Riley Children's Health is a nationally ranked pediatric health system that uses expertise, innovation and the latest advancements to deliver the highest level of patient care to children and families in Indiana and across the nation.
Riley Children’s Health Nursing Annual Report 2023
rileychildrens.org
Welcome to Nursing at Riley Children’s Health I’m excited to share our 2023 Riley Children’s Health Nursing Annual Report on behalf of the amazing 1,660 clinical nurses here at Riley Children’s. Every day, our nurses show their dedication to providing exceptional care to children with complex conditions and those with not-so-complex conditions.
In this report, we’ll dive into our strategic priorities, our professional practice model and some of the quality improvement projects that helped us earn our fifth Magnet Recognition Program® status in 2024. This recognition is particularly special as it’s our second one independent from the IU Health Adult Academic Health Center. At Riley Children’s, we work together within a strong professional governance structure alongside our interprofessional colleagues. This collaboration allows us to make decisions that improve our practice environment and keep us on track for success in caring for our patients and their families. Whether we’re caring for Indiana’s sickest kids or jumping into action for community health needs, Riley nurses always step up. We’re all about delivering top-notch care, pushing the boundaries in our field, and showing compassion to our patients and community. Thanks for taking an interest in Riley Nursing. We hope this report gives you a good insight into how committed we are as nurses to providing evidence-based, patient-centered care, which Riley Children’s is known for worldwide.
Table of contents
Welcome to Nursing at Riley Children’s Health .................. 1
Nursing at Riley Children’s .................................................... 2
The Riley Nursing Strategic Plan .......................................... 4
The Riley Nursing Professional Practice Model .................. 7
Megan Isley, DNP, MBA, RN, NEA-BC, NPD-BC Chief Nursing Officer
Nursing awards and recognition ........................................... 8
The Magnet Model and 2023 stories of nursing practice excellence ............................................ 10
2023 presentations and publications ............................... 12
Associate chief nursing officer Sharon Chaney PhD, RN, CENP Associate Chief Quality Officer Associate Chief Nursing Officer – Practice and Professional Development
Learn more about Riley Nursing
On the web: rileychildrens.org/about/nursing-at-riley
Facebook: @RileyChildrensHealth
X: @RileyChildrens
Instagram: rileychildrens
Riley Children’s Health Nursing Annual Report 2023 | 1
Nursing at Riley Children’s: 2023
Destination for nursing ■ 649 new team members onboarded including RNs, paramedics, LPNs and unlicensed assistive personnel ■ 321 travelers onboarded ■ 135 new graduate nurses graduated Entry-to-Practice Nurse Residency Program ■ 53 team members attended coach class
Patient outcomes ■ Reduction in CLABSIs: 32% decrease ■ Reduction in hospital-acquired pressure injuries: 51% decrease ■ Reduction in unexpected newborn complications: 45% decrease ■ % below goal for NTSV C-section rate: 2.5% ■ 15% improvement in Emergency Department access (door-to-doc) ■ 47% improvement in left without being seen (LWBS)
EMERGENCY DEPARTMENT
NURSES 1,660
INPATIENT ADMISSIONS 23,463
VISITS 65,071
LICENSED BEDS 456
OUTPATIENT VISITS 227,199
DELIVERIES 3,633
Program distinctions ■ Magnet®designated – only 10% of U.S. hospitals are Magnet designated; only 1% of U.S. hospitals have their fifth designation
EXCELLENT PATIENT CARE: 8 out of 10 patients are likely to recommend Riley Children’s
The Riley Emergency Department had a 12% increase in likelihood to recommend. Nursing implemented a discharge checklist which resulted in a 7% improvement year-over-year.
