Jo Goffinet
August 2021
Jo
Goffinet
,
MS, RN, CMS-RN
Clinical Nurse Specialist
SSM Health St. Mary's Hospital - Madison
Madison
,
WI
United States
Five years later, Jo keeps this initiative alive by using time at every unit-based council meeting to talk about cases where there was the potential for failure to rescue.
Jo Goffinet has consistently developed and led initiatives that promote top-of-license practice for registered professional nurses. We will provide two examples that exemplify Jo’s demonstration of “I am Professional.” The first has to do with the update and re-introduction of the Nurse-driven Urinary Catheter Removal Protocol which is based in research, best evidence, and professional nurse autonomy. St. Mary’s had such a protocol in use from 2007 to 2015; however, the nurse-driven protocol was removed from the nursing workflow during our conversion to single instance. This meant that a whole new generation of St. Mary’s nurses had to be supported during the implementation and beyond.
On a daily basis, Jo reviews all patients on the units she supports with a special focus on those with a urinary catheter. During this review she identifies those patients who lack an indication for the Foley and then rounds on the units to support the decision-making of the nurse regarding removal. While re-adoption of the protocol has been slower than desired, Jo’s diligence in supporting the critical decision making of the nurses she works with is an example of her own professional practice as a clinical nurse specialist, and also how her daily work supports achieving exceptional outcomes while supporting nurses to practice at the top of their license.
The second example has to do with the recently implemented Urinary Retention Protocol. Jo worked with hospitalists, urology providers, Epic builders, clinical educators, to name just a few to develop and implement the protocol in a timely manner. She provides daily support to bedside RNs as they initiate the protocol, assisting them to navigate the decision support, and use their assessment skills to support decision-making that avoids re-insertion of an indwelling urinary catheter. As part of her daily practice, Jo supports professional nurse autonomy, critical decision-making, and the advancement of the nursing profession within SSM Health.
Jo Goffinet’ s practice as a clinical nurse specialist is completely consistent with the “I am an Advocate” element of our Professional Practice Model. We provide examples of just a few of the ways in which Jo exemplifies advocacy and support for nurses across the span of their nursing careers. About five years ago, Jo, based on an emerging trend in patient care, developed an initiative titled “Preventing Failure to Rescue.” In each of three patient scenarios the nurse had recognized clinical deterioration but was unable to get the provider to respond, representing an emerging failure to rescue. Jo recognized that there was a systems issue at play that was resulting in failure to communicate and escalate concerns about a patient condition. When she analyzed the three cases in-depth, she recognized that nurses don’t always recognize and activate the resources that were readily available to them when a patient’s condition was deteriorating.
Jo put together a simple graphic that outlined the six resources readily available to every nurse on every unit: 1) trust in your own critical thinking and instincts; 2) the charge RN, nursing supervisor, manager, and CNS; 3) SBAR communication; 4) CUS words; 5) the Chain of Command; and 6) Rapid Response Team.
Five years later, Jo keeps this initiative alive by using time at every unit-based council meeting to talk about cases where there was the potential for failure to rescue, how activating the 6 resources resulted in better patient outcomes, and opportunities for improving our response to potential failure to rescue. Through the preventing to failure work Jo not only enhances the ability of nurses to respond to patient deterioration, but also helps nurses better understand how the total system of care impacts their practice.
Other examples of Jo advocating for nurses across the span of their career include the New RN Residency program that was developed at St. Mary’s under Jo’s guidance and Jo’s service as a clinical preceptor for senior and graduate nursing students from the University of Wisconsin – Madison. Jo is consistently generous with her time and energy spent supporting and developing the next generation of nurse leaders.
Jo Goffinet consistently demonstrates the “I am a Partner” element of our Professional Practice Model. We will describe just a few examples from Jo’s practice that exemplify partnership. As a clinical nurse specialist, one of Jo’s key role accountabilities is to be a partner to the managers she works with. Jo provides clinical leadership for the departments she serves, while her management partners provide operational leadership for those units. Jo’s relationship with her manager colleagues is an equal partnership with respect for the perspectives of the unit dyad partners being very much in evidence.
As we write this she is partnering with an MD for the development of evidence-based approaches to alcohol and opiate withdrawal which will require the implementation of validated assessment tools designed to fine tune treatment plans to the patient’s risk of harm from going through withdrawal. For these same initiatives she is partnering with the System Practice Leads, the System Professional Nursing Practice Council, and the System Nursing Informatics Committee. Jo can partner so effectively because she works hard to understand the perspective and priorities of others, while keeping everyone focused on what is best for the patient and family, and for the organization.
