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Nursing Annual Report 2010

SM

Children’s Hospital Los Angeles

A 2010 Overview

In This Issue

OUR HOSPITAL

• Licensed patient beds: 286

Letter from Magnet Managers . . . . . . . . . . . . . . . . . . 1

• Average daily census: 239.5

Letter from the Chief Nursing Officer . . . . . . . . . . . . . . 2

• Annual patient admissions: 11,420

Letter from the President and CEO . . . . . . . . . . . . . . . . 2

• Annual outpatient surgery cases: 8,886

Professional Development—Certification . . . . . . . . . . . 3

• Annual inpatient surgery cases: 6,575

Professional Development—Education . . . . . . . . . . . . . 8

• Patient days: 88,980

Professional Engagement . . . . . . . . . . . . . . . . . . . . . . 9

• Emergency and trauma visits: 97,000

Commitment to Community Involvement . . . . . . . . . . . 12

• Average length of stay in the hospital: 7.86 days

Recognition of Nursing . . . . . . . . . . . . . . . . . . . . . . 15

• Annual transport patients: 1,937

Culture of Safety . . . . . . . . . . . . . . . . . . . . . . . . . . 17

• Annual outpatient clinic visits: approximately 406,000

Another year as a Magnet-designated hospital has flown by!

• Patient visits at community sites through the Division of Adolescent Medicine: 9,756

And so much has happened in 2010. Our nurses truly

• Patients under the age of 4 years old: approximately 50 percent

walls. Nurses took time out of their daily lives to help those in need

• Outpatient clinics: 48

­demonstrated their excellent work inside and outside the hospital in Haiti. Nurses contributed their knowledge and expertise to the decisions made in the Collaborative Governance Structure. They also ­challenged themselves to achieve certification and advanced

OUR NURSES

• 68 percent of our nurse leaders have a national certification • 58 percent of our nurse leaders are certified as Advanced Practice Nurses • We have 79 Nurse Practitioners

degrees. Nurses continue to maintain collegial relationships with all disciplines to ensure the best patient outcomes. These are a few

Professional Practice Model . . . . . . . . . . . . . . . . . . . 19 Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Nurse Week Essay Winner . . . . . . . . . . . . . . . . . . . 23 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . 25 Nursing Mission and Vision . . . . . . . . . . . . . . . . . . . 25

of the many attributes featured in this Annual Nursing Report that define why WE ARE MAGNET. Margaux Chan, RN, BSN, CPN Susan Crandall, RN, BSN

• We have 15 Clinical Nurse Specialists • We have 7 Nurse Anesthetists • Average length of tenure for our nurses: 10 years • Our expert nurses taught approximately 950 nursing students in 2010

Cover: Edgar Ordonez, RN Cardiothoracic Intensive Care Unit Nurse and Versant™ RN Residency graduate.

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Welcome

Professional Development: Certification Our certified nurses are the pride of Children’s Hospital Los

­newsletter for the Los Angeles chapter of the Society of Pediatric

Angeles. The journey to certification requires intense discipline.

Nursing, writing for the Nurse Week Essay Contest and

To prepare for the certification exam, some nurses take a

­contributing articles to the hospital’s “RN Remedies” blog series.

preparatory class and participate in study groups. Gloria Verret, RN, CPN, studied with another nurse using nursing textbooks and practice test questions. “It was like studying for the boards, very intense and hard,” she says. Others choose to study alone for countless hours. No matter the approach, the work pays off when the nurse passes the exam.

Nurses commonly question the need for certification: “Why get certified?” The answer is, “Why not?” Verret started at a facility where there was no motivation to pursue certification or ­professional advancement. So when she arrived at Children’s Hospital, she was pleased to see that nursing knowledge and

2010 was a year of preparation. We began the year with an

The nurses at Children’s Hospital Los Angeles are some of the best

eye toward the transition into the Marion and John E. Anderson

anywhere. As they help us create hope and build healthier futures

However, the journey does not end there. Certified nurses must fulfill

­Children’s Hospital demonstrates its high regard for certified nurses

Pavilion. We spent more than 10 years intimately involved in the

for the children and families we treat, I’m consistently impressed by

certain requirements to maintain their certification, depending on

by offering them an hourly differential, a benefit not offered in many

planning of the beautiful, family-centered healing environment that

their skill, compassion and thoughtfulness.

the certifying body. This creates a commitment to lifelong learning

organizations. This drove her to challenge herself, personally and

by studying for required tests, attending conferences pertinent to

professionally, to accomplish certification and to advance up the

their certification and reading professional literature.

clinical ladder.

would become a trademark of the new building. 2010 took on a new level of dedication that included all of us.

As we ready ourselves for Magnet re-designation, I’m also grateful for our nurses’ professionalism and hard work. And we asked a

leadership are valued here. She was especially impressed that

Once complete, the building would be ours to create a state-of-

lot from them this year. Preparing to move into our new 317-bed

For example, to maintain her certification in Neonatal Intensive Care,

Requirements to uphold certification through continuing education

the-art hospital for the children and families we serve. Nurses and

inpatient tower, the Marion and John E. Anderson Pavilion, involves

Nicole Ainsworth, RNC-NIC, has to accumulate 45 Continuing

increase the knowledge base of certified nurses and promote

all members of the health care team at Children’s Hospital stepped

a monumental amount of planning, and in many cases our nurses

Education Units (CEU) instead of the minimum 30 CEUs required

patient safety. Certified nurses are more marketable for professional

up to begin the transition plan that would be fully implemented

are leading the charge. These duties come in addition to their work

for licensure renewal. Thus, the expectations of these governing

advancement, internally and externally. They also are empowered

in 2011.

caring for our patients, conducting research, achieving professional

bodies create a higher level of expertise, contributing to new

to share their knowledge and expertise in their workplace and

enrichment and advancing nursing as a profession. We cannot

knowledge in nursing practice.

community. Consumers who choose Board-Certified physicians

Details were planned, problems were resolved and excellence was achieved over and over again. I was proud every step of the

thank them enough for rising to this challenge.

In 2007, Niebuhr and Biel conducted an American Board of

way. Every member of the Children’s Hospital community was a

Weekly, I hear stories about how great our nurses are—from their

Nurse Specialties (ABNS) survey among certified and non-certified

valuable part of the process.

supervisors, their colleagues and the patient families in our care.

nurses to study their views of nursing certification. The ABNS survey

Our highly-skilled corps of nurses help make this place more than

found that 88 percent of nurses agreed that certification enhanced

just a hospital; it is a welcoming environment of hope and healing.

personal confidence in clinical abilities. More than 90 percent of

2010 also was a year of impressive collaborative governance work. It was a year of learning and problem-solving as we developed structure, accountability and broad professional

To all of our nurses: Thank you for the support and ­leadership you

collaboration. Again, I am proud of the success we experience

provide at Children’s Hospital Los Angeles.

in our vision to empower direct-care providers. I know our success is based on our passion to always be better. We all should feel grateful because we learn from each other every day. Jobs don’t get any better than that. I am proud to work with the nurses and Patient Care Services staff to make Children’s Hospital Los Angeles the best and safest hospital for kids and families.

Richard D. Cordova, FACHE President and Chief Executive Officer Children’s Hospital Los Angeles

as their health care providers will soon be cognizant of BoardCertified nurses and will expect quality care from them. ­Certification is not just mere letters after a name; it identifies nursing’s highest value of professionalism.

nurses agreed that certification enhances professional credibility

Certified Nurses:

and validates specialized knowledge.

• Have professional pride and achievement

Ainsworth expressed this confidence after passing the certification exam.

• Are identified by patients and families as credible experts in their field

“I felt that I knew the material well, which made me more confident when I taught or precepted new nurses in the Newborn and Infant Critical Care Unit,” she explains. The study also found that 98 percent of nurses agreed that certification enhances feelings of personal accomplishment. The conclusion of this study indicates that certified nurses are differentiated in the workplace as adept and proficient leaders.

• Are more likely to get offers for professional opportunities to contribute their expertise, such as invitations to join committees, participate in educational activities and serve on special projects • Are marketable, opening doors for career advancement • Are committed to continuing their education to uphold their certification

Mary Dee Hacker, MBA, RN, FAAN

Verret felt this sense of achievement after obtaining her certification

Reference:

Vice President of Patient Care Services and Chief Nursing Officer

in 2005. This motivated her to pursue many nursing opportunities.

