MVH History — Nursing

Nurse Debbie Connett doesn’t hesitate when asked what’s changed the most in nursing since the early 1990s.

“The biggest, biggest change is informational technology,” said Debbie, a nurse at MVH since 1974. “It has far and away impacted what we do the most. We had no computers in the nineties and now we live by the computer.”

Miami Valley Hospital’s move to the electronic medical record system known as EPIC started in 2006 and was implemented across the Premier Health system over the next two years. The system was designed to provide real-time clinical, financial and scheduling information about any patient at any location; reduce errors because of built-in security measures, and improve coordination of health services.

The new system meant the end of paper charts, those thick binders containing physician orders and nursing notes, the patient’s history and any other data pertinent to the patient’s care. But it also meant all nurses and medical staffers needed to be computer literate — facile at typing, searching and navigating the EPIC system. That was an easy task for some, but a chore to some of the more experienced staffers who weren’t as computer savvy.

“We had so many tears over those computers,” Debbie recalled in 2012, “but now they’re our friends and we couldn’t live without them. The great thing it provided is we can access so much patient information so quickly. You don't have to ruffle through charts, search for lost orders or call medical records and other hospitals. Now we’re all connected in the Premier Health system and we can get reports in seconds. There is a wealth of information to be had.”

“The downside,” she added, “is the technology takes time and concentration and we need to balance that with spending as much time as we can with our patients.”

More education

Debbie, a nurse in the Post Anesthesia Care Unit, has seen many changes in nursing since she graduated in 1974 with her diploma from The Miami Valley Hospital School of Nursing. For starters, the MVH School of Nursing no longer exists. It closed in 1986, morphing later into the Wright State University-Miami Valley College of Nursing and Health, which offers bachelors and master’s degrees.

In the last two decades, changes in the profession have followed the rapid evolution of the medical world in general.

Patients are living longer, but their acuity (the intensity of care required) is much higher. More is known about sickness and health, but medicine has become more complex, too. There are more specialties and subspecialties, newer and better technology, and the number and type of drugs nurses must track and administer has grown exponentially. Add to that shorter hospital stays, more knowledgeable patients (thanks to the Internet) and it’s a wonder nurses can keep up.

That’s why MVH started a policy in 2011 aimed at having an entire nursing staff with at least a bachelor of science in nursing degree. New nurses must have at least a BSN, or they’re required to attain their BSN within five years.

In making the change, nurse leaders were guided by The Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health. Other studies also have supported additional education for nursing, finding that as nurse education increases, patient mortality decreases.

“With the increased acuity of patients and shortened stays in the hospital, there’s a much greater need for nurses to more quickly integrate information and to lead the coordination of care from admission through discharge,” explained Deb Mals, MVH’s chief nursing officer and vice president of hospital operations, in 2012. “We must be astute at assessing and communicating the patient’s needs. Evidence in the literature supports that nurses are uniquely positioned to rescue the patient, as we are the profession at the bedside 24/7.”

The nurse must not only be an expert clinician, Mals added, “but an effective communicator with the patient, family and the entire care team.”

Center for Nursing Excellence

MVH nurse leaders say it was in the 1990s that more nurses started advancing their education beyond basic preparation. It was partly in response to the increasing complexity of health care, technology and patient needs. But at the same time, the growing opportunities and career paths the profession offered required more expertise through professional development and advanced formal education.

MVH responded with opening The Center of Nursing Excellence (CNE) in 1992. The Center, currently located in the Fred E. Weber Center for Health Education at MVH’s downtown campus, was designed to help nurses pursue their educational and professional goals just steps from their workplace. Later remodeled and named for Dayton area Realtor and philanthropist Jerry Colp, the Center contains advanced technology classrooms, lecture halls, a computer lab and a clinical skills lab complete with human simulators.

“We wanted to be a central point for professional development and lifelong learning for our nursing staff,” Jayne Gmeiner, the Center’s director, said in 2012. “We have several onsite programs for the BSN and MS so nurses can come in on their day off or leave work and come to class right here. We have programs with Wright State and Urbana universities and with Indiana Wesleyan. That didn’t exist in 1990, so that’s definitely an evolution based on the needs of our nursing staff.”

The Center offers courses for new and veteran nurses alike, said Gmeiner, MS, RN, NEA-BC. Its internship and externship programs, for instance, are designed to help those just starting out in their career make a smooth and safe transition from the student role to the self-assured practitioner.

The push toward more education is showing results. In 1990 most MVH nurses (45 percent) had a diploma and about 30 percent had their BSN. In 2012, more than half, or 55 percent, of the hospital’s 2,500 nurses had a BSN or higher degree. Approximately 200 nurses had a master’s degree and three had their doctorates. Of those, 55 were advanced practice nurses. APRNs hold a Masters or Doctorate in nursing and have clinical training beyond their RN preparation. They are trained and nationally certified to practice at an advanced level.

