2010
i - Mission Nursing Annual Report
Mission, Vision, and Values
Promoting health and wellness; providing compassionate, quality care.
A nationally recognized model of professional nursing practice committed to excellence.
As we live our mission and pursue our vision, we are guided by the following values:
Mercy, Excellence, Respect, Integrity, and Trust/Teamwork.
© Mission Hospital Nursing Practice Model
Introduction - ii
Nursing Leaders’ Retreats ........................................................................................................................................................................... 2
Mission Leadership Academy ......................................................................................................................................................................3
Manager’s Message on the Value of Sta ................................................................................................................................................... 4
Direct Care Nurse’s Appreciation of Leaders ........................................................................................................................................... 4
Awards & Recognition ..............................................................................................................................................................................6-8
Certications in Specialty Areas- New or Renewed in 2010 ................................................................................................................... 8
International Educator Michelle Deck ...................................................................................................................................................... 8
Four Units Collaborate for Annual Education Blitz .................................................................................................................................9
Integrative Healthcare Activities & Community Presence ...................................................................................................................... 9
Nurses on a Stroke Mission! ....................................................................................................................................................................... 9
Community Service ...............................................................................................................................................................................10-11
MCSD Oers Posters & Library to Other Units ..................................................................................................................................... 11
NICU Simulation at March of Dimes Gala ............................................................................................................................................. 11
RACE ........................................................................................................................................................................................................... 11
Higher Nursing Education .................................................................................................................................................................... 12-13
Nurses Week Kick-O Celebration .......................................................................................................................................................... 13
Mission Women Go Red! ........................................................................................................................................................................... 13
Professional Organizations Leadership....................................................................................................................................................14
Clinical Aliations ....................................................................................................................................................................................14
2010 Quality Day Winning Posters ...........................................................................................................................................................16
National Accreditation Program for Breast Centers ...............................................................................................................................16
Professional Educational Achievement Recognition (PEAR) ................................................................................................................16
Infection Prevention Nurse Liaisons ........................................................................................................................................................16
Geriatric Resource Nurses .........................................................................................................................................................................17
Diabetic Resource Nurses ..........................................................................................................................................................................17
Holistic Resource Nurses ...........................................................................................................................................................................17
Pediatric Resource Nurses .........................................................................................................................................................................18
Baby Friendly Designation .........................................................................................................................................................................18
Registered Nurse Clinical Ladder Program ..............................................................................................................................................19
Councilor Model Growth Timeline ..........................................................................................................................................................19
In Memoriam: Remembering Our Colleagues ........................................................................................................................................ 20
Nursing Research Studies ...........................................................................................................................................................................22
Heart Days Poster Winners .......................................................................................................................................................................22
Nursing Evidence Based Practice Projects ...............................................................................................................................................23
Registered Nurse Outcome Based Projects ..............................................................................................................................................25
IHI Teams ................................................................................................................................................................................................... 26
Nursing Research Fiesta ............................................................................................................................................................................ 26
Mission Hospital Research Institute ....................................................................................................................................................... 26
Lean Six Sigma Projects ..............................................................................................................................................................................27
Publications, Conference Attendance and Presentations ..................................................................................................................27-28
The Gratitude of Patients and Families ................................................................................................................................................... 30
Women’s Surgical Unit Pain Target Project ............................................................................................................................................. 30
Survivor Services Program in Labor and Delivery .................................................................................................................................. 30
Patient Falls Prevention..............................................................................................................................................................................31
Pressure Ulcers Prevention ........................................................................................................................................................................31
Delirium Identication, Prevention, and Treatment Project .................................................................................................................32
Patient-and Family-Centered Rounding on Pediatrics ............................................................................................................................32
It is hard to believe that a year has passed since I wrote my letter for the 2009 Annual Report. I
am lled with pride when I reect on the tremendous accomplishments we have achieved in 2010.
Through our partnership with the Institute for Healthcare Improvement, we have established
strategies to assist us with achieving the BIG(GER) AIM: “Achieving the DESIRED OUTCOME
without Harm, without Waste and with an Exceptional Patient Experience.”
The Clinical Ladder for the nursing division was implemented in September 2010. We have more
than doubled the number of nurses certied in their areas of expertise since 2008. Our nursing
research program continues to grow and develop with a focus on evidence-based practice and
improved clinical outcomes. Lastly, several of our programs have achieved national recognition,
such as our Chest Pain Center, RACE, Stroke Program, Oncology Program, and our Baby Friendly
Designation. All of these initiatives and the many others listed in our 2010 Annual Report are a
testament to the dedication, compassion and clinical expertise of our nursing sta.
Each year we raise the bar striving for continuous improvement in clinical outcomes and the
patient experience. You should be very proud of exceeding the goals we set for ourselves this past year. It is a privilege to
work with each of you, and I look forward to partnering together to achieve our BIG(GER) AIM: “Achieving the DESIRED
OUTCOME without Harm, without Waste and with an Exceptional Patient Experience”.
Kathleen Guyette
MSN, RN, NE-BC
Vice President and Chief Nursing Ocer
iii - Mission Nursing Annual Report
NURSING
EXCELLENCE
held on August 24
at the Lutheridge Conference Center included
thirty-nine direct care nurses from unit-based
shared decision making councils, nursing
managers, directors, and administrative leaders.
Information, inspiration, and ideas were
exchanged during seven speaker presentations
and a Practice Fair sponsored by the Marketing
and Communications for Nursing Excellence
Council.
Here is the list of presentations:
Councilor Model and Critical Components for Shared Decision
Making by Laurie Downs, BSN, RN, CCRN, Manager of Coli ICU
and Regina Phelps, PhD, RN, NEA-BC, Director of Nursing Practice,
Education and Research (NPER).
Mission Hospital’s Nursing Practice Model by Rhonda Robinson,
RN, Director of Orthopedics and Inpatient Rehabilitation Services
(pictured above) and Craig Harris, MPH, BSN, RN, CCRN, Manager
of Cardiovascular ICU, Recovery Unit, and Progressive Care. They were
the co-chairs for the original team of nurses formed in 2005 to design
the current Nursing Practice Model.
Nursing Strategic Plan 2010-2014 by Ginny Raviotta, MN, RN, NE-
BC, Director of Women’s and Children’s Services, and Regina Phelps,
PhD, RN, NEA-BC, Director of NPER.
Clinical Ladder—Nuts and Bolts by the Clinical Ladder Council
Chair Cheryl Gibson, MSN, RN-BC, Nursing Project Coordinator
for NPER, and Co-Chair Cathy Retskin, RNC, direct care nurse on
Labor and Delivery.
Service Excellence—Revitalizing the MERIT Standards by George
Karl, MDiv, MA, Director of Service Excellence.
Patient Centered Care by Carlton Rider, Interim CEO.
Nursing Governance Board—Accomplishments to Celebrate! by
Kathleen Guyette, MSN, RN, NE-BC, VP and CNO.
Irish-Themed Retreat
complete with playful attire and colorful table decorations prompted
laughter and joking in between serious conversations about nursing
excellence and shared decision making. Nursing directors, managers,
and members of the Nursing Governance Board attended the all day
meeting at the Renaissance Hotel in downtown Asheville.
Vice President
and Chief Nursing
Ocer Kathleen
Guyette, RN,
MSN, NE-BC,
led the group in
presentations
and discussions.
Directors and some
managers gave 15
minute reports on
the status of shared
decision making
(SDM) in their
respective areas.
Regina Phelps,
PhD, RN, NEA-BC,
Director, Nursing
Practice, Education
and Research
(NPER), presented
information about
“Growing the
Magnet® Culture.”
The chairs of house-
wide councils made
brief comments
about their groups.
Positive common
themes among many
SDM teams across
the organization
were identied: a lot
of sta involvement;
sta being vocal
in pointing out
opportunities for
improvement and
oering solutions;
and improved
perspective of all nurses being a part of one organization.
Mary Richard, RN,
Director of Heart Path
(right), sharing a light-
hearted moment at the
retreat with Outpatient
Heart Path nurse, Pam
Froncek, MSN, RN
(left).
Kim Reik-Johnson, RN, Manager of Neonatal ICU (left), stops at the
Practice Fair table to pick up her copy of the expanded Councilor Model poster
from Carey Estes, BSN, RNC, NUS of Neonatal ICU.
VP and CNO Kathleen Guyette, MSN, RN, NE-BC
(left), presented best Irish attire prizes to (L to R) Patrick
Ryan, BSN, RN, Manager of Mother/Baby; Leigh Angel,
BSN, RN, Manager of 9 North Stepdown; and Joe Lee,
BSN, RN, MHSM, MBA, Surgical Director of Heart
Services.
Lora Deitz, BSN, RN, NUS for Nursing Support Services
(left), and Carol Jackson, RN, MHS, Director of Nursing
Support Services (right) show o the ‘achievements pot of gold’
at the end of their department’s SDM team rainbow.
2 - Mission Nursing Annual Report
Retreats
Formal leaders have titles, which indicate their leadership position. Informal leaders are those who exhibit leadership qualities and do not hold a title.
All leaders inspire, encourage, recognize, and value others and prompt mutual respect.
Formal and informal nurse leaders at Mission Hospital met twice during 2010 to learn about professional development expectations, share some
lighter refreshing moments, and build camaraderie in planning for the future progress of nursing at our facility.
Kneeling left to right:
MSN, RN, Outpatient Heart Path
RN, of PMCU/PMSD
BSN, RN, of MSPC
BSN, RN, Neurosciences
RN, 6 North
BSN, RN, of CVOR
RN, 4 South
BSN, RN, Radiology
row two, left to right:
BSN, RN, CCRN, of MSICU
RN, of NICU
BSN, RN, CPAN
RN, Outpatient Infusion
RN, Spine
BSN, RN, PCCN, 9 North
RN, 9 North
BSN, RN, 9 North
RN, General Surgery
RN, CCRN, of CVPC
BSN, RN, Chest Pain Observation
BSN, RN, CCRN-CSC, of CVICU
RN, Copestone
row three, left to right:
BSN, RN, Mother/Baby
RNC, of SATU
BSN, RN, Pre-op
RN, Renal Medicine
RN, 8 North
BSN, RN, of PASU
RN, Women’s Surgery
RN, of CVICU
RN, of NTICU
BSN, RN, Stafng Pool
BSN, RN, CEN, of ED
row four, left to right:
RN, Coli ICU
MA, RNC, OCN, Oncology
RN, Vascular OR
RN, Pediatric Hem/Onc
RN, IV Team
RN, CGRN, Stafng Pool
RN, Trauma Care
Thirty nine direct care nurses representing shared decision making councils on their respective units attended the August Nursing Retreat.
The Mission Leadership Academy was implemented in 2010 with the objective of developing
new and existing leaders in establishing a base level of leadership competency throughout the
organization. Throughout the course, participants complete a three day “core curriculum”
facilitated by Mission Executive Leaders, outside consultants, and Human Resource Leaders
through didactic, experiential, and multi-media learning methodologies devoted to three facets of
leadership:
•
understanding what is expected of them as Mission leaders;
•
developing leadership competencies that have been identied as high priority;
•
ensuring competency with functional leadership responsibilities.
In the rst year, 389 supervisors, managers, and directors completed this course.
(Reprinted from Mission on Demand with permission.)
The list below includes leaders completing the course in 2010 who are nurses or
who work closely with nurses in providing patient care.
Leadership - 3
Appreciation of Leaders
Jackie Houtman, RN, Sta Nurse on
the Oncology Unit (pictured here), praised
her manager and clinical nurse specialist in
“The Blessings of Winter’s Chill.”
While this past winter [with heavy
snow] was undoubtedly a challenge for
all of us, it hopefully left us with food
for thought. Enjoying the comforts and
normalcy of day to day routines makes
it easy to take things for granted.
Traveling to and from work was
treacherous and fraught with tension.
If we made it up the mountain, could
we more importantly come to a safe
halt when we traveled back down
again? Would the next shift make it in
to relieve those nurses who diligently tracked the weather hoping for
signs that roads were passable? Those who were unable to travel home
slept, showered and borrowed scrubs and experienced rst-hand what
the patients tell us--the mattresses and pillows are not as comfortable
as ours at home, and unfamiliar noises make it harder to sleep.
The purpose of this reection is not to reminisce about the winter
chill but to acknowledge and pay tribute to our Oncology unit Manager
Dawn Neuhauser, RN, BSN, OCN and Diana Wortham, RN,
MSN, OCN, Clinical Nurse Specialist for Oncology. While Dawn and
Diana have a multitude of commitments and obligations, they are
always there for us. Both deserve a long over due thank you!
As nurses, our professional growth and development is nurtured with
their open door policy, welcoming any of our questions and concerns.
We are encouraged to seek advice and mentoring, and we know our
autonomy will be respected. As the need arises, Dawn and Diana
support us with hands-on care at the bedside, clearly reecting a love
for our patients and setting a standard we are proud to follow.
We can rest assured spring will follow winter. Perhaps even more
reassuring, though, is the knowledge that whatever the season, we are
blessed and privileged to work alongside these wonderful nurses.
Thank you, Dawn and Diana!
(Nursing News, Vol. 6, #4, April 2010)
on the Value of Staff
This message to the sta members of Coli
ICU was written by Manager Laurie
Downs, BSN, RN,CCRN, (pictured
here) in her weekly newsletter March 5,
2010 after a time of high acuity patients,
installation of new sky lifts, monitor
training, and, oh yes, heavy snow. It is
reprinted with permission.
Many times, I nd, it is dicult to
convey the essence or trueness of
what a manager has to say to sta.
Many managers, as administrators,
nd it dicult to share thoughts
and feelings with sta. Honest, straight forward talk is sometimes
misconstrued or criticized. Yet, as I led our sta meetings this week,
I felt a fullness of sorts in my throat, as I looked across the room at
the faces of a profession built on compassion, intelligence and vast
ability. I cannot help but share this with you.
All of you listened as I told the stories and made the proclamations
of what we need to do to keep ourselves compliant and up to speed.
Some of what we talked about was dicult. Much of what we
discussed was/is strategic, comes from the goals and objectives of
our organization and is evidenced based for healthcare practice. All
of what we discussed, no matter how mundane, was/is to encourage
meaningful life-giving care to patients.
I knew, as I nished the meetings, that most of you heard the
essence, will take the information and work like Trojans (someone
who is determined, strong, or courageous) to be the best and provide
thoughtful, patient-centered care. Every time we come here, we can
change a life. We can inuence healing, inspire hope and make peace
in the midst of despair. We are the movers and the shakers, and we
are the ones who can save lives or change lives. My life has been
touched and changed by you, and my heart is full of gratitude.
- Laurie L. Downs
Your most humble servant manager
(Nursing News, Vol. 6, #5, May 2010)
4 - Mission Nursing Annual Report
NURSING
EXCELLENCE
& Recognition
North Carolina Great 100 Nurses of 2010 included seven
Mission Hospital RNs. These RNs were chosen by their peers to be
honored as some of the best nurses in NC. They were celebrated by
their Mission peers at a reception on September 7 and joined other
honorees from across the state at a formal gala in Greensboro on
September 18. Since the inception of the Great 100 in 1989, a total of
157Mission nurses have been honored.
RN-C Mission Children’s Specialists
BSN, RN, NE-BC Women’s Surgical Unit
MSN, RN-BC
Nursing Practice, Education, and Research
BSN, RN, SANE-P,
SANE-A Mission Children’s Specialists
, MSN, RN, IBCLC
Nursing Practice, Education, and Research
BSN, RN,
OCN Oncology
RN, CCRN
Cardiovascular ICU & Recovery Unit
Spirit of Martin Luther King Award
Sallie McCall, BSN, RN, Manager of Clinical Operations at
Mission Children’s Specialists, received this award, which is
presented annually to a staff member from Mission Hospital
who demonstrates the ideals and the dream of Dr. King in their
work and community.
Other staff members nominated for this award were:
Copestone Adolescent Unit
Corporate Safety
Endoscopy
Environmental Services
MSN, RN-BC, NPER
RN, 8North
NA, PACU/Preop
RN, RACE Coordinator; Director of Cardiac Emergencies
RN, Pediatrics
MSN, RN, Director, Heart Services
Radiology
Anesthesia Tech, Asheville Surgery Center
Education Coordinator, Asheville Cardiology
RN, Manager of CHE
FNP, CHE
6N Adult Medicine
RN, Labor & Delivery
VP of Human Resources
RN, Director, PACU/Preop
Diversity Ofcer
Legal Services
Interpreter Services
RN, Neonatal ICU, posthumously
NA, PASU
Human Resources
Executive Assistant to CEO
Environmental Services
(Scope, Vol. 15, #2, January 22, 2010)
Spirit of Quality Award
went to Janie Fielder, MSN, RN,
NNP-BC, Medication Safety Nurse
Specialist, for her strong leadership in
improving quality of care for patients.
She is pictured here receiving her
award from
Dr. Dale Fell,
Chief Medical Ocer.
Award
given by the Southeast Region Wound Ostomy and Continence
Nurses Society was presented to Carol Parker, MS, BSN, RN,
CWON, of the Wound Healing and Hyperbaric Center. She was
selected for her professional “can do” attitude and her expertise and
inuence in mentoring other nurses in providing quality patient
care in the specialty of wound, ostomy, and continence nursing. She
was chosen from among nurses in North Carolina, South Carolina,
Georgia, Florida, Tennessee, and Alabama.
