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Nursing Management:
doi: 10.1097/01.NUMA.0000440633.25895.75
Feature: Richard Hader Visionary Leader Award

2013 Visionary Leader

Roller, Christine RN-BC

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Nomination author: Terri L. Spoltore, MSN, RN, CCRN, administrative director of Nursing, Medical Care Center, and 1 East, and Magnet ® Program director, Inspira Medical Center Vineland, Vineland, N.J.

The author has disclosed that she has no financial relationships related to this article.

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This manuscript is the winning Richard Hader Visionary Leader Award entry submitted to Nursing Management in recognition of Christine Roller, RN-BC, nurse manager of Inspira Health Network Vineland Medical Center's 1 East unit in Vineland, N.J. Christine was formally recognized for her achievements before the Keynote Address at Congress2013, September 11, in Chicago, Ill.

In recognition of her continued commitment to improving both nursing care and nursing outcomes, Inspira Health Network is pleased to nominate Christine Roller, RN-BC, for the Richard Hader Visionary Leader Award. Christine is the nurse manager of the Inspira Health Network Vineland Medical Center's 1 East unit. Christine has been an employee of Inspira Health Network (formerly South Jersey Healthcare) for more than 15 years. During that tenure, she has served in various capacities, including critical care and cardiac care clinical nurse, charge nurse, unit-based practice council chair, and assistant nurse manager. In 2004, Christine was recognized as the Johnson and Johnson Nurse of the Year.

Since assuming leadership of the 1 East unit, Christine has also voluntarily taken on numerous other leadership roles within the organization. These include assuming the role of a house nursing supervisor and working closely with the organization's human resources and education departments as a member of the orientation task force charged with reviewing, improving, and monitoring the Inspira Health Network's practices and policies for the recruitment, development, and retention of newly hired nurses. Furthermore, Christine is an active member of several interdisciplinary performance improvement teams working to reduce the incidence of falls, hospital-acquired pressure ulcers, and catheter-associated urinary tract infections across all patient populations and care units. In each of these committees, she serves as both a nursing leader and also an advocate for the special needs of the geriatric patients who have become the focus of her professional dedication and expertise.

Christine accepted the position of nurse manager of 1 East in early 2011. Shortly before that time, the University of Medicine and Dentistry of New Jersey (UMDNJ) and the New Jersey Geriatric Education Center (NJGEC) awarded Inspira Health Network a $211,000 grant in recognition of the organization's need to expand and improve the care provided to some of the New Jersey's most vulnerable patients: older adults. These funds were designated by the organization to support the 1 East unit in its pursuit of becoming an organization-based resource for the care of hospitalized geriatric patients and the unique challenges they face.

Since that time, Christine has worked tirelessly to solidify the unit's role as the primary provider of geriatric care within the Inspira Health Network. Christine worked to transform the organization's fledgling geriatric resource nurse (GRN) council into a vital and active group of clinical nurses, interdisciplinary healthcare providers, and nursing leaders. With Christine's leadership and mentoring, the council undertook a substantial and exhaustive review of existing literature regarding evidence-based best practices for geriatric nursing care. As a result of these efforts, the unit chose to pursue the recommendations and practice guidelines of the Nurses Improving Care for Healthsystem Elders (NICHE) organization. Members of the GRN council, including clinical nurses from 1 East and designated nurses from all units across Inspira Health Network (who have the potential to care for geriatric patients), worked to review, implement, and evaluate the effectiveness of NICHE--recommended best practices. As a result, Inspira Medical Center Vineland has been named a NICHE designated facility.

Christine's passion for improving patient care also encompasses aspects of the work environment that reach beyond the actual bedside. For example, she's a tireless champion of nursing professional development and exemplary professional practice. Through the maturation of the GRN council mentored by Christine, specialized care of geriatric patients has become fully integrated through the organization's professional practice model and models of nursing care delivery. Supported by funds from the UMDNJ and NJGEC grant, 100% of the nurses working in 1 East and 100% of the members of the GRN council have completed GRN training. This inclusive training consists of 20 hours of initial lecture and instruction and is then supported by 4 hours of annual competency-based educational modules.

In addition, both nursing specialty and formal academic education are a priority for Christine and the nurses working on her unit. To date, 50% of the clinical nurses working on 1 East hold a bachelor of science in nursing degree. In addition, nine of the remaining nurses have returned to school in pursuit of a nursing baccalaureate degree since Christine assumed the leadership of the unit. Recognizing that clinical knowledge is a key component of exemplary patient care, Christine also supports and mentors nurses working on her unit in their pursuit of national specialty certification. Her entire leadership team, as well as more than half of the eligible nurses working on her unit, are nationally certified in medical-surgical and/or geriatric nursing. Half of the nurses now eligible for certification are committed to (and actively participating in) a national certification study group supported and mentored by Christine.

Christine's commitment to patient care and a healthy working environment that fosters exceptional patient care has resulted in nursing satisfaction/engagement scores that consistently outperform national benchmarks in all measured domains. Perhaps most impressive is the dramatic increase seen in scores related to professional development and patient care. Scores in both areas have increased by more than 10% since Christine assumed leadership of the 1 East unit. During her tenure as nurse manager, nurse satisfaction scores related to training and development have improved from 84% to 94% favorable, representing a score nearly double the national average RN score of 59.7% favorable (as measured by HR Solutions, Inc.). Additionally, Christine's nurses recognize and value her concern for providing high-quality patient care. During her leadership tenure, nurses' satisfaction scores with their leader's commitment and concern for patient care increased from 80% to 89% favorable, showing that nurses on Christine's unit are substantially more satisfied than nurses nationally (when compared with a national benchmark of 79% favorable based on HR Solutions, Inc., data).

