The surprising thing I learned in the RN Residency program

By Andrea Flinn, registered nurse, medical/surgical unit, and graduate of CHOC Children’s RN Residency in Pediatrics program

The RN Residency Program at CHOC Children’s taught me more than I had ever imagined. The magnitude of my learning experience has made it nearly impossible to pinpoint one standout or breakthrough moment. However, reflecting upon my journey, one of my greatest takeaways is the fact that the smallest moments create the greatest impact. Here are a few of my favorites.

  • I have learned to really focus when playing your patient in Connect Four so they do not beat you in less than five moves.
  • I have learned that letting a parent help take their three-year-old’s temperature often times goes much smoother than when you try to do it yourself.
  • I have learned that the playroom and its volunteers are some of my greatest resources.
  • I have learned that bedazzling your five-year-old patient’s oxygen mask is not only awesome but will lead to them wanting to take it home.
  • I have learned to love education printouts for our patients and their families.
  • I have learned that taking the time to explain as much as you can to patients and parents goes a long way.
  • I have learned that receiving a drawing from a patient can turn your whole day around.
  • I have learned that crying is okay because sometimes your patient’s family just needs someone to cry with them.
  • I have learned to treasure each smile shared.
  • I have learned that fellow nurses are truly the best support system.
  • I have learned how the value of family greatly impacts our patient care experiences.
  • Most importantly, I have learned that each child is special and what we do here as pediatric nurses is much more than a job; it’s a blessing.
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CHOC chief nursing officer reflects on another year of nursing excellence

In honor of National Nurses Week (May 6-12), Melanie
Patterson, vice president, patient care services and chief nursing officer of
CHOC Children’s Hospital, shared a few nursing highlights from the past year. CHOC
nurses work in a variety of roles, from direct patient care to informatics. They
partner with our pediatricians and pediatric specialists, as well as other
staff, to advance care and safety for our patients and their families. Learn
more about their most recent contributions in this Q & A with Melanie.

CHOC received
numerous accolades for patient care and safety; among them Magnet® recognition.
What does this honor really mean?

This is our third time achieving Magnet recognition, reflecting our commitment to high-quality nursing practice. This is truly an honor and places us in an elite group of healthcare organizations; fewer than 500 (out of more than 6,300) hospitals in the country have achieved Magnet recognition.

To earn this distinction, we passed a rigorous and lengthy
process that required widespread participation from leadership and staff. We
are a much better organization because of our Magnet recognition, which raised
the bar for patient care and inspired every member of our team to achieve excellence
every day.

CHOC has taken a
leadership role in developing a pediatric system of mental health care in
Orange County, with an inpatient center as its centerpiece. Do you have any
updates to share?

Our Mental Health Inpatient Center opened last April, filling a gap in a fragmented system that left children younger than 12 with no inpatient services in Orange County. The innovative facility, which features a warm, healing environment, is the only one in the state to offer all private rooms and an option for parents to stay overnight with their child, as appropriate. We’ve admitted more than 600 children since we opened and achieved an 86 percent positive rating in our patient experience survey. In addition, our restraint and seclusion rates are far below the national average, as is nurse turnover. The Center’s team has worked hard to create the right combination of “people, place and practice” to promote the best outcomes for our patients and their families.

How has nursing
contributed to evidence-based practices?

Evidence-based practice (EBP) is a dynamic process of
integrating research, credible sources of knowledge, clinical expertise, and
patient and family preferences and values to achieve optimal patient outcomes,
enhance practice, and manage health care costs. We developed an EBP Scholars
program that is a formal six-month long program funded in part by the Walden
and Jean Young Shaw Foundation. Scholars receive education about the EBP
process and guidance in developing their own projects focused on improving
outcomes. Results have included an increased number of external poster and
podium presentations, and nurse-led projects submitted for research
consideration and peer-reviewed nursing publications. In addition, six
nurse-led projects were awarded grants for projects that resulted in meaningful
change, increased patient safety, and decreased cost of care.

How involved have
nurses been in research projects?

