Contributions of Banner Professional Nursing

Banner Estrella Medical Center (BEMC) received the prestigious Magnet designation in October 2015. Exemplars mentioned from the American Nurse Credentialing Center included the robust nursing succession planning and the interdisciplinary team collaboration.  Below are examples of professional nursing contributions in relation to the Banner Health Professional Practice Model (PPM).  Banner Health’s PPM is foundational in creating a professional practice environment and is imbedded within the structures and processes of BEMC. The PPM is a structure for nurses that supports the development of professional nursing practice and promote excellent patient care experiences.

Patients

• Head Shaping positioning device: nurses are educated in the evidence-based practice to correct dolichocephaly by using an infant head shaping positioning device in the Neonatal Intensive Care Unit (NICU).  The Banner Health Nursing Development Funds provided a grant to the NICU for the purchase of the positions devices and a caliper to obtain the Cranial Index. The practice change has proven to be beneficial in the NICU and increased awareness of health shape deformities throughout the NICU.
• Banner Dysphagia Screening Tool validated: BEMC was one of four Banner Health facilities to research and validate a dysphagia screening tool utilized by nursing to screen patients for dysphagia with prolonged mechanical ventilation. The dysphagia study was published in the American Journal of Critical Care and is being disseminated nationally and world-wide.
• VAN Screening tool added to ED nursing practice: to aid in quicker identification of large vessel occlusions of stroke patients, nurses at BEMC are educated to use an additional screening that is quick, effective and requires no calculation of scores: The Vision, Aphasia, and Neglect (VAN) screen tool. The VAN assessment tool aids in quicker identification of large vessel occlusions; thereby, aiding quicker transferring times for patients needing a higher level-of-care facility sooner when indicated.

Profession

• Diffusion Program: Banner Estrella Medical Center is focused on helping their employees develop resiliency in today’s fast-paced environment.  A program was created, developed and implemented to support all health care team members throughout any stressful or unanticipated event that may impact emotional well-being. The program helps to prevent burnout and build resilience. Care carts are also available to use when any unit or situation calls for a little extra care to care for BEMC employees after a stressful event.
• Shared leadership: Banner Estrella Medical Center has a robust interdisciplinary shared leadership (shared governance) program in individual departments as well as the facility-wide shared leadership committee. Recent projects that the BEMC (‘House’) shared leadership have collaborated and delivered: St. Mary’s food drives, employee car washes to donate either money or used healthcare equipment to the Southwest Lending Closet, selection of monthly STARS recipient (recognition program for individual and/or  a group award each month), patient supply rooms standardization, yearly Shop-n-Swap of hospital office supplies, Stairwell beautification project, EBP project resulting from Nurse Attitudes and Practices Promoting Sleep Study, development of a ‘Compassion Cart,’ ‘Scrubs Day’ where people bring in pairs of mildly used to staff members who need a pair scrubs, equipment labeling per unit/floor with color coding, and  labeling of orthopedic recliner. These projects are among the many that shared leadership has delivered at BEMC.
• RN recognition: Banner Estrella values their nurses and is privileged to honor and celebrate the many wonderful ways nurses contribute to the delivery of excellent patient care. Some of the ways BEMC recognizes outstanding nurses is through quarterly celebrations honoring nurses with The DAISY Award, annual Nurses Day celebrations and Awards and in the monthly Professional Practice e-update newsletters recognition section that honors BEMC nurses’ milestones for RN’s who: hold positions/offices in professional nursing organizations, publish, present at conferences, complete research or an evidence-based practice projects, earn a higher degree or obtain a national certification. Each unit has a beautiful and special recognition wall that was designed by clinical nurses and their collaborative partner in the security department (shared leadership) to honor each registered nurse who has taken their exam and received national certification for the specialty of their practice. Banner Estrella Medical Center registered nurses are also recognized for their research/EBP/PI work when receiving acceptance for conference posters and podium presentations through the support of educational funds. Additionally, nursing research Grant Awards recognize registered nurses and occurs each year if a BEMC RN submits and is selected for a grant for research, EBP or PI project. These grants are provided by the Nursing research Grant Awards from the Better Together Campaign, Nursing Development Fund.

Society

• Neonatal Intensive Care Parent Advisory Council: this council is an outreach of former NICU babies’ parents to new parents while collaborating with staff to provide enhanced emotional support to parents and families of Banner Estrella Medical Center’s tiniest patients. Examples of the council’s influence include a change in visiting hours and an increased number of NICU visitors allowed in the unit at one given time. The Neonatal Intensive Care Unit is open 24 hours/ 7 days a week and up to four (4) individuals may now visit the infant’s bedside at the same time. Other changes from input of the council has provided an improvement to the discharge process and the adoption of EBP Kangaroo Care (an evidence-based practice and technique for holding a baby skin-to-skin with their mother or father). The council is a wonderful mechanism for NICU patient family members to collaborate with other new parents and the nursing staff to enrich the care environment for BEMC’s tiniest patients.
• BEMC Patient Family Advisory Committee: this committee was established in September 2018 and includes community members from Phoenix, Goodyear, Avondale, Tolleson, Buckeye and Palo Verde. The committee’s work started with the development of a charter mission, vision and bylaws.  Discussions of the importance of caregivers’ understanding of their impact on patients and families motivated the committee to develop a program on Sensitivity Awareness Training  and presented the program by committee members to BEMC’s New Grad Forums. Other accomplishments include feedback on a new template for the ‘white board on the shower door’ project, review of the Discharge Packets that was developed by the Medical/Surgical department, and impressions on the new Banner Dress Code. Banner Estrella’s registered nurses value the committee’s views, suggestions and assistance in making healthcare easier so that life can be better so for community in which BEMC serves.
• OB-ESI Tool developed and evaluated through research study at BEMC: a four-level classification Obstetric Emergency Severity Index (OB-ESI) triage tool was developed, implemented and evaluated. This tool helps nurses to accurately triage and prioritize OB patients so that the most acute patients receive care in a timely manner. The OB-ESI became a part of Banner Health’s electronic medical record documentation in 2019 and the tool is being disseminated through a professional journal manuscript submissions and nursing conferences in Arizona. The goal is that the tool will be disseminated and used across the nation.

