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, these are vital components to building 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 through interdisciplinary relationships, professional autonomy, nurses as teachers, establishing professional models of care, and maintaining resource-rich facilities.
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 our 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
As a Magnet-designated organization, UTSW is committed to exceeding benchmarks across all performance areas, including nurse satisfaction. The first standardized nurse satisfaction survey at UTSW was conducted in 2021, marking a significant milestone in understanding and addressing nursing needs.
Most recently, the 2024 Glint RN Satisfaction Survey achieved an impressive overall participation rate of 73%. In all eight categories, UTSW scored above the national benchmark. Research consistently demonstrates a strong link between nursing satisfaction and optimal patient outcomes. When nurses find fulfillment in their roles, they exhibit higher levels of engagement, achieve reduced turnover rates, and contribute to enhanced organizational and patient outcomes.
Community Involvement and Outreach
One of the most rewarding ways UT Southwestern nurses share their experience with the community is by lending 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.
Rethinking Ambulatory Rapid Response Team Orientation Methods to Meet Staff Bandwidth
As patient volumes and acuity increase in the ambulatory setting, effective and highly trained Rapid Response Teams (RRTs) are essential to safe, quality care in urgent and emergent situations.
The scope of the ambulatory setting RRT’s responsibility entails dealing with multiple standing medical orders, processes, documentation, and equipment unique to the team, necessitating a high level of training. Given our staffing shortages and high patient volumes, it has become increasingly difficult for staff to complete initial orientation. The RRT Program Manager found inconsistent methods and quality of previous orientation processes and training.
From May to July 2024, a standardized online module was created that covered documentation procedures, policies, expectations, standing medical orders, event reporting, emergency medications, and ongoing training requirements to address the gaps. The new onboarding process integrated both online and in-person components, allowing for flexibility in training. After completing the online module, new RRT members began meeting with an RRT Site Coordinator to validate competencies and participate in mentorship with experienced team members.
UT Southwestern’s learning management system (LMS) was leveraged to facilitate the online portion of the orientation. The self-paced learning environment provides flexibility, minimizes disruptions to patient care, and streamlines the process of verifying and tracking course completion. At the end of July 2024, the new onboarding module was assigned to all current RRT members to ensure that all RRT staff received the same information.
Key members of the team played crucial roles in the development and implementation of the new onboarding process. The RRT Program Manager was instrumental in developing the RRT orientation and providing oversight to ensure alignment with clinical and operational needs. The Nursing Professional Development Practitioner (NPDP) created the online learning module, ensuring the content was comprehensive, engaging, and aligned with best practices in nursing education. The Site-Specific RRT Coordinators played a vital role in validating new members’ competencies and coordinating mentorship with RRT in clinics. RRT members shared their expertise and mentored new staff, contributing significantly to successful outcomes when utilizing the new onboarding process.
As a result, our onboarding process improved to become more standardized, robust, and flexible. Developing a comprehensive online learning module combined with in-person mentorship allows team members to complete training at their own pace without disrupting patient care. The utilization of the LMS provides consistent, high-quality content on essential topics such as emergency response standing medical orders, documentation, and event reporting.
In September 2024, post-orientation survey results showed that the new onboarding process was a resounding success, wherein 98% of participants perceived receiving adequate education, 93% were confident in their ability to respond, and 97% were satisfied with the new onboarding process. This blended learning approach significantly improved team preparedness and satisfaction. Also, RRT felt more confident and prepared by utilizing the new process. The redesign has cultivated a more engaged, confident, and capable RRT workforce, vital for enhancing patient safety and improving emergency response effectiveness in the ambulatory setting. Additionally, providing feedback was highly encouraged to ensure potential future improvement based on outcomes, reinforcing the commitment to continuous improvement and the success of the new process.
Contributors:
- Cara Hough, B.S.N., RN-BC, Nursing Professional Development Practitioner
- Mari Ann Lewis, M.S.N.-Ed., RN, AMB-BC, NPD-BC, Manager, Clinical Education & Professional Practice
- Ryan Reid, B.S.N., RN, CCRN, Nursing Program Manager
- Rebecca Tutt, M.B.A., B.S.N., RN, Director, Ambulatory Nursing
- Calli Wood, M.S.N.-Ed., RN, NPD-BC, Director, Ambulatory Nursing
NICU Beads of Courage
Former NICU parents who had twins initiated the Beads of Courage program at UT Southwestern Medical Center, demonstrating their deep empathy and understanding of the challenges faced by NICU families. Their twins were born extremely prematurely and consequently suffered from serious medical conditions that were treated in our NICU for more than two months. During that time, the parents felt powerless, leading them to initiate a fundraising campaign known as Kaylen’s Fight, named after one of their daughters who survived.
