Remember The Mission

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!!