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It Just Takes Two

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Vol. 7 •Issue 10 • Page 20
It Just Takes Two

The Wound, Ostomy & Continence Team at Morristown Memorial Hospital, Morristown, NJ, is name ADVANCE's Best Nursing Team for 2007

Between the two of them, Toni McTigue, APRN,BC, RN, CWOCN, and Janet Doyle-Munoz, BSN, RN, CWON, have more than 50 years experience in nursing. Both have had stellar careers, but it wasn't until this pair began working together in 2002 that they would reach the most productive part of their professional lives.

The expertise and guidance of these two certified wound, ostomy and continence nurses (CWOCN) has had an immeasurable impact on the patients and staff of Morristown Memorial Hospital, Morristown, NJ.

"A lot of what WOCN nurses do together is a partnership and it can either work or it can't," said Doyle-Munoz. "With Toni and me it really works."

McTigue agreed wholeheartedly. "Janet and I work well together because we share a passionate commitment to the care of our patients and we possess unique areas of expertise which are highly complementary," she said.

"Like anything else in patient care, great teamwork makes all the difference when it comes to producing positive outcomes," she added. "Working as a team, that's what Janet and I always strive to achieve."

Though small, this team proved mighty by besting nearly 100 other stellar nursing teams nominated in the Greater New York and New Jersey Metro region to be crowned ADVANCE's Best Nursing Team for 2007.

Building on Their Strengths

The successful partnership began 6 years ago when McTigue was hired as a CWOCN for hospital's wound, ostomy and continence management team. Previously working in home healthcare as a clinical specialist for 16 years, McTigue received her certification in wound care and continence in 1993. Along the way, she also gained invaluable research experience as a nurse practitioner.

In contrast, Doyle-Munoz has spent most of her 30-year nursing career in the acute care setting and worked almost exclusively at Morristown.

"I actually spent the first 15 years of my career as a hematology/oncology nurse," Doyle-Munoz said. "I was a staff nurse in the oncology unit when I joined the hospital's first wound care committee back in 1995. Out of that initial committee came the recommendation that the hospital hire a CWOCN."

Meg Eakin, MEd, RN, CWOCN, launched the program, and Doyle-Munoz was hired 4 months later. Working alongside Eakin, Doyle-Munoz received on-the-job training and took her certification exams in 1998. When Eakin left the position, McTigue came on board in 2002.

Their passion for working with acute and chronic wound management, ostomies and incontinence encouraged these specialized nurses to initiate interventions to improve the quality of patient care. Together they developed and implemented strategies for wound care management, pressure ulcer prevention and skin tear guidelines throughout the hospital.

Save Our Skin

Using the title "Save Our Skin," McTigue and Doyle-Munoz have charged Morristown's entire healthcare team with the responsibility to protect the integrity of patients' skin. This includes the prevention and management of pressure-related ulcers/wounds, wound management and fragile skin integrity.

"We use 'Save Our Skin' as our slogan to let everyone in the hospital know they are ultimately responsible for protecting the patient's skin," Doyle-Munoz said. "It's a multidisciplinary approach consisting of dieticians, physical therapy, vascular and plastic surgeons and nurses, of course. We got this whole team together and developed a wound care protocol."

The team's first educational program was a fair to kick off the program and was so successful it has become an annual event.

"Over the years we've gone from developing protocols and guidelines to hosting a regional Save Our Skin conference that has been so successful, 150-250 people attend the 1-day event we hold at the Madison Hotel," noted Doyle-Munoz, who says the first fair was held in the hospital auditorium.

Education Initiatives

Recognizing they are only two and identifying the need to be able to reach all the units and staff, McTigue and Doyle-Munoz developed a wound care committee. The goal of the committee is to work specifically with bedside nurses, educate them in wound, skin and ostomy care, and become designated unit wound care coordinators.

"We developed a learning program for nurses so they would be able to help us identify patients, intervene early and to be a resource for their peers on the unit," explained Doyle-Munoz. "They also help us with data collection for our prevalence studies. They are very dedicated nurses who have a passion for wound care."

Following successful completion of the program, which also includes wound healing as well as assessment, treatment and prevention, the nurses are presented with a certificate identifying them as wound care coordinators for Morristown Memorial Hospital.

"Since we started the program, Braden scale scoring is now done daily as opposed to weekly, and pressure ulcer prevention strategies are implemented when patients score in the low risk range of 18 and below," Doyle-Munoz said. "We do intensive education with our competency on how to interpret the Braden scale.

"We also developed a computerized 'trigger' for the wound care clinicians that alerts Toni and me if a patient has a Stage I to Stage IV wound," she added. "Before, our consults were done by phone. Now we also get a computerized printout that tells us who the patients are and where they are located so we can identify these patients more quickly."

Seeing Results

Innovative approaches such as these have led to a remarkable decrease in the amount of hospital-acquired pressure ulcers (HAPUs). In November 2005, the prevalence of HAPUs at Morristown was at 45 percent. Currently, the facility has no reported HAPUs.

