Wilmot Cancer Institute
Nursing
Wilmot Cancer Institute
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LETTER FROM THE WILMOT CANCER INSTITUTE’S CHIEF NURSING OFFICER
KC Clevenger, PhD, RN, BC-PNP, FAAN Chief Nursing Officer Wilmot Cancer Institute
I became the Chief Nursing Officer for Wilmot Cancer Institute in January 2018 and am honored to serve in this role during a time of remarkable growth and innovation. It is a privilege to present the 2018-2019 Nursing Report, which reflects the work of more than 400 talented nurses and nurse practitioners who are unwavering in their commitment to achieving excellence. Our nurses lead the way as clinicians, advocates, educators, mentors, providers and researchers – improving nurse practice, cancer care and ultimately outcomes in quality, safety and patient experience. We have developed new research education and training programs to support Wilmot’s pursuit of National Cancer Institute designation. In the following pages, you will see a reflection of these programs in the number of our nurses’ publications in peer-reviewed journals and in the high number of abstracts accepted for the annual Oncology Nursing Society Congress. Two Wilmot nurses have been accepted for the Strong Memorial Hospital and University of Rochester School of Nursing Research Internship, and we have also expanded the research nurse program, including the creation of a new role for Wilmot, the Research Nurse Manager. The persistence of our nurses in improving care is impressive as we continue to work to improve our ambulatory center’s nursing models. Our nurse-led projects are contributing to the American College of Surgeons Commission on Cancer requirements. Our nurse leadership has used evidence and a caring model to create an Oncology Residency Program, and we are consistently increasing nursing specialty certification across Wilmot and have a strong pre-certification education process. The accomplishments of our nurses exemplify our organizational values of integrity, inclusion, compassion, accountability, respect and excellence in patient care. The strength of our leadership is seen every day in their efforts to support not only their team, but those at other sites within our growing system. Compassion is evident in the care our nurses deliver every day at Wilmot Cancer Institute, and it is truly amazing. This report is intended to celebrate and recognize their achievements during the past year. I am in awe of the commitment the nurses demonstrate daily to our patients, their families and to each other, and I am privileged to see the profound impact nurses have at Wilmot. I look forward to the year ahead as we continue to strive for excellence.
KC Clevenger, Ph.D., R.N., BC-PNP, FAAN
On the Cover
Nicole Yates, R.N., gets additional supplies from the Medication Room on WCC7. Photo by Matt Wittmeyer The Wilmot Cancer Institute is a component of Strong Memorial Hospital.
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Wilmot Cancer Institute Nursing Annual Report Editorial Committee KC Clevenger, Ph.D., R.N., BC-PNP, FAAN Chief Nursing Officer Karen Abbas, M.S., R.N., AOCN Patty Bellohusen, M.S., R.N., C.N.L. Julie Berkhof, M.S., R.N., FNP-C Courtney Blackwood, M.S., R.N., NE-BC Meg Blaney, B.S.N., R.N. Tammy Clarke, M.S., R.N., OCN, BMTCN Amy Davey, B.S.N., R.N., OCN
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Ashley-Marie DiVincenzo, B.S., R.N. Deanna Drexler, M.S., R.N., OCN Sarah Floyd, B.S.N., R.N. Deanne Fuller, B.S.N., R.N., CHPN Jen Galdys, B.S.N., R.N., OCN Rhona Henry, B.S.N., R.N. Dwight Hettler, M.S., R.N., OCN, NE-BC, Jamie Littleton, M.S.N., R.N, CCRC Alicia Maston Coffin, M.S., R.N., OCN Julie Natale, M.S.N., R.N. Joyce Rampello, B.S.N., R.N., OCN Carolyn Ruffing, B.S.N., R.N., OCN Claire Somers, B.S.N., R.N., OCN Robin Stevenson, B.S.N., R.N., OCN
Editor / Writer Lydia Fernandez, Senior Public Relations Associate (585) 276-5788 Art Director/Designer Kathleen Mannix Feature Photography Matt Wittmeyer
CONTENTS Exemplary Professional Practice 4 Nursing Teams Meet the Needs of Growing Patient Population 6 Driving Away Fear, Improving Outcomes for Children Receiving Radiation 8 Nurse navigators bring calm in chaos after diagnosis
Structural Empowerment 11 Oncology Nurse Residency Prepares New Nurses for Bedside Leadership
Knowledge, Innovation and Improvements 13 Nurse Scientist Partnership Drawing More Nurses into Research 14 Nurses Innovate to Address the Needs of Clinical Trial Participants 16 Growing a Culture of Continuous Improvement
Transformational Leadership 18 Patient Access Specialist has Far-Reaching Impact 19 Leading Change through Communication and Connection 21 Wilmot Nurses Lead Regional Chapters of Professional Organizations
Accomplishments
22 Awards and Recognitions 23 Publications and Presentations
Vision: To be nationally recognized nursing leaders delivering comprehensive patient- and familycentered oncology care though innovation, education and research. Mission: To provide unified, precision oncology and palliative nursing through evidence-based practices enriched with a compassionate and integrative approach throughout our region.
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Nursing Teams Meet the Needs of Growing Patient Population
Wilmot Cancer Institute is upstate New York’s busiest cancer care provider. With a network of 13 locations throughout the Rochester and Finger Lakes region, Wilmot provides care to more than 17,000 patients each year, including more than 5,000 new cases annually. More than 400 nurses and advanced practice providers lead specialized teams and units to meet the needs of this diverse and growing patient population.
