This report highlights another year of nursing excellence across Memorial Health, sharing how the hard work and dedication of our nursing team members is improving patient care and advancing the field of nursing.
This culture of excellence is only possible when we provide opportunities for nursing team members to learn, grow and thrive. One area of focus for nursing leaders this year was encouraging the professional growth of our colleagues during their first year of practice.
We updated the Nurse Residency Program, which helps support new graduate nurses, and expanded mentorship opportunities so new nurses can benefit from the expertise and knowledge that our more experienced colleagues have to offer.
Our goal is to ensure that all nurses feel supported and encouraged, regardless of the setting where they work. This improves retention, but more importantly, it also strengthens our nursing culture and creates an environment in which everyone is able to contribute.
We hope you will take a few moments to look through this report and learn about everything we achieved together in the past year. Thank you to everyone who helped make these successes possible.
Warmest regards,
In June 2023, the Nurse Residency Program at Memorial Health (MH) was updated and expanded to serve the needs of all five MH hospitals.
“This restructuring was driven by a desire to provide equitable professional development opportunities for all new graduate registered nurses,” said Carrie Cantrall, MSN, RN, NPD-BC, Springfield Memorial Hospital (SMH) nursing outcomes improvement facilitator and co-coordinator of the residency program. “We also created mechanisms to collect participant feedback and increase specialty-specific clinical skill development. This will better prepare them for their first year of clinical practice.”
The revamped Nurse Residency Program provides a standard, formal support system for RNs transitioning into practice across Memorial and includes six professional skills seminars that integrate hands-on activities and simulation to apply seminar topics to bedside practice.
Small group reflections within the seminars, facilitated by experienced bedside nurses, provide a confidential forum for discussion and support. Specialty-specific clinical skills classes are led by subject matter experts and focus on developing skills in emergency, critical care, medical/surgical, maternity, perioperative and psychiatric nursing care. Content experts from within Memorial present and facilitate sessions to ensure real-world applicability and a successful transition to practice.
“This comprehensive program helps ensure that new nurses are well-prepared and supported as they begin their careers at the bedside,” said Cantrall.
In addition to receiving support from the Nurse Residency Program Coordinators and small group reflection leaders, nurse residents are paired with a nurse mentor who provides further personalized support to aid in their professional growth.
Mentorship has long been a cornerstone of MH’s commitment to nurturing our nursing staff. Linking the MH Mentor Program with the MH Nurse Residency Program ensures that each nurse resident establishes a mentor-mentee relationship following completion of their preceptor-led orientation. Forming a mentor-mentee relationship early in the Nurse Residency Program sets new graduate nurses up for success with the support they need to excel in their roles.
To gauge the success of these program changes, Memorial Health is tracking various outcomes. Participant survey results and new graduate nurse turnover data provide valuable insights into the program’s impact and effectiveness.
“The expansion of the Nurse Residency Program underscores the importance of the transition to practice,” said Lauren Mardirosian, MSN, RN, NPD-BC, SMH nursing outcomes improvement facilitator and co-coordinator of the residency program. “By providing comprehensive support and tailored learning experiences, we aim to equip new graduate RNs with the skills and confidence they need to excel in their roles across the organization.”
In 2023, Lydia Allen, MSN, RN, CMSRN, nurse manager of Acute Care, identified a need for a formal Nursing Mentor Program at Lincoln Memorial Hospital (LMH).
Using the mentoring program at Springfield Memorial Hospital as a guide, she updated and adapted the content to meet LMH’s needs and then piloted the new program on the Acute Care Unit with the help of five experienced nurses who accepted an invitation to become a trained mentor. Using the Academy of Medical Surgical Nursing’s Mentor Self-Assessment tool (adapted with permission from AMSN), each mentor completed a self-assessment before and after completing the mentor education program. The group saw a 17% increase in perceived experience and knowledge after completing the formal mentor class. Once mentor training was completed, six identified mentees from Acute Care chose from the available mentors, reached out and formed a mentor/mentee relationship.