Children’s Hospital Los Angeles

“Being a CPN has given me professional confidence and pride,”

Niebuhr, B. & Biel, M. (2007). The value of specialty nursing certification. Nursing Outlook, 55(4), 176-181

she notes. “I started to volunteer to be on housewide councils, including the Recruitment and Retention Council and House of Representatives.” She has even started writing, editing the 2

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Our Certified Nurses 2010 Critical Care Registered Nurse (CCRN ) Carolyn D e La Cruz Pasiwen Virginia A. Culla Elizabeth Suzanne Daley Sylvia Gomez Juliet Christine Goss Kathleen S. McIntyre Lisa A. Rizzi-Wagner Sandra X Shepard Victoria J. Winter Donna Guadiz Monica Horn Michelle Anne Costabile Nhu N. Tran Josephine O. Ellashek Nancy Aguirre Frances Blayney Alejandra Briseno Agnes E. Bundac Rebecca S. Cales Sherry Cauley Suzanne Rose Chan Corinne M. Costley Gena M. Favero Heidi D. Geary Ronda N. Habaradas Fereshteh Kiani Catherine D. Klatzker Sandra Lee Louis M. Luminarias III Katherine M. Meyer Joseph M. Ng Monica Nuss Garineh Selina Petrosian Monica Lee Rice Pacita M. Sangalang David Schmidt Diana Z. Sepulveda Suzette Dee Sweeney Linda A. Topper Linda C. Young Victoria Joanne Duncombe Nancy Blake Nancy Ann Pike

6 North Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic ICU Cardiothoracic Transplant Cardiothoracic Transplant Neonatal ICU Neonatal ICU Critical Care Services Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Pediatric ICU Nursing Director Cardiothoracic Surgery

Certified Pediatric Nurse (CPN) Nora A. Delgado Giuliana V. Fiore Amy Jean Girguis Natalie Goldman-Merritt Michelle M. Karlu Jolene Marie Knapp Angela Adriana Madrid Susan Martinez Sarah G. Ramirez Erin Schmidt Abigail Barbara Shetland Marcela M. Solorio Lesley Navea Abcede Linda B. Allen Leticia Avram Arnie B. Banez 4

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5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

East East East East East East East East East East East East West West West West

H O S P I TA L

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Emma A. Clark Sarah Duffy Margaret-Ellen Frankel Susan L. Gonzalez Frances H. Guzek Susan D. Jensen Justin Albert Markle Cheryl Ann McCauley Francis Mombay Janaya Morgan Sharlene C. Odhner Judith A. Tighe Donna Lee Vanca Diana H. Vaughn Polin Yousefzadeh Elaine Butterworth DeAnn Sabrina Campbell Anne A. Casale Eileen R. Duncan Kristine N. Gawley Lavonda R. Hoover Elaine C. Iwamoto Christine S. Limann Patricia Mueller John Rutland Caroline Kelton Sanborne Afton Nicole Schrimpf Flora W. Yuen Lori L. Chan Yvonne M. Hughes-Ganzon Van Nga T. Nguyen Amanda Esther Price Julita Arceo Reyes Vanessa Rios Megan Summers Gloria N. Verret Jennifer L. Baldwin Olivia Banuelos Monica M. Ciccarelli Aileen De Guzman Darcey Lynn Diaz Kay M. Gilmore Tammy Lynne Johnson Marcia Lachelle Massey-Norfleet Victoria Ann Miller Theresa Tostado Chrystal Uy Elysia M. Weiner Ashlei M. McCloud Aileen Yanga De Guzman William C. Kenny Annie Yeremian James Connard Raulin D. Feria Elisa D. Barrios Terece Charme’ Jones Rica Sharon Prospero Morzov Beth Christie Clark Anabel Enriquez Costa James Tom Cottrell Mariella Flores Armstrong Hao Nicole M. Magni

5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 5 West 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 East 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 North – Rehab 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West 6 West Allergy/Immunology-Clinical Allergy/Immunology-Clinical Cardiothoracic ICU Cardiothoracic ICU Care Coordination CCC Critical Care Services Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department

Vanessa B. Martinez Jon M. Mc Kinnon Morales Monica Inge M. Morton Angela M. Quijada Lindsay Quirk Denise M. Sherwood Amanda Silver Valerie Tripoli Stephanie Valenzuela Robin L. Wood Jody Leigh Castrillon George Dennis Cruso Terri E. Stambaugh Julissa M. Forte Julye A. Henley Kathleen Elizabeth Kelts Paul A. Ciriacks Jeanette M. Goggins Rachel Guinn-Jackson Kim Hodge Kerri Hunter Kathy Kelly Velma Leon Guerrero Linda S. Loiselle Gayle C. Luker Marisa Martinez Christopher L. May Allison McCune Christina Ng Nancy O’Gorman Amy Omuse Kimberly Pandora Hodge Joan Marie Flom Pritchard Martha Samuel Felicia Tremmel Ana Borde Laurie F. Newton Cynthia K. Burrola Allan J. Cresencia Jessica Lawson Garcia Erin L. Lowerhouse Margaux Chan Jason Robert Vargas Sherry Nolan Jennifer M. Huson Sheila Kun Olivia J. Brett Vanessa Guerrero Claudia McCullum Veronica Wallace Debbie L. Hand Judith Sherif Stacey B. Adler

Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Department Emergency Transport Hem-Onc Nursing NICCU Neurology Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Nursing Resources Outpatient Rehabilitation Services PACU PACU PACU PACU PACU (ASC) PACU (ASC) 5 East Pediatric ICU Pulmonary - Clinical Pulmonary Function Lab Radiology Nursing Radiology Nursing Radiology Nursing Surgical Admitting Transport Cardiothoracic Surgery

Certified Pediatric Hematology -Oncology Nurse (CPHON) and Certified Pediatric Oncology Nurse (CPON) Irene V. Aberin Dania Marisa Bourque Staci A. Castillo Renee A. Flores-Garcia Heather Joy Mehl

4 4 4 4 4

East East East East East

Johanna Navia Marifel Pagkalinawan Sacha Lauren Reis Afshid Roozrokh Gina Marie Santangelo Kerry S. Vancura Sonya L. Williams Melissa Stewart Aguirre Diane Rita Altounji Michelle Castle Sona Daldumyan Lizzele J. Dulay Meghan Meehan Courtney A. Rogers Laura J. Vasquez Willow Voytko Cara Suzanne Wise Paula J. Ybarra Jennifer C. Blaney Kristina Brown Vilma L. Evangelista Dawn P. Landery Paul D. Liehr Mary F. Moses Donna M. Quiroz Dannielle Seluta Shinyi Tang Ngaire F. Wilson Sarah Toba Zannella Ann Eldise Hart Gwendolyn M. Kimball Alice Sanchez Tracy Ellen Kruger Jamie Tripp Bacani Stana Bogojevic Margaret S. Bottcher Armi F. Bui Sherri Lynn Carcich Rhonda D. Cellura Shanna Christoffersen Kei Yun Chung Nancy S. Hart Dee Imai Maria-Theresa Lapinid Alice Loo Deborah Marino Kathleen McGinty Maki Okada Tina M. Patterson Ma Luz Reyes Susan L. Rhoads Patricia Rios Meagan Elizabeth Schiavone Anne Schwartz Nord Belinda P. Sia Karen Faith Sidi Christina Izumi Smith Anthony Opimo Maria L. Medina-Velasco Diane M. Grade Kellie A. Loera Rita L. Secola Peggy L. Townsend

N U R S I N G

4 East 4 East 4 East 4 East 4 East 4 East 4 East 4 West 4 West 4 West 4 West 4 West 4 West 4 West 4 West 4 West 4 West 4 West BMT BMT BMT BMT BMT BMT BMT BMT BMT BMT BMT Care Coordination Care Coordination Dialysis Emergency Department Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing PCS Cancer Center 4 East Hem-Onc Nursing Nursing Director 4 West/BMT

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Our Certified Nurses 2010 Neonatal Intensive Care Nursing (RNC-NIC) Susan Cline Nicole C. Ainsworth Sonja Alli-Casella Susan V. Bugsch Carol E. Cadaver Beverly S. Drummond Sandra Luz Espinosa Johanna Constance Gaeta Robert Fred Giesler Anne B. Gleeson Dolores M. Greenwood Heather Ann Hackett Carrie Leigh Jennewein Kyong Ran Kim Laura A. Klee Lorie J. Pagado Victoria Pniel Diane E. Real Lisa Marie Rosik Suet Ching Sham Carolyn S. Waddell Robin B. White Elsa M. Yedinak Maxine Orieji Ogbaa Denise Navarro Weibel Cynthia Diane Atkinson Pamela Lynn Costa Jennifer Jordan Karen Elizabeth Helton Rapoport