Apheresis: This four-bed facility performs plasmapheresis, plateletpheresis, leukapheresis, and erythrocytapheresis. The team also harvests circulating bone marrow stem cells for use in transplantation. They collaborate with multiple departments throughout the hospital to coordinate care for patients. Clinics: This team provides care for patients at 13 locations across a region that spans 120 miles. They provide direct clinical care, patient education, care coordination and telephone triage support for patients seeking care for all medical oncology and hematology diagnoses. Hematology/Oncology (WCC7): This 30-bed unit cares for patients with hematologic and solid tumors, including leukemia, lymphoma, multiple myeloma and multiple solid organ cancers. The most common admissions include cancer treatment, infections/neutropenic fever, oncologic emergencies, pain control, failure to thrive and end-of-life care. This unit also serves as the resource to administer chemotherapy across the institution, most commonly in the intensive care units. Infusion Centers: This team provides care for patients at 13 locations across a region that spans 120 miles. With an emphasis on consistency in orientation, training and practice, they provide standardized care and services such as chemotherapy, monoclonal therapy, immunotherapy, blood/platelet transfusion, therapeutic phlebotomy, red blood cell exchange, subcutaneous and intramuscular injections, vaccinations, and IV hydration. Care for complex study patients is also available at Wilmot Cancer Center and select other sites. Palliative Care: This team provides interdisciplinary care focused on relief of pain, symptoms and stress for patients with serious illness, regardless of the diagnosis. They provide inpatient services in the 12-bed Sussman Palliative Care Unit (4-1200) and outpatient services at the Wilmot Cancer Center and several of Wilmot’s regional locations. Radiation Oncology: Across seven locations, this team provides assessment, education, triage, care coordination, direct physician clinic support and application of nursing interventions for patients who need radiation therapy. Pediatric radiation oncology services are provided at Wilmot Cancer Center. Nurses have specialty training, including ACLS; PEARS; pre-, intra- and post-sedation/anesthesia care; GYN HDR assist; and contrast administration.
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rachel hayward, R.N., prepares CAR-T cells for an infusion in the Samuel E. Durand Blood and Marrow Transplant Unit (WCC6).
Samuel E. Durand Blood and Marrow Transplant Unit (WCC6): This 22-bed unit provides autologous, allogeneic, umbilical cord blood and haploidentical transplants for adult and pediatric patients with various blood cancers. The HEPA-filtered unit is part of a FACT-accredited program that also provides outpatient services and CAR T-cell infusions. Surgical Oncology (WCC5): This 28-bed unit cares for post-surgical oncology patients, including hepatobiliary, urology, colorectal, ENT head & neck, ENT specialty patients, and medical oncology patients. It can handle up to four progressive care (step-down) patients at one time.
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Driving Away Fear, Improving Outcomes for Children Receiving Radiation
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When Julie Natale, M.S.N., R.N., began working with pediatric patients in Radiation Oncology, she quickly recognized that pivotal moment every family faces. “The child would be playing in the waiting area, and then the nurse would come out,” Natale says. “There would just be this change. The fear would set in, and the child would cling to the parent or caregiver. It would be a rigid walk to the treatment room, with the child burying their head in the parent or caregiver’s chest.” Natale would watch them walk stiffly and slowly down the hall, with the parents’ fear growing too. The children would require anti-anxiety medication and sedation for their daily sessions, and it made Natale wonder: How could we make this different? She turned to the literature and found descriptions of using music therapy, child-life specialists, and other kinds of distractions to help these young patients in various health care settings. While Natale found many descriptions of these strategies, she did not find any studies of their impact on outcomes. Then one day, she found a video from a dental practice that used a battery-operated, remote-controlled mini car to bring young patients in for their procedures. One of the nurses in the video talked about how using the car had decreased the use of anti-anxiety medications by 75 percent, but the data had never been published. As a Doctorate of Nursing Practice (DNP) student at St. John Fisher College, Natale saw an opportunity to bring evidence into practice. She presented the idea for using a mini-car to Radiation Oncology leadership. Within a few weeks, a mini white Mercedes arrived — complete with seat belt, lights, a radio and windshield wipers — courtesy of an anonymous donor. Natale quickly engaged with Facilities, Engineering, Fire Safety, Legal and others to get the car up and running for patients who are 3 to 6 years old. She worked with Anesthesiology to help them prepare, she developed training for the Radiation Oncology staff, and she led practice driving sessions to ensure patient safety. She also created a policy for use that serves as a model
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for other areas that are looking to implement similar practices. “From clinical observation, it makes a difference,” Natale says. “The dynamic between the parents, children and staff is different. They look forward to it. They come down the hallway excited to be here. There are smiles, and parents and caregivers taking pictures.” Natale is looking to document more than that, though. As part of her DNP scholarship project, she is just beginning to collect data to evaluate the impact of the car on the use of anti-anxiety, induction and sedation medications, as well as on parent and staff satisfaction. She is also measuring the impact on resources and how potential reductions in the use of sedation may reduce the need for additional staff to help during treatments. “This is not just about improving Radiation Oncology practices,” Natale says. “No one should have to watch a child go through treatment. If there’s anything we can do to make it better, we have an obligation to do that, and the science needs to back that up.” She is also interested in the long-term impact of the mini car. Sedation has many side effects, and young children often need sedation as part of their radiation treatments. That sedation can sometimes be required for as many as 36 daily treatments. If the car leads to less use of sedation, that may also mean fewer side effects for these children. “This has impact not just in the moment,” Natale says. “This is about the child’s wellness.” It is also attracting interest from other cancer care providers. After presenting this project at ONS Congress in April and after one of the radiation oncologists presented at an international meeting, Natale says she has had calls from programs around the world seeking her insights. Her work has also helped connect Wilmot Cancer Institute with Stanford University to become part of a multi-center study of interventions like the car to help young patients during procedures. “It’s making a big difference,” Natale says.
