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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 8 

Denise VermeltfoortEnhancements to Nursing Professional Practice

By Denise Vermeltfoort, MSN, RN, NE-BC

Nursing professional practice has continued to evolve in response to an ever changing healthcare environment. Nurses throughout the organization, in a variety of roles and settings, participated in governing the practice, designing and implementing new systems, developing new educational tools, conducting research and participating in performance improvement collaboratives. Most importantly these efforts resulted in achieving improved outcomes for the patient and the nursing profession.



Nursing governance councils and interdisciplinary committees created an environment that promoted collaboration, shared decision-making and accountability, ensuring exceptional patient care outcomes. The nursing governance structure provided the organizational structure for the oversight of nursing practice. Nursing governance councils included the Executive Nursing Council, Practice Council, Nurse Practitioner Council, Nursing Peer Review Committee, Patient Care Division Leadership, Nursing Informatics Council, Professional Development Council and Nursing Research Committee. The structure included several interdisciplinary committees; namely, Family-Centered Care Steering Committee, Lactation Committee, Palliative Care Steering Committee, Patient/Family Education Committee and Customer Service Committee. New this year was the establishment of the Ambulatory Practice Council comprised of direct care nurses focused on the practice of nursing in the ambulatory setting.


Care Delivery

Enhancements to the provision of patient care were comprised of implementing a number of new evidence-based practice standards. Other efforts focused on planning for the transition from hard copy documentation to electronic documentation systems. Lastly, efforts focused on enhancements to the discharge planning process.

  • Through evidence-based practice reviews practice standards were enhanced and new systems and/or products were implemented for:
    • Pediatric Early Warning Systems (PEWS)
    • Sorbaview dressings
    • Insulin Pen
    • Microclave IV tubing
    • Sigma Pump
    • Respirators
  • Promoted nursing activities to support avoidance of nosocomial infections related to ventilator associated pneumonia, surgical site infection and central line-associated bloodstream infections.
  • Refined process between Value Analysis Committee and Practice Council for the review, evaluation and implementation of new products impacting the practice of nursing.
  • Initiated practice changes to support implementation of the electronic clinical documentation system.
  • Developed content for nursing and RCP clinical documentation in preparation for the implementation of electronic documentation.
  • Evaluated Pediatric Admission Data Base and Interdisciplinary Plan of Care to ensure regulatory standards, organizational and individual unit policies and standards of care were met.
  • Adopted the Clinical Care Classification module for care planning.
  • Initiated pilot program for Walgreen’s Bedside Delivery of Medications.
  • Developed “Family/Caregiver Teaching Notification Alert” tool to enhance communication with staff and families related to vendor involvement with discharge preparation.
  • Enhanced family-centered care through unit-based initiatives.


Professional Practice

Systems supporting the practice of nursing included implementing the new Scope of Practice/Delineation process streamlining the process for new hires and for request and granting of additional privileges for all nurse practitioners.


Professional Development

Tools, new programs, and enhancements supported the ongoing development of nursing staff at Children’s Hospital and throughout the Central Valley.

  • Developed modules for an evidence-based practice toolkit.
  • Implemented quarterly Journal Club, reviewing and discussing research articles.
  • Restructured clinical orientation to include new programs, processes and technology.
  • Provided mentorship, education and training to healthcare professionals in various community organizations.


Nursing research projects in FY10 included:


Common Component of Current Nursing Professional Practice Models in the
Acute Care Setting in the United States of America

Principal Investigator:
Denise Vermeltfoort, MSN, RN, NE-BC

Keitha Mountcastle, EdD, RN, NNP-BC 

Margi Dragomanovich, BSN, RN, NE-BC


National Database Nursing Quality Indicators (NDNQI)

Principal Investigator:
Carole Cooper, MHA, BSN, RN, CPN


Retrospective Case Matched Study to Identify Variables Associated with
Hospitalized Children at Risk for Falling at Children’s Hospital Central California.

Principal Investigator:
Carole Cooper, MHA, BSN, RN, CPN


Retrospective Case Matched Study to Evaluate the Predictability of the Toronto Children’s Hospital Pediatric Early Warning (PEW) Tool and Bristol Children’s PEW Tool Identifying Acute Care Patients at Risk of Developing Critical Illness.

Principal Investigator:
Mary-Ann Robson, BSN, RN, CCRN

Mary Jo Quintero, RN, CCRN, CPN

Lori Medicus, MN, RN, CNS, CPNP

Carole Cooper, MHA, BSN, RN, CPN


The Impact of Nursing Education on Preventing Catheter Associated Urinary Tract Infections.

