Celebrating Nurses Week 2019

THE MSLC PROFESSIONAL PRACTICE MODEL

“

“

CARING is the essence of NURSING. -JEAN WATSON

2019 NURSES WEEK MAY 6-12 AT MONTEFIORE ST. LUKE’S CORNWALL, WE HAVE 404 REASONS TO CELEBRATE!

Dear Colleagues, Happy 2019 Nurses Week! I would like to take this opportunity to thank you all for your dedication, compassion, and passion for the work you do each and every day. I am honored and proud to call you my colleagues. I can’t begin to express my admiration and appreciation to all the nurses employed at MSLC who work so tirelessly at keeping our patients safe while providing the most exceptional care.

This community is very lucky to have the best and the strongest clinical nurses partnering with them in their health care needs. Not every hospital can boast about the passion and dedication of its nurses as well as the connections within the community.

As we celebrate Nurses Week this year, I have reflected on the many reasons why I am so proud of our nurses at MSLC, including the commitment, dedication, accountability, passion, and compassion we demonstrate to our patients and their families. These attributes are what separates MSLC nurses from the rest. Your dedication, support and incredible stamina for ensuring that we not only meet the needs of our patients and families but provide this care with exceptional clinical outcomes, is overwhelming. It is in this spirit that we come together in celebration of the hard work and devotion of the entire MSLC nursing team.

“YOUR DEDICATION, SUPPORT AND INCREDIBLE STAMINA FOR ENSURING THAT WE NOT ONLY MEET THE NEEDS OF OUR PATIENTS AND FAMILIES BUT PROVIDE THIS CARE WITH EXCEPTIONAL CLINICAL OUTCOMES, IS OVERWHELMING.”

NURSES DEMONSTRATE AUTONOMY IN BIRTHING CENTER In 2017, the clinical nurses in the Birthing Center were concerned about PPH rates in their maternal patients. They felt that additional nursing measures needed to be in place for nursing protocol standardization and autonomy, adding strength and urgency in addressing PPH. At that time, if a patient began experiencing PPH, nurses had to call a physician to initiate a treatment plan.

Along with their managers, the Birthing Center nurses (Margaret Speedling, Sue Formisano, and Colleen Murphy) set out to research and develop a nurse-activated obstetric hemorrhage emergency management plan which would allow them to activate treatment immediately, utilizing a protocol, thereby improving outcomes for their patients. Utilizing the evidence obtained from the New York State Safe Motherhood Initiative (SMI), they learned that standardization of practices, tools and guidelines improves the response time of a healthcare team, leading to improved maternal patient outcomes.

Thank you all for the strong bonds that we share with each other. We not only have a cohesive, professional relationship but many of us are very lucky to also share a personal connection. I am often reminded that we are truly a family and take care of each other as we take care of this community.

California, the first state to address postpartum hemorrhage in maternal patients, created a task force resulting in the OB Hemorrhage Toolkit. The toolkit allows for improved readiness, quicker recognition of an OB hemorrhage, enhanced response time and the appropriate recording of information containing standardized definitions and consistency.

So, my dearest colleagues, I want to thank each and every one of you for all you do. I hope you take the opportunity to join in the celebrations we have planned this week. It is with much joy that I wish you all a heartfelt Happy Nurses Week. I look forward to celebrating with all of you, not only this week but throughout the year as we continue to excel in our overall performance and care for our patients and customers.

The Birthing Center nursing team identified that several important components of the toolkit were not a part of their standard practice and agreed that adding the missing nursing components would positively contribute to the maternal patient outcome. The team developed procedures and tools that would incorporate autonomy in utilizing a nurse-created and nurse-driven OB hemorrhage checklist and a recorder form for patient monitoring in addition to the ability to call a code based on the progression of the checklist.

Sincerely,

The result was a standardized Obstetrical (OB) Hemorrhage Recorder form and an Obstetric (OB) Hemorrhage Checklist as the basis for monitoring blood loss and activating a code H.

My Dear Nursing Colleagues,

QUIET PACS Following a complaint by a patient regarding difficulty sleeping at night due to noise on the unit, Bonnie pulled the 5 North team together, addressing both shifts to include the entire team of RNs, licensed practical nurses (LPNs) and patient care assistants (PCAs). Bonnie discussed the patient’s complaints and asked for suggestions on how to reduce noise levels at night. Bonnie and the team brainstormed on what could have been done differently for this patient.

Heather Osmin, RN shared that she had visited a family memebr at another hospital and noticed a QuietPac on his night stand. Heather stated the QuietPac contained earplugs to reduce noise and an eye mask to block out light. She also stated the kit contained little sentiments of care such as lip balm, a word puzzle and a notepad and pencil to write questions and any thoughts or concerns.

Over the course of the next several days, Bonnie continued to meet with her team discussing the patient’s experience and sharing Heather’s QuietPac. All agreed that this was a good idea to move forward with. Bonnie advocated to Margaret Deyo-Allers to obtain this needed resource for our patients. Margaret agreed and after a short product trial on 5N yielded some very positive results, Quiet Pacs were ordered for all inpatient areas.

Happy Nurse’s Week! As we go into this week and celebrate all of you, as well as this incredible profession we share, I want to convey how proud I am of the dedication, team effort and sincere desire to impact the lives of those we have the pleasure to serve. MSLC is a better place because of the nursing care delivered 24 hours a day, 7 days a week, 365 days a year by all of you.

Nursing has long been defined as both an art and science. Nursing is a fine art.

According to Florence Nightingale, it is “the finest of the fine arts.” Nursing is not really a technique, but a process that incorporates the elements of the soul, mind and imagination. Please take a moment during this week to reflect upon the impact Florence Nightingale had on our profession. Nightingale had changed the way care would be delivered for every more.

So, in closing my dear colleagues, I leave you with a verse written by Henry David Thoreau:

CLINICAL NURSE ADVOCATES FOR PERIPHERALLY INSERTED CENTRAL CATHETER NURSE IN SUPPORT OF PATIENT CARE Presently at Montefiore St. Luke’s Cornwall, Peripherally Inserted Central Catheter (PICC) lines are inserted by the Vascular Access Team (VAT) at the bedside by Tammy Hufcut or within the Interventional Radiology (IR) department. Tammy who works part-time, recognized an upward trend of PICC line insertions by VAT. Noticing this incline, Tammy began to track monthly data from January 2017 to August 2018 using an Excel spreadsheet, identifying the number of PICC insertions by VAT versus the number of PICC insertions by IR. Analyzing and utilizing the data, Tammy found the results confirmed a steady increase in PICC line insertions.

With the analysis of the data collected coupled with the evidence-based research, clinical nurse Tammy was able to advocate for the acquisition of resources to support the delivery of care.

Together, Tammy, Bev Keefer, and Margaret Deyo-Allers devised a plan to ensure that full-time hours for PICC placement by PICC RN are covered. Lisa Lambros Lyons agreed to learn how to insert PICC lines and obtain additional competency achievement with Tammy. Lisa now can provide PICC insertion on the days that Tammy is off.

