Nursing Year in Review
Read our latest nursing year in review to discover how our incredible nurses increased access to services, supported their colleagues and provided life-changing hope, care and cures.
Care Across the Continuum
We will improve the continuity of care across the healthcare settings where our patients receive care — in the community, hospital and ambulatory settings.
Expanding Access to Seattle Children’s Cancer and Blood Disorder Center
- In conjunction with the opening of the Forest B building at the hospital campus, Seattle Children’s Center for Cancer and Blood Disorder (CBDC) reevaluated their access to care and made adjustments to meet the patient population needs. Specifically, CBDC and Seattle Children’s Pediatric Blood and Marrow Transplant (BMT) Program partnered to move all outpatient BMT care from Fred Hutchinson Cancer Center’s campus to Seattle Children’s and expanded operating hours to allow for earlier and later patient appointments.
- Benefits of this work include: all pediatric BMT care now occurs at Seattle Children’s (inpatient and outpatient); patients can come earlier or later for their appointments, allowing them to miss less school. Nurses shifted their work hours and model of care to better support these improvements.
Mental and Behavioral Health
We will increase our ability to care for our patients’ mental health needs.
Cross Training Nurses to Support Mental and Behavioral Health Needs
- Supported Seattle Children’s Psychiatry and Behavioral Medicine Unit (PBMU) by cross training 17 acute care float pool nurses to care for patients on the PBMU.
Psychiatric Advanced Practice Provider Fellowship
- The Seattle Children’s Psychiatric Advanced Practice Provider (APP) Community Partner Fellowship aims to provide advanced education and training in pediatric mental health to increase access and improve outcomes for youth with acute and chronic mental health needs.
- The fellowship is a 12-month program aimed at training novice psychiatric APPs, inclusive of both psychiatric nurse practitioners and physician assistants.
- The fellowship includes bimonthly didactic sessions and clinical rotations in inpatient, outpatient and community-based settings focusing on the care of children and adolescents with complex behavioral and mental healthcare needs.
- In 2023, the fellowship received $1.5 million in grant funding to increase the number of fellows trained each year and to launch partnerships with community agencies.
- Current community partnerships include Ryther, who recently hired a graduate of the fellowship. Planned future partnerships include Pediatric Associates of Whidbey Island and Community Health Center of Snohomish County.
Equity, Diversity, Inclusion and Anti-Racism
We will value the uniqueness of each patient, family member and colleague, and work to meet their individual needs.
Elimination of Disparities of Central Line Infections
- Black and African American patients as well as patients who use a language other than English have shown higher rates of central line-associated blood stream infections, also known as CLABSI.
- Clinical Nurse Specialist Megan Stimpson and Home Infusion Supervisor Jennifer O’Malley joined others to investigate and reduce CLABSI, investigating preventable disparities, prompting additional research into existing practices.
- To learn about the central line experience first-hand from families, the CLABSI team partnered with Seattle Children’s Patient and Family Experience team to facilitate interviews with parents of children with central lines. Families who identified as Black or African American as well as families who use a language other than English shared perspectives and observations about working with care teams on central lines, zeroing in on the challenges they faced and ideas for improvement.
- Using this valuable information, a series of interventions were launched to improve the central line experience and reduce CLABSI, including offering patient materials on central lines that are translated into five languages and counting. The team also created videos in English and Spanish that families can reference when a central line is placed for their child as well as a simple graphic to explain the care steps.
- The CLABSI team shared disparity metrics with clinical teams across all units and created a new central line nurse role that focuses on central line placement, observation and safety. The “central line nurse” is a new specialized position whose entire job is centered around central line placement, observation and safety.
- These efforts eliminated CLABSI disparities for Black and African American patients and patients who use a language other than English in fiscal year 2023
EXPLORE Pediatrics Program
- The EXPLORE Pediatrics program started in partnership with the University of Washington Minority Association of Pre-Health Students and is geared toward students or recent college graduates.
- The program funds certified nursing assistant (CNA) training and certification and a six-month CNA experience in one of Seattle Children’s inpatient acute care units.
- The program supports increasing the diversity of Seattle Children’s nursing workforce.
- Ninety two percent of students from the first cohort were hired by Seattle Children’s. (The second cohort finishes March 2024.)
Heritage University Collaboration
- Seattle Children’s hosted Heritage University nursing students for a four-week clinical rotation at the hospital campus.
- Since 2016, Seattle Children’s has partnered with Heritage University, where 80% of students identify as Hispanic/Latinx or Native American, to invest in career pathways for students historically underrepresented in the nursing field.
- About 12% of Heritage University students that completed clinical rotations are now Seattle Children’s employees.
National Association of Hispanic Nurses New Washington State Chapter
- Registered nurse Genevieve Aguilar helped found the new Washington State Chapter of the National Association of Hispanic Nurses (NAHN). Nurses’ NAHN membership fees are eligible for reimbursement.
