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Johnson receives Cancer Nursing Career Development Award

On August 10, 2001, Liz Johnson, RN, Ellison 14 staff nurse and past recipient of the Stephanie Macaluso Expertise in Clinical Practice Award, received this year’s Cancer Nursing Career Development Award. The award, funded by the Friends of the MGH Cancer Center, is given each year to recognize the meritorious practice of a staff nurse providing direct care to cancer patients.

Oncology clinical nurse specialist, Joan Gallagher, RN, chair of the award selection committee, thanked the Friends of the MGH Cancer Center for their continued support of this award and for continuing to recognize and encourage exemplary cancer nursing over the years.

Associate chief nurse, Jackie Somerville, RN, introduced Johnson, saying, "Liz has worked on Ellison fourteen for seven years. She was nominated by her nurse manager, Carol Ghiloni, who wrote: ‘Liz exemplifies the true meaning of professional nursing—she is warm and caring, a teacher and a mentor.’ Among Liz’s many accomplishments, she completed the MGH Spiritual Caregiver Fellowship Program, she is a member of the HOPES Seminar Committee (and a frequent presenter), she volunteers in the Cancer Resource Room, and participates in the Ellison fourteen staff nurse time-planning committee. It is with great pleasure that I introduce and congratulate our distinguished recipient, Liz Johnson!"

The monetary award is intended to be used for continuing education for the recipient, but Johnson plans to use the money to establish a program that helps support and retain newer oncology nurses.

Four other nurses were nominated for the Oncology Nursing Career Development Award; they are: Susan Finn, RN, Blake 2 Infusion Unit; Kara Olivier, RN, staff nurse, Bigelow 12 Infusion Unit; Emily Horey, RN, staff nurse, Bigelow 12 Infusion Unit; and Agnes Froio, RN, staff nurse, Radiation Oncology.

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Jeanette Ives Erickson

When you love what you do, it’s easy to be the best

As you may have heard, MGH has been recognized by US News and World Report as one of America’s top three hospitals. This is an incredible honor and true validation of the excellent work you are all doing. I commend you!

I think everyone would agree that our continued high performance in the US News and World Report rankings has a great deal to do with our commitment to providing multi-disciplinary patient care. I recently received a letter from a physician applauding the inter-disciplinary practice of a particular unit. He remarked that collaboration and teamwork were key to the success of that unit, and comments like this are common in every clinical setting. We are fortunate that this level of teamwork is so much a part of the fabric of our practice.

When I’m asked about the impending shortage of healthcare workers, I always go back to what brought us to national recognition in the first place: excellence in patient care. The real solution to the shortage is to remain connected to our values. Treating clinicians with dignity and respect and giving them the tools and resources they need is the best retention strategy.

As far as long-term recruitment strategies, we need to convey to young men and women the richness and personal reward that comes with careers in health care. Just last month, we invited a group of Girls Scouts from across the country to visit MGH, and we introduced them to the vast opportunities awaiting them in health care. In Dr. Sylvia Rimm’s book, How Jane Won (in which I’m honored to be included), more than a third of the successful women profiled mentioned the impact of scouting on their lives. We will be doing more work with the Girl Scouts and other youth groups to create opportunities to teach young people about careers in health care.

I am about to celebrate my 5th anniversary as senior vice president for Patient Care Services. At a recent retreat, I asked our leadership team to tell me what they thought about the following questions:

• Based on our outcomes of the past five years, when they write the history of MGH, what will they say about us?
• If we could go back five years, what would we do differently? Were we bold? And if not, why not?
• What is our vision for the next five years?

These are difficult questions, but without this level of self-exploration and critical examination, how would we approach the next five years when challenges will be even greater?

