While heeding the call to care for others, nurses in New Jersey and Hudson Valley have been thinking outside the box when it comes to patients and processes. From embracing complementary therapies to implementing shared governance councils, local nurses are working to improve the profession and patient care one unit at a time. This Nurses Week, help Nursing Spectrum celebrate these special nurses and RNs everywhere who have given their all and more for the passion of nursing.
Finding Special NursesMarianne Guerriero, RN
Patients who come to Ramapo Ridge Psychiatric Hospital in Wyckoff, N.J., are experiencing an acute psychiatric episode, and their behaviors associated with these episodes can be challenging to manage. They might be unable to care for themselves, organize their thoughts, communicate their needs or be compliant with their treatment.
Finding that special nurse, who is patient, non-judgmental, able and willing to accept patients with difficult behaviors or physical needs is critical, says Marianne Guerriero, RN, BSN, nurse executive at Ramapo Ridge Psychiatric Hospital.
Guerriero figured out a way to meet the challenge. Ramapo hosted an open house and provided a one-hour continuing education program, and representatives from human resources, CE and nursing staff and management spent time talking with potential candidates.
Guerriero, administration and staff also developed a curriculum of courses for both new and experienced nurses. One series of courses is called Triaging and Priortizing Clinical Concerns, and the other is a nurse mentorship program for new RNs who are hired, which lasts for several months and culminates with a Spirituality in Nursing conference. Guerriero matches new nurses with preceptors throughout their orientation and beyond.
Through these initiatives we have found those special nurses, nurses who are compassionate, caring and accepting of others, Guerriero says.
Earning Everyones RespectElaine Greenhalgh, RN
When surgical/orthopedics staff nurse Elaine Greenhalgh, RN, of Good Samaritan Hospital in Suffern, N.Y., looks back on her nursing career, she recalls a program that influenced who she is today. Through the National Health Service Trust Institute, Greenhalgh was selected to participate in a program called Being with Patients, which showed how staff behaviors and attitudes could positively or negatively influence patient experiences.
A consultant nurse and project leader spent time observing the delivery of nursing care and the nurses interactions with patients at different times and locations. Following the observation sessions, the nurses and consultant discussed the experience. The sessions made me take a closer look at how I could improve my communication skills and empathize with patients and their families, Greenhalgh says. The program not only improved our practical and interpersonal skills, it also helped our team relationships and the quality of our care.
To this day, Greenhalgh applies what she learned from the NHSTI. As a charge nurse, Elaine demonstrates strong leadership and earns the respect of everyone on the healthcare team because of her clinical expertise and excellent communication skills, says Catherine Browne, RN, MSN, CAN, director of nursing for pediatric and med/surg services. Patients and families often write letters saying that she is the best nurse they have ever met.
Transforming Patient ComfortSylvia Isaacson, RN
Embracing a model of alternative complementary approaches to healing self and system, Sylvia Isaacson, RN, MSN, OCN, manager of the Inpatient Oncology and Outpatient Infusion Center at Morristown (N.J.) Memorial Hospital, focuses program development on enhancing patient and staff experiences through healing, touch, compassion and authentic presence.
We have developed the role of patient liaison, someone who helps patients identify their unmet comfort needs during hospitalization and coordinates services to enhance the patient and family experience, Isaacson says. She also has been instrumental in bringing in complementary modalities such as music, massage, Reiki, healing touch and pet therapies.
Isaacson didnt stop there. After writing a grant in support of an Essential Oils Certification program, Isaacson received a four-year grant, and eight nurses completed the course. The team also is in the process of presenting a research proposal to the institutional review board for approval. The focus of the study will be on the use of peppermint inhalation essential oil in postoperative nausea/vomiting.
An advocate and mentor, Isaacson is an active member of the newly developed Healing Culture Committee and Holistic Practice Committee and has completed the Birch Tree Center for Health Care Transformation course.
Navigating Rehabilitative CareSusan Hecht, RN
Susan Hecht, RN, nursing rehabilitation liaison, is an educator and advocate for patients and their families at Saint Francis Hospital in Poughkeepsie, N.Y. Despite the challenges she faces every day with screening patients and coordinating care with case managers, insurance companies, physicians and families, Hecht uses her nursing knowledge and resources to assist patients in receiving rehabilitation care.
When other facilities deny patients acute rehabilitation, Hecht sees their potential, and after intense therapy at Saint Francis, these patients are discharged successfully to home. She is respected by patients, families and colleagues for her knowledge, compassion and commitment, says Gayle ORourke, PT.
Hecht was instrumental in getting a 42-inch flat screen TV donated for the community room and a Nintendo Wii system installed for patient use during rehab.
