Notable Nursing - Cleveland Clinic

Notable Nursing 

A Publication For Nurses By Nurses | Fall 2007 

Feature Story 

Facing the Crisis: 

Cleveland Clinic Takes Practical and Proactive 

Steps to Tackle the Nursing Shortage – p. 04 

Also Inside 

Profiles of Nursing Success – p. 01 

Studying Nighttime Noise and Patient 

Satisfaction – p. 08 

Can Nurses Decrease Length of Stay 

after Cardiac Surgery? – p. 09

From the 

Chief Nursing Officer 

As you read this issue of Notable Nursing, you 

will see the word “opportunity” used many times 

in different contexts. I think that typifies nursing 

at Cleveland Clinic – a wealth of opportunities for 

employment, for learning, for personal and professional 

growth, for advancement. The opportunities 

in all those areas have never been greater at 

Cleveland Clinic. 

On the employment front, the planned fall 2008 

opening of the 250-bed Sydell and Arnold Miller 

Family Pavilion for the Cleveland Clinic Heart and 

Vascular Institute means that we are preparing to 

significantly expand our nursing staff. We are excited 

about the opportunity this presents for bedside 

nurses, nurse managers and advanced practice 

nurses to work in a state-of-the-art environment 

at the leading heart center in the country. 

By recruiting excellent nurses in all areas and 

helping them to grow in their careers here, we can 

build a solid nursing organization with a high level 

of knowledge capital. To support this goal, we offer 

phenomenal resources for career support and advancement, 

from new-hire support groups to career 

coaches, to preceptors and specialized orientations. 

Our new nursing clinical simulation lab, a replicated 

patient unit for hands-on learning and continuing 

education, is the latest example of the exceptional 

resources available here. 

This is a dynamic time for nursing at Cleveland Clinic 

as we grow in number, knowledge and opportunities. 

Whether you are an experienced nurse or a new 

graduate, we invite you to be part of it. 

Sincerely, 

Claire Young, MSN, MBA, RN 

ChiEF NuRSiNg oFFiCER 

Table of Contents 

p.04 Cover Story: Facing the 

Nursing Shortage 

p.08 Studying Nighttime Noise 

in hospitals 

p.09 Can We Decrease Length of 

Stay after Cardiac Surgery? 

p.10 Urology/Gynecology Conference 

p. 14 Orthopaedics Conference 

p. 18 Cardiac Care Conference 

p. 22 Nursing News 

p. 24 Nursing Research Conference 

p. 25 Nurse of Note 

Executive Editor 

Michelle Dumpe, PhD, MS, RN 

E-mail comments about Notable 

Nursing to dumpem@ccf.org 

Editorial Board 

Claire Young, MSN, MBA, RN 

ChiEF NuRSiNg oFFiCER 

Mary Beth Modic, MSN, RN, CNS 

DiABETES AND PATiENT EDuCATioN 

Claudia Straub, MSN, RN, BC 

NuRSiNg EDuCATioN 

Robbi Cwynar, BSN, RNC 

ThoRACiC & CARDiovASCulAR SuRgERy 

Nancy Albert, PhD, RN, CCNS 

NuRSiNg RESEARCh 

Christina Canfield, MSN, RN, CNS 

MEDiCiNE 

Deborah Solomon, MSN, RN, CNS 

SuRgERy 

Barbara Reece, MSN, RN 

DiRECToR, MEDiCiNE AND BEhAvioRAl hEAlTh 

Christine Harrell 

MANAgiNg EDiToR 

Michael Viars 

ART DiRECToR 

Deborah Durbin 

MARkETiNg MANAgER 

To add yourself or someone else to the mailing list, 

change your address or subscribe to the electronic form 

of this newsletter, visit clevelandclinic.org/nursing. 

Notable Nursing Fall 2007 

Profiles of Success 

Four Cleveland Clinic nurses who cultivated their own paths to career satisfaction 

No matter what their level of experience, nurses who join Cleveland Clinic can expect plenty of opportunities for 

advancement early in their careers. Some of those who have prospered in their profession began here as summer 

nurse associates or patient care nursing assistants during college. They worked alongside veterans who taught 

them about tending to patients’ needs and listening to their stories. 

By graduation, many aspiring nurses already know Cleveland Clinic is where they want to be. And when 

graduate school beckons, the hospital encourages nurses to continue working while pursuing their studies. 

This reinforces the desire to stay and carve out fulfilling long-term careers. Here are the stories of a few 

nurses who have utilized their opportunities at Cleveland Clinic to cultivate satisfying careers. 

Christina Canfield, MSN, CNS | Age 31 

Clinical Nurse Specialist, Department of Nursing Education 

and Professional Practice Development 

Education: BSN, kent State university, 2000; MSN/CNS, 

Kent State University, 2006; certified by the American 

Nurses Credentialing Center as an adult medical-surgical 

clinical nurse specialist 

When and why did you decide to become a nurse? 

I decided to become a nurse after weighing the benefits and 

disadvantages of several career options. I had considered 

majoring in education, physical therapy and pharmacy, in 

addition to nursing. I chose nursing because it was the best 

way to combine the best aspects of each profession. 

First job/unit assignment at Cleveland Clinic: My first 

position at Cleveland Clinic was as a patient care nursing 

assistant on g81 (internal medicine/otorhinolaryngology/pulmonary). 

I was hired into this position before I graduated. 

Describe your path from that first job to where you are 

now. I moved from PCNA to registered nurse when I 

graduated and passed my boards. i spent about 2½ years 

as a staff nurse on G81, learning to care for patients with 

complex head and neck surgeries and those who had difficulty 

weaning from mechanical ventilation. I served as a 

preceptor for new nurses, as a unit-based skin care nurse 

and a geriatric resource nurse. 

I have always been interested in teaching and, in September 

2002, I became a clinical instructor responsible for 

coordinating orientation, teaching classes and providing 

in-service and continuing education. 

in July 2004, my supervisor created a position called the 

“clinical nurse specialist intern,” in response to a relative 

shortage of clinical nurse specialists. I attended graduate 

school while continuing to work, assuming more and more 

CNS duties. When i graduated in May 2006, i assumed 

full CNS responsibilities for two internal medicine units. 

One of the units I cover is where I began my career. The 

specialized knowledge I gained there has served me well 

throughout the years. 

Greatest accomplishment as a nurse: Attending graduate 

school and becoming licensed as a clinical nurse 

specialist. in my current position, i serve as a clinical 

expert and resource. 

What do you hope to achieve in the next few years? 

To successfully complete a nursing research project that 

impacts how we provide patient care. I would like to 

publish or present the results. 

How do you balance work, family and other leisure time? 

I have a very supportive family. They were willing to sacrifice 

a lot while I was in school, and they went the extra mile to 

make sure things ran smoothly while I juggled other responsibilities. 

I work with a lot of amazing people, and I’m happy 

to say they’re my friends both at work and outside of work. 

What helps you manage stress after a hectic day or week 

at work? I often take time during my commute home to 

reflect on the day’s events. I try to pick at least one thing 

that went very well and one thing I learned each day. In an 

institution like Cleveland Clinic, there’s always something. 

Focusing on these things keeps me going. 

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Notable Nursing clevelandclinic.org/nursing 

Lauren Mattern RN, BSN | Age: 25 

Clinical Instructor, Department of Nursing Education and 

Professional Practice Development 

Education: BSN, Case Western Reserve university, 2004 

When and why did you decide to become a nurse? 

My mother, a pediatric nurse, told wonderful stories about 

caring for children and their families. I never realized how 

much a nurse could impact someone’s life until one day, as I 

was shopping with my mother, I witnessed a patient’s family 

member make a point to stop and thank my mother. it made 

me smile and realize that I wanted to have that same feeling 

of accomplishment that comes from caring for others. 

First job/unit assignment at Cleveland Clinic: i started as 

a nurse associate on G91, cardiology step-down, in 2003. 

Describe your path from that job to where you are now. 

I worked the summer before my senior year of college and 

continued throughout the school year, following a nurse and 

developing clinical skills. After graduation, I joined Cleveland 

Clinic full time as a registered nurse on the same unit 

and provided care to step-down patients at the bedside. 

In 2007, after 2½ years as a staff nurse, I became a clinical 

instructor in the Department of Nursing Education and 

Barbara Reece, RN, MSN | Age: 55 

Director of Nursing, Medicine 

and Behavioral Services 

Education: AND, Kettering College of Medical Arts, 1975; 

BSN, University of San Diego, 1987; MSN, Case Western 

Reserve university, 1989 

When and why did you decide to become a nurse? in 

high school, after working as a candy striper and then as 

a nursing assistant. Prior to this, I had always wanted to 

be a kindergarten teacher. 

First job/unit assignment at Cleveland Clinic: i started 

in 1975 as a staff nurse on a GI unit. After one month, 

the nurse manager let me transfer to psychiatry. I had 

been assigned to the psychiatric unit when I was a nursing 

assistant and became “hooked.” 


After two years as a staff nurse, an assistant nurse manager 

position opened on the child/adolescent psychiatry unit. 

Two years later, the nurse manager position became available. 

I was in that position for five years. In 1984, I went 

back to school for my BSN. After graduating, I returned to 

Cleveland and entered graduate school to become a clinical 

nurse specialist in adult psychiatric/mental health nursing. 

While in graduate school full time, I worked in Cleveland 

Clinic’s weekender program. 

Professional Practice Development. I teach basic dysrhythmia 

and critical care to nurses in orientation and provide 

staff members with continuing education. 

Greatest accomplishment as a nurse: having a patient ask 

for you by name. It is truly amazing how much trust and 

faith a patient has in a nurse. When this happened the first 

time, I realized how rewarding it is to be a nurse. 


My goal for the coming years is to continue to provide our 

caregivers with the best possible education so they, in turn, 

provide our patients with the best possible care. To achieve 

that goal, i also plan on exploring educational options. 


Carefully. It is often difficult to balance your career and your 

life. Planning and setting a schedule has been the best way. 


at work? i enjoy scrapbooking, baking and spending time 

with my family. 

(After obtaining her MSN, she held two jobs elsewhere before 

“coming home” to Cleveland Clinic years later as manager 

of behavioral services.) Within two years, the nursing 

division re-organized, and my position was upgraded. In 

2005, I became director of medicine nursing, and I have 

managed both areas since then. 

What do you hope to achieve in the next few years? i hope 

to complete a coaching program and develop formalized 

mentoring for nurse managers and assistant nurse managers 

in leadership skills, specifically human resource management. 

