Spring 2005 - Harvard University

Nursing
News
Brief
An update on
professional nursing
at Beth Israel Deaconess
Medical Center
Spring 2005
Supporting professional nursing practice
New resources for clinical staff in place
The novice nurse caring for a patient with complex
needs...The experienced nurse seeking new challenges
as she develops her practice...The night nurse whose
patient has a cardiac arrest and who has four other
patients on his assignment...The nurse whose patient
has a nonhealing wound...What do all these nurses
have in common?
t Beth Israel Deaconess, all these
nurses now have
more immediate access to
the clinical supports they
need to address numerous
clinical and professional
issues. The new resources
are the result of a drive to
enhance support for bedside clinical practice. Says
Dianne Anderson, R.N.,
senior vice president of clinical operations, “This work
came from a realization that
in an organization that is
growing and expanding, we
needed to focus on supporting practice on the units.”
Anderson adds, “Having
these supports in place not
only puts nursing expertise
right where it is needed
most; it also allows for the
formation of a more cohe-
sive professional nursing
staff. Stronger nurses can
forge stronger collaborative
relationships with physician colleagues and other
clinicians, helping us to
grow our Premier Nursing
Practice Model.”
Nurse specialists
and unit educators
Clinical nurse specialists
(CNSs) have been critically
important players in the
push to increase clinical
supports. Currently,
more than 15 CNSs are
available to staff. Many
now cover only one or two
units, making them more
immediately available to
staff and ensuring that they
become integrated into
specific patient care teams.
(For more on the CNS group
at BIDMC, see profiles
beginning on page 3.)
Support from the CNS
group and an increase
in overall staffi ng have
combined to give nurse
managers new options in
planning staff professional
development. In some
areas, clinical nurses have
been designated as “unit
educators” – a role that has
a dual benefit. It provides
protected time for an
experienced clinical nurse
who may be interested in
a career path that involves
education; and it is another
way to ensure that less
experienced staff have the
wealth of resources they
need to develop their clinical
skills.
Duane Young-Kershaw,
R.N., unit educator in the
emergency department
(ED), says that having
someone in a dedicated role
as educator has enabled
a more comprehensive,
collaborative clinical
education program to
Dianne Anderson, R.N.
■ continued on page 2
1
■ New clinical supports,
including admission facilitators,
administrative clinical
supervisors, and clinical
educators, are helping to ensure
that nurses have the resources
they need, day or night. Shown
here are some of the nurses
in these support positions.
Back row: Pat White, R.N.;
Kevin Hannon, R.N.; Brenda
McDonough, R.N.; and Diana
Gist, R.N. Front row: Alison
Small, R.N.; John Ryan, R.N.;
Tina Heinz, R.N.; and Mark
Joseph, R.N.
develop in the ED. He notes,
“The ED nursing team is
currently collaborating with
the emergency medicine
physicians to develop a
unit-based ACLS program.”
Young-Kershaw has also
been able to work on
creative approaches to meet
the education needs of a
large staff working multiple,
overlapping shifts. He
explains, “We created online
classes with specific interest
points, such as psychiatry,
hypothermia, trauma, and
sepsis. These tutorials are
always available to view and
reference throughout the
work day.”
Off-shift supports
New supports for nurses
working evenings, nights,
and weekends have also
been established. Previously,
several clinical advisors
covered the entire hospital
on off-shifts, responding
to both clinical and
administrative issues.
Because of the scope of
2
their responsibilities, they
were not able to spend large
blocks of time in any one
area. Now, night educators
have been added to provide
additional support during
the off-shifts. The educators
are experienced clinical
nurses who respond to
emergencies, lend a hand
on busy units, or provide
education on practice
changes or new technology.
Says night educator Theresa
Joyce, R.N., “Often we need
to be good listeners, observe
what is happening on a
unit to ensure safe patient
care, and assist staff in their
critical-thinking process and
professional development.”
She adds, “I see myself as a
mentor, coach, and support
person for the night nursing
staff.”
Specialized resources
A number of other
centralized resources are
also in place to help support
care. Paula Hayes, R.N.,
and Donna Quinn, R.N.,
are enterostomal therapy
nurses who provide care and
consultation for patients
with any kind of ostomy
device. Janice Cunnane,
R.N., recently joined
the staff as a centralized
resource in wound and skin
care management. Wendy
McHugh, R.N., a critical
care nurse who completed a
Medical Ethics Fellowship
at Harvard Medical School
in 2004, is available to
consult with staff about
ethical issues. And to help
ensure that newly admitted
patients get to the right bed
in a timely fashion, nurses
working as admission
facilitators are now available
around the clock.
Marsha Maurer,
R.N., director of clinical
operations for medicine,
surgery, and psychiatry,
says that the new clinical
supports are good news
for the medical center on a
number of levels. Not only
do they support excellence
in practice; the high demand
for this level of support
is evidence of a healthy,
thriving nursing service.
She comments, “We had an
outstanding season of hiring
new staff and brought on
342 new registered nurses
in fiscal year 2004. At the
same time, these staff are
coming into an increasingly
acute environment and
need to handle sicker and
sicker patients. Hence the
need for clinical supports
and mentoring around the
clock.” ■
Expert Practice
Meet the clinical nurse specialists!