6 - Mission Nursing Annual Report
CNA Award
was presented October 6 to Edna Crowe, CNA II,
(pictured here) of 9 Stepdown, a progressive care adult
medicine unit. She was one of two CNAs chosen out
of 43 nominees from across Western North Carolina
(WNC). Established in 2003 by Margaret Noel, MD,
founder of MemoryCare, the award was named in honor
of Georgia Crump, a Mission Hospital Licensed
Practical Nurse who began her career as a CNA and now
works in Mission’s Community Health Enhancement.
Edna was chosen for the way she “...goes above and
beyond to ensure that her patients’ needs are met.”
MSN, RN,
GCNS-BC, Geriatric CNS,
Nursing Practice, Education and Research
RN
Asheville Surgery Center
, MSN, RN, IBCLC
Nursing Practice, Education, and Research
BSN, RNC-OB
Labor and Delivery
ADVAnCeD PrACtiCe nurSe AwArDS DireCt CAre nurSe AwArDS
liCenSeD PrACtiCAl
nurSe AwArD
nurSe eDuCAtor AwArD
BSN, RN
General Surgery
MSN, RN,
Nursing Education Specialist II,
Nursing Practice, Education, and Research
RN, CMSRN
8 North
RN, CEN
Emergency Department
LPN
General Surgery
RN
General Surgery
Excellence Awards
Twelve nursing sta members received Excellence Awards at the Nurses’ Week Kick-O Event on May 4 in the MAHEC Auditorium. Winners were
nominated by their peers and selected by a committee whose members did not see names of those nominated. Selections were made based on the
documented exemplary clinical practice of the nominees. VP and CNO Kathleen Guyette, MSN, RN, NE-BC, presented the awards and read a
portion of each winner’s nomination.
Other CNAs nominated from Mission were:
(Scope, Vol. 15, #20, October 22, 2010)
nurSe mAnAger AwArD
BSN, RN, MPH, CCRN,
Manager of Cardiovascular ICU and Recovery
Unit and CV Progressive Care
CertifieD nurSe
ASSiStAnt AwArD
CNA
Mission Children’s Specialists
Empowerment - 7
in Specialty Areas New or Renewed in 2010
MSN, RN, CNS for Oncology
MSN, RN CDE,CNS
Nurse Educator, Health Education Center
Certified in
Case ManageMent nursing- rn-
BC
BSN, RN, Spine Center
BSN, RN, CCRP, Research Institute
MBA, MHA, RN, CCRP, Manager, Clinical
Trials, Research Institute
RN; Coli ICU
RN; CVICU/RU
RN; CVICU/RU
BSN, RN; Cardiology ICU
(All of Emergency Department)
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
RN
Coordinator, Integrative Health
RN Cardiovascular Progressive Care
MA, Infection Prevention
MS, MT, Infection Prevention
RN, Labor and Delivery
RN, NICU
BSN, RN Manager, Women’s Surgery Unit
MHA, BSN, NE-BC, Director, Critical Care Medicine
MSN, RN
Director of Cardiovascular Services
MN, RN Director,
Women’s and Children’s Services
BSN, RN-C
Director of Perianesthesia Services
MHS, RN
Director Vascular Center/Radiology Nursing
MSN, RN, AHN-BC
Director, Integrative Healthcare
BSN, RN, Cardiovascular OR
MSN, RN
Nursing Education Specialist II NPER
MSN, RN-BC
Education Specialist II NPER
PhD, RN,
NEA-BC, Director, NPER
RN, Mission Children’s Specialists
MS, RN, CNS, Pediatrics
RN, Pediatrics
RN
Mission Children’s Clinic, Pediatric Gastroenterology
RN
Mission Children’s Clinic Pediatric Gastroenterology
BSN, RN Pediatric Nurse Clinician
RN, NUS, Pediatrics
BSN, RN Pediatric Intensive Care
, BSN, RN, Pediatric ICU
BSN, RN, CCRN
Asheville Surgery Center
, RN, Mission Children’s Specialists
RN , Asheville Specialty Hospital
RN, Nursing Support Services
RN, Neurosciences
RN, General Surgery
RN Endoscopy
RN, Women’s Surgical Unit
RN, Women’s Surgical Unit
RN
Stepdown and Medical/Surgical Pools, Nursing Support Services
BSN, RN Oncology
Progressive Care Certied Nurse—PCCN
BSN, RN
BSN, RN
BSN, RN KateTobin, BSN, RN
RN
RN
BSN, RN
(All of 9 North Stepdown)
Ambassador Awards
are presented at the monthly meeting of
the Nursing Governance Board. Nurses and
support sta are recognized for their eorts
in various aspects of nursing professional
development and improved quality care and
patient outcomes. Awards were not given in
March or August due to the Nursing Leaders’
Retreats held instead of NGB meetings.
Award winners for 2010 were:
BSN, RN,
Nursing Documentation Coordinator, NPER
Coordinator for Education, NPER
Administrative Assistant
MSN, RN, CAPA,
Manager of Professional Nursing Practice, NPER
MSN, RN-BC
Clinical Nurse Specialist for Research, NPER
MN, RN, NE-BC
Director, Women’s and Children’s Services
MSN, RN
NE-BC, VP and CNO
MSN, MBA, MHIM,
RN, Manager of Nursing Informatics
RN
Nursing Informatics Senior Specialist
BSN, RN
House Supervisor
MSN, RN-BC
Education Specialist II, NPER
8 - Mission Nursing Annual Report
Michelle Deck
International presenter, author and educator Michele Deck, RN, MEd, BSN, LCCE, FACCE,
met with 20 nurses from Nursing Practice, Education, and Research (NPER) on October 6. She
presented a ve-hour hands-on session about planning a research project to evaluate methods of
sta development education.
During seven days in December, Michele returned and taught 32 classes about falls and falls
prevention to Mission Hospital sta, as part of a research study about methods of nursing
education led by primary investigator Darlene Schleider, BSN, RN, Nursing Education
Specialist I, NPER.
Activities & Community Presence
Members of the Integrative Healthcare (IH) department were busy in 2010 providing
numerous educational activities for Mission sta, outreach opportunities to the community,
and collaborating with local and regional organizations to further the presence of Holistic
Nursing.
, lasting two days and one night, provided experiences for
rejuvenation, self-growth, and education. The retreats were held at beautiful, local retreat
centers, where sta could experience complementary therapies, such as healing touch, massage
therapy, aromatherapy, acupuncture, gentle chiropractics, yoga, tai chi, breathing exercises,
and many other techniques for stress management and self-care. In 2010, were 12 retreats with
185 sta members participating, for a total participation of 616 since the Holistic Retreats
began in Fall of 2008.
were one-day single topic seminars oered for hospital sta members at
dierent locales such as NC Arboretum, Lutheridge Retreat Center and Mission Hospital. In
2010, there were 10 self-care days with 197 total participants.
to sta included 15 classes on topics like self-
care, dance movement, reexology, and non-pharmacological approaches to pain management.
IH sta oered modalities such as massage, aromatherapy, and Healing Touch, to Mission
co-workers during at least eight health fairs and events. The department participated in
sponsoring Nurses Week keynote speaker, the renowned author, Bertice Berry, PhD, in her
address during a special celebration.
throughout the year brought elements
of Integrative Healthcare to 27 local and regional groups, such as the Medical Minority
Mentorship Program, Asheville Buncombe Institute of Parity Achievement (ABIPA), the US
Forestry Service, and the Institute of Emerging Issues in Raleigh.
involved organizations like Mountain Area Health Education
Center (MAHEC), Asheville-Buncombe Technical Community College, Western Carolina
University, and the Blue Ridge Holistic Nurses Network.
on a Stroke Mission!
Robin Jones, BSN, CNRN, Stroke Coordinator, reported that this past year, the Stroke
Program was busy educating the community and our professional colleagues about the three
R’s of Stroke:
• RECOGNITION of Warning Signs
• RAPID TRANSPORT to a Stroke capable Emergency Department
• REDUCING RISK Factors for Stroke
There were 24 community events, including Stroke Screening events with McDowell and Blue
Ridge Hospitals. We provided 23 educational events for nurses, therapists, and physicians,
including our bi-annual WNC Stroke Conference, a two-day event in Asheville with over 150
providers in attendance! We traveled the region meeting with EMS and ED personnel from
Murphy to McDowell Hospitals….from Avery to Rutherford counties!
We teamed up with our colleagues from EMS and Cardiology to launch a community
education program “Minutes Matter” on early recognition and action for Sudden Cardiac
Arrest & Stroke (FAST). Many sta from Mission and other agencies have volunteered
time to teach “compression-only CPR” and the aid for FAST (Face, Arm, Speech and Time)
recognition of stroke symptoms. In July 2010 we teamed up with the Emergency Nursing
Department and NC Heart Disease and Stroke Prevention to oer a new course “Acute Stroke
Life Support.” A seven hour class is available every other month, and participants can register
via WebIn-service.
In 2010, Neurosciences and Neurotrauma ICU met the goal with 100 percent of the sta
completing the Stroke and ICH education modules and 100 percent of the sta are certied
in the NIH-Stroke Scale Assessment!!
We are proud to say we earned the GOLD PLUS award from the American Heart/Stroke
Association for the second year in a row. This is a national recognition for sustained
achievement in stroke quality indicators!
for Annual Education Blitz
This year 6 North, 9 Stepdown, and Pulmonary
Medicine Care Unit/Pulmonary Medicine
Stepdown (PMCU/SD) combined eorts for
the annual education blitz. The blitz planning
team included Ellen Ferguson, BSN, RN,
PCCN, NPER; Carlin Smith, BSN, RN,
NPER; Cathy Hebert, RN, CNS-BC,
NPER; Leigh Angel, BSN, RN, Manager
of 9 Stepdown; Glenda McCall, BSN, RN,
Manager of PMCU/SD; and Vickie West,
BSN, RN, 6North Manager.
Following the March Nursing Retreat, which
focused on Magnet® expectations, the team
was inspired to include Mission Hospital’s
nursing practice model in the theme of
the blitz. “Rise to the Challenge for our
Patients and Families,” was developed using
“CHALLENGE” as the acronym for the
elements of Mission’s nursing practice model:
Collaboration, caring, communication
Helping
Autonomy, Advocacy
Lifelong Learning
Evidence Based
Nursing Practice
Goal Directed
Empowerment
In order to accommodate such a large group of
sta attendees, supervisors, transfer mobility
coaches and preceptors from each unit jumped
on board to help. Facilitating sta completion
of the educational modules were:
RN
RN
UA
RN
RN
NA II
RN
RN
RN
NA II
BSN, RN
Blitz facilitators, dressed in bright orange and yellow outts and
wearing whimsical sunglasses, inspired fun and enthusiasm dur-
ing the annual education blitz sessions. Left to right are Carlin
Smith, BSN, RN, of NPER; Diane Allen, RN, 6 North; Edna
Crowe, NA II, 9 Stepdown; Ellen Ferguson, BSN, RN, PCCN,
of NPER; Karen Randolph, NA II, 9 Stepdown; and Joann
Disbrow, RN, 6 North. Photo by Katie Cheatham, BSN, RN
RN
RN
RN
CNA I
RN
RN
RN
RN
RN
CNA I
RN
Empowerment -9
Volunteered at the CARE (Communities Are Responding
Everyday) Clinic in Charlotte, a free comprehensive clinic
for area residents that did not have insurance coverage.
About 2,000 patients were seen that day.
CNA I
Unit Assistant I
Coli ICU
Members of church medical team, accepting assignment
to attend all services during specied weeks and be
accessible via pager and radio plus be prepared to use
AED portable debrillator in emergencies
RN
Adult Medicine
RN
Rapid Response Team
RN
Nursing Support Services
MSN, RN; Manager,
Professional Nursing Practice, NPER
Volunteered on a mission trip to the mountains of Haiti
from April 3-10 helping with ve clinics servicing 1400
children with nutritional needs
MSN, RN,
Neonatal CNS
RN, Neonatal ICU
Volunteer builder for the 2010 Women’s Build House for
the Asheville Area Habitat for Humanity
RN
PeriAnesthesia Care Unit
United Way Back-to-School Supply Drive
MSN, RN-BC
Nursing Education
Specialist II, NPER
Volunteer in Cochabamba, Bolivia, at an in-hospital
residence for families of pediatric patients and assistant to
Montana surgeon instructing local Bolivian surgeons on
the use of laparoscopic equipment for procedures other
than cholecystectomy and appendectomy
RN
Surgical Services
Altamont Theatre Board of Directors Secretary
BSN, RN
Nursing Documentation Coordinator, NPER
Board of Directors My Sister’s Place, an agency in
Madison County, which helps those affected by domestic
violence and sexual assault.
Asheville Area Habitat for Humanity
ACLS; BLS; PALS courses with course fees to various non-
prot agencies.
Asheville Buncombe Institute of Parity Achievement
Health Fair & Volunteer.
Minutes Matter
MSN, RN-BC
Nurse Education
Specialist II, NPER
Volunteer at ABCCM; Skin Screening at Asheville Mall;
Cardiovascular Health Screen and u vaccines on St.
Joseph Campus.
RN, CVICU
Participated in a mission trip to Haiti in February
following the catastrophic earthquake.
Volunteer for United Way Day of Caring
BSN, RN,CCRC, CCRP
Clinical Research Nurse, Research Institute
Chair for Mission’s United Way Campaign
Rathbun Center Advisory Board Member
March of Dimes Board Member (ad hoc)
MN, RN, NE-BC
Director of Women’s and Children’s Services
Volunteered at ABCCM and Manna Food Bank
RN, NICU
Helped lead/instruct a backpacking trip in October in
the Cotopaxi National Park of Ecuador, bringing the
rst ‘Leave No Trace’ Master Educator course to South
America. ‘Leave No Trace’ is the US federal and state
ofcial public education campaign for the stewardship
of our environment, as it pertains to non-motorized
recreational use.
BSN, RN, BS
Medical/Surgical ICU
United Way Day of Caring, the annual community-
wide event that matches volunteers with service
projects to benet Asheville and Buncombe
County nonprots, schools and public entities.
Alice Iannetta
Alissa Pope
Amie Fluharty
Amy Good
Amy Cooper
Amy Desrochers
Amy Holguin
Angela Burrell
Angelisa Banks
Ann Ford
Arne Paulson
Ashley Dotger
Ashley Harn
Barbara Marsh
Beverly Hopps
Brandi Ashe
Brandy Dotson
Brenda Sommer
Brenda Canter
Carey Estes
Carla Ballard
Carolyn Parker
Catherine Graham
Cathryn Francis
Cecil Clark Jr
Charles Waycaster Jr
Cherie James
Cheryl Worley
Christi Britt
Christina Miller
Christine Foster
Claudine Cuento
Clay Tison
Crela Landreth
Cynthia Gaffney
Cynthia Green
Cynthia Allen
Dawn Wascoe
Deborah Lawing
Dewey Taylor Jr
Diane Davis
Donna Cook
Donna Peek
Dorothy Bryant
Kyong Stark
Laura Ball
Laurie McLean
Lee Davis
Leslee Sprague
Leslie Shell
Linda McNeil
Margaret Howie
Margaret Bollo
Mark Steinke
Mary Bradt
Mary Yacopino
Mary Katherine Smith
Mary Martin
Megan Riddle
Melanie Norman
Melinda Bryant
Melissa Bartlett
Michelle Setzer
Michelle Moore
Nancy McCall
Nancy Rutkowski
Pansie Huffstedtler
Patricia Spry
Patricia Kirby
Patrick Ryan
Priscilla Hayes
Rachel Bemis
Rachel Alosky
Rebecca Dalton
Regina Phelps
Dorothy L Silver
Dorothy Rogers
Doy Hill
Elaine Mordenti
Elena Nolan
Erika Martin
Fabienne Sterckx
Felichia Jones
Frank Aria
George Hopkins
Gina Jones
Jacqueline Cutler
Jacqueline Popp
James DeGrave
Jane Fredrickson
Janet Ray
Jennifer Retamal
Jennifer Roberts
Jeremy Smith
Jermaine Davidson
Jessica Martin
Jody Curry
Judy Caraker
Julia Shipman
Julie Shelton
Julie Thomas
Kathy Daley
Karen Chappell
Karen Bianchini
Karen Cassidy Diez
Karen Killian
Katie Cheatham
Kathleen Leake
Katrina Brooks
Keva Morgan
Kimberly Borne
Kim Reik-Johnson
Kitty Ratzlaff
Kristina Derrick
Roger Moss
Rose Evanoff
Ruth Ann Savage
Sally Fisher
Sarah Lefebvre
Scott Robinson
Scott Danks
Shawn Beane
Sheila Plemmons
Shelby Bjorlie
Joy Clifton
Sommer Buchanan
Stephen Weeks
Steven Schmidlin
Susan Buckner
Susan Bradburn
Susan Funderud
Susan Jones
Tatyana Edwards
Tiffany Davi
Todd Wyndham
Tonya Mace Mease
Valerie Gulledge
Valerie Dennis
Vickie Oliver
Victoria Whitlatch
Virginia Moss
Wendy Robinson
William O Myers III
Wilma Sprinkle
10 - Mission Nursing Annual Report
Coordinator for the United Way
Back-to-School Supply Drive,
which provided book bags and
school supplies for more than 360
area children due to the generous
donations of Mission employees.
