Nursing was ranked the most trusted profession in 2017, according to the annual Gallup poll on honesty and ethicalstandards. We all know that being able to rely on others is crucial when we are hurting, sick or vulnerable. We need assurance that those who are charged with our care will be there and will do the right thing every time. Given the fact that we served 265,373 unique patients in 2017, you can trust that our team of nurses understands — and can be relied upon — to consistently pull through for the care of our patients and families.
University Health System is committed to continuously providing high quality, compassionate patient care and refining standards of nursing practice. Our strong culture, constant improvement and commitment to excellent patient care have resulted in measurable outcomes. We have earned national accreditations and distinctions over recent years for developing exceptional programs.
I am proud to present the 2017-2018 University Health System Nursing Annual Report. In 2018, the Health System submitted its application for the Magnet Nursing designation by the American Nurses’ Credentialing Center (ANCC) for the third time. In order to achieve Magnet status, a facility must exemplify five model components: Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, New Knowledge, Innovations and Improvements, and Empirical Quality Results.
This is a journey that never ends. In the year ahead, I look forward to working with our team of nurses and partners. Nurses will be involved in multiple clinical process improvement projects, policy and procedures development and revisions, and nurse quality monitoring. We will continue our commitment to nurse recruitment, nursing excellence, evidence-based nursing care and mentoring the next generation of healthcare professionals.
Tommye Austin, PhD, MBA, RN, NEA-BC
For 100 years, University Health System has served a vital role in San Antonio and throughout Bexar County — providing
outstanding care to those who need it, training the next generation of health professionals and working to find new and better treatments through research. Over the course of that history, we have followed a core set of values that guides and defines us.
The Nursing Professional Practice Model reflects the mission of the University Health System to provide high quality and compassionate care to our community. In January 2003, the theory of Modeling and Role Modeling, developed by Helen Erickson, PhD, RN, AHN-BC, FAAN, was adopted to guide our nursing practice. Using Modeling and Role Modeling, nurses aspire to accept and respect individuals’ unique views of themselves and their world. Sixteen years and two American Nurse Credentialing Center Magnet designations later, Modeling and Role Modeling continues to guide nursing practice and care delivery throughout the Health System and the community it serves.
In preparation for University Health System’s third Magnet designation, Dr. Erickson was invited to meet with nursing staff in 2018, to explore how Modeling and Role Modeling has affected the delivery of healthcare within our Health System. During unit tours with Dr. Erickson, nurses shared examples of how Modeling and Role Modeling shaped their academic development and defined their delivery of care.
Edwin Calderon, a talented artist, University Health System employee and nursing student, was commissioned to create a painting in honor of Dr. Erickson that represents Modeling and Role Modeling, the history of University Health System, and its role in the health of the community. Mr. Calderon describes his interpretation as a direct representation of how hospitals and communities can collaborate together to create a synergistic effect of health and prosperity. Just as human beings are holistic in mind, body and spirit, so are paintings. Every brush stroke radiates a different colored personality and belief. When blended together, we can truly appreciate its holistic nature.
The painting includes San Antonio landmarks to represent the community that University Health System serves. Among these are landmarks that represent the vital role and history of the University Health System, including the historical Robert Brady Green Hospital from 1917, the original Bexar County Hospital of 1968 and the recently constructed Sky Tower of 2014. These landmarks illustrate our commitment to transform healthcare and serve the community. The artist’s approach subtly includes the concepts within Dr. Erickson’s theory that represent a nurse’s objective and subjective view of the client. The intent of the hidden words is to encourage the observer to pause and interact with the painting, similarly to the way a nurse must pause and interact with the patient. Dr. Erickson’s open arms represent the “long arm” or influence of nursing while illustrating the University Health System’s role in extending that nurturance to the community.
The painting was presented to Dr. Erickson on December 4, 2018, in San Antonio by the artist and University Health System nursing staff during the Nursing Living Legends (Grand Rounds with Dr. Helen Erickson) luncheon sponsored by the University Health System Center for Clinical Excellence.
Hospital emergency departments throughout the industry struggle to overcome the stigma that emergency departments are often overcrowded with stressed-out patients. The University Health System Emergency Department (ED) is making positive strides to turn the tide, thanks to the leadership of Tommye Austin, PhD, MBA, RN, NEA-BC. As Senior Vice President and Chief Nurse Executive for University Health System, Dr. Austin has overseen changes to the ED patient flow model that have driven a consistent positive performance in outcomes and processes.
The University Hospital ED is a high profile area that serves as the “front door” to the community. The ED redesign was implemented to improve efficiency and quality of care delivered to ED patients, reduce door-to-physician times, decrease the number of patients that leave without being treated and shorten the overall length of stay for discharged patients. When Tommye joined University Health System in May 2017, she worked with ED physicians and staff to create a work flow and standardize the patient flow model to effectively move and place patients on the right track. Quality Matters Consulting team was recruited to assist with the efforts.