The Beads of Courage program was supported by NICU leadership and nursing staff members who attended workshops and trained each staff nurse on how to create meaningful beads and understand the importance of the initiative.
The program was also designed as an intervention to support other families coping with their infants' serious medical conditions. When their infant is discharged home, the beads serve as a meaningful symbol honoring the courage displayed throughout their treatment journey. This program is not just about treatment, it’s about the stories of courage symbolically represented through the use of colorful beads, which become tangible and visual tokens to commemorate treatment milestones. Every bead tells a story of courage, honor, and hope.
Goal: The Beads of Courage program in our NICU aims to provide emotional support and recognition for families navigating the challenges of their infants' medical journeys. By using colorful beads to symbolize significant milestones and experiences, the program fosters resilience, hope, and a sense of community among families and caregivers. Each bead represents a unique event in the child's treatment, allowing families to visually narrate their stories and celebrate achievements, no matter how small.
Timeline Summary of Actions Taken
- Assessment and Planning: The NICU team assessed the current implementation of the Beads of Courage program to identify strengths and areas for enhancement. Feedback from families was collected to guide improvements.
- Resource Enhancement: With support from the Kaylen's Fight organization, additional beads were secured alongside educational materials, ensuring that all families had access to a comprehensive experience.
- Program Reinforcement: The enhanced program was relaunched during a staff meeting, emphasizing greater involvement of nurses in presenting beads during critical milestones. Staff aimed to create more meaningful moments for families.
- Feedback and Evaluation: After the relaunch, the team gathered feedback from families and staff to evaluate the emotional impact and effectiveness of the enhancements.
- Ongoing Improvements: Based on the feedback, adjustments were made to refine the program further. Ongoing collaboration with Kaylen's Fight has ensured sustained support and resources for families.
This initiative was characterized by strong interprofessional collaboration. Key participants included NICU nurses who provided direct care and social workers who offered emotional support. The partnership with the Kaylen's Fight organization not only provided funding but also personal insights that enriched the program. Together, this collaborative effort significantly enhanced the emotional well-being of families navigating the NICU experience.
The NICU Beads of Courage program not only empowers our parents and our NICU graduates but also symbolizes the caring and compassion that each of our nurses demonstrated to our patients during their treatment path on their journey home. It touched our patients’ heart so much that they initiated a fundraising campaign, in memory of their daughter Kaylen, called “Kaylen’s Fight,” A formal gala event is held every year and has raised funds to support our unit and provide more equipment such as transport isolettes, new Giraffe OmniBeds, an Neonatal Resuscitation Program manikin that helps further staff education, feeding pumps, and more, which we desperately need.
Contributors:
- Mikki Burciaga, B.S.N., RNC-NICU, NICU Assistant Manager
- Roxann Davis, RN, NICU staff
- Jamie Del Valle, RN, NICU staff
- Becky Ennis, M.D., Neonatologist NICU
- Becky Scherer, RN, NICU staff
- Oralenda Smith, M.B.A., RN, NICU Manager
Teamwork Makes the Dream … UNIT!
Data from the Nursing Solutions Inc. National Health Care Retention Report show a national nursing turnover rate of about 22.5% in 2022 and a slightly better rate of 20.7% in 2023, though that percentage still reflected a decline, signaling that there is still a need to improve nursing retention. The safe functioning of health care teams is in jeopardy when turnover is high. Not only does it often lead to an increase in workload for those remaining on the team, but nursing retention issues can also negatively affect patient care outcomes.
Our team manages and leads multiple neuro progressive care departments at a large academic medical center. It has not been immune to challenges with nursing retention that have plagued the nation. At the beginning of September 2022, our departments suffered a record high turnover rate of 20.2%.
To address this issue, we placed emphasis on exploring ways to enhance teamwork among staff members to improve engagement and the work environment.