Let me share with you some of the reasons your leadership team thinks we are a world-class institution, worthy of the ranking we received in US News and World Report:

• The launching of The Center for Clinical & Professional Development, which has responsibility for all educational activities and our nursing research program. In just a few short years, we have created a mechanism to fully fund all staff seeking specialty certification, full-funding for local and national conference attendance, funding for fellowships in leadership, spiritual caregiving, and diversity, and a number of research grants.
• Implementation of our eight-committee collaborative governance communication and decision-making structure. More than 300 clinicians participate in collaborative governance and each committee is led by a clinical or non-clinical staff member.
• Our alignment with schools in the Boston area to create collaborative partnerships in developing tomorrow’s caregivers.
• The creation of recognition and award programs to celebrate clinical practice. The Stephanie M. Macaluso Expertise in Clinical Practice Award is just one of eight new recognition programs we’ve launched in the past few years.
• The creation of a culture that supports a diverse patient population and workforce.

One of the most rewarding moments I’ve had as leader of Patient Care Services was when a physician told me recently that he wished he was a member of the department of Nursing. He sited the wonderful work we are doing and added that it looked like we were having a good time, too.

When you love what you do, it’s easy to be the best!

Updates

It is my pleasure to inform you about the following additions to our team:

• John Murphy, RN, MS, has accepted the position of nurse manager of the Blake 12 Neuro ICU. He comes to us from South Shore Hospital where he managed a critical care unit; he will start later this month.
• Chris Annese, RN, MS, nurse manager of the Central Resource Team and clinical supervisors, is taking on permanent leadership of the IV nursing team, effective immediately.
• White 8 and 10 welcome Marliese Palank as their new operations coordinator.

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Recruitment Initiatives... and improved toothbrushes!

The Fielding the Issues section of Caring Headlines is an adjunct to Jeanette Ives Erickson’s regular column. This section gives the senior vice president for Patient Care a forum in which to address current issues, questions, or concerns presented by staff at various meetings and venues throughout the hospital.

Question: The hospital is busier than ever; how are we doing with nurse recruitment?

Jeanette: The good news is that we have hired 342 nurses since October 1, 2000. And we want to hire an additional 100 nurses within the next few months. The best way to fill all our nursing positions, as well as respiratory therapists, physical therapists, and social workers, is for each employee to recruit another employee. I truly believe we can do this.

Question: Has the PCS Employee Referral Program been successful?

Jeanette: I’m pleased to report that since implementation of the PCS Employee Referral Program in early July, 15 employees have been hired, including: 9 clinical nurses, 3 physical therapists, 1 speech pathologist, 1 respiratory therapist, and 1 sterile processing technologist. The program will be extended through October 28, and then reevaluated.

Question: I recently saw television cameras on one of the units. What was going on?

Jeanette: They were filming four two-minute interview segments for BostonWorks TV, which will air over a four-week period from September 9, to September 30, 2001. Each week a nurse will profile a different clinical specialty. Two of these interviews will air on NECN prior to the next Career Expo on September 16th. The Career Expo will be mentioned as added advertising for this recruitment event. In addition, we will have an ad featuring MGH nursing career opportunities and the Career Expo in the Sunday Globe on September 9th.

Question: How were the interviewees prepared?

Jeanette: Each of the four nurses interviewed, Jen Carr, RN, Cardiac SICU; Tina Schipani, RN, Ellison 16 Medicine; Patty Hanson, RN, Blake 12 Neuro Intensive Care; and Eileen Comeau, RN, Blake 7 MICU, were given briefing materials and some pre-interview coaching. They did a superb job describing their work and why MGH is the best place to be a nurse.

In the fall, a media training program will be offered to clinicians and leadership interested in becoming part of the Patient Care Services media team. This effort will be coordinated by Marianne Ditomassi, executive director of my office, in conjunction with The Center for Clinical & Professional Development. More details will follow on this program.

Question: At the last Staff Nurse Advisory Meeting concerns were raised about the quality of toothbrushes provided to our patients. Can you give us an update on this issue?

Jeanette: We are going to purchase new toothbrushes. Materials Management is exploring alternative options for a more robust toothbrush. They will bring samples forward for review by the Nursing Practice Committee at their next meeting on September 11th.

