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    NURSING A N N U A L R E P O R T 2 019

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    CAPITAL HEALTH’s 2019 Nursing Annual Report CO NTENTS // TRANSFORMATIONAL LEADERSHIP // EXEMPLARY PROFESSIONAL PRACTICE 1 A Letter from Deborah Mican 34 Just Culture // Walk of Respect 2 2019 Nursing Leadership 35 Emergency Department Keeping Trenton Warm 3 DNV-GL Accreditation // Deborah SED 36 My Baby and Me 4 Intermediate Care Unit // Advisory Board 37 NICU’s Golden Hour // Lullabies of Love 5 Organization of Nurse Leaders 38 Hopewell Admission/Discharge Nurse Project of New Jersey (ONLNJ) 39 DEUCE Rounds 6 NJ Safe Haven Initiative 40 National Database of Nursing Quality 7 Shared Governance Indicators (NDNQI) 41 Capital Women in Philanthropy Grants // STRUCTURAL EMPOWERMENT 42 LGBTQIAA Community Care 8 March of Dimes 43 Interdisciplinary Rounds // Safety Equipment and Education 9 2019 Daisy Awards 44 Fall Tips // Workplace Violence Committee 10 Celebrating Nursing Week 45 Insulin Protocol at Hopewell 11 Nursing Clinical Ladder Program 46 Decrease in Ventilator Associated Events (VAE) 13 Nurse Residency 47 Better Nurse-Patient Communication 16 Quality Care 17 New Jersey State Nurses Association // Advanced Pharmacology Day // NEW KNOWLEDGE AND INNOVATION 18 Trauma Programs // Community Events 48 Nursing Research at Capital Health 22 Magnet Escape Rooms 49 Publications // Podium Presentations 23 STAR Program 50 Poster Presentations 24 Giving Back to the Community 51 Cerner Project Kick-Off 26 Military Service // Breast Cancer Champions 52 Wound Management and Hyperbaric 27 Healthcare Hero Awards Medicine // Cardiac Rehab 28 Patient and Family Education Day 29 Clinical News 30 APN Council 31 Cancer Center Unit-Based Practice Council 32 Nurses Teaching Others

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    // TRANSFORMATIONAL LEADERSHIP A Letter from Deborah Mican, PhD, BSN, RN, MHA, CNOR Vice President, Patient Services and Chief Nursing Officer Capital Health nurses are dedicated to improving the health of their patients, their patient’s families, and the community as a whole. In 2019, our nurses expanded their community outreach by providing care to patients at many new medical practice sites and at the satellite emergency room at Capital Health at Deborah – Emergency Services in Browns Mills, New Jersey. As we continue the journey to our fifth Magnet designation, I am certain that Capital Health nurses can achieve anything they set their minds to. Nurses are the very backbone of any hospital organization, and as we work to advance Capital Health as an independent hospital system for the region, it is imperative that our nurses are a central point of focus and Capital Health remains dedicated to improving the lives of every one of them. The strength of our nurses was demonstrated during our 2019 nursing satisfaction survey, where our nursing response rate was the highest it has ever been. Not only did this exceed our expectations, it also highlighted the empowerment of the nursing workforce and our nurses’ desire to have their opinions heard and counted. The results of the survey help us move forward on our Magnet journey, and we will continue to support a model where nurses have a voice on committees, where nurses lead committees as chairs and co-chairs, and where nurses are engaged in the day-to-day operations of all aspects of care at Capital Health. I would like to thank each one of you for your dedication to the nursing profession. Patient care is not an individual effort—it takes a team, and the team of nurses at Capital Health continues to amaze me. Rest assured, as your leader, I promise to make sure the voices of nurses are heard at every level of our great organization. Warmest wishes, Deborah Mican, PhD, BSN, RN, MHA, CNOR Vice President, Patient Services and Chief Nursing Officer 2019 Nursing Annual Report 1

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    // TRANSFORMATIONAL LEADERSHIP Changing of the Guard: 2019 Nursing Leadership The year 2019 saw many changes in nursing leadership at Capital Health. Congratulations and best wishes were extended to Ruthann Tobolski, MHA, BSN, RN, NEA-BC, Pat Michael, MSN, RN and Linda Wood, RN as they entered retirement. Collectively, they have more than 120 years of nursing experience at Capital Health! YOUR 2019 NURSING LEADERSHIP TEAM: Gina Petrone Mumolie, Kathleen Morris, MSN, RN, CCRN, NEA-BC DNP, MBA, RN, NEA-BC Divisional Director, Neuro, Advanced Senior Vice President, Cardiovascular, and Wound Care Hospital Administration Deborah Mican, PhD, BSN, RN, Colleen Price, MSN, RN, APN, AGACNP-BC MHA, CNOR Divisional Director, Patient Care Services, Vice President, Patient Care Services Capital Health Medical Center – Hopewell and Chief Nursing Officer Melissa Chichilitti, MSN, RN, CCRN Rona Remstein, MSN, RN Divisional Director, Patient Care Services, Director, Oncology Services Capital Health Regional Medical Center Regina Ciambrone, DNP, MBA, RN, NEA-BC Valerie Scannella, MSN, RN-BC Divisional Director, Maternal Child Health Divisional Director, Perioperative Services Services and Clinic Gregg Sharp, BSN, MA, RN, CEN, NE-BC Barbara Grande, MSN, RN-BC Divisional Director, Emergency Department Director, Clinical Informatics and Observation Gail M. Johnson, RN, NEA-BC, CJCP, MSN, EdD Oluwatomi Wahab, MSN, RN Director, Clinical Education, Regulatory Director, Renal Services Affairs and Infection Prevention NEW NURSE MANAGERS IN 2019 Joanna Cavacini, MSN, RN Stephanie Singer, BSN, RN-BC Nurse Manager, Observation Nurse Manager, Pediatrics Brian Decker, MBA, BSN, RN, CEN Kristen Stuenckel, BSN, RN, CCRN Nurse Manager, Emergency Department, Nurse Manager, Trauma Medical Capital Health at Deborah – Emergency ICU/Intermediate Care Unit, Services Capital Health Regional Medical Center Eric Elcenko, BSN, RN, CCRN Teresa Swantek, RN, BSN, CEN Nurse Manager, Critical Care, Nurse Manager, Emergency Department, Capital Health Medical Center – Hopewell Capital Health Regional Medical Center 2 CAPITAL HEALTH

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    // TRANSFORMATIONAL LEADERSHIP DNV-GL Accreditation and Training Bring Us Closer to ISO-9001 Certification In 2019, Capital Health experienced its second DNV-GL survey at each campus. Each visit was conducted to follow up on findings from the 2018 surveys. These surveys were highly successful, with surveyors clearing all fifteen findings from the 2018 survey at Hopewell and all but one of the twelve findings from the 2018 survey at RMC. The nurses and other clinical staff were huge contributors to the success of these visits. Thank you for your focus on quality and safety! Nursing and other hospital leadership also took part in DNV-GL trainings. During the summer of 2019, an ISO-9001 educational session offered leaders a deep-dive into the ISO standards. The training provided sharper focus on areas for improvement while also helping to identify areas of success as we journey towards ISO certification. Training sessions conducted later in the year helped participants learn new methods for conducting internal audits. These exercises give Capital Health more ownership of the auditing process, ultimately leading to self-identification of process issues. This will allow Capital Health to create a safer, more quality-driven, high reliability organization. Capital Health Opens New Satellite Emergency Department On July 1, 2019, Capital Health assumed operation of the satellite emergency department (SED) located on the Browns Mills campus of Deborah Heart and Lung Center. The opening of the SED was made possible due to the hard work and efforts of a multidisciplinary team co-led by Regina Ciambrone, DNP, MBA, RN, NEA-BC. Long hours were spent to ensure that the unit was ready for a seamless transition. Capital Health welcomed twelve new nurses and six clinical staff members to the team. Thank you to all who assisted in the opening! 2019 Nursing Annual Report 3

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    // TRANSFORMATIONAL LEADERSHIP Intermediate Care Unit at RMC Opens on 3 North A new Intermediate Care Unit (IMU) on 3 North at Capital Health Regional Medical Center (RMC) opened on Monday, April 1, 2019. The IMU staff provides care to those who are considered higher acuity patients but do not need the level of an intensive care unit. Upon its opening, Colleen Price, MSN, RN, APN, AGACNP-BC was the nurse manager of the IMU, which includes six licensed beds, as well as two pediatric trauma beds that were previously located on the unit. The unit opened with a safe and slow approach to the transfer of appropriate patients from the Trauma/Medical ICU, followed by the gradual acceptance of ER patients later in the day. Thank you to everyone who helped with the launch of this new unit at RMC! Further Developing Nursing Leadership Capital Health’s ongoing partnership with the Advisory Board continues to provide leadership training for management at all levels, from assistant nurse managers to vice presidents. The consulting firm provides support and resources to help health care facilities improve performance throughout the organization. Session topics included: • Improving Patient Experience • Instilling Accountability • Leading through Vision • Managing Vision and Purpose • Mastering Three Conversations to Stop Turnover • Interviewing and On-Boarding • New Manager Orientation • Just Culture for Managers and Supervisors • Emotional Intelligence 4 CAPITAL HEALTH

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    // TRANSFORMATIONAL LEADERSHIP A Leader Inside and Outside of Capital Health Thank you to Trish Tatrai, RN, MS, OCN, CBCN (breast cancer navigator at the Capital Health Cancer Center) for completing a two-year term as chairperson of the Certified Breast Care Nurse (CBCN) Test Development Committee of the Oncology Nursing Society (ONS)! Trish’s contributions to the committee assisted in the development of nurses who encompass the entire spectrum of breast care nursing practice across the nation. The Nursing Workplace Environment and Staffing Council (NWESC) The Nursing Workplace Environment and Staffing Council (NWESC) was created in 2016 by the Organization of Nurse Leaders New Jersey (ONL NJ). Capital Health joined the pilot initiative in 2017 with a few other organizations, including Lourdes Health System, Hunterdon Medical Center, Jersey City Medical Center, and Jefferson Health. Since then, 37 hospitals across New Jersey have implemented hospital-based NWESCs. The NWESC was formed to establish safe practice environments, and in doing so create a forum that gives a respected voice to staff nurses and allows for collaboration with leadership. Each hospital-based council is comprised of more than 51 percent direct care nurses and is co-chaired by the Chief Nursing Officer and a direct care nurse. NWESC committee members receive training at the ONL NJ with other hospitals, which provides a unique opportunity to network and share experiences. After this training takes place, members meet within their organization’s NWESC committee to improve the nursing workplace at their respective institutions. The guiding framework of the NWESC is the American Association of Critical Care Nurses (AACN) Standards for Establishing and Sustaining Healthy Work Environments. These standards include: • Meaningful recognition • Skilled communication • Effective decision making • Authentic leadership • True collaboration • Appropriate staffing Capital Health has chosen three standards to work on and formed subcommittees accordingly: appropriate staffing, meaningful recognition, and skilled communication. Since its initiation, Capital Health’s NWESC has strived to uphold its mission to provide a formal collaborative structure that gives clinical staff nurses and leaders a respected voice in determining human and environmental resources needed to provide the best care and optimize outcomes for the patient’s we serve. Throughout 2019, Capital Health’s NWESC participated in several initiatives. The Staffing Subcommittee completed an exploratory survey regarding direct care nurses’ experience with hospital-supplied mobile phones. More specifically, the goal was to determine the number, source and perceived significance of the calls 2019 Nursing Annual Report 5