Organizer for Mission’s participation
in the annual United Way Day of
Caring
MSN, RN
Director of Heart Services
Medical and dental mission February
6-13 providing care to hundreds of
people affected by the earthquake
near Port-au-Prince, Haiti. Also
helped replace a roof system and
second oor of a church. Provided
food to an orphanage and several
schools
RN
NUS, Nursing Support Services
Volunteered for Glenwood Baptist
Church
BSN, RN
Clinical Research Nurse, Research Institute
Board of Directors member-YWCA
of Asheville
Board of Directors member-Action
for Children NC
Volunteer for Room in the Inn
RN, MBA
Business Manager
Women’s and Children’s Services
Vice-chair, Board of Directors for
Asheville Buncombe Institute of
Parity Achievement (ABIPA)
Board of Directors YWCA
MSN, RN, NEA-BC,
AHN-BC
Director, Integrative Healthcare
Board Secretary for Health Partners,
which is the Healthy Carolinians
Coalition for Buncombe County
Co-chair for the Community Providers
Forum of Health Partners
Member of the Health Focus Area
for United Way
MSN, FNP-C
Emma Clinic/Mission CHE
Monthly volunteer at Loving Food
Resources, a pantry that helps people
with HIV and AIDS
BSN, RN
Staff Health/Occumed
Volunteers for Ladies Night Out, a
mammography, health screening and
health education program provided
on the rst Thursday of each month
at Mission Hospital’s Breast Program
Center
RN, SATU
BSN, RN, NE-BC, Manager,
Women’s Surgery Unit
MSN, RN, OCN,
Radiation Therapy
MSN, RN-BC,
Nursing Education Specialist II, NPER
RN, CVICU
RN, Manager, Clinical Informatics
RN, Neonatal ICU
RN, Oncology
RN, Wound Therapy Center
RN, PACU
RN, Infection Prevention
, RN, Cancer Research
, RN, Wound Therapy Center
RN, IV Therapy
RN
LPN, Oncology
RN,
Senior Clinical Informatics Specialist
Served soup, salad, and dessert to
Mission Hospital patients’ family
members staying at the Rathbun
Center on the evening of December
7
(MSICU) RNS
to Other Units
Medical Cardiology Stepdown (MCSD) opened their quarterly
education blitz in November to nurses on other units. Poster
sessions for contact hours were available to any nurse who wanted
to drop by the 5 Heart Echo Classroom. Joan Vassey, BSN,
RN, Nurse Educator I, and Lisa Clark, MSN, RN, CPAN,
Nurse Educator II, planned the ve sessions of Skills Lab and
Posters Review. Lora Balerno, MSN, RN-BC, CCRN, CNS for
Cardiology, coordinated ve speaker presentations by company
representatives and Mission Hospital Pharmacist Aubrie Raerty.
The MCSD library implemented by Lisa Clark, MSN, RN,
CPAN contains resources related to cardiology, electrocardiography,
certication review in critical care (CCRN) and progressive care
(PCCN), and miscellaneous nursing topics available to any nurse in
the hospital.
(Nursing News, Vol. 6, #13, December 2010)
at March of Dimes Gala
Nurses and a respiratory therapist from the Neonatal ICU (NICU)
prepared and displayed a mock ICU setting in the lobby of the
March of Dimes 20th Anniversary Gala on October 8 at the Grove
Park Inn. The event raises money for community grants and
research investigating the causes and treatment of premature births.
Autumn Ballard, RN; NicoleWells, BSN, RN; Gary Trimby,
RRT-RCP, NPS, C-NPT; Maggie Holmes, BSN, RN; and Meera
Ganatra, BSN, RN displayed two dolls surrounded by ICU
equipment like a radiant warmer, a ventilator, and IV infusions. The
goal was to help community members realize the importance and
impact that the March of Dimes has on premature babies.
Mission Hospital is one of 122 hospitals throughout NC that
participates in the Reperfusion of Acute Myocardial Infarction in
Carolina Emergency Departments (RACE). This project focuses
on improving patient outcomes from heart attacks. Community
education about risk factors, signs and symptoms and steps in getting
treatment is part of the role of this project.
At the 2010 Mountain State Fair in Asheville, more than 50 nurses,
certied nursing assistants, and other auxiliary personnel from 23
hospital areas volunteered 300 hours at the “Minutes Matter” booth.
They instructed over 4,500 people on the importance of calling 911,
recognizing the signs and symptoms of a stroke and heart attack and
how to perform compression-only CPR.
There were 28 community screenings and educational events in the
region during 2010. With screenings, potential high risk community
members are educated on their risk factors and steps to follow to
reduce the chances of a heart attack. Additionally, 21 educational
classes were provided for nurses, EMS personnel, and physicians for
local and regional areas. Emphasis was placed on the recognition
of signs and symptoms of heart attack, modifying risk factors, and
expediting ST Elevation Myocardial Infarction patients to the Cath
Lab.
Nearly 5,000 Mission employees completed a Heart Attack Awareness
learning module, which included the physiological changes during a
heart attack and steps to take if this occurs with our patients, visitors,
and fellow sta members.
Mission Hospital was also awarded the 2010 Gold Performance
Achievement Award for improvement in the treatment of Acute
Myocardial Infarction patients through implementation of ACTION
Registry – Get with the Guidelines (GWTG) and in-hospital
initiation of the American College of Cardiology/American Heart
Association STEMI/NSTEMI Clinical Guideline Recommendations.
Empowerment - 11
BSN, RN
MCSD
BSN, RN
Manager, Cardiology ICU
BSN, RN
Trauma Care Unit
BSN, RN
House Supervisor
BSN, RN
8 North
BSN, RN
MCSD
BSN, RN
MCSD
BSN, RN
Emergency Dept
BSN, RN
CVOR Manager
BSN, RN
8 North
BSN, RN
Chest Pain Observation Unit
BSN, RN
Rapid Response Team
BSN, RN
Nurse Clinician, CVOR
BSN, RN, NUS
Nursing Support Services
, BSN, RN,
Copestone
BSN, RN, CCRN
Cardiovascular ICU/RU
BSN, RN, CRNI
IV Therapy
RN
Medical/Surgical ICU
BSN, RN
Neurotrauma ICU
BSN, RN
Cardiovascular Progressive Care
BSN, RN
Emergency Dept
BSN, RN
MSICU
BSN, RN
House Supervisor
RN
Pulmonary Medicine Care Unit (PMCU)
RN
MCSD
CNA I
Copestone Adolescent Unit
RN
Neurosciences
RN
Neurotrauma ICU
MHS, RN
Director, Nursing Support Services
, RN
Emergency Department
RN
Adult Medicine
RN
Neurosciences
RN
Rapid Response Team
, RN
General Medicine
RN
Neurosciences
RN
Emergency Department
RN
Cardiology ICU
RN
Cardiovascular Progressive Care
RN
Heart Services Case Manager
RN
Medical/Surgical Pool
Nursing Support Services
RN, ED
RN
Medical/Surgical Pool; Nursing Support Services
RN, ED
RN, PMCU
RN
Nursing Support Services
RN
Surgical Services
RN
Neurosciences
RN
MCSD
, RN
Neurosciences
RN
Manager, General Surgery
RN
Manager, Neurotrauma ICU
RN
House Supervisor
, RN, CPON Pediatric
Outpatient Hematology/Oncology
, RN
Neurotrauma ICU
RN
Women’s Surgery Unit
RN
Adult Medicine
RN, CEN, NUS;
Emergency Department
RN
PMCU
RN
PMCU
RN
6 North
RN
Neurosciences
RN
Neurotrauma ICU
RN, ED
RN, NUS, PMCU
RN
ED Admit Unit
MSN, RN-BC Nursing
Education Specialist II NPER
MSN, FNP
Oncology
MSN, RN-BC
Nursing Education Specialist II, NPER
MSN, RN
Cardiology ICU
MSN, RN
Manager, PMCU/PMSD
MSN, RN
Case Manager, PMCU/PMSD
MSN, ANP
Neurosciences
MSN, RN
Nursing Education Specialist II, NPER
MSN, RN
Nurse Educator I, NPER
MSN, BBA
PMCU/PMSD
NNP, RN
Neonatal ICU
MSN, RN
Director, Heart Services
MSN, RNC Nurse
Educator II, NPER
MSN, RN
Director, Adult Medical/Surgical Units
MSN, RN
Manager, Medical-Surgical ICU & Rapid
Response Team
MSN, RN
Manager, Medical/Surgical Progressive Care
MSN, RN , Manager,
Professional Nursing Practice for NPER
MSN, RN
Manager, 6 North
MHS, RN, NE-BC
Director Vascular Center/Radiology Nursing
MSN, RN-BC
Nurse Educator I, Senior Services
BSN, RN ED
BSN, RN, CEN; ED
BSN, RN
Cardiology ICU
BSN, RN
Nurse Educator I, NPER
BSN, RN; ED
BSN, RN
Labor and Delivery
BSN, RN, OCN.
Manager, Oncology
BSN, RN
Heart Services Outreach
BSN, RN Nursing
Support Services
BSN, RN
Nurse Educator I, NPER
Education
LPN
Neurosciences
RN
7 North
RN
Medical Cardiology SD
RN
PeriAnesthesia Care Unit
RN
Labor and Delivery
RN
Neurosciences
RN
Neurosciences
RN
Mother/Baby
RN
Pulmonary Medicine Care Unit
RN
Cardiology ICU
RN
9 NSD
RN
Trauma Care Unit
RN
Neurosciences,
RN
Olson Huff Center Medical Practice
RN
Neurotrauma ICU
RN
Trauma Care Unit
CNA II
Pediatrics Hematology/Oncology
CNA II
Neurosciences
HUC
Neurosciences
LPN
6 North
BSN, RN
Medical Cardiology Stepdown (MCSD)
BSN, RN
Oncology
BSN, RN
MSICU
BSN, RN
Nursing Support Services
BSN, RN
NPER
BSN, RN, CPAN, CAPA;
Post-Anesthesia Care Unit
12 - Mission Nursing Annual Report
BSN
Neurotrauma ICU
BSN, RN
Manager, 8 North
MSN, RN, BBA
(in post-graduate FNP program)
PMCU/PMSD
BSN, RN
CVICU
BSN, RN, REMTP (in FNP
program) Air Medical, MAMA
BSN, RN
(in FNP program) Neurosciences
BSN, RN
Nursing Informatics
BSN, RN
Nursing Informatics
BSN, RN, ONC
Manager, Orthopedics
BSN, RN; ED
RN, BSN
Risk Manager
BSN, RN, CEN
(in FNP program) Emergency Department
BSN, BSN Manager, 9 NSD
BSN, RN
Diabetes Clinician
BSN, RN
(in FNP Program) Staff Health/Occumed
BSN, RN
Nurse Educator I, NPER
BSN, RN, NUS
MCSD
BSN, RN, CCRN;
(in FNP program)
Coli ICU
RN
(in Nurse Midwifery), Oncology
BSN, RN
Manager, MCSD
BSN, RN, CNRN
Stroke Program Coordinator
BSN, RN
Interim Director, ED
BSN, RN, CPN
Nurse Educator I, NPER
RN, BSN
Manager, 7 North
BSN, RN
Clinical Informatics
Clinical Informatics
MSN, FNP/PNP, BC
(in Doctorate of Nursing Practice program)
Developmental Behavioral Pediatrics
Inductions
BSN, RN; ED
BSN, RN
Critical Care and Stepdown Pools
Nursing Support Services
BSN, RN
Medical/Surgical ICU (MSICU)
BSN, RN
Nursing Documentation Coordinator, NPER
BSN, RN
Manager, Oncology
BSN, RN
Nursing Support Services
BSN, RN
Trauma Care Unit
BSN, RN
Women’s Surgery Unit
BSN, RN
8 North
RN
ED
Nurse Extern
Nursing Support Services
BSN, RN
Neurotrauma ICU
BSN, RN,
REMTP, Air Medical, MAMA
BSN, RN
8 North
Nurse Extern
Nursing Support Services
BSN, RN
Nurse Clinician, Cardiovascular OR
Nurse Extern
Nursing Support Services
BSN, RN
Manager, 9 North Stepdown
BSN, RN
NUS, Nursing Support Services
BSN, RN
Staff Health Services
BSN, RN
Women’s Surgical Unit
RN
IV Therapy
BSN, RN
Mother/Baby
RN
Medical/Surgical ICU
BSN, RN
Cardiovascular Progressive Care
BSN, RN
MSICU
Mission Hospital sta members volunteered on February 18 to oer
morning and evening sessions of cardiovascular health risk screening,
nutritional guidance, and educational information to female hospital
employees. Nearly 250 women took advantage of this awareness
campaign sponsored jointly by the Heart and Women’s Service Lines.
Sta member volunteers paused for a picture during health screenings:
Seated L-R:
Debbie Kirkman, RN-BC, BSN,
Cardiovascular Outreach
Sarah Hinson
Community Health Enhancement
Kathy Bryson, RN, Utilization Review
Val Pulsifer, RNC, NUS, Mother/Baby
Irisha Pomerantze, Russian Interpreter
Kick-Off Celebration
A special Nurses Week Kick-O event was held May 4 in the MAHEC
Auditorium. The program included:
• A presentation of background music and photos of Mission nurses
across the organization, produced by Leigh Angel, BSN, RN,
Manager of 9 Stepdown;
• Nursing Excellence Awards to 12 nurses and State of Nursing address
by Kathleen Guyette, MSN, RN, NE-BC, VP and CNO;
• Keynote Address by renowned author Bertice Berry, PhD, who
praised Mission nurses for their dedication to providing excellent
patient care; and Blessing of the Hands ceremony, led by Nancy
McCall, RN, Pediatrics.
Melanie T. Clark, RN, Mission Children’s Specialists, and co-chair of R&R Council (left),
paused with Dr. Bertice Berry (center) and Jeanie Bollinger, RN, of the Cardiovascular
ICU/Recovery Unit, and chair of R&R Council (right) after Dr. Berry’s standing ovation speech.
Standing L-R:
Brett Mills, CNA, Stang Pool
Linda Y. Smith, RN, MSN, IBCLC, CNS
for Neonatal, Women’s, and Mother/Baby
Kathleen Leake, RN,
ED Chest Pain Observation Unit
Lisa Wilcocks, RNC, Mother/Baby
Frank Castelblanco, RN,
Heart Regional Services
Fern Webb, Tobacco Addiction Specialist
Empowerment - 13
Afliations
Coordinated by Tina Barnes, MSN, RN, NEA-BC, CAPA,
Manager of Professional Nursing Practice, NPER
(January-
September). Coordinated by Cheryl Gibson, MSN, RN-BC,
Nursing Education Specialist II, Nursing Practice, Education
& Research
(October-present).
Organizations Leadership
, CNA I; Unit Assistant I; Coli ICU
RN; Coordinator, Integrative Health
BSNRN, MHS, CPAN; Nurse Education Specialist II, NPER
MSN, RN-BC; Nursing Education Specialist II, NPER
MSN, RN; Nurse Education Specialist II, NPER
RN, CPAN, CAPA; Post-Anesthesia Care Unit
BSN, RN; Nursing Documentation Coordinator, NPER
BSN, RN, MPH, CCRN; Manager of Cardiovascular ICU
and Recovery Unit and CV Progressive Care (CVICU/RU & CVPC)
BSN, RN, MBA, HN-BC, HTCP, HTI; Holistic Nurse Specialist;
MN, RN, NE-BC; Director, Women’s and Children’s Services
MSN, RN-BC, Nursing Education Specialist II, NPER
BSN, RN, CAPA; Post-Anesthesia Care Unit
MSN, RN, CCRN-CMC-CSC, CPAN Clinical Nurse Specialist for Research; NPER
, MSN, RN, NEA-BC, AHN-BC; Director, Integrative Healthcare
BSN, RN; Staff Health/Occumed
, BSN, RN, CCRN, CSC; Unit Educator for CVPC
BSN, RN-BC, CES; Director, Heart Path
BSN, RN, CCRN, CSC; Asheville Surgery Center
MSN, RN, CAPA; Manager, Professional Nursing Practice
14 - Mission Nursing Annual Report
Nursing, Surgical Technology, and Emergency Medical
Sciences Students
Flat Rock, NC
Nursing and Surgical Technology Students
Spruce Pine, NC
Nursing Students
Clyde, NC
Nursing Students from Haywood Community College,
and Tri-County Community College
Cullowhee, NC
Undergraduate and Graduate Nursing, and Emergency Medical
Care, Physical Therapy Students
Emergency Medical Science
Exercise Science
Genetic Counseling
Graduate Nursing
Health Information Technology
Medical Technology
Nurse Midwifery
Nursing
Physical Therapy
Radiation Therapy Technology
Respiratory Therapy
Sonography
Speech-Language Pathology
Surgical Technology and other specialties.
Appalachian State University
Arcadia University
Case Western University
Catawba Valley Community College
Central Piedmont Community College
Chattanooga State University
Duke University
East Carolina University
East Tennessee State University
Edgecombe Community College
Elon University
Emory University
Frontier School of Midwifery & Family Nursing
Gardner-Webb University
Georgia State University
Lebanon Valley College
Lees McRae College
Lenoir Rhyne University
Mars Hill College
North Georgia College & State College
South College
Southwestern Community College
University of North Carolina-Chapel Hill
University of North Carolina-Charlotte
University of North Carolina-Greensboro
University of Tennessee
Western Carolina University
Western Piedmont Community College
Wingate University
Winston-Salem State University
NURSING
EXCELLENCE
Winning Posters
, and
for “NICU/Peds Collaboration Standardizes
Syringe Medication/Flush to Improve Quality, Consistency.”
and team
for “Implementing a Geriatric Hip Fracture Program.”
and for “PCCN Building
a Culture of Certication.”