B
eth Israel Deaconess Medical Center now boasts a large pool of talented clinical
nurse specialists who are supporting practice in a variety of ways. According to the
National Association of Clinical Nurse Specialists, a CNS is a nurse with advanced
academic preparation (master’s degree or higher) who is “an expert clinician in a specialized
area of nursing practice.” At BIDMC, many of these advanced practice nurses blend direct
patient care and development of more junior staff into a single, integrated role. Others
provide broad-based support for clinical or administrative programs.
Here are profi les of the nurses in this impressive group. Don’t hesitate to call on them to
help you with issues related to their specialties!
Leslie Ajl, R.N., a psychiatric
nurse specialist, consults
with staff regarding the
emotional and psychological
needs of their patients,
and supports staff as they
interact with peers and
other disciplines. She says
she tries to “help staff to
grow as nurses and enjoy
their work,” adding, “I feel
I have the most wonderful
job. I work with nurses and
observe their commitment
to patient care, and I have a
chance to help facilitate that.
I love it all.”
patients. Mentoring staff at
all levels is very rewarding.”
Laurie Bloom, R.N.,
is an education nurse
specialist. She coordinates
the development of the
nursing education calendar,
co-chairs the Education
and Research Council,
coordinates student
placements, serves as
liaison between BIDMC
and academic institutions,
and facilitates access to
the medical center for
nurses employed by outside
agencies. She has been in
a CNS role at the medical
center since 1980, and
notes, “I like that I have
a chance to connect with
so many nurses and other
health professionals. My
work to help develop quality
educational programming is
gratifying because it helps
advance our professional
practice model.”
Michele Boucher, R.N.,
an expert in medical and
surgical nursing, is CNS
for the emergency cardiac
■ continued on next page
Marcia Bixby, R.N., a critical
care nurse specialist, works
with staff and patients in the
SICU, TSICU, and CSRU
at the medical center. She
coordinates orientation
and continuing education,
provides support to staff
during times of high acuity
on the unit, and helps
introduce new equipment
or procedures. She says, “I
enjoy working with staff and
providing care to critically ill
Laurie Bloom, R.N.
Leslie Ajl, R.N
Michele Boucher, R.N.
Marcia Bixby, R.N.
3
■ continued from page 3
care program and for
Farr 2. Her work includes
providing ongoing support
for med/surg nursing
orientation. She also was
recently appointed to the
faculty of the University of
Massachusetts Amherst.
A nurse at BIDMC for 19
years, Boucher is in her
second year of practice as
a CNS. She says, “I enjoy
being a resource to new and
experienced staff regarding
their practice; it is very
gratifying to help nurses
problem-solve. The role
also allows me to continue
my own learning and
professional development.”
Kerry Carnevale, R.N., is the
CNS on Farr 9, the vascular
surgery unit. She works
with the nurse manager to
identify practice issues that
need attention, participates
on the unit-based shared
governance councils,
provides consultation on
complex patient care needs,
helps orient new staff,
and mentors staff who
are progressing through
the clinical advancement
program. She says, “No one
aspect of my role is more
rewarding than another.
The whole is greater than
the sum of its parts. One of
the most enjoyable aspects
is being able to work with
a talented, intelligent,
supportive, and witty CNS
peer group.”
John Cotter, R.N., has been
on staff for 25 years and
is entering his fourth year
as a CNS at the medical
center. Specializing in the
care of cardiology patients,
he works with patients and
staff on Farr 6 and in the
CCU. He shares, “What
is most interesting about
my role is the continuous,
rapid advancements,
both pharmacological
and technological, in the
care of coronary artery
disease, heart failure, and
dysrhythmias.”
Joanne Devine, R.N., has
been a psychiatric nurse
specialist at BIDMC since
1987. Her role includes
evaluating patients who need
one-on-one observation,
consulting on patients with
a wide variety of psychiatric
issues, and supporting
clinical staff. Devine also
is the medical center’s
addiction nurse specialist
and provides comprehensive
consultation to colleagues
caring for patients with
drug or alcohol abuse.
She comments, “What
I enjoy most is working
with patients from a
variety of backgrounds and
circumstances, and working
collaboratively with the staff
at BIDMC.”
Jean Gillis, R.N., one of
the newest members of
the CNS group, works
with the staff on Farr 5
to care for neurosurgery/
neuromedicine patients.
On staff at BIDMC for 10
years, she took the CNS
position after completing
her master’s degree in 2004.
She says, “I really enjoy
supporting and teaching
the nurses and facilitating
patient care. I also fi nd it
rewarding to work with the
interdisciplinary team to
effect change and support
and improve care.”
Kerry Carnevale, R.N.
R.N
Joanne Devine, R.N.
John Cotter, R.N.
4
Jean Gillis, R.N.
Charlotte Guglielmi, R.N.,
is the CNS for perioperative
services at BIDMC and has
been on staff for 28 years.
She provides practice and
policy support, facilitation
of staff development, and
mentoring to staff. She is
involved in patient safety
initiatives both at BIDMC
and on a national scale
through her work in the
Association of periOperative
Registered Nurses (AORN),
for which she currently
serves as secretary. She
comments, “I love the scope
of my role as well as the
autonomy. I love the way it
challenges me to improve
the practice of the art and
science of nursing.”
