"PattyCarolSusanSallyBeth. Sometimes it seems like it should be one word. We are the day-shift nurses on the co-occurring recovery unit at the Brattleboro Retreat, a 114-bed substance abuse and psychiatric treatment facility in southern Vermont. Together we have more than 140 years of experience in psychiatric nursing, but all that knowledge doesn't explain why we make such a great team."

With these words, staff nurse Sally Caltrider, MSN, FNP, RN, and her unit cohorts caught the interest of ADVANCE editors.

Clear Expectations

When Caltrider came to this busy unit 5 years ago, charge nurse Susan Mello, RN-C, let her know the lay of the land.

"When she told me, 'I hope you have your running shoes on,' I knew this unit was not for the faint-of-heart," Caltrider explained. "It is the fastest-paced place I have ever worked, yet it was clear to me from the start these nurses personified teamwork, and I was welcome to join if I was willing to work as hard as they did."

Five years later, Caltrider is definitely a part of the team.

"We laugh a lot, there are days we swear a lot, and we've also shed a few tears along the way, but we get up every day and do it again, because at the end of the day we know we've done a good job," she said. "Our patients tell us so every day."

Vareen O'Keefe-Domaleski, EdD, MSN, RN, NEA-BC, vice president of patient care services/CNO, was surprised and pleased when the group asked to meet with her shortly after her arrival in 2007.

"They're a highly competent group of nurses, just so clear about what their roles are, what the expectations are, and how they, as professionals, define the environment on their unit," she said. "They came to me and let me know, 'This is who we are and what we do,' and I respected that. It's important to note we find such highly dedicated nurses throughout our organization, strong clinicians in control of their own nursing practice and supportive of great teamwork."

Patty, the Princess

Each of the five nurses is a strong professional in her own right. Staff nurse Patty Brown, RN, affectionately known as "The Princess" because of her affinity for donning a tiara when the mood strikes, came to Brattleboro Retreat as a mental health worker in 1971.

"I've worked on many units and have a huge history to fall back on," she said. "When caring for patients, I look at the person as a whole, emphasizing the psychosocial piece."

Carol Whitaker, RN, staff nurse, values Brown's examples. "Patty is very good at setting limits with patients in a straightforward way, often with humor," she said.

"Patty doesn't have the quotient of need that many nurses do, and doesn't need to be well-liked, although she certainly is," added staff nurse Beth Kiendl, RN.

Carol, a Great Role Model

Whitaker, who has been a nurse since 1968 and a Retreat employee for the past 22 years, is a great role model with a strong Midwestern work ethic.

"I became part of this group of nurses when we were working on the Women's Unit, and continued our relationship when we came here to the co-occurring recovery unit," she said. "I try to be fair, methodical, level-headed, organized and even-tempered."

Susan, or Zippy for Short

Mello, nicknamed Zippy for the speedy way she gets things done, explained, "I'm supposedly the charge nurse, but I couldn't do it without these women. I'm not afraid of confrontation and want what's best for the patients."

Caltrider characterized Mello as the big-picture person. "There have been several times when we have been between nurse managers, and Susan has stepped in to make the unit run extremely well, even making improvements," she said. "When a new manager comes on board, Susan greets her with open arms and helps her acclimate to the unit."

Brown appreciates Mello's open-minded approach to management. "I love Susan because I can tell her exactly what I think!" she chimed in.

Sally, an FNP

Caltrider, on the other hand, is more of a detail person, stubborn and well-organized.

"I started as a mental health worker in 1979 at the Retreat before going off to nursing school and working elsewhere. I came back as a family nurse practitioner in the clinic, and then decided I didn't want to do that anymore," she said.

"I've been on this unit for 5 years, and my background as an FNP really helps with the medical issues that arise here."

Kiendl admires Caltrider's grit.

"If Sally believes something is right for patients or staff, she really pursues it," Kiendl said.

Beth, Outspoken but Compassionate

Throughout her 31 years at the Retreat, Kiendl has remained compassionate and laid back.

"But when I do set limits, it's pretty clear," she cautioned. "I like working with other people, especially this group of nurses. I'm outspoken, and have learned over the years how to organize myself in my own special way.

"I like to affect an environment on the unit. I'm certainly not a small presence wherever I am!"

Caltrider admires Kiendl's approach to life.

"Beth is the most open-minded and nonjudgmental person I've ever met," she explained.