Remember The Mission

Lois Shillito and Kathy Cook with Helen Erickson

Intermediate Progressive Care Unit (IPCU) hosted Dr. Helen Erickson in the first “Modeling and Role Modeling (MRM) Grand Rounds April 29.  Application of our Professional Practice Model based on MRM theory to the diverse patient population in IPCU is challenging.  PPM once understood by nurses is a guide to delivery of targeted care based on patient needs.  These nursing interventions then lead to more satisfied patients with better outcomes.  Katherine Cox, BSN, RN, Kathy Cook, BSN, RN, Esther Hazlewood, RN, Jenny Ramos, RN, and Lois Shillito BSN, RN, shared their personal experiences of the challenges and the benefits of integrating MRM in their nurse/client relationships.

Nurses face the challenge of adapting to ongoing changes and meeting the demands in healthcare added to the acuity of our patient population.   Elements of care are being measured to provide better patient outcomes.   Nursing can become so focused on achieving certain measurements that we can forget that we are working with an individual human being with basic human needs.  We can only realize these needs when we are able to give ourselves a few moments to see our patients through their own eyes and see their disequilibrium between body, mind and spirit. We need to acknowledge that, in caring for our clients, we must address these three areas of the patient’s world to provide holistic care for better patient outcomes.

The following case is an example of how nurses were able to understand a unique individual patient and address this patients needs. 

Beatrice (assumed name), accompanied by her father was brought from the Emergency Center to our unit during the night shift. While staff settled her into the new environment, her father approached me to share some of her history.  She was 28 years old, but has the mind of a 12 year old.  Born with hydrocephalus, she had several surgeries at another facility resulting in cardiac arrest, tracheostomy, and the inability to walk. She presented with fever, shortness of breath and diagnosis of pulmonary embolism.

The first night must have been frightening, as she was in an unfamiliar environment. While her father was welcome to stay he needed to attend to wheelchair-bound wife.  She had also been a patient in our unit and they expressed confidence that Beatrice would be given the same level of care.  This conversation opened a window of trust and facilitated an understanding of how to care for Beatrice that would be essential for getting her through procedures and daily care.

First challenge was a chest CT.  I reassured her that I will be with her in CT which made her smile. Positioning her for the procedure was quite a challenge, because of limited ROM. With constant coaching and encouraging words regarding how much she is able to do, Beatrice successfully completed the CT.  She had a big grin on her face, knowing that she did a great job during the procedure. We all praised her after the CT.

Daily visiting hours were always something Beatrice looked forward to. Her mom and dad came in the evening and staff allowed them to stay beyond the visiting hours, playing games or watching her favorite TV show together. I would hear laughter from the room and look to see her laughing with her parents. Occasionally, the father would perform trache suctioning. Beatrice would give thumbs up during these happy moments, perhaps reassuring me that she is happy and feeling fine. After mom and dad left, Beatrice experienced problems sleeping or would constantly be pressing her call light even after nurses had been in the room trying everything to make her comfortable. She would ask to be suctioned frequently just to get staff in her room.

Beatrice was in a room by herself.  In reconsidering her emotional and mental equivalent to a 12 year old I asked if she would like to move to another room across from the nurses’ station.  There she could see all the staff, and to this she smiled and nodded right away.  So that morning, as soon as a room was available, she was moved to a room across from the nurses’ station, and from that point on she would hardly use her call light, as she began feeling that she was always with people. She still gave a thumbs up signal when I passed by, either a sign of reassurance for me or of appreciation for where was placed.

With all the collaboration of the different interdisciplinary team, Beatrice recovered and was discharged to a very supportive family.  Emotions such as anxiety, fear, hopelessness, and powerlessness are not measurable, yet it takes very little effort to address these basic individual needs that are major factor to reach the goal of our patient’s holistic health. These basic needs should never be treated as a source of disruption, because all it takes is a moment or two of perception to understand the client’s world and to establish a trusting relationship, which is a basic essence of providing holistic care to achieve equilibrium of health for our clients.

Click to see Professional Nursing Model

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

Celebrating the good news.

The Foundation Room of University Hospital was filled with emotions of anticipation, excitement and even fear, as employees waited eagerly for the phone call that would change University Health System history. Hundreds of other staff members, who couldn’t be in the Foundation Room for the call, watched it live on their computers via webcast.