In January 2018, the consulting team formed a baseline using historical data and conducted a site visit to assess the work flow, patient flow, and care delivery areas. Working with the University Health System ED Task Group, the Power Us ED initiative was born. Power Us ED officially rolled out in May 2018. In the new process, patients initially register and meet with a nurse to discuss the reason for the visit. After registration, the patient is assessed by the ED Physician in Triage area. This flow model allows attending physicians, providers and nurses to work together to assess every patient and address each patient’s needs.
In June 2018, University Health System leadership held nine Always Events for all University Health System and UT Health San Antonio personnel to introduce the Power Us ED model. All sessions included training on how to demonstrate the Tap Out process, explain leadership and purposeful rounding and incorporate AIDET into practice. AIDET is a framework for staff to communicate with patients and their families. AIDET is an acronym that represents a way to communicate with people in achieving satisfaction: Acknowledge, Introduce, Duration, Explanation and Thank you. A total of 136 ED staff attended.
The Power Us ED initiative revamped the triage process. The fast-track area originally had 12-14 beds dedicated to patients with Emergency Severity Index (ESI) levels of 4 to 5. These patients comprised approximately 15% of the ED population. To create a standard flow for patients, fast track (ESI 4 to 5) and mid-track (ESI 3) rooms merged to reduce wait times and decrease overall length of stay. The areas were merged to “Power Pod” in December 2018. ESI helps rapidly identify and prioritize patients that can’t wait and helps determine acuity of the waiting room and the Emergency Department as a whole.
University Health System honored more than 250 nurses for their exemplary professional practice and commitment to our patients during the annual University Health System Nursing Excellence Awards. The ceremony, held May 9, 2018, was in conjunction with the annual celebration of Nurses Week. University Health System and nursing leadership Senior Vice President and Chief Nurse Executive, Tommye Austin PhD, MBA, RN, NEA-BC; Senior Vice President, Theresa De La Haya MPH, BSN, RN; Vice President and Associate Chief Nursing Officer, Charles Reed PhD, RN, CNRN; Vice President and Associate Chief Nursing Officer, Irene Sandate DNP, MSN, RN, NNP-BC; and Vice President and Associate Chief Nursing Officer, Nelson Tuazon DNP, DBA, MSN, RN, NEA-BC, CENP, CPHQ, FNAP, FACHE, also honored nurses with 20 or more years of experience for their continued service and commitment to providing high quality patient care. Family and friends of the honorees also joined in the celebration.
University Health System celebrated the contributions of all staff during National Hospital Week. A new event in 2018 also recognized Certified Health Professionals day. On May 8, 2018 in the main garden of the hospital, a celebration featured Vice President and Associate Chief Nursing Officer, Charles Reed PhD, RN, CNRN and four certified health professionals including Nursing, Child Life, Pastoral Care, and Occupational Therapy, speaking on the importance of national certifications. University Health System has more than 1,200 certified health professionals, and approximately 200 health professionals attended the event. A reception followed the celebration, allowing for collaboration and team building among the disciplines. Each year, certified professionals are given a gift and recognized for attaining national certification in their field.
For more than 100 years, the University Health System has played a key leadership role in educating skilled and compassionate healthcare professionals. A collaborative spirit has guided many of its innovative programs.
One of those collaborations began in 2016 when the University Health System began a partnership with Texas Tech University Health Science Center, School of Nursing, to become a premier clinical site in San Antonio for their Accelerated BSN Program: Second Degree BSN and Veteran to BSN tracks (VBSN).
The Second Degree and VBSN programs are unique in that they pair one student with a BSN nurse (a clinical coach) at the Health System for the entire program. In a traditional undergraduate nursing program, a group of students is under the supervision of a single faculty member, and the nursing students are placed with various nurses on different nursing units throughout the course of their program.
Debbie Sikes, DNP, RN, CNE, Veteran to BSN Director, Texas Tech University Health Science Center, noted, “University Health System has been an amazing partner and we have been supported since day one. It has been a synergistic relationship. The Health System has brought staff, faculty and a simulation lab to develop new nurses and provide veterans the opportunity to expand their career path.”
In a collaboration with UT Health School of Nursing, University Hospital is helping students in the Doctor of Nursing Practice (DNP) Program with career development and instruction in San Antonio. The emphases of the program include inter-professional collaboration, leadership and critical evaluation of outcomes, systems improvement, and policy advocacy to effectively manage change and employ strategies for advancing programs of care and clinical practice in complex healthcare settings.
The Health System also is helping to provide technology and patient education to improve the patient experience. DNP Program students Tanya L. Panula, MSN, RN-BC, CMSRN and Patricia Fichter-Patrick, MSN, RNC-LRN, CNE utilized educational videos regarding side effects of anesthesia, and assisted in employing skylight technology to help improve patient satisfaction. The students met with clinical staff to review data and determine key drivers for targeting their educational interventions.