Nurses become clinical experts, but there isn’t as 

much emphasis on how to deal with people, especially in 

difficult situations. 


My great nieces keep me energized and full of joy. Gardening 

is such a grounding activity. My sister and i plant a major 

vegetable garden each year. I love to read journals and fiction 

and try to leave large blocks of time on weekends to read. 


at work? i go home, eat a leisurely dinner and read the 

paper. i also love to sleep and make sure i get enough sleep 

to adequately do my job. 

clevelandclinic.org/nursing Fall 2007 

quote 

Rachael Lynn Taggart, RN, BSN | Age: 25 

Registered Nurse, Heart Failure Intensive 

Care Unit (H22) 

Education: BSN, The University of Toledo/ Medical University 

of Ohio (consortium program), 2004; Sigma Theta Tau 

(nursing honor society); ACLS-certified 

When and why did you decide to become a nurse? My 

freshman year of college. It was very spur of the moment. I 

had wanted to concentrate on exercise physiology, but then 

decided on something more “people-oriented.” Struggling 

in chemistry class for that major, I was mortified at my 

grade despite my best efforts. A young lady in my dorm 

talked about how much she loved her nursing classes and 

how great her professors were. So, I told the nursing college 

counselor that I wanted to be a nurse. That was that. 

Looking back, that day was a major turning point. Both my 

grandmothers were registered nurses and very influential in 

my decision. One of them is still practicing. 

First job/unit assignment at Cleveland Clinic: With one 

year left in school, I was accepted into the nurse associate 

summer program. For 12 weeks, I worked side by side 

with the nurses (on M72/palliative care and pain management). 

I had been in a hospital only once before, with my 

grandmother on Take your Daughter to Work Day. When 

the program ended, management offered me a position for 

the rest of the summer as a patient care nursing assistant. 

I worked as needed on holiday breaks and long weekends 

during my senior year. 

Several wonderful, very experienced nurses on that floor 

taught me so much about life, death, and everything else 

in between. I worked with Dyanne Thomas most often, and 

she always exceeded my expectations and patient expectations. 

She is one of those nurses who you would think has 

“seen it all” and dealt with it gracefully. She made me feel 

like I was born to do the job. She was funny, serious, soft 

and firm when she needed to be. I also fell in love with the 

patients and their stories. My career would not be the same 

had I not worked on that floor. 

“Several wonderful, very experienced nurses on 

that floor taught me so much about life, death, 

and everything else in between.” 

– Rachael Lynn Taggart, RN, BSN 


After I graduated, I wanted to stay on M72. I was told by 

management that, while they liked me very much, they 

were not hiring new graduates. I was devastated. But I “got 

gutsy” and decided i might like the iCu. i had heard about 

H22 (heart failure intensive care unit). They were hiring 

new grads. I shadowed one day and loved it. 

Greatest accomplishment as a nurse: Being selected as 

“Nurse of the Year.” Also, I recently went to preceptor class 

and oriented my first new grad nurse for H22. Lastly, I took 

care of a man for several weeks who was very sick and on 

the transplant list. he ended up getting a heart and going 

for surgery on one of my night shifts. Just the other day, he 

walked back into our unit looking handsome, healthy and 

having had great biopsy results. I was so proud! 


To take CCRN classes and get that certification, and maybe 

a master’s degree so I can teach nursing someday. 


It is difficult sometimes, working rotating shifts – two 

weeks of days and two weeks of nights. Immediate family 

and friends have my work schedule, and I keep track of 

theirs. We end up doing things whenever I can. Working 

three 12-hour shifts each week and two weekends per 

month leaves room for mini-vacations and road trips. I 

play a lot of phone tag, listen to voice mail and send emails 

to keep in touch. 


at work? I recently bought my first house, so I have been 

doing yard work and gardening. I love going to the beach or 

a park and walking or rollerblading. I have a YMCA membership 

for exercising when the weather is cold or rainy. I 

also enjoy massages and fizzing foot scrub. 

3


Facing the Crisis: 

Cleveland Clinic Takes Practical and Proactive Steps to Tackle the Nursing Shortage 

The U.S. Bureau of Labor Statistics projects the current nurs- 

ing shortage to reach 800,000 by 2020. As a 1,000-bed tertiary 

care medical center, Cleveland Clinic constantly faces the 

challenges of recruiting and retaining qualified nurses at all 

levels. Add to that staffing requirements for the new 288–bed 

Cleveland Clinic Heart and Vascular Institute facility, scheduled 

to open in fall 2008 (see The New Heart of Cleveland 

Clinic, Page 7), and you have a nursing shortage issue that has 

elevated to top priority for the institution, according to Chief 

Nursing Officer Claire Young, RN, MSN, MBA. 

Retention is a two-fold challenge, Young says. “One element 

is attracting and hiring the right people, and the second is 

retaining the high-quality people whom we hire.” 

To address these needs and develop strategies for more effective 

recruitment and retention, the Cleveland Clinic Division 

of Nursing held a Retention Summit last fall. As a result of that 

meeting, at least 10 new projects related to hiring and retention 

are in various stages of implementation. 

In the face of a national nursing shortage, Cleveland Clinic is 

addressing nurse hiring and retention from every angle and is constantly 

exploring innovative approaches to maintaining the highest 

quality nursing staff. The issue has become even more significant 

as Cleveland Clinic prepares for a major expansion next year. 

Effectively Recruiting the Best 

Attendees at the summit agreed that the key to retaining 

nurses is the interviewing and hiring process, says Lois Bock, 

RN, BS, Director of Nurse Recruitment. “Our goal is to place 

nurses in an environment where they will succeed,” she says. 

“We do this by matching their career interests and goals with 

the right position for each individual.” 

The all-RN nurse recruitment team at Cleveland Clinic goes 

beyond the usual hiring practices and processes to achieve 

this perfect match. The team has found that career assessment 

and coaching to assist potential hires in determining 

their best job fit are essential to successful hiring and contribute 

significantly to retention, Bock says. 

Job applicants who are undecided as to where their interests 

lie are matched with a recruiter who will assist them through 

the hiring process, she explained. As part of that process, applicants 

are encouraged to job shadow. “By following a nurse 

on the floor for an hour or more, the applicant experiences the 

work flow and pace and the unit’s environment,” she explains. 


Shadowing exposes potential hires to the ways in which 

Cleveland Clinic nursing differs from clinical rotations during 

nursing school, Young says. “Cleveland Clinic is a unique 

place in its pace and patient acuity, and the better a nurse 

understands that going in, the higher the chance that he or 

she will be happy here and stay.” 

An Innovative Partnership with Area Nursing Schools 

Recognizing that a shortage of nursing faculty to train new 

nurses underlies the nursing shortage, the division started a 

Deans’ Roundtable Faculty Initiative in 2005 with the deans of 

area nursing schools to discuss this aspect of the problem. 

Through the initiative, 275 Cleveland Clinic nurses were 

identified as potential faculty members and a Web site was 

developed that matches these nurses with available teaching 

opportunities at participating schools. Nurses who are 

interested in teaching log on to the Web site and submit a 

professional profile, and participating nursing schools post 

course profiles for which they are seeking faculty on the Web 

site. The Web site compares applicants and positions and 

assigns matches. 

The Deans’ Roundtable Faculty Initiative also provides 

ongoing support through a series of educational offerings, 

including one-day faculty development programs, continuing 

nursing education programs and quarterly newsletters that 

prepare potential faculty to become nurse educators. 

The initiative also helps Cleveland Clinic in its ambitious 

efforts to recruit new nursing graduates. 

“We now are partnering with area nursing schools to let their 

graduates know that our arms are wide open to them and that 

we have all the tools to support them throughout their career 

at Cleveland Clinic,” Young says. 

Cleveland Clinic’s student loan assistance is one tool that 

new graduates may find very attractive. Through this program, 

Cleveland Clinic will pay up to $10,000 in student loans for 

nurses who qualify. In return, the nurse makes an employment 

commitment to Cleveland Clinic. 

To woo new graduates from farther away, Cleveland Clinic 

offers a weekend visitation option. At these once-monthly 

sessions, graduating nursing students who live more than 75 

miles away visit Cleveland Clinic on a Saturday for a question 

and answer luncheon, a campus tour, an interview and a shadowing 

experience. Participants enjoy complimentary dinner, 

parking and an overnight stay in a hotel. 

“Although the weekend program represents a major commitment 

on our part, it has been highly successful,” Bock says. 

“The hiring ratio from these events is about 80 percent, so it is 

well worth our while.” 

Helping Newly Hired Nurses Adjust 

As a result of the Retention Summit, the Division of Nursing 

has enhanced its welcoming and orientation for newly hired 

nurses. Once a new hire is on board, every effort is expended 

to help him or her feel welcome and part of the team, beyond 

the formal orientation that all new Cleveland Clinic employees 

go through. 

The focus is on personalizing the experience to meet the 

new hire’s needs based on his or her education and experience. 

“Every new hire is matched with a Primary Preceptor, an experienced 

nurse who serves as a career resource, a listening ear and 

a sounding board,” explains Carol Santalucia, MBA, Director of 

Nursing World-Class Service. Additional unit-based preceptors 

also assist the new nurse through clinical orientation, which 

focuses on clinical competence, patient care content expertise 

and socialization to the unit culture. 

On the social and personal side, new hires are invited to 

participate in informal support groups and quarterly division 

social events. 

Special Attention to Retention 

Attracting and hiring nurses is only one side of the equation 

for meeting staffing requirements, Young emphasizes. 

Keeping them is equally or more important, not only from 

the financial perspective because of the cost of hiring and 

training new employees, but also from a quality perspective, 

she says. 

“Retaining our nurses is essential to maintaining a consistent 

quality of care,” she says. “Retention gives us a constant, high 

level of knowledge capital at the bedside.” 

Retention is a complex issue, she added, particularly in the 

Cleveland Clinic environment, “where nurses experience 

physical, mental and emotional labor all at one time.” 

For many nurses, opportunities for professional growth and 

career advancement are important to their job satisfaction. By 

its structure as a large, multicenter health system, Cleveland 

Clinic abounds with career opportunities. 

“We encourage nurses to move around if needed to find the 

position that is the right fit for them,” Young says. “Nursing at 

Cleveland Clinic is very diverse with many different types of opportunities. 

