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.
Clinical nurses 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.
UTSW has a strong shared governance structure that includes all staff from all areas and disciplines, as reflected in the following diagram.
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 assures 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. By the end of FY 2021, UTSW employed 2,025 specialty certified nurses.
A significant body of research indicates that a more highly educated nursing workforce can help ensure the U.S. population has access to high-quality, patient-centered care. The Institute of Medicine (IOM) recommends having at least 80% of nurses holding a bachelor’s degree or higher. The UT Southwestern Nurse Executive Cabinet has been working to increase reimbursements for nurses pursuing higher degrees in order to encourage their educational efforts while still working. The UTSW Nurse Executive Board is ultimately responsible for putting in place programs and policies regarding obtaining higher education for nurses in all areas. As illustrated in the graph on the right, our program has steadily maintained the objective of having at least 80% of our nurses holding a B.S.N., at a minimum.
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.)
The UTSW Clinical Ladder is open to all clinical nurses involved in direct patient care.
Clinical Education and Professional Practice and the Department of Ambulatory Clinical Education and Professional Development both support nursing and therapy staff members across Inpatient and Ambulatory Areas, advancing the philosophy, mission, and vision of UTSW Nursing Services. In 2021 a group of dedicated educators committed to excellence in education, put into place the Nursing Professional Development Practice Model (ANPD, 2016) to leverage learning to meet and exceed organizational outcomes.
UT Southwestern Nursing Professional Development (NPD) practitioners are master’s-degree-level prepared in Nursing Education and require NPD certification within 18 months of hire. The NPD practitioners operationalize environmental scanning, proactively plan educational programming, and work collaboratively with both unit-based educators and clinical educators on both education teams to meet the learning needs at the individual, unit, and organization level. Unit-based Educators and Ambulatory Clinical Educators, are minimal of baccalaureate prepared registered nurses with clinical expertise specific to the units and clinics they support.
In 2021 UTSW successfully reaccredited as a Provider of Nursing Continuing Professional Development (NCPD) by the American Nurses Credentialing Center’s (ANCC) Commission on Accreditation. Through CY 2020 and 2021, more than 240 NCPD activities were offered to more than 3,500 registered nurses and over 400 health care providers. Activity highlights included Nursing Grand Rounds, Ethics in Science and Medicine Grand Rounds, Celebration of Excellence, Rapid Improvement Event (RIE) Training, and Year of the Nurse.
Aspire to Achieve seminars support nurse leadership training focusing on the needs of the clinical leader at both bedside and in the clinic. All current nurse coordinators, assistant nurse managers, nurse managers, and nurse directors attend this educational series, led by the Advisory Board and Organizational Development and Training, alongside nurse leaders.
NCharge classes supported charge nurse training focused on fundamentals of the charge nurse role, supervisory skills, and leading change for more than 400 front-line nursing leaders.
In 2021, the education teams facilitated more than 66,000 online lesson completions in over 600 unique courses for clinical staff in both the hospital and ambulatory settings. Top courses included Crash Cart Updates, COVID Training for RNs, RN Onboarding, Central Line Dressings, COVID Medication and Vaccine Safety, and Essentials of Critical Care Orientation for Nurse Residents/RN Fellows.
Nursing student placements exceeded 700 from nine affiliated Schools of Nursing, with 20 summer externs.
The UT Southwestern Resuscitation Department is an authorized American Heart Association training center providing Heartsaver, BLS, and ACLS courses to UT Southwestern employees and students. In 2021, we expanded to our off-site clinic and additional locations so clinical staff across the UTSW system were able to participate in the RQI program. The added locations included the Aston building, the Radiation Oncology Building, and Professional Office Buildings 1 and 2. The program now serves more than 4,000 staff members with hands-on skills training each quarter within their clinical area, along with on-site classroom BLS, ACLS, and Heartsaver courses serving more than 1,000 additional staff.
The Neonatal Resuscitation Program transitioned from using the 7th edition of NRP modules via the health stream platform to the 8th edition via RQI platform. The deadline for completing all 7th edition activities was Dec. 31, 2021. Starting Jan. 1, 2022, 8th edition NRP materials were required for use though RQI. There were a total of 15 NRP classes in 2021 with 115 participants including five residents.
CEPP continues to lead three practice transition programs. The UTSW Nurse Residency Program is accredited by the American Nurses Credentialing Center (ANCC) Practice Transition Program. In 2021, our program introduced an ambulatory track. In addition, our Patient Care Technician (PCT) Residency program is a partnership with Dallas College under the “You’re Hired” grant from the U.S. Department of Labor to expand apprenticeship programs. Throughout 2021, more than 300 nurses and PCTs were hired into the practice transition programs, including:
The Medical Intensive Care Unit (MICU) on the 8 Blue area of UTSW is enriched with stories of leadership, empowerment, innovation, and improvements. In the past year and more, nurses have led through a period of great resignations in the MICU, and the continuing COVID pandemic has challenged the team daily. CLABSIs (central line-acquired blood stream infections) became an increasing challenge in the MICU, which effectively functioned as the COVID Special Pathogens ICU. The infection rate increased from two CLABSI occurrences in 2019 to 14 CLABSI occurrences in 2020. The increase in morbidity and extended length of stay of COVID patients added to our increased numbers; almost every COVID patient had to have a central line due to the need for vasopressor administration.