Front-line team members voiced concerns to unit leadership regarding the phenomenon of low teamwork among their peers and teammates. Unit leaders conducted one-on-one interviews to gather feedback about causes of low teamwork. Our leadership team used a variety of quality and process improvement tools to work through these causes, including cause and effect diagrams, pareto charts, and the four-step model called the Plan-Do-Study-Act (PDSA) cycle. All staff provided rankings for the pareto chart to determine what the best course of action would be for our departments.
Our ranking results revealed the top reason for low teamwork was that roles, tasks, and accountability were not being clearly defined. Our leadership team then created a “Teamwork” workgroup that consisted of representatives from all roles (RNs, patient care technicians, and unit secretaries) from both day and night shifts. The workgroup met various times to brainstorm ideas and to set specific timelines and task expectation lists for each role. The team then used various tactics to present these expectations, including role playing teamwork scenarios that demonstrate the importance of effective communication in resolving conflicts. After a four-month observation of the initial intervention, the group reconvened and developed ideas for a mid-shift huddle and intentional check-ins focused on resources and help needed to further solidify teamwork during busy shifts. These ideas were presented to the unit-based council and then formally rolled out to the entire team. We have integrated the mid-shift huddle into both day and night shifts, seven days a week, led by the charge RN and leadership members when they are available.
To increase teamwork and improve retention, we used Glint survey results to measure engagement, teamwork, accountability, collaboration, resources, and recognition. Overwhelmingly, this project demonstrated positive quantitative results in both our Glint team's scores and turnover rates. As of August 2024, our turnover rate plummeted to 5.3%. Our overall engagement score increased by five points, which is 15 points above the benchmark, with equally remarkable increases in accountability (seven points) and teamwork (six points), both well above the national benchmark. This data resulted in an abstract being accepted to the 2025 Annual AONL Conference, taking place March 30-April 2, 2025, in Boston, Massachusetts.
Our results have highlighted the need to gather unfiltered concerns and ideas from front-line staff to improve the work environment and team dynamics. It is important to note that this was not a quick fix but a long-term project that our team has been dedicated to over the past two years. Patience and understanding have been key to our collaborative effort, which involved listening to our team members’ voices and investing in various interventions to improve teamwork and morale, which ultimately led to improved retention and decreased turnover.
Contributors:
- Alexa Collins, M.B.A., B.S.N., RN, SCRN
- Thanh Cubria, B.S.N., RN, CMSRN
- Kaitlyn Dupriest, M.B.A., B.S.N., RN, CCRN
- Sheena John, B.S.N., RN
- Jenny Vo, B.S.N., RN, CMSRN
What the BEEP? Mitigating Beep Fatigue and Enhancing Patient Satisfaction in Infusion Clinics
Infusion pumps produce frequent beeps, often requiring nurse intervention. During a 10-hour shift, a nurse may hear approximately 1,000 beeps, each prompting an action. While nurses are trained to interpret and respond to these beeps, patients often associate them with distress or malfunction, leading to stress and increased use of the nurse call button. This creates a cycle of “beep fatigue” for nurses and dissatisfaction for patients.
At the Aston Infusion Clinic, our goal was to reduce beep fatigue for nurses while improving patient understanding of the alarms. We focused on two key areas: medication titration and completion.
Intervention
In December 2023, the clinic completed 864 patient appointments with a staff of six RNs per day. For the nursing staff, we established a goal of responding to pump alarms within 60 seconds using a collaborative care model.
Key data from December included:
- 2,361 pump alarms over 20 clinic days
- ≈ 47,220 total beeps (20 beeps per minute)
- ≈ 394 beeps per RN per day
The initiative aimed to educate patients on infusion pump alarms, setting expectations about the number, purpose, and duration of beeps before using the nurse call light. Nurses explained the team-based approach, assuring patients that any of the six RNs on staff could promptly address their needs.
Collaborative teamwork proved essential to minimizing beep fatigue and enhancing patient satisfaction. Through teamwork, nurses responded quickly to alarms while maintaining care plans, minimizing delays, and avoiding additional call light alarms. This approach optimized efficiency and strengthened patient trust in the care team.
Using the team-based response model, we achieved the following:
- Response Time: Nurses responded to pump alarms within 60 seconds.
- Patient Satisfaction: Education and prompt responses reduced alarm-related interruptions, improving patient confidence and satisfaction.
- RN Satisfaction: Collaboration fostered trust among staff, enhanced efficiency, and reduced individual workload.
