TL7
Advocacy and Influence TL7
Provide one example, with supporting evidence, of a Nurse AVP/Nurse Director's or Nurse Manager's leadership that successfully guided nurses through change.
Example: Oncology/Renal Unit Transitioning to Accept Inpatient Hospice Patients
Reason for Change
A Community Health Needs Assessment (CHNA) was completed for Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) in 2022. One identified community need was emotional and behavioral health services. Over the last several years, CHI SVHS has faced challenges related to running out of space because of its growth. When the CHI SVHS leadership team began developing a plan to address the identified community need for emotional and behavioral health services, they first examined the existing hospital space to ensure it was being used as efficiently as possible. As a first step in being able to offer additional behavioral health services, CHI SVHS needed to change how the hospice program was structured. The hospice program, in partnership with Arkansas Hospice (AH), had been housed on 5 West (5W) of the hospital as a standalone hospice unit. (Evidence TL7-1, 2022 CHI SVHS CHNA)
Effective September 1, 2022, AH no longer occupies 5W, but instead partners with CHI SVHS to provide the same level of hospice care on 2 West (2W), an Oncology/Renal medical inpatient unit. Douglas Ross, MD, FACEP, President CHI SVHS, sent a letter to all employees explaining the reason for this change. (Evidence TL7-2, Letter from President)
Strategies and Actions by Nurse Manager to Guide Nurses through Change
CHI Administration and AH collaborated to prepare for the closing of the Arkansas Hospice unit on 5W and transitioning hospice patients to 2W as smoothly as possible in June 2022. Weekly Zoom meetings were held to discuss the planning and logistics of this transition. The leadership of Angela Pike, MSN, RN, CMSRN, Nurse Manager 2W, was essential in successfully guiding the 2W clinical nurses and support staff through this change.
Ensuring Staff Training
Pike identified the need to train current 2W clinical nurses and staff members to care for this new patient population. This would involve a change in practice and a shift in the oncology nurses’ mindset, from treating/hoping for a cure for their patients to now also caring for hospice patients and considering end-of-life care. Training materials included an emphasis on pain management, dyspnea management, using medication and non-conventional methods, spiritual/emotional well-being, and required hospice charting.
Pike collaborated with AH and the CHI SVHS Education Department to hold an in-person educational seminar for the 2W clinical nurses and support staff on August 23 and 25, 2022. The in-person seminar, presented by Jennifer Waters, BSN, RN, CHPN, AH Nurse Educator, covered hospice philosophies, medication administration, palliative care, signs and symptoms of death and dying, and supportive care of the dying patient and their family. (Evidence TL7-3, Hospice Education Flyer) (Evidence TL7-4, Hospice Education PPT-Rosters)
Creating a Hospice “Quick Tip” Resource
Pike recognized that the process for admitting a hospice patient differs from that for admitting an acute care patient. She therefore created a quick tip sheet to serve as a guide for admitting hospice patients and for daily charting requirements and distributed it to the clinical nurses. (Evidence TL7-5, Admission Tip Sheet)
Starting a Nursing Support Group
When the unit began serving hospice patients, several clinical nurses expressed concern to Pike about the emotional toll that hospice patients can take on caregivers. Pike responded by collaborating with Daniel Cartaya, MD, Palliative Care Physician, who then presented an emotional self-care in-service for all interested clinical nurses and support staff on September 20, 2022. This served as a nursing support group, covering topics such as spiritual care, emotional well-being, and self-care.
Ensuring Increased Communication
Clinical nurses brought concerns about hospice staffing assignments to Pike. In response, Pike led a process change meeting on September 23, 2022 with the charge nurses and the clinical director of nursing for 2W to discuss patient assignments. All involved decided to assign hospice patients only to the nurses who requested to take them and no longer assign them according to room assignments. This change improved clinical nurses’ emotional well-being and decreased their stress.
Pike’s leadership was vital in successfully guiding the nurses through 2W’s transition to care for hospice patients. Pike’s support in providing the necessary resources and listening to her clinical nurses enabled a smooth change while providing excellent patient care to the new hospice population on 2W.