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Student Outreach

Cancer Center Student Nurse Internship Program

This summer for the first time, the MGH Cancer Center offered a pilot internship to two student nurses to allow them to explore various sub-specialty areas of cancer nursing. Nursing students, Linda Choute, of the University of Massachusetts, and Nicole Labatte, of the University of Connecticut, were the first candidates to participate in the Cancer Center Student Nurse Internship Program, an intensive, two-month, preceptored work experience.

Students rotated through a series of clinical oncology settings including the Infusion Unit, Radiation Oncology, and the Ellison 14 Oncology-Bone Marrow Transplant Unit.

Says Labatte, "I was able to observe many different nursing roles, such as staff nurse, nurse practitioner, clinical nurse specialist, and nurse manager. I already knew I wanted to pursue my master’s degree and become a nurse practitioner, but this experience just reinforced that desire. I thoroughly enjoyed my experience here; not only did I learn an incredible amount, I had the opportunity to work with a phenomenal staff!"

Says Choute, "I had some incredible conversations with patients and really got to know their personal thoughts and feelings about their diagnosis and treatment. It was so beneficial to spend time in the different specialty areas. I could really appreciate the different roles of nurses in the inpatient and outpatient settings, and get a sense of the workload, pace and staffing needs."

For more information about this pilot program, contact Joan Agretelis, at 6-8267.

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Nursing Grand Rounds

Caring for Haitian Women

On Thursday, August 2, 2001, Karen Hopcia, RN, occupational health nurse practitioner, and Suzelle Saint-Eloi, RN, clinical educator, presented, "Caring for Haitian Women," as part of Nursing Grand Rounds. Hopcia, speaking from her extensive research and her experience caring for Haitian women, stressed the importance of taking cultural beliefs and practices into consideration when caring for individuals of all cultures and backgrounds.

"Boston," said Hopcia, "has the third largest Haitian population in the country, second to Miami and New York, making it especially important that healthcare providers be knowledgeable and culturally aware in caring for this patient population."

Hopcia provided information on Haitian culture including language (French and Creole), religion (Catholic, Protestant, Voodoo) and a sampling of commonly held health-related beliefs and practices. But some of the more powerful information came in the form of quotes from some of her Haitian patients:

"I don’t drink anything cold, not even water. I don’t feel good when I drink cold. I feel uncomfortable drinking or eating something cold. No ice."

"We do a lot of home remedies instead of going to the hospital. Even here (in this country)... I will not go until the last minute."

"I don’t believe that I have this sickness... God wants it to be that way, that’s it. Nothing else. Nothing to do with good or bad. God wants me to be sick."

"Until you get sick, no one is going to think, well maybe I should go to the doctor."

Hopcia spoke of Haitians’ belief in natural versus supernatural illnesses. Some illnesses may be caused by angry spirits or deceased relatives or voodoo practitioners. She observed that, "Many Haitians will ultimately visit a Western healthcare provider, but usually only after trying home remedies or visiting a Haitian folk healer."

Saint-Eloi, who is of Haitian descent, spoke from both a personal and professional perspective. She explained various folk and herbal remedies used by many Haitian families, and shed light on the kinds of treatments Haitians seek from "local" healers, including "Docte Zo" (bone doctor), "Fam Saj" (midwife), "Hougan" (a voodoo priest), or a "Pickirist" (a person who provides injections for different illnesses). She spoke about "mauvais san," or a "bad blood episode" attributed to a number of vague health complaints.

Saint-Eloi compared a number of Haitian health practices with Western practices, saying, "By understanding the beliefs and practices of Haitian families, we are better able to combine the two for a complementary approach that will effectively improve health, control costs, and optimize utilization of medical services." For instance, where Western medicine uses castor oil primarily as a cathartic or laxative, Haitians use castor oil in a number of remedies, including massage to cleanse the body of illnesses and impurities.