POINT OF PRIDE: The strength of our leadership is seen every day in our efforts to support not only our team, but those at other sites within our growing system.
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In the Chaos of Diagnosis, Nurse Navigators Clear a Path for Care
Wilmot began its nurse navigator program in 2017 with Ruffing in the Comprehensive Head & Neck Cancers Clinic. Her goal was to reduce the time-to-treatment interval and thereby improve patient outcomes. Within nine months, she helped cut the time from diagnosis to treatment by 16 days, a statistically significant improvement that has also led to improvements in patient and provider satisfaction. “It’s very rewarding to be there when patients get diagnosed, and to be able to assure them that they’re not alone,” Ruffing says. “I Michael Yeaw walked out of his earlobe and walked me back into the help them understand that whatever first appointment at Wilmot Cancer hospital like I was a schoolboy. She they encounter here can be managed, Institute. got my attention.” that this is a place they should feel He’d just learned that he had Ruffing, who smiles at Yeaw’s safe.” tonsil cancer. He was going to need a recollection, doesn’t remember it Wilmot’s navigator program was feeding tube and a grueling regimen quite that way. But she remembers designed to be led by nurses because of chemotherapy and radiation. He bringing him back inside, looking him of the clinical expertise they bring to was facing 135 appointments at in the eye and explaining what the interactions with patients and with Wilmot over the next 56 days. coming months would entail. Part of treatment teams. And he wasn’t going to do it. her role as a navigator is to assess “Nurses have the ability to All he could think about were the her patients’ communication style, understand the diagnosis and referral treatments for Hodgkin lymphoma and Ruffing quickly saw that Yeaw information such as scans, and we that he’d had more than 30 years needed her to be a straight-shooter. can assess acuity to see who needs before. He’d been in prison at the “The words that came out of her the most support,” says Ruffing, who time, with no support and no way to mouth, they were serious,” Yeaw participates in the multidisciplinary manage the pain. says. “She didn’t sugar-coat any of it. tumor board meetings. “It was so brutal I don’t know She told me the truth.” Nurse navigators also play a how I did it,” he says. She also made sure his 135 key role in building trust with new When Yeaw, now 56, walked appointments had the least impact patients. out of his appointment, his nurse on his schedule as possible. “Having a nurse who knows the navigator Carolyn Ruffing, B.S.N., “I never missed an appointment, specific disease can help expedite the R.N., OCN, got up and followed and I never missed a day of work,” patient’s care, and patients feel more him out. says Yeaw, who finished treatment secure and confident when they’re “I was 230 pounds at the time,” last fall, got married in December and talking with someone who has that Yeaw says. “She grabbed me by the is back out on his Harley. expertise,” says Cheryl Turner, B.S.N.,
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“I get a story about the patient and see what they’ve been through already to help the team anticipate what the patient will need.” – Cheryl Turner, B.S.N., R.N., OCN
“It’s not just radiation, surgery and chemo anymore … It’s complex, and you need to be knowledgeable” – Joe DeMarco, M.S., R.N.
“I am their primary contact initially, being their stability in such an unstable situation.” – Sue Fowler, B.S.N., R.N.
POINT OF PRIDE: The accomplishments of our nurses exemplify our organizational values of integrity, inclusion, compassion, accountability, respect and excellence in patient care.
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In the Chaos of Diagnosis, Nurse Navigators Clear a Path for Care continued from page 8
R.N., OCN, the navigator for patients with multiple myeloma and benign hematologic conditions. While nurse navigator roles are customized to the needs of their patients, their goal is the same — to identify and address barriers to care. They are an added resource for the treatment teams, and they often serve as the first contact patients and families have with Wilmot. The nurse navigators coordinate appointments before treatment begins, ensure consistent communication between service lines and treatment teams during active treatment, advocate for referrals for support services, and act as a central contact for patients. “I am their primary contact initially, being their stability in such an unstable situation,” explains Sue Fowler, B.S.N., R.N. Fowler meets her patients at their initial appointment when they learn their pancreatic cancer diagnosis from their surgeon. As part of that appointment, whether with Surgical Oncology or Medical Oncology,
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Fowler will take notes for the patient and family, so they can focus on the discussion. She is there to help them better understand their diagnosis and treatment options, as well as to provide emotional support. She also provides patients and families with a wide range of education related to chemotherapy and managing side effects, and she provides tours throughout the cancer center. “I get them through the unknowns to the knowns,” she says. By contrast, Turner does not often meet her patients in person. She will connect with them by phone before their first appointment to answer any questions and to help schedule any required pre-testing. She also obtains medical records and creates a summary to prepare the treatment team for that first appointment. “I get a story about the patient and see what they’ve been through already to help the team anticipate what the patient will need,” Turner says. “It makes for a more efficient visit. The providers have more information going in, and more questions
can be answered.” Navigation is a growing role. Joe DeMarco, M.S., R.N., recently began serving as a navigator in Thoracic Surgery, helping patients with lung or esophageal cancers. The rapidly evolving nature of cancer care makes navigation essential, he says. “It’s not just radiation, surgery and chemo anymore,” DeMarco says. “It’s immunotherapy and targeted therapy, and as the number of older people is growing, the need is really going to explode. It’s complex, and you need to be knowledgeable.” That knowledge is at the core of establishing trust and connection, and for Yeaw, that meant Ruffing looked him in the eye and not sugar-coating anything. “She’s not going to lie to you. If you put your mind to it, she’ll get you through it,” Yeaw says. “She’ll find a way to make it work for you and get you out the other side.”