She has since extended the program to all LMH nursing units and shared the program with all Memorial Health hospitals. Any recent graduate who is hired at LMH is now required to choose a mentor to support them and bridge the gap between orientation and nurse residency through their first year of service and beyond. Other new hires or transfers into a new nursing department will be offered the opportunity to be a mentee and have mentor support. Mentor classes will continue to be offered on a quarterly basis at LMH for any nurse interested in becoming a mentor.
“Mentorship is an important way we can build connections within our nursing teams, help new nurses feel welcome and ensure more experienced nurses have the opportunity to share their knowledge,” Allen said.
Licensed practical nurses (LPNs) provide patient care under the supervision of registered nurses (RNs) and physicians. They work in a variety of care settings but are most commonly found in physician clinics and skilled nursing facilities.
Prior to 2022, Springfield Memorial Hospital (SMH) had fewer than ten LPNs on the inpatient care team. Limitations in LPN practice, such as blood administration and some intravenous medications, makes the RN role more desirable in a high-acuity hospital setting. However, increasing interest among LPNs to work in hospitals led SMH to actively recruit LPNs into team nursing models.
Two local LPN programs, Capital Area School of Practical Nursing and Lincoln Land Community College, regularly bring students to the hospital setting for clinical rotations. Many of these students begin their practice as an LPN and immediately begin “bridge” programs to become an RN. Early engagement of LPNs in the hospital setting provides an opportunity to transition LPNs into a RN role in the future. Over the last year, SMH has more than doubled the number of LPNs providing care and that number continues to rise as students explore the many available nursing pathways.
“LPNs are making important contributions to nursing at SMH,” said Jennifer Bond, DNP, RN, NEA-BC, SMH vice president and chief nursing officer. “We’re pleased to help LPNs get the education and support they need to make the transition to the RN role if they are interested in advancing their careers.”
A comprehensive orientation program is essential to new graduate nurse retention.
The Springfield Memorial Hospital Emergency Department (ED) orientation team has continued to refine an orientation program that meets the learning needs of new nurses and fosters a supportive and enriching environment conducive to professional growth.
In additional to robust clinical training in a wide spectrum of skills and scenarios, the ED orientation process includes strong support for new nurses transitioning into their first professional nursing role. New nurses are paired with experienced preceptors who provide invaluable guidance, support and a sense of belonging within the ED team, fostering a culture of collaboration and continuous learning.
“We give new nurses frequent opportunities to voice concerns and share experiences,” said Jennifer Love, BSN, MBA, CEN, TNS, ECRN, Memorial Health system administrator for emergency and trauma services. “The program actively celebrates their milestones and achievements to reinforce a sense of accomplishment and foster sustained motivation and engagement.”
Starting in 2024, all new graduate nurses beginning their career in an Emergency Department at any Memorial Health hospital will embark on a similar orientation process.
Each summer, Memorial Health (MH) hosts a Summer Nurse Internship.
Leaders from Human Resources, Organization Learning, Outcomes Improvement and executive leadership plan this experience at all five Memorial hospitals.
The seven-week program provides hands-on experiences with a designated nurse preceptor for Associate Degree in Nursing (ADN) and Bachelor of Science in Nursing (BSN) pre-licensure nursing students who are entering their senior year or last semester of nursing school.
This immersive experience increases students’ understanding of the multi-faceted clinical nurse role by practicing assessment, critical thinking and communication with interdisciplinary teams. The internship also provides an opportunity for MH to recruit students into RN positions after graduation, as well as hire students into patient care technician positions prior to graduation. Each year, approximately 60% of interns accept positions as RNs with MH and retention for those participating in this program is 89% at two years.
“Feedback from the 2023 cohort of 35 student nurses was extremely positive,” said Charla Warren, MSN, RN, CMSRN, Springfield Memorial Hospital (SMH) nurse manager and program coordinator for the internship. “We’re excited that 21 participants chose to start their career as new graduate registered nurses with Memorial Health upon graduation.”
Each year beginning in January, MH offers a six-month Nurse Leader Internship for emerging nurse leaders.
