ECMO Reunion:

a ‘magical’ event for patients, families, and staff

More than 250 people enjoyed a reunion picnic on Saturday, August 10, 2002, at Curry College in Milton, Massachusetts, including 50 patients who have undergone ECMO therapy at MGH over the years.

The event marked the 11th ECMO reunion where family members and survivors of ECMO therapy have had an opportunity to gather again with the MGH caregivers who provided their life-saving care.

ECMO—Extra-Corporeal Membrane Oxygenation—is a form of treatment that uses an artificial lung and pump to support patients with acute respiratory and cardio-respiratory failure.

ECMO supplies oxygen to the body’s tissues, often giving the patient that extra time needed for the underlying disease to heal. ECMO also helps prevent new problems from occurring as a result of the high ventilator settings, which can themselves cause lung injury.

The use of the artificial lung to help support patients is not new. The technique was first studied in the 70s when it was found to be unhelpful in adult patients. But later, high rates of success were reported in treating newborns with acute respiratory failure.

ECMO was re-introduced at MGH in 1988 for newborns. After much success, ECMO was tried in some older pediatric patients and even occasionally, in adult patients. Our ECMO program currently treats 15–20 patients per year at many sites throughout the hospital.

At this year’s reunion, families of children who received ECMO therapy had a chance to come together with caregivers who have provided ECMO therapy for the past 14 years.

Maureen Campbell underwent ECMO therapy when she was 14 months old. Today, she is a happy, healthy, 13-year-old girl. Says Maureen’s father, Tom Campbell, "We love coming to this reunion every year to see staff and all the other kids who’ve benefitted from ECMO therapy."

Respiratory therapists who specialize in ECMO therapy, NICU and PICU nurses, support staff, social workers, and physicians had an opportunity to renew acquaintances with past patients.

Children of all ages were mesmerized by magician, Steve Charette, and his amazing sleight of hand. Picnickers enjoyed playing at the craft table and watching the ever-popular Jubilee Puppet Show, presented by puppeteer, Ron Comeau, a regular performer at ECMO picnics for the last ten years.

And with this summer’s relentless heat, the swimming pool and snow-cone machine were a welcome treat.

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Jeanette Ives Erickson

Recruitment and Retention

An interview with Megan Brown, HR representative; Marianne Ditomassi, RN, executive director to the office of senior vice president for Patient Care; and Steve Taranto, HR manager for PCS

Jeanette: Marianne, I know we’re employing a wide range of strategies to market MGH Nursing; but I’m not sure staff are aware of all our efforts. Can you describe our recruitment initiatives?

Marianne: We really are taking a multi-faceted approach to marketing MGH Nursing; we’re aggressively pursuing every opportunity to recruit new and experienced nurses. I think it’s fair to say we’re using some unique and creative approaches as well tapping into some of the more traditional advertising venues. We are definitely getting the word out.

Megan: Perhaps the most visible recruitment strategies we’re currently using are the Nursing Image Campaign, the Employee Referral Program, and the Career Expo that’s scheduled for September 15th.

Steve: The image campaign was a collaborative effort between nurses and Human Resources. We worked closely with the Staff Nurse Advisory Committee (SNA) to make sure we captured the essence of MGH nursing. Representatives from the SNA were asked a series of questions to help identify what aspects of MGH nursing we wanted to spotlight.

SNA representatives took those questions back to their units for even more feedback. So we were able to tap into a good cross-section of the department. Nurses identified attributes such as diversity, flexibility, strong leadership, and a supportive yet challenging environment as our most compelling recruitment incentives.

Megan: The result is an ad campaign that features MGH nurses, men and women, new and experienced, representing all role groups and diverse backgrounds, from within the department of Nursing and outside the department as well. Ads show nurses, in groups or individually, holding a sign that says: "We chose MGH" or "I chose MGH."

Response to the ads has been very positive.

Marianne: The Employee Referral Program, which began on July 1, 2001, has proven to be one of our most successful recruitment tools. To date, almost one hundred new employees within Patient Care Services have been hired as a result of the program. Approximately six new employees per month have been hired into the department of Nursing, and two per month into the health professions.

And the referring clinician receives $1,000 (taxable) gross wages.

