Wellstar Health System's Nursing Annual Report highlights “The Wellstar Experience.” The Wellstar Experience serves as a guide for how our team members interact with each other and the patients and communities we serve. It brings our values to life and is the foundation for everything we do.
THE WELLSTAR EXPERIENCE 2024 Nursing Report
WELLSTAR PROFESSIONAL PRACTICE MODEL
Shared Leadership
Professional Development
P
E
NURSING MISSION Caring Compassionately. Practicing Professionally.
Exemplary Practice
Creative Innovations
R
Teamwork
NURSING VISION Wellstar nurses will be recognized as national leaders in the practice of nursing by promoting:
Holistic patient and family centered care
Quality and innovation
Education
Evidence- based practice
Nursing research
WELLSTAR MISSION To enhance the health and well-being of every person we serve.
WELLSTAR VALUES We serve with compassion.
We pursue excellence.
WELLSTAR VISION Deliver world-class healthcare to every person, every time.
We honor every voice.
BRINGINGPEOPLECARETOLIFE I am pleased to share Wellstar’s 2024 Nursing Annual Report. As I reflect on our accomplishments over the past year, I am deeply inspired by the work and contributions of our nurses. Their commitment to our patients, families and communities we serve is reflected throughout this report, and I could not be prouder to work alongside them. This year’s report highlights “The Wellstar Experience.” The Wellstar Experience serves as a guide for how our team members interact with each other and the patients and communities we serve. It brings our values to life and is the foundation for everything we do. As you read along, you will observe stories that reflect The Wellstar Experience through our nurses’ dedication, outstanding accomplishments, innovative solutions, evidence-based practice and national recognition. With the addition of Wellstar’s Medical College of Georgia, we are revolutionizing healthcare, enhancing the well-being of communities and significantly impacting the lives of people throughout Georgia. Our team at Spalding Regional Medical Center was designated Pathway to Excellence® by the American Nurses Credentialing Center (ANCC). The Pathway to Excellence designation identifies the elements of professional work environments where nurses can grow professionally and feel encouraged. We launched three nursing mentorship programs designed for nurses in all roles and career stages; our ICU teams at West Georgia and Paulding Medical Centers were awarded the Beacon Award, Paulding and North Fulton Medical Centers Emergency Rooms received the Lantern Award by the Emergency Nurses Association® and our teams at Douglas and Paulding Medical Centers achieved PRISM Awards.
It is a great honor and privilege to recognize the devoted nurses and care partners across Wellstar through this annual report. Their work inspires me and showcases their unwavering dedication to the patients and communities we serve.
Susan M. Grant , DNP, RN, NEA-BC, FAAN Executive Vice President, Chief Experience Officer and Chief Nurse Executive Wellstar Health System
1 | 2024 NURSING REPORT
Wellstar System Overview
Our patients are the center of everything we do. We’re nationally ranked and locally recognized for our high-quality care, inclusive culture, exceptional doctors and caregivers. We’re one of the largest and most integrated healthcare systems in Georgia with more than 30,000 team members—including approximately 8,600 nurses and more than 3,900 physicians and advanced practitioners.
11 inpatient hospitals
3 inpatient hospice facilities
91 rehabilitation centers
5 health parks
8 cancer centers
2,729 licensed hospital beds
1 pediatric center
20 urgent care facilities
8 emergency departments
3 senior assisted living facilities
35 imaging centers
320+ medical office locations
This report reflects System information as of Fiscal Year 2024: July 2023 – June 2024.
2 | WELLSTAR HEALTH SYSTEM
Hospitals
Health Parks
A Wellstar Cobb Medical Center B Wellstar Douglas Medical Center C Wellstar Kennestone Regional Medical Center D Wellstar MCG Health Medical Center and Children’s Hospital of Georgia E Wellstar North Fulton Medical Center F Wellstar Paulding Medical Center
1 Wellstar Acworth Health Park 2 Wellstar Avalon Health Park 3 Wellstar Cherokee Health Park 4 Wellstar East Cobb Health Park 5 Wellstar Vinings Health Park
G Wellstar Roosevelt H Wellstar Spalding Medical Center I Wellstar Sylvan Grove Medical Center J Wellstar West Georgia Medical Center K Wellstar Windy Hill L Wellstar Columbia County Medical Center (coming in 2026)
Pediatric Centers Senior Living Centers Inpatient Hospice Facilities Cancer Centers Urgent Care Facilities Medical Office Locations Imaging Centers Rehabilitation Centers
PICKENS
HALL
3
BARTOW
FORSYTH
CHEROKEE
FLOYD
E
1
4
GWINNETT
2
C
F
COBB
K
A
PAULDING
5
B
DEKALB
FULTON
DOUGLAS
GREENE
COLUMBIA
AIKEN
NEWTON
CLAYTON
CARROLL
MCDUFFIE
RICHMOND L D
HENRY
FAYETTE
COWETA
HEARD
I
SPALDING
BUTTS
H
LAMAR
J
PIKE
MERIWETHER
TROUP
G
UPSON
HARRIS
3 | 2024 NURSING REPORT
Awards & Designations
At Wellstar we are committed to creating a healthy work environment where nurses feel empowered and valued. Our nurses are an integral part of the healthcare team, with a voice in policy and practice. Recently, many of our teams earned national designations or are in pursuit of recognition. These honors are evidence of our nurses’ dedication to enhance quality of care, nursing safety and the future of healthcare delivery.