“These roles were not in existence in 1990,” said Mals.

“The evidence is clear,” she added. “The more educated nurses are, the better the care provided. A key directive for our future is to ensure nurses engage in lifelong learning that will enable them to lead changes to advance health care.”

More empowered

Besides more education, nurses 20 and 25 years ago were seeking a greater role in decisions affecting their workplace — matters involving policies and procedures, best practices and the direction of their profession. Nurses sought a stronger role in advocating for their patients, too.

In 1988, hospitals leaders responded with a “shared governance model” that eventually grew into the MVH Triforce Council of today. The Council promotes autonomy and empowers all nurses across the organization to guide, develop, implement, and evaluate nursing practice.

A key component is the Peer Review Council, which promotes a collegial environment, leadership development, and individual nurses moving from "novice" to "expert." The council also facilitates an online, anonymous review process by which nurses receive feedback to enhance their practice.

The Triforce’s work has led to several positive patient outcomes, including fewer falls, improved IV phlebitis rates and a reduction in hospital-acquired infections, among other key clinical outcomes and work environment improvements.

“We were really coming into our own in the early 1990s,” recalled Debbie Connett, the PACU nurse now in her sixth decade at MVH (she was a candy striper in the late sixties). “With shared governance, we felt more empowered. Today, we have an active role in the hierarchy of the hospital concerning policy and procedures, and we have a presence on most committees and strategy groups within our institution. That presence has dramatically increased over the past 20 years.”

Debbie added that shared governance has fostered collaboration, a greater sense of teamwork and camaraderie. “All of us want to be competent in our patient care, and we want our fellow workers to be equally competent. We share our knowledge and skills for the benefit of the patient.”

Magnet Status

In 2004, Miami Valley Hospital earned a distinction that it and no other hospital in the Dayton area had earned before: Magnet Status for Nursing Excellence by the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association. MVH was just the fifth hospital in Ohio and one of only 115 hospitals nationally to reach this ultimate benchmark in quality nursing.

The award recognizes that the nursing staff of the hospital meets high standards of patient care, nursing excellence, and innovations in professional nursing practice. Additionally, the award signifies the hospital provides an environment that empowers nurses, values their contributions and supports nursing leadership.

According to the ANCC, Magnet hospitals consistently deliver better patient outcomes than non-Magnet hospitals, including more time nurses spend at the patient’s bedside, shorter lengths of patient stay, lower patient mortality rates, higher patient satisfaction rates, and higher nurse retention, recruitment, and job satisfaction rates.

Only 5 percent of hospitals across the United States have achieved Magnet distinction. An even smaller percentage of hospitals have earned re-designation. But Miami Valley did just that in 2008 when it earned its second Magnet distinction, and again in 2012 when it captured its third.

Said Mals: “Our patients share with us every day how our nurses make a difference in their lives, and it is this consistent delivery of high quality care that says to our patients: no matter where you are within our hospital you are being cared for by the very best."

The Patient Experience

In 2012 Premier Health announced a redoubling of its efforts to recognize patients — as well as the patient’s families and significant others — as the center of its existence. Called “The Patient Experience,” the effort targets every facet of each Premier hospital, from the storeroom to the boardroom, stressing that each employee has an important role in creating the most healing, nurturing, and valued experience possible for patients and their families.

Explained MVH President and CEO Bobbie Gerhart in 2012: “When you're talking about patients who come to your hospital, they truly come at a vulnerable state. It might be a short patient visit, or one where the patient might have contact with 50 people participating in their care. But if even one of those people breaks that patient experience, that’s what the patient remembers. We always want our patients to feel as though they were cared for in absolutely the best way possible.”

Some of the guiding principles behind the Patient Experience include:

We can only be successful as a team when they patient and family are the first members of the team.
The Patient Experience starts with me and how I interact with every person, every time
Excellent quality, safety and service are expected
We must live up to our core values in every encounter. Everyone deserves our Respect, Integrity, Compassion, and Excellence.
We must build trust at every opportunity, and
Provide a seamless experience for every person, every time, in every way

“In the past we focused on tactics to improve the patient experience,” said Angela Ware, RN, Miami Valley’s director of Patient Experience, in 2013. “This is about creating a different mindset, a different culture, improving the way we interact and communicate with each other and with patients and their families, doing those things that breed a more positive patient experience.”

