N
ursing
Dear Nursing Colleagues,As I shared with you in my letter at the end of last year , the fiscal environment for healthcare organizations and healthcar e employees is extremely challenging but, in spite of these difficult circumstances, Kaleida Health nursing achieved much in 2011.
In the new year, I would like to reiterate my commitment to you,
our patients and to quality. As I solicit your suppor
t and leadership to move forward and continue our success and impr
ove our circumstances in 2012, I would also like to shar
e a New Year’s resolution. Many of us make New Year’s resolutions with the best of intentions but by February, resolutions start to fade along with holiday lights and wishes. I
made a resolution this year that I intend to keep. I would like to shar
e it with you. I have resolved, despite challenges at work and home, to be mor
e grateful and not allow myself to fall into being a victim by my own doing, the “poor me trap.” I have always
felt that one of the greatest “gifts” of bedside nursing was the feeling of personal gratitude. No matter what was going on in my life or with work or school, I was not the one on the stretcher or in the bed. That thought always pr
ovided me with a sense of grounding in regard to priorities and puts life’
s concerns in perspective. On that note, I plan, to a greater extent, to promote a sense of “gratitude” thr
ough leadership, to lead with a greater sense of purpose and determination, to cr
eate opportunities for innovation and strategy, not just respond to challenges. T
o get ahead of the curve, to do this I need to ask each of you to take a greater leadership role at the unit level; be
relentless in our goal for patient quality and safety
, truly deliver patient focused care and embrace change and be open to the possibility that change may pr
esent its own opportunities for each of us professionally and personally
. As bedside leaders, I look to you to create solutions to deliver care in a more effective and efficient manner
, to lead by example, see the glass not only half full but filling up.
The IOM’s, Institute of Medicine’s 2000 Report, “To Err is Human,”
quantifying medical error and listing it as the eighth leading cause of death in our countr
y, clearly identified nurses as the best person to catch medical err
or. The IOM’s report a decade later, “The Future of Nursing Advancing Health,”
sees us, nurse professionals as critical in ensuring the health of the nation. It also asks nurses to “fully practice,” which includes the roles of advocate and bedside leader
. Leadership at all levels will see us through this challenging time of
transition and position Kaleida Health nursin
g to lead with changes to healthcare and create a new and improved care delivery pro
cess that is satisfying to patients, families and to us as nurses.
Sincerely,
• Nursing Leadership .. pg 2-5
• Education and Patient Safety ... pg 5-8
• Hot Topics ... pg 8-9
• Nursing Research....pg 10-11
• News at The Sites ..pg 11-18
• VNA ... pg 18-20
• Long-Term Care
... pg 20-22
• Upcoming Events
... 22-24
Spring ~ 2012 ~ volume 5, issue 1
Nursing
Leadership
34 Year Nursing Veteran
Re-energized by Education
Mickey Monte is a nurse on 2E at MFSH; a nurse for34 years and in November, 2011 completed the Kaleida Daemen Executive Leadership and Change graduate program. “The program has given me a lot of strength”, Mickey shares, “I feel reinvigorated
regarding nursing.” Mickey admits she is as passionate today about bedside nursing as she was when she graduated from the E.J. Meyer School of Nursing in 1978. She says even in challenging times, and there have been many in her career, she is positive and her perspective is “what can I learn from this rather then poor me.” Mickey, now in her three plus decades of nursing, says that she finds herself mentoring new nurses in the same ways she was mentored. Mickey was a nurse’s aide at Deaconess while attending nursing school and was mentored by a seasoned nurse by the name of Grace. Although not the formal mentoring program we have today, Mickey attributes her success and love of nursing to the guidance and support she received from Grace in her first year. She says the bonds between herself and Grace and the support she received were so wonderful that one of her daughter’s
middle name is Grace, after her mentor.
Mickey returned to school for her BSN after her daughters had finished college; she had always wanted her BSN but waited for her girls to finish graduate school. The opportunity to
participate in the Kaleida leadership program came as Mickey was just completing requirements for her BSN. She says it was fortuitous and she really loved it. Mickey says she was a bit intimidated by some of the managers but quickly gained confidence and plans to continue in the program.
Mickey has had an impressive career with recruiting, supervisory and leadership experience. She left management in the late 80’s but returned to Kaleida in 1992 to 2 North. She loves vents and fast paced nursing and caring for families as well as patients. She attributes her ability to deal well with conflict to her
leadership training. Mickey says she is a different person since completing the 6 graduate credits in Leadership. “I’m different at work; I don’t jump to conclusions, I ask a lot of questions, and ask what else is involved here?” She says
she is sharing her knowledge with her co-workers and supporting them to look beneath the issue to find out what they can change to make a difference. As a 34 year veteran, Mickey is use to nurses turning to her for clinical advice but now she feels this has expanded to leadership. She says it feels really good to be helping the team grow professionally.
Mickey thinks this program is a good thing for Kaleida and it will help grow perspective for staff and managers regarding each other. The advice she would give to someone considering the program; “go into it with an open mind; you’re going to learn a lot and it could change your life!”
Nurse Manager Engages
Support Staff in UPC and as
Partners in Care Delivery
Research is clear regarding the impact of the UAP (Unlicensed Assistive Personnel) and RN relationship on quality and patient care. As with all care providers, the extent to which teamwork and authentic collaboration exists can impact unit culture and patient outcomes. The ability to support and integrate UAPs as vital and effective team members willbecome increasingly critical in the next five years with the looming
nursing shortage. (Kalisch 2011) Marlene Schiferle’s (left) unit is
a DEU (Dedicated Education Unit) in partnership with D’Youville College. At a fall debrief of students, faculty and staff, for the purpose of analyzing the model and opportunities for improvement, it was the students who identified
that they were impressed with the engagement of the PCAs on the unit. Several of the students commented on this; “there is a great sense of teamwork here between the nurses but also with the support staff, the PCAs were great, they really helped with our learning and we helped them with baths when we could.” Mimi Haskins, UB instructor commented, “The culture on the unit reflects Marlene’s and the entire nursing team’s leadership; it’s not the norm in healthcare and it made a great environment for the students to learn.” Marlene, manager on 9S at BGH, feels her unit has successfully integrated UAPs into her Unit Partnership Council and hourly rounding; she sees the aides as “super users” to ensure the hourly rounding stays on track. She also has one of her UAPs, Linda Littlejohn, on her falls committee as she points out that “the aides are closest to her patients and the best persons to be involved in solutions for fall prevention.” UAPs are extensions of nurses and it is essential that they and nurses work in partnership to give the best possible care to patients. Marlene says it has been a process, engaging UAP staff in changing the unit culture; it began with identifying that there were issues on the unit with delegation and therefore opportunities to improve. As a manager she said she focused on developing and utilizing strengths and minimizing weaknesses. One of her currently most engaged UAPs was not always so. Marlene says “she was always a hard worker who gave quality care but was not always engaged with the team.” Giving her appropriate responsibilities and time
to participate in the UPC and the falls committee, created satisfaction and over time, enhanced her engagement in the unit and with the team. Marlene says that when they first changed from nurses’ aides to PCAs with increased job responsibilities, it was challenging for both nurses and PCAs to navigate the change successfully. She says it was apparent that, “we as nurses and myself as a manager, needed to invest in them and their clinical development.” Marlene says the enhanced partnership and self directed PCAs has helped make her nurses better nurses. She said last Nurses Week, her nurses chipped in to buy $20 Tim Horton cards for all of their PCAs. 9 South’s newest nurse Laura Hanley, a 2010 nurse residency graduate, led the initiative to recognize the PCAs; Laura feels they are part of our success as a team. Marlene mentioned that her nurses have commented that when they float to other floors, they don’t have the same level of support and commitment from the PCAs and are very proud of theirs. Marlene views the manager role as that of a coach and change agent. Although she has a management career spanning 30 of her 34 years of nursing practice,
she credits her experience in the Daemen Executive Leadership and Change program as giving her greater tools to effectively lead her staff. Marlene will be graduating this May from the program and was a member of the first Leadership cohort in 2009. Managing is important for the day to day operations but developing teamwork requires leadership skills, Marlene shares. She feels “blessed” to have had Peggy Schlotterbeck, SICU manager and BGH nurse recruiter Sandy Boneberg in her cohort; “we learned to be more effective leaders, and how to lead change more effectively.” She also feels it is critical for her and her staff to have a clear vision for the unit and patient care. Marlene says she appreciates the tools inherent in being a situational leader but feels over-all, transformational leadership is essential to respond to the rapid changes in healthcare, technology and practice. On 9S since 1986, she has seen her unit change from neurosurgery to ortho to Hospice and neurology; Marlene sees change and being a continual learner as the only constants in healthcare and nursing. In February of 2012, Marlene’s unit transformed into a ALC Unit.
