Office of Nursing Services (ONS)

Registered Nurse: Maria VanHart, RN, CEN; Las Vegas, NV

Ms. VanHart is a strong resource and role model for her peers. She demonstrates leadership, providing patient centered care in a safe, efficient, and cost-effective manner. She handles high acuity and critical care assignments in the main Emergency Department (ED) and assumes the role of Charge Nurse, Triage Nurse, and Corona Virus Disease 2019 (COVID-19) Screener. She is a member of the Rapid Response and Code Blue Teams. She responds to Code Whites, Code Sepsis and Code Gray emergency calls without hesitation.

Ms. VanHart performs comprehensive physical, psychological and spiritual assessments to a wide variety of patient populations with complex medical and surgical conditions requiring emergency care. She applies the nursing process to systems and processes at the unit, team, and workgroup level to improve the care our Veterans receive. She is a unit peer leader for safe patient handling equipment. She has trained and validated the competencies of staff on various mobility equipment improving the safety of patients and staff during transfers.

Ms. VanHart maintains her CEN by accumulating 100 Continuing Education Units in a four-year period. She increases knowledge by reading Nursing Journals and other professional resources. Additionally, she attends professional conferences and symposiums related to her practice in emergency and critical care nursing and shares the knowledge gained with her peers.

Ms. VanHart is also the departmental resource for the care of pediatric patients in an emergency. She is an educator and skills validator for precipitous delivery and ED pediatric care during our annual Emergency Department Skills Fair. Through her efforts, 100% of the ED RNs and Intermediate Care Technicians (ICT) have their pediatric competencies validated during this event.

Registered Nurse Expanded Role: Victoria Church, RN, MS, CNS-BC; Portland, OR

Victoria (Vicki) Church demonstrates expert nursing practice at the local, regional and national level. She is the Chair of the Office of Electronic Health Record Modernization (OEHRM) Acute Care Delivery (ACD) Council, a national VA council. Working at the national level she oversees testing and validation of all nursing content. This work is a necessary part of the conversion from CPRS/VistA to the Cerner platform, directly impacting the electronic health record (EHR) residing on a joint Department of Defense (DOD) and VA platform. As a liaison to Office of Nursing Services (ONS), in the ACD chair role, she facilitated the creation of a standard operating procedure (SOP) for the first two pilot sites as well as initiating the national SOP for nursing documentation to be used enterprise wide. Above and beyond her involvement as the ACD Chair, she leads the integration of IV infusion technology as part of Cerner implementation. Beginning her work in August 2019, she actively directs the taskforce for development of the VISN 20 library and in a parallel process, the creation of a national infusion pump library. The VISN and national library work has included the change management system and obtaining executive ownership. In addition to the nominee’s national work she also exhibits expert nursing practice as the Clinical Nurse Specialist for Med/Surg, Cardiac Telemetry since November of 2003. In this capacity she is clinically responsible for the telemetry centralized studio, education, and training of the health care team and provides inpatient consultation for complex arrhythmia management, alarm fatigue and monitoring.

Ms. Church, in an expanded role, has always looked to evidence-based findings to guide her clinical practice, landing on the Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) as her personal guide and how she communicates what constitutes sound evidentiary findings to others. In her capacity as ACD Council chair, she introduced the JHNEBP to all Electronic Health Record Modernization (EHRM) clinical councils and evaluated over 450 enterprise tools resulting in 312 standard tools for all health care teams, 35 of which were specific to nursing. She also facilitated, utilizing the JHNEBP principles, the alignment for all joint Department of Defense (DOD) and Veteran Affairs (VA) facilities charting. It was also in this capacity that she took the foundation of evidence-based practice (EBP) and applied it to building a bridge, until full practice authority is obtained, through the conversion of protocols to clinical pathways, utilizing order sets and algorithms for nurses, in all clinical areas, practice within their scope of practice.

