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Celebrating UCSF APPs during
National Advanced Practice Provider (APP) Week
September 26-September 30, 2022
Hot Beverage and Hot Opportunities--Stipends and Committees
Teach for UCSF and Program for Interprofessional Practice and Education
Leadership Academy for APPS and Evidence Based Practice Opportunities
Click here for recordings of the above events
Contact your manager to receive your appreciation gift--a stainless steel thermal bottle imprinted with UCSF APP mission and vision.
In photo (Top left): Mt Zion Ortho PAs's Jardena 'Jay' Garner and Lawrence Lam
(Top right): ZSFGH Medicine PierreCedric Couch, NP (Bottom left): Anonymous Parnassus NPs. (Bottom right): NPs Yawen Yeh and Theresia Soetjipto.
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This month's fireside chat highlights Legina "Gina" Garrett, DNP, MSN, RN, ACNP-BC who shares her military experience has shaped her career. Also, in this 14 minute video she describes how her DNP prepared her to lead the UCSF APP Onboarding program as well as learn about all the opportunities available to you.
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New Interim NP Supervisor for Pediatric Neonatal Department
Emilie Menard, MS, RN, CPNP-AC, has been a UCSF employee since 2007. She started her career as an RN in the PICU, completed her AC-PNP degree from the UCSF SON in 2013 and has been an NP in the PICU/TCUP for the last 8 years. Emilie has been the Lead NP for the PICU/TCUP the last 3 years and is integral in development of the TCUP APP program. In addition to her lead activities, Emilie has continued to support the SON with student placement, precepting and lectures. She has been the NP lead for several quality improvement projects in the PICU including MIBG sedation coordinator, PICU experience workgroup and CALM projects and is a previous president of NAPNAP.
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Pediatric Solid Organ APPs Celebrate 25th Annual Picnic
NPs Megan Keating, Jessica Brennan, Marilyn McEnhill and Lisa Gallagher along with other staff and volunteers hosted its 25th annual picnic for their pediatric patients and families who have undergone kidney, liver or heart transplants. Over 325 people were in attendence at McNears Beach in San Rafael. Since January 2022, there have been more than 20 pediatric solid organ transplants.
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Intensive Care Nursery APPs lead QI projects | |
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In Photo (left to right):
Laurel Pershall NP, Stephanie Smith NP, Kathy Chamberlain NP, and Chele Evans NP
These Intensive Care Nursery (ICN) NPs at Mission Bay, completed a six month Small Baby Care Specialist Program along with a group of RNs to learn how to optimize the care of Extremely Low Birth Weight infants (ELBW) at based on current evidence and best practice strategies. The course included extensive information on each system and covered almost every aspect of ELBW care. The program was designed to prepare interdisciplinary ICN staff to take the NNC-ELBW certification test.
Our goal in participating in the program with our RN team is to enhance our management of the smallest, high-risk patients in the ICN to improve the care and outcomes for each baby and their family.
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Grow, Babies, Grow! is an ongoing multidisciplinary QI project in the ICN at Mission Bay. Initially it was the California Perinatal Quality Care Collaborative (CPQCC) also titled Grow, Babies, Grow in late 2018. It was a 1.5 year multi-center collaborative aimed at reducing the percentage of very low birth weight (VLBW <1500 grams) babies discharged with growth failure as defined by decrease of more than 1SD below their birth weight Z-score. The team was so excited by their initial outcomes that they have continued to add new interventions through multiple PDSA cycles.
From 2018 through the end of Quarter 1 in 2022 they were able to decrease the percentage of VLBW babies discharged with growth failure from 19% to 6%, without increasing the rate of necrotizing enterocolitis (NEC) or decreasing breast milk at discharge in their MB ICN. Our original smart aim was to reduce our initial rate by 20%, which would have resulted in a change from 19% to 15%.
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Contemporary Issues in Advanced Practice
Friday, October 21, 2022
Register for this conference and hear your colleagues share their expertise with latest best practices in Advanced Practice.
The UCSF Office of Advanced Practice in partnership with the UCSF APP Education Committee invite you to participate in the upcoming conference: Contemporary Issues in Advance Practice on October 21st, 2022. UCSF designates this live virtual activity for a maximum of 6 AMA PRA Category 1CreditTM. $55.00 registration fee
Keynote speakers:
Victoria Keeton, PhD, RN, CPNP-PC
UCSF Department of Obstetrics, Gynecology & Reproductive Sciences
“Social Determinants of Stress and their Impact on the Health of Latinx Mothers and Children”
Rosalind de Lisser, PhD-c, FNP, PMHNP UCSF Health “Caregiver Burnout”
Sarah Palilla, PA-C, MMS UCSF Health “Bariatric Surgery Program”
Plus Special Interest Tracks: Education Performance Track, Mental Health Track
Orthopedic Track, Pain Management Track
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APP Town Hall
Tuesday October 25, 2022 4-5 PM
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Improving the work experience for our people is an ongoing organizational priority, with each year offering an opportunity for us to re-focus on the items of greatest importance to you.
