Patient Resources

Exemplary Professional Practice

Exemplifying the true essence of the Magnet model, UT Southwestern provides nurses with an environment that fosters excellence through continual learning and the development of transformational leaders. As an organization that values, recognizes, and encourages continuing education and professional certifications, UT Southwestern is dedicated to using these vital components to build our nurses' professional development and practice. As a leading academic medical center, we support our nurses in pushing past the status quo to create a new level of excellence. We continue to shine within our community, state, and nation by maintaining interdisciplinary relationships, professional autonomy, and resource-rich facilities and by having nurses serve as teachers and professional models of care.

Nursing Professional Practice Model at UTSW

Nurses at UT Southwestern provide the highest-quality patient care through the application of relationship-based care, which focuses on what matters most: caring and healing relationships at the point of care. Compassion, knowledge, and evidence-based care formulate the foundation for excellence and make a profound difference in the patient’s ability to recover and heal. The UT Southwestern Nursing Professional Practice Model is based on the belief that patients and families are at the center of everything we do and are our partners in care. Patients and families are honored as individuals and cared for with dignity and respect.

Our model provides a framework for achieving excellent clinical outcomes by allowing nurses to practice professionally. Through this framework, we put our vision into action. The model guides our decisions, supports the delivery of professional nursing care and quality outcomes, ensures consistency in nursing practice, and promotes a healthy environment for the delivery of care. The nurse-patient relationship is strengthened through a focus on continuity of care and interdisciplinary collaboration. Nurses at UT Southwestern are empowered through a shared governance structure to make decisions while building professional accountability. Nurses have a strong voice on issues impacting nurses. Our practice environment values, encourages, recognizes, and rewards innovation, creativity, and scholarly pursuit to improve patient care.

Nurse Satisfaction Survey

Research literature shows there is a vital connection between nursing satisfaction and optimal patient outcomes. When nurses find fulfillment in their work, they have higher levels of engagement and lower levels of turnover, and both organizational and patient outcomes are improved.

As a Magnet organization, UTSW strives to be above the benchmark in all areas of performance, including nurse satisfaction. The most recent standardized nurse satisfaction survey was conducted in 2021. Looking forward, the Glint RN satisfaction survey is set to be administered again to UTSW nurses in 2024.

In 2023, all nurses were invited to participate in the Values in Practice (VIP) engagement survey as UTSW employees. Overall, 77% of nurses responded to the survey which is an all-time high for UTSW and significantly above the benchmark for academic medical centers.

Community Involvement and Outreach

One of the most rewarding ways UT Southwestern nurses share their experience with the community is by sharing their skills, knowledge, and time as volunteers. From formal volunteer programs to impromptu acts of service, our nurses make a difference in the health and well-being of their local communities while also bettering themselves as nurses by offering their services and lending a hand. UT Southwestern encourages nurses to participate in many ways and through many local entities, putting their expertise into action and developing professionally through community involvement.

2023 Flu Campaign Improved Offerings

Since joining Ambulatory Operations at UTSW in 2021, Alison Isabelle, M.S., B.S.N., RN, Manager of Clinical Operations, has been involved in coordinating the annual Ambulatory Flu Campaign. The campaign typically offers patients four flu shot kiosks as well as drive-thru options. While efforts in previous years offered a convenient way for many patients to receive their annual flu vaccine, Isabelle identified a gap in the services offered to the more vulnerable patients who were seeking vaccination.

According to the CDC, “People 65 years and older are at higher risk of developing serious complications from flu compared with young, healthy adults.” Due to their increased risk, a higher dose or adjuvanted flu vaccine is the best source of protection for this population. Because UTSW previously offered only the regular flu vaccine, many older adult patients decided either to cancel their appointment or receive a vaccine that did not provide the optimal defense against the flu virus.

In line with CDC guidelines, UT Southwestern in 2023 began administering higher-dose or adjuvanted flu vaccines to individuals age 65 and older due to their increased susceptibility to severe flu-related complications compared to younger, healthier adults. This initiative underscored UTSW’s commitment to exemplary professional practices.