The minutes seemed like hours as University Health System team members waited for the phone to ring. But, when the clock hit 11:30 a.m., the silence in the room was almost unbelievable, as Nancy Ray, our Chief Nursing Officer, picked up the phone, with speakers turned up, to talk to Gail A. Wolf, DSN, RN, FAAN, Chair of the Commission on Magnet® Recognition. As soon as Dr. Gail said, “Congratulations, you are have earned Magnet status,” the cheers, tears and clapping sounds of staff echoed throughout the hospital. Becoming a Magnet designated organization validated all the hard work of hundreds of employees who believe and practice quality care every single day!  The five year journey was well worth it.

Dr. Wolf told staff that the American Nursing Credentialing Center (ANCC) in Washington, DC, made a unanimous decision to grant University Health System Magnet designation.

Just after the phone call.

Our health system is the first and only healthcare organization in San Antonio and South Texas to earn Magnet status. Only six percent of the hospitals and healthcare systems nationwide have earned this designation. UHS President/CEO George B. Hernández, Jr. said, “Today is one of the proudest moments in UHS history. Congratulations!”

Through a complex application and review process, including an intensive three-day onsite survey, UHS successfully demonstrated its commitment to providing excellent care for all patients, sustaining nursing excellence and transforming the culture of a work environment. The recognition is a reflection of the support the nursing staff receives in order to fulfill the health system’s mission. It is referred to as the “gold standard” in measuring the quality of care that healthcare consumers can expect.

“We are so pleased and proud,” said Nancy Ray. “Magnet is a journey; a process and a structure to assure the best outcomes are achieved for all patients.”

A hug of celebration.

Just as magnets attract metals, Magnet hospitals and health systems attract the best nurses and health professionals. They also offer patients reassurance they are being cared for by a team with a proven track record for providing excellent care and positive outcomes for their patients. The health system, owned by the taxpayers of Bexar County, which serves as our region’s lead Level 1 trauma center and academic medical center, is now among a very elite group of healthcare institutions.

The Magnet Recognition Program was created in 1983 by the ANCC, a subsidiary of the American Nurses Association and the world’s largest and most prestigious nurse credentialing organization.

Click here to see how we shared the great news with our community.

Greeting appraisers at UHS.

When we first learned we were getting a Magnet site visit from the American Nursing Credentialing Center (ANCC), it was such an exciting moment.  We were actually the first healthcare system in San Antonio to receive such exciting news. Some of us believe that our organization is the best kept secret, when it comes to excellent healthcare organizations.  Our staff was ready to prove that the documents submitted were only a small glimpse of the wonderful work performed by everyone at University Health System.

On November 16-18, 2009, Nancy Ray, MA, RN, our chief nursing officer, proudly welcomed the ANCC appraisers. The appraisers Karen L. Hildebrandt MSN, RN, CNAA; Shawn M. Ulreich MSN, RN; and Janet F. Weaver, MSN, RN, CNA-BC, spent three days at University Health System

Our team was ready to “show-off” their clinical expertise, collaboration, shared governance, cultural diversity, research, professional practice and more. Every unit and clinic created specialized boards of their unit’s stories, and our Magnet Champions had been hard at work making sure that all their nurses were ready to tell their incredible stories. The staff was decked out in promotional buttons telling the appraisers to “Ask Me about our Journey to Magnet.” The appraisers were escorted by Magnet Champions that kept them on schedule.

Best Practice -   Skin Care

George B. Hernández, Jr., University Health System President/CEO; Peggy Deming, University Health System CFO; Christain Vasquez, University Health System COO; and Nancy Ray, RN, CNO, along with University Health System Board Chair, Roberto Jimenez, M.D., and members of our senior administration, welcomed ANCC appraisers, as they visited our health system. Our leadership staff and the appraisers took part in a dialogue that covered many topics, including the mission of the organization and the challenges faced in providing healthcare to the uninsured. The appraisers were excited to hear about our achievements as an organization in earning awards and recognitions, as well as the determination to aspire to be a Magnet organization.