"Annual Advanced Practice Provider Work Experience Survey--Net Promoter Score"
Presented by Ivette Becerra-Oritz MPH, NP, RN, NEA-BC, C-PNP
and Rosie Krauter FNP-BC, CORLN
Meeting ID: 924 2127 0836
Password: 048286
Click here for an overview of the data describing UCSF Health APP results (includes Benioff Children Hospital Oakland and West Bay campuses data combined). All the data from the NPS survey can be viewed via The Provider Experience APP NPS results- Tableau Server (must use MyAccess click here)
Did you miss the prior Town Halls? Click here to view prior Town Halls on APP Utilization, Time Study, AB 890 (must log into MyAccess).
Email advancedpractice@ucsf.edu to suggest future Town Hall topics.
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APP Standards & Compliance News | |
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Time Study
The time study is the method for identifying and categorizing services and activities performed by APPs and physicians. This time study is a requirement of the Department of Health care services to claim uncompensated costs by entities such as UCSF, to receive funds from the Center for Medicare and Medicaid services (CMS).
What does an APP need to do?
If you are an East Bay APP (inpatient and/or outpatient): please review this Town Hall presentation.
If you are an West bay APP (inpatient and/or outpatient): click here for Town Hall presentation. Click here for slidedeck.
What is the mandatory learning module?
The learning module will explain how to categorize your daily activities and complete the qualtrics form. Completion of the learning module is an annual requirement. More info forthcoming.
How frequently does an APP need to submit time study information?
Monthly. The APP will be notified 5 business days before the start of the Time Study. Both APP and their direct manager will need to electronically sign the Time Study.
Who must do the Time Study?
Clinical physicians and APPs at all UCs for whom a bill for services is generated and who are paid by the health system. Providers in full time research do not participate.
Drop In Office Hours:
"Time Study Q&A. We can help you complete your time study"
Friday October 14, 2022 12-1:00 PM
Wednesday October 26, 2022 8-9:00 AM
Meeting ID 916 4136 5715
Password 478753
If you have questions please contact advancedpractice.ucsf.edu
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APP Education Stipend
Change to Quarterly submission
Effective October 1, 2022, The APP Conference/Publication Stipend application will be due on the 1st Friday of the following months: January, April July, October. This is a change from rolling submissions. Please note that if you awarded the stipend, submission of the receipts are due within 25 days from the end of conference. For more information, click here.
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Justice, Equity and Inclusion News | |
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Latinx Heritage Month: Virtual Ofrenda 2022
Ongoing until October 31, 2022
You are invited to join the collective Latinx organizations & the Multicultural Resource Center at UCSF in participating in their virtual ofrenda (offering) by placing an object, image, and words to dedicate to a loved one. Please honor and respect this space.
Click here.
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Emergency Paid Sick Leave (EPSL) extended until December 31,2022
This is in line with the assembly Bill, AB 152, that Governor Newsom signed on September 29, 2022. This bill extends the employee entitlement of COVID-19 supplemental paid sick leave to Decemeber 31, 2022. The Univiersty is providing up to 80 hours of 2022 EPSL for full-time employees and the two-week equivalent for part time employees. This is not a new allocation of 80hours. Its the same 80 hours that employees are eligible to use up until September 30, 2022, but now has been extended until December 31, 2022. Click here for more details.
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New APPs Who Joined UCSF Health
Please extend a warm welcome to our newly hired APPs
Emily Davenport Alonso Thoracic Med Onc
Mythilla Karunaratne, NP Cancer Center
Alison Kast NP Clinical Decision Unit
Jennifer King, PA OrthoSpine
Jessica Treiber, PA Ortho Pediatrics
Annie Li, NP Gyn surgery
Amanda Ling, Psych ZSFGH
Mayra Mendoza CRNA Anesthesia
Hannah Myers, NP Obstetrics Clinic FOGG
Patrick Nguyen, PA Radiology ZSFGH
Zaira Torres NP Cancer Center
Joanna Yu, NP Anesthesia
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APP Job Corner
Refer an APP colleague to work at UCSF and potentially earn $2000 for yourself. For more info: referral program
Be sure they note your name at time of application submission.
There are many new postings for October 2022
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Quality and Safety is a True North Pillar and a Strategic Priority at UCSF Health. The goals are to achieve zero harm and to improve clinical outcomes. The Standardized Infection Ratio (SIR) is a statistic used to track healthcare associated infections over time. In 2021, compared to all other UC Medical Centers, UCSF had the highest SIR rate with Catheter Associated Urinary Tract Infections--meaning UCSF had the most hospital acquired infections.
The introduction of indwelling urinary catheter removal protocol is one tactic to reduce CAUTI's as prompt IUC removal is a key cornerstone of decreasing the risk of CAUTI.
What is the nurse driven indwelling urinary catheter (IUC) removal protocol?
The bedside nurse will review the patient’s clinical indication for a IUC every shift, and if a clear clinical indication is not met, they are authorized to remove the IUC. The first call provider will be informed via page or Voalte that the IUC was removed. All foley catheter orders will default to the nurse driven IUC removal protocol unless the ordering provider chooses to opt out by selecting one of the four provider-driven indications for an IUC.