The campaign’s primary objective was to ensure the highest-quality care for all patients by providing both regular and adjuvanted flu vaccines at UTSW’s flu kiosks and drive-thru locations. Prior to the beginning of the 2023 flu season (in August), Rebecca Tutt, B.S.N., RN-BC, Director of Nursing, ordered the adjuvanted flu vaccine for the Ambulatory Float Pool to administer. Isabelle then collaborated with the Caitlin Ornelas, RN, Float Pool Nurse Supervisor, to develop safeguards to prevent medication errors associated with this additional vaccine offering. In collaboration with Kyle Gabriel from the EMR team, the Immunization Clinic workflow was revised to ensure manual vaccine selection. In September, UTSW patient flu kiosks and drive-thrus began offering both adjuvanted and regular dose vaccines and continued until the campaign's closure in mid-November.

As of Nov. 1, the campaign had successfully administered 2,139 adjuvanted vaccines to individuals age 65 and older. This initiative has established a standard to maintain for future flu seasons. Campaign staff at UTSW’s various flu shot locations received positive feedback from patients expressly because of the adjuvanted vaccination option.

  • Kyle Gabriel, EMR Business Analyst Supervisor
  • Alison Isabelle, M.S., B.S.N., RN, Manager of Clinical Operations
  • Allece Merchant, M.B.A., B.S.N., RN, NE-BC, Director of Ambulatory Clinical Initiatives
  • Caitlin Ornelas, B.S.N., RN, Nurse Supervisor
  • Rebecca Tutt, B.S.N., RN-BC, Director of Nursing

Geriatric Certification

Within the past three years, the Emergency Department (ED) at Clements University Hospital has grown exponentially. Patient visits to the ED have increased across the board, and because approximately 30% of those visits are now from geriatric patients, the ED needed to enhance its services to improve the care of older adults. Stakeholders included a team of nurses, physicians, and ancillary leaders who were deeply passionate about improving geriatric care in the ED.

The goal was to achieve a Level 1 Geriatric Emergency Department Accreditation (GEDA) – something no other ED in Texas has yet done.

The accreditation process required fulfillment of approximately two dozen requirements and best practices related to providing quality care for geriatric patients, including enhanced staffing and education, implementation of geriatric-focused policies and procedures, continuous quality improvement, outcome measures, and ensuring the continuity of care for older adults. The interdisciplinary team used a collaborative approach, involving coordinated care and expertise among nursing, emergency medicine, care coordination, pharmacy, therapy, and operation stakeholders. Interventions associated with the GEDA application included increased RN education in areas such as abuse and neglect, increased screenings for patients with delirium and cognitive impairment, heightened fall prevention measures, and standardized assessments for function/functional decline with geriatric patients. Quality improvement was tracked and trended to ensure geriatric care focused on acute needs and other concerns that could lead to an increased risk for hospitalization.

The outcome of the work resulted in the ED at UTSW becoming the first accredited Level 1 Geriatric Emergency Department in Texas.

  • Bryan Brown, RN
  • Thomas Dalton, M.D.
  • Rachel Delevett, M.B.A., CCLS
  • Deborah Diercks, M.D.
  • Rachel Faidley, M.S.N., RN, CEN
  • Richard Fernandez, M.S.N., RN
  • Donna Fletcher, B.S.H.A.
  • Lindsay Jacobs, Pharm.D., M.P.H., BCCCP
  • Mike Mayo, M.S.N., RN, CCRN
  • Samuel McDonald, M.D.
  • Carl Piel, M.D.
  • Matthew Sherman, M.D.
  • Ieva Skauge, B.S.N., RN, CEN
  • Rob Turer, M.D.
  • Homer Walag, PT, D.P.T.
  • Byron Westbrook, M.H.A., LSSGB

APP Navigator Program

In 2020, the Advanced Practice Provider Engagement Committee was formed by the Office of Advanced Practice Providers (OAPP) to further invest in the engagement and belonging of advanced practice registered nurses (APRNs) and physician assistants (PAs) at UTSW. The committee comprises two subcommittees: Wellness and Recognition. The Wellness Subcommittee was created to provide more connection and social interaction for UTSW advanced practice providers (APPs) and has four workgroups to help accomplish that goal: APP Connection, APP Wellness Resources, APP Inclusion and Belonging, and the APP Navigator Program. The APP Navigator Program was created to support newly hired APPs – both those who are new to practice and those who are more advanced in their clinical careers but new to the UT Southwestern Health System.