In 2023, eight nurses from across MH participated in the program, using the Magnet and Pathways to Excellence Standards to learn and grow in their own personal leadership journey.
Nurse leader interns begin the program with self-reflections using the StrengthsFinder assessment by Gallup. Each month they attend a didactic session and participate in eight hours of shadow experiences with nurse leaders in all five MH hospitals. By the end of the internship, they develop a professional resume or CV and are coached on interview techniques.
On the final day, nurse leader interns give a presentation for MH nurse leaders describing a leadership challenge they identified over the course of the internship. Many current MH nurse leaders participated in prior cohorts of the internship, gaining exposure to leadership opportunities available to MH nurses.
Nursing teams at DMH achieved a major reduction in hospital-acquired infections in fiscal year 2023, meeting all National Healthcare Safety Network goals.
In January 2023, a project by the Nursing Performance and Outcomes Council began decreasing the prevalence of catheter-associated urinary tract infection (CAUTI). The interventions put into place as a result of the project included Chlorhexidine gluconate (CHG) bathing daily, CHG Foley care twice daily and development of an Infection Prevention Bathing Policy. The result was zero recorded CAUTI for eleven months, helping DMH exceed their goal for prevention of hospital-acquired infections for 2023.
“Eleven months without a single CAUTI is an amazing achievement,” said Stacey Taylor, MSN, RN, DMH Director Professional Nursing Practice. “This project shows how simple interventions can make a huge difference in the well-being and outcomes of our patients.”
In 2023, the Emergency Departments at Lincoln Memorial Hospital (LMH) and Taylorville Memorial Hospital (TMH) implemented medication barcode scanning in their Emergency Departments (ED).
Research shows that barcode scanning is instrumental in safely administering medications to patients.
A team of nurses, pharmacists, information technologists and providers collaborated on the project to update technology and infrastructure within the EDs to support the change. This included making sure medication information entered into the electronic health record was shared with the Omnicell medication-dispensing wall cabinets, reducing the risk of a nurse selecting the wrong medication for a patient.
All colleagues and providers completed classroom and hands-on education for the order entry and scanning process.
“We continue to monitor the process and make improvements as needed,” said Casie Milner, BSN, RN, ED manager. “We’re pleased that the current compliance rate with bar code scanning is 92.1%. This project has truly made a difference in medication safety at both hospitals.”
A multidisciplinary team led development of a closed-ICU model at Decatur Memorial Hospital, including nursing leadership, trauma-acute care surgery, cardiovascular services, interventional radiology, hospitalist medicine, family medicine and emergency medicine.
Under the new intensivist-led ICU model, when a patient is ICU status, the Intensivist team will be primarily responsible for patient communication, family communication, nursing communication, consultant communication and transitions of care.
The project team held a series of meetings with the key stakeholders to gather feedback from the groups who were affected by a transition to this model. Through these meetings, an Admission Guideline was developed to outline the admission and transition process from the unit. Education was provided to all stakeholders and the ICU team prior to implementation.
The ICU Closed Model was implemented in June 2023. The success of this project is being evaluated through monitoring of quality markers related to this model. These quality markers include length of stay in the ICU, ventilator weaning, reintubations, early mobility and decreased nosocomial infections. The length of stay in the ICU is now at 1.91 days which greatly decreases the patient’s overall hospital length of stay. Ventilator days in fiscal year 2024 averaged 71.8 per month as compared to 123 in fiscal year 2023.
Mechanical ventilation provides life-sustaining care for patients who cannot breathe independently, but too much time on a ventilator can lead to significant complications.
Weaning patients off a ventilator early decreases the risks of delirium, pneumonia and oversedation, which can significantly increase length of stay.
SMH nurses and respiratory therapists developed an evidence-based protocol to wean patients off the ventilator in a timelier manner. With support from the critical care physicians, the bedside clinical team assesses the patient for readiness to wean off the ventilator and follows strict guidelines to take the patient off mechanical ventilation.
One year after implementation, ventilator complications decreased by 31% and overall days of mechanical ventilation decreased by 17% at SMH.
