October-November 2012 Nursing Notes - The Medical Center

~ Communicating Helps Caregivers ~
O c t o b e r – N o v e m b e r
2 0 1 2
IN THIS EDITION
2 Betsy’s Corner
2 Wellness Visit Reminder
2 Thank You, Pediatric
Nurses!
3 Clinical Ladder
Challengers
3 Show Your Pride…Get
Certified!
4 Stuff the Turkey Food
Drive
4 Congratulations!
4 ESD Appreciation Day
on 4D/OHR
5 Clinical Support Ladder
5 Welcome New Nurses
5 Congratulations
6 Council Reports
Commonwealth Health Corporation’s
nursing mission is to care for people
and improve the quality of life in
the communities we serve through
our practice, education, research,
innovation, and collaboration.
Completing a “Code of Arms” at the Emergency
Department TowER of Emergency 2012 Competency Fair
The Emergency Department selected a theme
with a Medieval flair for the 2012 Competency Fair
held August 21–24. Participation continues to be
at 100% for this event! Making their way through
“Sherwood Forest” to the registration table, the staff
was attired in various garments and crowns, depicting
the Medieval time period. The staff entered
the “TowER of Emergency to attend clinical skill
stations. The stations were given names corresponding
to the theme. Among them were: “Black Plague”
TB Skin Testing; “King ARTher” Arterial Lines;
“Blood Letting” Chest Tubes and Auto Transfusion;
“Turkey Legs” EZ-IO; “Trumpeters” Triage; “Court
Jester” Customer Service; and “Stocks” Restraints.
Information and skills were given and demonstrated by the staff.
Our break room was transformed into the “Banquet Hall” complete with refreshments
throughout the week. Also, burlap goodie bags were distributed to attendees for
their participation.
Multiple comments were given by participants. “Over the top. Great.” (Angie
Gipson, RN); “Great! Again.” (Sandra Meredith, RN); “Fun and informative.” (Hannah
Johnson, SNR); “Fabulous!” (Karen Ray, RN); “Fun!” (Jenna Wright, RN); “Superb
as always!” (Elaine Priest, House
Administration).
To create this educational event
takes considerable planning, research
in best practice and organization.
Through the Unit Based Council of
the Emergency Department, procedures
were suggested to be included
in our Competency Fair. This is an
excellent method to have staff demonstrate
selected skills and communicate
information to the whole department.
We are very fortunate to have the artistic talent of Amy Blick, RN and Dwayne
Cardwell, RN in the Emergency Department to bring all of the theme ideas to reality.
April Anderson, ED Tech, LPN assisted again in our set up. April Ford, Monitor Tech,
assisted in folder creation for each participant as well as making copies of handout material.
Our Competency Fair is a true committee effort.
We look forward to another successful Competency Fair next year.
Anne Afton, BSN, RN, CNIV, Competency Chair
Charge Nurse, Emergency Department

Betsy’s Corner
Betsy Kullman
Chief Nursing Officer
The beauty of the fall is upon us,
and I hope that everyone will take a
couple of hours sometime out of your
week to take a leisurely drive or stroll
and enjoy the beautiful fall colors. Like
the beauty of the trees and leaves, I see
the beauty in each of you. The way that
you care for patients, the time you take
to spend with families during stressful
times, the above and beyond gestures
that you do for patients and families.
Each of you is unique and beautiful in
your own special way. Thanks for giving
of yourself each and everyday for
our patients and families.
As you know, we have been working
on Value Based Purchasing, Core
Measures and HCAHPS measures for
some time. We have seen improvements
in many areas, but we still are
not where we need to be. We need everyone’s
assistance in assuring that all
of the measures are completed and documented
plainly in the patient record
so that the coders can find the documentation.
We are currently changing
some of the documentation of CHF and
will be sharing the final results with
you in the near future. Everyone must
know what the measures are and be
able to assess if your patient is included
in these measures. We will be doing
some re-education beginning with our
November shared governance meetings.
All of these measures are here to
stay so we need to make them a part of
our daily routine. We are working with
Mark Hanson to build as many into our
documentation as possible. If you have
any ideas for improvement, please
bring those to your clinical manager or
to the monthly CIS shared governance
meeting which meets in the Auditorium
at 12:30 p.m. the first Tuesday of each
month.
I hope that many of you were
able to attend the poster presentations
October 17-18. The posters were
impressive and showed that evidencebased
nursing practice is alive and
thriving at The Medical Center.
Our annual Clinical Ladder
Recognition Dinner was held on
November 15. All spring inductees and
renewals as well as the fall ones were
invited.
