Partnership Forged in Shared Mission
To Optimize Patient Care, Advance the Practice of Nursing

University of Maryland Nursing

Cynthia Fox, BSN, RN, is shown here teaching a group of second-semester juniors from the nursing school for their clinical rotation in adult health.

Nursing excellence is vital – for patients, of course, and for nurses. It is with this guiding principle that a new partnership has grown from the shared mission of the University of Maryland Medical Center (UMMC) and the University of Maryland School of Nursing (SON)

The partnership, called University of Maryland Nursing, has been created with a vision to optimize patient outcomes by enhancing nursing practice.

Here are some ways it will benefit nurses at the hospital and faculty and students in the school:

• University of Maryland Nursing will give nurses at UMMC more opportunities and support to pursue their personal and professional goals. They will be able to maintain their clinical careers as well as teach, pursue an advanced degree or conduct research.
  
  
• Faculty at the School of Nursing and nurses at the Medical Center will be able to collaborate on research studies that are of great interest to nurses and that will translate evidence into practice at the bedside and education in the classroom.
  
  
• School of Nursing students will receive more clinical instruction from practicing UMMC nurses who have expertise in subspecialties such as trauma, neurocare, oncology, intensive care and infectious disease.

“Nurses want to grow professionally and develop in their career and education, and we want to help them to do that seamlessly,” says Lisa Rowen, DNSc, RN, vice president for patient care services and chief nursing officer for UMMC.

“They can diversify their jobs and education, all within this medical center and our world-class nursing school,” Rowen says. “We have a fabulous nursing school right across the street. I know, because I’m an alumna of that school.”

“Most schools of nursing have partnerships with their affiliated medical centers,” says Allan. “University of Maryland Nursing is at another level, and of greater magnitude.”

“Most schools of nursing have partnerships with their affiliated medical centers, but this new initiative is different,” says Janet D. Allan, PhD, RN, CS, FAAN, dean of the University of Maryland School of Nursing.

“University of Maryland Nursing is at another level, and of a greater magnitude. It really addresses our joint mission and our vision for optimizing patient outcomes.”

“The school is really delighted that Lisa Rowen, although she has been the CNO at UMMC for a very short time, has already brought her exciting vision not just to nursing at the Medical Center, but also to the School of Nursing through this partnership,” says Allan.

Rowen says the idea for a stronger partnership grew from the first conversation she had with Allan earlier this spring, during Rowen’s interview before she was even hired as the chief nursing officer. Allan was asked to participate in the search process for a new CNO, and their earliest conversation naturally turned to partnership. With both of them so passionate about the need, the time was right to make it happen.

Rowen is excited about the opportunities for growth that the partnership will provide for nurses at UMMC.

“With University of Maryland Nursing, a nurse can have one foot in the Medical Center and the other foot in the School of Nursing, and not have to leave our campus in order to continue to develop in our profession,” Rowen says.While many nurses at UMMC have done this in the past, she says, there has not been a formal structure to support and encourage them.

“This is something very new, and a very different way of life,” Rowen says. “We’ve never had a program like this that is jointly promoted and supported by both the Medical Center and the School of Nursing.

“Nursing is a demanding career, and we want people to have opportunities to pursue whatever appeals to them, at different stages in their lives,” Rowen says.

“Before, many nurses managed to find ways to integrate clinical practice, education, research or consulting,” Rowen says. “But what we are doing now is making these opportunities available to all nurses, and encouraging them in a way that will create a culture that advances nursing practice.”

For example, staff nurses who have an idea for research can be paired with a faculty member at the School of Nursing who has research expertise. In the past, not all nurses may have had a place to take an idea to study and analyze.

UMMC nurses will have more opportunity for pursuing a bachelor’s or advanced degree, although they will still have to apply and be accepted at the SON on their own merits. Once accepted, however, the nurses qualify for a tuition benefit of up to $10,000 a year for graduate-level tuition, and up to $6,000 for undergraduate- level tuition – twice the rate at which the Medical Center reimbursed tuition in the past. Also new this year: these tuition benefits will be paid up front, as a nurse registers for the courses, rather than by reimbursing nurses at the end of the year.

The new partnership includes a council of members from both UMMC and the SON and is organized into four main areas of nursing: clinical practice, education, research and consultation services to other health care professionals. (See box, below)

The collaborative efforts began with the Medical Center providing about 20 of its nurses by next semester to serve as clinical instructors for the SON while continuing their roles for the Medical Center. Each clinical instructor is responsible for a group of students for an entire clinical rotation.