“In addition to the excellent clinical outcomes, this project brought about greater collaboration between nursing, respiratory therapists and physicians,” said Beth Fullington, MS, RN, NE-BC, SMH director of nursing operations. “It’s rewarding to see what we can achieve when we work together.”
Nursing teams at SMH are consistently focused on reducing patient falls and falls with injuries.
“Reducing falls not only improves a patient’s experience, but also decreases length of stay and the cost of care,” said Kimberly Yeley, DNP, RN, ONC, SMH nursing outcomes improvement facilitator.
SMH nurses noticed that among all patients identified as being at a high risk for falls, those experiencing confusion and impulsivity had a higher likelihood of being injured in a fall during their hospital stay. An electronic dashboard was developed to quickly identify these patients based on documentation in the medical record.
After an extensive review of current research and best practices, the nursing team implemented a pilot project on the orthopedic unit. The pilot project included three key interventions for this patient population: bed in lowest position, increased monitoring of the patient and safety of their environment, and most importantly, a set of floor mats. These padded floor mats were placed around the patient’s bed or chair to reduce the impact of a potential fall.
Initial success on the orthopedic unit led to expansion of the project to the neurology and urology units. Falls with injury dropped by over 52% on these pilot units, leading to widespread implementation on all inpatient care areas.
After noting an increase in hospital-acquired pneumonia at Decatur Memorial Hospital (DMH), the Nursing Performance and Outcomes Council initiated a project that identified underperformed oral care, lack of early ambulation and delays in consulting speech therapy as possible factors in the increase.
An action plan and strategies to prevent hospital-acquired pneumonia were developed and implemented on Nov. 30, 2023. A goal was set for 80% of adult acute care inpatients to have an aspiration risk assessment completed within 24 hours of admission. An additional goal called for 95% of ventilated patients to have oral care documented every four hours.
As a result of that work, nursing leaders are now monitoring compliance with aspiration risk assessments for all adult acute care inpatients, as well as oral care for ventilated patients.
“Our goal is to decrease hospital-acquired pneumonia rates by 30% in the coming months,” said Stacey Taylor, MSN, RN, Director Professional Nursing Practice. “We believe these interventions can help us meet and even exceed that goal.”
Cesarean deliveries carry both short- and long-term risks such as surgical site complications, longer length of stay, higher cost of care and morbidity risk in future pregnancies.
The Illinois Perinatal Quality Collaborative launched a statewide initiative to increase the number of vaginal births to optimize maternal and neonatal outcomes.
As part of this initiative, the Springfield Memorial Foundation provided funding in 2023 to have labor nurses from across MH participate in specialized training called Spinning Babies, taught by a nationally recognized instructor. This course provides nurses with techniques to help mothers labor effectively and increase their chances for a vaginal delivery. As a result of this training and engagement with patients in promoting vaginal delivery, the SMH rate of babies delivered by C-section is 3% lower than the statewide goal.
“It’s encouraging to see C-section rates continue to decrease as a result of this training,” said Kathy Patrick, MBA, BSN, RNC-MCC, BC-NE, PMH-C, SMH nurse manager.
Caring for families who experience perinatal loss is difficult and requires an in-depth understanding of the dynamics of grief and confidence in supporting families facing such a terrible loss.
MH is fortunate to have a nurse leader certified as a Perinatal Loss Instructor who provides classes to MH nurses, chaplains and social workers to become Perinatal Loss Coordinators.
With support from a 2023 grant from the Springfield Memorial Foundation, participants can attend the class and receive all course materials free of charge. The perinatal loss course equips caregivers to share information on attachment, relationship-based care, dynamics of grief, photography and memory-making, as well as the simple “do’s and don’ts” to avoid inadvertent harm and trauma to families.
“All of us are proud of the support we offer to grieving families after the loss of their baby,” said Patrick. “While it is an extremely difficult situation for everyone involved, this support is an essential component of comprehensive maternal services.”
The LMH nursing team, which received its first Pathway designation in 2019, is one of 201 nursing teams across the world to have earned this designation and one of only two in Illinois.