Christine Kristeller, R.N.,
is the nurse specialist on
11 Reisman, caring for
acute geriatric and medical
oncology patients. A 25year employee of the medical
center, she specializes in
gerontological nursing and is
also a certified wound care
nurse. She provides both
bedside care and clinical
consultation to staff. She
notes, “There is nothing
I love more than helping
nurses to develop clinically
and professionally. My
role allows me to positively
impact their growth, which
is very satisfying.”
Marion Longo, R.N. , has
a 30-year background
as a psychiatric nurse
specialist with expertise in
communication, delegation,
team-building, and
confl ict management. She
is currently the specialist
responsible for the education
and development of
unlicensed nursing assistants
and patient care technicians.
She also coordinates crisis
prevention training for the
hospital and works with the
patient observer program.
She has been on staff at the
medical center for almost
20 years. Of her role, she
says, “I enjoy teaching and
working with staff, helping
them with communication
and team-building skills.”
Kim Olivieri, R.N., is
CNS on Farr 7. In her
role, she helps orient new
staff, provides targeted
educational programming
for experienced staff,
consults on patient care
issues, and serves on a
number of hospital-wide
committees. On staff since
1994, she has been in the
CNS role for two years.
Commenting on her work
with novice staff, she notes,
“It has been gratifying to
watch a group of novice
nurses develop into strong,
clinically adept professionals
and to have been part of
that development process.”
Kathy Picard, R.N., is a CNS
in critical care, covering
MICU A and B on the west,
and the Finard MICU/SICU
on the east. She has more
than 20 years of experience
in critical care and has been
a CNS for nine years. She
served as a nurse in the Air
Force, achieving the rank of
captain. Of her experiences
at BIDMC, she shares, “I
love working with the nurses
in critical care at BIDMC.
They are the smartest and
most genuine nurses with
whom I have ever worked.”
Kathy Picard, R.N.
■ continued on next page
Kathy Picard, R.N.
Marion Longo, R.N.
Charlotte Guglielmi, R.N.
Christine Kristeller, R.N.
Kim Olivieri, R.N.
5
■ continued from page 5
Tina Pierro, R.N., has been
the CNS in labor and
delivery for almost five
years. She is responsible
for staff development and
ongoing staff education,
and specializes in clinical
care of the high risk/critical
care obstetric population.
Commenting on her
role, she emphasizes the
satisfaction she gets from
being involved in broadbased quality initiatives,
noting, “Being involved
with changes, from planning
to implementation, is very
rewarding.” She adds that
the variety in her role is also
a plus, and says, “I enjoy the
education/clinical resource
piece the most.”
Jeanne Quinn, R.N.,
is a CNS with clinical
experience in trauma,
surgery, orthopedics, and
medicine. She is currently
based largely on CC6A,
working with the unit’s
nurse manager to meet the
needs of novice nurses on
that unit. She coordinates
central and unit-based
nursing education, serves
on a number of hospital
committees, and is a parttime faculty member at
Boston College. She says, “I
am most satisfied in this role
when I am working with the
nursing staff on patient care
issues. The most rewarding
aspect of this position is the
diversity that the role offers.
No two days are ever the
same.”
Chris Richards, R.N., is
the CNS for outpatient
hematology/oncology. She
serves as a resource to
staff, develops processes
to facilitate practice, and
helps coordinate continuing
education activities. She
also liaisons with the
research nurse group to
make sure that clinical
staff in the treatment area
have information on new
protocols. She comments,
“Our entire hematology/
oncology team consists
of dedicated and talented
people. I am very proud to
be a part of that team!”
specialist in the NICU.
In her role, she provides
education to staff and
families, facilitates practice
advancements, participates
in research, and is involved
in numerous hospital-wide
initiatives and programs.
She says, “I work in an
area where we care for
infants born between the
cusp of viability and term,
helping premature infants
who should have still been
developing in the safe
environment of the uterus
survive and thrive in the
harsher environment of the
NICU.” She fi nds her role
gratifying, noting, “The role
of the CNS is the ideal way
to provide support to the
bedside nurse so the nurse
can provide excellent care
with up-to-date practices.” ■
Susan Young, R.N.
Tina Pierro, R.N.
Jeanne Quinn, R.N.
6
Susan Young, R.N., is nurse
Chris Richards, R.N.
Leading the
Field
Tales from Turkey
Chris Richards, R.N., travels to Istanbul
n October of 2004, Chris Richards, R.N., oncology clinical nurse specialist at
BIDMC, was invited to join a small group of oncology experts from BIDMC on a
consultation visit to Acibadem Healthcare Group in Istanbul, Turkey. The trip was
sponsored by Harvard Medical International (HMI), a subsidiary of Harvard University
that is involved in a variety of international health care initiatives. According to HMI,
Acibadem has embarked on a plan to become “the focal point of progress for health care in
Turkey,” and, toward that end, is working with HMI to develop educational programs for
its clinicians.
