CareNurses

Transforming

2010/2011Nursing Report

www.billingsclinic.com

Contents [ Letter from Lu Byrd, RN, MN, NEA-BC, CNO ii

[ Magnet...It’s What We Do Here 3

[ Nursing Committed to Advancing Education 4

[ Nurses MUST Do Their Best to Protect Patients 7

[ Keeping Hand Hygiene Front and Center 8

[ Nursing’s Role in Patient Placement 11 for Best Outcomes

[ Creating Best Practices in Managing 12 Hypertension Education

[ Life-Saving Community Work 15

[ Patient Education is One of the 16 Key Factors of Our Success

[ Guiding Patients through Cancer Care 19

[ Positive Outcomes with Positive Deviance 20 Reducing MRSA Transmissions

[ Letter from Nicholas Wolter, MD, CEO 21

Our vision to be a national leader in quality, safety, service and value has posed many wonderful opportunities for us. With this vision in mind, Billing Clinic and the Nursing Division have taken on many new challenges and have accomplished so much these past two years.

The nursing staff at Billings Clinic understands that our work is about the patient and what he or she needs. The focus to details assuring that everything is done for the patient the first time/every time is amazing, and this commitment is the breath of this organization. Nurses know it is not always easy to fulfill this role. Changes in health care today have made the role of the nurse so complex. The silver lining in that complexity however is a drastic increase in the number of opportunities for the professional nurse. Still one of the most trusted professions in this country, nurses make a difference in so many ways. Our roles are about service, giving and caring. And the need is so great! The staff at Billings Clinic has such a high level of commitment to this role. Their compassion and

dedication surpasses any other personal experience of mine. Billings Clinic’s patients are part of our family, and the staff takes such pride in caring for those patients every day.

Often we do not take the time to appreciate the difference we make in people’s lives every day: the patients’ lives, family members’ lives, our co-workers’ lives, and our individual family and friends’ lives. Nursing is very challenging today, and the nursing staff at Billings Clinic takes on the challenges by making a commitment to patient advocacy. Yet we all know there is a cost to this expenditure of energy. Burnout continues to be an adverse effect of the demands on the role. So how do we support each other and advance the profession, because the patients need us? Together, leading change would be my answer. Nursing has changed drastically in the last 10 years and we know the future of nursing continues to evolve with the uncertainty of health care. Nursing must always stay patient centered. Teamwork and engagement are the two strengths needed for the future of nursing. Although these skills can be challenging, nurse leaders need to share a vision that keeps the patient at the center of the health care world and emphasizes the importance of embracing and leading change. I am proud of the staff at Billings Clinic for their commitment to our vision. Striving to be a national leader is very hard work. Through engagement to evidence-based practice, Billings Clinic nurses stay on the leading edge of their practice, allowing them to participate in informed decision making that will assist them in selecting the right choices for our patients.

I hope you can feel my passion for the individuals who contribute to our team and make this annual report possible. We are blessed to have a beautiful campus and facility in a beautiful location. Yet, I repeatedly say that it is not the brick and mortar that make the difference in our success. Our staff makes the difference every day, and they are the best!!

With deepest respect to my team,

Lu Byrd, RN, MN, NEA-BC

Lu Byrd, RN, MN, NEA-BCBillings Clinic Vice President of Hospital Operations and CNO

Dear Staff, Colleagues and Friends

ii 1

On October 19, 2011, in a packed conference room filled with staff nurses, nursing leadership, medical staff, hospital and clinic leadership we learned that we had again achieved Magnet designation for another 4 years. Billings Clinic received initial designation in 2006.

Magnet Appraisers arrived at Billings Clinic on August 8, 2011 greeted by over 250 staff members sporting the color purple, one of the signature colors of Billings Clinic. This “sea of purple” was just another indicator of the enthusiasm and energy that Billings Clinic staff are proud of obtaining and maintaining our Magnet Recognition.