Principal Investigator:
Carole Cooper, MHA, BSN, RN, CPN

Auralia Ayala, BSN, RN, CCRN

Oliver Pelayo, BSN, RN, CCRN

Louella Legaspi, ASN, RN, CCRN

Stephanie Eddings, BSN, RN, CCRN


Collaborative Relationships

Interagency collaboration was highlighted this past year with performance improvement activities in the area of child advocacy and neonatal care.

  • Multi-Agency Identification and Investigation of Severe and Fatal Child Injury:
    Guidelines for Networking, Communication and Collaboration
  • CCS-CPQCC Breastmilk Nutrition QI Collaborative: Improving the Utilization of Breastmilk in the NICU



Patient, organizational and workforce outcomes were numerous including:

  • Achievement of a nursing vacancy rate of 0.43 percent.
  • Employee satisfaction resulting in a 97 percent workforce commitment ranking when benchmarked
    against 350 national organizations.

The percent of eligible nurses with national certification reached an all-time high of 41.62 percent,
exceeding the previous year’s 38.75 percent.



Nurses are certified in a number of specialty areas.

Case Manager Certification (CCM)

Certified Asthma Educator (AE-C)

Certified Ambulatory Perianethesia Nurse (CAPA)

Certified Clinical Research Associate (CCRA)

Certified Clinical Research Coordinator (CCRC)

Certified Critical Care Nurse (CCRN)

Certified Diabetes Educator (CDE)

Certified Emergency Nurse (CEN)

Certified Flight Registered Nurse (CFRN)

Certified Anesthesia Technician and Technologist (Cert. A.T. and Cer.A.TT)

Certified Family Nurse Practitioner (CFNP)

Certified Hospice and Palliative Nurse (CHPN)  

Certified Neonatal Intensive Care Nursing (RNC-NIC)

Certified Neonatal Nurse Practitioner (CNNP)

Certified Nurse Operating Room (CNOR)

Certified Nursing Professional Development (RN-BC)

Certified Neonatal Pediatric Transport (C-NPT)  

Certified Post Anesthesia Nurse (CPAN) 

Certified Pediatric Emergency Nurse (CPEN)

Certified Professional in Healthcare Quality (CPHQ)

Certified Pediatric Nurse (CPN)

Certified Pediatric Nurse Practitioner (CPNP)

Certified Pediatric Oncology Nurse (CPON)

Certified Rehabilitation Registered Nurse-Advanced (CRRN/CRRN-A)

Certified Wound, Ostomy, Continence Nurse (CWOCN)

International Board Certified Lactation Consultant (IBCLC)

Lamaze Certified Childbirth Educator (LCCE)

National Certified Counselor (NCC)

Nurse Executive, Board Certified (NE-BC)

Pediatric Nurse Practitioner-Board Certified (PNP-BC)

Registered Nurse-Certified (RN-C)

Registered Nurse Credential Inpatient Obstetrics (RNC-OB)          

RN-BC Ambulatory Care Nursing ANCC  

Women's Health Care Nurse Practitioner-Board Certified (WHNP-B)


  • The percent of nurses with a bachelor’s degree or greater continued to increase from 62 percent to 64 percent. This includes eight nurses with doctorate degrees. Seventy-two nurses were pursuing advanced academic degrees of which 41 are enrolled in a master’s program and two in a doctorate program.


  • The PICU and NICU achieved zero central line-associated blood stream infection (CLABSI) and ventilator associated pneumonia (VAP) in multiple monthly reporting periods.
  • Left without treatment (LWOT) continued to decline from 3.2 percent to 2.4 percent. Since 2005, Children’s Hospital has accommodated approximately 25,000 patients who would have previously left without treatment as a result of an organization-wide performance improvement effort.

 Another year is past, but not forgotten.

The efforts and outcomes achieved have impacted the lives of our patients, their families and our profession.



In This Issue

Nursing Yesterday, Today & Tomorrow - Making A Difference

Nursing Through The Generations

Family Footsteps: Generations of Influence

Family Footsteps: Born To Be…

Family Footsteps: Nursing, It's In The Family

It's Not Your Grandma's Student Program

Nurse of the Year 2011

Evaluation of the Humpty Dumpty Fall Risk Screening Tool

Enhancements to Nursing Professional Practice

Contributions to Practice

Leadership in Professional Nursing Organizations