The People’s Choice Award went to
for
“Helping Hands: Junior Volunteers Work as Lifeguards Against
Harm.”
for Breast Centers
In August, the Cancer program hosted surveyors from
the National Accreditation Program for Breast Centers,
who reviewed our Breast Cancer Program. This
review included several areas of the hospital, including
Radiation Therapy, Breast Center, Asheville Imaging,
inpatient units where post-op breast care is provided, as
well as private practice oce documentation related
to breast care follow-up. A Breast Steering committee,
consisting of breast surgeons, pathologists, medical
oncologists, radiation oncologists and many others
worked together for the past year to ensure our
compliance of the 27 required standards of care.
Our Breast Program received a three-year/full
accreditation with the National Accreditation Program
for Breast Centers (NAPBC)! We were found to be fully
compliant with all 27 standards.
The very positive comments of the surveyor validate
that we have an outstanding team providing exceptional
care!
“Kelly Condra, MD Radiation Oncologist, serves as
the physician champion/breast program leader of Mission
Hospital’s Breast program. Her ability to stimulate academic
and meaningful dialogue at the Pre-treatment Breast
Conference is without question.”
“ Asheville Imaging, MQSA-certied and ‘on-site,’ includes 30
plus ACR-certied radiologists who read up to 200 screening
studies daily.”
“Mission’s Breast Program has one of the most comprehensive
‘navigation’ programs in place that I have seen in my experience
as a reviewer. The attention paid to patient needs and education
is impressive. There are two breast care navigators that
provide more than full-time services in the way of patient
navigation from the time of initial complaint/abnormal
imaging all the way through to treatment and survivorship.”
“Mission’s Breast program has managed to maintain a
‘community, small-town’ feeling in caring for its breast
patients. However, the programs volumes in caring for patients
throughout 17 counties in North Carolina prove that the
program is anything but ‘small.’ All members of the team show
genuine enthusiasm for providing these patients with the best in
breast care. The administrative support in funding the sta and
technology necessary is also most impressive. “
(PEAR)
In June 2010, Mission Hospital nalized the Nursing Education & Practice
Retention Grant, a three-year federal grant through the Health Resources & Services
Administration (HRSA), Bureau of Health Professionals. The grant aligned with the
Professional Educational Achievement Recognition (PEAR) program and provided
funding for the administrative facilitation and curriculum development for professional
development and clinical courses.
Cheryl Gibson, MSN, RN-BC, Nursing Project Coordinator; Heidi Sherman,
MSN, RN-BC, Sta Development Coordinator and Thresa Lukacena, Media
Specialist and Oce Technician, provided oversight for the PEAR Program through
Nursing Practice, Education & Research. The Mission Healthcare Foundation
facilitated the nancial management of the grant resources.
Nurse Liaisons
The rst meeting of the new Infection Prevention (IP) Nurse Liaison Program was held
on August 15.
Rachel Long, MT, MEd, CIC, Manager of IP and Public Health Epidemiologist,
hosted 30 nurses from 26 nursing areas. The key purpose of the group is improvement
of patient outcomes by facilitating better understanding of:
1) IP reports at Mission
2) How IP monitors infections
3) Nosocomial infections
4) The “bugs” that cause infections
5) Process improvements to decrease patient infections.
Registered nurses who participated in the rst IP meeting were:
Medical Surgical Progressive Care
Neurotrauma ICU
Manager,Women’s Surgical Unit
Director, Nursing Support Services
Labor and Delivery
ED
Trauma Care
Neurosciences
IV Team
MCSD
8 North
General Surgery
Children’s Dental
Renal Medicine
Manager, Coli ICU
Manager, 9 North Step Down
General Surgery
Renal Medicine
Medical Surgical ICU
Neonatal ICU
Manager, NTICU
Coli ICU
NUS, MCSD
Psychiatric
Services
, Mission Children’s Specialists
Asheville Surgery Center
Pulmonary Medicine Stepdown
Dialysis
NUS, CVICU
Manager, 7 North
16 - Mission Nursing Annual Report
Nurses
During 2010, thirty-four Geriatric Resource Nurses (GRN) graduated from special classes at Mission
Hospital bringing the total to 230 GRNs trained across the hospital, including the Emergency
Department and outpatient areas. A similar program is available for non-licensed personnel such as
nursing assistants, called the Geriatric Trained Provider (GTP) program. There are 30 GTPs working
at Mission. In 2010, 18 sta graduated as GTPs (12 from Mission and six from the Council on Aging).
The Mission GRN/GTP program is part of a nationwide organization called Nurses Improving Care
to Health System Elders. GRNs are involved in many initiatives throughout the hospital to improve
the bedside care of older adults, including delirium prevention, fall prevention and reduction of
catheter-associated urinary tract infections.
Two GRNs were honored for their outstanding service to the elders at Mission, Barb McElroy,
RN, Nursing Support Services, and Joy Brooks, RN in the ED. Both are tireless advocates for their
patients and role models for sta. Linda Hensley, CNA in CICU was awarded GTP of the Year for
her dedication to individualized patient care and leadership in elder care.
Other GRN projects in 2010 included educating unit sta on geriatric order sets, such as the geriatric pain protocol, PRN Elder care order set, and
geriatric acute delirium plan.
Another GRN program was added that brings together 15 community nurses from Community Care of WNC and local long-term care facilities. The
goal is to promote smooth transitions for elders, as they move through dierent health care settings, through collaboration between sta at these
settings. We learn the needs of each level of care, and strive to strengthen communication to provide the best care possible for the elders of our
community. Nursing Practice, Education, and Research and Senior services collaborate in providing the GRN/GTP program.
Nurses
Started in 2009 and supervised by Tish
Alspach, RN, MPH, Inpatient Glucose
Coordinator, the Diabetes Resource
Nurse (DRN) program has graduated
161 nurses from 42 departments. Of
these DRNs, 32 graduated in 2010.
The function of the Diabetes Resource
Nurse is to:
• Serve on their units in a resource
capacity.
• Utilize the knowledge gained
through the training session and
the follow-up classes to enhance
their knowledge of diabetes.
• Assist their peers to develop
strategies on their units to
maintain patients’ glucose levels
within target ranges.
• Share the information that they
have acquired with nurses on
their units.
• Develop and utilize relationships
with the Inpatient Diabetes
Clinicians.
Nurses
Since April 2009, there have been 231 Holistic Resource Nurse (HRN) Program graduates. Forty-one
of those graduated from four classes in 2010.
This course, sponsored by the Integrative Healthcare Department, focuses on evidence based nursing
practices and the core values of Holistic Nursing from the American Holistic Nurses Association and
the American Nurses Association. The class guides nurses in the art and science of holistic nursing
and oers ways of thinking, practicing, and responding both personally and professionally to bring
healing to the forefront of healthcare.
Emphasis is placed not only on preparing for the Holistic Nursing Certication (HNC) exam, but in
preparing Mission nurses to serve as Holistic Resource Nurses in their roles as clinicians, educators,
and researchers. Components of this course include an organized base of knowledge, competencies,
denitions, theories, and research. Course content is applied during 24 hours of classroom experience
over three weeks.
“The goal is to promote
smooth transitions for
elders, as they move
through dierent health
care settings, through
collaboration between
sta at these settings.”
Professional Practice - 17
Nurses
The Pediatric Resource Nurse (PRN) Program was begun in 2010 with the goal of improving pediatric care at Mission Hospital and throughout
Western NC.
The program is oered to nurses locally and regionally. Pediatric care in this hospital and two area organizations was positively impacted by projects
resulting from nurse participation in the rst two groups, listed below.
Projects from the First Two Pediatric Resource Nurse Programs:
• Needle gauge/lengths/sites – Mission ED
• Risk of increased QT Interval in children taking antipsychotics - Copestone
• Pediatric Pain Scales – Mission ED
• Trauma Orientation – Mission ED
• Soft language suggestions posted at nursing unit – Pardee Hospital
• Pediatric Education Series – CarePartners
• Oral Rehydration Therapy protocol – Mission ED and Inpatient
• Temporal Artery Thermometry – Mission ED and Inpatient
• Decorating 4 waiting rooms for pediatric patients/families – Mission ED
• New cleanable, child-friendly books - Asheville Surgery Center
• Pediatric intravenous start/lab draw kits - Mission ED
• IV teaching book - Mission ED
• Broselow arm bands – Copestone
• Weight at triage – Mission ED
• Distraction bucket – Pardee Hospital
• Toy Cleaning policy and set-up – Pardee Hospital
• Relationship between nausea and vomiting and uid decit – Asheville Surgery Center
Three programs were oered in 2010
with 52 graduates.
ED
Copestone
Asheville Surgery Center
Endoscopy
Nursing Support Services
Genetics
Angel Hospital
CarePartners
Haywood Hospital
Harris Hospital
McDowell Hospital
Pardee Hospital
Transylvania Hospital
Designation
In 2010, Mission Hospital became the rst hospital in NC and one of 89 in the US to earn
Baby Friendly designation. The rigorous certication initiative to encourage women to begin
and continue breastfeeding is part of an international UNICEF /World Health Organization
(WHO) eort designed to give babies the immediate and long-term health benets of
breastfeeding.
In a two-day survey,
over 60 physicians,
sta members, senior
leadership, and new
mothers proved Mission’s
compliance with the
Ten Steps to Successful
Breastfeeding for
Hospitals, as outlined
by UNICEF and WHO.
The Mission Healthcare
Foundation helped
accomplish the extensive
sta education of 250
people by purchasing the
18 hours of mandatory
online education.
(Scope, Vol. 15, #9, May 7, 2010)
Nurses and other key sta members who helped plan and/or teach the 2010 PRN courses were:
BSN, RN, CPN
RN, CPN
BSN, RN, CPN
BS, CCLS, Child Life Specialist
BSN, RN, CPN
MS, RN, CPN
BSN, RN, CPN
BSN, RN, CPN
RN, CPN
BSN, RN
BSN, RN, CPN
BSN, RN, CPN
RN, BSN, CPN
RN
BA, CCLS, Child Life Specialist
CCLS, Child Life Specialist
BSN, RN, SANE-P, SANE-A
MSN, PNP-BC
RN, CPN
18 - Mission Nursing Annual Report
Ginny Raviotta, MN, RN, NE-BC
Director of Women’s and Children’s Services
Joni Lisenbee,
Lactation Center Coordinator
Kathleen Guyette, MSN, RN, NE-BC
Vice President and CNO
Kim Delk, BSN, RN, CPN
Manager of Pediatrics
Patrick Ryan, BSN, RNC, CCE
Manager of Mother/Baby
Kim Reik-Johnson, RN
Manager of Neonatal ICU
Brenda Smith, BSN, RN, NE-BC
Manager of Women’s Surgical Unit
The Registered Nurse Clinical Ladder Development team was formed in
September 2009 to create an advancement system for the non-supervisory
Registered Nurse. The team of direct care Registered Nurses, Nurse
Leaders, and Nurse Educators, began with a literature search and review
of clinical advancement models. The timeline for implementation was
discussed and created over the span of the next months.
The purpose of the Clinical Ladder program, supervised by Cheryl M.
Gibson, MSN, RN-BC, Education Specialist II, NPER, and guided
by the Clinical Ladder Council, is to promote excellence in clinical
nursing practice; develop and recognize nursing care quality; support the
highly experienced Registered Nurse in direct care; facilitate career and
professional development; and enhance retention and recruitment.
The Registered Nurse will submit a Clinical Ladder Portfolio including:
resume or curriculum vitae; clinical exemplar; elements of evidence; and,
evidence based project or research project. The Clinical Ladder Portfolio
provides the Registered Nurse an opportunity to showcase professional
achievements and critical thinking skills. October-December 2010 marked
the rst opportunity for Registered Nurses to apply to advance to Level
3 of the Clinical Ladder Program. We celebrate 52 Registered Nurses that
achieved Clinical Ladder Level 3 in February, 2011.
Growth Timeline
In August, 2009, the Nursing Governance Board (NGB) was established as
the central body for Mission’s Nursing Shared Decision Making Councilor
Model. From then to the end of December, 2010, the major hospital-wide
councils grew from six to eight major councils and three supporting
councils.
January 20, 2010 First meeting of the Nursing Night Council.
April 2010 Supporting councils added:
• Clinical Ladder
• Marketing & Communications
• Retention & Recognition
May 25, 2010 Organizational meeting of Advanced Practice Nursing
Council.
Noteworthy accomplishments of the NGB during 2010 include:
• Formation of a subcommittee which developed the Nursing
Strategic Plan based on the ve components of the Magnet®
model and linked to the goals of the Mission Hospital Strategic
Plan.
• Representation at Nursing Professional Practice Fairs in February
and April on four hospital campus areas to increase awareness of
the Councilor Model of Shared Decision Making.
• Decision to include brief summary reports of each council’s
monthly meeting in Nursing News each month.
• Endorsement of Guidelines for Managers’ Weekly Newsletters
and monthly Nursing News, plus
• Guidelines for Abstracts, Posters, Speakers, PowerPoints, and
Articles for Publication.
NURSING
INFORMATICS
COUNCIL
NURSING
PRACTICE
COUNCIL
NURSING
PROFESSIONAL
DEVELOPMENT
COUNCIL
ADVANCED
PRACTICE
NURSING
COUNCIL
NURSING
NIGHT
COUNCIL
NURSING
QUALITY
COUNCIL
NURSING
ADMINISTRATIVE
COUNCIL
NURSING
RESEARCH
COUNCIL
NURSING
GOVERNANCE
BOARD
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C
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C
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SUPPORTING COUNCILS
Clinical Ladder
Marketing &
Communication
Retention &
Recognition
Professional Practice - 19
H e a lt h U ni t C o o rd i n at or
7 North
Emergency Department
Lab-Pathology
Remembering Our Colleagues
Memories of their teamwork, kind words, and friendly spirits live on long after they have gone.
They are remembered for their service to our patients.
Emergency Department
,
Asheville Anesthesia Associates
at Asheville Surgery Center
Oncology
20 - Mission Nursing Annual Report
NURSING
EXCELLENCE
Nurses’ Attitudes Toward Obesity Quantitative
MSN, RN
Cardiology ICU
Is there a difference in the completeness of discharge instruction
when utilizing the electronic record versus the paper template
instructions?
Quantitative
MSN, RN
Manager of 6 North
Does Medication Error Reporting Increase with Anonymity? Quantitative
MSN, RNC
Effect of a Pediatric Resource Nurse Program on Knowledge,
Skills, and Comfort of Non-Pediatric Nurses
Quantitative
MS, RN, CPN
Clinical Nurse Specialist, Pediatrics
NPER
BSN, RN, CPN
NUS on Pediatrics
BSN, RN, CPN
Nurse Educator I, Pediatrics, NPER
Assessing Impact of Breastfeeding-friendly Programs in North
Carolina’s Hospitals on Mothers’ Satisfying Intention to Breastfeed
Quantitative
BSN, RN, IBCLC
Lactation Center Coordinator
WNC Breastfeeding Center
Impact of Education on Condence Level of Nurses Caring for
Families Experiencing a Pregnancy Loss
Quantitative
BSN, RN
Nurse Clinician, Fullerton Genetics
BSN, RN
Manager, Women’s Surgical Unit
Preparing the New Graduate Nurse: Evaluating the New
Graduate’s Self-Efcacy (or Self-Reported Comfort in
Competence) of a restructured critical, progressive and
emergency care orientation model
Quantitative
BSN, RN
Medical/Surgical ICU
Proactive Palliative Care in Intensive Care Units: Does It Impact a
Patient’s Length of Stay?
Quantitative
BSN, RN
Interactive Teaching Strategies and the Effect on Knowledge and
Outcomes
Quantitative
BSN, RN
Nursing Education Specialist I NPER
PhD
Professor, University of NC Charlotte
PhD, RN, NEA-BC Director, NPER
RN, MEd, BSN, LCCE, FACCE;
Creative Teaching Strategies Expert
MSN, RN-BC
On-line Learning Expert
MSN, GCNS-BC Content Expert
Winners
PEOPLE’S CHOICE
Jill Howell, MSN, RN, Nurse Clinician for Surgical Services, “Beta Blockers”
First Place
Heart Path sta members Gail Stephens, RN; Virginia Fox, RN; and Cathy Gibson, PH. I Assistant, “Patient Teaching”
Second Place
Cathy Hebert, RN, MSN, CNS for Geriatrics “Managing Geriatric Delirium”
Third Place
Bonnie Oliver, RN, American Heart Association Nursing Education Specialist I; Jill Rabideau, RN, Medical/Surgical
Pool, Nursing Support Services; and Lora Deitz, BSN, RN, NUS for Nursing Support Services, “Sim-Man”
22 - Mission Nursing Annual Report
Delirium in the Elderly
Delirium protocol dened and impact
made
BSN, RN; Chest Pain
Observation Unit
RN, ED
All Mission Hospital Units
Chest Pain Obs
Delirium Reduction: Moving Ahead
With Hospital-Wide Initiative
All processes in place to decrease
delirium
RN-BC, Nurse Educator,
Senior Services
MSN, RN, GCNS-BC,
Geriatric Clinical Nurse Specialist, NPER
,
Coordinator of Dementia Responsive Care
Senior Services
Progressive Mobility Protocol
Effect of increased mobility in CVICU
patients
RN, CCRN, CSC; Nurse
Educator for Cardiovascular ICU and Recovery
Unit (CVICU/RU)
BSN, RN, CCRN, CSC;
CVICU/RU
CVICU
ICU Initiatives for
Patient-Centered Care
Mobility, delirium protocol, decrease
incidence of Catheter Associated
Urinary Tract Infections, Ventilator
Associated Pneumonia, Central Line
Associated Blood Stream Infections,
and Pressure Ulcers
BSN, RN, CCRN
Nurse Educator, Critical Care
MSN, RN
Manager, Medical/Surgical ICU
BSN, RN
Manager, Coli ICU
Coli ICU , MSICU
Precedex and Sedation
Use of Precedex for extubation with
decreased side effects
BSN, RN, CCRN
Critical Care
RPH
Pharmacy
Coli ICU
Intravenous Insulin Pilot Tighter control for hyperglycemia
BSN, RN, CCRN
Nurse Educator, Critical Care
RN
Inpatient Glucose Clinician
Coli ICU
Knowledge, Innovations & Improvment - 23
DePArtment outCome BASeD ProJeCt
Labor & Delivery
Can we increase breastfeeding rate/documentation within rst hour of
neonatal life? Can we improve documentation of skin to skin contact with
baby/mother at birth?
