2021 Nursing Annual Report

EBP Council supports nurses’ pursuit of excellence

Children’s Minnesota nurses pursue excellence in their practice by continually asking, “Is there a better way?” Answering that question is the goal of evidence-based practice, a framework for holistic care that takes into account research, clinical findings and patients’ values. The Research and Evidence Based Practice (EBP) Council at Children’s Minnesota promotes integration of EBP into practice. The council also supports nurse-driven research and EBP projects by providing education and resources as they investigate evidence, make practice recommendations and implement changes.   

In 2021, the council expanded access to the Nursing Journal Club, which provides all nurses the opportunity to discuss recent literature with a focus on applicability to practice at Children’s Minnesota. They also revised the Nursing Research, EBP, and Innovation pages on the Children’s Minnesota Nurse Web, supported the launch of a new EBP cohort, and developed guidelines for student projects to better align with the organization’s strategic goals.   

The council is open to any nurse with an interest in EPB nursing research and innovation.

Council members

  • Pamela Barnard, MSLS, Librarian, Allina Library Services
  • Jennifer Barry, BSN, RN, Patient Care Manager, 5th Floor Neurosciences St. Paul
  • Roberta Basol, MA, RN, NE-BC, Senior Director, Center for Professional Development and Practice
  • Nicole Beckman, PhD, APRN-CNP, Director of Clinician Experience, Hospital Medicine Program
  • Ana Brown, BSN, RN, CCRP, Nurse Case Manager, Cancer and Blood Disorders Clinic
  • Andrew Crow, MSLS, Librarian, Allina Library Service 
  • Rebecca Ebert, BSN, RN, BCLC, NCC, Clinical Nurse, Lactation Support Program St. Paul
  • Shayna Fleming, DNP, RN, CNOR, Clinical Practice Specialist, Perioperative Services
  • Julie Graczyk, MSN, RN, Clinical Nurse, NICU St. Paul 
  • Amy Hoelscher, DNP, RN, ROP Program Manager, ROP
  • Casey Hooke, PhD, APRN, PCNS, CPON, FAAN, Associate Professor, University of Minnesota School of Nursing
  • Theresa Kenzie, BAN, RNC, MLT, Clinical Nurse, NICU St. Paul 
  • Song Khang, BSN, RN, CPN, Clinical Nurse, Nursing Informatics
  • Jarell Koras, MSN, RN-BC, CPN, CLC, Nursing Excellence Program Manager, Center for Professional Development and Practice
  • Kim Lorence, MS, RN, CPNP, NPD-BC, Clinical Education Specialist, Center for Professional Development and Practice – Chair 
  • Emily Petermeier, BSN, RN, RNC-LRN, CLC, Clinical Nurse, Float Team Minneapolis
  • Jennifer Rivera, DNP, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist, Neonatal Services Minneapolis

Neonatal Neuroprotective Care Committee advances standards of care  

Beginning in 2019, the Neonatal Neuroprotective Care Committee at Children’s Minnesota continued its work to ensure a standard of neuroprotective care for all babies. This includes strategies and interventions to help babies who are receiving neonatal care to better conserve energy, grow stronger, sleep better and stay on track for the maturation of their brains and nervous systems. The interprofessional committee includes nurses, clinical educators, occupational, speech and physical therapists, clinical nurse specialists, and patient care managers. The committee is led by two clinical nurses: Katie Nitz, BSN, RN, RNC-LRN, NTMC, ICC Clinical Nurse; and Jill Dotzler, RN, CCRN, RNC-NIC, RNC-LRN, NTMNC, CBC, NICU Minneapolis. Neonatal clinical nurse specialists also support the committee and include: Kristin McCullough, MS, APRN, ACCNS-N, C-NNIC, Clinical Nurse Specialist-NICU St. Paul; and Jennifer Rivera MSN, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist – Neonatal Services Minneapolis.  