ANCC Pathway to Excellence Designation
ANCC Journey to Magnet Excellence Designation
The Sterling Council Georgia Oglethorpe Award
Malcolm Baldrige National Quality Award
Wellstar Cobb Medical Center Wellstar Douglas Medical Center Wellstar Kennestone Regional Medical Center Wellstar North Fulton Medical Center Wellstar Paulding Medical Center Wellstar Spalding Medical Center Wellstar West Georgia Medical Center Wellstar Sylvan Grove Medical Center
FY27
FY29
FY23
FY29
FY21/25
FY27
FY25
FY29
N/A
FY26
FY20/23
FY26
FY27
FY28/29
FY23
FY26
N/A
FY22
FY19
FY21
FY24
FY28
FY26
FY29
FY22
FY27
FY23
FY26
FY26
N/A
FY24
FY26
FY23
FY27
FY23
FY26
Wellstar Windy Hill
Wellstar MCG Health Medical Center and Children’s Hospital of Georgia
N/A
FY28
FY27
FY29
Early in Journey
Achievement in <3 years
Document Submission
Achieved Designation
4 | WELLSTAR HEALTH SYSTEM
EXEMPLARY PRACTICE The continuous pursuit of excellence in care WELLSTAR HEALTH SYSTEM This year, Wellstar continued on the path to top nursing performance and
world-class patient care. Using the American Nurses
resources. We expanded our placement capacity, with a total of 1,429 clinical RN rotations. The Nurse Wellbeing Council took steps to enhance health and resilience. The focus on meaningful recognition and participatory decision-making continues. Exemplary Professional Practice New care models address staffing shortages with approaches like virtual nursing and bathing teams. The Telesitter Program, launched in 2021, has avoided nearly 200 falls. New Knowledge, Innovations and Improvements We’re integrating evidence-based practice into patient care and encouraging nursing research and quality improvement projects.
Many of these projects were presented at conferences or published in academic journals. Supported by an engaged Nursing Quality Council, Wellstar continues to focus on process improvement and standardizing best practices in fiscal year 2025. We plan to expand mentoring programs to improve nurse retention, while creating additional academic partnerships that enhance recruitment and retention. Eleven Wellstar hospitals are currently on the ANCC Journey of Excellence, with dedicated teams striving to achieve the highest levels of nursing excellence and patient care. n
Credentialing Center’s Magnet® standards, Wellstar made notable progress in improving turnover rates, staffing levels and the quality of nursing care. Specific achievements include work in the following four key components: Transformational Leadership We filled four Chief Nursing positions and welcomed a System Vice President for Professional Nursing Practice. Our nursing turnover rate decreased from 14.3% to 12.7%, compared with a national benchmark of 18%. Structural Empowerment The Rising Stars Nurse Resident Mentoring Program offers nurses in training unique educational experiences, guidance and
EXEMPLARY PRACTICE Lantern Award shines light on emergency department brilliance WELLSTAR PAULDING MEDICAL CENTER Wellstar Paulding Medical Center Emergency Department has earned the Emergency Nurses Association’s (ENA) 2024 Lantern Award for demonstrating excellence in leadership, practice, education, advocacy and research performance. This is their second consecutive three-year designation. The award serves as a visible symbol of the commitment to quality, safety and a healthy work environment. n
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ROSE Award Winners Brittany Cannon, Front Office Lead Tamatha Moore, CMA Katherine Miller, CMA (top middle) Catherine Gullo, Referral Specialist (top left)
Celena Smiley, CMA Jennifer Lynch, Front Office Cher’ie Lightbody, CMA Tiana Thomas, Front Office
DAISY Award Winners Katrina Rose-Hopson, LPN (left) Lindsay “Greer” Sorrells, RN Supervisor (right)
EXEMPLARY PRACTICE Recognition showcases top performance WELLSTAR MEDICAL GROUP Hundreds of nominations were submitted in response to a new opportunity for Wellstar Medical Group nurses and staff to be recognized for excellence.
Wellstar Medical Group (WMG) proudly introduced the DAISY and ROSE (Recognition of Service Excellence) awards programs, which have been a longtime fixture in Wellstar hospitals. Both honor nurses, as well as clinical and non- clinical support staff who exemplify Wellstar’s mission, vision and values by delivering world-class care and service to patients and their families. The DAISY Award recognizes and celebrates nurses and the care and kindness they deliver. Nominations are submitted by patients, families and fellow team members. The ROSE Award is given to nursing support professionals and other non-clinical and support team members who demonstrate exceptional service and compassion.
Throughout the year, the WMG awards committee reviewed over 400 nominations, including countless expressions of gratitude from patients, peers and leaders for WMG team members whose dedication exceeded their expectations. The committee looks for team members who make a difference in patient experiences and workplace culture. In this first year of involvement with the programs, two DAISY and eight ROSE Award winners were named. Katrina Rose-Hopson was WMG’s first DAISY winner. She persisted to make sure that a patient she believed needed prompt medical attention was seen by her cardiologist ahead of the initially scheduled appointment. In the patient’s words, “I was told when I arrived at the ED in an active heart attack that my main artery
was 99% blocked and that I had what’s known as a ‘widow-maker’ blockage. Had Katrina not tried one more time to get me in with the cardiologist, the results could have been fatal. Katrina saved my life.” Since the introduction of these award programs, countless inspirational stories have been shared that showcase the incredible talent and commitment to excellence that our medical group
team members extend to our patients and each other. n
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EXEMPLARY PRACTICE PRISM Award recognizes excellence in medical-surgical nursing WELLSTAR DOUGLAS MEDICAL CENTER AND WELLSTAR PAULDING MEDICAL CENTER
The Academy of Medical Surgical Nurses (AMSN) and the Medical-Surgical Nursing Certification Board present the PRISM Award® to recognize medical-surgical units for outstanding patient care outcomes and nursing engagement. In January of 2023, Wellstar Douglas Medical Center 3 North Medical Unit began its PRISM journey and earned designation in May 2024. n
The Wellstar Paulding Medical Center (WPMC) 5th Floor Medical Surgical Unit began its journey to PRISM excellence in 2019, led by nurse manager Fleurette Joseph, MBA, BSN, CNML. Fleurette and the 5th Floor Medical-Surgical Team received the news of their PRISM award on October 17th, 2023, and were presented with a plaque during a special ceremony on January 5th, 2024, by AMSN Board Member, Mark Lee, MS, BSN, RN-BC. n
Fleurette Joseph, MBA, BSN, CNML, Nurse Manager
EXEMPLARY PRACTICE Two teams win Beacon WELLSTAR WEST GEORGIA AND PAULDING MEDICAL CENTERS Two groups proudly accepted the Beacon Gold and Silver. The Wellstar West Georgia Medical Center Intensive Care Unit (ICU) learned in January 2024 that it was the recipient of a Gold Beacon Award for Excellence, given by the American Association of Critical-Care Nurses (AACN) to recognize critical care units that provide high-quality patient care in a healthy work environment.
