1. STEP FORWARD
JUNE 28TH, 2013
UNIT MEETING

2. Unit Meeting Objectives
Discuss issues concerning staff
Discuss what processes are currently working on the unit
Brainstorm solutions to improve workflow on the unit / teamwork
Vote on 3 initiatives to work on as a Unit

3. Guidelines Each discussion is designated 20 minutes
Each person has 30 seconds to offer comment, no stories. (elaboration granted another 30 seconds)
Raise your hand for comments, or write your comments on paper and pass to your left.
Voting at end of meeting will take place
Shared Decision will work voted initiatives.

4. Staff Concerns 20 minutes What is broken? What does not make sense?
What would you like to change?
What is missing?

5. Staff concerns More IP phones – carry IP phones
Increase number of glucometers on POD 3
Increase number of computers on POD 3
More extra large BP cuffs
Noise ear – for ongoing monitoring
Physician champions – who has our back and part of the team (addressing patient needs/issues) – Physician/Nurse Communication
Clarification/process to obtain order to step down (ie. Post PCI) – ICU level vs progressive care vs designated intervention POD
Process to obtain staff during peak admission times: mass text (can be used to communicate – ie schedules done)
Professionalism – code of conduct, healthy work environment, workplace bullying, teamwork.
Voices/comments/professionalism in the hall – overhead by patients/families
“Feel like I’m on my own.”
TL assignments same as team member (number, acuity) – unable to fulfill the role – exhaustion, no reciprical help
Physical cleanliness/neatness (customer service perception)
I & O’s
NA on night shift
6am duties now done by RN (weights)

6. Staff Concerns Task list items
Vital sign frequency – relook at guidelines/expectations
Process of staff rotation: ICU – stepdown
Preceptor/Preceptee assignments (ie being TL at same time as precepting, appropriate assignments)

7. Staff Successes 20 minutes What works well?
What would you like to see more of?
Examples of successful processes & solutions
Other Comments

8. Staff Successes Number of nurse aides – helpful/nice
Nurse aide on each POD
Assistant manager rounding process – lead by example; taking an interest in staff/assignments/patients (plan: shift lead core team training)
Orientation process: need to look at “young” new experience for professional and clinical development to build next generation of clinical leaders.
Preceptee satisfaction – comments regarding teamwork/support/feeling welcomed
Patient satisfaction – positive patient comments
Discharge appointments – readmission reduction!
QUALITY – focusing on quality initiatives with reduction of HAI’s (ie. CAUTI, VAP, CLASBI) = patient outcomes
CLINICAL PHARMACISTS: approved for 2 additional positions
Staff accomplishments – education, etc
Medication availability
DA role – improved unit audits – better utilization of time – “right person to do the right job” vs nursing doing and improved billing outcomes (7 periods in a row – under budget - $100,000)
Improved stock/equipment – not running out of items (thanks to Kathy)
Telemetry on the wall
Other equipment needing to be visual?
Available IV pumps/poles when needed and they are clean!
Rising to the occasion on difficult shifts (assignments) and teamwork . What works:
Care during emergency situations

9. Suggested Improvements
NA role: add blood sugars (expand work load), on each POD, “team”; trial different shifts
Clinical support: mentors (“double-layer”), patient quality, nurse burnout, safety
Communication: between PODS, with shift lead, CPC
Consider adding to annual review process: positive peer review teamwork/collaboration examples (or add to portfolio)
Develop culture/tools (peer review) – develop card/box at KRONOS
Staffing: text messaging (on call list, general communication); consider designated on-call ideas/guidelines to cover holes
Unit social ‘activities’ – ideas, others interested? (new blood)
CPC: getting NA down on 3-11
Develop Teamwork process: team nursing vs TL role vs charge vs ?
Optimize care delivery
Zero tolerance – unprofessional/unhelpful behavior (motivation/holding each other accountable/teamwork skills)
Take care of each other – emotional support

10. CCU VOTE: Suggested Improvements
Expand the NA role
Develop clinical support structure (ie. Mentoring)
Improve day-to-day shift communications
Develop positive peer review teamwork processes
Develop text messaging process
Initiate staffing processes to address “holes” (on call)
Optimize care delivery (ie TL, charge, team nursing)
Re-energize unit “social” activities
Develop a zero tolerance culture: unprofessional/unhelpful behavior

11. Other items discussed:
Joint Commission visit/readiness expectations: July 26th
Code Blue role
Life Banc update
Dialysis process
NICHE – geriatric survey

12. Questions?