2021 Nursing Annual Report

COVID-19 vaccine distribution

Since the beginning of the COVID-19 pandemic in 2020, Children’s Minnesota nurses have been at the forefront of response efforts. Some of the most skilled nurses with previous experience managing outbreaks became leaders on the Hospital Incident Command System (HICS) team: Patsy Stinchfield, MS, APRN, CPNP, CIC, Senior Director of Infection Prevention and Control; Adriene Thornton, MA, RN, CIC, FAPIC, Infection Preventionist; Wendy Berg, BSN, RN, CIC, Infection Preventionist; and Joe Kurland, MPH, CIC, Vaccine Specialist. The HICS team was charged with coordinating a system-wide response to the pandemic, including monitoring and implementing recommendations from the Centers for Disease Control and Prevention (CDC) and the Minnesota Department of Health (MDH). Vaccine eligibility changed quickly; in a matter of months, guidelines expanded multiple times, requiring the team to develop new processes to support.

To provide as many COVID-19 vaccines as possible, Children’s Minnesota’s vaccination efforts were extensive. Teams first set up vaccine sites at the Minneapolis and St. Paul campuses before moving vaccines to the primary care clinics. Clinic hours were extended at the St. Paul campus and West St. Paul clinic to accommodate families. Vaccine clinics were coordinated with the Minneapolis YMCA. The Children’s Minnesota mobile clinic administered vaccines in Brooklyn Center, an initiative that was coordinated with Brooklyn Center Community Schools, the Brooklyn Center Community Center and Representative Ilhan Omar.

Noting lower vaccination rates for people of color, Stinchfield, Thornton and Mona Rippy, quality and safety patient experience coach, prioritized health equity efforts by engaging teams within Children’s Minnesota and in the community to provide education about vaccine safety, efficacy and the impact of COVID-19 on communities of color.

Thornton partnered with Dr. Zeke McKinney, program director for HealthPartners’ Occupational and Environmental Medicine and lead researcher for the Astra Zeneca COVID-19 vaccine trial at HealthPartners, to provide community education during radio programs, news interviews and podcasts. Thornton’s work with Black Life Amplified, a virtual town hall meeting that discussed the impacts of COVID-19 on Black Minnesotans, is also among her many efforts to reach people with accurate information.

In 2021, more than 10,000 vaccine doses were administered by Children’s Minnesota nurses and other staff. By November 2021, Children’s Minnesota reported 99% of employees were vaccinated or had an approved exemption. The expertise and outbreak-related knowledge of Children’s Minnesota nurses and staff has led to evidence-based practices for all health care providers and extraordinary care for our patients, their families and employees across the organization.

Staffing model reinvented to improve readiness for care

In March 2021, Children’s Minnesota took a closer look at its nurse staffing model and began making strategic changes to improve readiness for patient care.   

Prior to COVID-19, Children’s Minnesota’s nurse staffing models hadn’t required much calibration thanks to relatively stable patient volumes year over year. But in the wake of upheaval from the pandemic, uncertainty around organization staffing and forecasts for a rare summertime surge of respiratory syncytial virus (RSV) cases, Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer and senior vice president of patient care services, and colleagues recognized a need for more detailed census and staffing models.   

The team developed a complex model that takes into account census forecasts and available staff to yield data-driven predictions for staffing needs in an area at any given time. The algorithm predicts each unit’s census based on scheduled surgeries, emergency department volumes, acuity and average length of stay to identify how many nurses and clinical support associates will be needed for each shift in the upcoming week.  

Additionally, unit leaders input information about open positions, new hires and onboarding to better see where staffing needs are prevalent. With the findings from this detailed analysis, nursing leaders collaborated with human resources partners on strategies to ramp up recruitment. They also adapted the application and interview process to allow nurses to select more than one care area, which widened opportunities for both employer and employee.   

To further improve readiness for care and patient safety and comfort, Children’s Minnesota is investing in strategic and operational management to guide the flow of patients, develop staffing plans, and more closely review processes. In November 2021, Njau restructured nursing leadership to add a Director of Clinical Operations role. This role will be critical to continue overseeing and improving patient flow and staffing resources management.   