Please welcome our two new clinical
managers: Caitlin Burklow on 4C
and Mary Jo Baker on 5A. Both have
been nurses at The Medical Center for
several years and will be an asset to the
Nurse Management Team.
Betsy
Don’t Forget!
Have YOU completed
your 2012 Annual
Wellness Visit?
Due no later than
December 31, 2012
An Annual Wellness Visit with a Healthcare
Provider of your choice is required during
calendar year 2012. To demonstrate
completion, you must fax your completed
Annual Wellness Visit Form to 796-4517
before 12/31/12. If you do not do so,
effective April 1, 2013, you will be
defaulted to the PPO Plan AND you will
pay a higher premium cost (computed to
be $1,058.00 annually).
The Annual Wellness Form is available
in the CHC intranet HR Payroll folder
(Human Resources / Benefit Programs /
Wellness Pay$ / Annual Wellness Form).
Reminder: Annual Wellness exams are also
available in the Employee Health Clinic.
Make your appointment now, before
appointments are filled. Call 745-1263,
or extension 1263.
Applies to employees enrolled in the CHC
Medical Plan before November 1, 2012.
Questions? Contact Human Resources
at 745-1540.
October 7–13 was National
Pediatric Nurses Week. As the
manager of 5C, I would like to say
“thanks” to an awesome staff for
the work you do every day. Staff
members participated in daily
celebrations and give-aways during
the week.
Deborah Wilson, BSN, RN, NE-BC
Clinical Manager 5C/Dialysis
Page 2

Congratulations
Clinical Ladder
Challengers
In 2012, the Clinical Ladder had a
total of 35 nurses succeed in their
challenges to reach the status of CNIII,
CNIV or, for the first time this year, CNV.
April had 17 challenges and October
had 18 challenges.
April:
CNIII
Dorcas Allen
Kim Dethridge
Renee Fisher
Mary Ford
Sarah Graves
Stephanie Gregory
Amy Groce
Sarah Harrison
Beverly Jaggers
Deborah Jones
Tracy Metzger
Stacy Mosier
Allison Strader
Rita Wilson
CNIV
Shaune Harris
Kristin Smith
Virginia Erin Wallace
October:
CNIII
Brittany Baxter
Teresa Bertrand
Carie Cosby
Beth Crawley
Kimberly Gowen
Sherry Jackson
Claire Alice Kirby
Kay Miller
Gail Peck
Amye Rowland
Shauna Stice
Stephanie Steff
Ashley Towe
Brittany Whitaker
CNIV
Dorcas Allen
Kim Dethridge
Stephanie Gregory
Misty Hughes
CNV
Debra Smith
Show Your Pride…Get Certified! by C. Alice Kirby, RN, MSN
First our committee would like to
recognize Michelle Perkins, CNRN
and Stacie Young, CCRN who have
recently obtained their certifications.
Both Michelle and Stacie work in ICU.
Congratulations!
Last month, Lisa Cox, RN on 4D
did a great job discussing the many
reasons why a nurse should obtain
his or her certification. I would like to
talk about obtaining the certification;
but first I have a story to tell (surprise
surprise).
I obtained my certification as a
psychiatric mental health nurse many
years ago when my primary focus in
healthcare was related to child/adolescent
and adult mental health nursing.
I was so excited when I learned that
I had passed the exam. What a fun
adventure. I and three of my nursing
friends loaded up in the car and went to
Louisville to spend the night and take
our exam. Girls night out and slumber
party all rolled into one. I was soooo
much younger. We stayed at the Galt
House. Dinner out. Walked around.
Actually ran into a few movie stars in
town filming Demolition Man. This really
shows how long ago this was. Now
to get to the end of my story. We all felt
like we were prepared for the exam.
Many group study sessions, networking
with others who had completed this
project, and incredible support from
management. We were ready!
So what happened? Don’t worry…
we all passed the test, but we got lost
getting to the testing site. This was
all before Garmin and GPS. Thank
goodness we started early. We barely
made it on time and stress levels were
through the roof. Got the picture?
After the exam was over, we all
started comparing exam questions and
answers. We were so sure we had failed
the exam. Again, this was before computer
exams with immediate results.
So, after a few more days of worry we
got the notice that we could now put a
“C” after RN. I was so proud. We all
were. I had it monogrammed on my lab
coat and scrubs.
Fast forward to now. I kept that
certification for over 10 years, but I
did not renew my certification when it
came due a few years ago and I had to
give up my “C.” I regret this everyday.