BGH Staff Nurse
leader makes 5 North
a great place to be a
Patient (and a colleague)
Betty Webber is a staff nurse on 5 North. She can’t tell you exactly how long she has been there but it’s like family, “feels like I’ve always been a part of this unit.” Betty recently planned andc o n n e c t i o n s
N
ursing
organized a luncheon (on her day off) for her colleagues to welcome the new hires on her team. The team and luncheon included nurses, physicians, PT/OT, housekeeping and support staff. Betty decorated the patient/ family lounge, which looked like a fancy bridal shower, with gold table runners, candelabras, flowers and coordinating plates, napkins and silverware. Asked why, Betty says “I like to make people feel comfortable and welcome, it helps people to know someone really cares.”
Betty says she has never done events professionally but likes celebrating birthdays, babies, weddings and just about anything. She likes picking a color theme and the rest just happens. The “just happens” part is due largely to the generosity of Betty who buys the supplies herself. Betty insists this is nothing and that “she is lucky to have exceptionally great people to work with.” Her RN colleague Donna chimes in, “she’s special, I was off sick for a few days, Betty called and wanted to know what she could do for me, even my family didn’t do that.” Additionally, Betty sends cards to everyone on leave and feels these are small things to have someone feel just a little bit better.
Betty is someone who is uncomfortable in the limelight (we couldn’t coax her into the picture at the luncheon). A Kaleida employee for 47 years, since the age of 16, Betty has not planned on retirement yet. “My body will tell me when it’s time, but that time isn’t here yet,” Betty shares. Betty says she doesn’t know where the time went. She attended a high school based LPN program and as part of this she was
allowed to work as a nurses’ aide at age 16. She worked at Deaconess for 16 years as a LPN and then as a RN after graduating from ECC in 1974. When the system merged, she came back to BGH. A great believer and “lover” of education, Betty completed her BSN in gerontology and MS in social sciences in 1980 and 87. During this time she raised three children and in her spare time; buys, renovates and re-sells houses. She shares that her grandmother, mother and now her daughter are all handy. She also buys and fixes up cars and sells them or gives them to people in need.
Betty said she raised her children to be self reliant and had a master calendar with rotating chores from age 9 for each and extras if they wanted to earn allowance. Betty chuckles and shares it took her two sons a long time to get married because “they couldn’t find anyone as good at cooking, housekeeping and ironing as they were.”
What Betty likes best is “helping people.” She credits her strong religious upbringing and shares she was “saved” at age 9. She says this was the beginning of everything in her life. Joining the church early helped shaped Betty’s life and her desire to help and “treat people the way I wanted to be treated.”
Betty says she loves being part in the recovery of patients on her floor. The rehab unit is short term, average LOS is 2 weeks with stroke patients up to 4. Pre-hospitalization, her patients’ most recent address was home and about 90% are able to return after their stay on the unit. Betty says she loves
helping patients severely disabled by stroke or trauma focus on what they can do rather then what they can’t; “we celebrate little accomplishments and then eventually they can go home.” Betty says everyone on the team contributes. Herself a patient, Betty shares the person who most comforted her was the cleaning lady; she was the one who took the time to see me as a person, listen and made me feel better.”
The only thing you can count on is change Betty shares, nothing stays the same. Betty thinks this is a good thing. She encourages new nurses to listen to their patients and think about how important what you say and do is to the patient and the family. She says she learns all the time even when something bad happens. She tries to treat everyone with kindness and compassion and again with a chuckle says “that isn’t always easy, even for a Christian.”
Stephanie Lotito, 5 North unit supervisor, says she is blessed to have the staff on 5 North. “It’s incredibly important to our patients that we work together and we are very good at collaborating and communicating.” Stephanie says that two of the three attending physicians have been on the floor for a long time and credits the unit effectiveness with longevity within the interdisciplinary team. Stephanie shares that the unit is a therapy driven unit and the care plan has to be interdisciplinary to work. Once a week interdisciplinary Rounds focus on where the patient started, where they currently are and what are the goals for the up-coming week.
“Everyone is focusing on getting the patients home; we involve our families in this process,” Stephanie states. She says she can’t credit the team enough for making her job so rewarding. She said the team is looking forward to the opening of the GVI and being able to care for a greater number of patients and their families.