Implementing Evidence-Based PracticeValera A. Hascup, RN
Two years ago, Valera A. Hascup, RNC, PhD (c), MSN, CTN, CCES, was offered the opportunity to develop the role of nurse researcher at Somerset (N.J.) Medical Center. To move the research process forward and promote a culture of scholarly inquiry and enthusiasm, Hascup accomplished these goals in a short time.
Somersets annual Nursing Research Day in November 2009 showcased 15 unit evidence-based practice projects, and two original unit research projects. Staff prepared their evidence-based projects using Bernadette Mazurek Melnyks model, and the medical librarian assisted them in searching databases for the best evidence.
The original projects were quantitative and qualitative projects developed by staff after identifying a unit clinical concern. Nursing frameworks guided both projects that received Institutional Review Board approval.
Every group prepared a project abstract, and the 17 projects were featured in a research booklet that was presented to Research Day attendees and members of the Executive Council. The staff presented their projects via PowerPoint and oral discussion, and two projects were selected for presentation at national professional organizations.
As a researcher, Hascup shows staff how research theory and nursing frameworks provide structure and support best practices. Because some staff have not been exposed to the formal evidence-based or research process, I am proud to introduce and guide nurses at Somerset in the exciting world of nursing research, Hascup says. It gives them the chance to explore and find answers to their clinical practice questions based on the best and current evidence.
Reducing Medication ReactionsSusan Nelsen-Tallon, RN
As lead member of a team of clinical managers at the Visiting Nurses Association of Central Jersey in Red Bank, Susan Nelsen-Tallon, RN, BSN, participated in Homecare Advances in Management and Practice, a national evidence-based practice improvement program that incorporates best practice geriatric assessment skills into nursing care.
Nelsen-Tallon and members of the IT department at VNACJ incorporated the CHAMP medication program into the VNACJ electronic patient record system. Once a nurse enters a patients list of medications, the system will indicate if there could be a severe medication reaction, and nurses are prompted automatically on the steps they need to take. Nelsen-Tallon implemented a procedure throughout the VNACJ that requires nurses to notify physicians within 24 hours, whether by phone or fax, about the results. If a nurse enters a new medication, the system will run the medication interaction program again.
This process has improved the VNACJ clinicians ability to educate patients and communicate with physicians in a timely manner and, therefore, has reduced patient hospitalizations because of medication reactions. In addition to the severe medication reactions we have avoided, there are benefits to patients who might have less severe responses, Nelsen-Tallon says.
Forming a Voice for NursesLeigh Anne McMahon, RN
When Leigh Anne McMahon, RN, MS CCRN, stepped into the role of CNO at White Plains (N.Y.) Hospital Center from her previous position as director of nursing there, she inherited a nursing division that was eager for change. Enthusiastic to begin the Magnet journey, she wanted to return power and decision making back where it belonged with the nurses.
McMahon tackled the task of transforming the organization into an environment of shared decision making. The council structure and the first shared governance body, the Nursing Practice Council, was identified. Within this primary council, key decisions were made about nursing practice at the hospital, and representatives from each unit and specialty brought forth recommendations and standards that guide the facilitys nursing practice. As the voice of the nurses grew stronger, so did the shared decision-making structure, McMahon says.
Other councils grew within the nursing division: Professional Development, Quality, Research, Finance, the Night Shift Council and individual unit councils. From the shared decision-making structure came the creation of the first model of nursing practice at the center: The Professional Practice Model.
Today shared decision making is thriving at WPHC, McMahon says. It is inspiring and energizing to see nursing practice be an autonomous entity, as it should be. Throughout the organization, nurses share challenges and victories together, always working toward excellent patient care and advancement of the profession.
Pinpointing Perinatal SafetyJane Ciaramella, RN
As a perinatal clinical specialist at White Plains (N.Y.) Hospital Center, Jane Ciaramella, RNC-OB, MS, C-EFM, IBCLC, has coordinated a number of perinatal safety projects for the Maternal Child Division. Working with nurse leaders and staff, Ciaramella developed a training program using the OB simulator NOELLE, which simulates high-risk, low-frequency obstetric events.
The nursing team learned the intricacies of working a simulator and planned for the addition of visual and auditory cues that help make the scenario lifelike. We videotape some of the drills and always debrief after the drill with learning material, Ciaramella says. Sometimes we have announced planned drills, and other times we show up unannounced with a scenario ready to unfold. They have implemented multidisciplinary drills on a quarterly basis.
Ciaramella also developed an initiative that addresses the mental health of postpartum moms and was instrumental in developing and implementing staff educational programs, such as a grand rounds event featuring a nationally known expert. After collaborating with mental health providers in the community, Ciaramella began a screening process for postpartum mothers, which involves patients answering a self-administered screening called the Edinburgh Postnatal Depression Scale. If a patient scores in the at-risk category, the healthcare provider is notified, and a psychiatrist or social services evaluate the patient.