Nicole Snow, LPN ; Pittsburgh, PA

Nicole Snow routinely demonstrates effectiveness in improving and delivering care. Ms. Snow works as the Clinical Associate on a Patient Aligned Care Team (PACT). In the PACT the Clinical Associate is responsible to assist the Primary Care Provider (PCP), RN Care Manager (RN), Medical Support Assistant (MSA) and other Interdisciplinary team members with the delivery of preventative care, care coordination and chronic disease management. One example of Ms. Snow being effective in improving patient care is through assisting her team with chronic disease management. She collaborates with her RN and PCP to identify patients who have non-complex uncontrolled Hypertension. Once identified, she conducts one on one nurse visits to help her patients achieve normotensive blood pressures. She uses evidence-based techniques, such as motivational interviewing, to identify ambivalence and other barriers to compliance. By engaging in these discussions, Veterans develop patient-centered goals to support achieving and maintaining BP control. Other more rewarding outcomes include reduction or elimination of medications, weight loss or getting social issues addressed that lead to better outcomes. Her success with these visits is manifests in the performance outcomes of her PACT. Because she conducts these visits and has success with the patients, her PACT was able to reduce the number of patients who had elevated blood pressures over 140/90 from 26% at the end of FY2019 to 23% at the end of June 2020.

Ms. Snow routinely collaborates with her team to provide outstanding care. Some more prominent examples display her compassion, astuteness, and proficiency. One example to recall is when she recognized a decline in a patient’s condition and engaged the Provider to initiate treatment. She was assisting a patient, who underwent a uterine biopsy in clinic. While assisting the patient with dressing, she noticed the patient’s awareness and color fading fast. She obtained her blood pressure to learn it too was dropping. They also thought her blood sugar was dropping. Ms. Snow called for the Gynecologist to intervene. She treated the patient with heat packs, crackers and fluids and monitored her for a few minutes. Eventually the patient’s vital signs stabilized and was able to be discharged. Her quick recognition contributed to a swift intervention and possibly saving the patient an Emergency Room visit. Ms. Snow recently saw the patient in clinic for an appointment. She was recently approached by the patient, who profusely expressed thanks to for being there and holding her hand and comforting her through that frightening experience.

Healthcare Tech: Jonathan Lowman, HT; Little Rock, AR

Mr. Lowman began employment in the Emergency Room at Central Arkansas Veterans Healthcare System (CAVHS) in June of 2019. In that short amount of time, he quickly became an asset to the department and facility. Mr. Lowman’s background as an Emergency Medical Technician and a Veteran provided unique experiences to view Veteran care through a different lens. One of the areas that Mr. Lowman identified as an opportunity for improvement is the prevention of fall related injuries at home. Mr. Lowman researched fall related injuries in elderly and found that, 2.8 million geriatrics are treated in emergency departments for fall injuries, with 30% those being hospitalized. He also discovered that, Arkansas ranked number one, with the national high 34% of people 65 or older falling with injury each year. Utilizing the human centered design process, which he received training on, Mr. Lowman developed Operation Vertical Veteran (OVV). OVV is a low cost, high impact intervention to reduce fall related injuries that occur in the home. Veterans who visit the Emergency Department (ED) and are found to be at a high risk for a fall related injury receive a kit containing gripper socks, hip pads, a rib cap, and educational materials. In addition, a Care in The Community and/or outpatient falls consult for a home safety evaluation is generated to ensure follow-up and continuum of care.

During the discovery phase, before developing OVV, Mr. Lowman collaborated with the fall prevention coordinator, ED staff, Logistics, and the CAVHS Innovation Specialist. He conducted voice of the customer interviews to develop and operationalize OVV. This helped ensure sustainability, as when you understand the persons you’re trying to affect and then plan from their viewpoint you grow concepts that they’ll embrace. The project is in the pilot phase and despite the pandemic, preliminary feedback from Veterans is positive.

Mr. Lowman sought out opportunities provided through the VA Innovators Network and participated in multiple trainings. This included 3 Box solution and Human Centered Design. After completion of the courses, Mr. Lowman was able to move OVV from a concept to a fully operationalized program that shows sustainability promise. Mr. Lowman’s also participated in spark/seed/spread webinars offered through the INET. These consisted of scheduled virtual sessions on pitching, return on investment, voice of the customer interviews, and ensuing project sustainability. Mr. Lowman is currently enrolled in courses in pursuit of his Bachelor of Science in Nursing.