For example, Cynthia Fox, BSN, RN, and Rita Herzog, MS, RN, CNRN, two nurses who are senior partners in the Medical Center’s Neurocare/Surgery unit, are team-teaching a group of second-semester juniors from the nursing school for their clinical rotation in adult health.

Herzog has extensive teaching experience, but for Fox, this opportunity has been her first position as an instructor. She has been at the Medical Center for 25 years. Having the chance to teach – while she is completing work for her own master’s degree at the School of Nursing – has made her work more exciting, she says.

“I enjoy the diversity of my roles,” Fox says. “I staff the unit and have senior partner duties, and I have students two days a week. It’s stimulating for me to be able to do all of the things I do.”

Allan says the increase in instructional staff through UMMC nurses who will be clinical instructors will enhance the education of the students, but may not be enough to increase the enrollment for the school or make a large dent in the nursing shortage.

In Maryland alone, the state is expected to be short 10,000 nurses unless aggressive action reverses the trend. Nursing schools in Maryland had to turn down or wait-list close to 2,000 qualified applicants in 2006 because of the shortage of faculty, Allan says. Nationwide, 40,000 qualified students could not enter nursing schools because of the shortage.

“The largest challenge in recruiting and retaining faculty has to do with resources – there aren’t enough nurses, and not enough money to pay faculty on par with what they could earn as practicing nurses,” Allan says.

“Most practicing nurses who would have the qualifications to teach can make at least $30,000 more than we would be able to pay them,” Allan says.

By opening the door to a Medical Center nurse to teach one class or clinical group at the SON without having to give up his or her job and salary, the partnership can help to address the faculty shortage. Ultimately, however, Allan says, a much bigger influx of money will be the only way to solve the problems behind the shortage of both nurses and faculty.

A Key to Nurse Retention and Recruitment

Rowen believes this partnership will allow the Medical Center to attract and retain more nurses because it allows them to diversify their jobs and careers within the profession.

“Nursing is a demanding career, and we want people to have opportunities to pursue whatever appeals to them, at different stages in their lives,” Rowen says. “We know that, nationwide, new graduates are also at risk for leaving the profession, so we want to do a better job of preparing and keeping them engaged.”

In their new partnership, the Medical Center and the University of Maryland School of Nursing will focus on four areas:

From Bench to Bedside

Scientists and Clinicians Join Forces to Battle Pain

The nurses who deliver chemotherapy to patients at the University of Maryland Medical Center’s Stoler Pavilion see it often: Some of the drugs that kill cancer cells can cause a side effect known as peripheral neuropathy (pain or numbness) in the hands and feet. It can start as pins and needles, but get bad enough to seriously affect a patient’s quality of life or even halt the therapy. The pain often goes away after the therapy stops, but not always.

Two nurses are leading a team investigating whether exercise or other factors might play roles in reducing this type of neuropathy. Their research partnership is part of a larger one between the Medical Center and the University of Maryland School of Nursing.

Susan G. Dorsey, PhD, RN, assistant professor and co-director of the School of Nursing’s Developing Center of Excellence in Disorders of Neuroregulatory Function, has dedicated her career to the study of pain. She is working at the basic science level in a laboratory.

Dorsey has joined with Nancy Gambill, MS, CRNP, manager of ambulatory nursing for the UM Marlene & Stewart Greenebaum Cancer Center, as co-principal investigators of this study. They and their respective teams are designing a project they hope will lead to more ways to treat and reduce peripheral neuropathy associated with chemotherapy.

“We’re all very excited about it, especially if we can come up with some sort of solution for these patients,” says Todd Milliron, RN, lead ambulatory interventional nurse in the infusion clinic, and one of Gambill’s staff working on this study. “We’ve had patients who are involved in clinical trials, but for us to be carrying out the research from the beginning is new.”

“It’s important for us to tie into the academic environment at the School of Nursing,” Gambill says. “We have nurses who are pursuing advanced degrees, and some who are interested in research – but not necessarily if it means leaving patient care. So this partnership is the kind of thing that keeps giving nurses an opportunity to have greater impact, whenever they are ready to branch out.”

Nancy Gambill, MS, CRNP, of the Greenebaum Cancer Center, and Susan G. Dorsey, PhD, RN, of the School of Nursing, show a patient how she can log any pain she experiences on a digital device, for a study the two nurses are leading jointly.

The new partnership between the Medical Center and the School of Nursing will encourage and facilitate more such research projects. This particular project led by Dorsey and Gambill was cultivated by Karen Johnson, PhD, RN, director of nursing research for the Medical Center. Johnson’s position is new this year, and is a dual appointment: Half of her salary is paid by the Medical Center, and half by the School of Nursing. She serves as a coordinator to foster and encourage more research among nurses at the Medical Center who have clinical expertise, in collaboration with faculty at the School of Nursing who have expertise in research.