This culminates ongoing work led by the Magnet Team over the past three years. Final documentation submission took place May 2011, with the site visit August 8-10, 2011. Three American Nurses Credentialing Center (ANCC) appraisers conducted three full days of extensive interviews, unit visits and document reviews.

As we continue on our journey with nursing excellence we are continually inspired and motivated by our nursing peers and colleagues who strive for constant improvement, best practice and safety for our patients and fellow coworkers.

Nursing staff at Billings Clinic serve as care providers, care navigators, care managers, patient safety officers, accreditation leaders, educators, clinicians, scientists, researchers, risk managers, clinical managers, service line directors. Our most important role is to use the influence we have in these roles to be change agents and innovators to facilitate our vision of being the best in the nation for quality, safety and service.

Magnet… It’s What We Do Here

Left to right: Celeste Dimon, RN, MSN; Barb Diehl, RN, MSN, NEA-BC; Marie McGarrah; Lu Byrd, RN, MN, NEA-BC, CNO; Dr. Nick Wolter, CEO

Left to right: Keri Cross, RN, BSN; Christy Buffington, RN, BSN; Cindy Frank, RN, BSN, OCN; Jeannine Brandt, RN, PhD, APRN, AOCN

Billings Clinic staff create a Sea of Purple to welcome the

ANCC Magnet Appraisers

2 3

65%66%67%68%69%70%71%72%73%74%75%

% B

SN o

r Hig

her

201120102009

Billings Clinic Degree Improvement% BSN or Higher

% BSN or Higher 69.47% 70.48% 71.51%Feb-09 Feb-10 Feb-11

Education is a primary focus for developing and preparing nurses for the future of nursing. Billings Clinic enjoys a high percentage of BSN-prepared nurses at the bedside.

Billings Clinic is committed to continued professional nursing growth. Due to the existing high BSN rate and low level of vacancies, the goal is to increase the BSN and advanced nursing degree rate by a minimum of one percent per year. In the fall of 2008, with a continued

commitment to improving the overall BSN and MSN rate, Lu Byrd, RN, MN, CNO established the expectation that an individual unit will maintain a minimum of 60 percent BSN-prepared direct-care nurses. Nursing staff have responded to that expectation. The organization’s average is well above the NDNQI mean at the unit level with two units exceeding 80 percent and four other units exceeding 60 percent BSN nurses for all years following that challenge.

Nurses Committed to Advancing Education

Left to Right: Tricia Montgomery, RN, BSN; Rebecca Schiffer, RN, BSN, OCN; Susi Bunkers, RN, BSN; Tammy Roberts, RN, BSN. Billings Clinic nursing staff has met the challenge to increase BSN prepared nurses.

4 5

Medication UseSafety Team

The nursing division at Billings Clinic uses a facility-wide approach for proactive risk assessment and error management through the work of the MUST team. The Medication Use Safety Team (MUST) took its roots from the Inpatient Surgical Unit to increase efforts to create safer medication practices using an interdisciplinary team. MUST had its first meeting in January 2010.

The Medication Use Safety Team (MUST) is comprised of direct care nurses (representing most hospital departments), pharmacists, nurse clinicians, risk and quality specialists, and informatics. The team also has medical support with a physician representative and reports to Pharmacy & Therapeutics Committee. The team analyzes medication errors that have occurred and looks for trends, risk-taking behaviors, and system failures. Based on the information uncovered, the team rapidly implements practice changes and other reduction strategies to reduce the risk and recurrence of medication errors.

A few of the accomplishments during the short tenure include:• Implementation of several alerts on the eMAR

including the early/late administration alert and the minimal interval alert

• Modification of standard administration times for subcutaneous insulin

• Re-configuration of barcode scanning devices to prevent the inadvertent bypassing of alerts

Another objective for the team is to contribute to the body of knowledge regarding medication safety on a national level. As the team uncovers system contributors to error, they are submitted to the Institute of Safe Medication Practices (ISMP) medication error reporting program (MERP). The team believes that lessons learned at Billings Clinic can make a difference on a national level. The Institute of Safe Medication Practices (ISMP)

has published two newsletters that focus on medication errors submitted by the Medication Use Safety Team.