"I think we made the wound care protocol evidence-based and expanded it greatly," McTigue said. "I was at the NPUAP [National Pressure Ulcer Advisory Panel] Pressure Ulcer Convention when they talked about deep tissue injury during the conference. Because this brought more awareness to the types of tissue ulcers involved, I came back and we incorporated it into our own protocol. We then were in the forefront of identifying tissue color changes and types of injuries."

To further enhance the education of all nurses, each unit has wound care binders for reference. The information guides the staff in a variety of topics including assessing skin integrity, using the Braden Scale for documentation accuracy, evidence-based skin tear guidelines and criteria for ordering specialty beds and specific standardized wound care products. Also included are treatment guidelines to incorporate into the patient's plan of care.

Spreading the Word

Doyle-Munoz and McTigue also developed the "Save Our Skin" Web site, a hospital-wide computer program available to all Morristown nurses. The site incorporates information about CWOCN, wound care coordinators, wound care guidelines, skin tear education and links to current resources on wound/ostomy care. Outcomes consistently and dramatically improved at Morristown as the pair and the wound care committee re-educated nurses and nursing assistants in evidence-based prevention protocols.

"The Web site came about a year and a half ago in response to us trying to think outside the box," Doyle-Munoz explained. "We needed to find a way to get vital information about wound care out to the staff and have it available 24 hours a day. It was becoming increasingly difficult to get the entire staff together and the Web site became the best way to get the information out there."

In addition to their work with Morristown staff, the team is consulted to work with outpatients with complex ostomy/fistula problems. They also teach preoperative classes to patients about to undergo ostomy resulting surgery and they facilitate the Morris County Ostomy Association, a support group dedicated to enhancing the quality of life to ostomates.

On the Horizon

The team is passionately committed to advancing evidence-based practice as demonstrated through their many projects and research involvements.

Currently, they are involved with clinical specialists and nurse researchers in a study on pressure support surfaces in the emergency department and operating room. Data is collected through prevalence studies monthly and submitted quarterly to National Database for Nursing Quality Indicators (NDNQI) for national benchmarking.

They also are in the process of publishing a wound care brochure to educate patients and their families about wound care.

"I personally think our roles are only going to expand," Doyle-Munoz said. "Wound and ostomy nurses are a vital part of any hospital team and consumers are becoming much savvier about the care of their loved one's skin.

"It's becoming unacceptable to develop a pressure ulcer in the hospital."

Andrea Kerr is a frequent contributor to ADVANCE.

Going the Extra Mile

NICU nurses at NYU Medical Center, New York, NY, demonstrate their commitment to patients each and every day

The NICU nurse team at NYU Medical Center, New York, NY, took team nursing to a new level this year. From individual recognition to team awards and demonstration of clinical expertise, this group of highly dedicated professionals is a testament to solidarity and commitment to quality patient care.

In addition to providing the best care to the tiniest of patients on a daily basis, this devoted team continuously seeks out ways to improve and educate those in the field. Their dedication and willingness to always go above and beyond the call of duty earned them a spot among the 2007 Best Nursing Teams.

"In June, the staff held a conference on nursing strategies for the NICU," said Joan M. Cutrone, MA, RN, CPN, LNC, nurse manager, in nominating her team for the contest. "The conference was attended by more than 100 nurses from the tri-state area. From the onset, this project was an interdisciplinary collaboration of nurses, neonatologists and clerical staff."

Finding a Better Way

Together, the nurses planned a full-day program covering the latest practice on feeding infants, oxygen administration and current trends in NICU practice.

"They designed the brochure, booked the speakers, and organized the caterers and the advertising campaign," Cutrone reported. "It was a project run entirely by the staff and their efforts were recognized with an Employee Team Spotlight Award."

The team earned another award for its dedication to streamlining a complicated surgical procedure.

"To improve patient care and safety, it was decided that infants who needed patent ductus arteriosus (PDA) surgery would have the procedure right in the NICU and not go to the main OR," Cutrone explained. "This eliminated the difficult task of moving critically ill, intubated infants from the ninth floor to the sixth floor, thus exposing them to various bacteria as well as the logistics of moving a vast amount of equipment.

"An interdisciplinary team met to address logistics, equipment needed, infection control and staff responsibilities," she continued. "A standard of care was developed and a tour of the unit to map out the procedure was completed. As a result of the team's efforts, we have completed almost 30 PDAs to date, have no infections, and received an Employee Recognition Team Spotlight Award."

Teamwork in Action

Even on the soundest ship, smooth sailing is never assured. When an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) occurred on the NICU in July 2006, the staff refused to collapse under the pressure of blame and negativity.

Instead, they rose to the occasion, quickly working with the infection control and prevention team to initiate strategies to control the MRSA spread. The outbreak was quickly brought under control and the team received its third award, the Employee Recognition Award for Team Safety.

The team's compassion, dedication and professionalism are evident to both patients and families. However, during one particularly exhausting, stressful and sad evening, a neonatal attending witnessed firsthand their teamwork in action and under pressure.

"One night in the NICU, an infant with multiple congenital anomalies was born," Cutrone explained. "Despite 12 hours of nearly non-stop interventions, the infant died. As a result of the efforts of the entire night shift team, the neonatal attending wrote a letter expressing how grateful she was for the team's support.