A caregiver wearing blue scrubs with a mask and face shield uses a stethoscope to examine a child on a hospital bed.
A woman with medium length blonde hair is speaking to the camera. At the bottom of the screen it says: Masha Bowen, APRN CNP DNP Pediatric Nurse Practitioner, Children's Minnesota Trauma Team.
The left side of the image says Bedside Handoff: Where and how the injury occurred, additional injuries, interventions thus far, vital signs and trends, pain management and support needs. on the right side shows a child in a hospital bed wearing a gown.
A woman with long blond hair pulled back, wears goggles, a mask and a face shield is speaking to someone who is blurred and partially off screen. On top of the image there is text that says "How the injury occurred."

Video developed to strengthen trauma care  

As the system that cares for more injured children than any other in Minnesota, Children’s Minnesota is responsible for delivering the most specialized care for pediatric trauma patients. That responsibility requires ongoing, high-quality education.   

In 2021, experts in nursing, trauma care and communications developed an educational video focused on pediatric trauma assessment in the acute care setting. Constructive feedback from staff on existing education materials, the evolution of trauma care on both Children’s Minnesota hospital campuses, the ongoing trauma education needs for inpatient staff and the release of new education requirements by the Minnesota Department of Health for Level 4 trauma centers all uncovered a need for this new educational content.   

Nursing trauma experts, Mariya Bowen, DNP, CPNP-AC/PC; Erin Janushka, BAN, RN, CPN; and Sara Wiplinger, MN, RN, CCRN-K, led this collaborative project with marketing and communications, trauma services, and the Center for Professional Development and Practice. The team developed an educational video that demonstrates key considerations in assessing a patient with traumatic injury while highlighting the continuum of care for children including integration of social work, chaplaincy and child life services. Additionally, the video is shorter, more engaging, easily trackable and available through Self-Service, and more targeted to nurses at the bedside.   

Nursing trauma experts collaborated with Chris Phillips, visual marketing consultant, to develop a script, identify actors and record the various components of the assessment of a trauma patient in the acute care setting. Recording was completed in the simulation lab at the Children’s Business Center. Several family members of Children’s Minnesota staff were included as actors, and care was taken to ensure all actors were representative of the diverse patient population that Children’s Minnesota serves.   

This educational recording is now available on Children’s Minnesota’s intranet. To date, more than 100 nurses have viewed the recording and it is used for onboarding nurses in units that will care for injured children.    

Trauma care video project team

  • Mariya Bowen, DNP, CPNP-AC/PC, Pediatric Nurse Practitioner, Trauma Services
  • Angela Chen, BSN, RN, CPEN, CPN, TCRN, Clinical Educator, Emergency Department Minneapolis
  • Family members of Laura Plasencia, Angela Chen and Ruti Doto
  • Erin Januschka, BAN, RN, CPN, Clinical Educator, 6th floor Minneapolis 
  • Farron Kennedy, M. Div., Staff Chaplain, Spiritual Care
  • Janet Logid, MAN, RN, NPD-BC, CPEN, Clinical Education Specialist, Center for Professional Development and Practice
  • Chris Phillips, Visual Marketing Consultant, Marketing and Communications
  • Laura Plasencia, MPH, BSN, RN, TCRN, Manager, Trauma Services
  • Faith Pyne, BSN, RN, Clinical Nurse, 6th floor Minneapolis
  • Mary Sicoli, BSN, RN, Clinical Nurse, Emergency Department Minneapolis
  • Sara Wiplinger, MN, RN, CCRN-K, Clinical Practice Specialist, 5th floor St. Paul
  • Inesa Zbarouskaya, MSW, LICSW, Social Worker

Arctic Sun® Temperature Management System improves care

 The Arctic Sun® Temperature Management System is a noninvasive system that controls and monitors body temperature in the range of 32°C to 38.5°C. It’s used to induce mild hypothermia or maintain normal temperature in an effort to prevent secondary brain injury and improve neurological outcomes following a hypoxic-ischemic event. 