Behavioral Health Nurse
Loves the
Role of Patient
Advocacy
Donna Gatti is a BGH diploma graduate and a BGH RN for almost a quarter of a century. After a year of experience in med/ surg, she joined thebehavioral health team at BGH, where she is a staff nurse on 12N. Donna is chair of her UPC and a member of BGH’s CPC and the corporate practice council, NAC. She is a member of the 4th Daemen cohort and started her first graduate course this past January with 13 other staff nurses who are interested in developing leadership skills to be more effective at the bedside. Donna also plans to start an on-line, RN to BSN program in 2012. Donna was always interested in the behavioral aspects of nursing and originally had wanted to be a social worker. She says when she did her student psychiatric rotation at 80 Goodrich, she was “hooked.” The complexity and acuity of in-patient psychiatric patients has dramatically changed over the past two decades similar to in-patient, acute care. Still,
Donna says her love for psychiatry, her patients and their families hasn’t. Although many patients have underlying addictions as well as an acute psychiatric disorder, Donna says it is critical to meet her patients where they are with their disease, with empathy and without judgment. She feels as a mental health nurse it is critical that she is knowledgeable about, psychiatric and medical disease
processes, addictions and particularly side effects of current psychiatric pharmaceuticals. Donna strongly feels that compassion and understanding are just as important for her to be an effective clinician as are her clinical skills and knowledge. She also feels, despite the high recidivism, that she is part of healing with patients and families. “There is still enormous stigma and shame attached to mental illness,” Donna shares. She feels there is also a myth that mental illness and addictions strike educationally and socially disadvantaged persons more frequently then
others, which is not true. Donna says many of her patients are highly educated as well as professionals. She tells her patients, mental illness is what you have, not who you are; it does not need to define you. Donna says that stress changes brain chemistry, and personality can change
assessment and recognition of disease symptoms. A thorough assessment with both patients and families to understand behavior and functioning prior to admission is essential to assist in establishing a baseline and determining effective treatment. Though some patients may not be able to hold a job, they encourage patients to volunteer. The ability to build self-esteem via the opportunity to do something meaningful for others can be an effective part of healing. Donna says she does look at every patient and family as her own and treats them as she would like her family or friends to be treated in the same circumstances. They look at you with eyes that say, “I’m feeling crazy and scared and I need your help,” Donna says this is what makes behavioral health a great place to practice nursing and intensely satisfying.
Nursing Education
and Patient Safety
Nursing Education Update
Jen Jennings, (left) DNP, MS, FNP-BC Manager - Corporate Clinical Education“Be the change you wish to see
in the world” -M. Gandhi
In Clinical Education we have had a progressive year with a multitude of accomplishments and have worked to achieve consistency in practice, through evidence based analysis ultimately enhancing practice and affecting care at the bedside. Our bedside caregivers remain the focus of our work and we strive daily to ensure quality practice to influence positive
c o n n e c t i o n s
N
ursing
Donna Gatti with WCHOB Nurse Recruiter Cherie Hepp at 2011 Magnet Conference.
patient outcomes. Despite organizational change and challenges, our core and site educators have maintained their focus on quality initiatives and truly epitomize teamwork. We have updated our educational programs and are re-evaluating our educational delivery, to align with 21st century educational standards and offer enhanced education to larger numbers of Kaleida staff. In addition, we have strengthened our collaborations with our academic partners, WNY practice partners and outlying hospitals. We have continued to revise and improve the curricular content of our classes, skill laboratories and simulation learning. Highlighting the “need to know” topics, while offering opportunities for the visual, auditory and kinesthetic learner ensures our classes are efficient and productive while achieving learning outcomes.
Quality
Restraints and phlebotomy re-demonstrations are close to
completion corporate wide to ensure accreditation with DNV standards. Central Venous Line (CVL) removal is an internal quality initiative that is a result of best practice, evidence based literature review to improve our competency and improve patient safety.
Streamline Practice
CPR practice, training and ensuring competence proved challenging for the educators as the target audience varied widely at each site. An educational task force examined current practice corpo-rate wide, synthesized the literature for best practice and national guidelines
for acute care facilities; resulting in a revised CPR policy, target audience and practice to meet national standards. Glucose POCT was an essential project, as this process was inconsistent from site to site, particularly the re-cert process varied widely between Kaleida sites. Our team is in the process of finalizing a proposal that will be presented to the Nurse Executive team as well as oversight for approval in an effort to standardize practice from a corporate perspective.
In an effort to utilize Mosby to its potential, our task force is working toward a goal to solicit specialty committee support/approval to integrate our policy and procedure to reflect Mosby guidelines. This will be a longitudinal process, however with group support our goal is to place a (K) next to the procedures that have been reviewed and approved. We recognize that our Kaleida Health nurses want to do the right thing and review procedures; therefore, the (K) will ensure that they can confidently achieve this in a NY minute.
Support Seasoned Nurses
With transition and movement within the system, we are making preparations to support nursing staffthat are or will be transferring to different units or sites in the coming months. A pathway has been devised to address each type of transfer whether it is a nurse who is transferring from a clinic setting to a medical surgical setting or a critical care nurse transferring from a critical care unit to the emergency department. A learning needs assessment will be completed by an educator with each transferring employee to ensure their individualized learning needs are identified. To prepare for those transferring into telemetry or critical care areas, we will be offering biweekly Basic Knowledge Assessment Tests (BKAT) at different times and different sites to assess further learning needs. Communication is the key in this process. Educators will be working closely with managers and human resources staff to make sure each transfer is addressed. Our goal is to support all nursing staff that is affected by this movement.
Collaboration
Internally, we have re-evaluated our chemo administration competency and jumped on the opportunity to partner with our neighbors that are experts in oncology and chemotherapeutic therapy, Roswell Park Cancer Institute. It was a collaborative approach to offer our RPCI partners education in ACLS, while they offer chemo education and competency consultation. Included in the chemo competency for our nurses on 9S at BGH and at MFS is simulation learning, direct observation at RPCI’s chemo infusion center and a competency checklist with an annual update.
Kaleida Health nurse educators Michele Natwora and Judy Laurenzi at Roswell research day.
c o n n e c t i o n s
N
ursing
Academic Partnerships
The DEU scholarly and research team is making great strides, Dr. Connie Vari as well as Diane Ceravolo, educator Kelly Foltz-Ramos, Jessica Castner, 13N staff nurse Barb Tomasov and myself have recently submitted a scholarly manuscript for publication. We are strategizing with academic and practice partners to present for a fall webinar series to address the local and national nursing community’s interest in our Residency program and DEU models.
Shift Report:
What you share could save
your patient’s life
Kristina Marquez presented her quality improvement poster at the November 16th research day at Roswell Park Cancer Institute, entitled, “Shift Report: What you share can save your patient’s life.” Over 250 area nurses and nursing students attended the event and the project received a great deal of attention and positive feedback from fellow staff nurses who attended the event.
Dr Burnes Bolton, Vice President for Nursing at Cedars Sinai Medical Center in Los Angeles spoke at Roswell Park Cancer Institute. Dr. Burnes Bolton was part of the research team from Robert Wood Johnson and the institute of Medicine’s 2010 “Future of Nursing Advancing Health” Report. One of the major recommendations of the report is to implement nurse residency, or other transition programs, to support the process of applying theory to practice.
