Developing the Clinical Nurse Leader Role in the Baptist ... · Developing the Clinical Nurse Leader ... q Based on Dr. Jean Watson’s Theory of Transpersonal Caring n caring is

Developing the Clinical Nurse Leader Developing the Clinical Nurse Leader Role in the Baptist Hospital of Miami Role in the Baptist Hospital of Miami

12 Bed Hospital Model12 Bed Hospital Model ©©

A Best Practice for Care Delivery RedesignA Best Practice for Care Delivery Redesign

CNL TeleconferenceJoan Shinkus Clark RN, MSN, CNAA, BCJanet Maloney RNC, MSM-HM, CNA, BC

Flor Aguirre RN, BSN, OCNMaria Encinas RN, BSN, OCN

March 15, 2006

March 15, 2006 CNL Teleconference 2

Baptist Hospital of MiamiBaptist Hospital of Miami

q Part of Baptist Health South Florida

q 577 Bedsq Community, Not for Profitq Magnet Hospital since 1998n First in Floridan 11th in Nationn Re-designated in 2002


Framework for Practice

q Based on Dr. Jean Watson’s Theory of Transpersonal Caringn caring is central to the nursing role

and its mission as a distinct professionn caring is often the measure by which

patients evaluate their “cure-dominated” experience

n caring is transpersonal in nature, involving the one caring as well as the one being cared for


Current Healthcare System

q Patients are older, sicker, and better informedq Healthcare spending, reimbursement and

advances in science and technology have pushed dramatic changes in length of stay and setting

q Physician care patterns have changedq Nursing delivery patterns have changed

YetYet……q Patients’ expectations have not changed!

Realities


Why it was locally important to change (2000-2001)

q Rapid growth inpatient volumes amidst capacity constraints within the facility

q Increased responsibility for hospital to intervene to ensure physician commitment and continuity

q Increased risk with numbers of novice nursing staffq Patient satisfaction consistently validating

communication and coordination as an issueq Staff dissatisfaction with re-engineered hospital

environment of the 1990’s


The Twelve Bed HospitalThe Twelve Bed Hospital©©

Care Delivery ModelCare Delivery Model


TwelveTwelve Bed HospitalBed Hospital©©

q Describes a model for coordinating patient care

q Breaks a patient care unit into small, manageable segments of 12 or more beds, depending on physical layout of the patient care unit

q Places a Patient Care Facilitator in the “lead” role for all the patients in the 12 bed hospital

12 Bed 12 Bed 12 Bed

12 Bed 12 Bed


Patient Care Facilitator (PCF)

q PCF functions as a clinical leader for RNs, LPNs, and other staff, not as manager

q Knows about each patient in their hospital

q Consistent figure for patient in the hospital to offset fragmentation

q Acts in the role of ‘traffic control’ in coordinating rollout of the plan for care

q Acts as the primary liaison for physicians, other disciplines, and families

q Monitors competency and mentors team members and students


Twelve Bed Hospital©- 48 Bed Unit

PCF

PCF

PCF

PCF

•Patient Care Center

Manager

•Asst Patient Care Center

Manager

•Charge (Resource) RN

RNRN

RN RN

RN RN

RN

CNA

CNA

CNA

CNA

CNA

CNA

CNA

RN

12 Beds

12 Beds

12 Beds

12 Beds

CNA


Twelve Bed Hospital© as Care Delivery Model

‘Twelve Bed’ care model incorporates best attributes of traditional nursing practices /delivery models

Team Nursing: Same staff work together all the time

Primary Nursing: PCF coordinates care 24/7 for all patients in group

Modular Nursing: PCF and team work in the same area of the unit on a daily basis

Case Management: PCF is a liaison between third party payors, physicians, and other disciplines in the coordination of care and payment for services


Vice President Chief Nursing Officer

Nursing Director

Registered Nurse (CN I,II,III)

Assistant Patient Care Center Manager

Assistant Patient Care Center Manager

Registered Nurse (CN I, II, III)

Graduate Nurse Licensed Practical Nurse Nursing Care Technician

Other Allied Health Professional*

Registered Nurse (CN I,II,III)