The teams led by Dorsey and Gambill have been meeting regularly. They created an electronic site to share articles and engage in discussion. Their goal is to begin the study in the next several months, and they are in the process of developing a protocol for the University of Maryland Institutional Review Board.

Dorsey’s lab studies the molecular and cellular mechanisms of how chronic pain develops and persists. In particular, Dorsey was studying the increased sensitivity to pain that can be a side effect of chemotherapy drugs.

Recently, Dorsey’s lab discovered the novel finding that exercise significantly reduced pain behavior in mice after they received a variety of chemotherapeutic agents. The exercise was in the form of voluntary running on a wheel. An interesting fact: The mice will run for a total of 6K (about 4 miles) in one night.

Dorsey and Gambill discussed how the findings in laboratory mice might be worth exploring in humans.

“At this point, we are not suggesting any therapeutics or interventions, including exercise,” Dorsey says. “It is premature. First, we need to understand more about the potential molecular and cellular mechanisms and pathways that underlie the peripheral nerve damage and the pain behaviors that can be caused by these drugs.”

In the lab, Dorsey and her colleagues will examine changes in gene expression in the mice and examine nerve conduction to evaluate the degree of nerve damage caused by the chemotherapeutic drugs. Then, they will correlate these findings with the “nocifensive” (pain-avoidance) behaviors by the mice.

“In patients, we can examine the same types of outcomes,” Dorsey says, including gene expression, genotype and nerve-fiber conduction. But with the patients, it will be correlated with their reports of pain and how well they are functioning, using a small device that is like a personal digital assistant (PDA) and functions as a daily pain log.

“Once we understand more about the underlying mechanisms, then we would try to identify novel therapeutic opportunities that can be tested in patients, including the possible use of aerobic and resistive exercise training,” Dorsey says.

Commitment to Excellence News

Definition of Excellent Service Crosses All Job Titles

Now that thousands of UMMC employees have become familiar with Commitment to Excellence (C2X) through employee forums held in the Medical Center Auditorium, the next step is to define what excellent service looks like on a daily basis.

That’s where the Behavioral Standards Team comes in. One of the six teams leading C2X, this one has just completed its first task: identifying five “behaviors” that are important to the UMMC community. They are appearance, respect, communication, service and accountability.

Setting universal standards for everyone – from physicians to support staff – is important to creating a culture in which all physicians and employees deliver excellent service every day, says Karen E. Doyle, MBA, MS, RN, CNAA-BC, director of patient care services for the R Adams Cowley Shock Trauma Center. Doyle is the team leader for behavioral standards.

“Sometimes visitors and patients are lost. If you see that little look on their face, just say to them, ‘How can I help you?’ The more you do it, the more it will catch on.” – Monica Moore

“Behavioral standards, like respect and communication, are basics to human co-existence. And it’s how we want others to treat us.” – Lovella Eugenio, BSN, RN.

“The behavioral standards are really about fundamentals that any employee can adhere to – it’s about manners,” Doyle says. As they developed their list, Doyle says, they looked at similar lists from other institutions focusing on service excellence. Yet none of them included a category that the team considered most important – respect.

“None of the other institutions mentioned respect, but that was a big one for us,” Doyle says.

The Behavioral Standards team knew that respect was important for employees at UMMC because of feedback from the Employee Opinion Survey and the Employee Advisory Council. When managers asked employees to define good leadership, respect was one of the most common answers.

“It’s important that we listen to employees when they let us know what they think,” Doyle says. “Making sure that ‘respect’ is on our list of standards shows that we are listening.”

Kimberly Ferguson, RRT, a respiratory therapist and member of the Behavioral Standards team, said respect applies to so many areas – including both personal appearance and the appearance of the hospital – that it simply had to be one of the standards.

“Appearance is also very important,” she adds. “The way we present ourselves at work reflects how we do our job and how we respect ourselves, the patients and the Medical Center. But, the ‘appearance’ standard goes beyond each individual to the appearance of our surroundings. Little things matter: picking up trash when walking down the hall or making sure a patient’s room is clean and tidy.”

Ferguson adds, “Patients have a choice about where they want to receive their medical care, so let’s remember, ‘You never get a second chance to make a first impression!’ ”

The team’s next step is to define what each area means in practice. “Once we define what those behaviors look like, then we look at performance – how we measure what a positive attitude looks like, for example,” Doyle says.

The team will also design support materials to familiarize all staff with the standards.While these standards may come naturally to some employees, the focus of C2X is to make sure that they can be followed by all employees, all the time.

With C2X, Doyle says, “Service excellence should be so ingrained in our culture that job applicants will have to read these standards and agree that they want to be a part of such a culture.”