Steve: The Career Expo will be held September 15th here at MGH, and more expos are scheduled for November, January and April (See shaded box on previous page). We have an extensive advertising plan to publicize the event, so we’re expecting a large turnout.

Megan: The expo will be advertised in:

• An insert in Advance for Nurses Magazine; 67,500 issues in New England (entire circulation); 8/19/02
• Direct-mail post card to 75,000 nurses in New Hampshire, Massachusetts, and Rhode Island; 8/26/02
• Taxi-top ads on 75 cabs in the Boston area; 9/1/02
• Mobile media on Cape Cod; 9/2/02
• Full-page ad on back cover of On Call in the issue featuring the Clinical Recognition Program; 9/5/02
• Half-page ad in The Boston Globe’s Big Help section; 9/8/02
• Half-page ad in The Worcester Telegram; 9/8/02
• Third-of-a-page ad in The Boston Metro; 9/9/02
• A tab insert in The Boston Metro that reads: "Find your nursing career at Massachusetts General Hospital;" 9/9/02
• Mobile media at Gillette Stadium; 9/9/02 (and at all Patriots’ home games)
• A special outer wrap advertising the Nursing Career Expo will appear on 5,000    complimentary issues of The Boston Globe to be distributed at highly visible sites in Boston including MBTA stops and high-traffic intersections; 9/10/02
• Half-page ad in The Boston Globe; 9/15/02
• MGH Hotline
• Caring Headlines

The expo will be advertised on a number of career-search Internet sites, and an item will be distributed via the MGH All User e-mail system.

Jeanette: That’s very impressive. You mentioned, ‘mobile media.’ Can you tell us more about that?

Steve: The mobile media campaign is actually very exciting, and a first-time undertaking for us. Mobile media is a large, portable billboard that’s mounted on the back of a truck so it can be moved from location to location. We’ve been displaying it at the Sagamore Bridge on summer weekends to take advantage of that high-visibility location. And we plan to display it at Gillette Stadium for all of the Patriots’ home games and at the Head of the Charles Regatta in October.

Jeanette: What a great idea. What else are we doing to market MGH Nursing?

Marianne: We’ve been holding interview sessions, called ‘Walk-In Wednesdays’ since January of this year. Anyone interested in applying for, or learning more about, nursing positions at MGH can go to the Human Resources Office on White 14 and have a guaranteed interview with an HR representative between the hours of nine and five.

Megan: Having a designated time for walk-in interviews makes the application process more accessible and convenient for many prospective candidates. And sometimes we’re able to arrange an interview with a nurse manager the same day.

Jeanette: What are we doing to attract high-school and college students?

Steve: We have a number of school outreach programs, some, where we go into schools and speak or attend job fairs, and some, where students come to MGH for tours and hands-on experiences.

Megan: I’ve learned that whenever I go to a job fair at a school to bring a nurse with me. I’ve found that students have questions only nurses can answer, and it sparks a more meaningful dialogue when students can talk one-on-one to a professional nurse.

Jeanette: What are some of the more creative venues we’ve used?

Steve: As reported in Caring Headlines, we displayed our "Simply the Best" banner near the Charles Street/MGH T station over the July 4th weekend. We used it again in Charlestown during the Bunker Hill Day celebration. And just recently, as part of Boston’s annual "Chalk One Up for the Arts" Festival, Megan drew a chalk rendering of our logo on the sidewalk at City Hall Plaza.

Jeanette: So. Are all our efforts working?

Marianne: Our vacancy rate is significantly lower than it has been in past years, and we’ve hired more than 275 nurses in fiscal year 2002.

Jeanette: Excellent. Thank-you, all. That was very informative. If staff have ideas or suggestions about marketing MGH Nursing, whom can they call?

Megan: They can call me at 726-5593.

Nursing Career Expo

Welcome: staff nurses (all specialties), new graduate nurses, clinical nurse specialists, nurse managers, and PCAs

Tours will be offered of the:

Neurology/Neuroscience Unit, Neuro ICU, Respiratory Acute Care Unit, Cardiac Arrhythmia Step-Down Unit, Coronary Care Unit, Cardiac SICU, Cardiac Surgical Step-Down Unit, Cardiac Access Unit

Free CEU Offerings:

• "Management of the Neuro-Compromised Head Trauma Patient," presented by Jean Fahey, RN, MSN (12:30-1:30; Haber Room)
• "New Care Strategies: Care of the Acute Stroke Patient," presented by Mary McKenna Guanci, MSN, RN, CNRN (2:00-3:00; Blake 12 Library)

Sunday, September 15, 2002

12:00–4:00pm

North and East Garden Dining Rooms

Parking provided in the Fruit Street and Parkman Street garages

Refreshments will be served.

