Magnet® Excellence

The NewYork-Presbyterian Lower Manhattan Hospital Department of Nursing is under the direction of Vice President and Chief Nursing Officer (CNO), Joan Halpern (pictured right: center), MS, RNC, NNP, NEA-BC. She is responsible for providing strategic vision, direction, and leadership for the Department of Nursing and other clinical departments. As CNO, Ms. Halpern is responsible and accountable for the provision of nursing services 24 hours a day, 7 days a week, and her functions include fiscal planning, resource allocation, staffing, healthy work environment, and employee relations.

Directors of Nursing direct each clinical service line and work with the CNO to plan and coordinate service line activities. Patient Care Directors manage the daily operations of the unit.

In November 2020, Ms. Halpern led the NewYork-Presbyterian Lower Manhattan team to its first Magnet® designation. ANCC Magnet Recognition® is the highest and most prestigious international distinction that a health care organization can receive for nursing.

At NYP Lower Manhattan, clinical nurses are involved in processes and activities that target the retention of a highly skilled nursing workforce in their organization. In late 2019, the nursing team in Labor & Delivery acknowledged an opportunity to decrease turnover on the unit. Lisandra Torres, MSN, RNC-OB, C-EFM, Patient Care Director, Labor and Delivery, partnered with Dado Tandia, MSN, RNC-OB, FNP-BC, Labor and Delivery clinical nurse, to review the literature and develop an intervention that would improve the unit turnover rate.

In January 2020, the Labor and Delivery team implemented evidence-based interventions, which provided a structured transition process that extended beyond orientation. These interventions included:

• Extending the orientation period for an additional week
• Maintaining new nurses on day shift for an extended period after completing orientation
• Implementing a “buddy-system”; assigning every new hire to an experienced nurse buddy on the same shift to serve as a direct resource to the new nurses, providing them with additional support and understanding of workplace policies/procedures, systems, and processes, and helping them to adapt to the unit culture

After implementing the changes for several months, Ms. Torres, Ms. Tandia, and the Labor and Delivery found that after implementation of the buddy system and other evidence-based practices to address retention of nurses, the turnover rate improved substantially. The interventions received very positive feedback on post-intervention surveys with Labor and Delivery unit nurses reporting an improvement in workplace satisfaction and camaraderie. The team also noted a marked increase in the engagement in unit initiatives and projects.

NYP Lower Manhattan clinical nurses engage in professional peer feedback processes and are involved in activities that improve the quality of clinical care provided to patients. In 2019, Arianna Dinelli, MS, RN, MEDSURG-BC, and Stephanie Legall, BSN, RN, MEDSURG-BC, clinical nurses on the 5C Medical/Surgical Unit, identified an opportunity to improve rates of central line associated blood stream infections (CLABSI) by leveraging peer feedback processes to ensure professional accountability for evidence-based central line care improvements.

5C clinical nurses follow a bundle of evidence-based practices to prevent CLABSI in patients with central lines, and includes placing a sterile red cap on the end of reusable intravenous (IV) administration sets between uses to avoid potential contaminants. Ms. Dinelli and Ms. Legall noted that the compliance of sterile cap utilization was below the target goal and recognized that enhancing nursing practice through utilization of a peer-to-peer platform would help meet the 5C unit goal of eradicating CLABSIs.

Ms. Dinelli and Ms. Legall implemented a multipronged intervention to improve nursing practice related to central line care with a focus on sterile red cap compliance and utilizing a peer-to-peer education and accountability format. The intervention included comprehensive education to clinical nurses on proper central line care and maintenance, discussion of central line care at huddles, a “quick tips” sheet emailed and shared in high-traffic nurse areas, reminders and educational material posted on a unit white board, and nurse-to-nurse discussion and real-time feedback provided during central line care audits.

Ms. Dinelli and Ms. Legall tracked sterile red cap compliance during and after implementation of their peer-to-peer initiative. By three months after the intervention, compliance had met their targeted goal. Throughout 2020, 5C remained CLABSI-free and the peer-to-peer education and accountability leveraged by 5C clinical nurses to enhance quality and evidence-based care of patients with central lines contributed to this positive outcome.