“It is something to be able to paint a picture, or to carve a statue, and to make a few objects beautiful. But it is far more glorious to carve and paint the atmosphere in which we work, to effect the quality of the day – This is the highest of the arts.”

Thank you for making a difference and for the extraordinary care delivered at MSLC. You are the best of the best!

Warmly,

Joan

“MSLC IS A BETTER PLACE BECAUSE OF THE NURSING CARE DELIVERED 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR BY ALL OF YOU.”

REMOTE MONITORING REDUCES PATIENT FALL RATES In 2017, the implementation of a telesitter program created a redesigned work environment empowering nurses to utilize AvaSys® as an intervention, where technology posed as a video camera would replace a physical sitter in the patient’s room.

Dear MSLC Nurses, It is truly an honor to be a part of this incredible nursing family.

I would like to take this opportunity to mention just a few of the extraordinary acts of kindness and compassion that I have had the privilege of experiencing first hand from our nursing colleagues.

• The MSLC perioperative team collected money as a gift from the tooth fairy for a pediatric patient who underwent a tooth extraction • An ED RN sat with the spouse of a patient and held her hand while our team coded her husband.

• Our inpatient nursing teams worked in collaboration with our ED charge nurse to mobilize patients out of a busy ED to accommodate potential victims of a house fire in our community.

It was felt that MSLC would benefit from remote monitoring of certain patients, specifically those assessed as a fall risk, to maintain patient safety while alleviating staffing pressures. This program focused on creating the Visual Continuous Monitoring for Patient Safety Using the AvaSys TeleSitter Solution Policy (PC 0222). This policy outlines the telesitter environment and how to implement use of the camera and the criterion for its use. The policy also recognizes the initiation of the telesitter as a nursing intervention to help prevent falls and patient injury.

Under the redesigned telesitter work environment, once a patient has been identified as appropriate for a telesitter by the nurse, a portable rolling camera is obtained by a healthcare team member and placed at the bedside. This camera is an extra set of eyes on the patient that is monitoring remotely, viewing 360 degrees. This camera replaces the physical sitter while maintaining patient safety. The PCA is stationed in the remote monitor room, and also has the ability to speak to the patient and provide redirection, if warranted, through the camera system.

If the patient is not compliant in following directions, the PCA triggers an alarm heard through the camera system. This alarm sound had to be incorporated into the work environment for identification and urgent response time. 5 North was one of the first units to see a decreased fall rate when using this technology.

• An ICU nurse sat next to a patient, encouraging him and supporting him, as he told his loved one some very difficult news.

• While managing a code hemorrhage, our birthing center team, in coordination with the ED, saved a woman’s life while making a point to keep her family informed, supported, and hydrated.

These are just a few examples of the many every day acts of kindness and compassion that define our incredible MSLC nursing team. These extraordinary acts of humanity are so deeply ingrained into the work we do every day, making it seem completely routine and ordinary.

Happy Nurses Week to all of our admirable MSLC nurses. Thank you for your dedication to this incredible profession and thank you for making an impact on our patient’s lives each and every day!

With gratitude and respect,

Stephanie

Stephanie Paruolo Assistant Vice President of Patient Care Services

ONCOLOGY SERVICES EARNS COMMISSION ON CANCER ACCREDITATION In June 2018, the interprofessional Oncology Services Team at Montefiore St. Luke’s Cornwall (MSLC) was awarded a three-year certificate of accreditation from the Commission on Cancer (CoC) with a silver level commendation for the Cornwall Oncology Center. Accreditation from the CoC is a statement in recognition of cancer care programs in providing comprehensive, high-quality and multidisciplinary care that is patient-centered. Such programs are distinguished as having improved upon patient survival and their quality of life through a standard setting, prevention, research, education and monitoring. Achievement of the CoC accreditation requires dedication and consistent quality improvement in the clinical care of patients.

EXAMINING PROCESS TO INCREASE PATIENT THROUGHPUT The Patient Throughput Committee, whose membership includes clinical staff Emily Terry from 5 North and David Demetres from the ED, are always brainstorming ways to decrease the amount of time admitted patients must wait in the ED before being transferred to their room.

An action plan was created to close the communication gap and encourage teamwork using 5 North as a trial unit. The team discussed a plan to implement a charge RN phone to promote timely communication between the ED and the units. This phone would be handled exclusively by the inpatient unit charge RN who has the responsibility for the flow of admissions and discharges on the unit. The new process would entail: • The ED nurse placing a call to the inpatient unit charge RN phone when a clean and ready bed appeared on their teletracking. The phone call would require verification from the charge RN that the bed is ready on the unit.

• The next step would involve the charge RN handing the phone off to the nurse who is to receive the patient to accept report from the ED, a process that was not being used.

• Additionally, the team spoke about implementing a daily huddle for the ED and inpatient units at 4:30 p.m. where the inpatient units would share the anticipated discharges and time before change of shift occurred. In return, the ED would also disclose the anticipated movement of patients to appropriate units based on the discharge report given.

Thus, under the new process, there would be open communication and full disclosure, where nursing would know and understand the throughput goal before the change of shift occurrence.

When I heard about the opportunity to send a thank you to the amazing nurses that provide the art and science of nursing here at Montefiore St. Luke’s Cornwall, I couldn’t help but start with my friend and our Chief Nurse, Margaret Allers. Her wisdom in the development of this inaugural book that provides our nurses with thanks and recognition for their tireless pursuit of greatness for those we serve is a testament to her passion and honor to our profession. Thank you, Margaret, for your steadfast commitment to our patients, families, and staff.

As the Senior Vice President of Transformation, having responsibility for the clinical areas of ED, Trauma, Infusion, Radiation Oncology, Wound Care, Pain Management, & Dialysis, I would like to send a special thank you to all the nurses who make me so very proud of our profession. Day in and day out, each of you demonstrate your compassion, skill, and passion for the profession that is witnessed and recognized by many. As a member of the Credentials Committee, a committee who has a responsibility to vet any new physician or provider requesting hospital privileges, we are often made aware of how “amazing” the nursing staff here is and so unique in their commitment to care.

Thank you to each of you for your uniqueness, skill, stamina, and determination in making MSLC the healthcare delivery system it is, and for choosing MSLC to share your talents. Happy Nurses Week to all of you!

Dan

Daniel Maughan Senior Vice President, Transformation

REDUCING MSLC ED/CATH LAB DOOR-TO-BALLOON TIMES Door-to-balloon time is the key determinant of patient survival from an ST-elevation myocardial infarction (STEMI). Blocked arteries should be reopened within 90 minutes for best patient outcomes according to the American Heart Association (AHA). Hospitals should strive to refine and reduce processes to ensure the guidelines of 90 minutes or less are being adhered to or improved upon.

To the Cath Lab/IR Nurses, I have the privilege to work closely with highly-skilled and caring nurses who are committed to continuously improving health care, providing a remarkable experience for our patients and making a lasting difference in our patients’ lives. I am especially grateful for our team’s determination to make a difference every day.

I want to take a moment to reflect on our accomplishments this year and to acknowledge this truly talented team that is the best in the business. The collaboration within our department allows us to provide the highest quality of care. This teamwork is truly something I am so proud to be a part of.

