"I can’t really imagine working anywhere but Mass General - I feel like the opportunities within nursing are really unmatched."
Kendra Lehman, MSN, FNP, Chief Nurse Practitioner, Emergency Department (ED) Observation Units
"I started working at the Massachusetts General Hospital Emergency Department (ED) as a patient care associate (nursing assistant) while I was a nursing student at Simmons College. On my first day, I was just overwhelmed. I had never been to Mass General and it seemed huge, with so many people, and it was extremely busy and fast-paced. Yet at the same time I instantly knew I wanted to be a part of it. Shifts flew by and I felt like every second I was learning and doing. The nurses really went out of their way to make sure we had every opportunity to learn, and they looked out for us and understood how excited we were to be there. Twenty years later, as chief nurse practitioner for Mass General’s ED Observation Units, I am doing what I dreamed of doing as a student yet my journey as a nurse at Mass General has also been more varied and rewarding than I could have imagined.
After graduation and two years as a staff nurse on the Mass General vascular surgical floor, I was able to meet my goal of becoming a staff nurse in the ED. Four years later, I started to take part-time classes towards a Master's degree to become a nurse practitioner (NP) and Mass General supported me in reaching this goal. I received tuition reimbursement, and because of an educational partnership Mass General has with Northeastern, Northeastern gave me a free class each quarter in exchange for organizing a paramedic internship program in the ED.
I gained experience as an NP in positions at the Partners Occupational Health Service and at the Mass General North End Health Center. Both were wonderful opportunities to work in different settings, but I found ED Nursing was still my passion. I accepted a position as an NP in the Mass General ED and, not long after that, I had the opportunity to move to the ED Observation Unit. The Observation Unit, which had opened in 2007, was a pilot to test a new way of handling ED patients who needed an extended ED visit with additional medical care and monitoring, but weren't clearly acute enough to require admission to the hospital. For 24 hours, we provide them with specialized care and we ultimately make a decision about whether they require hospitalization. Our Unit is an NP-run practice, with an attending physician who rounds on patients once a day. Otherwise, we manage the patients autonomously, with help from attendings when we need it. Within a year, an opening emerged for a chief nurse practitioner position to manage the Observation Unit’s NP group and act as a liaison with the ED, which is 12 floors away. I applied for and was offered the position.
One of the reasons the Observation Unit has proved to be successful is because it helps decompress the ED while keeping hospital beds open for patients who need them. In 2012, because of the success of the unit’s model, Mass General decided to open another 18-bed ED Observation Unit, greatly expanding the scope of my management role. It’s gratifying that other area hospitals now want to talk to us about how our model works because they want to start it in their own hospital.
I can’t really imagine working anywhere but Mass General. I feel like the opportunities within nursing are really unmatched. The role I have now didn’t exist a couple of years ago. The next opportunity I’ll be excited about may not exist yet either. In the meantime, I am surrounded by fantastic, unbelievably skilled clinicians who inspire me to bring my own “A-game” to a role that I find enormously satisfying and challenging."