Remember The Mission

“The highest reward for a person's toil is not what they get for it, but what they become by it.”  -  John Ruskin                        

CEO/President, George B. Hernandez, Jr. waits while presenter makes introductions.

Kicking off the New Year, UHS nurses, support staff and senior level administrators came together for the Nursing Strategic Planning retreat. Nancy Ray, CNO, introduced CEO/President George Hernandez who provided the political horizon on health care reform.  His message was one of hope and encouragement!  Using Bob Dillon’s song, Times are changing , he emphasized that our organization is in a great position to meet the new challenges in health care.  Peggy Deming, CFO provided the audience with the financial data and how we can achieve our mission with a margin through excellence in patient care. Mark Webb delighted everyone with animation of our new facilities and UHS future!  Christian Vasquez, COO spoke for the first time to many nurses since joining UHS in August.  Her message was clear that our patients come first; we are here to provide them with care that not only satisfies them but exceeds their expectations.  Michelle Ingram provided a roadmap to the Quality solution in which we must become savvy in our use of data and metrics.  Last but not least, Nancy Ray, CNO set the stage for the afternoon!  Outlining the goals of quality, customer service, fiscal strength, and continuity of care for the nursing journey to professional excellence always strive for the best! Today is an opportunity for nurses to demonstrate their skill, dedication, and passion for the UHS mission in creating 2010 strategic plan.

Brainstorming Session

Over 90 UHS nurses formed several groups to brain storm on improving operations and fostering continuous improvement efforts in their units while serving patients. Dr. Jean Setzer, UHS Strategic Planner provided this large group with her skilled guidance and enthusiasm in creating the plan. She led each group with empowering suggestions to help nurses achieve their goals while using tools that would strategically implement their unit’s ‘action’ priorities. Goals and opportunities were identified and discussed as each participant enthusiastically expressed their ideas. As bright colored note pads and flip charts encompassed the room, it was clear each participant was dedicated to the goal at hand.   The plan and our Strengths, Opportunities, Aspirations, Results (SOAR) can be clicked on here.  The day provided new excitement, prospects for the future, and a plan!    The journey to excellence continues!

by Marilyn Green

My first experience with University Hospital was as a young, inexperienced Medina County EMT. We brought an out of county patient to the EC. This patient was found down, and had no physician and no history. The patient was left by another county's EMS service at the very tiny hospital in Medina County. Possibly saving this patient's life meant taking him elsewhere. We proceeded to Bexar County.

Bexar County took the patient into the EC. As we were making an escape an EC nurse came down the hall after us. As the male EMTs with the stretcher made a very hasty retreat, I was left behind to answer questions as to who would take responsibility for this patient and to hear the reasons why out of county patients should not be left. Even as she seemed to be angry, the nurse and I both knew there was no alternative to the patient's care. As an employee of UHS, I have learned that regardless of finances UHS stands for quality patient care.  What a concept. The longer I have been here the more I appreciate how UHS employees truly care. How great is it to feel really needed? Every day we make a difference in a patient's life.

As I am planning retirement I cannot help but to remember landmarks of my time here, like the first heart lung transplant
and the first lung transplant. Other firsts for me necrotizing fascitis, toxic shock, multitrauma, CABG, kidney transplant.
All of this was so new to me, I had worked in small rural hospitals. It may just be memory, but so many nurses touched me. The joy of spending time with them, some never left the hospital after surgery, some never left SICU.
Two really stand out, they still had time to laugh. Neither had sadness.

With that, I never imagined that I would work in such a large hospital, much less stay for 23 years.

