James N Leach, RN, TNCC

Present Nurse Manager – Emergency Services: ED, Covid Infusion & Surge OverflowJames A Haley VA Med Center, Tampa, FL

• 347 bed hospital, 40 bed ED/FT with approximately 43,000 annual visits, 14,000 admissionsData analysis – VSSC, HRSMART (Query), Power BI – for departmental metric trackingCompleting monthly reviews related to leave, overtime (budgeted vs utilization), length of stay, delays in care, triage delays, etc Primary mental health reviewer for ensuring compliance with C-SSRS and following CSREProject co-lead for RIE – Green Belt

• Stat team creation and implementation for 24/7 dedicate code team response

• Union, OIG and Mahalik response point of contactMentor for 2 assistant nurse managersMember of patient flow committee with monthly reportable related to departmental length of stayKey Departmental Metrics

• Left without being seen rate <1% exceeding national target of 2% and VISN average of 1.4%Boarded <4 hours 5% exceeding 10% national targetEDIS utilization 93% exceeding 75% national targetDoor to triage time FYTD 1 min exceeding national target of 12 minsTotal patient length of stay FYTD 190 mins exceeding national target of 200 mins and improved 3 mins in comparison to FY22Door to doc FYTD 15 mins exceeding national target of 25 mins 

• Shared governance facilitator and mentor for frontline staff Facilitate missed opportunity call back identifying high risk patients immediately Primary participant in Emergency Management mass casualty drills and eventsActive participant on RIE’s within the facility: 1:1/close observations, Intermediate Health Technicians, Fast track flow, mental health through put and left without being seen processes Completion of national staffing methodology tools to identify standard staffing requirements with comparisons to ENA staffing models for best practiceSuccessful completion of organizational risk assessments and accreditation complianceMember of Environment of Care team for facility readinessQSV & JPSR reviewer and respondentCompletion of executive leadership briefs and compliance reportsPrimary completion of departmental standard operating procedures and facility service line agreementsCreation of nurse driven sepsis protocol to ensure timely serial lactic acids and adequate fluid recusations rate – facility mortality rate improved from 51.3% to 7.9% in FY23Implementation of National Tele-Stroke Program to reduce door to needle time for intravenous thrombolytics from 62 minutes to 44 minutes.Tracking of all code assist with ED RN response time of 4 minutesRealignment of surge department and FTE August of 2023 with a decrease in admission length of stay in 45 days of 11 minutesRealignment of covid infusion clinic and FTE 

• 347 bed hospital, 40 bed ED/FT with approximately 43,000 annual visits, 14,000 admissions and 6,000 employee/volunteer visitsEnsured continued compliance with enhanced flow process; included use of Vocera, BMS, and EDIS. Improved average admission delay-boarding FY18 1.88 to 1.81 FY19 Shared governance facilitator and mentor for frontline staff Skilled member of root cause analysis teams 6-part folder reviews and completions to ensure compliance for Joint Commission readiness Participated in ESI and Nurse first conversion to decrease ED length of stay by 6 mins, creating a times savings of 5,250 mins per week cumulatively amongst all ED patients Facilitated the implementation of a two-tiered triage system to decrease facility triage times from 13 minutes to 4 minutes Facilitate missed opportunity call back identifying high risk patients immediately Partnered with Emergency Management to complete mass casualty and active threat drills Active participant on RIE’s within the facility: 1:1/close observations, Intermediate Health Technicians, Fast track flow and left without being seen processes Utilization of national staffing methodology tools and staffing by location for proven organizational outcomes Skilled high reliable organizational mentor Improved departmental retention rate from greater than 30% in FY 18 to less than 5% in FY 21 Successful completion of risk assessments and accreditation complianceSuccessful completion of White, Yellow, and Green belt Lean Sigma Six program training 

• Yellow belt certification project- Supply room redesign to decrease overstock and waste

• Conducted several fact-finding investigations and made recommendations with ER/LRMember of Environment of Care team for facility readinessConducted interviews and followed through on the hiring process for Registered Nurses and Health Care TechniciansImplementation of an external emergency department and successful completion of readiness compliancePrimary completion of departmental standard operating procedures and facility service line agreementsSkilled in VATAS, Acustaf, VISTA, CPRS, Teams and Microsoft OfficeLeadership team obtained a trust score > 95%

James A Haley VA Med Center, Tampa, FL

Registered Nurse – Emergency Department James A Haley VA Med Center, Tampa, FL

347 bed hospital, 38 bed ER/FTFunction in charge capacity, promoting throughput and decreasing length of stayCollaborating with leadership regarding staffing, patient incidents and concernsFacilitate teamwork and promote effective communication among staffConsistent rounding with providers, during excessive length of stays, to help troubleshoot obstacles in place that are preventing proper dispositions. Helped expedite patients from the emergency department to inpatient bed by collaborating with the Nursing Supervisor.Collaborate daily with management to ensure that all staffing needs were met to efficiently keep the department flowing. Communicate closely with the Nursing Supervisor during peak volume times to assure emergency department staff is being utilized efficiently. Give staff in-service meetings on changes to policies and procedures and assist with daily huddles.Manage the care of patients who present to the Emergency Department with a range of problems including non-urgent complaints to life threatening emergent crises. Assess patient’s immediate needs, prioritize their care, and organize a treatment plan from admission to discharge. Serve as a clinical resource for fellow staff and assist in the delivery of patient care.Use nursing process to assess, plan, implement, and evaluate veteran patients. Assist with education, precept new employees, and mentor USF students doing clinical rotations through the Emergency Department.

Registered Nurse – Emergency Department Florida Hospital Zephyrhills, Zephyrhills, FL

Manage staff assignments while assigned as relief Charge Nurse Perform nursing responsibilities that include patient treatment, monitoring, and documentation Ensure that all patients receive necessary and appropriate treatment and are accurately informed of their conditions and updated of any changes General nursing responsibilities include, assessment, medication administration, admission, discharges, patient/family education, and developing an appropriate plan of care. Collaborate with appropriate medical staff to ensure the individualized plan of care meet the patient’s needs and are appropriately executed.

Emergency DepartmentPalms of Pasadena Hospital, St. Petersburg, FL

Developed skills necessary to effectively work in Emergency Medicine Learned to rapidly assess patient conditions and set forth plan of care that would provide patient with best possible outcome. Learned to utilize electronic medical records for accurate detailed assessments and medication administration. Completed and maintained all required training to include ACLS, BLS, PALS, and NIH Stroke certification.Worked effectively with all facets of the nursing department and physicians to deliver safe quality care to patients.

Correctional Officer Sergeant Florida Department of Corrections, Zephyrhills, FL

Supervised incarcerated individuals who needed direct supervision inside a dormitory setting. Maintained and scheduled 37 staff members. Directed and controlled flow of institution by utilizing controlled movement of incarcerated individuals to reduce the number of safety incidents. Assisted with annual in-service training for all staff

Hero Award – 2021 Down syndrome of Tampa Bay team Advocate – 2020 to 2023 Creation of medical response team – 2021 – New Walk Church