Magnet Champions

From beginning to end, everyone had an amazing time. Our Magnet Champions who served as escorts for the appraisers could not believe all of the great things happening at each clinic. The champions said they felt a boost of pride each time they saw GREAT work in action. It was simply amazing! Community stakeholders and our school of nursing also shared the incredible work being done at University Health System. Plus, various presentations were made on our Evidence Based Practice, Professional Practice Model and Nursing Research. 

At the end of the site visit, our staff felt confident in sharing their five year Magnet journey with appraisers. Too often we are so preoccupied with the destination, we forget the journey. The site visit was our opportunity to showcase our journey, what we achieved and how we continue our mission for excellence!

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.

Documents ready to be sent off.

“Put the argument into a concrete shape, into an image, some hard phrase, round and solid as a ball, which they can see and handle and carry home with them and the cause is half won.”    - Ralph Waldo Emerson

Our Magnet stories took many shapes and forms. They were as solid as a baseball. As it turned out we had stories, pictures, graphs and even a DVD of our nurses and patients explaining our Professional Practice Model.

The Magnet Project Director, Evelyn Swenson-Britt, MS, RN, showed no mercy as everyone was asked to contribute stories and ideas so we could create concrete images for our Magnet Appraisers to read. We had stories from nursing leaders, department directors, educators, vice presidents; and team members from inpatient, ambulatory, AirLife, information systems, respiratory, pharmacy, shared governance, and of course, our Magnet Champions! We had facts and figures available to show within our budget, outcomes, safety, quality and demographics. The spread sheets were endless. The stories were written, edited and read multiple times. Every story included some material from the 88 sources of evidence.

It’s no doubt that it takes an entire organization like University Health System to provide the evidence to support Magnet documentation. When all the data was completed and compiled, it was reduced to a DVD and mailed with plenty of positive thoughts and hopes for an opportunity to show more.

As Emerson reminds us, “Reality is more excellent than the report.”We hope to show our American Nursing Credentialing Center (ANCC) appraisers all the hard work and dedication that our employees are committed to in making the data on these documents come to life during their future Magnet site visits to University Health System.

By Evelyn Swenson-Britt, MS, RN

The 2006 Strategic Plan for Patient Care Services was approved by the Operations Council Monday (February 13).

Many of you have not seen this document since our work session in November 2005. Please note that there has been some massaging of the ideas that were initially presented, but the overall goals have remained the same.


The plan utilizes the 2005 format. The overview is on the first tab; the entire plan is on the last tab. Navigate to sections of interest by clicking to the appropriate tabs. View the plan here!

Please share this information. Communication is key!

The first Breakfast of Champions of the New Year on January 17 focused on documenting each unit's magnet journey. As Champions showed scrapbooks and talked about milestones, participants like Alma Nlemadim, RN III were imspired to document their own Magnet Moments of 2005.

By Alma Nlemadim, RN III, CCRN, MPA

On August 31, 2005, after hearing that San Antonio was receiving over 10,000 hurricane evacuees, my daughter and I began to assemble 15 backpacks called “Care Packs." We filled them with bottled water, Gatorade, crayons, cookies, coloring books, combs, brushes, etc. and delivered them to Latreece Brown, MSW in the University Hospital EC.

Peggy Silva, R.N., the nursing supervisor helped coordinate efforts to deliver the Care Packs to families who were arriving from New Orleans with only a few items of clothing in a bag.

On Sunday we left three Care Packs on the pediatric unit and six in the emergency room. Five were distributed to patients on TCU and CDU during the night.

From August 30 through September 8, the CDU received over 22 Katrina patients with various problems. A majority of admissions were ill due to their inability to obtain needed insulin and other medications. The UHS staff in various ancillary departments -- from Radiology to CDU -- worked together to provide the best care to all of these patients.

On her third inpatient day at University Hospital, Patient M. received three large bags filled with gowns, robes, bath and body lotions, gift certificates, a check from the staff, talc powders, sugar free snacks, books, and a Bible -- all purchased by the nurses and radiology techs of this caring system.

Ms. M had multiple diagnostic procedures. She met many dedicated employees during her one week stay. Our employees listened and did everything possible to make her stay pleasant.

Each night, Ms. M would speak of the goodness of all of the employees at University Health System. The caring attitude displayed by the staff and the excellent care Ms. M received exemplify our whole hearted commitment to Magnetism and Community Service.