The quality improvement poster Kristina presented began during the nurse residency program’s quality improvement session. Kristina Marquez, Kristen Kennedy and Mary
Krebs all work in the CVICU at BGH. As new graduates they all had difficulty with what to share regarding their patients during hand-off. Kurt Adamchick, a fellow nurse from the NSICU at Gates developed an organized “new grad” report sheet and shared it with the nurses from BGH CVICU. The CVICU nurses tailored the report sheet to the
patient population and decided to “share notes,” along with two other new graduate nurses Anne Abramowski and Kristina Rodriguez. They still use this new report sheet to make sure they relay all the information
crucial to the patient’s care and on the opposite end, ask all the questions they need to know to care for their patients when they start their shift. Additionally they have found it even more important since the transition to the EMR; navigating and finding where all the critical information regarding their patients is listed is not yet hardwired so the knowledge that
they relay during hand-off is crucial. All three nurses were 2010 graduates of the University of Buffalo; Kristina was an ABS graduate. The nurses did not know each other at UB but became friends as part of the first residency cohort. Although they all did their senior internship at BGH in critical care, it did not fully prepare them for the challenges of working there as a new graduate. The new RNs all had similar thoughts regarding the value of the residency program, that the ability to share their fears was incredibly helpful. Additionally, even with critical care classes, they felt the review provided in the skills lab and clinically focused classes were very helpful. All three said even after the successful completion of the Residency program they had highs and lows with respect to clinical skills and critical thinking; and the ability to validate and support
each other post Residency was terrific. They are incredibly grateful to their manager, Peggy Schlotterbeck, for seeing the value in the Residency and despite scheduling challenges, ensuring they were able to attend the monthly classes. The 3 grads also give credit for their success to their CVICU colleagues whom they unanimously state, “are the best.” They agree that they were welcomed, nurtured and never made to feel inhibited about asking questions. All agree that not all units have such teamwork and
Beth Nicastro (Left) UB faculty with Kaleida Health nurse resident Kristina Marquez.
Nurse residents-Kristina Marquez, Kristen Kennedy and Mary Krebs.
again give Peggy credit for hardwiring “Huddles” in the unit. Kristen, Kristina and Mary agree that they and their colleagues were a little skeptical about the Huddles
but all agree it helps support teamwork and each other by checking in with their teammates twice a day. The group says they didn’t believe their teamwork could be improved, “we have unbelievable
teamwork in the unit, we have fun at work!” We admit that the Huddle enhanced what we had and definitely focuses on “our patients” as a collective versus “yours.” Kristina says “Peggy hardwired the Huddles in a strong yet gentle manner; it does so much good for nurses and for patient care and provides the ability to support each other so we can deliver the best care.”
Kristina, Kristen and Mary were part of the 2010-2011 nurse residency cohort along with about 90 other nurses from local hospitals. This year, an additional 76 new graduate nurses are benefiting from the monthly professional development sessions hosted by Kaleida Health and attended by nurses from Roswell, ECMC and the VA.
Behavioral Health Educator
Supports Training for
Customer Safety
Mary C. Genzel MS, RN, BCContinuing education programs are linked to employee retention and improved
patient satisfaction. According to research by Srinivas (2008), staff training is related to retention when it is on-going.
During the first week of May 2011, Todd Casey and Ray Hole, RN’s in BGH Emergency Room and myself, attended a program which ultimately led us to become certified Crisis Prevention Institute (CPI) Instructors for Nonviolent Crisis Intervention®, an international
training program.
“Crisis intervention is a small segment of time in which staff members must intervene with another person to address behavior that may escalate into disruptive or even violent incidents.” The goal of the program is to interact in a way that provides for the Care, Welfare, Safety and Security of all involved in a crisis situation. Care - showing compassion and empathy,
Welfare - supporting emotional and physical well being, Safety - preventing danger, risk and injury and Security
- ensuring harmony - not harm. The Nonviolent Crisis Intervention®
program clarifies basic elements of violent behavior and then strives to balance practical applications and humanistic concerns.
Behavioral Health (BH) has been providing Assaultive Behavior Management training since the late 1990’s. Since 2009, BH has utilized the CPI Nonviolent Crisis Intervention Program® and in 2011 implemented
a CPI Training Program provided 2 times per month. Our goal is to have the CPI Nonviolent Crisis Intervention®
program become integrated into continuing education for the BGH Emergency Room.
Hot Topics
CPR Change
Registered Nurses
Licensed Practical Nurses
Respiratory Therapists
Radiology Technicians
Mental Health Workers who provide direct patient care, will perform CPR for a patient emergency. For other unlicensed healthcare workers, performing CPR will NOT be a job responsibility even if you are certified or may perform these skillsONLY:
Todd Casey and behavioral health educator Mary Genzel.
in another job capacity outside of Kaleida Health. This may be a change in practice for some individuals. Responsibilities would still include dialing 7911 to call the Code Blue, bringing emergency equipment to the bedside, assisting visitors and other patients on the unit and running errands.
For questions, please contact your manager.
Transfusion Related Acute
Lung Injury – TRALI
TRALI is a rare but potentially fatal reaction to blood products.
TRALI is characterized by acute non-cardiogenic pulmonary edema following a blood transfusion.
TRALI reactions have been reported most frequently following plasma components
(FFP) and uncommonly following platelets or RBC. The mechanism is not fully understood and is believed to be associated with the presence of anti-HLA and/or anti-granulocyte antibodies in the donor plasma. (i.e. multiparous females and donors who have previously received transfusions).
TRALI usually occurs within the first two hours after transfusion, but can happen as long as six hours later. The diagnosis is made on the basis of clinical and radiographic findings. There are no classic laboratory findings associated with TRALI reactions.
Signs and symptoms may include but are not limited to: dyspnea, respiratory distress, acute hypoxemia, fever and tachycardia. Radiological picture is that of bilateral pulmonary infiltrates without evidence of cardiac compromise or fluid overload.
Interventions for this type of reaction should be guided by the physician, as per policy CL.53 Adult/Pediatric Transfusion Therapy.
Changes in: Adult Influenza/
Pneumococcal Immunization
Policy
1. Screen all inpatients during the admission process in the Immunization Summary on the Patient’s Admission History in PowerChart. Complete Adult
Pneumococcal/ Influenza Vaccination Orders (KH01183) for downtime. A standing order is in policy for adults - an attending MD would have to order NOT to administer:
Pneumococcal Vaccine-(not seasonal) All adult patients 18 to 64 years with chronic health conditions or 65 years or older admitted to Kaleida Health year round.
Influenza Vaccine (seasonal) – September –
March - all patients admitted to Kaleida ages 18 years or older
2. Obtain Consent - patient to read and sign Vaccine Information Sheet (KH01159 - Pneumococcal; KH01160 - Influenza); if patient refuses, document on screening database.
3. Scan SIGNED Vaccine Information Sheet (VIS)to pharmacy - triggers delivery of vaccine dose to unit. Retain original in medical record. For sites with CPOE, RN to enter the appropriate order using the “Initiate Influenza/Pneumonia Immunization” protocol.
4. The vaccine(s) will be scheduled for the next routine medication administration time - unless patient refuses, is contraindicated or as directed by their physician’s written order.
