Annual Nursing Report 2019

Innovations & Knowledge

at Children’s Nebraska

Kathy English, MSN, MBA, RN, FACHE
Executive Vice President, Chief Operations Officer
& Chief of Nursing Officer
Children’s Nebraska

The Year in Review

It is my honor to lead such a group and to present their accomplishments in our 2019 annual report. Throughout this report, you will see evidence of their impact on the patients and families who we are privileged to serve, and their contributions to the profession of nursing. I am so proud to highlight their accomplishments which make such a difference at Children’s.

2020 Vision for Nursing at Children’s

In 2020, we look forward to renewing our Magnet designation for the fourth time, as well as our Beacon awards in the NICU and PICU. We are also implementing a comprehensive “door to door” cardiac care unit and preparing to move into a new patient tower that will nearly double our bed capacity.

While 2020 has officially been designated as the Year of the Nurse by the World Health Organization and the American Nurses Association, at Children’s every year is the year of the nurse!

— Kathy English, MSN, MBA, RN, FACHE
Executive Vice President, Chief Operations Officer & Chief of Nursing Officer at Children’s Nebraska

Children’s Nebraska earned Magnet ® status in 2006, 2011, 2016, and is currently submitting documentation for our 4th designation in 2020. The ANCC’s Magnet Recognition Program® is the highest and most prestigious credential a healthcare organization can achieve in relation to quality patient care and nursing excellence. To earn the designation, Children’s met and exceeded evidence-based criteria that shows a safe high-quality health care environment, with an emphasis on:

We’re Constantly Learning, Innovating, & Improving

The nurses at Children’s Nebraska are committed to advancing knowledge and making contributions to professional nursing.

Nursing Published Articles

• Early mobilization of infants intubated for acute respiratory failure.

  Holding infants in the intensive care unit has been shown to improve health outcomes, but there has been little research on the safety and effectiveness in very young infants (less than 6 months of age). Our research found that holding young infants who are intubated for respiratory failure is safe and does not affect duration of intubation, length of intensive care unit stay, or length of hospital stay.

  Early mobilization of infants intubated for acute respiratory failure.
  Laura Ortmann, MD; Anne Dey, DNP, RN. Published in Critical Care Nurse, 2019, Volume 39, Number 6, 47-53.

• Disclosure of adverse events: A guide for clinicians

  One of the most challenging parts of being a clinician is telling patients and their families about adverse events — unexpected outcomes of treatment that harm (or could potentially harm) patients.We developed a program for clinicians that provided training and tools to apply when discussing these events. The program empowered clinicians and improved their confidence in their ability to have these difficult conversations.

  Disclosure of adverse events: A guide for clinicians.
  Kimberly Peterson, MSN, APRN-PCNS-BC, CPN; Mary Rutherford, MD; Denise Drvol, MD; Darlen Barkman; Amber Phipps, MBA, DBA; Roberta Hales, MHA, RRT-NPS, RN, CHSE; et al. Published in Pediatric Quality and Safety, 2019, Issue 4, Volume 4, 1-6.

• Don’t have a doubt, get the catheter out: A nurse-driven CAUTI prevention protocol

  Urinary catheters can lead to catheter-associated urinary tract infections (CAUTIs), and the duration of catheter use increases the risk of CAUTI. Catheters that are necessary at first may remain inserted for longer than needed. We developed a guide for the patient’s nurse to use when determining if the catheter is necessary or can be removed. This led to fewer instances of unnecessary catheter use, decreased duration of catheter days, and reduced CAUTIs.

  Don’t have a doubt, get the catheter out: A nurse-driven CAUTI prevention protocol.
  Melissa Schiessler, BSN, RN, CCRN; Lisa Darwin, BSN, RN, CPN; Amber Phipps, MBA, DBA; Lindsay Hegemann, BSN, RN, CPN, CIC; Brenda Heybrock, RN, CIC; Andrew Macfadyen, MD. Published in Pediatric Quality and Safety, 2019, Issue 3, Volume 4, 1-5.