The MUST practice was cited as an Exemplary best practice by the Magnet Commissioners after our redesignation visit in August 2011.

Nurses MUST Do Their Best to Protect Patients

The Institute of Safe Medication Practices (ISMP) has published two newsletters that focus on medication errors submitted by the Medication Use Safety Team.

Connie Anderson, RN, BSN, CMSRN, OCN serves as a leader in teaching oncology

staff best practices in medication safety.

6 7

Keeping Hand Hygiene Front and Center

It started in Infection Control with Medical Technician Jennifer Mellgren-Blackford and Nancy Iversen, RN, who identified

an opportunity to use our nursing creativity to visually display what our practices for hand hygiene are at Billings Clinic.

With a video featuring health care professionals demonstrating hand hygiene practices while singing a version of the Hokey Pokey, Billings Clinic submitted the Scrubby Dubby video to “It’s in Your Hands” YouTube™ video contest, sponsored by 3M and the Association of peri-operative Registered Nurses (AORN).

The video is narrated by Joey Traywick, the hospital’s then organizational development learning consultant. He has since earned his RN degree and worked as a staff nurse in the emergency department. Known for his exhuberance and creativity, he was one of the

key drivers in the production of this award winning video. Surgical Services partnered with Traywick and Mellgren to solicit the involvement of over 80 employees from all over the organization to star in the production. “The development of this video brought new and additional awareness of the importance of good hand hygiene practices to all areas of Billings Clinic. Nursing staff were able to invite colleagues from all departments to participate and have fun while doing something important for our patients and ourselves. Nursing was honored to take the lead in forwarding an important message throughout the organization,” stated Jackie Hines, RN.

With more than 2,500 votes, Billings Clinic was announced as the winner during the 2010 AORN annual Congress in Denver, and received a $5,000 educational grant. Funds from the grant have gone to support the education of nursing staff at Billings Clinic.

Sarah Leland, RN, BSN, CMSRN, ensures safe patient care by practicing proper hand-washing techniques

Billings Clinic staff enthusiastically participate in the Scrubby Dubby hand hygiene video.

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Emergent Transfers to ICU - 2011

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Nursing’s Role in Patient Placement for Best OutcomesBillings Clinic identified a higher than expected mortality rate with patients who had a diagnosis of sepsis. At the same time the nursing staff identified a trend amongst patients who were admitted to the medical-surgical units who were transferred into ICU within 12 hours of admission with progressive sepsis.

A team of physicians and registered nurses began meeting in October 2010 with the assignment to review the evidence around the care of the septic patient and create a bundle of care which would begin upon entry to Billings Clinic. In January 2011, the team introduced a screening tool for the ED admissions. This tool would be nurse driven using patient identifiers. If the patient had an infection and two other criteria, they were identified as possible sepsis. This was identified on the ED Patient Board with a “sepsis” icon.

Patients are screened early in the ED with early goal directed therapy implemented, early antibiotic therapy following cultures and initiation of vasopressors as needed. Patients are admitted to ICU and often have a short length of stay because of the early therapy and stopping the progression of sepsis.

Nursing has been integral to the implementation of this initiative. Without registered nurses completing the screening and following the established evidence-based protocols, the septic patient would not be receiving consistent evidence-based care.

Work continues to improve outcomes. Not all septic patients are identified in the ED. The team has also worked on the creation of screening tools for the medical-surgical nurses with a proposal to trial the screening in the inpatient cancer unit.

Aimee Wagner, RN, BSN, transports a patient to the Intensive Care Unit.