As the highest Beacon level, gold also rewards staff-driven excellence in sustained unit performance and improved patient outcomes that exceed national
benchmarks. Feedback from the AACN review noted the unit’s strengths in areas including interdisciplinary communication and teamwork, adaptability to improve patient outcomes
and use of evidence-based practices. Congratulations to Nurse Director Kristin Hays, MSN, RN, NEA-BC, Nurse Manager Alicia Kirby, MSN, RN, and the entire West Georgia ICU team on this impressive achievement. In June of 2024, the Wellstar Paulding Medical Center ICU earned its first Silver Beacon Award for Excellence. The ICU team, led by Nurse Manager, Jeffrey Cochran, BSN, RN and Jim Ingerson, MSN, RN, CNL, Clinical Nurse Leader, will be recognized in May 2025 at the National Teaching Institute & Critical Care Exposition (NTI) Conference to be held in New Orleans. n
7 | 2024 NURSING REPORT
Wellstar Heroes
“To win a DAISY means that you made a memorable impact. I treat every patient with kindness, respect and compassion every time, and it was an honor to receive a DAISY from such a special patient.” Kenzie Hanson, BSN, RN | Labor and Delivery
EXEMPLARY PRACTICE Patient beyond grateful for nurse’s support WELLSTAR WEST GEORGIA MEDICAL CENTER As joy turned to worry in the delivery room, a patient heard only one voice—that of a nurse with compassion and a heart of gold. A thank you from a grateful patient is always appreciated by Wellstar nurses. A patient of Kenzie
to see or hold our baby, my husband and I cried and prayed while the nurses did everything they could. In a room filled with people, I heard only one voice, Kenzie’s, as she comforted me and gave me hope.” Thankfully, the baby recovered fully and is doing great. The patient says she thinks of Kenzie and the amazing support she provided every day. She adds, “Kenzie’s bedside manner, knowledge and kindness all point to her calling as a labor and delivery nurse. Our family is forever grateful for her loving care.” Congratulations to Kenzie on a well-deserved DAISY Award! n
Hanson, BSN, RN, a member of the Labor and Delivery team at Wellstar West Georgia Medical Center, took the next step, nominating Kenzie for a DAISY Award for compassionate care. The patient recalled, “Into the morning hours things were going well, as nurse Kenzie coached and encouraged me. But things took a turn for the worse when I delivered my son after an hour of pushing. The sounds of cheering in the delivery room gave way to silence as he struggled. For 16 long minutes, unable
8 | WELLSTAR HEALTH SYSTEM
EXEMPLARY PRACTICE “She never left our side.” WELLSTAR SPALDING MEDICAL CENTER Spalding nurse helps family navigate the unimaginable, showing a level of compassion and respect that will never be forgotten.
Friday, March 17, 2023, was the hardest day Christen and Will will ever know. Six hours and 41 minutes after saying hello to their newborn, Elizabeth “Ellie” Jane, they had to say goodbye. Many people supported Christen, Will and their family, but none more than Spalding Labor and Delivery nurse Cierra Ridgeway, RN. Christen had met Cierra years before when both were nurses in the Spalding ICU. About halfway through the pregnancy, the couple learned that their baby had multiple rare, life-ending cardiac issues. Christen immediately started talking to Cierra about what delivery day would look like.
Their goal was for Ellie to know only love for the few minutes she was expected to live. As Christen put it, “God gave us six hours and 41 minutes to love on sweet Ellie Jane, to hold her and memorize every detail of her precious nose, lips, fingers and toes.” Cierra never left their side, honoring every request, grieving with them and taking photos and videos. After Ellie passed, Cierra lovingly bathed her and took footprints for the family to cherish. Christen adds, “The respect and compassion she showed us will live in our hearts, along with our memories of Ellie, forever.” n
“Supporting this family through the birth of Ellie Jane, humbled me and changed who I am forever. They are etched into my heart forever, and I am just grateful I was able to have a meaningful purpose in their journey.” Cierra Ridgeway, RN | Labor and Delivery
9 | 2024 NURSING REPORT
EXEMPLARY PRACTICE Home health trio goes the extra mile WELLSTAR ACUTE SERVICES – HOME HEALTH Delivering home health services can be one of the most demanding roles in nursing.