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    // TRANSFORMATIONAL LEADERSHIP NWESC cont’d and use this information to guide future interruption-reduction efforts. A total of 154 RNs participated from 15 inpatient units across both campuses. Overall, nurses believe phone calls are disruptive and strongly desire practice change. They particularly value uninterrupted time during morning medication pass (9 a.m. – 10 a.m.) and shift change (7 a.m. – 8 a.m., 7 p.m. – 8 p.m.). Ancillary departments were the most frequently identified callers, although the nature and frequency of calls varied heavily by unit. The Skilled Communication Subcommittee adopted the THINK concept, after The THINK Concept learning about it at one of the New Jersey Hospital Association’s Nursing Workplace Environment and Staffing Council (NWESC) sessions. The THINK acronym, Truthful-Helpful-Inspiring-Necessary-Kind, is used to promote clear and respectful T ruthful communication between care providers. The concept is also part of the campaign to reduce bullying in the workplace. In collaboration with Capital Health’s Public H elpful Relations department, the sub-committee developed a video starring NWESC I nspiring staff members that is used during Capital Health’s employee orientation process to promote the THINK concept. A THINK poster was also created for use within N ecessary all hospital units. The video and poster were presented at the Department Head Meeting & PSO Group Meeting in 2019. Both can be viewed on CapitaLink under K ind the Magnet webpage. The sub-committee also created an educational Power Point presentation for all managers to share during the nursing peer review process for 2019. The Meaningful Recognition Subcommittee created and developed projects to recognize nurses and their professional accomplishments by enhancing the corporate culture of gratitude at Capital Health. In May, the group encouraged nominations for the March of Dimes Nurse of the Year awards. This project honors the tireless efforts of nurses in 11 categories who are celebrated at an award gala in November each year. The committee is also working with the Information Systems team to develop a link on the external webpage to recognize Capital Health nurses and allow the public to see our nurses’ important contributions to health care in our community. NJ Safe Haven Initiative As part of NJ First Lady Tammy Murphy’s visit in February 2019 to raise awareness of New Jersey’s Safe Haven program, we saw the premier of a video public service announcement. Thanks to Capital Health registered nurse Regina Nwosu, EMS team members Walter Rogers and Maria Arce, and all first responders for their parts in this powerful video and the great work they do every day in our community 6 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Shared Governance Councils Give Nurses a Voice Capital Health adheres to a shared governance structure that provides nurses with the opportunity to express concerns, share projects and celebrations, and propose ideas. These councils are successful because of their clinical nurse leadership, the council chair, and co-chair. In 2019, the shared governance chairpersons were: The Shared Accountability Coordinating Council (SACC) Nancy Distelcamp, BSN, CEN, TCRN Education and Professional Development Council Geri Secrest, RN Nursing Informatics Council Barbara Flood, BSN, RN-BC Pam Esher, BSN, RN, SCRN Nursing Practice Council Erin Kelly, RN Nursing Quality Council Christine Clark, BSN, RN Elizabeth Pearsall, RN Research and Evidence-Based Practice Council Vera Kunte, DNP, APN,C 2019 Nursing Annual Report 7

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    // STRUCTURAL EMPOWERMENT March of Dimes Awards: Recognizing Exemplary Nurses Each year, the March of Dimes New Jersey recognizes and honors nurses across the state who have gone above and beyond in providing excellence in patient care, nursing practice and nursing education. Nurses from all service areas are eligible to be nominated by peers for excellence in one of the following 11 categories:  Adult Health  Nurse Leader  Advanced Practice  Nurse Manager  Critical Care  Nursing Research, Evidence-Based Practice  Neonatal and Pediatrics and Informatics  Non-Hospital and Home Care  Rising Star  Nurse Educator  Women’s Health In 2019, more than 140 nominations were submitted for the March of Dimes New Jersey Nurse of the Year Awards. Capital Health’s nominees were: Diane Boka, MSN, RNC-OB, C-EFM Deborah Mican, BSN, RN, MHA, CNOR Melissa Chichilitti, MSN, RN, CCRN Victoria Pantoja, BSN, RN, CEN Katherine Donaldson, MSN, WHNP-BC, Debra Pracko-Wagner, BSN, RN, CNOR RNC-OB, CPLC, C-EFM Colleen Price, MSN, RN, APN, AGACNP-BC Shannon Foster, BSN, RN-BC Rona Remstein, MSN, RN Barbara Grande, MSN, RN-BC Cheyenne Rothermel, BSN, RN, CEN, SANE-A Gail Johnson, RN, NEA-BC, CJCP, MSN, EdD Michele Vazquez, MSN, RN-BC Amanda Mihaich, BSN, RN-BC Tina Vigna, BSN, RNC-OC, C-EFM April Lang, MSN, APN, C Michelle Samedi, RN Six nominees from each category are chosen as finalists. Finalists were honored at the March of Dimes New Jersey Nurse of the Year Awards Gala on November 13, 2019, including an award presentation to each category’s winning recipient. Capital Health had nine finalists in their respective categories.  Adult Health: Shannon Foster and Debra Pracko-Wagner  Nurse Leader: Gail Johnson and Rona Remstein  Nurse Manager: Diane Boka and Colleen Price  Nursing Research, Evidence-Based Practice and Informatics: Katherine Donaldson and Barbara Grande  Women’s Health: Tina Vigna Congratulations to Rona Remstein, who was chosen Congratulations to all of our as Nurse of the Year for Nurse Leader category! nominees and finalists. Thank you for everything you do for Capital Health and our patients! 8 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT 2019 DAISY Awards The DAISY Award is an international program that rewards and celebrates the extraordinary clinical skill and compassionate care given by nurses every day. From the simplest acts of comfort to providing care in the most challenging circumstances, Capital Health nurses make extra effort part of their standard procedure. We are proud to recognize our nurses for the exemplary bedside care that they provide to patients and their loved ones on every shift. Capital Health Regional Medical Center Honorees: Kyeisha Frink, RN Kalaivani Panneerselvam, BSN, CCRN Trauma Medical ICU Neuro ICU Lauren O’Donnell, RN, BSN, TCRN Tanisha Sosa, RN, BSN Emergency Department Emergency Department Capital Health Medical Center – Hopewell Honorees: Elizabeth Braun, BSN, C-EFM Kelly Scheuerman, BSN, RN Labor & Delivery Float Pool Barbara Mizenko, RN, RNC, OB, Nicole Siplin, RN C-EFM Float Pool Labor & Delivery 2019 Nursing Annual Report 9

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    // STRUCTURAL EMPOWERMENT Celebrating Nurses Week at Capital Health EXCELLENCE IN NURSING PRACTICE AWARD RECIPIENTS RMC HOPEWELL Jessica Arteaga, RN-BC Christine Brooks, RN Surgical Trauma Unit Emergency Room Nancy Distelcamp, BSN, RN, CEN, TCRN Adam Caponi, BSN, RN Trauma Department 4M Josephine Flores, BSN, RN, CCRN Melissa Chichilitti MSN, RN, CCRN Trauma Medical ICU/IMU Nurse Manager, Intensive Care Unit Susan Larson, RN Courtney Flesch, RN Float Pool Pediatric Unit Mary Rosner, MSN, RN Shannon Foster, RN Community Health Education Assistant Nurse Manager – 6M Rebecca Stansbury, MSN, RN, CNOR India Henderson, BSN, RN Operating Room 5M Teresa Swantek, BSN, RN Laura Moran, BSN, RN, CDCES Emergency Room Diabetes Educator Ashley Taylor, BSN, RN Robin Redondo, RNC-OB Trauma Medical ICU/IMU Labor and Delivery Michelle Wilson, BSN, RN Janice Schenck, RN, CPEN 2 Front Pediatric Emergency Room Trauma-Medical Intensive Care Unit/ Debbie Schuster, RN Intermediate Care Unit Operating Room Excellence in Nursing Team Award Kristen Stuenckel, BSN, RN, CCRN Nurse Educator – Intensive Care Unit 4M Excellence in Nursing Team Award PARTNERS IN PRACTICE RECIPIENTS RMC HOPEWELL Nursing Supervisors Nursing Supervisors 3 Front-South Mental Health Counselors Pharmacy IT Team Jennifer Kral and Erica Moncrief Capital Health Librarians 10 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Nursing Clinical Ladder Program After many years in the planning phase, and with much support from Cheif Nursing Officer Deborah Mican, Capital Health proudly implemented a Nursing Clinical Ladder Program, utilizing the Benner Novice to Expert Model. The Clinical Ladder Committee worked to design a cohesive program that supports the initiatives of Capital Health and validates the many accomplishments of Capital Health nurses. Clinical Ladder Committee Members: Deborah Mican, PhD, BSN, RN, MHA, CNOR Joyce Merrigan, DNP, CPLC, CBC, CBCC, Committee Chair C-EFM, RNC-OB Karen Adamczyk, BSN, RNC-NIC Roxanne O’Byrne, MSN, OCN Christina Allen, DNP, AGCNS-BC, RN-BC, CEN Gary Oravsky, MSN, CRN Gregory DeMari, BSN, RN-BC Diane Patterson, MSN, RNC-NIC Susan Ditommaso, RN Colleen Price, MSN, RN, APN, AGACNP-BC Margaret Estlow, MSN, PPCNP-BC, CPEN Gregg Sharp, BSN, MA, CEN Maryann Foley, BSN, CNOR Donna Talley, MSN, CCRN, CNL Michelle Johnson, BSN, RNC-OB, C-EFM Patricia Tatrai, MSN, CCRN, CBCN April Lang, MSN, APN-C Domonique Wilson, BSN Cheryl Lang, MSN, APN-C, CEN Laura Zesski, RRT Kate Lodise, RRT The goal of the program is to recognize and reward nursing’s contributions to quality care and highlight evidence-based practices that positively influence patient outcomes. Research shows that clinical ladder programs improve job satisfaction and organizational commitment from nurses while fostering professional growth, increasing BSN and specialty certification rates, increasing quality of nursing care, and reducing turnover while sustaining a Magnet Culture. The program rewards professional advancement for nurses through active participation in growth and learning endeavors by providing a monetary compensation initiative. Nurses may apply for the program by submitting a completed binder that includes core performance criteria: education, clinical expertise, performance and professional development. Applications are reviewed by the Clinical Ladder Committee and receive final approval from Deb Mican. 2019 Nursing Annual Report 11