I have to look back on UH nurses, so many. How can I say thank-you?
Noel Schaffer who hired me.
Kate Robertson who kindly kept me employed
Virginia Zamora who put up with me
Vangie Castro ARRT (retired) who brought me to radiology
Susan Gerhardt who always keeps her sense of humor
Debbie Fraley and Michelle Kaderli, the best ACLS instructors
Pamela Mann, best BCLS instructor trainer
Kevin Hart current boss. What an inspiring person.
Kristi Hill-Herrera always ready to discuss any issues
Wen Pao with so much common sense and intuition
Nancy Ray who leads an incredible group of nurses
Tom Culwell so supportive as night supervisor
Jackie Powers who works so hard, but is always professional as I call about getting a patient bed that is not there.
Michelle Ryerson, a trusted confidant and resource on all things pediatric prior to becoming Associate Administrator
Amy Hensz always available, sometimes late into the evening.
Radiology nurses that have made my job such a rewarding experience.
Radiology technologist and support staff.�
I can look back on so many things, it would take many pages to complete.

UHS, keep on going for magnet status. Do not give up. There is not a group of nurses anywhere that deserve it more.

Nationally, nurses’ value certification as it enhances personal accomplishment, provides personal satisfaction, demonstrates professional growth, validates specialized knowledge, enhances professional credibility and provides a professional challenge.  Just to name a few values!   UHS nurses have made it clear how they value certification.  CLICK HERE TO SEE ALL CERTIFIED UHS NURSES AND HOW THEY VALUE CERIFICATION.

At UHS nurses throughout the organization have demonstrated this professional excellence and were recognized on National Certification Day on March 19th!  The Recruitment, Recognition, Retention Council co-chaired by Robert Yancey and Amy Henz created a wonderful event during days and nights to express how appreciative we are of our Certified Nurses! 

Nancy Ray, CNO was on hand for both events to express her gratitude and support for nurses who are certified along with encouragement for every nurse to become certified and demonstrate their specialized knowledge!  Additionally every certified nurse received a letter of appreciation from George Hernandez, CEO and a special gift pen engraved “We are Proud of You!”   


How are units creating cultures that encourage certification?  Intermediate Progressive Care Unit Magnet Unit Council encourages staff to take every opportunity to earn recognition.  They want all nurses to demonstrate their professional practice through Nursing Professional Clinical Advancement.  The support has helped create determination and personal drive for 5 nurses to obtain their CCRN certification in the last year.   Mariamma Shaju, Sherly Biju, Jai Philip, Allyamma Kuruvilla, Bessie Moonummackal, and Renimal Kochumon, have now brought the total of nationally certified nurses in IPCU to 29%.

To encourage certification, IPCU’s Magnet Council maintains a National Certified Recognition bulletin board mounted on our "Hall of Fame".  The board is filled with pictures of National Certified RNs, other staff who have obtained certification in the past and provides staff with review materials.  We also celebrate successful certification achievements with a unit party!  Now that review materials are provided by the hospital free and we are dedicated to honor National Certified Nurses, we believe that there will be an increased awareness and interest among UHS RNs to be nationally certified.

Thank you to RRR council and Amy Hensz for recognizing UHS Nationally Certified Nurses even at 1030 PM on March 19 to include the other half of UHS (nightshift)."We are UHS too!”
 

In 2006/2007 Reneau Elsworth, PT; Noel Schafer, RN; and, Julia Aulner, PT identified a need for outpatient nursing staff to be competent in the crutch training of patients requiring crutches during off hours to facilitate discharge.  This prompted us to work in collaboration to develop nursing competencies in this area.

Reneau and Julia completed all of the crutch training competencies for the nursing staff and trained one person as a staff “Super Trainer.”  This allowed the outpatient nursing staff to continue to train all new staff members to be competent in this area as well.

In doing so, we feel we have been able to decrease length of stay, improve patient satisfaction, and improve the overall efficiency of services provided.

In early 2009, PT/OT had the opportunity to work with a small child with a gun shot wound to the left arm requiring extensive arterial and nerve grafts from his left leg to facilitate recovery.  In the process, he lost a great deal of strength and range of motion in his left leg and became fearful of intervention.