Richards traveled with colleagues Lowell Schnipper, M.D., chief of hematology/oncology at BIDMC,
and Hester Hill Schnipper, LICSW, lead social worker
in oncology and a cancer survivor. They visited
Kozyatagi Hospital, an oncology and neuroscience
hospital in Istanbul. The focus was on breast cancer
treatment and the multidisciplinary approach to care.
During their three days at the hospital, the BIDMC
team gave lectures both on advances in breast cancer
treatment and on team-building and collaboration
in oncology care. According to Richards, integrated,
multidisciplinary care is a new concept to clinicians
at Acibadem and something they are very much interested in developing. Says Richards, “I
spoke about care of the patient undergoing radiation therapy and about post-surgical care,
but then participated in a collective session on the idea of a multidisciplinary team and how
you implement it.”
In what Richards described as an emotional conclusion to the visit, Acibadem hosted a
session in which the HMI team fielded questions from members of the community. Most of
the questions were from patients who were being treated for cancer, and Richards credits
Acibadem for reaching out to patients and families in a culture that has traditionally been
far less open. Richards notes, “My hat is off to Acibadem because they are attempting to
help people recognize that they can be part of their health care, which is an emerging trend
in Turkey.”
Richards was inspired by the dedication and commitment to excellence she saw in her
Turkish colleagues. She shared, “There was a commonality of wanting to do what’s best for
the patient, of striving for excellence in patient care. That was a bond that was easily recognizable in spite of the language and cultural differences.” ■
I
■ Chris Richards, R.N.,
traveled to Turkey with a
group of BIDMC oncology
experts to provide education
on advances in breast
cancer treatment as well as
multidisciplinary teamwork
in cancer care. Shown are
Hester Hill Schnipper, LICSW;
Chris Richards, R.N.; and
Saliha Koc, R.N., director
of nursing at Acibadem
Healthcare Group in Istanbul.
The trip was sponsored
by Harvard Medical
International.
Note: Pat Folcarelli, R.N., Ph.D., director of professional practice development, and
Joanne Ayoub, director of organizational development and staffing, will be traveling
to Turkey this spring with the HMI group to work with nurse managers at Acibadem
on leadership development.
7
Innovation
Get ready for iShift!
ll nurse managers at BIDMC
are familiar with
“holes” in their staffi ng
schedules – shifts when not
enough staff are scheduled
to work. What is the best
way for nurse managers to
fi ll those holes? How does
a manager ensure that the
holes are fi lled in a timely
way? Suppose more than
one nurse wants to work
a particular shift: What is
the most equitable way to
ensure that everyone gets
an equal chance at working
open shifts?
The answer?
iShift@BIDMC!
An innovative, Webbased scheduling program,
iShift is an important new
component of the medical
center’s commitment to staff
satisfaction, recruitment and
retention, and excellence in
patient care. It came about
through the efforts of an
ad hoc work group led by
Wanda Shelton, director of
fi nancial systems for clinical
operations, her staff, and
staff from communications
and information systems.
By making staff scheduling more autonomous and
dynamic, iShift promises to
be an efficient, effective, and
equitable way to solve common staffi ng problems, and
– at the same time – meet
important recruitment and
retention goals.
A
8
■ Farr 5 resource nurse Karen Lonati, R.N., (right) and Nurse
Manager Kirsten Boyd, R.N., explore the new scheduling tool that
gives all nurses on Farr 5 a chance to sign up for open shifts online.
In the pilot program on Farr 5, nurses helped each other learn the
iShift system, with 100 percent of the unit signing up in less than
one week.
Easy to get onboard
Here’s how it works: Staff
– including nurses, unit
coordinators, patient care
technicians, and other
patient care staff – register
online to participate in the
program. The registration
takes minutes to complete
and documents the staff
person’s credentials, experience, and a “profile” of his
or her skills. Full-time, parttime, and per diem staff
may register. The employee’s
manager reviews and approves the registration and
skills profile to ensure it is
accurate, and then activates
the employee as an iShift
participant.
The employee can then
view open shifts that have
been posted by managers
throughout the medical
center and use the system
to indicate shifts he or she
would like to work. The
information is relayed to
the relevant manager, who
scans the requests, looks
at the qualifications of
those requesting shifts, and
makes a decision on the best
match for each opening.
The system then notifies the
person via e-mail of his or
her assignment. The person’s
pay will be adjusted automatically because the system
was set up to interface with
the department’s payroll
system, sparing managers
the task of manually adjusting an employee’s time when
he or she works extra hours
through iShift.
Staff development and
recruitment benefits
Project leaders envision
a wealth of benefits from
iShift that go beyond fi lling
staffi ng holes. Kathleen
Sussek, R.N., nurse manager
overseeing the program,
says she hopes iShift will
be used as a professional
development tool for those
wanting to explore new
practice areas. For example,
suppose a nurse from a
medical unit is interested in
cardiac care. Using iShift,
the nurse may request to
work an open shift on the
cardiac unit. The manager
of the cardiac unit can look
at the skills and experience
of the medical nurse as well
as other staff working that
shift, and may decide that
the request would work well
for both the nurse and the
unit. Sussek thinks this kind
of opportunity to develop
expertise in other specialties
will help retain experienced
nurses at the medical center.