The program aims to provide each new-hire APP, APRN, and PA regular connection points with a peer Navigator who is a motivated and seasoned APP within the organization and positioned to offer support and engagement, promoting a sense of belonging and connection. Newly hired APPs who enroll in the Navigator Program can ask questions, share their experiences, and receive timely responses from the Navigator with whom they were paired.

Note. The format is “actual score (over/under benchmark).”

Within their first month of hire, all APPs are informed of the Navigator Program several times (during APP orientation, during monthly new-hire Coffee Chat connections, and during touchpoints with APP leadership). New hires are invited to complete a REDCap survey as an entry point, indicating their years of experience, clinical context, and any area of desired support, learning, or growth. Prospective Navigators are required to have been employed at UTSW as an APP for more than two years and are vetted by the OAPP through an interactive, informal development program (currently offered quarterly) that is separate from our more formal and goal-focused APP Mentorship program. The interactive program reinforces program goals, offers best practices for engagement with the new hire, and provides resources to support answering frequently asked questions of APPs who are new to UTSW.

Prospective Navigators are paired with a new hire based on their skills, interests, experience, and responses to the REDCap survey. The OAPP program coordinator and Wellness executive sponsor meet with the Navigator workgroup members monthly to review newly returned surveys and pair new-hire APPs with Navigators on a rolling basis. Before formalizing the pair, the OAPP verifies with the prospective Navigator’s department leadership that the APP is in good standing and can participate in the program outside of work hours.

The new-hire APP and Navigator are informed of the pairing through an email from the Navigator workgroup. The Navigator is encouraged to initiate contact with the new hire within two weeks of assignment, to attempt to meet face-to-face for at least the first encounter, and to agree upon the cadence and format of ensuing meetings (monthly to bimonthly) for up to one year. Navigators and new-hire APPs are asked to complete mid-program and post-program surveys that compare pre-program ratings of belonging, engagement, and intent to stay at UT Southwestern. The Navigator Program aims to improve belonging and retention for both new and seasoned APPs through the connection and support offered by peers. Mid- and post-program surveys also seek feedback regarding ways to optimize the experience.

Glint Values in Practice (VIP) engagement surveys provide insights into the level of personal and professional support that APPs perceive they receive at UT Southwestern. Fall 2020 was a peak for APPs in the “Engagement” category at 82, with a downward trend to a nadir of 72 in fall 2022. In the FY 23 Operational Plan, UT Southwestern began tracking APP turnover on the Balanced Scorecard, focusing on retaining and engaging this specific workforce.

Starting a new job as an APP can be overwhelming and intimidating for new graduates and those new to our large and complex health system. APPs on smaller teams or regional campuses may feel isolated and wish for peer connections. The APP Navigator Program is designed to counter that isolation and provide that connection and support. By measuring the engagement, belonging, and intent to stay pre-, mid-, and post-program, we hope to show that both new hires and tenured APPs derive benefit in some, if not all, measures of engagement through their participation in this program.

The first four pairs of new hires and Navigators were matched in May 2023 as a small pilot group. In July 2023, we sent out a mid-program survey to seek feedback. This provided insights regarding managing the timing of pairing and anticipating and adjusting for any extended leave, such as Family and Medical Leave Act-related leave, within the pair. An informal check-in with participants via email was done again in November 2023. Due to the small pilot group size, we do not have adequate data regarding trends in belonging, engagement, or intent to stay. We made programmatic adjustments to support the formal program launch on Sept. 1, 2023, and look forward to tracking participation and impact throughout FY 24.