- Through this work, Genevieve engaged nursing students and Seattle Children’s nurses, and took a student to a national conference.
Equity, Diversity, Inclusion and Anti-Racism
- Four key drivers of nursing’s equity, diversity, inclusion and anti-racism plan include: diverse nursing workforce; belonging and engagement; learning and growth opportunities; equitable nursing care.
- Seattle Children’s nursing teams partnered with other organizational groups, including Workforce Development and Planning, and Talent Acquisition, to make continued progress on the plan’s workforce measures, listed below:
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- Increase racial/ethnic diversity of all clinical nurses from end of fiscal year 2022 (FY22).
- Increase overall racial/ethnic diversity by 3% by end of fiscal year 2023 (FY23) (baseline 25.6% to target 28.6%). End of FY23: 29.1%.
- Increase underrepresented* clinical nurses by 2% by end of FY23 (baseline 12% to target 14%). End of FY23: 14.3%.
- Increase racial/ethnic diversity of nurse residents from overall FY22 cohorts.
- Increase underrepresented nurse residency applicants by 3% by end of FY23 (baseline 22.3% to target 25.3%). End of FY23: 25.5%.
- Increase underrepresented nurse residency hires by 3% by end of FY23 (baseline 21.9% to target 24.9%). End of FY23: 26.1%.
- Stabilize clinical nurse turnover for both underrepresented and by individual race/ ethnicity to not exceed rate of all nurses (percentages below are as of the end of FY23, Sept. 30, 2023):
- Increase racial/ethnic diversity of all clinical nurses from end of fiscal year 2022 (FY22).
Professional Development
We will develop programs and provide resources that foster development of each nurse to reach their full potential throughout their career.
Bellevue College Collaboration
- Seattle Children’s and Bellevue College’s partnership allowed nurses with an associate degree in nursing to earn a bachelor’s degree in nursing. The program was designed for working nurses and tuition and fees were covered by Seattle Children’s.
Charting Your Course: Navigating Your Nursing Journey, Discovering Your Professional Identity Education Series
- “Charting Your Course: Navigating Your Nursing Journey, Discovering Your Professional Identity, Finding Your Why” was a three-part series of four-hour educational sessions intended to provide resources for personal and professional development.
- Content was aimed at providing additional skills and insights for working with team members with varying goals. Attendees did not need to attend all three sessions.
- Session 1: Awareness
- Understanding personality types
- Understanding one’s stress tolerance
- Understanding one’s coping skills
- Session 2: Inclusion
- Understanding generational differences
- Creating authentic connections
- Creating an inclusive environment
- Session 3: Restoration
- Self- care practices
- Power of appreciation
- Reflection to promote positive change
- The sessions were offered free to Seattle Children’s employees with contact hours and all nursing residents were enrolled in the educational offering. Each session was associated with 3.5 hours of continuing education.
Clinical Development Nurse Implementation
- A post-pandemic decrease in the experience of Seattle Children’s clinical nursing teams, particularly on night shift, resulted in a decrease in nursing satisfaction and increase in nursing turnover. To address this experience-complexity gap, the Clinical Development Nurse (CDN) Program provides night shift clinical staff development through just-in-time education, clinical reasoning development and peer-to-peer coaching.
- In 2023, there were 43 CDNs, with over 4,000 CDNRN encounters.
- Following the implementation of the CDN role, survey responses show positive results. For example, there was a 9% increase to the question, “If I have a clinical question or need, critical thinking support help is available in the moment.” There was a 4% decrease to the question, “I am overwhelmed by my patient care responsibilities and workload.”
Retention
We will create a work environment and provide opportunities where nurses feel valued and supported throughout their careers.
Revised Nursing Leadership Rounding
- Rounding provides leaders with the opportunity to touch base with employees, make a personal connection, find out what is going well and identify improvements. Purpose of connection by rounding ensures that teams know their leaders care for and value them, provides an opportunity to recognize those doing a great job, demonstrates a commitment to resolving issues and a willingness to follow-up.
- Seattle Children’s has supported leadership rounding for many years. The method of conducting rounding was revised in 2023 with scripts/rounding dialogue for the leaders to ask intentional openended questions to workforce members.
- A Safe and Health Work Environment tool, the Think-Say-Do model, was incorporated into the rounding dialogue to allow more time to address workplace safety concerns and to allow additional coaching opportunities to occur in how to prevent or resolve conflict between workforce members, patients and families.
Preceptor Recognition
- The Housewide Development of Nurses’ Shared Governance Council created preceptor pins to recognize preceptors.
- The council also hosted a preceptor celebration during Nurses Week, recognizing preceptors with the most hours and those nominated by their peers.
Staff Support and Wellness
We will create and maintain a safe and healthy work environment.