“The walls are coming
down,” she says. “It is a
wonderful retention tool.”
Plans are also underway
to enable nonemployees to
join BIDMC on a per diem
basis specifically to register
for iShift and explore practice at BIDMC. With links
to employment applications
and a special orientation
program that will be run
by Sussek, those who are
thinking about working at
the medical center will be
provided with an easy, userfriendly, and structured way
to experience BIDMC without an upfront commitment
to standard weekly hours.
The program was
piloted on Farr 5 and will
roll out to the rest of the
medical center in the coming months. Kirsten Boyd,
R.N., nurse manager of
Farr 5, is enthusiastic in her
praise of the program. She
notes, “iShift has created a
more proactive method for
local units to complete the
schedule, and I am excited
that it will provide staff
house-wide with a vehicle
to explore their own career
development.” ■
■ A brochure for BIDMC staff spells out the ease and benefits of using iShift.
9
Clinical
Narrative
The power of
touch
The sense of urgency in an emergency room practice might lead some to assume that
there is little time for softer elements of care such as the “power of touch.” In this clinical
narrative, Andrew Harding, R.N., shows that the human factor in the nurse/patient
relationship can be more important than ever in high-acuity settings.
t was a very busy night shift in the emergency department. I took a moment
to step back and reflect on the situation in the unit. From the corner of my eye,
I could see a restless patient waiting in the hall. It was an elderly woman who was
scheduled for an MRI because of recent falls.
I approached this woman, who was very nervous about her upcoming MRI. I explained
some of the details of what would happen, but she was only mildly relieved by what I said.
I explained that she could receive medications to help ease her anxiety, but she refused,
explaining that she thought this might make her “lose control.” When the time arrived for
her exam, I was the one available to transport her to the MRI suite.
During the trip, we continued to talk.
She explained she was lonely and afraid to be
without someone at her side. Since the death
of her husband, she found living alone was
frustrating and sad. While she had family
nearby, she hated to be a bother to them.
As we approached the MRI suite, I placed
my hand on her shoulder. She reached up
and put her hand over mine. When she was
settled on the MRI exam table, I headed
back to the emergency department.
After the MRI, the patient came back
to the ED. As I was passing by her stretcher,
she stopped me and said, “You were great
for being there with me.” I wasn’t really sure
what she meant, since I had left after making
sure she was safe on the table. She continued,
“During that entire procedure I could feel
your hand on my shoulder and I was comforted. I didn’t really feel alone in that box.”
This story reminds me of the power
of touch. People can go for years without
receiving a kind touch, especially after the
death of a spouse. I make it a point to shake
every patient’s hand when I introduce myself.
Though this simple handshake may seem like a formality, I try to be genuinely welcoming
and warm. My goal is to focus for the moment on this one patient and allot them all the attention I have to give. As a nurse, I know these seemingly simple contacts can make a huge
difference for patients who may feel frightened or alone. ■
I
■ Andrew Harding, R.N.,
has learned that touch can
play an important part in
compassionate care.
10
Council
Updates
Through the shared governance councils, nurses can
provide input into decisions that affect practice. For
information on how you can become involved, please speak
to your nurse manager.
Research and Education
Council
Chaired by Laurie Bloom,
R.N., and Denise CorbettCarbonneau, R.N.
Re-invigorating a nursing
research program at the
medical center is a new
area of focus for this
council. They are gathering
information on resources
available to researchers and
making plans to serve as a
review board for nursing
research projects. The
council is completing its
work on revamping the
clinical nurse residency
program, and recently
brought recommendations
to the Nurse Manager
Council.
Recruitment and
Retention Council
Chaired by Kirsten Boyd,
R.N.; Mary Francis
Cedorchuk, R.N.; Rachel
Hutchinson, R.N.; and Pat
Noga, R.N.
The council provided
input into enhancement
of the hospital’s tuition
reimbursement policy, which
improves reimbursement for
tuition and payment toward
specialty certification prep
courses and exams. The
council has compiled an
ongoing list of staff reward
and recognition ideas to be
implemented on individual
units. These ideas include
an annual Caring Award,
a High Five Award, and a
unit-based newsletter. The
council has provided creative
suggestions to improve staff
parking options.
Quality and Safety
Council
Chaired by Pat Folcarelli,
R.N., Ph.D.; Jane Foley,
R.N.; and Marsha
Maurer, R.N.
The council is working on
the development and launch
of a new Web-based incident
reporting system. Members
also are collaborating with
the IS team and the Incident
Reporting Steering Group to
bring this new and greatly
improved system to life.
Upcoming work will center
on transfer of information
during patient hand-offs.
Practice Council
Chaired by Linda
Denekamp, R.N.,
and Cheryle Totte, R.N.
In addition to their ongoing
work on policies and
standards, this council
continues to respond to
issues or concerns about
practice brought forward
by nursing staff and by
changing medical practice
and technology within the
medical center. They are
collaborating with a group
examining standards related
to care of the person of
size, and with the Nursing
Pharmacy Committee to
examine drug guidelines.
The group is examining
ways to interface with the
other shared governance
councils and continues work
on standardizing practice
elements throughout the
medical center.