Cath Lab How can we decrease turnover time in cath lab and improve the ow?
Pediatrics Use of infrared temporal artery thermometers for pediatric patients
Cardiac ICU Guidelines for visitation in the intensive care
Endoscopy
Planning, developing, & coordinating a fall regional nursing conference for
Western North Carolina Society of Gastroenterology Nurses & Associates
IV Therapy Central Line Associated Blood Stream Infections (CLABSI)
Cardiovascular ICU Progressive upright mobility process
Emergency Department
Emergency Department wait times: Was there a process to decrease wait
times & increase patient satisfaction?
Neonatal ICU
Practice recommendation: incorporating discharge teaching during NICU
stay
Neonatal ICU How can discharge teaching be improved in NICU?
Inpatient Wound Care
Would unit based Wound Ostomy Continence Nurse (WOCN) & monthly
pressure ulcer surveillance improvement improve Hospital Acquired
Pressure Ulcer (HAPU) rate?
Operating Room
Is there a process to improve specimen labeling in the Operating Room?
OR Control Plan
Oncology
Do Mission Hospital’s current chemotherapy policies reect the most
current standards of practice set forth by the ASCO/ONS joint standards,
ONS, OSHA, and NIOSH?
Labor & Delivery
Do adult survivors of sexual abuse have a high risk for a negative or
traumatic birth experience? Creation of a Survivor Services Program.
Cardiac ICU
Patient/Nurse comfort and satisfaction with two methods of femoral
sheath removal
Inpatient Wound Care
Can we reduce Hospital Pressure Ulcer (HAPU) incidence rates on a
consistent basis to improve patient outcomes and avoid cases or non-
reimbursement?
Labor & Delivery
Optimizing thermoregulation in the healthy neonate during the rst few
minutes after birth
Emergency Department
Parental education & oral rehydration therapy in pediatric patients to
prevent ED visits, revisits, & admissions due to severe dehydration
Mother Baby Visitation practices in mother baby to implement quiet time
Emergency Department
Will increased knowledge and comfort with the pediatric patient lead to
better care? Focus: trauma education
MSICU Preparing the new graduate nurse: evaluating the new grad self-efcacy
Surgical Pre-Op Communication between physicians & staff
Neonatal ICU
Evidence for providing better & earlier supportive developmental care to
premature infants
Cardiovascular ICU
Preventing phlebotomy blood loss in ICU patients through the use of
3-way stopcock
9 Stepdown
What are the barriers to pursuing & successfully obtaining certication?
How do we overcome these barriers? What are the benets to
certication?
24 - Mission Nursing Annual Report
DePArtment outCome BASeD ProJeCt
Outpatient Heart Path
What impact does a cardiac rehab-based, group health coaching intervention
have on the lifestyle on the participants, in addition to a traditional advisory
service in relation to the activity program at hand?
Neonatal ICU Application of cycled light in NICU
Asheville Surgery Center
Integrative Clinical Information System Collaborative Project & the timing of
physician orders before & after the implementation of CPOE
Inpatient Wound Care
What is the rate of skin tears at Mission Hospital? How can we reduce this
number? Is staff education & implementation of a prevention protocol efcacious
in reducing skin tears & assuring treatment according to policy (Simple Wound
Protocol #9.15)?
Pediatrics Use of Smart Pump/guardrail technology in the Pediatric population
Pediatrics
Is there a need for palliative care education for patients with life limiting or life
ending illness?
Radiation Oncology
Implementation of a nicotine cessation/performance improvement program in
radiation oncology
Labor & Delivery Patient repositioning & pressure ulcers after epidural injections.
Mission Children’s Specialist
What is the best practice to obtain accurate history from a preschool child who
may have been abused?
Mother Baby Women’s experience of abnormal papanicolaou smears
Asheville Surgery Center
Why are Urine Pregnancy Tests (UPT) performed for pre-surgical patient in the
outpatient setting?
Mother Baby Visitation practices in mother baby to implement quiet time
Cardiovascular ICU Suction canister placement in the unit; investigation of product change
Neonatal ICU Buccal care with human milk for the low birth weight infant (<1500 gms)
Inpatient Wound Care How can the pressure ulcer rate be reduced at Mission Hospital?
IV Therapy
How effective are saline ushes when compared to heparin ushes in
maintaining patency of central venous access devices in hospitalized adult
patients?
Endoscopy
Change in standard of care for Automated Implanted Cardiac Debrillators
(AICD) & inquiry to update practice standard
Labor & Delivery
Is it possible to give healthy adults too much IV uid? Retrospective chart review
of IV uid documentation
Asheville Surgery Center
Why are Urine Pregnancy Tests (UPT) performed for pre-surgical patient in the
outpatient setting?
Asheville Surgery Center
Why are Urine Pregnancy Tests (UPT) performed for pre-surgical patient in the
outpatient setting?
Inpatient Wound Care
Interventions to decrease the Hospital Acquired Pressure Ulcer (HAPU) rate at
Mission Hospital
Air Medical
What is the effect of duration of duty of patient care performance in air medical
crews working longer than 12-hour shifts?
Cardiovascular ICU Standardization of practice: post-operative order set
Vascular Center
Will customization of current electronic documentation system assist with
implementation of electronic charting in interventional nursing compliance with
regulatory standards?
Neonatal ICU Pulse oximetry testing of the high risk infant in a personal car seat
Neonatal ICU Buccal care with human milk for the low birth weight infant (<1500 grams)
Inpatient Wound Care
Differences between neonatal/pediatric skin, give the healthcare provider
information that enable selection methods of prevention & various treatment
modalities for a variety of wound types that is based on current research
DePArtment outCome BASeD ProJeCt
Labor & Delivery
Can we increase breastfeeding rate/documentation within rst hour of
neonatal life? Can we improve documentation of skin to skin contact with
baby/mother at birth?
Cath Lab How can we decrease turnover time in cath lab and improve the ow?
Pediatrics Use of infrared temporal artery thermometers for pediatric patients
Cardiac ICU Guidelines for visitation in the intensive care
Endoscopy
Planning, developing, & coordinating a fall regional nursing conference for
Western North Carolina Society of Gastroenterology Nurses & Associates
IV Therapy Central Line Associated Blood Stream Infections (CLABSI)
Cardiovascular ICU Progressive upright mobility process
Emergency Department
Emergency Department wait times: Was there a process to decrease wait
times & increase patient satisfaction?
Neonatal ICU
Practice recommendation: incorporating discharge teaching during NICU
stay
Neonatal ICU How can discharge teaching be improved in NICU?
Inpatient Wound Care
Would unit based Wound Ostomy Continence Nurse (WOCN) & monthly
pressure ulcer surveillance improvement improve Hospital Acquired
Pressure Ulcer (HAPU) rate?
Operating Room
Is there a process to improve specimen labeling in the Operating Room?
OR Control Plan
Oncology
Do Mission Hospital’s current chemotherapy policies reect the most
current standards of practice set forth by the ASCO/ONS joint standards,
ONS, OSHA, and NIOSH?
Labor & Delivery
Do adult survivors of sexual abuse have a high risk for a negative or
traumatic birth experience? Creation of a Survivor Services Program.
Cardiac ICU
Patient/Nurse comfort and satisfaction with two methods of femoral
sheath removal
Inpatient Wound Care
Can we reduce Hospital Pressure Ulcer (HAPU) incidence rates on a
consistent basis to improve patient outcomes and avoid cases or non-
reimbursement?
Labor & Delivery
Optimizing thermoregulation in the healthy neonate during the rst few
minutes after birth
Emergency Department
Parental education & oral rehydration therapy in pediatric patients to
prevent ED visits, revisits, & admissions due to severe dehydration
Mother Baby Visitation practices in mother baby to implement quiet time
Emergency Department
Will increased knowledge and comfort with the pediatric patient lead to
better care? Focus: trauma education
MSICU Preparing the new graduate nurse: evaluating the new grad self-efcacy
Surgical Pre-Op Communication between physicians & staff
Neonatal ICU
Evidence for providing better & earlier supportive developmental care to
premature infants
Cardiovascular ICU
Preventing phlebotomy blood loss in ICU patients through the use of
3-way stopcock
9 Stepdown
What are the barriers to pursuing & successfully obtaining certication?
How do we overcome these barriers? What are the benets to
certication?
Knowledge, Innovations & Improvment - 25
Fiesta
A Research Fiesta was presented on May 5 in the Glenn
Theater, featuring original nursing research presentations
and six evidence-based project posters displayed in the
Stevens Board Room. The event, organized by Kathy
Daley, RN, MSN, CCRN-CMC-CSC, CPAN, Clinical
Nurse Specialist for Research, revolved around a Cinco de
Mayo theme of celebrating nursing accomplishments.
Research speaker presentations were:
• Linda Anderson, MSN, RN
Director of Adult Medical and Surgical Units – The
Eects of Purposeful Rounding by Management
and Nursing Sta on Sta Satisfaction, Patient
Satisfaction and Safety
• Heidi Sherman, MSN, RN-BC
Nursing Education Specialist II, NPER –
Blended vs. Lecture Learning: Outcomes for Sta
Development
• Melissa Ballard, FNP, RN, and
Danette Brinkley, FNP, RN
both of the Mother/Baby Unit – Literacy in
Post-partum women in Western North Carolina
• Kathy Hefner, MSN, RN
Director of Heart Services – Timeliness of
Coronary Reperfusion in ST-Segment Elevation
Myocardial Infarction After State System
Implementation: Are There Gender Dierences?
In July, 2009, ve Mission Hospital leaders were invited to Washington D.C. to
share Mission’s success in providing low-cost, high quality healthcare. The one-day
symposium was conducted by the Institute for Healthcare Improvement (IHI), a
worldwide leader in healthcare quality improvement.
From that meeting came a unique oer from IHI: on-site consultations to take
an even closer look at Mission’s processes. After an assessment and evaluation of
Mission Health System’s quality initiatives, IHI representatives presented the nal
report and recommendations on March 19, 2010, to an estimated 100 Mission
Health System leaders, including board members, physicians and administrators.
(Scope, Vol. 15, #7, April 2, 2010)
Based on the IHI report, several teams were established to begin the process
of achieving Mission’s aim of attaining breakthrough levels of performance and
national quality leadership.
IHI Critical Care Team – Sedation Holiday
Team Purpose:
Sedation Holiday to eliminate, in qualied patients, continuous sedation, in an
eort to reduce length of stay and Ventilator Days in critically ill patients in the
MSCIU and then spread to all ICUs in the Hospital
Multidisciplinary Rounds Tool to streamline and standardize the RN
communication to the Critical Care Team during daily rounds, and then spread to
all ICUs in the Hospital
Spontaneous Breathing Trials - upcoming
IHI Medication Management Team – Coumadin Therapy
Team Purpose
To assist patients on Coumadin with better outcomes and an INR range of 2 – 3
throughout their hospital stay; provide Coumadin instructions to all patients on
Coumadin; provide INR follow – up
IHI Medical Surgical Team – SBAR
Team Purpose:
The communication between providers and nursing sta is essential to deliver
quality, safe, cost-eective care to our patients. The SBAR tool will equip clinicians
with the information required to make complete decisions regarding the patient’s
care. It will guide nurses to deliver concise and organized information including
recommendations when contacting providers concerning their patient. This will
improve the quality of the communications, increase sta satisfaction, and result
in increased patient satisfaction. The overall goal is to promote a culture of safety
and reduce patient harm.
IHI Peri-Operative Team – WHO Checklist
Team Purpose:
Increase compliance with the use of the World Health Organization (WHO) Safe
Surgery Checklist
Research Institute
The Mission Hospital Research Institute nurses with the
assistance of others coordinated 32 research studies in 2010.
The support of these studies involved completing study
start-up activities, completing regulatory requirements,
conducting in-services for Mission sta, completing
Institutional Review Board and Research Administrative
submissions, as well as consenting patients, monitoring
patients throughout the research interventions, and
performing patient follow-up procedures.
During the past year, a total of 1108 patients were screened
for potential research participation, and nine new research
studies were implemented involving seven therapeutic
areas. The areas include cardiovascular, vascular, and
general surgery, orthopedics, neurology, trauma and general
medicine. These studies provide valuable information for
improving the care of patients with conditions such as
heart valve disease, vascular disease, stroke, traumatic brain
injury, hernia repair, several orthopedic injuries, as well as
u and deep vein thrombosis (DVT) prevention.
The research nurses who help promote research
opportunities for our patients and sta are: Rachel
Alosky, BSN, RN; Claudine Cuento, BSN, RN, CCRC,
CCRP; Lynne Hampton, MBA, MHA, RN, CCRC,
CCRP, Manager of Clinical Trials; Tracy Nanney, BSN,
RN, and Leslie Shell, BSN, RN.
26 - Mission Nursing Annual Report
Projects
Induction Scheduling
L&D, Mother/Baby, Maternal Fetal Monitoring Unit
: Ginny Raviotta, Dr. Kellett Letson, Melinda Bryant
: Jan McKendrick, Patrick Ryan, Martha Hill, Erin Roberts
: Denying preferred induction dates and bumping scheduled
inductions.
: The Women‘s Service Line established specic guidelines for
scheduling induction cases--August 1.
: Denied or bumped cases dropped by 18 percentage points.
This was both statistically signicant (not due to chance) and practically
important (providers are far more likely to get their patients induced
when requested).
Dictation Distribution
Fullerton Genetics Center
: Dr. Bill Allen and Linda Costello
: Kathi Balsinger, Kelly Tison, Stephanie Bollinger
: The dictation process takes too long, and the time from
patient visit to dictation distribution (mailing) is widely variable.
: Three strategies were implemented: eliminated excessive steps
in the process; smoothed the process to minimize inconsistent ow;
and standardized the dictation within and across the various roles in the
process.
: There was a statistically signicant reduction in the mean
dictation turnaround time after the process changes were implemented
in August.
Pain Control
Women’s Surgical Unit
: Brenda Smith, Kathleen Guyette, Dr. Kellett Letson
: Melanie Norman, Melissa Wilson, Nancy Mastrantonio,
Tracy Hannah
: Surgical patients reported pain scores above their preferred
target before discharge.
: Eleven improvements were implemented that centered around
three strategies: changed pain assessment (monitor, revaluate, treat);
increased patient controlled analgesia (PCA) utilization; developed ‘pain
as the 5th vital sign’ practice.
: Reduced the percentage of patients not meeting their pain
target by 50 percent.
Chemoprophylaxis (DVT, VTE, PE)Trauma Service
: Kelli Moore, Kathy Gier, MarySue Carson, Dr. Dale Fell
: Terrie Smith, Larry Buckner, Dr. William Shillinglaw, Dr.
James Keel
: Adult trauma patients with solid organ injuries (liver,
spleen) managed non-operatively are not receiving appropriate
chemoprophylaxis, which helps prevent deep vein thrombosis (DVT);
venous thromboembolism (VTE), and pulmonary emboli (PEs).
: The improvements centered on the establishment of Spleenic
Management guidelines.
: Due to the scarcity of this particular patient population (liver,
spleen injuries), we are waiting for enough data to evaluate results.
,
MSN, APRN, RN, BC, CDE
, Simulation Laboratory
Coordinator, was been notied that the article she co-authored with two
Western Carolina University faculty members, “Blending Technology in
Teaching Advanced Health Assessment in a Family Nurse Practitioner
Program: Using Personal Digital Assistants in a Simulation Laboratory” has
been accepted for publication in the Journal of the American Academy of
Nurse Practitioners (JAANP). Publication is expected around August 2011.
,
RN, MS
, coordinator for Integrative Healthcare, and
, RN,
Pediatrics, were published in the Fall 2010 issue
of Beginnings, the ocial magazine of the American Holistic Nurses
Association (AHNA). Their article, “Holistic Case Studies Demonstrate
Powerful Outcomes at the Bedside,” highlights the use and benets of
Healing Touch and guided imagery in actual patient encounters.
,
RN
, Neurosciences, presented the “Know
Stroke,Think FAST” program for Claxton Elementary students in February.
,
MSN, RNC, Neonatal CNS, NPER;
and ,
RNC
, and ,
BSN, RNC
, both of Neonatal ICU, published
“Computerized Physician Order Entry: Lessons Learned from the Trenches”
in the July/August 2010 issue (Vol. 29, No. 4) of Neonatal Network, The
Journal of Neonatal Nursing, the ocial publication of the Academy of
Neonatal Nursing™.
,
MSN, RN, GCNS-BC, Geriatric CNS, NPER
, presented “Reducing
Delirium with a Team Approach” in April at the 13th annual conference of
Nurses Improving Care to Health System Elders (NICHE) in Baltimore.
