Executive Chief Nursing Officer Marilyn Dubree, MSN, R.N., reviewed the challenges of the past year and highlighted what Vanderbilt University Medical Center nursing is doing to prepare for the future at last week’s State of Nursing address, scheduled to coincide with National Nurses Week.
“We have accomplished a lot, but it’s never enough to stand still,” said Dubree. “As we look forward to the future, we are changing the way we provide care. It’s an exciting time. We have the opportunity to reinvent the way we do our work.”
She reported that the more than 4,500 VUMC direct care nurses are the best nurses in Middle Tennessee, according to a consumer confidence survey, and Vanderbilt remains the preferred health care organization. A majority of nurses, 62 percent, are bachelor’s prepared, showing Vanderbilt’s progression toward 80 percent of registered nurses being bachelor’s prepared by 2020. After a challenging fall, nurse turnover rates now appear steady and are aligning more closely to national benchmarks.
“Going forward, we know we need to be able to better coordinate the care of our patients. We must use evidence at every juncture of patient care, and it’s imperative we engage our patients and families,” Dubree said.
A system-wide example of how changes have been made to support clinical nurses is the nursing model for the clinical staff leader. This program embraces attributes such as vision, empowerment and innovative thinking to develop transformational leadership throughout the organization. This work started at Monroe Carell Jr. Children’s Hospital at Vanderbilt in October 2012 and will be completed with implementation at Vanderbilt University Hospital this fall.
Evaluation of areas within Vanderbilt that have already adopted this approach show significant improvement with managers and staff providing positive feedback.
“My commitment is to the engagement of staff,” said Dubree. “We work really hard to make sure that happens, and when we don’t do that well our efforts suffer.”
The shared governance structure and active staff nurse councils provide ongoing feedback, and the rapid cycle work redesign approach has spawned improvements based on hundreds of observation hours and nurse focus groups.
To date, rapid cycle work redesign has improved standard medication administration times, shortened nursing documentation procedures, eliminated unnecessary manual data entry and enhanced the process of finding equipment. All projects cycle in 100-day waves. Working together, Dubree believes they will result in efficiencies in care and time savings.
She highlighted current work such as transitions of care, the Standard Inpatient Operating Model, Valve Surgery Bundle care coordination, Discharge toolkits and the Center for Women’s Health’s population management clinic model.
“Our work is about teams — nurses, physicians, therapists and others — coming together to effectively work, communicate and assist the patients we serve. Our commitment as an organization is to being stronger and better than we were before.”