5. Document the administration of the vaccine in Bridge and
PowerChart under Immunization Schedule Tab document vaccine name, manufacturer, Lot #, expiration date, dose, unit of measure, route, site, date and time given, Vaccine Information Statement (VIS) date and your initials. Check appropriate box if patient not given vaccine - refused or reason for contraindication. 6. Reassess the patient for adverse effect-check for signs of adverse
reaction-substantial adverse reactions are reported to Pharmacist (Policy CL.32).
c o n n e c t i o n s
N
ursing
Nursing
Research
Mergers, Survival and
Bedside Leaders
Jessica Castner, RN, MS Kaleida Coordinator for Nursing Research Literature on merger can be summed up in three stages: 1) grief and loss
2) survival mode
3) strategic alignment to improvement As a nation, we are very good at reacting and describing what we dislike around us. Success in integration and merger depends on the opposite: a clearly defined vision, an end result that we are all willing to work towards together. Creating a vision involves thinking of a future we, as nurses, all want to be true. A compelling vision is one that concentrates on what makes us unique. For example, envision the most skilled nursing workforce caring for the most complex patients and achieving the safest outcomes. Envision an organization that makes the most intelligent use of professional nurses’ time and talents, eliminating wasteful and unnecessary practices that exhaust compassion. Visioning helps us see through the grief and loss, pulls us out of survival mode and helps us align our efforts together for better patient care. Without a vision, we often feel like new initiatives
and patient safety improvements are a flame lit underneath us that burns,
rather than a flame lit in our hearts to move us forward.
As organizations restructure, we lose members of our work family we may care deeply about—people who mentored and supported us. It is common to experience grief and loss about our work “home” – the changing physical space and our work “family” - the changing culture and work groups. It is imperative that we anticipate, accept and structure healthy expressions for grief and loss for ourselves and our co-workers. Something big and important is over; the work as we knew it before the merger, but it is time to ask, “What else do we want to be over now?” As we cope with loss, we can face an opportunity for incredible change. Ask yourself and those around you what would you like to be over as we integrate and redefine–negative work environments for nurses? Poor
delegation practices? Workplace bullying? Making excuses instead of updating our knowledge? Without frontline staff taking control of making positive changes in integration, grief
and loss can spiral into a cycle of uncertainty, anxiety and resistance— leaving improvements in patient care at risk. Business research indicates that merging worksites and companies often fail to achieve the planned financial and productivity results because they get stuck in survival mode. Short-term financial crises and organization - member dissatisfaction are common. Setting short-term goals like just getting through the day or just getting through the merger can actually result in worsened outcomes for patients. We can’t wait until after the integration to determine best practices and the long term goals. We can’t wait until after the integration to envision the future worth working towards. Nurses, as the heart and soul of the hospital, are at particular risk for the negative impact of getting stuck in survival mode. In survival mode, we may have very clever strategies and initiatives, but we may work inconsistently. Survival mode is about workload; workloads increase drastically without ever moving the ultimate outcome like patient satisfaction, falls and pressure ulcers. An organization in survival mode sounds like a challenging and unhappy place for a nurse to work, and we must work together to set forth a clear vision to pull out of survival mode as quickly as possible.
Integrating and merging organizations face overwhelming challenges which can be a danger and an opportunity. Let’s take this opportunity to work together towards a vision of skilled and
Nursing leadership-Jodi Witherell, Mary Beth Campo, Jessica Castner, Sue Brooks and Gates staff RN-Amy Klopp.
compassionate care, coach each other towards lifelong learning, engender opportunities for bedside nurses as system and care leaders and ensure strategic direction that allows for the voice of bedside nurses to drive system improvements.
News at the Sites
BGH Nurses Participate in
Spirituality Conference
Cathy Papia RN, BSNFamily Nurse Liaison – MICU On October 25th health care professionals and pastoral care staff from Western New York gathered at The Millennium Hotel to engage in a full day seminar entitled “Exploring the Dimensions of Health Care in a Religiously Diverse Community.” Spearheaded by Father Richard Augustyn and our own Kaleida Health Bereavement Committee, the conference was also co-provided by ECMC and The Network of Religious Communities. Spirituality is expressed through participation in religion and/ or belief in God, family, naturalism, humanism and the arts. All of these factors influence how patients and health care professionals perceive health and illness and how they interact with one another. The day was comprised of group lecture as well as intimate small group discussion on various faith traditions. The focus of the day was to identify cultural and religious beliefs and practices that may influence patient care. Expert presenters included, Dr. Othman Shibly, a professor at UB Dental School and Islamic
scholar, Dr. David Holmes a family medicine practitioner who routinely incorporates spirituality assessment into his patient care and Rabbi Lazarus-Klein of Temple Sinai who has years of experience in pastoral care. Other faith traditions presented included Hinduism, Sikism, Native American, Buddhism, Christianity, BaHa’I and The Church of Jesus Christ of Latter Day Saints.
Participants hopefully left the conference with greater insight and sensitivity to many faith traditions. Additionally we received some concrete tools to incorporate spirituality into patient care. As with all we do as care providers, even in instances where you are not familiar with the faith practices of a patient, respect translates well into any religious belief.
Gates and BGH ED Staff
Nurses Coordinate Training to
Ensure Teamwork and Safety
Cheryl Marcel, RN,CENEighteen months ago the manager of the ED at BGH asked the UPC to reach out to the Gates UPC and start
meeting together. For the first year, the group met every two months. By the end of the first year they had identified the need for more frequent meetings due to the large volume of work to be done before the new ED opened and their Gates colleagues joined them in March. Cheryl Marcel, a practicing Kaleida ED nurse for almost 4 decades, the president of the UPC at BGH and the president of the local chapter of the
ENA reached out to the Gates UPC, contacting Ana Lewis, a graduate of the ED pilot internship program who is the UPC president elect from Gates. Cheryl acknowledges that both sites were a little nervous about the first joint meeting but quickly realized they had a common focus. She gives credit to Mary Kulinski (from Gates) who serves as secretary and timekeeper for the joint UPC, keeping them on track with the agenda. They initially coordinated some social events to “get to know each other” including participating in the Corporate
Challenge. The UPC quickly identified education as a need and focuses for the committee and identified aspects of nursing education that were missing from each site. For example, Gates did not have orthopedics, psych or “fast track” and BGH did not have stroke. After months of planning, a
c o n n e c t i o n s
N
ursing
Religious Diversity Conference- Cathy Papia, Rose St. Pierre, Kimberly Dale, Cynthia Hamm, seated Heidi Lowitzer.
Mary Kulinski, Mel Cox and Cheryl Marcel– ED Education Day.
six hour education program of didactic, skill practice and simulation learning was developed. They offered the program four times at the end of October. They also discussed patient flow and how to get critical patients to diagnostic, interventional or critical care units
as quickly as possible. Additionally, training focused on identifying where emergency equipment was housed, including O2 tanks, fire extinguisher and the emergency tent utilized for contamination victims was even opened for training purposes. Cheryl said, in her 38 years in the ED, she had never seen this opened. During these four days 100% of the staff from Gates and BGH was trained including support staff; support staff received a modified, three hour program. The UPC
also looked at opportunities for house staff to assimilate quickly into the new environment. They took the opportunity to contact ECMC and
changed some of their equipment carts to reflect what they saw as a more effective process at ECMC; they changed an “airway cart” to an “airway box” which is portable but contains the same emergent equipment. They
also changed the name of the “central line cart” to ECMC’s name of, “critical care line cart.”