Residency Helps New Nurses Prepare to Become Bedside Leaders
To help close the knowledge and skills gap that many newly graduated nurses face, Wilmot developed an Oncology Nurse Residency Program. A supplement to the 12-week orientation, Wilmot’s nurse residency program launched in September 2018 with a cohort of 24 new graduates or nurses with less than a year of acute care experience. The residency focuses on inpatient nurses, and the cohort meets once a month for eight hours. The day-long sessions include classroom instruction, skills practice, shadowing and visits to different parts of the hospital that interface with the cancer center. “The residency is designed to give the basics that new nurses need, to help them understand the resources available to them and to meet new people,” says Karen Abbas, M.S., R.N., AOCN, who helped establish Wilmot’s Nurse Residency program. “It emphasizes individualized growth and development opportunities to help new nurses transition from student to bedside leader.” The classes are based on the Core Curriculum for Oncology Nursing and Quality and Safety Education for Nurses (QSEN) competencies. Topics include
symptom management, oncologic emergencies, nursing professional practice and patient education. “The added education, skills and socialization components of nurse residency programs have been shown to increase new nurse satisfaction, which leads to better nursing retention,” says Deanna Drexler, M.S., R.N., O.C.N., who developed the curriculum as part of her master’s capstone project. “Ultimately, a nurse residency program is a win-win for new grad nurses, as well as the system they’ve been hired into.” While Wilmot’s nurse residency focuses on the hard skills new nurses will use in practice, it also emphasizes the soft skills they’ll need in different situations. Those soft skills include communication and helping the new nurses understand what it means to be in the profession. Rachel Starkweather, R.N., who joined Wilmot’s Samuel E. Durand Blood and Marrow Transplant Unit (WCC6) last year, says the residency gave her a built-in support group, and it has provided important perspective she might not have otherwise gotten. “We recently visited infusion, and that
helped me correlate what those nurses do with what we do,” Starkweather says. “And it helped me understand more what my patients go through when they’re not with us.” In addition to the classes and other training, each nurse resident must also complete an evidence-based practice project. The projects are intended to help prepare the residents as they work to become Level III nurses, who have increased responsibilities that may include staff orientation, patient care coordination, or other unit/service activities. For Taylor McEachon, R.N., that project is focused on eliminating unnecessary waste from WCC6. After she started on the unit last summer, McEachon began to notice how many unopened supplies were being thrown away as rooms used for blood and marrow transplant patients were cleaned. These rooms undergo special cleaning procedures to accommodate patients who have compromised immune systems. McEachon began to wonder if unopened supplies from these rooms might be safe enough for donation through InterVol, a non-profit agency that recovers and redistributes medical supplies worldwide. “I am hoping to see more medical supplies being donated rather than being thrown away,” McEachon says. Regardless of how her project turns out, participating in the residency program has inspired McEachon to continue her education. “Being a part of this residency program, I have realized just how much I have learned in one year, yet how much I still have to learn,” she says. “I am excited to return to school this fall to pursue my master’s in the Family Nurse Practitioner program here at the University of Rochester.”
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POINT OF PRIDE: We have developed new research education and training programs to support Wilmot’s pursuit of National Cancer Institute designation.
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Nurse Scientist Partnership Drawing More Nurses into Research
In a collaborative effort, Wilmot and the University of Rochester School of Nursing support nurse-initiated research programs through the development of the Oncology Nurse Scientist Partnership. Led by Ph.D.-level nurses with advanced training in research principles and methodology, the Partnership is aimed at advancing oncology research. The scientists also act as mentors for direct care nurse-led research. “Despite the increasing numbers of publications, science often fails to translate the research findings into improved patient care,” says KC Clevenger, Ph.D., R.N., BC-PNP, FAAN, Wilmot’s Chief Nursing Officer. “Nurses are in a unique position to bridge this translational gap by combining the profession’s approach of holistic care and research activities.” Being able to bridge that gap means helping nurses recognize that they are involved in research nearly every day and equipping them to contribute questions and ideas to scientific discussion. Seeing this need, nurse scientist Jamie Oliva, Ph.D., ANP-BC, BMTCN, has developed a research education and training series through the Partnership to help Wilmot nurses understand how to use and manage research and to lead their own projects. “As nurses, we need to know how to find evidence, how to choose evidence to evaluate, and we need to know how to appraise it,” Oliva says. “Then we need to know how to apply it. So, if you don’t know those aspects of evidence-based practice, then you are limited in your ability to contribute to meaningful clinical outcomes for our patients, because, theoretically, everything that you do in patient care should be evidence-based.” But getting more nurses involved in research has historically been a challenge for a variety of reasons, ranging from needing dedicated time away from the patient to limited opportunities for research education and training to a lack of awareness that conducting research is even an option for nurses.
That’s why Clevenger insisted that nurse scientists be based in the clinic environment. “Having a nurse scientist onsite, particularly in an academic setting, has been shown to have a snowball effect with nurses becoming proficient at both asking questions and then answering them using rigorous scientific methodology,” Clevenger says. “It can lead to scientific breakthroughs that combine research with the real world.” Since the Partnership began in 2018, Wilmot’s nurse scientists have already brought existing research findings to the direct care nurses, fostered and guided small tests of change, mentored quality improvement projects, and are overseeing small research studies. They have also made sure that a nurse scientist sits on the research review and feasibility committee for all oncology research at Wilmot. These efforts support Wilmot’s pursuit of National Cancer Institute designation, and they are helping to raise Wilmot Nursing’s profile nationally. This year, Wilmot was recognized as one of the sites with the highest number of abstracts accepted from a single institution at the annual Oncology Nursing Society Congress. In addition, the Partnership is leading to new roles within Wilmot, including a Research Nurse Manager, who oversees the growing team of research nurses across the cancer center. Wilmot’s nurse scientists are also building resources to help other nurses interested in growing their experience with research. Among these resources is an Oncology Research Council that includes Wilmot nurses, nurse scientists, leaders, representatives from the Clinical Trials Office and others. This group meets regularly to discuss what research is underway at Wilmot and how nurses can get involved. The Partnership also hosts monthly sessions on research essentials that include topics such as developing abstracts and what’s in a research budget. “The clinical practice is so busy, and thinking about research is so big,” Oliva says. “We are committed to figuring out how to overcome these barriers.”
