Nurse leadership cultivates the change in the hospital emergency department

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Nurse Leadership Cultivates Change in hospital s Emergency Department Over the past three years, the ED at St. Vincent?s Medical Center in Bridgeport, Conn., has undergone to complete transformation. From restructuring the 140-person staff to renovating the ED, the Michael j. Daly Center for Emergency and Trauma Care have taken patient and staff satisfaction scores from the single digits to the 90th percentile.

According to Kathleen Woods, RN, MSN, CEN, director of the ED, before the transformation began the ED had a 14% RN vacancy rate to lack of structure and long wait times. Hired as a change agent in 2007, Woods began the transformation process by following John Kotter?s theory on leading change.Kotter to Harvard Business School professor and author, focuses on individual and management support to enact change in the workplace leadership.

Initiating Change

To create a sense of urgency, Woods evaluated resources and educational opportunities and submitted an action learning project. ?We had to get rid of the apathy, ? Woods says.

Her second step was forming strong staff coalition, which began by having charge nurses and other leaders reapply for their positions to determine if they were the best candidates for their jobs. The new ? comprising new and old employees ? was selected to ensure 24/7 staff leadership. To reduce conflicting personalities, to peer-interview committee also was included in the reassignment process.

Woods St Vincent?s envisions as a destination with a 0% hospital RN vacancy rate, an ED newsletter, meetings and staff accountability consistent. To get buy-in and empower employees to carry out the vision, she started processes pilot groups with new staff.For example, two RNs and a secretary would try a new patient care process with eight to 10 patients. During the pilot phase, Woods trusted staff to adjust patient care to what worked best, even if it veered from the initial idea, she says.

Nina Fausty, RN, MS, assistant vice president of patient care services, says Woods is effective in getting her staff through periods of destabilization because she is willing to change course if concerns arise. ?The change [she has helped create in the ED] has been evidence-and theory-based.Transformational leader, quintessential She?s ? Fausty says.

The ED also took on new nursing grads who were paired with preceptors to help assimilate them to the system. ?The six to seven preceptors take the job seriously, ? says ED Nurse Manager Joe Halkowicz, RN, who has been with St. Vincent?s for 35 years.?If that person fails, the preceptor feels like he [or she] ?.

Throughout the ED refinement process, employees have been recognized for jobs well - done with monetary rewards and praise from programs such as Touch My Heart, in which staff and patients hospitalwide write down how staff members affected their lives. Some stories have been so touching they?ve brought tears to eyes, employees? Halkowicz says.

?If we hadn?t had the level of commitment across the board, we wouldn?t be where we are today, ? says Dale Danowski, RN, BSN, MBA, vice president of patient care services and chief nursing officer.

Bonuses were re-evaluated also. All managers now get bonuses based on whether they meet their goals, which creates more employee accountability, Danowski says.Continuing education and earning higher degrees also are encouraged with incentives, such as tuition reimbursement programs.

Trying New Things

After completing phase one of the ED construction, it was decided it would be beneficial to have a nurse patients as they check in to assess reduces ED wait times. This nurse, called the first nurse, is stationed at the front desk.The experienced triage nurses in this role perform a visual assessment and take the patients? vitals to decides if they will be admitted, discharged, or see a physician quickly and triaged.

For example, when patients present with abdominal or chest pain, they are seen by an ED physician and nurse within minutes, says Kathy Gearing, RN, who works in the first nurse role. This type of assessment the sicker people care quicker, Gearing ? ?gets says.

Patients with less serious complaints, such as a cold or sore throat, will be sent to the Express Care Plus area to receive treatment.A new locked-down unit was created near the ED for behavioral health patients, which have improved the safety of staff and patients.On that unit to behavioral health nurse and an evaluator provide specialized care.

Gearing says there is much more teamwork and communication between nurses with the establishment of the first nurse position. But staff are not the only fans of this approach.Gearing says patients like the immediate interaction with healthcare staff, and patient satisfaction scores have increased dramatically since the position was implemented in January.

Another useful tool is an eight-hour shift report sent out every morning by hospitalwide electronic Jody Gerard, MD, FACEP, chairman of the ED, that details daily averages, such as door-to-floor times.The physicians, nurses and other staff with Woods brainstorm every morning on how to fix problems immediately.Because of the frequent brainstorming sessions to tweak processes to improve flow, Woods says 85% of patients are seen in less than an hour, and the ED has reduced its patient safety events from one per month to one per year.

Renovation Plans

The ED will triple in size when construction is completed in 2011, Halkowicz says.It will feature 60 beds, an increase of 32 from the original Ed The flow of the ED is continually reworked as newly renovated open parts.When renovations are finished, the ED will encompass 40,000 square feet and will be able to serve 80,000 patients annually.As each phase is completed, construction Fausty says the ED staff carefully measures patient volumes and adjusts staffing according to need.

Other new features of the ED are a four-room triage unit, six new critical care rooms with monitoring systems and dialysis compatibility, updated two connected trauma rooms that can accommodate two patients each if necessary in a disaster, dedicated radiology scanning technology, a new waiting area to bereavement private suite, new administrative space, locker room, staff an EMS lounge and a security office.
Coming soon as other phases are completed will be specialized trauma and critical care suites, dedicated OB/GYN rooms, to decontamination facility for hazardous spills and more.

?You have to really give credit to the entire [ED] team;about teamwork, ? Fausty it?s says.?That?s the secret to their success, and I have the utmost respect for them.They are role models. ?

Editor?s note: For a photo gallery of the ED, visit www.Nurse.com/gallery/StVincentsED.

Heather Cygan regional is editor of Nurse.com/NewYork.

Send an email to editorNTL@gannetthg.com or post a comment below.

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