■ Only Entry-to-Practice Nurse Residency Program in Indiana accredited by the Commission on Collegiate Nursing Education; accreditation received in 2022 Specialized nursing practices ■ Indiana’s first obstetrical intensive care unit (OBICU), which opened at Riley Children’s in 2021, innovates the way nurses care for maternal patients. In our model, OBICU nurses are dually trained and competent in critical care and obstetric nursing. ■ Riley Children’s dedicated team of cardiology-trained nurses cares for patients in the Riley Heart Center cardiovascular intensive care unit and step-down units. ■ Specially trained nurses in the Riley Burn Center care for children from their first visit through recovery after surgery. Research highlights Nurses at Riley Children’s are engaged in research related to: ■ Pediatric nurses’ perspectives on suicide screening and prevention ■ Pediatric palliative care education and its impact on nursing awareness and perception of pediatric palliative care ■ Lived experiences of caring for an infant with cleft palate ■ Food insecurity
Education and specialty certification
Associate of Science in nursing 12%
Bachelor of Science in nursing 82%
Graduate degree 6%
Certified clinical RNs 21%
Certified nurse leaders 57%
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The Riley Nursing Strategic Plan What’s our vision for Riley Nursing? How do we realize it?
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Strategic priority: Empower nurses to lead
These were the two key questions Riley nurses sought to answer in coming together in early 2021 to update the nursing strategic plan for Riley Children’s. Nurses representing all of Riley Children’s had the opportunity to participate in the plan’s development. The previous Nursing Strategic Plan was reviewed at a Riley Nursing Forum and a World Café was held with forum attendees to brainstorm ideas. Additional opportunities were provided for team members to submit additional ideas. We wanted to ensure that every nurse at Riley Children’s had the opportunity to have their voice heard in the creation of the Nursing Strategic Plan. As a result, more than 100 nurses participated in the Riley Nursing Strategic Plan. The Riley Strategy Council—with more than 30 nurses representing all levels and types of Riley nursing—was then formed to create the Nursing Strategic Plan based on the brainstorming activities.
INITIATIVE Structural empowerment
PROGRESS TOWARD GOAL: 2021 – 2023 ■ Established a Riley specific conference attendance policy and process ■ Achieved transition to practice accreditation ■ Offered evidence-based practice workshops ■ Development of individual professional development plans for all nurse leaders ■ Implemented monthly nursing grand rounds presentations ■ Support and participation in the Center for Nursing Excellence ■ Creation of content and delivery of Elev8 program
TACTICS ■ Implement a learning needs assessment and offer professional development from findings ■ Professional development ■ Transition to practice program ■ Professional organization involvement ■ Community engagement and involvement
The Riley Nursing Strategic Plan launched in 2021 and is built upon four strategic priorities:
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Empower nurses to lead
Engage our elite nursing talent
Foster autonomous
Advance nursing excellence
nursing practice
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Strategic priority: Engage our elite nursing talent
Nurse executive sponsors for each of the strategic plan strategic priorities routinely report progress to nursing team members.
INITIATIVE Transformational leadership
TACTICS ■ Mentoring and succession planning ■ Change management ■ Advocacy ■ Communication and visibility of leaders ■ Implement engagement initiatives
Riley Children’s Health strives to lead and inspire nurses to engage in their practice to advance the care and health of pediatric and maternal populations. Our vision is that Riley Children’s Health nurses are engaged and empowered to practice at the top of their scope with autonomy and excellence, leading the next generation of nurses.
PROGRESS TOWARD GOAL: 2021 – 2023 ■ Established executive rounding including night rounding ■ Partnerships with talent acquisition ■ Hosted various hiring events ■ Diversity, equity and inclusion initiatives ■ Creation of Riley One Team nominations ■ Creation of a Riley-wide interprofessional engagement committee ■ Facilitation of surprise video compliments ■ Facilitation of the why wall
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The Riley Nursing Professional Practice Model At the heart of the Riley Nursing Professional Practice Model is what matters most to Riley clinical nurses: the patient.
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Strategic priority: Foster autonomous nursing practice
Surrounding individualized patient care delivery are the generative relationships established between the patient, family, community, team and self (nurse). Generative relationships are cultivated from clinical nurses who exemplify clinical expertise, embrace learning, have a spirit of inquiry, are professionally engaged and foster relationships. Surrounded by united professional governance, clinical nurses are able to exercise the advocacy, autonomy, accountability and authority of professional nursing practice to deliver Individualized patient care.