Saint-Eloi offered the following guidelines when caring for Haitian families:

• Talk with your patients about their health beliefs and practices
• Gather information
• Develop a framework for planning care
• Negotiate the plan of care as necessary
• Follow up with patients and families to ensure compliance and understanding.

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Exemplar

Phillips 20 nurse steps in to bring comfort and advocacy to dying patient

My name is Kimberly Charette, and I am a staff nurse on the Phillips 20 General Medical Unit. Mr. V was a gentleman in his 60s who came to MGH to be treated for worsening shortness of breath. When he arrived, he was able to communicate and was being maintained on 3-4 liters of nasal cannula oxygen, with nebulizer treatments as necessary. He was diagnosed with end-stage pulmonary fibrosis, which he had acquired after working in a factory for many years. The plan of care for Mr. V was medical management and a thoracic/surgical consult. Prior to the surgical consult, Mr. V started to deteriorate. His oxygen requirements became significant, his breathing was greatly labored, and his blood pressure was elevated. Mr. V was well aware of his worsening medical status, and was becoming increasingly anxious. He had two children and a long-time girlfriend whom he was planning to wed.

I had assisted other nurses in caring for Mr. V, but realized that he had not yet been assigned a primary nurse. I felt that Mr. V needed more continuity of care and a strong advocate, so I asked to become his primary nurse. I made it my number one priority to bring him some comfort and relief.

On my first day as Mr. V’s primary nurse, I found him on 70% high-flow oxygen, and 7 liters of nasal cannula oxygen. His oxygen saturation was 88%; respiratory rate in the high 30s–40s; blood pressure 150/90; heart rate 110, and rhonchus breath sounds bilaterally. I quickly introduced myself and explained what I was going to do. I gave him a nebulizer treatment, called Respiratory Care Services and the intern.

I told Mr. V I was going to suction him, and got him some medicine to make him feel better. He told me to go away and leave him alone. He said a lot of people had told him they would "make him feel better," and they hadn’t. He was very reluctant to let me suction him due to unsuccessful and painful prior attempts. I talked him through the nasal suctioning, and was able to remove a significant amount of thick mucus. He was amazed and felt better afterward. His oxygen saturation was now in the low 90s, which made him a little more comfortable. Mr. V had become very fixated on the oxygen numbers on the monitor. When the respiratory therapist arrived we increased his high-flow oxygen to 100%, which also helped slightly. I talked with the intern about Mr. V’s breathing. He had been using his accessory muscles to help him breathe for days now, and was quickly tiring from the labor of breathing. I suggested morphine to ease his breathing rate, but the intern didn’t feel comfortable with this for fear of suppressing his respirations.

It was determined that Mr. V was not a good candidate for surgery; his only option was medical management. The medical interns wanted to try steroids and ativan, which were unsuccessful. I suggested a positive-pressure breathing machine (CPAP) to assist Mr. V in his breathing efforts, and I moved him closer to the nurse’s station, for better visualization. After many conversations with the intern about trying morphine, I agreed to monitor Mr. V closely myself if we tried a small dose. A small dosage of morphine was administered and I checked his vital signs frequently. I monitored his mental status and placed Mr. V on our continuous monitoring system.

Within a short time Mr. V was much more relaxed; his respiratory rate decreased to 28; blood pressure 134/80; heart rate 100; and his oxygen saturation was 92–94%. He was able to sleep for the first time in what Mr. V said was "days." I documented his progress and discussed it again with the intern. Mr. V was put on a small dose of morphine every 6 hours for comfort. At the end of my 12-hour shift when I said good-bye to Mr. V, he put his hand on my cheek, mumbled, "Thank-you," through his CPAP mask and started to cry.

Over the next week, Mr. V came to terms with the fact that he was dying quickly from his pulmonary fibrosis. Eventually, he was placed on a continuous morphine drip, which made him just comfortable enough to perform small tasks, such as brushing his teeth and using a commode instead of the bedpan. This gave him back some independence and modesty, which Mr. V liked. Arrangements were made with the help of our whole team for Mr. V to transfer to a hospice unit and carry out his last wish of marrying his long-time girlfriend the following weekend.