Over the years, Christy Evans, BSN, RN, Anna Bettikofer, LPN and Lauren Womack, LPN have been responsible for providing home health care to countless patients in Paulding County. As a team, these three collaborate to provide patient-centered care to over 55 patients at any given time. As an RN, Christy is dependent on the expertise of both Anna and Lauren to be her eyes and ears when she cannot see their patients. This trio is committed to providing PeopleCare to all they encounter and to ensure their patients are regularly discharged from home health services with goals met. Both compassion and a commitment to excellence are required to identify and overcome obstacles to meet those goals.
Below are just a few examples of the care they provide: n For one patient, Christy took the time to assist an elderly mother in using a Hoyer-lift and place an alternating pressure pad on her daughter’s hospital bed to manage a stubborn wound. n Anna returned to another patient’s home (who she had seen earlier in the morning) to assist and provide troubleshooting efforts on a pacemaker transmission. n At a joint visit with Lauren, leadership watched her display compassion to an anxious patient, while calling 911, due to an elevated blood pressure and an infected wound. n
Christy Evans, BSN, RN | Home Health Nurse
Anna Bettikofer, LPN | Home Health Nurse
Lauren Womack, LPN | Home Health Nurse
10 | WELLSTAR HEALTH SYSTEM
“The Sigma program empowered me to be a leader in a critical safety situation even without a formal leadership role. My passion to advocate for patients’ safety will always be my goal.” Darleen Rideau, BSN, RN, CAPA | PACU Nurse
EXEMPLARY PRACTICE Wellstar nurses present at national program WELLSTAR WINDY HILL The international conference of nursing leaders, Sigma, invited two Wellstar nurses to speak
about their experience transforming healthcare. In November 2023, PACU Nurse Darleen Rideau, BSN, RN, CAPA and Director of Nursing Erin Glover, DNP, MHA, RN, NE-BC, NPD-BC, presented at the 47th Sigma Biennial Convention in San Antonio, Texas, to discuss their involvement in the national Nurse Empowerment Program, sponsored by the Johnson & Johnson Foundation. Wellstar had the largest representation in the program, with 350 participants. During the two-month program, Darleen and other clinical nurses enjoyed access to Sigma courses in leadership, communication, conflict management, healthy work environment, diversity and other areas.
Among the Wellstar participants, 71% said the program boosted their leadership skills and 93% experienced job advancement since completing it. Darleen was able to share her personal experience as a program participant with international colleagues and identified specific clinical benefits to her participation. She said, “The most significant outcome of 2023 that I can directly attribute to my completion of the Nurse Empowerment Program was the correction of the narcotic medication safety issue occurring in Epic, affecting the pediatric patient population.” n
11 | 2023 NURSING REPORT
THEWELLSTAREXPERIENCE
We serve with compassion. Connect with purpose. n I greet others with a smile and give my full attention in every interaction. n I introduce myself, share my role and call others by their preferred name. n I listen without interrupting and confirm what I have heard. n I clearly communicate, find answers and explain next steps.
Care and support. n I treat everyone with kindness and respect. n I help others. n I honor personal boundaries for all. n I take care of my well-being.
12 | WELLSTAR HEALTH SYSTEM
TEAMWORK Hospital team reduces hypoglycemic events WELLSTAR DOUGLAS MEDICAL CENTER
An interdisciplinary approach was the key to a successful pilot project involving nursing, pharmacy, nutrition and other departments.
At Wellstar Douglas Medical Center, an interdisciplinary team took on the challenge of reducing hypoglycemic events, especially related to insulin administration. The opportunity
the correct sliding scale insulin sensitivity and point-of-care blood glucose frequencies. Patients at risk were monitored daily and recommendations were made to providers. The Nursing/Food Services department created a process to detect inappropriate diet orders for patients with an A1C above 6.5% and a history of diabetes. Nursing also developed a tool to help bedside nurses identify and report patients at risk. The project saw excellent results. Nursing interventions on the unit led to a 33.3% reduction in treated hypoglycemic events. There were significant improvements in compliance with dietary orders, and in communication during IDRs. Thanks to education and monitoring, medication errors were decreased by more than 25%. The results of this successful pilot will be shared at several upcoming conferences. n
TEAMWORK Team members rush to patient in distress WELLSTAR SYLVAN GROVE MEDICAL CENTER Quick action, smooth team- work and a call from a loving spouse combine to save a life. Wellstar Sylvan Grove registration received a call from a woman asking that they be on the lookout for her husband. While driving in his truck, he experienced chest pain and was on his way to the emergency department. As he stepped out of the truck, the man fell forward. Nursing staff rushed in, starting CPR in the parking lot. The patient was in ventricular fibrillation, a potentially life- threating cardiac condition. To restore his normal rhythm, the patient required 19 electrical shocks. With time of the essence, Sylvan Grove team members stabilized the patient and transferred him to Wellstar Spalding Medical Center; there he was treated, released and fully recovered. n
resulted from the Vizient 2023 Hospital Quality and
Accountability Scorecard. A 30- bed medical floor was selected as the site for a pilot review of all hypoglycemic events. The review revealed that these occurrences were associated with incorrect insulin, insufficient nutrition and changes in inpatient conditions. Using Lean Six Sigma problem- solving, the team identified countermeasures and monitored outcomes. The hospital pharmacy developed a real-time metric for hypoglycemic events requiring a dextrose antidote. The pharmacy also implemented an action plan for the availability of insulin in automated drug delivery systems. Double checks ensured
13 | 2024 NURSING REPORT
CREATIVE INNOVATIONS A year of focused