Nurse Clinician/

Support Partner

Administrative Partner


Support Partner


7-3 3-11 11-7

Generic Table of Organization for Patient Care Centers

*Other support personnel vary depending on type of unit (ex. monitor technician - telemetry unit)

Patient Care Facilitator (PCF) /

Advanced PCF

Patient Care Center Manager Assistant Patient Care

Center Manager


PCF Role and Selectionq BSN required for entry level q Full-time position (not reflected in

direct hours of care); Clinical Nurse IVq Salaried position q 24/7 accountabilityq Reports directly to Patient Care

Center Manager q Certification preferredq 3 years acute care experience with clinical maturity, team

leadership and excellent communication skillsq Provides direct care as backup for staffq Hours worked according to needs of patient, family or MD

n Expected to work one weekend shift and some off-shift hours every month


Advanced PCFAdditional Responsibilities

q MSN (CNL, CNS or ARNP)q Clinical Nurse Vq Expert resource for all aspects of

patient care deliveryq Certified in clinical specialty areaq Responsible for data collection,

analysis and follow-up within service line-based collaborative performance improvement teams

q Leader in organizational initiativesq Works closely with management

team in planning clinical goals and objectives for patient unit


Influence of PCF Role on Retention

Director of Nursing CNO

Patient Care Center ManagerResource Nurse

SupervisorAsst Patient Care Center Manager

Faculty (dual appointment with

School(s) of Nursing)

EducatorPerformance Consultant

Clinician (CN IV)

Adjunct Faculty

Advanced PCFsClinical Specialist (CN V)

ARNPs (CN V)Nurse Researchers (CN VI)

PCF (CN IV)

Advanced PCF(CN IV)

Clinical Nurse(CN I,II,III)

CLINICAL TRACKCLINICAL TRACK

EDUCATOR TRACKEDUCATOR TRACK

MANAGER TRACKMANAGER TRACK


PCF Trainingq Selection and orientation coordinated by the Twelve Bed

Project Managerq Five week training period including:

n Two weeks with experienced PCF on their home unitn One week with experienced PCF on the new PCF’s home unitn 2-4 days with an experienced social workern Time with: ¤ Risk Management ¤ Pastoral Care¤ Utilization Review ¤ Patient and Guest Relations¤ Ethics Consultant¤ International Services

q Attends specialized leadership course tailored to implications of this role


Twelve Bed Hospital©Implementation: History

Pilot begun on 51 Bed CV Unit

Research begun on pilot CV unit

Pilot extended to two 50 bed Med-Surg Units

12-Bed Hospital Project Manager appointed

12-Bed Model

presented to

Leadership Group

12-Bed Model

defined for rest of hospital

RolloutPlan

initiated

12-Bed ModelFully

Deployed

4th Qtr 2000 4th Qtr 2001 2nd Qtr 2002 2nd Qtr 2002

4th Qtr 20024th Qtr 20021st Qtr 20033rd Qtr 2004

The Clinical Nurse Leader sm


Education-Practice Partnerships

q 85 academic institutions providing CNL degree with >165 practice sites piloting CNL demonstration programs

q Baptist is partnering with the Christine E. Lynn College of Nursing at Florida Atlantic University n 11 PCFs currently enrolled in CNL program


PCF versus CNL

q The two roles have similarities. Exceptions related to the PCF role at Baptist Hospital include:n Entry level qualifications are at the baccalaureate level

with specialty-based certificationn Unit/Department-based versus population-based (DRG)n Does not necessarily address the full continuum of care,

although PCFs provide contact information for follow-up

n Definition into 12-16 bed units across all departmentsn 12 Bed concept and role is theory-based (i.e.

transpersonal caring)

Twelve Bed Hospital©Results

Research ~ Caring Framework


Caring FrameworkThe PCF role impacts patients positively through patients experiencing increased caring. When a patient indicated they had a PCF, they experienced significantly higher (p<.000) caring means for all subscales as measured by the Cronin and Harrison Caring Behaviors Assessment Tool©, 19884.25258YES

3.82165NOExistential/Phenomenological/Spiritual

Forces

4.66274YES

4.42169NOHuman Needs Assistance

4.41268YES

4.15167NOSupportive/Protective/Corrective

Environment

4.32267YES

3.93168NOTeaching/Learning

4.21261YES

3.63164NOExpression of Positive-Negative feelings

4.26275YES

3.86171NOHelping/Trust

4.55281YES

4.18176NOHumanism/Faith-Hope/Sensitivity

MeanNHadPCF?

