Empowering Nurses to Drive Change

This interview highlights the journey of two nurses from the University of California Irvine (UCI) Health who spearheaded a project to reduce surgical site infections in their cardiovascular surgical step-down unit. Through collaboration with multidisciplinary teams, leadership support, and focused education, they created a comprehensive patient care booklet that significantly improved outcomes.

Over seven consecutive quarters, the unit maintained zero surgical site infections, demonstrating the power of nurse-led initiatives. The project also fostered greater teamwork, empowered staff, and inspired similar efforts in other units and hospitals. Their story offers valuable insights into implementing successful changes in healthcare, from overcoming challenges like funding and data management to building a culture of innovation and collaboration.

How Everyday Nurses Drove Change and Achieved Zero Infections

allnurses: Can you both start by sharing your names and the organization you work with?

Randy: My name is Randy Mark Padua. I currently work at Kaiser Permanente Medical Center as an educator and assistant nurse manager, but this project was born in UCI, where I previously worked as a staff nurse.

Annie: My name is Annie Nguyen. I am a clinical nurse III at UCI Health on the cardiovascular surgical step-down unit. I'm also the chair of our unit practice council and the chair of our image of nursing council.

allnurses: Great. Can you give me just a general overview of your project?

Randy: The project was conceived out of the problem that existed back in quarter four of 2021 with the cardiovascular service line, which was the number of superficial surgical site infections. Basically, the service line had the highest number of infections in the health system, so we worked on decreasing the surgical site infection with focused education. We came up with a booklet for our nurses to use for their patients. 

allnurses: Did you have certain metrics or numbers that you were hoping to achieve?

Annie: Yes,

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We were hoping to achieve zero surgical site infections by quarter two of 2022.

allnurses: Were you successful? 

Annie: We were successful and continue to be for seven quarters now.

allnurses: That's great. Did you guys use the core track device for this project? 

Annie: Not for this project, but we do use it at our hospital.

allnurses: Gotcha. How did Edwards Life Sciences contribute to the project? What was their role?

Annie: They gave us $1,000 grant, and we use that money to procure our swag items so things to keep nurses engaged, right, like pens, tote bags and badge rails. We decided to keep it basic with those.

allnurses: Alright, so you guys worked on this project. Were there other nurses, physicians, staff, or even administrators that were involved?

Randy: Yes, definitely. We had to involve, first, the surgeons and the PAs to help develop the booklet, because most of the information, there were educational pieces that they want the patients to go home with.

Then we've involved our unit leaders, so to speak, our charge nurses and relief charge nurses to help us roll out the project. And management was very supportive. Our managers, nurse managers, and even the director of critical care and the director of education.

allnurses: Great. Can you talk about if and how you were able to share your best practices with other units and even other hospitals?

Annie: Yes, we are the only cardiovascular step-down unit that really discharges our open-heart patients right now. We did have to disseminate this information to our CVICU, because during, and post-pandemic we were surging a lot, so we had high patient volumes in our institution and our unit didn't always have beds for the ICU patients to transfer out. 

What we ended up doing was discharging patients directly from the ICU, who really needed to utilize this booklet and become familiar with it. At UCI, it's us, the CV-Step Down, and the CVICU utilizing this. 

Outside of UCI, we have connected with Southern Illinois Hospital. They did reach out to see if they could potentially utilize this booklet to help with their outcomes. 

allnurses:  Are they implementing it now? 

Annie: We haven't heard back, but they were interested. And, you know, the resources were available online, so hopefully it helped in some way. 

allnurses: You had mentioned you had seven quarters in a row of success. Are there plans to track the long-term impact and cost savings?

Annie: Absolutely, we're going to continue to track this for years to come. 

allnurses: And what does that involve? Is that you guys, or is it going to be more nursing leadership or administrative involvement as well?

Annie: Yeah, we get our reports from nursing leadership, which I believe gets it from our quality department.

allnurses: What do you think will be the future for a project like this? I mean, are you seeing advancements, or how does that look five years from now?

Randy: Well, speaking of workflow perspective, the nursing leaders in the unit, especially the bedside nurses, the staff nurses as well, they try to look for things that need improvement.

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This project inspired them to look for solutions to improve the workflow continuously. 

We spread this out to our CVICU sister unit and they are now looking at implementing some other stuff on their end. Since we've had zero infections for seven quarters, I think looking and moving forward we're going to have to make sure that the booklet is also continuously updated, just to keep up with new advancements as well.

allnurses: Did you guys encounter any unexpected challenges or learn something new that you didn't think you would from this project?

Annie: Absolutely, we learned a lot about the purchasing process in our organization, it's not as straightforward as we thought it would be. Also, getting the grants from Edwards Life Sciences, I guess it was deposited into some account, and then we had to retrieve it from that account before we could use it. We had to put it into our cost center and then go out shopping with only approved vendors from the organization. Then they would send out the purchase order, the invoice, and all that stuff. That was a big learning curve. 

allnurses: Lots of hoops and red tape.

Annie: Yes, lots of hoops and red tape. And then also just gathering data. We didn't know that there were so many different platforms that you could gather data from, so that was a big eye opener as well. 

Randy: Even just rolling out the project — we are a small unit, but the size, considering we're only 16 beds, we still faced challenges with ensuring that everyone in the unit is captured in terms of rolling out the educational piece.

allnurses: And you'd mentioned some of the stuff that you've gotten for the other nurses. How did working on the project contribute to empowering nurses and fostering a culture of collaboration and innovation within your unit?

Annie: We had 12 key teaching topics, one shift would cover three topics, and then we would look at each other's documentation to see where we could fill in the gaps next. We really collaborated that way without really talking about it. It was just kind of in our documentation, so that was kind of cool.

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And it really brought us together, because we saw the results, and it showed that we positively impacted our patients in a good way — we prevented infection, and it really brought us together and made us really proud of our work.

Randy: And the booklet was not just used by nursing even the physical therapists and the occupational therapists used the booklet when they worked with the patients. So, it was a multi-disciplinary and interdisciplinary approach.

allnurses: That's great. What's next for you guys? Are you guys planning additional projects? 

Annie: That's a very good question. Randy has met his dream of the podium presentation. You know, I never really thought of this for myself, but I was happy to go along for the ride. Next, we are looking to get published somewhere.

Randy: We're going to work on translating this into a more professional manner, to make sure that it gets published out there. And hoping to do more projects.

Annie: Yeah, hoping to identify more issues, or, you know, areas of improvement, so we can launch another project — a whole new project outside of this.

Randy: And we're also looking forward to build up other nurses, especially our new grads, to get on board with projects like this.

allnurses: That's great. Last question, what advice would you give to other nurses looking to implement a research project like this?

Annie: I would definitely say go for it.

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Go for it. Speak to somebody, leadership preferably, and they will guide you in the right direction. 

Look for AACN Clinical Scene Investigator (CSI) projects. I mean, CSI has really helped us a lot to grow, understand, and really navigate this whole path. Also, don't be scared if you identify an issue, speak up. Maybe leadership doesn't know about it, so it's good to just speak up and put it out there. You just never know you, you might  get so much support out of nowhere, like really unexpected.

Randy: For me, it would have to be, be active in professional membership organizations, especially the AACN. I've always been active with AACN since I started to become a nurse in the United States. I was dreaming of this like 15 years ago. Now it's come to reality. So, had I not joined AACN, and had I not been active, I would not have been speaking to you right now and presenting to all the nurses. 

allnurses: That's awesome. Thanks, guys. Appreciate it. 

Annie & Randy: Thank you so much.