Documentation and
Information Systems
Council
Chaired by Allison
McHugh, R.N., and Kim
Olivieri, R.N.
Intensive work on the
initial patient assessment
is ongoing, including
clarification of demographic
information, more detailed
assessment of pressure
ulcers, automatically
generated care plans
corresponding to various
stages of skin breakdown,
and a link to the special
bed protocol. In the coming
months, members also will
revise the CAPD flowsheet
and develop an improved
method to document
dressing changes. The
group’s biggest project,
however, will be to clarify
and ensure consistency of
various documentation
policies. The council is
looking for new members,
especially from the OB and
intensive care units. ■
11
Premier
Nursing
Advanced practice nurses
lend special expertise to care teams
s professional
nursing practice
continues to
thrive at BIDMC, nurses
in advanced practice roles
are making their mark in a
wide variety of clinical areas.
In addition to the clinical
nurse specialists profiled in
this issue, there are more
than 50 nurses credentialed
in advanced practice roles
at the medical center.
Working in both inpatient
and outpatient settings,
these highly specialized
professionals provide expert
care for patients; serve as
mentors for more junior
clinical staff; and inject
A
excellence, collaboration,
and scholarship into the
practice arena.
Nurse practitioners in HCA
help lead practice initiatives
The medical center’s
outpatient primary care
practice, Healthcare
Associates (HCA), boasts a
longstanding and successful
model of collaboration
between nurse practitioners
(NPs), physicians, social
workers, and others
caring for ambulatory
patients. As members of
multidisciplinary care
teams in HCA, NPs bring
an important nursing
perspective to primary care.
Michele McHugh, R.N.,
has been an NP in HCA
for almost 10 years. She
says that the unique needs
of each patient help dictate
who will be involved in
providing care. For example,
a patient with chronic illness
and multiple, long-term
needs will likely receive
care from both a physician
and an NP as well as other
members of the HCA team.
Notes McHugh, “We
examine, diagnose, and
treat patients; but we bring
a nursing perspective to the
situation. I think the blend is
really positive for patients.”
In recent months, NPs
in HCA have helped to lead
an exciting series of initiatives to identify ways in
which professional nursing practice can be further
developed in their setting.
With a grant received from a
patient, they hired a consultant to help study options
in a number of areas, such
■ In HCA, many patients are
followed by both physicians
and nurse practitioners.
Here, a patient listens to
recommendations from
advanced practice nurse Michele
McHugh, R.N., and Gerry
Smetana, M.D.
12
as overall clinical practice,
including evidence-based
practice; networking and
collaboration with nursing
leaders at the medical center; expansion and development of the clinical nurse
role; avenues for individual
professional education and
development; development
of a research program; and
models for care of patients
with chronic illness.
McHugh says all members of the nursing staff have
been involved in the work,
and she credits them with
bringing to fruition a proposal – presented recently
to BIDMC nursing leadership – for the creation of a
nurse manager role in HCA.
McHugh notes that having
a nurse manager dedicated
to the practice will help
provide the infrastructure
needed to ensure the success
of the practice development
work.
Expert care in cardiology
Another longstanding
model of successful NP
practice can be found on
the cardiology inpatient
service known as CMI
(cardiac medicine
interventional). This team of
clinicians cares for patients
undergoing interventional
cardiology procedures,
such as catheterizations or
electrophysiology studies.
For the past 16 years, NPs
have been managing the
hour-to-hour needs of these
patients before and after
their procedures. They
assess each patient before
the procedure and follow
them throughout their stay.
They write orders, monitor
■ Advanced practice nurse Sue
Gallagher, R.N., (right) assesses
and monitors inpatients in the
cardiac medicine interventional
program. She works closely
with cardiologists and clinical
nurses; here, she talks with
a patient and Mariann
McDonough, R.N., in the cath
lab holding area.
each patient’s recovery,
manage complications, and
plan for discharge.
Sue Gallagher, R.N.,
who has been an NP on
the CMI team for 15 years,
says that the collaborative
relationships she develops
with clinical nurses and cardiologists are what make the
system work. She says, “Our
physician colleagues really
respect our practice, and we
have a special relationship
with the nursing staff. We
rely on them as the fi rst line
providers…we have a trust
in each other’s roles that
make things work well.”
Opportunities abound
For BIDMC nurses
contemplating a move to
advanced practice, there are
opportunities to observe
many iterations of the
advanced practice role.
In the NICU, a team of
NPs provide day-to-day
management of critically
ill neonates. In obstetrics,
nurse midwives provide
expert clinical care
throughout the perinatal
process. In the OR, certified
registered nurse anesthetists
administer anesthesia and
sedation to patients.
In addition, nurse
practitioners round with
physicians each day and
manage the care of patients
in cardiac surgery, vascular
surgery, and neurosurgery.
Joyce Scally, R.N., nurse
practitioner in neurosurgery,
cares for patients in the ICU
as well as on the general
unit. She follows up on the
results of diagnostic tests,
helps plan discharge, and
coordinates care with consult teams and nursing staff.
Commenting on her role,
she notes, “I really enjoy coordinating the care of these
patients. It is satisfying to
be able to help them recover
from surgery and get back to
their lives.”