They were "responsive, attentive, helpful and maintained calm during very stressful situations where many physicians were making numerous requests for multiple medications and procedures. Their level of professionalism was at its best," the physician said.

"I'm very proud to be working with this staff."

Andrea Kerr is a frequent contributor to ADVANCE.

With Open Arms

RCU nurses at Vassar Brothers Medical Center, Poughkeepsie, NY, work with local nursing schools to grow their own nurses

Registered nurses on the respiratory care unit (RCU) at Vassar Brothers Medical Center, Poughkeepsie, NY, have developed a successful way to "grow their own" through initiative and recruitment/retention.

The RCU is a challenging 30-bed med/surg unit providing care for up to 14 ventilated patients and 16 telemetry patients.

"Often, what separates our patients from critical care or end-of-life care is a matter of hours," said Jacqueline Kavouras, BA, RN, nurse manager, in her nomination of the team for ADVANCE's Best Nursing Team contest.

"The staff is skilled at identifying life-threatening events and intervening toward escalation in care, while at the same time recognizing end-of-life issues in caring for patients and their families. Their ability to capture the urgency of intervention, in combination with providing support and dignity at end of life, is astounding."

While teamwork is essential to care for medically complex patients, it is in the area of recruitment and retention that the RCU team shines and earned the team a place among the 2007 Best Nursing Teams.

Bridge to Practice

"Three years ago the RCU was a different place," recalled Kavouras. "Agency nurses comprised a large part of the staffing mix. There was an absence of 'ownership' on the unit and morale was low. Staff turnover was high, burnout was prevalent and patient care was at risk for being compromised. We collectively decided we had to stop the downward spiral and improve the quality of care and our ability to function as a team."

In 2001, Vassar Brothers launched an innovative orientation program for graduate nurses called the bridge-to-practice (BTP) program. Unable to recruit experienced RNs due to the nursing shortage, RCU was eager to tap into the graduate nurse (GN) population. The first BTP orientation included two GNs hired for RCU.

Since then, RCU developed a BTP-RCU program specifically suited toward orienting new grads to working in the RCU. This specialty orientation added topics and skills that were pertinent to the patient population of RCU.

"An example of our successful recruitment/retention efforts is that there are no vacant positions currently in RCU," Kavouras said. "Since 2001, RCU has helped mentor and train 43 GNs for RCU as well as for new units opening within the hospital. There is a list of novice nurses waiting for the opportunity to be placed into this challenging, dynamic environment."

RCU Goes to College

To further recruiting efforts, the RCU reached out to nursing students from local colleges who were doing clinicals on the unit.

"The staff took a proactive approach by embracing students as they rotated through the unit for clinical and recruiting them early on," Kavouras said. "Allowing students the opportunity to work with a complicated patient-mix in a hands-on environment fostered the beginning of team building between the staff nurse, the ancillary staff and the students."

Networking with four local nursing schools became routine for the staff. Nursing instructors began to seek out unit leaders for preceptor roles and student requests for placement on RCU increased. Post graduation, RCU became one of the most desired units for GNs to begin their nursing career.

"I really enjoy working alongside the RCU nurses and appreciate their dedication to fostering a welcoming educational environment for student nurses," said Jill Brennan-Cook, MS, RN, CEN, assistant professor of nursing at Mount Saint Mary College, in her nominating letter to ADVANCE.

"The RCU nurses provide strong role models for the students by providing the highest quality of nursing care possible. One can see the student nurse's anxiety lessen with each rotation to the RCU because of the gentle guidance and support provided by the RCU nurses."

Andrea Kerr is a frequent contributor to ADVANCE.

School Days

School nurses in Elizabeth, NJ, rise to the continuing challenge to leave no student behind

Nurses in the Elizabeth, NJ, School District provide emergency services, evaluations, control diseases and do interventions. They treat children with special needs, disabilities and chronic diseases, all while working in an inner-city community of multi-ethnic populations who have diverse health challenges.

Meet the nursing staff of New Jersey's Elizabeth Board of Education Nursing Services, whose adaptability to the changing landscape of school nursing earned them a runner-up spot in ADVANCE's 2007 Best Nursing Team contest.

A generation ago, the school nurse cleaned and bandaged the occasional scraped knee and sent home children with stomachaches or fevers. Today's school nurse increasingly treats students with complex medical conditions. Diabetes, ADHD, childhood obesity and seizure disorders are becoming increasingly common in the students who walk the hallways of public schools.

"Working with children with special needs, disabilities and chronic disease requires that we successfully interact as a member of a multi-disciplinary team providing services to the students to facilitate a safe, secure environment where the student can be educated," said Cathleen P. Lear, MS, RN, in her nomination letter.

The Front Lines

Lear refers to her nursing peers within the Elizabeth school system as the "front lines." Located near Newark, NJ, and 30 miles outside of New York City, Elizabeth School District's nurses are often the only link the student population has to healthcare.

"School nurses have a specialized focus in meeting the complex needs of a diverse population," Lear said. "We are not always looked upon by our colleagues with the respect we deserve. We are the front lines. Often we work independently and split-second decisions are required of us to save lives. We deliver services without the benefit of other healthcare professionals and make nursing decisions on behalf of our students."