Another way that Jo exemplified partnership was evident when she was tapped to provide overall leadership for our 2021 Joint Commission triennial survey. The first thing Jo did was review the results of our 2018 survey, a recent mock survey, and the results of monthly tracer activities. She noticed consistent findings across all these data sources; in other words, the same issues and problems were repetitive and being consistently identified. In Jo’s word, we keep “fixing the finding” instead of fixing the flawed system that leads to the finding. Jo partnered with administration, every nursing unit, medical imaging, maintenance, supply chain...the list goes on and on….to develop better systems and lasting solutions. The result was a small number of findings relative to the size of our organization and the length of our survey (5 days). Most importantly, there was not a single finding in the “widespread” category.
Jo Goffinet demonstrates the highest level of accountability for the rigor and quality of the work she produces. She is disciplined, thorough, and has finely tuned critical analytic skills. The “I am Accountable” element of our Professional Practice Model is exemplified in Jo’s practice as a clinical nurse specialist. Jo is the Co-Chair of our Clinical Performance Excellence Council (CPEC) and she uses the Johns Hopkins Nursing Evidence Based Practice Model to teach clinical RNs how to recognize opportunities to improve care and systems of care, to find, analyze, and synthesize evidence, and design and implement an evidence-based improvement project. Nurses completing projects sponsored by CPEC changed the way we care for babies with neonatal abstinence syndrome and provided the early seed for the bladder scan and straight cath portion of the Nurse-driven Indwelling Urinary Catheter Removal Protocol, to name just a few. Projects currently being conducted will provide an evidence-based approach to: 1) post-op/post-procedure vital signs; 2) nurse-driven central line removal, and 3) a low tech but high touch approach to patients with delirium, again to name just a few. These projects are not only successful at nurturing clinical curiosity and bedside science, but they also improve outcomes for patients and the organization. Jo’s mentorship of nurses and her highly accountable leadership for the CPEC are foundational to that success.
A second example of Jo demonstrating accountability for the outcomes produced by nurses and the organization involves our Nursing Peer Review Committee. Jo is one of the CNS members of the committee and was instrumental in the development of the structures and processes that guide the work of the committee. These include a committee charter and policy, confidentiality guidelines, committee process flow, case evaluation forms, and various letters for inquiry, notification of appropriateness of care, and final determination. One of the accountabilities of any profession is to evaluate and continuously improve the quality of service/work delivered to the public. Formal peer review is one way that the profession of nursing can demonstrate our accountability to patients and the organization and Jo’s work in this area exemplifies the Accountable “I am” statement from our Professional Practice Model.
Jo Goffinet is a servant leader who consistently aligns her practice with the mission, vision, and values of St. Mary’s Hospital and SSM Health. In her role as servant leader Jo also acts as a transformational leader. Her leadership style is dedicated to developing staff RN followers into leaders within the hospital and the larger health care system. Not only does she cause positive change in individuals, but she also has produced positive change to our systems of care through her own research and evidence-based practice, but also through her approach to Joint Commission readiness, her attunement to questions bubbling up from the point of care, and her ability to partner across disciplines. She demonstrates the “I am a Leader” element of our Professional Practice Model in her daily work across multiple levels of our system.
For example, Jo serves on our ministry Clinical Performance Excellence Council, the Wisconsin Professional Nursing Practice Council, and the System Professional Nursing Practice Council. At each council she insists that proposed changes be backed up with data, evidence, or externally identified best practice. Most recently, Jo joined the Musculoskeletal Clinical Program and was challenged to identify an approach to aligning and standardizing joint replacement order sets from across our system. This is no small challenge, but Jo quickly developed a process that breaks the various order sets into stage of care components and fully allows for variation to be identified and rectified to the fullest extent possible. When this was mentioned during a recent Teams meeting an informatics leader on the call exclaimed, “My God, that’s been on my wish list for so long and it is so needed.” In the end, leadership is about promoting positive change and then giving followers the information and tools they need to understand why change is necessary, and then to support them as they work through the change. As a clinical nurse specialist, Jo demonstrates and practices leadership in all that she does.
Jo is a respected member of the interprofessional team. She is viewed as a trusted and knowledgeable resource for clinical staff, managers, and other members of our care team. She is highly collaborative and always willing to go the extra mile to advocate for practices that support the nursing staff, our patients, and members of the interprofessional team. Jo has an amazing passion for promoting the profession of nursing, as well as safe practice guidelines. As a clinical practice leader Jo has made recommendations for nursing practice at the department and organization level that have been foundational to the tremendous work accomplished by our care teams. She is involved in multiple system practice work groups and her voice has been instrumental in the development and sustained utilization of various practices and protocols designed to improve patient care and outcomes. The managers Jo works with consider her the co-leader of their departments and value her support and clinical expertise. Clinical RNs have the utmost respect and trust for Jo and place the highest value on her mentorship and ability to share her knowledge base with all. Jo is not only a member of Professional Governance councils at the ministry, region, and system levels, she is also a member of the unit-based councils for those units she serves. She assists the councils with tracking, trending and displaying performance data and her guidance has paid off in terms of staff ability to articulate not only the unit goals, but also improvement plans as well as barriers that are being worked through. Jo has spent her clinical career working to ensure that we can deliver the highest value care to our patients and their families.