Emergency Department NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU NICCU PCS Education Department Institute for Maternal-Fetal Health NICCU Institute for Maternal-Fetal Health

Certification in Nursing (RNC) Susan R. Benson Cheryl Estepa Barton Marlene Beranek Emi Kotoh

Endocrinology Cardiology Institute for Maternal-Fetal Health Institute for Maternal-Fetal Health

5 East Pain Management

Certified Clinical Transplant Coordinator (CCTC) Stephanie Johnson Donna Guadiz Monica Horn

Liver Transplant Cardiothoracic Transplant Cardiothoracic Transplant

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L O S

Susan L. Cesinger Martha A. Martinez

Emergency Transport Emergency Transport

Certified Pediatric Emergency Nurse (CPEN) Russ Gill Claire Meyer Nicole D. Sheppard Susan D. Jensen Nicole M. Magni Nancy O’Gorman

Emergency Transport Emergency Department Emergency Department 5 West Emergency Department Nursing Resources

Certified Professional in Health Care Risk Management (CPHRM) Karen Prommer

Risk Management

Certified Rehabilitation Registered Nurse (CRRN) Rachel Blackburn

Care Coordination

Certified School Nurse Medical Genetics

Certified Wound, Ostomy, Continence Nurse (CWOCN) Beth Harrison

Ambulatory Care

Certified Nurse Administration (NEA-BC) Nancy Blake Beverly S. Drummond

Critical Care Services NICCU

6 East Pediatric ICU

Orthopaedic Nurses Certification (ONC) Ann M. Wakulich

Orthopaedics

Certified Nursing Professional Development (RN-BC) Marilyn Deon Mills Suzanne Taylor Sylvia Gomez Frances Blayney

Urology H O S P I TA L

Certified Neonatal & Pediatric Transport (C-NPT)

Catherine D. Kissinger Teresa L. Loera

Endocrinology Endocrinology Endocrinology Endocrinology Endocrinology Endocrinology Endocrinology Endocrinology Endocrinology

Certified Gastrostomy Nurse Valerie Gordon

Operating Room Peri-operative Services Peri-operative Services Operating Room Operating Room Operating Room Operating Room Operating Room Operating Room Peri-operative Services Operating Room

Certified Nurse Administration (NE-BC)

Certified Diabetes Educator (CDE) Anna Gastelum Bitting Meredith Mae Bock Louise A. Brancale Eulalia Carcelen Nancy Chang Barbara Hollen Mary T. Mc Carthy Debra Dee Miller Vanessa Lizzet Mansilla

Kristi M. Brandt Nancy Bridges Randall Cook Melinda R. Dizon Verzhine Fodolyan Angela M. Hartley Meredith Renee Johnson Janet J. Quigley Florence E. Rivera Dawna Lee Willsey Minako Yasumura

Michele Paige

Certified Clinical Nurse Specialist Sherry Nolan Meghan Sullivan Middleton

Certified Nurse Operating Room (CNOR)

A N G E L E S

Radiology Nursing Nursing Director Cardiothoracic ICU Pediatric ICU

Certified in Pain Management Meghan Sullivan Middleton

Pain Management

Certified Lactation Educator/Counselor (CLE) Christine S. Limann

6 East

Certified Registered Nurse Infusion (CRNI) Johanna Navia Stana Bogojevic

4 East Hem-Onc Nursing

Certified Adult Nurse Practitioner (CANP) Roy Villena Tatlonghari

Employee Health Services

Certified Family Nurse Practitioner (CFNP) Constance C. Gallardo Marilyn Harris Anthony Hernandez Caroline Kwong Vanessa Lizzet Mansilla Melanie T. Moya Carol A. Okuhara Lillian Vicky Rosu Nancy Ann Pike

Radiology Adolescent Medicine Surgical Admitting Cardiothoracic Surgery Endocrinology Employee Health Services Cardiothoracic Surgery Cardiothoracic Surgery Cardiothoracic Surgery

Primary Care Certified Family Nurse ­P ractitioner (CFNP-PC) Yvonne J. Olive

Surgical Admitting

Certified Pediatric Nurse Practitioner (CPNP) Tizita Amde-Michael Cheryl Estepa Barton Susan M. Carson Kirsti Catton Margo Coon Jennifer N. Donkin Kristen Ethridge Anna Christine Evans Karla Aurine Haynes Helen Lau Patricia A. McMahon Peterson Jennifer L. Murray Kaberi Mozumder Mary Baron Nelson Donna Nowicki Lisa Oda Maki Okada Paola I. Pederzoli Kasey Rangan Maria D. Reyes Yael L. Rosenthal Bianca M. Salvetti Nanora Thompson Kynna Nichole Wright Vanessa Rios Jennifer L. Baldwin David Schmidt

UCEDD – DMH Cardiology Hem-Onc Nursing Cardiothoracic Surgery Radiology Nursing Hem-Onc Nursing Cardiothoracic Surgery Hem-Onc Nursing Plastic Surgery/Craniofacial Plastic Surgery/Craniofacial Hem-Onc Nursing Pain Management Cardiothoracic Surgery Radiology Nursing/Anesthesia Pediatric Surgery 5 West Hem-Onc Nursing Hem-Onc Nursing Hem-Onc Nursing Pulmonary Hem-Onc Nursing Pediatric ICU Adolescent Medicine Hem-Onc Nursing 6 North – Rehab 6 West Pediatric ICU

Acute Care Certified Pediatric Nurse ­P ractitioner (CPNP-AC): Mary Mc Culley Andrea Lynne Parker Gina Zambetti Carol A. Okuhara Lillian Vicky Rosu Nancy Ann Pike Stacey B. Adler Leticia R. Boutros Beatrice L. Chun Debra A. Rannalli Mary Virgallito Marifel Pagkalinawan

Cardiothoracic Surgery Pediatric Surgery Pediatric Surgery Cardiothoracic Surgery Cardiothoracic Surgery Cardiothoracic Surgery Cardiothoracic Surgery Surgical Admitting Surgical Admitting Surgical Admitting Radiology Nursing 4 East

Primary Care and Acute Care Certified ­P ediatric Nurse Practitioner (CPNP-PC/AC) Susanne Matich (Carvajal) Pamela Michelle Faire Melanie Green Deborah G. Harris Denna Jung Deborah L. Jury Meghan Sullivan Middleton

Radiology Nursing Cardiothoracic Surgery Cardiothoracic Surgery Hem-Onc Nursing Radiology Nursing Pain Management Pain Management

Primary Care Neonatal Nurse Practitioner (NNP-PC) Marlene Beranek Pamela Lynn Costa Sharon Fichera Jennifer Jordan Emi Kotoh Bonnie Lee Karen Elizabeth Helton Rapoport Johanna Constance Gaeta

Institute for Institute for NICCU NICCU Institute for Institute for Institute for NICCU

Maternal-Fetal Health Maternal-Fetal Health Maternal-Fetal Health Maternal-Fetal Health Maternal-Fetal Health

Certified Registered Nurse Anesthetists Melissa Bailey Paula Belson Sara Glasser Mary Iwaszewski Judy Koempel Sarah Polkinghorn Shinny Thomas

Anesthesiology Anesthesiology Anesthesiology Anesthesiology Anesthesiology Anesthesiology Anesthesiology

Total number of certified nurses: 312 Total number of certified nurse practitioners: 57 Total: 369

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Professional Development: Education

Professional Engagement

Advanced Degrees

Collaborative Governance

New Advanced Degrees in 2010

Children’s Hospital Los Angeles values nurses with advanced degrees, offering a degree differential and opportunities for professional growth and promotions. To increase the number of BSN-, MSN- and PhD-prepared nurses, Children’s Hospital strongly supports and

Bachelor’s Degree

making happens at the staff level and to improve efficiency, coordination

received a BSN

and ­communication among the hospital’s Patient Care Services (PCS)

Teresa Esquivel, RN, (4 West) received a BSN

initiatives. The following are council accomplishments for 2010.

Liberty Garcia, RN, (4 West) received a BSN

leaders allow flexible scheduling to accommodate school

Khadijah Khan, RN, (Rheumatology) received a BSN

education and informs nurses of opportunities for ­advanced degrees at local colleges and universities. These opportunities include:

Vanessa Rios, RN, (6 North) received a BSN Tyla Vecchiarelli, RN, (Post Anesthesia Care Unit) received a BSN

Master’s Degree

• Tuition assistance program

Cheryl Franco, RN, (Clinical Care Coordinator) received an

• RN to BSN program grant • Terry Varatta Scholarships for nursing graduate students • Nursing college and university information sessions at Children’s Hospital Thinking of going back to school? Just do it!

