Perinatal Safety & Quality Specialist Leverages over 25 years of Experience to Transform Nursing ...

Thank you for joining me for another episode of the Nursing Strategies for Success podcast with this episode's guest, Jeanette Zocco. Jeanette is a leader in the perinatal quality and safety arena with over 25 years of experience in obstetrics. She has worked as a bedside nurse, charge nurse, clinical nurse leader, a perinatal safety nurse, and quality improvement performance specialist. She is known for developing innovative perinatal quality and safety programs in collaboration with multidisciplinary teams.

So let's welcome Jeanette to the show.

Welcome to the Nursing Strategies for Success podcast, brought to you by The Nurse Speak, a show where we rally some of our nation's greatest nurse leaders, educators, experts, and advocates to tackle some of our greatest challenges that the nursing profession faces. My name is Damion Jenkins, and I'm your host for this show. So sit back, relax, and get ready to learn that nurses can do anything.

Okay, Jeanette, thank you so much for joining me on the Nursing Strategies for Success podcast. Why don't you take a moment and introduce yourself to the listeners? Let them know a little bit about who you are, where you started in nursing, and where you are today.

Well, good morning. Thank you, Damion Jenkins. And so first off, thank you so much for giving me the opportunity to speak today. Um, so my name is Jeanette Zocco and I'm a perinatal quality and safety specialist and I've been a nurse for 27 years. I started, the majority of that has been in the perinatal space. I started off as a bedside nurse working antepartum, postpartum, and newborn nursery, and then really spent the majority of my time as a labor and delivery nurse. And that's the majority of my time at the bedside. Then I moved on to a nurse leader role as a clinical nurse leader, perinatal safety nurse, and most recently, I'm in the role of a perinatal patient safety program manager.

Wow.

For a healthcare system within the state of Connecticut. And also along the way, I authored a book.

Nice.

A study guide.

Awesome. So you've done a tremendous amount of work. And first of all, thank you so much for all of your years of dedication to patient care and nursing excellence. I'm sure you've not only helped, you know, thousands of families, but you've also helped probably hundreds and hundreds of nurses also in their career in the profession specialty that you're in. So thank you so much for that. All right, so let's talk about it. What is the thing, right? So you have lots of experience, you've seen lots of things, probably a lot of really amazing things, some not so amazing things, but it sounds like you're in a space of advocacy and you've written a book and we wanna talk about that book a little later. But let's talk about what is the challenge that you've seen in nursing that you wanted to be a part of the solution?

Sure. So I think the challenge is sort of multifactorial.

It's never one thing, right? It's never just one thing, right?

Okay.

So let's, if we, if we must, let's touch on maybe 3, right? 3 of the main things.

All right, so number one, we know that there is a significant amount of preventable harm within our healthcare system, right? So we can talk about impact on the patient.

Mm-hmm.

So this was initially highlighted in 1999 by the Institute of Medicine with a landmark report called To Err Is Human: Building a Safer Health System. Does this ring a bell a little bit?

Yep, sure does.

So 44,000 to 98,000 deaths occur yearly from preventable medical errors. And since then, the literature has demonstrated similar results and validated those findings. So we know that in a lot of these instances, it's preventable harm. So there's— the takeaway is that we can do better. And that's really looking at all areas of healthcare. Specifically, the issue in the perinatal space is maternal mortality and morbidity. So deaths and significant complications that are pregnancy-related that can occur in or around the birth process. So the problem here is that the US is a significant outlier in comparison to other industrialized nations in terms of our rate of maternal mortality. And when we look at the causes of maternal mortality specifically, the majority of these cases, again, similar to what the IOM and other literature has shown, the majority of these cases are preventable. Again, the takeaway: we can do better here.

Yeah.

And the solution partly is quality and safety work and culture change and teamwork. So that's really a huge— those are the big buckets of work that my work has centered on.

Right.

And the culture and teamwork, I think when you talk to nurses, that is some of the angst and frustration when there is not a safe culture where they feel empowered to speak, speak up, where they feel safe admitting mistakes or reporting errors, where they feel like there's good processes in place and teamwork with their colleagues. Those are sort of the big issues that are out there.