INITIATIVE Exemplary professional practice
PROGRESS TOWARD GOAL: 2021 - 2023 ■ Creative roles for care delivery models ■ Creation of an education and document on nursing plans of care ■ Established patient hygiene guidelines for Riley Children’s ■ Established and implemented virtual nursing peer review training ■ Spread of nursing peer review process to Riley Heart Center, NICUs and maternity spaces ■ Creation of education and communication for professional governance
TACTICS ■ Interprofessional collaboration ■ Nursing peer review ■ Ethics and culture of safety ■ Improvement of nurse sensitive quality indicators and patient experience ■ Nursing professional governance
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Strategic priority: Advance nursing excellence
Riley Children’s professional governance structure
Riley Nursing Strategic Priorities
INITIATIVE New knowledge, innovation and improvements
TACTICS ■ Nursing research, evidence-based practice and quality improvement ■ Nursing presentations and publications ■ Establish Magnet® champions ■ Reward and recognition of excellent nursing practice PROGRESS TOWARD GOAL: 2021 – 2023 ■ Magnet® document writing, submission and site visit ■ Developed a process to share nursing sensitive quality indicator outcomes at nurse director meetings each quarter ■ Yearly nurses week recognitions and celebrations ■ Yearly Riley Innovations in Practice conference
Riley Nursing Strategy Council
Riley Professional Governance
Riley Interprofessional Innovation in Practice Council
Riley Professional Governance
Nurse Leader Council
Professional Practice Council
Nurse Peer Review Council
Manager Ops Council
Policy/Procedure Council
HAC Councils – CLABSI, HAPI, CAUTI
Nursing Super User Group
Safety Advocates
Department/Unit Professional Governance Council
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Nursing awards and recognition 2023 Riley Children’s Health nursing awards
DAISY Team Award – Nursing Practice Team
“The mission of this team is to lead and inspire nurses in engaging their practice to advance the care and health of pediatric and maternal populations across Riley Children’s Health. In late 2022, there was an increase in the number of harm events Riley patients experienced. True to their purpose, this team adjusted their work and prioritized rounding on 100% of the patients at high risk for harm every day in the last few months of 2022. Exemplifying the value of
Nurse Excellence Award – Drue Kluemper, Labor and Delivery
“Drue truly showed her nursing excellence in the care she provided for my daughter and my family. She didn’t just see a patient, she saw a person. A person at their lowest, going through the most difficult thing they will ever go through. Thank you Drue, for helping me through the scariest and hardest night of my life. Thank you for treating not only me and my husband with respect and sympathy, but also for treating Penelope with dignity. When our car pulled up to go home, I stood up and we hugged. I told her I hope the next time our lives cross paths that she is helping our rainbow baby into this world.” Coach Award – Anna-Kay Bailey, OBICU “Anna-Kay recognizes coaching as an opportunity not only to share her wealth of knowledge, but also to individually grow as a nurse and informal leader. Anna-Kay advocates fiercely for her patients and truly demonstrates the IU Health values of compassion and purpose when coaching. She is an excellent role model for nurses new to our unit and a valued member of our team.” Margaret Martin-Roth Award – Stacy Nance, Hematology & Oncology Infusion & Surgery Clinic “Stacy represents what every professional nurse should strive to be. She is professionally engaged, utilizing her clinical expertise to advocate for her patients and team members. She fosters relationships with her patients, their families, her team and many disciplines at Riley. She embraces learning and has a spirit of inquiry. She has been involved in many EBP projects and has been a lead on several nurse-led research projects.”
> The Wound Ostomy Continence Nurses and Clinical Nurse Specialists are part of this team. If you would like to learn more about the Clinical Nurse Specialist role at Riley Children’s Health please review the Clinical Nurse Specialist Annual Report
Team, they collaborated with other departments, mentored and coached frontline team members to complete this important work. Throughout this last year the team members remained engaged, several team members won awards, presented, published their work, and participated in various initiatives and councils to improve the outcomes for Riley patients and team members. This team has exemplified the value of compassion with how they have advocated for their patients, the teams they serve and each other this past year. For these reasons and many others, this team is highly deserving of the DAISY Team Award.”
