Patient Resources

Structural Empowerment

Clinical nurses in all settings across campus have a voice within the UT Southwestern shared governance organizational structure, which is built on a solid foundation of teamwork and collaboration. Shared decision-making and accountability empower nurses with a process for determining professional nursing practice. These organizational standards are developed through staff-led interdisciplinary committees, task forces, and councils to improve patient outcomes and experiences. Nurses at all levels take conscious ownership of patient care, safety, ethics, research, performance improvement, and evidence-based practice. Our shared governance structure supports the practicing nurse as a key decision-maker with a credible, sought-after perspective. This model strengthens practice by supporting relationships and partnerships among clinical areas, providing an innovative and collaborative environment to bolster our quality patient outcomes.

Shared governance structure

UTSW Shared Governance Structure

UTSW has a strong shared governance structure that includes all staff from all areas and disciplines, as reflected in the following diagram.

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UT Southwestern nurses validate their mastery of skills, knowledge, and abilities through certification and meet ongoing learning and practice requirements through recertification. The certification process ensures patients and their families that the nurse caring for them has demonstrated experience, knowledge, and skill in the complex specialty of their care. Nurse certification and continuing education contribute to an environment of professionalism and a culture of retention. Certification also differentiates UT Southwestern from other health care organizations, demonstrating to consumers that we have attracted the most skilled and experienced nursing professionals.

Educational Levels

UT Southwestern strives to be a leader among academic medical centers. Our Nurse Executive Cabinet, made up of the CNE, CNO, and ACNO, is ultimately responsible for initiating programs that support nurses in all roles in obtaining higher degrees and nurses in direct patient care in attaining an 80% B.S.N. rate, along with master's and doctoral degrees for nurse leaders. As illustrated in the graph, we have steadily maintained this objective:

Clinical Ladder

UT Southwestern’s Clinical Ladder process promotes clinical growth, professional growth, and development; addresses recruitment and retention; and encourages and rewards nurses in direct patient care and nonadministrative roles.

“Recognition, reward, and retention of the experienced nurse in positions of direct clinical practice – along with the documentation and adequate description of their practice – are the first steps in improving the quality of patient care.” (Patricia Benner, M.S., RN, “From Novice to Expert.” The American Journal of Nursing, 82(3), 1982, p. 407.)

APP Clinical Ladder

The Advanced Practice Provider Clinical Ladder (APPCL) is a 12-month program that encourages advanced practice registered nurses (APRNs) to enhance their clinical and professional skillsets, which in turn advances their professional trajectory. The AAPCL comprises four tiers, each with specific requirements incorporating Clinical Service, Professional, Educational, and Research Expectations.

The APRN starts the clinical ladder journey by submitting a Letter of Intent and completing an application, which includes the project the APRN proposes. The APPCL Committee reviews these materials for approval. Thus far, clinical ladder projects have included research studies, quality improvement projects, podium presentations, publications, and journal club participation. While these projects enhance the participants’ professional growth, they also align with UTSW’s mission and vision of providing world-class patient care.

Throughout the years, the APPCL Committee and the Office of Advanced Practice Providers have strived for continual improvement of the Clinical Ladder program. As a result, there have been enhancements of a streamlined data management system, simplification of the application process, improvement in communication of program requirements, and increased efficiencies in the review process.

As the Office of Advanced Practice Providers continues to grow and the APRN workforce continues to flourish, the APPCL has seen a significant increase in program participation. The total number of projects has increased from 50 projects in 2018 to 96 projects in 2020.

Clinical Education & Professional Practice (CEPP) Outcomes for 2020

Education Efforts, Initiatives Ramp Up Throughout 2020

Clinical education at UT Southwestern includes teams from both hospital Clinical Education and Professional Practice (CEPP) and Ambulatory Clinical Education and Professional Development (ACEPD). Both teams have experienced tremendous growth throughout 2020, providing educational support and onboarding to all they serve. In response to the pandemic and limited onsite gatherings, the teams completely reimagined the delivery of the new-employee orientation and onboarding programs. Together, they successfully oriented/onboarded more than 1,500 new UT Southwestern employees, while also providing emergent, pandemic-specific education in unit/clinic training sessions on personal protective equipment and other topics.

In 2020, the CEPP team welcomed new managers – Shinto Thomas, M.S.N., RN, PCCN-K; Nargis Ali, M.S.N., RN, NPE-C; and Mandi Longoria, B.S.N., RNC-OB (pictured, left to right) – growing the team’s leadership foundation to facilitate focused support of both organization-wide and unit-specific educational initiatives. CEPP also fully implemented the unit-based educator (UBE) role in 2020, adding 20 nurses with unit-specific expertise to the team. Throughout the year’s many challenges, CEPP not only sustained current programming but continued to meet the needs for ongoing programming. The team’s highlights for 2020 include:

  • Welcoming more than 200 nurse residents, nurse fellows, and PCT residents, the largest cohorts ever
  • Entering an exciting partnership with Dallas College’s Department of Labor Apprenticeship grant, facilitating the expansion of the PCT residency to a full year and offering additional workforce development opportunities for these new PCTs just starting their health care career journey
  • Delivering PPE refresher courses and COVID-19 training to more than 2,000 hospital staff in three months

Meanwhile in 2020, the ACEPD team doubled in size, due primarily to the enormous amount of growth in the ambulatory clinical setting. With this growth, several new programs rolled out during the year or are in development. The team’s highlights for 2020 include:

  • Expanding the Resuscitation Quality Improvement (RQI) program to three outpatient locations in July, with 508 participants; this program will continue to grow to other outpatient locations throughout 2021
  • Launching the Telephone Triage Education program: Telephone Triage Clinical Nurse Educator Amber Hearron, B.S.N., RN, developed an in-depth, comprehensive onboarding program for triage nurses to support this primary role of the ambulatory nurse. The program provides at-the-elbow training and support for new UT Southwestern triage nurses and will continue to expand over the next several years.
  • Developing and implementing COVID-19 support initiatives, including:
    • Supporting drive-thru testing
    • Supporting the Occupational Health Clinic by delivering care to UT Southwestern staff
    • Supporting UT Southwestern’s vaccination efforts across multiple vaccine sites by providing vaccination administration refresher education, communicating and managing schedules at each of the sites, and contributing operational support to ensure UTSW staff and patients experienced the high-quality care expected from UT Southwestern Medical Center

An Empowered Workforce

Patient Care Techs Improve Teamwork in Zale 5

Zale 5 Unit-Based Council (UBC) Chair Casey Syma, B.S.N., RN, and UBC members consisting of unit staff in a variety of roles led a collaborative effort with the unit’s patient care technicians (PCTs) to determine a plan to provide timely patient care and improve teamwork. A plan was suggested by PCT Taryn Collins to create a buddy system for the PCTs. Under the plan, the PCTs would designate an hour block during their shift to provide care (such as patient showers) and work together to provide coverage for the needs of each “buddy’s” patients. In addition, during the buddy system coverage, if the responding PCT needed support, patient calls would be rerouted to the primary nurse or charge nurse. The UBC reviewed and approved the initiative, and the new process was implemented in August 2020 with great success. The daily assignments and “PCT buddies” are now identified in the staff lounge prior to the beginning of each shift. To ensure the initiative continues to be successful, the Zale 5 staff meets monthly to discuss progress and areas of opportunity for further collaboration.

NSICU Implements Creative, High-Quality Training Simulations

New and reinforced education is typically presented to nurses through modules, check-offs, routine classes, or unit champions who are expected to teach their counterparts. Nurses are, by and large, in favor of such continuing education, but receiving it before or after a 12-hour shift, or on their day off, negatively impacts work-life balance. Fortunately, there are other ways to provide this needed training, and they don’t require a full day or expensive equipment to produce. Two ways we’ve found involve having high-quality simulations for neuroscience nurses. The Neuroscience Intensive Care Unit (NSICU) implemented educational escape rooms and in-hospital mock stroke codes (IHMSCs) to help facilitate learning. These activities, outlined below, were designed to provide not only new learning methods and structures for presenting information to bedside staff in a fun, engaging way but to build trust, mutual respect, and communication and teamwork skills in the process.

Escape Room

The NSICU unit-based council (UBC) organized an "Escape Room Committee.” Escape rooms and their puzzles integrate concepts learned through motivational team-building exercises. The team-based educational initiative was designed to have a one-hour time limit. Each task in the escape room was based on unit-specific educational needs ranging from acute stroke assessment to External Ventricular Drain (EVD) management. The escape room was created in an empty NSICU room with a mannequin and NSICU-specific instrumentation. In order to “escape,” team members had to work together and demonstrate knowledge related to common neurologic topics. On average, the teams completed their “escape” in approximately 39.5 minutes.

In-Hospital Mock Stroke Codes (IHMSCs)

IHMSCs were developed to target specific clinical educational needs. Traditional mock stroke codes require only minimal effort or verbal responses and minimize staff participation. For the NSICU IHMSCs, a Plan-Do-Study-Act tool was used to facilitate improvement and optimize buy-in. Based on identified elements, mock scenarios were created to ensure all areas of the hospital impacted by stroke codes were included. This involved mock stroke codes on multiple floors to capture the learning needs of bedside staff in different departments at Zale Lipshy Pavilion.

To maximize the potential for improvement, the IHMSC learning platform involved an actor-patient being in a bed on either a ward or intensive care unit. The nurse was aware of the actor-patient’s admission and history but unaware of the actor-patient’s new neurological deficits. The nurse participants were expected to respond and initiate a stroke code. With that done, staff then followed the actor-patient throughout the hospital, including imaging and radiology intervention when it was called for. After the mock stroke codes, a debriefing was conducted involving the multiple Zale units affected by the scenario. The information obtained resulted in the development of tools to help improve standards of care, such as a stroke badge buddy and a stroke code metrics binder and checklist for the stroke code team leader.