Across the country, nursing shortages and budget restrictions impact the number of professionals available to care for students. The schools of Elizabeth, NJ, are no different. Lear said there is a strong sense of loyalty and dedication among the district's RNs who have risen to these challenges. These professionals provide nursing services to schools without nurses, cover for absent nurses and do whatever is necessary to provide continuity of care for students and staff throughout the district.

"We operate each office within budgetary guidelines, seeking services at no charge for students and families whenever possible," Lear said. "School nurses make do with the supplies that are available. We support each other and have immense respect for our colleagues, always listening to each other, seeking ways and means to make things better."

Sharpening Their Skills

Providing quality healthcare to the children is essential, but education is equally vital to these school nurses. In addition to attending monthly nursing meetings and obtaining CEUs, many of Elizabeth's nurses belong to county and state nursing associations. Lear noted that while many on the nursing team hold master's degrees, the quest for learning does not end there.

"We have the benefit of services from many community agencies who work with us to learn new skills or refresh those skills which we have not used regularly," Lear said. "When a student arrives or returns to school needing professional nursing care, which only we can provide, we are ready to meet those needs through a varied support system."

Crisis Intervention

Elizabeth school nurses also provide psychological and sociocultural support to students. All are members of crisis intervention teams within their school buildings and rally to help meet the needs of those in emergency situations.

"If one or more of us learns of a need, perhaps of a student, family or employee, we connect with each other to provide necessary services, knowledge of referral options and help to maximize other resources," Lear said.

"We never leave a student who is in need, and often miss lunches, work late or provide other interventions. We treat students as we wish our own children to be treated."

Andrea Kerr is a frequent contributor to ADVANCE.

Creating a Team

The Education Committee of the CCU at Albany Medical Center, Albany, NY, builds bridges by relying on each other

The education committee of Albany Medical Center's coronary care unit (CCU) made it their mission to create a healthy work environment by implementing the five characteristics of team building: trust, accountability, positive conflicts, results and communication.

The committee's new mission is in direct contrast to the approach used previously. In her nomination letter for the ADVANCE Best Nursing Team contest, unit educator Diane P. Hamilton, BSN, RN, said the U.S. Army's former catch phrase, an "Army of One," more accurately described the former running of the unit.

"We went through new management and there was no push for education at all," Hamilton explained during a recent interview with ADVANCE. "We lost a lot of staff as a result. Finally, we got a new nurse manager, Mary Perrecone, MS, RN, CCRN, who was very pro-education and developed nurse educator positions."

Back on Track

It wasn't long before the education committee was re-established by the new nurse manager and unit educators, who encouraged each of the unit's 62 RNs to join. This resulted in a team of 15 members, which continues to grow.

The committee soon identified a number of opportunities to improve CCU processes including restructuring new staff orientation, improving communication at shift change and between professional staff, and standardizing critical care documentation.

With an extensive list of concerns to address, the committee developed a number of goals to advance CCU performance while dividing tasks among CCU education committee members based upon their areas of expertise. One of the first items the committee tackled was getting new staff up to speed on the unit.

"With recent turnover in staff, the unit faced a large number of inexperienced nurses," Hamilton said. "The committee restructured the orientation process for new staff, resulting in the development of guidelines and goals for both preceptors and orientees. Preceptors follow and evaluate orientees by utilizing unit-orientation guidelines. Staffing was adjusted to allow for charge nurses to be free of patient care and act as a resource for new staff. This process brought our 24 new recruits through orientation to be a fully competent level II CCU."

Communication improved when the nursing report was changed from its traditional format to a system known as SBAR (Situation Background Assessment Recommendation) and accompanied by walking rounds to visually review patient status.

"In addition, the entire CCU staff meets at 7 a.m. and 7 p.m. for 'round table report,' a unit-based report to increase staff awareness of unit activity," Hamilton said. "Participation in physician rounds was encouraged to facilitate collaborative practice."

Improving Improvements

Improvements in documentation and a new medication system requiring barcoding stressed both experienced and newer staff members, who felt increased demands on their time.

The education committee considered how to solve this dilemma and developed a solution utilizing the resources of patient care assistants. This change resulted in the drafting of a CCU-specific job description for PCAs.

Additionally, the committee uses a variety of ways to bring education and communication together on the CCU. Team members developed resource books and educational posters, videotaped inservices for all shifts to view, and created a monthly "top 10" list of practical CCU nursing tips and advancements.

"Healthcare today is changing at lightening speed and requires learning as a lifelong process," Hamilton said. "The CCU education committee has worked together this year developing a sense of teamwork, improving staff morale and advancing patient care outcomes. None of these activities would have been possible without the participation of all team members.

"We are no longer an army of one, but a team of 15."

Andrea Kerr is a frequent contributor to ADVANCE.

Finding their NICHE

4 South nurses at Riverview Medical Center, Edison, NJ, bring ideas and innovation to the forefront

The nurses of 4 South at Riverview Medical Center, Edison, NJ, have distinguished themselves among their peers. A 32-bed med/surg unit, 4 South averages approximately 10,000 admissions per year and has the distinction of being the first Model of Care Unit in the Meridian Health System.

