Structural Empowerment

Clinical nurses have a voice within the UT Southwestern shared governance organizational structure, which is built on a solid foundation of teamwork and collaboration. Shared decision-making and accountability empower nurses with a process for determining professional nursing practice. These organizational standards are developed through staff-led interdisciplinary committees, task forces, and councils to improve patient outcomes and experiences. Nurses at all levels take conscious ownership of patient care, safety, ethics, research, performance improvement, and evidence-based practice. Our shared governance structure supports the practicing nurse as a key decision-maker with a credible, sought-after perspective. This model strengthens practice by supporting relationships and partnerships among clinical areas, providing an innovative and collaborative environment to bolster our quality patient outcomes.

Certifications

UT Southwestern nurses validate their mastery of skills, knowledge, and abilities through certification and meet ongoing learning and practice requirements through recertification. The process assures patients and their families that the nurse caring for them has demonstrated experience, knowledge, and skill in the complex specialty of their care. Nurse certification and continuing education contribute to an environment of professionalism and a culture of retention. Certification also differentiates UT Southwestern from other health care organizations, demonstrating to consumers that we have attracted the most skilled and experienced nursing professionals. By the end of FY 2022, UTSW employed 2,103 specialty certified nurses.

Educational Levels

A significant body of research indicates that a more highly educated nursing workforce can help ensure the U.S. population has access to high-quality, patient-centered care. The Institute of Medicine (IOM) recommends having at least 80% of nurses holding a bachelor’s degree or higher. The UT Southwestern Nurse Executive Board (NEB) Cabinet has been working to increase reimbursements for nurses pursuing higher degrees to encourage their educational efforts while still working. The UTSW Nurse Executive Board is ultimately responsible for putting in place programs and policies promoting higher education for nurses in all areas. As illustrated in the graph on the right, our program has steadily maintained the objective of having at least 80% of our nurses hold a B.S.N., at a minimum.

Total number of RNs with B.S.N. or higher = 2,554

Clinical Ladder

UT Southwestern’s Clinical Ladder process promotes clinical growth, professional growth, and development; addresses recruitment and retention; and encourages and rewards nurses in direct patient care and nonadministrative roles.

“Recognition, reward, and retention of the experienced nurse in positions of direct clinical practice – along with the documentation and adequate description of their practice – are the first steps in improving the quality of patient care.” (Patricia Benner, M.S., RN, “From Novice to Expert.” American Journal of Nursing, 82(3), 1982, p. 407.)

The UTSW Clinical Ladder is open to all clinical nurses involved in direct patient care.

Education Outcomes

Clinical Education and Professional Development (CEPD) and the Department of Ambulatory Clinical Education and Professional Development both support nursing and therapy staff members across inpatient and ambulatory areas, advancing the philosophy, mission, and vision of UTSW Nursing Services. In 2022, a group of dedicated educators committed to excellence in education put into place the Nursing Professional Development Practice Model (ANPD, 2016) to leverage learning to meet and exceed organizational outcomes.

UT Southwestern Nursing Professional Development (NPD) practitioners are master’s-degree-level prepared in nursing education and require NPD certification within 18 months of hire. NPD practitioners operationalize environmental scanning, proactively plan educational programming, and work collaboratively with unit-based educators and clinical educators on both teams to meet the learning needs at the individual, unit, and organization level. Unit-based educators and ambulatory clinical educators are registered nurses with a minimum of a bachelor’s degree plus clinical expertise specific to the units and clinics they support.

Resuscitation Quality Improvement (RQI) Program

The UT Southwestern Resuscitation Quality Improvement (RQI) program is an authorized American Heart Association training center providing Heartsaver, BLS, and ACLS courses to UT Southwestern employees and students. In 2022, we continued expanding our off-site clinic and additional locations so clinical staff across the UTSW system were able to participate in the RQI program. The program now serves more than 5,600 staff members with hands-on skills training each quarter within their clinical area, along with onsite classroom BLS, ACLS, and Heartsaver courses, serving more than 1,000 additional staff.

