Nursing and Patient Care Services

FY 2009 Report
UWHC Authority Board
Maureen P. McCausland, DNSc, RN, FAAN

November 4, 2009

Agenda
Nursing and Patient Care Services
Accomplishments
Respiratory Care
Clinical Nutrition

Initial Nursing Goals March, 2004

Strategic Goals 2006-2008
Professional Practice Model
Recruitment and Retention
Nursing Sensitive Outcome Measures
Financial Measures
Conclusions
Future Challenges

Respiratory Care Services

The Respiratory Care Practice Council has
continued to focus on practice enhancements.
The department provided 260,000 treatments and
diagnostic tests.
The shortened ventilator days LOS related to
increased use of protocols has been maintained.
The FY 2009 turnover rate was 2.0%.
The FY 2009 year-end vacancy rate was 0%.
No travelers were used in FY 2009.

Respiratory Care
Involved in all health-link application go-lives
Members of the department continue to be leaders in
professional organizations
Matt OBrien received the Presidential Scholarship for
Masters in Biotechnology
Anne Flaten elected President-elect of the WSRC
Pulmonary Function Lab added exhaled Nitric Oxide
testing capability (used as a clinical guide for asthma
management)
Expanded the use of mini-bal procedure (improves
accuracy of diagnosing ventilator associated pneumonia
and reduces the use of unnecessary antibiotics)
Implemented the Rapid Response Team
4

Infection Control
A significant leadership transition
occurred with the retirement of
Dennis Maki, MD
Nasia Safdar, MD, has ably
assumed leadership
The department has led the
organizational response to H1N1
5

Clinical Nutrition Services

Successfully matched applicants for our internship program. For 6
openings, we went down to number 13 for our first choices.
Facilitated role of clinical nutrition in inpatient model of care redesign.
Expanded role of clinical nutritionist in adult nutrition support team and
developed staff capable of supporting a pediatric nutrition support
team.
Continued to successfully train future professionals in the UWHC
Dietetic Internship Program.
Collaborated with Princeton Club West & East to provide nutrition
education and individual counseling to membership.
Consulted on healthy cafeteria initiatives. Effectively worked with
Food Service management staff to modify recipes, menus, portions,
and service. Analyzed nutrient content of recipes and foods offered.
Worked with Public Affairs to market and disseminate information.
Provided caf patron education during heart and nutrition month.

Strategic Goals 2006-2008

UWHC Nursing Strategic Goals
Deliver excellent patient care across the continuum which is evidence based
and fiscally responsible.
Create a professional practice environment which supports clinical nurses
characterized by collaborative governance, participative decision-making and
a commitment to professional development.
Provide superior customer service to patients and their families.
Identify and act upon opportunities to advance collaboration with the University
of Wisconsin School of Nursing.
Enhance operational efficiency by minimizing barriers to patient access and
streamlining patient throughput.
Apply the power and potential of technology and informatics to support
delivery of superior care and enhance the effectiveness of professional
nursing.
Recruit, retain and develop nursing leaders in clinical practice and clinical
management.
Create and nurture a spirit of inquiry in all nurses from the systematic
evaluation of ones own practice, to the translation of research findings into
practice and contribution to established programs of research at the University
of Wisconsin-Madison School of Nursing.

UWHC Professional Practice

Model

Practice Model Update: Nursing Care

Delivery System

The primary nursing model at UWHC

continues to be mature, but still has
the potential to be more substantive.
Primary nursing is an essential
component of the interdisciplinary
model of care.

Professional Practice Model:

Interdisciplinary Collaboration
Clinical nurses continue to report high satisfaction
with physicians appreciate what I do in the
NDNQI survey.
We continue to address concerns related to
improving communication and relationships
between nurses and physicians as necessary.

10

Professional Practice Model:

Evidence Based Practice
The Nursing Practice Council completed three
EBP guidelines for:
Catheter associated UTI
Care of patients in isolation
Care of patients in restraints and use of patient safety attendants

11

Professional Practice Model:

Clinical Advancement &
Recognition

The recognition activities for National

Nurses Week were successful.
Leah Curtin, RN, FAAN was the
keynote speaker.
Genevieve Nicol-Sey, BSN, CCRN,
CNRN, RN received the Primary
Nursing Award.
The clinical advancement program
design was completed.
12

Professional Practice Model:

Clinical Advancement & Recognition

Peggy Wiederholt, RN, Head and Neck

Oncology nurse coordinator received
the inaugural American Society for
Therapeutic and Radiation Oncology
(ASTRO) Nurse Excellence Award.