To get there each hospital is providing training, tools and department-level coaches for the staff. One tool includes the AIDET acronym. When you enter a patient’s room, for example, Acknowledge the patient, Introduce yourself, inform the patient how long you will be there (Duration) or how long a procedure might last, Explain why you’re there/what you’re doing, and Thank the patient on your way out.

Said Mals, “The goal is to provide a ‘Premier’ experience, that when you go to any Premier Health hospital you will have a similar hospital experience. When patients leave here, our goal is that they feel cared for and respected, that we connected with them in a very human, meaningful way, and we’ve restored their health to the fullest extent we possibly could.”

Looking ahead

Like medicine itself, the nursing profession will continue to grow and challenge the industry, said Mals, who retired from MVH in 2014.

“Over the next 10 years we’ll have a significant nurse shortage as the baby boomers retire,” she said. “That shortage is really looming out there and we need to keep our eye on it.”

Debbie Connett, for one, is doing her part to help. She’s raised two daughters who have become nurses, and she recommends the profession to anyone looking for a rewarding career that touches lives.

“No matter what kind of day you’re having, every day you do something good, something really important,” she said. “I’ve always, always felt what we do is valuable. We make a difference here.”

Setting the Course for Excellence

MVH has produced a Nursing Annual Report since 2005. Here are some highlights:

2005

MVH Triforce Council, the hospital’s nursing shared leadership model, receives national attention with outstanding triannual review from JCAHO
MVH becomes first hospital in Dayton to receive the Joint Commission’s Gold Star of Approval for treatment of acute coronary syndrome, heart failure, and stroke. Also becomes first hospital in Dayton to achieve Designated Stroke Center accreditation by JCAHO

2006

Clinical Nurse Leaders Pilot Project – CNLs are highly skilled, masters prepared clinicians who are educated in outcomes-based practice and quality improvement. They work directly at bedside with nurses, patients, families and physicians. In December 2006 two MVH nurses were among only 83 nationwide to be certified as Clinical Nurse Leaders.

2007

On-Site BSN Completion Program — Nurses looking to complete their BSN degree on-site are excited about the BSN Completion Program, a collaborative program with Wright State University-Miami Valley College of Nursing and Health. Classroom learning takes place at the hospital and is delivered via Interactive Video Distance Learning. The program, which begins each fall, holds class one day a week and can be completed in seven consecutive quarters.

2008

Relationship-Based Care — Enacted in March, the initiative focuses on building and strengthening relationships with colleagues, patients and oneself. Goal is to foster a positive work environment that keeps patients and employees at the center of the hospital’s focus.
Palliative Care team celebrates 10 years of providing education, support and relief to patients with serious and often terminal illnesses and their families. Began in 1998 as one of the country’s first 100 such programs. Cared for 26 patients in first year to more than 800 in 2008.
Compassionate Hands Program — New facet of PC team in which volunteer nurses support patients on the Pulmonary Units and ICU who are dying, critically ill and need family support.
Center for Nursing Excellence moves into renovated space; renamed for Jerry Colp, a local Realtor and philanthropist who contributed to the project.
Bar codes boost patient safety. Nurse or respiratory therapists scan patients ID band, scan the code on the pill or vial, then validate the transaction in the EPIC system. Nurse leaders call it the “gold standard” for meeting the five “rights” of safe medication administration: right patient, right drug, right dose, right time and right route.

2009

Hospital moves to a system of color-coded attire for all staff members working in direct patient care and clinical support positions. New standard aims to make it easier for patients to differentiate nurses and other caregivers, and to present a professional image that supports patients’ peace of mind about the services they are receiving.
Minority Nurse Manager Fellowship Program — A collaborative fellowship with the corporate diversity program, the program helps prepare minority nurses for nurse management positions. Goal is to ultimately increase diversity in nursing leadership. The fellowship, funded by the Miami Valley Hospital Foundation, helps minority nurses develop their leadership skills and prepare for the transition to the nurse manager role.

2010

Mobile Education Lab introduced — A 44-foot training lab on wheels that offers continuing emergency medical education services to nurses and other care providers throughout the region; MVH first hospital in the area with a vehicle of this kind
MVHS Hyperbaric Unit opens

2011

500 nurses certified in their area of specialty, a 17 percent increase over 2010
Increased diversity in nursing leadership through Minority Fellowship
Ended year with 54 percent BSN workforce
Bed “redistricting” and private room conversion plan leads to 95 percent private rooms at MVH main campus.
Heart and Vascular Intensive Care Team becomes Dayton’s first recipient of the Beacon Award for Excellence from the American Association of Critical-Care Nurses. Award recognizes critical care units that have improved every facet of patient care.