I would like to take this opportunity to express my appreciation to all of you for your commitment to providing the best healthcare possible for our patients.

Thank you for all that you do every day — • For making a million little split-second decisions for the benefit of the patients; • For making the patients the focus of your day and sometimes your nights; • For planning for patients long before they even arrive in our department; • For working together to provide that little extra special touch, for smiling and laughing and reassuring patients daily; • For placing your hands on patients shoulders to calm and comfort; • For thinking of new ways to improve our practice ; • You have made a difference in so many ways and in so many people’s lives, including mine.

Thank You and Enjoy your Nurses Week!

Diane Wilkinson, Evelyn Crimmins, Christina Troy, Megan Frank, Lisa Lambros-Lyons, Kellie Casey, Jennifer Parker, Anne Caldwell, Adrienne Hardy, Mike Demchak, Jennifer Wittekind, Tammy Hufcut, Nancy Jacob and Jacki Jardine

Bev

Beverly Keefer Director Cardiovascular Services, Cath Lab/IR

At MSLC, door-to-balloon time is recognized as a vital measurement for patient mortality and morbidity. In January 2017, although the average door-to-balloon time met or outperformed the AHA guidelines of 90 minutes or less, it was recognized that there was room for improvement.

The internal hospital measurements of door-to-balloon time identified inconsistencies in meeting AHA guidelines per case. Some cases presented with a door-to-balloon time of 50 minutes, while other cases were well above the AHA guidelines at 145 minutes. The Chest Pain Committee at MSLC included leaders and staff (Christina Troy, Cath Lab; Diane Wilkinson, Cath Lab; Melissa Fitzsimmons, ED; Davis Demetres, ED) acknowledged the need to address these inconsistencies.

In the first quarter of 2017, based on the literature review and internal expert input, the committee revised the door-to-balloon processes and implemented the following strategies: • Creating an algorithm that would trigger a STEMI alert notification to all appropriate personnel via an ED overhead announcement and cell phones. This would improve upon response time and patient outcomes.

→ S = Symptoms of pain and location identified by EMS

→ T = Triage within five minutes

→ E = EKG completed within 10 minutes → M = MD notification – Assessment completed within 10 minutes by ED physician, and STEMI team notified through a burst page and call operator

→ I = Immediate preparation for transfer to catheterization lab within 45 minutes • Establishing a Chest Pain (CP) EKG to facilitate EKG completion within 10 minutes of ED arrival for patients presenting with chest pain.

• Requiring EMS personnel to notify the ED staff of any patient presenting with a possible STEMI for early team activation.

• Having EMS personnel draw all labs prior to ED arrival.

• Developing a STEMI information packet to streamline processes.

• Designing a STEMI box to hold frequently used medications, Cardiac Catheterization Labcompatible EKG leads and defibrillator pads to restructure and simplify workflow steps.

• Having EMS staff participate in quality initiatives helping to demonstrate improvement in data measures.

CATH LAB NURSES ARE ALL HEART The ACC/American Heart Association (AHA) guideline for patients presenting with ST- segment elevation myocardial infarction (STEMI) recommend a reperfusion time of 90 minutes or less. These guidelines have proven to provide better patient outcomes, resulting in Medicare linking them to quality as an indicator for reimbursement. Therefore, continual surveillance of the process to improve reperfusion guidelines and patient outcomes is essential.

We have been blessed to work with two wonderful RNs in the last year. Vanessa Swingle, our Radiation Oncology Nursing Coordinator and Karen Ciardullo, our Oncology Nursing Coordinator. Both play very different roles but both have touched our patients lives in very important ways.

In 2016, the Cath Lab internal data revealed inconsistencies in maintaining the recommended guidelines for reperfusion times. Measures included door to first EKG < 10 minutes, door to practitioner assessment < 10 minutes, and Door-to-Balloon Time (D2B) < 90 minutes. As a result, we identified the need to review and improve our process of caring for STEMI patients.

On our initial meeting, Vanessa was very reserved and quiet but when I asked her why she wanted to go into oncology she shared a very special story that showed she was the perfect fit for our patients and the philosophy we have built in our department. Vanessa has shown her true colors. Every day she embodies the heart of being a nurse through her compassion, dedication, integrity and stewardship. The patients can never express how thankful they are when speaking about Vanessa. We had one very sick patient who really did not want to continue with her treatments. Beside the radiation and chemotherapy, the side effects were really wearing our patient down to the point that she wanted to stop her curative treatment and just take her chances. Every day Vanessa made sure that she was at the nursing station when the patient walked through the door to greet her with a smile and give her a pep talk. The patient finished her 35 fractions of treatment and was coming back weekly for skin checks to ensure everything was healing well. She expressed how instrumental Vanessa was in her cancer journey. We are very thankful to work with such a special person, as well as a special nurse.

Patients suffering from STEMI, usually associated with a blocked coronary artery are more likely to survive if the identified coronary artery is opened within 90 minutes once received at a STEMI center. This requires hospital and Emergency Medical Service (EMS) personnel to recognize the signs of STEMI and take quick and appropriate action. Collaboration and trust between these respective personnel is required to meet these goals and assure positive patient outcomes.

As our oncology nurse navigator, Karen has done an exceptional job in assisting to develop our oncology navigation program as well as our lung screening program. Karen has stepped into many people’s lives and really been able to make a difference. Karen has been instrumental in saving lives by educating the community, as well as our medical staff, on the importance of early lung screening. To date we have had eight positive cancer diagnoses out of the lung screening program. All patients were early stage and all were all able to have surgery. As a nurse navigator Karen’s job is never boring, frustrating at times, and surrounded by challenges, especially when she has very little authority to ensure patients get the assistance they deserve. Karen takes on all these responsibilities with a warm, compassionate heart and most importantly, is a great advocate for the patient. This has been shown numerous times in how Karen has been able to work with the patients in the oncology navigation program and get them the services they deserve.

Thank you for your compassion and caring Vanessa & Karen! Thank you for all that you do for our patients!

Janelle

Janelle Carr AVP, Oncology & Ambulatory Services

Nicole

Nicole Pogelschek Director of Radiation Oncology & Oncology Navigation

An interdisciplinary team was identified and brought together. Members included all disciplines that had contact with these patients. The cardiac catheterization lab staff, the ED Staff including physicians and techs, along with EMS personnel worked together to review current processes and identify areas impacting the goals of treatment for STEMI patients.

Issues identified from processes were mapped and together the team developed a plan and implemented the strategies to assist with the STEMI Alert notification processes and improved processes to facilitate EKG completion within 10 minutes of arrival to the ED for patient presenting with CP. Education was given to the EMS personnel to notify ED staff of any patient presenting with possible STEMI for early team activation. The cath lab staff worked with the ED to update policies and protocols to assure that all equipment and medications were easily accessible.

Results: We focused on measuring specific elements of time within the STEMI patient’s care process resulting in an improvement of our overall performance outcomes. Every minute counts!

