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.
Protecting Postoperative Patients Through New Epic Documentation
In early 2025, multiple incident reports were filed in the Zale and CUH PACUs involving postoperative patients who received preoperative EXPAREL injections but did not have the required EXPAREL wristband in place. EXPAREL is a long-acting local anesthetic administered preoperatively by anesthesia providers and requires a wristband to be worn for 96 hours to alert clinicians that additional anesthetics, such as lidocaine, cannot be administered due to risk of severe reactions. To address this patient safety risk, PACU leadership and Patient Safety partners identified the need for dedicated Epic documentation to confirm EXPAREL band placement and verification across the care continuum.
In March 2025, an interprofessional documentation optimization request and SBAR were submitted to create new Epic documentation fields for EXPAREL band placement and verification. In April 2025, incident data were reviewed with the Senior Patient Safety Coordinator, and the proposal was approved by the Nursing Informatics Council and forwarded to the Epic team. From April through August 2025, the project team collaborated with Epic analysts to develop and refine the new documentation. In August 2025, the finalized Epic changes were implemented across UT Southwestern Medical Center, including new charting fields for PACU and inpatient nurses and visual safety banners in shift and professional exchange reports. Overall, these enhancements standardize EXPAREL band verification, improve visibility for all providers, and reduce the risk of serious medication interactions, strengthening postoperative patient safety systemwide.
Contributors:
- Loan Do, M.S.N., RN
- Steven Sisson, B.S.N., RN, CPPS
- Tamla Wells, B.S.N., RN, CCRN
- Nursing Informatics Committee
Creating Midshift Schedules for CVICU RNs
The Cardiovascular Intensive Care Unit (CVICU) at UT Southwestern is a high-acuity surgical unit managing three to seven scheduled cardiac surgeries daily in addition to emergent cases. Prior to this initiative, all CVICU nurses worked traditional 12-hour shifts and frequent midshift assignment changes to accommodate surgical volume disrupted workflow and increased risk. In February 2024, data revealed a 12% increase in medication errors compared to Q4 2023, an average of 15 event reports per month related to incomplete care, with 68% of staff nurses reporting high stress related to assignment changes. A CVICU town hall and staff survey held in February 2024 confirmed widespread dissatisfaction with handoffs and assignment disruptions, with staff recommending a midshift RN model to better align staffing with surgical case volume.
In March 2024, a pilot was launched introducing two midshift RN roles, 10 a.m.-10 p.m. and noon-midnight, with nurses volunteering for three-week rotations. A post-pilot survey conducted in April 2024 demonstrated strong support, leading to the establishment of two permanent midshift RN positions, with additional rotational opportunities maintained. Post-implementation outcomes showed a 38% reduction in medication errors, a 50% decrease in incomplete care event reports, and 92% of staff reporting reduced stress and improved workflow. Charge nurses reported fewer last-minute assignment changes and improved patient flow, while staff feedback highlighted improved continuity of care, work-life balance, and retention, particularly among nightshift nurses transitioning into day roles. This initiative demonstrates how responsive scheduling design can improve patient safety, workflow efficiency, and nurse satisfaction in a high-acuity surgical environment.
Contributors:
- Danielle Emmerton, B.S.N., RN
Rapid Cycles, Real Results: Applying PDSA to Optimize Emergency Department Throughput
During FY24, the Emergency Department (ED) at UT Southwestern experienced prolonged patient length of stay (LOS), with a median LOS of 346 minutes for discharged patients. This delay negatively impacted patients’ experience and contributed to a high rate of patients leaving before completing care (LBTC). The primary bottleneck identified was the time to physician evaluation. A multidisciplinary team – including physicians, nurses, APPs, pharmacists, social workers, care coordinators, and management engineers – was assembled to address this issue. The goal was to reduce LOS and improve throughput by redesigning patient flow and minimizing delays in provider assignments. Baseline data showed that only 20% of patients were assigned to a provider within 15 minutes of triage, far below the target of 80%. The team brainstormed several interventions and selected the “flip chair” model to improve vertical patient flow. This model allowed mid-acuity patients to be evaluated in designated chairs within each pod, expanding the concept beyond the existing Supertrack area. Key interventions included:
- February 18 and 20: Soft launches of the flip chair model initiated in two pods with different physicians.
- February 25: Full dayshift implementation of flip chairs took place across all pods.
- April 1: Dedicated RNs were assigned to perform lines and labs in the sub-waiting area.
- Training was provided to RNs and M.D.s on patient selection and flow logistics.
- Data analysts and engineers collaborated to refine measurement definitions and collect performance data.
This initiative was supported by the Emergency Department Flow Subcommittee and involved iterative PDSA cycles to refine logistics and improve outcomes.
The intervention led to a significant reduction in time-to-provider assignment, especially for ESI II-IV patients. Performance improved across 15-, 30-, and 45-minute thresholds, with a >50% decrease in time to provider assignment. Variability in performance also decreased, indicating improved standardization. The ED Outpatient Overall Rating improved by 2% in absolute terms, and total LBTC rates declined by approximately 33%. The refined line/lab process further enhanced throughput. These results demonstrate that the flip chair model created a sustainable improvement in ED flow and patient experience.
Contributors:
- Tessa Clarkson, B.S.N., RN
- Richard Fernandez, D.N.P., RN
- Ralph Michael Sia, B.S.N., RN