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Exemplar

Ellison 14 nurse sees dignity in the ‘drudgery’

My name is Liz Johnson, and I am a nurse on the Ellison 14 Oncology Unit. For the umpteenth time that day, it seemed, I was cleaning excrement up off the floor. If people only knew what I do for a living, I thought.

I had placed a commode by the patient’s bed because she had a hard time getting to the bathroom without experiencing incontinence. But once again, excrement found its way to the floor. I checked to be sure the pot had been returned to the commode. It was there, correctly placed. Why, I wondered, did management of elimination continue to be a problem for this patient?

I swallowed my annoyance—I truly don’t enjoy cleaning excrement up off the floor—I made sure my facial expression was friendly, and got some towels to clean up.

"I’m sorry," Ms. L said. "It’s so disgusting. I don’t know what I’m doing wrong."

"Don’t worry about it," I replied, very conscious of my tone. "It happens."

I looked at her, brow furrowed, and my annoyance turned to sadness as I thought again that it really wasn’t her fault. No one wants to lose control of their bodily functions.

"For some reason," I said, attempting to look at the problem objectively, "you seem to be leaning to the right on the commode. Do you notice a difference between how you feel on your left and right side?"

"No, not really," she said.

Ms. L had neuropathies in her left hand and arm from leukemia in her spinal cord.

"Given the problems you’ve had with your left hand, I wonder if you might be experiencing differences between left and right up and down your body?"

Her mishap was, after all, a perfect cue for good nursing assessment. I deliberately kept my tone low key, intent on getting information without alarming her.

"I don’t really feel any difference," she said.

I nodded and assisted her back to bed. "Maybe the equipment just feels strange to you," I said, knowing in my heart of hearts that I would have a hard time using a commode in lieu of standard plumbing. "It’s not like using the bathroom."

A line from a play I had recently read came to mind: "Why is it that the idea of mopping the floor just doesn’t have the same appeal as dancing, but what’s the difference, really? It all involves energy and doing something and affecting people."

Why indeed? What is the difference? Why is one associated with drudgery and the other with freedom? In a sense, there’s more dignity in the drudgery.

These reflections led me to other thoughts about the nature of work; my work. Why shouldn’t I mop the floor? There are people who engage in this kind of activity for a living, and when you get to know them, you discover they’re complex, philosophical people, each in their own way, who derive dignity from the work they do, which gives them self-worth and builds their spirits.

A short time later, I was called to help another patient who needed assistance using the commode. I gave him a steadying hand as he painfully struggled to make the transfer. A split second later, urine sprayed all over the floor.

"What’s wrong with me?" he growled testily. "I’m always doing that."

I was struck by how readily patients blame themselves for things beyond their control. I couldn’t help chuckling to myself. Here we go again, I thought.

"Don’t worry about it," I said, touching his shoulder. "These contraptions are cumbersome at best. I’ll clean it up in no time."

"Thank-you for not getting mad," he said.

I felt bad, thinking that someone else may inadvertently have conveyed frustration to this patient.

"Oh," I said, "you’ve felt as if people have been impatient with you?"

He nodded, his lips pressed together.

"I’m sorry you’ve had that experience."

Cleaning up around him as he sat there trying to evacuate in this unnatural place, in this unnatural position, I thought how demeaning it must feel sometimes to be a patient. I thought what it must be like to have to struggle to meet one of life’s most basic needs on a contraption next to a big picture window, while someone privileged to be fully clothed and able to walk out of the building at any time puttered about nearby.

"Mr. N," I said, giving the floor a final swipe and placing a dry towel under his feet, "I bet you’d like to be alone for a few minutes. I’ll be standing by the door. Just call when you need me."