,
MSN, RN, GCNS-BC, Geriatric CNS, NPER
, presented Mission’s
Delirium Prevention Project in a November 17 NICHE webinar. A question
and answer session included Senior Services sta
,
RN-BC
, Nurse
educator;
, Coordinator of Dementia Responsive
Care; and
,
MSN, GNP
.
,
RN, CCRN
, Educator for Cardiovascular ICU and Recovery
Unit, spoke at the National Teaching Institute and Critical Care Exposition in
Washington, DC, May15-20, as an expert in glycemic control.
,
MSN, ANP, Senior Services
;
MD
; ,
MD
; and ,
MSN, FNP, of Four Seasons
, collaborated with
,
MD, MHS
; ,
MSPH
; ,
MBA, MPH
;
; ,
MD
, and ,
MD
,
all of Duke University Cancer Center, to co-author “Establishing a Regional,
Multisite Database for Quality Improvement and Service Planning in
Community-Based Palliative Care and Hospice” published in the Vol. 13, # 8
issue of the Journal of Palliative Medicine.
,
BSN, RN, MBA, HN-BC, HTCP, HTI
; Holistic Nurse Specialist,
spoke at the MAHEC Annual Premature Conference on “Circle of Caring:
NICU Sta.”
,
RN,
RACE Coordinator and Director of Cardiac
Emergencies, presented information about therapeutic hypothermia at the NC
Organization of Nurse Leaders (NCONL) District One quarterly meeting on
July 30 at Pardee Hospital in Hendersonville. He also spoke about “Minutes
Matter,” an initiative in Western NC to teach members of the community the
signs and symptoms of stroke and compression/hands-only CPR.
Publications, Conference Attendance and Presentations
Knowledge, Innovations & Improvment - 27
,
RN
, RACE Coordinator and Director of
Cardiac Emergencies, appeared in Mission Hospital TV spotlights reporting
the improved patient outcomes using therapeutic hypothermia for cardiac
arrest. He also spoke on the same topic on September 14 at the NC Nurses
Association Mountain Region meeting at Haywood Regional Medical Center.
,
MSN, RN-BC
, presented her research poster “Blended
vs. Lecture Learning: Outcomes for Sta Development” at the Southern
Nursing Research Society Conference in Austin,TX, February 3-6.
,
MSN, RN-BC
, Nursing Education Specialist II in NPER,
presented a one-hour Webinar to 70 nurses across the US on September
29. Her topic, “Using a Blended Learning Approach to Teach Critical Care
Pharmacology,” was oered by Mosby’s eLearning and Elsevier, a global
publishing leader in healthcare information.
,
RN, BSN, IBCLC
, Lactation Center Coordinator, WNC
Breastfeeding Center, and
,
RN
, Mother/Baby, presented
“Our Journey to Baby Friendly” to the South Carolina Breastfeeding
Coalition on August 25 in Columbia.
,
MS, RN, CNS for Pediatrics
; ,
MSN, RN
, Neonatal
CNS;
, MSN, RN, IBCLC
, CNS for Neonatal ICU and Mother/
Baby; and
,
BSN, RN
, Nurse Educator I for Pediatrics,The
poster “NICU/Pediatric Collaboration Standardizes Syringe Medication/
Flush to Improve Quality, Consistency” by was presented in Atlanta, GA,
March 9-11, at the Annual Forum for Improving Children’s Healthcare and
Childhood Obesity Congress.
,
MS, RN, CNS for Pediatrics;
, BSN, RN,
Nurse
Educator I for Pediatrics;
, MSN, RNC,
Neonatal CNS,
NPER; and
, MSN, RN, IBCLC,
CNS for Neonatal ICU and
Mother/Baby, presented their poster “Pediatric Neonatal Collaboration for
Medication Safety” at the Vermont Oxford NICQ Annual Meeting in Austin,
TX, April 29-May 2.
,
RN, MSN, CCRN-CMCCSC, CPAN
, CNS for Research, published
“Incidences of Arrhythmias in ASA I Patients in Phase I PACU” in the
October issue of the Journal of PeriAnesthesia Nurses.
,
MSN, RN, NE-BC,VP and CNO,
was pictured and quoted
in the October 18 issue of ADVANCE for Nurses, Southeastern States. She
commented about nursing professional development initiatives at Mission.
Our hospital was among four top ranking hospitals out of 445 across the
Southeast in the 2010 Readers’ Choice Survey. Hospitals were chosen based
on excellence in quality of care: organizational culture; communication;
professional development, and retention eorts.
,
RN, ONC
, Manager of Orthopedics, presented her poster
“The Inuence of Peripheral Nerve Blocks in Total Knee Postoperative Care”
at the 2010 National Association of Orthopedic Nurses Congress in May.
,
RN
, and
RN
, both of 9 North Step
Down received funding from the Mission Healthcare Foundation to attend
CURRENTS: 27th Annual Critical Care and Emergency Conference in
Hilton Head, SC, August 5-8.
,
BSN, RNC,
of Nursing Practice, Education, and
Support, and three nurses from Renal Medicine,
RN
;
,
RN
, and ,
RN
, attended the Fall meeting of the
American Nephrology Nurses Association (ANNA) in Las Vegas October
8-11.
,
RN, MSN, NEA-BC, AHN-BC
, Director of Integrative
Healthcare;
,
BSN, RN, MBA
, HN-BC, HTCP, HTI;
,
BSN, RN
, HN-BC, HTCP; and ,
PhD, ThD, BSN,
HN-BC,
presented “Stepping Stones: Achieving an Integrative Healthcare Framework
“ at the American Holistic National Association annual conference in
Boulder, Colorado, June 3.
,
RN, MSN, NEA-BC, AHN-BC
, Director of Integrative
Healthcare;
,
BSN, RN, MBA
, HN-BC, HTCP, HTI; and
,
BSN, RN
, HN-BC, HTCP, presented “Creating an
Environment for Healing Touch in the Hospital Setting” at the Healing
Touch Worldwide Program in Denver on August 7.
,
RN, MSN, NEA-BC, AHN-BC
, Director of Integrative
Healthcare, presented “Tools for Stress Resilience” at the Women’s Health
Conference at MAHEC on November 12.
,
BSN, RN, MHA,
Orthopedic Program Coordinator,
presented her poster “Implementing a Geriatric Hip Fracture Program” at
the National Association of Orthopedic Nurses conference in Seattle, May
15-20.
Mission Nurses attended the NC Organization of Nurse Leaders
(NCONL) state meeting and conference May 20-21 in Charlotte:
,
BSN, RN, NUS
on Trauma Care; ,
BSN, RN
,
Manager of Trauma Care;
,
BSN, RN,
NUS on Trauma
Care;
,
BSN, RN
, NUS, Nursing Support Services;
,
MHS, RN
, Director of Nursing Support Services;
,
RN
, NUS on Trauma Care; ,
MPH, BSN, RN, CCRN
,
Manager of CVICU/RU and CVPC;
,
BSN, RN
, NPER; and
,
BSN, RN
, Manager of 9 Stepdown.
, Pet Therapy coordinator; , Director of
Grant Development with Mission Healthcare Foundation; and
,
RN, MSN, NEA-BC, AHN-BC
, Director of Integrative Healthcare,
presented “Bark, Wag and Love,” nursing research on Pet Therapy and
the therapeutic eects of Pet Therapy, at the American Holistic National
Association annual conference in Boulder, Colorado, June 3.
,
BSN, CNRN, RN
, Stroke Program Coordinator, attended
the nursing symposium at the International Stroke Conference held in San
Antonio in February.
,
BSN, CNRN, RN
, Stroke Program coordinator, and
,
NP
, for Mission Neurology, presented a three-hour nursing
education class, “Acute Stroke: Assessment and Management,” on April 28th
to 25 RNs at McDowell Hospital. This class was one step in the process
of McDowell Hospital’s achieving a Stroke Treatment Capable Hospital
designation from the NC Oce of EMS.
Thanks to the generous support of the Mission Healthcare Foundation, eight
direct care nurses attended the Magnet ® Conference in Phoenix October
13- 15. Five nurse leaders accompanied the group to the gathering of over
6,000 nurses from across the US and 15 foreign countries. Those attending
were:
,
BSN, RN, CCE
, IBCLC, Prenatal Education/
Breast Feeding Center;
,
RN
, 6 North; ,
RN
, Copestone; ,
BSN, RN
, Mission Children’s
Specialists;
,
BSN, RN
, Trauma Care;
,
BSN, RN
, Operating Room; ,
BSN, RN
,
Neurosciences;
,
BSN, RN
, Chest Pain Observation
Unit; VP and CNO
,
MSN, RN, NE-BC
;
, PhD, RN, NEA-BC
, Director of NPER; ,
MSN, RN
,
Manager of Professional Nursing Practice;
,
BSN,
RN, OCN
, Manager of Oncology; and ,
BSN, RN
, Nursing
Documentation Coordinator.
Publications, Conference Attendance and Presentations
28 - Mission Nursing Annual Report
NURSING
EXCELLENCE
Pain Target Project
A new bull’s eye pain
management tool was
developed on the Women’s
Surgical Unit to make sure
that pain control is optimal
on the post-surgery oor
and on discharge home. Four
nurses comprising the Pain
Project Team spent more
than 400 hours learning
Lean Six Sigma methodology
and working on the pain
control project.
The team consisted of
Melissa Wilson, BSN, RN,
CMSRN, Nursing Educator
I of Nursing Practice,
Education, and Research;
Melanie Norman, BSN,
RN, MBA, Manager of
Performance Improvement;
Tracy Hannah, RN, NUS
and Nancy Mastrantonio,
RN, NUS. The team also involved sta nurses on the unit. All were supported by
sponsors Kathleen Guyette, MSN, RN, NE-BC, Vice President and Chief Nursing
Ocer; Kellett Letson, MD, Service Line Leader, and Brenda Smith, BSN, RN,
NE-BC, Manager of Women’s Surgical Unit.
The nine-month project was implemented at the end of August 2010. Process
changes include the following:
• Pain is considered a fth vital sign and is documented along with every
check of blood pressure, heart rate, respiratory rate, and temperature.
• A large laminated bull’s eye target hangs on the wall in every room as a
constant reminder of each patient’s stated pain target score for comfort.
• The bull’s eye sign lists methods of comfort that may be used instead of
or to compliment pain medications: ice, heat, re-positioning, relaxation
techniques, or aromatherapy from Integrative Healthcare.
• Reminder signs to document pain levels are posted on all computer
monitors on the unit.
Improved outcomes were immediate and signicant. One month after project
implementation, there was a 50 percent decrease in the percentage of patients who
reported on discharge that their actual pain was higher than the goal they had set.
The simple changes prompted increased involvement of the patient in her daily plan
of care and better pain control, which facilitates mobility and healing.
of Patients and Families
Many patients and their family members are touched by
the quality care and comfort they receive from Mission
nurses and other sta. Here are several comments
showing their gratitude.
“The way the nurses and sta on these two units [Medical/
Surgical ICU and Pulmonary Stepdown] performed their
duties was above reproach. Their professionalism, compassion,
understanding, and devotion to duty are commendable. They
treated my entire family with the utmost respect in our time of
need.”
“Mission was good to our family! It is my belief that [the sta]
have assisted in giving your hospital system the good reputation
that Mission has. Based on the care that we received, I would
certainly recommend Mission Heart Services to anyone.”
“I hope to convey my family’s sincere appreciation to the many
employees that went out of their way to ensure my wife had the
best care possible. From the time we arrived, the entire emergency
room sta acted with such professionalism and wasted no time
assessing her condition, calling Code Stroke, and getting her the
necessary emergency care that was needed. Every sta member
from environmental services to the chief neurologist treated us
with respect, dignity, and exceptional professionalism.”
“My wife and I want to commend your sta for the superb care
and attention given to a friend of ours visiting from England,
who was a patient in the ICU and Trauma Care units. I recently
retired as a Professor in the Medical School at Ohio University,
and the caring attention [our friend] received during her stay at
Mission was something we always tried to instill in our students.
[Our friend] had nothing but praise for your hospital and the
excellent care provided.”
“The attitude from all persons encountered during this visit
was welcoming, pleasant, extremely competent and professional.
The extra eort taken to ensure that I felt like I was important
and listened to was evident. The care taken so that I understood
procedures and follow-up requirements was appreciated.”
“From the nursing sta to the aides, medical people and
housekeeping, your sta were superb. I am still amazed at the
dedication of all your sta.”
“The nurses on the fourth oor were nothing short of marvelous
and exceptional. The attention and the care they provided was
fantastic.”
Melissa Wilson, BSN, RN, CMSRN, (left) talks with Nancy
Mastrantonio, RN, NUS, (right) about the bull’s eye pain target
as she prepares to record the patient’s desired level of comfort. The pain
target signs are also written in Spanish.
Program in Labor and Delivery
Thanks to the initiative of direct-care nurse Christine Conrad, BSN, RNC-OB, pregnant survivors of sexual abuse now participate in a plan of care
aimed at reducing stress and emotional trauma during labor and delivery at Mission Hospital. A dedicated phone
line on the Labor and Delivery (L&D) unit, information in prenatal education booklets, and yers and business
cards in the bathrooms of physicians’ oces allow survivors to privately contact a nurse.
Begun in April 2010, the Survivor Services Program has expanded to include ve RNs who assist with plans of care:
L&D nurses Christine Conrad, Katie Conklin, Erin Kimmel, Barb Allen, who speaks Spanish, and former
L&D RN, Micki Kidd, Women’s Operating Room, who serves as a resource for a planned Cesarean section.
An individualized plan of care developed by the client and the nurse is sent to the obstetrician and placed on the
patient chart, as directions for all sta involved with the birth process. The plan of care fosters an environment
where the survivor feels respected, heard, and in control.
Five survivors have beneted from the program, three of whom delivered at Mission. Additionally, a Survivors
Services Resource Nurse program is in the nal stages of development. Facilitated by the support of L&D Manager
Melinda Bryant, BSN, RN, the program is expected to grow, as pregnant survivors across Western NC nd out
about the service.
BSN, RNC-OB
30 - Mission Nursing Annual Report
Prevention
The Falls Advisory Team chaired by Cathy Hebert,
RN, GCNS-BC, Geriatric Clinical Nurse Specialist
of Nursing Practice, Education, and Research,
supports the system goal of reducing patient harm.
The team consists of a representative from each
nursing unit or system department.
The falls representatives ensure that their unit’s falls
are analyzed for trends and provide regular feedback
and education to their colleagues. Representatives
attend monthly meetings where they collaborate on
system initiatives in falls reduction. The team has
made a dierence by:
• revising the patient risk assessment,
• creating an interdisciplinary plan of care,
• introducing new equipment, and
• reviewing patient falls for trends then
intervening appropriately, such as
identifying the risk of falling from specialty
beds.
Falls prevention is an increasing challenge in acute
care, as the patient mix becomes older with more
complex chronic and acute illnesses. The patient
falls rate varied during FY 2010 with a consistently
declining rate during the last quarter (see graph).
The focus of Mission nurses is not only the
reduction of the falls rate but the injury rate as well.
A goal of reducing patient injuries by 20 percent
was achieved in 2010. Nurses helped meet that
goal by close attention to best practices, including
purposeful rounding; use of bed and chair alarms;
and individualized patient risk assessment with
interventions.
Prevention
Skin integrity is important in the health of all
patients. The clinical skills of direct care nurses and
consultations with Wound Ostomy Nurses (WON)
play major roles in the prevention and treatment
of skin break-down. Skin assessments are done by
direct care nurses on admission and every shift
throughout the patient’s hospital stay. If a patient’s
Braden Risk Assessment Scale is less than or equal
to 18, nursing sta implement the prevention
protocol. These measures are taken to:
• reduce pressure;
• reduce shear, friction, and skin tears;
• control moisture and incontinence; and
• moisturize skin.
Pressure ulcer data is collected throughout
the hospital on designated dates to determine
prevalence and incidence, according to the National
Database for Nursing Quality Indicators (NDNQI)
guidelines. During the calendar year of 2010, the
percentage rate of patients with hospital acquired
pressure ulcers decreased with a nal quarter rate of
1.7 percent (see graph).
OCT NOV DEC JAN FEB MAR APRMAY JUNE JULY AUG
SEP
0
1
2
3
4
5
3.66
3.43
2.76
3.96
3.77
3.16
4.30
2.50
4.13
3.66
3.44
3.29
1
2
3
4
5
1st Quarter
2010
2nd Quarter
2010
3rd Quarter
2010
4th Quarte
r
2010
4.05
3.17
1.4
1.7
Empirical Outcomes - 31
Family-centered rounds on Pediatrics 3G allow parents/caregivers to participate in the care of their
children.
Grey Tilden, MD, Family Medicine Resident
Bethany Lynch, mother
Kathryn Cziraky, MD, Family Medicine Resident
Laura Baskervill, RN, Pediatrics
Ansley Miller, MD, Pediatrics
Brayden Lynch, infant
Eric Smith, MD, Family Medicine Resident
Identication, Prevention, and Treatment Project
A multi-disciplinary task force, developed in 2007 to research
and address delirium at Mission Hospital, continued in 2010
after successful implementation on two pilot units. The
performance improvement project was designed to reduce
incidence of hospital-acquired delirium, improve recognition
and diagnosis of delirium, and apply eective treatment using
nationally recognized evidence-based best practices.