Partner in Care – Mackenzie Fahey, Quality and Safety
“Mackenzie has done so much work with partnering with nurses and nurse leaders across the hospital. He has helped us to work smarter with the resources we have available to do the same work. Mackenzie has been added to a multitude of work across the hospital because of the impact he is able to have on the projects he is tackling, his willingness to collaborate and because he has been able to have a significant impact on the quality of care we provide to our patients every day. He is always willing to help and lend his expertise to nurses and nurse leaders across the organization.”
2023 DAISY Winners
2023 Distinguished Nurses
DAISY Leader Award – Amy Birchfield, Manager of Nursing Practice
JANUARY: Peyton Wilson, CVICU
FEBRUARY: Stacy Gibson, Riley North PICU
MARCH: Jennifer Wilson, L&D
Ali Langtry, ED
Cindy Fiscus
LaTanya Malone
APRIL:
“I have seen this nurse leader grow tremendously in the last few years. This nurse leader demonstrates the value of compassion in the way she genuinely cares for her team. She has good relationships with each of her team members. She understands the strengths of each of her team members and can capitalize on those strengths to empower and engage them and improve outcomes. She delivers constructive feedback clearly and consistently to ensure growth in each team member. This leader is an excellent candidate for the DAISY Leader Award because of the environment she creates, her ability to encourage critical thinking and problem solving, and the way she advocates for her team.”
MAY: Aaron McLellan, PPCU
JUNE: Makayla Howard, RMT NICU
JULY: Jennifer Vanhooser, NICU
AUGUST: Paula Miller, ECMO
Stacy Nance
Inna Kislyuk
SEPTEMBER: Brooklynn Buedel, NICU
OCTOBER: Amber Schiefelbein, FOC OP Surgery
NOVEMBER: Maci Frantz, 8E
DECEMBER: Rebecca Fenes, CVICU
Tiffany Smith
Jacob Harmon
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The Magnet Model and 2023 stories of nursing practice excellence
Magnet® Model
There are five main components of the Magnet®Model: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovations & Improvements and Empirical Outcomes. The following stories are examples of how Riley nurses exhibited the components of nursing excellence and the Magnet Model in 2023.
Riley Children’s submitted Magnet documentation in the summer of 2023 and hosted Magnet appraisers from the American Nurses Credentialing Center (ANCC) on Nov. 28 – 30, 2023, to obtain their fifth Magnet Designation. Magnet designation is a recognition given to a hospital for excellence in nursing. Only about 10% of hospitals in the world have this designation and less than 1% of hospitals have achieved this designation five times. The documentation and site visit demonstrates that a hospital meets the threshold of excellence in nursing set forth by the ANCC. The official designation decision was announced on Jan. 19, 2024, as the Riley One team members listened to the call in the Riley Outpatient Center (ROC) Auditorium. Sharon Pappas, chair of the national Commission on Magnet voluntary governing body, which assesses nursing quality, achievements, leadership, education, collaboration, innovation and patient outcomes, had the privilege of delivering the good news to an enthusiastic group of nurses and Riley leadership in the ROC auditorium. “The commission has reviewed all of your submitted documentation and findings from your recent site visit. It is my high honor and privilege to officially notify you that the Commission on Magnet has unanimously voted to credential Riley Children’s Health as a Magnet organization for the fifth time,” she told the group. “Congratulations!”
All rights reserved. Reproduced with the permission of the American Nurses Credentialing Center.
Transformational leadership Elev8
In May 2024, more than 40 Riley One team members, including 14 nursing team members, were nominated by their leaders to participate in the Elev8 Riley Leadership first cohort. This leadership development series was comprised of eight sessions including Leveraging Change, Compassionomics, Crucial Conversations, Operational Excellence, Financial Acumen ending with Atomic Habits and a graduation ceremony. The purpose of Elev8 Riley Leadership was to explore each team member’s connection to purpose as leaders and how to foster those connections with team members.