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Nurses Innovate to Address the Needs of Clinical Trial Participants
Wilmot Cancer Institute has one of the largest cancer clinical trial portfolios in upstate New York, and almost all of these studies are based at the Wilmot Cancer Center on the University of Rochester Medical Center campus. Wilmot has ambitious plans to extend its clinical trials infrastructure to its regional locations, and Nursing is helping to lead these efforts with a system that addresses the needs for additional education to manage, support and balance the research regulations with safe, quality care of the patient. This system includes a standardized communication process for clinical trials, a portion of the Wilmot Cancer Center Infusion Center dedicated to clinical trial participants, and a training program for nurses and staff managing research visits. This unique model among cancer centers allows oncology nurses to specialize in research patient care, and it allows study patients to remain integrated in their infusion centers. Jamie Littleton, M.S.N., R.N, CCRC, the Clinical Trials Office Research Nurse Manager, developed and implemented this system to integrate clinical trial communications into the EPIC Medical Record using the Research Tab. By using this tab, the study coordinators are able to distill the complex details of a clinical trial in a simplified, standardized format that meets the needs of the schedulers and nurses in the clinic and infusion center, while maintaining both organizational and research standards.
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With Wilmot Infusion Center Nurse Manager Claire Somers, B.S.N, R.N., OCN, Littleton created a Research Infusion Pod that has grown to include five infusion chairs and one quick chair to ensure that the clinical trials patients get the best possible care while adhering to clinical trial regulations. They are looking to expand again in 2020. They also trained a multidisciplinary team in the infusion center to focus on trials, delivering study drugs and ensuring quality care while minimizing errors. The team includes 13 nurses who rotate through the study pod, and another cohort will be trained this fall. The Research Nursing team has added two nurses — one based at Wilmot Cancer Center and one to support the regional locations — who are dedicated to clinical trial visits. Recruitment is also underway for another nurse to support a specific disease group. In addition, as the clinics expand this fall at Wilmot Cancer Center, a dedicated phlebotomy lab with specially trained staff will serve all study patients. The goal is to reduce wait times and emphasize quality and accuracy. Littleton has shared her system at the Association of American Cancer Institutes’ Clinical Research Initiative meeting and at the Oncology Nursing Society Congress, and she has been invited to share her insights at cancer centers across the country.
POINT OF PRIDE: We have expanded the research nurse program, including the creation of a new role for Wilmot, the Research Nurse Manager.
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Growing a Culture of Continuous Improvement
When he worked as a patient care technician while in nursing school, Grant Williams, B.S.N., R.N., spent part of each shift restocking rooms on Wilmot’s Hematology/ Oncology Unit (WCC7) with supplies for blood draws and IVs. After graduation, he began working as a nurse on the unit, and he noticed that many of those supplies were being wasted at discharge. “I saw what was being wasted consistently in every room, and I thought about what I could focus on to eliminate that waste,” Williams says. He tracked the waste for several weeks and estimated that more than $400 worth of supplies was being thrown out every couple of months. After some research, he proposed a potential solution — a cart stocked with the relevant supplies that would be kept ready in the clean supply rooms. Whenever a nurse needed to do a blood draw or IV set-up, they could bring the cart and park it outside the room for easy access to what they need. He brought the idea to his nurse manager, and it became the focus of a Unit-Based Performance Program (UPP) project. UPP is a hospital-wide, inpatient unitbased approach to encourage continuous improvement in patient safety, patient and family-centered care, and
efficient operations. Through UPP, each unit identifies projects that will bring together nurses, providers and participants from other disciplines to have a broad impact on the unit. At Wilmot, nurses often initiate UPP projects. Their culture of continuous improvement and proximity to patients keep them attuned to what more can be done, says Tammy Clarke, M.S., R.N., OCN, BMTCN, Wilmot’s Oncology Care Outcomes Manager, who helps to advise UPP teams. “Nobody is happy with the status quo, even though the status quo is good,” Clarke says. “We’re always looking to make things better.” For example, the team on Samuel E. Durand Blood and Marrow Transplant Unit (WCC6) has put their focus on reducing central-line blood infections (CLABSI). While their CLABSI rates are in line with national benchmarks, preventing infection is a high priority. “Our patients are so immune-compromised that any little infection can be life-threatening,” says Miriam Lerner, B.S.N., R.N., BMTCN, OCN, a safety nurse on WCC6. They turned to the literature for ideas and came up with a UPP project proposal to use Chlorascrub swabs instead of alcohol preps on the central lines. They
POINT OF PRIDE: Our nurse-led projects are contributing to the American College of Surgeons Commission on Cancer (CoC) requirements.