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

Kimberly was introduced to Mr. V as she assisted other nurses with his care. Through these episodic interactions she saw a patient whose physical and emotional condition was very fragile. So she stepped up. It’s challenging enough to care for a patient who is exhausted and frustrated by his illness. But when compounded by the realization that the illness is terminal, the situation becomes that much more delicate. Kimberly’s clinical knowledge, her compassion, and her ability to be present for Mr. V, even as he tried to dismiss her, are the signs of a true professional. Kimberly’s advocacy for her patient never wavered; she did everything possible to make Mr. V comfortable and facilitate relief of his respiratory distress.

I think Mr. V’s muffled, "Thank-you," spoke volumes. Indeed, thank-you, Kimberly.

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Resources

New teen resource in PFLC

The Blum Patient and Family Learning Center (PFLC) is pleased to announce the addition of a teen resource section. Mindful of the many grave issues confronting adolescents today, more than two dozen volunteers spearheaded an effort to make meaningful, non-judgmental information available to young people in a timely manner on the web. The teen resource section is located within the Consumer Health Web Links on the PFLC website.

The group began by defining the scope of issues that teenagers deal with in their day-to-day lives. In addition to general health-related issues, areas of focus included school violence, drug and alcohol use, driving, relationship issues, suicide and safety, among others.

Identifying appropriate links required a great deal of time and patience, as the group reviewed countless potential links in their research of each topic on the web. The Patient Education Committee approves all materials provided by the PFLC, so all of the links identified by the volunteer group were evaluated and approved by the Patient Education Committee before being posted on the website.

Now that the site is up and running, the group will continue to search for links to enhance this valuable resource, and in the near future they will research links appropriate for a kids’ resource section. The site can be accessed at: www.mgh.harvard.edu/depts/pflc/teenlinks.htm.

For more information, call the Patient Family Learning Center at 4-7352.

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MGH-Timilty Partnership

Summerworks Program

An important part of our strategic plan involves attracting, preparing and recruiting bright young men and women for future positions at MGH. And one of the most promising programs we have in place to support that effort is our educational partnership with the James P. Timilty Middle School in Roxbury.

On Wednesday, August 8, 2001, ten Timilty students who participated in this year’s Summerworks Program, presented posters in the Central Lobby, showcasing their work experiences in various settings and departments throughout the hospital, including Nursing, Police & Security, Patient Transport, the Office of the President, and others. The seven-week, part-time, internship program combined interactive workshops and discussions with real-life work situations to provide students with a realistic look at career opportunities soon to be available to them. And if these poster presentations were any indication, it won’t be long before some of these young people are right back here putting their experience to good use at MGH!

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Surveys

Pharmacist-Nurse Medication System Satisfaction Survey

Tell us what you think!

—by Janet Duffy, RN, project manager

The second annual Pharmacist and Registered Nurse Satisfaction with the Medication System Survey was distributed to patient care units and to the Pharmacy on September 4, 2001. It is the hope of the Pharmacy-Nursing Performance Improvement Committee that staff will take this opportunity to give needed feedback on this important system.

The multi-disciplinary committee, comprised of nurses, pharmacists, operations coordinators, operations associates, and pharmacy technicians, has implemented a number of changes to improve systems for medication distribution. The team is committed to supporting staff in preparing, delivering, and administering medications safely and efficiently.

Last year more than 500 staff nurses and 30 pharmacists responded to this survey. Because so many took the time to respond, we had a good indication of how the changes were working and where additional efforts needed to be focused. Once again, your feedback will be invaluable as improvement efforts continue to be implemented.

All responses are confidential. Results of the survey will be shared in future issues of Caring Headlines and other mechanisms. For more information, please call Joan Fitzmaurice (6-9282) or Lois Parker (6-2503).

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