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Intervention (n=876)Clinic 1 (n=681)Clinic 2 (n=748)

Creating Best Practices in Managing Hypertension EducationPrincipal Investigator Valerie Canton, RN, MN, FNP conducted nurse-led research at Billings Clinic with a team of physicians, social workers and registered nurses. This research also established registered nurses as principal investigators in the Center for Clinical and Transformational Research (CTR), which had historically used physicians and PhDs to fill this role in its health services research studies.

The project aimed to improve the use of best practices in managing hypertension among Billings Clinic clinicians. After establishing provider consensus regarding best practices in managing hypertension, nurses were the target population to assure accurate and reliable blood pressure monitoring. Through observation by the principal researcher it was found that nursing practice varied by education and experience.

Protocols were developed, which included recording patient arm circumference and selecting appropriate cuff size, which are used to take blood

pressure. Pre- and post-chart reviews were conducted to measure nursing behavior change.

Nursing staff identified barriers to meet new established protocols, which led to increased

need for collaboration between providers and nursing staff. This was accomplished through ongoing meetings and work sessions to alleviate barriers to best practices. The changes in provider and nurse behaviors resulting from the intervention have significant implications for HTN (hypertension) management at Billings Clinic. The bottom-up approach to behavior change proved successful in changing behaviors of providers and nurses caring for patients with hypertension.

This intervention resulted in increased interaction between providers and nurses. Though some providers had retaken blood pressures on patients for 20 years, they began to trust nurses’ actions after witnessing their accurate blood pressure measurements. This change impacted clinical practice by improving workflow and reducing redundant practices. Ultimately, as the clinic became more efficient and practices more accurate, the quality of patient care improved.

Jan Hemmer, RN, BSN, visits with a patient to determine the best plan of care.

The bottom-up approach to behavior change proved successful in changing behaviors of providers and nurses caring for patients with hypertension.

12 13

Life-Saving Community WorkBillings Clinic nurses are a critical part of the health of our community. Two registered nurses have taken community health to a new level. Jennifer Toepfer, RN, and Debbie Meyer, RN, co-coordinate the education of Basic Life Support (BLS) skills to area high school students.

Through work with health/physical education classes at either the freshman or sophomore level, BLS has been added to each area high school’s curriculum. Students can complete the requirements and obtain CPR certification at the end of the class.

Working with Billings Clinic’s American Heart Association-approved Community Training Center, these registered nurses, assisted by other qualified instructors, have been able to provide lifesaving education that students can use to improve the health of their communities throughout Montana.

All students receive BLS education regardless of ability to pay. Students who cannot afford the low cost of certification are awarded a scholarship provided by Billings Clinic Community Training Center.

Since 2007, over 7,300 students have been provided BLS instruction by Billings Clinic. Over half of those students chose to become CPR certified. Also, students were introduced to caring health care professionals as instructors, leading to excellent role modeling.

The best post-project tools are student evaluations and staff willingness to accommodate our program into their curriculum.

Class evaluations score from a 4.3-to-4.5 on a 5 point scale. Included are handwritten comments such as: “Great class! Now I know how to save a life! Thanks!”

Debbie Meyer, RN, BSN, instructs high school students in CPR.

Since 2007, over 7,300 students have been provided BLS instruction by Billings Clinic. Over half of those students chose to become CPR certified.

14 15

The Department of Reproductive Endocrinology and Infertility (REI) began In vitro Fertilization Lab (IVF) Services in July 2009; the first such sub specialty in Montana and Wyoming. In February 2011, Billings Clinic opened the first IVF Lab to serve women and men from Montana and Wyoming who had previously had to travel to Seattle, Denver or Salt Lake City for these reproductive services. Montana and Wyoming couples can now have their diagnostics as well as their IVF cycles here “at home”.

RNs play a critical role in the REI/IVF team approach to care. Patient education and preparation is critical to the success of In vitro fertilization. Zoey Hallam, RN, BSN, and Julia Johnerson, RN, BSN, spend countless hours conducting education, reinforcing,

reassuring, sharing pregnancy successes and comforting a negative pregnancy result or the loss of a positive pregnancy.