• Implementation of a nursing based order set: Improved antibiotic administration times for pediatric ED patients with therapy-induced neutropenia and fever

  When children have chemotherapy-induced neutropenia and fever, they need antibiotics as soon as possible. Administering antibiotics within 60 minutes of arriving at the emergency department (ED) is ideal for reducing the risk of poor outcomes, such as admission to the Intensive Care Unit. We made three practice changes developed three interventions that together resulted in patients receiving their antibiotics significantly faster with 83% of patients receiving antibiotics within 60 minutes — compared to 0% before.

  Implementation of a nursing based order set: Improved antibiotic administration times for pediatric ED patients with therapy-induced neutropenia and fever.
  Tana Lukes, BA, BSN, RN, CPN; Katharine Schjodt, MSN, APRN-PCNS-BC, CPN, CPHON; Leeza Struwe, PhD, MSN, RN. Published in Journal of Pediatric Nursing, 2019, Volume 46, 78-82.

• A retrospective review of patient outcomes in the pediatric HEROES weight management program

  Pediatric obesity is a significant public health concern in the US. Our study described the impact of HEROES (Healthy Eating with Resources, Options, and Everyday Strategies) — the stage 3 and 4 weight management program at Children’s. Within the first six months of the program, we found that all participants had decreases in BMI, with the greatest change seen in the children completing education, fitness and exercise interventions. We also found significant improvement in health-related quality of life (HRQOL) scores. The HEROES program impacted physical and behavioral changes for both children and families.

  A retrospective review of patient outcomes in the pediatric HEROES weight management program.

  A retrospective review of patient outcomes in the pediatric HEROES weight management program. Mary Jane Hawkins, BSN, RN, CPN; Shirley Wiggins, PhD, RN; Leeza Struwe, PhD, MSN, RN. Published in Applied Nursing Research, 2018, Volume 43, 18-23.

• The effect of team configuration on the incidence of adverse events in pediatric critical care transport

  When pediatric patients are transferred between US hospitals, they are in the care of specialty pediatric transport teams. However, there has been little consensus in the industry about the best team configuration. Our study compared teams comprised of a) two registered nurses (RNs), and b) one RN and one critical care paramedic who had been through a rigorous training and education program. We found no difference in patient outcomes and safety between the two team configurations.

  The effect of team configuration on the incidence of adverse events in pediatric critical care transport.
  Emily Colyer, BSN, RN, CFRN; Megan Sorensen, BSN, MHA, RN, CEN; Shirley Wiggins, PhD, RN; Leeza Struwe, PhD, MSN, RN. Published in Air Medical Journal, 2018, Volume 37, Issue 3, 186-198.

• Operational impact of a critical care transport duty time tool journal

  The Commission on Accreditation of Medical Transport Systems requires transport programs to have tools that address issues such as whether or not to accept a transport request. Patient transport teams often accept all transport requests, even if their shift is about to end. This results in them working overtime, which affects fatigue and alertness, and can put patients and crew in danger. Our goal was to create a risk assessment tool to help transport teams decide if they should accept transfer requests, resulting in less overtime work without negatively impacting transport operations.

  Since implementing the tool, we have seen a 48% decrease in transports resulting in teams staying over one hour past their shift without decreased transport requests. The tool improves crew and patient safety, and increases awareness of safety as a standard.

  Operational impact of a critical care transport duty time tool journal.
  Megan Sorensen, RN, MHA, BSN, CEN, NEA-BC; Robert Chaplin, MD, FAAP. Published in Air Medical Journal, 2018, Volume 37, Issue 6, 352-356.

