Few hospital systems are as committed as Seton to giving bedside nurses a voice in hospital policy and practices. All Seton nurses are encouraged – and, in fact, expected – to act autonomously, think critically and offer ideas to help the network continue to improve patient care.

After 18 years as an SMCA OR nurse, Karen Winsor became a Clinical Nurse Specialist to pursue teaching at the college level. Instead, she found that her advanced degree allows her to care for patients in a way she’s never been able to before.

“As a CNS, I function within a nursing model and look at the entire patient, not just the diseased or injured part,” she explained.

Karen recently presented a case study to the APN Council as part of the ongoing peer professional evaluation for APNs. Her patient was a homeless woman who was admitted to UMCB with a complicated open ankle fracture that was grossly contaminated with tissue loss.

Repairing the fracture was only one part of this woman’s treatment. Karen coordinated the patient’s care with an interdisciplinary team including infectious disease, psychiatry, physical therapy, occupational therapy, social services and wound care. She developed and initiated a nutritional protocol to promote fracture healing. Social Services also played a role by locating the patient’s estranged daughter.

Six weeks after admission, the patient was discharged with her daughter by her side. The fractured ankle was stabilized and healing, the wound was free of infection and the soft tissues were healing with 100 percent take of her skin graft.

“I’ve never felt more empowered in my entire nursing career than I do in this job,” Karen said. “I feel valued by my co-workers, supervisors, physicians and especially by my patients and their families.

"I have the great opportunity of serving as a Nursing Congress representative for my department. Through this involvement, I have learned what Shared Governance means and what its advantages are. I have also learned how Nursing Congress is involved in the safety and quality of patient care that the nurse at the bedside offers."

Chipo Ndlovu, RN,
SMCA, Cardiology

Karen Winsor,
  • a friend
  • a mother
  • a mentor
  • an educator
  • a nurse
  • a caregiver
  • a quilter
  • a gardener
  • a world traveler
  • a confidant

Nursing Congress and Specialty Councils

Shari Moore, CCGRN,
SMCW, Endoscopy

Seton’s nationally recognized shared governance model, Nursing Congress, gives direct-care nurses a voice in decisions affecting clinical nursing practice. Nursing Congress and Specialty Council meetings are held monthly and are open to all Seton nurses. Attendees are encouraged to provide feedback, while voting members of Nursing Congress may take official action to approve or reject a pending policy, procedure or protocol. Nurses who are interested in becoming voting members of Nursing Congress should speak with their clinical managers.

A Congress community survey is offered biannually to nursing at all levels. Based on the feedback, some changes have been instituted including shared governance orientation, which was expanded to include nursing educators and nursing management. Attending a Congress/Specialty Council meeting was added to all nursing orientation programs.

"I love being part of Shared Governance and participating on the Surgical Council. I won Surgical Specialty Nurse of the Year in 2008 and feel wonderful that my participation is recognized. But most gratifying is watching Seton grow, seeing my department improve and knowing that I have been a part of it."

Shari Moore, CCGRN,
SMCW, Endoscopy

Patient Outcomes

Seton nurses are empowered to use data, evidence-based practice and research to continually improve patient outcomes.

Pressure Ulcers

Seton has committed to the ambitious goal of zero hospital-acquired pressure ulcers. Nursing’s role in meeting this goal is critical and efforts to consistently apply the SKIN bundle are paying off. In the first quarter of fiscal year 2009 (July-September 2008), the prevalence rate for pressure ulcers, stages II-IV, was 2.2 percent – the lowest level in more than a year.

Patient Falls

Seton is continuing to reduce the number of patient falls. In addition to investing in new patient-lift equipment, the network has created a network falls team and has implemented a series of standardized measures to identify high-risk patients.

Network-wide, the number of patient falls decreased from 80 to 46 between January and August 2008. During that same period, the number of patient falls with injury decreased from four to one.

Nikki Rivers, RN, network liaison for falls prevention and senior nursing director for Seton Medical Center Hays, attributes this improvement to the network falls workshops held in late February/early March 2008. She also credits the hard work of individual fall champions assigned to each site/department and the dedication of nurses at the bedside.

Surgical Care Improvement Project

The Institute for Healthcare Improvement invited Seton’s surgical care improvement project team to Nashville in December 2008 to participate in its 20th-Annual National Forum on Quality Improvement in Health Care. The team presented “SCIP by the Numbers: Safety through Standardization.”

The goal of SCIP is to prevent surgical infection and venous thromboembolism in surgical patients. Seton is working to achieve 100 percent compliance with Joint Commission Core Measures. As of July 2008, five key SCIP measures had more than 88 percent compliance rate network-wide.

Venous Access

Gwen Irwin, RN,
Clinical Manager, UMCB, Venous Access

Venous Access has created a new interactive forum on Setonville, an online community where employees can exchange information, ideas and interests. The forum contains regularly updated information and allows Seton nurses to engage in a dialogue with one another about best practices in venous access. Gwen Irwin, RN, clinical manager of Venous Access, monitors the site on a regular basis and is available to answer questions submitted by Seton nurses.

"There was a time when things would be happening on the East Coast and the West Coast before finally trickling to Texas. In the last eight years, we’ve changed our practice to where we are up with everybody and doing the research of data and articles to find exactly what “best practice” is. So I think we’re staying on the leading edge."

Gwen Irwin, RN,
Clinical Manager, UMCB, Venous Access

Intermediate Care

Patches Pace, RN,
Clinical Manager, UMCB, IMC

Patches Pace joined Seton as a University Medical Center Brackenridge staff nurse five years ago. Now an Intermediate Care clinical manager, she has also worked as a night charge nurse and educator. Although “poorly understood,” Patches said that the “IMC is the hottest piece of real estate at UMCB. Everyone wants their patients in our unit because they know they are going to get great care.”

Patches wants people to understand the complexity of working in the IMC. “IMC is a specialty of its own,” she explained. “To be a good IMC nurse, you need the critical-thinking skills of an ICU nurse and the high-touch bedside skills of a Med/Surg nurse.”

Because IMC can be a stressful environment, Patches works hard to build pride within her unit and to ensure her nurses feel appreciated. She provides honest feedback and emphasizes teamwork.

Over the years, Patches has developed several deliberate, yet simple strategies to improve staff retention. For starters, she is committed to keeping her unit fully staffed and selecting the best charge nurses for the job, as their role is key to fostering teamwork. She has also created a staff e-mail group to share information with her 50-plus staff and makes it a point to send home personal thank-you notes to the family members of nurses who have worked overtime.