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    // STRUCTURAL EMPOWERMENT Nursing Clinical Ladder Program cont’d Congratulations to all nurses who achieved Clinical Ladder status in 2019! Clinical Nurse Level 1 (CNL 1) Linda Bowers, BSN, RN Alix McLean, BSN, RN Jeffrey Clair, BSN, CCRN-K, RN-BC Amanda Mihaich, BSN, RN-BC Mary Kate Culp, RN Sean Murphy, BSN, RN-BC Danielle Estelle, BSN, RN Elaine O’Connor, RN, CNOR Raymond Forte, MSN, RN, CEN Debra Pracko-Wagner, BSN, CNOR Maria Gilli, BSN, SCRN Mary Rosner, MSN, RN Jeff Gusst, BSN, MBA, RN, CEN Janice Schenck, BSN, RN, CPEN Betsy Kington, MSN, RN-BC Cheryl Smith, BSN, RN-BC Susan Kirsch, BSN, RN, CPAN Rebecca Stansbury, MSN, RN, CNOR Karen Lakatos, BSN, RN Timothy Sullivan, BSN, RN Brenda LoCastro, RN, CAPA Clinical Nurse Level 2 (CNL 2) Clinical Nurse Level 3 (CNL 3) Marian Moore, BSN, CCRN, TCRN, RN-BC Nancy Distelcamp, BSN, CEN, TCRN Deborah Stabile-Wisniewski, DNP, CCRN-K, Beth Falkenstein, BSN, RN, CEN, TCRN CNE, CMRSN, NE-BC Geraldine Sanfillippo, MSN, SCRN Nurse’s Day – Clinical Ladder Presentation 12 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Nurse Residency: Bringing Eagerness and Energy to the Nursing Workforce The Nurse Residency Program is geared towards new graduate RNs. In 2019, Capital Health coordinated two Cohort Groups. The January Cohort had 20 new graduate RNs and the August Cohort had 36 new graduate RNs. The program includes a 10-week rotation during which the residents spent time on each of the Medical/Surgical units. If a resident shows interest in a specialty unit (such as Maternal Child Health, Critical Care, Dialysis, or Psych), time can be spent time on those units as well. After the rotation is over, the residents and nursing personnel jointly decided on the best unit for each resident. This program also includes a didactic portion in which the residents attended seven nurse resident classes, basic arrhythmia class, ACLS, and the critical care course before continuing on to the mentoring program. The Mentoring Program is a 6 -12 month program that includes clinical enrichment days and lecture days. Clinical enrichment days allows residents to pick areas of the hospital that they normally would not get to see and spend a day shadowing an RN. For example, a nurse on the surgical unit may want to spend a day in the OR or in the PACU. This experience not only gives the resident an overview of what occurs in these areas, but also strengthens interpersonal relationships between these units. Understanding the flow of the OR and PACU also ultimately help with the flow on their unit. In addition to clinical enrichment days, residents also attend lecture days. These lecture days include topics geared towards the needs of the new graduate RN. Examples include delegation, interpersonal skills, nursing practice and legislation, career advancement, and additional topics that emphasize self-care modalities. Congratulations to all the 2019 nurse residents! Kelly Audette, BSN, RN Dainen Green, BSN, RN Prabhjot Pandher, BSN, RN Kelly Bailey, BSN, RN Ashley Grochala, BSN, RN Brianna Polk, BSN, RN Daniel Brenner, BSN, RN Emily Gunia, BSN, RN Jazelyn Roman, RN Victoria Bright, BSN, RN Sade Harris, RN Jenna Romano, BSN, RN Corianne Cha, BSN, RN Anna Janusz, BSN, RN Robert Rowlands, BSN, RN Emily Ciaramella, BSN, RN Stella Kim, BSN, RN Steven Spadafino, BSN, RN Victoria Citta, BSN, RN Jennie Kolaski, BSN, RN Kristen Schrapp, BSN, RN Stacey Coleman, RN Nicole LeJeune, BSN, RN Melissa Sturchio, BSN, RN Lois Comly, BSN, RN Shaina-Marie McDaniel, BSN, RN Andrew Sullivan, BSN, RN Izzy Dejesus, BSN, RN Casey McGovern, BSN, RN Rachel Sweezy, BSN, RN Caryn Diller, BSN, RN Mark McGowan, BSN, RN Brianna Tattory, BSN, RN Shannon Donahue, BSN, RN Kaleigh McKenna, BSN, RN Christian Taylor, BSN, RN Joshua Donlen, BSN, RN Mathew Melone, BSN, RN Davia Titus-Thomas, BSN, RN David Edden, BSN, RN Dianelis Mendoza, BSN, RN Elizabeth Van Curen, BSN, RN Soraya Falcao, BSN, RN Felicia Mignon, BSN, RN Allison Wainwright, BSN, RN Madison Foglia, BSN, RN Chris Mozdy, BSN, RN Bridget Watson, BSN, RN Rosa Giammarino, BSN, RN Michelle Niles (Tkachuk), BSN, RN Caitlyn Weik, BSN, RN Marissa Gorgol, BSN, RN Samantha Norton, BSN, RN Rachel Windisch, BSN, RN Brianna Gosselin, BSN, RN Victoria Nwachukwu, BSN, RN 2019 Nursing Annual Report 13

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    // STRUCTURAL EMPOWERMENT Nurse Residency cont’d Here are what some of the nurse Victoria Citta I currently work on the Surgical unit, 4M. I residents had to say about the enjoy taking care of all of my patients, and I especially enjoy being able to see patients Nurse Residency Program: make a full recovery post-surgery. The nurse residency program and the people I have met along the way have helped me tremendously in transitioning as a Kelly Audette new nurse. I aspire to achieve my MSN within the next I am currently working on Steen 2, the few years. One day, I hope to work in nursing academia. surgical trauma unit, which I absolutely love. I think the nurse residency is absolutely amazing! Not only is it an Madison Foglia opportunity to fine tune some of the skills we didn't I’m a 2019 graduate from The College of New Jersey and get to do a lot of in clinical, but we got to see a lot of I work on 6M, the Telemetry unit in Hopewell. As a new departments that we wouldn't normally have had the graduate with no clear direction, the residency program chance to without the program. One of the best parts gave me the opportunity to experience multiple clinical was being able to follow various nurses and pick up a areas to find one that suited me. What I love about 6M lot of random skills and see how differently each of them is that I’m constantly learning, we see a wide range of ill work. It helped me develop my own way of charting, organizing and getting through my shifts more efficiently patients, not only including cardiac but neuro as well. I’m and offer better quality nursing care than if I had just also so lucky to be surrounded by a team of intelligent, went straight to a floor after school. passionate nurses who are always willing to support me. Daniel Brenner Emily Gunia I completed the residency program in May 2019. I have I am a staff nurse in Capital Health’s Pediatric been practicing on the Surgical Trauma unit at Regional. Emergency Room. The Nurse Residency at The residency program gave me an opportunity to be Capital Health has given me an amazing ahead of other new graduates. I had an opportunity to opportunity to be a nurse at an amazing learn different skills from vastly different nurses. When hospital, in the field I always dreamed of working in. The I started my unit based orientation, I had already been Nurse Residency Program helped me transition smoothly practicing skills for a few months, so it allowed me to from a student nurse to a staff nurse, while making engulf myself in the specifics of my unit. It allowed me relationships with peers and mentors that will help me to bring in an outside perspective to my unit that I would continue to grow in my nursing career. not have been exposed to if it were not for residency. I try to help with the nurse residents anyway I can because Brianna Gosselin I know what this program has the potential to do for I am a staff nurse on 2 Front, Capital Health’s our organization and for the new graduates entering Inpatient Cardiology unit. I am so grateful the program. for the opportunity I’ve had in the Nurse Residency Program because it has exposed Emily Ciaramella me to various specialties in nursing and gave me the I am currently a nurse on Steen 1 at the Capital Health chance to interact with numerous staff members. Regional campus. One of my aspirations as a nurse is to go back to school and become a nurse practitioner. However, for now I am enjoying my time on Steen 1, and being a part of the residency program. Thank you to everyone at Capital Health for welcoming the new nurses, and helping us along the way! 14 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Nurse Residency cont’d Ashley Grochala Melissa Sturchio I work with an amazing team on the I completed the nurse residency program Surgical-Trauma Unit at RMC. The Nurse last Spring and I am happily employed in Residency Program was beneficial because the Hopewell ED. I had a very positive I had the opportunity to get a feel for a experience in the Nurse Residency variety of different nursing paths and everyone was Program and would strongly recommend it to other extremely welcoming! new graduates. I am proud of the progress I have made over the past year as a new nurse and I continue to learn every day. Nicole LeJeune I work on Outerbridge 1 at RMC. The Nurse Residency Program was an awesome Andrew Sullivan opportunity for me because I didn’t know I currently work nights in the Emergency where or what type of unit I wanted to work Room at the Hopewell Campus. The on. I’m thankful the program led me to my coworkers, my Nurse Residency Program really helped awesome preceptor, and a unit where I’m always learning! me to not only meet fellow new graduates, but help streamline the process when it Casey McGovern came to learning about Capital Health’s policies, I work in Labor & Delivery and absolutely procedures and the various pieces of equipment that love it! The Nurse Residency Program gave the nursing staff use on a daily basis. I would highly me the opportunity to work in a specialty recommend this program to any new graduate! right out of school. My future goals in nursing include continuing to learn how to be the best Davia Titus-Thomas bedside nurse I can be and go back to school to be a I currently work on Steen 2 at RMC. The nurse practitioner in the near future! Nurse Residency Program meticulously assists with grooming the new nurse to transition into the professional nursing Michelle Niles (Tkachuk) arena. Having been able to initially rotate through I currently work on Hopewell’s Telemetry various units, it serves to broaden one’s clinical outlook unit (day shift)! Capital Health’s residency while at the same time narrowing to find the area that program has helped me ease into the role grasps one’s interest the most. In this program, you of independent nurse nicely! I had plenty of never feel alone because you are always supported by time to acclimate to the hospital and unit prior to being your team. on my own as a nurse. I felt like I was never on my own since day one, and I most certainly have a great support group on the unit and through the program, now! I Elizabeth Van Curen couldn’t ask for anything more as a new nurse. I work in Hopewell’s main OR. I love the OR because I have the ability to see many different areas of surgery and no day is ever the same. Something I enjoyed about the Nurse Residency Program is the support I had from other new nurses and the ability to try many different areas of nursing. 2019 Nursing Annual Report 15