• Utilizing data reporting for transport research

  Quality management is fairly new for Emergency Medical Services (EMS). Developing policies and procedures that enable the highest quality of care and safety must be the focus for EMS leaders, and this can only be driven by patient data. However, this data can be difficult for emergency teams to report when they are providing care in the field and do not have as much time for documentation. We implemented a new program called ImageTrend, which makes in-the-field documentation easier and faster. This allowed us to have the data we need to examine emergency patient care and improve EMS.

  Utilizing data reporting for transport research.
  Megan Sorensen, RN, MHA, BSN, CEN, NEA-BC. Published online on Journal of Emergency Medical Services, July 13, 2018.

• Creative play: A nursing intervention for children and adults with cancer

  This article explored the role of play in decreasing the anxiety, stress, and social isolation often felt by patients undergoing cancer treatment. Nurses encourage both normative play (play that would happen outside of the hospital, such as puzzles or games) and medical play (using play to explain and address fears about procedures and treatments). Adding play to medical therapy allows children to laugh and act like kids. It also helps nurses care for the ‘whole’ person, which improves job satisfaction and reminds them of why they chose the profession.

  Creative play: A nursing intervention for children and adults with cancer.
  Adrienne Schleisman, BSN, RN; Published in Clinical Journal of Oncology Nursing, 2018, Volume 22, Issue 2, 137-140.

Evidence Based Practice (EBP) Projects

EBP projects are quality improvement initiatives that have led to the implementation of practice changes at Children’s Nebraska.

• Our EBP Projects

  Large volume infusion tubing set-up in the NICU: Are Buretrols necessary?
  2019 – NICU Staff RNs
  Taylor Kolvek, BSN, RN & Hannah Walgren, BSN, RN

  Autologous Blood Storage & Administration in the PICU
  2018-2019 – PICU Staff RN
  Julie Johnsen, BSN, RN, CPN

  Implementation of Area Specific Safety Huddles
  2018-2019 – Council on Outcomes, Research, & Evidence-based practice (CORE) team project
  Co-leaders: Kirsty Eden, BSN, RN, CPN, Staff RN Short Stay Unit & Amy Phillips, MSN, APRN-CNS, CCRN-K

  Triage Training in the ED: Development of an Evidence-based Program
  2018-2019 – ED Staff RN & Clinical Educator
  Lisa Harner, BSN, RN, CPN & Krisi Kult, BSN, RN, CPEN, CPN

  Nail polish: Can nurses safely wear it?
  2018-2019 – NICU Staff RNs
  Emma Legett, BSN, RN & Paige Yager, BSN, RN

  Nurse Driven ED Triage Administration of Ondansetron (Zofran)
  2017-2019 – ED Staff RN
  Kacie Baber, BSN, RN

  Management of Patients Not Tolerating Essential Medical Treatment during Transport
  2018 – Transport Staff RN
  Kyle Martin, BSN, RN, CNPT

  Nurse Driven Foley Removal Algorithm
  2018 – PICU Staff RN
  Lisa Darwin, BSN, RN, CCRN, CPN

  Infusion Center FTE Utilization Improvement
  2018 – SPC Staff RN
  Amanda Gunhus, BSN, RN, CPN

  Preventing Nulytely Aspiration
  2018 – Med Surg team project
  Stephanie Johnson, MSN, APRN-ACCNS-P, CPN – Clinical Nurse Specialist
  Sarah Mimick, BSN, RN, CPN & Laura Micek, BSN, RN, CPN – Staff RNs Med Surg

  Use of CHG Scrub at the Start of Each Shift in NICU
  2018 – NICU Staff RN
  Lindsey Mittelbrun, BSN, RN

  Safe Administration of Allergy Injections to Minimize Patient Reaction
  2018 – SPC Allergy Clinic Team
  Danielle Herbolsheimer, BSN, RN Staff RN; Christi Thompson, BSN, RN, CPN, Nursing Manager; Hana Niebur, MD

  Emergent Delirium in Phase 1 Recovery
  2017-2018 – CARES/PACU Staff RN
  Mary Drouillard, BSN, RN, CPN, CCRN

