Remember The Mission

Nurse Imagemakers

Lisa Sanchez, RN, administrative director, Patient Care Services, University Health Center-Downtown, and Irene Garcia-Sandate, MSN, RN, NNP-BC, who is on leave from the Neonatal ICU and Newborn Services, University Hospital, have been nominated for the 2010 South Texas Nurse Imagemaker award, by the Texas Nurses Association (TNA), District 8, and the Delta Alpha chapter of Sigma Theta Tau International (STTI) Nursing Honor Society.Sanchez and Sandate were among 34 other nurses recognized as “Nurse Imagemakers” for South Texas. In addition, Sanchez earned the Ruth Stewart Excellence in Nursing award. The awards were presented during a special luncheon held at Oak Hills Country Club, San Antonio, on May 22.All Imagemaker nominees are invited to write an essay on their definition of “Professional Image,” including two examples of how their practice contributes to the professional image of nursing.  Each year, one South Texas nurse is honored with the Ruth Stewart Excellence in Nursing award. The award, named for Ruth Stewart, a recognized nurse leader, educator and activist who set the “gold standard” for a positive image through community service and nursing accomplishments, selects the recipient of this honor.

Lisa Sanchez

Irene Sandate

Sanchez was overwhelmed and honored to earn the Ruth Stewart award this year. She told the crowd that she had a few gray hairs to prove her nursing career had been full of challenges and hard work. She was also quick to praise those who had made her the person she is today, especially her parents. Sanchez thanked Steve Enders, Sr. VP, Ambulatory Services; and Chris Vasquez, COO, for their support and vision.As the first healthcare organization to achieve Magnet status in San Antonio and South Texas, University Health System was also recognized and honored during the event.

Delta Chapter Sigma Theta Tau and the District 8 Texas Nurses Association recognized all of the University Health System staff in attendance and provided Evelyn Swenson-Britt, MS, RN, Magnet Project Director, a certificate in honor of the health system’s Magnet achievement.“University Health System honorees were also celebrated as nursing leaders whose contributions to our organization were pivotal in achieving Magnet Recognition,” said Swenson-Britt, MS, RN, Magnet Project Director.The 34 nurses selected as 2010 South Texas Nurses Imagemakers from healthcare educational and professional organizations in the South Texas community are honored as nurses who consistently model:

• A professional image and positive, caring attitude


• Leadership qualities


• A commitment to continuous learning


• Significant contributions to organization and community

For over 25 years, Sigma Theta Tau has recognized excellence in nursing through the Nurse Imagemaker award. Since 2006, the Texas Nurses Association, District 8, has partnered with Sigma Theta Tau to honor area nurses of distinction. Nurses are selected by their organizations to receive this award because of their professional image, positive and caring attitude, leadership qualities, commitment to continuous learning, and significant contributions to their organization and community.

Receiving Imagemaker Award

Nancy Ray

Welcome to Nurses Week.
Team members from across University Health System celebrated their Magnet status during Nurses Week – May 10-16. During the week, it seemed like no one could stop jumping with joy and excitement over becoming a “magnetically” excellent healthcare organization.  (See ad for Nurses week)

On the first day of Nurses Week, nurses were greeted by UHS executives, Mariachis and lots of Magnet balloons! They were provided with copies of the new nursing newsletter, emPOWERED, a quarterly publication featuring stories about our nursing excellence. The names of our nurses were spotlighted in our local newspaper, Express-News, for everyone in the city to know and appreciate the great nurses that work in our organization. (See ad)

The rest of the day was dedicated to our Magnet Celebration!  Mr. George B. Hernández, Jr., UHS President/CEO; Peggy Deming, CFO; Chris Vasquez, COO; and Nancy Ray, CNO, were the party leaders!   The festivities kicked off at University Center for Community Health with cheers, dancing and proclamations from Texas State Representative Trey Martinez-Fischer, District # 116. Nancy Ray read the proclamation during the celebration. The unveiling of the trophy and the congratulatory message from Gail Wolf, DNS, RN, FAAN Chair, and Commission on Magnet Recognition, made it official. Plus, Nancy’s favorite moment couldn’t arrive a minute sooner. She was excited to distribute the Magnet pins to staff members. Everyone was ecstatic to finally wear their “magnetically” wonderful pins! The entire organization joined in the pinning as it takes an entire organization to obtain Magnet Recognition.