“ Being a part of the initial Elev8 cohort was an amazing opportunity. I feel honored that Riley invested in our leadership development and growth in this way. Building relationships and learning alongside great leaders helped enforce the concepts we were learning. It also strengthened our leadership team; going through the experience with the triad of medical director, nursing director and administrator allowed us to implement the concepts in real time as we worked through projects over the course of the year.” – Jen Engelmann, MBA-HC, BSN, RN, NE-BC, Director of Clinical Operations, Acute Care Center “ The best part of Elev8 was attending with interprofessional leaders representing all of Riley Children’s Health. It gave me an opportunity to interact and learn from other leaders that I am not necessarily around in my day-to-day work … Overall, I took away the importance for me as a leader to take the time to reflect on my emotional side and tap into the emotional sides of others. I tend to prefer thought over emotions, but I have learned that it is really the emotional part that motivates us all. I often take on other people’s problems and fix the problems for them. As a leader, work isn’t in the answer but in the question and helping other team members manage their own issues. It was an honor to be selected to participate in the inaugural Elev8 cohort group along with so many excellent Riley Children’s Health leaders.” – Kristin Miller, MSN, RN, NE-BC, CPN, Director of Nursing Practice, Magnet Program Director
“ I appreciated learning more about compassionomics. I assumed positive intent previously, but this cohort helped deepen that appreciation and understanding of others and helped me guide them in that learning as well and being able to share my learnings with my team and other leaders around me. I appreciate the investment in me as a leader, and my growth and development. These sessions were clearly thought out and planned in advance. Taking the time to plan for these events to ensure they are meaningful to participants shows the initiative of Elev8 was intentional and purposeful in growing and developing leaders.” – Nettie Wilson, MSN, RN, CPEN, CPHQ, NE-BC, Clinical Manager – ED, Center of Hope/ Pediatric Forensic Nursing
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Structural Empowerment At Riley Children’s Health clinical nurses provide culturally and socially sensitive care to our patients. Kathleen Head, BSN, RN, CPN, CPHON, a clinical nurse on the Hematology/Oncology Unit, 5 West is an approved bilingual provider in Spanish at IU Health and a Spanish Educator. Kathleen identifies patients with the preferred language of Spanish. She meets with the patients and families to assess their needs and better understand their individual language preferences so the teams at Riley can best care for them, the caregivers can be fully included in the patient’s care, and education needs can be met. Kathleen is instrumental in ensuring that patients, caregivers, and team members at Riley have access resource to improve language access. This includes establishing an interprofessional language access council and advocating for additional video interpretation devices. Exemplary Professional Practice At Riley Children’s Health team members frequently partner with patients and families to influence change in the organization. In 2023, an interprofessional team of providers and nurses identified that patients did not have access to appropriate products to provide ethnic hair care. This group partnered with supply chain and the Riley Patient and Family Advisory Committee to identify the products that were needed, trial the products, and ensure that the appropriate products are available for use. In September of 2023, a bonnet, wide tooth comb/brush, shampoo and conditioner, hair care kit, and mesh bag were added to the supply ordering system which allows departments to order these products to provide appropriate hair care for all patients and families. New Knowledge, Innovations & Improvements Clinical nurses at Riley Children’s Health incorporate professional specialty standards or guidelines to implement a practice new to the organization. In early 2023, Tracy Swift, BSN, RN, CWON, clinical nurse and Cara Flanigan, BSN, RN, CWON, clinical nurse partnered with the interprofessional Riley-wide, hospital acquired pressure injury group to implement the use of the Braden QD scale to assess pressure injury risk. The Braden QD scale takes into consideration the medical devices the patient has which was not part of the previous assessment tool. The implementation of the Braden QD assessment tool has allowed clinical nurses to better appreciate the unique risks of hospitalized pediatric patients. Team members have noticed improvements in the removal of necessary devices, padding of devices, and other interventions directed towards addressing the challenges posed to the skin by medical devices.
Presentation and Publications Riley Children’s Health nurses are committed to disseminating new knowledge, innovations and improvements to the community of nursing. Here is a list of some of the presentations and publications that Riley nurses participated in in 2023: Presentations Bass, Sarah. Early Detection Can Reduce Suicide Risk in Ambulatory Care, American Academy of Ambulatory Care Nursing, 2023. Brown, Hilary & Hardacker, Sarah. (2023, July 28). Riding the waves of change: An NPD department re-design. Association for Nursing Professional Development. Clements, Hilary. (2023, Dec). Utilizing Nurse Executive competencies to plan Associate Administrator department growth and development (poster presentation). Riley Interprofessional Innovation in Practice Conference. Riley Hospital for Children, Indianapolis, IN. Estridge, Danielle & Hardacker, Sarah. (2023, Dec). Re-designing the new nurse orientation model (podium presentation). Riley Interprofessional Innovation in Practice Conference. Riley Hospital for Children, Indianapolis, IN.