Carative Factors (subscales)


Do you feel ready to go home?

100.0%77.7%22.3%% Had PCF

40831791CountTotal

100.0%81.3%18.7%% Had PCF

25720948CountYES

100.0%71.5%28.5%% Had PCF

15110843CountNOHad a PCF

YESNO Total

Ready to Go HomePatient Responses

Chi Square: Exact Significance p = .026


Did everyone who took care of you seem to know about your care?

Chi Square: Exact Significance p = .000

100.0%82.4%17.6%% Had PCF

46638482CountTotal

100.0%89.2%10.8%% Had PCF

28825731CountYES

100.0%71.3%28.7%% Had PCF

17812751CountNOHad a PCF

YESNO Total

Everyone Knew CarePatient Responses

Quality Measures


Acute MI – Core MeasuresP

erc

en

t

A M I A C E I o r A R B f o r L V S Dp char t

Temporary: UCL = 115.00, Mean = 75.88, LCL = 36.76Inspected Mean = 10.76, Counts Mean = 8.17

U C L

Mean

L C L

J C A H O T o p 1 0 %

Focused A t ten t ion by PCF

Jul 02

Aug 0

2

Sept 0

2Oct 0

2

Nov 02

Dec 02Jan

03Fe

b 03

Mar 03Ap

r 03

May 03Ju

n 03Ju

l 03Au

g 03

Sept 0

3Oct

03

Nov 03Dec

03Ja

n 04

Feb 0

4Mar

04Ap

r 04

May 04Jun

04Ju

l 04

Aug 0

4

Sept 0

4Oct 0

4

Nov 04Dec

04Ja

n 05

Feb 0

5Mar

05Ap

r 05

May 05Ju

n 05Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5

Nov 05

Dec 05

0

20

40

60

80

100

120

140

Pe

rce

nt

A M I A s p i r i n a t A r r i v a lp chart


UCL

Mean

LCL

J C A H O T o p 1 0 %

Focused At tent ion by PCF

Jul 02

Aug 0

2

Sept 0

2Oct 0

2

Nov 02Dec

02Ja

n 03

Feb 0

3Mar

03Ap

r 03

May 03Ju

n 03Ju

l 03

Aug 0

3

Sept 0

3Oct 0

3

Nov 03

Dec 03Jan

04Fe

b 04

Mar 04Ap

r 04

May 04Ju

n 04Ju

l 04

Aug 0

4

Sept 0

4Oct

04

Nov 04Dec

04Ja

n 05

Feb 0

5Mar 0

5Ap

r 05

May 05Jun

05Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5

Nov 05Dec

05

8 0

8 5

9 0

9 5

100

105

110

Pe

rce

nt

A M I A s p i r i n P r e s c r i b e d a t D i s c h a r g ep chart


U C L

Mean

L C L

J C A H O T o p 1 0 %


Jul 02Au

g 02

Sept

02Oct

02

Nov 02Dec

02Jan

03Fe

b 03

Mar 03Ap

r 03

May 03Ju

n 03Ju

l 03

Aug 0

3

Sept 0

3Oct

03

Nov 03Dec

03Ja

n 04

Feb 0

4Mar

04Ap

r 04

May 04Jun

04Ju

l 04

Aug 0

4

Sept 0

4Oct

04

Nov 04Dec

04Ja

n 05

Feb 0

5Mar

05Ap

r 05

May 05Jun

05Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5

Nov 05Dec

05

80

85

90

95

100

105

Pe

rce

nt

A M I B e t a B l o c k e r a t A r r i v a lp char t


U C L

Mean

L C L

J C A H O T o p 1 0 %


Jul 02

Aug 0

2

Sept

02Oct 0

2Nov

02

Dec 02Ja

n 03

Feb 0

3Mar 0

3Ap

r 03

May 03Ju

n 03Ju

l 03Au

g 03

Sept 0

3Oct

03

Nov 03Dec

03Ja

n 04

Feb 0

4Mar 0

4Ap

r 04

May 04Ju

n 04Ju

l 04

Aug 0

4

Sept 0

4Oct 0

4Nov

04Dec

04

Jan 0

5Fe

b 05