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    // STRUCTURAL EMPOWERMENT Certified Nurses Lead the Way to Quality Care Professional certification demonstrates a nurse’s knowledge and competence in providing safe, quality patient care. Certification has been shown to benefit the individual nurse, patients, and the employing organization as a whole. In 2019, Capital Health nurses continued to prove their excellence through certification, with an overall organizational certification rate of 41%. The top five units with the highest certification rates of clinical nurses are: UNITS CERTIFICATION RATE* LDR 84% Specialty Care Transport Unit 63% Hopewell Same Day Surgery 62% Neuro ICU 60% Infusion Unit 57% * Based on # certified clinical nurses/# eligible clinical nurses (> 2 years of experience in specialty) L&D Certified Nurses 16 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT NJSNA Provider Unit Thrives As a Provider Unit approved by the New Jersey State Nurses Association (NJSNA), Capital Health offers continuing education programs for nursing and other disciplines. This robust program strives to present informative and engaging educational sessions for professional development. A continued goal of the program is to increase the number of annual offerings and participants. In 2019, we offered 145 sessions, nearly doubling the number of educational programs in 2018 (which was 76). We accomplished this by adding 46 unique programs to 20 recurring sessions or series. More than 2,300 Capital Health staff members and other health care professionals attended our conferences and events, receiving almost 9,500 continuing education hours. Advanced Pharmacology Day In the state of New Jersey, advanced practice registered nurses (APRNs) are required to maintain national certification. The American Nurses Credentialing Center (ANCC) mandates that 25 - 50 contact hours of pharmacology credits are needed for recertification. Each year, APRNs from Capital Health’s Department of Clinical Education—Kim Coleman, MSN, RN, APN,C and April Lang MSN, RN, APN,C—coordinate an all-day Advanced Pharmacology Seminar. This program identifies important pathophysiology concepts common to the care of patients using pharmaceuticals and integrates new pharmacologic therapies in the management of patients. Participants in this program interact through the discussion of proper pharmacotherapeutics based on clinical and case presentations while incorporating evidence-based changes into practice. Topics in the 2019 Advanced Pharmacology Program included medications dealing with patients in pain, beta lactams, alcohol and opioid withdrawal, and medication reconciliation. This past year, April Lang, MSN, RN, APN,C and Michele Vazquez, MSN, RN-BC conducted an hour-long presentation, “The Care of the Patient undergoing Gender Confirmation Surgery.” This program awards more than six contact hours that can be applied to the mandated hours needed to obtain certification renewal. Hospital Week (Sports Team Day) 2019 Nursing Annual Report 17

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    // STRUCTURAL EMPOWERMENT Injury Prevention Programs by the Bristol Myers Squibb Trauma Center Provide Valuable Education to Community Members of All Ages PROGRAM TYPE PARTICIPANTS # CLASSES Adult Distracted Driving Awareness 309 2 Adult Fall Prevention 314 11 American Heart Association - CPR 82 9 At Risk Kids – Trauma Alert Resuscitation Management 18 1 EMS Paramedic Refresher – Triage and S.A.L.T. Triage 27 1 Internal Disaster Drill 100 2 Grandparent Workshop – 61 2 Infant CPR, Car Seat Safety and General Infant Home Care High School Health & Safety Programs – Don’t Be an Impaired Driver 1,200 1 Nursing Programs and Presentations – 30 1 Career Day at Mercer County Technical Schools Operation Prom Night – Driver Safety 575 5 Trauma Physician Presentations – Dr. Michael Kelly, Dr. Yuri Rojavin 330 9 Advanced Trauma Life Support 61 4 Physician Assistant Presentations – Jennifer Keat-Wysocki, PA-C presented 53 1 ‘Spotlight on a PA in Specialty Practice’ Career Day at Hunterdon Central High School 25 1 18 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT TRAUMA PROGRAMS (cont’d) PARTICIPANTS # CLASSES Julie Le, PAC helped provide reconstructive surgery for pediatric 32 1 and adult patients in Guayaquil, Ecuador RN – Trauma Care After Resuscitation 50 1 RN Trauma – Critical Care Orientation 147 6 Schwartz Rounds Programs for all Capital Health Staff 380 6 (organized by Dr. Yuri Rojavin) Special Operations Combat Medics Team presented by 86 7 Dr. Michael Kelly and SFC Corey Terry St Francis School of Nursing Presentations – 45 1 Chest Tubes and Auto Transfusions Stop the Bleed – Bleeding Control (BCon) course for community, staff, 650 38 police, and EMS providers (6 bleeding control kits were distributed) TNCC – Trauma Nurse Core Course, National Certification 83 4 2019 Trauma Symposium 131 1 TRAUMA LECTURE SERIES Muscular-Skeletal Assessment for Trauma Patients 15 1 BCon Bleeding Control 39 1 Geriatric Trauma Assessment 21 1 Pediatric Trauma Assessment 21 1 Trauma Physician Presentations – Advanced Trauma Life Support (ATLS) 110 5 2019 Nursing Annual Report 19

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    // STRUCTURAL EMPOWERMENT COMMUNITY EVENTS AND PROGRAMS PARTICIPANTS # CLASSES Are We There Yet? – Car Seat Safety Program for Adults 214 5 Back Packs for Trenton – Elementary School-Aged Children Safety Event 100 1 Patient and Staff Education Day at Capital Health – 75 2 RMC / Hopewell Cub Scout – Pedal Power Safety Packets 10 1 Driver Safety and Awareness – Rider University in Ewing 200 1 Driver Safety and Awareness – Global Industry Staff 200 1 Health Event in Robbinsville Ewingfest Event 300 1 Fall Prevention – Hopewell Township Senior Picnic Event 200 1 Living Waters – Family Safety Event in Robbinsville 100 1 Summer Safety – Mercer County Safe Kids Day at Arm & Hammer Park – 150 1 Trenton Thunder National Night Out 2019 at the East Windsor P.A.L. Sports Complex 2,000 1 National Night Out 2019 at the Bordentown Police Event 250 1 National Night Out 2019 at the Ewing Township Police Event 1,000 1 Driver Safety – Rider University Staff Event 200 1 Shad Festival in Lambertville, PA 1,000 1 Annual Safe Kids Bike Rodeo – St. Lawrence Rehabilitation 350 1 Trauma Day at Arm & Hammer Stadium – Trenton Thunder 800 1 Healthy Kids Day – Capital Area/Trenton YMCA 500 1 20 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT COMMUNITY EVENTS AND PROGRAMS PARTICIPANTS # CLASSES Stop the Bleed – New Jersey State House – Trauma Day 150 1 Summer Safety 300 4 SCHOOL PROGRAMS PARTICIPANTS # CLASSES Walk This Way – Pedestrian Safety for Preschool and Elementary 736 23 School Students I’m Safe in the Car – Seatbelt Safety for Children 353 9 Pedal Power – Bike and Helmet Safety for School Aged Children 1,057 24 Let’s Have a Concussion Discussion – 334 9 Concussion Awareness for School Aged Students SAFETY EQUIPMENT DONATIONS Pedal Power Program Distributed Bicycle Helmets to Participants 160 — Bicycle Helmet Giveaway – 6 — Children and Patients at RMC and in the Community Protective Gear – Education and Distribution 2 — Convertible Car Seats and Booster Seats to Families and Children in Need 3 — Informational packets about Car Seat Safety, Pedal Power (bike and helmet safety), Distracted Drivers, No Texting Safety, Concussion Awareness, Older 250 — Adult Fall Prevention, Pedestrian Safety Distributed tourniquets to police departments within our catchment area 26 — Bleeding Control Kits Presented at Stop the Bleed programs 12 — TOTAL 16,033 217 2019 Nursing Annual Report 21

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    // STRUCTURAL EMPOWERMENT Magnet Escape Rooms Members of Magnet Masters, a committee that focuses on cultivating the culture of Magnet, recognized that our fellow nurses would benefit from a fun, interactive activity to learn about the Magnet Recognition Program and demonstrate its value to Capital Health and its nurses. Mary Kate Culp, RN, clinical nurse and co-chair of Magnet Masters, proposed the idea of creating a Magnet Escape Room to promote nursing engagement and increase the visibility of the committee. After first learning of concept at the Magnet Conference in 2018, Mary Kate wanted to bring it to Capital Health. The committee also determined an escape room would be an innovative way to encourage the nursing staff to participate in the 2019 National Database of Nursing Quality Indicators (NDNQI) survey, which is an essential tool used to accurately portray clinical nurses’ perceptions. A small subcommittee of the Magnet Masters enthusiastically worked to make this idea a reality: Mary Kate Culp, RN Chrissi Peyton, MSN, RN Amanda Fletcher, BSN, RN, OCN Christina Allen, DNP, AGCNS-BC, N-BC, CEN Pam Esher, RN, SCRN Colleen Price, MSN, RN, APN, AGACNP-BC Roxanne O’Byrne, MSN, RN, OCN The project began with the creation of poster boards containing information about the history of Magnet, fun facts, previous results and information on the NDNQI survey, and initiatives the committee was working on to improve nursing satisfaction and practice. Next, the committee assembled a number of riddles, puzzles, and clues that encouraged participants to uncover the information required to “escape” the room. In addition to successfully increasing nurses’ knowledge and improving their perception of Magnet, the Magnet Masters observed that this activity also promoted teamwork and collaboration among the participants. Positive feedback was given on a post-event survey, and many of the participants encouraged using this method for future learning activities. The Magnet Escape Room’s success was also demonstrated through the astounding increase in nursing’s NDNQI response rates at Capital Health. Both campuses exceeded the national average of 70 percent response rates, with 73 percent at Capital Health Medical Center – Hopewell and 89 percent at Capital Health Regional Medical Center. In addition to exceeding the national average for the first time ever, we greatly exceeded our 2018 response rates, including a more than 20% increase at Capital Health Regional Medical Center! This fun and interactive learning strategy is a great example of how a professional development activity can be designed to promote nurse engagement and improve professional practice. 22 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT STAR Program The Special Thanks and Recognition (STAR) Program continued to grow in popularity in 2019. This program is a way for any Capital Health employee to show appreciation for colleagues who provide amazing care and great work, day in and day out. Capital Health’s core values of integrity, compassion, excellence, and teamwork guide our actions and ensure we are accomplishing our mission and bringing our vision to life every day. By recognizing one another for hard work and achievements, the STAR Program reinforces and perpetuates the positive behaviors that foster a healthy work culture and exceptional patient care. Whether it’s for day-to-day accomplishments or efforts that go above and beyond a colleague’s usual responsibilities, the STAR program allows Capital Health employees to recognize, honor and celebrate the individuals and teams who are at the core of our success. When recognition is done right and with sincerity, it can be powerful to those receiving it and ultimately leads to a culture of thanks and appreciation. In 2019, almost 10,800 STAR cards were issued. TOP THREE E-CARD SENDING DEPARTMENTS IN 2019: Antepartum/Postpartum at Hopewell 1,262 Capital Health Medical Group 1,229 Emergency Room at Regional 799 TOP THREE E-CARD RECEIVING DEPARTMENTS IN 2019: Emergency Room at Regional 1,092 Antepartum/Postpartum at Hopewell 744 Emergency Room at Hopewell 681 Wear Blue Day 2019 Nursing Annual Report 23