Head, Kathleen. (2023, May). Language accessibility (poster presentation). IHI Patient Safety Congress, Maryland.
Humphery, Heather. (2023, Dec). 3 Dimensional Cardiac Defect Heart Models (poster presentation). Riley Interprofessional Innovation in Practice Conference. Riley Hospital for Children, Indianapolis, IN. Knight, Kelly, Hollar, Melissa, & Edge-Reetz, Mackenzie. OB ICU Nursing: An Innovative Counteroffensive to Maternal and Neonatal Morbidity and Mortality, The Women’s Hospital Annual Perinatal and Neonatal Symposium and Riley Interprofessional Innovations in Practice Conference. Seibold, Dianne & Smith, Tiffany E. (2023, Dec). Implementing the tiered skills acquisition model in a complex operative environment (podium presentation). Riley Interprofessional Innovation in Practice Conference. Riley Hospital for Children, Indianapolis, IN. Publications Bass, Sarah, Scholes, Kathryn, & Smith, Diane. (2023). Preventing nurse burnout to improve nurse retention in primary care. Journal of Nursing Management, 54(12): 26-33. Preventing nurse burnout to improve nurse retention in prima... : Nursing Management (lww.com) Brown, Hilary. Utilizing Nurse Executive Competencies to Plan House Supervisor department growth and development. 21(5): p547- 550, Oct 2023. https://doi.org/10.1016/j.mnl.2023.06.009 Utilizing Nurse Executive Competencies to Plan House Supervisor Department Growth and Development - ScienceDirect Engelmann, Jennifer & Klein, Nicole. (2023). Operation allies welcome: What matters most to patients and team members when cultures collide. Nurse Leader, 21 (5): 543-546. Operation Allies Welcome: What Matters Most to Patients and Team Members When Cultures Collide - ScienceDirect Hutchins, Larissa, King, Karen L., Piroso, Christina V., Williams, Laura M., Hardacker, Sarah N., Birnbaum, Shira, & Curley, Martha A. Q. Design and implementation of a new orientation program based on core competencies and a clinical mentor model. Journal for Nurses in Professional Development 39(6):p E228-E232, 11/12 2023. | DOI: 10.1097/NND.0000000000000993 Design and Implementation of a New Orientation Program Based... : Journal for Nurses in Professional Development (lww.com) McSweeney, Julia, Colglazier, Elizabeth, Becerra, Jasmine, Leary, Brienne, Miller-Reed, Kathleen, Walker, Stephen, Tillman, Katy, Magness, Melissa, Ogawa, Michelle, Bannon, Whitney, Kivett, Tisha, Jackson, Emma O., Davis, Anne, Shepard, Cathy, Richards, Susan, Whalen, Elise, Engstrand, Shannon, DiPasquale, Zachary, & Connor, Jean A. Failure to tolerate continuous subcutaneous treprostinil in pediatric pulmonary hypertension patients. Pulmonary Circulation. 2023 Apr 1;13(2):e12224. doi: 10.1002/pul2.12224. PMID: 37143765; PMCID: PMC10151594. https://pubmed.ncbi.nlm.nih.gov/37143765/ Failure to tolerate continuous subcutaneous treprostinil in pediatric pulmonary hypertension patients - McSweeney - 2023 - Pulmonary Circulation - Wiley Online Library
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Riley Children’s Health Riley Children’s Health is Indiana’s only full service statewide pediatric health system. Riley Children’s offers complete, comprehensive pediatric care ranging from routine primary care checkups to the most complex acute care needs from highly skilled pediatric specialists. The system connects patients with expert primary care and specialty care physicians in communities across the state of Indiana. Riley physicians treat patients in their home communities, bringing top-notch care close to home. This statewide network is an extension of Riley Hospital for Children, one of the nation’s leading children’s hospitals consistently ranked a Best Children’s Hospital by U.S. News & World Report . rileychildrens.org
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