This redesignation is a testament to LMH’s continued commitment to providing extraordinary care to our patients and communities and building a positive practice environment where nurses and the entire interdisciplinary team are valued for their skill and expertise.
The acute care unit at TMH strives to create great patient outcomes.
To engage all nursing colleagues in the department with quality improvement efforts, the unit began sharing department results for all nursing colleagues to view. Colleagues can compare their own performance (anonymized with a “secret number” for privacy) with other individuals in the department. This data is shared with the nurse manager, who holds individual meetings with nursing team members to recognize good performance and identify areas for improvement.
“Our nursing team members on acute care are committed to improving performance to ensure the best outcomes for our patients—not only as a team, but also as individuals,” said Vicki Myers, MAL, BSN, RN, Acute Care Manager.
In May 2023, JMH received its fourth consecutive Magnet designation from the American Nurses Credentialing Center (ANCC).
The ANCC Commission on Magnet gave JMH special recognition in several areas, including interdisciplinary collaboration within the Memorial Pain Clinic at JMH.
The Pain Clinic nursing team and physicians collaborated to investigate alternative pain relief methods after a community health needs assessment found a high rate of substance use disorders, including opioid use, in the community. The team began administering lidocaine intravenous infusions to help decrease the number of opioids prescribed and reduce the dependence on opioids for patients with chronic pain. Lidocaine intravenous infusion has been shown to be successful in controlling pain for patients with opioid dependency when other approaches have failed.
A team of clinical nurses conducted an audit to determine if patients received relief from pain after they received the infusion. They reviewed 137 charts to gather data on the patients’ pain scores before and after lidocaine infusion. They found that the overall average pain score reported by patients was 6.3 on a 0-10 scale prior to receiving the lidocaine infusion. After the infusion, the average score dropped to 3.4, showing that patients’ perception of pain decreased almost 50% after receiving a lidocaine infusion.
In response, clinic staff increased the availability of lidocaine infusions at the clinic. The infusions are now offered two days a week and can be administered to three patients at a time.
“I am proud of how our lidocaine infusion clinic has grown,” said Ashley Hood, RN. “I have seen how lidocaine infusions have significantly reduced our patients’ pain and increased their quality of life. I have had patients tell me that it has changed their lives. It is these great patient outcomes that make my job so rewarding.”
Smartphones are a major part of everyday life—and they are an important tool in the clinical setting as well.
When Taylorville Memorial Hospital (TMH) opened a new state-of-the-art nursing unit in 2020, they incorporated smartphones into clinical care. In 2023, a large electronic health record integration project led two additional MH hospitals in Lincoln and Springfield to put smartphones in the hands of every nursing team member. DMH and JMH will incorporate smartphones in late summer of 2024.
Through mobile applications, clinical teams can make calls through an active phone directory, send secure messages to physicians, communicate information about work assignments, answer call lights and talk to patients in their rooms. As mobile applications continue to expand in healthcare, MH nurses are in a prime position to adopt innovations and improvements in hospital workflows.
“Smartphones can be a powerful tool for communication,” said Cindee Fassero, MSN, RN, NE-BC, SMH director of nursing operations. “Their use continues to transform how we work.”
For many patients, a successful transition from hospital to home requires good communication and collaboration among their care team. This includes a willingness to involve the patient in goal-setting and discharge planning.
On Nov. 1, 2023, Taylorville Memorial Hospital (TMH) instituted weekly interprofessional care meetings for all patients in the hospital’s Swing Bed unit. These meetings are attended by the patient, their family member(s), primary care nurse, physician, care management nurse, discharge planner and nurse educator and rehabilitation services (if involved). Attendance at these meetings has exceeded the goals set by the project leaders, who have received positive feedback from patients, families and TMH colleagues.
“It’s important that patients and their loved ones feel a sense of ownership in their care,” said Missy Keiser, MSN, RN, CNML, Perioperative manager. “These meetings help them become more involved and give them a more powerful voice while improving outcomes once they return home.”