Improved nursing and medical practice guidelines, order sets,
and preventative interventions used on the initial pilot units,
Orthopedics and 6 North, resulted in decreased incidence
of delirium, length of stay, and direct costs to the units. In
2010, 8 North was added as the third pilot unit. Two more
units, 9 North Stepdown and 7 North, will be added in 2011
with hospital-wide implementation in the fall. Partnerships
throughout the Mission Health System are planned for 2012.
Various aspects of the project include the following:
• An active electronic report for “At-Risk Elders” prints
on pilot units and has hospital-wide capability.
• Order sets, such as Acute Geriatric Delirium,
Geriatric Pain, and PRN Elder medication orders with
embedding of Geriatric Nursing Care Guidelines, are
reviewed for ecacy and usability.
• An electronic version of the Confusion Assessment
Method (CAM) was developed and is currently used on
pilot units.
• A work team is designing a new Iview-compatible and
scalable observation screening tool to replace CAM.
• Classroom education on all pilot units is required. Re-
assessment and revision of this education model is a
priority in moving toward hospital implementation.
• Development of an electronic audit tool is in progress.
• The goal is rapid, ecient and consistent data gathering
and analysis to measure outcomes and assess the
eectiveness of interventions and education.
Members of the Delirium Identication, Prevention and
Treatment Project are:
• Champion: Dr. Christina McQuiston, Medical
Director of Senior Services
• Team Leaders and members: Betsey Bent, Director
Senior Services; Maria Hines, RN-BC, Nurse
Educator, Senior Services; Nancy Smith-Hunnicutt,
Coordinator Dementia Responsive Care; Cathy
Hebert, RN, GCNS-BC, Geriatric Clinical Nurse
Specialist, NPER; and Marc White, Performance
Improvement.
• Many ad-hoc members who apply their expertise within
smaller focused work groups.
on Pediatrics
Commitment and participation
from sta are required in the
patient-and family-centered
morning rounds implemented
on Pediatrics 3G. Pre-rounding
briengs are held and include
physicians, the nursing unit
supervisor, social workers, and a
Child Life team member. Other
elements include respect and
dignity; information sharing; and collaboration.
The Pediatric nurses are vital in teaching patients and families how to be
full members of the team. Patients and family members who may be used to
being passive recipients of care have to become familiar with the concepts
of information sharing, collaboration, respect and dignity.
Benets of having the patient, family and health care team working toward
mutually set goals include
• decreasing repetitive, ineective or counterproductive activities,
and
• improving understanding, satisfaction and safety.
One mother agreed that the team approach is of value to the family and
patient. Bethany Lynch participated in the family-centered rounds during
her son Brayden’s hospital stay. She commented, “It works out very well to
be able to ask questions and get dierent opinions. I think it’s great.”
“It works out very
well to be able to ask
questions and get
dierent opinions. I
think it’s great.”
32 - Mission Nursing Annual Report
Editor
BSN, RN
Nursing Documentation Coordinator,
Nursing Practice, Education & Research
Cherry[email protected]
828.213.1863
Consultants and Reviewers
PhD, RN, NEA-BC
Director,
Nursing Practice, Education, and Research (NPER)
MSN, RN, NEA-BC
Manager, Professional Nursing Practice, NPER
AA, BS
Scope Editor, Community Relations
Education Coordinator
Nursing Practice, Education, and Research
Contributors
RN, GCNS-BC
Geriatric Clinical Nurse Specialist, NPER
, MSN, RN-BC
Education Specialist II, NPER
MS, RN, CPN
CNS for Pediatrics, NPER
RN, MHA, MSOM, OCN
Administrative Director Cancer & Infusion Services
RN, MSN, NEA-BC, AHN-BC
Director of Integrative Healthcare
MBA, MHA, RN, CCRC, CCRP
Manager Clinical Trials, Research Institute
RN-BC
Senior Services
RN, BSN, MBA
Manager, Performance Improvement
BSN, CNRN
Stroke Program Coordinator
Photos
AA, BS
Scope Editor, Community Relations
BSN, RN
Nursing Documentation Coordinator, NPER
Abernethy, Dr. Amy P ......................
27
Adams, Jan ......................................
3
Adams, Laurann ..............................
26
Adams, Mary Lou ........................
3, 14
Adams, Paula ..................................
11
Adamson, Patricia .......................
3, 26
Adcock, Kelly ...................................
12
Adcock, Stacey ................................
3
Alagna, Frank ...................................
3
Allen, Barb .......................................
30
Allen, Dr. Bill ....................................
27
Allen, Crystal ...................................
24
Allen, Cynthia ..................................
10
Allen, Diane ......................................
9
Alosky, Rachel ............................
10, 26
Alspach, Tish ...............................
3, 17
Alvaro, Andrea ..................................
3
Ammons, Nancy ..............................
20
Anderson, Kimmie ...........................
16
Anderson, Linda .....................
3, 12, 26
Anderson, Rhonda...........................
24
Andrews, Julie .................................
13
Angel, Leigh .................
2, 3, 9, 13, 16, 28
Annico, Vicki .....................................
3
Anthes, Denise ......................
14, 27, 28
Apple, Lacie .....................................
12
Aria, Frank .......................................
10
Arledge, Jenny .............................
3, 12
Arnold, Vicki ........................
3, 8, 12, 26
Ashe, Brandi ....................................
10
Asplund, Brenda ..............................
26
Astin, Wade .....................................
13
Austin, Ti ..........................................
28
Avery, Kathey ...................................
11
Ayers, Linda ......................................
3
Babaoff, Courtney ...........................
28
Bagwell, Heidi ..................................
12
Bailey, Karen ................................
3, 12
Baldwin, Jessica ..............................
12
Balerno, Lora ...................................
11
Ball, Laura .......................................
10
Ballard, Autumn ...............................
11
Ballard, Carla ...............................
8, 10
Ballard, Melissa ...............................
26
Balmer, Aubrey ................................
12
Balsinger, Kathi ................................
27
Banks, Amanda ...............................
13
Banks, Angelisa ...............................
10
Banner, Kelli .....................................
28
Barkei, Sandra .................................
28
Barnes, Tina .........
3, 8, 10, 12 ,14, 28, 33
Barnwell, Renee ..........................
3, 13
Barrett, Morgan ......................
3, 13, 16
Bartlett, Melissa ...............................
10
Baskervill, Laura .........................
24, 32
Battle, Carlton ..................................
6
Beachem, Laura ..............................
24
Beane, Shawn .................................
10
Beck, Barina .....................................
8
Beckham, Linda ..............................
24
Beddingeld, Mary Jane..................
12
Beeks, Andrea ..................................
6
Bell, Julie ..................
8, 16, 18, 22, 28, 33
Bemis, Rachel .................................
10
Bender, Kim .....................................
13
Benedict, Katherine ..........................
3
Bensinger, John ................................
3
Bent, Betsey ................................
3, 32
Benton, Cindy ..................................
28
Berry, Dr. Bertice .........................
9, 13
Bianchini, Karen ..............................
10
Biddix, Velda ....................................
24
Billings, Corrianne ...........................
16
Bjorlie, Shelby..................................
10
Blair, Karen .......................................
3
Blake, Cynthia .................................
11
Blankenship, Andrea .......................
11
Blankenship, Paula ..........................
26
Bollinger, Jeanie ................
3, 13, 23, 24
Bollinger, Stephanie .........................
27
Bollo, Margaret ................................
10
Boone, Lisa ..............................
3, 7, 16
Borne, Kimberly ...............................
10
Borowski, Donna ..............................
3
Bowers, Kelly ...................................
13
Bowlin, Barbara ................................
3
Boyd-Jones, Evadora .................
13, 26
Bradburn, Susan ........................
10, 26
Bradt, Mary ......................................
10
Brandon, Jonathan ........................
3, 9
Bravo, Fonda ....................................
8
Brewer, Rachel ................................
12
Brinkley, Danette .............................
26
Britt, Christi.............................
3, 10, 11
Brooks, Joy ...........................
12, 17, 24
Delk, Kim .........................................
18
Deloache, Barbara ............................
7
Dennis, Valerie .................................
10
Derrick, Kristina ...............................
10
Desrochers, Amy .............................
10
DeVoe, Rebecca ...............................
8
Diez, Karen ......................................
10
Disbrow, Joanne ............................
3, 9
Donnelly, Carole ..............................
33
Dotger, Ashley .................................
10
Dotson, Brandy ...............................
10
Downes, Mary E. ..............................
8
Downs, Laurie ......................
2, 4, 16, 23
Duffy, Diane .....................................
24
Dunn, Terry ......................................
11
Ebert, Denise ...............................
3, 12
Edwards, Lisa ...................................
3
Edwards, Susan ...............................
3
Edwards, Tatyana ............................
10
Eier, Alicia ............................
12, 13, 24
Eighmey, Katrina ..............................
28
Eller, Anna ........................................
12
Emmert, Katy ...................................
24
Ensley, Alison...............................
8, 24
Erb, Elizabeth ..................................
13
Erickson, Bill ....................................
12
Erickson, Kristine ..............................
8
Escobar, Beatriz ...............................
3
Estes, Carey ...........................
2, 10, 27
Evanoff, Rose ..................................
10
Evans, Brent ....................................
12
Evans, Moyra ....................................
9
Everling, Misty ..................................
9
Farmer, Luci ......................................
3
Faunce, Andrea ...............................
12
Fell, Dr. Dale ................................
6, 27
Ferguson, Ellen .................................
9
Ferguson-Reilly, Rachel ...................
12
Ferrigno, Carla .................................
12
Ferrigno, Susanne ............................
8
Ferris, Dr. Julian ...............................
26
Fielder, Janie ............................
3, 6, 26
Fisher, Amy ......................................
18
Fisher, Jessica ..................................
7
Fisher, Sally .....................................
10
Fisher, Velinda ..................................
6
Flowers, Libby ..................................
9
Fluharty, Amie ..................................
10
Forbes, Jennifer ..........................
22, 24
Ford, Ann .........................................
10
Ford, Chris ..................................
12, 14
Foster, Christine ..............................
10
Fox, Cindy ........................................
7
Fox, Elaine ........................................
8
Fox, Heather .....................................
3
Fox, Virginia .....................................
22
Fraga, Dawn ....................................
26
Francis, Cathryn ..............................
10
Franke, Elaine ...................................
9
Fredrickson, Jane ........................
8, 10
Fricks, Patricia .................................
26
Frohmut, Hans ..................................
8
Froncek, Pam ................................
2, 3
Fugate, Victoria ........................
3, 8, 27
Fuller, Linda ......................................
7
Funderud, Susan .............................
10
Futch, Beverly...................................
3
Futch, John ......................................
3
Gaffney, Cynthia ..............................
10
Gambrell, Dianne ....................
3, 24, 26
Ganatra, Meera ...........................
11, 24
Garcia, Ralph ....................................
6
Gardella, Tiffany...............................
23
Garrett, Celena .................................
8
Garrett, Jessica ................................
8
Gblokpor, Agvessi ...........................
27
Genito-Tamaray, Kathleen ...............
24
Gibbs, Bryanna ....................
3, 8, 16, 24
Gibson, Cathy ..................................
22
Gibson, Cheryl ....................................
......................2, 6, 8, 10, 11, 12, 14, 16, 19, 33
Gier, Kathy ..............................
3, 27, 28
Gill, Kassie .......................................
12
Gilliam, Kim ......................................
6
Gilliland, Makeca ..............................
6
Gladin, Jason ..................................
12
Glenn, Tarik .......................................
6
Gleydura, Deborah ...........................
8
Godfrey, Joyce .................................
3
Godfrey, Lynn .............................
11, 16
Godfrey, Stephanie ......................
3, 28
Good, Amy ......................................
10
Goodwin, Melanie............................
16
Gordon, Gail ................................
6, 18
Governo, Scott ................................
13
Brooks, Katie ...................................
11
Brooks, Katrina ................................
10
Brown, Allison ..................................
18
Brown, Chris ....................................
26
Brown, Darlene .................................
9
Brown, Elizabeth.........................
12, 13
Brown, Janice ...................................
8
Brown, Sandra ..................................
7
Bruckner, Danielle .............................
7
Bryant, Dorothy ...............................
10
Bryant, Melinda .................
3, 10, 27, 30
Bryson, Kathy ..................................
13
Buchanan, Sommer .........................
10
Buckner, Katrina ..............................
12
Buckner, Larry ............................
26, 27
Buckner, Susan ...............................
10
Bugg, Linda ................................
12, 23
Bull, Dr. Janet ..................................
27
Burchett, Millie ..................................
3
Burgess, Kellie .................................
18
Burrell, Angela .............................
8, 10
Burts, Jennifer ........................
8, 10, 11
Butler, Mary ......................................
7
Byas, Shae Lynn ..........................
8, 16
Cadwell, Susan .................................
8
Cagle, Sandy ...................................
12
Canter, Brenda ................................
10
Capps, Stephanie .............................
3
Caraker, Judy ..................................
10
Cardwell, Jamie ..........................
12, 26
Carlson, Debra ...........................
24, 27
Carpenter, Alesia .............................
27
Carpenter, Renee ..............................
3
Carson, Mary Sue ..............
3, 12, 16, 27
Carson, Mildred ................................
6
Carter, Candace ...............................
8
Carter, Fran ......................................
20
Carter, Michael .................................
6
Carter, Nicole ...............................
7, 26
Carter, Stacie ...................................
12
Carver, Athena .................................
24
Case, June ......................................
24
Case, Sandra ....................................
3
Castelblanco, Frank .......
3, 6, 13, 27, 28
Cate, Julian ......................................
18
Cathey, Mary ...................................
24
Chandler, Pam ............................
13, 22
Chappell, Karen ...............................
10
Cheatham, Katie ..............
3, 8, 9, 10, 16
Chromey, Michelle ............................
3
Clark Jr, Cecil ..................................
10
Clark, Lisa ........................................
11
Clark, Lisa P. ....................................
12
Clark, Melanie T. .........................
12, 13
Clement, June .................................
16
Clement, Zachary ...................
3, 13, 16
Clifton, Joy ..................................
3, 10
Coleman, Darren .........................
6, 24
Condra, Dr. Kelly..............................
16
Conklin, Katie ..................................
30
Conner, Amanda ..............................
12
Conner, Shawn ................................
12
Connor, Michael ...............................
3
Conrad, Christine ...................
7, 24, 30
Cook, Donna ...................................
10
Cooper, Amy ....................................
10
Cooper, Autumn ...............................
3
Cooper, Christi .................................
12
Corn, Jeffery ....................................
12
Costello, Linda.................................
27
Council, Leslie ..................................
6
Crabb, Toni .............................
9, 12, 16
Craig, Cara .......................................
9
Crawford, Linda ...............................
13
Crowe, Edna ..................................
7, 9
Crump, Georgia ................................
7
Crumpton, Courtney ........................
18
Cuento, Claudine ....................
8, 10, 26
Curry, Hope .....................................
13
Curry, Jody ......................................
10
Cutler, Jacqueline ............................
10
Cziraky, Dr. Kathryn .........................
32
Daley, Kathy ...................
8, 10, 14, 26, 28
Dalton, Rebecca ..............................
10
Danks, Scott ................................
3, 10
Davi, Tiffany .....................................
10
Davidson, Jermaine .........................
10
Davis, Amber ...................................
12
Davis, Deborah .................................
3
Davis, Debra ....................................
12
Davis, Diane .....................
10, 12, 22, 24
Davis, Lee ........................................
10
Deck, Michele ..............................
8, 22
DeGrave, James .........................
10, 24
Deitz, Lora .................
2, 3, 12 ,13, 22, 28
Graham, Catherine ..........................
10
Green, Cynthia ................................
10
Green, Gregory .................................
3
Green, Sandra ..................................
6
Greene, Dawn .........................
3, 23, 27
Greene, Jennifer ...............................
3
Grey, Danny ......................................
8
Grey, Paula .......................................
8
Grindstaff Jr., John ...........................
3
Grogan, Karen .................................
33
Gruber, Dennis ..................................
9
Guffey, Caycee ................................
12
Gulledge, Valerie ..............................
10
Guthrie, Becky ..................................
3
Guyette, Kathleen ...............................
............................. iii, 2, 7, 8, 13, 18, 27, 28, 30
Guzik, Debbie ...................................
8
Hales, Amy .......................................
8
Hallstrom, Gina .......................
7, 12, 13
Hamizidis, Christina .........................
16
Hamlett, Katie ..................................
10
Hampton, Lynne .....................
8, 26, 33
Haney, Thania ...................................
8
Hannah, Tracy ............................
27, 30
Hanson, Dr. Laura ............................
27
Hardin, Pam .....................................
28
Harker, Matthew ..............................
27
Harmon, Mary .............................
3, 6, 8
Harn, Ashley ....................................
10
Harris, Craig ........................
2, 7, 14, 28
Harrison, William ..............................
3
Hart, Dr. Andrew ..............................
26
Hartwick, Mary Etta .........................
11
Hartzog, April ..............................
10, 12
Harvey, Kelly .....................................
3
Hayes, Dorothee ..............................
11
Hayes, Priscilla ................................
10
Heatherly, Joan ................................
16
Hebert, Cathy ..
7, 9, 22, 23, 27, 31, 32, 33
Hefner, Kathy ...............
3, 6, 8, 11, 12, 26
Hefner, Patrick .............................
8, 12
Hefner, Trivia ....................................
12
Hemstreet, Linda ...........................
3, 6
Henderson, Carrie Ann ....................
12
Henderson, Judy ..............................
3
Henderson, Dr. Shaw.......................