Information coming soon! 

As a three-time Magnet®-designated facility, Banner – University Medical Center Phoenix (BUMCP) values and supports nurse autonomy, professional growth, and the generation and implementation of new nursing knowledge through evidence-based practice and nursing research. BUMCP nurses are recognized for their contributions to patients, the nursing profession, and society at large.  

Contribution to Patients: BUMCP nurses provide patient-centered nursing care using process improvement and evidence-based practice methods to achieve excellence in patient outcomes. Nursing care delivery is based on the principles of human caring, defined by Joanne Duffy’s Quality Caring Model. 

Examples include: 

• Personal Care Folders to assist patients in transitioning from hospital to home
• Nitrous oxide administration to reduce pain in laboring women
• Aromatherapy to reduce post-op nausea & vomiting in the PACU
• Care coordination across the healthcare continuum for patients with Cystic Fibrosis
• Hypoglycemia rate reduction in Medical-Surgical patients
• Process changes to reduce door-to-treatment times in acute CVA patients arriving in the Emergency Department
• Research study supporting the use of abdominal binders by post-operative cesarean section women to reduce pain and improve satisfaction
• Early mobility of geriatric patients in Medical-Surgical units to reduce hospital length of stay
• Implementation of infant-directed feedings to maximize oral intake for premature neonates in the Neonatal Intensive Care Unit (NICU)
• Implementation of new external urinary catheter for females to reduce indwelling urinary catheter days and catheter-related complications 
• Use of oral glucose gel in hypoglycemic newborns to reduce insertion of intravenous lines and nursery admissions 
• Clinical nurse involvement in improvement teams to reduce hospital-acquired complications, such as patient falls, pressure injuries, and central line and urinary catheter-related complications.
• Nurse staffing adjustments are made based on patient populations and acuity

Contribution to Profession: BUMCP nurses are supported to practice at the highest level within their scope of practice. As such, professional development is valued and promoted, and nurses create and implement innovative practices based on empirical data. BUMCP nurses collaborate with the interprofessional health care team and are recognized internally as well as externally to the larger community

Examples include:

• Tuition assistance and scholarships support nurses to advance their formal education, with 71% of the BUMCP nursing workforce prepared at a BSN or higher level
• Financial and study support is provided to facilitate nurses obtaining national certification, with 33% of eligible nurses nationally certified
• BUMCP offers a Clinical Ladder to recognize direct care BUMCP nurses for their level of expertise and advancement in contributing to patients, profession, and society.
• Continuing nurse education is offered through online and in-person platforms, including CE Direct and monthly Nursing Grand Rounds, respectively
• Shared Leadership councils drive department- and organization-level improvements such as the Hybrid Shift Report Transition process, patient whiteboards in the new patient tower, and unit-based education councils.
• BUMCP partners with the DAISY Foundation to recognize nurses who go above and beyond in providing compassionate, excellent patient care.
• BUMCP RN satisfaction performance, reported by the National Database of Nursing Quality Indicators (NDNQI), outperforms the national mean for all subscales on the Practice Environment Scale, the Job Enjoyment Scale, and Nurse Autonomy measure.
• Implementation of a Behavioral Emergency Response Team to deescalate disruptive behavior of patients with psychiatric diagnoses admitted to Medical-Surgical units
• Dissemination of nursing research and evidence-based practice to the greater nursing community through robust presentation and publication portfolio

Contribution to Society: BUMCP Nurses collaborate with internal and external partners to influence healthier patient populations. Examples include:

• Internal process improvement projects to ensure timeliness of care, such as:
  • Discharge coordinators to promote accuracy and timeliness of hospital discharge
  • Administration of Hepatitis C Vaccinations to reduce treatment wait times for Liver Clinic patients
  • Enhanced Recovery process for Cesarean Section patients to reduce hospital length of stay
  • Reorganized clinic space to promote efficiency in patients undergoing elective Transesophageal Echocardiogram (TEE) procedures
• Nursing research and evidence-based practice are at the core of BUMCP nursing. Ongoing projects in both have changed practice within Banner Health, as well as the larger nursing community through projects such as:
  • Peanut Ball for Laboring Women research study to reduce cesarean section rates
  • Research study to identify Compassion Fatigue in Nurses. Subsequent evidence-based practice interventions to address/ offset Compassion Fatigue
  • Evidence-based project changed IV site rotation practice across Banner Health
  • Nurse-driven protocols, such as indwelling urinary catheter removal, oral care to reduce mucositis in oncology patients, and a hypertension protocol for obstetrical patients
• BUMCP nurses promote healthier communities through various projects and partnerships:
  • BUMCP Trauma outreach programs, including distracted/ drunk driving program and bicycle safety for children
  • Arizona Opioid Assistance & Referral Line operated by BUMCP’s Poison and Drug Information Center
  • March of Dimes fundraising
  • American Heart Association fundraising
  • Partnership with Ben’s Bells and Arizona Donor Network to provide emotional support to families considering organ donation