Children’s Minnesota nurses choose a more effective temperature management system  

The Arctic Sun project was identified based on nursing anecdotal reports of the cooling blankets malfunctioning, being difficult to use, and not maintaining targeted temperature without significant effort and manipulation of the blanket. This indicated the need for a more reliable, effective and easy-to-use temperature management system to cool or maintain target temperature for post-cardiac arrest, brain injury and very high fevers.   

After researching and reviewing various systems, Melanie Kuelbs, DNP, APRN, PCNS-BC, CCRN-K, clinical nurse specialist in the pediatric intensive care unit, proposed trialing the Arctic Sun Temperature Management System. The literature showed patients achieved target temperature in a timely manner, maintained target temperature, experienced decreased shivering and had no adverse skin injury.   

Several disciplines participated in assessing the appropriateness of the Arctic Sun from their particular lens. The various disciplines involved in the assessment process included neonatal, pediatric and wound ostomy nurses; neonatologists and pediatric intensive care providers from both Minneapolis and St. Paul; cardiac ICU; radiology; and supply chain. The team was led by Melanie Kuelbs, Heidi Shafland, Jennifer Rivera and Kristin McCullough.   

Results of the project

Since the product was launched in May 2021, data indicates quicker times to target temperature, improved maintenance of target temperature, and once the patient reaches the target temperature, only variations of 0.1 degrees are recorded. Clinical nurses have noted decreased shivering and fewer requirements for additional sedation and muscle relaxant.   

Project team

Nurses became superusers and trained other coworkers to utilize the Arctic Sun. Nurses from each unit — cardiovascular intensive care unit (CVICU), pediatric intensive care unit (PICU), and neonatal intensive care unit (NICU) in St. Paul and Minneapolis — trialed the product and approved how it functioned and maintained the correct temperature.  

Project team members 

  • Julie Graczyk, MSN, RN, Clinical Educator, NICU St. Paul  
  • Karen Jackson, RN, Clinical Educator, NICU Minneapolis 
  • Deanna Johnson, MA, APRN, CP, WOCN, Skin Integrity Nurse Practitioner, Wound Ostomy Care   
  • Melanie Kuelbs, DNP, APRN, PCNS-BC, CCRN-K, Clinical Nurse Specialist, PICU   
  • Kristin McCullough, MS, APRN, ACCNS-N, Clinical Nurse Specialist, NICU St. Paul   
  • Amanda Melin, MSN, RN, Clinical Educator, PICU Minneapolis   
  • Ann Marie Nie, MSN, APRN, CFNP, CWOCN, Skin Integrity Nurse Practitioner, Wound Ostomy Care   
  • Jedd Nivala, BSN, RN, CCRN, Clinical Educator, PICU Minneapolis  
  • Jennifer Rivera, DNP, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist, NICU Minneapolis  
  • Lisa Sanford, BSN, RN, Clinical Educator, PICU St. Paul   
  • Heidi Shafland, MSN, APRN, ACCNS-P, CCRN-K, Clinical Nurse Specialist, CVICU    
  • Chris Willett, MSN, RN, CCRN, Clinical Educator, Cardiovascular ICU   

Behavioral health opens the Partial Hospitalization Program

Even before the COVID-19 pandemic, the need for acute mental health services for kids was on the rise across the nation. Parents were increasingly bringing their kids to emergency departments for primary mental health concerns. Demand for outpatient care was also surging. By March 2021, a year after the start of the pandemic, there was a 30% increase in the number of children needing emergency mental health care over the previous year, and approximately 50% more kids were admitted for a mental health crisis.   

In June 2021, Children’s Minnesota launched a new intensive outpatient mental health day program called the Partial Hospitalization Program (PHP). Located in Lakeville, the PHP serves as a bridge between inpatient and outpatient care, allowing adolescents ages 12 to 18 to receive acute mental health care without needing to be in a hospital. For some kids, the PHP is a transitional phase after they leave inpatient care but before they return to school. For others, the PHP is a step up in care when weekly or bi-weekly outpatient services aren’t enough.   