I had the CEUs and the hours needed. I
just let something important to me as a
nursing professional slip away.
I want it all back. I have study
materials that the hospital has provided
for support. Classes are being
offered throughout the year for different
reviews such as the recent CCRN
review that more than 30 people
attended. Practice test questions are
available upon request. Many resources
are available through the Education
Department.
Also, I am looking forward to posting
the names of each nurse when they
obtain their certification status. We
are very fortunate to have leadership
that supports on-going education and
certifications. So, get on board and get
certified. Just think about the story you
will have to tell to the next generation
of certified nurses! Nothing is standing
in your way except your own personal
choice. And, you can have it monogrammed
on your scrubs!
The Retention, Recognition, and Recruitment Council would like
to thank those employees who work in Distribution for saving us
the boxes for our Thanksgiving Food Drive and delivering them
to the auditorium on October 17. We appreciate them very much
and want to send out a great big Thanks!
Page 3

Turkey Drive to Benefit Salvation Army
It’s hard to believe Thanksgiving is
right around the corner, which means
along with the weather getting cooler
and the leaves changing color, it’s also
time for our annual Turkey Drive benefiting
our local Salvation Army! This has
1st Place – ED
STUFF THE
TURKEY
2nd Place – 4C
always been a popular and successful
event, and we set our goal even higher
this year. We “Filled Connie’s Office” with
4,355 canned goods and other nonperishable
food items!
Boxes were distributed to the units
on October 17; however, this year
“plain” boxes were distributed, and the
units will be decorating their own boxes.
A prize was awarded for the most
creative decorating based on the judging
of a team from the RN and Clinical
Support Recruitment and Retention
Commit tees. The winners were: 1st
Place – Emergency Department; 2nd
Place – 4C; 3rd Place – Infection Control.
3rd Place – Infection Prevention
Congratulations!
Millie Caffey, RN, CMSRN, 4A
passed the Medical-Surgical
Nursing Certification! The Med-Surg
Certification exam is on line and can
be taken right here in Bowling Green.
Go to www.amsn.org for information
on certifications or contact Vickie
Mullins or Mary Ford on 4A.
Ambulatory Surgery is very proud of
one of its own, Sandra Gross, RN. In
2001, Sandra took a leap of faith in
making a career change after more
than 20 years as a quality controller
and entered the nursing program
at WKU. She graduated in 2009 with
her Associate Degree in Nursing
and then enrolled immediately into
the BSN program. She will graduate
in December. During this phase,
Sandra has received the Outstanding
Leadership Award twice, has been
selected as the recipient of the RN
to BSN Engagement Award, and is
soon to have her article, “The Hats
of Nursing,” published in Kentucky
Nurse. Our hats go off to Sandra for all
her hard work and dedication to the
nursing profession.
Environmental Services Appreciation on 4D/OHR
by Paula DeVore, RN, MSN, BSN, CCRN, CNIV
4D/Open Heart Recovery
is very grateful to our
Environmental Services Staff for
everything they do. It is normal
to see Harvey Carter or Diane
Lightfoot offer our patients’
families a cup of coffee or a kind
word. Robin Young greets everyone
with a smile and a “what can
I do for you” attitude. They do so
much more than clean. They offer
excellent customer service to the
patients and to their co-workers.
It is definitely a team effort with ESD staff, left to right: Robin Young, Harvey
our Environmental Services staff. Carter, Diane Lightfoot and Felicia Walker.
They are more than the “cleaning
people,” they are part of our family.
To show our appreciation, we hosted a surprise luncheon on October 2. It
warmed our hearts to be able to do something for those who do so much for
us. We truly appreciate everyone of them and are honored to work beside such
caring people!
Page 4

Show your pride…
Get Certified!
Congratulations to the following
nurses who have achieved
certification:
ICU
Leslie Rosssetter – CCRN
Stacie Young – CCRN
Michelle Perkins – CNRN
Corie Schaefer – CNRN
Nursery/NICU and 2B
Stacy Mosier – IBCLC
Tracy Wheeler – RNC-LRN
Latricia Riley – RNC-LRN
Rachel Garrison – RNC-LRN
Dorcas Allen – RNC-LRN
Stephanie Blackburn – RNC-LRN
Haley Embry – RNC-LRN
Laura Gregory – RNC-MNN
Welcome!
We would like to take a moment
to introduce our new nurses to
the hospital. Please take time to
make their experience pleasant.