1. Montefiroe St. Luke’s Internal Data Measures A. Door to EKG< 10 minutes improved from 84% to 90% B. Door to ED Practitioner assessment < 10 minutes improved from 80% to 90% C. D2B < 90 minutes improved from 88% to 97% Only due to the cath lab staff’s continual efforts were we able to improve processes.

By updating our process of caring for STEMI patients with standardizing equipment, improving communication between healthcare providers and facilitating the STEMI notification process patient care and outcomes improved and patients continue to receive optimal care in our lab.

As we celebrate National Nurses Week I want to recognize all of you for your incredible and invaluable service in providing care to our patients every day.

Nurses are the largest portion of the health care workforce. You are its front lines and its backbone. You are consistently ranked among the most trusted professionals, with honesty and ethical standards rated even higher than those of the clergy, doctors, and police officers.

You spend more time with patients than any other health care provider and have unique insights about the interplay among the factors that affect patient care. Nurses bring an important voice and point of view to patient care and policy discussions. You are in a perfect position to empower families to perform the caretakerâ&#x20AC;&#x2122;s role and are strong patient advocates.

You are the caregivers, communicators, and decision makers. You are the hand-holders, the voice-of-reason, the 3 a.m. vitals-checkers. You become the around-the-clock best friend by the bedside, the calming voice, the familiar face full of compassion.

To many, you are guardian angels.

Nursing is a passion for those filled with compassion.

I am so proud to be on the Magnet Journey with all of you!

Happy Nursesâ&#x20AC;&#x2122; Week!

Sue

Sue Curry Director Clinical Practice The Infusion Center has a group of nurses who are not often front and center. They have years of experience and many have worked in every area of the hospital throughout their career.

They are a quiet bunch in outpatient services who just make it work with their camaraderie.

They treat every patient like family. However, they often take care of the sickest patients at their weakest and most vulnerable moments. They are our oncology nurses who often spend their time holding the hands of our chemo patients, wrapping the warm blankets around them when they get the chills from the cancer killing agents we are pumping into their body, and holding basin as they empty their stomach for the fifth time during this treatment.

Heroes are not always identified by their capes and masks. They are often those who shy from the attention and act on their innate, good nature.

Thank you, Cathy, Vilma, Maureen, Lisa, Colleen, Sara and Wayne, for all that you do each and every day!

Janelle

Janelle Carr AVP, Oncology & Ambulatory Services

Pain management is a unique setting within nursing because we get to know our patients on a personal level. We get to know all about their lives, their families, their good times and bad.

We cannot choose one patient that we help but rather write about a group of patients we believe we help the most. These patients all have Chronic Regional Pain Syndrome better known as CRPS. This condition causes severe pain in different extremities depending on the trauma. Many times, we are the first facility to diagnose and help these patients. We see most of these patients weekly and some twice a week. The combination of injections and medications we provide allows them to live a semi-normal life.

One patient we see weekly with this condition tells us without these injections he can not get out of bed. He relies on the injections to allow him to do simple ADLs many of us would take for granted.

Another patient, a high school student who twisted her ankle while hiking, was unable to walk without crutches since the incident. She was unable to participate in gym or have a normal high school experience. After months of injections and the right combination of medication, she is now living abroad in Belgium for her senior year.

The help the pain management team provides changes lives, and we are honored to have such a great team. We understand the population of patients we see can be overwhelming and trying at times, and we want to give a huge thank you to the nursing staff for always having the patience to stay positive no matter what. Each of you are an asset to the organization.

Thank you, Barbara, Kristen, Sha, Cheryl, Taj, Nadine, Jody, Vilma, Alyssa and Roni. We couldn’t ask for a more caring and awesome team.

Janelle

Janelle Carr AVP, Oncology & Ambulatory Services

Courtney

Courtney Smith Pain Management Coordinator

As we celebrate National Nurses Week, we would like to take this opportunity to express our sincere gratitude and appreciation to all the staff of the Intensive Care Unit (ICU) and Stepdown Unit (2N) at Montefiore St Luke’s Cornwall. Every day you provide quality care to our patients and their families during the most vulnerable moments of their lives. The care you give helps Montefiore St Luke’s Cornwall achieve our mission of providing exceptional healthcare and improving the lives and well-being of the people in the communities we serve. I am honored to partner with you as we offer these essential healthcare services to the people in this community.

Happy Nurses’ Week!

Elizabeth

Elizabeth Quansah Director of Critical Care

Renata

Renata Kargul Critical Care Clinical Coordinator

INTENSIVE CARE UNIT NURSING STAFF Henry Atakora Deena Joseph Ginger Norton Deanna Boyd Renata Kargul Jennifer Perez Beth Castaldo Sandra Kratz Heather Pesciotta Anne Clark Matthew Lazarski Margie Skelly Anne Davis Adam Memawe Elise Sylvester Julianna Finnegan Paula Mendez Charlotte Talbot Maureen Foote Juan Mera Sandra Taylor Nancy Griffin Jill Mongelli Aristotle Tolentino Benjamin Hayes Melissa Morales George Valdez Marlene Johnson Shanty Nedumthakady Sharon VanDalinda Ed Jones Megan Nier 2 NORTH NURSING STAFF Jennifer Bautista Ashley Higgins Rosanne Callahan Sharon Liefden Dorothy Carlton-Graff Maggie Macutay Rey Cruz Jennifer Magur Rebecca Delarosa Elizabeth Mahoney Patricia DeToro Ester Medina Edward Flowers Karolina Monroe

Brianna Paolini Jennifer Salvucci Eileen Schug Rebecca Taylor John Thompson Mary Walker

THANK YOU ED TEAM!!!

What a great year it has been. We can’t thank you all enough for the amazing strides that have been made this past year. Because of you, our patient perception scores are at an all time high.

The level of courtesy and respect shown each day is truly second to none.

Happy Nurses’ Week to the incredible team of Administrative Nursing Supervisors here at MSLC. You are the true epitome of a team; rain, sleet, or snow, you demonstrate unwavering accountability to our patients and this organization. As we move towards Magnet and focus on the autonomy of our nursing department, we look to all of you as a model of empowerment and professionalism. It is an honor to work with such a strong, autonomous, and committed group of professionals. Happy Nurses’ Week to an amazing team!

This past year has been a true testament to what we can accomplish for our patients when we all come together as a TEAM. As your leaders, we could not ask for a better team of professional nurses. We are truly thankful for the level of commitment you have in providing exceptional patient care each day.

Esther Asuncion, John Bilancione, Julia Reid-Brown, Sharon Brown, Beth Corcoran, Kathy Downes, Joanne Gleason, Vee Kaur, Gwen McNally, Joyce McRae, Mary O’Brien, Linda Titmas, Eileen Hernandez-Valdez

Enjoy all the great surprises this Nurse’s week and as always, thank you!

With respect and gratitude,

Christopher

Christopher Rhynehart ED Clinical Nurse Manager

Kathy

Kathy Sheehan Director of Emergency and Trauma Services

Stephanie

Stephanie Paruolo AVP, Patient Care Services

Deborah

Deborah McTamaney Manager, Patient Flow

Shout out to the amazing team of admission discharge and medication reconciliation nurses.