We don’t believe that one size fits all when it comes 

to nursing positions.” (For examples of nurses who have created 

rewarding career paths at Cleveland Clinic, see Page 1.) 

Another option for any registered nurse or licensed practical 

nurse who seeks more flexibility is Cleveland Clinic Agency 

Resources. This new Cleveland Clinic spin-off company is essentially 

a nursing temporary agency, except that nurses who sign on 

with the agency work exclusively for Cleveland Clinic hospitals. 

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Qualified nurses who are registered with the agency go 

online to check current temporary staffing needs, select the 

ones that fit their personal schedule and sign up to work 

those hours. “Nurses must be clinically qualified for the job 

and must commit to working at three facilities within the 

Cleveland Clinic Health System,” Bock explains. “The agency 

gives nurses the flexibility they want and assures Cleveland 

Clinic of a qualified pool of professionals to meet temporary 

staffing needs.” 

A State-of-the-Art Learning Center 

To support clinical learning and professional development, 

the Department of Nursing Education and Professional Practice 

Development recently opened a high-tech learning center 

that includes an eight-bed laboratory. The clinical simulation 

lab, funded by Hill-Rom Co., includes six patient beds in a 

standard patient care unit configuration, two intensive care 

beds and an infant intensive care crib. 

“Everything in the lab is real, except the patients,” says Michelle 

Dumpe, PhD, MS, RN, Associate Chief Nursing Officer, Nursing 

Education and Professional Practice Development. “The lab is 

equipped with everything that a real patient unit or intensive 

care unit would have, including laptop computers for bedside 

charting, a crash cart and a supply room. All the equipment 

is operational.” 

Six of the beds are occupied by interactive simulator models 

that can have their vital signs taken realistically and can be 

moved and repositioned in the beds. The two models in the 

intensive care unit are fully programmable to simulate real-life 

critical care situations such as ventilation, cardiac monitoring 

or intravenous fluid delivery. 

The lab, fully operational by January 2008, will have multiple 

uses, Dumpe says. “We will be using it for continuing education 

for staff nurses to learn new techniques and technology, 

for clinical testing for job advancement and for validating a 

new hire’s hands-on skills during orientation. Particularly for 

new hires, the lab is one way to help bridge the gap between 

nursing school and the reality of clinical practice.” Interventions 

occurring in the lab will be videotaped for later review 

and discussion by the nurse and a preceptor, she added. 

The expanded Nursing Education and Professional Practice 

Development Department, which recently moved to new, 

totally redesigned quarters on the main campus, also includes 

a new 40-station computer center for online learning. Nurses 

now can enroll online for training, scheduling it at their convenience, 

and go to the computer center to take the course. 

Online offerings include in-service training as well as courses 

for personal development and career advancement, Dumpe 

said. “Our staff of more than 30 nurse educators is continually 

developing new classes for staff education,” she said. “It’s a 

part of Cleveland Clinic’s commitment to ongoing professional 

career education for our nurses.” It’s also a perfect complement 

to the new simulation lab, she added, allowing nurses 

to take the didactic portion of a course in the computer center 

and go through a clinical check-off in the lab. 

Nursing students in the computer lab of the Learning Center for Nursing Practice Excellence. Students receive instruction in the simulation lab. 


quote 

“Our goal is never to turn away a qualified nurse. And once they are here, we 

want to support them in their personal and career goals in every way possible.” 

– Claire Young, RN, MSN, MBA, Chief Nursing Officer 

An Emphasis on Health, Wellness and Life Balance 

Also the result of the Retention Summit, the division has 

implemented a nursing wellness initiative that addresses the 

health of the mind, body and spirit through exercise programs, 

nutrition education and other wellness-focused opportunities. 

“At Cleveland Clinic we are passionate about patient advocacy 

and satisfaction,” Santalucia says. “The best way to achieve 

that is by taking care of our employees.” 

The Parent Shift Program, an innovative scheduling approach, 

is another example of how Cleveland Clinic is trying to meet 

nurses’ personal needs in addition to their professional needs. 

Introduced three years ago, this popular scheduling option 

is designed for parents or caregivers who need to be home in 

the early morning and late afternoon but have several hours 

available in the middle of the day to work. The Parent Shift 

Program lets nurses work the mid-day hours without requiring 

a commitment to a complete shift, making it ideal for nurses 

with family responsibilities. 

Career Options Abound for Veteran Nurses Too 

Some senior nurses want to stay in bedside nursing, but for 

those who are seeking other choices, the Division of Nursing 

has created a range of nursing positions that are less stressful 

and intense. Positions such as Admitting Nurse give Cleveland 

Clinic and its patients the benefit of the experience and knowledge 

of senior nurses while satisfying the nurses’ desire for a 

less-intensive work situation still within nursing. 

Senior nurses also enjoy priority scheduling and opportunities 

to become instructors and preceptors. “Senior nurses are 

foundational to building a solid nursing organization,” Young 

said. “It’s very important that we keep these employees in 

whom we have put our faith and trust.” 

E-mail comments to youngc@ccf.org, dumpem@ccf.org, bockl@ccf.org and santalc@ccf.org. 

The New Heart 

of Cleveland Clinic 

Construction is under way for a new 

Heart and Vascular Institute facility at 

Cleveland Clinic. Scheduled to open in 

2008, the new 10-story hospital tower and 

technology center will provide a comprehensive 

model of care where patient care, 

research and education are offered in one 

location. Features include: 

• Outpatient diagnostic facilities 

including 115 exam rooms and 170 

physician offices 

• Technology building for complex 

and highly technical procedures 

• Inpatient facilities featuring 288 

(mostly private) hospital beds 

• Fully-equipped conference center 

For more information regarding the new 

Heart and Vascular Institute facility, visit 

clevelandclinic.org/heartcenter. To learn 

more about nursing opportunities, visit 

clevelandclinic.org/jobs/nursing.htm. 

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Studying Nighttime Noise and Patient Satisfaction 

A bright idea came to mind after many patients at 

Cleveland Clinic had told Terri Murray, RN, BSN, 

about nighttime noise disrupting their sleep: 

Let’s do a study. 

Murray and Jackie Spence, RN, nurse managers in the Heart 

and Vascular Institute’s cardiothoracic stepdown units, set out 

to explore if a correlation existed. They assessed patients’ perceptions 

of noise and impact on sleep and whether perception 

of noise is based on demographic or surgery variables (age, 

gender, medical history, surgical procedure type, etc.) instead 

of unit environment. 

It’s the first study of this kind, says Spence. “The literature 

search only found other studies that measured noise level 

ranges in decibels.” 

From January through May, the nurse managers surveyed a 

total of 150 randomly selected adult patients on three floors. 

The patients’ primary reason for hospital admission was postoperative 

recovery after coronary artery bypass graft and/or 

valve procedure. 

Exclusion criteria consisted of several elements: admission 

for a different reason; age less than 18 years; other surgery or 

medical condition; unwilling to give written informed consent 

to participate; unable to read or write English; mentally 

impaired close to discharge (when data are collected); or any 

psychiatric or psychological condition. 

After three nights in the unit, patients who qualified were 

asked to fill out a 24-item survey. This was designed to determine 

which factors tend to disrupt sleep and which are likely 

to promote relaxation between 11 p.m. and 6 a.m. 

The survey measured patients’ perceptions of average nighttime 

noise on the floors by showing evidence of 15 different 

factors, such as roommate snoring, nurses talking, and equipment 

moving in the hallway. 

A Likert-type scale first identified that the noise factor did 

indeed occur and then measured how often and severe it 

seemed. It also evaluated the extent to which it made falling 

asleep or staying asleep difficult. 

The survey also listed 10 sleep-promotion factors and asked 

patients if they benefited from any of them during their last 

two nights in trying to relax, sleep better, or block out noise. 

This included ear plugs, a CD player, television set, eye shields, 

medication, change of roommates, private room, room door 

closed, and nurses’ use of soft voices and making less noise. 

In addition, data collected in an ongoing registry of all open 

heart surgery cases will be used to determine if patient, medical 

condition or surgery variables influence patient perceptions 

of noise at night. 

Data will be analyzed using descriptive statistics, correlation 

statistics and differences between groups (high vs. low 

perceptions of nighttime noise). 

Once the final results are complete, Murray and Spence hope 

to publish their research. 

“Understanding relationships of variables that we cannot 

change (age, gender, ethnicity, medical background, etc), 

those we can change and patient’s perception of the environment 

as noisy can aid in planning to optimize sleep,” 

says Murray, “which may, in turn, improve overall patient 

satisfaction with the hospital experience.” 

E-mail comments to murrayt@ccf.org or spencej2@ccf.org. 


Can Nurses Help Decrease a Patient’s 

Length of Stay after Cardiac Surgery? 

Study findings indicate it’s not likely 

Following a study of cardiac surgery patients, nurses at Cleveland Clinic concluded that bleeding, 

respiratory complications and/or the need for red blood cells after surgery delay the initiation of Coumadin, ® 

which prompts a longer stay for patients. 

Patients taking Coumadin ® after cardiac surgery stay three 

days longer in the hospital on average than those who do not, 

based on Cleveland Clinic registry data. But it was unclear 

why – and whether something could be done to intervene and 

alter hospital processes. 

Another unknown was whether nurses should focus attention 

on systems that prompt better post-discharge monitoring of 

clotting activity, so that patients could be sent home faster. 

“With this as our background, we set out to get some answers,” 

says Robbi Cwynar, RN, BSN, BC, Clinical Manager of Thoracic 

and Cardiovascular Surgery. 

Cwynar and two colleagues – Nancy Albert, PhD, RN, CCNS, 

CCRN, CNA, Director of Nursing Research and Innovation, 

and Carol Hall, MSN, CNP, a nurse practitioner in Thoracic 

and Cardiovascular Surgery – recently conducted the study 

that entailed retrospective chart review of patients who underwent 

coronary artery bypass graft surgery or valve surgery at 

Cleveland Clinic in 2004. 

“I have been on the committee to look at length of stay and 

have been interested in length of stay for many years,” says 

Cwynar, a Cleveland Clinic nurse for 28 years. 

The nurses used an Institutional Review Board approved 

registry that contains data on all patients undergoing cardiac 

surgical procedures. For inclusion in the study, patients had to 

be receiving Coumadin® after surgery, but not beforehand, and 

their circumstances had to fit other requirements (e.g., a nonemergency 

surgical case and being younger than 85 years old). 