MSN (Nursing Education) Jamie Lin, RN, (Pediatric Intensive Care Unit) received an MSN (Leadership and Management) Jessica Moller, RN, (Bone Marrow Transplantation) received an MSN (Nursing Leadership and Management) Sasha Reis, RN, (4 East) received an MSN/PNP/CNS Desiree Ritter, RN, (Nursing Resources) received an MSN

Nurse Leaders 3% Associate’s Degree

42% Bachelor’s Degree

(Health Administration)

C H I L D R E N ’ S

House of Representatives (Chairs: Nicole Ainsworth, RNC-NIC, and Shannon Duffy, MPH, RD, CNSD) • Proposed that applicants for the Versant™ RN Residency be ­required to have a bachelor’s degree. • Instituted Unit Huddles within PCS (See page 18 for more ­information on Unit Huddles).

Recruitment and Retention Council (Chairs: Vanessa Guerrero, RN, BSN, CPN, and Carola Mendez, Child Life Specialist) • Conducted a PCS Needs Assessment to understand the ­recruitment and retention needs of staff. • Improved bilateral communication between Human Resources and PCS staff. • Implemented the Electronic Employee Suggestion Box in ­collaboration with Human Resources. • Collected information from different PCS disciplines regarding recruitment and retention activities.

• Introduced the Huddles concept and its application for all work areas to the House of Representatives. • Recommended the use the PES scale for the 2010 Children’s Hospital Los Angeles survey. • Implemented the placement of the communication board at employee entrance. • Contributed suggestions for the Employee Time Off Changes. •Quality Coordinated activities for Nurse Week 2010 Council (Chairs: Jennifer Baldwin, RN, CPN,

and Kristine Gawley, RN, CPN)

• Developed the NPO (Nil per os, Latin for “nothing by mouth”) project aimed at improving patient/family satisfaction scores related to the NPO policy/procedure which involved surveying parents of children who required NPO status. Provided suggestions related to policy changes, incorporating changes in KIDS ordering process and staff/physician education and analysis. • Developed “Medicus Interruptus,” a multi-unit performance improvement project, which aims to decrease administrationrelated medication errors by 80 percent by minimizing work interruptions and standardizing the medication administration process (See page 17 for more information on Medicus Interruptus). • Developed Falls Prevention project, with a goal of a reduction in the number of patient falls while using a multidisciplinary approach, updating current policy and care plan and making

Kim Tull, RN, (5 West) received an MSN/FNP

1% Doctorate Degree

54% Master’s Degree

The American Nurses Creditialing Center Magnet Recognition Program Guidelines for 2013 state that all nurse managers must have a bachelor’s degree in nursing—a goal that Children’s Hospital Los Angeles already has achieved. 8

Governance structure continues to meet its goals: to ensure decision-

Victoria Duncombe, RN, (Pediatric Intensive Care Unit)

­encourages nurses to pursue advanced degrees. Nurse and home life. The hospital offers financial support for

After another year and a change in membership, the Collaborative

• Coordinated all PCS discipline recognition weeks and ensuring recognition and activities are included in staff e-newsletter and calendar.

H O S P I TA L

L O S

A N G E L E S

Members of the House of Representatives.

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Professional Engagement recommendations for providing non-slip, circumferential footwear for patients. Also improved signage regarding the risk of patient falls and developed patient/family teaching information.

(MPCs) for end-of-life care and heart, lung, kidney, liver and small bowel transplants. • Emergency Review Form and feedback process after Rapid Response Team/Code Blue.

• Developed the Intravenous (IV) Infiltrate Reduction plan, a ­multidisciplinary/multi-council collaboration with the goal of reducing all grade 3 and 4 IV infiltrates to zero. Provided modification of the IV infiltration Incident Report Form, initiated a house-wide pilot of a new IV securement device and developed recommendations for education. • Developed the Hand Hygiene Project, a system that will require implementation of the hand hygiene performance improvement project if any unit/clinic has two consecutive quarters of total compliance data that are below the benchmark of 90 percent. Also implemented public display of hand hygiene data for all inpatient units. • Provided input regarding the selection of new isolation gowns related to cost/usage issue of the current gown supply. • Conducted Unit Tracer Presentations for the council, while providing input regarding deficient areas, their fishbone analysis and action plans. • Reviewed various performance improvement project presentations for evaluations and follow-up.

• Prepared Contrast Screening Form to be uploaded into KIDS (computerized charting). • Worked with hospital policy coordinators to facilitate review and approval process. • Completed 360 Peer Review for performance evaluation for implementation in July 2011.

Carola Mendez, Child Life Specialist (left), and Vanessa Guerrero, RN, with Richard D. Cordova, FACHE, president and chief executive officer, Children’s Hospital Los Angeles.

transfer to a higher level of care. Also developed PEWS audit form, and unit audits are done for compliance and improvement of the process. Compliance rates are increasing throughout the hospital.

• Completed Scope of Practice grids for PCS disciplines, including Unit Assistants, Patient Care Service Aides, Pharmacy, Spiritual Care Services, Social Work, Speech Pathology, outpatient medical assistants and Diversity and Language Services. • Collaborated with Patient Falls Task Force.

Education, Research and Development Council (Chairs: Edahrline Salas, RN, BSN, MA, and Sandra Hall, RN, BSN) • Scheduled and facilitated the PCS Grand Rounds. • Organized the housewide PCS Education Fair.

• Updated the audit tool for Multidisciplinary Plan of Care (MPC), Data-Action-Response-Plan (DARP) and education power notes.

• To help resolve communication issues, the “Situation, Background, Assessment, Recommendation, Questions” (SBARQ) process for hand-off communication was improved by developing the Ticket-to-Ride communication tool, utilizing the KIDS electronic medical records system for real-time information at report, when communicating with doctors or when calling reports to other units.

• Analyzed unit generic biannual audits to ensure 90 percent compliance.

• Updated Ticket-to-Ride form and worked with SuperKIDS team to move form into KIDS.

° IV Infiltrate Forms: re-education of staff related to use ° SBARQ: re-education and evaluation

• Implemented a new audit tool for Licensed Vocational Nurse documentation.

• Reviewed all current care plans to aid in the development of the Electronic Multidisciplinary Plan of Care (eMPC).

• Implemented Pediatric Early Warning Score (PEWS) systems, based on vital signs and behaviors. PEWS is designed to help identify kids at risk of getting sicker and prevent the need for a

• Improved the process for generating discharge instructions for patients and families.

° Medication Error Reduction Plan (MERP) preparedness ° Sterillium/Remedy hand lotion

Clinical Practice Council (Chairs: Nida Oriza, RN, BSN, and Terrie Ballard, RN, CPN)

Edahrline Salas, RN, enjoys a lighter moment during a presentation.

• Implemented and recommended education plans and ­evaluations on: ° Epidural policy update education ° PEWS Education Aileen De Guzman, RN, (left) and Kim Kaloustian, PT.

° Positional car seat testing ° Formula powder pointers ° Code evaluation process update ° Nasogastric (NG) and tracheostomy policy update education

• Approved and implemented new Multidisciplinary Plans of Care

° Ultrasorb pads/linen usage: education to work areas ­regarding product change ° Point-of-care testing reagent and supplies update education ° Central venous catheter (CVC) teaching recommendations ° Infection Control policy updates: education to work areas regarding policy changes • Selected recipients for the Terry Varatta Scholarship for nursing graduate students. • Research Infrastructure: advised and identified needs, including a research class, in coordination with Felicitas dela Cruz, RN, DNSc. House of Representatives members listen to a presentation. 10

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Gloria Verret, RN, (left) and Joan Clark, RN. N U R S I N G

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Commitment to Community Involvement International Help More than half of the 1,000 nurses at Children’s Hospital ­ Los Angeles regularly volunteer in the local and global community. In tandem with physicians, surgeons and other pediatric experts, nurses from the hospital reach thousands of children a year from around the world. Their dedication to providing care for children in underserved areas of the globe—both at home and abroad—is the result of knowledgeable staff backed by an organization that values and respects diversity while actively addressing children’s health barriers and disparities. During the two-week deployment to Haiti, nurses tended to wounds, sepsis, severe dehydration and respiratory distress brought on by the quake.

More than half of the 1,000 nurses at Children’s Hospital ­Los Angeles regularly volunteer in the local and global community.

