November 24, 2014

Working as One Nursing Team Across States and Continents

Integration efforts make all nurses part of the team

Around the world QD-690×380

In 2010, the Cleveland Clinic Stanley Shalom Zielony Institute for Nursing Excellence launched the Vascular Access Resource Nurse (VARN) program aimed at increasing knowledge of best practices in vascular access. Hundreds of nurses throughout the health system enrolled in the intensive eight-hour education program, held at Cleveland Clinic’s main campus. Although nurses at Cleveland Clinic Florida could not readily attend the class in person, they were not left out – 30 nurses participated through video conferencing.

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Offering long-distance learning is just one of many ways the Zielony Nursing Institute is ensuring that nurses outside of Northeast Ohio receive the same access to professional development, resources, clinical best practices and more. Cleveland Clinic nurses are on the same team, whether they work at main campus, more than a thousand miles away at Cleveland Clinic Florida or across oceans at Cleveland Clinic Abu Dhabi.

Communication is key

Making sure that nurses in long-distance locations remain in the loop begins with nursing leadership, including Executive CNO Kelly Hancock, MSN, NE-BC, RN, and Cleveland Clinic’s eight associate chief nursing officers. “They set the tone for integration and make sure everybody has a voice at every level,” says Kerry Major, MSN, NE-BC, RN, Chief Nursing Officer at Cleveland Clinic Florida. “If you don’t have leadership that supports that philosophy, then all the emails in the world aren’t going to help you be part of the enterprise.”

Ms. Major points to the recent rollout of the nurse residency program as an example. At the beginning of the year, Cleveland Clinic unveiled its own program to bridge the education-to-practice gap in nursing. It’s a radical transformation in the way the health system onboards and trains new graduates, concentrating on competency and simulation. Major and her colleagues collaborated with a team from Nursing Education and Professional Development, led by Associate Chief Nursing Officer Joan Kavanagh, MSN, NEA-BC, RN. Six nursing directors from Cleveland Clinic Florida worked with Kavanagh to develop a timeline for instituting the residency program. Then staff from Ohio traveled to Florida to assist with the first cohort.

Since 2006

From the time the 150-bed hospital in Weston, Florida, joined the Cleveland Clinic health system in 2006, its nurses have felt included. When the Zielony Nursing Institute was formed in 2008, nurses from Florida joined in strategic planning. “My leadership team and I were involved in the integration from the very beginning,” says Major. “We were active participants in the strategy around what the Nursing Institute would look like” – which is to say, what her team would look like.

Nursing teams use a host of tools, including video conferences, texts, emails, conference calls and instant messages. “It’s a constant dialogue,” says Major. “Over the years, we have built up networks with our peers in Ohio, and no one here is hesitant to reach out to them.”

When Cleveland Clinic Florida began its quest for Pathway to Excellence® Program designation, the coordinator was in constant contact with those who handled the designation process at the health system’s four Pathway to Excellence hospitals. “They were instrumental in helping us put our application together and successfully receive designation in May [2014],” says Major. The process also was made easier because the Florida hospital adheres to the same policies and procedures as all Cleveland Clinic hospitals.

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Shared policies

Representatives from Cleveland Clinic Florida are members of the systemwide Policies and Procedures Committee, giving them a voice in the development and implementation of guidelines that affect bedside nursing. All policies and procedures are available online on the nursing intranet site, making them easy to access for any Cleveland Clinic facility. This was especially helpful to Randall Steven Hudspeth, PhD, MSN, MBA, RN, when he became CNO of Cleveland Clinic Abu Dhabi in 2011. (He is now a consultant.)

The hospital in the United Arab Emirates (UAE) will open in 2015. Hudspeth’s role during the three-plus years he served as CNO included building relationships within Abu Dhabi and the UAE, interacting with the construction team, and developing and executing the recruitment plan for more than 1,000 clinical caregivers.

A new CNO in Abu Dhabi

In May of 2014, Ann Williamson, PhD, NEA-BC, RN, took over as CNO at Cleveland Clinic Abu Dhabi (CCAD). A key attraction of this new career opportunity for her was the strong enterprise nursing leadership and the team at Cleveland Clinic, and the sense that CCAD would be an international replication of the very best that the health system has to offer. Williamson has already spent concentrated time at main campus and has plunged into the challenges of finalizing the orientation/onboarding processes, in collaboration with Cleveland Clinic leadership. When CCAD opens, caregivers will be fully prepared and patients will have the best opportunity for excellent outcomes.

Since January 2014, Cleveland Clinic Abu Dhabi has hired approximately 750 clinical staff from North America, Europe, Australia, New Zealand, India, the Philippines and the Middle East. “We’re not telling them how to be a nurse or allied health provider (AHP)—we’re telling them how they’ll be a nurse/AHP here,” Hudspeth says. “And we’re using Cleveland Clinic’s fundamental tools to do that,” Williamson adds. This includes practice protocols, the EPIC electronic medical records system and the Cleveland Clinic model of care.

Respecting cultures

While much of this framework will remain intact at the 350-bed hospital in Abu Dhabi, some things had to be changed to meet laws in the UAE or to respect the Middle Eastern culture. For this reason, Hudspeth oversaw the arduous task of reviewing all Cleveland Clinic protocols. Some were edited for minor reasons, such as semantic differences. For example, any references to “elevators” were changed to “lifts.” Other alterations impacted treatment: Certain medications used in the United States are not available in the UAE.

These kinds of changes aren’t made only at international healthcare facilities. Cleveland Clinic Florida has adapted policies too, primarily to meet state regulations. For instance, the State of Florida requires that patient care policies be reviewed annually, but this is not a requirement in Ohio. So the Florida hospital’s policies are on a different review cycle.

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Perhaps the largest changes at Cleveland Clinic Abu Dhabi were made because the vast majority of citizens are Muslim. “We took Cleveland Clinic’s model of care and added on nuances for the Middle East using a framework called the Crescent of Care, which guides the care of Arab Muslim patients,” says Hudspeth. Individualization to the environment of care is important, so in Abu Dhabi, if a patient is nearing death, the nursing staff may be requested to reposition the bed to face the holy city of Mecca.

It’s about relationships

But the overarching goal of providing quality, relationship-based care remains identical. “The relationships you have with patients are the same whether you are on the Cleveland Ohio main campus, in Florida or in Abu Dhabi,” says Williamson.

The Zielony Nursing Institute strives to keep its nursing leaders and frontline staff at all facilities abreast of any initiatives aimed at keeping patients safe, providing a healing environment, promoting professional development and supporting evidence-based practice. “We truly feel a part of the enterprise,” says Major. “We are one Cleveland Clinic.”

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