The partnership that you create with our patients cannot be underestimated. Each one of you makes a tremendous impact on our patient’s ability to successfully transition as a patient, and a to independently manage their care at home.

Thank you for all that you do!

Sue Candela, Bridgit Ebert, Susan James, Jeff Jordan, Noel Vinoya With respect and gratitude,

Stephanie

Stephanie Paruolo AVP, Patient Care Services

Join Us!

ELEBRATE

ENT’S M T R A P E NCY D E G RES! R O E C M S E S E P H T HCAH G N I D N A OUTST AS WE C

March 6

.m. and at 6:30 a d e rv e s t will be 9 p.m.

Breakfas p.m. and

NURSING SHOUT OUTS These two amazing nurses may not work at the bedside, but they know how to find all the details in a patient’s medical record to support the need for the wonderful care provided by our bedside nurses and ensure we are paid for this care.

Thank you, Carissa and Lourdes, our fabulous Appeal Nurses!

Jill

Jill Barton Vice President, Revenue Cycle Happy Nurses Week to our clinical documentation specialists Beena George, Janeen Lorenzo and Joanne Santacroce! We appreciate everything that you do to ensure that we have the documentation in the medical record to support the complexity of our patients! Each successive year we see the direct impact that all of you have on improving documentation of existing co-morbidities. You make a difference! Thank you!

Mary

Mary Kelley Vice President, Quality Management In the two years working in the Foundation at Montefiore St. Luke’s Cornwall, my engagement with our nursing professionals has come primarily through my weekly HCAHPS Executive Rounding in the Birthing Center, NICU, Infusion, and Pain Management. The nurses and staff in these units continue to impress me week after week with their steadfast dedication and expertise in caring for our patients and patient families. Additionally, through the Foundation’s Grateful Patient program, when I am at the bedside checking on our various hospital donors, I often receive an “unsolicited” report on our nursing staff by our donors. It is always extremely complimentary and glowing regarding the extraordinary care that is delivered by our nursing professionals across the units. I stand in awe of our fantastic nursing team here at MSLC who work tirelessly 24/7 through blizzards and tornadoes to give our MSLC patients and patient families the best possible experience they can have while in our care. To our fantastic MSLC nurses— keep up the great work and enjoy your well-deserved nurses week celebrations!

Anne Marie Anne Marie Schoonhoven Executive Director, St. Luke’s Cornwall Health System Foundation Thank you for all that you do for our patients, their families and the entire community. You are such an essential piece of the puzzle and the care and compassion that you provide each and every day does not go unnoticed. Happy Nurses Week! You deserve to be celebrated!

Kate Kate Dabroski Vice President, Marketing, Public & Community Relations

HAPPY NURSES WEEK TO OUR ED NURSES! Janine Andretta Maria Baptista Chris Baumann Deborah Benzal Melissa Bew Robert Canavan Sarah Catherall Toni Crisci Ryan Degnan David Demetres Julianne Denesha Andrew Dipaul Rosanna Edreira Diana Fernandez Pam Fitch Aline Folefack Liberty Gomez- Gioia Michael Gormley Catherine Grace Donna Hannigan Lorna Ho-Sang-Davidson Todd Hulbert

Megan Iacomacci Margarita Ibbs Anna Jakubek Kristina Kantor Blanca Lemos Jessica Lozado Bridget McNulty Abigail Mensah Jenna Nardi Dennis O’Dell Kathryn Pillet Donna Ramsey Erwin Rances Angelina Roberts Erin Skrobanski Liberty Somma Erin Starr Brenda Taylor Dorothy Upshaw-Fredericks Joanee Tubbs Natasha Reynolds-Hucey

THE “ANGELS” OF 3 NORTH Amongst all of the hustle and bustle of our busy med-surg unit, there are extraordinary things happening on 3 North and exceptional care is being given to each and every patient. Being selected to be a part of the Montefiore St. Luke’s Cornwall team is an honor and privilege – one that our nurses do not take lightly. Their dedication and commitment to their patients and quality care are evident in their actions that are seen, as well as those that sometimes go unnoticed but are truly genuine acts of love and compassion towards our patients and their families.

“They may forget your name, but they will never forget how you made them feel.”

-Maya Angelou The poignant quote relates to our roles as nurses and the work we do because despite the challenges and frustrations we may face, we continually show up and give 100% of ourselves to our patients. In my interactions with patients and their families, I am often made aware of incredible situations in which our nurses have gone above and beyond for their patients. These little moments, no matter how simple or commonplace they may seem to the nurse at the time, have changed the lives of our patients and will forever be a part of their memory of the compassionate care they received at MSLC. A patient’s family recently recounted their mother’s stay and described our nurses as “God’s Angels.” Their mother had been a patient on 3 North for an extended period of time when she decided that she would prefer to continue her treatment as comfort measures only. As our nurses often do, they asked questions about the patient and her life as well as her interests and hobbies. Dawn Mott discovered that the patient had been a ballroom dancer and loved to dance. From that point forward, Dawn would dance with this patient in her room, taking careful steps and allowing the patient to support the weight of her tired body on her own. As the patient’s condition deteriorated Dawn continued her dancing sessions with the patient, but instead of standing Dawn would dance by holding the patient’s arms and methodically moving to the music (often which was Dawn’s singing).

On another occasion, another patient’s family described to me how their mother, who was also at the end of her life, told them that when they left for the evening Dawn would not let her be alone and would stay late after her shift to hold her hand and make sure she had a hug each night.

These patients’ families will never forget how Dawn made them and their family members feel.

Another patient recently explained to me that he felt touched and “at home” when Ally Miller was his nurse and was able to joke with him and keep their conversations light. He described how Ally would tirelessly accommodate his needs and any request he made, all while making him laugh and taking his mind off the pain he was experiencing and the sadness he felt about being away from his family. This patient will never forget how Ally made him feel.

SOMETIMES IT’S JUST MEANT TO BE Dr. Cestari’s patient arrived in Same Day Surgery at 8:30 a.m. for a 10:30 case on Wednesday, March 19. There was a delay due to an unforeseen situation from the previous. KC was the primary RN and handed off report to Laura at 1 p.m. to resume care. While we kept updating the patient and family with details on the delay, an exact time was not able to be identified. We gave an option for the patient to come back the next day since we couldn’t identify the exact time due to the surgeon working in the operating room, but the patient and family declined. Dr. Cestari was able to come out and speak with the patient in same day and explain to them that for the safety of her surgery and how long he had been operating, it’s best to come back first thing in the morning.

The next day, the primary RN was Aimee. The patient verbalized that she was anxious and upset about being delayed from the prior day. Aimee provided emotional support and sat with the patient a few minutes to form a patient bond and listen to her. The patient opened up to Aimee when she realized that she was from Pine Bush. The patient lost her son four years ago and Aimee knew him from school and basketball. The patient got very emotional and said that she felt an immediate connection to Aimee. Aimee told the patient that she remembered how good a basketball player he was and his beautiful blonde hair.