  • Engagement Committee Chair: Arpita Patel, M.P.A.S., PA-C
  • Wellness Subcommittee Co-Chair: Nicole Streich, M.P.A.S., PA-C
  • APP Navigator Program Work Group Lead: Nicole Streich, M.P.A.S., PA-C
  • Workgroup Members: Yu Guan, M.P.A.S., PA-C; Jessica Simon, APRN
  • Committee Coordinator: Alyse Chambers
  • Committee Executive Sponsor: Laura Kirk, M.S.P.A.S., PA-C

Midnight Huddle

The Nobl rounding platform helps capture real-time feedback from patients and staff and provides the leadership team with the insights to deliver service recovery and capture the voice of the employee. During one of the Nobl rounds on Aug. 11, 2023, Mary Ann Abrenica, RN, suggested that the night shift do a midnight huddle to help a co-worker who might be overwhelmed with an assignment. The idea was brought up to Sharon Le Roux, M.S.N., RN, OCN, the nurse manager of 11 Orange, who thought it was brilliant.

The initiative involved collaboration between 11 Orange nurses, patient care technicians, and the leadership team comprising Le Roux and assistant nurse managers. To implement the idea, the night shift created a midnight huddle during which all staff would go to the nurse station and provide updates on how each one was doing. If one person was too busy with a task, another nurse would help them. Patient care technicians were also included and would share their progress regarding their patients. Once everyone received the updates, any specific concerns and quick hits could be addressed.

As the midnight huddle continued to grow, other topics of discussion where staff could find support were included. An example of this included supporting new nurses in following skin pathway orders step by step. Hattab Al-Shudifat, B.S.N., RN, suggested providing education on commonly administered medications for oncology patients to refresh seasoned RNs' knowledge while reinforcing essential information for new RNs. Some lighthearted topics were eventually incorporated into midnight huddles, such as planning for holiday parties on the unit or providing celebration news. One highlight of the midnight huddle that has evolved is the 3- to 5-minute exercise sessions led by Sunmi Lee, B.S.N., RN, OCN, to promote employee well-being.

The following interprofessional groups collaborated on this initiative: 

  • 11 Orange RNs and PCTs
  • 11 Orange leadership team (ANMs + NM)

The midnight huddle is still a work in progress, but it has grown to bear the fruit of suggestions from staff. Sometimes, on days when the unit’s admissions rates are high, it becomes a challenge to complete the huddle in person. When the unit is too busy to meet in person, staff use 11 Orange secure chat messaging or Vocera chat to huddle virtually.

This initiative has promoted teamwork and camaraderie within 11 Orange, significantly bolstering staff morale, fostering inclusivity, and enhancing workflow efficiency.

  • Chelsea La Fond, B.S.N., RN, OCN
  • Sharon Le Roux, M.S.N., RN, OCN
  • Morgan Parker, B.S.N., RN, OCN
  • Nerissa Uy, B.S.N., RN, OCN

Director: Ruben Castillo, D.N.P., RN, CCRN, NE-BC

Night shift RNs & PCTs:

  • MaryAnn Abrenica, B.S.N., RN
  • Hattab Al-Shudifat, B.S.N., RN
  • Mael Andres, PCT
  • Jeffy Bartholomae, B.S.N., RN
  • Leigh Baxter, B.S.N., RN
  • Jessica Mae Cariaga, PCT
  • Precious Collins, PCT
  • Debbie Delgado, B.S.N., RN
  • Terefu Fentaye, PCT
  • Mikayla Garaux, B.S.N., RN
  • Mya Howell, PCT
  • Jamie Jacob, B.S.N., RN
  • Aby Joseph, PCT
  • Sunmi Lee, B.S.N., RN, OCN
  • Maryann Maramba, B.S.N., RN
  • Lindsay Mendoza, B.S.N., RN
  • Kenna Muff, B.S.N., RN
  • Sara Nessel, B.S.N., RN
  • Chinna Ojimadu, B.S.N., RN
  • Amy Porche, B.S.N., RN
  • Melissa Rodgers, RN, OCN
  • Jaicey Thomas, B.S.N., RN
  • Delilah Toledo, B.S.N., RN
  • Ramona Warkola, B.S.N., RN, OCN
  • Catrina White, PCT
  • Tracy Wilson, B.S.N., RN
  • Linda Zhu, B.S.N., RN

Reducing Falls

As in previous years, the FY 23 Operational Plan focused on prioritizing patient safety by monitoring nurse-sensitive indicators that identified opportunities for overall improvement. To align with organizational strategic goals, the Medical-Surgical Unit 10 Green concentrated its collective efforts on reducing the number of inpatient falls. Because 10 Green patients had experienced the highest rate of patient falls in 2022 at William P. Clements Jr. University Hospital, the team understood the importance and necessity of drastically reducing fall events by strengthening the fall plan and increasing adherence to existing safety measures for the unit’s patients.