UHS Celebrates being Magnetic.

The party continued at University Health Center-Downtown with many more cheers, posters, food and the unveiling of the trophy, not to mention, more Magnet pins! Staff celebrated with music as the Magnet Champions ripped through the paper to the sounds of “We are the Champions!”  Pride was everywhere as CareLink cheerleaders led the crowd in a special “I am UHS” cheer!

University Hospital was the last stop for two more celebrations!  Not to be outdone, the Magnet Champions at University Hospital provided the crowd with a celebratory “Texas” dance and songs!  City of San Antonio Councilman W. Reed Williams, District # 8, was on hand to read the proclamation from the City of San Antonio signed by Mayor Julian Castro. The posters were displayed throughout the cafeteria from multiple units and departments from across the organization, demonstrating how each provides a critical piece to our Magnet designation.

Last but certainly not least, our night shift celebration began at 11 p.m. with more cheers, dancing and food! Mr. Hernández and Nancy provided the crowd with yet another proclamation from Texas State Senator Leticia Van De Putte, District #26. Team members were filled joy and pride over their hard work and dedication to providing excellent care. Their work has never gone unnoticed, as they labor throughout the night to help make our patients better.

The week continued with the annual Walk in My Shoes program, as UHS executives shadowed nurses for a morning. Also, several units conveyed their wonderful massages in a special essay contest describing their “magnetic” status. Various units enjoyed cake and punch in honor of Florence Nightingale’s birthday and the launching of the Nursing Ethics Council. This final celebration completed the Nurses Week 2010. We celebrated our commitment to excellence, and to making a difference in the lives of our patients in San Antonio and South Texas!

Click here to view more "Magnetic" images.

Elizabeth "Ann" Maxey, RN, CCRN; Chasity McDonald, RN, CCRN; Michael Payne, RN, CCRN

Written By: Elizabeth "Ann" Maxey and Chasity McDonald

The Beacon award is a well deserved award for our unit.  The minute I heard about the award and what it meant to receive it, I knew our unit had to get it.  The idea was initially pitched to us by Craig Marshall, who was responsible for setting us on our Beacon Journey so many years ago.  We already met a great many of the criteria and the criteria that we did not meet we set out on the road to accomplishing. The word journey, is used a lot to describes the process in receiving the award and, to be honest, I cannot think of a better word.  We did not sit down one week and fill out the application. The process started and continued to evolve over several years. We had highs and lows just like any journey you take.  One of the great attributes about the Beacon Award is that it encompasses a 360 degree picture of the unit.  This means no one person can accomplish this task alone.  It is not only about nurses; it takes a whole team.  It encompasses everyone who has an interaction in our unit: patients, techs, physicians, clerks and visitors. For example that extra minute a nurse takes to answer a family's concerns, or the nurse that studies day and night to become certified.  The many years and dedication of service we have in the TICU alone screams Excellence.  I never had a doubt in my mind we would not receive the award. Then, finally,

I received a text message, "We won Beacon," from my co-worker Sonia Figueroa!  I remember standing in my kitchen and I could not contain my excitement! Word traveled pretty fast. Nancy Ray was very supportive and she gave our unit the opportunity to send 2 staff representatives to Washington, D.C. and represent the Transplant ICU and UHS at the American Association of Critical-Care Nurses' National Teaching Institute (NTI), where new Beacon Award unit recipients were recognized. I jumped at the chance. Our Director chose the two TICU Beacon Award representatives after asking those interested in making the trip to write a letter stating "WHY I SHOULD BE CHOSEN TO REPRESENT TICU AT NTI IN WASHINGTON, D.C.".  When Michael called and told me that I was selected to go, along with Chasity McDonald, it was the icing on the cake!!