Paul Beachem............................. ED
Jenee Beck....................................5B
Kataum (Kathy) Boka .............ICU
Hannah Bryson......................NICU
Krista Dulay................................. ED
Matthew Geegan...................... 3D
Paul (Taylor) Harned................. ED
Audrie Hinson............................ 5A
Keithena Holman...................... 4A
Amila Jackupovic...................... 3D
Laura Jenkins...............................5C
Ashley Lambert...........................4B
Angela Martin......................... L&D
Marissa McGuire.........................3B
Kerissa McKinney...................... ED
Sarah Morris.................................5C
Megan Murphy.......................... 5A
Rita Pierce.................................. ICU
Michael Rippy............................. 3D
Michael Schlabach.................... ED
Lauren Sledge............................ 3D
Mark Smith...................................4C
Brittanie Thompson................. 4A
Tonja Wilt......................................4C
Gina Wright................................. ED
Clinical Support Ladder by Natasha Winchester, RN
Gear up for the new Clinical
Support Ladder coming out in April
2013! All nursing support personnel
will have the opportunity to submit a
binder with evidence of extra projects
and activities beyond their job description
to the Clinical Support Ladder
Committee that meets the second
Tuesday of every month at 11 a.m. in
Classroom 2. Two workshops will be
held between now and April to help
those interested in putting together a
binder. Dates for the workshops will
be announced in the near future. Also,
anyone is welcome to attend a committee
meeting for further information.
The Clinical Support Ladder is
similar to the RN Clinical Ladder,
but with a few unique differences. It
consists of four levels ranging from
“Novice” to “Change Agent.” New
employees to the corporation will
begin at the Novice level once they
complete their orientation period. After
two years of employment (or one year
with an exceptional evaluation score
and manager approval), the employee
automatically moves to level two, or
“Competent.” To climb the ladder to
level three, and eventually to level
four, the employee must submit a
binder to the Clinical Support Ladder
Committee with the evidence of extra
work/projects.
Current employees who wish to
challenge the ladder will first submit
a binder to move to level three. After
six months at level three, you become
eligible to submit another binder
to move to level four. Like the RN
Clinical Ladder, level three is associated
with a five percent raise, and level
four is associated with another five
percent raise.
A document describing approved
projects and details of the submission
process will be accessible to all
employees soon under the education
folder found on your desktop. All
projects must be completed within two
years of the date of submission.
A unique characteristic of the
Clinical Support Ladder is the incorporation
of the Five Standards of
Care (Professionalism, Clinical Skills,
Education, Quality Initiatives, and
The new Clinical Support Ladder
will begin in April 2013!
Leadership). The employee must submit
evidence of five approved projects/
activities, each representing a Standard
of Care.
Approved projects are further
broken down into Category A and
Category B. Category B is slightly
more rigorous and difficult to complete
than Category A. The only difference
between submitting a binder for level
three status versus level four status
is that more projects must be from
the Category B option to become a
level four.
There will be a form available to
all managers/supervisors that must be
submitted for every employee to move
up each level of the ladder. It states
they meet the minimum criteria of
Standards of Care for that level.
If you have questions, comments
or concerns, please visit one of our
monthly meetings or attend one of our
workshops (dates TBA). Co-workers
who have put together a binder for
their own Clinical Ladder are also
great resources to help those who are
interested! You can also email Natasha
Winchester, RN at wincnm@chc.net or
Julie Burba at burbja@chc.net.
Page 5

Notes From Shared Governance
by Betsy Kullman, Executive Vice President/Chief Nursing Officer, and Pat Gilpin, 3B Clinical Manager I
Standards and Practice
Stroke and Dysphagia Report: Bill
Singletary reported the June, July and
August data from our stroke indicators.
There are still issues with patients not
receiving the following: VTE prophylaxis
(one in June and three in August);
antithrombotic therapy(one in June and
one in July); dysphagia screening not being
done (four in June, three in July and
five in August); caregivers given educational
materials (didn’t check the stroke
education box correctly upon discharge
— three in June, one in July and one in
August); and rehabilitation assessment
not done (one in June, two in July and
one in August). Bill Singletary stressed
with the group to “Trust the Triggers.”
CHF indicators for the month of
August were at 92.11%. A discussion was
held about the need for consistency on
these measures. The Yes/No box has been
removed on the discharge sheet for CHF.