Nursing plays a central role in PHP programming. Nurses provide ongoing assessment, intervention and education from the initial visit through the duration of the child’s stay. Group programming is led by nurses and focuses on the skills that impact an adolescent’s overall health, including sleep hygiene, nutrition, physical activity and mindfulness practice. Nurses also monitor the patient’s physical health and medication, and work with the interdisciplinary team to ensure all care needs are met while in the PHP.   

The PHP focuses on coping skills and interventions that will allow an adolescent to remain safely in their home, especially during nights and weekends, and successfully transition back to their school or community setting. The program incorporates many modalities of therapy and mental health services, including individual and group activities, family therapy, music, art, recreation, psychoeducation, life skills, and general health and wellness education. The PHP operates Monday through Friday from 8 a.m. to 3:30 p.m. The typical length of stay is two to four weeks.  

Since June 2021, more than 149 adolescents have been assessed for the PHP and 106 completed the program. Planning is underway for a second location in Roseville. It is expected to open in early 2023. 

Partial Hospitalization Program team

  • Sarah Boman, DNP, APRN, Psychiatric Nurse Practitioner 
  • Jessica Brisbois, LICSW, Lead Program Therapist
  • Kelly Gandhi, RN, Partial Hospitalization Program Nurse
  • Claire Lindgren, LGSW, Program Therapist
  • Lindsay Nyseth, RN, Partial Hospitalization Program Nurse
  • Mariana Pereyra Pitts, LICSW, Program Therapist
  • Joel Spalding, MD, Medical Director of Acute Mental Health Services and Psychiatry
  • Jordan Weiss, BA, Behavioral Health Associate
  • Jamie Winter, RN, MBA, Director of Behavioral Health

Nurses develop vaccine protocol to boost flu immunizations  

In 2021, Children’s Minnesota clinical nurse Elizabeth Vanney, BSN, RN, led efforts to boost influenza vaccinations —which reduce flu-associated deaths by almost 65% — among emergency department patients. Recognizing the need for higher vaccination rates among all children but especially Black children, who are statistically less likely to be immunized against the flu, Vanney began collaborating with two leaders in health equity initiatives at Children’s Minnesota: James Burroughs, senior vice president, government and community relations, chief equity and inclusion officer; and Alex Heisel, MSLOC, OLCC, CPPS, experience and health equity manager.   

Initial efforts included work group meetings, gathering of internal data and literature review of evidence-based practice. Recognizing the opportunity to implement a nurse-driven protocol, Vanney recruited three other clinical nurses for the committee, including Felicia Addae, RN; Megan Van Hoorn RN, BSN, CPN, CPHON; and Jessica Vikla, RN. The Children’s Minnesota protocol was generated from the evidence-based, nurse-driven influenza vaccine protocol at Children’s Milwaukee that demonstrated great success in their first two seasons; the department vaccinated almost 4,500 children.  

The emergency department influenza vaccine protocol is designed to work in tandem with initiatives in the clinics and inpatient units to improve vaccination rates. Once the design and the implementation process were determined, next steps included educating the emergency department clinical staff regarding the screening for and administering of flu vaccines through a nursing protocol in both Minneapolis and St. Paul EDs. A focus was placed on nursing communication; emails, PowerPoints, FAQs, and just-in-time training were created and utilized in dispersing information and providing education.   

How it works

Nurses screen patients for vaccine eligibility after the patient is triaged in the emergency department. If patients meet criteria, and caregivers agree, the influenza vaccine and optional topical analgesia will be automatically ordered. Promoting a safe, therapeutic environment and advocating for the best interests of individual patients through the co-ordered option for analgesia was an important inclusion within the protocol. The vaccine is then administered at the end of the emergency department visit.    

This opportunity has opened the doors to encourage more authority and freedom for the clinical nurses at Children’s Minnesota. In the first three weeks of implementation, the ED team screened over 1,000 patients for the flu vaccine on both campuses and administered 54 flu vaccines to eligible patients.   

 

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