"Thank you," he said simply, his tone confirming my hunch about his need for some privacy. I waited outside the door and indulged in a few moments of reflection. What I had been doing was not glamorous and certainly didn’t involve the sophisticated reasoning and psycho-motor skills I like to think make up the essence of my work. However, my education enabled me to think about the significance of my engagement in these so-called menial tasks and the opportunity to provide quality care inherent in them.

I thought about what a uniquely privileged position we nurses occupy. Patients allow us to be a part of some of their most intimate moments, moments that many of them would not even share with a spouse, parent, or child. The manner in which I manage those moments determines how patients feel about themselves and how receptive they are to receive care from me and my colleagues.

My professional education guided me to perform the most mundane activity in such a way as to set a tone that would have ripple effects between the patient and other caregivers.

I heard echoes from my very first course in nursing fundamentals, which seemed like ancient history. My classmates and I learned that the essence of nursing is assisting the patient with his immediate needs and doing so in a way that preserved his dignity, fostered a sense of autonomy, and promoted a sense of self-worth. Once high-sounding words of a value system my professors no doubt hoped they would instill in us, these concepts floated about the hallway reminding me of how I continue to find joy in my profession, even in the unpleasant tasks, and how these concepts, learned so long ago, have endured in spite of all the sophisticated advancements in knowledge and technology.

Hildegarde, Martha, and Ida 0. Dorothy, Ida T, and, oh, Florence, too. Hello, wherever you are. Know that you have become my old friends. Thank-you for many years of pleasure and for the principles that continue to give me meaning.

Comments by Jeanette Ives Erickson, RN, MS, senior vice president for Patient Care and chief nurse

Who among us cannot relate to this narrative? You don’t have to be a patient or a clinician to appreciate the indignity of having your most personal human needs become the center of attention in unfamiliar surroundings at a time when you’re already feeling helpless and vulnerable.

Liz shows us with grace and compassion, the exquisite privilege of performing these ‘mundane’ tasks.

When you hear Liz tell it, there is indeed, "dignity in the drudgery."

This is a simple narrative but it delivers a powerful message. I join Ms. L and Mr. N in saying, thank-you, Liz.

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Chaplaincy

Remembering Our Patients

—submitted by the MGH Chaplaincy

An increasingly frequent practice at MGH, one that calls attention to the importance of supporting one another in times of sadness and crisis, is the growing number of memorial services being held on patient-care units at MGH. Unit-based memorial services are a comfort for families and friends of patients who have died, and also for staff who are deeply affected by the loss.

The Thoracic Oncology Unit held a memorial service on Wednesday, April 3, 2002, in the MGH Chapel for family members of patients who had died on their unit.

Karen Sommer, RN, nurse practitioner, and the thoracic team designed and participated in the service. Says Sommer, "I think staff and patients both appreciated the re-connect. It brought a sense of relief to staff to see that family members had been able to move on. It was also important for staff to be able to communicate with families in a setting apart from the treatment area. It allowed for more intimate conversation."

The first pediatric memorial service was held in 1991, organized by NICU nurses, Bernadette Smorawski-Riley, RN, and Anne Armstrong, RN. Parents of children who died in the NICU, PICU, and pediatric units were involved in planning the program. Families who lost children during childbirth became part of the service in 1995. The Comfort and Support After Loss Team (a collaboration of nurses, social workers, child life specialists, residents and chaplains, and coordinated by obstetrics social worker, Fredda Zuckerman) plans the annual service, held the first Sunday in November.

Ellison 14 has offered memorial services for staff for several years. Ellison 14 staff nurses, Liz Johnson, RN, and Esther Odette, RN, along with oncology chaplain, Mike McElhinny, organized the most recent service held this past fall. Services provide staff with an opportunity to talk, ease some of their grief, and better cope with the loss and suffering they witness. Says McElhinny, "When I arrived here four years ago, staff were hesitant to talk about death, but recently they seem to be more comfortable speaking about it and how it affects them. The memorial services have become an important way for staff to collaborate and support one another in our daily lives."

The Gillette Center for Women’s Cancers (Gynecologic Oncology) held its first service of remembrance on May 9, 2002, specifically for staff. Dr. Annkathryn Goodman and clinical social worker, Marie Elena Gioiella, led the planning; they hope to hold a service quarterly. Says Goodman, "Staff seem to appreciate the opportunity to acknowledge, in the presence of the multi-disciplinary team, the joys and challenges of caring for patients and families. We learn more about patients from what is shared by team members. There is no other forum in which to discuss these experiences."