The new emergency room covers 1 square acre of property and is considerably larger than the old ER. Representatives from the new monitor companies showed ED
staff the new CVP monitor, Stryker came to show therapeutic hypothermia machines, as well as the new carts for the ER
which includes weight scales for more accurate medication dosing. Other learning stations included EVD insertion, pediatric codes and pediatric equipment and insertion of IO devices. Deb Steck and Melissa Baxter from the Gates stroke program showcased poster presentations for stroke and medication dosing. Ellen Eckhardt RN from WCHOB’s PICU participated to help staff become more familiar with debriefing (TeamSTEPPS tools to enhance performance). One of the suggestions that arose
from the debriefing education and has been implemented is using debriefs after critical events as needed. On the first day of training the WCHOB education team brought “Noel” an OB/ Birth simulator and educated the staff on imminent vaginal deliveries and infant recovery. New ceiling lift devices were demonstrated. Emergency preparedness carts and processes were reviewed and where their new storage area will be in the event of a disaster. We had nurses teaching nurses about setting up the new CVP lines. Recently retirees Fannie White from ICU, Katrina Howard RN from ER, Rosemary Burgio RN, Juanita Lewis ED staff and Donna Lanning RN from ER volunteered their time to help with registration, assigning lockers and issuing new keys for the equipment carts and cupboards. It was terrific teamwork! The event both challenged and engaged participants. The joint ED UPC contributed to gift baskets, donating wine baskets, movie tickets, dinner certificates and a bushel of orchard apples. Our physicians also helped “support the festivities.” You may have seen the bright red shirts that they are wearing which has a photo of both hospitals. The logo on the shirts says, “Joined in excellence”.
The joint ED UPC committee challenges each consolidating department from both hospitals to
Deb Steck, Gates Stroke Coordinator, reviewing stroke guidelines . BGH ED Coordinator,
Sandra Watkins and Gates ED Manager Bunny O’Brien collaborate on ED education day.
Debra Cook, Rosemary Burgio and Mary Kulinski at ED orientation registration.
Fannie White and Donna Lanning back from retirement to help in the ED opening.
have a seamless transition. As one of the committee members said: “I need you working by my side, and you need me as well. Let’s do this together.”
Gates
Managers
and DEU Clinical Instructor
present at State AONE
Conference
Gates managers Sue Brooks and Pat Myers were thrilled with the opportunity to not only attend the NYONE, New York Sate Association of Nurse Executives, conference this past November, but were asked to do a presentation on the DEU model. Kaleida won the “Best Practice Award” for their abstract submitted in 2009 on the DEU model and its development and implementation at Kaleida. Both Pat and Sue have been managers of DEUs at Gates, 7W and 8W. Tom Cyman, clinical faculty member since the origination of the DEU model on 8W spoke about his role and experience as a Clinical Instructor. Because of his passion for the role, Tom was also asked to speak at UB’s nursing graduation ceremony. Tom loves the ability to impact on the quality of the clinical education of new nurses. The group was thrilled with the interest from their NY State colleagues regarding the model and the fact that Kaleida is seen as a leader and expert in this area. They also discussed the WNY DEU Best Practice committee, coordinated by Kaleida
which includes academic and practice partners from the WNY area focusing on the sustainability of the model, research and support for new models. The presentation included the history of the DEUs in WNY; Linda Steeg, nursing faculty from the University of Buffalo attended a conference at the University of Portland (the University of Portland brought the model back from Australia where it was developed) in 2008 and reached out to Kaleida to collaborate the first DEU in WNY which opened on 8 West at Gates in 2008 and on 7 West in January 2009. The Kaleida team was passionate about the impact of the DEU model on staff engagement, professionalism and practice. They also shared how the model grew from one unit, with one academic partner to
7 units with three academic partners, including an AAS program. The team emphasized the importance of relationships in the planning, implementing and the sustainability of the model. Key
relationships are those with the faculty, manager and CIs as they determine the success of the model as
scheduling staff, patient assignments and flexibility are crucial. RNs, Tom Cyman and Samantha Shivers were DEU champions on 8W and were instrumental in the staff on their unit embracing the model and the students. Sue, Pat and Tom were impressed by the passion and professionalism of the group and felt energized in being able to present to such an engaged group of nurses. It also felt great to know that to this group, they were viewed as DEU experts and innovators.
Gates Manager Passionate
about Research
Eric Bachman, (below) RN, BSN is the manager of ISCU/NIU and the NICU at Gates. He is passionate about getting staff nurses engaged in research. He has been a nurse since 1992, graduating with a RN/AAS from New Jersey. Eric relocated to Buffalo to take a position in the Trauma Unit at ECMC. His interest in areas that influence nursing practice initiated involvement in the development of the first clinical information system in the TICU. In 2001 he accepted a research
coordinator position with Dr Flynn, a trauma surgeon. This is where Eric’s interest in bedside research and making a difference in patient care originated. After maintaining the research initiative for five years, Eric left to pursue a position as an EMR
c o n n e c t i o n s
N
ursing
Karen Taggart, Kara Denison, Erika Sobocinski and Gail Insalaco practice Pediatric Code.
consultant for GE Healthcare and was thrilled to be exposed to change theory and Six Sigma as a tool to drive change.
Eric joined the nursing staff at Kaleida in 2007 to work the night shift in the Gates NICU but was side lined a few months later when he and his motorcycle were struck. He was taken to the Trauma Unit at ECMC where he previously practiced and spent 3 months recovering. Shortly after his return to Gates, he accepted a position as supervisor and in 2009 was promoted to the Nurse Manager on 7C. Most recently, Eric has taken on the additional responsibility of the NICU. He completed his BSN from Robert’s Wesleyan, a 17 month modular program and plans to continue on in the Master’s program after the collocation is completed. He finds one of the greatest challenges as a manager is to lead by example. Eric feels strongly that a nurse manager can’t be “just a manager;” he believes he/she must be someone who “sets high standards and who knows what good practice is.” Eric feels that his experiences as a staff nurse in the NICU and TICU have helped him be a better clinician and coach for his staff; “you can’t just look at the level of spinal cord injury, you have to look at it from the patient’s perspective and see the big picture impact on his or her life.” What he likes best about being a manager is the opportunity to drive change. Eric says that the GE experience and being exposed to six sigma and CAP from the organization that developed it, General Electric, was great. “Best practice in nursing necessitates constant change, you learn
something new everyday and have the opportunity to apply it and improve care,” Eric shares. Eric loves the continuous learning that is an inherent part of good nursing, he also loves the opportunity to remove barriers and help his staff develop professionally. Eric recently challenged one of his seasoned nurses from the NICU, Sue Demcie, to investigate the availability of funding based on process improvement; “what could we do better?” Currently they are exploring the feasibility of utilizing an iPad to transfer information from shift report directly to a electronic tablet so the receiving nurse has the exact information that was written by the charge nurse on the preceding shift. Looking at the vulnerability for errors during hand-off is an issue that the staff would like to minimize by utilizing technology. The staff nurses felt that utilizing this technology to transfer information could be a significant improvement in patient safety and minimize error due to miscommunication. The team is pursuing several grant opportunities at this time. Eric states, “promoting nursing research can only benefit our practice and profession” believing that once the nurses participate in the study, other areas of best practice will be identified and challenged.