Well, I would agree 100%, and it's not just in the pericare space, right? It's not perioperative, it's not any of that. It is everywhere. If you don't have a really good work culture, and if you don't have a supportive team that is there to assist you when you need that help, then that leads to burnout, resentment, shortcuts, doing the bare minimum, using up all your PTO and sick time because you need mental health days because it's so frustrating for you to come to work. And this is systemic across every system, every facility, every specialty. It truly is a problem that a lot of us in our positions are really struggling to find ways to manage. And of course, we know all the right things to do, and we implement these processes. And over time, with continued support and consistency, we can get there, right? I think you and I both have the experience where we have contributed towards transforming cultures and improving these outcomes through that work. But we alone are only one person, right? So if we don't have a supportive team around us, then we can only do so much ourselves, right? And so that's kind of, you know, where I've been for the last maybe 7 or so years of my nursing career is really trying to facilitate these ideals into organizations, whether it's academic or whether it's clinical, to really formulate these teams that are going to support one another and build the culture that we all want and deserve. Right? Because we need it not only for our own professional growth, but also for patient and resident outcomes. If we're not doing well as a professional, then how are we going to deliver excellent outcomes? It's just, it's impossible, right? So, awesome. So, I mean, that's really important. And did you have any more to share about any other additional issues that you may have seen that had led you to pivot yourself into leadership and/or advocacy? Beyond, you know, the culture and lack of team support?

I think those were really the big buckets, and there's a lot to all of those.

Multiple.

Areas of opportunity. Yeah, and I can speak to, for instance, you know, process work. I think having efficient processes in whatever we do is so critically important. And I'll give a quick example. I presented at an AWHONN conference in New York about implementing obstetric rapid response teams in a, like, a mid-level teaching hospital in the Northeast and my experience in taking a team through that journey. Well, that's process, right? It's an evidence-based process. We know that we have better outcomes when we have a standardized response to emergencies. Instead of all hands on deck, everyone responding to that bradycardia, which is the most common scenario in labor and delivery, having a predesignated team. And this is like a standardized team that we've developed ahead of time, everyone knowing their roles, everyone knowing what the response looks like, a quick notification process so that we're not trying to remember all the people who need to be called and managing all those callbacks, but it's a swift activation. And then we get the patient to the OR where they need to be with the people who need to be there in a timely manner with a good outcome. So when you have processes like this in place, it creates efficiency, it creates improved outcomes, And it creates better satisfaction in your, your work environment. If I, as a nurse, know exactly what I need to do and I perform well and I have a good outcome, that makes me feel good about my job. And unfortunately, there may be times where there's a bad outcome, but again, I know if I did everything in my power along with my other colleagues, then that makes it a little easier to work through the triggers associated with sometimes bad events, right?

Absolutely.

So having those standardized processes is a key part of quality and safety work.

Yeah, for sure. And, you know, piggybacking off of that, in my years of being an educator and having to validate folks for their understanding in these processes, that alone If there is clear-cut instructions, directions, ongoing review and validation to make sure they don't lose those skills, that's so important because, you know, throughout my years I work with some of the brightest nurses that I've ever worked with, but if they're not reviewing some of these processes and protocols on an annual basis at a minimum, they may not remember those things, right? And when the situation does arise, they also don't feel prepared. And so, you know, making sure that that in addition to creating these very clear processes and protocols, documenting them, teaching them, validating the initial learning, but it has to be also ongoing learning, which I think a lot of organizations sometimes fail to put the resources in place to make sure that's happening. You know, they do pretty good with onboarding. You know, they make sure we have enough manpower to do onboarding typically, but then it's the ongoing review. The ongoing validations that I think sometimes fall through the cracks. And so it would be very important to just make sure that your initial work doesn't get lost by having that ongoing review, right?

Yeah, and that is such an incredible point, Damion. You're speaking to sustainability, and a key part of quality and safety work is having a plan for sustainability on the— initially when you are implementing any type of process or change or bundle, whatever it happens to be. So just like you're saying, making sure that we are including this education in your onboarding and then threading it into consistent ongoing education. So, and there's lots of different ways that you can do that. You can have in situ simulation, depending on what the topic is, you can have in situ simulations to reinforce the content. You can, ask folks to debrief after events occur, to reflect on the experience, reflect on what happened, and to reinforce key concepts. But having that sustainability plan is certainly key to making sure that the process sticks, people understand the why behind it, and that work continues. And unfortunately, I have to say, I've learned the hard way. And I've had to redo work at times because I didn't have that good plan in place. Right.

And it's important to create that in the initial, you know, before you even release the education, right, to have that sustainability plan. How are we going to do ongoing review? How are we going to ensure that our clinicians are able to maintain this competence level despite the infrequencies of these events, right? Because, you know, our emergency events, hopefully are infrequent. And so, you know, things like a code, for instance, you know, some nurses can work 10 years and never see a single code. And I've been fortunate enough as a, you know, clinician to never personally have a code for any of my patients that I've cared for. So, if I'm not teaching the work or reviewing the work, then I may forget those key concepts and the algorithms and the protocols of what to do in that event. So, it is really important that we have this. And so, one thing that I've also noticed is, you know, sometimes people who make the decisions, right, in organization leadership positions, sometimes they don't really think about making sure that these things are in place. And it takes folks like you and I, you know, managers, charge nurses, DONs, directors, that kind of thing, to make sure that we have those in place. But do you have any tips for even the bedside nurse, someone who's doing the direct care, on how they can advocate for their own ongoing continuing education? Because sometimes they just wait for someone to come to them and say, hey, you have to do these reviews, you have to do these courses. Um, what would you recommend for someone who's feeling like they need more information or need more help in a certain area to be more prepared?