Caring for the Dying Patient: Palliative Care

Former MVH President and CEO Bill Thornton calls the hospital’s Palliative Care Program “one of the bright spots” in his tenure. The program’s genesis dates back to 1993, when nurses and hospital leaders wanted the hospital to better serve its dying patients and their families through an interdisciplinary approach that would ease the patient’s transition to a death that is as comforting and dignified as possible.

“(Nurses, counselors and others) would spend time with these families during the patient's last days, trying to explain what was going to happen, just listening and talking to them, helping them figure out what type of arrangements needed to be made once the patient succumbed,” Thornton recalled in 2012. “You cannot imagine the amount of letters we received from patients’ families saying, ‘What a difference you made in our lives.’”

Today, the Palliative Care Program sees more than 1,600 patients a year, offering comfort, education and counseling to patients and families alike.

Backed with funding from the Miami Valley Hospital Foundation, the Palliative Care Program was established in 1998 and based on a research project that was originally conducted during 1993.

Key Palliative Care accomplishments over the years:

1999-2004

Music Therapy Program — In collaboration with the Palliative Care Team and Oncology Nursing Staff, a music therapy pilot program was initiated. The pilot program utilized senior-level music therapy students from the University of Dayton to provide music therapy to our patients at MVH with positive patient satisfaction results.
Massage Therapy Program — Volunteer licensed massage therapist provided massage therapy to a select group of patients based on participating pilot physician order to see if a continued service should be considered at MVH. MVH now offers Massage Therapy on an in-patient basis to patients and is also available to employees.
Patient/Family education materials — The Palliative Care team created/obtained patient/family education brochures related to advance directives, Ohio State Comfort Care-DNR, brain death, and dying.
Staff education — The Palliative Care team is routinely integrated into nursing and patient care technician hospital orientation. Additionally, education offerings are provided for residents and other healthcare providers on quarterly basis.

2005-2011

Interdisciplinary Rounds — Every Thursday morning from 8:30am to 9:30am. This meeting has led to improved interdisciplinary clinical care and communication among team members.
Expanded Resources of Palliative Care Team to include additional Support CNS and RN hours to cover increasing patient volumes.
Community Advanced Care Planning Education Series focused on updating our community advance care planning.
Brain Death and Advanced Directives Staff Education — This project was presented at the annual Ohio Hospice and Palliative Care (OHPCO) annual meeting.
Electronic Medical Record Transition — The EPIC system facilitated the evolution of a data tracking for palliative care patients designed collaboratively with Good Samaritan Hospital (closed in 2018). The data tracking system allows for reporting on many aspects of the palliative care program that helps guide process improvements for the palliative care patients/families.
Observed Stimulated Clinical Experience (OSCE) — Interactive End of Life Education Program- in collaboration with Wright State University Boonshoft School of Medicine and MVH Trauma team to present an End of Life education program for 3rd and 4th year medical students. The students are placed with simulated patient and families to discuss topics such as “Breaking Bad News”, facilitating a “Do Not Resuscitate Discussion,” and presenting the topic of “Hospice Care.”
Donation After Cardiac Death (DCD/Organ donation) — Providing presence, care coordination and symptom management with the team, patients, and families who are experiencing a Donation After Cardiac Death (DCD).
Compassionate Hands Program & Nutrition Cart — In collaboration with the MVH Volunteer office, the palliative care team created the “Compassionate Hands” volunteer nurse program. Since its inception, the program has provided nearly
3,300 visits giving “extra special touches” to our patients that are dying and or have no family or friends to be present with them. The evaluations from the MVH nursing staff, patients, families, and the volunteer nurses have been overwhelmingly positive. In collaboration with Nutrition Services team, “snacks” are provided to the families of our dying patients. These activities truly deliver a “margin of excellence’ to the patients/families of MVH during very stressful and difficult times.
Implemented Veterans Recognition program on Veterans Day 2009 in collaboration with the Ohio Hospice Veterans Partnership and the MVH Volunteers. Patients who are cared for by the palliative care team are offered the option to have a small service recognizing any military veteran. The service is performed at bedside and the patient receives the state recognition pin and a United States Flag, thanking them for their military service. Additionally, veterans are provided information for Honor Flight. Honor Flight is a national non-profit organization that strives to provide a one day, all-expense paid trip for military veterans to visit their memorials in Washington DC. Over 200 patients at MVH have been recognized for their military service.
Miami Valley Hospital partnered with The Hospice of Dayton and the Oncology Leadership Team with the designation of 4 Hospice General Inpatient (GIP) Beds on 5ENE for those patients/families choosing The Hospice of Dayton as their Hospice Care Provider. These beds are “Virtual” in that any private room on 5ENE and are intended for patients that are in the active stages of dying. The purpose and intent of these GIP beds is to provide a peaceful transition for patients and families with a continuity of environment.

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