2023 AWARD WINNERS
BSN, RN, CNML, CCRN
Cardiology Stepdown Unit 7100
Duke University Hospital
DNP, NP-C, AACC, FAANP
In March 2022, Ashley transitioned from being an Assistant Nurse Manager of our Pediatric Cardiac ICU to being the Nurse Manager for an adult Cardiology Stepdown Unit. And, she was nominated for all that she has already accomplished in this new role. Described as a bold, yet compassionate and humble leader, she engaged staff on all shifts to build rapport and to ensure that their perspectives drove decision-making. She invested in developing her leadership team; revamped staff meetings; initiated a Scheduling Committee to ensure equity and clear expectations; created an Emergency Basics program, with classroom training and roving in-services; implemented an alert process to notify nursing leaders about emergency events or needs; and operationalized new strategies to prevent falls and hospital-acquired infections.
This individual transitioned from Clinical Lead (CL) to Nurse Manager (NM) in a different service line, with an unfamiliar patient population and age range, several months ago. She had to balance solving long-standing issues on the unit with building trust and rapport with the new team. She accomplished this with humility and grace.
Her approach included making herself available for all shifts – days, nights and weekends – and ensuring the perspective of the staff drove decision-making. It is not uncommon that she comes in at 5 a.m. to start her day. Staff on all shifts regularly share their appreciation for having time to spend with their leader and being able to have their voices heard. She is a role model for her Assistant Nurse Managers (ANMs), who have also adopted being visible, interactive and available for all shifts.
Because staff is comprised of both tenured and newer staff, she tailored her actions to meet the needs of both. She used principles acquired during her time as a CL and bedside nurse to guide actions improving staff engagement, as well as quality and safety outcomes. It is evident she truly cares about her staff and is passionate about serving the staff and the patients in her new role.
She excels in identifying gaps in quality and safety, and creating resources to remedy issues. She is a bold leader who will speak up in a professional manner to ensure all angles of an issue are considered and the right thing is done for both the patients and staff. Prior to transitioning into the nurse manager role, she had oversight of Skin Care Champions in her area and pressure injury (PI) improvement work, which led to a significant reduction in PIs. She developed resources demonstrating how to correctly use Z-FloTM positioners. She was also instrumental in work to reduce PIs related to endotracheal devices. This led to a significant reduction in device-related PI’s.
She appreciates the value of thinking about solving long-standing problems in a “new” way. An example of this follows. After reviewing RL6 trends and emergency reports, she identified an ongoing theme of staff needing on-site leadership support to manage interdisciplinary conflict over the clinical management of patients and escalation of concerns. She implemented a new practice that was adopted across her service line. The Health Unit Coordinator calls the ANM for that unit through the assigned TC51 phone whenever there is an emergency event or an identified need. This ensures they are aware of current issues and can provide immediate support and guidance to the bedside nurse, Charge Nurse and team.
As Clinical Lead, she championed efforts for DUHS Safe Patient Handling & Mobility, including fall prevention education, new equipment training and skills revalidation. As Nurse Manager, she used these foundational principles to create a new approach to falls education on her unit. This educational series was themed after the fall season, and offered education pertinent to the role of the Nursing Assistant and nursing staff (permanent and contract). She partnered with hospital experts to create the content and ensured there would not be drift through audit review and leadership rounding. She is in the process of creating an evidence-based practice project in support of this work.
She has played an active role on the DUHS Clinical Practice Council, DUHS Cardiac Monitoring Committee, DUHS Nursing Quality Council, and has been instrumental in revising multiple policies. This has fostered enthusiasm in her staff to participate in this work. On her new unit, she recognized that new strategies needed to be implemented to solve existing quality issues. She partnered with the Dialysis and Vascular Access Teams and engaged the perspective of nursing staff to identify the contributing issues for falls and central line-associated blood stream infections (CLABSIs) and developed actions to improve outcomes.
As a Clinical Lead, she developed a “CAPE” (Cardiac Arrest Prevention & Education) Nurse role by sharing best practices and learnings from the review of cardiac arrest cases. This program provided education/best practice recommendations for nurse workflow when patients are received from the OR and for post-operative care principles to decrease the likelihood of cardiac arrest within the first 24 hours following procedures. This work generated positive outcomes and significantly reduced cardiac arrests in this setting. She shared this work as a poster presenter at a professional conference.
Recently, the unit she manages celebrated over one year without a catheter-associated urinary tract infection (CAUTI). This was attributed to the initiatives and support of staff that she put in place. She empowered the Hospital-Acquired Infection (HAI) Champions to engage with staff during audits and provide real-time feedback and education. This led to a climate in which staff routinely discuss the indications for a Foley catheter to be placed and removed. She collaborated with the ANMs to provide education focused on HAI prevention and CHG bathing protocol to RN and NCA staff.
She excels in developing others professionally. She is truly thankful for the professional development opportunities she had as a Staff Nurse, Clinical Lead, and NM and, in turn, wants to support others. She recognized that her two ANMs had different leadership experiences and knowledge bases, with one being tenured and the other being newly appointed. To further develop them as leaders and build cohesiveness and unity amongst their leadership team, she implemented weekly meetings to establish and evaluate priorities for the unit, as well as review key leadership principles. This investment into her leaders paid off, and both have shared favorable feedback with this approach.
Monthly staff meetings were revamped based on staff and ANM input. To better meet the needs of the team, she developed a staff meeting matrix. Topics focused on education, unit operations, regulatory readiness, patient safety, and quality and were noted on a grid indicating which month(s) information would be covered. Having the information repeated on a certain cadence ensures the topics will be offered to new hires at different time points throughout the year, and also reinforces the content for other staff. Unit Super Users and Champions were engaged in the report outs, which leads to their feeling valued and recognized for their roles.
This nurse is a bold, yet compassionate and humble leader who always advocates for the right thing to be done in support of patients and staff.