So, I mean, I think there's different, uh, um, suggestions for the bedside nurse. I think they can advocate for themselves by going to their educators and their nurse leaders and saying, hey, you know, I'm noticing, you know, maybe they're noticing a theme or an issue that's come up and we could really use some education around this, or we could really use some process work around this. I think that's, that's huge in connecting sometimes leadership with some of the key areas that staff need to focus in on, and it's so important. I think one of the things I've always done is I always go to that frontline staff for their input.

Absolutely.

Because they are so important in anything we do and getting their input. But the other thing that folks can do is educate themselves so they can learn about quality and safety work. If there's specific topic areas that they want to focus in on, there's, there's so many resources out there. Certainly getting certifications is a way to elevate practice. So there's, there's a lot of different resources, but you kind of have to seek those out on your own as well. There's conferences. I will throw out there that the book I created talks a lot about, or really is focused in on quality and safety and is a great resource for bedside nurses to, to learn sort of the history behind it, how it evolved, the different aspects of quality and safety, including teamwork and communication and how you can take a team through quality and safety projects. I also think that staff nurses can get involved in clinical leader programs, and that is just, it's just phenomenal because it forces you to actually maybe do some research, do some projects and get a little uncomfortable in doing some of that work and expand your practice.

Absolutely. And, you know, I've also noticed that the good old, like, safety committees and things like that kind of fell to the wayside. Of course, with the pandemic, a lot of those, you know, what I— what some people would consider, you know, career boosting journeys or whatever the case may be, it's going to benefit not only yourself as a professional, but also your colleagues when you share that information with them. You know, early in my nursing career, I was a committee chair for every committee possible because I wanted to learn and I wanted to expand my clinical competence and I wanted to be able to help others when they felt incompetent or unsure of their own practice. And that's something that we need to bring back really kind of, you know, diligently. We need to work on reestablishing those committees, but, you know, not making it a burdensome task at the same time because, you know, delivering the patient care is already complicated and takes a lot of time. Time, but ensuring that our frontline staff have the opportunity to have paid hours to work on those committee initiatives. It's something that I find very important that organizations should invest in. Just budget a little bit of extra time, maybe, you know, a shift a month or something like that, where they can spend time doing the work that needs to be done to drive the initiatives for the committees. That in itself is something that's helped me throughout my career, and I know it can certainly help others as well.

Yeah, and if I could just add to that, if nurses are able to come out of staffing for meetings, it's really helpful because they're already there.

Correct. Correct. They need to come out of the numbers to fully engage in those meetings, be present, pay attention, contribute. And it's the same for in-services as well. I believe that in-services should also be when they're not trying to juggle a patient assignment at the same time. So, you know, one of my main jobs in my current role is to facilitate in-services for the facility. So I make sure I cover all hours, all shifts, even weekends, to make sure that people have an opportunity to come in, clock in either before their shift, stay after their shift, and/or come in on a day off and get paid for their time. To engage in that learning because that learning is so essential for their performance and for our patient outcomes.

Yes, multiple opportunities is what— multiple opportunities, making sure you're getting them at all different times. And I could, if I could add, Zoom is so great because people can still get paid but join in from home if it just if they don't wanna come in for that hour. I think that's a nice opportunity that we didn't have years ago and we do have now. In terms of committee work, as QI and work processes are being implemented, let's say you were, you're working on hemorrhage. I just wanna add, oftentimes you're forming a quick work group that's really only going to meet like a couple of times until you get like the work up and running. So sometimes you're just asking folks to commit to like 4 hours, 1 hour a month until you can get it into place. But giving them the opportunity to take part in the work, making sure that it works for their time, like it's a good time for them to, to meet, is just other things to consider in engaging staff.

Yeah, absolutely. And I think anyone listening to this episode would, you know, be able to take all of these strategies and implement them directly into practice. So whether you're a new nurse at the bedside looking for ways to improve the process within your own setting, or you're an experienced nurse looking to reestablish that QI process on your unit, because your managers and maybe the directors of your department are already swamped and they can't take on the load by themselves. We all have a part to play into creating the environment and the patient outcomes that we want and deserve. So, it really is an everybody in type situation. You know, certainly there's going to be people who are not interested in being part of the committees and things like that. They want to focus on just being clinicians, and that's fine. We should always, honor everyone's strengths and weaknesses and try to make sure we put people in the right places. But anyone who's interested in really kind of taking on that ownership of the unit, for instance, or department, then certainly by all means, try to organize a committee and see how you can improve change. It's amazing when you have at least 3 or 4 people interested who work on it consistently, the change starts to happen. It's pretty cool how that works. All right, Jeanette, so let's talk about your book, right? So you wrote this book. What's the title? Where can people find it? And, you know, what are the, the main concepts that people can get out of this book?