“I wanted to help through action,” says Anne Vitug, RN, who works in the Pediatric Intensive Care Unit (PICU) at Children’s Hospital and traveled to Haiti. “I think that’s why we do what we do as doctors and nurses. We can use what knowledge we have and

“Culturally sensitive nursing care is business as usual at Children’s

make a difference.”

Hospital Los Angeles,” says Noreen Clarke, RN, MSN, who

Nurses’ time and talents also are deployed at home when

directs the International Craniofacial Children’s Fund (ICCF) at the hospital, which helps provide treatment to international patients. “We’re used to dealing with children from a variety of cultures and we have the infrastructure to support their special needs.”

When the Haitian earthquake struck in 2010, nurses from Children’s Hospital were among 20 hospital volunteers who traveled to the devastated country to provide medical support.

other key communications. Together, these tools ensure that the

who came to Children’s Hospital for life-saving surgery through a

hospital is ready and prepared to help.

collaboration between ICCF, Mending Kids International and the

Injured by an improvised explosive device (IED) in Baghdad,

internationally through programs such as Operation Smile,

Hashim was brought to the U.S. for treatment for head trauma in

­Mending Kids International and Interplast.

August 2010. He then underwent a series of surgeries at Children’s

traveled to the devastated country to provide medical support.

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recovery. Now healthy, Hashim has returned to Iraq.

organization committed to improving health conditions in Haiti.

it’s a child from Bangladesh, Ethiopia or Christmas Island, we are

by the quake.

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assisted every step of the way during the boy’s months-long

“The bottom line is that we are prepared,” Clarke says. “Whether

sepsis, severe dehydration and respiratory distress brought on

Nancy Aguirre, RN, (from left) Alanna Rowley, RN, and Alejandra Briseno, RN, in Haiti.

Hospital to place a titanium plate over his injured skull. Nurses

The group offered help through Project Medishare, a nonprofit

During the two-week deployment, nurses tended to wounds,

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Children of War Foundation.

others from the hospital, regularly donate their much-needed skills

­Children’s Hospital were among 20 hospital volunteers who

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countries through ICCF, the privately funded organization Clarke

One special case was Hashim Zareef, a 10-year-old boy from Iraq

When the Haitian earthquake struck in 2010, nurses from

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In 2010, nurses took part in the care of 34 children from 16

and a Diversity Services Department that aids in interpretation and

Pre- and post-operating room nurses and nurse educators, among

Jace Vargas, RN, (left) and Anne Vitug, RN.

­international patients come to Children’s Hospital for treatment.

directs at the hospital.

Those important tools include diverse staff, extensive training in cultural competency, years of experience with diverse populations

Volunteers offered help through Project Medishare, a nonprofit organization committed to improving health conditions in Haiti.

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Commitment to Community Involvement

Recognition of Nursing: The 2010 DAISY Awards

Institute for Maternal-Fetal Health

The DAISY Awards, which recognize nurses who

Foundation was established to honor nurses who positively impact

­exemplify excellence in patient care, have become a

the lives of their ill patients and coping families.

When expecting parents discover that their unborn child is

celebrated tradition at Children’s Hospital Los Angeles.

Children’s Hospital is one of more than 50 hospitals in the

Bonnie and J. Mark Barnes founded the DAISY (Diseases Attacking

United States that have partnered with the DAISY Foundation.

the Immune System) Foundation in memory of their son, J. Patrick

Recipients of the DAISY Award receive a certificate, a DAISY pin,

Barnes, who died of complications from his autoimmune diseases

Cinnabon® cinnamon rolls and a unique hand-carved statue called

(idiopathic thrombocytopenic purpura) at age 33. In tribute and

“The Healer’s Touch,” created by artisans in Zimbabwe, Africa.

not healthy, the stressors they experience include coping with their unfortunate reality while simultaneously figuring out how to get help. It’s not easy to find medical services that will try to assist in the need of both the mother and fetus, as well as promote open communication and collaboration between health care teams.

appreciation of the nurses who cared for their son, the DAISY Sheila Perez, RN, BSN

Irene Klecha, RN, MSN

To resolve such fragmented care, Children’s Hospital Los Angeles and the University of Southern California (USC) partnered to

Currently, Perez and Klecha coordinate care for more than

establish the CHLA-USC Institute for Maternal-Fetal Health (IMFH).

90 patients at a time. “I talk to the perinatologist, obstetrician,

This program, unique to Southern California with only a few similar

neonatologist, geneticists, surgeons and the unit accepting the

programs nationwide, provides comprehensive care to mothers and

patient,” says Perez. This coordination is vital to the team’s

their unborn children. The program recognizes that it must treat both

communication so that no information is left out. They prepare

the mother and the fetus separately because they require different

packets complete with the mother’s information, the physician’s

therapies. But the program also ensures that specialists collaborate

notes, lab and diagnostic results and deliver them to the accepting

and coordinate care for optimal health and a safe delivery.

units, usually the Newborn and Infant Critical Care Unit or

January

February

March

April

Cardiothoracic Intensive Care Unit. They also notify the team

Kerry Moller, RN

Alice Loo, RN, MSN, CPON

Cathy Foster, RN, MSN, PNP

Miguel Aventino, RN

May

June

July

August

Maria Lapinid, RN, BSN, CPON

Maria Dakan, RN, BSN

Margaux Chan, RN, BSN

Lindsay Quirk, RN, BSN

September

October

November

December

Donna Quiroz, RN, BSN, CPON

Stephanie Brown, RN, BSN

Cheryl Barton, RN, MSN, NP

Christina Smith-Cruso, RN, BSN, CPON

The IMFH team is made up of an interdisciplinary group of ­obstetricians, specialty physicians, nurses and psychosocial counselors. The office is located at Hollywood Presbyterian

of the mother’s expected delivery date and coordinate the neonate’s transfer to Children’s Hospital.

Medical Center, adjacent to Children’s Hospital. The mother

In addition, they offer comfort to parents by giving them their

comes to receive obstetrical care and meet with the Children’s

pager numbers for any questions, concerns or emotional support.

Hospital team of specialized physicians, including neonatologists

They even try to attend the delivery, to provide the parents with

and surgeons. The team and parents discuss the recommended

reassurance and to ensure the continuity of care after birth.

plan of care for the unborn child, based on specialized tests and diagnostics. Once the child is delivered at Hollywood Presbyterian, the baby is transported to Children’s Hospital via the Children’s Hospital Transport Team.

These nurse care managers truly embrace the spirit of nursing. They are teachers. They are autonomous and critical thinkers. They are patient advocates. They provide psychosocial support. They are interdisciplinary facilitators. Without their nursing service,

The parents’ journey to the IMFH begins with their obstetrician. Doctors refer patients to the IMFH if they detect a fetal anomaly. These referrals generally come from the Los Angeles area, but have come from as far as Bakersfield and the Inland Empire. Once the mother arrives, she is further evaluated by one of two nurse care

the continuity of care would be broken. Perez describes her role in the IMFH with pride. “It is a hard job, but it is rewarding,” she says. “The IMFH is nurse-driven; we coordinate the care. We are the patient advocates.”

managers: Sheila Perez, RN, BSN, and Irene Klecha, RN, MSN. Perez and Klecha have a special and comprehensive role in coordinating care for both the mother and unborn child. Perez explains that her initial role, when she meets the families for the first time, is to “introduce myself and explain what I do. I spend time with them to best explain the defect and its pathophysiology. Then I listen and support them emotionally.”

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Recognition of Nursing Mary Dee Hacker Inducted as a Fellow into the American Academy of Nursing

Culture of Safety The “GEM” (Going the Extra Mile) Award The GEM Award recognizes individuals,

Across the country, medication errors account for most

including nurses, who exemplify the

mistakes made in hospitals.

values of Children’s Hospital Los Angeles:

At Children’s Hospital Los Angeles, a new program aims to

Excellence, Teamwork, Service, Respect and Knowledge. These are the values that make ­Children’s Hospital one of the Nurse Sandra Espinosa, NNP, was honored with a GEM award in May 2010.

New Project Aims to Reduce Medication Errors

top hospitals in the nation.

change that norm. Based on the MedRite program created by Kaiser Permanente, the Medicus Interruptus project seeks to decrease interruptions that most nurses experience while giving patients medication. “The goal is to reduce distractions for nurses and anyone else who administers medication,” says Sherry Nolan, RN, MSN, CNS, clinical manager of 5 East. “Lots of research shows that you have to focus. It’s a complex task, and it’s hard when you’re interrupted all the time.” Nolan worked on the project with the Patient Safety Subcommittee, part of the Quality Control Council at Children’s Hospital. As adviser, she and Cheryl McCauley, RN, CPN, committee chairwoman and a nurse on 5 West, serve as group coordinators.