Child Life Specialist, Jessica Tarcin, CCLS and I,  Julia Aulner, PT collaborated to make rehabilitation “fun” and used “Big Wheel Races” combined with other modalities to facilitate functional return.

This child looked forward to therapy each day; his range of motion improved by over 30 degrees in three days and the family was given an easy method of “play therapy” that was extremely beneficial to this child.  By discharge, he had nearly full functional return of his leg and his family was able to participate in seeing the continued return to functionality of his left leg.

Carla Mc Daniel RN

Intermediate Progressive Care Unit (IPCU)

The position of Admission Nurse was created when UHS wanted to meet and/or exceed Joint Commission’s standards for patients admitted in the EC, but waiting for a floor bed.
Intermediate Progressive Care (IPCU) was given the task of correcting this lapse

Now, since University nurses know how to admit a patient, this was seemingly an easy mission to fulfill. All we had to do was figure out who, of the patients waiting in the Emergency Center (EC), had admission orders, find them, and admit them! Right? Well, nearly.

We have learned how to look at Sunrise and determine who has admit orders, how long each patient has had their orders and has been waiting for a bed, and where to locate them.  We begin by printing out our first census of the day.  Those with the longest wait times are checked to see if they have been admitted or do we need to see them first.

The first time I was assigned to be the Admission Nurse for the day. It started at about 0730 with a quick stop at the Bed Board Meeting. This let all of the players – House Supervisor, Nurse Managers, and me, know the game plan for the day.

I then moved from the conference room to the vast unfamiliar zone known as the EC. We really don’t get to know the staff. They come up on the unit, drop off patients, and they go away again.  Their unit routines are different from most. At least, they’re different from my unit’s.  And, it seemed, I was always in someone’s way! What seemed like chaos to me, was a “nice, quiet” day to the EC staff, according to the RN I spoke to that day.

I first had to find a C.O.W. (computer on wheels) so that I could move from bed to bed and accomplish my goals. This C.O.W. needed to have all the admitting paperwork with it and it would be a plus if it did not roll like the goofy shopping cart at HEB!

The admission nurse’s responsibilities are to do an Admission History (all parts), initial assessment, Rights and Responsibilities, Nutrition Evaluation, Discharge Summary and make sure each patient received a hospital handbook.  The goal is to do as many as possible in the course of our shift.

This means, if the patient does not speak English and admission nurse does not speak the language of the patient, an interpreter must be found.  Hopefully, there will be an English speaking family member available, as the EC staff does not always have the time to assist us. If we find that the patient is intubated or unable to speak, we attempt to find a family member who can give us the information we need. If that fails, we chart a note informing the accepting staff which parts of the admission process need to be completed. We then do a physical assessment on the patient and chart it in Sunrise. The patient will sign the Rights and Responsibilities, if able, and a copy is placed in the chart.

Once the patient is assigned to a room, if all parts of the admission are completed, all the admitting floor needs to complete is an inventory of personal belongings. I know that by admitting the patient in the EC, it makes their arrival on my unit a very smooth transition. The patient is able to settle into their bed and begin the healing process with very little fuss. The staff here reports that their workload is greatly decreased by not having to admit their new patient and they are able to focus on taking care of their medical needs.

While I, personally, have gotten no feedback, my Nurse Manager, Wen Pao reports that when we started this process, we had a little more than 0% on the completion of the admission process. In the short time we’ve been going to the EC to do the admissions, we have improved to greater than 90%.  While we will continue to strive to reach 100%, it needs to stay above 90% to satisfy University Hospital and Joint Commission standards.

It is the hopes of the Admitting Nurses from IPCU that the service we are providing to the hospital not only fulfills Joint Commission guidelines, but also makes the receiving nurse’s job on the other units lighter.

I believe the most important aspect to consider out of this event is the fact that it reflects our nursing model because the two members of the MISS Foundation who are conducting these in-services were patients "first" and based on their experience with a fetal demise, became advocates for other women like themselves and now "train" the professionals to the "needs and wants" for these particular group of patients. We are listening and considering what they need the most from us in their time of sorrow.

