Exemplary Professional Practice

As a local leader in advanced neuro care, Sacramento Medical Center expanded the Wellness to Prevent Stroke and Wellness After Stroke educational programs. These free educational programs are open to both members and non-members. It focuses on community education regarding stroke prevention, lifestyle modification, rehabilitation, social services and spiritual care, and recovery after stroke. The participants learn to recognize stroke signs and symptoms, make lifestyle modifications—diet, exercise, and stress management—and adhere to prescribed medications.  

Taught by a multidisciplinary team of clinical nurses, dietitians, and other health professionals specializing in stroke care and prevention, the program has been warmly received, and classes are now being held in assisted living facilities, where patients are usually placed while recovering after a stroke, bringing needed education to stroke patients, caregivers, and the community. 

Almaz Haile, MSN, RN, CCNS, a Neuro Clinical Nurse Specialist who facilitates the program, shared: “It’s rewarding to see patients and their caregivers learn about stroke prevention through lifestyle changes and to witness stroke survivors and their families regain confidence in their recovery. This program equips participants with valuable knowledge, empowering them to make informed health decisions to make lifestyle changes and promote overall health and wellness.” 

Patient D. Gomez suffered an ischemic stroke and attended the Wellness After-Stroke class; he shared: “I didn’t realize how much my diet could impact my health. Learning about the foods by reading the food labels helps me watch what I eat, and it’s important because I have high blood pressure. I now understand how to avoid food high is salt. I highly recommend this class to other patients.” 

In the operating room (OR), formalin is commonly used as a preservative for biological specimens, such as tissues removed during surgery, which must be stored for pathological examination. However, traditional manual formalin dispensing methods increased the staff’s exposure risk to fumes. Formaldehyde fumes can cause respiratory irritation, allergic reactions, and long-term health issues, so proper handling and safety precautions are essential.  

A baseline assessment was conducted to measure the frequency and severity of formalin spills and staff exposure to formalin fumes. Chemical exposure (e.g., respiratory exposure through inhalation) is one of the top five incidents in Sacramento’s Main OR from October 2023 to July 2024. Out of twenty-two incidents, 13% were reported as chemical exposure. Staff feedback highlighted concerns and areas for improvement, shaping the implementation strategy. 

To address this concern, a multidisciplinary team, including nurses Ian Tumulak, BSN, RN, SNII- Safety Lead, Johnjay Roque, BSN, RN, SN IV-Safety Co-Lead, Jennice Singh, MSN, RN, CNOR, ANM, Chris Cooley, ADN, RN, ANM, Amelia Dayucos, MSN, RN, CNOR, Nursing Professional Development Specialists, perioperative leaders and pathologists collaborated to review safety procedures and advocate for resources to minimize or prevent staff exposure to formalin in the OR. 

The initiative began with a comprehensive review of existing formalin handling procedures, identifying areas where spills and fume exposure were most likely. A cost-benefit analysis and vendor evaluation led to the selection and installation of an automatic dispensing machine in the OR. A training program for staff related to device use and workflow changes was also implemented. 

Following the implementation in May 2024, a significant reduction in formalin exposure levels and spills was observed. The incidence of formalin spills has decreased to zero, and staff reported that the air quality in the specimen management area had improved. Staff also reported increased confidence in handling specimens and a higher perception of safety. Additionally, the precision of formalin dispensing was enhanced, ensuring optimal conditions for specimen preservation. 

Deep Brain Stimulation (DBS), an advanced treatment for movement disorders like Parkinson’s disease, essential tremor, and dystonia, is now available at Kaiser Permanente in Sacramento. This procedure involves implanting electrodes in targeted brain regions to regulate abnormal activity through electrical impulses, offering patients improved quality of life and restored independence. 

Implementing the DBS surgery program required strong interdisciplinary collaboration among physicians, nurses, surgical technicians, specialists, and department leaders. The outcome relies not only on surgical expertise but also on pre-and post-operative care, workflow optimization, and robust training. 

Clinical nurses, nurse leaders, and Nursing Professional Development Specialists (NPDS) played a key role in implementing the DBS program. Amelia Dayucos, MSN, RN, CNOR, a Perioperative NPDS, led efforts to prepare staff for this new service. “When I first learned that this program was coming to Sacramento, I knew staff preparation would be critical. Our team worked on developing a comprehensive education program tailored to our staff’s learning needs,” she explained. She emphasized the importance of engaging clinical nurses in the process, noting, “Clinical nurses must be part of workflow design as experts in nursing care because they will use and execute the processes.”  