The Palliative Care Service holds a service of remembrance and hope twice each year for families of patients they have cared for. Services are held in the MGH Chapel, and all hospital staff are welcome. Services include music, reflection, and the lighting of memorial candles. The next service will be held Wednesday, November 6, 2002, at 5:30pm.

The Volunteer Department holds a memorial service whenever one of their volunteers dies. Director, Pat Rowell, organizes services as needed.

Memorial services provide a meaningful opportunity for staff and families to pray, share memories, and help deal with their grief. For assistance in planning a memorial service, please contact the Chaplaincy at 6-2220.

The Employee Assistance Program

presents

"Stress Management in Today’s World"

Presented by Stacey Drubner, JD, LICSW

Seminar will educate staff on the causes of stress and help participants adapt coping styles to more effectively respond to stressful situations.

September 12, 2002

12:00–1:00pm

Wellman Conference Room

For more information, call 726-6976.

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Education/Support

Second class graduates from New Graduate Critical Care Nurse Program

The second class to graduate from the New Graduate Critical Care Nurse Program was recognized at a special luncheon reception in the Wellman Conference Room on Thursday, August 22, 2002. The program, facilitated by Scott Ciesielski, RN, and Laura Mylott, RN, is a joint educational offering of Patient Care Services and the MGH Institute of Health Professions.

A six-month, intensive orientation period that includes both theory and practice is designed to give new graduate nurses extended knowledge in critical care. Participants receive classroom instruction at the IHP and unit-based, clinical experience here at MGH.

In her opening remarks, senior vice president for Patient Care, Jeanette Ives Erickson, RN, said, "Ninety-eight applications have already been received for the next class of the New Graduate Critical Care Nurse Program. The word is out—MGH is the place to be!"

The luncheon was an opportunity to celebrate the accomplishments of the new graduates, and to thank the preceptors whose contribution to the program is pivotal. Said Ives Erickson, "This occasion marks a five-year relationship between Patient Care Services and the IHP, bringing education and service together to address the real needs of our community and the country.

Speaking on behalf of the preceptors, Nancy Giese, RN, staff nurse on the Bigelow 13 Burn Unit, shared some of her observations of the preceptor experience, noting the level of confidence she grew to have in her orientee. Said Giese, "You have all done a remarkable job. I just ask one thing of you as you graduate. When you get to a point in your careers where you feel you want to move on to greater challenges, don’t leave MGH. Just put on a different hat—nurses wear many hats at MGH. And we need nurses like you. Nurses who care, nurses who think outside the box. You are the future."

For more information about the program, call 6-3130.

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Senior Health

Keeping your heart healthy

On Monday, Au- gust 26, 2002, in the East Gar- den Dining Room, Dorothy Noyes, RN, nurse practitioner for the MGH Heart Failure Clinic, presented, "Heart Health in 2002," as part of an educational series sponsored by the MGH Senior HealthWISE Program.

Noyes spoke about the risk factors for heart disease, including: gender (male), age (over 65), a history of obesity, hypertension, diabetes, a family history of heart disease, a sedentary life-style, and smoking.

Obviously, some risk factors are beyond our control, but Noyes suggested that individuals try to minimize the risk of heart disease by actively trying to manage their weight, diet, blood pressure, amount of physical activity, glucose levels, and smoking.

Identifying smoking cessation and weight control as two of the most important steps in preventing heart disease, Noyes recommended eating a diet rich in fruits, vegetables and fiber; limiting the intake of saturated fats; walking and other exercises to stay active; following doctors’ advice regarding medications; and finding a good program/support system to help stop smoking.

Noyes went on to say that a high-fiber diet helps prevent the absorption of fat in the body. Foods that are liquid at room temperature are better for you than foods that are solid at room temperature (olive oil versus butter). A person’s ideal body weight should be approximately 100 pounds if you’re 5 feet tall; plus 5 pounds for every inch over 5 feet (for women) and 6 pounds for every inch over 5 feet (for men).

MGH Senior HealthWISE is a community benefit program of MGH and the MGH Senior Health Practice. For more information about the program, or the educational series, please call 724-6756.

