ChristianaCare MICU Earns First-in-the-Nation Honor for Nursing Excellence

In March 2020, the pandemic was just beginning and the first COVID-19 patients were being admitted to ChristianaCare. The Medical Intensive Care Unit (MICU), with its high-level critical care, was about to become a ground zero.

While the nurses on this high-performing unit were no strangers to complex cases, the unknown of the emerging pandemic brought anxiety and trepidation. But not for long.

“Once we got through those emotions, we recalibrated: We are a team and an important part of the community,” said Paige Merring, MSN, RN, CCRN, a nurse on the MICU for seven years.

“We had a noble job to do, which was taking care of very sick patients. Everybody came together and stepped into their role as an ICU nurse.”

Above, Olivia Ross, BSN, RN; Maureen Seckel, MSN, APRN; Carol Ritter, MSN, RN; and Paige Merring, MSN, RN, prepare to add the MICU’s fifth Beacon Award to the unit’s trophy case. The MICU holds the most Beacon Awards in Delaware.

This spirit of solidarity is at the heart of the 24-bed MICU at Christiana Hospital, and it is a driving force behind the unit’s most recent Beacon Award for Excellence from the American Association of Critical-Care Nurses. The award is the highest achievement in critical care nursing.

It is the fifth time that the MICU—Delaware’s first Beacon Award-winning unit—has received the national award and the second time it has earned the gold level. The unit holds the most Beacon Awards in Delaware.

“Through their relentless and uncompromising pursuit to deliver care that is nonpareil, the nurses of ChristianaCare’s MICU have become the paragon of what our profession can accomplish,” said Ric Cuming, Ed.D., MSN, RN, NEA-BC, FAAN, ChristianaCare’s chief nurse executive.

“The success that our ChristianaCare MICU has trailblazed, even in the face of this pandemic and continuously elevating benchmarks, also has catalyzed our health system’s other intensive care units to achieve unprecedented gains in safety and quality that have been recognized with the AACN’s Beacon award, the touchstone by which all critical care nursing excellence and quality are measured.”

On a unit where everyone brings a level of expertise to serve together, MICU Assistant Nurse Manager Lindsay Hootsy, BSN, RN, consults with pharmacist Rachel Fett, Pharm.D.

Beacon awards celebrate the professional dedication that a nursing team demonstrates in going above and beyond to provide respectful, expert care.

ChristianaCare is one of only 152 health care institutions in the nation and the only in Delaware to have gold-level units. In 2008, the MICU was the first unit in the state to receive the Beacon Award and is now the only unit in Delaware to receive the award five times.

Of the six Beacon Award-winning patient care units currently in the state of Delaware, five are at ChristianaCare. The others at ChristianaCare are the Transitional Medical Unit (silver); Surgical Critical Care Complex (silver); Transitional Surgical Unit (silver); and the Cardiovascular Critical Care Complex (three-time gold winner). Beacon Award designations are active for three years.

ChristianaCare respiratory therapists are close collaborators with the MICU’s nurses. The Beacon Award is a testament to nurses and the entire care team who serve in a spirit of solidarity.

“It is a testament to our nurses and the entire care team that we continued to reach milestones in patient safety and satisfaction even during the COVID-19 pandemic,” said Carol Ritter, MSN, RN, CCRN-K, CNML, who has been nurse manager on the MICU for 10 years and a leader on the unit during all of its Beacon Award wins.

“Everyone brings a level of expertise to the unit. We truly serve together.”

The MICU’s commitment to data-driven, evidence-based care proved especially valuable during the pandemic’s early days.

Prone positioning, a technique to help patients with acute respiratory distress syndrome (ARDS) to breathe better, had been a longtime practice on ChristianaCare’s ICUs, with the leadership of Maureen Seckel, MSN, APRN, ACNS-BC, CCNS, FCCM, FCNS clinical nurse specialist and a nationally respected critical care expert. Prone positioning became a standard practice nationally in the treatment of patients with COVID-19 and ARDS.

“On our unit, we empower the team to provide evidence-based care and have the tools to guide the practice,” Seckel said.

“Because of this we were able to incorporate a highly effective, life-saving measure into COVID-19 care early in the pandemic.”

MICU caregivers created a flower wall as a memorial to patients who died from COVID-19. In a poem, MICU nurse Amber Hiltner, RN, wrote of the impact of COVID-19 on patients, families and staff: “Still I see the train coming, everyone is powerless to stop it. Is today the day? The bell tolls for thee, and also for me.”

Continuous improvement is a hallmark of the unit. The MICU has seven Comprehensive Unit-based Safety Program teams that follow data-collection processes to view trends and compare them to national standards to improve care and outcomes.

“The whole unit is involved in collecting data to assess and make changes,” said MICU nurse Olivia Ross, BSN, RN, CCRN.

Ross and Merring, now nursing excellence manager, worked with leaders and colleagues to compile the unit’s efforts and achievements and write the application.

Among the MICU’s accomplishments are excellent outcomes in common hospital-acquired infections, even during the pandemic:

  • Zero instances of catheter-associated urinary tract infections in three years.
  • Zero instances of central line bloodstream infections in one year.
  • Reduction of pressure injuries by 91% to date compared to FY21.

The unit’s dedication to being exceptional today and even better tomorrow also focused inward during the pandemic. During a time of constant change, the team recognized the need for support to handle the unprecedented stress and strain the pandemic wrought.

“To give the most vulnerable patients the highest levels of care on a consistent basis, we needed to take care of ourselves and one another too,” Ritter said.

Ritter and team leaders instituted open-door policies and welcomed to the MICU rounding licensed psychologists who offered real-time check-ins.

The Beacon Award has been a resounding lift and reward for the MICU team members.

“Having this recognition, especially during times of distress in the community and the world, signifies excellent nursing care,” Merring said. “And to me it signifies an amazing team and great outcomes, which is the primary purpose of why we are all here.”