After reviewing the factors surrounding falls occurring on 10 Green, several circumstances were associated with underperformance for this safety benchmark. One primary issue noted was that most falls occurred while patients were transferring to or from the bathroom. In most instances, the fall bundle was being used appropriately with a gait belt, a walker, and a staff member assisting the patient as they walked. During these transfers, patients experienced sudden episodes of weakness or dizziness and were then safely assisted to the floor. These unfortunate changes in condition for patients significantly increased the patient fall rates. Other contributing reasons identified for the increased patient fall rate included improper use of chair pad alarms, a high number of floating staff members who were unfamiliar with the 10 Green fall protocols, and a vulnerable glioblastoma patient population susceptible to experiencing symptoms of weakness and dizziness.

The NDNQI falls indicator rate (total patient falls per 1,000 patient days) in June 2022 was 6.63, which was well over the national benchmark. Determined to change the trend of the patient fall rate, the 10 Green team collaborated to develop and enact a fall reduction action plan beginning in July 2022.

The action plan incorporated several comprehensive initiatives that worked to increase the staff's knowledge and awareness of fall susceptibility of the patients on 10 Green. Many interventions involved specific equipment and actions the nurses and staff could take to reduce falls. These included:

  • All 10 Green staff members reviewed HD scoring and signed a Fall Recommitment document in their employee file.
  • Leadership and peer audits were implemented to validate HD scoring, as well as follow-ups for repeated falls.
  • HD assessments are now to be completed and documented twice each shift to assess for fall risk changes that frequently can occur throughout the shift.
  • 10 Green’s response to HD scoring (different from the standard in Epic) is heightened to include “All patients scored a Moderate Fall Risk (11-14) regardless of mobility status/scoring require a full set of fall precautions.”
  • Use of the Sara Stedy sit-to-stand aid has been incorporated for all patients who use a walker to ambulate to and from the bathroom.
  • Preferential use of seat belt alarms is now placed over chair alarm pads.
  • A “no refusal” bed alarm policy is now in place.
  • Any patient receiving Go-Lytely bowel prep is required to be monitored for fall precautions.
  • Assignments are limited for 10 Green nurses and staff whose patients are diagnosed with glioblastoma. Additional interventions for this patient population include:
    • Required to use a Sara Stedy to and from the bathroom.
    • Use of low beds/fall mats, Purewicks, urinals, and primo fits are considered early in their care plan.
    • Use of bedside commodes is discouraged.
    • All float staff are provided a copy of 10 Green’s Fall Action Plan at the start of the shift by the oncoming charge nurse, who reviews the plan with them.

Other interventions included interprofessional collaboration with the multidisciplinary team, such as:

  • Establishing a partnership with therapy leadership and the therapy department to adhere to the 10 Green Fall Action Plan
  • Physical therapy department changing its verbiage to better support nursing judgment regarding fall risk status; instead of saying “You are independent,” therapists began to say, “You have no further skilled needs”
  • Establishing a partnership with the Hospitalist Medical Team to garner its support in deferring fall risk status to nursing (thank you, Abey Thomas, M.D.)

This fall reduction action plan was communicated via emails, handouts, and quick hits; in staff and charge nurse meetings; and on the visual management board. The plan and interventions were fully operationalized by January 2023.

The goal of this project was to reduce the fall rate and improve patient safety. With all efforts implemented, the 10 Green team achieved a substantial reduction of fall events. The rate of falls decreased over the entire year. As of Dec. 1, 2023, 10 Green had seven inpatient falls, much lower than the 29 total recorded for the previous year. The change is notable in the 10 Green NDNQI falls indicator rate, which remained below the national benchmark for 2023, being reported as 1.16 (total patient falls per 1,000 patient days) as of September 2023.