The patient told Aimee that her procedure was, “Meant to be delayed so she could have a nurse that knew her son.” The patient was worried that people in the town would forget him. Aimee let her know that his photos and messages remembering him are still on Instagram. She was so touched and happy to hear he’s living on in people’s memories in the Pine Bush community.

The patient kept saying, “It was meant to be!” She told Teri and Christine that, “The entire staff in same day surgery were supportive, informative, and empathetic to the situation.” Kudos to everyone on the staff who made her experience a positive one and touched her life.

QUALITY TEAM SHOUT OUT Happy Nurses Week to Linda Dombroski, Rebecca Rosario-Dure, Kathy Fanitzi, Margaret Stack, Rebecca Rosario-Dure, Tyra Thompson and Carol Wilson. You each have made such an important contribution to improve the quality of care at Montefiore St. Luke’s Cornwall! Your dedication, attention to detail, and enthusiasm have helped us to shine not only in PI projects, but also in the data that is available to the public and impacts our reputation! We could not ask for a more committed team! Thank you! Thank you! Thank you!

Mary

Mary Kelley Vice President, Quality Management

ENDOSCOPY NURSES BECOME PART OF THE FAMILY We started treating a patient with a GI genetic disease which required a PEG tube from the time he was in his early teens. Every six months to a year we would have to replace the PEG tube, and we grew very attached to this young man. His brother also acquired this genetic disease, however, he did not need the PEG tube.

Over the years, we became very attached to this family. In his twenties, he met someone and eventually got married. We were all invited to the church, and a couple of nurses attended the ceremony.

After a couple of years, and still replacing his tube, he announced that his wife was pregnant.

The family was apprehensive and hoped the baby would not inherit this genetic disease.

The patient had healthy twins with no sign of this genetic disease. Eventually the patient had his PEG tube removed permanently, and they lived happily after.

SURGICAL TEAM SHOUT OUTS PACU: We want to recognize the recovery room nurses for keeping the patients safe and comfortable while recovering from surgery. The team of eight women who ALWAYS put their patients first and provide patient centered care — Gail, Pam, Lisa, Anne, Chris, Lana, Nadine, Erin and Ann — YOU ALL make this team dynamic! The level of accountability, teamwork, and professionalism shines through you all. The perioperative leadership team is proud to work with such autonomous critical care Registered Nurses! Happy Nurses Week! Thank you!

Endoscopy: Happy Nurses Week to Brenda, Maggie, Mary Grace, Gia and Diana, the hardest working endoscopy team! Your long hours and countless add-on procedures NEVER go unnoticed. Your patients appreciate your warm smiling faces while undergoing procedures, especially in the middle of the night emergency cases. You make patients and families feel comfortable with your warm touch, compassionate care, and bedside demeanor. Happy Nurses Week! This team is second to none!! Thank you!

SDS/PAT: Happy Nurses Week to Alena, Aimee, KC, Debbie, Sue, Tanya, Mary Ellen, Wanda, Elena, Anne, Peg, Deb, Laura, Mary Beth and Carol! Wishing everyone an awesome week of celebrating your hard work, dedication, and commitment to excellence and quality bedside care for the surgical patient. Your patient survey scores are the highest ever on discharge information and communication about what to expect while recovering. Kudos to you all! We all shine together, so let’s celebrate the positive impact you have on your patients and families! Thank you!

You’d never imagine how a simple goodbye could impact a person as much as it did one morning when Ryan Cruz said his goodbyes to a patient and wished her well on her next steps on the road to recovery. For that moment, that patient told me that she felt loved and important to someone. Little did Ryan know, this patient’s husband and child had died in the past year, and she felt as though her world was ending prior to this reminder that she was not alone. She will never forget how Ryan made her feel that day.

Often, we encounter a patient whose long length of stay makes them feel more like a member of our team than a patient. This was recently the case with a patient, who for multiple reasons, was hospitalized for more than 30 days, including her birthday. Samantha Mangiaracina organized a birthday party for this patient complete with a cake and a stunning rendition of “Happy Birthday.” While this gesture may have seemed simple to some, the impact it had upon this patient was life-altering – one that she will never forget.

I could go on and on with stories that I’ve been told about our amazing nurses. It is evident that they are truly exceptional in every way. There are days when they tell me that they don’t know how they are going to get through the day, and they feel as if we can barely walk off the unit at the end of their shift. However, at the end of each day, every one of our nurses should feel pride in the work they’ve done and the impact they’ve made upon our patients as they will truly never forget how we’ve made them feel.

Thank you to all the 3 North nurses from the bottom of my heart for all that you do for your patients and this hospital.

Kristen

Kristen Prince Clinical Nurse Manager, 3 North

THE AMAZING NURSES OF 3 NORTH Sally Triggani Colette Gayton Samantha Mangiaracina Claire Abayon-Olitan AnnMarie Dietz Dawn Mott Irene Mera Raquel Rogers Yamaris Vaillant Allie Miller Irene Kysyhstsya Gia Drony Kim Kieva Vivian Djanie Brenda Pare Arthur Bolado

Amanda Bullis Stephanie Herbert Ryan Cruz Jacqueline Stinson Stephanie DeStefano Cassandra Davis Brenda Ramjug Anh Bui Kelly Carrol Kayla Clarino Alyssa Mejia Ashanti Brown Jessica Olevencia Heather Williams Brianna Spaulding

As you may or may not know, in a life and death situation there is a laser focus on the outcome of the patient. From the team’s perspective they didn’t think that having a father come into the room and view the room and the tidiness of the room would be a positive outcome. Since time was of the essence, the OR manager reached out to her colleague, Stephanie Paruolo to assist in escorting this patient’s father to the OR suite. Again, with the apprehensiveness of the all the staff not wanting this father to see his son in this way, as Stephanie and the OR manager brought the father in the OR suite the father immediately went to his son.

“WE MAKE A LIVING BY WHAT WE GET, WE MAKE A LIFE BY WHAT WE GIVE.” – WRITER UNKNOWN This quote that I have chosen for my team says it all. Every day the nurses on 4 North make a life through their endless, unselfish efforts of providing exceptional patient care.

My nurses on 4 North are committed to their cause of compassionate and thoughtful connections. Every day they are faced with the challenge of death and dignity for their patients.

I see how each nurse comforts the sick and dying while consoling their families with grace and a great deal of sympathy. I am overwhelmed with emotion while I think of each and every nurse on 4 North and the life they make by giving. I am proud of my nursing team and their dedication to their profession, the patients and their families!

Happy Nurses Week to the best team ever.

Even though CPR was progressing, the father put his hand on his son’s forehead, leaned down and kissed it. The father immediately turned toward the OR manager and fell into her arms and thanked her for allowing him to see his son for the last time.

The father was escorted to his family. After the OR Manager debriefed with the team members in the room, there was a new outlook that was achieved about families coming into the OR suite when it is possible that the family member will expire prior to the end of the procedure. The operating team also gained a perspective that the family member didn’t see the operating room with all its equipment and clutter related to attempts to save this patient; the operating team members saw a father having an opportunity to say goodbye to his son personally.

Montefiore St. Luke’s Cornwall has an amazing Operating Room team. I am honored to work every day with each and every one of them. Their dedication to their unit goes above and beyond. We thank each and everyone.