The education was being done, but the
box was being checked incorrectly or not
being checked at all. When discharging
CHF patients, you will need to highlight
or circle the CHF indicators that pertain
to these patients. We should notice a difference
in our November numbers. If you
have questions, contact your manager,
Kevin or myself. A long discussion was
held regarding the core measures and
the HCAHPS most recent scores. This
will be an added agenda item that will be
discussed monthly so we can track our
improvements. Pain goals were discussed
as an improvement for Pain Well-
Controlled measure. We also discussed
beginning education on new medications
as soon as they were ordered instead of
on the day of discharge.
Recruitment and Retention:
A co-chair is needed for this committee.
Plans for a Senior Nurse Recognition
Tea for February were discussed, and
details will follow. The Stuff the Turkey
Food Drive was discussed. Food boxes
must be delivered to Administration on
the morning of Friday, November 16. We
are challenging everyone in the corporation
to bring at least one food item and
please check the expiration date on the
food item to make sure that it is current.
Human Resources stated that there are
17 nurse vacancies corporate-wide. New
graduate interviews are currently being
conducted. SNR interviews will be conducted
soon.
Research Council:
The Evidence-based Poster
Presentation was held on October 17 and
18. Congratulations to our winners: 1st
place went to ED; 2nd place to NICU and
3rd place to PACU. A discussion regarding
a traveling trophy for the 1st place
winner was held and will be investigated
for next year. Please watch for workout
sessions for the 2013 Evidence-based
Posters that will begin after the first of the
year. Each unit is expected to participate
in this activity as we are all responsible
to keep up with evidence-based practice
for our specialties. The Sigma Theta Tau
Research Day will be held on Friday,
November 16 at Greenwood Church of
Christ. If you do not need CEUs, there
will not be a charge. The topic of bringing
the Journal Club back was discussed. We
will be looking for a time slot on shared
governance day for this.
Nursing Quality Improvement:
Bill Singletary presented the Stroke
Information for the months of June, July
and August. Betsy Kullman presented
CHF indicators and the changes that have
occurred in the documentation process.
Core measures and HCAHPS measures
were also discussed. The need for concurrent
review of each of the charts affected
by all these measures was discussed and
that it has to be a group effort by everyone
involved in the patient’s care. All
committee members were asked to bring
their ideas to the next meeting regarding
how we can monitor these indicators on a
concurrent basis.
Nursing Development Council:
Nursing competencies were due
November 1. The survey for all nurses
to update their credentials was sent out
by Erin Desmarais on October 19. The
committee is to encourage their units to
complete the survey as this is valuable
information for our nursing department.
Misty has arranged to obtain a space in
Nursing Notes to recognize nurses for
their certification achievements. All managers
need to send the names to Misty
when certification is achieved to be in
the nursing newsletter. The Lighthouse
on-line meeting is open to all preceptors
through December 6 to participate in. The
Student Development Packets that are being
used in ICU and Surgery are a success
and are enhancing the student’s learning
experience. A discussion was held regarding
where other units are in the process
and how a generalized packet could be
developed for the Med-Surg floors.
Clinical Ladder Committee:
The Clinical Ladder Celebration
will be held on Thursday, November 15
at Christ Methodist Church in Bowling
Green. Invitations have been sent to those
nurses who achieved a Clinical Ladder
designation in April 2012, October 2012
or are currently certified. The Clinical
Nurse V was approved, and we will be
recognizing our first nurse for achieving
this on November 15. A Clinical Support
Ladder Workout session was held on
November 14.
Policy and Procedure Committee:
The revised Conscious Sedation
policy will be ready for distribution soon
after Pharmacy reviews the drug list
one last time. The Nursing Policy and
Procedure Index is in the S-drive. The
Suspected Adverse Drug Reaction and
Administration of Medication policies
have been revised and were approved
by the committee. You will be receiving
these revised policies via e-mail soon.
Informatics
On November 27 at 0400 there will
be a MediTech update. This will require a
shift to paper for both the remaining part
of night shift and for day shift until it is
up and running properly. Paper MARs
will be distributed. FormFast will be up
and running to print other needed paper
documents. The new system has some
enhancements that should help the system
run faster by allowing more than one
module to remain open at a time allowing
the user to transfer back and forth to
module needed.
One major change in this update will
occur in the medication reconciliation
part of the system. For this reason, for the
first 24 hours after the update, staff will
have to revert to entering the home medications
in the admission assessment. The
Emergency and Outpatient Departments
will revert to using the old paper medication
reconciliation form during this time.
There will be 30-minute in-services
in classroom 1 scheduled the week of
Thanksgiving for as many staff as possible
to attend to learn about all the changes
with the new updates.
The remaining of the meeting we
reviewed MediTech modules for duplications
and process improvements.
Page 6