Mar 05Ap

r 05

May 05

Jun 0

5Ju

l 05

Aug 0

5

Sept

05Oct 0

5Nov

05

Dec 05

70

75

80

85

90

95

100

105

110

Pe

rce

nt

A M I B e t a B l o c k e r P r e s c r i b e d a t D i s c h a r g ep chart


UCL

Mean

LCL

J C A H O T o p 1 0 %


Jul 02

Aug 0

2

Sept 0

2Oct 0

2Nov

02Dec

02

Jan 0

3Fe

b 03

Mar 03

Apr 0

3

May 03Ju

n 03Ju

l 03

Aug 0

3

Sept 0

3Oct 0

3Nov

03Dec

03

Jan 0

4Fe

b 04

Mar 04

Apr 0

4

May 04

Jun 0

4Ju

l 04

Aug 0

4

Sept

04Oct 0

4Nov

04

Dec 04Ja

n 05

Feb 0

5Ja

n 05

Feb 0

5Mar 0

5Ap

r 05

May 05Ju

n 05Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5Nov

05Dec

05

7 0

7 5

8 0

8 5

9 0

9 5

100

105

110

Pe

rce

nt

A M I S m o k i n g C e s s a t i o np chart


U C L

Mean

L C L

J C A H O T o p 1 0 %


Jul 02Au

g 02

Sept

02Oct

02

Nov 02

Dec 02Ja

n 03

Feb 0

3Mar 0

3Ap

r 03

May 03Ju

n 03Ju

l 03

Aug 0

3

Sept 0

3Oct

03

Nov 03

Dec 03Ja

n 04

Feb 0

4Mar 0

4Ap

r 04

May 04Ju

n 04Ju

l 04

Aug 0

4

Sept 0

4Oct

04

Nov 04Dec

04Ja

n 05

Feb 0

5Mar 0

5Ap

r 05

May 05Ju

n 05Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5Nov

05Dec

05

40

60

80

100

120

140


CHF – Core MeasuresP

erc

en

t

H e a r t F a i l u r eA C E I n h i b i t o r U s e

p chart

UCL = 100 .41

Mean = 75.18

LCL = 49.95

J C A H O T o p 1 0 %

Focused Attent ion by PCF

Jul 02Au

g 02

Sept

02Oct 0

2Nov

02

Dec 02

Jan 0

3

Feb 03

Mar 03

Apr 0

3

May 03

Jun 0

3Ju

l 03Au

g 03

Sept 0

3Oct

03Nov

03Dec

03

Jan 0

4Fe

b 04Mar 0

4Ap

r 04May

04Ju

n 04Ju

l 04

Aug 0

4

Sept

04Oct 0

4Nov

04Dec

04Ja

n 05Feb

05Mar

05

Apr 05

May 05

Jun 0

5Ju

l 05

Aug 0

5Se

p 05Oct 0

5Nov

05Dec

05

4 0

5 0

6 0

7 0

8 0

9 0

100

110

Pe

rce

nt

Hear t Fa i lu reA s s e s s m e n t o f C a r d i a c F u n c t i o n

p char t

UCL = 101.74

Mean = 91.83

LCL = 81.91

J C A H O T o p 1 0 %

Focused Attention by PCF

Jul 02Au

g 02

Sept 0

2Oct

02Nov

02Dec

02Ja

n 03Fe

b 03Mar 0

3Ap

r 03May

03Ju

n 03Ju

l 03Au

g 03

Sept

03Oct 0

3Nov

03

Dec 03Ja

n 04

Feb 04

Mar 04

Apr 0

4

May 04

Jun 0

4Ju

l 04Au

g 04

Sept 0

4Oct 0

4Nov

04Dec

04

Jan 0

5Fe

b 05Mar 0

5Ap

r 05May

05Ju

n 05Ju

l 05

Aug 0

5Se

p 05Oct 0

5Nov

05Dec

05

65

70

75

80

85

90

95

100

Pe

rce

nt

H e a r t F a i l u r eD i s c h a r g e I n s t r u c t i o n s

p chart

U C L = 6 7 . 4 8

Mean = 48.26

LCL = 29.04

J C A H O T o p 1 0 %

Focused Attent ion by PCF

Jul 02

Aug 0

2

Sept

02Oct 0

2Nov

02Dec

02Ja

n 03

Feb 0

3

Mar 03Ap

r 03

May 03Ju

n 03Ju

l 03

Aug 0

3

Sept

03Oct 0

3

Nov 03Dec

03Jan

04Fe

b 04Mar 0

4Ap

r 04