On arriving to D.C., we attended the NTI Opening Ceremony. Sitting among seven thousand of our colleagues, I suddenly realized the impact that winning the Beacon Award had on me. When they asked all of the newly recognized Beacon winners to stand, I looked around saw such a small number of people stand up from the sea of 7,000 people sitting, and I knew we were among the elite. NTI was such a great learning experience and a fun time in general, to have gotten to share it with my co-worker was like no other

TICU is #1

(San Antonio, TX)    University Hospital’s Transplant Intensive Care Unit (TICU) has received the Beacon Award for Critical Care Excellence from the American Association of Critical Care Nurses (AACN). The TICU team is the first intensive care unit in San Antonio and just the second transplant ICU in the nation to receive this prestigious award. Developed in 2003 by the AACN, the Beacon Award recognizes individual critical care units that exhibit high-quality standards and exceptional care for patients and families while fostering and sustaining healthy work environments.

There are about 6,000 intensive care units in the United States, and less than four percent of them have been recognized for achieving, maintaining and documenting these extremely high standards. “This award is living proof of the great quality and service delivered on our transplant unit," said George B. Hernández, Jr., University Health System president/CEO.

"We are all so proud of the work done by this talented and dedicated team," added Christann Vasquez, University Health System chief operating officer.

To receive the award, a unit must meet 42 different criteria in six categories, including: Patient outcome, Evidence-based practice and research, Leadership and organizational ethics, Excellence/innovation in recruitment and retention, Education, training, and mentoring and Promoting healing environments.

The Beacon also provides nursing care units a way to better measure systems, outcomes and environments. “Your unit sounds like a great place to work and exhibits many Beacon qualities," wrote one of the Beacon Award reviewers.

"By reading your application, I get the sense that your unit holds each staff member and itself as a whole to a very high standard. Through all of the examples that you provided, I was able to develop an understanding of your unit culture," added another. “The teamwork of your unit staff and management is apparent in every exemplar. You have provided many excellent examples of unit based activities that show a consistent and pervasive sense of collaboration and excellence in practice."

Nancy Ray, RN, University Health System’s chief nursing officer, knows she has the best nurses in San Antonio. “It is so incredible what you all accomplish every day. I am so thankful you are UHS."

Michael Payne, RN, administrative director of the TICU agrees. “This is such a huge achievement! You all consistently provide the highest quality care and I hope you all take some time to pat yourselves on the back and appreciate your achievement.”

“I want you all to know how proud I am of you, and what a pleasure it is working with you," added Dr. Glenn Halff, medical director, University Transplant Center, and interim dean of the UT Health Science Center School of Medicine.

The AACN is the largest specialty nursing organization in the world, representing the interests of more than 500,000 nurses providing care to critically ill patients. University Health System was recently designated as a Magnet facility by AACN and this new award is further demonstration of the organization's commitment to excellence in patient care, and recruiting and retaining the very best nursing staff. To learn more about the Beacon Award, please visit www.aacn.org.

Charles Reed and Susanne Thees presenting Podcast Poster.

University Health System makes an impression at the Nursing 2010 Symposium held in Las Vegas during the 1st week in April. Approximately 1200 nurses from around the United States and Canada attended the conference which offered educational sessions focused on elevating nursing practice, inspiring transformation, and promoting innovation while enhancing cognitive and practical skills.  Ileana Fonseca, Susanne Thees, and Charles Reed presented FOUR posters highlighting initiatives worthy of our Magnet designation. These posters represented areas of process improvement, staff engagement, education, and quality.

The first poster:  Engaging Staff with Data: Implementing Nursing Quality Dashboards. Describes how UHS implemented dashboards to bring quality nurse sensitive indicator data to the bedside nurse.

