Following a year of research, task force meetings, logistics, pro formas, recruitment and interviews, the Student Nurse Apprenticeship Program (SNAP) went live at St. Luke’s in the Treasure Valley in June 2018.
Ten students from Boise State University, Northwest Nazarene University and Lewis-Clark State College who are pursuing their bachelor’s degrees in nursing have joined the first cohort. The goal of SNAP is to create a formative environment for these students, who have completed at least their junior years. The nurse apprentices (NAs) will be paired one-on-one with a seasoned nurse preceptor in the experience-rich clinical support unit. The NAs will experience a variety of clinical experiences to help develop their critical-thinking skills with regards to patient care.Some anticipated highlights of SNAP:
SNAP follows in the footsteps of a pilot Externship Program in Magic Valley led by Val Leonard, MSN, RN, NEA-BC, Senior Director, Nursing/Patient Care. That program is now in its third year with five participants.
Pam Springer, PhD, RN, ANEF, NEA-BC, BC, Senior Director, Clinical Learning and Student Services (CLaSS), envisioned an expanded apprenticeship program as a model for the development of employed nursing students. Reuben DeKastle, BSN, MSHA, RN, CNOR, NEA-BC, Manager, CLaSS, shepherded the development of the apprenticeship program in the Treasure Valley while engaging a talented multidisciplinary, multi-site team.
SNAP in the Treasure Valley has been approved for three annual cohorts of 10 participants.
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St. Luke’s Virtual Care Center (VCC) serves as a hub to explore clinical, technical and operational innovation. The center supports care transformation and delivery across the acute, post-acute and ambulatory settings and includes programs such as the TeleICU, Transfer Center, Teleneurology, Remote Patient Management, and a growing list of outpatient telehealth specialties. The center is powered by cutting-edge technology coupled with skilled clinicians including 32 nurses (RNs) who provide and support safe and meaningful care across the health system. Programs supported and established in collaboration with the VCC demonstrate improved patient outcomes, lower total cost of care, operational efficiency gains as well as improved access to care.
“Merging technology and care delivery is the way we have to operate in order to be successful in population health,” says Krista Stadler, BSN, RN, Senior Director of Telehealth Services for St. Luke’s Health System. “With the growing Idaho population and consumer demand for convenient care, we have to explore how we can use technology to achieve our goals and meet the needs of our patients.”
Nursing is a vital component across the spectrum of telehealth services, with roles ranging from clinical coordination, direct patient care, programmatic design and operational leadership. Often, the coordination required to effectively provide on-demand telehealth services begins with the important work of the Transfer Center RNs who file an average of 23,000 connections per month, efficiently connecting providers and managing the myriad of logistics to efficiently connect patients with the right resources.
One of the more well-known programs in the VCC includes RNs supporting critical care patients and care teams through St. Luke’s TeleICU, which has been a standard of care across the health system ICUs since January 2011. Using live, two-way, audio-video technology and decision support software, nurses and physicians work collaboratively with bedside care teams to monitor and intervene on the most acute of patients. This collaboration has resulted in saving more than 120 lives and 9,500 ICU days across the health system in 2018.
One of the newest programs and RN roles in the VCC is that of a care manager for the Remote Patient Management (RPM) Program. This program couples technology and nursing to care for complex care patients with chronic disease in their homes. Using a tablet and Bluetooth-connected peripheral devices, patients complete a daily health session which includes vital sign measurements, branching logic symptomatic questions, education and social support. The data from these sessions is automatically sent to the VCC where specialized software triages patient results and identifies patients who need support immediately. The RNs review patient trends, then intervene and coach patients via phone, text or video sessions. They also communicate directly with the patient’s primary care physician when concerns or the need for new orders are identified.
As one of the first St. Luke’s RNs to experience this innovative and unique way to practice nursing, Anna Dillon, BSN, RN, has insight into how our patients are responding to this model of care: “The technology really disappears into the background as you form genuine connections with your patients. I have seen patients so overwhelmed by their conditions that they have given up hope, transform to motivated and empowered patients creating and sustaining change for themselves independently. Patients love the access and support conveniently built into their everyday life.”
The RPM program has consistently demonstrated the ability to comprehensively and proactively support the patient using technology-enabled care, resulting in a 58% reduction in ED utilization, 80% reduction in acute care admissions, and when the patient is hospitalized, their length of stay has been reduced by 86%.