In addition to sharing his passion for nursing research with staff, Eric has challenged his staff to commit to professional certification in Neuroscience nursing. His goal for 2012 is to have 50% of the staff receive this distinction; currently 28% of his nurses have attained the specialty certification. Debbie Steck, Clinical
Specialist for neuro, developed and delivered a review course for the exam this past fall. The certification is by far one of the most difficult to attain but Eric is confident in his team. “I believe I have the best specialty critical care nurses in the network in the NICU, I am confident of their success.” With the upcoming collocation, Eric’s unit 7C will transition from an Intermediate Surgical Care Unit to a Neurosurgical Step-Down Unit, currently an unfilled need. Eric said 7C is a great place to transition for nurses interested in the NICU. It provides an opportunity to gain experience and confidence fostering a successful transfer into the critical care unit. “The nursing staff has been instrumental in preparing for the success of this transition.” “Each nurse has had a positive contribution to the level of practice, education, and patient flow that we need to incorporate before we arrive at our new unit.” Eric loves nursing and shares, “it may sound clichéd but the opportunity to make a difference with my staff and my patients keeps me here.” Originally a pre-med student, Eric switched to nursing because he thought he could make more of a difference. After ten years away from trauma nursing he still bumps into patients and families who are grateful for his care. “I can still make a difference in my patient’s lives by supporting my nurses and help them pursue excellence.” Eric shares he never wants to lose the bedside connection.
c o n n e c t i o n s
N
ursing
TeamSTEPPS Huddle utilized
to Decrease Falls at DeGraff
For the past two years, theTeamSTEPPS Huddle format has been formally used for all falls occurring at DeGraff. The nursing supervisor initiates a Huddle post patient fall to debrief regarding the incident and look at opportunity to improve. Following a fall, a multi-disciplinary team holds a “post fall huddle.” All aspects of patient care are reviewed, potential missed opportunities for prevention are discussed, and changes to the plan of care are implemented. The site fall team meets monthly to debrief on all falls and leads implementation of strategies to reduce falls. Since its inception, the fall
rate at DeGraff has decreased. This is more impressive as the MRU unit was included in 2011 stats but not in 2010. The majority of patients on the MRU are neurology and at high risk for fall. With 10 months of stats for 2011 to date the rate has been reduced form 4.37 to 3.26.
ACE UNIT at DeGraff
supported by NICHE Training
The ACE (Acute Care of the Elderly) unit opened on the 4th floor at DeGraff in July of 2011. ACE isa care delivery model for seniors. To prepare for this, manager Julie Tussing, nurse educator Heather Nugent and Dan Ryszka attended
the NICHE program. This is a 38 contact hour course which met one day per week from March until July. It is a program developed by the Nursing Education at New York
University and consists of on-line tutorials, webinars, conference calls and testing. It is considered essential for an ACE unit’s success. All three completed the program successfully and became NICHE certified (Nurses
Improving Care for Health System’s Elders). Julie said the group also learned about their own barriers and strengths in developing the ACE unit. Julie says she and the staff on 4 felt they were sensitive to the elderly but the ACE unit and
NICHE training was taking it to a whole new level. The ACE unit patient population is 70 and over, being admitted to an acute care facility with an acute condition. They are patients who are admitted from home and the plan is to
ensure they are discharged to home. Care, once hospitalized, focuses on maintaining current levels of functioning and returning them to the community. Treatments include
recreational therapy and music piped into the unit to encourage walking twice a day. With Heather’s assistance, training for all 4th floor nurses was completed. An ACE notebook was developed with a staff read and sign to ensure that all staff was aware of the NICHE philosophy. NICHE training was also placed on talent management for all staff including housekeeping, PCA’s and other support staff. Julie also says that third party payers are interested in ACE units and reduction of LOS, pressure ulcers and their ability to return patients home. Julie says they began Interactive Rounds on the unit in November and will include the patient and family in the discussions. Julie says the entire unit is excited by the opportunity to be innovative, cutting edge but mostly about doing the right thing.
DeGraff ACE unit staff. Julie Tussing with NICHE poster
TeamSTEPPS team at DeGraff Memorial Hospital.
DeGraff Educator Heather Nugent coordinates skills fair.
Mother Baby DEU faculty
and MFSH midwife is
Passionate about the
DEU Model
Jen Guay, RN,CNM, MS -D’Youville College Nursing Faculty
The Dedicated Education Unit (DEU) began three years ago on MFSH’s postpartum unit. The DEU model of clinical nursing education grew from the concern that new graduates were not adequately prepared to the demands of nursing clinical practice. Both students and faculty alike believe students are not adequately prepared for their first nursing job. Experience-based learning, or hands-on clinical practice, is vital to the transition of the student to the professional nurse (Benner, 2010; Benner, Tanner, and Chesla, 2009). Experience-based learning engages the student in clinical decision making, priority setting, and the ethical decision making process for each patient they encounter (Benner, 2010; NLN, 2008).
The maternal-newborn DEU at MFSH was one of the first DEUs in a specialty area in the United States. Students are socialized into the role of the nurse, modeling communication and teaching aspects of nursing as well as assessment, technical and prioritization skills necessary in the role of the nurse. In a traditional clinical model, students must wait for their instructor to perform nursing care. In the DEU, students can care for patients in real-time, allowing them to master multiple skills and care for more patients.
Debriefing of students has been
extremely positive, with all amazed at everything a nurse does in one shift. They are inspired by the love of nursing from their preceptors. Preceptors like sharing their expertise and watching the student gain confidence and skills as they progress through the rotation. In maternal-newborn nursing, communication and teaching of new mothers and their support systems is vital to the health of the mother and her newborn. The partnership between Kaleida Health and D’Youville College continues to grow, closing the gap between academics and clinical practice. By strengthening the clinical education of our future nurses, we will enhance the quality and safety of patient care.
Manager Coordinates
second Annual Wound Care
Conference at MFSH
Sue Huffer, RN, MS Nurse Manager – 2E
This year’s skin resource nurse’s education day was held November 10th. The “Skin is In” skin care conference, a six hour program focused on challenges in ulcer prevention and treatment, was attended by 27 nurses from across Kaleida. Sue Huffer and MFSH’s wound care nurses, Barb
Schraufstetter and Deb Mitro worked with vendors in skin care equipment and Kaleida wound care experts to present the rotating station-style conference. There were 6 hands-on, interactive stations and attendees rotated stations every 45 minutes.
#1 Wound VAC –
Ostomies with a VAC dressing, Bridges, Provena dressing, Mushrooms, Y-connectors and Foot wounds.