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    // STRUCTURAL EMPOWERMENT Capital Health Nurses Give Back to the Community at Home and Abroad Every year, Amanda Mihaich, BSN, RN-BC volunteers locally with Camp Can Do, a national organization that provides the camping experience for children with cancer and their siblings. There are three separate weeks for the children to attend – a sibling week, week one patient camp, and week two patient camp. In each of these weeks, these kids get to be kids again. The camp is run completely by volunteers, including a full medical staff for each week. A pediatrician and several nurses are on site and on call 24/7 in case any issues come up. Amanda serves as one of these nurses. When a child first arrives to Camp Can Do, the medical team assesses them, reviews their medication list, and reviews any allergies with the child to compare against medical records. The medical team then goes back to the infirmary and double-checks medications against the medical records sent to camp with the child. The nurses manage all medications (except emergency medications such as inhalers and epi-pens, which are kept with the child), and distribute the medications appropriately. During their downtime, the medical team is able to enjoy camp with the kids, a part of the experience that is priceless and memorable. Camp can be just as important to the treatment process as the chemotherapy the children are receiving. By meeting other children going through the same treatments (or those have already gone through the treatments and are now in remission), campers learn and grow from each other and get the extra motivation they may need to continue fighting the disease. The children go from strangers to practically family in just a few short days. Children who arrive at camp feeling self-conscious because they are bald, have scars, use an assistive device, or have difficulty walking are encouraged by others who have gone through similar experiences. By the end of the week, they ditch the bandanas, jump in the pool without covering their scars, and try as hard as they can to walk a little more each day. Campers form long-lasting bonds with one another and keep each other motivated through the toughest fights of their lives. 24 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT On the international front, Heather Keller, MSN, CEN is part of a team of volunteers from Capital Health who travel to Guatemala each year with family members to provide medical care and help build houses for the community. The team provides medical screenings and interventions and educates villagers on dental care and feminine hygiene practices. Patients and family members in the village are supplied with toothbrushes, toothpaste, dental floss, eyeglasses and sunglasses. It’s not all work and no play, however, as the team also takes time to teach villagers how to crochet, repurpose plastic bags to make sleeping mats, and play with local children. As it has been in other years, 2019 was very successful. The team built nine houses in four days and provided local villagers with much needed medical care, knowledge, and supplies to better care for themselves. In the team’s combined visits to Guatemala over the years, they have provided medical care for more than 1,200 patients. 2019 Nursing Annual Report 25

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    // STRUCTURAL EMPOWERMENT Registered Nurse Joyce Toriano Recognized for Military Service Registered Nurse Joyce Toriano, MSN, RN, SCRN, was recently welcomed back to the Neuro ICU by coworkers at Capital Health Regional Medical Center after serving in Kuwait for 13 months as a colonel in the Army Reserve. Gina Petrone Mumolie, DNP, MBA, RN, NEA-BC, senior vice president of Hospital Administration, was on hand to present flowers along with Nurse Manager Christine Carter, MSN, CCRN, CNRN, PCCN, SCRN who provided Joyce with some of her favorite local cuisine. Joyce also received a patriotic quilt from representatives of the Quilts of Valor Foundation, a non-profit organization dedicated to recognizing veterans and service members touched by war. Since its founding in 2003, Quilts of Valor has awarded more than 200,000 quilts to veterans in all 50 states. Champions Against Breast Cancer The fight against breast cancer was bigger and stronger than ever in 2019. Breast cancer navigator Trish Tatrai, RN, MS, OCN, CBCN and Dr. Rose Mustafa joined the Hopewell Valley Gridiron Club Bulldogs Football team to support the team’s efforts to increase breast cancer awareness from August through October among students, educators, and their fans. The team raised $1,500 for our Center for Comprehensive Breast Care, making them champions of our patients and the community. 26 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Healthcare Hero Awards Honor Staff for Outstanding Health Education The Healthcare Hero Award, sponsored by the Patient and Family Education Committee, is an annual award presented to a Capital Health System nurse, pharmacist, dietitian, social worker, physical therapist, or any other allied health professional who cultivates interdisciplinary teamwork and exceeds expectations in health education. A winner is chosen from each campus. Nominees distinguish themselves by possessing unique qualities in the management and delivery of health education. In addition, nominees exceed excellence in their ability to meet the individual health education needs of their patients. The contributions of these professionals have a positive impact on the practice of health education for patients and their families as well as their colleagues in health care. Two winners at Capital Health were presented awards in their departments and were recognized and honored at the February department head meeting. The 2019 winner of the Healthcare Hero award at Capital Health Regional Medical Center was MIKE PARYLAK, RRT-ACCS, a respiratory therapist in the Neuro Intensive Care unit. Mike’s nomination letter describes him as someone who colleagues see as a resource and who consistently provides education to all stakeholders in the Neuro ICU. He is solely responsible for all education and new processes for respiratory therapy in the Neuro ICU and frequently precepts and acts as a mentor to all new staff there, including nurses, respiratory therapists, and medical staff. Mike does all this with great enthusiasm and professionalism, with neuro intensivist Dr. Anita Maraj describing him as vital team member whose insights and contributions to the multidisciplinary team are invaluable. The 2019 winner of the Healthcare Hero award at Capital Health Medical Center – Hopewell was ERIN BENDER, BSN, RN from the Ambulatory Surgery Center. Erin is a preoperative staff nurse who is described by her coworkers as dynamic, engaging, and a nurse who always goes above and beyond for her patients. One such example of this is explained in her nomination letter. When a six-year-old patient needed a procedure, Erin found out that the child did not have a booster seat in the car. Determined to ensure that the child would be safely transported with a proper car seat, Erin utilized every resource at her disposal to rectify this situation so this child could have the procedure they needed. She expertly navigated this challenge (including a language barrier) while performing her duties as a charge nurse and taking care of other patient needs. Erin expertly seized this opportunity to provide education to the parents and advocate for her patient, and her nomination letter goes on to say that this is just one example of many where Erin has showcased excellence and compassion in her delivery of patient care and health education. 2019 Nursing Annual Report 27

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    // STRUCTURAL EMPOWERMENT Patient and Family Education Day Brings Awareness of Community Programs The Patient and Family Education Committee held the annual Patient and Family Education Days at Capital Health Medical Center – Hopewell and Capital Health Regional Medical Center in October 2019. Both events were free to the public and part of Capital Health’s outreach efforts to the communities it serves. The goal and mission of Patient and Family Education Day is to provide a wide variety of health education while highlighting all the services, departments, and assistance that Capital Health has to offer. In total, more than 600 people attended and both events were well received. Departments that participated in the 2019 events included Cardiac Rehabilitation, Diabetes Education, the Cancer Center, Respiratory Care, Pulmonary Services, Oasis Salon and Wellness Spa, Crisis and Mental Health Services, the Marjorie G. Ernest Joint Replacement Center, Renal Dialysis Services and the NJ Sharing Network, Patient Experience, Audiology, Bristol-Myers Squibb Trauma Center, and Volunteer Services. 28 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Clinical News: Information Close at Hand With the never-ending expansion of digital technology, we’re all inundated with emails and online requests. To take a break from the digital overload, the Practice and Education and Professional Councils are disseminating information the old fashioned way. Beginning in 2017, Kim Coleman, MSN, APN,C collected information from these councils to publish the monthly Clinical News newsletter. This newsletter captures important practice and educational information for our staff’s development and growth. Due to reader demand for more information, what started out as a two-page handout printed out on each unit quickly evolved, Jessica Serrano, RN and Kelly Audette, RN and by 2019 Clinical News had become a monthly 14-page publication that is mass produced by the Capital Health print shop. Entries into the newsletter include (but are not limited to) DNV highlights/hospital updates, Clinical Ladder opportunities, new clinical information, educational programs at Capital Health, Cornerstone Corner, “Can You Interpret that Rhythm?”, IV Corner, and a congratulations section to recognize staff who have received awards. Jessica Serrano, BSN, RN and Kelly Audette, BSN, RN, both RNs on Steen 2 at RMC, say that the information is valuable, particularly the section highlighting upcoming educational programs. Kim Wiley, RN on 5M at Hopewell, likes that having monthly updates compiled into one source, saying “It’s easy to retrieve new as well as reinforced information.” Readers have also commented that it is nice to just sit down and read a hard copy of the newsletter in a relaxed environment. Kim Wiley, RN 2019 Nursing Annual Report 29

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    // STRUCTURAL EMPOWERMENT APN Council: Leading the Way The Advanced Practice Nursing (APN) Council at Capital Health was formed in the fall of 2015 to promote and support the diverse and expanding role of advanced practice nurses. This group is composed of clinical nurse specialists (CNS), certified nurse midwives (CNM), certified registered nurse anesthetists (CRNA), and nurse practitioners (NP). The purpose of this committee is to promote and support the diverse and expanding role of advanced nursing practice based on empirical evidence. The objectives of the council are to:  Identify and evaluate trends in APN practice, legislation and scope of practice. • Promote collaboration between APNs, professional registered nurses (RNs) and other clinical care providers. • Identify and promote the contributions of advanced practice nursing to safe and high quality patient outcomes. • Monitor and ensure the quality of APN practice through peer evaluation and outcomes. The official duties of the council are to monitor organizational, regional, and national trends in APN practice and legislation; implement and monitor evidence-based practice with regard to all aspects of advanced practice care; collaborate with the Research and Evidence-based Practice Council to support and participate in clinical research; collaborate with the Education and Professional Development Council to plan and facilitate educational programs for APNs, RNs, and other clinical care providers; participate in the peer review process within the Patient Services Division and designated APN practice areas outside of the Patient Services Division; and promote and support APN practice by encouraging the credentialing of licensed APNs using Capital Health’s established process. Since its inception, the group has worked to standardize collaborative agreements, recommend changes to contracts and the credentialing process, improve orientation for APNs, and assess and improve the peer review process at the advanced practice level. Here at Capital Health, we have APN representation on the Professional Practice and Credentialing Committees. Additionally, the members of the council have worked to advocate for APN practice both internally and externally and to promote the understanding, image and practice of APNs. Meetings are held monthly, with quarterly Lunch and Learn programs. In 2019, educational programs consisted of Management of the Inpatients with Diabetes, Medicinal Cannabis: Real Medicine or Reefer Madness, and Highlights of 21st Century Pain Management: A Rapidly Evolving Area of Patient Care. In addition, this group also hosted a dinner lecture on June 10, 2019, entitled “Recovery & Monitoring Program (RAMP) Nurse Substance Abuse Treatment,” sponsored by the NJ State Nurses Association. Rosemary Silva, MSN, APN,C, The number of APNs keep growing. In 2019, 150 APNs were invited to attend this Council Chair prestigious group at Capital Health. 30 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Cancer Center Institutes New Unit-Based Practice Council The Cancer Center started its first unit-based practice council in September 2019. This was a new concept for the department, but the team embraced the idea and were eager to get involved in the shared governance model of Capital Health. The Cancer Center has a unique structure. It is a hospital-based outpatient department, which includes Radiation Oncology, the Infusion Center, and various disciplines throughout. Bringing the shared governance model here is shining a light on the unique issues of this department and encourages other similar outpatient departments within Capital Health to follow suit. The unit-based practice council’s initial goal was to bring together the diverse team members of the Cancer Center and spark their interests in championing meaningful changes within their department. The council was started by Amanda Fletcher, BSN, RN, OCN, then a clinical nurse in the Infusion Center. Amanda currently chairs the council alongside Preiona Cruse, RN, co-chair of the council and clinical nurse in the Infusion Center. The council has been a great success and attendance is growing as they plan future projects Hospital Week (Superhero Day) 2019 Nursing Annual Report 31