A collective commitment to research and innovation has led to significant improvements in the care of the unit's primarily geriatric patient population. It's innovation earned the team a spot among the 2007 ADVANCE Best Nursing Teams.

A Model of Care

"Model of Care is designated by meeting many standards set forth by the American Nurses Credentialing Center (ANCC)," explained Eddie Perez, BSN, RN, in his nomination of the team. "Many of these standards speak to the items that are evaluated in the judging for the distinction of best team.

"In the area of retention, 4 South boasts an average of 16 years seniority among the full-time and part-time nursing staff, totaling 22 nurses. There are only three nurses who do not have a double-digit anniversary date."

The team of 30 RNs is not one to rest on seniority or laurels. It continuously seeks out opportunities for professional growth.

"In seeking initial Model of Care designation, staff nurses agreed to maintain national certification and participate in the hospital-based clinical ladder," Perez said. "To date, 100 percent of the nursing staff is nationally certified in med/surg or geriatric nursing and 100 percent of the staff participates in the clinical ladder program, which has many requirements.

"One requirement is that the staff initiates and maintains unit-based educational programs," Perez continued. "This showcases the knowledge that the tenured staff on the unit possess and are willing to share with each other."

To fulfill Model of Care's research requirement, the team completed and presented research detailing the use of bed alarms and fall rates. Staff nurses presented their findings at a Meridian Health System conference in June 2006.

Restraining Restraints

During a recent interview with ADVANCE, Perez said restraint use was probably the most significant topic tackled by the unit.

"In the beginning of 2006, 4 South took on a performance improvement project with the goal of eliminating the use of restraints on the unit," he said. "Considering the patient population and volume on the unit, it is astounding that 4 South has had only three episodes of restraints for the entire year and none since March. This is truly a testament to the skill, patience and determination of the entire team."

Perez attributes much of the team's ability to avoid restraint usage to 4 South being a Nurses Improving Care for Healthsystem Elders (NICHE) unit. The nurses and patient care assistants all attend specialized training and educational seminars in order to provide detailed care to the elderly population. Fall prevention strategies that come from NICHE-related initiatives have spread from 4 South to the entire hospital.

"Recently, the hospital adopted a method initiated on 4 South to identify patients who are at risk for fall when traveling to testing and other areas outside of the unit," Perez noted. "Moreover, 4 South is playing a lead role in the initiation of a 'Ticket to Ride,' a pilot that will not only identify and alert all areas of patients who are at risk to fall, but also meet the requirements of the SBAR (Situation Background Assessment Recommendation) communication standards set forth by the Joint Commission."

The characteristics and accomplishments that make up the 4 South team result in the delivery of quality patient care. And the ownership every team member feels toward the unit transcends to the patient's bedside.

Andrea Kerr is a frequent contributor to ADVANCE.

Calling the Shots

ADVANCE thanks the nurse leaders who served as judges for 2007's Best Nursing Team

Jennifer Pettis, RN, RAC-Ct, is a policy analyst and consultant for the New York Association of Homes and Services for the Aging (NYAHSA). She began working in long-term care as a nurse's assistant in 1988 and is a skilled nurse manager. She has also worked in acute care and office settings as well as in the area of wound care case management.

With NYAHSA's ProCare Consulting, Pettis provides various consulting services to members, including mock surveys, staffing analysis and reviews of and staff training regarding the MDS (including PPS), RAPs and care planning. She provides training on the RAI through the State University of New York at Albany's School of Public Health and is a master trainer for the American Association of Nurse Assessment Coordinators.

Denise E. Williams, MS, BSN, RN, nurse manager of 7 South at New York Hospital Queens, was selected as the ADVANCE Best Nurse Leader for 2006. When she accepted her position in 2005, she took over a 40-bed unit serving actively weaning ventilator patients, with a staff desperate for leadership.

"Our nurse leader faced a unit which was without a manager for several years; staff felt unappreciated, working on a very stressful unit," wrote Angela Augustine, BSN, RN, CMSRN, in her nomination of Williams. "The staff reflected the community of a very culturally diverse population. Our nurse leader overcame these challenges by getting to know her staff as individuals and as a group."

Once Williams accepted the nurse manager position, she posted inspirational sayings regularly on bulletin boards throughout the unit and gently interspersed activities to improve organizational dynamics on the unit. A powerful informal communicator, she takes a hands-on approach to patient and staff relationships. She also makes good use of regular meetings to acknowledge the positive achievements on the unit.

Well-aware nursing retention begins with effective recruitment methods, Williams involves nursing staff in the hiring process from the very beginning. This participatory interview process has worked very well, bringing onboard several new nurses who have been valuable assets to the staff.

Anna J. Sers, MSN, APRN, CNAA,BC, is a psychiatric clinical specialist for consultation/liaison at Westchester Medical Center, Valhalla, NY. A certified psychiatric clinical specialist and nursing administrator with 33 years of mental health experience, her career has encompassed a variety of settings with populations ranging from children to geriatrics.

After earning her BSN and MSN from Herbert H. Lehman College, Sers started her career in New York City, serving as a staff nurse at Fordham Hospital in the Bronx. She went on to hold positions at several other facilities, including Brookdale Hospital in Brooklyn, Metropolitan Hospital Center in Manhattan, and Coler Memorial Hospital on Roosevelt Island.