Note: This is Jo's 2nd DAISY Award!
On a daily basis, Jo reviews all patients on the units she supports with a special focus on those with a urinary catheter. During this review she identifies those patients who lack an indication for the Foley and then rounds on the units to support the decision-making of the nurse regarding removal. While re-adoption of the protocol has been slower than desired, Jo’s diligence in supporting the critical decision making of the nurses she works with is an example of her own professional practice as a clinical nurse specialist, and also how her daily work supports achieving exceptional outcomes while supporting nurses to practice at the top of their license.
The second example has to do with the recently implemented Urinary Retention Protocol. Jo worked with hospitalists, urology providers, Epic builders, clinical educators, to name just a few to develop and implement the protocol in a timely manner. She provides daily support to bedside RNs as they initiate the protocol, assisting them to navigate the decision support, and use their assessment skills to support decision-making that avoids re-insertion of an indwelling urinary catheter. As part of her daily practice, Jo supports professional nurse autonomy, critical decision-making, and the advancement of the nursing profession within SSM Health.
Jo Goffinet’ s practice as a clinical nurse specialist is completely consistent with the “I am an Advocate” element of our Professional Practice Model. We provide examples of just a few of the ways in which Jo exemplifies advocacy and support for nurses across the span of their nursing careers. About five years ago, Jo, based on an emerging trend in patient care, developed an initiative titled “Preventing Failure to Rescue.” In each of three patient scenarios the nurse had recognized clinical deterioration but was unable to get the provider to respond, representing an emerging failure to rescue. Jo recognized that there was a systems issue at play that was resulting in failure to communicate and escalate concerns about a patient condition. When she analyzed the three cases in-depth, she recognized that nurses don’t always recognize and activate the resources that were readily available to them when a patient’s condition was deteriorating.
Jo put together a simple graphic that outlined the six resources readily available to every nurse on every unit: 1) trust in your own critical thinking and instincts; 2) the charge RN, nursing supervisor, manager, and CNS; 3) SBAR communication; 4) CUS words; 5) the Chain of Command; and 6) Rapid Response Team.
Five years later, Jo keeps this initiative alive by using time at every unit-based council meeting to talk about cases where there was the potential for failure to rescue, how activating the 6 resources resulted in better patient outcomes, and opportunities for improving our response to potential failure to rescue. Through the preventing to failure work Jo not only enhances the ability of nurses to respond to patient deterioration, but also helps nurses better understand how the total system of care impacts their practice.
Other examples of Jo advocating for nurses across the span of their career include the New RN Residency program that was developed at St. Mary’s under Jo’s guidance and Jo’s service as a clinical preceptor for senior and graduate nursing students from the University of Wisconsin – Madison. Jo is consistently generous with her time and energy spent supporting and developing the next generation of nurse leaders.
Jo Goffinet consistently demonstrates the “I am a Partner” element of our Professional Practice Model. We will describe just a few examples from Jo’s practice that exemplify partnership. As a clinical nurse specialist, one of Jo’s key role accountabilities is to be a partner to the managers she works with. Jo provides clinical leadership for the departments she serves, while her management partners provide operational leadership for those units. Jo’s relationship with her manager colleagues is an equal partnership with respect for the perspectives of the unit dyad partners being very much in evidence.
As we write this she is partnering with an MD for the development of evidence-based approaches to alcohol and opiate withdrawal which will require the implementation of validated assessment tools designed to fine tune treatment plans to the patient’s risk of harm from going through withdrawal. For these same initiatives she is partnering with the System Practice Leads, the System Professional Nursing Practice Council, and the System Nursing Informatics Committee. Jo can partner so effectively because she works hard to understand the perspective and priorities of others, while keeping everyone focused on what is best for the patient and family, and for the organization.
Another way that Jo exemplified partnership was evident when she was tapped to provide overall leadership for our 2021 Joint Commission triennial survey. The first thing Jo did was review the results of our 2018 survey, a recent mock survey, and the results of monthly tracer activities. She noticed consistent findings across all these data sources; in other words, the same issues and problems were repetitive and being consistently identified. In Jo’s word, we keep “fixing the finding” instead of fixing the flawed system that leads to the finding. Jo partnered with administration, every nursing unit, medical imaging, maintenance, supply chain...the list goes on and on….to develop better systems and lasting solutions. The result was a small number of findings relative to the size of our organization and the length of our survey (5 days). Most importantly, there was not a single finding in the “widespread” category.