attention on patient falls achieved its goal WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER Nurses led a multi-level effort to understand more about falls with injury and develop plans and protocols to significantly reduce them. A review of fall incident reports at Wellstar Kennestone Regional Medical Center revealed an opportunity for improvement. At the end of the 2023 fiscal year, the hospital’s Falls Committee set a goal to reduce the rate of inpatient nursing unit falls from 0.61 to 0.43 falls per patient over the course of a year. Under the leadership of executive sponsor Chenille Jones, MSN, RN, CNL, the committee got to work. Debriefings of every fall incident were conducted during daily safety huddles. Weekly and monthly summaries of fall trends were shared with nursing directors and executive directors for review with managers. On the department level, the introduction of Centrella beds enhanced team members’ ability to monitor bed alarms. Nursing departments included a review of fall-prevention elements in bedside shift reports. Fall prevention audits were conducted and highlighted on visual management boards, and post-fall documentation was prioritized. Based on an assessment of the types, quantities and locations of fall-prevention equipment throughout the hospital, steps were taken to ensure that team members have easy access to gait belts and walkers for every patient. The Kennestone initiative also included pilots, including a trial of bedside fall mats for patients at increased risk. Four departments piloted the use of care partners to focus on mobility beyond toileting. As a result of these efforts, Kennestone saw a decrease of 76% in falls with injury, and a drop of 18% in total falls from FY23. Congratulations on a focused and successful initiative! n
TEAMWORK Nurses welcome community to heart health fair WELLSTAR PAULDING MEDICAL CENTER Increasing heart health education and awareness was the goal of a new community program. Certified by the Joint Commission as a Primary Heart Attack Center, Wellstar Paulding Medical Center is laser focused on preventing and treating heart disease. Providing heart health education and resources to the community is an important part of that commitment. Heart Failure Nurse Navigator Holly Holtzclaw, BSN, RN, OCN, came up with the idea of a Heart Health Fair. She partnered with Paulding nursing colleagues to voluntarily plan, promote and staff the September 2023 event. The fair, which was held in the hospital’s atrium lobby, attracted some 200 visitors. The goal was to bring heart health education and awareness to patients, families, team members and others in the community. The event promoted heart failure classes, cardiac wellness programs and steps for self-care. There was a hands-only CPR demo, as well as raffle gifts and other prizes. Supporting Holly were event volunteers, including cardiac educators/clinical nurses Becky Falkins, MSN, RN, CVRN-BC, and Rhonda Higginbotham, BSN, RN; as well as Heather Haney, BSN, RN, CMSRN, and Michelle Powell, BSN, RN. Congratulations to Holly and her team, who hope to make the fair an annual event. n
76% reduction in the number of patient falls with injury
18% reduction in total falls
14 | WELLSTAR HEALTH SYSTEM
>$1,000 in donations of baby supplies from event
EXEMPLARY PRACTICE First Cobb community baby shower was a huge hit WELLSTAR COBB MEDICAL CENTER It was all about moms and babies at this festive inaugural event hosted by Cobb’s Women’s Center. Wellstar Cobb Medical Center hosted a first-of-its kind community baby shower, welcoming over 100 guests to celebrate moms and babies. The May event featured tours of the Women’s Center, plus education sessions, snacks, information and giveaways. A dozen community partners, local businesses and organizations participated, contributing over $1,000 in donations including breast pumps and a bassinet. The “mom”umental gathering received rave reviews, and the Women’s Center anticipates making it an annual event! n
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PROFESSIONAL DEVELOPMENT Residency program yields improved retention WELLSTAR KENNESTONE REGIONAL MEDICAL CENTER Strategies to recognize and honor the achievements of nurse residents were put in place with excellent results.
The Kennestone Nurse Residency Program supports new graduate nurses in their first year of practice and is part of the Wellstar PTAP® accredited new nurse residency program. Kennestone averages around 145 new graduate nurses in a year, but its average retention rates for nurse residents was falling below the 90% goal. The residency program team implemented a multi-dimensional strategy to keep new graduate nurses. This dedicated team is made up of Diane Hall, BSN, RN, Manager of Nursing Pipeline, Melanie Copeland, MSN, RN, CPN, and Samantha Smith, BSN, RN, all Nurse Residency Professional Development and Retention Specialists.
Melanie and Samantha conduct weekly rounding throughout orientation, then transition to monthly rounding until the resident graduates. They create personalized moments of appreciation through notes, small gifts and recognition during residency classes. A Kennestone Nurse Residency Council was established as a platform for residents, preceptors, educators and leaders to address the program’s strengths and opportunities. In response to feedback from the council, a graduate pinning ceremony was introduced to celebrate the achievement and highlight graduates’ evidence-based practice projects. The efforts
of a collaborative community contributed to a soaring retention rate of 96% for fiscal year 2024. n
Kennestone Nurse Resident Retention Rate
96%
91%
85%
78%
FY21
FY22
FY23
FY24
SHARED LEADERSHIP Family caregivers get valuable support WELLSTAR WINDY HILL A nurse-led project helped increase understanding and reduce confusion for family members caring for trach patients at home.
Occasionally, patients being treated at Wellstar Windy Hill’s progressive care unit are unable to wean from the ventilator or reach decannulation due to their medical condition. Families caring for these patients at home require multi-disciplinary training that can be confusing and overwhelming. During a session at the ANCC Magnet® and Pathway® Conference Clinical Nurse Leader Sarah Meffert, MSN, RN, CNL, CCRN, learned of a project to standardize the home-training process. Sarah assembled an interprofessional workgroup that developed two interventions to help with the standardization of the process. The first was a
discipline-based training checklist addressing the skills a caregiver would need. The second was a resource folder including a list of community resources, equipment and supplies available at discharge, plus handouts on the skills covered in the training. Since implementation in September 2023, staff noted improved communication among the team around family training. Families reported feeling more prepared for discharge and having a better idea of what to expect. The checklist is now used for all discharge-to-home training, with the resource folder also available in Spanish. n
16 | WELLSTAR HEALTH SYSTEM
SHARED LEADERSHIP Wellstar Paulding nursing research attracts international interest WELLSTAR PAULDING MEDICAL CENTER An Australian nurse used funds from a scholarship to travel to Wellstar Paulding Medical Center to learn nursing best practices.