We encourage a culture of inquiry among our nurses. Our
Nursing Research and Innovation Council promotes the integration of research,
and innovation into practice, and facilitates nurse involvement in related
activities across the organization. Our Nursing Research Associate
Training Program provides a meaningful and relatable approach to empower nurses,
at all levels, to participate in multidisciplinary research. Participants
attend classes and receive hands-on training with a clinical research
coordinator.

One example of nurse-led research was focused on pupillary
assessment (examining pupils’ reaction to light). This is important in
neurological evaluations because changes in the size, equality and reactivity
of the pupils can provide vital diagnostic information. Evidence suggests that
the traditional pen-light pupil examination is subjective and has low precision
and reproducibility. Automated hand-held pupillometers have recently been used
to provide more objective measurements of pupillary size and reactivity. Studies
suggest early detection of subtle changes using pupillometers may improve patient
outcomes in adults, yet there is not much literature on its use in children.

Over the past few years, our nurses have established an
organizational database of automated pupillometry to provide evidence for the use
of pupillometers in children. Findings from a preliminary study were presented
at the American Association of Neuroscience Nurses national conference in
Denver, Colorado this past March and demonstrate a statistically significant
inverse relationship between pupillometer readings and increased intracranial (inside
the skull) pressure. We have since expanded the use of pupillometers in our
emergency department and started additional multidisciplinary studies.

How have your nurses
taken leadership roles in advancing patient safety throughout the hospital?

CHOC nurses have initiated and/or been asked to participate
in numerous quality improvement projects focused on enhancing patient safety. I
am especially proud of our team of safety coaches whose roles are to reinforce
― often through real-time feedback ― safe practices. This team now consists of
88 clinicians from more than 25 different areas across our entire healthcare
system.

Additionally, we recently created the role of discharge
nurse navigator whose focus is on successfully transitioning patients from the
hospital to their homes. This includes educating families on after-care
instructions and any other follow-up recommended by their physicians. The
ultimate goals are decreasing readmission rates and improving patient and
family satisfaction. We’ve seen our seven and 30-day readmission rates decrease
beyond our initial goals and patient/parent satisfaction regarding nurse
communications increase.

What makes CHOC
nurses so unique?

Obviously, I am biased and think our nurses are the best in the profession. Every day, I have the privilege of witnessing the countless ways they preserve the magic of childhood. They are compassionate advocates for our patients and families, and proactive in implementing positive change that improves the care and service we provide. They are also collaborative, partnering with our physicians, each other and staff from across the entire healthcare system. They are committed to nursing excellence in everything they do, and selflessly dedicated to advancing our mission and our vision. I am incredibly fortunate to lead such an amazing team.

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CHOC Children’s PICU Earns Gold Beacon Award Recognizing Exceptional Patient Care for Third Time

The American Association of Critical-Care Nurses (AACN) recently conferred a gold-level Beacon Award for Excellence in the pediatric intensive care unit (PICU) at CHOC Children’s Hospital. This is the third time CHOC has earned the gold-level distinction.

beacon-logo

The Beacon Award for Excellence recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-year, three-level award with gold, silver or bronze designations meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

“The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes,” explains AACN President, Clareen Wiencek, RN, PhD, ACNP, ACHPN. “Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care.”

CHOC’s PICU earned a gold award, the highest designation, by meeting the following evidence-based Beacon Award for Excellence criteria:

  • leadership structures and systems;
  • appropriate staffing and staff engagement;
  • effective communication, knowledge management, learning and development;
  • evidence-based practice and processes; and
  • outcome measurement.

“This award is further validation of our entire pediatric intensive care team’s dedication to the highest standards of patient safety and care,” says Melanie Patterson, RN, MHA, DNP, vice president, patient care services and chief nursing officer, CHOC Children’s Hospital. “We are entrusted with caring for some of the sickest and most medically fragile patients, and our goal is to deliver the best possible outcomes for them and their families.”

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An Opportunity to Touch Lives Through Knowledge, Compassion

Maureen Garrett, a charge nurse in the neonatal intensive care unit (NICU) at CHOC Children’s at Mission Hospital, believes she gains as much from her patients and families as they do from her.

“I have learned about courage, strength, resilience, love and joy by sharing in their hospital experience,” she says. “I love seeing a family grow from the overwhelming fear they first experience with an unexpected, premature birth to a confident, competent mother and father taking their newborn home.”

choc-mission-nicu-nurse-maureen
Maureen, a registered nurse in the neonatal intensive care unit at CHOC Mission.