Sers joined St. Francis Hospital, Poughkeepsie, NY, in 1996 to manage the adult/adolescent inpatient psychiatric units. In 2000, she took over as director of mental health programs. After a brief stint as director of mental health programs for Putnam Hospital Center, Carmel, NY, she joined Westchester Medical Center in November 2006.

An active member of the American Organization of Nurse Executives and an editorial board member, Sers is a past recipient of the New York State Nurses Association's Administrator of the Year award for District 12. She's published and presented frequently on a variety of nursing topics, from depression in the elderly to advanced practice nursing.

Among the Best

With so many great nominations for the 2007 Best Nursing Team contest, it was hard to choose just a few to recognize as Editor's Choice

Multidisciplinary Collaboration

Serving one of the most diverse populations in the nation, nurses at Elmhurst Hospital in Queens demonstrate on a daily basis how they collaborate to produce the best outcomes for patients.

No place is that more true than in the immunology clinic, where five nurses work with the director of infectious diseases, the immunology clinic supervisor, the immunology clinic nursing supervisor, a pharmacist, case-managers and a consumer.

"The objective is to improve services using specific measurable goals," said Andrea M. Odwin-Clarke, NP, who nominated the team.

The immunology clinic provides care and advocates for approximately 1,000 HIV/AIDS outpatients and many others with hepatitis C, tuberculosis, sexually transmitted diseases and more.

These nurses not only share experiences with local colleagues, but also spread their knowledge. They traveled to Russia to share their nursing experiences and they presented two poster presentations at the International AIDS conference held last year in Toronto, Canada.

"A well-functioning team acknowledges that life is fragile, human experiences are important and that people will 'never remember what you said, but how you made them feel,'" Odwin-Clarke said.

Elmhurst Hospital is part of New York City Health and Hospital's Corp.

Institutional Change

Skin care at Robert Wood Johnson University Hospital (RWJUH) at Rahway has come a long way in the past 3 years. Before 2003, the skin care committee went though the motions of measuring skin integrity quarterly, but not much real change came from it, said Denise Gerhab, BSN, RN, WCC, nurse manager for Care Connection/SNF at RWJUH at Rahway.

Then, the committee was restructured and a nursing director was appointed to facilitate the group and challenge the new chair — a staff nurse on the sub-acute care unit — to collaborate with a physician and the committee of 12 RNs to improve patient outcomes.

The committee worked collaboratively to design, develop and implement a new skin care program. They sought feedback from a variety of clinical and non-clinical staff and began the process of streamlining the assessment tools and protocols for staff. Articles about evidence-based skin care practices were circulated, staff were given inservices and "All About Skin" binders were made available on units.

The initiatives improved patient care — as evidenced by a significant decrease in hospital acquired pressure ulcers in 2004-2006 — and also improved the work environment for nurses.

"The success RWJUH at Rahway has achieved is overwhelmingly due to the input of the professional nurse into the design, development of standards and protocols, implementation and monitoring of the skin care program, and evaluation of outcomes achieved," Gerhab said.

Retention Strategies

Recruitment of new nurses isn't enough to keep nursing jobs filled. You must also retain them.

The team on 4 East oncology at CentraState Medical Center, Freehold, NJ, does a host of things to support each other professionally and personally, said Diana Chiaro, MSN, APN,C, RN, AOCN, in her nomination of the 16-nurse team.

"We encourage each other to achieve goals, such as completion of national certifications. We utilize our pastoral care colleague and social worker to assist in dealing with difficult situations. Our nurse manager has developed Healing Circles for staff," Chiaro said. "We foster 'we' thinking and utilize individual strengths to create team synergy. We trust and respect one another."

The 4 East team has revised its unit-based orientation program to provide maximum support for new staff, orienting them not just to the unit but also to the team's philosophy, Chiaro said.

One unique aspect of this group's retention effort is its semi-annual staff retreat.

"This event spans over a weekend to allow different members of our team to attend," Chiaro said. "The purpose is to renew and refresh ourselves and also to participate with special team building activities facilitated experts."

Beyond Tasks to Heart

The nurses on 9 Garden South, Infectious Diseases, at NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY, have been on the forefront of the HIV/AIDS pandemic since its inception.

In her nomination essay, Iva Grant, RN, explained the transition that has occurred over the past 25-plus years.

"We have gone from providing palliative care to patients wasted by some new, unknown disease to providing the most technologically advanced care to patients given renewed hope and spirit by medications and treatments that seem to actually work," Grant said.

Due to the nature of the disease, many of the unit's patients return to the floor at one point or another. Nurses take care of patients through their actions, they monitor vital signs and lab values, insert Foley catheters and IVs, program infusion pumps and change dressings, administer medications, and provide patient and family education, among a host of other tasks.

And while the nursing skills needed to perform these tasks are honed and expanded over the years, it is this team's innate ability to interact with patients at a deeper level that makes them special.

"We listen. We share common experiences. We acknowledge each patient's humanness," said Barbara Tucker, RN.