  Taking Vital Signs Prior to Discharge to Decrease Readmission Rates
  2017-2018 – 5 Med Surg Nurse Clinical Educator
  Ellen Mata, BSN, RN, CPN

  Drawing Lab Specimens from a PIV
  2017-2018 – 6 Med Surg Staff RN
  Teresa King, BSN, RN, CPN

  Transitioning the Neurology Seizure Patient from Pediatric to Adult Care
  2016-2018 – Neurology Clinic
  Libby Leute, BSN, RN, CPN, Staff RN SPC & Melissa Fanning, BSN, RN, Case Management

Research Projects

• Current Research Projects

  Nurse retention: Why do you stay? (IRB#848-19EX)
  11/2019-current – Director of Pediatric Critical Care & Director of Medical-Surgical
  Anne Dey, DNP, RN, NE-BC & Crystal Smith, DNP, RN, NE-BC

  Nursing knowledge and confidence in assessing iatrogenic withdrawal (UNMC IRB exempt)
  11/2019-current – Cardiac Care Unit Staff RN
  Maggie Theiler, BSN, RN

  Optimizing family centered care in the PICU (UNMC IRB exempt)
  11/2019-current – PICU Staff RN
  Leah Keune, BSN, RN

  Temperature checks can be disruptive: Determining how often they should be done in pediatric private duty nursing (UNMC IRB exempt)
  10/2019-current – Children’s Home Health Private Duty Staff RN
  Sara Denly, BSN, RN, CPN

  Identification of risk factors for emergence delirium for the child experiencing procedural sedation (IRB#650-19EP)
  9/2019-current – CARES/PACU-Radiology Staff RN
  Lydia Becker BSN, RN, CPN

  Need for resuscitation in pediatric trauma patients through the use of thromboelastography (TEG) (UNMC IRB exempt)
  9/2019-current – PICU Staff RN
  Hannah Lindberg, BSN, RN

  Implementation of nurse led rounds and daily patient goals in the PICU (UNMC IRB exempt)
  8/2019-current – Director of Cardiac Care Unit
  Alyss Burgert, BSN, RN, CCRN, NE-BC

  Intraoperative autologous blood storage & usage in pediatric cardiac surgical patients with cardiopulmonary bypass (UNMC IRB exempt)
  7/2019-current – PICU Staff RN
  Julie Johnsen, BSN, RN, CPN

  The THRIVE training to improve leadership confidence in response to staff stress: A DNP quality improvement project (UNMC IRB exempt)
  7/2019-current – Director of Clinical Operations
  Marcie Peterson, MSN, RN, CCRN, CNML

  Implementation of pediatric cardiac shunt dependent precautions to increase nursing knowledge and improve patient outcomes (UNMC IRB exempt)
  7/2019-current – Cardiothoracic Surgery Nurse Practitioner Intern
  Kelsey Spackler, BSN, RN

  Comparing perceived self-efficacy between simulation modalities in crycothryoidotomy training amongst pediatric critical care transport team members (UNMC IRB exempt)
  6/2019 – Transport Staff RN
  Rebecca Meredith, BSN, RN, CCRN, CNPT

  THRIVE: Transforming Healthcare stress through Relational, Intentional and Versatile Empowerment (UNMC IRB exempt)
  5/2019-current – Performance Improvement RN & PICU Intensivist
  Melissa Schiessler, BSN, RN, CCRN & Alison Miller, MD

  Improving Postoperative Pain Management in the NICU (UNMC IRB exempt)
  5/2019-current – NICU Staff RN
  Laura Graves, BSN, RN, RNC

  Radiation exposure with nasojejunal insertion in the PICU (UNMC IRB exempt)
  11/2018-current – Hospitalist Nurse Practitioner Intern
  Hilary King, BSN, RN, CPN

  Potts shunt data repository (IRB#547-18EP; multi-site)
  10/2018-current – Pulmonary Hypertension Coordinator
  Venus Anderson, MSN, APRN-FNP-BC