Teri

Rosa

Diane Vinciguerra Operating Room Manager

Christine

Rosa Keane Clinical Nurse Manager, 4 North

Kim Gurnee Tracy Diaz Rachel Reeves Nadine Stewart-Graham Stacy Ryle Adrienne McCarthy Roni Codett Emri Roman Carol Mucci Jenna Oberle Michael Legaspi Nadine Jeanty-Rouchon Bessa Cosaj Patricia Adam Julie Gonzalez Theresa Muschett-Diaz Kristin Medina Kelly Mascia

Diane

Teri Egitto Director of Perioperative Services

Regina Zeoli Teasha Nugent-Jerume Beth Laymon Eric Nieves Annette Hart Stephanie Parmesar Melissa Sullivan Jocelyn Vazquez Jostalynn Babcock Britney Masucci Claudia Pastor Patricia Lieme Melania Rijfkogel Griselle Hernandez-Velez Miranda Colfax Ashley Ladka Ilene Guzman

Christine Rao Clinical Nurse Manager Same Day Sugrery PACU Ann Fee-Burke Pam Fitch Gail Toth Nadine Martin Christine Gentile-Baumann Lisa Congelosi Erin Harnett Ann Machado Svetlana Khmelnitskaya Ashley Ladka

OR Paula Serra Toni Bouton Maureen Merchant Donna Florie Donna Ortiz Deb Brock Olga Munoz Farlae Buttner Jessica Secor Ed Kraus Kristin Gilmour Holly O’Hern

ENDO Brenda Taguer Linda Callinan Gia Meyer Diana Fraine Margaret Ruzzi Mary Beach

ASU/PAT Susan Axtell Kathryn McMullen Aimee Croce Alena VanZetta Debra Hannigan Carol Richardson Debbie Toussaint Peg Gallaghan Laura Cook Anne Cichocki-Luffman Mary Beth Henderson Mary Ellen Robillard Wanda Waring Elena Alvarez Tanya Camacho

A NEW PERSPECTIVE COMES FROM TRAGEDY In all surgical cases, RN circulators, registered nurses who provide patient care before, during and after surgery, are the last people patients see before being placed under anesthesia by the and the first ones they see when they when they wake up. It’s a high-stress job that requires emotional and physical stamina, the ability to operate complicated equipment and knowledge of literally hundreds of operative procedures as well as surgical instruments and supplies.

On a typical eight-hour shift, an operating-room nurse may be involved in up to four cases, ranging from patients undergoing gall bladder surgery to victims of auto accidents.

For operating room nurses, a sense of humor is considered a necessity for emotional survival.

At Montefiore St. Luke’s Cornwall, a Level III Trauma Center offering all services 24 hours a day, seven days a week, the operating-room staff consists of 12 registered nurses.

This is a story about a day in the life of an operating room team—Donna Florie, Paula Serra and Liz Cruz, who all have years of experience in the operating room.

May 2, 2018: At 1 p.m., the operating room received a phone call that a patient was found to be in traumatic arrest and was being transported to the OR. The charge RN quickly rounded up the operating room team members who proceeded to open and prepare the room. At 1:30, the patient was transported to the holding area where the operating room team evaluated the patient prior to going into the OR suite.

The patient was a 17-year-old male who was brought to the ER by EMS status post-MVA. He was a restrained driver who collided with a tree. Without delay, the patient was transported to the OR suite one by one of the team members. The room was set up for an emergent exploration.

As the procedure progressed, the OR manager was receiving phones calls that family members were arriving at the hospital at different times. The Director of the Emergency Department was bringing these family members up to the OR waiting room to await the outcome of the procedure.

Rounds were conducted on the OR suite routinely, and at approximately 3 p.m., it was noted that the patient was not responding, and that the death of this patient was possible. It was at that point that the OR manager discussed with the team in the room that the father would like to come in and see his son and say goodbye. The team was very apprehensive to allow anyone one in the OR suite since the team had taken all life-saving measurements for the patient and the attempts hadn’t had a good outcome.

A BIG HEART IN THE FACE OF HEARTBREAK A patient arrived in Labor and Delivery with complaints of diffuse abdominal pain with nausea and vomiting. She was assessed, and it was found that the infant no longer had a heartbeat. The doctor was called and arrived to deliver this sad news to the mother and father of the infant.

The baby was delivered shortly thereafter.

When there is a fetal demise in the Birthing Center it is a very sad time for the family as well as the staff. It takes hours of time discussing bereavement with the family and preparing the baby for the family to hold and love their little one for the short time they have. The nurses take many pictures of the baby as well as make Christmas ornaments, take hand and foot imprints and even cut off a lock of hair for a keepsake. Along with these tasks the staff spend an enormous amount of time talking with the family and helping the families to make decisions such as whether to get an autopsy or where to bury their baby.

I have no words how honored I am to be the manager of this wonderful group of men and women. If I had to describe the entire staff in one word I would say, “family.” We laugh together and at each other, we shed tears together, and just like a family, we don’t always get along. But when there is a need, they all pitch in and support each other. We get together for the holidays, celebrate birthdays, retirements, new babies, and make sure we get together for our annual summer picnic.

Every day is not peaches and cream, and I get angry with them more than I want to, but I wouldn’t change a thing. Just like a family, it takes the “mamma” to not be happy and no one is happy to get things moving.

Over the last few years, there have been so many stories about our family. We have a nurse, Allison, that punched out after her shift and sat with a dying patient until her family arrived from out of town. We have nurses, Nicole and Tami, who took time out of a busy day to hold hands with a dying patient and pray with her. We have a nurse, Denise, who literally gave a patient the clothes off her back. Too many of us lost loved ones, and just like a family, we supported each other and shed tears. There are too many stories.

Patient care is their priority. We have so many patients that appreciate them and request 5 North if they are readmitted. They welcome being the Urology/Bariatric floor so they can shine on their expertise in caring for those patients. Every single one of them brings something to the team.

They are a fun group. They can be a frustrating group, but they are my second family. I cannot wait for all of them to get their nursing excellence recognized by obtaining our Magnet Status.

I hope you enjoy your week - - the bus is still moving, remember where your seat is!

Bonnie

Bonnie Heal Bariatric/Urology Service Line Director

One nurse in the Birthing Center (BC), Jess Molosh, stands out tremendously by using her own time and money to buy memory boxes, ornaments, molds for 3-D impressions of hands and feet and other items that she finds to enhance the memory box for the families. On the day this woman delivered her baby, it was extremely busy on Labor and Delivery. Jess was home and heard the sad news of the demise and offered to come in to do the bereavement with the family. Jess spent hours talking with this family and taking beautiful pictures and foot and handprints as well as making keepsakes for the family.

This is an example of a nurse going above and beyond for a patient. Jess knew the other nurses in the BC that day were tremendously busy and knew this mother and family needed an enormous amount of time and energy. She supported her patient and her colleagues by coming in on her own time to do the best thing for her patient. The kindness and love she displayed to this bereaved family went far above and beyond any expectations.