Daily M.D.s, APPs, pharmacists, and members of the Apheresis Department and MICU staff acted as one heroic and cohesive team to bring about the best possible outcomes for each COVID patient. Throughout the year, CLABSI Committee representative Daniel Luterman, B.S.N., RN, CCRN; Manager Blair Lane, B.S.N., RN, CCRN; UBE Kathy McGraw, B.S.N., RN; Zech Thompson, M.S.N., RN; and Joy Kissee, M.S.N., RN, tirelessly audited central lines and brought the issues to management. In addition to re-education on central line care practices, nursing staff who were involved in direct patient care were called to brainstorm root causes and possible solutions.
New central line dressing change kits were introduced. CLABSI debriefs continued. Patient care technicians (PCTs) were involved to witness and assist nursing staff with central line dressing changes. Ms. McGraw led an investigational survey on nursing practices related to central line and line care. A new and comprehensive central line-related two-hour mandatory training addressing the existing gaps took place. Currently, the charge nurse visualizes central line dressings every shift and audits the necessity of the procedure. The nurse advocates the change from central line to a PICC line if central vein access continues to be needed; meanwhile, nursing staff will attempt to get blood cultures by peripheral sticks. There is a blood culture draw checklist present in every patient room. As a result of these efforts, the care team achieved zero CLABSIs for 100 consecutive days.
The care team led by nurses on 6 Green saw an opportunity to improve the number of patient falls related to three identified repetitive causes: orthostatic hypotension, a form of low blood pressure that occurs when standing up from a sitting or lying position; vagal response, which occurs when the vagal nerve is stimulated, leading to dizziness, nausea, and imbalance; or an incorrect score on the Hester Davis Fall Risk assessment. In addition to educational reviews and equipment assessments to resolve each issue, audits and new measures were implemented.
Three new interventions were implemented. The first of these was establishment of a No Pass Zone, requiring all staff to respond to bed alarms, regardless of the primary staff assigned to the patient. Secondly, the Hustler Award was created to recognize staff members who “hustle” to the bed alarms the fastest and follow the Hester Davis protocols. Thirdly was the escalation process for noncompliant patients: When a patient was unwilling to cooperate with fall precautions, the primary registered nurse and patient care technician would first try to educate the patient about fall precautions, then notify the medical doctor and charge nurse, and then the ANM, manager, and house operations if needed. This process allowed the care team to establish that each member of the team was on the same page and could form an action plan for patient safety. In addition, the repetition of patient education regarding fall prevention by different care team members would, by design, increase awareness and prevent incidents.
The yearly employee flu vaccine campaign always demands interprofessional collaboration, and this year presented new challenges with the approval of COVID-19 vaccine boosters for health care workers occurring around the same time. The departments of Occupational Health, Ambulatory Nursing, and Ambulatory Special Pathogens collaborated on planning the employee flu efforts in a way that optimized staffing resources across these priority areas and provided opportunities for UTSW faculty, staff, and learners to receive both the annual flu vaccine and their COVID-19 booster.
The intended goal of the yearly employee flu vaccine campaign is to provide an opportunity for UTSW staff, faculty, and learners to receive their flu shot in a convenient location to be compliant with the UTSW flu vaccine policy. Planning began in 2020 to ensure vaccines were pre-booked to secure the massive order of doses. For the first time, UTSW’s Pharmacy Services collaborated with all three teams to ensure on-schedule distribution across clinics and sites both on and off campus.
This year’s flu campaign introduced a central website for all content related to influenza and flu vaccines. A team from the Department of Communications, Marketing, and Public Affairs was assembled to coordinate and create marketing materials, including focused flu video content such as addressing common flu vaccine myths. As the time to launch approached, the Ambulatory Special Pathogens team ensured staffing resources were optimally equipped and deployed to provide both employee and patient flu and COVID-19 vaccines at multiple sites across campus. Employees could receive both the flu and COVID third-dose vaccines at the Education Center on the second floor of Clements University Hospital, among other sites. The initiative resulted in providing 10,143 flu shots to UTSW faculty and staff.
In preparation for the possibility of a nursing and physician shortage, the Office of Advanced Practice Providers (OAPP) collaborated with UTSW physician leadership to develop an APP Critical Care Fellowship. The goal of the fellowship is to educate, mentor, and develop APPs to train to the top of their scope of practice in areas such as the Medical Intensive Care Unit, the Cardiovascular Care Unit, the Surgical Intensive Care Unit, and the Neuroscience Critical Care Unit.
Highly functioning APPs from each of the ICUs were selected to create the APP Core Team who would then partner with physician faculty to create a robust, in-depth experience in and knowledge of evidence-based critical care units.
The yearlong program consists of didactic learning sessions taught by APPs, physicians, physical therapists, nutritionists, and pharmacists, and these sessions are augmented by clinical rotations with clear clinical goals. Examples of these experiences include performing critical care procedures such as lumbar puncture, thoracentesis, paracentesis, thoracotomy, and endotracheal intubation, among many others. Each clinical rotation is preceded by a didactic component specific to the patient population in that particular critical care area. A total of 146 applications were submitted, but only 76 of these (55 NPs and 21 PAs) met all the necessary requirements. Reviewers narrowed the field of applicants down to 18, nine of which were interviewed. Two fellows were chosen from those finalists. The inaugural fellowship class included a UTSW RN who had recently graduated from her APRN program.