May 04Ju

n 04

Jul 04

Aug 0

4

Sept 0

4Oct 0

4

Nov 04

Dec 04Ja

n 05

Feb 0

5Mar

05Ap

r 05

May 05Jun

05Jul 05

Aug 0

5Se

p 05Oct 0

5

Nov 05Dec

05

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

80

85

90

Pe

rce

nt

Hear t Fa i lu reS m o k i n g C e s s a t i o n

p char t

Mean = 74.48

LCL = 24.35

J C A H O T o p 1 0 %

Focused Attention by PCF

Jul 02

Aug 0

2

Sept

02Oct

02

Nov 02Dec

02Ja

n 03

Feb 0

3Mar

03Ap

r 03

May 03Ju

n 03Jul

03

Aug 0

3

Sept 03

Oct 03

Nov 03

Dec 03Ja

n 04

Feb 0

4Mar

04Ap

r 04

May 04Jun

04Jul 04

Aug 0

4

Sept

04Oct 0

4Nov

04Dec

04Ja

n 05

Feb 0

5

Mar 05Ap

r 05

May 05Ju

n 05Ju

l 05

Aug 0

5Se

p 05Oct 0

5

Nov 05Dec

05

0

10

20

30

40

50

60

70

80

90

100

110

120


Pneumonia Core MeasuresP

erc

en

t

CAP Ant ib io t ic T iming w i th in 4 hours o f Ar r iva lp chart


U C L

Mean

LCL

Jul 04

Aug 0

4

Sept 0

4Oct 0

4Nov

04

Dec 04

Jan 0

5Fe

b 05

Mar 05

Apr 0

5

May 05

Jun 0

5Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5Nov

05

Dec 05

10

20

30

40

50

60

70

80

Pe

rce

nt

CAP Smoking Cessat ionp chart


UCL

Mean

LCL

Focus Attention by PCF

Jan 04

Feb 04

Mar 04

Apr 0

4

May 04Ju

n 04

Jul 04

Aug 0

4

Sept 0

4Oct 0

4

Nov 04Dec

04Jan

05Feb

05Mar

05Ap

r 05

May 05

Jun 0

5Ju

l 05

Aug 0

5

Sept 0

5Oct 0

5

Nov 05Dec

05

0

20

40

60

80

100

120

140

Pe

rce

nt

CAP Blood Cul turesp chart


U C L

Mean

LCL


Jan 0

4

Feb 0

4Mar 0

4Ap

r 04May

04Ju

n 04Ju

l 04

Aug 0

4

Sept

04Oct

04

Nov 04

Dec 04

Jan 0

5

Feb 0

5Mar 0

5Ap

r 05

May 05

Jun 0

5Ju

l 05

Aug 0

5

Sept

05Oct

05

Nov 05

Dec 05

65

70

75

80

85

90

95

100

105

Per

cent

CAP Ini t ia l ATB Select ion non-ICUp chart


UCL

Mean

LCL

Jul 04

Aug 0

4

Sept 0

4Oc

t 04Nov

04Dec

04Jan

05Feb

05Mar

05Ap

r 05

May 05

Jun 05

Jul 05

Aug 0

5

Sept 0

5Oct 0

5

Nov 05

Dec 05

30

40

50

60

70

80

90

100

110

Pe

rce

nt

CAP Pneumococca l Vacc ina t ionp chart


UCL

Mean

LCL


Jan 0

4Fe

b 04Mar 0

4Ap

r 04May

04Ju

n 04

Jul 04

Aug 0

4

Sept

04Oct

04

Nov 04

Dec 04

Jan 0

5

Feb 0

5

Mar 05

Apr 05

May 05

Jun 0

5Ju

l 05Au

g 05

Sept 0

5Oct 0

5Nov

05

Dec 05

20

30

40

50

60

70

80

90

100

Patient Satisfaction


86.2

74.2

7877.7

77.2

85.7

80.583.3

86.6

91.4

83.985.7

81.882.3

96.9

93.1

86.988.4

60

65

70

75

80

85

90

95

Percent

Jul-Sep 2002 Oct-Dec 2005

4 BCVI3 Tower3 Main4 Tower4 Main5 Main5 TowerOBWomens

12 Bed Hospital Implementation

BEFORE AFTER

Press Ganey 90th percentile


Press-Ganey Patient Satisfaction Survey“Nurses Kept You Informed”