As CHOC Mission celebrates its 25th anniversary this month, Maureen is among a special group of employees who have been with the hospital since day one. She joined the CHOC Children’s health system in 1991, when she was hired to help open CHOC Mission.

Opened in 1993, the children’s hospital operates on the fifth floor of Mission Hospital in Mission Viejo. The 54-bed hospital is the only dedicated facility for pediatrics in south Orange County, surrounding coastal areas and north San Diego County.

Through the years, Maureen has served in several capacities at CHOC Mission and has witnessed much evolution inside the hospital – most notably, she says, the hospital’s family – centered-care philosophy.

“The most significant change has been the dramatic shift to family-centered care where families really are viewed as part of the team, and hospital operations are designed to empower parents and facilitate their involvement in their child’s hospitalization,” Maureen says.

Maureen initially pursued a career in health care because she wanted to help others, and create a work-family balance.

“I love the opportunity to touch people’s lives through both knowledge and compassion,” she says. “In nursing, there are so many opportunities and so much flexibility. I knew it would be the kind of career that would allow me to be a parent but still allow me to grow professionally and be challenged always.”

Maureen’s enthusiasm for CHOC Mission extends far beyond mere professional pride: Her own two daughters received care in the hospital’s NICU, her own unit.

Shortly after the hospital’s founding, Maureen’s eldest daughter was born in 1994 at 32 weeks gestation and spent about a month in the NICU.

Maureen’s second daughter, just like her older sister six years before her, also arrived early, at 32 weeks gestation. She stayed in the NICU for about three weeks.

“I had trust in everybody here,” Maureen said. “I knew it was a good staff. If your baby ended up the NICU, where would you want them? I’d want her here. I had an intimate relationship with the people caring for them because I worked there.”

The experience of being a parent in the NICU influenced Maureen’s work moving forward.

“You think when you work in any area that you have a decent perspective, but once you walk it yourself, it does make you more sensitive,” she says.

Maureen knows firsthand how important having a nearby high-quality children’s hospital is for the community. And while CHOC Mission and its staff are celebrating a quarter century of serving south Orange County and beyond, no one is resting on their laurels.

“I hope that CHOC Mission will continue to grow in size and services as the community around it continues to grow,” she says. “I hope we will have a more active role in health and wellness promotion in addition to providing services for those affected by illness.”

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A Career of Helping People: Nora’s Story

Years ago, when Nora Higa was settling on a career, her main interest was helping people. She found that and more as a critical care nurse in the pediatric intensive care unit at CHOC Children’s at Mission Hospital.

“I work with an amazing group of professionals,” Nora says. “We are small but mighty. Everyone pulls together with such teamwork, especially when we have particularly challenging cases. It enables us to give the best care to our patients and their families.”

norqa-critical-care-nurse-choc-childrens-at-mission-hospital
Nora, a critical care nurse at CHOC Children’s at Mission Hospital

Nora has served CHOC Mission’s patients and families since the hospital opened its doors on the fifth floor of Mission Hospital in 1993.

Celebrating 25 years of service this month, the 54-bed hospital is the only dedicated facility for pediatrics in south Orange County, surrounding coastal areas and north San Diego County.

“I’m very proud to be a part of the organization,” Nora says. “Families really appreciate the personal care they get. I met a family recently who has been in hospitals all over the place, but said they really felt the caring of the nurses and the quality of the care at CHOC Mission.”

Throughout her time with the organization, Nora has appreciated the changing technology at CHOC Mission, as well as the collaboration with Mission Hospital.

“We are privileged to continue collaborating with Mission Hospital and be part of the verified pediatric trauma team,” she says. “This has given us the opportunity to care for some challenging and interesting trauma patients which has resulted in some amazing and rewarding outcomes.”

As CHOC Mission begins its next quarter century of service, Nora looks forward to her role in ongoing efforts to advance pediatric healthcare in south Orange County and beyond.

“I hope that we will be able to continue to serve the families of south County with the highest level of care, compassion and expertise,” she says.

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