RQI Program

NRP Neonatal Resuscitation Improvement Program

The Neonatal Resuscitation Program facilitated a total of 23 classes, including classes for the nurse residents and fellows. The NRP program has fully transitioned to the RQI platform. In 2022, a total of 146 participants completed NRP classes including 17 residents and fellows. This is the 2022 course and participant breakdown below:

• NRP Essentials – 10 classes, 87 participants
• NRP Advanced – 10 classes, 42 participants
• NRP for Residents – 3 classes, 17 residents

Transition to Practice

CEPD continues to lead three practice transition programs. The UTSW Nurse Residency Program is accredited by the American Nurses Credentialing Center (ANCC) Practice Transition Accreditation Program. In 2022, the program’s ambulatory track added more graduates. In addition, our Patient Care Technician (PCT) Residency Program partners with Dallas College under the “You’re Hired” grant from the U.S. Department of Labor to expand apprenticeship programs. Throughout 2022, more than 300 nurses and PCTs were hired into the practice transition programs, including:

• 277 nurse residents
• 63 RN fellows
• 33 PCT residents
• 8 MOA residents

Improving Patient Discharge Times on 10 Blue

Patients needing to be discharged after a lung transplant procedure require a complex coordination of a multidisciplinary care team. Data collected on the lung transplant recipient discharge process revealed there might be some delays in the process that could be improved. A task force was created to perform a gap analysis and evaluate reasons for delays. The team was also responsible for designing strategies to meet earlier discharges.

During the study period from October 2020 to August 2022, 933 lung transplant recipients were discharged from the hospital. The data collected came from three categories: discharge order time (DOT), actual time of discharge (ADT), and reasons for discharge delay. Frequent barriers for delay of discharge included transportation, medication delivery, laboratory work, and placement of discharge orders by the provider team. Interventions for improvement included priority discharge rounding, collaborative communication with care coordination, and beginning patient education at the time of admission; all were implemented as strategies. At the beginning of the study period, the mean discharge order time and actual discharge time was between 13:10 and 15:17. As of September 2022, the mean DOT and ADT remained at between 12:49 and 15:16.

Residency Program Aims to Set Up Medical Office Assistants for Success in Ambulatory Clinics

Nurses on 12 Blue identified responsiveness to patients' needs as a top priority for their unit. Helping geriatric patients get to the toilet as soon as they want was one way the team could improve this operational goal. After consulting with UTSW geriatricians, nurses found existing literature addressing falls related to toileting but no information addressing the quality aspect of the patient’s perception of responsiveness. The unit addressed this issue in part by having nurses use the Hester Davis fall risk assessment to score patients on urgency. Those who scored as having urgency were enrolled in a scheduled toileting program where the patients were taken to the bathroom every hour.

Nurses used a teamwork approach in getting their patients to participate in the toileting program. Early in the project, a challenge was issued to use the chat function (in Epic) to engage all team members because it is probable that both the primary nurse and the patient care technician (PCT) are in different rooms at the same time. The charge nurse had an Epic report of patients with this risk factor; they notified the health unit coordinator (HUC) so that person could give the hourly toileting form to the oncoming RN. The primary RN coordinated with the PCT to toilet with the patient at the top of the hour. The team used clear and supportive communication with the patient, such as, “I am here for your hourly rounding. Let’s go to the bathroom; I have the time.” Caretakers were encouraged to stay in the room and provide moral support. If the patient continued to decline toileting, nurses encouraged the patient to attempt double voiding to see if that would help with emptying the bladder.

Creating a Multidisciplinary Approach to OR Configurations on L&D

The workflow for the OB anesthesia team is critical to the success of the Labor & Delivery services on 5 Blue. In 2021, the operating rooms on the floor were adjusted to improve the needs of the anesthesia team as the sole focus of the new OR configuration. As time passed, circulating nurses, surgeons, and OB surgical technicians spoke up about how the configuration was not working for all. Some of the issues identified included increased risk of cross contamination, difficulty in accessing needed supplies, patient privacy concerns, and increased difficulty getting the patient on the OR bed emergently. An OR Reconfiguration Task Force was organized to meet the needs of all key stakeholders and produce a multidisciplinary approach to make adjustments.