"Through our quiet presence, we assure them they won't go through this alone," she added. "We'll be right there with them."

Facing the Final Journey

While many people helped establish The Saint Barnabas Hospice and Palliative Care Center Inpatient Unit at Monmouth Medical Center, it was the nurses who brought it to "life."

From it inception in 2000, the nursing team has displayed tremendous initiative, according to Ellen Coughlin, MPA, RN, vice president of patient and family services at the West Orange, NJ-based facility.

Many of the nurses were on staff at Monmouth and believed passionately about the need for a unit dedicated to caring for patients at the end of life.

"All of the nurses rolled up their sleeves and pitched in to transform a closed unit into a thriving care center. They cleaned rooms, organized supplies and set up a meditation room for families complete with books and tapes," Coughlin said. "As we started to admit patients, the nurses worked to accommodate requests to create a homelike setting."

The team transformed the unit into an Italian Bistro to celebrate an important event in the life of one patient. They turned a patient's room into the Magic Kingdom — complete with staff dressed as Mickey Mouse, Cinderella and others — to fulfill a young mother's dying wish to experience Disney World with her child.

When the nurses were faced with the care of a patient who was severely disfigured and very angry, they embraced the challenge, Coughlin wrote. Having no home to return to, the nurses "adopted" the patient, washed his clothes at their homes and replaced them as he lost weight.

"Their unconditional love turned a very bitter and angry man into someone who died knowing that he was loved," she said.

These "angels on earth" continue to create miracles every day.

Improving Relations

The Emergency Department leadership team at Overlook Hospital, Summit, NJ, has undergone massive changes in the past 2 years. They moved into a new state-of-the-art 42 bed unit, had a management change with both a new nursing leadership team and a new physician leadership team, and witnessed an approximately 75 percent change in the nursing staff.

"With this huge amount of change all occurring at the same time, we realized to become a successful department that would deliver safe, quality patient care, the nursing leadership team needed to collaborate and partner with the ED physician leadership team," said Sharon Kelly, MSN, RN, CNAA, ED nurse manager, in her nomination.

The first initiative the team undertook was improving its Press Ganey patient satisfaction scores. To do this, the team realized they needed to change the culture of the department.

They held joint collaborative staff meetings and team-building sessions for both RNs and physicians. They worked to open lines of communication.

They asked questions and respected each other's opinions. And it worked.

Press Ganey patient satisfaction scores improved dramatically from the 29th percentile in January 2004 to the 90th percentile in December 2006. Patient flow has also improved, from 2004 when it took an average of 68 minutes before an ED patient was seen by a physician, to an average of 22 minutes in 2006.

Continuing a Legacy

When Judy Furey, RN, patient service manager for Team 77 of the Visiting Nurse Service of New York (VNSNY), was absent from work and did not answer her phone, her friends and colleagues knew something was wrong. Three nurses working in Judy's East Side neighborhood checked her apartment. Police and EMTs forced the door open and found Furey. She'd died from a cerebral aneurysm.

Distraught, the nurses nevertheless sprang into action, said Josephine Carlos, MA, RN, who nominated the team.

A colleague organized support groups in conference rooms so staff could mourn together or privately. Another walked Furey's dog around to colleagues who "found it so healing to touch Judy's pet as a way to say goodbye," said Mary Beaudet, social work manager.

Nurses from other teams jumped in to cover patients that day. The next day, team 77 divided Furey's patients and Carlos rejoined the team so all 350 patients in their care would continue to receive the gold standard of care that Furey exemplified.

"We picked up the slack," Carlos said. "Our team huddled together crying, supporting each other while meeting our commitments in tribute to Judy, who was always about the patient."

In 2002, Furey won an ESPRIT Award, VNSNY's highest honor. She was praised as an "inspirational mentor, who finds every patient's situation deserving of special attention. Her drive, motivation and positive spirit encourage her team to perform at their highest level."

After Furey's wake, team 77 gathered at the same Italian restaurant where they'd long celebrated accomplishments, Carlos said.

"We saved a place for Judy, with a glass of her favorite wine."

Sharing Ideas

The Nursing Practice Committee of South Nassau Communities Hospital, Oceanside, NY, was formed in February 2006 to develop, review and revise policies, procedures and standards of care related to professional nursing practice.

The team is composed of 30 RNs from all clinical nursing units, nursing education, research and development, nursing leadership and performance improvement, said Eileen Mahler, MSN, RN,C, who nominated the team.

"The innovation and commitment of team members has taken us from those first steps wading carefully into reviewing policies to diving head-first into prioritizing and assuming projects that enhance the quality of care for patients throughout our organization," Mahler said.

Knowledge — especially evidence-based — is power, Mahler added. The committee takes an active role in staff education. Several team members publish a monthly bulletin to communicate changes and recommendations to the nursing staff. Members conducted a house-wide "Hands-up Campaign," a 3-day around-the-clock education related to the use of the two identifiers and handwashing.

"The nursing practice committee is a model for nursing at its best," Mahler said. "Its diversity is its strength. Nursing members range from novice to expert, from different cultures, backgrounds and generations.

"They may not always agree but can always reach a consensus."