An IVF “cycle” has different phases. When a woman begins a cycle she goes through a period of “stimulation” where her ovaries are stimulated with various medications to prepare and mature many ovarian follicles. The RN’s role is to educate the woman in the timed use of these medications and help her understand the sequencing of these medications. Injection teaching and further knowledge sharing on how these medications will affect, not only her body, but her emotional state are a crucial part of patient education.

In the first four batching of cycles, over 50 in total, for calendar year 2011, Billings Clinic has achieved success rates higher than the national average. Given the newness of the lab these outcomes are especially noteworthy.

Patient Education is One of the Key Factors of Our Success

Reproductive Endocrinologist and Infertility Specialist Christopher Montville, MD, and Zoey Hallam, RN, BSN, collaborate as they prepare for an in-vitro fertilization procedure.

...further knowledge sharing on how these medications will affect, not only her body, but her emotional state are a crucial part of patient education.

16 17

Guiding Patients Through Cancer Care

Cancer care nurse navigators exemplify interdisciplinary collaboration across multiple settings to ensure the continuum of care. The cancer care navigators seamlessly guide patients through multiple departments in the continuum of care during an emotionally and physically challenging time.

Most importantly the navigator engages with the patient and his or her family to help navigate the complex environment encountered when newly diagnosed. The cancer care navigator’s role includes:• Coordinating care with various medical

specialties participating in the patient’s care and treatment

• Providing education on the diagnosis and answering questions regarding treatment options

• Reviewing supportive therapies available to the patient during and after treatment

Cancer care navigators help patients and families navigate a complex medical environment when the patient and family need support the most. Advantages of this model include:• Increased patient/family satisfaction• Increased patient/family involvement in the

care process• Decreased length of time between initial

diagnosis of cancer and initiation of treatment

Left to Right: Cancer Care nurse navigators Deb Hofer, RN-BC; Deb White, RN, BSN, OCN; Mary Lou Iverson, RN, MSN; Lora Wingerter, RN, BSN, OCN; Danielle Wright, RN, BSN, OCN; Kathy Aders, RN, BSN; Cindy Frank, RN, BSN, OCN; Pat Mahana, RN, CBEC

Danielle Wright, RN, BSN, OCN confers with one of the many patients she navigates

through the cancer care system.

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Time from Ref to 1st Appt Median Time from Dx to 1st Tx Median

Timeliness of Care for Virtual Rectal/Anal Clinic PatientsCalendar Year 2010-2011

18 19

MRSA Clinical Surv Qtrly Data(infections colonizations)

Housewide Healthcare-associated MRSA Infections1999 - December 31, 2011

0.21 0.15(4 peopleinfected)

0.32(9 peopleinfected)

0.34(14 peopleinfected)

0.44(20 peopleinfected)

0.75(33 peopleinfected)

0.85(38 peopleinfected) 0.77

(34 peopleinfected)

0.30(14 peopleinfected)

0.13(6 peopleinfected)

0.33(15 peopleinfected)

0.34(16 peopleinfected)

0.28(13 persons

infected)

0.0

0.2

0.4

0.6

0.8

1.0

1999 2006 2007 2008 2009 2010 CY 20112000 2001 2002 2003 2004 2005

PD/MRSA Project began in May 2006

2005 - 201167% reduction in Healthcare- associated MRSA Infections

AST began in ICU Jan '07

AST began in IPM Nov'08

AST began in: *ICC Feb '09

*SSU July 09

AST began in IPS Feb '10

AST began in ATU Aug '11

Over 50% of MRSA infections occur in US hospitals and are associated with increased length of stay, ICU stay and morbidity. Using an innovative social and behavioral change process called Positive Deviance (PD) frontline staff acted their way into consistent use of MRSA prevention practices resulting in a significant reduction of health care-associated MRSA infections.