UWHC nurses outscored peers at 27

academic medical centers in their
knowledge and treatment of pressure
ulcers, sleep, incontinence and use of
restraints in the Geriatric Institutional
Assessment Profile funded by the
Hartford Institute at NYU Division of
Nursing

Dr. Paul Harari, Jack Fowler Professor and Chairman of

the Department of Human Oncology at the UWHC and UW
Carbone Comprehensive Cancer Center and Peggy
Wiederholt, RN

Dianne Danis, MS, RN, NEA-BC,

FAAN, Director of Nursing Practice
Innovation, was inducted into the
American Academy of Nursing.
Dianne Danis, MS, RN, NEA-BC, FAAN,
Director of Nursing Practice Innovation

13

Professional Practice Model:

Clinical Supports
The HealthLink design and implementation
benefited tremendously from the leadership of the
clinical nurse specialists, nursing education
specialists and the nursing informatic specialists.
Two major applications were installed:
Clinical Documentation
CPOE
The AFCH Pain Clinical Nurse Specialist has
continued to develop clinical nurses as pain
resource nurses and has standardized care of
children having painful procedures.
14

Professional Practice Model:

Organizational and Managerial Structure

The collaborative governance

structure received outstanding
reviews from the Magnet
appraisers.
The Advanced Practice Nursing
Council was launched.

15

Collaborative Governance Structure

16

Non Clinical Supports

Support from non clinical areas
continue to be a strength for our
organization, particularly
environmental services and
facilities planning.

17

Recruitment and Retention of

Professional Nurses
Steady progress has been made in both the
recruitment and retention of professional nurses.
The RN vacancy rate continues to decrease and
this has a positive impact on UWHC operations
and on nursing sensitive outcome variables.
The total RN vacancy rate as of June 2009 was
-3.4%.
The use of traveler and agency nurses was 19.0
FTE YTD across the entire organization.

18

Recruitment and Retention of

Professional Nurses

19

Recruitment & Retention of

Professional Nurses

Turnover of professional nurses was at

its lowest point since tracking began in
FY 02 or 6.2% (104 individuals) in
FY09.
Turnover of nurse residents in the first
year of practice was 6.5% (N=11)
which was a decrease from FY08
(11.5%, N=19).
20

Recruitment & Retention of

Professional Nurses

21

Recruitment and Retention of

Professional Nurses

UWHC continues to be dependent on

new to practice nurses but successfully
recruited more experienced RNs in
FY09.
FY 2008 hires-289

FY 2009 hires-259

101 experienced RNs (35%)

70 experienced RNs (27%)
166 new to practice nurses (57%) 163 new to practice nurses (63%)
22 per diems (8%)
26 per diems (10%)

22

Registered Nurse Workforce

Planning
Nurses continue to practice part-time at UWHC but 59.87% now
work .9 or greater FTE.
The mean age of registered nurses is 39.1 at UWHC with a range
from 21.4 years to 68.4 years.
The bell shaped distribution of the age of RNs in direct care continues
to be an advantage for UWHC.
We have a substantial mid-career brain trust.
The aging of the RN workforce and the numbers of RNs projected to
reach retirement are significant issues for the organization especially
in the ambulatory, surgical services and psychiatric nursing areas.
Ambulatory positions are predicted to fill easily with transfers from
inpatient areas. New graduates will be the primary source of staff for
inpatient and surgical services areas.
7 of 62 eligible RNs retired in FY09. The average age at retirement
remains 60 years of age.

23

Percent of Nurses in Age Bracket

Includes Residents/ADNTP

24

Mean Age of Nurses by Division

With and Without Residents/ADNTP
Data as of 6/30/09

25

Minimum/Maximum Ages of RN Staff

FY 2005 FY 2009

26

Number of RNs Who Retired

FY 2005 FY 2009

27

Forecast of RN Retirement

28

Professional Job Satisfaction and

Engagement

The national sample contains

696 hospitals
234,588 RNs
14,738 nursing care units.

Nurses professional job satisfaction

trends continue to demonstrate progress
on variables that are meaningful to them.
We now have 6 years of NDNQI
comparative data. The response rate for
2008 was 77% (N=1259).
26 UWHC units achieved a 100%
response rate.