St. Luke’s is also expanding the reach of ambulatory specialist providers while improving patient satisfaction by offering providers and patients the ability to connect in rural clinics through telehealth technology. Currently, providers from pulmonology, cardiology, sleep, nephrology, urology, medical oncology, pediatric surgery and neurodevelopmental pediatrics are all able to offer telehealth to prevent unnecessary travel and expand convenient accessibility for patients. This has created more than 100 additional patient visits on providers’ local schedules this year. In-person assistance for physicians and patients navigating this experience is provided by Thaona Garber, BSN, RN, St. Luke’s first Telepresenter RN. Garber’s nursing support has been a significant factor in the high levels of patient satisfaction measured in these programs. These and other ambulatory services will be expanded across the organization’s rural settings over the coming months and years.
Regardless of the care setting, telehealth is a way to enhance the services already provided by the patient’s primary care team and to close care gaps quickly and efficiently.
“This space will allow us to grow our services and capacity throughout the organization to ensure patients have access to the right care at the right time, regardless of geographic location,” Stadler says. “We believe there is an opportunity to improve a patient’s access to care and ensure that care is patient-centered.”
Professional Advancement Through High-performance and Skill (PATHS), St. Luke’s professional development program created to empower and engage clinicians, has demonstrated great success in its first two years. Participants are achieving both their professional goals and project goals. Several participants received promotions into leadership positions. In the first two cohorts, 21 participants were awarded a bonus of up to $1,500 for the effort, quality and outcomes of their completed project.
PATHS received applications from 40 clinicians who submitted a project idea to the program in 2018. Three nurses who completed the program include Kayli Lewis, MSN, RNC; Sydni Elliott, BSN, RN; and Cindy Blakely, BSN, RN, CMSRN.
Dextrose Gel for Treatment of Newborn Hypoglycemia is being led by Kalyi Lewis, MSN, RNC, from Mother-Baby at the Boise Hospital. Lewis discovered that hypoglycemia is one of the top reasons for transferring infants from Newborn Nursery (NBN) to the Neonatal Intensive Care Unit (NICU). This involves higher costs, separation of parent and infant, interruption of breastfeeding and a higher level of invasive intervention. Lewis reviewed and evaluated research on buccal dextrose gel for glucose stabilization in infants. She worked with a group of stakeholders to create a protocol for the treatment of newborn hypoglycemia. From there a three-month trial was performed at St. Luke’s Boise to evaluate impact; the main goal being decreased NICU transfers. Project outcomes showed a dramatic decrease in transfer rates, as more infants had adequate treatment and time to stabilize without having to be transferred to the NICU. Lewis is now leading the implementation of this practice in all the NBNs throughout St. Luke’s Health System.
Divided Waiting Room was led by Sydni Elliott, BSN, RN, from St. Luke’s Treasure Valley Pediatrics. The goal for this project was to improve patient satisfaction through patient-centered care by preventing the spread of illness. While caring for families at the Boise Treasure Valley Pediatrics Clinic, Elliott often heard requests for a divided waiting space so that children coming in for a well visit are not exposed to those who are ill. Elliot states, “Families had been asking for a divided waiting space for some time, and also our waiting rooms lacked adequate hand-hygiene stations.” Through collaboration with parents, clinic staff and Infection Prevention, a plan was developed. The waiting room was divided, and two disinfection kiosks were placed at the entrance to each new space. Patient satisfaction scores increased following the changes. When asked about her professional growth during participation in PATHS, Elliot says, “This has been my first experience with the Johns Hopkins research tools and there was a lot to learn about the best/correct use of the forms. I am still incredibly far from an expert, but I have learned how they do help organize research and assist in the interpretation of evidence/literature/reviews.”
Green Gowns was led by Cindy Blakely, BSN, RN, CMSRN, from Cardiac Procedures in Magic Valley. When Blakely heard about PATHS, she decided that she wanted to submit a project about a “pet peeve” with current patient green gowns that snap at the shoulder and are often broken. “No patient should ever be handed a gown that is not properly working,” Blakely says. It was something that has always bothered her, so she decided to do a project to address the problem in her department. She partnered with the linen department to observe the flow of gown cleaning and care and to identify hospital cost associated with gowns. From there she met with the representative from the manufacturer and identified a process for collecting the damaged gowns and sending them back for repair, at no cost to the organization. “Working for a large company, we can often feel our voice is not heard or that it matters,” Blakely says. “This is your opportunity to make a change and address the issue. The PATHS program allows for you to do this.”
This year's report highlights the accomplishments and exemplary outcomes of our talented nurses.
Our 2016 report expanded to include the entire St. Luke's Health System for the first time, including our successful implementation of a system-wide electronic health record.