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    // STRUCTURAL EMPOWERMENT Capital Health Nurses Teaching Others At Capital Health, there are many nurses who, in addition to their daily jobs, assist in advancing the nursing profession by mentoring nursing students and colleagues who wish to advance their careers. Through instruction and precepting, our nurses guide, tutor and provide direction based on program and individual objectives and goals. Serving as a preceptor is a rewarding experience that gives each instructor an opportunity to make contributions to the next generation of nurses. Nurse preceptors in 2019 included: Christina Allen, DNP, AGCNS-BC, RN-BC, CEN Regina Kukulski, MSN, ACNS-BC Karen Avila, MSN, RN Vera Kunte, DNP, APN,C Julie Blumenfeld, CNM, MSN April Lang, MSN, APN,C Bruce Burns, MSN, NE-BC Cheryl Lang, MSN, APN,C, CEN Christine Carter, MSN, CCRN, CNRN, PCCN, SCRN Luzeneida Lewis, MSN, APN,C Ellen Clancey, MSN, FNP-BC Dawn Mormando, BSN, RNC-OB Kim Coleman, MSN, RN, APN,C Susie Nawrock MSN, APN,C Lisa Ennis MSN, RN Daniela O’Neil, MSN, FNP-BC, APN,C Gary Fassler, MSN, RNC-OB Colleen Price, MSN, RN, APN, AGACNP-BC Karen Giquinto, MSN, APN,C Kristy Reed, MSN, APN,C Donna Gottschall, MSN, RN-BC Shannon Renitsky, MSN, APN,C Barbara Grande, MSN, RN-BC Debra Roccuzzo, MSN, APN,C Judy Harkins, MSN, APN,C Mary Rosner, MSN, RN Jennifer James, MSN, RN, NE-BC Rosemary Silva, MSN, APN,C Additionally, senior nursing students from Thomas Edison State University are partnered with a clinical nurse every year to complete a 60-hour transition experience. The purpose of the transition experience is to allow students to spend five one-on-one shifts with an experienced nurse, allowing for a full immersion experience in nursing. The students find the experience extremely valuable and are grateful for the time and dedication of their preceptors: Theresa Allen, RN Kasha Kania, BSN, RN-BC Jessica Arteaga, RN-BC Samuel Kirsch BSN, RN Victoria Auden, BSN, RN Katie Locastro, BSN, RN-BC Antonia Belardino, BSN, RN-BC Jessica Moreland, BSN, RN Elise Carasio, BSN, RN-BC Jonas Moulic, BSN, CCRN Melissa Falzone, RN Marge Olkowski, BSN, CGRN, CPAN Gary Fassler, MSN, RNC-OB Helene Tomlinson, RN Stacey Goode, BSN, RN-BC Katie Wolon, BSN, RN India Henderson, BSN, RN 32 CAPITAL HEALTH

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    // STRUCTURAL EMPOWERMENT Capital Health Nurses Teaching Others cont’d Here’s what some of our preceptors/instructors had to say about their experience: Gary Fassler Karen Avila During 2019 I was a clinical instructor for Holy Family I precepted Melissa Calix, MSN, RN, CNL, CCRN, Clinical University, leading 20 students through their Nursing Care Nurse Educator ICU Hopewell, during her Capstone Care of the Childbearing Family rotation. These sessions of the Clinical Specialist Educator program at TCNJ. As gave the students experiences in Labor and Delivery, the RN Outcomes Coordinator for Cardiology, I assisted Ante-Partum, Post-Partum and Newborn Nursery. What Melissa with implementing a Heart Failure Discharge was really rewarding is that by the end of the rotation Checklist to educate and guide 6M nurses through the almost all of the students came to appreciate what the discharge process. Melissa implemented the checklist to Maternity nurses do and really enjoyed their session. ensure patients were well versed on their disease state I also had the privilege of being a preceptor for two and how to manage their health. students from the Thomas Edison State University Accelerated BSN program. Both students were accepted Colleen Price into the CH Nurse Residency Program and are hoping to I have precepted both BSN and MSN students. It is a fun get positions in Maternity. experience as you get to work with individuals aspiring to further their knowledge growth in the nursing field. It is Donna Gottschall inspiring and rewarding. I precepted Mike Strano, the educator in ED. He was a staff nurse while I was precepting him and interviewed Ellen Clancey while I was precepting him. Mike helped with the Fall The Advanced Practice Nursing programs that I have Safety project and now continues with supporting the precepted for in the last year are diverse; the students fall committee for the emergency department and did are APN masters or doctorate candidates and include attend cancer committee meetings with me that upper several universities. UPENN Women’s Health matriculated administration would attend. students in summer semesters for family health, Chamberlain for adult medicine, and Rutgers for final Shannon Renitsky semester comprehensive care, including inpatient settings. I precepted Emily Garretson (now Cook) for her FNP program. Emily came onboard with Capital Health as the first NP to be a part of the STARS program. Emily was a pleasure to have as she is energetic and eager to learn. 2019 Nursing Annual Report 33

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    // EXEMPLARY PROFESSIONAL PRACTICE The Journey to a Just Culture In our Just Culture journey in 2019, we saw a focus on education at CAPITAL HEALTH and training. Capital Health is committed to improving patient care by refining system processes and eliminating all preventable patient safety events. From staff to senior leadership, more than 1,000 employees have attended quarterly education sessions and workshops. Additionally, employees received mandatory education and departments held Just Culture staff meetings in order to enhance learning. Over 100 department heads and managers had more than 250 staff meetings focused on education regarding the use of the Just Culture algorithm during event investigation and the application of Just Culture accountability within their department. An onboarding template has been developed so that new employees receive consistent education on the Just Culture algorithm, our accountability/safety reporting policies, departmental expectations of Just Culture, and the employees’ role in patient safety and reporting. Since Capital Health’s Just Culture kickoff in 2016, the number of safety reports with feedback to the reporter has increased dramatically. All employees are encouraged to report close calls and should be recognized for identifying them –“good catch” e-cards are now available through the STAR program. In late 2019, the Verge safety reporting system was enhanced to include information about the use of the Just Culture algorithm. This leads to enhanced accountability and consistency in order to continue building a greater culture of trust within the organization. Reporting close calls allows for procedural, process, and departmental changes to occur throughout the organization and prevents similar events from occurring again. In our effort to become a High Reliability Organization, we look forward to employee-led focus groups and continued leadership development. Walk of Respect With help from the NJ Sharing Network, Capital Health initiated its Walk of Respect program. This is becoming a widely adopted tradition in hospitals across the country as a way for staff to show respect to a patient or a patient’s family that has agreed to organ donation. With the permission of the donor’s loved ones, employees who are not engaged in patient care are encouraged to quietly stand in the hallway as a donor is wheeled to the operating room. Employees also quietly stand in the hallway as the family of the donor exits and re-enters the hospital to help raise the flag in front of our hospital to honor the donor. 34 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE The Emergency Department at Capital Health Regional Medical Center: Keeping Trenton Warm Homeless patients who receive care in the Emergency Department at Capital Health Regional Medical Center (RMC ED) are occasionally required to have their clothes removed and discarded. Recognizing the possibility of these patients being discharged without appropriate clothing (especially in the winter), Emily Floria, RN, BSN stepped in. Emily is a new graduate nurse resident who worked as a staff nurse in the RMC ED and created the “Keep Trenton Warm” clothing drive. The goal of the program is to provide proper winter outerwear at discharge for this vulnerable population. Emily designed a flyer and posted it around the hospital, asking employees to donate coats and various other winter items. She provided large donation boxes to collect the items that were donated. RMC ED nurse manager Teresa Swantek, RN, BSN, CEN supported the effort by assisting with the appropriate Capital Health approvals, providing communication to the staff via email through their EHuddle newsletter, and promoting the new program at staff meetings. Teresa also allowed the donated items to be stored in her office. The response was overwhelming, and Emily received eight large bags of supplies. This allowed the RMC ED staff to provide warm coats to many appreciative patients. Deborah Haber, RN, MSN, CEN continues to assist with the program by organizing the donations for easier distribution. Deborah also works collaboratively with the Capital Health Thrift shop to seek out donations of clothing for patients in need. Patients now leave the RMC ED dressed properly and warm. This collaborative effort is an example of how staff nurses identify problems and take the lead to make positive changes for the patients at Capital Health. 2019 Nursing Annual Report 35

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    // EXEMPLARY PROFESSIONAL PRACTICE For My Baby and Me Program Promotes Healthy Mothers and Babies The For My Baby and Me Program is funded by a New Jersey State grant that provides integrated opioid treatment programs for pregnant women and new mothers. Through its Institute for Urban Care, Capital Health works with community partners to identify, connect, and treat pregnant women and post-partum mothers. The goal is to provide substance use treatment during and after pregnancy, sober living, medical care, and a support system to avoid relapse. Capital Health’s community partnership with Home Front, Catholic Charities Diocese of Trenton, Rescue Mission, Henry J. Austin Health Center, and Trenton Health Team fosters a collaborative approach not only with each other, but also with the families. Initiation to the program begins with a call to the hotline number (609.256.7801), which is answered by a recovery peer support specialist who begins engaging the pregnant or recently post-partum mother. If she has opioid use disorder and is willing to participate in the program, the peer support specialist then meets with the mother for an initial screening to determine eligibility for the program and assesses her for safe and sober living conditions. Program staff then connects the mother to prenatal care and her children to pediatric care. Care is coordinated with an outpatient provider along with medication-assisted treatment using buprenorphine or methadone. The program also provides transportation, food/clothing, legal services, job and housing readiness training, educational support, and child care. With the assistance of Nursing Informatics, the Institute for Urban Care screened 21,089 women for pregnancy and opioid use disorder in 2019. Of all the patients screened, 120 were positive from Capital Health’s Emergency Departments, Health Start Prenatal Clinic, and OB Triage. Of those women, 22 participated in the For My Baby and Me program. Under the direction of Dr. Eric Schwartz, executive director of Capital Health’s Institute for Urban Care, Kim Watson, RN managed the program from January to July 2019, when Sherry Dolan, MPH assumed management duties. On February 20, 2019 New Jersey’s First Lady Tammy Murphy visited Home Front and met with women enrolled in the For My Baby and Me Program, where she saw first-hand the tremendous impact this program has had on the community and the patients. 36 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE NICU’s Golden Hour In 2019, there were 395 babies born at Capital Health who required the intensive care provided by the Neonatal Intensive Care Unit (NICU) team. Of babies like these, approximately 4% are born between 23 and 26 6/7 weeks. Effective teamwork and communication among neonatal and obstetrical care teams in the delivery room decreases medical errors that can affect infant mortality and morbidity. Standardizing and promoting a bundle of evidence-based interventions in delivery room management of very low birth weight infants (less than 1,500 grams) may improve infant care processes. A multidisciplinary care team developed evidence-based protocols and procedures to standardize the care of infants born between 23 and 26 6/7 weeks to promote teamwork and improve efficiency. The NICU’s Golden Hour program aims to improve outcomes by establishing clear role assignments and standardizing the use and preparation of equipment in readiness for resuscitation and admission to the NICU. The Golden Hour protocol is multifaceted to include a pre-delivery briefing, standardized NICU admission room setup, delivery room preparation, role assignments, resuscitation and stabilization, transport to the NICU, and a debrief. Once in the NICU, standardized care practices continue and are completed within a two-hour period. A checklist is utilized to capture quality measures for program improvement. An equipment/ supply card, based on gestational age, is available for easy recognition of appropriate items the staff needs in preparation for the delivery, resuscitation, and stabilization of the newborn. Education for the staff included an initial small group PowerPoint presentation, a Cornerstone education assignment, and a video of the delivery room process and role assignments prepared by Capital Health NICU personnel. The staff also participated in hands-on stations that allowed for simulation and return demonstration for standardized, critical skills required by the nursing staff. A fluid warmer, used to quickly heat fluids essential for infusion within the first hour of life, was purchased through a grant from Capital Women in Philanthropy (a second warmer was purchased in the event of a twin delivery). The Golden Hour program is a quality improvement project based on the premise that improving the admission process for these vulnerable infants will improve their long-term outcomes (morbidity and mortality). Data on process measures (admission temperature, time to start TPN, time to first antibiotic, etc.) are collected in the hope that an improvement in these process measures will correlate with an improvement in long term outcomes (mortality, infection, IVH, etc.). Plan-do-study-act (PDSA) cycles are done as needed to incorporate new ideas and/or interventions to monitor their effect on process measures. Lullabies of Love As a new way to make newborns and their loved ones feel even more special, the Josephine Plumeri Birthing Center at Capital Health Medical Center – Hopewell started a program known as Lullabies of Love. After the birth of a child at Capital Health Medical Center – Hopewell, families who choose to participate in the program initiate play of a 15-second version of Brahms’ Lullabies Lullaby recorded by local musicians who are Capital Health volunteers. The short song is played throughout the hospital. Capital Health has joined hospitals nationwide in a practice that warms the hearts of patients, visitors, and staff. Lullabies of Love is a joint effort of Capital Health Nursing and the Maternity Services, Patient Experience, Volunteer Services, Development Office, and Media Resources departments. 2019 Nursing Annual Report 37