- Operational Efficiency: Appointment lengths aligned accurately with Epic’s theoretical durations, ensuring optimal resource use.
The teamwork approach ensured timely, seamless care delivery. Patients, reassured by prompt responses to pump alarms, were less inclined to use call lights, reducing alarm frequency and nurse fatigue.
Implementing a team-based care model for pump alarm response decreased beep fatigue among nurses and improved patient satisfaction. Nurses’ collaborative efforts ensured efficient, high-quality care, demonstrating the value of teamwork in addressing operational challenges in clinical settings.
Contributors:
- Ami Gollihar, RN, Nursing Supervisor
- Rebecca Tutt, M.B.A., B.S.N., RN, Nursing Director
- Shannon Wishin, Clinic Manager
- All Aston Infusion Clinic nursing staff
Decreasing Readmission of Post-Transplant Patients by Improving Diabetes Management Education
Managing diabetes in transplant patients is a complex task due to multiple factors, including the effects of immunosuppressive medications and glucose metabolism post-transplant. Patients must understand the disease process, medications, and lifestyle changes. In complex scenarios, such as when a newly diagnosed diabetic patient is sent home with insulin for temporary use or when tapering the steroid dose, the insulin instructions can change. Such situations can confuse patients who return to the hospital to ask questions about unclear discharge instructions or, worse, to address a decline in their condition due to a lack of or incomplete information.
In looking into the readmission rates, data gathered in 2022 showed that 12.5% of all post-transplant cases were related to diabetes management. Patients returned to the hospital due to a lack of understanding in managing blood sugars and the appropriate use of the sliding scale. Uncontrolled blood sugars can put the patient at immediate risk for organ rejection, severe infection, and even death. Our initiative aimed to decrease the 30-day readmission rates of recent kidney and liver transplant patients due to a knowledge deficit on insulin management by at least 50% from 2022 to 2023.
To address this gap, a Diabetes Teaching Task Force was formed, comprising nurses, a unit-based educator, a transplant pharmacist, and an endocrine team. The teaching process began when the patient’s anesthesia had worn off and he or she was alert. The primary nurse gave each patient an “Inpatient Diabetes Education Questionnaire” to gauge their comfort level with insulin and blood sugar checks. This patient-centered approach, which prioritizes each patient’s needs and comfort, was instrumental in fostering a sense of empathy and care throughout the initiative.
A resource handbook, Diabetes Survival Skills, was developed as a comprehensive guide for patients and their families. It provides detailed information on symptoms of hyperglycemia and hypoglycemia, how insulin works, and how it is administered. The handbook includes a QR code that gives access to videos on using a glucose meter and an insulin injection pen. These resources were provided to every diabetic patient to enhance their understanding and management of the disease process. The transplant pharmacist communicated with the assigned RN, charge RN, and the Diabetic Task Force about the type of insulin ordered and the glucometer. Then the RN completed the teaching with the assistance of the endocrine team. Finally, the learning was documented in the patient’s medical record.
Creating a secure chat, named “7Green Diabetic Task Force” in Epic significantly enhanced communication among the team for this project. This platform allowed nurses, pharmacists, and the endocrine team to connect with the patient promptly, ensuring a seamless transition. The efficient and connected communication system fostered a sense of unity and shared responsibility, ensuring everyone was on the same page and contributing to the initiative’s success.
Upon discharge, the patient completed the same questionnaire provided on admission to determine whether the educational materials enhanced their understanding. This feedback was crucial in identifying areas for improvement and ensuring the initiative remained patient centered. Additionally, two copies of the endocrine instructions – one for the patient’s transplant binder and another one for their home – were provided for easy retrieval when needed.
With the program in place, our discharge information score in the Press Ganey survey was in the 99th percentile. Results indicate a 60% reduction in readmissions within 30 days of post-transplant patients related to insulin management in 2023 compared to 2022. The significant improvement showed that the teaching project was effective in helping patients understand their post-transplant diabetic management. Empowering patients, customizing their learning, and equipping them with knowledge and skills in diabetes management will help improve their quality of life and reduce complications.
Contributors:
- Mary Garcia, M.S.N., RN, WCC
- Manju George, M.S.N., RN, CMSRN
- Anitha C. Litty, APRN, FNP-C CDE
- Van Ngo, Pharm.D., BCPS
- Jocelyn Ponce, B.S.N., RN, CMSRN