Mary Dee Hacker receives her certificate from American Academy of Nursing president-elect Joanne Disch, PhD, RN, FAAN.

Medicus Interruptus works like this:

Mary Dee Hacker, MBA, RN, FAAN, vice president of Patient Care Services and chief nursing officer at Children’s Hospital Los Angeles, received the prestigious honor of being

• Nurses preparing and administering medication wear a reflective yellow sash.

­inducted as a Fellow into the American Academy of Nursing. Hacker was inducted Nov. 13, 2010, during the Academy’s 37th annual Meeting and Conference in Washington, D.C. The Academy’s ­Fellows represent the nation’s most accomplished nurse leaders in education, management, practice and research. “Receiving this recognition is truly an honor for me,” says Hacker, who began her career at Children’s Hospital in 1975 as a staff nurse. Her distinguished career includes many achievements and honors, including leading the hospital to Magnet Recognition in 2008 and being the driving force behind the innovative Versant™ RN Residency in Pediatrics Program, created in 1999 in response to the national nursing shortage. Hacker also received the Diane Cooper Lifetime Achievement Award from NurseWeek magazine in 2009, and was recognized in 1997 by California Medicine magazine as one of “California’s 100 Most Interesting and Influential Healthcare Leaders.” A frequent speaker at state,

Humanism Award winner Lisa Hatter, RN, BSN, with Richard D. Cordova, FACHE, president and chief executive officer, Children’s Hospital Los ­Angeles and Eyal Ben-Isaac, MD.

The Morris and Mary Press CHLA Humanism Award Since 1973, Children’s Hospital Los Angeles has upheld the tradition of honoring individuals and a department/work area— all of whom have been nominated by their peers.  

other hospital groups and parents to explain the project. “When

began serving as pilot units for the error-reduction program in May.

you’re out in the middle of the hall, people catch you and ask

The goal was to decrease administration-related

“Nurses thought this idea was a little hokey at first, but now they’re

while standardizing the process. Medication error rates from

seeing that they can get really focused.”

the participating floors were then calculated by the Quality

job expectations in demonstrating superlative and consistent

Department. The program was rolled out to the entire

kindness and thoughtfulness in their interactions with co-workers,

hospital in the fall.

patients and guests. The 2010 Nursing winner was Lisa Hatter, RN, BSN, and 6 West won the Work Area category.

the nation’s health care system.

Angeles a warmer, friendlier and more compassionate place. A N G E L E S

In addition to training programs, posters and fliers were made for

for such a program, Nolan says. Both 5 West and 5 East

workers and a work area or division who go beyond their daily

customer relations and care also make Children’s Hospital Los

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Observations throughout the hospital demonstrated the need

medication errors by 80 percent by the end of August,

being a strong advocate for the nursing profession and improving

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• Signs on carts read, “Meds Being Given, Please Do Not Interrupt.”

questions, whether they’re physicians or parents,” Nolan says.

Their respect, service, excellence, knowledge and teamwork in

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The Medicus Interruptus project seeks to decrease interruptions that most nurses experience while giving patients medication.

The Morris and Mary Press CHLA Humanism Awards honor

regional and national meetings, Hacker says she is committed to

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• Yellow and black tape around medication carts indicates that the nurse in the “square of silence” should not be interrupted. The steps of medication administration are posted as well.

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Culture of Safety 6 North Unit Huddles

Professional Practice Model are caring for patients. The on-coming charge nurse leads the

The Magnet Recognition Program envisions health care as a

Now, as we go through the process of Magnet re-designation, the

Huddles and announces the updates from a Huddle announcement

dynamic entity, continually evolving into a better system of

application request calls for the organization to demonstrate how

sheet that is updated by managers every Monday.

care. This is why the program stresses that hospitals must

nurses have analyzed, evaluated and modified the Professional

The focus is to communicate any updates to staff before they start

“raise the bar” to achieve high-quality patient outcomes.

Practice Model.

their shift. Information on the Huddle announcement sheet includes how many patients are expected for that particular shift, staffing situations, any critical patient status changes, events happening in the hospital, new or updated policies, requirement deadlines like CHEX and which manager is on call. Huddles also can be used to

In 2006, a group of nurses of all levels created the Professional Practice Model to illustrate nursing practice at Children’s Hospital Los Angeles. It was presented house-wide for nurses to embrace and was included in the Magnet document submitted in 2007.

recognize staff for achievements, thank people for working overtime

In fall 2010, a group of nurses called the Magnet Champions came together to re-evaluate the model and make revisions to fit the current vision of Children’s Hospital. They also brought the model to their own units/departments for more nursing input. After all the nurses’ collaborative efforts, the new Professional Practice Model was finalized in the spring of 2011.

and introduce new staff.

Overcoming Challenges There were challenges to implementing Unit Huddles because they

A 6 North night shift Huddle.

represented change. For example, some were concerned that

Merriam Webster’s definition of huddle is “to come

Huddles would cause staff to start reports late, make reports take

together closely in a group.” This definition perfectly

longer, increase overtime or waste staff time. The reality is that they

describes the concept behind Unit Huddles at Children’s

are short—five minutes—and decrease overtime. They also make

Hospital Los Angeles. The Huddles have a simple goal:

reports more efficient because staff already have an idea of how

to increase communication and teamwork.

their shift is going to go.

In 2008, before Unit Huddles were implemented on 6 North, an internal survey gathered feedback on teamwork and communications. The results showed room for improvement.

With consistent effort and support from the 6 North managers and leadership committee, huddling is now a positive reality on 6 North.

Phan Dang, RN, brought up the idea of Huddles at the unit

Positive Change

leadership retreat in January 2008; Huddles had been used

Huddles have improved staff awareness. Because changes are

effectively at her previous job and increased teamwork and

constantly communicated to staff via Huddles, compliance with

communication. The leadership team embraced and supported

new hospital and unit requirements has improved dramatically.

the concept, and Huddles were officially implemented on 6 North on Feb. 12, 2008.

Tardiness also has become a very rare issue because everyone is required to huddle at the beginning of every shift. Huddles set the

Children’s Hospital is a teaching facility with constant change.

tone for the beginning of every shift and include every staff

A challenge to any teaching facility is to communicate these

member: RNs, LVNs, patient care service aides, unit assistants

changes to staff. It is sometimes difficult for staff members who

and even nursing students. This has definitely led to increased staff

do not work daily to keep up with email updates, policy and

satisfaction with teamwork and communication because everyone

­procedure changes and any new events or requirements—­

knows that they are part of the team.

especially ones that affect patient care. This same concern also was expressed in the Patient Care Services Recruitment and Retention Survey done in January 2010.

What are Unit Huddles?

SM

The building blocks represent what nurses do at Children’s Hospital Los Angeles. They capture what is essential in our practice. Teamwork and lifelong learning are key to providing family-centered care to our patients. The continuous circle

Exactly one year after Unit Huddles were implemented, the same

represents our ongoing efforts to acquire and share knowledge, to provide

internal survey was given to 6 North staff. The results reflected very

­service, to give respect to our patients, families and colleagues and to improve

positive improvements in the staff’s perception of communication

and sustain quality in our practice.

and teamwork. Huddles are an excellent tool that will be used for

A Unit Huddle is a five-minute-or-less “huddle”—a gathering of all

years to come.

on-coming staff. These short meetings occur at every change of shift, so that all on-coming staff can huddle while the current staff 18

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Innovation

Research

RN Bloggers Create Dynamic Community Education Forum

Lectures Karen Rodriguez, RN, gave an oral presentation, “Nurse ­Practitioner Championed: Pediatric Trauma Continuity Clinic

As a pediatric nurse, Kelli Anderson, RN, BSN, ­(Cardiac

Utilizing the ‘Medical Home’ Concept,” at the American Pediatric

­Catheterization Lab) is accustomed to family members,

Surgical Nurses Association in Orlando, Fla., in May 2010.

neighbors and friends asking her all types of child-related health and safety questions. As a mom of two teenage

Laura Klee, RN, participated in the panel discussion, “ECMO:

boys, the 22-year veteran nurse also has firsthand

the Southern California Experience,” for the first Coastal California Association of Neonatal Nurses educational conference in

experience with topics that concern parents most. Now,

February 2010.

Anderson and a select group of other ­Children’s Hospital

Edahrline Salas, RN, (left) and Jessica Klaristenfeld, RN, next to their poster at the Organization of Healthcare Educators Program.