        - Marisol Leija RNC

Read story and watch video!

Registered nurses at University Health System (UHS) who obtain national certifications in their specialty have achieved practice
excellence. These clinical experts perform varied roles, depending on the nature of the position, unit/clinic and patient population. The
unifying characteristic for these role models is the level of confidence that can be placed in them by administrators, colleagues and our
patients and their families. Nationally certified nurses enhance our ability to achieve optimal patient outcomes, improve patient safety
and quality of care and lower mortality rates.

To learn more about how to obtain a national certification in your specialty, please contact Bonnie Schranner, BSN, RN, RN-BC,
Continuing Education Coordinator, ext. 8-1709.

We are proud to honor our nationally certified nurses!

Nursing professional behavior is being exhibited as University Health System. Nurses are publishing, seeking grants, and sharing their expertise at national conferences and even with governors' healthcare policy advisory panels! 

Valerie Girard-Powell, Staff Nurse I, in the Operating Room published three articles in the month of May as part of an UTHSCSA interdisciplinary team.  The articles were published in the AORN Journal!  Please click here for descriptions of these articles. 

Rosanna Estrada, Staff Nurse II in the Hematology Oncology Unit was a member of a research team that published study results on assessing cardiac health.  The article by Jeanette A. McNeill, DrPH, RN; Jennifer Cook, PhD, RN; Marveen Mahon, BSN, RN; Maureen Rauschhuber, PhD, RN;  Mary Elaine Jones, PhD, RN and Rosanna Estrada BSN, RN was published in the July issue of the AAOHN Journal.  Please click here for an abstract of this study.  

Deborah Stolz, RN, BSN and Rosemary Cerda, RN, in collaboration with Mickey L. Parsons, PhD, MHA, RN; Pat Cornett, EdD, MSN, RN submitted a poster on the transforming care process within Hartman Pavilion to the annual Academy of Medical-Surgical Nurses Convention.  They received first place in the Leadership Category!   Click here to view "Transforming Medical-Surgical Nursing at University Health System:  A Quality of Care and Working Life Model"

Charles Reed, MSN, RN and Laura Fornos MA received a $4,166 grant from the Stafford Pryor Charitable Trust to purchase a ”digital playback" system .  They are developing an innovative research study on musical cueing of staff and families to TURN patients at regular intervals as an intervention to reduce pressure ulcers. 

This was only one of many scholarship activities Charles was involved in. He presented at four national conferences including: American Nurses Association National Database of Nursing Quality Indicators, Society of Critical Care Medicine Congress, American Association of Critical Nurses National Teaching Institute and the Summer Institute on Evidence-Based Practice: Innovation for Quality & Safety. He presented a total of six posters and two podium presentations.  Click here to view  

Another honor was when Charles received the 2008 Administrative Specialty Award of Critical Care Medicine for his abstract on “Improving Tight Glycemic Control With The Adjunct Use Of A Data Management Software Program”  Click here to view the poster this poster.  His most impressive experience was when he presented the implications of implementing tight glycemic control in ICUs to three governors' healthcare policy advisory panels.

by Valerie Girard, RN, SNI

Surgical Services




I am a RN in surgical services and recently went on vacation. When returning from vacation during the airplane boarding process the flight crew made an announcement for any medical personnel to come to the front of the plane immediately. I dropped my bags and rushed to the area to find a gentleman on the floor on the ramp a step before boarding the plane. Upon assessment the man had no respirations or circulation. I began CPR. Several minutes later I was joined by an off duty EMS staff member from the airport. We worked in tandem until an AED was available. We shocked the gentleman twice before he returned to a normal sinus rhythm. He was then taken by EMS to an area hospital. I was overjoyed at the end of the flight when the pilot came over the PA system to announce the gentleman had been taken to an area hospital and underwent a cardiac cauterization and was doing well!