Despite the consistent quality of care delivered to geriatric patients on Christine's 1 East unit, she's committed to continual performance improvement. Christine has recently embarked on a novel nursing project that will, before the close of 2013, become an original nursing research study. Christine has developed a program in which specially trained volunteers will be routinely working on the 1 East unit. This select group of individuals has assumed a routine and consistent presence on the 1 East unit. They're providing specialty interventions tailored to the unique needs of geriatric patients, including companionship, reading, and other diversional activities. This creative and innovative program has already inspired several other nursing leaders to pursue a similar program on other units throughout all four of the Inspira Health Network's Medical Centers.

Numerous clinical improvements that have subsequently been disseminated through Inspira Health Network can be traced to innovations in nursing knowledge and practice piloted on Christine's 1 East unit. As a transformational leader, Christine has empowered her staff members to continually look for opportunities to improve and develop the nursing care delivered on her unit. This culture of inquiry has led to an environment that fosters the development, application, and refinement of new and innovative nursing practice. Included among the accomplishments achieved by the 1 East unit under Christine's leadership are the incorporation of an Acute Care for the Elderly (ACE) model of care, outcome-focused NICHE rounds, a delirium protocol (and ensuing nursing research study), and several health information management technologies.

More than 40% of all patients admitted to the Inspira Medical Center Vineland are age 65 or greater. In recognition of the unique needs of these patients, Christine led the GRN council and the 1 East unit-based practice council in the development of outcomes-focused NICHE rounds. NICHE rounds are now conducted twice weekly on 1 East and include all relevant disciplines, such as nursing, medicine, pharmacy, dietary, rehabilitation, and social services. Since the implementation of NICHE rounds, nursing quality-related patient indicators have improved dramatically. For example, restraint utilization has been all but eliminated from the unit with only one episode of restraint use and one incident of hospital-acquired pressure ulcer development being documented in the last full calendar year. Coupled with these improvements in patient outcomes are operational level improvements. Since the initiation of NICHE rounds, length of stay on 1 East has also steadily declined from a historic mean of nearly 6 days to a current stay of only slightly above 4 days.

Senior leaders of Inspira Health Network validated the substantial improvements in patient outcomes affected by Christine and her nurses by officially recognizing 1 East as an ACE unit in early 2012. Since that time, the organization has supported numerous structural and procedural improvements on the unit, including revised admission criteria, geriatric specialty equipment, and the addition of a geriatric medical director. In addition to the numerous tangible improvements in care associated with ACE designation, Christine identified one outstanding opportunity for improvements in geriatric care that transcended all organizational units and service lines. The accurate assessment and management of delirium present a unique challenge to healthcare providers and organizations of all levels and specialties. Careful and early identification of delirium coupled with goal-directed interventions has largely been associated with numerous favorable patient outcomes, including decreased hospital-associated complications.

Christine is the primary partner of UMDNJ faculty in the development, implementation, and testing an evidence-based delirium assessment and management protocol. As such, she's also the primary investigator of an original nursing research study designed to evaluate the effectiveness of the educational program (delivered via multimedia webcasts, virtual classroom lectures, and computer-based learning platforms) on staff member knowledge regarding delirium. In addition, the research study has been designed to elevate the evaluation of effectiveness to higher levels by assessing the impact of the education on the practice of nurses as measured by utilization of delirium assessment tools and nurse-driven protocols. Based on the impact that the ACE model of care (and its emphasis on delirium awareness) has had on 1 East, Christine worked with senior nursing leaders to offer the delirium protocol educational intervention (and the subsequent organization-wide protocol) to all nursing staff members in the organization who have the potential to care for geriatric patients. In doing so, Christine again became the driving force for organization-wide clinical practice improvements. The new knowledge garnered from this study will impact practice across each of the organization's campuses and service lines.

Christine also routinely recognizes the impact that healthcare technology can have on safe patient care. Because poly-pharmacy is a pervasive challenge in the care of older adults, Christine readily volunteered to work directly with the organization's informatics task force in piloting and refining numerous new technology enhancements on the 1 East unit. She led the organizational pilots for point-of-service automated medication dispensing, computerized medication administration (which revealed the potential to decrease medication errors associated with a patient's decreased cognition), and clinical documentation. Significant improvement to end-user interfaces were realized in each of these systems based on input from Christine and her nursing team. Each of these technologies has since been incorporated throughout the entire Inspira Health Network. Recognizing that home medication reconciliation remains a challenge for older adults, as does comprehensive care planning, 1 East is currently acting as a voluntary pilot unit for two additional technology improvements designed to facilitate the safe and efficient completion and documentation of both processes.

In closing, it's worthy to mention that Christine's achievements as a transformational and visionary leader have been recognized outside of Inspira Health Network. Her contributions to the field of geriatric nursing have been recognized by the New Jersey State Nurses Association and the NICHE organization. Both organizations have included Christine's contributions to nursing practice and nursing knowledge in recent and upcoming regional and national conferences and summits. Inspira Health Network feels these accomplishments only further exemplify the profound impact Christine's leadership has had on geriatric patient care in our organization, our community, and our region. As such, it's our distinct pleasure to submit her work and accomplishments for your consideration.

Wolters Kluwer Health | Lippincott Williams & Wilkins

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