Jo Goffinet demonstrates the highest level of accountability for the rigor and quality of the work she produces. She is disciplined, thorough, and has finely tuned critical analytic skills. The “I am Accountable” element of our Professional Practice Model is exemplified in Jo’s practice as a clinical nurse specialist. Jo is the Co-Chair of our Clinical Performance Excellence Council (CPEC) and she uses the Johns Hopkins Nursing Evidence Based Practice Model to teach clinical RNs how to recognize opportunities to improve care and systems of care, to find, analyze, and synthesize evidence, and design and implement an evidence-based improvement project. Nurses completing projects sponsored by CPEC changed the way we care for babies with neonatal abstinence syndrome and provided the early seed for the bladder scan and straight cath portion of the Nurse-driven Indwelling Urinary Catheter Removal Protocol, to name just a few. Projects currently being conducted will provide an evidence-based approach to: 1) post-op/post-procedure vital signs; 2) nurse-driven central line removal, and 3) a low tech but high touch approach to patients with delirium, again to name just a few. These projects are not only successful at nurturing clinical curiosity and bedside science, but they also improve outcomes for patients and the organization. Jo’s mentorship of nurses and her highly accountable leadership for the CPEC are foundational to that success.
A second example of Jo demonstrating accountability for the outcomes produced by nurses and the organization involves our Nursing Peer Review Committee. Jo is one of the CNS members of the committee and was instrumental in the development of the structures and processes that guide the work of the committee. These include a committee charter and policy, confidentiality guidelines, committee process flow, case evaluation forms, and various letters for inquiry, notification of appropriateness of care, and final determination. One of the accountabilities of any profession is to evaluate and continuously improve the quality of service/work delivered to the public. Formal peer review is one way that the profession of nursing can demonstrate our accountability to patients and the organization and Jo’s work in this area exemplifies the Accountable “I am” statement from our Professional Practice Model.
Jo Goffinet is a servant leader who consistently aligns her practice with the mission, vision, and values of St. Mary’s Hospital and SSM Health. In her role as servant leader Jo also acts as a transformational leader. Her leadership style is dedicated to developing staff RN followers into leaders within the hospital and the larger health care system. Not only does she cause positive change in individuals, but she also has produced positive change to our systems of care through her own research and evidence-based practice, but also through her approach to Joint Commission readiness, her attunement to questions bubbling up from the point of care, and her ability to partner across disciplines. She demonstrates the “I am a Leader” element of our Professional Practice Model in her daily work across multiple levels of our system.
For example, Jo serves on our ministry Clinical Performance Excellence Council, the Wisconsin Professional Nursing Practice Council, and the System Professional Nursing Practice Council. At each council she insists that proposed changes be backed up with data, evidence, or externally identified best practice. Most recently, Jo joined the Musculoskeletal Clinical Program and was challenged to identify an approach to aligning and standardizing joint replacement order sets from across our system. This is no small challenge, but Jo quickly developed a process that breaks the various order sets into stage of care components and fully allows for variation to be identified and rectified to the fullest extent possible. When this was mentioned during a recent Teams meeting an informatics leader on the call exclaimed, “My God, that’s been on my wish list for so long and it is so needed.” In the end, leadership is about promoting positive change and then giving followers the information and tools they need to understand why change is necessary, and then to support them as they work through the change. As a clinical nurse specialist, Jo demonstrates and practices leadership in all that she does.
Jo is a respected member of the interprofessional team. She is viewed as a trusted and knowledgeable resource for clinical staff, managers, and other members of our care team. She is highly collaborative and always willing to go the extra mile to advocate for practices that support the nursing staff, our patients, and members of the interprofessional team. Jo has an amazing passion for promoting the profession of nursing, as well as safe practice guidelines. As a clinical practice leader Jo has made recommendations for nursing practice at the department and organization level that have been foundational to the tremendous work accomplished by our care teams. She is involved in multiple system practice work groups and her voice has been instrumental in the development and sustained utilization of various practices and protocols designed to improve patient care and outcomes. The managers Jo works with consider her the co-leader of their departments and value her support and clinical expertise. Clinical RNs have the utmost respect and trust for Jo and place the highest value on her mentorship and ability to share her knowledge base with all. Jo is not only a member of Professional Governance councils at the ministry, region, and system levels, she is also a member of the unit-based councils for those units she serves. She assists the councils with tracking, trending and displaying performance data and her guidance has paid off in terms of staff ability to articulate not only the unit goals, but also improvement plans as well as barriers that are being worked through. Jo has spent her clinical career working to ensure that we can deliver the highest value care to our patients and their families.
Note: This is Jo's 2nd DAISY Award!