In memory of September 11th

The MGH Chaplaincy will offer a special service on the one-year anniversary of September 11th. The service will include participants of many religious traditions and will be tele-conferenced to the Haber Conference Room.

Wednesday, September 11, 2002

11:30am–12:00pm

O’Keeffe Auditorium.

A moment of your time...?

The Pharmacy Nursing Performance Improvement Committee (comprised of nurses, pharmacists, operations coordinators, operations associates, and pharmacy technicians) has initiated a number of changes to improve systems for medication distribution.

The group is committed to the on-going implementation of changes and improvements that support the safe and efficient administration of medications. 

This month, we will be conducting the 3rd annual staff satisfaction survey. Last year, nearly 500 nurses responded! Because so many of you gave thoughtful feedback, we learned a lot about what was working and where continued improvement was needed.

On September 4, 2002, surveys will be distributed to patient care units. Please take this opportunity to complete the survey and be an active part of the improvement initiative.

Thank-you.

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Educational

Offerings

When/Where	Description	Contact Hours
September 13 8:00am–4:30pm	Staying on Top of Your Game: Advanced Cancer Nursing O’Keeffe Auditorium	---
September 13 8:00am–4:30pm	Staying on Top of Your Game: Advanced Cancer Nursing O’Keeffe Auditorium	1.0
September 17 1:00–3:00pm	Pacing: Basic Concepts Haber Conference Room	---
September 18 7:30–11:30am, 12:00–4:00pm	CPR—American Heart Association BLS Re-Certification for Healthcare Providers VBK 401	- - -
September 19 10:00–11:30am	Social Services Grand Rounds "An Overview and Application for DBT." O’Keeffe Auditorium. For more information, call 724-9115.	CEUs for social workers only
September 19 8:00am–4:15pm	Neuroscience Nursing Review 2002 (Day 2) Wellman Conference Room	TBA
September 19 1:30–2:30pm	Nursing Grand Rounds O’Keeffe Auditorium	1.2
September 21 1:30–2:30pm	MassGeneral Hospital for Children-Partners CME Conference Westin Hotel, Waltham	Up to 4.5
September 23, 25, 30, and October 1, 2, 7 7:30am–4:00pm	ICU Consortium Critical Care in the New Millennium: Core Program VA Boston Health Care System	45.1 for completing all six days
September 24 and 25 8:00am–4:30pm	BLS Instructor Program VBK601	13.2 for completing both days
September 25 8:00am–4:30pm	Conversations at the End of Life Training Department, Charles River Plaza	---
September 25 8:00am–2:30pm	New Graduate Nurse Development Seminar II Training Department, Charles River Plaza	5.4 (contact hours for mentors only)
September 26 8:00am–4:30pm	Psychological Type & Personal Style: Maximizing Your Effectiveness Training Department, Charles River Plaza	8.1
September 27 8:00am–4:30pm	Nursing: A Clinical Update (MGH School of Nursing Alumni Homecoming Program O’Keeffe Auditorium. For more information, call 617-726-3144.	---
October 2 1:00–3:00pm	Caring at the End of Life: a Video and Panel Discussion Haber Conference Room	2.4
October 3 7:30–11:30am, 12:00–4:00pm	CPR—American Heart Association BLS Re-Certification for Healthcare Providers VBK 401	- - -
October 3 1:30–2:30pm	Nursing Grand Rounds O’Keeffe Auditorium	1.2
October 4 and 18 8:00am–5:00pm	Advanced Cardiac Life Support (ACLS)—Provider Course Day 1: O’Keeffe Auditorium.  Day 2: Wellman Conference Room	16.8 for completing both days
October 9 8:00am–4:30pm	Introduction to Culturally Competent Care: Understanding Our Patients, Ourselves and Each Other Training Department, Charles River Plaza	7.2
October 23 8:00am–2:30pm	Mentor/New Graduate RN Development Seminar I Training Department, Charles River Plaza	6.0 (mentors only)

If you are unable to attend a program/workshop for which you have already registered, please notify The Center for Clinical & Professional Development at 726-3111 to allow someone else to attend in your place. Thank-you. To apply for nursing continuing education contact hours, please contact Brian French, RN, at 724-7843.