The committee set a goal to improve positioning in 2021, in conjunction with the implementation of a new product line of positioners by DandleLION Medical™. Positioning refers to how infants are placed in the care setting, ideally providing an encircling supportive structure that allows a baby to push against boundaries and supports their physiological flexion, similar to their experience in the womb. The committee provided visual and video resources as well as a position aid guideline document to reinforce correct use of positioning aids.

As part of improvement efforts, the committee assessed current positioning in the neonatal units using the individualized positioning assessment tool (IPAT). More than 80% of infants were assessed and results will be used to develop content for Neonatal Education Days in the spring.   

The committee also implemented monthly neuroprotective care rounds, in which members rounded in their individual units and debriefed after each session to improve the rounding process. In addition to improving positioning, other initiatives supported by rounding include:  

  • Environment of care: sound and light 
  • Massage   
  • Feeding readiness    
  • Standing transfer   
  • Skin to skin   
  • Swaddle bathing   
  • Safe sleep    

Neonatal Neuroprotective Care Committee members

  • Becky Baker, MSN, RN, RNC, Clinical Educator, Mercy NICU
  • Diane Dingley, MS, CCLS, Child Life Specialist, Child Life Minneapolis
  • Lanae Doiron, RN, Clinical Nurse, SCN
  • Jill Dotzler, RN, CCRN, RNC-NIC, RNC-LRN, NTMNC, CBC, Clinical Nurse, NICU Minneapolis
  • Anna Erickson, BSN, RN, Clinical Nurse, NICU St. Paul
  • Deborah Freeman, MSN, RN, Patient Care Manager, ICC
  • Karen Jackson, RN, Clinical Educator, NICU Minneapolis
  • Zena Jaen, MS, CCC-SLP, Speech Therapist, PM&R St. Paul
  • Jade Kelzenberg, BSN, RN, Clinical Educator, ICC
  • Karen Martin, MAN, RN, CNML, Patient Care Manager, NICU St. Paul
  • Kristin McCullough, MS, APRN, ACCNS-N, Clinical Nurse Specialist, NICU St. Paul
  • Kim Myhre, OTR/L, CNT, CCC-NTMICOT, PM&R Minneapolis
  • Denise Moen, RN, Clinical Nurse, Mercy NICU
  • Megan Nielsen, BSN, RN, Clinical Educator, NICU St. Paul
  • Katie Nitz, BSN, RN, Clinical Nurse, ICC
  • Hannah Pinkerton, BSN, RN, RNC, Clinical Nurse, ICC
  • Heidi Poser, BSN, RN, Clinical Educator, SCN Minneapolis
  • Jennifer Rivera, MSN, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist, Neonatal Services Minneapolis
  • Mary Schwartz, RN, RNC-LRN, BFS, NTMC, CPNNANN, Neonatal Developmental Care Specialist Designation, Clinical Nurse, Neonatal Float Minneapolis
  • Melissa Voicik, RN, BSN, Clinical Nurse, NICU St. Paul
  • Jennifer Volk, OTPM&R Minneapolis
  • Susan Wethern-Kestner, RN, BSN, Clinical Nurse, NICU Minneapolis
A woman in a white jacket faces a crowd with her arms in the air. The crowd smiles and claps while watching her.

This presentation was incredible. It really shifts your perspective and reminds you of the things that truly matter in life, including taking care of oneself. The sincerity and authenticity of the content made all the difference.”
– Wellness conference attendee

Wellness support for nurses during the pandemic 

Nurses are used to working in busy and stressful environments, but the COVID-19 pandemic elevated the stress in hospitals and clinics like many had never previously experienced. Surges of the virus, tight staffing and high patient loads impacted health care organizations nationwide. As a result, health care professionals reported considerable mental health challenges.   

 Children’s Minnesota nurses reported high rates of burnout and fatigue during feedback opportunities, including the Nursing Excellence Survey in February 2021. The results of the survey indicated nurse engagement was lower than in the past, while resiliency and burnout were higher. The survey results were consistent with reports of distress seen on the units.  