Inge Morton, RN, presented a lecture, “Pediatric Trauma:

Los Angeles nurses are sharing their vast knowledge in a

Debbie Jury, RN, gave a guest lecture, “Principles of Pediatric

Late Onset Complications,” at the Emergency Nurses Association/

more global and Internet-savvy way: by blogging.

Pain,” at the UCLA School of Nursing.

Emergency Department Approved for Pediatrics Conference

Anderson, Jennifer Buchanan, RN, MSN, (Cardiology) and

Jennifer Murray, RN, lectured on the subject of pediatric palliative

Deborah Braidic, the hospital’s manager of Web content, launched

care and nursing education at the 2010 American Academy of

the innovative RN Remedies blog series in November 2010.

Kelli Anderson, RN, (left) and Jennifer Buchanan, RN.

Blog post topics range from common childhood conditions to safety tips for injury prevention and issues regarding teen health. Since its launch, seven more nurse bloggers have joined the

education and cutting-edge research. So it’s not surprising that the RN Remedies blog series is accumulating a steady core of followers.

at Presbyterian Intercommunity Hospital in Whittier, Calif., in October 2010.

Hospice and Palliative Medicine, and at the Hospice and Palliative

Victoria Winter, RN, presented “Family Making: A Grounded

Nurses Association Annual Assembly in Boston.

Theory Study” at the Sigma Theta Tau Conference, Nursing

Colleene Young, RN, gave lectures on “Hemofiltration Case

Odyssey 2010, in San Diego in October 2010.

Studies” and “ScVO2 Monitoring: Revealing What Traditional

Anna Evans, RN, presented a care report, “Pregnancy in a Patient

RN Remedies team, supported by the hospital’s in-house blogger,

Featuring a new post each Monday morning, the series receives

Vital Signs May Not” at the Pediatric Critical Care Nursing

with Anaplastic Oligodendroglioma Taking Temozolomide,” at the

Web Content Coordinator Lisa Timmons. In addition, regular

approximately 1,000 hits each month. Readers are encouraged to

Conference in San Diego in October 2010.

Society of Neuro-Oncology meeting in Montreal, Canada, in

contributors Gloria Verret, RN, CPN, (Surgical and Kidney/

email questions or post comments, creating an intimate connection

Liver Transplant) and Tere Jones, RN, CPN, (Medical/Surgical)

between the nurse bloggers and readers.

Colleene Young, RN, gave a presentation on “Nurse Responsibilities

have joined Anderson and Buchanan as featured bloggers by consistently contributing blog posts during the program’s crucial first six months of existence. “A large part of our job is educating the parents of our patients,” says Buchanan, who has been working at Children’s Hospital for the past four years and also is a certified lactation educator. Buchanan has been working with children her whole life, enjoying previous roles as a camp counselor, snowboard instructor and patient care associate. “This blog allows us to get the information out to the community beyond our patients and their families,” adds Buchanan, who began her nursing career in the Newborn and Infant Critical Care Unit at Children’s Hospital. As Gallup’s national survey indicates year after year, nurses are among the most trusted professionals in the nation. Meanwhile, Children’s Hospital nurses are at the forefront of continuing

and Clinical Decision-Making When Caring for Critically Ill

“We’re working on developing the blog and expanding it to reach

Pediatric Patients Requiring Continuous Renal Replacement

a broader community,” explains Braidic. “Our nurses have such

Therapy” at the European Academy of Paediatric Societies in

great passion and dedication, and we’re so proud of them. This

Copenhagen, Denmark, in October 2010.

unique program really allows our nurses’ voices to be heard.”

Fran Blayney, RN, presented a lecture, “Acute Kidney Injury:

As the site grows, Buchanan says she hopes to see more nurses

Investigating an Old Criminal with a New Tool,” at the Pediatric

start blogging. “We have so many experts at this hospital. We

Critical Care Nursing Conference in San Diego in October 2010.

can be a great source of information for families everywhere.”

David Schmidt, RN, presented two lectures, “CVVHDF: A Nurse-

Anderson, who also teaches puberty classes at elementary

Run Program” and “Busting BSI in the PICU,” at the Pediatric

schools in her community, says she never thought she would be a

Critical Care Nursing Conference in San Diego in October 2010.

“blogger,” but likes the opportunity to reach out to people, educate

Noreen Clarke, RN, and Susan Cline, RN, presented “Maka’s

the community and make a difference.

November 2010.

Story: Bringing International Health Care to our Hometown,” at the

Posters Karen Rodriguez, RN, had a poster presentation, “Implementation of a Pediatric Trauma Continuity Clinic Utilizing the ‘Medical Home’ Concept,” at the Society of Trauma Nurses (STN) in Orlando, Fla., in April 2010. Diane Altounji, RN, Monica Grover, RN, and Peggy Townsend, RN, presented their poster, “Caring for the Caregiver: Supportive Care for Nurses,” at the Association of Pediatric Hematology/ Oncology Nurses conference in Minneapolis in October 2010. Jessica Klaristenfeld, RN, and Edahrline Salas, RN, presented their poster, “Poster Presentation Projects: An Innovative Method

“It’s a whole new world,” she says. “I was walking down the hall

National Magnet Conference in Phoenix in October 2010.

the other day and someone yelled out that they had just read my

Sandra Watcher, RN, presented a lecture, “Making the Complex

Professional Nurse,” at the National Nursing Staff Development

Simple: Teaching our Pediatric Patients,” at the American College

Organization Conference in San Diego in June 2010.

blog … that’s a great feeling.” Visit Wearechildren’s.org for the RN Remedies blog.

for Dynamically Bridging an RN Resident’s Journey from Student to

of Rheumatology’s (ACR) Scientific Conference in Atlanta in November 2010. She also was a facilitator for the conference’s Infusion Therapy Networking Session and served as a moderator.

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Research Posters

Nurse Week Essay Winner Publications

(continued)

Laura Vasquez, RN, and Rita Secola, RN, presented their poster,

Meghan Middleton, RN, and Debbie Jury, RN, co-wrote

“Developing a Nursing Education Tool for Administration of

an article, “My Aching Back,” for Therapy Times Magazine.

Chimeric Antibody in High Risk Neuroblastoma Patients,” at the Association of Pediatric Hematology/Oncology Nurses conference in Minneapolis in October 2010.

Catherine Goodhue, RN, co-published “Disaster and Mass Casualty Events in the Pediatric Population” in the November 2010 issue of Seminars in Pediatric Surgery.

Peggy Townsend, RN, Maria Velasco, RN, Kellie Loera, RN, and Rita Secola, RN, presented their poster, “Capturing the Educational Needs and Preferences for Generational Differences in Hematology/ Oncology/BMT Nursing,” at the Association of Pediatric

Catherine Goodhue, RN, co-wrote “Disaster Preparedness Among Medical Students: A Survey Assessment” in the September/ October 2010 issue of the American Journal of Disaster Medicine.

What About the Nursing Profession Makes You Passionate? By Adam Brenneman, RN, BSN Pediatric Intensive Care Unit During nursing school, I remember always hearing that nursing was not a profession, that it was an art, a passion even. Part of me wrote it off, dismissing it as overzealous nursing professors obsessed with their profession. Sure, I enjoyed nursing, but was it a passion? It was not until I started

­Hematology/Oncology Nurses conference in Minneapolis in

Catherine Goodhue, RN, co-published “Disaster Olympix:

working in the Pediatric Intensive Care Unit at Children’s

October 2010.

A Unique Nursing Emergency Preparedness Exercise” in the

Hospital Los Angeles that I realized those professors might just

January/February 2010 issue of Journal of Trauma Nursing.

be onto something. During my relatively short career, I have

Jennifer Blaney, RN, Donna Quiroz, RN, Hazel Kolpak, RN,

seen more on my unit than I ever thought I would. My patients

Jasmin Uy, RN, and Kristin Malicse, RN, presented their poster,

Karen Rodriguez, RN, and Catherine Goodhue, RN, published

“Utilizing a Patient-Centered Medication Calendar to Improve the

“Pediatric Nurse Practitioner Implementation of a Pediatric Trauma

Discharge Process in the BMT Population,” at the Association

Continuity Clinic Utilizing the ‘Medical Home’ Model” in the

of Pediatric Hematology/Oncology Nurses conference in

Summer 2010 issue of the Journal of Trauma Nursing.

­Minneapolis in October 2010.