Monica Moore, patient administrative services team leader for the Shock Trauma Center, has a unique perspective from the Shock Trauma front desk on what may be the busiest intersection at the hospital.

Moore remembers when the “We Care” customer service program started two years ago. The staff was excited, but the behavior didn’t become ingrained in the culture. “Everyone was gung ho at first, but it dies down if you don’t continue it as part of your daily routine.”

C2X is showing signs of becoming more deeply ingrained. For example, Moore says Jeffrey A. Rivest, president and chief executive officer, makes a point of greeting people as he walks through the Medical Center, and that his example sets the tone for the entire staff to emulate.

“There’s that extra step of acknowledging your co-workers,” Moore says. “You see him do that, and it trickles down. It becomes second nature.”

News

Survey Rates Safety and Quality of Care

UMMC Makes Leapfrog Group Top Hospitals List

For the second year in a row, the University of Maryland Medical Center has been named to the Leapfrog Group list of the best acute-care hospitals in the nation for patient safety and quality of care. The Medical Center community celebrated the honor on Oct. 11 with an ice cream party and an invitation to the staff to wear green all day. The celebration was quickly organized by the C2X Employee Loyalty Team.

The honor was especially satisfying because the criteria became even more rigorous this year – fewer hospitals made the list – yet the Medical Center’s performance scores actually increased.

UMMC was among 1,285 hospitals that submitted data and documentation for the 2007 Leapfrog Hospital Quality and Safety Survey. This year’s list includes only 41 hospitals (33 general acute care hospitals and eight children’s hospitals). Last year, 50 hospitals made the list. Leapfrog added new and more stringent measurements in 2007, and some hospitals that were on last year’s list did not satisfy this year’s criteria.

The Medical Center community celebrated the honor on Oct. 11 with an ice cream party and an invitation to the staff to wear green all day.

“Inclusion on the Leapfrog Group’s list for the second year in a row demonstrates our continuous focus on quality patient care and patient safety,” says Jeffrey A. Rivest, UMMC president and chief executive officer. “It is a reflection of the diligence and dedication of our clinical staff – the doctors, nurses, pharmacists, therapists and support staff who provide excellent care for patients every day.”

The Leapfrog Group, founded by the Business Roundtable, represents large corporations and public agencies that buy health benefits for employees. The organization intends to use its influence to initiate breakthrough improvements – or “leaps” – in health care safety, quality and affordability.

The organization uses objective criteria to rate hospitals based on outcomes and patient volume for selected high-risk procedures, as well as on staffing levels and specific measures taken to ensure patient safety.

“Once again this year, we earned the highest possible scores from Leapfrog for our activities to prevent infections, medication errors and complications,” says Timothy J. Babineau, MD, MBA, senior vice president and chief medical officer.

A key factor for safety and quality is a hospital’s implementation of computerized electronic order entry, which means that lab tests, imaging studies and medications are ordered by providers electronically, to reduce errors.

“We have now fully implemented computerized order entry throughout the University of Maryland Medical Center, which is a significant achievement,” Babineau says. Of the hospitals that responded to the Leapfrog survey, only one in 10 had fully implemented computerized provider order entry.

The Leapfrog survey also considers the number of high-risk procedures performed at each hospital as part of its criteria, since the higher the number and the more experience an institution has, the better the outcomes.

This year, the Leapfrog Group survey added information about bariatric and aortic valve surgery to the list and included surgeon experience in these and other high-risk surgeries to evaluate hospitals.

Medical Center staff performed 145 bariatric surgeries in the past year. The Leapfrog standard was 100. For aortic valve replacement, 132 procedures were performed here, compared to a Leapfrog standard of at least 120. The Medical Center had 945 cases of percutaneous coronary intervention (such as balloon angioplasty) in one year. The Leapfrog standard was 400.

Other areas where the Medical Center’s volume exceeded the Leapfrog standard were: abdominal aortic aneurysm repair, esophagectomy, pancreatic resection, high-risk deliveries and neonatal ICU cases.

Staffing ICUs with intensivists, attention to adequate staffing of nurses and good communication among health care workers and between those workers and patients are also part of the Leapfrog Group’s criteria, and are two areas in which the Medical Center scored high.

“The recruitment and retention of an exceptional group of nurses is crucial to providing excellent care,” says Lisa Rowen, DNSc, RN, senior vice president for patient care services and chief nursing officer. “Creating a collaborative, professional and enriching environment for our nurses and other patient care staff is one of our top priorities.”

For more information about the Leapfrog Group: http://www.leapfroggroup.org/news/leapfrog_news/Top_Hospitals