Kris McCully, Katy Howell and Michelle Weber may all have the word “coordinator” in their titles, but their jobs as nurse coordinators couldn’t be more different.
McCully, a veteran inpatient clinical coordinator, has worked at Akron Children’s Hospital for 30 years. She began working with pediatric patients while she was still a nursing student at The University of Akron.
McCully works on the unit designated for patients age 12 and older who have cystic fibrosis and congenital heart disease, so she and her team see a fair share of adult patients these days.
“We just discharged a 63 year old,” McCully said. “Our oldest patient ever was 88.”
For McCully it’s all about prioritizing her very busy days.
“I listen to huddle and get comprehensive reports from the charge nurse,” she said. “I’m really nosy when it comes to our patients. I want to be equipped for their needs.”
Her job duties include reviewing patient orders, tests, treatment plans and progress notes, assigning nurses their patients for the day, pitching in at the bedside when needed, handling staffing and workflow projections, and conducting performance evaluations for the unit’s nurses, medical assistants, child life specialists and secretary.
On this day, with only 2 open beds on the 24-bed unit, prioritizing is a must.
Focusing on improving clinical care
Down on the 4th floor, pediatric intensive care unit performance improvement coordinator Katie Howell is at the bedside of 11-week-old Bailey as part of her safety rounds related to an ongoing quality improvement project on central line associated blood stream infections, otherwise known as CLA-BSI.
“I communicate with the families about what they can do to help prevent these types of infections,” Howell said. “When your child is hospitalized you often feel helpless. This is a way they can participate in caring for their child.”
Howell stresses proper hand hygiene and recognizing neon green caps that should be attached to the end of a baby’s IV to prevent germs from accessing the line.
“Many of our performance improvement initiatives are based off CDC guidelines,” Howell said. “I’m part of a team that helps translate them from paper to practice.”
Howell works closely with the nursing education coordinators, one of whom is Michelle Weber, to make sure new hires have the knowledge they need to keep patients safe.
Using simulation to train new nurses
On this particular day, Weber is conducting an orientation session for newly hired nurses at Akron Children’s Austen Simulation Center for Safety and Reliability. Addressing CLA-BSI protocol will be one of the tasks her new recruits will simulate.
All new nurses spend a week with Weber learning about patient safety and education, medication administration, palliative care, spirituality, Lifebanc, pediatric assessment, code carts, workplace violence, cultural competence, and child maltreatment.
“We spend 2 afternoons as part of their orientation week covering the 3 nursing sensitive indicators in the hands-on skill stations (CLA-BSI, CA-UTI, and PIV Infiltrates) as well as respiratory equipment usage and patient scenarios to recognize a deteriorating patient situation,” Weber said.
Upon completion of the week-long orientation, each new nurse is paired with a preceptor for about 8 weeks in the acute care areas. Critical care nurses typically stay with a preceptor longer.
“I enjoy nursing orientation because I like helping new hires understand our priorities and culture to ensure they are comfortable either starting or continuing their nursing careers here,” Weber said.
Typical day not always typical
Back on McCully’s unit, one of the nurses has come to her with a charting error regarding a patient’s weight.
“The physician prescribed medication based off the child’s weight on the chart,” said McCully. “We need to get that fixed so the patient can get the proper dosage.”
Although she’s not at the bedside very often, she jumps in when necessary, including getting a urinal for a patient, changing a diaper and troubleshooting an IV.
McCully answers phones while her staff takes their lunch break and ensures rooms are equipped with essentials like toothbrushes and toothpaste.
McCully is active on many councils and committees. A few of her more significant contributions include helping to create the CARE ladder, a program that recognizes and rewards nurses for their clinical, educational or leadership skills, and serving on the interview committee that has hired 4 different chief nursing officers over the years.
“I find it benefits me to know more information and know more people in the hospital,” McCully said. “The more I know, the better I’m equipped to help provide improved outcomes for patients, nurses and the hospital as a whole.”
Howell has spent a good portion of her day in meetings.
She started with a project meeting about improving nursing restraint documentation.
“This issue is different because it’s all about documentation,” Howell said. “I’m confident the PICU nurses are providing the care, they just aren’t documenting because it’s cumbersome. Documentation should never be hard because patient care is hard enough.”
Howell hopes to take advantage of some different functionalities in Epic, the hospital’s electronic medical record system, to help solve the issue.
Another one of Howell’s ongoing initiatives involves decreasing the frequency in which nasal gastric (NG) feeding tubes are accidentally dislodged.
“This is a problem we’ve identified,” Howell said. “Babies between the ages of 6 to 12 months are 3 times more likely to have this happen.”
Howell helped create orange signs that are hung at the bedside of at-risk patients, educating parents and visitors to be careful when handling the child.
Howell is 1 of 3 performance improvement coordinators hospital-wide.
“Part of my job is to go out and tell people what they’re doing wrong. However, I try to focus on what people are doing right too,” she said. “Nurses are just as likely to receive an email from me telling them they did something well.”
To get an appreciation for what the bedside nurse encounters, Howell chooses to spend roughly 20 hours a month as a bedside nurse.
“If it’s my job to try and change the work, understanding and doing the work is essential.”
Back in the Austen center, Weber leads an in-service on changing central line dressings.
Only about 40 percent of the nurses who come through orientation are new grads. The rest are more experienced nurses.
“Even experienced nurses ask to be treated like new grads because many have never worked in a pediatric setting,” Weber said.
While 1 person practices changing dressings and caps, Weber encourages others to coach off a checklist based on the maintenance bundle she provides them.
“Sometimes it’s the simple things like reminding people to wash their hands before putting on their gloves,” she said.
After rotating through 3 more stations, which included placing indwelling urinary catheters, peripheral IVs and bagging and suctioning patients in respiratory distress, the new hires are done for the day.
They’ll be back the next day to do simulated patient scenarios to enhance their critical-based thinking.
“It’s a safe environment where you can make a mistake, but learn from it,” Weber said. “We want our new staff to feel they can come to simulation with questions and leave with the tools needed to perform safe patient care.”
For more information on careers at Akron Children’s Hospital, check out our current job opportunities.