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got approval from Infection Prevention for a six-month trial, and Lerner and her colleagues have been performing weekly audits to ensure the practice is in place. “The project is going pretty well,” she says. “We are looking forward to analyzing the final data.” The UPP team on Wilmot’s Surgical Oncology Unit (WCC5) is focusing on efforts to reduce its 30-day readmission rate. To do this, they are addressing not just whether a patient is medically ready for discharge, but also whether the patient feels ready. “A lot of the literature shows that readmission rates are strongly linked to patients’ perceived readiness for discharge, as opposed to their medical readiness for discharge,” says Katharine Schwartz, M.S., R.N., who is leading this project as part of her Clinical Nurse Leader (CNL) preparations. “If a patient doesn’t feel ready, there’s a much greater chance that they’re going to
be readmitted. That’s what we’re trying to really hone in on and to bring that medical and patient readiness into alignment.” They have developed a patient-centered discharge preparation checklist that they begin implementing as soon as a patient is admitted. The checklist is designed to serve as a guide through hospitalization to discharge, and it helps patients see their progress. It includes factors such as whether patients understand how to use their medication and any equipment they’ll go home with and any concerns they have about going home. Schwartz is also creating a cue card that will be placed in each room to prompt the nurses to ask patients key questions and start conversations to help prepare them for discharge. “The patients for whatever reason don’t like to tell the doctors what their discharge concerns are, but they will tell the nurses,”
Schwartz says, adding that it’s likely because of the continuity that patients have with Nursing. “Nurses are in a unique position because most of these gaps that we can work on improving, they happen at the bedside,” she says. The unit is starting to see the impact of their efforts in a slight decline in overall readmissions, and they expect that over the long-term, they will see a bigger effect. In addition to 30-day readmission, the project will measure factors such as checklist utilization and completion, home care utilization, patient readiness for discharge, length of stay and non-medical delays in discharge. “Nurses play an integral role in quality improvement,” Clarke says. “The UPP projects provide an avenue for us to share our ideas and explore new opportunities for evidence-based practice. They truly highlight our nurses’ leadership and commitment.”
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Patient Access Specialists have Far-Reaching Impact
When the inpatient units at Wilmot Cancer Center debuted in 2012 and 2014, they helped to open up beds elsewhere in Strong Memorial Hospital, alleviating pressure from a growing census. Within a couple of years, though, Wilmot’s units began exceeding capacity, regularly overflowing patients back into the already full medical/surgical units at Strong. Even with plans for additional beds at Wilmot in the works, the inpatient leadership team had to find a new solution. The answer came in creativity, collaboration and the creation of a new Nursing role, called the Patient Access Specialist (PAS). The PAS team includes Joyce Rampello, B.S.N., R.N., OCN, and Molly Shanto, B.S.N., R.N., OCN, who are both full-time Level IV nurses with oncology expertise. Together, they manage patient flow from the clinics, infusion centers, outpatient satellites and the Emergency Department to appropriate inpatient areas at Wilmot. They work closely with Strong’s centralized Admitting Clinical Coordinator (ACC) team, which has historically managed the hospital’s more than 800 beds. “We felt like a decentralized model would work better for us,” says Dwight Hettler, M.S., R.N., OCN, NE-BC, co-director of Nursing at Wilmot, who created the PAS role. A few months after the PAS debut, Wilmot and the nearby affiliated Highland Hospital also launched a new collaboration that allows some solid tumor oncology patients to be admitted to Highland’s East 5 unit, where specially trained teams, including Wilmot physicians, care for them. This collaboration would not have been possible without the PAS to identify patients appropriate for the unit and to arrange their transportation. Combined, the PAS and the collaboration with Highland have had a major impact on Wilmot’s admissions.
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In the first year: • The PAS has diverted 405 out of 1,330 urgent admissions patients away from the ED and directly admitted these patients to oncology-specific floors at Strong and Highland. • The PAS helped reduce by 10 percent the average time oncology patients have to wait in the ED for a bed once the decision to admit is made. • By absorbing the admission process, the PAS freed up the clinic and infusion nurses to devote their attention to managing patient flow through their clinics, providing more nurse-to-patient time and improving staff satisfaction, which has had a direct relationship to improved patient satisfaction. “This has really helped our patients,” Rampello says. “They are spending less time in the ED, they’re going to oncology-based floors with staff who have the expertise they need, and we’re even starting to see small reductions in their length of stay.” In addition to these quantifiable effects, the PAS team has also helped improve communication between Nursing and the physicians. Because the PAS office is centrally located at Wilmot Cancer Center between the clinics and the inpatient units, providers often stop by. “Communication is 90 percent of the job,” Rampello says. “The physicians come in and talk about their patients and what they’re going to need, and we get them into the appropriate bed.” Since taking this role in spring 2018, Rampello says she’s had a lot of questions from her colleagues. “This is a totally different kind of nursing than I’ve ever done before. It’s been fun and challenging,” Rampello says.
Leading Change through Communication and Connection
Wilmot Cancer Institute is among the largest clinical enterprises at the University of Rochester Medical Center and one of its most complex. Over the last several years, it has grown from two locations within Rochester to 13 sites within a 120-mile radius. This rapid expansion has brought significant increases in outpatient volumes and inpatient admissions, as well as challenges in ensuring that cancer care is provided at the same high standard and with the utmost compassion no matter where a patient is seen.