“Once we had a list of all cases that met inclusion criteria, 

we randomly selected cases for review, based on hospital 

length of stay,” Albert explains. “Patients were grouped as 

‘short length of stay,’ defined as seven days or less for isolated 

coronary artery bypass grafting (CABG) and nine days 

or less for valve surgery or combination CABG and valve 

surgery; or ‘long length of stay,’ defined as more than 

seven days after CABG or more than nine days after valve 

or combination surgery.” 

Of the 82 patients, 33 underwent isolated CABG and 49 had 

valve or combination procedures. There were few differences 

between the groups in demographics, medical history, common 

complications such as atrial fibrillation or adverse events, 

and use of angiotensin-converting enzyme (ACE) inhibitors 

and beta-blocker therapies. 

Patients with longer length of stay had bleeding complications 

that extended their days in intensive care and overall time in 

the hospital. They also tended to be older (mean age 73.5 years 

vs. 68.5 years). Patients with longer length of stay exhibited 

more post-operative respiratory insufficiency and were more 

likely to receive red blood cells. In addition, they had more 

consultations for other services (e.g., pulmonary medicine). 

As for Coumadin ® therapy, patients with longer length of stay 

had a greater time lapse between the surgery date and start of 

the medication. The nurses concluded that bleeding, respiratory 

complications and/or need for red blood cells after surgery 

delay the initiation of Coumadin ® . This, in turn, prompts 

a longer stay, increases costs of care, and postpones recovery 

or rehabilitation. 

“Ultimately, the factors that were found to lengthen hospital 

stay are not factors easily tweaked by nurses to change clinical 

outcomes,” Albert says. “We cannot control bleeding or respiratory 

complications that occur even with excellent post-operative 

management.” 

“And since so few patient variables were significant predictors 

of long length of stay,” she continued, “we cannot even create 

a risk score to determine who is at risk before surgery, and 

then try to be more vigilant in assessment and care delivery to 

prevent complications.” 

However, the findings offer valuable insight. They can help 

healthcare providers identify intensive care unit patients 

who develop bleeding or respiratory complications, so that 

discharge planning could be started sooner. For instance, 

clinicians could assess clotting time earlier, possibly initiate 

Coumadin® more quickly, and adjust dosing to achieve the 

target dose in less time. 

E-mail comments to cwynarr@ccf.org and albertn@ccf.org. 

9

3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe 

Cleveland Clinic’s 3rd annual urology/gynecology Nursing Conference was held April 21 at the 

InterContinental Hotel and Bank of America Conference Center on Cleveland Clinic’s main campus. 

The one-day conference was directed to nurses and other allied healthcare professionals. Topics 

included methods of prevention for HPV to eradicate cervical cancer; trends in treatment for benign 

prostatic hyperplasia; advances in treatment for urinary incontinence; conveying sensitive information 

to patients; and robotic surgery in urology. 

Course Co-Directors were: Susan Beam, RN, BSN; Brian Klein, RN, BSN, BA, CNOR; Janet ursinyi, 

RN; Michelle Suhy, RN, BSN, CuRN; Dorothy A. Calabrese, RN, MSN, CNP; Laurel Stevens, RN, BA; 

and Debra O’Connor, LPN. 

Breaking Bad News 

Kathleen Lupica, RN, MSN, CNP, CCRN 

Breaking bad news is part of our 

job; a learned skill that is well worth 

our time and effort. 

There are six key steps to breaking bad 

news, and the first is learning how to start. 

Setting is vital; you want to do it in person, 

in a calm, private place without distractions. 

It is up to the patient to determine 

who else should be present. 

The next step is finding out what the 

patient knows. Start with no assumptions, 

and let the patient tell you what 

he or she knows. Use vocabulary similar 

to the patient’s and pay attention to the 

patient’s body language. 

The third step is finding out what patients want to know. For example, ask if they’d 

like details or just main points about the tests that came back. Often your role is just 

to confirm what they already suspect. 

Fourth is sharing information in a therapeutic manner. It’s best to start by listening 

to their concerns and responding in a way that is truthful, positive and realistically 

hopeful. Pause often and let them speak. Ask if they understand and be ready to 

clarify or repeat facts. When asked for a timeline, use ballpark figures and explain 

that statistics provide only a range. 

Next, respond to their feelings. Tell them it’s OK to be angry. Offer a tissue if they 

cry and use therapeutic touch. Let them know that guilt is useless. Be sure not to 

provide premature reassurance; it’s OK to remain silent rather than promise what 

you can’t deliver. 

Lastly, after explaining the diagnosis, outline some treatment options, help create a 

possible plan and talk about what outcomes can be expected. Remind patients of the 

things that will help them cope – their family, their faith. Finally, give them a specific 

next step, such as the date of their follow-up visit and leave the door open to any 

questions they may think of later. 

E-mail comments to lupicak@ccf.org. 

Kathleen Lupica, RN, MSN, CNP, CCRN 


11


Robotics for Surgical Specialties 

georges-Pascal Haber, M.D. | Section of Laparoscopic and Robotic Surgery, glickman urological and Kidney Institute, Cleveland Clinic 

Diana Baker, RN, BSN | Clinical Coordinator, glickman urological and Kidney Institute, Cleveland Clinic 

Though robots have had a hand in urological 

surgery since the early 1990s, their role continues 

to evolve in exciting ways. 

Earliest robots, such as the Aesop, were little more than static 

holders of laparoscopic cameras. Then newer features were 

added, such as infrared sensors that enabled some robots 

(endo assist) to move in synchrony with the surgeon’s hand. 

These earlier robots helped us see, but were still a limited 

preview of the life-like 3-D views we get from today’s devices. 

The da Vinci ® surgical robots used widely today first entered 

the OR in late 2000. They brought not only better visualization, 

but improved dexterity. Unlike older designs, these new 

instruments can operate at a 90-degree angle, enabling precise 

movements even within a tightly confined surgical field. 

The robots in clinical use today don’t provide tactile feedback 

to the surgeon, nor do they include various energy devices, 

such as laser tools. 

We are currently in the final stages of testing a laser tool for 

use in robotic prostatectomies and partial nephrectomies. 

The advantage of these lasers is that their beams can be 

tightly focused, reducing the amount of thermal damage 

and risk to nearby nerves. 

Diana Baker, RN, BSN 

Georges-Pascal Haber, M.D. 

However, even with better robots, the surgeon who sits at an 

operating console across the room from the patient needs 

skilled assistance. An assistant surgeon remains at the 

bedside providing manual suction and clipping, and a nurse 

performs several key roles, including troubleshooting and 

docking the robot. 

Aside from making the next generation of robots smaller 

and less expensive (current designs are over $1.2 million), 

engineers are working to equip them with ‘augmented virtual 

reality.’ These are GPS navigational systems that give precise 

feedback on the positions of each instrument. They also have a 

memory, allowing the surgeon to have an instrument return to 

any previous position. 

Further in the future are robotic devices that provide a surgeon 

with layered visualization and 3-D reconstructions of a tumor 

made from CT and MRI scans. Different colored zones are 

highlighted around the tumor providing a guide for optimal 

tumor removal. 

Developing a Personal Formula for Contentment 

Scott Bea, Psy.D. | Clinical Psychologist, Department of Psychiatry and Psychology, Cleveland Clinic 

Happiness is not a destination, but a journey: not 

something you achieve, but rather something you 

must continually work at. 

Yet, coming to this realization isn’t easy in a consumer-driven 

society where we’re indoctrinated into thinking that happiness is 

about having ‘stuff.’ We’re busier than ever before, and working 

more hours, so it’s hard to give relationships the time they need. 

Some of our unhappiness may also be a leftover from the 

conditioning of the early human brain. In order to survive, 

it had to stay focused on things that could kill us, no matter 

how nice the rest of our surroundings were. Anxiety was 

good; happiness a luxury. To overcome this history, we have 

to recondition how we see our environment. 

One step is to be a ‘gift giver’ – not of material things, but of 

your time, energy and attention. Another step is to complain 

less (70 percent of American conversations are characterized 

by complaint) and give compliments and praise more. Studies 

show that 16 instances of praise to every instance of criticism is 

an ideal ratio to keep people functioning well. 

A third is to be happier with who we are and not get caught 

up in the frustrating pursuit of trying to be like someone else. 

This requires us to be more aware of and take responsibility 

for what we really need and to not let others determine what 

is important. 

Forgiveness is another key step. We must understand that 

people come with a wide range of abilities, intelligence and 

other behavioral traits. We need to be more forgiving of others 

who may have less ability than ourselves. 

Like any good habit, learning to be happy takes practice. At 

bedtime each night, think of three good things you did that 

day. If you go to sleep with positive thoughts, you’ll sleep better 

and wake up more refreshed. In the morning, make a list 

of the five things you’re best at and during the day commit at 

least one random act of kindness. 

To reduce the impact of everyday worries, take 15 minutes 

each day to make a list of everything that’s worrying you. When 

you make the list daily, it trains your brain to under-respond to 

the worries, diluting their impact on your state of mind. 

3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe

7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe 

Held in February at the InterContinental Hotel and Bank of America Conference Center on Cleveland 

Clinic’s main campus, conference attendance skyrocketed with 254 registered participants, according to 

Co-Directors Deborah De Mars, RN, RNFA, ONC, Dawn gerz, RN, RNFA, ONC, and William J. Wick, 

Coordinator of Orthopaedic Materials in the Department of Orthopaedic Surgery. 

The conference opened with broadcast of a live total hip 

arthroplasty, performed by Cleveland Clinic orthopaedic 

surgeon Lester S. Borden, M.D. 

In a Q&A session following the surgery, Dr. Borden and his 

nurse, Sharon Pivonka, RN, RNFA, reflected on the evolution 

in total joint surgeries. As a resident in the 1960s, Dr. Borden 

saw total hips take up to eight hours with high blood loss and 

infection rates of 15 percent. 

“Initially, we didn’t have the instrumentation to get these 

implants in and to resurface the bone,” Dr. Borden explained. 

“Instrumentation has made a huge difference. Today, we have 

higher quality implants, better instrumentation, less blood 

loss and much lower infection rates.” 

Scars are smaller and rehabilitation is faster. Cement is out. 

“We want the patient’s bone to grow into the implant,” he said. 

Bedside nurses should get patients moving. Hip and knee pa- 

tients should sit in a chair the day following surgery, putting 75 

percent of their weight on the unoperative leg. Physical therapy 

should begin the following day. “There is no science in overpro- 

tecting patients,” Dr. Borden said. He added, “The sooner the 

patient gets moving, the better for them psychologically.” 