87.5

79.781.7

77.8

77.8

85

79.7

88.7

85.3

90.8

87.387.3

80.9

84.7

95.9

94.2

87.288.8

60

65

70

75

80

85

90

95

Percent

July-Dec 2002 Oct-Dec 2005

4 BCVI3 Tower3 Main4 Tower4 Main5 Main5 TowerOBWomens

12 Bed Hospital ImplementationBEFORE

AFTER



Press-Ganey Patient Satisfaction Survey“Attention to Special/Personal Needs”

Nurse Satisfaction


NDNQI RN Satisfaction Survey“Teamwork Between Coworkers”

(Individual Level Response)

Baptist Hospital NDNQI RN Satisfaction Survey 2003-2005

"Teamwork"(Individual Level Response)

0

10

20

30

40

50

60

70

80

2003 NDNQI2003 All Units BHM2004 NDNQI

2004 All Units BHM2005 NDNQI2005 BHM All Units

Individual Level Question:

There is a good deal of teamwork between my coworkers and me.


NDNQI RN Satisfaction Survey“Sufficient Time for Patient Care”


"Time for Patient Care"(Individual Level Question"

0

10

20

30

40

50

60

70

80

2003 NDNQI2003 All Units BHM2004 NDNQI2004 All Units BHM2005 NDNQI2005 BHM All Units

Individual Level Question:

I have sufficient time for direct patient care.


NDNQI RN Satisfaction Survey“Job Enjoyment Score”


"Job Enjoyment"

0

10

20

30

40

50

60

70

80

2003 NDNQI2003 All Units BHM2004 NDNQI2004 All Units BHM2005 NDNQI2005 BHM All Units

Individual level Question:

I am fairly well satisfied with my job.