Berkhof and Hettler
With the leadership of Nursing Directors Julie Berkhof, M.S., R.N., FNP-C, and Dwight Hettler, M.S., R.N., OCN, NE-BC, Nursing plays an important role in addressing these issues and ensuring Wilmot’s success as upstate New York’s leading cancer care provider. As a team, they complement each other’s skills. They bring expertise in ambulatory and inpatient operations and a deep understanding of cancer care. With their
emphasis on collaboration and connection, they have established relationships across the Medical Center and its affiliates that have enabled Wilmot to bring its vision of comprehensive cancer care to fruition across the Rochester and Finger Lakes region. “Together, they have elevated nursing practice across the cancer center, not just in terms of patient care but also in leading change and linking issues with solutions,”
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Leading Change through Communication and Connection continued from page 19
says KC Clevenger, Ph.D., R.N., BC-PNP, FAAN, Wilmot’s Chief Nursing Officer. While Berkhof oversees nursing and operations at Wilmot’s regional sites and Hettler oversees them at Wilmot Cancer Center, their roles are intertwined. With their emphasis on open communication, they have built trust among the staff and strong bonds with the managers, creating high-performing nursing teams. With more than 400 nurses, this supportive environment has led to one of the highest staff engagement scores within the institution, a turnover rate of less than 5 percent and a certification rate of 38 percent. “My goal from a leadership standpoint is to empower nurses so the only thing they need to worry about is taking care of patients,” says Hettler, who has been a nurse for 24 years and at Wilmot for 18. In practice, that translates into building leaders, encouraging education and certification, and advocating for the needs of nurses across operations. “They operate on principles of collaboration and trust,” says Alicia Maston Coffin, M.S., R.N., OCN, senior nurse manager at Wilmot’s Pluta Cancer Center. “We can approach either of them with our ideas and concerns, knowing they will listen. When we bring up a need, such as staffing, they will immerse themselves in understanding the issue and the possible solutions. They develop a proposal and go advocate for us.” With web conferencing and other technology, Berkhof and Hettler bring together teams regularly not only to stay in touch, but also to make sure that geography is not a barrier to excellence. “Face-to-face communication is an important part of strong relationships, and everything we do is based on trust and mutual respect,” says Berkhof, who has been a nurse practitioner for 15 years. “Julie and Dwight bridge the 120 miles between us,
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and they connect us across the inpatient-outpatient divide,” says Courtney Blackwood, M.S., R.N., NE-BC, nurse manager on Wilmot’s Hematology/Oncology Unit (WCC7). “They make a point of knowing our nurses’ names and details about their children. They also keep tabs on what’s happening in our units. They genuinely want to know the good and the bad in order to make things better.” Berkhof and Hettler are also ingrained operationally, and their impact can be seen in many facets of Wilmot. They have played critical roles in opening Wilmot’s regional locations and in clinical expansions within the Wilmot Cancer Center, based at Strong Memorial Hospital. Across the institute, they see opportunities and launch innovative solutions that not only benefit patients but also improve operational efficiency. Last fall, for example, Berkhof launched Wilmot’s first telemedicine service, based at the Ann and Carl Myers Cancer Center at Noyes Health in Dansville, an hour south of Rochester. To make this possible, she brought together several departments, both at Strong and at Noyes, to provide access to tobacco dependence counseling for any cancer patient and to provide follow-up appointments for neuro-oncology patients. Last spring, Hettler created a new Nursing position, called the Patient Access Specialist, to help streamline urgent admissions for oncology patients. This role has helped divert patients from the Emergency Department and ensure that they are admitted to units with oncology expertise. “Julie and Dwight have a passion for oncology care, for their colleagues, and for the patients and families we see,” Clevenger says. “This passion is evident in their every interaction and decision, and it makes their leadership more than just the sum of their individual efforts.”
Wilmot Nurses Lead Local Organizations, Represent Nationally
For more than 35 years, Wilmot nurses have helped lead the local chapters of professional organizations, including the Genesee Valley Oncology Nursing Society (GVONS), the Finger Lakes Regional Chapter of the Hospice and Palliative Care Nurses Association (HPNA) and Sigma Theta Tau International (STTI) Honor Society of Nursing, Epsilon Xi Chapter. As members and leaders, Wilmot nurses participate not just in professional development, training and networking, but also in community service and supporting academic endeavors for nurses coming into the field. “The mission of Sigma, for example, includes advancing world health and celebrating nursing excellence in scholarship, leadership, and service,” says Jamie Oliva, Ph.D., ANP-BC, BMTCN, president of Sigma Theta Tau, Epsilon Xi Chapter, based at the University of Rochester. “Members have an opportunity to contribute to our local community and a global network.” In addition to leading at the local level, Wilmot nurses participate in these organizations’ national meetings, and their numbers are growing. Sixteen nurses from Wilmot Cancer Institute presented research at the 2019 ONS Congress meeting, representing the largest number from Wilmot in recent memory. “This type of recognition shows how engaged our staff is with oncology education, quality, and research,” says KC Clevenger, Ph.D., R.N., BC-PNP, FAAN, Wilmot’s Chief Nursing Officer. Approximately 4,500 people from across the world attend this oncology nursing meeting, and having such a strong presence at this meeting demonstrates that Wilmot nurses are not only involved with research, but are leading the way in advances in patient care. “Our nursing team has made great strides in a number of areas when it comes to research,” says Dwight Hettler, M.S., R.N., OCN, NE-BC, co-director of Nursing at Wilmot. “Compared to national peers, it’s just amazing to see how far ahead of the curve our nursing teams appear to be in a number of ways.”
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Awards and Recognitions Dwight Hettler, M.S., R.N., OCN, NE-BC, 2019 ONS Linda Arenth Excellence in Cancer Nursing Management Award. JoAnn Snyder, R.N., CORLN, 2019 Wilmot Nursing Quality of Life Award. Annie Molodetz, B.S.N., R.N., OCN, 2018 UR Nursing Excellence in Precepting Award. Amy Terranova, R.N., University of Rochester Medical Center 2019 Board Excellence Award. Melanie D. Bobry, B.S., R.N., OCN, 2019 National Nurses Week New Knowledge, Innovations and Improvements Award. Patty Bellohusen, M.S., R.N., CNL, Gilda’s Club Rochester Cancer 2018 Hero Award of Merit Program (CHAMP) Colleen Wheeler R.N., N.P., Advance Practice Provider of the year award 2018-2019. KC Clevenger, Ph.D., R.N., BC-PNP, FAAN, American Academy of Nursing Fellowship
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Publications
Podium Presentations
Flannery, M; Stein, KF; Dougherty, DW; Mohile, S; Guido, J; Wells, N. Nurse-Delivered Symptom Assessment for Individuals With Advanced Lung Cancer. Oncol Nurs Forum. 2018 Sep 1;45(5):619-630.