Kate

Jeanne

Kate Elias Clinical Nurse Manager Birthing Center & NICU

Jeanne Boydston Director, Birthing Center & NICU

BIRTHING CENTER Brenda Cramer Jennifer Duffy Susan Formisano Stacey Lloyd Bridget Mannese Simone Cimino Sandra Graynor Lori Roberts Susan Seigerman Sharon Johnsen Colleen Mayer

Jessica Molosh Christina Cassidy Tracy DePaoli Dory Sullivan Andrea Moresco Allison Neville Kellyne Fonrose Patricia Sorg Keri Romero Mary Pat Bailey Leann Pogemiller

Christina Lonkewycz Lois Vanderbeck Lori Holmes Lori D’Amato

Michelle Vinolas Maryann Dederick Kochumol Joseph Mary Morris

Jana Strasova- Harrington Kelly Hoffman Emily Burke Mary Jean Rogers Kayleigh Perotta Kelly Raby Chelsea Munkelt Sheri May Margaret Speedling Angella Laing-Rogers Tammy Foster

NICU Rhonda Armstrong Shannon Hurban Lorelei Horn

FAMILY SAVING FAMILY On a holiday weekend in May 2018, the ED staff received a call from EMS stating they were on their way with an actively seizing 38-week pregnant woman. The ED staff immediately called the Birthing Center (BC) staff to inform them. Since there was no doctor in the BC at that time, the staff told the ED they would bring the fetal monitoring equipment to them. The BC staff notified the NICU, the two obstetricians that would perform a C-section if necessary, and the neonatologist of the impending emergency and all replied they were on their way. The BC charge nurse, planning for the worst, instructed the staff to set up the OR for a C-section.

Three nurses from the BC arrived in the ED with fetal monitoring equipment as well as medications (Magnesium Sulfate) used to stop/prevent seizures in a pregnant woman. As the BC nurses arrived in the ED, the patient arrived via EMS, still actively seizing. The ED staff jumped to care for the patient’s respiratory and hemodynamic needs by obtaining multiple IV sites and intubating a seizing patient. The BC staff took over for the care of the fetus and the obstetrical emergency by hanging the Magnesium bolus and assessing the fetus by placing the fetal monitor on the patient. The two OB docs and the neonatologist arrived at the same time.

The fetal heart rate was initially normal but soon plummeted to a dangerously low rate. The OB docs decided it was necessary to perform an emergency C-section right there in the ED. The BC and neonatal staff were called and all OR equipment, as well as infant warmer and resuscitation equipment, were rushed to the ED. There were 59 patients in the ED this day and every space was taken. The BC/ Neonatal nurses turned to set up the infant resuscitation equipment and somehow, the ED staff had removed a patient from the bay next to the where the seizing patient was, which allowed for the set up of the infant equipment. The OB docs put sterile gowns right over their clothes and delivered a lifeless infant by C-section. A full resuscitation of the baby ensued with good results. The mother’s surgery was completed, and she was transferred to ICU to manage her airway and blood pressures. The infant was transferred to NICU. Mother and baby were reunited on the second day after delivery and went home together four days after birth.

This is an example of pure teamwork with each team utilizing their expertise. In the multiple debriefings that occurred, both the ED team and BC team noted that they were so surprised that no one even had to say anything. They worked like a well-oiled machine just doing what had to be done to ensure the best care of the patient and her baby.

Happy Nurses Week to all 5 North RNs! Theresa Clark Doreen Shallow Sylvia Seaman Nicholette Rohrer Alexis Incantalupo Carolyn Destefano Deb Jainariain Allison Muller Kelsey Gonzalez Danielle Kramer Paul Mongelli Arianna Pawliczek Mary Riley Chelsea Crawford Autumn Drake Natalia McCafferty Heather Osmin

Denise Barley Barbara Crana Emily Terry Toni Casciano Noelle Darcy Matthew Agazzi Stephanie Jacks Erica Bariletti Denise Knowles Nicole Scott Jenna Dubois Sherri Spell Jessenia Suarez Mary D’amico Amanda Pastor Tania Dubon Zara Zaeem

Nicole Stevens, Orthopedics, Urology & Bariatrics Patient Navigator

TOTAL JOINT NURSE GETS PATIENTS UP AND MOVING In October 2018, it was noted that our total joint patients who were received from PACU later in the day were not getting out of bed until the next morning per the existing protocol.

Early mobility is an evidenced-based practice and since Tristen Hohmann was our night shift joint nurse, she was delegated as our mobility champion. This included not only getting patients out of bed, but not allowing them to use bedpans. Patients either used a bedside commode or ambulated to the bathroom. Tristen has been diligent in getting the patients out of bed as well as assisting her colleagues do the same.

Since the early mobilization became the standard, our length of stay has hovered around two days, our rapid response rate related to orthostatic hypotension has decreased, and our discharge to home has increased to 88-90%. In March 2019, that percentage was closer to between 95-100%.

In September 2018, I was hired as the Director of the Orthopedic Service Line and 7 North. It can be difficult to fill the shoes of someone that the staff highly respected and liked both personally and professionally, but I can say that they welcomed me warmly.

Kudos to Tristen for her diligence in mobilizing the patients early and ultimately resulting in patients being discharged to home!

They have been receptive to new ideas, willing to implement changes and overall, have been able to share stories, concerns and freely question the why when changes are made. They work well as a team, are supportive of one another, but more importantly, they make our patients a priority. The staff receives many accolades from patients, are well respected by our physicians and praise each other as well.

PAT & PACU NURSES CARE GOES BEYOND HOSPITAL WALLS

It has been very easy to acclimate to 7 North and to be able to embrace the staff. They have made it very comfortable not only for myself but for new hires also.

A huge shout out to the nurses on 7 North and a very well deserved congratulations and Happy Nurses Week!

Fran

Fran Revella Director of the Orthopedic Service Line/7 North

Jody Freimour Theresa Nostrand Helen Finn Georgette Ramirez Tristen Hohmann Linda Curry Meghan McDowell

Alli Cherian Jeanine Roe Kristin Castelonia Amber Cardona Adele Benjamin James Dana Caruso

Dr. Gina Del Savio had a patient coming in for surgery that needed assistance for home care with her husband who has advanced Alzheimer’s disease. The patient was having a repair of her fractured humerus and voiced concerns for how she was going to care for her husband while recovering. Dr. Del Savio reached out to Mary Beth in pre-access testing and Anne in PACU to arrange services.

Mary Beth and Anne engaged Christine Rao for help on how to get this request in place.

Christine worked with Renee in case management and then consulted with Jennifer in IT to get a home care consult into Meditech for surgical patients that need these services. We were able to get her home care services and physical therapy at home to help support her recovery and her social needs.

This story shows the attention to details in making this patient’s surgical story a positive experience with support for her and her spouse. Thank you for the group effort in making this happen! Pre-admission testing and the recovery room nurses are faced with difficult social situations to help patient’s have the best outcome for recovery. This team voices concerns and advocates for their patients every day!! Great teamwork in making it happen!

A screen shot of the new protocol implemented in PAT for social & case management needs which went live in March 2019.