Total hip patients use a walker or crutches for four weeks 

after surgery, followed by a cane for four more weeks, to give 

muscles around the implant time to heal. To avoid dislocating 

a new hip, patients avoid bending over to pick up an item or 

sitting with their knees above their waistline. 

Nursing Students Invited 

Conference planners invited professors and students from 

nursing programs at Cleveland State University (CSU) and 

Huron School of Nursing as guests. 

“In academia, we don’t get opportunities to see surgeries,” said 

Marilyn Weitzel, Professor of Pediatric Nursing at CSU. “I was 

glad the surgeon was so kind to the (patient’s) family. Our 

nursing program stresses that a patient is more than an individual, 

each comes with a family.” 

“Seeing a live surgery reminds me of why I became a nurse,” 

said Michael McQueen, senior at Huron School of Nursing. 

“Nursing provides a great forum for collaboration, something 

is always happening and there is always something to learn.” 

Huron School of Nursing students. Back row, from left: Bill Wingler, Michael 

McQueen, James Tighe. Front row, from left: Jennifer Dolence, Jennifer Tramte, 

Heather Pennington, and Huron faculty member Lydia Glaude, MSN, CNP, RN. 

Future of the OR: The goal is OPTIMAL 

Operating rooms are typically “overcrowded, paper-based and designed for 1970s procedures,” said 

Jonathan L. Schaffer, M.D., M.B.A., of the Cleveland Clinic Advanced Operative Technology group in the 

Department of Orthopaedic Surgery and one of the architects of the Cleveland Clinic project to develop, 

design and construct the Orthopaedic OR of the Future. The project was launched six years ago to 

improve quality, increase capacity and manage costs more efficiently. 

“Most operating rooms run from 7:30 a.m. to 5:30 

p.m. at an inefficient 42 percent utilization rate,” 

Dr. Schaffer said. Access, quality and value will 

characterize optimal use in the future, he said. 

His project team came from every department 

and from among patients and families. They dis- 

covered many inconsistencies that wasted time: 

sterile gloves in different places and arthroscopy 

tables set up in different ways. 

In planning, the team discarded old assumptions 

and integrated new design elements from Euro- 

pean operating rooms and corporations that had 

developed new production facilities. Looking at 

opportunities to improve performance, the team 

determined the difference if patients were trans- 

ferred from the OR table to a bed on the count of 

two instead of three – the second of time for each 

move could mean a theoretical $1 million savings 

in labor costs annually. 

OR nurses and technicians helped develop the new look and refine proce- 

dures and processes. “We wanted the OR of the future to be easier on the 

nurses who spend eight to 12 hours there every day,” Dr. Schaffer said. 

Three orthopaedic ORs were redesigned along with support areas and the 

sterile core between the rooms. Scheduled surgeries were re-routed and 

nurses extended the work day as needed to keep the schedule going and 

to avoid delays during construction. “The commitment and efficiency of 

OR nurses meant a savings of 189 percent in construction program costs,” 

he said. 

The new operating rooms are streamlined for optimal use. Supplies such 

as gloves are located in the same place in each room; arthroscopy tables 

have a consistent setup and the technical and implant rooms are opti- 

mally organized. A central documentation and control area in each OR 

has three computers. Controls for lights, cameras and pumps are within 

easy reach of the circulating nurse. Up to one additional joint procedure 

can be accommodated per day per room. 

“These ORs are now coherent, properly functioning workspaces,” said 

Dr. Schaffer. “The future of the Orthopaedic OR is very bright.” 

Metrics used in Developing 

Plans and Processes for the 

OR of the Future: 

• Increase efficiency and productivity 

of the surgeons, OR staff and hospital 

support personnel 

• Improve patient outcomes 

• Decrease pain 

• Restore function 

• Avoid complications 

• Increase satisfaction 

• Provide greater value to society 

7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe

7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe 

Risk Management: Staying out of a Courtroom 

Vicki Bokar, CPHRM | Director of Clinical Risk Management at Cleveland Clinic 

Orthopaedic surgery ranks among the top five specialties in terms of being named most frequently in malpractice 

claims. Nationally, some of these claims have resulted in large settlements, including a $7.5 million 

settlement for failure to diagnose Compartment Syndrome, and a $16.1 million settlement for failure to diagnose 

lower leg thrombosis that resulted in the death of a young patient. Surgeons and physicians aren’t the 

sole targets. One claim was targeted toward a nurse who inadvertently used IV tubing that was not sterile. 

The most common allegations in orthopaedic claims include: 

• Improper performance of surgery 

• Improper management or judgment 

• Failure or delay in diagnosis or treatment 

• Postoperative complications 

• Infections 

• Complications under casts 

• Wrong surgery 

Informed consent issues are often tagged onto the primary claim. 

Nurses, physicians and other practitioners play a role in every 

single situation listed above. Thus, each member of the team can 

take steps to avoid malpractice claims. Don’t expect that certain 

diagnoses or complications will present with textbook signs and 

symptoms because the patient’s presentation may be atypical. 

Unless you remember this, you may inadvertently miss important 

subtle clues that should be communicated to a physician. 

Observe and listen carefully to the patient. Limit distractions in 

your clinical practice and you will minimize your risk of making 

an error. Internal systems should be adequate and effective, 

such as tickler systems to assure that important test results are 

reviewed and reported in a timely manner. Ensure that every 

patient has one healthcare professional coordinating the plan 

of care wherever possible, particularly in the outpatient setting. 

This can help prevent things from “falling through the cracks.” 

Avoid disagreements with colleagues and/or making inappropriate 

comments within hearing of patients or families. 

Do not jump to conclusions or speculate when an event 

occurs. You may not have the whole story at the time. 

Introduce residents as members of the healthcare team to 

avoid additional risks to hospitals with teaching programs. 

Be aware that diagnostic errors often occur on weekends or 

holidays, so communication and handoffs must be thorough 

and complete. Don’t rule out a problem without sufficient 

evidence to support that decision. 

Proper documentation should reference only information 

related to patient care. Include every phone call, care-related 

activity (including patient response) and any instructions provided 

to patients. Date and time each note, avoid late entries 

and never, ever alter a medical record. Review the documentation 

of others to assure that you know all pertinent information 

on your patient. Beware of clicking on the wrong menu item 

from electronic medical record’s drop down menu. 

Patients sue primarily because their surgical outcomes do 

not meet their expectations. Prior to surgery, provide patients 

with written educational materials about their procedure and 

ensure they have realistic expectations. These materials may 

supplement the consent process and help patients to better 

understand potential risks and benefits. Inform surgeons if 

the patient has unrealistic expectations and/or does not seem 

to understand what was discussed during the consent process. 

Departure from the standard of care is one of the elements 

that must be proven in a malpractice case, so educate 

yourself regarding best practices. Nurses on a particular 

unit might want to identify their 15 best safety practices and 

ensure through ongoing monitoring that everyone follows 

them without deviation. Coach one another. Repeat back everything 

someone says to you. Know and follow the Universal 

Protocol. Wash your hands before and after patient care. 

If you remain vigilant and conscientious in your delivery of 

patient care at all times, you will have little reason to worry 

about a malpractice lawsuit. 

E-mail comments to bokarv@ccf.org. 

Rekindling the Spirit 

Scott Sheperd, Ph.D., a nationally known speaker and 

author, invited participants to examine beliefs about stress 

and to rekindle their passion. 

“Adults whine all the time,” Dr. Sheperd said. “When someone 

whines at lunch – don’t you try to top them with your own sad story?” 

The audience erupted in laughter. 

Through humor and targeted examples, Dr. Sheperd challenged participants 

to stop using the word stress. “Words have power,” he said. 

“They don’t just describe a situation, they create it.” 

Marriage, divorce, job changes and moves are not stressful at all, he 

said. Neither are holidays. “We bring the meaning to the events of our 

lives. There are no stressful meetings, jobs or days. Stress is not a fact, 

but an opinion,” he said. 

He wondered aloud why we let other people determine our mood. 

“We can choose to be joyful and peaceful. Yet, we give away our personal 

power. We avoid responsibility for our lives and pass the buck every 

chance we get.” 

“I’m a big believer in the power of the human spirit,” he said. “Decide 

that as long as you aren’t dead, you will choose to be alive.” 

Scott Sheperd, Ph.D. 

To Reclaim Personal Power 

• Become aware of your attitude. 

• Forgive. 

• Think “Rainbows Happen.” 

• Stop talking like a victim. 

• Don’t let routines become ruts. 

“The only difference between ruts 

and graves is the depth.” 

• Make small changes and follow through. 

• Don’t wish life away. (I wish it was 

summer, Friday, vacation . . .) 

• Slow down, feel the rhythm of being alive. 

• Make every day a good day. 

• Be with people you love and care about. 

• Watch your words – they have power 

to create. 

• Do something every day that makes 

you feel passionate about life. 

• Every night, ask yourself how you handled 

the day. If you handled it poorly, 

resolve to change your mind, which 

takes courage. 

7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe

26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe 

In its 26th year, the Dimensions in Cardiac Care nursing conference was a unique academic event 

designed to provide the latest trends in patient management and technology. The event was held April 

15-17 at the InterContinental Hotel and Bank of America Conference Center on Cleveland Clinic’s 

main campus with the purpose of providing the nursing professional with a national forum to share 

knowledge and information regarding the care of the cardiac patient. Nurses representing interventional 

cardiology, cardiovascular medicine, cardiothoracic surgery and transplantation attended the 

event co-chaired by Nancy Albert, PhD, CCNS, CCRN, CNA; Kelly Hancock, BSN, RN and Kathleen 

Tripepi-Bova, MSN, RN, CCNS, CCRN. 

Rearranging the gI Tract: esophageal Surgeries 

Kathleen Tripepi-Bova, MSN, RN, CCNS, CCRN | Thoracic Surgery, Medical Cardiology and Transplant 

Though esophageal cancer is not very common, adenocarcinoma of the esophagus is the type most commonly 

seen in the united States. For those patients who are candidates for surgical resection of esophageal cancer, 

an esophagogastrectomy may be performed. In this procedure, the majority of the esophagus and a portion of 

the stomach are removed, and the now tubular stomach is brought up into the chest and is reconnected to the 

remnant esophagus in order to sustain function. 