Mr. Lowman’s background in emergency operations was vital in the development and execution of CAVHS COVID pandemic response. He assisted with the development and implementation of the CAVHS drive through and park and swab clinic. When, CAVHS sister facility in Alexandria needed support, after Hurricane Laura, Mr. Lowman was front and center in the reception planning. He set up the receiving area and helped coordinate the movement and transport of Veterans to the appropriate areas in the medical center.

Nurse Executive: Kelly Irving, MSN, RN; Houston, TX

There are many examples of how Kelly Irving has shown leadership in the development and achievement of organizational goals. In response to the emergence of the COVID- 19 Coronavirus, the Michael E. DeBakey VA Medical Center (MEDVAMC) set its organizational goals to focus on the delivery of quality patient care, while protecting the staff, patients and family members within the MEDVAMC community. Ms. Irving displayed remarkable leadership by making thoughtful and deliberate decisions during a time of true uncertainty. For instance, under Ms. Irving’s leadership, more than 80 staff members consisting of temporary nurses, full-time staff, and retired annuitants were hired to ensure that adequate nursing staff were available to fulfill the organizational goal. With minimal notice, Ms. Irving ensured that a four-month agreement was executed with a national vendor to provide healthcare professionals under contract to the organization. Twenty contract nurses provided care to patients in the Intensive Care Units. Additionally, Ms. Irving initiated the request for a retention pay award for inpatient nurses providing direct bedside care during the pandemic. In support of the other facilities within VISN 16, Ms. Irving led an assessment of MEDVAMC’s resource pool in April 2020. Based on her actions, seven Intensive Care Unit nurses were deployed to assist the Southeast Louisiana Veterans Health Care System to provide emergent care services to the Veterans and Humanitarians of New Orleans. Ms. Irving's guidance of the facility’s nursing leadership led to the development of a contingency plan to bolster the availability of direct care nursing staff in the event of a staffing shortage. Her efforts included identifying all available staff from non-inpatient areas across the healthcare system to participate in a streamlined training curriculum for nurses without recent inpatient bedside care. Ms. Irving orchestrated the development and implementation of a 2-day skills and competency validation fair to validate the non-inpatient nursing staff’s competencies in the event they were needed on inpatient units during a surge. Skills were validated for more than 400 clinicians. Due to Ms. Irving’s leadership the organization continually meets its goals of providing high quality, safe nursing care to our veterans and ensuring staff safety during the global pandemic.

Ms. Irving constantly promotes patient safety and quality outcomes as top priorities for MEDVAMC nursing staff and leaders. As the chair of the MEDVAMC Nursing Leadership Council, she engages with nursing leaders and other stakeholders within the MEDVAMC shared governance council structure to achieve these quality patient outcomes. The organization posted the lowest fall rates in VISN 16 for fiscal years 2018 and 2019. The MEDVAMC currently has the lowest VISN 16 fall rate for fiscal year 2020. Ms. Irving ensures that quality metrics are tracked and trended. She presents these data weekly to the Medical Center Director. Action plans are developed to improve performance measures, as needed. For instance, quality improvement initiatives have been carried out to decrease the number of hospital-acquired infections. Outcomes from these actions include: 0 acute care methicillin-resistant staphylococcus aureus (MRSA) infections from February 2020 through July 2020 and a VISN low MRSA rate of 0.07 for fiscal year 2020. The organization has had only one Central Line Associated Blood Stream Infection (CLABSI) in FY2020 and has outperformed the national (1.09) and VISN (1.45) benchmark rates for Catheter Associated Urinary Tract Infections (CAUTI) for FY2020 with a rate of 0.66. Ms. Irving believes that patient outcomes are directly impacted by the health and satisfaction of the nursing staff. This is in alignment with the MEDVAMCs professional practice model, based on Jean Watson’s Science of Caring theory. Acting on the professional practice model, Ms. Irving has implemented multiple strategic interventions to improve nursing satisfaction. To provide nursing staff opportunities for stress reduction activities, Ms. Irving championed the creation of Caritas rooms throughout the organization. The Caritas rooms are areas developed for staff to engage in holistic healing, crucial conversations and self-assessment. To encourage the overall health of the nursing staff, Ms. Irving had the organization register as collaborator with the American Nurses Associations (ANA) Healthy Nurse Healthy Nation (HNHN) Initiative. This initiative focuses on utilizing intra-facility resources such as wellness coaches, mental health clinicians, work safety advocates and nutritionists to create an overall healthy work environment for the nursing staff. Dating back to fiscal year 2016, the organization has outperformed the nursing satisfaction categories of overall satisfaction, conflict resolution and psychological safety for registered nurses on the All Employees Survey.