A multipronged intervention was implemented. Active MRSA surveillance testing, contact precautions for colonized and infected patients, hand hygiene promotion, and environmental cleaning were all implemented over several years.

No routine attempts to eradicate MRSA colonization were used. Led by the Infection Control Department, infectious disease specialist RNs and physicians, efforts were coordinated to implement new processes, reinforce best current practices and measure outcomes.

Hospital-wide incidence of MRSA infections decreased by 76% (0.85 to 0.20 per 1000 patient days), p=0.000. The PD approach engaged frontline staff to consistently practice known MRSA prevention behaviors. These data suggest that significant hospital-wide reductions in endemic MRSA incidence can be achieved.

Positive Outcomes with Positive Deviance Reducing MRSA Transmissions

Embracing Our Vision to Transform CareAs Billings Clinic employees, we are committed to provide the best service experience and outstanding quality care our patients need and deserve. From a clinic appointment to a hospital or long-term care stay, our nurses are at the forefront, integral in providing complete care and safe care for our patients.

Behind the scenes our nursing team collaborates on multi-disciplinary teams to implement transformational changes that directly impact the way we provide patient care. Through expertise and involvement, nursing serves as a catalyst for change demonstrated through decreased infection rates, serving as preceptors to student nurses, ensuring the safety of our medication practices, engaging in research for nursing best practices, all which results in benefits to the community and region we call home.

At the national level, collaborative knowledge sharing with the Institute of Safe Medication Practices was recognized and cited as an exemplary best practice during our recent Magnet redesignation site visit. In the future, Nursing at Billings Clinic will continue to have the opportunity to impact health care across the country, while providing compassionate, evidence-based care to our patients in our region.

On behalf of our organization, I want to extend my heartfelt congratulations and respect to our excellent nurses and nursing leadership team for their unwavering commitment to our patients and to the high standards that being a second time designated Magnet organization requires. To be the best takes humility, tenacity of purpose, courage and a willingness to measure the impact on those we serve. Thank you for exceeding patient expectations every day and for always putting the patient first.

Nicholas Wolter, MD, CEO

Nicholas Wolter, MDBillings Clinic CEO

20 21

CareNurses

Transforming

www.billingsclinic.com

Billings ClinicP.O. Box 37000Billings, Montana 59107-7000(406) 238-2500 or 1-800-332-7156

Certified Gastrointestinal Registered Nurse (CGRN)Elizabeth Brown, RNDarlene DeCock, RNJoan Getchell, RN, BSN

Critical Care Registered Nurse Certification (CCRN)Carol Blackwell, RN, BSNDania Block, RN, BSNLibby Brindley, RN, BSNAnne Burrell, RN, MSNRosemary Fischer, RN, BSNKathleen Gallogly, RNMelissa Gerving, RN, BSNRoxanne Harris, RNAmber Hellekson, RN, BSNLynn Hilliard, RNJust Humphrey, RN, BSNJulie Klarich, RN, BSNAmber Knuths, RN, BSNWendy Magid, RN, BSNKathleen Mortensen, RN, BSNElizabeth Potter, RN, BSNTheodore Shelton, RN, BSNGinger Silvers, RN, BSNDarcy Smith, RN, BSNJulie Surrell, RNLaurie Sutphin, RN, BSNDeana Thompson, RN, BSNSarah Turner, RN, BSNClaudia Watrous, RN, BSNAndrea Wells, RN, BSNMartha Wetstein, RN, BSN

Emergency Nursing Certification (CEN)Lauraine Big Medicine, RN, BSNRebecca Brockel, RN, BSN

Robert Canan, RN, BSNRebecca Frye, RN, BSNAmy Goffena, RN, BSNTina Hedin, RNKimberly Kovarik, RNJeanne Lambeth, RNDennis Nemitz, RNMark Polakoff, RN, BSNRikki Rumph, RN, BSNLisa Stevens, RN, BSN