When Australian nurse leader Whitney Johnson read a journal article by Wellstar Paulding Medical Center nurses, she was intrigued. The article, “Lending a Helping Hand-Mentoring through Chaos!,” was published in the Journal of Nursing Management . Whitney reached out to the authors, sharing her interest in Paulding’s nurse mentoring work and other topics. Whitney, deputy director of nursing for the Alfred Mental and Addiction Health Program at Melbourne’s Alfred Hospital, was the recipient of a scholarship that allowed her to travel internationally to study relevant programs and practices in mental health. She chose to visit Wellstar Paulding, where she was informed about resources supporting nursing research, as well as relevant studies and innovative best practices.
During her visit, Paulding hosted a Nursing Research and Best Practices event. Paulding clinical nurses and nurse leaders were on hand, as well as nurse leaders from the Center for Nursing Excellence and Kennesaw State University. Also discussed were two research studies on nurse mentoring, and a study on virtual nursing, featuring insights from a Paulding virtual nurse. Other discussions centered on charge nurse and manager training, Magnet® journey best practices and a review of Wellstar extern and residency program retention data. Whitney shared information about challenges and best practices from Alfred Health, with the focus on nurse education, advocacy and barriers to mental health treatment. n
Research Dissemination Team: Front row left to right: Michelle Gaddis, PhD, RN; Holly Hopkins, MSN, RN; Whitney Johnson, Deputy Director of Nursing, Melbourne, Australia; Lydia Casteel, MSN, RN, CCRN; Molly (Meriel) McCullum, PhD, RN Second row left to right: Joysline Ndungu, DNP, RN, PCCN; Sharlene Toney, PhD, RN; Kim Knotts, MSN, RN, NEA-BC; Lisa (Margot) Hedenstrom, PhD, RN, MBA, NEA-BC; LeeAnna Spiva, PhD, RN Back row left to right: Katrina Nelson, BSN, RN; Julie Cooper, BSN, RN, CCRN; Cheryl Williams, MSN, APRN, FNP
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THEWELLSTAREXPERIENCE
We pursue excellence. Take responsibility. n I put safety first and speak up when something isn’t right. n I am accountable for my work and accept responsibility for my actions. n I am dependable, I do what I say I am going to do. n I use feedback to improve my performance.
Explore with curiosity. n I ask questions when I don’t understand. n I embrace change with a positive mindset. n I suggest and engage in new ways to improve our work. n I actively learn new things to grow my skills and knowledge.
18 | WELLSTAR HEALTH SYSTEM
TEAMWORK Nurses lead adaptation of digital patient tool WELLSTAR WINDY HILL AND KENNESTONE REGIONAL MEDICAL CENTER New resource offers focused patient education to better prepare patients for knee and hip replacement surgery.
An innovative collaboration between orthopedic nurses at Windy Hill and Kennestone is achieving its ambitious goal—to improve the patient experience for Wellstar patients undergoing knee and hip replacement surgery. The nurses were motivated by the fact that joint patients receive a great deal of potentially confusing information from various sources. They hoped to streamline and focus that content. Amanda Hill, Windy Hill Total Joint RN Coordinator, was intrigued to learn about Care Companion, an interactive patient assistance tool available through Epic’s MyChart. Amanda reached out to her Kennestone counterpart, Rebekah Tumlin, with the idea of customizing the tool for Wellstar total knee and hip replacement patients. Their aim was to create a version that would provide pre-op support and minimize potential complications during recovery.
Amanda and Rebekah worked closely with the Epic team for over a year to develop the tool. The new Care Companion reinforces patient education topics, recommends actual tasks and invites the patient to complete surgery-specific questionnaires to help clinical staff assess a patient’s status and readiness. Certain responses are flagged, indicating that the patient may require follow-up communication from the nurse coordinator. Starting in January 2024, the MyChart Care Companion was completed and offered
to Kennestone and Windy Hill Total Knee Replacement patients. A hip care version was introduced in June. n
The new Care Companion reinforces patient education topics, recommends actual tasks and invites the patient to complete surgery-specific questionnaires that help clinical staff assess a patient’s status and readiness.
EXEMPLARY PRACTICE Total Joint Center aims higher WELLSTAR WINDY HILL ORTHOPEDIC & TOTAL JOINT CENTER
held monthly Total Joint Clinical Huddles to ensure a consistent pathway of care. After an intensive two-year application process, the
Center received Joint Commission for Advanced Certification. The team is continuing to aim higher and has total shoulder and total ankle replacement programs underway along with collaborations with Wellstar Kennestone Regional Medical Center on the digital tool MyChart Care Companion. n
The Wellstar Windy Hill Orthopedic & Total Joint Center, an outpatient surgery facility, opened in 2020. Since opening, the team has developed performance measures, candidate criteria guidelines, required education programs and
19 | 2024 NURSING REPORT
CREATIVE INNOVATIONS Nurses bring expertise to new discharge unit WELLSTAR NORTH FULTON MEDICAL CENTER The problem of emergency department overcrowding was addressed by creating a nurse-staffed discharge unit that’s increasing efficiency and decreasing bottlenecks.