These are but a few
examples of the advanced
practice roles nurses are
embracing at BIDMC.
Is advanced practice in your
future? Ask one of these
colleagues for more
information! ■
13
Spotlights
Professional activities of
nursing staff (listed in bold)
from September 1, 2004 to
November 30, 2004.
Publications
Sharon Gates, Mooar
P. Cuidados Primarios
Musculoesqueleticos
(Portuguese translation of
Musculoskeletal Primary
Care). Rio de Janeiro:
Guanabara Koogan; 2005.
Charlotte Guglielmi. Board
acts to prepare AORN for
the future. AORN Journal.
2004; 80(4):645-646.
Presentations
Kathleen Clark Hussain.
Implementation of
glucose control tracking to
reduce mediastinitis after
cardiac surgery. Institute
for Nursing Healthcare
Leadership, Boston, Mass.
Kathleen Clark Hussain and
Carr J. Glucose control to
reduce mediastinitis after
cardiac surgery. Hospital
and Medical Group Quality
Forum, Blue Cross and Blue
Shield of Massachusetts,
Framingham, Mass.
AORN Multispecialty
Conference: Ambulatory
& Office-based Surgery,
Columbus, Ohio.  Roles
and career opportunities
in nursing. MaSNA Annual
Meeting, Boston, Mass.
Labor and Delivery
Childbirth Nursing
Team received Johnson
& Johnson’s Childbirth
Nursing Award for 2004
for the second consecutive
year.
Patricia McNamee and Penny
Greenberg. Ensuring team
Yvonne Michaud was the
accountability for patient
safety. Whidden Memorial
Hospital, Cambridge
Healthcare Alliance,
Everett, Mass.
Yvonne Michaud.
Abdominal emergencies
and trauma management.
Certification Review Course
for Emergency Nurses,
Holy Family Hospital,
Methuen, Mass.  Traffic
safety materials for diverse
populations. Emergency
Nurses Association Annual
Conference, San Diego,
Calif.  Nurse-led trauma
tertiary survey in the
community hospital setting.
Lawrence General Hospital,
Lawrence, Mass.
Christina Richards.
Multidisciplinary care of
the breast cancer patient.
Acibadem Healthcare
Group, Istanbul, Turkey.
Barbara Rosato. Evaluation
and management of
common breast problems:
abnormal mammograms.
Primary Care/Internal
Medicine: Principles and
Practice, Cambridge, Mass.
recipient of the Stryker
Advanced Nursing Practice
Scholarship from the
National Emergency Nurses
Association.  She also
received a Federal Nurse
Traineeship Award.
New certifications
Laurinda Michaud,
international board
certified lactation
consultant
Yvonne Michaud, advanced
trauma care for nurses
Barbara Muth, critical care
nursing
Stephen Smail, critical care
nursing
Lisa Tulipani, oncology
nursing
Sharon Tutkus, professional
nutraceutical and antiaging consultant
Academic degrees
Lorraine Britting, master of
science, Simmons College
Kevin Flinn. Treatment
options for erectile
dysfunction after radical
prostatectomy. Prostate
Support Group, Boston,
Mass.
Charlotte Guglielmi.
Celebrating our value
– articulating our legacy.
AORN of Western
Massachusetts 50th
Anniversary Symposium,
Springfield, Mass.  Hot
topics in conscious sedation.
14
Awards and honors
Lorraine Britting received
the Excellence in Clinical
Practice Award from
Simmons College.
Elizabeth A. “Bunny”
Brooks, Debra Gonchar,
and Catherine Kilroy
received the Beth Israel
Deaconess Medical Center
Perioperative Services 2004
Caring Award.
Professional leadership
activities
Marcia Bixby developed
and initiated seven surveys
to evaluate critical care
nursing practice in an eroom format. These surveys
are available to Society
of Critical Care Medicine
members.
Charlotte Guglielmi was
invited to attend the
Kudos
Labor and delivery nurses share Robert M. Melzer Leadership Award
n September of 2004,
the annual Robert M.
Melzer Leadership
Awards were presented
to members of the BIDMC
community. The Leadership
Awards – named in
recognition of Robert
Melzer’s contributions
to the medical center
as former Chair of the
Board and Interim CEO
– this year recognized
BIDMC staff who have led
“constructive, lasting, and
all-embracing change.”
I
One of the three awards
went to Benjamin Sachs,
M.D., obstetrician/
gynecologist-in-chief, and
members of the Labor and
Delivery Team Training
Steering Committee.
Sachs and the committee
were recognized for their
cutting-edge work on
team training in obstetrics,
which is now receiving
national recognition. The
citation accompanying the
award noted, “The work
of the labor and delivery
team goes
well beyond
its own service
in the Reisman
Building. Other
departments
in the hospital
have benefited
from their
experience, and
soon the entire
country and the
world will also
read about this program in
medical journals. We can
be proud that this initiative
truly will make a difference
for thousands of people.”
Congratulations to Sachs,
the five nurses who were
recognized with this award,
and their colleagues on the
committee:
■ Jeanette Blank, R.N.
resource nurse, labor and
delivery
■ Susan Crafts, R.N.
resource nurse, labor
and delivery
■ Penny Greenberg, R.N.
obstetrics and gynecology
quality improvement specialist
2004 AORN Advocacy
Day, Washington, DC. 