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    // EXEMPLARY PROFESSIONAL PRACTICE Hopewell Admission/Discharge Nurse Project The Inpatient Cardiology and Medical units at Capital Health Medical Center – Hopewell identified challenges with the nursing admission process, including both staff and patient input. Among patient criticisms of the process were the length of time nursing staff were away from their other patients and the nursing staff’s inability to greet patients in a timely manner due to workflow. In collaboration with the Float Pool nursing team, the staff developed and implemented a trial admission/discharge (A/D) nurse. The trial started in September 2019 and continued until December 2019. The A/D nurse operated 11 a.m. – 11p.m., Monday through Friday to capture the busiest admission and discharge times. The team focused on 6M, 5M, surge, and ED holds. The admission/discharge nursing team was empowered to develop a workflow to promote patient throughput, and to adjust the workflow based on patient volumes. The team initially set a goal to achieve 25% of all admissions and discharges and agreed to meet weekly for a month to work on challenges and adjust the goals as needed. On the first day of implementation, the team completed 69% of the admissions, and by the third day of implementation, the team was able to complete 67% of all discharges. Through feedback from the admission/discharge team and the staff nurses, the focus shifted to completing admissions over discharges. The team felt that discharges completed by the unit-based nurses were easier to more thoroughly manage, as they had an in-depth knowledge of the patients. This did not mean that the admission/discharge team stopped doing discharges, but rather they simply focused greater attention on admissions. After this shift, the team completed 70-100% of patient admissions for 6M and 5M daily. In the event volumes are low for these units, the admission team adjusts and completes admissions for other units, including the Observation Unit. Thank you to the Admission/Discharge Nurse Team for their work in making this project a success: Debbie Mican, PhD, BSN, RN, MHA, CNOR Sean Murphy, BSN, RN-BC Vice President, Patient Care Services and Amanda Mihaich, BSN, RN-BC Chief Nursing Officer Shannon Foster, BSN, RN-BC Colleen Price, MSN, RN, APN, AGACNP-BC Divisional Director, Patient Care Services, Marion Boakye-Asante, BSN, RN-BC Capital Health Medical Center – Hopewell Susan Larson, BSN, RN-BC Jennifer James, MSN, RN, NE-BC Dawn Panzitta, BSN, RN Nurse Manager Float Pool Kesha Phillips, BSN, RN-BC Donna Gottschall, MSN, RN-BC Frances Kiadii, BSN, RN-BC Nurse Manager Medical Unit, Capital Health Medical Center – Hopewell Nardi Soriano, RN-BC Stephanie Cepparulo, BSN, RN, PCCN Adam Caponi, BSN, RN-BC Nurse Manager Inpatient Cardiology, Dominic Fratelli, RN-BC Capital Health Medical Center – Hopewell 38 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE DEUCE Rounds Continue to Decrease Use of Restraints The DEUCE model was started in the Psychiatric Screening Center in 2015. Many of the patients SCREENING CENTER referred to the Screening Center would rather not be RESTRAINT EPISODES there due to the stigma and fear of hospitalization. 25 Additionally, since assessments, dispositions and 19.26 transfers of patients can be time consuming, patients 20 14.76 were escalating during the wait time. 12.9 15 9.98 9.03 The Psychiatric Screening Center team collaborated 10 on ways they could prevent patients from escalating. 5 Issues patients complained about the most were delays 0 with food, update on their treatment, and addressing 2015 2016 2017 2018 2019 their comfort needs. The Psychiatric Screening Center Restraint Episodes per 1,000 Patients then started doing Dietary, Update, and Comfort (DUC) Rounds, which were completed every two hours. During this time, either a screener or a psychiatric nurse checked in on their patients and asked relevant questions and/or provides relevant updates, using the DUC model as a guide. Since first implementing DUC rounds, the use of restraints began to drop and continued to decrease throughout the years. In 2017, DUC was changed to DEUCE. The E’s were added for Education and Empathy. At that time, DEUCE was also added to the Handle of Care Behavior Management Program, which is taught to Capital Health employees. Some of the key points with the DEUCE model are: • Explanation of dietary needs and rules. Educating patients on why finger foods are served, as well as portion sizes helps to alleviate any questions they may have. Discussing when meals arrive, as well as addressing other patient needs, allows the patient to feel their dietary needs are being met. • Educating the patient on hospital policies and procedures (sending medications to pharmacy, no smoking etc.) before they ask so they have a complete understanding of the expectations. • Continuously communicating and updating the patient on their plan of care. This helps keep them calm and alleviate uncertainty that can contribute to escalation. • Checking in with the patients about their comfort regarding anything from room temperature, TV choices, or activities. Sometimes, patients may need to use the phone or figure out a plan for care of a family member or pet. Communicating with the patients about these concerns allows for them to feel comfortable and calm during their time at the Crisis Center. • Being empathic and using reflective listening with the patients. By answering questions, empathizing safety, and showing a caring demeanor, the patient feels that staff has their best interests at heart. In 2019, DEUCE Rounds continued to be successful in decreasing use of restraints and seclusion events, with the lowest number of restraint episodes in five years. 2019 Nursing Annual Report 39

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    // EXEMPLARY PROFESSIONAL PRACTICE National Database of Nursing Quality Indicators RN Satisfaction Survey In October of 2019, Capital Health participated in its annual RN satisfaction survey. The survey, administered by the National Database of Nursing Quality Indicators (NDNQI), measures nurses’ satisfaction in seven categories: • Autonomy • Fundamentals of quality nursing care • Professional development • Adequacy of resources and staffing • Leadership access and responsiveness • RN-to-RN teamwork and collaboration • Interprofessional relationships All clinical nurses (defined as nurses who spend more than 50% of their work time providing direct patient care) who began working at Capital Health prior to July 7, 2019 were invited to participate in the survey. The overall response rate between both hospitals was 79%, far exceeding response rates from previous years. New Magnet regulations, effective in 2019, state that an organization cannot proceed to site visit unless the RN satisfaction standard is met. The standard requires that the majority of units outperform a survey benchmark in at least three of four selected survey categories. The four categories must be consistent across all units. Based on our survey results, Capital Health has met the Magnet standard, with 23 of 43 units outperforming in at least three of the following four categories: Autonomy, Quality of Nursing Care, Professional Development, and Interprofessional Relationships. A special congratulations to those units that outperformed the benchmark in all seven categories, for at least one comparison group: • 6M • Hopewell ED • 3 North/ IMU • 3 Front South • Steen 2 40 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE Capital Women in Philanthropy Grants There were eleven grants awarded from Capital Women in Philanthropy in 2019, going to projects where nursing and/or an inter-disciplinary group focused on patient care at Capital Health. Anatomical Models for Staff and Patient Education • 4M Surgical Care Unit n Purchased anatomical models for 4M Surgical Care Unit that are utilized during orientation and ongoing educational sessions. Behavioral Health Self-Care Toolkit • Behavioral Health Department n Self-Care Toolkit aimed at community outreach, education, and engagement in treating patients and helping them achieve their mental health goals. Chest Pain Center Education for the Community • Quality Department n Supported outreach initiatives focusing on education and prevention of heart diseases. Two of these initiatives were Heart School for children and Early Heart Attack Care for adults. COPD Navigator/Health Coach • Respiratory Care n Developed patient packets that include standardized educational materials for patients with COPD and pneumonia to improve quality of care. Early Mobility Program in the ICU at Hopewell • Intensive Care Unit, Hopewell n Introduced an evidence-based mobility program for patients cared for in the ICU, which included acquiring safe patient handling equipment. Golden Hour Protocol Project • Neonatal Intensive Care Unit n Purchased fluid warmers for intravenous fluids administered within the first sixty minutes of life to high-risk infants cared for in our Level III NICU. Hands-Free Pumping Bras for NICU Moms • Neonatal Intensive Care Unit n Purchased hands-free washable pumping bras for mothers caring for their newborns in the NICU. Pediatric Health Education Programs • Community Education n Supported community-based programming for small children about hand washing, stroke safety, and sun safety. Protecting the Mental Health of Healthcare Staff • Psychiatric Screening Center n Supported the expansion of Capital Health’s Annual Psychiatric Conference, inviting health care professionals in our community to join Capital Health staff in attending this training and education forum. Second Victim • Psychiatric Emergency Service/Trauma n Implemented the Caring for the Care Giver R.I.S.E program to support our health care providers and help them process and cope with traumatic situations in the work place. Surgical Care Unit 10/5 Rule • 4M Surgical Care Unit n Designed and distributed T-shirts for 4M Registered Nurses, Patient Care Assistants, Mobility Technicians, and Unit Secretaries promoting a pilot program that reinforced a welcoming environment throughout Capital Health. 2019 Nursing Annual Report 41