Emergency department (ED) patients who have been treated and given discharge orders are sometimes kept in the ED due to transportation issues, or because family members haven’t arrived to take them home. To remedy that, Wellstar North Fulton Medical Center created a six-bed discharge unit. The new unit is staffed with a dedicated transporter and three North Fulton RNs, Lisa Williams, Heidi Kluesner and Kathryn Myric, who also helped launch the initiative. The new protocol is limited to patients who have scheduled transportation, are not experiencing certain infections and are not in hospice. Extended ED stays contribute to crowding, as well as poor patient outcomes and a less positive patient experience. Also, having a dedicated area for patients to wait means that acute beds can be opened sooner. Getting comfortable with the new arrangement proved challenging for some nurses who were
accustomed to controlling the discharge process and the admission timeframe. Once they realized that the new process decreased their workload, the process became standard. The new unit is meeting stated goals. About four months after it opened, more than 60% of acute care discharges passed through the discharge unit, and 43% of discharges were transferred there, or were discharged by 2 pm. n
50% reduction in time from bed request to bed assigned in FY24 versus FY23
4,140+ ED boarding hours saved in FY24, with an average of 12 hours per day saved
TEAMWORK Nurses share Windy Hill Orthopedic success at national gathering WELLSTAR WINDY HILL Nurses’ presentations on superior care earn recognition at prestigious industry event.
Windy Hill Total Joint Program team members presented award-winning posters at this year’s National Association of Orthopaedic Nurses (NAON) congress. Rhonda Brunner, RN, Nurse Manager Surgical Services, and Amanda Hill, BSN, ONC, RN, Total Joint RN Coordinator, presented Going for Gold! A Retrospective Review of Our Total Joint Program’s Journey for Advance Certification . Their poster won first place in the ambulatory surgery center category. Another presentation by Amanda, Dear Future Drivers , a letter
to new nurse coordinators or those starting a new program, placed third overall in the leadership category. Amanda was also invited to share her experience as a first-time congress participant on the NAON podcast, No Bones About It . She considered it “an awesome opportunity to shine light on the amazing work Windy Hill’s Total Joint Program is doing.” Windy Hill is one of only three programs in the state to hold the Advance Certification for Total Knee and Hip Replacements from the Joint Commission. n
Scan code below to listen to NAON podcast, No Bones About It
20 | WELLSTAR HEALTH SYSTEM
CREATIVE INNOVATIONS Wellstar MCG is breaking new ground from the air WELLSTAR MEDICAL COLLEGE OF GEORGIA Wellstar MCG Health AirCare is Georgia’s first pre-hospital program to introduce life-saving whole blood.
In a groundbreaking initiative, Wellstar Medical College of Georgia (MCG) Health AirCare, the state’s pioneering air medical program, has introduced a program that provides whole blood to trauma patients being transported to the hospital by air. It’s an important step beyond the existing protocol, which provides packed red blood cells and liquid plasma, not whole blood, to trauma patients en route to treatment. Recent studies point to improved patient outcomes for patients receiving whole blood rather than blood components. In addition, the potential for resuscitation increases when whole blood is given earlier. This giant leap forward in state- wide trauma and critical care is under the leadership of Program Director Zack Lancaster, RN, and
Medical Directors Dr. Bradley Golden and Dr. Phillip Coule. Wellstar MCG Health AirCare collaborated with Wellstar MCG trauma, emergency and pediatric departments to assess the needs, review regulatory requirements, identify safety considerations, evaluate process logistics and establish protocols and training. One of the major hurdles to overcome was ensuring that precious blood supplies are not wasted. Unlike traditional component products, unused whole blood could not be returned and redistributed to other hospitals because they did not maintain a whole blood inventory. AirCare collaborated with Shepeard Community Blood Center and Wellstar MCG Trauma and Emergency departments to develop a process to redirect the
unused blood where it was most needed, essentially eliminating wasting unused whole blood. Wellstar MCG Health AirCare remains at the forefront of improving patient outcomes and redefining standards in delivering critical care services. n
82 units of blood products administered by AirCare crew to 53 different patients in FY24. 37 of those units were whole blood administered safely to trauma and medical patients.
21 | 2024 NURSING REPORT
SHARED LEADERSHIP Committee introduces changes to improve outcomes for stroke patients WELLSTAR PAULDING MEDICAL CENTER Hospital takes action to reduce the time between a patient’s arrival in the emergency department and administration of a potentially life-saving drug.
One of the stroke treatments in use at Wellstar Paulding Medical Center (WPMC) is timely delivery of the clot-dissolving medication Tenecteplase. In 2022, the Emergency Department found itself above the door-to-needle (D2N) period recommended by the American Heart Association and American Stroke Association (45 minutes for 50% or more of acute stroke patients). The WPMC Acute Stroke Committee jumped into action. The interdisciplinary group is co- led by Alicia Allen, MSN, RN, CEN, director of emergency services, and Cathleen Gibson-Starling, BSN, RN, AMB-BC, emergency services manager. A review of data found that one area of concern was a lack of documentation about reasons for the delays.