What is the provider driven indications for placing and maintaining an IUC?
For patients with the following conditions, providers can opt-out of the RN-driven IUC removal protocol and place a provider-driven IUC order:
- GI, GU, Gyn, or OB surgery or pelvic trauma requiring IUC
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Chronic urinary obstruction and not a candidate for clean intermittent catheterization (CIC) – note that urinary obstruction during the hospitalization does not count as chronic urinary obstruction
- Difficult IUC placed by provider (e.g. urology consultant)
- Undergoing continuous bladder irrigation, bladder pressure measurements, or medication administration via IUC
If one of the above indications is applicable to the patient and selected, the provider must place a “remove foley catheter” order prior to the foley being removed by the bedside nurse.
What are the clinically accepted indications for placing and maintaining an IUC?
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Need for accurate hourly I&O in critically ill patients (e.g. you are actively adjusting care on an hourly basis based on the I&Os)
- Acute urinary obstruction or retention
- Healing promotion for perineal/sacral wounds (stage III/IV) without alternative management strategy
- Required prolonged immobilization (e.g. unstable spine)
- Peri-operative fluid management up to 24 hours post-op
- Specific removal time indicated by order (e.g. “Remove catheter POD#1 at 6 am)
- Hazardous materials contained in urine (e.g. chemotherapy or radiation)
Per protocol, the bedside nurse will remove the IUC when any of the above clinical situations resolves or is no longer applicable to the patient.
What are NOT clinically accepted indications for placing and maintaining an IUC?
- Substitute for urinary incontinence care
- Obtain diagnostic tests when patients can voluntarily void
- Prolonged postoperative use without appropriate indications (see above appropriate indications)
- Routine use for patients receiving epidural anesthesia/analgesia
These are some common examples where IUCs are not clinically indicated, and is not an exhaustive list. Per protocol, the bedside nurse will remove the IUC in any of the above clinical situations or those that are outside of the clinically accepted indications for placing and maintaining an IUC.
What happens if I need strict Ins and Outs to clinically manage my patient? Can I put the IUC back in?
There are other modalities for collecting strict Is and Os for your patient beyond an IUC, and nurses have training to collect accurate urine output measurements using urinals, bedside commodes, urinary hat collection devices, and/or clean intermittent catheterization. There are also external urinary collection devices that have been rolled out across all adult inpatient units. You may discuss the best option(s) for your patient with the bedside nurse.
What if my patient has an IUC but does not have an order for the IUC?
A best practice alert (BPA) will fire during business hours, and you will be able to place an order for the RN-driven IUC removal protocol.
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Poetic Medicine for the "Wounded Healer"
Many of us, whether we identify as being in the "healing arts" or not, have wounds that we understand as the foundation of our own ability to heal and to have compassion for others. In these sessions, we will open to whatever it is we consider our own "wounded places" and allow our poem making to be part of our healing process.
Click here to register for Poetic Medicine For the "Wounded Healer"
Wednesday October 12, 2022 1030-1130 AM
Wednesday October 26, 2022, 1030-1130 AM
Click here for more information
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Effective Communication
Contributed by Mike Rabow, MD, FAAHM
Director, Symptom Management Service
Medical Director of Palliative Care, Helen Diller Family Comprehensive Cancer Center
Director, The MERI Center for Education in Palliative Care at UCSF/Mount Zion
Associate Chief of Education & Mentoring, Division of Palliative Medicine
Over time, clinicians can help patients cultivate "prognostic awareness" (a capacity to understand one's prognosis and the likely illness trajectory"
In 2013, Vicki Jackson, MD, the Chief of Palliative Care at Massachusetts General Hospital, wrote a seminal paper with her colleagues about “the cultivation” of prognostic awareness (J of Palliative Care. 2013:16,894). The idea is for patients to truly and accurately understand their prognosis (and then make the best decisions for their care), patients must develop, over time, not just an accurate cognitive understanding, but also an open, realistic emotional understanding and acceptance of the prognostic estimate.
“Early in the course of illness” Jackson writes, “although most are provided with statistical information about their prognosis by their oncologist, many patients react to the information they have received in ways that leave them unable to make personal or medical decisions. Some patients react by not wanting to think or talk about their prognosis. Others feel the information does not apply to their situation or cognitively integrate the information but feel too emotionally burdened and decide to put off dealing with their mortality until a future point.”
Click here continue
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Ivette Becerra-Ortiz, DNP, MPH, NP, RN, NEA-BC, C-PNP Chief of Advanced Practice Providers | |
Kurstan Del Rosario Senior Operations Analyst | |
Tara Valcarcel, MSN, RN, CPNP-PC Director, Pediatric Advanced Practice Providers | |
Roseanne "Rosie" Krauter, FNP-BC, CORLN Director of Clinical Systems | |
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Brandon Sessler MMS,PA-C
Director of Professional Practice Fellowship Coordinator
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Alisa Yee, MSN, ACNP-BC
Director of Operations
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UCSF Health PRIDE Values Professionalism • Respect • Integrity • Diversity • Excellence | | | | | |