29

Professional Job Satisfaction and

Engagement

Participation decreased 6 points from

last fiscal year.
Scores have remained high since 2003:

Individual Satisfaction Scores

Satisfied with the status of nursing 17% increase
Career Development 16% increase
Participation in decision making 8% increase
Work Group Satisfaction Scores
Autonomy 10% increase
Professional status - 11% increase
Task - 11% increase
30

Professional Job Satisfaction and

Engagement

Individual nurses continue to report

moderate to high satisfaction with no
variables in the low category.
High satisfaction

teamwork between co-workers

physicians appreciate what I do for patients
satisfied with my job
nurse manager is a good leader

31

Professional Job Satisfaction

and Engagement

Moderate satisfaction

Time for patient care

Participate in decision making
Autonomy in daily practice
Satisfied with status of nursing
Salary is satisfactory
Satisfied with CNO
Career development opportunities

Low satisfaction
No variables

32

Professional Job Satisfaction and

Engagement
Intent to leave1 has increased from 2007

89.8% of nurses reported that they plan to stay at UWHC (1.6 pt

(1.7%) decrease)
82.6% plan to remain on their same unit
7.2% plan to transfer to another unit at UWHC

10.2% reported intent to leave UWHC

3.6% plan to seek a direct patient care role outside UWHC

2.7% plan to leave direct care
1.3% plan to seek a new career
2.6% plan to retire

18% improvement from 2003 to 2008

regarding nurses intent to leave UWHC

particularly true for those that would seek a direct patient care role
outside of UWHC

1 Percentages do not equal 100% due to rounding

33

Professional Job Satisfaction and

Engagement

34

Educational Preparation and

Professional Certification
UWHC nurses are well educated

74% hold a BSN or higher degree

65% hold a BSN
11% hold a Masters degree and 9% hold a Masters degree in
nursing
0.2% hold an earned doctorate

The number of UWHC nurses achieving

professional certification has increased
again in FY09 from only 7% (N=81) in 2004
to 21% (N=376) in 2009.
35

Career Development
Experienced nurses have voiced their concerns
about lack of learning opportunities and this was a
concern of the Magnet appraisers as well.
Career development for all professional nurses
continues to be a priority at UWHC.
Two visiting scholars have accepted an invitation
to do an external review of our educational
program.
The new cultural diversity theoretical framework is
being implemented.
36

Leading and Managing in a Professional

Practice Discipline

The grand rounds series, Leading and Managing

in a Professional Practice Discipline, was
continued in FY 2009.
The FY 2009 series was built on four major
conceptual areas:

Evidence based leadership and management

Emerging knowledge in clinical practice
Language of reflective practice and clinical skill acquisition
Quality and safety

Nationally recognized leaders who joined us in the

Leading and Managing in Clinical Practice
Discipline were:
Susan Adams, DScN, University of Iowa, Director of the National Nursing
Practice Network
Leah Curtain, RN, FAAN
Katharyn May, DNSc, RN, FAAN

37

Nursing Sensitive Outcome

Measures
The American Nurses Association named UWHC the #1
Academic Medical Center for Nursing Quality.
There is a very concerning trend in satisfaction with
nursing care with all practice areas ending FY 2009 below
the 90th percentile.
A variety of analyses and interventions are underway.
Themes related to the impact of HealthLink and the
financial environment in FY 2009 have emerged.
The following slides show the current status of nosocomial
pressure ulcers, falls and patient satisfaction with nursing.

38

Nursing Sensitive Outcome

Measures: Falls

39

Nursing Sensitive Outcome

Measures: Falls

40

Nursing Sensitive Outcome Measures:

Nosocomial Pressure Ulcers

41

Patient Satisfaction with Nursing

42

Patient Satisfaction with Nursing

43

Patient Satisfaction with Nursing

44

Patient Satisfaction with Nursing

45

Staffing Effectiveness
We continue to evaluate our staffing
effectiveness and submit our data to
national benchmarking programs.
We have continued a number of strategies
to meet these requirements:

UWHC-wide staffing plans are developed at the

cost center level
Staffing variables are reviewed in all RCAs

46

Staffing Effectiveness
Strategies continued:

Each inpatient unit reviews monthly data on

three clinical indicators (falls, pressure ulcers
and patient satisfaction with pain) and two
human resource indicators (direct care vacancy
rate and direct nursing hours per patient day).
Staffing level related performance metrics
include the RN vacancy rate, NHPPD, RN skill
mix and nursing sensitive outcome variables.

47

Total Holdovers

48

Operational Efficiency and Patient

Access

49

Conclusions
We have had an outstanding year
Magnet Recognition
ANA Quality Award

The UWHC nursing and patient care services team

continues to make substantial, quantifiable progress.

Significant increase in capacity, particularly ability to accept transfers

Improved financial performance
Improved patient satisfaction
Improved RN satisfaction

RN turnover is continuing to decrease and this is being

driven by improvements in the practice environment and
the economy.
UWHC has a very large number of RNs with less than
three years of experience. Continuing development of
them as well as experienced nurses.
50

Future Challenges
Addressing the recommendations of
the Magnet Commission.
Positioning nursing and UWHC for
success in the world of health care
reform and innovative fiscally
responsible practice.

51