Unfortunately, adenocarcinoma has no symptoms and is 

rarely diagnosed until the tumor blocks about 75 percent 

of the esophagus, causing dysphagia. Such late detection 

means a 5-year survival of only five to 20 percent. 

One diagnostic strategy occurs with patients who have signs and 

symptoms of GERD (gastric esophageal reflux disease). These 

people are susceptive to a condition called Barrett’s esophagus, 

which may become adenocarcinoma of the esophagus. Regular 

GI surveillance identifies the cancer in its earliest stages before 

it can spread outward from esophageal lining to lymph nodes. 

Esophageal ultrasound plays a key role in the clinical staging of 

esophageal cancer. It is an outpatient procedure that looks at tumor 

depth and proximal lymph node involvement of esophageal 

cancer. This is very helpful in determining treatment strategies. 

Just what is involved in the esophagectomy varies with where 

the tumor is and what alternate conduits are available for use. 

The most commonly used alternate conduit is the stomach, 

which is remade into the tube that is connected to the remaining 

portion of the esophagus. 

If the stomach is not available, the jejunum, (Rous-En-Y) or 

midsection of the small intestine, is used. The duodenum 

(upper section) is avoided because of its attachments to the 

pancreas and biliary sytme. If neither of these options is 

available, the colon may be used (colonic interposition). 

Risk of complications after esophagectomy are increased by 

the fact that the GI tract is not a sterile environment. Risk of 

chylothorax is as high as 60 percent, and treatment requires 

a no-fat diet. However, a new procedure, a lymphangiogram, 

allows for identification of the area of leak so that the leak can 

be identified and sealed off. 

Despite ongoing advances, esophageal surgeries remain 

complex procedures with significant mortality and morbidity. 

Best results are obtained in specialized medical centers with 

experienced nursing care, as nurses usually identify postoperative 

problems first. 

E-mail comments to tripepk@ccf.org. 

Can We Reverse Coronary Artery Disease? 

Steven Nissen, M.D., Chairman of Cleveland Clinic’s Department of Cardiovascular 

Medicine, was one of the keynote speakers at the Dimensions in Cardiac Care 

Conference. In his speech, entitled “Can We Reverse Coronary Artery Disease?,” 

Dr. Nissen talked about how, despite ongoing good efforts, coronary artery disease 

remains a leading cause of death among men and women. 

He explained that for many years CAD was believed to be a disease of lumen narrowing, but 

recent evidence has shown this to be otherwise. The real problem, as revealed by intravascular 

ultrasound, is the accumulation of atherosclerotic plaque in the vessel walls. As the plaque 

builds up, it leads to outward displacement of the vessel wall, with the plaque accumulating 

for years or even decades before it starts to occlude the vessel and show up on an angiogram. 

So plaque is the ‘tip of the iceberg’ of coronary disease, Dr. Nissen said, with the vast majority of it, 

some 99 percent, hidden from view. Yet, to effectively treat CAD, all of the hidden plaque needs to 

be treated. 

Many treatment efforts have been focused on lowering cholesterol, particularly LDL levels, using 

statins to get LDL down to 110 mg/dL in order to slow disease progression. But, Dr. Nissen said, the 

question remains as to whether disease progression could be halted or reversed if the levels were 

pushed even lower. 

Evidence from clinical studies (the Reversal Trial and the Prove IT trial) showed this could be done 

if LDL was lowered to 70 mg/dL. It also showed that the lower LDL was driven, the more disease 

progression was retarded. 

These studies had another important finding 

– that aggressively lowering LDL also pushes 

down levels of C-reactive protein, a marker of 

inflammation. Statins appear to play a dual, 

helpful role, with each role apparently independent 

of the other. 

Dr. Nissen said some of the latest studies 

are looking at raising HDL, lowering blood 

pressure, or using even more potent statins 

to reduce plaque volume. In that last regard, 

there has been some exciting early evidence. 

In a study lasting only 24 months (the Asteroid 

trial), investigators were able to reduce plaque 

levels by nearly 7 percent by lowering LDL to 

60 mg/dL. 

Over the next decade methods will be developed 

for early diagnosis of CAD, while the 

plaque is still developing, Dr. Nissen said. 

Better tools for moderating LDL, HDL, inflammation 

and high blood pressure also should 

be available. 

Steven Nissen, M.D. 

26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe

26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe 

Advances in Cardiac Imaging 

Scott D. Flamm, M.D. | Head of Cardiovascular Imaging, Department of Radiology, Cleveland Clinic 

The application of MRI and CT cardiac imaging to 

clinical practice continues to evolve in exciting ways. 

Today, MRI is not only the gold standard for evaluating left 

ventricular function, it also is used to assess valve function 

and myocardial ischemia and viability. It is a noninvasive, 

non-ionizing, nontoxic approach that delivers high-resolution 

images with detailed information on both heart morphology 

and function. The main restrictions to its use include the presence 

of pacemakers, ICDS and intracranial aneurysm clips, 

and large body habitus. 

Advances in CT technology, particularly the advent of multidetector 

CT, has greatly broadened its use in cardiac assessment. 

Rapid patient throughput (up to 8 patients per hour) 

and improved image resolution (down to 0.5 mm) means it 

can now provide functional as well as structural feedback. Ionizing 

radiation remains the main limit to wider use; a 64-slice 

CT of the coronary arteries can provide the equivalent radiation 

dose of 450 to 600 chest X-rays or more. 

Diuresis in Heart Failure 

Nancy M. Albert, Ph.D, CCNS, CCRN, CNA | Director, Nursing Research and Innovation, Cleveland Clinic 

We need a better way to measure and monitor hemodynamic 

congestion. Some internal monitoring devices that are part 

of an implantable cardioverter-defibrillator (ICD) provide 

additional information to track patient status. They indicate 

if there’s been a new bout of atrial fibrillation, look at AT/AF 

ventricular rate during the day and night, provide heart rate 

variability data, and track patient activity over time. 

One company’s internal monitoring ICD device provides a 

trend of internal left chest impedance cardiography. Because 

air offers greater resistance to electrical flow than water, a 

high reading means the patient is dry and a low reading tells 

us the patient is wet. The device is always on, eliminating the 

need for patient adherence, and data can be retrieved from any 

remote computer. While valuable data is obtained, this still 

provides just one part of the picture. 

Unlike traditional diuretics, which increase risk of mortality 

(by 37 percent) even as they improve symptoms, new drugs may 

The newer CTs are now as much a functional as a morphological 

tool as they convert two-dimensional scans into 3-D renderings. 

Such data allows us to reconstruct the beating of the left 

ventricle and yields quantitative data on LV function on par 

with echocardiography and MRI. The improved resolution of 

CT images makes it an important tool in planning valve procedures, 

as well as a postoperative check on placement. Despite 

the growing use of CT in cardiac imaging, the role of MRI has not 

diminished, but evolved. We are developing new ways to look at 

the aorta, both spatially and temporally, creating visualizations of 

valve function and turbulence, throughout systole and diastole. 

We are now performing stress perfusion protocols, and with 

newer contrast materials, that enable us to distinguish between 

reversible and irreversible areas of myocardial damage. 

A new type of MRI scan known as “delayed-enhancement” 

magnetic resonance imaging has a spatial resolution that is 

5-10 times better than NMR or SPECT, and allows us to distinguish 

between heart muscle that is healthy and muscle that is 

dead. This type of study can be performed in less than an hour 

and with no ionizing radiation. 

Hemodynamic congestion is the No. 1 reason for the rehospitalization of patients with heart failure. Yet such 

congestion can be difficult to diagnose, which means that, too often, patients with decompensated heart failure 

may be sent home in a sub-clinical congested state, raising the risk of future rehospitalization. 

help reduce volume overload in other ways. One is an inhibitor 

of the anti-diuretic hormone – arginine vasopressin. Vasopressin 

is a potent vasoconstrictor that regulates water and sodium 

reabsorption. Studies of this new drug show that those taking 

it, compared to placebo, had greater urine ouput and better 

normalization of serum sodium from baseline to discharge. 

Selective A1 adenosine receptor blockers have a direct impact 

on glomerular filtration rate, helping patients shed a bit more 

urine, and seem to provide optimal diuresis when used in 

combination with furosemide. 

Ultrafiltration, while not new, is an area of active research in 

patients with heart failure. Most trials are small, but show 

that ultrafiltration is a safe procedure and, compared to 

those patients receiving standard treatment, it decreased 

time to rehospitalization, days of rehospitalization and 

length of stay when hospitalized. 

E-mail comments to albertn@ccf.org. 

Valvular Heart Disease 

Deborah Klein, MSN, RN, CCRN, CS | Cardiac ICu and Heart Failure Special Care unit 

Through age and disease, heart valves that once 

opened like clockwork can become regurgitant, 

incompetent or stenotic, and generally fail to close 

completely. The types of possible dysfunction are 

several, as are the treatment options. 

Sometimes infective endocarditis can cause such valve 

problems, with the infection due to IV drug use, staph aureus 

migrating along a catheter line or a prosthetic heart valve. It 

presents as a rapidly developing high fever, with profound 

chills and sweats and requires a blood culture, physical exam 

findings and echocardiography to confirm diagnosis. Since 

it has such a high mortality rate (25 percent among general 

population, and 40-70 percent for those 70 and older), proper 

medical management is a must. However, this requires identifying 

the source of the infection. Surgery may be indicated if 

hemodynamic instability develops, fever persists and there is 

evidence of valvular abscess or system emboli. 

The gradual buildup of lipid deposits on valve leaflets leads to 

calcification, impaired leaflet movement and a narrowing of 

the orifice, known as stenosis. Narrowing of the aortic valve 

(AV) orifice restricts blood flow and poses a burden on the left 

ventricle, leading to increased ventricular wall thickness and 

dysfunctional hemodynamics. Aortic stenosis can present as 

dizziness, syncope after exercise, chest pain, atrial fibrillation, 

ventricular fibrillation or ventricular tachycardia. Diagnostic 

scans are likely to show left ventricular (LV) enlargement, 

thickened leaflets and a significantly reduced AV area. Medical 

management may include diuretics, reduced dietary sodium, 

avoidance of vigorous activity as well as beta blockers, statins 

and vasodilators. 