#2 Products –
Prevalon Boot, Restore Trio
dressing, Coviden incontinence care pads, AquacelAG, HydrogelAG, Triple care, Sage wipes.
#3 Ostomies –
Challenging ostomies, barrier rings, denuded skin, fungal issues, flush and retracted stomas.
#4 Staging –
Pictures of Stages and test. Fungal, Dermatitis and Skin tears.
#5 Support Surfaces –
Synergy, Triflex, Clinitron, Isoflex, Sof-Care.
#6 Documentation –
A to Z for skin documentation in the EMR.
Skin Resource Nurse Education Day- Barb Schraufstetter, Sue Huffer and Deb Mitro. MFSH staff, D’Youville students and faculty work together on
c o n n e c t i o n s
N
ursing
100% of the participants rated the conference excellent to good. Comments from attendees included; “Much improved over last year’s format, I liked rotating through stations, it allowed for more
interaction,” “Everyone should have to come to this!” “I picked up some good tips.” The corporate skin team with Chairperson Sue Huffer hopes to continue this as an annual event.
WCHOB “Revisits” ED-Pilot
with New Graduates
The ED pilot which was implemented system wide in 2009 and 2010 is a high quality training program for new graduates which realized a 100% retention rate over its two year history. The program was developed in response to a national (and Kaleida) problem attracting nurses to practice in the ED. WCHOB felt that although they were
able to increase recruitment in the area, the strength of the “home grown” graduates was impressive and they decided to continue the program as a site based pilot in 2011.
The WCHOB ED
intern program began in June 2011 with the 2 new graduates, Jason Edmiston and Ann Bukowski, both 2011 D’Youville College graduates. Jason worked as a Nurses’ Aide for 18 months in the ED at WCHOB before applying for the program. Jason said the NA position helped him decide he “loved the ED,” it’s
fast paced, Jason definitely saw this as his practice niche. Jason said he loves the continuous learning the ED affords and the ability to apply what he learns in a variety of situations. He also loves the staff and sees it as a highly developed team; “it feels like home here.” Ann knew she wanted to specialize in pediatrics. She loves the ability to get a wide view of pediatrics patients in the ED. She had her clinical rotations in nursing school on V9 and V10. She gives a lot of credit for her developing confidence to her preceptors, Jane Stockman, a previous graduate of the ED-pilot program, Joe Lukasik and Kristina Kubiak. Anne said that each preceptor brings something unique to teaching; “Joe teaches you to anticipate and critical think with a variety of scenarios, Kristina gives tough assignments that definitely challenge you and Jane
coaches you to do your best.” As with Jason, Ann feels the team is warm and welcoming and is invested in her success as a new nurse. Becky Roloff, ED nurse educator and program coordinator had Jason and Ann attend general corporate orientation and then complete WCHOB RN orientation. They spent the month of June getting to know the work flow in the ED, bonding with their preceptors and learning about the program curriculum, both class work and clinical experience.
In the month of July, they continued with June’s themes, but added pain management and fluid and electrolyte management. Becky developed a comprehensive ED curriculum that builds on previous learning; she utilized several case studies to allow the two to apply theory to patient care. During WCHOB EMR Go-live in August, Jason and Ann functioned as EMR “super users” for the ED; this bolstered both of their confidence in using the new system and the fact that they could now “support” their colleagues.
September 2011, the ED interns joined the Nurse Residency Program (NRP). The WCHOB educators had stations set up where the interns could spend as much time as they needed practicing mediport insertions and dressing changes, IV insertions, NG insertions, trach care, etc. In this non threatening environment, they were encouraged to ask questions, as well as review different techniques used by their preceptors and other nurses they have encountered in their clinical practice. The interns also attend adult critical care classes and have spent 3 weeks clinical time in L&D as well as high risk maternity.
Betty Beyer, RN, MS, accepted the ED Nurse Manager position after the interns had started. She quickly became a champion of the program and feels the quality of the interns is exceptional. Betty has been in management for over two decades and in the Kaleida system for 25 years. She feels that these interns have a stronger knowledge base then any nurses transferring or being hired into the ED; they know more then the average
WCHOB Ed Pilot Team: Ann Bukowski Becky Roloff, Betty Beyer and Jason Edmiston.
ED nurse. Along with program completion the two will sit for ACLS and PALS certification.
Faculty Beth Nicastro
“Loves” Pediatric
specialty DEU
Beth M. Nicastro MS, PNP-BC Clinical Assistant Professor of Nursing
State University of New York at Buffalo
The faculty of the University of Buffalo School of Nursing and
staff at Women and Children’s Hospital of Buffalo are engaged in an academic service partnership referred to as the Dedicated Education Unit (DEU) on floors V4 and V10, respectively. Beth Nicastro, PNP-BC , the UB Clinical Faculty Coordinator (CFC) works in collaboration with Donna Koscielniak, RN, nurse manager and the entire nursing team. This project began in the fall semester of 2009.
The DEU has allowed the students to work under the supervision of experienced RNs with specialized preceptor training. The DEU nurse is an adjunct faculty member and functions as a mentor and bedside clinical educator. Students proclaim that this experience has allowed them to experience “true clinical practice” while still learning in school. Generally, two students are paired with a DEU nurse, as they work together to assess and manage the care of multiple patients. The DEU nurse acts as clinical faculty for the student nurses in order to ensure patient safety. The nurse manager, with input from the University faculty coordinator, pre-assigns patients based on course objectives/content and the nurse’s
assignment. Comments from students have been overwhelmingly positive and have included, “I get to know my patients better and involve them in the decision making regarding their care.” The University faculty monitors student progress, and supports CIs (staff nurse preceptors).
This experience has exposed the students, some for the first time, to interprofessional practice; students are able to learn from and work collaboratively with child life specialists, physicians, social workers and respiratory therapists as they care for pediatric patients. They have also been able to practice TeamSTEPPS tools via daily rounds. The DEU students give and receive report; something that rarely is possible in the traditional clinical model. Students also report that they have been able to see “pediatric” response to chronic illness and pain as well as observe staff role models as they deliver compassionate care to the patients and their families. Anecdotal evidence suggests that the DEU model may assist in the recruitment of new graduates and increase patient and nurses job satisfaction. My thanks
extend to the entire health care team at Women and Children’s Hospital for their warm engagement of the UB nursing students in this amazing teaching-learning environment!
Visiting Nurses
Association of WNY
Home Health Care Nursing
Lisa Greisler, RNVP, Clinical Services Home Care The home care industry, along with the rest of the health care industry is in a state of change. The demand for nurses in the home health field has grown and is expected to continue to grow due to the shift in where patients are being cared for as a result of cost
containment measures, the growth in the geriatric
population and as a result of technological
advances within home health care itself.
According to the US Department of Health and Human Services (2004), it is projected that the demand for full time equivalent RNs within home health care will increase 109% from the year 2000 to 2020. All of these changes are positive for the VNA which continues to experience steady growth every year. This creates a constant demand for nurses for us at the VNA- different than most other health care settings.
Beth Nicastro (center front row) with DEU students and WCHOB staff.