Susanne Thees and Ileana Fonseca presenting Success is in Their hands.

The second poster: A Nurse's Subscription to Knowledge: Cultivating a Community of Learners Through Podcasting. Illustrates how to create, produce, and implement effective podcasts. Provides examples of podcasts produced at UHS.

The third poster: ENGAGING STAFF: Success is in Their hands.Demonstrates how staff participation in shared governance is more than just attending meetings, it is about engaging staff and tapping into an individuals’ talent to create a Healthy Work Environment.

The fourth poster: Patient Safety: Improving the Accuracy of Patient Identification While Performing Point-Of-Care Blood Glucose Tests. Exemplifies how a collaborative effort of multiple departments was successful in improving the accuracy of patient identification while reducing the number of invalid tests.

Nursing Research Week

Every day nurses at University Health System encounter situations that pose questions of what the nurse do in a given situation should.  Patients arrive for care and treatment with complex social situations, impacted by limited resources, which may be simple or very complex in nature.  When these patient’s situations create ambiguity or conflict, stress occurs.  

Sources of stress or conflict may be related to the different roles of the nurse as patient advocate, as hospital employee, as well as providing care under the direction on a physician.   This ambiguity or conflict may create moral distress when the nurse perceives that what is in the patients’ best interest may not be accomplished because of lack of autonomy or other institutional impediments.   Moral distress in nursing is disequilibrium that occurs when nurses are conscious of the morally appropriate action a situation requires but cannot carry out the action because of institution obstacles. 

The intensity of moral distress is influenced by the organizational culture which may impact the nurse in a variety of ways.  The organizational climate guides how ethical issues are addressed and creates an ethical climate. Organizational ethical climate is defined as the conditions and practices that affect the way difficult patient care problems, with ethical implications, are discussed and decided. Power, trust, inclusion, role flexibility and inquiry are present during these conditions

Jeanie Sauerland BSN, RN and Mary Anne Peinemann, MSN, RN wanted to understand more about these complex situations at University Health System.  They formed a discovery group in April 2009.  They became Co-Principle investigators along with discovery members Debra Fraley, MSN, RN, Bonnie Schranner, MSN, RN and Kathleen Marotta, BSN, RN.  Their mentor Catherine Robichaux, PhD, RN with expertise in nursing ethics led the way through their discovery process providing the latest in research as well as a guiding hand through grant fund application and the Institutional Review Board.   

These bold investigators were awarded grant funding from the Delta Alpha Chapter of Sigma Theta Tau International to study this phenomenon in November 2009.   Their questions “What are the levels of moral distress, perceptions of ethical climate and experiences of moral residue of registered nurses employed in acute nursing care units?” and  “Is Moral Distress related to the Ethical Climate within a Clinical Unit/organization?” will be answered after approval is received from the Institutional Review Board in the spring of 2010!  

Be looking for their exciting updates and conclusion to this Discovery Group!!

 

 

SIDS is a sudden and unexplained death that usually occurs while the infant is asleep. Placing the infant on his/her back to sleep and other safe sleep practices have shown to reduce incidence of SIDS. Since parents tend to follow practices that they observe in the hospital setting, staff should be vigilant in teaching and modeling the supine sleep position and safe sleep guidelines.

A Safe Sleep Task Force was created last June, 2009 and it includes staff nurses, rehabilitation, the medicine administrative director, the continuity of care coordinator and the educator. They created guidelines based on evidence from studies and other units’ practices. A pre-implementation survey was conducted and mandatory in-services were given over a period of 2 weeks. The staff was instructed to begin implementing the information they learned from the in-services. After one month, a post-implementation survey was conducted and there was marked improvement in the staff’s behaviors and attitudes about infant’s safe sleep.

The NICU staff has started to implement safe sleep by initiating discussions with parents and caregivers and modeling safe sleep practices to them.

A poster about this process improvement project was also created and presented by NICU educator, Irene Lopez RNC at UTHSCSA. Click to view poster.

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.