Sometimes endocarditis, calcification or aortic root dilation 

can cause aortic valve leaflets to incompletely close, allowing 

backflow into the left ventricle known as aortic regurgitation 

(AR). It also puts hemodynamic stress on the LV. In acute cases, 

Deborah Klein, MSN, RN, CCRN, CS 

it presents as a sharp rise in LV and left atrial (LA) pressures, 

pulmonary edema and acute heart failure. With more chronic 

AR, there is left-sided heart failure over time. Once confirmed 

by echocardiogram, management may include a vasodilator 

and nifedipine if asymptomatic. Beta blockers are avoided since 

they lengthen diastole. Vasodilators can be given to slow LV dilation. 

Valve replacement is an option if management fails. 

Stenosis and regurgitation also occurs to the mitral valves. In 

mitral stenosis, there is LA hypertrophy, pulmonary hypertension 

and development of atrial fibrillation, since hypertrophy 

stretches the atrial conduction fibers. The expanded LA can 

also cause hoarseness if it compresses the laryngeal nerve. To 

manage stenosis and pulmonary congestion, diuretics and 

beta blockers are given; to treat atrial fibrillation, digoxin, 

calcium channel blockers and anticoagulant may be used. Surgical 

options range from a balloon valvuloplasty, to valvotomy, 

to MV repair or replacement. 

With mitral regurgitation, various drugs help reduce the leakage 

of blood (afterload) into the LA, including nipride, ACE-I, nitrates 

and hydralazine. Valve repair or replacement is also an option. 

E-mail comments to kleind@ccf.org. 

26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe

22 


Cleveland Clinic Nursing News 

PRESENTATIONS 

AORN 54th Congress of the Orange 

County Convention Center 

March 2007 | orlando, Florida 

Making a Difference Through Research 

Siedlecki SL, PhD, RN 

AORN 54th Congress of the Orange 

County Convention Center 

March 2007 | orlando, Florida 

Poster Presentation: Making Research Reality 

Siedlecki SL, PhD, RN 

Preventative Cardiology Nurses 

Association Annual Symposium 

April 2007 | Minneapolis, Minnesota 

Poster Presentation: Heart Failure 

Knowledge: What’s Race Go To Do With It? 

Albert NM, PhD, CCNS, CCRN, CAN 

Trochelman K, MSN, RN 

Howey K, MS 

10th Congress of Society 

of Chest Pain Centers 

April 2007 | Nashville, Tennessee 

Case based treatment – Things to do right 

and what not to do wrong 

Albert NM, PhD, CCNS, CCRN, CNA 

Cardiac Surgery Symposium 

April 2007 | lima, ohio 

Advances in Critical Care Nursing 

Hill K, MSN, RN, CCNS-CSC, CNS 

33rd Annual Critical Care Update 

April 2007 | las vegas, Nevada 

Anatomically Correct: How Cardiac Anatomy 

Impacts the Postoperative Course 

5 Things I Wish I Knew About Chest Pain 


Northeast Ohio Case Management 

Network Annual Conference 

April 2007 | Cleveland, ohio 

Ethics, Case Managers, and Planning Ahead 


Dimensions in Cardiac Care 2007 

April 2007 | Cleveland, ohio 

- Case Studies in Heart Failure 

- Valvular Heart Disease 

- 12 Lead ECG Course 

- So You want to be an APN 

Klein D, MSN, RN, CCRN, CS, CNS 

Ohio Consortium of 

Nursing Learning Labs 

April 2007 | Findlay, ohio 

A New Menu for Skills Lab Practicum 

Price K, BSN, RN 

Midwest Political Science 

Association Meeting 

April 2007 | Chicago, illinois 

Medicaid Tele-Reimbursement Policy: 

Explaining State Innovation 

Schmeida M, PhD, MSN, RN, CNS 

Pediatric Endocrine 

Nurses Society Conference 

April 2007 | Portland, oregon 

APN Case Study: Growth Failure in 

Patient with Down’s Syndrome, 

Hypothyroidism and Type 1 Diabetes 

Switzer C, MSN, RN, CPNP, CDE, NP 

Challenges in Cardiology 

Dar Al Fouad hospital 

May 2007 | 6th october City, Egypt 

- Clinical Management of Heart Failure 

- Drugs Used for Heart Failure 

- The Importance of Self-Care in 

Managing Heart Failure 


Heart Failure State of Science 

Conference American Heart 

Association Council of 

Cardiovascular Nursing 

May 2007 | Washington, D.C. 

State of Clinical Practice 


National Teaching Institute 

and Critical Care Exposition 

May 2007 | Atlanta, georgia 

Beyond the Horizon: Drug and Mechanical 

Diuresis in Heart Failure 


National Teaching Institute and 

Critical Care Exposition 

May 2007 | Atlanta, georgia 

Issues in Heart Failure: Management 

Adherence and Polypharmacy 


American Transplant Congress 

May 2007 | San Francisco, California 

Cardiovascular Disease in 

Solid Organ Transplantation 

Hoercher KJ, RN, Director, 

Kaufman Center for Heart Failure 

American Geriatric 

Society Conference 

May 2007 | Seattle, Washington 

Poster Presentation: Moving Forward by 

Looking Back: A Proactive Reminiscence 

Program for Depressed Elderly 

Simon J, BSN, RN, Rader E, Marrie K, MSN, 

RN, Campbell J, M.D. 


3rd Annual Meeting of the American 

Association of Heart Failure Nurses 

Developing the Science of Heart 

Failure Nursing 

June 2007 | San Diego, California 

- Research: Understanding It and Applying 

It to Practice 

- The Ins and Outs of Publishing 


Society for Vascular 

Medicine and Biology 

June 2007 | Baltimore, Maryland 

Sublingual Administration of Warfarin: 

A Novel Form of Delivery 

Batke-Hastings S, MSN, CNP, MBA 

Carman TL, M.D. 

Society for Vascular Medicine 

and Biology’s 18th Annual 

Scientific Sessions 

June 2007 | Baltimore, Maryland 

Poster Presentation: Sublingual Administration 

of Warfarin: A Novel Form of Delivery 

Batke-Hastings S, MSN, CNP, MBA 

5th Annual Conference of State 

Nursing Workforce Centers 

June 2007 | San Francisco, California 

The Other Shortage 

Dumpe ML, PhD, MS, RN 

Kavanagh J, MSN, RN 

Western Thoracic Surgical Association 

June 2007 | Santa Ana Pueblo, New Mexico 

Prognosis of Patients Removed from a Transplant 

Waiting List for Medical Improvement: 

Implications for Organ Allocation and 

Transplantation in Status 2 Patients 

Discussant: Robbins RC, M.D., Chairman, 

Cardiovascular Surgery, Stanford University 

School of Medicine 

Presenter: Hoercher KJ, RN, Director, 

Kaufman Center for Heart Failure 

Scholarship of Teaching and Learning 

(SoTL) in Nursing Conference 

August 2007 | Cincinnati, ohio 

CNS Student Competencies in Outcomes 

Planning and Evaluation: Curricular 

Considerations and Exemplars 

Canfield C, MSN, RN, CNS, Coughlin 

R, MSN, RN, CNS, Jacobson A, PhD, RN, 

Jacobson K, MSN, RN, CCNS, Ludwick R, 

PhD, RN.C, CNS, Rock R, MSN, RN, CCNS, 

Soat M, MSN, RN, CCNS, Solomon D, MSN, 

RN, CNS 

Heart Failure Society of America 

September, 2007 | Washington, D.C. 

Expert Panel: Case Discussion in Heart Failure 

Hoercher KJ, RN, Director, Kaufman 

Center for Heart Failure 

PuBLICATIONS 

Albert NM 

Non-ST-Segment Elevation Acute 

Coronary Syndromes: Treatment 

Guidelines for the Nurse Practitioner. 

Journal of the American Association 

of Nurse Practitioners. 

2007;19:277-289. 

Fonarow GC, Yancy CW, Albert NM, 

Curtis AB, Stough WG, Gheorghiade 

M, Heywood JT, Mehra M, O’Connor 

CM, Reynolds D, Walsh MN. 

Improving the Use of Evidence-based 

heart Failure Therapies in the outpatient 

Setting: The IMPROVE HF Performance 

improvement Registry. 

American Heart Journal. 

2007;doi:10.1016/j.ahj.2007.03.030 

Albert NM, Fonarow G, Abraham W, 

Chiswell K, Stough WG, Gheorghiade 

M, Greenberg BH, O’Connor CM, 

Sun JL, Yancy CW, Young JB. 

Predictors of Delivery of Hospital-based 

heart Failure Patient Education: A Report 

from OPTIMIZE-HF. 

Journal of Cardiac Failure. 

2007;13:189-198 

Gheorghiade M, Abraham WT, 

Albert NM, Stough WG, Greenberg BH, 

O’Connor CM, Pieper K, She L, 

Yancy C, Young JB, Fonarow GC. 

Relationship Between Admission Serum Sodium 

Concentration and Clinical outcomes 

in Patients Hospitalized for Heart Failure: 

An Analysis From OPTIMIZE-HF Registry. 

European Journal of Heart Failure. 

2007;doi:10.1093/eurheartj/ehl542 

Albert NM, Zeller R. 

Development and Testing of the Survey 

of Illness Beliefs in Heart Failure Tool. 

Progress in Cardiovascular Nursing. 

2007;22:63-71 

Coughlin RM 

Recognizing ventricular Arrhythmias and 

Preventing Sudden Cardiac Death. 

American Nurse Today. 

2007;2(5):38-44 

Dumpe ML, Kanyok N, Hill K 

Use of an Automated Learning 

Management System to validate 

Annual Nursing Competencies. 

Journal for Nurses in Staff Development. 

2007;6 

Hill K 

Contributor and Consultant. 

ECG Strip Ease. 

Philadelphia: Lippincott, Williams, 

and Wilkins, Inc. 2006. 

Hill K 

The Ps and Qs (and RSTs) of Assessing 

and Differentiating Chest Pain. 

Mosby’s Nursing Consultant. 

St. Louis: Elsevier, Inc. April 2007. 

www.nursingconsult.com/das/stat/ 

view/69433923-2/cup. 

Bhudia SK, McCarthy PM, Kumpati 

GS, Helou J, Hoercher KJ, Rajeswaran 

J, Blackstone EH. 

Improved Outcomes After Aortic Valve Surgery 

for Chronic Aortic Regurgitation With 

Severe Left Ventricular Dysfunction. 

Journal of the American College of Cardiology. 

2007;49:1465-71 

Sharma MS, Hoercher KJ, 

Starling RC, Alster JM, Deglurkar I, 

Blackstone EH, Smedira NG. 

Seeing the Future: Strategic Decision 

Support for Heart Transplant. 

