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

Helene with UHS Staff

After surviving cancer and three brain surgeries, Helene Neville, a registered nurse from Phoenix, AZ , marked the halfway point of her 2,520-mile run across the country, delivering a VERY important message on healthy living to fellow nurses, who work in the front line of patient care. Helene received a warm welcome from University Hospital nurses who presented her with a special “Survival Kit,” as she made her way to the hospital.

Helene, also a fitness coach and trainer, says her health battles have empowered her to promote health and fitness. She was diagnosed with Hodgkin’s disease in 1993 and had conquered the disease in 2001 which meant surviving three brain surgeries that were performed between 1991 and 1997.

Helene is making several stops along the way to promote both the run and her health and fitness book, Nurses in Shape, as she runs from Ocean Beach, CA, to Jacksonville Beach, FL, in 100 days. Her journey, called One on the Run, began May 1 and she’ll finish on August 17 as she celebrates her 50th birthday.

Helene Neville

“My run is not to realize my dreams, but to help others realize theirs,” says Neville, “The focus of my book is to educate nurses on how to reach higher levels of mental, emotional and physical wellness so that they may better serve their patients.”

University Health System nurses are honored that Helene chose University Hospital as her rest stop. University Health System earned Magnet status in February 2010, and is the first and only healthcare organization in South Texas to achieve Magnet recognition by the American Nurses Credentialing Center (ANCC), in Washington, D.C.

To learn more about Helene’s run across the U.S.A., visit www.oneontherun.com. You can also join her Facebook fan page, and cheer her on during her journey to healthy living!

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.

“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!

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!

What Lewis and Clark can teach us.

Bedside nurses are in the driver’s seat when it comes to identifying research questions. Each day bedside nurses see a variety of problems and various patient responses. They often ask themselves, “Why did that happen?”  This question raises the researcher’s curiosity and desire to understand the occurrence.   The value of research for nurses and all their patients is profound!  It is the basis for practice and understanding the truth. Our patients depend on us for the delivery of quality care. And, the TRIP “Translating Research into Practice” is a journey worth taking! 

This was the theme and message for Nursing Research Week: 2009! (Click here to see the week’s agenda).  Our road trip included unit and classroom presentations for nurses on bibliographic databases that nurses can access day or night at work, or even at home. The trainers from EBSCO Publishing, Ellen Westling and Bryan Gottsman, made these presentations possible for both the day and night shifts at University Hospital. 

During the week, we had our Second Annual Community Scholarship Showcase. University Health System, Texas Nurses Association, Delta Alpha Chapter at Large, STTI and Santa Rosa CHRISTUS, partnered to provide the nursing research forum. Stephanie Woods RN, PhD, associate dean and associate professor, Texas Woman's University and former colleague of many in San Antonio, delighted the audience with her presentation “Advancing Nursing Science in Patient Care Settings:  What the Journey of Lewis and Clark can Teach Us Today.”

Dr. Woods used the Lewis and Clark expedition as an analogy to the development of new nursing knowledge and the cultivation of innovation. Lewis and Clark will be viewed as principal investigators (PIs) who lead a team (the Corps of Discovery) in an effort to map previously unknown territory.  The expedition and the many discoveries advanced knowledge, debunked myths (presence of the Northwest Passage) and forged relationships. The result, to understand that the expedition allowed will serve all those who follow them.  Likewise when nurses engage in research they help to create new nursing knowledge, cultivate innovation and map new territory.  This ultimately serves those who follow, include other nurses, clinicians and patients.  Research does not typically occur in the absence of teamwork.  Like the Corps of Discovery, nurses must partner to conduct research and advance knowledge.

In addition, the community all joined together in sharing multiple poster presentations and networking about their work. As the previous year, it was an absolutely incredible experience for all to see the great innovation and research going on in San Antonio.

Click to see the schedule

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!!