Launched Adaptive Social Response
- Adaptive Social Response was co-designed with the community to help eliminate disparities and engage with families who need extra support early on and match their needs with the right support and resources. Adaptive Social Response replaces the Code Purple system which had disproportionate impacts for Black and African American patients.
- Nurses provided feedback during early project stages, a collection of nurses joined the co-design team that developed the core recommendations for building the new system, and nursing leaders engaged with the project team to design Adaptive Social Response. All hospital campus and Springbrook nursing leaders trained their teams in the new system.
Ground and Reset Support Tool
- Ground and Reset is a support tool for nurses and workforce members who are directly or indirectly involved in a challenging situation. It is designed to help gain a better understanding of the situation or event; recognize if immediate safety action is necessary; determine what steps should be taken for team members to be successful for the rest of the shift; and promote post-shift resiliency.
- The tool provides methods and techniques about how to check-in with colleagues, offer moments of mindfulness, and focus on listening.
- Ground and Reset is intentionally designed so that all roles can facilitate it within their area — nurses, social workers, staff support members, etc. Dedicated Behavior and Staff Support team members are also available, if needed.
Healthy Work Environment Council
- Provided education to Health Work Environment unit chairs about the American Association of Critical Care Nurses’ six categories of a healthy work environment: skilled communication; true collaboration; authentic leadership; effective decision making; appropriate staffing; and meaningful recognition. Each chair is focusing on a pillar for their area.
Townhalls
- Nursing townhalls occur bimonthly in person and virtually. The themes are communicate, celebrate and rejuvenate. Topics include sharing updates, recognizing nurses and presenting wellnessrelated information.
- At the town halls, Harmony Hill provided education aimed at building resiliency and community while reconnecting to the joy in work. Harmony Hill is an organization focusing on wellness and inspiring healthy living for all people. They shared information around mindfulness, selfcompassion, gratitude, communication with self, communication in relationships. Townhall sessions include short didactic from Harmony Hill staff, breakout sessions to discuss content with other nurses, group sharing and debriefing. Additional resources are available in digital format for later reference.
Workforce Development
We will develop innovative approaches for staffing and care models that optimize nursing scope of practice to provide patients and families with excellent care.
Expanded the Nurse Technician Role
- A nurse technician is someone enrolled in a nursing program of study and has completed at least one clinical course. Nurse technicians are registered with the Washington Board of Nursing and can provide patient care in alignment with their current level of education. The role is a pathway for recruiting new nurses to Seattle Children’s. Many nurse technicians transition to nurse resident roles upon obtaining nursing licensure.
- Approximately 50% of our nurse technicians were certified nursing assistants at Seattle Children’s prior to becoming a nurse technician.
- In 2023, the nurse technician program expanded to most care areas across the organization.
- The nurse technician scope of practice was reevaluated to allow nurse technicians to practice at the highest level of their scope identified by the board of nursing. Nurse technicians have been integrated into patient care models across the organization.
- In 2023, Seattle Children’s onboarded 77 nurse technicians.
Expanded Nursing Initiated Standing Orders
- Nursing initiated standing orders (NISO) meet specific criteria for orders that can be placed by nurses to initiate patient treatment or intervention prior to assessment by a provider.
- NISOs are placed by nurses and must be signed off by a licensed provider within 48 hours.
- NISOs make care delivery more efficient because in well-defined situations nurses do not have to contact providers prior to initiating orders.
- Use of NISOs expanded in 2023. Examples include:
- Seattle Children’s Orthopedics and Sports Medicine: Nurses can place specified orders for diagnostic X-rays or ultrasounds so results will be ready for the provider at the patient visit.
- Seattle Children’s Odessa Brown Children’s Clinic: Nurses can place COVID-19 vaccine orders for patients and the community.
- Inpatient units: Infection Prevention nurses can place orders for measle post-exposure prophylaxis.
- Emergency Department and Urgent Care continue to expand medications or interventions registered nurses can order prior to being seen by a provider.
- Inclusion and exclusion criteria are well defined to ensure safety with NISO order placement.
Research
2023 fiscal year highlights
- 2 studies funded
- 1 full-time professor nurse scientist hired
- 9 studies in progress
- 7 publications
- 15 poster or podium presentations (plus Seattle Children's Nursing Research Symposium)
- 15 Doctor of Nursing Practice projects completed
- 20 Doctor of Nursing Practice projects in progress
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Working at Seattle Children’s
To reach our goals, we are committed to recruiting and retaining the best nurses. We invite you to search our current job openings.
Seattle Children’s provides opportunities for our nurses to learn and grow in an innovative environment while being in full partnership with other providers on multidisciplinary teams. We support and engage our nursing staff with training and educational opportunities, state-of-the-art-facilities and equipment, shared governance and comprehensive benefits.
When hiring, we look for nurses who share our passion for family-centered care and who practice at the top of their profession. Whether you are a new nursing graduate eager to participate in our healing environment, or a seasoned professional committed to advancing the practice of nursing, we welcome your application.