System Design
Faculty model of precepting
Stefania Romano, BSN, RN, Anna Chermside, BSN, RN
In FY22, Lurie Children’s onboarded 400 nurses, a dramatic increase from previous years, and the number will be higher in FY23. To successfully onboard this increased number of orientees, a group of nurses introduced the faculty model of precepting as a creative solution. With this new model, a preceptor is paired with two or more orientees during the last four to six weeks of orientation. The new nurses progressively assume more independent responsibilities for patient care, while receiving preceptor support when they need additional resources. Kaitlin Koralik, BSN, RN, CCRN, CBC, Nursing Professional Development Practitioner (NPDP), led the launch of the model in the Regenstein Cardiac Care Unit, followed by Lisa Tieman, BSN, RN, NPD-BC, CPN, NPDP, and Lisa Zimbler MSN, RN, CPN, NPDP, on the acute care floor 20. To date, nearly 50 orientees completed the program on these units. Their feedback on surveys was consistently positive, affirming that they felt more confident in their role and appreciated the time to practice independent decision-making.
Promoting a Healing Culture
Deirdre Guthrie, PhD, Director, Wellbeing and Joy in Practice
Knowing the importance of supporting nurse wellbeing, Lurie Children’s became one of the first hospitals to create a wellbeing position specific to the Department of Nursing. Under the leadership of Deirdre Guthrie, PhD, Director, Wellbeing and Joy in Practice, Lurie Children’s has implemented initiatives designed to promote, protect, and improve wellbeing on an organizational, team level, and individual level. To this end, Guthrie has:
- Established an inspirational speaker series open to all in the organization to highlight wellbeing practices from outside experts.
- Facilitated Healing Circles within teams to begin the process of healing from the stressors of the healthcare environment through gathering a circle of companions who understand the challenges of being a healthcare provider. Healing Circles provide an open and honest setting to reflect and digest the impact of patient care on staff members.
- Offered individual wellbeing coaching for nurse managers and led the design and development of Recharge Rooms. These rooms provide an environment separate from patient care areas that can be utilized to perform micro-practices related to wellbeing which provide sustainment throughout the shift.
Overall Guthrie is working on creating a sustainable design to build nurse wellbeing into the culture of the organization to ensure Lurie Children’s nurses are practicing in the healthy work environment that allows nurses to flourish. “We know relationships and social support are foundational to healthy work cultures. In fact, it is a key priority of the US Surgeon General’s office this year. I understand how critical it is for me to listen and respond to the voices of those working on the frontline. They know best how to tailor and adapt wellbeing strategies to meet their needs.”
400+
Nurses onboarded in FY22
Staffing and scheduling improvements
With the passing of the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2021, the Staffing and Scheduling Council worked with Nursing leadership to implement the law into Lurie Children’s nurse staffing practices. Comprised of representatives from inpatient units and the Emergency Department, staffing and scheduling meetings now occur with increased frequency to discuss specific data related to patient acuity, staffing challenges and patient outcomes. These supplemental efforts to optimize staffing come at a crucial time when the nursing profession is seeing a large exodus. The Staffing Variance Tool that was developed has helped proactively address concerns from frontline staff. “The Staffing Variance Tool is a way for any staff to report staffing challenges that have occurred or assignments outside the posted grid in a non-retaliatory manner,” said Sara Evans, BSN, RN, CPN, Resource Team, Chair Staffing and Scheduling Council. “Instead of waiting for change, we evaluate reports alongside the data every other month with leadership buy-in and address issues head-on.”
Mentorship roles for nurses
Over the past two years, Lurie Children’s has utilized innovative nursing roles to support clinical nurses. Clinical Quality Coordinators (CQC) are nurses who help coordinate quality and safety initiatives throughout the hospital. The role was initially piloted in the CCU, now all inpatient units as well as the ED and Surgical Services have a CQC. The CQCs have focused on leading improvements related to hospital acquired conditions, developing and implementing a PPE Spotter program during the COVID-19 pandemic, and partnering with nursing and medical directors to lead HRO work in their areas. The role of Nursing Professional Development Associate (NPDA) was initially created for newer nurses on the night shift in the acute care units to develop skills and has expanded with additional roles for more areas. The NPDAs are a key resource for clinical nurses and provide targeted education especially on new devices and protocols. They put together carts and tip sheets around specific education, such as a new type of feeding tube, and discuss care protocols and the “why” behind what they are to do. “These roles have been critical in developing our newer nurses, especially their skills and critical thinking around issues that arise in the course of providing care,” said Karen Richey DNP, MBA, RN, NEA-BC Associate Chief Nursing Officer, Inpatient Services. “Each year we’ve grown to add positions that support nurses and our patients benefit from this creative approach to care.”