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Diane Thorgrimson, MHSA Executive Director, Patient Services Administration Kathy Chavanu, MSN, RN

NACHRI: CPSP User Meeting June 26, 2009 Alexandria, VA CPSP Webinar: Utilizing Benchmark Data – July 28, 2009. Diane Thorgrimson, MHSA Executive Director, Patient Services Administration Kathy Chavanu, MSN, RN Vice President, Quality Improvement and Clinical Support Services.

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Diane Thorgrimson, MHSA Executive Director, Patient Services Administration Kathy Chavanu, MSN, RN

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  1. NACHRI: CPSP User MeetingJune 26, 2009Alexandria, VACPSP Webinar: Utilizing Benchmark Data – July 28, 2009 Diane Thorgrimson, MHSA Executive Director, Patient Services Administration Kathy Chavanu, MSN, RN Vice President, Quality Improvement and Clinical Support Services

  2. CHILDREN’S NATIONAL MEDICAL CENTER • 283 Bed Acute Care Pediatric Academic Medical Center with over 34 Subspecialties • Employees • ~5000 Staff • ~450 Physicians • ~1300 Nurses • 14,700 Annual Admissions • 83,000+ Annual Emergency/Urgent Care Visits • 300,000+ Annual Ambulatory Visits • 50% Medicaid population

  3. 2001/2002 RN Vac Rate 28% IP RN Vac Rate 35% Turnover Rate 23% Ratio of CNMC to Contract RN 67:33 bb RN Workforce Environment

  4. RN RESTRUCTURE STEERING COMMITTEE • Address Compensation Issue • Provide Professional Development • Tuition Assistance • Certification • Continuing Education • Quality of Work Life • Flexible Schedules • Weekend Option • Senior Nurse Incentives

  5. Recruitment 100 day recruitment campaign “The Magic of Children’s is You” Internship Program Fellowship Program Professional Development Academic Partnerships Scholarship Program Child Care Technician Program Hired 2nd nurse recruiter Contracted with high profile recruiters Budget HPPD Replacement/Non-productive time Skill Mix Staffing and Scheduling Strategies Employed

  6. 2001/2002 RN Vac Rate 28% IP RN Vac Rate 35% Turnover Rate 23% Ratio of CNMC to Contract RN 67:33 2003 - Present RN Vac Rate < 10% IP RN Vac Rate < 5% Turnover Rate <11% Ratio of CNMC to Contract Contract RN 95:5 RN Workforce Environment

  7. RN Workforce Outcomes NSI, 2009: National range: 6.1 to 23.2%

  8. RN Workforce Outcomes NSI, 2009: National turnover rate = 21%

  9. RN Workforce Outcomes NSI, 2008: Contract RNs used in Children’s Hospitals w/less than 300 beds: 22 to 134 (CNMC = 21.4)

  10. NACHRI: CPSP Data

  11. NICU Outcomes

  12. NACHRI: CPSP Data

  13. NACHRI: CPSP Data

  14. A Strong Nursing Workforce is an Essential Component in Hardwiring Quality and Safety into Practice and Building the Business Case for Nursing.

  15. NurseStaffing and Quality Outcomes Outcomes The Aiken Study: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction • Clear links between: • staffing levels and patient success • staffing levels and burnout, job dissatisfaction & nurse retention Linda H. Aiken, PhD, RN; Sean P. Clarke, PhD, RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD, RN; Jeffrey H. Silber, MD, PhD, Journal of the American Medical Association, Vol. 288, No. 16, October 23-30, 2002.

  16. NurseStaffing and Quality Outcomes Outcomes Nurse Staffing and Quality of Patient Care, Agency for Healthcare Research and Quality, US DHHS, AHRQ Publication No. 07-E005, March 2007. • A review of 94 studies demonstrated consistent evidence that improved nurse – patient ratios was associated with reductions in: • hospital-related mortality; • failure to rescue; and • other hospital acquired conditions.

  17. Laying the Foundation for Nursing Quality • Strong Workforce • Recruitment and Retention • Professional Development and Advancement • Certified Workforce • Clinical Preceptorship/Mentorship • Nurse Leadership Development • Shared Nursing Leadership • Professional Practice Model • Scientific Knowledge and Evidence Based Practice to Impact the Outcomes of Care • Nursing Quality and Safety program

  18. Recognizing the Value of Nursing Outcomes “Nursing care and outcomes must be integrated yet distinguishable from other disciplines. In order for CNMC to break-through in Nursing and impact the overall quality outcomes of patient care, Nursing must define its outcomes and impact within the multidisciplinary team.” N. Robinson, VP of Patient Services/CNO

  19. Nursing Outcomes

  20. NACHRI: CPSP Data

  21. NACHRI: CPSP Data

  22. REDUCING CODES OUTSIDE THE ICU • HKU reduced codes and unplanned returns to the ICU by 88%: • Implemented a Rapid Response Team • Advanced EKG training for nursing • Implemented an early recognition and response assessment tool

  23. NACHRI: CPSP Data

  24. EFFICIENCY OF TIMELY DISCHARGES • Reduced length of stay on the Surgical Care unit by 11% with increased volume and case mix • Implementation of discharge appointment times • Afternoon discharge rounds on all units

  25. Division of Nursing: Quality Outcomes ‘ • IV Infiltrates increasing • Resources allocated by CNO • Implemented a RN driven IV Team • Reduction in PIV by 50% (Q1)

  26. Business Case for a Strong Nursing Workforce: ROI • Demonstrated Improved Outcomes related to Nursing Care • National Best Practice for RN Recruitment & Retention • Regional Employer of Choice for Pediatric Nursing • Managed overall escalating resources related to workforce • Created the Foundation for a Sustainable Culture of Nursing Excellence at CNMC

  27. Acknowledgements • Ned Zechman, President and CEO • Nellie Robinson, MS, RN • Debra Derickson, MSN, RN • Linda Talley, MS, RN • Jesus Cepero, MSN, MPA, RN • Tara Taylor, MPH, RN • Simmy Randhawa, MS, RN • Debbie Freiburg, MS, RN • Sharon Bostic, BSN, RN • Mary Daymont, MSN, RN • Lisbeth Fahey, MSN, RN • Jo Talley, MSN, RN

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