Gina Dickey, a clinical nurse specialist, removes a portable heart monitor in a chest pain unit she helped organize at Washington Regional Medical Center in Fayetteville.
Patients Benefit From Nurses’ Push for Advanced Training, Roles at Hospital
Earning a master’s degree at the University of Arkansas was only the first step when three local nurses proposed to create new advanced nursing roles at Washington Regional Medical Center. The women also had to show hospital administrators how having clinical nurse specialists would benefit the bottom line.
With their success, the hospital’s patients also came out winners.
“Gina (Dickey) and I had an advantage in showing the hospital what having clinical nurse specialists on staff could mean because as students we developed T-REX,” said Sheryl Davis about the program called Team Response to Extremes that she and Dickey created. “It has had tremendous positive patient outcomes. With this rapid response program, the hospital’s mortality rate was 30 percent below predictions. We can’t point-blank say T-REX is the reason but with other initiatives at the hospital, it makes a difference in patient care.”
The T-REX system allows nurses to determine more quickly that a patient’s condition is deteriorating before it reaches a crisis point, Davis said. The key to the program’s success was total acceptance by the staff, she said. Davis and Dickey continue to educate new hires and provide annual refresher education to staff.
Sheryl Davis, director of critical care at Washing-
ton Regional Medical Center, describes the rapid-
response system she and other clinical nurse
Photos by Brooke McNeely Galligan“The literature is very clear about the importance of buy-in,” Davis said. “We guaranteed buy-in by giving the program a personality. Our staff doesn’t even call it a rapid-response program; they all call it T-Rex. We put signage everywhere down to stickers on every phone with the number to call for the team.”
Davis, Dickey and Kim Fancher-Gonzalez graduated from the Eleanor Mann School of Nursing’s first Master of Science in Nursing class in 2007 and earned national certification as clinical nurse specialists.
Davis described the clinical nurse specialist position by comparing it with the nurse practitioner, an advanced practice nurse more familiar to most people.
“A nurse practitioner is generally concerned with one patient population at a time, while a clinical nurse specialist takes a global, systems-level approach to improving patient outcome,” she said. “Both have an impact at the patient level and are directly involved in patient care, but the clinical nurse specialist is looking at the big picture. They put systems in place so that what happens to one patient to ensure a positive outcome will also happen to other patients.”
Davis, who became the hospital’s director of critical care in 2008, said she recently interviewed a nurse for another clinical nurse specialist’s position.
“She asked me what skills were necessary to be successful,” Davis recalled. “I told her being self-directed was very important because there will not be someone standing over your shoulder telling you what to do. You have to see what needs to be done. You have to come up with projects and show down the road what’s being done.
“The other thing I said was that you have to be organized,” Davis continued. “You may have a project on our plate and you need to do it in a timely fashion, but if a crisis comes up, you have to drop that project, take care of the crisis and then get back to the project.”
Clinical nurse specialists also emphasize evidence-based practice and conduct research when developing initiatives. Davis, Dickey and Gonzalez belong to several nurses’ associations that provide cutting-edge information in various specialties.
Sheryl Davis, from left, and Gina Dickey listen as
Kim Fancher-Gonzalez talks about her role in
educating staff nurses.
Gonzalez, who coordinates nursing staff education programs for the hospital, developed a two-year medical-surgical nurse residency program after crunching numbers to determine additional support was needed to retain those nurses.
“These nurses were feeling overwhelmed, and they would leave for clinic jobs,” said Dickey.
Gonzalez is working now with 30 medical-surgical nurses in both a once-weekly classroom setting and providing one-on-one education and support.
“I monitor them extensively,” she said. “They will never get to where they have no questions, but they will be confident and they will know they always have someone supporting them. I push them hard and they know that attention results in fewer mistakes.
“They are done with school but they are not done learning,” Gonzalez explained.
She also develops treatment protocols and informational material, including an instruction manual to use with chemotherapy patients.
“The information we had on chemotherapy training was outdated and needed to be updated,” Gonzalez said.
Dickey, who is based in the emergency department, developed a chest pain center in the emergency room that was scheduled to open in September.
“Getting a chest pain center is my newest role,” she said. “The hospital is seeking national accreditation as a heart center and this is part of that.”
The four-room unit will be used for patients who come into the emergency room with chest pains, but who are determined by initial lab work and an EKG done within the first hour of their arrival not to be having a heart attack, according to Dickey.
“Then, they will go into this unit and be put on a portable heart monitor,” she said. “This will be their patient room until we figure out what’s wrong. If a second round of lab work doesn’t indicate the problem, they do a stress test here.”
Dickey said she was happy as a staff nurse at the hospital but felt she could make things better and that higher education was the way to go. When she began the clinical nurse specialist role, she educated other staff nurses by showing them ideas that could improve patient care at the hospital.“I tried to introduce a little bit at a time,” she said. “When nurses hear they are going to help someone, those are the magic words.”