Nurses, alongside their interdisciplinary partners, were instrumental in designing workflows, creating educational resources, and ensuring the best patient care. In the Operating Room, neurology nursing lead clinical nurses Earl Penalosa, BSN, RN, co-lead, Nancy Nguyen, BSN, RN, Surgical Tech Trevor Williams, OR Neuro Specialist Dustin Leyden, and Larry Bodden, MD, epilepsy neurosurgeon, conducted mock trial runs to optimize workflow, created detailed preference cards, visual board, and equipment use guides. 

To guide post-operative care, Post Anesthesia Care Unit (PACU) clinical nurse Olga Bodnar, BSN, RN, and nursing team worked with Dr. Bodden, MD, to create pre- and post-operative workflows tailored to the procedure. The team also developed a checklist to guide the PACU nurses and streamline post-op care. In addition, the PACU education committee also led and implemented staff training sessions about DBS. 

The interdisciplinary perioperative team’s work at Sacramento Medical Center has expanded Kaiser members’ access to DBS treatment. It also highlighted the critical role of nurses, from clinical to leadership, as leaders and change agents. 

Employee feedback shapes organizational priorities, work culture, and staff satisfaction. Voluntary and anonymous surveys and direct report rounding are some of the mechanisms for capturing and addressing staff input. Sacramento Medical Center embraces a culture of continuous listening, ensuring employees have multiple avenues to share their feedback.  

The People Pulse Survey 

Conducted biannually in the Spring and Fall through Glint, the People Pulse Survey is available to all hospital employees except physicians. The survey focuses on engagement, speaking up, team effectiveness, workplace and patient safety, inclusion, culture of health, talent development, organizational performance, integrity and ethics.  

The RN Excellence Survey 

A prerequisite for the Magnet application, the RN Excellence Survey, administered by Press Ganey, captures nurses’ feedback on seven domains of excellence, including nursing autonomy, adequacy of resources and staff, interdisciplinary collaboration, teamwork and collaboration, nursing leadership access and responsiveness, and nursing professional development. 

Employee Feedback 

In 2024, Sacramento’s staff feedback survey results indicate a positive employee engagement and satisfaction trend. The People Pulse engagement index, which measures overall staff engagement, has improved compared to previous survey years. Similarly, the RN Excellence survey also reflected a significantly improved nurses’ satisfaction and engagement, outperforming national benchmarks in five domains (adequacy of resources and staffing, interprofessional relationships, leadership access and responsiveness, and professional development) in most units surveyed. 

Sacramento had a 98% response rate in the third quarter of the People Pulse survey and 75% in the RN Excellence Survey, placing the medical center among the top performers regionally. Esperanza Chaves, MSA, BSN, RN, Chief Nurse Executive, noted, “The fact that many staff members participated in the surveys means that our staff trust the process and their commitment to the organization’s growth. They want to be part of the solution and have confidence in the organization’s commitment to taking meaningful action. We cannot enhance employee engagement without the staff’s feedback. It is an ongoing process, and actions to improve it must evolve with the dynamic changes in the work environment and culture.”  

Wellness Councils  

In 2022, Sacramento Medical Center established Wellness Committees within nursing units and a hospital-wide Wellness Council under the Nursing Professional Governance Council structure. This initiative was launched in response to staff feedback from the People Pulse Survey, which highlighted challenges such as low staff engagement, burnout, and low morale. The overarching goals are to improve morale, strengthen team dynamics, reduce burnout, and enhance staff engagement. 

The clinical nurses lead the unit-level committees and the hospital-wide Wellness Council, which have been implementing initiatives and promoting staff well-being and team-building-related activities at work. In addition to workplace-focused efforts, the committees also organized out-of-work activities designed to build personal connections and deepen relationships among team members.  

Maureen Coloma, BSN, RN, Wellness Committee lead in the ICU, shared her perspective: “Out-of-work activities help me learn more about my colleagues outside of their work roles. Connecting in a relaxed setting and having fun is important to recharge. Our unit staff looks forward to these events because they create a sense of camaraderie. Even when some events require out-of-pocket costs, staff eagerly participate, often bringing their families to share in the fun.”