Sure. So this book is a study guide for the National Certification Obstetric and Neonatal Quality, um, Obstetric and Neonatal Quality and Safety Certification Exam. It doubles as a general resource for all things Quality and Safety for Perinatal Nurses. It is on Amazon, it's self-published, and it's titled exactly as really I just said, Obstetric and Neonatal Quality and Safety, CONQS Study Guide, a Practical Resource for Perinatal Nurses. And essentially I originally intended to be just the study guide and I used the NCC, guideline that they provided on, on their website. And it has historical information on the quality and safety movement within the United States. It touches upon different quality and safety methodologies, improvement approaches like Lean, Six Sigma, the IHI Model for Improvement, PDSA, It talks a lot about TeamSTEPPS in teams, team training, the role of leadership. So that's just to name a few. Mm-hmm. I did make a point of putting in lots of patient examples and case examples and stories because I think that's an easy way to demonstrate concepts and make it applicable to real life.

Right.

Um, I like to say it's not a PhD read, so it's not too complicated that you have to like take notes and try to figure out exactly what it means. It's very much plain language, easy to read, designed for at the end of a long shift if you want to pick it up and read and get some key takeaways, you can. But there's a lot of things that you can take right into your your clinical environment and implement. And again, it was, you know, it's written through my lens. So I've lived in the space for a long time, and I gave some tips and tricks as to what can be helpful for implementation that I found to be successful in my practice in working with the interdisciplinary teams.

And you know what, I think all educational materials unless you are working on that PhD or DNP, should be written plainly. It's been one of my biggest gripes throughout nursing education ever since I was a student, that sometimes the theoretical explanations are too abstract, right? They're not quite concrete enough for them to be practical for a new nurse learning how to apply these concepts. And oftentimes, you know, despite the best effort, not all nursing programs and/or instructors or professors have the ability to break down the concepts in a way that just makes sense for the new learner. They're so smart, right? I give them credit of being so smart and so theoretical that sometimes it just comes off sounding like textbook. And so, You know, one thing that I've really done with all of my educational materials and trainings is that just break it down, make it simple. We wanna be able to teach someone as if they know nothing so that way they can just put all the pieces together. And as they move throughout their career, we can make the information more conceptual and less, you know, concrete because they already understand those foundations. So just, you know, so the fact that you wrote it, as you explain, is kind of on a simpler read. I love that. I think it's super important because we're all busy and if we have to figure out what we're reading, then we're going to put it down. We're not going to keep reading, right? We want something that we can get that's going to help us right away and that we can start applying right away. So I, I'm, I'm interested in getting your, your study guide, even though I probably will never go for that certification because that's not my specialty. I think just being able to read it and take away some of the key concepts you have in there. Would be very interesting for me. So I will have the way that people can connect to your publication in the show notes of this episode. Do you have any other connections or ways people can find you in the world that you would like to include?

On my website, if people want to pop over there, obneonatalstudyguide.com, there's actually a lot of free resources. So I have articles that I've published on there and different tip sheets. So you're welcome to kind of pop around over there and check it out. And there is also a weekly email that folks can subscribe to for lots of just free quality and safety content. Again, you know, my goal is really just to spread the word and inspire passion and more work in, in the related field.

Awesome. Well, thank you so much, Jeanette, for joining me on the Nursing Strategies for Success podcast. I think the work that you are doing is tremendously important, and I want to thank you personally for the work that you're doing. I know you're helping so many people, um, so I look forward to staying in touch, connecting more, and maybe we'll meet up in person one day.

That would be awesome, Damion. Thank you so much. And, uh, yeah, I hope I'm trying to do a little bit of good out there. So, uh, thank you for having me today. Thank you for your work as well.

Thank you, my pleasure. We'll talk soon. Take care. Okay, bye-bye.

And that concludes episode 11 of season 3 of the Nursing Strategies for Success podcast with this episode's guest, Jeanette Zacco. We hope that everything we shared for you in this episode will help you lead the charge and find your success within your nursing profession. All the ways to connect with Jeanette will be in the show notes of this episode. And as always, if you have any questions about anything we shared, feel free to visit thenursespeak.com/contact and get in touch touch with me. I would love to have a conversation with you. So until next episode, take care, be well, and remember that nurses can do anything.