The State of Nursing at UNC Medical Center Mary Tonges, PhD, RN, NEA-BC, FAAN Senior Vice President and Chief Nursing Officer, UNC Medical Center May 10, 2013

University of North Carolina Medical Center Commitment to Caring

People Onsite RN to BSN Program begins May 15, 2013 with 30 UNC Medical Center (UNCMC) employee students

People Onsite Nursing Assistant II program graduated 54 NA employees in 12 months with 100% successful completion

People Research Council completing literature review to identify evidence-based best practices for fatigue management plan Survey to assess fatigue to launch June, 2013

Service UNCMC in 91 st percentile for patient satisfaction in Press Ganey 600+ bed, hospital database Nursing in the 96 th percentile

Service Also in 96 th percentile : Meals and personal issues (privacy, pain control) Diversity Council helped achieve Health Equality Index (HEI) status for the care of LGBT patients

Quality 87% of units outperforming National Database for Nursing Quality Indicators (NDNQI) benchmark for skin care 80% of units outperforming NDNQI benchmark for alternatives to restraints 70% of units outperforming NDNQI benchmark for fall prevention

Quality Catheter-Associated Urinary Tract Infection rate reduced from.73/1000 patient days to.56 (against goal of at least 5% reduction to.65 ) Deep Vein Thrombosis and Pulmonary Embolism rate reduced from 12.3/1000 cases to (against goal of at least 5% reduction to 11.7)

Quality Quality IndicatorPrevious RateGoalResults Catheter-Associated Urinary Tract Infection.73/1000 patient days Reduce rate at least 5% to. 65 Exceeded goal by. 9%; rate reduced to. 56 Deep Vein Thrombosis and Pulmonary Embolism 12. 3/1000 cases Reduce rate at least 5% to 11.7 Exceeded goal by 1. 6%; rate reduced to 10.01

Quality Medical Progressive Care Unit (MPCU) first UNCMC intermediate care unit to receive Beacon Award from American Association of Critical Care Nurses (AACN) and Gold at the Gold level

Finance Through March Fiscal Year ‘13 Budget Index: Percent of budgeted expense $’s spent = 99.7% (.03% under budgeted expenses) Productivity Index: Relationship between labor and budgeted volume = 100.4% (.04% better than target)

Finance Through March Fiscal Year ‘13 Budget Index 99.7% budgeted expense $’s spent:.03% under budgeted expenses Productivity Index 100.4% retention between labor budgeted volume:.04% better than target

Growth Opened our newest unit, 7 Neurosciences, a 24 bed SurgicalOncology/ENT unit, October, 2012 Opened 14 bed GI Surgery unit on 6 East November, 2012 Designing new 24 bed Medical Progressive Care Unit for 3 Bedtower and 24 bed Bone Marrow Transplant Unit for 1 Neurosciences to open 2014

Growth Opened 24-bed SurgicalOncology/ENT unit on 7 Neurosciences October, 2012

Innovation Partners in Practice Celebrating 1 year anniversary of full implementation of Partners model on 4 Anderson North May 14, 2013 “Changing before you have to.” Captain Sully Sullenberger

Innovation Partners in Practice Successfully expanded to 6 East when opened November 1, 2012 Planning further expansion to 7 Neuroscience and beyond

Partners in Practice First Year Outcomes MetricPre-implementationPost-implementation Patient Satisfaction (Press Ganey) Overall mean = 84.9 Nursing mean = 88.1 Overall mean = 87.9 Nursing mean = Fall Rate (per 1,000 patient days) * -.15 Catheter associated Blood Stream Infection (per 1,000 device days) ** Salaries--200 K savings - 200K NDNQI Job Enjoyment Scale * 135 days since last fall ** No CABSI since 5/14/12

Innovation Epic Health Core Information System Clinical Informatics Council for UNCHCS comprised of nursing and other clinical leaders from UNCMC, Rex and Chatham to lead policy and workflow decision- making

Innovation Epic Care Team includes 11 UNCMC RNs 36 UNCMC RN Subject Matter Experts

Innovation Professional Practice Council continues to develop and implement nurse-driven protocols including electrolyte replacement and house wide Foley catheter removal

Innovation Partnering with Patients and Families Patient and Family Advisory Boards expanded beyond Children’s (Neonatal Critical Care and Pediatric ICU) and Cancer Hospitals to Family Medicine and Jaycee Burn Center

Innovation Partnering with Patients and Families Patient and Family Advisors: Review educational materials Participate in interviewing applicants Assist in designing new units Teach patient’s perspective to health care learners

“A strong, growing, nursing profession isn’t a byproduct of a thriving healthcare system. It’s a prerequisite for it.” Donna Shalala We Believe in the Power of Nursing! We are CAROLINA NURSING