Steps toward improvement included mock drills led by stroke program coordinator Teresa Hale, MSN, RN, CEN, to evaluate standard workflow, processes and response times. The committee discussed ways to notify radiology teams to expedite alerts for patients presenting with acute signs and symptoms of stroke. In addition, clinicians were instructed on documentation best practices by committee physician lead Dr. David Schulze. These and other interventions helped achieve the goal of reducing WPMC’s D2N time to under 37 minutes. The achievement has been widely recognized within and beyond Wellstar. n
Mean Tenecteplase Door-to-Needle Time (in minutes)
40% reduction
55 minutes
41 minutes
37 minutes
33 minutes
Q2 2022 (Apr-Jun)
Q3-4 2022 (Jul-Dec)
Q1 2023 (Jan-Mar)
Q2 2023 (Apr-Jun)
Q3 2023 (Jul-Sep)
n Pre-intervention
n Post-intervention
22 | WELLSTAR HEALTH SYSTEM
PROFESSIONAL DEVELOPMENT Center for Nursing Excellence strengthens preceptor program WELLSTAR CENTER FOR NURSING EXCELLENCE Nurses find new ways to attract students and team members interested in sharing their knowledge and expertise. Clinical preceptors bring classroom knowledge to the clinical environment. They are essential to advancing nursing education and building the nursing workforce to meet high demand. A grounded orientation period with dedicated preceptors helps students and staff feel safe and confident in their learning environment. Unfortunately, the supply of qualified preceptors is decreasing nationwide as experienced nurses retire or leave the profession. Wellstar is countering this trend by providing preceptor training and resources for team members interested in stepping into the role. The current program offered by the Center for Nursing Excellence (CNE) has been enhanced with more virtual classes and in-person bootcamps—24 of these attracted 267 participants in fiscal year 2024. Another change is facility-based, train-the-trainer classes for nurse professional development practitioners. A Preceptor Advisory Council meets monthly to track progress and provide support. Wellstar currently offers a $2.00/hour premium for hours spent precepting by registered nurses,
FY24 PCCA Grads: 14
42 received Certified Nursing Assistant certification 8 became Certified Medical Assistants
certified as Patient Care Technicians
6 enrolled in pre-med programs
PROFESSIONAL DEVELOPMENT Paulding high school students get a jump-start on healthcare careers WELLSTAR HEALTH SYSTEM Students get practical experience and earn academic credit as part of an exciting community partnership. Mentoring and guiding the next generation of healthcare professionals is critically important to Wellstar Health System and the communities we serve. Since 2022, Wellstar has partnered with the Paulding College & Career Academy (PCCA) on a pathway program that allows Paulding County School District high schoolers to get hands-on experience in healthcare as they prepare for roles in nursing support and other areas. Students enrolled in the career program can choose from tracks in healthcare, cybersecurity, energy and mechatronics. In addition to their coursework, students on the healthcare track do their clinicals at Wellstar Paulding Medical Center. Upon completion of the program, participants receive both high school and college credit from Chattahoochee Technical College. A strong, ongoing partnership between Wellstar and the Paulding County School District is helping young people discover their future direction and helping to shape the future of healthcare. n
and a $1.00/hour premium for preparation by nursing support personnel. The CNE looks forward to continuing this important work, shifting to local preceptor communities within Wellstar hospitals and encouraging the participation of more preceptors across the System. n
25 bootcamps held with a total of 267 attendees in FY24
23 | 2024 NURSING REPORT
THEWELLSTAREXPERIENCE
We honor every voice. Welcome and include. n I take actions to include others and foster a sense of belonging. n I seek to understand others because I want to know their point of view. n I ask for advice if I am not sure how to talk to others who are different from me. n I join conversations with an open mind and look for the good in others.
Collaborate and celebrate. n I work well with others in accomplishing shared goals. n I contribute to my team’s success. n I share information with the team and provide the chance to ask questions so we can make the best decisions. n I thank others and celebrate the successes of those around me.
24 | WELLSTAR HEALTH SYSTEM
TEAMWORK Marking nurses week by helping one another WELLSTAR DOUGLAS MEDICAL CENTER Douglas nurses share their energy and compassion with the friends and neighbors they serve.
Across the country, National Nurses Week is an opportunity to celebrate the role of nurses in providing the best care to patients and members of the community. At Wellstar Douglas Medical Center, one of the ways nurses celebrate is by volunteering. This year, the recipient of their generosity was the S.H.A.R.E. (Someone
Helping Another Through Resources and Education) House in Douglasville. The nonprofit provides crisis
intervention and support for those impacted by family violence. Services include a crisis line, emergency shelter, emergency food and clothing, transitional apartments, legal advocacy, case management, children’s program, counseling and education. Working with Shelter Director Marie Washington, Douglas nursing leaders decided on a purse drive, as the event was scheduled a week before Mother’s Day. The initial goal was to provide 20 purses for those currently residing at the S.H.A.R.E. House shelter. Thanks to the energy and enthusiasm of Douglas nurses, 70 purses filled with hygiene supplies were assembled and delivered! n
70 purses filled with hygiene supplies were donated by nurses
EXEMPLARY PRACTICE Pathway to Excellence is well earned WELLSTAR SPALDING MEDICAL CENTER Spalding team members earn prestigious designation after a rigorous application process.
In March of 2024, Spalding achieved the Pathway to
Excellence® designation by the American Nurses Credentialing Center (ANCC). The Pathway to Excellence designation identifies the elements of professional work environments where nurses can grow professionally and feel encouraged. For an organization to earn the prestigious distinction, it must successfully undergo a thorough review process that documents quality initiatives in creating a positive work environment — as defined by nurses and supported by evidence.
The designation is granted based on the confirmed presence of 64 elements of performance, categorized into six standards: Shared decision-making, Leadership, Safety, Quality, Well-being and Professional Development. In addition to
meeting all the criteria, Spalding RNs participated in a voluntary survey administered by the ANCC. Spalding joins Wellstar Douglas, West Georgia and Windy Hill, which have also been recognized with this prestigious designation. n
25 | 2024 NURSING REPORT
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