Director: John Rohrer, MHA; Madison, WI

The Madison VA has a strong spirit of inquiry and prides itself on outstanding quality outcomes that are driven by robust support for nurses to continuously engage in evidence-based practice (EBP) initiatives. Nurses at all levels are expected to work on projects within nursing and in interdisciplinary groups. EBP is infused in all areas of nursing. Whether nurses enter the Madison VA through the Veterans Affairs Learning Opportunity Residency (VALOR) program, the Post Baccalaureate Nurse Residency Program (PBNR), Transition to Practice Program (TTP), or come to us as a seasoned staff nurse, they all are encouraged and expected to engage in an EBP project. Mr. Rohrer supported the need for and acquisition of an EBP Clinical Nurse Leader (EBP-CNL) in addition to a Nurse Scientist to mentor and facilitate best practice initiatives and project work from idea generation through implementation, evaluation and dissemination. The role of the EBP-CNL was timely and innovative and is the first of its kind in nursing. Together, the Nurse Scientist and EBP-CNL teach VALOR, PBNR, TTP and staff nurses at all levels. Staff nurses are mentored individually or through our EBP Scholars Program. All these groups present at a nursing grand rounds (currently in a virtual format) to both staff and leaders. Mr. Rohrer is always present for these presentations, providing wonderful questions, insight and recognition, which supports efforts to move nursing practice forward for the best clinical and quality outcomes. Recently, a 5-year program evaluation of our EBP Scholars Program was published, and results reflected that nurses who were in the program had improvement in continued engagement in EBP, engagement in multidisciplinary workgroups, mentoring others, taking on leadership roles and returning to graduate school. At any given time, there are over 70 on-going nursing projects related to quality and safety in nursing. Mr. Rohrer has been a pillar of support behind all of this work and a number of specific EBP patient safety initiatives at the Madison VA including: Implementation of High Reliability Organization (HRO) principles; Active falls/mobility/safe patient handling committees; Focused Nurse-to-Nurse bedside handoff; Alarm Fatigue: 58% reduction in nuisance telemetry alarms in the ICU and Step-Down units; Implementation of clinically indicated peripheral IV removal with no increase in infection or phlebitis rates (which was a 2018 Shark Tank Finalist Project); and Improving time to care for mental health patients presenting to the Emergency Department (which was awarded a best practice podium presentation at the University of Wisconsin Nursing EBP and Research Fair and was acknowledged as a Magnet Designation Exemplar in November 2019). Two nursing research studies have been led by Madison VA nurses over the last three years: Missed Nursing Care; and Mindful Nurse: Promoting Veteran Centered Care and Safety. Each has been disseminated nationally.

Mr. Rohrer is an incredible ally and advocate for nurses at the Madison VA. He strongly values and supports nursing leadership throughout the organization. The Madison VA is currently on the journey to becoming a High Reliability Organization (HRO). This is a key strategic priority for Mr. Rohrer. Because he so strongly values the role of nurses, he selected nurses to play key roles in the HRO journey - roles like the Chief of Organizational Improvement and the HRO Facility Champion. He also expanded the number of RN patient safety managers. Not only does he create opportunities for nurses to serve in leadership roles, but he also ensures that nurses always have a place at the table, and he creates space to listen to their thoughts, opinions and ideas. Nurses at all levels are invited to be on hospital-wide committees and councils. Currently the hospital-wide Integrated Ethics Committee, Facility Quality Council, Patient Electronic Record Information Technology (PERIT) and Emergency Response Committee are chaired by nurses. Most recently, the Incident Command Team has included nurses as key stakeholders and leaders in our response to COVID 19. Mr. Rohrer is an exceptional leader and a true collaborator to the discipline of nursing. He promotes a culture of shared governance by making sure that nursing practice decisions are made by nurses. He embraces the notion that nurses should be autonomous in their practice, and through the shared decision-making committee structure, he recognizes that nurses should decide how best to address nursing practice issues.