Certified Medical-Surgical Registered Nurse (CMSRN)Connie Anderson, RN, BSNGreta Beam, RN, BSNKathy Boston, RN, BSNHeidi Brown, RNAmanda Brownell, RN, BSNRoberta Cooley, RNTammy Cozzens, RNKrisena Curry, RN, BSNBrenda Doherty, RN, BSNCurtis Ferrin, RN, BSNJeremiah Fisher, RN, BSNKatherine Gowan, RN, BSNRachael Gray, RNLisa Gutierrez, RN, BSNLisa Hastings, RNDee Hogue, RN, BSNAmanda Jennissen, RN, BSNMichelle Kirkhorn, RN, BSNNichole Krugler, RN, BSNTeresa Lehman, RN, BSNSarah Leland, RN, BSNAmber Lowry, RN, BSNKristie Marquess, RN, BSNMichelle Martell, RNLisa McDowall, RNTeresa Mielke, RNKarla Monteith, RN, BSNDorothy Morris, RNJeanne Morse, RNMary Orler, RNDonna Parker, RN, BSNAmanda Pierce, RN, BSNHolly Riley, RN, BSNTabatha Rivera, RN

Roxanne Rivers, RNLori Ryan, RN, BSNWilliam Salminen, RN, BSNTanya Saunders, RNSusan Schneider, RN, BSNKimberly Shroyer, RNRose Smith, RN, BSNCory Steiner, RN, BSNMariah Strachan, RN, BSNVirginia Waller, RN, BSNGayle Webster, RNConnie White, RN, BSNThomas White, RN, BSNDawn Wilson, RN

Certified Nurse Operating Room (CNOR)Holly Adams, RN, BSNConnie Becker, RN, BSNErin Bequette, RN, BSNCynthia Carlson, RN, BSNMalissa Carr, RN, BSNJune Edwards, RN, BSNSara Fenton, RN, BSNCarol Henning, RN, BSNKelly Higbie, RN, BSNSusan Jessop, RN, BSNLyndie Jolly, RN, BSNAndrea Miller, RN, BSNPerry Patton, RN, BSNCorina Schwarzinger, RN, BSNSheryl Teini, RNSarah Thomas, RN, BSNDenise Twichel, RN, BSN

Certified Pediatric Emergency Nurse (CPEN)Tara Zoanni, RN, BSN

Registered Nurse, Certified in Inpatient Obstetrics (RNC-OB)Nadine Gotschall, RNJulia Lennick, RN, BSNKatie Prom, RNSharon Roach, RN, BSN

Tiffanie Shipman, RNEmily Soft, RN, BSNJoanna Thompson, RN, BSNLaurie Wilson, RN, BSN

Oncology Certified Nurse (OCN)Linda Arnold, RNDelayne Gall, RNElizabeth Gruba, RNChrystal Martin, RNRadonna McComb, RNKerry Nichols, RN, BSNTara Nye, RN, BSNDanielle Piseno, RNTerri Polesky, RN, BSNRebecca Schiffer, RN, BSNSusan Schott, RNAmy Walton, RN, BSN

Progressive Care Certified Nurse (PCCN)Shere Cooney, RN, BSNKathleen Cooper, RN, BSNDavid Fisher, RN, BSNCrystal Gaines, RN, BSNDarrin Peplinski, RN, BSNJennifer Tafelmeyer, RN, BSNCassie Wolfe, RN, BSN

Psychiatric Mental Health Certified Nurse (PMHCN)Leslie Bouchard, RNKeri Cross, RN, BSNKaren Robey, RN, BSNDebbie Smith, RNJames Stanton, RN, BSN

Low-Risk Neonatal Certified Registered Nurse (RNC-LRN)Angie Higgins, RN, BSNSusan McAtee, RN, BSNLucinda McLean, RN, BSNTifan Picard, RN, BSNAmanda Poepping, RN, BSNJanis Taylor, RN, BSNBecky Uhrich, RN, BSN

Nurses Certifying their Practice