 Wellness and resiliency for all employees are priorities at Children’s Minnesota. Many efforts provided additional wellness support for nurses in 2021, including two conference opportunities:   

  • The annual Critical Care Nursing Conference offers sessions reflective of the interests and needs of attendees. During the 2021 conference in April, Mary Holtschneider, nurse educator and keynote speaker, talked about her work on nursing resiliency and mindfulness. Feedback from the conference was positive and attendees said they gained new tools for facing challenges. “When things get difficult, I’m going to remember to pause and breathe. I also really liked the word of the year. That would be a nice way to incorporate mindfulness in my daily practice,” said one participant.  
  • In Fall 2021, Children’s Minnesota hosted Activating Our Resiliency Sessions where motivational speaker, author and healthcare provider, MacDana Selecon, shared her experiences as a trauma survivor. Selecon covered topics like burnout, compassionate leadership, trauma awareness and cultural sensitivity. More than 150 nurses attended these sessions and feedback was overwhelmingly positive and appreciative. One attendee said, “This presentation was incredible. It really shifts your perspective and reminds you of the things that truly matter in life, including taking care of oneself. The sincerity and authenticity of the content made all the difference.”   

Also in Fall 2021, the Children’s Minnesota wellness team was formed to develop support opportunities and connect nurses to resources. Other actions taken by this team included communicating with patient families to explain the staffing situation and ask for understanding, organizing Children’s Minnesota music therapists to play soothing music at the Welcome Center on both campuses, and placing beverage makers in breakrooms to offer staff warm drinks during their shifts.  

Children’s Minnesota remains committed to the health and wellness of all employees and will continue to offer programs to support the well-being of each and every one of our important team members.  

Hospital flow initiative improvement opportunities 

The goal of the hospital flow initiative is to provide the right care, in the right place, at the right time, while ultimately trying to match hospital capacity to patient demand. Throughout the discovery process, Children’s Minnesota uncovered opportunities and prioritized various tactics to build a foundation for hospital flow improvement work and to embark on a strategic organizational change.   

In March 2021, Caroline Njau, MBA, BSN, RN, NEA-BC, chief nursing officer and vice president of patient care services, endorsed a hospital flow project and became the executive sponsor following a clearly identified need through the campus and care redesign initiative. She partnered with Aimee Sznewajs, MD, acute care and pediatric hospital medicine medical director, who was intimately tied to this project and was a clear physician leader for this important work. Carly Glander, MBA, MSN, RN, surgery verification program manager, represented nursing and co-led this effort. The work of this team focused on building a foundation for future performance improvement opportunities.

View the diagram from the Institute for Healthcare Improvement

Projects

  1. Development of level of care clinical criteria: This document will reflect clinical agreement on level of care by diagnosis between the acute, critical, and neonatal care communities and will result in a patient placement grid deliverable. This work will be finalized and implemented in 2022.  
  2. Development of a draft capacity management standard operating procedure (SOP): This will provide a system-level action plan for improving hospital-wide patient flow when reaching 90% or greater capacity in one or more care communities. This work will be finalized and implemented in 2022.  
  3. Implementation of an emergency department (ED) capacity risk standard operating procedure (SOP): Provide a system-level action plan for improving hospital-wide patient flow when the ED demand exceeds the resources available to provide care to a critically ill or injured patient in the ED. This work was prompted by the inability of our hospital to go on emergency medical services divert and thus, was rolled out as phase one of our system-wide capacity management standard operating procedure.  
  4. Building metrics to support hospital flow: Collaborate with data analysts and other experts to begin discussions on using data to make decisions about hospital flow opportunities and create visual management tools (dashboards) for shared understanding with frontline staff. This work will be continued in 2022.  
  5. Developing standard work: This will be continued in 2022.  
    • Patient flow huddles: Modified the agenda of the former bed board meetings/bed huddles to maximize information shared from the microsystem level relative to hospital flow.  
    • Capacity management: Developed five standard work document drafts for utilizing Cerner capacity management to improve real-time visual accuracy of patient placement.  
    • Definitions: Identify and communicate a shared understanding of definitions used for capacity calculations.  