  Validation of distress and sedation tool (Comfort B) in the Transport and Emergency Department environment (UNMC IRB exempt)
  5/2018-current – Transport Staff RN
  Kristen Foster BSN, RN, CCRN

  Teach back as an intervention to improve discharge education (UNMC IRB submitted & pending approval)
  2/2018-current – CARES/PACU/SOU Clinical Education Specialist
  Monica Schneider MSN, RN, CPN

  Measuring the acuity of pediatric critical care nursing using the Complexity Assessment and Monitoring to Ensure Optimal Outcomes (CAMEO©): A multi-site experience (IRB# 514-17EX; multi-site)
  10/2017-current – Director of Pediatric Critical Care & Clinical Nurse Specialist Nursing Education
  Anne Dey, DNP, RN, NE-BC & Amy Phillips, MSN, APRN-CNS, CCRN-K

  Caregiver reasons for pediatric ED return visits (IRB#135-18EP)
  5/2017-current – Emergency Department Staff RN
  Shuntel Blecher, BSN, RN, CPEN

• Research Projects Concluded in 2018-2019

  Pain Management Education: Communicating Collaborative Priorities and Needs (IRB# 734-17EX)
  11/2017-08/2019 – Performance Improvement Quality & Patient Safety Nurse
  Amy Vacek, BSN, RN, CPN

  Evaluation of cost related to placement of post-pyloric feeding tubes in critically ill pediatric patients (IRB# 782-18EX; UNMC IRB exempt)
  11/2018-3/2019 – PICU Nurse Practitioner Intern
  Lisa M. Darwin, BSN, RN, CCRN, CPN

  Utilizing a pictorial nausea assessment scale in pediatric oncology (UNMC IRB exempt)
  8/2018-3/2019 – 6 Med Surg Staff RN
  Mary Benson, BSN, RN, CPN, CPHON

  Implementation of an oral care bundle on a pediatric oncology inpatient unit (UNMC IRB exempt)
  7/2018-1/2019 – 6 Med Surg Staff RN & Hospitalist Nurse Practitioner Intern
  Stephanie Kammrad, BSN, RN, CPN

  Prevention of perioperative hypothermia (IRB# 723-11EP)
  02/2012-12/2018 – Nursing Education Specialist Surgical Services
  Susie Beedle, MSN, RN, CPN

  How does prompt antibiotic administration in febrile neutropenic pediatric oncology patients impact transfers to PICU (IRB# 657-17EP)
  11/2017-11/2018 – 6 Med Surg Staff RN
  Teresa King, BSN, RN, CPN

  Pain agent use with PIV catheter insertion in children pre/post measure of pain agent use after education offered (IRB# 476-17EP)
  8/2017-8/2018 – Hospitalist Nurse Practitioner
  Kristina Mueller, BSN, RN, CPN

  The effect of preoperative pre-warming in pediatric spine and cranial surgery patients (UNMC IRB exempt)
  10/2017-08/2018 – CARES/PACU Manager
  Monica Schneider, BSN, RN, CPN

  Hemostatic disk or antimicrobial patch: A description of central line dressing change occurrences in critically ill neonates (Clarkson IRB exempt & UNMC IRB confirmed exempt)
  2017-4/2018 – NICU Clinical Education Resource
  Megan Gombold, BSN, RN, RNC-NIC

  Implementation of an evidence-based caregiver education bundle for central line cares in newly diagnosed pediatric oncology patients discharging home with an external central line (IRB# 166-17EP)
  04/2017-04/2018 – Hematology/Oncology Nurse Practitioner
  Johnna Feik, MSN, APRN-NP and Shirley Wiggins, PhD, RN

  Verbal versus written education to improve parent compliance with Feeding documentation after discharge in children with congenital heart disease (UNMC IRB exempt)
  4/2017-4/2018 – Cardiology Clinic Staff RN
  Venus Anderson, BSN, RN