NYP Lower Manhattan operating room (OR) clinical nurses are active in reviewing unit data, including OR on-time starts, to gain insight into improvement opportunities. Delayed OR start times can result in clinical inefficiencies and patient dissatisfaction. OR clinical nurses Katherine Otanez-Alejo, BSN, RN, CNOR, and Florinda Ramos, BSN, RN, CNOR, identified an opportunity to apply innovative interventions to improve OR on-time starts.

Ms. Otanez-Alejo and Ms. Ramos conducted a root cause analysis and determined that there was an opportunity to apply an innovative approach to help start cases on time through leveraging the OR night shift nurse. They developed a plan in which night shift nurses would be assigned to identify the most complex OR cases scheduled for the morning and begin the OR setup process for those cases, which includes preparing instrumentation, equipment, supplies, patient interviews, and chart review, prior to the change of shift at 7:30 am. Ms. Otanez-Alejo and Ms. Ramos implemented their plan at the end of 2019.

Ms. Otanez-Alejo and Ms. Ramos monitored OR case start times and found that after implementation, the number of OR cases that started on time increased substantially. This intervention is now a standard process in the operating rooms of NYP Lower Manhattan.

Publications

Krakowski, A., O’Brien, J., Xuereb, K. (2020). The journey of the purple butterfly [Abstract]. Journal of Pain and Symptom Management, 59(2), 501.

Remegio, W., Rivera, R. R., Griffin, M. Q., Fitzpatrick, J. J. (2020). The professional quality of life and work engagement of nurse leaders. Nurse Leader, 2021 Feb;19(1):95-100.

Sun, C., Fu, C., O’Brien, J., Cato, K., Stoerger, L., Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding. Is there an impact on patient falls? The Journal of Nursing Administration, 50(6), 355-362.

2020 Awards and Recognition

2020-2024 ANCC Magnet Designation
NewYork-Presbyterian Lower Manhattan Hospital

2020-2023 AACN Beacon Award for Excellence: Silver
3C Intensive Care Unit
NewYork-Presbyterian Lower Manhattan Hospital

HRSA Platinum Award
Health Resources and Service Administration – National Hospital Organ Donation Campaign
NewYork-Presbyterian Lower Manhattan Hospital

American Heart Association: Gold Plus Award
American Heart Association Get With the Guidelines
Target: Stroke Elite Honor Roll and Type 2 Diabetes Honor Roll
NewYork-Presbyterian Lower Manhattan Hospital

Appointments
Warly Remegio, DNP, RN, NPD-BC, NEA-BC, CCRN-CSC
2020-2022 President-Elect
Philippine Nurses Association of New York, Inc.

Special Recognition
Warly Remegio, DNP, RN, NPD-BC, NEA-BC, CCRN-CSC
Fellow, Young Professional Voices
American Organization for Nursing Leadership

Podium Presentations

Joan Halpern, MS, RNC, NNP, NEA-BC; Aaron Kranich, JD. Leveraging the “Human” in “Human Resources”: Working Together with HR to Enhance Nurse Leader Engagement and Competencies. September 2020: Nursing Management Congress (virtual).

Warly Remegio, DNP, RN, NEA-BC, NPD-BC, CCRN-CSC.The Professional Quality of Life of Nurse Leaders: Why Does it Matter? December 2020: International Filipino Diaspora. Sydney, Australia.

Warly Remegio, DNP, RN, NEA-BC, NPD-BC, CCRN-CSC.The Voice of Nursing. Leading the World to Health. Keynote Speaker. October 2020: Medical Colleges of Northern Philippines and International School of Asia and the Pacific, Tuguegarao City, Philippines.

Poster Presentations

Eda Oskara, PhD, RN, CHSE; Warly Remegio, DNP, MS, RN, NP-BC, NEA-BC, CCRN-CSC; Patricia Myers, MS, MT, CLS, CHSE. Building and Implementing a Cardiac Arrest Simulation Program Using Deliberate Practice to Increase Nurses’ Preparedness: A Collaborative Partnership of a Medical Center and University. January 2020: 20th International Meeting on Simulation in Healthcare, San Diego, CA.

Jon Snyder, MD, FAACOG; Johanna Schisler, MSN, RNC-OB. Inter-professional Simulations to Reduce Rate of Erb’s Palsy. September 2020: Annual Weill Cornell Medicine Quality Improvement and Patient Safety Poster Symposium (virtual).