Victoria Winter, RN, wrote a chapter, “Excellence in Practice:

on caring for our patients but on their families as well. I have

Dawn Landery, RN, Mary Moses, RN, and Shinyi Tang, RN,

A Resident-Centered Care Program in a Long-Term Facility,” in the

seen parents and families at the absolute worst time in their

presented their poster, “Developing an Allergy Protocol Kardex

Artinian Intersystem Model: Integrating Theory and Practice.

lives, and it did not take me long to realize that this unit was

for the Hematopoietic Stem Cell Patient,” at the Association of

Mary Dee Hacker, MBA, RN, FAAN, published an article,

Pediatric Hematology/Oncology Nurses conference in

“Magnetically Charged,” in ADVANCE for Nurses in

­Minneapolis in October 2010.

October 2010.

Maki Okada, RN, and Kathleen Meeske, RN, presented their

Catherine Goodhue, RN, had an article, “Medical Home

poster, “Operationalizing Exercise Guidelines for Anthracycline-

Model,” published in the April/June 2010 issue of Journal of

have ranged from newborns to 25-year-olds. They have had everything from chronic illnesses that have made it impossible for them to leave the hospital to an accidental trauma that has landed them in our care. As pediatric nurses, we focus not only

not for the faint of heart, or those who lacked passion. Maybe I did have a passion for nursing. Maybe I was not giving myself enough credit. But there came a moment when it became utterly clear to me

Chair of the Department of Pediatrics, Vice President of Academic Affairs and Director of The Saban Research Institute D. Brent Polk, MD, with Nurse Week essay winner Adam Brenneman, RN, BSN.

that nursing was my passion. In order for you to understand it,

him, and since infant hearts are hard to come by, we waited ...

I would need to tell you a story. It is hard to explain the pure

and waited. He needed a machine to breathe, and a small

at the Association of Pediatric Hematology/Oncology Nurses

joy that I feel remembering it. It’s a story about a baby boy

pharmacy of medications given around the clock to maintain his

conference in Minneapolis in October 2010.

and the night he got a new heart. There is a disease known

optimal health. Almost every single nurse on the unit had been

as cardiomyopathy, which literally means heart muscle disease,

his nurse at least once. Many of us had cared for him more

and as you can imagine, it is not very compatible with living.

times than we can remember. All of us had our ups and downs

The only cure is a heart transplant. That is where our story begins.

with him, from rocking out to soft rock all night long with him

Treated Cancer Survivors at Children’s Hospital Los Angeles,”

Fran Blayney, RN, Cindy Rowlett, RN, Sue Bugsch, RN, Fran Guzek, RN, Jessica Klaristenfeld, RN, and Debbie Reid, RN, presented a poster, “Implementing Preceptors Best Practices: Teaching and Supporting the Model Preceptor,” at the ­Organization of Healthcare Educators Program in Pasadena, Calif.

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Trauma Nursing.

As pediatric nurses, we focus not only on caring for our patients but on their families as well.

(his favorite song being “Careless Whisper” by George Michael, at least that’s what I like to think), to watching him extubate himself four times on four separate occasions, with a mere flick of his head (which was almost cute because you got to see him without a tube in his mouth, but we were too busy being scared out of our minds and running around trying to

Due to his disease, the baby boy had been calling the Pediatric

get ready for the emergent re-intubation). But no matter what,

Intensive Care Unit at Children’s Hospital Los Angeles his home

he always had an endearing quality to him. He was only

since he was born ... nine months before. Our mission for the

months old, being put through more than most of us could ever

nine months was to keep him alive until we found a heart for

imagine, yet he kept on truckin’ along. N U R S I N G

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Nurse Week Essay Winner What About the Nursing Profession Makes You Passionate? (continued from page 23)

Acknowledgements: We would like to thank the following people for contributing to this report:

When I walked onto the unit that night there was a rumor, a whisper in the air, so soft as though we did not want to jinx him,

Magnet Oath As a member of this Magnet Hospital, I pledge to uphold the Children’s Hospital Los Angeles culture of distinction. I will advocate and support the further advancement of excellence in my practice. As an integral part of the

Richard D. Cordova, FACHE

Children’s Hospital Los Angeles community, I will continue to promote collegial

Mary Dee Hacker, MBA, RN, FAAN

­interdisciplinary teamwork. Utilizing the Forces of Magnetism, I will strive to

Carolyn Kendrick

provide even higher-quality family-centered care. I will constantly endeavor to

It was so strange seeing his mom packing up all his belongings

Doris Lymbertos

advance my expertise through lifelong learning. Lastly, I do swear to do all in

that had accumulated over the past nine months. She was

Robin Moore DeCapua

my power to maintain the highest standards and practices of my profession.

crying tears of joy while constantly being interrupted by hugs

Leslie Neuman

from the many health care providers who were so overjoyed by

Suzanne Taylor, RN-BC, MSN, EMT

Nursing Mission Statement

this moment. His mother was eternally grateful for every one

Elaine Verdugo

of us, no matter how small of a part we played in her baby

Adam Brenneman, RN, BSN

boy’s life here at Children’s Hospital, from housekeeping to

Tracy Kumono

attendings. We all were afraid to leave on our breaks for fear

Matthew Pearson

of missing the send-off.

Jim Deeken

Nursing Values

Chandra Broadwater

• At Children’s Hospital Los Angeles we value advancement and innovation

that this little boy was finally getting a heart. You could literally see every nurse’s and doctor’s face light up as the words sunk in.

In a flurry of good wishes and tears, he was carted away through a tunnel of nurses, doctors and health care providers with such pomp and circumstance worthy of royalty. As the moment arrived and the OR staff prepared for transport, we all began to gather, overwhelmed, knowing that his time had come. We nurses comforted his mother, who was crying

Nursing outcomes. • We provide family-centered care involving multidisciplinary ­collaboration. • We embrace the cultural diversity of families and staff in our practice of caring for children.

Nurse Week essay winner Adam Brenneman, RN, BSN.

mother had us to lean on, she had hope and the support she

Margaux Chan, RN, BSN, CPN, and Susan Crandall, RN, BSN Magnet Program Managers

needed to be strong for her baby. As I watched that baby

Nursing Guiding Principle Children’s Hospital Los Angeles Nurses embody the principles of integrity, respect, leadership and advocacy in our daily work.

boy roll away, I finally appreciated the passion that was

Creative Direction:

Nursing Philosophy

nursing. I finally grasped why I was a nurse.

Jim Deeken

We, the Nurses of Children’s Hospital Los Angeles, embody individualized

­children?” It is a simple response: because I am passionate

getting a new heart. In a flurry of good wishes and tears, he

about it. Yes, this job can be intense, and yes, sometimes it

was carted away through a tunnel of nurses, doctors and

seems like the bad outweighs the good. But sometimes ...

health care providers with such pomp and circumstance worthy

you get to stand in a hallway, an hour after you have already

of royalty.

clocked out, and hear the sounds of a heart monitor getting

ever realized. In that moment, I understood if it had not been for

in a diverse community.

Sheila Perez, RN, BSN

Phan Dang, RN

tears of joy, many of us tearing up as well. Her baby boy was

more important than most realize, more important than I had

innovative and evidence-based Nursing care for children and their families

in Nursing practice, professionalism and meaningful recognition for quality

Kelli Anderson, RN, BSN

I get asked all the time, “How can you work with sick

the reason why I am passionate about what I do. Nursing is

creating opportunities which support an environment of excellent, integrated,

Sarah Brown Jennifer Buchannan, RN, MSN

uncontrollably, her eyes red and face soaked with her own

As the travel monitor faded into the distance, I realized this is

We are committed to advancing the professional practice of Nursing by

closer and closer with a child’s mother you’ve come to know over the past nine months, and you get to see her face light up as she sees her baby boy for the first time ... with his brand new heart.

family-centered care. Research, ­evidence-based practice and lifelong Design:

learning are the foundations for our practice. Our Nursing decisions integrate

Wendy Byle

sound clinical judgment, ethical responsibility and compassion to optimize patient outcomes.

Editors: Sarah Brown Chandra Broadwater Matthew Pearson

Nursing Vision Nursing care at Children’s Hospital Los Angeles is recognized internationally as a model for Nursing excellence. By utilizing best practice, we provide outstanding family-centered care in an environment that honors its diverse community. We strongly promote lifelong learning and collaborative interdisciplinary ­relationships. In addition, our emphasis on Nursing research,

the effort of all of the PICU nursing staff, that baby boy would

The tin man begged for a heart, and all he got was some

leadership and professional development makes Children’s Hospital Los

not have made it to this moment and would not be getting a

velvet stuffed with sawdust. That night, a baby got a new heart,

Angeles the organization of choice for a career in pediatric nursing.

new heart. I finally comprehended that it was because his

and I have to admit ... the real thing is far more magical.

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