26
Hennessy, Maridaun ....................
3, 12
Hensley, Debra .................................
8
Hensley, Kristi ...................................
3
Hensley, Linda .............................
7, 17
Hensley, Penny ................................
20
Henson, Lisa .....................................
8
Hickey, Patrick ..................................
3
Higdon, Angie ..................................
10
Hill, Doy ...........................................
10
Hill, Martha ..................................
3, 27
Hillman, Joyce .................................
14
Hines, Maria ...........
12, 16, 23, 27, 32, 33
Hinson, Patricia ................................
3
Hinson, Sarah ..................................
13
Hipps, Lou .......................................
25
Holguin, Amy ...................................
10
Holler, Laura ....................................
13
Holmes, Maggie .........................
11, 16
Hopkins, George .............................
10
Hopps, Beverly ................................
10
Hoskyns, Martha .............................
16
Houck, Jessica ...........................
12, 25
Houtman, Jackie ...........................
3, 4
Hovey, Janice ..................................
23
Howell, Jill .......................................
22
Howie, Margaret ..............................
10
Hudson, Derek .................................
26
Huffer, Gena .....................................
3
Huffstedtler, Pansie .........................
10
Hulihan, Deidre ................................
27
Humble, Jim ....................................
26
Humes, Dana ...................................
12
Hunnicutt, Andrea ...........................
27
Hunt, Laurel .....................................
28
Hyman, Amber ................................
18
Iannetta, Alice ..................................
10
Inman, Stacy ....................................
3
Jackson, Carol ................
2, 3, 12, 16, 28
Jackson, Melba ...............................
12
Jackson, Thelma ...........................
7, 9
James, Cherie .................................
10
Jenkins, April ...................................
12
Jenne, Anne ......................................
3
Jones, Angela ...................................
6
Jones, Felichia .................................
10
Jones, Gina .....................................
10
Jones, Jill ..................................
3, 8, 26
Jones, Robin ..................
3, 9, 13, 28, 33
Jones, Susan ...............................
3, 10
Joslin, Dr. Scott ...............................
26
Joyce, Karen ....................................
18
Justice, Beth ....................................
25
Karl, George .....................................
2
Kaylor, Jennifer ................................
25
Keel, Dr. James ...............................
27
Kelley, Kathy ....................................
12
Kelly, Tricia .......................................
16
Kenyon, Nikki ..................................
11
Kerley, Jennifer ...........................
12, 16
Kidd, Micki .......................................
30
Killian, Karen ....................................
10
Kimmel, Erin ....................................
30
Kindell, Julia .....................................
7
King, Adam .................................
10, 14
King, Sherry ...................................
3, 8
Kirby, Patricia ..................................
10
Kirkman, Deborah ..................
3, 12, 13
Kittrell, Selena...................................
3
Krance, Lauren ................................
16
Krause, Chryste ................................
3
Laird, Marsha .........................
11, 13, 14
Landreth, Crela ................................
10
Langford, Jackie ..............................
11
Lawing, Deborah .............................
10
Leake, Kathleen ........
3, 10, 12, 13, 23, 28
Lebed, Nataliya.................................
7
Lecroy, Dr. Michael ..........................
26
Ledford, Cherie ................................
12
Lee, Joe .........................................
2, 3
Lee, Marianne ..................................
11
Lefebvre, Sarah ...........................
7, 10
Letson, Dr. Kellett .......................
27, 30
Letterman, Crystal ...........................
12
Lewis, Daniel ....................................
7
Lewis, Debbie ..................................
16
Liberatos, John ................................
25
Lilly, Susan ........................................
8
Lingerfelt, Donna ....................
3, 18, 25
Linquist, Cheryl .................................
3
Lisenbee, Joni ...................
3, 18, 22, 28
Logan-Thompson, Carol ............
11, 25
Long, Rachel ..........................
3, 16, 26
Lorenz, Lourdes .........
3, 8, 11, 14, 28, 33
Lowrance, Jon .................................
10
Lucey, Mary .....................................
13
Lukacena, Thresa ........................
8, 16
Lyda, Anita .......................................
16
Lynch, Bethany ................................
32
Lynch, Brayden ...............................
32
Mace Mease, Tonya ........................
10
Maher, Jason ..............................
12, 13
Mahowald, Emily .............................
13
Manfred, Karen ................................
12
Mangusan, Ralph .......................
12, 13
Marsh, Barb ................................
10, 14
Martin, Brian ....................................
12
Martin, Erika ....................................
10
Martin, Heather ................................
12
Martin, Jessica ................................
10
Martin, Mary ....................................
10
Mashewske, Tammy .........................
8
Mashni, Sam .....................................
3
Mason, Tori .......................................
3
Massey, Barbara ...............................
3
Mastrantonio, Nancy .............
12, 27, 30
Matthews, Sunny .............................
11
McCall, Glenda .........................
3, 9, 12
McCall, Kristina .....................
12, 22, 28
McCall, Melissa Rogers ...................
12
McCall, Nancy ............................
10, 13
McCall, Sallie ...............................
6, 26
McClure, Celeste ..............................
7
McCormack, Holly ............................
3
McCraw, Deanna .........................
3, 28
McCurry, Barbara ............................
12
McDonough-Leota, Molly ................
13
McElreath, Katherine .......................
25
McElroy, Barb ..............................
8, 17
McGinnis, Harriet ..............................
3
McJunkin, Cindy .....................
6, 18, 25
McKee, Ruth ....................................
26
McKemie, Katie ...............................
13
McKendrick, Jan .............................
27
McLean, Laurie ............................
3, 10
McManus, Sue .................................
3
McMullen, Angela ............................
12
McNeil, Linda ..................................
10
McQuiston, Dr. Christina ............
16, 32
Melton, Nellie ....................................
7
Messer, April ...............................
12, 13
Messino, Mickee .............................
18
Metcalf, Ashley ............................
3, 12
Michel, Lisa ......................................
3
Middleton, Kent ................................
8
Miller, Dr. Ansley ..............................
32
Miller, Christina ............................
3, 10
Miller, Deandra .................................
12
Mills, Brett .......................................
13
Mills, Sabrina ...................................
12
Mims, Dr. Susan ...............................
3
Mires, Brenda ..................................
11
Mitchell, Jerri ....................................
3
Mitchell, Susan ................................
25
Mohammed, Faisal ......................
8, 12
Mohammed, Sarah ...........................
8
Moore, Barbara ................................
3
Moore, Gina ................................
10, 12
Moore, Julia ......................................
3
Moore, Kelli .....................................
27
Moore, Michelle .................
8, 10, 14, 25
Mordenti, Elaine ...............................
10
Moretz, Darby ..............................
3, 11
Morgan, Keva ..................................
10
Morgan, Laurie ................................
26
Morris, Cheryl .............................
18, 22
Morris, Dr. John ...............................
27
Moseman, Karen ........................
13, 28
Moss, Roger ....................................
10
Moss, Virginia ..................................
10
Mullins, Star ......................................
7
Murphy, Betsy .................................
27
Myer, Deb ........................................
25
Myers III, William .............................
10
Nanney, Tracy ..................................
26
Neelands, Laura ...............................
7
Neimer, Donna .................................
26
Nerona, Aileen ..................................
8
Neuhauser, Dawn ..............
4, 12, 13, 28
Newton, Ben ....................................
11
Noel, Dr. Margaret ............................
7
Nolan, Elena ....................................
10
Noland, Robin ..............................
9, 12
Norman, Melanie ...........
3, 10, 27, 30, 33
Norman, Sheri .................................
16
Norris, Carole ...................................
3
Novotny, Betsy .................................
3
Nugent, Rikki ...................................
27
Odom, Cherry ......
8, 10, 12, 13, 14, 28, 33
Odom, Susan ...................................
3
Oliver, Bonnie ..................................
22
Oliver, Vickie ....................................
10
O’Neil, Linda ....................................
25
Orozco, Teresa.................................
12
Parker, Carol ................................
6, 10
Parr, April .........................................
16
Parsons, Karen ...........................
12, 13
Patterson, Tracie..............................
16
Paulson, Arne ..................................
10
Payne, Aneta ....................................
3
Payne, Gwen ...................................
12
Peek, Donna ...............................
10, 26
Penland, Angela ..............................
12
Pennell, Lannie ................................
11
Petty, Tamara .................................
6, 7
Phelps, Dr. Regina ..
2, 3, 8, 10, 22, 28, 33
Phillips, Jerri .....................................
3
Phillips, Kelly ...............................
3, 12
Pike, Susan ..................................
3, 28
Pinkerton, Kim .................................
25
Plemmons, Sheila ............................
10
Poling, Kathy ....................................
3
Pomerantzeff, Irisha.........................
13
Pomeroy, Virginia ..............................
8
Ponder, Kathey .................................
3
Pope, Alissa .....................................
10
Popp, Jacqueline .............................
10
Porche, Melisa ...............................
8, 9
Poss, Linda ......................................
11
Postlewaite, Cheryl ..........................
25
Pugh, Melanie ...................
11, 12, 13, 25
Pulsifer, Valerie ............................
3, 13
Putnam, Sonja ..................................
3
Queen, Terri ...................................
3, 8
Quinn, Brandi ...................................
3
Rabideau, Jill ..............................
12, 22
Radcliff, Sheila .............................
3, 13
Radford, Barb .................
7, 8, 10, 12, 14
Rafferty, Aubrie ................................
11
Rambo, Sarah ..................................
8
Ramirez, Anne ..................
10, 16, 27, 28
Randolph, Karen ...............................
9
Ratzlaff, Kitty ..............................
10, 25
Raviotta, Ginny ..........
2, 8, 10, 14, 18, 27
Ray, Janet ...................................
10, 26
Rayeld, Jan .....................................
3
Redmon, Crystal ...............................
8
Reed, Nathan ..................................
12
Reik-Johnson, Kim .................
2, 10, 18
Repasy, Rachel ................................
12
Retamal, Jennifer.............................
10
Retskin, Cathy .......................
12, 16, 25
Rhodes, Alicia ...................................
7
Rhodes, Lori .....................................
3
Rice, Karen .......................................
3
Rice, Rosemary ...............................
25
Richard, Mary ...........................
2, 3, 14
Riddle, Megan .................................
10
Riddle, Sandra ..................................
7
Rider, Carlton ....................................
2
Riportella, Christine .........................
25
Roark, Michelle .................................
8
Robbins, Fred ..................................
20
Roberts, Doug .................................
26
Roberts, Erin ....................................
27
Roberts, Jennifer .............................
10
Robertson, Deborah ...............
3, 12, 13
Robinson, Creola .............................
12
Robinson, Lawrence .........................
6
Robinson, Rhonda ............................
2
Robinson, Scott ...............................
10
Robinson, Wendy ............................
10
Rockstroh, Colleen ..........................
25
Rodemaker, Linda ...........................
18
Rogers, Dorothy ..............................
10
Rogers, Halley .................................
13
Rogers, Jon .....................................
12
Rolls, Maxine ...................................
12
Roloff, Maria .....................................
6
Roper, Cheryl ...................................
16
Roten, Kimberly ...............................
23
Rouse, Julie ......................................
3
Rubenstein, Parmjit ..........................
3
Ruccio, Ashley ..................................
7
Rule, Lee .........................................
13
Rushlow, Andrea .............................
13
Rutkowski, Nancy ............................
10
Ryan, Patrick ..................
2, 3, 10, 18, 27
Sanchez, Veronica ............................
6
Sartor, Veronica ................................
6
Savage, Ruth Ann ............................
10
Sawyer, Barb ...................................
25
Scarboro, Terrie ...............................
11
Scarbrough, Lynn ........................
6, 11
Schafer, Julia (Watts) .......................
25
Scharett, April ...................................
3
Schiffman, Ted ..................................
3
Schleider, Darlene........................
8, 22
Schmidlin, Steven ............................
10
Schmidt, Jackie ...............................
12
Schroder, Tonja .........
8, 13, 16, 18, 22, 28
Schryer, Lori ....................................
28
Scobie, Clare ....................................
6
Scruggs, Martha ..............................
28
Seaver, Teri ......................................
20
Setzer, Michelle ...............................
10
Severson, Joel .................................
20
Sheeler, Jeanne ...............................
28
Shell, Leslie ...........................
10, 11, 26
Shelton, Julie ...................................
10
Shelton, Kim ....................................
12
Sheppard, Janet ..............................
12
Sherman, Heidi .......
12, 14, 16, 22, 26, 28
Sherman, John ................................
13
Shetley, Martha .......................
3, 11, 26
Shillinglaw, Dr. William .....................
27
Shipman, Julia .................................
10
Short, Susan .....................................
6
Silver, Dorothy .................................
10
Silver, Leah ....................................
8, 9
Simmons, Blair ................................
18
Sims, Rachel ....................................
3
Simuel, Gloria ..................................
12
Sinclair, Karen ..................................
12
Small, Cora .............................
3, 11, 26
Smart, C J .......................................
22
Smith, Amanda .................................
8
Smith, Betsy ....................................
25
Smith, Brenda
3, 6, 8, 11, 16, 18, 22, 27, 30
Smith, Burdine ..................................
6
Smith, Carlin ................................
9, 12
Smith, Dr. Eric ..................................
32
Smith, Jeremy .................................
10
Smith, Kathy ...........................
3, 13, 28
Smith, Linda Y.................
6, 7, 13, 16, 28
Smith, Mark ......................................
3
Smith, Martha ..............................
3, 28
Smith, Mary Katherine .....................
10
Smith, Terrie ....................................
27
Smith-Hunnicutt, Nancy ........
23, 27, 32
Sommer, Brenda ..............................
10
Spaeth, Cynthia ...............................
25
Spittle, Stephanie ........................
3, 12
Sprague, Leslee ...............................
10
Sprinkle, Wilma ................................
10
Spry, Patricia ...................................
10
Stark, Kyong ................................
3, 10
Stegall, David ...................................
3
Steinke, Jeffery ................................
12
Steinke, Mark ..................................
10
Stephens, Gail .................................
22
Sterckx, Fabienne ............................
10
Stewart, Amy ....................................
8
Stewart, Jo .......................................
3
Stewart, Kristy ..................................
3
Stines, Elina ......................................
7
Strout, Steve ................................
7, 12
Swagart, Patricia .............................
13
Swingle, Kim .....................................
7
Taylor, Chris .....................................
23
Taylor Jr, Dewey ..............................
10
Teague, Mary ............................
3, 9, 28
Telford, David ....................................
6
Thomas, Julie ..................................
10
Thomason, Rebekah ........................
7
Thompson, Kelsey ...........................
12
Thorpe, Edith ....................................
7
Thorpe, Mae .....................................
9
Thurston, Heather ............................
12
Tilden, Dr. Grey ................................
32
Tipton, Shannon ..............................
12
Tison, Clay .......................................
10
Tison, Kelly ......................................
27
Tobin, Kate .......................................
8
Tompkins, Kathryn ............................
3
Tomsky, Nan .....................................
3
Travis, Lucille ...................................
22
Treadaway, Ann Marie .....................
28
Trebilcock, Beth ................................
8
Trevino, Carleen ...............................
28
Trimby, Gary ....................................
11
Turvin, Kari .......................................
12
Vassey, Joan ....................................
11
Vendely, Lyne ....................................
9
Vieira, Stewart ..................................
7
Vincent, Susan ...........................
12, 13
Vyvyan, Aaron ...................................
8
Ward, Karen .....................................
13
Wascoe, Dawn.................................
10
Wax, Rachael ....................................
8
Waycaster Jr, Charles ......................
10
Wealsh, Linda ...................................
7
Webb, Fern ......................................
13
Webb, Lori ........................................
3
Weeks, Stephen ..............................
10
Wells, Nicole ....................................
11
West, Janet ......................................
12
West, Vickie .........................
3, 9, 12, 22
Wheeler, Jane ..................................
27
Whitaker, Stephanie..........................
3
White, Delena ...................................
7
White, Marc .....................................
32
White, Martha ...................................
7
Whitlatch, Victoria ...........................
10
Whitson, Brandy ...............................
9
Whitt, Susan .....................................
3
Wiedenhaupt, Bonita ...................
6, 18
Wilcocks, Lisa..................................
13
Wilcox, Carl .....................................
10
Wilkinson, Jenny .........................
3, 25
Williams, Andi .........................
8, 14, 27
Williams, Kitty .............................
12, 13
Williams, Lisa ..............................
16, 28
Willmott, Sarah ................................
28
Wilson, Angela D .............................
25
Wilson, Carriedelle...........................
12
Wilson, Melissa ......................
13, 27, 30
Wilson, Sharon ................................
26
Wing, Kristina ...................................
3
Wirman, Nancy-Jo .........................
3, 8
Wolf, Heather ...................................
12
Woodard, Gina.................................
13
Woody, Anja ......................................
3
Woody, Beth .....................................
8
Wooten, Monica .........................
12, 13
Worley, Cheryl ..................................
10
Wortham, Diana .............................
4, 8
Wortman, Penelope .....................
3, 16
Wright, Amorita .................................
7
Wright, Connie .................................
26
Wright, Kathy .....................
3, 10, 11, 12
Wyatt, Susan ...................................
33
Wyndham, Todd ..............................
10
Yacopino, Mary ...........................
10, 11
Yarboro, Kat .....................................
28
Yaver, Jodi .......................................
18
Zafar, Dr. S. Yousuf ..........................
27
Ziegler, Winnie ..................................
3
509 Biltmore Avenue, Asheville, NC 28801
www.missionhospitals.org