Alone & Together

Together, the nursing team of the Therapeutic Apheresis Service (TAS) of the New York Blood Center (NYBC) deliver approximately 3,000 therapeutic apheresis procedures, wrote Ann Marie McDonald, BSN, RN, in her nomination.

Alone, each nurse visits dozens of patients each week in their homes and in the hospital.

Together, the team serves 80-plus hospitals across a 200-mile radius in the tri-state area.

Alone, each nurse treats patients with leukemia in a blast crisis, thyroid storm, sickle cell disease and other life-threatening or life-limiting illnesses.

Together, they are available 24/7.

Alone, each nurse brings something unique from their past nursing experience to their job with TAS.

Together, they share goals, knowledge and best practices. They learn from each other. They communicate regularly via e-mail, conference call and weekly meetings. They improve the care for patients across the continuum.

Alone, mobile apheresis RNs work autonomously. They create their own schedules. They meet clinical, logistical and even traffic challenges head-on.

Together, they can and do achieve excellence.

Taking the Initiative

With changes in the complexity of inpatient admissions and the unique rehabilitation environment where patients are encouraged to achieve maximal independence, falls in rehabilitation units have increased over time.

Concerned about the frequency of these falls, the staff of JFK/Johnson Rehabilitation Institute, Edison, NJ, undertook a fall safety initiative. A team atmosphere evolved.

"We recognized the need to improve our current fall prevention program and come up with new creative ways to reduce falls and fall-related injuries in our four rehabilitation units," said Maria Jinky R. Valdez, MSN, RN, CRRN, assistant nurse manager, and Ann Santos, BSN, RN, CRRN, charge nurse, both of the brain trauma unit at JFK/Johnson.

The rehab safety Star committee was formed in September 2005. The team was formed with rehab RNs, patient care technicians and rehabilitation services. It is comprised of four subcommittees facilitated by fall safety champions within their respective areas of responsibility. The acronym STAR (scripting, trending, awareness/education, and rounding) describes the role of each member.

"Our team went to great lengths to help our program succeed," Valdez and Santos said. "Members worked side by side, consistently committing their time, effort and talent to come up with safety strategies. We designed safety posters/signage, wrote safety scripts and developed educational materials, patient safety brochure, assessment tools and a rounding checklist to help achieve our goals."

And it worked. Inpatient falls have decreased from 5.4 falls per 1,000 patient days in September 2005 to 4.3 falls per 1,000 in December 2006.

Meeting Challenges

The team of step-down unit of 8 East at the Hospital for Special Surgery, New York, NY, has had its share of challenges to overcome. Their collaborative style and collective wisdom have helped them leap each obstacle in their path.

First, the nursing team planned and executed a move of the entire department from 4 East to a new state-of-the-art unit on the eighth floor, said Janice Minucci, MSEd, RN, manager of recruitment and retention, who nominated the team with Cheryl Conwell, ANP.

Postop patients with multifaceted musculoskeletal, cardiac, pulmonary, rheumatoid and blood disorders, along with hip and knee replacements with a host of comorbidities and complex spinal surgeries make up some of the typical patients treated by this team. Nurses on the step-down unit are particularly concerned with pain management, falls prevention, medication reconciliation and infection control.

The next challenges the team successfully faced included:

  • increasing nursing education to include more evidence-based practice;

  • improving nurse-physician relationships;

  • helping nurses become more autonomous in their practice;

  • bolstering professional development efforts for staff; and

  • mentoring team members to help them meet the highest clinical standards.

    While many of the measures were underway already — the Hospital for Special Surgery is a Magnet hospital, after all — the team on this unit took each measure another step or two forward.

    They created a nurse residency program to support the growth and development of all nurses who wanted to work with the specialized orthopedic population. Eight nurses who've gone through the program continue to work on the unit.

    All for One

    The staff of the 1D surgical unit at Franklin Hospital, Valley Stream, NY, works like many other hospitals. Nurses are assigned to care for specific patients each shift, said Michelle Osborne, MSN, RN, CNN, who nominated the team. Franklin Hospital is part of the North Shore-Long Island Jewish Health System.

    But there is no shirking of duties or patient tug-of-wars because each nurse considers every patient to be "their" patient.

    "Everyone answers call bells. This includes the nurse manager, assistant nurse manager, nursing assistants, unit secretaries and even environmental services," Osborne said. "Our premise is that anyone can acknowledge a patient/family's need and then direct it to the appropriate personnel."

    The team works together to care for patients. They may help each other by completing an admission assessment, picking up medications from the pharmacy, transporting a patient, talking to a family member, assisting a physician with a procedure and a host of other ways.

    This teamwork was especially appreciated last summer when one nurse was diagnosed with breast cancer and nine other staff members had positive mammograms and had to undergo some form of biopsy.

    The staff rallied together to support one another. They held prayer breakfasts to offer emotional and spiritual support and they volunteered to covers nights and weekends when staff members had to undergo testing.

    "At the end of the day, it can be said we made our best efforts to provide the best care to our patients and families," Osborne said.

    "The care we provide for our patients gives us a sense of fulfillment and validates the reason for our chosen profession."

    Lyn A.E. McCafferty is editor at ADVANCE.




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