Report: Nursing staff has made big progress at CMC

It was uncomfortable at first, but the nursing staff at Coulee Medical Center has made a cultural adjustment for transparency in the service of improvements to patient care at the hospital.

So said Chief Nursing Officer Ramona Hicks in a presentation to the chamber of commerce on substantial changes in nursing and other processes at the facility.

Hicks, whose CNO position gives her oversight of nursing, surgical services, pharmacy, laboratory, radiology, outpatient services, labor and delivery and emergency room, started that job two years ago, after having worked at the hospital since 1993 in "almost every area."

At that point, most of the nurses at the hospital were not hospital employees, but were temporary "agency" nurses, brought in by a firm that contracted with the hospital.

"I came over and realized I didn't know anybody," Hicks said.

Hiring and retaining its own nursing staff, as opposed to using agency nurses, Hick said, has saved CMC $1.4 million over the last two years.

Not only is using agency nurses a much more expensive way to fill staff needs, Hicks said, but working toward building an effective team can be difficult when staff changes frequently.

"You can't make any improvements when you have no idea who's going to be on shift," she said.

Hicks changed the management model from one that had five "nurse-managers" to a "charge nurse" model that keeps more nurses on the floor.

The skill mix on the floor has also changed, with more nurses and fewer nurse aides attending patients. That was important for achieving a new directive from management: improve patient safety.

Hicks said the nurses set their goal for zero patient errors. They haven't achieved that yet, but they're getting closer, as reported to hospital commission members by Chief Executive Officer Scott Graham.

Graham reported in December that medication errors are trending down, with a high of 11 last January to one in October. Patient falls, he said, decreased from a monthly average of 2.4 in 2012 to an average of 1.8 per month in 2013.

Another new concern introduced to staff, Hicks said, was the realization that efficiency - with supplies, with hours worked and more - has to count for more with a new mortgage to pay on a new facility.

CMC dropped the amount spent on agency nurses in acute care from $1.3 million in 2011 to $215,000 in 2013, and on its own nurses from $2.6 million in 2011 to about $2 million last year. And total patient care services staffing expense dropped from $5.44 million in all of 2011 to $3.53 million through November of last year, Hicks said.

Speaking to the Grand Coulee Dam Area Chamber of Commerce Dec. 12, Hicks said she originally put the 26-slide powerpoint report together to help the staff get an overview of their progress.

"Sometimes you just forget how much you've done, how far you've come ..." she said.