She was also appointed
AORN Representative to
the Anesthesia Patient
Safety Foundation Regent’s
Workshop on Audible
Alarms.
celebration in May.
Applications for
advancement are accepted
any time. For more
information, contact your
nurse manager.
Clinical nurse
advancements
Karen Fecteau, R.N.
Andrew Harding, R.N.
Hallie Kasper, R.N.
Congratulations to the
following staff who
received advancement
through the Clinical
Nurse Advancement and
Recognition Program.
Advanced nurses will be
formally recognized at the
annual nursing awards
Advanced to clinical
nurse III
Advanced to clinical
nurse IV
Beth Burns, R.N.
Tracey Pollard, R.N.
■ Susan Mann, M.D.
director of obstetrics
and gynecology quality
improvement
■ Ronald Marcus, M.D.
administrative director of
obstetrics and gynecology
outpatient services and
obstetrical services
■ Patricia McNamee, R.N.
clinical director of labor and
delivery and obstetrics
■ Stephen Pratt, M.D.
director of obstetric
anesthesia
■ Barbara Stabile, R.N.
obstetrics and gynecology
quality improvement
specialist ■
■ BIDMC’s Labor and
Delivery Team Training
Committee received a 2004
Robert M. Melzer Leadership
Award for work related to a
national team training trial.
Above, the team is shown with
Major General Kenneth Farmer
(left) after receiving a plaque
from the U.S. Department of
Defense, which was among the
funders of the trial. Continuing,
from left to right: Patricia
McNamee, R.N.; Jeanette
Blank, R.N.; Susan Crafts, R.N.;
Benjamin Sachs, M.D.; Penny
Greenberg, R.N.; Stephen Pratt,
M.D.; Barbara Stabile, R.N.; and
Susan Mann, M.D. Not shown:
Ronald Marcus, M.D.
Nursing News Brief
An update on professional nursing at Beth Israel Deaconess
Medical Center
Writing/Editing:
Corrigan Kantz Consulting, Inc.
Contributors:
Pat Folcarelli, R.N., Ph.D.
Andrew Harding, R.N.
Pat Noga, R.N.
Shared governance council
chairs
Design:
Colvin/Williams Design, Inc.
Photos:
Beth Israel Deaconess Media
Services. Page 8 photo
courtesy of Harvard Medical International. Page
7 Blue Mosque photo ©
Historylink101.com and found
at Turkey Picture Gallery.
Shown on cover:
Meredith Carlisle, R.N.
Nursing News Brief is published
three times a year by the division
of patient care services at Beth
Israel Deaconess Medical Center,
and is distributed to professional
nursing staff and select individuals, schools, and organizations.
© 2005, Beth Israel Deaconess
Medical Center, all rights reserved.
Please send comments
or suggestions to:
Pat Folcarelli, R.N., Ph.D.
Beth Israel Deaconess
Medical Center
330 Brookline Avenue
Boston, MA 02215
15
Dianne J.
Anderson, R.N.
senior vice president,
clinical operations
Let me begin by wishing each of you a very happy and
healthy start to spring!
At my last writing, we were anxiously preparing for
a JCAHO visit, and – as you know – we came through
with flying colors! Our visit was extremely positive,
with only three “fi ndings” for improvement. Thank you
to everyone for helping us to shine. The medical center
looked especially neat and clean, and the staff who spoke
clinical staff. In the Recruitment and Retention Council,
we heard from new staff that they needed to have greater
on-unit availability of specialists and educators and
we have restructured the roles to provide that. We also
heard about the education needs at night, and we created
the night educator role to provide supports to our night
nurses. The additional clinical nurse specialists and clinical educators, the administrative clinical supervisors and
with our surveyors were outstanding in their ability to
describe the excellent care that they deliver each day.
I was particularly proud of our novice staff, many of
whom were the “face of nursing” to the surveyors on the
units. Each nurse who was interviewed articulated a thorough understanding of the plan of care and was able to
describe performance improvement initiatives that made
patient care at BIDMC safer than ever. The challenge
for us going forward is to hold the gains achieved during
the planning for the JCAHO process. I hope that each
of you will resolve to maintain the standards outlined by
JCAHO for safe, high-quality care for all of our patients.
In this issue of our nursing newsletter, we describe
the enhancements we have made to support practice
development at the medical center. This past year, as we
focused on retention of our talented pool of nurses, we
embraced a commitment to build additional supports for
admission facilitators, and the increase in centralized
and unit-based supports all contribute to the delivery of
quality patient care. We hope that these positions will
enhance the experiences of novice practitioners at our
medical center while providing opportunities for our
expert clinical staff to become involved in practice
development and quality improvement initiatives.
We are so pleased that we have been able to respond
to the requests we heard and to provide these outstanding resources. I hope that you take the opportunity to
seek out these men and women. These professionals are
here to help you develop your practice and provide excellent nursing care. I encourage you to get to know them
and take advantage of their presence and their important
contributions to the mission of our medical center. ■
330 Brookline Avenue
Boston, MA 02215
16
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