Project team members

Hospital flow core project team 

  • Sponsor: Caroline Njau, MBA, BSN, RN, NEA-BC, Chief Nursing Officer and Vice President of Patient Care Services 
  • Physician Co-lead: Aimee Sznewajs, MD, Medical Director, Department of Pediatric Hospitalist Medicine and Acute Care Services 
  • Nurse Co-lead: Carly Glander, MBA, MSN, RN, Surgery Verification Program Manager, Value and Performance 
  • Kattie Bear-Pfaffendorf, MBA, CPHQ, Lean Six Sigma Green Belt, Performance Improvement Consultant, Value and Performance 
  • Catherine Miller, MPH, Improvement Director, Value and Performance 

Emergency department capacity risk SOP 

Hospital Flow Core Project Team plus: 

  • Jen Olsen, MHA, BAN, RN, Interim Patient Care Manager, Emergency Department St. Paul
  • Scott Elsbernd, MS, PED-BC, NEA-BC, Interim Director of Emergency Services, Emergency Department
  • Rob Sicoli, MD, Medical Director, Emergency Services

Level of care 

Hospital Flow Core Project Team plus: 

  • All chiefs, patient care directors, patient care managers, patient care supervisors, medical directors, nurse practitioners of neonatal, critical care and medical/surgical  
  • Angela Briggs, ADN, RN, PED-BC, CPN, Assistant Nurse Manager, Limited Stay Unit St. Paul
  • Theresa Duffy May, MA, BSN, RN, Senior Director, Care Continuum and Informatics
  • Lisa Durben, MSN, RN, Assistant Nurse Manager, NICU Minneapolis
  • Tami Koth, RN, PED-BC, CPHON, Assistant Nurse Manager, 7th Floor Minneapolis
  • Melanie Kuelbs, DNP, APRN, PCNS-BC, CCRN-K, Clinical Nurse Specialist, PICU
  • Erica Linnell, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center
  • Kim Lorence, MS, RN, NPD-BC, CPNP, Clinical Education Specialist, Center for Professional Development and Practice
  • Jennifer Rivera, MSN, APRN, ACCNS-N, RNC-NIC, Clinical Nurse Specialist, Neonatal Services Minneapolis
  • Heidi Shafland, MSN, APRN, ACCNS-P, CCRN-K, Clinical Nurse Specialist, Cardiovascular ICU
  • Karen Swenson, MHA, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center
  • Pamela Wicklund, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center

System capacity management standard operating procedure 

Hospital Flow Core Project Team plus: 

  • Erica Linnell, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center
  • Paul Paulisich, MSN, RN, NEBC, Interim Patient Care Director, Critical Care 
  • Pamela Wicklund, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center  

Patient flow huddle 

Hospital Flow Core Project Team plus: 

  • Morgan Hanson, AA, Senior Resource Management Coordinator, Care Traffic Control Center
  • Tami Koth, RN, PED-BC, CPHON, Assistant Nurse Manager, 7th Floor Minneapolis  
  • Erica Linnell, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center 
  • Paul Paulisich, MSN, RN, NEBC, Interim Patient Care Director, Critical Care 
  • Pamela Wicklund, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center

Capacity management standard work 

Hospital Flow Core Project Team plus: 

  • Lindsey Bernath, BSN, RN, Clinical Nurse, Cardiovascular ICU
  • Angela Briggs, ADN, RN, PED-BC, CPN, Assistant Nurse Manager, Limited Stay Unit St. Paul
  • Sharyl Buetow, BSN, RN, CPEN, CPN, Assistant Nurse Manager, Emergency Department St. Paul
  • Lisa Durben, MBA, BSN, RN, Assistant Nurse Manager, NICU Minneapolis
  • Adam Frost, CWR Supervisor, Environmental Services
  • Cindy Hammiller, Shared Services Manager, Environmental Services
  • Michelle Heroux, BSN, RN, Senior Clinical Systems Analyst, ITS Clinical Applications
  • Laure Orgon, MA, RN, Clinical Informatics Manager, ITS Informatics
  • Roberto Rios, CWR Supervisor, Environmental Services
  • Pamela Wicklund, BSN, RN, Hospital Nursing Supervisor, Care Traffic Control Center

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