  Perceptions of nurses and medical assistants related to the practice of pediatric height and length measurements in the clinic setting (UNMC IRB exempt)
  4/2017-4/2018 – Nurse Practitioner Gastroenterology
  Amanda Beranek, BSN, RN

  Depression screening in GI clinic and incidence of depression (UNMC IRB exempt)
  10/2017-3/2018 – Staff RN ICU FLEX
  Casey Kilpatrick, BSN, RN, CPN

  Implementation of a delirium screening tool in a PICU (UNMC IRB exempt)
  6/2017-3/2018 – Staff RN PICU
  Abby Wachholtz, BSN, RN

  Routine administration of a standardized depression screening tool in the adolescent oncology patient (UNMC IRB exempt)
  7/2017-3/2018 – Staff RN 6 Med Surg
  Kaelee Stuchlik-Steffensmeier, BSN, RN

  Sepsis screening in Pediatric Patients: A Retrospective Chart Review in a Midwestern Pediatric Emergency Department (UNMC IRB exempt)
  8/2017-3/2018 – Staff RN PICU
  Kara Reyes, BSN, RN

  Factors influencing successful transition of RNs into pediatrics (UNMC IRB exempt)
  1/2018-5/2018 – Director Med Surg
  Crystal Smith, MSN, RN, NE-BC

  Critical Care Transport. The purpose of this research is to study the effect of team configuration on the rate of adverse events occurring during pediatric interfacility transport (IRB# 107-17EP)
  03/2017-02/2018 – Staff RN Transport
  Emily Colyer, BSN, RN, CFRN, CTRN, CEN, C-NPT

We’re Proud of Our Awards, Recognitions & Honors

U.S. News & World Report

U.S. News & World Report has ranked Children’s in five pediatric specialties in the new 2018-19 Best Children’s Hospitals rankings: Cardiology and Heart Surgery, Pulmonology, Gastroenterology & GI Surgery, Orthopedics, and Diabetes & Endocrine Disorders
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Commission On Accreditation Of Medical Transport Systems (CAMTS) Accreditation

CAMTS accreditation affirms that, by ground or by air, Children’s Nebraska provides the best pediatric and neonatal critical care
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ACS (American College Of Surgeons) Trauma Verification

Children’s trauma program successfully completed the re-verification process for our trauma center and we were officially re-verified as an ACS Level II trauma center
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Beacon Award For Excellence

This is awarded to units that meet or exceed quality standards based on proven indicators of excellence.
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Recognized As A Safe Sleep Designated Hospital

The Safe Sleep Program promotes safe sleeping practices for infants to prevent Sudden Infant Death (SIDS).
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March of Dimes

March of Dimes honors nurses with 20+ years of experience who demonstrate the essence of nursing related to professional contributions, giving back and compassion for their patients.
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Positive Image of Nursing Award

The Positive Image of Nursing Award is a recognition and award program facilitated by the Nebraska Nurses Association to honor outstanding professional Registered Nurses whose commitment and dedication exemplify a “Positive Image of Nursing.”
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The DAISY Award

The DAISY (Diseases Attacking the Immune System) Award is an international recognition program. DAISY Award recipients personify Children’s Nebraska’s remarkable patient experience.
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Nebraska School Nurse Of The Year Award

The Excellence in School Nursing Award, sponsored by the Nebraska School Nurses Association (NSNA), honors one School nurse who has demonstrated leadership and excellence in the practice of School nursing.
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Robert E. Murphy Spirit Of Caring Award

This annual award, initiated by the family of Dr. Robert E. Murphy, honors a pediatric nurse who exemplifies those qualities that provide comfort and support to children and their families during a hospital or clinic experience.
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Florence Nightingale Award

The Florence Nightingale Award is a peer-nominated award for nurses who exemplify characteristics that Florence Nightingale, the founder of modern nursing, demonstrated.

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