Physician Satisfaction


Physician Survey

77%

81.2%

90.1%88.5%

65.0%

74.4%

81.5%

81.8%

77%

89.7%

89.9%90%

77%

92.4%

97.5%

93%

50%

60%

70%

80%

90%

100%

Overall Nursing Care Nursing Staffresponse to MDs

Manage Emergencies D/C Coordination

BenchmarkMar-03Jun-04Mar-05

Organizational GoalsPatient Throughput


Per

cen

tBaptist Hospital 11 AM Discharges-Med Surg Units

34226

38133

41846

38325

39329

37838

36650

33454

40040

35635

40649

34653

39963

40744

39849

38250

28837

41348

41876

37257

36847

37050

35060

40072

41857

34548

34858

36568

37957

BHM Med Surg totalBHM Med Surg before 11

p chartTemporary: UCL = 18.19, Mean = 12.99, LCL = 7.79

Inspected Mean = 376.66, Counts Mean = 48.93

UCL

Mean

LCL

Goal 33%

Hurr. Katrina 8/26

Hurr. Rita 9/20

Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/02-1

/06 20

06

1/9-1/

13

1/16-1

/20

0

5

10

15

20

25

30

35

40


Per

cen

tBaptist Hospital 2 PM Discharges-Med Surg Units

342106

381121

418143

383133

393131

378130

366146

334137

400146

356110

406163

346139

399170

407141

398161

382146

288101

413144

418193

372165

368151

370154

350167

400202

418188

345146

348161

365166

379170

BHM Med Surg totalBHM Med Surg before 2



UCL

Mean

LCL

Goal 66%

Hurr. Katrina 8/26 Hurr. Rita 9/20

Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/02-1

/06 20

061/9

-1/13

1/16-1

/20

0

10

20

30

40

50

60

70


11 AM Discharge Outcomes Med- Surg/Oncology Nursing Unit

Pe

rce

nt

5 T o w e r 1 1 A M D i s c h a r g e s37

444

94612

427

373

3 64

428

4 09

444

4 34

409

3 57

434

4810

405

4610

2511

5415

5215

4910

429

3010

256

3714

4 01 2

298

2 68

4415

3 51 0

5T total5 T b e f o r e 1 1

p c h a r tTemporary : UCL = 41.59, Mean = 21.89, LCL = 2.20

Inspected Mean = 39.69, Counts Mean = 8 .69

U C L

Mean

LCL

G o a l 3 3 %

Hurr . Wi lma 10/24

Hur r . R i t a 9 /20Hurr . Kat r ina 8 /26

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/2-1/

6 200

61/9

-1/13

1/16-1

-20

0

5

10

15

20

25

30

35

40

45

Pe

rce

nt

5 T o w e r 2 P M D i s c h a r g e s3712

4 42 0

4622

4 21 7

3717

3614

4 22 3

4019

4 41 5

4310

4016

3515

4315

4820

4021

4621

2519

5 43 0

5224

4 92 3

4218

3018

2516

3732

4022

2922

2615

4423

3 51 8

5T total5T before 2

p chartTempora ry : UCL = 72 .19 , Mean = 48 .39 , LCL = 24 .60

Inspec ted Mean = 39 .69 , Counts Mean = 19 .21

U C L

Mean

LCL

G o a l 6 6 %Hur r . R i t a 9 /20

Hurr . Kat r ina 8 /26

Hur r . Wi lma 10 /24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/2-1/6

2006

1/9-1/

13

1/16-1

-20

20

30

40

50

60

70

80

5 Tower Percent Discharged by 11:00 AM

5 Tower Percent Discharged by 2:00 PM


Pe

rce

nt

5TD Flor Aguirre 11 AM Discharges151

132

236

192

170

162

201

173

181

232

152

162

171

174

141

212

113

224

263

193

132

82

72

81

93

50

52

125

62

5TD total5TD before 11

p chartTemporary: UCL = 42.43, Mean = 14.81, LCL = none


UCL

Mean

Goal 33%

Hurr. Wilma 10/24

Hurr. Rita 9/20

Hurr. Katrina 8/26

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17-

10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21-

11/25

11/28

-12/02

12/05-

12/09

12/12

-12/16

12/19

-12/23

12/26-

12/30

1/2-1/

6 200

6

1/9-1/1

3

1/16-1

-20

0

10

20

30

40

50

60

Pe

rce

nt

5TD Flor Aguirre 2 PM Discharges153

136

2310

197

177

167

209

176

180

236

156

162

176

176

145

218

114

229

267

194

136

84

74

87

97

54

54

125

63

5TD total5TD before 2



U C L

Mean

LCL

Goal 66% Hurr. Rita 9/20

Hurr. Katrina 8/26

Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-1

0/7

10/10

-10/14

10/17-

10/21

10/24

-10/28

10/31

-11/04

11/07-

11/11

11/14

-11/18

11/21

-11/25

11/28-

12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/2-1/

6 200

6

1/9-1/1

3

1/16-1

-20

0

20

40

60

80

100

Pe

rce

nt

5TA Maria Encias 11 AM Discharges91

1 15

63

71

72

62

63

94

1 02

71

1 04

83

123

1 24

102

92

