This is part of an ongoing series of audio profiles of front-line improvers.
Clinical Nurse Specialist
Columbus Regional Hospital
My name is Jennifer Dunscomb. I am a Clinical Nurse Specialist at Columbus Regional Hospital in Columbus, Indiana. It's a community hospital, 325 beds. We have an average daily census of about 150 beds. We're a multispecialty hospital, but we are not a trauma center, and we are not an academic center, so we don't have residents. We pretty much are very embedded in our community with a lot of different programs. I have been a Clinical Nurse Specialist since 1997 and I have been at the hospital for five to seven years.
I work a lot with other disciplines — physicians, nurses, therapists, administration — really to help from a clinical standpoint evaluate the evidence that's out there, and then help facilitate the teams to improve the care. My initial role started out more at a unit focus, and then that kind of grew to more systems level, because we found that within one area of our hospital, when we were looking at certain care, like for heart attack patients, it wasn't just focused on one particular unit, that it crossed over multiple units.
We have the physicians at the same table, driving the care of the medical plan. But then, there's other things that we bring to the table that's unique and different, helping them to understand how nursing's involved in the patient's care. How maybe respiratory therapy is involved in the patient's care — even quality perspective. And I think that it really highlights for our physicians a need that they can understand the medical domains, but they don't really understand all the other pieces. They don't understand the processes. And when we work towards the processes of care, and when we work towards the measurement, and they see good outcomes for their patients, and not only do they see good outcomes, it brings value and it saves them time, then they start to buy in even more. So we have very active physician champions.
We’ve implemented within the last year our Rapid Response Team. Our physicians have been very satisfied with that because it's decreased the amount of unnecessary calls that they received in the middle of the night. And it also gives them the right information about their patients, especially in a critical situation. What's been an interesting outcome of that is I've had multiple physicians ask me, “When are we going start having patients and families being able to access the team?” We're going to try it for next year.
I think as a Master's and having a degree as a Clinical Nurse Specialist, it's really looking at evidence-based practice and then how do you get that evidence-based practice out to the nurses to help to advance the practice of nursing. Did I think that I'd be able to influence at such a great level? No! So that gives me just a really solid sense of reward. And I think that that speaks a lot to our administration and the culture that they’ve set up because they’ve allowed us to really be innovative in our ways that we carry out the work, and always questioning the work, and always feeling like we can do better.
As I recall when I first started within the organization, we had kind of that "change fatigue," and we had the "flavor of the month," whatever the focus of the new initiative was. And then I think we started to get very focused on how we deliver good quality of care and then how that's balanced. How do we balance quality, how do we balance finance, how do we balance patient satisfaction, how do we look at all those elements and having specific measures that everybody's focused on? And I think what's interesting about our leadership, that I really saw a tremendous shift, is when we started looking at that as a whole organization and how each individual component influences. So it's not just the clinical units, like the nursing, that's influencing the quality measures, the nurses or the physicians, it's really about how do you, as a housekeeper, influence quality. That could be just about washing your hands.
I had our clinical engineering ask about our ventilator-associated pneumonia rates. And they assured that… our beds were always in good control, so that if we ever had a mis-functioning bed, we'd get it fixed, so we can ensure their head-of-bed was always up. Or that the sinks, that if there is ever a request put in, that the sinks were broken, that we'd get those prioritized and fixed right away. That’s for me when everything started shifting within our organization and everybody started to become focused.