2009 State of the Department

Voice of the Nurse Shaping the Future

Mairead Hickey delivered the fourth annual State of the Department of Nursing address to nurses in Bornstein Amphitheater.

The voice of the nurse is shaping the future of nursing at BWH.

This theme of the 2009 BWH Nurse Recognition celebration coupled with the Nursing Vision of excellent care to patients and families with the best staff in the safest environment resonated throughout the annual State of the Department address delivered in May by Chief Nursing Officer and Senior Vice President of Patient Care Services Mairead Hickey, PhD, RN. Hickey presented details on the work being done throughout the department, providing examples of how nurses at all levels of the organization are leading and participating in activities that benefit patients, families and the entire nursing community.

“The ‘Voice of the Nurse’ is about you and your work and ensuring that your voice shapes the future of our department,” Hickey said.

Excellent Care to Patients and Families

BWH’s commitment to patients and families is experienced in positive ways as reported back to the hospital through patient satisfaction surveys.

Hospitalized patients have given BWH nurses mean survey scores of 90 or better in the last three quarterly Press Ganey Inpatient Satisfaction surveys, dating back to September 2008. These are the best scores and put BWH nurses in the 99th percentile of 500-plus bed teaching hospitals that use Press Ganey.

“This is an incredible testimony to the work BWH nurses do every day, and to the relationships between nurses and patients and families,” Hickey said.

BWH’s commitment to patients and their families is apparent in every room of the Carl J. and Ruth Shapiro Cardiovascular Center, which opened last summer. BWH nurses took a lead role in designing the patient rooms and inpatient units in the Shapiro Cardiovascular Center recognizing the central role families play in patient recovery.

In addition, BWH finalized the Patient and Family Centered Care Philosophy statement in the last year with input from patients, families, nurses and clinical staff. The BWH Patient and Family Advisory Group, comprised of patients, families, nursing and clinical leaders, was created to provide the institution feedback on a hospital-wide level, and patient and family advisory groups in oncology and the NICU do the same in these specialty areas.

“These groups help us ensure that we, as an institution, never lose sight of our patients and families,” Hickey said.

Nursing Practice Environment

The role of the Department of Nursing is to create an environment in which all patients and families receive excellent care and all nurses feel supported in their practice and professional development. Maintaining the professional practice environment supports the nurse-patient relationship, which is at the heart of nursing’s work. “We learn and grow every day with our patients and families,” Hickey said.

Department efforts and programs are aimed at ensuring a practice environment in which every nurse can develop in his or her practice to provide excellent nursing care to patients and families and that the voice of the nurse is present in decision making. Hickey detailed “Finding and Defining the Good,” one of the department’s long-term initiatives aimed at uncovering, preserving and extending the characteristics of excellent practice found in BWH nurses (see related story below).

Nursing committees celebrated their successful first year. Contributions from Standards, Policies and Procedures, Informatics and Clinical Innovations, Quality Safety, and Care Improvements, Patient and Family Education and, most recently, Nursing Practice, are examples of how nurses from different practice areas and roles are actively engaged in influencing the practice environment to foster excellence in patient care and optimize patient outcomes.

Best Staff, Safest Environment

There are many new and ongoing nurse-led programs throughout the department. Hickey spoke of the successes in the End of Life Nursing Education Consortia, completed by 60 nurses, the redesign of the newly-licensed nurse program, the perioperative integrative care program, the Dedicated Education Unit on Tower 14 and the preceptor program and workshop, in addition to clinical programs, including acute care documentation, Ethics Rounds in the ICUs, and the CWN Palliative Care Program. Nurses also have played significant roles in opening the Shapiro Cardiovascular Center and Foxborough ambulatory care facility.

“There is a tremendous amount of clinical wisdom in BWH nurses, and many of you have grown your practice here,” Hickey said. With years of experience at BWH almost evenly distributed between one and 10 years and 11 years or more (see graph below), Hickey spoke of the importance of this demographic for the future in order to ensure a smooth transition as nurses near retirement. “We have a strong cohort of new nurses coming into the department which is critical to the future, and these new nurses are mentored by our more experienced nurses,” she said.

Nurses are partnering with physicians, administrative leaders, and other clinical leaders in team collaboration efforts across disciplines to accomplish department and hospital-wide goals. Some of these efforts include the design of the rapid response system, implementation of the WHO surgical guidelines in the Operating Room, designing care of the chronically and critically ill cardiovascular patient and establishing guidelines on managing delirium.

Also this past year, nurses continued to make vital contributions to maintaining the safest environment. Ongoing installation of ceiling lifts, the new nurse call system in CWN, upgrades to Alaris pump drug libraries and additional epidural pumps are a few examples. Several nursing and unit-based teams are working to improve hand hygiene among all care givers, and the pressure ulcer prevalence teams have made significant contributions over the past year.

In addition, Hickey’s presentation included details on the impressive array of internal and external awards and honors received by BWH nurses in the past year and the leadership provided by BWH nurses in local regional and national professional nursing organizations.