41

113

137

1 11

95

95

61

1 34

1 23

1 13

93

1 45

1 54

5TA total5TA before 11



U C L

MeanGoal 33%

Hurr. Wilma 10/24

Hurr. Rita 9/20

Hurr. Katrina 8/26

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/2-

1/6

2006

1/9-1/1

3

1/16-1

-20

2 0

4 0

6 0

8 0

100

Pe

rce

nt

5TA Maria Encias 2 PM Discharges93

1 18

64

73

72

62

64

96

1 03

71

105

87

125

125

107

94

42

1 16

1 31 0

115

97

96

64

137

1 24

1 16

96

1 48

1 58

5TA total5TA before 2



UCL

Mean

L C L

Goal 66%

Hurr. Rita 9/20

Hurr. Katrina 8/26

Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07-

11/11

11/14-

11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/1

6

12/19

-12/23

12/26

-12/3

0

1/2-1/6

2006

1/9-1/1

3

1/16-1

-20

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

Pe

rce

nt

5TC Jan Roy 11 AM Discharges60

162

92

82

61

80

92

112

101

60

72

41

90

132

132

113

70

142

90

80

102

70

62

102

124

91

5TC total5TC before 11



UCL

Mean

Goal 33%

Hurr. Wilma 10/24

Hurr. Rita 9/20Hurr. Katrina 8/26

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-

7/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-1

0/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

0

10

20

30

40

50

60

70

Pe

rce

nt

5TC Jan Roy 2 PM Discharges61

163

94

84

65

82

96

116

105

60

73

42

94

135

137

115

75

148

92

84

104

73

64

108

128

95

5TC total5TC before 2



UCL

Mean

L C L

Goal 66% Hurr. Rita 9/20

Hurr. Katrina 8/26Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-

10/7

10/10

-10/14

10/17-

10/21

10/24

-10/28

10/31

-11/04

11/07-

11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

0

20

40

60

80

100

120

11AM Outcomes by PCFP

erc

en

t

5TB Susan Howard 11 AM Discharges72

40

81

82

70

60

72

30

60

71

81

71

50

60

30

53

32

72

43

1 12

1 00

60

61

63

72

41

62

62

72

5TB total5TB before 11



UCL

Mean

G o a l 3 3 %

Hurr. Wilma 10/24

Hurr. Rita 9/20

Hurr. Katrina 8/26

7/04-7

/08

7/11-7

/15

7/18

-7/2

2

7/25-7

/29

8/01-8

/05

8/08

-8/1

2

8/15-8

/19

8/22-

8/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-

9/30

10/3-

10/7

10/10

-10/14

10/17

-10/21

10/24-

10/28

10/31

-11/04

11/07-

11/11

11/14

-11/18

11/21-

11/25

11/28-

12/02

12/05-

12/09

12/12

-12/16

12/19

-12/23

12/26-

12/30

1/2-1/

6 200

6

1/9-1/1

3

1/16-1

-20

0

1 0

2 0

3 0

4 0

5 0

6 0

7 0

8 0

9 0

Pe

rce

nt

5TB Susan Howard 2 PM Discharges75

43

84

83

73

63

74

31

61

73

82

74

50

64

32

54

33

73

43

1 16

1 01

62

64

66

73

44

63

64

73

5TB total5TB before 2



U C L

Mean

LCL

Goal 66%

Hurr. Rita 9/20Hurr. Katrina 8/26

Hurr. Wilma 10/24

7/04-7

/08

7/11-7

/15

7/18-7

/22

7/25-7

/29

8/01-8

/05

8/08-8

/12

8/15-8

/19

8/22-8

/26

8/29-9

/02

9/05-9

/09

9/12-9

/16

9/19-9

/23

9/26-9

/30

10/3-1

0/7

10/10

-10/14

10/17

-10/21

10/24

-10/28

10/31

-11/04

11/07

-11/11

11/14

-11/18

11/21

-11/25

11/28

-12/02

12/05

-12/09

12/12

-12/16

12/19

-12/23

12/26

-12/30

1/2-1/

6 200

6

1/9-1/1

3

1/16-1

-20

0

2 0

4 0

6 0

8 0

1 0 0

1 2 0

1 4 0

PCF #1 PCF #2

PCF #3 PCF #4


Nursing Statistics

0%

5%

10%

15%

20%

2001 2002 2003 2004 2005

Turnover Rates 2001-2005

Baptist HospitalFlorida

0%

5%

10%

15%

20%

2001 2002 2003 2004 2005

Nurse Vacancy Rate 2001-2005

Baptist HospitalFlorida


Next Steps

q Improve standardization among PCFsq Extend 12 bed concept to other disciplinesq Measurement on all key outcomes by PCF q Integration with a “care manager” roleq Evaluate as a system-wide deliveryq Formal cost-benefit analysis and further

research


Contact Information:

Joan Shinkus Clark RN, MSN, CNAA, BCBaptist Hospital of [email protected]

Janet Maloney RN, BC, MSMBaptist Hospital of [email protected]

Documents

Developing the Clinical Nurse Leader Role in the Baptist ... · Developing the Clinical Nurse Leader ... q Based on Dr. Jean Watson’s Theory of Transpersonal Caring n caring is