Journal of Heart and Lung Transplantation. 

2007;26(Supplement, February 2007):S209 

Magyer D, Smedira NG, Hoercher KJ, 

Navia JL, Mihaljevic T, Taylor DO, 

Starling RC, Gonzalez-Stawinski. 

Outcomes of Female Heart Transplant 

Recipients Bridged to Transplantation with 

a ventricular Assist Device. 

Journal of Heart and Lung Transplantation. 

2007;26(Supplement, February 2007):S89 

Smedira NG, Hoercher KJ, 

Feng J, Klingman L, Starling RC, 

Blackstone EH. 

Transplant Should Not Be Delayed While 

Awaiting Functional Recovery in Patients 

on Mechanical Circulatory Support. 

Journal of Thoracic and 

Cardiovascular Surgery. 

2007 (in press) 

Klein DG 

From Novice to Expert: Clinical Nurse 

Specialist Competencies 

Acute and Critical Care Clinical Nurse 

Specialist: Synergy for Best Practices 

Philadelphia, PA: Saunders (Elsevier); 2007. 

23

24 


AWARDS 

Nancy Albert, PhD, CCNS, CCRN, CNA 

Inductee, American College of 

Critical Care Medicine 

Society of Critical Care Medicine 

Nancy Latza, RN 

Certification 

Certified Registered Nurse Infusion 

(CRNI) examination 

Cheryl Switzer, MSN, RN, CPNP, CDE 

Kathy Bielek, BSN, RN, CPON 

Barbara Donaho Distinguished 

Leadership in Learning Award 

Kent State University 

Rose Vamos, ENA 

Class of 2007 Valedictorian 

Cleveland State University 

3RD ANNuAL NuRSINg ReSeARCH CONFeReNCe 

Nancy Albert, PhD, CCNS, CCRN, CNA 

Chair of the Science Sub-Committee for 

Advanced Heart Disease Taskforce 

Council of Cardiovascular Nursing of 

the American Heart Association 

Betty Ching, MSN, RN 

Secretary, Board of Trustees 

Heart Rhythm Society 

Betty Ching, MS, RN 

Invited Chair and Faculty 

28th Annual Scientific Session of 

the Heart Rhythm Society 

May 2007 | Denver, Colorado 

Susan Curtis, MSN, RN, CCRP 

Chair, Northeast Ohio Local Chapter 

The Society of Clinical Research Associates 

APPOINTMENTS 

Paul Egan, MS, RN 

Invited Faculty 

28th Annual Scientific Session of 

the Heart Rhythm Society 

May 2007 | Denver, Colorado 

Georgina Rodgers, BSN, RN, OCN 

Review Board Appointment 

Clinical Journal of Oncology Nursing 

Mary Schmeida, PhD, RN, MSN, CNS 

Chair, National Panel on 

Implementing Health Policy 

Midwest Political Science Association 

April 2007 

Cheryl Switzer, MSN, RN, CPNP, CDE 

Treasurer 

Pediatric Endocrinology Nursing Society 

Making Nursing Research a Reality: 

Perils and Practical Solutions 

Leah Curtin, DSc, RN, clinical professor 

of nursing at the university of Cincinnati 

College of Nursing and Health, set the 

tone for the 3rd annual Nursing Research 

Conference May 10 with her keynote 

address, “The Metaphysics of Health 

and Disease.” 

The purpose of the Department of Nursing 

Innovation and Research’s conference was to 

encourage and inspire registered nurses to par- 

ticipate in meaningful research. Curtin’s lively 

review of recent studies on the relationship of 

social, demographic and psychological factors 

to health and disease provided fertile ground for 

new research. 

“Research in this field, dating back to the 1970s, 

demonstrates that social conditions determine 

an individual’s risk of disease and that an 

individual’s early life determines future health 

events,” Curtin explained. 

She traced the history of this concept by citing 

famous studies from each decade of research, 

including several recent papers that link early 

childhood nutrition and sensory stimulation to 

an individual’s ability to cope with stress and, 

ultimately, to adult health status. 

“Childhood influences determine coping skills, 

and early deficits cannot be overcome,” Curtin 

stated. “Those who are lacking in nutrition and 

social stimulation early in life have a vulnerability 

to disease.” 

She concluded by challenging nurses to consider 

the questions of what creates a healthy population 

and where health funding should be spent. 

“Knowing the impact of nutrition, low stress and 

social support on future health or illness, overlaid 

with the need to create a healthier population, 

we have to ask these questions,” Curtin 

stressed. “The opportunities for further research 

in this area are tremendous.” 


Nurse of Note 

Debra Albert, RN, MBA, CNAA, believes in making 

the most of the professional opportunities that come 

her way. This attitude has been the impetus for her 

evolving career at Cleveland Clinic during the past 

20-plus years, and helped her progress from bedside 

nursing as a new graduate to her present position as 

Associate Chief Nursing Officer. 

As her own career path exemplifies, “Cleveland Clinic is a 

great organization where you can always count on new op- 

portunities,” Albert says. “We are always changing, leading 

to new and exciting opportunities for nurses at every level 

throughout the organization.” 

Mentoring Helped Her Move Forward 

Albert began at Cleveland Clinic as a BSN student from 

The University of Akron in 1986. She worked as an aid and 

then as a staff nurse on the internal medicine and geriatric 

unit for five years. In 1991, 

Albert’s nurse manager 

quote 

encouraged her to consider a 

promotion to assistant nurse 

manager and then mentored 

Albert for two years. 

Mentoring relationships like 

those she has experienced 

in her own career are an important 

element of nursing at 

Cleveland Clinic, Albert notes. “I personally owe my success 

to good nurse mentors, and we have many of them here. I tell 

nurses not to be afraid to reach out for help,” she says. “I stand 

on the shoulders of my predecessors, and hopefully, new 

nurse leaders will stand on mine.” 

After two years as an assistant nurse manager, Albert moved 

up to a position as nurse manager for Inpatient Rehabilitation 

and the Epilepsy Monitoring Unit. Coinciding with her 

promotion, she enrolled in a master’s of business administration 

program to expand her knowledge of the business side of 

healthcare. She completed her degree in 1997. 

A Career-Changing Opportunity 

In 1996 Albert was promoted to director of neuroscience and 

rehabilitation nursing, adding the neurology and neurosurgery 

units to her responsibilities. Without prior experience 

in the neurosciences, Albert says she was challenged daily to 

learn and expand her skill set. 

Debra Albert, RN, MBA, CNAA 

“We are always changing, leading to new 

and exciting opportunities for nurses at 

every level throughout the organization.” 

– Debra Albert, RN, MBA, CNAA 

“Early on, I had to prove myself to physicians who questioned 

my ability but who gradually came to respect me as a peer,” 

she comments. “Ultimately, this was probably the position in 

which I grew the most, personally and professionally.” 

Albert was named Director of Surgical and Post-Acute Care 

Nursing in 1998, followed by a promotion in 2000 to Vice Presi- 

dent for Nursing-Chief Nursing Executive at Euclid Hospital, 

an affiliate within the Cleveland Clinic Health System. 

This was a significant change, 

offering a different perspec- 

tive on nursing, Albert reflects. 

“It was a chance to see another 

facet of nursing where patient 

acuity and focus was different 

than here at main campus.” 

An Offer She Couldn’t Refuse 

When Chief Nursing Officer 

Claire Young, RN, MSN, MBA, called in January 2006 to recruit 

Albert to her current position, “I couldn’t refuse,” Albert says. 

“It was coming home. I grew up here personally and profession- 

ally, and I couldn’t turn it down.” 

Now pursuing a master’s degree in nursing, Albert balances 

her professional career, education and a family that includes a 

husband and two young sons. On all fronts, “I’m always thinking 

about what’s next, what can I do better,” she says. 

The same desire to look to the future also infuses Cleveland 

Clinic, Albert says, and is one of the reasons she has found 

great satisfaction here. “This is a place where everyone is motivated 

to constantly improve and strive to discover how we can 

provide better patient care.” 

“If an individual wants a place to grow, this is it,” she says. “Anyone 

with a passion for nursing can accomplish great things here.” 

E-mail comments to albertd@ccf.org. 

25

Your Destination for Nursing Practice 

Save the Date: September 29, 2007 

Nursing Open House 

10 a.m. – 2 p.m. 

Cleveland Clinic Lerner Research Institute 

First Floor Commons Area 

Find your perfect match at Cleveland Clinic, and create the 

kind of nursing career that best suits your interests and needs. 

By attending our open house, you can: 

• Meet our leadership team and nursing staff 

• Interview with our nurse managers 

• Tour our exceptional facilities 

• Apply online for available positions 

To learn more about nursing opportunities or to register 

online, visit clevelandclinic.org/nursing. 

10th Annual Innovations in 

Neuroscience Nursing Conference 

October 4-6 

Intercontinental Hotel and 

Bank of America Conference Center 

Cleveland, Ohio 

For information or to register, visit clevelandclinic.org/nursing 

9th Annual Pain Management 

Conference for Nurses and Allied 

Healthcare Professionals 

October 6 

Executive Caterers at Landerhaven 

Mayfield Heights, Ohio 

For more information, visit clevelandclinic.org/painmanagement 

The Cleveland Clinic Foundation 

9500 euclid Avenue / W14 

Cleveland, OH 44195 

Weekend Immersion 

in Nursing Informatics 

October 26-27 

Cleveland Clinic Lyndhurst Campus 

Lyndhurst, Ohio 

To register, contact Stephanie Vargo at 216.445.4010 

or vargos2@ccf.org 

Dimensions in Cardiac Care 

March 9-11, 2008 

Intercontinental Hotel and 

Bank of America Conference Center 

Cleveland, Ohio 

For more information, contact Kathy Hill at hillk4@ccf.org 

Heart and Vascular 

Institute Nursing Internship 

Cleveland Clinic has created an internship program 

specifically designed to develop new graduates into the finest 

cardiac nurses in the nation. 

As an intern in one of the three areas offered – cardiothoracic, 

cardiac or transplant – you will work alongside some of the 

best nurses and physicians in the country and will be able to 

work with state-of-the-art therapies and treatments for a variety 

of severe heart-related conditions. 

Don’t miss out on this excellent opportunity to train in the 

nation’s leading hospital for cardiac care. Applications are 

available online at clevelandclinic.org/nursing and will be accepted 

through April 2008. For more information, please call 

216.297.7704.

Notable Nursing - Cleveland Clinic

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