Littleton, J; Somers, C. Implementation of a Dedicated Study Pod within an Oncology Infusion Center. Western New York/Finger Lakes Region Research Day. June 2019, Rochester, NY.
Norton, SA; Wittink, MN; Duberstein, PR; Prigerson, HG; Stanek, S; Epstein RM. Family Caregiver Descriptions of Stopping Chemotherapy and End-of-Life Transitions. Supportive Care in Cancer. (2019) 27: 669. Epub 2018 Jul 28.
O’Leary, S. Increasing Nurse Capacity in Research and Evidence-Based Practice through Education. Western New York/ Finger Lakes Region Research Day. June 2019, Rochester, NY.
Knapp-Clevenger, R. Nursing Research: Impact on Cancer Care, Funding and Hicks, BL; Brittan, MS; Knapp-Clevenger, R. NIH Research Programs. Genesee Valley Group style central venous catheter educaOncology Nursing Society Annual Teaching tion using the GLAD model. (2019) 45:67-72. Day, October 2018. Henrietta, NY.
Panels
Posters
Clarke, T. Quality Improvement Best Abstract Presentation: The Value of a Just Culture and Encouraging the Reporting of All Events. ONS Congress, April 2019. Anaheim, CA.
Abbas, K; Clarke, T, Zeller, K; Hettler, D. Evaluation of the Cleveland Clinic Capone-Alber Fall Risk Score on an Adult Hematology Oncology Unit. ONS Congress, April 2019. Anaheim, CA.
Littleton, J; Somers, C; Merry, C. Implementation of a Dedicated Study Pod within an Oncology Infusion Center. ONS Congress, April 2019. Anaheim, CA. Littleton, J. Implementing an EPIC Based Standardized Communication Process Specific to Clinical Trials. ONS Congress, April 2019. Anaheim, CA. Mallaber, P; Fung, C; Knapp-Clevenger, R; Williams, G. Oncology tobacco treatment: How many visits are recommended for success? ONS Congress, April 2019. Anaheim, CA. McLaughlin, K; Olsan, T; Hettler, D; Davey, A. Utilizing the S.M.A.R.T. Discharge Protocol to Empower Surgical Oncology Nurses’ Promotion of Patient Readiness for Discharge. ONS Congress, April 2019. Anaheim, CA. Natale, J. Driving Away Anxiety in Radiation Oncology. ONS Congress, April 2019. Anaheim, CA.
O’Leary, S. Increasing Nurse Capacity in Research and Evidence-Based Practice Estlinbaum, B. Nurse-Developed, PatientSpecific Plans to Improve Motivation Bell, L; Skinner, K; Hanford, D. Assessing and through Education. ONS Congress, April and Engagement in Their Own Care: Treating Lymphedema Using Bio-Impedance 2019. Anaheim, CA. Development of Post-Bone Marrow Spectroscopy in Breast Cancer Patients. ONS Santacesaria, N. Using Mindfulness and Transplant Care Reference for Allogeneic Congress, April 2019. Anaheim, CA. Self Determination Theory to Promote Stem Cell Transplant Patients. ONS Congress, Psychological Well-Being and Physiological Harmor, D; Sabatka, S. Formation and April 2019. Anaheim, CA. Health in Bone Marrow Transplant Patients. Evolution of a Support Group for Survivors ONS Congress, April 2019. Anaheim, CA. Knapp-Clevenger, R; Bell, R; Flannery, M; Afflicted by Head and Neck Cancer. ONS Norton, SA; Oliva, J. Nursing Research: Congress, April 2019. Anaheim, CA. Stevenson, R; Galdys, J; Coffin, A. Crossing Impact on Cancer Care, Funding and the Distance: Creating a Strong Foundation Henry, R. Fostering and Promoting NIH Research Programs. Genesee Valley for Ambulatory Oncology Nursing Practice. Resilient Interdisciplinary Teamwork for Oncology Nursing Society Annual Teaching ONS Congress, April 2019. Anaheim, CA. Bed Expansion while Maintaining Safe Day, October 2018. Henrietta, NY. High Quality Patient Care in the Blood and Williams, G. The Task Sheet Tool to Improve O’Leary, S; Oliva, J. Nursing Research: Marrow Transplant Unit. ONS Congress, Communication. ONS Congress, April 2019. How and Why. Western New York/Finger April 2019. Anaheim, CA. Anaheim, CA. Lakes Region Research Day. June 2019, Hettler, D; Henry, R; Clarke, T; Britt, D. Rochester, NY. An LPN Mobility Nurse Improves Patient Outcomes on the Inpatient Oncology Service. ONS Congress, April 2019. Anaheim, CA.
Wilmot Cancer Institute
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Wilmot Cancer Institute 601 Elmwood Avenue, Box 704 Rochester, NY 14642
38% of Wilmot nurses have an oncology certification.
Wilmot employs more than 400 nurses and nurse practitioners.
Wilmot is Tier I in the Press Ganey Engagement Survey.
Olean
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@wilmotcancer
@wilmotcancer