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    // EXEMPLARY PROFESSIONAL PRACTICE Enhancing Care of the LGBTQIAA Community In May 2019, Capital Health welcomed new surgeon Dr. Christine McGinn. In preparing for Dr. McGinn’s specialty of transgender surgeries, leadership recognized the need for process changes and increased education and awareness, not only for the post-surgical care but also for cultural sensitivity related to caring for transgender patients and the LGBTQIAA community as a whole. Pat Michael, MSN, RN and Bruce Burns, MSN, NE-BC led a multidisciplinary committee to operationalize culturally sensitive processes, from registration through discharge. The team instituted measures that ensure proper patient identification, including preferred name and pronoun, for all patients. Education sessions on the care of the transgender patients were also held, and Kim Coleman, MSN, RN, APN,C provided in-services on cultural sensitivity throughout the institution. Additionally, Capital Health staff participated in community events supporting the LGBTQIAA community, including FACT Bucks County St. Patrick’s Bingo and the Pride Parade in New Hope. 42 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE Interdisciplinary Rounds In an effort to enhance communication and plan a more efficient discharge, interdisciplinary rounds were initiated on in-patient units in 2017 with the participation of hospitalists, nurses, physical therapists, social workers, palliative care team, case managers, and nutritionists. The rounds continued in 2019 and focused on throughput of the patients. Two subcommittees were developed to look at length of stay and the discharge process. These subcommittees established flow charts and found trends that negatively impact the process of the discharge and found ways to improve the process. In 2019, the next development was the initiation of the afternoon flow huddle conference call to assist in removing any last minute barriers and ensure a safe, timely, and effective discharge. Physicians, managers, charge nurses, case managers, and physical therapists participate in this call, which also utilizes teletracking to identify barriers and trends. Communication to the patients is increased by placing the estimated discharge date on the white board and writing the hospitalist’s name on the board along with the patient’s goal for the day. During the fourth quarter of 2019, physicians introduced the 9 a.m. discharge time as a trial to try to aid patient flow and make beds available earlier. Interdisciplinary rounds are a success due to the dedication and support of Dr. Jessica Codjoe; Dr. Omega Ball; Dr. Anasse Soudi; Barb Grande, MSN, RN-BC; Angela Dito, MSN, RN-BC; and inpatient managers, physical therapists, case managers, and nutritionists. Safety Equipment and Education Marian Moore BSN, RN-BC, CCRN, TCRN has been working with the Resuscitation Committee for the past two years. She has advocated to get additional automated external defibrillators (AEDs) placed on the Capital Health Regional Medical Center campus. In 2019, additional AEDs were purchased for this purpose. With the equipment placement, Marian also advocated for placing tourniquets inside the AED boxes on both campuses. The Security Team was educated on “Stop the Bleed” practices and technique. These practices will allow for quicker response to internal emergencies. Thank you Marian for helping to create a safer environment for all! The Changing Landscape of Concussion 2019 Nursing Annual Report 43

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    // EXEMPLARY PROFESSIONAL PRACTICE Fall Tips Hopewell – 5M Patient Falls In 2019, the Fall Committee introduced the Fall Tips 3.5 3.17 3.14 3.2 3.05 3.02 3.03 initiative and also trialed 3 self-releasing alarm belts. The 3.31 2.5 2.19 Fall Tips initiative is determined 2 2.42 to be best practice. After 1.5 2.04 2.03 initiating the Fall Tip program 1.71 and trialing the alarm belts, the 1 0.66 0.65 1.32 1.28 incidence of falls in 5M declined 0.5 from 25 in 2018 to 13 in 2019. 0 Stay tuned for more success in Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 reducing falls! 2018 2019 5M Total Falls per 1,000 Patient Days Comparative Bed Size 100 – 199 Workplace Violence Committee Safety is a top priority for both patients and staff at Capital Health. The Workplace Violence Committee, a multidisciplinary team that includes nurses from the Emergency, Mental Health, Maternal Child Health, and Medical Surgical Services departments, strives to provide a safe environment for all employees. Among the many initiatives the were implemented in 2019, the team’s accomplishments include: • Additional security staffing in 3 Front Mental Health, 16 hours a day/seven days a week • Additional security staffing in the Crisis Center, 24/7 • Full-time armed security coverage in the Emergency Department at Capital Health Regional Medical Center • Monthly Workplace Violence Committee Meetings in the Emergency Department at Capital Health Regional Medical Center • Handle with Care de-escalation training (CHS 275, Security 89, Deborah 12) • Updated patients with security indicators • Workplace violence signage in patient care areas • Wireless panic alarm installations • New employee orientation covering workplace violence • Workplace violence webinars offered throughout the year These efforts led to a decrease in workplace violence incidents, from 84 in 2018 to 56 in 2019. 44 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE Insulin Protocol at Hopewell The insulin protocol was created by Dr. Gillis-Funderburk with the goal of reducing hyperglycemia and hypoglycemia during hospitalization. The protocol started as a pilot project on 6M in July 2016. Patients on the protocol demonstrated improved glycemic control and less hypoglycemic events than patients managed on insulin regimens outside the protocol. These positive outcomes supported the expansion of the protocol beyond a pilot program. In June 2019, the insulin protocol was expanded to 5M, and subsequently to medical patients on 4M in October 2019. Patients on the Observation Unit holding for a bed on 4M, 5M, or 6M are also eligible for the protocol. Patients with a diagnosis of type 1 or type 2 diabetes, or those with steroid-induced hyperglycemia within the first 24 hours of admission to the hospital, are eligible for the protocol. Patients with insulin pumps, endocrinology consults, and/or pregnancy are excluded, as well as patients transferred from the ICU setting to the medical floor. To determine the patient’s insulin regimen, pharmacy follows an algorithm to decide the type of insulin that is appropriate for that patient (ranging from correction/sliding scale only to a basal/bolus approach). Factors that determine the patient’s insulin regimen include age, weight, and outpatient diabetes medications. After the initial profile order, these patients are followed daily by a member of the diabetes team, and necessary dose adjustments are made according to the patient’s needs. Capital Health’s insulin protocol is different than other insulin regimens, due to the correctional/sliding scale insulin being ordered with meals and with a separate more conservative HS coverage to prevent morning hypoglycemia. Finger stick frequency is still ordered before meals and HS. Mealtime insulin (if ordered) is given along with correctional insulin if the patient eats more than 50% of his/her tray. Patients may also be ordered a daily basal insulin (Lantus or Levemir) at 11 a.m. By switching basal/long-acting insulin from HS dosing to AM dosing, there has been a profound reduction in fasting hypoglycemia. There is educational material for nurses to teach patients how to switch back to HS dosing, should they choose upon discharge. Thank you to the diabetes educators Jaclyn Gabauer, MSN, APN,C, AGCNS-BC, PCCN; Laura Moran, BSN, RN, CDCES; and Lucille Rosso, MSN, RN, CDCES for making this program a success! OB Hemorrhage Simulation 2019 Nursing Annual Report 45

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    // EXEMPLARY PROFESSIONAL PRACTICE Decrease in Ventilator Associated Events (VAE) at Capital Health Regional Medical Center The data for Ventilator Associated Event (VAE) rates were reviewed, and it became clear in 2017 RMC Ventilator Associated Events (VAE) that there was an increase in both the Neuro ICU as well as the Trauma Medical ICU (TMICU). Each 25 20 event was investigated, and several occurrences 20 Number of VAE were based upon the positive end-expiratory 21 15 pressure (PEEP) level being increased from 5cm 15 10 to 8cm in the Neurosciences ICU due to physician 4 3 preference. Literature and the practices of other 5 institutions were reviewed, and findings showed 1 0 that starting at a PEEP of 6cm was a common 2017 2018 2019 practice and had little or no difference than a PEEP Neuro ICU TMICU level of 5cm. This information was presented to the Critical Care Committee, and the recommendation was to initially start at a PEEP of 6cm for all patients, as well as ventilator bundle monitoring. The processes and products used in the ventilator circuit were reviewed and a trial for a new in-line suction catheter was initiated in April of 2017. The Endoclear in-line suction catheter had literature to support a decrease in VAE rates. Capital Health transitioned to this product in the third quarter of 2017 to reduce VAE rates. Unfortunately, TMICU saw an increase in VAE in 2018. Due to the advocacy of nurses, respiratory therapists, and the leadership team, this in-line suction catheter was switched back to the original product in 2019, leading to large decline in VAE. This entire process of VAE reduction was collaborative, with staff from nursing, respiratory care, quality, infection prevention, supply chain, and administration working together to develop a plan for improvement. Data collection was obtained and reviewed monthly at VAE meetings, and adjustments were made based on the collected findings. All care providers (nurses and respiratory therapists) were included, and their observations and suggestions ultimately resulted in the reduction in VAE rates. Congratulations to these teams in the efforts to improve outcomes for our ventilated patients! Nurse’s Week 46 CAPITAL HEALTH

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    // EXEMPLARY PROFESSIONAL PRACTICE New Graduates Strive for Better Nurse-Patient Communication on Steen 1 In May 2019, Jen Clark BSN, RN; Melissa Everett BSN, RN; Kaley Kowalick BSN, RN; and Mary Caye Marquez BSN, RN were new graduate nurses who had just come off orientation on Steen 1. During their time on orientation, they noticed a resistance to (and lack of) bedside shift reports on the unit, which was causing the nurse-patient communication to suffer. Nurses were feeling frustrated with the increase in questions from patients and their loved ones, who expressed that they were not being informed about their care. These new graduate nurses came together to refresh and reinvent the bedside shift report on Steen 1. After researching the latest evidence-based practices on bedside shift reports, they utilized what they felt would work best for their unit and their patients. In an “invitation” they created for patients who were admitted to Steen 1, they asked which “guests” were allowed to participate in bedside shift report and included a card that explained the process and purpose of the handoff. Lastly, they enclosed a note card for the patients and family to jot down questions to ask during the shift-to-shift exchange. After implementing this new process, Steen 1 had a drastic increase in their Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in the “communication with nurses” category. In addition to patients and family being happier and asking fewer questions, the nurses experienced less interruptions from the patients and family members, which helped ease some of the frustration during their shift. As the nurse-patient communication on Steen 1 continues to improve with this patient-centered approach, the rapport between nurses and patients will strengthen, making the hospital experience more positive for everyone. COMMUNICATION WITH NURSES Patient Satisfaction Scores – Steen 1 100 90 83.3 77.4 91.1 92.3 80 70 77.8 74.1 60 50 40 50 46.7 30 20 10 0 March May July August October December January 2019 2019 2019 2019 2019 2019 2020 2019 Nursing Annual Report 47

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    // NEW KNOWLEDGE AND INNOVATION Nursing Research at Capital Health PROTOCOL TITLE PRINCIPAL INVESTIGATOR Understanding the Experience of Clinical Nurses’ Involvement in Decisions about a Health Work Vera Kunte, DNP, APN,C Environment and Staffing: A Pilot Study The Reality of Nursing Incivility: How to Identify Katherine Donaldson, MSN, WHNP-BC, RNC-OB, It and Stop the Cycle CPLC, C-EFM National Evidence-Based Oncology Navigation Metrics: Multisite Exploratory Study to Demonstrate Patricia Tatrai, RN, MS, OCN, CBCN Value and Sustainability of Navigation Programs The Effectiveness of Intergenerational Education on Communication and Collaboration Among Chelsea Lebo, MSN, RN-BC, CHSE Inpatient Nurses Evaluation of the A to D Resuscitate Me Role Margaret Estlow, MSN, PPCNP-BC, CPEN Assignment Protocol for Pediatric Resuscitation Hospital to Home: Easing the Transition with Dawn Alerassool, DNP, RN, CCRN, CNE Prescribed Education and Follow-up Implementation of an Incident-Based Christina Allen, DNP, APN, C, RN-BC, CEN Nurse Peer Review Program Project to improve the no-show rate Denise Hare, DNP, APN,C in a primary care office Hospital Week – Crazy Sock Day and Fun Scrubs Day 48 CAPITAL HEALTH

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