge a wide variety of patients who would otherwise have taken up an inpatient bed. Last fiscal year, over 205 patients were safely discharged, this represents 44.4% of the elective cases. None of whom returned to the emergency room with complications.

On the surgery side, patients who would otherwise have been admitted to the hospital are more likely to go home the same day due to new technologies utilized in surgery. The volume of patients discharged the same day has increased, once again freeing up inpatient beds. In 2023, the team safely discharged 1,369 patients.

In October 2023, the team presented their successful partnership with the Norma Melchor Heart and Vascular Institute (HVI) on the accomplishment of same day discharges at the American College of Cardiology.

Members of the team are excited to share this work in a poster presentation at the upcoming Magnet Conference in October 2024 in New Orleans.