Notable Nursing - Cleveland Clinic
Notable Nursing - Cleveland Clinic
Notable Nursing - Cleveland Clinic
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<strong>Notable</strong> <strong>Nursing</strong><br />
A Publication For Nurses By Nurses | Fall 2007<br />
Feature Story<br />
Facing the Crisis:<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Takes Practical and Proactive<br />
Steps to Tackle the <strong>Nursing</strong> Shortage – p. 04<br />
Also Inside<br />
Profiles of <strong>Nursing</strong> Success – p. 01<br />
Studying Nighttime Noise and Patient<br />
Satisfaction – p. 08<br />
Can Nurses Decrease Length of Stay<br />
after Cardiac Surgery? – p. 09
From the<br />
Chief <strong>Nursing</strong> Officer<br />
As you read this issue of <strong>Notable</strong> <strong>Nursing</strong>, you<br />
will see the word “opportunity” used many times<br />
in different contexts. I think that typifies nursing<br />
at <strong>Cleveland</strong> <strong>Clinic</strong> – a wealth of opportunities for<br />
employment, for learning, for personal and professional<br />
growth, for advancement. The opportunities<br />
in all those areas have never been greater at<br />
<strong>Cleveland</strong> <strong>Clinic</strong>.<br />
On the employment front, the planned fall 2008<br />
opening of the 250-bed Sydell and Arnold Miller<br />
Family Pavilion for the <strong>Cleveland</strong> <strong>Clinic</strong> Heart and<br />
Vascular Institute means that we are preparing to<br />
significantly expand our nursing staff. We are excited<br />
about the opportunity this presents for bedside<br />
nurses, nurse managers and advanced practice<br />
nurses to work in a state-of-the-art environment<br />
at the leading heart center in the country.<br />
By recruiting excellent nurses in all areas and<br />
helping them to grow in their careers here, we can<br />
build a solid nursing organization with a high level<br />
of knowledge capital. To support this goal, we offer<br />
phenomenal resources for career support and advancement,<br />
from new-hire support groups to career<br />
coaches, to preceptors and specialized orientations.<br />
Our new nursing clinical simulation lab, a replicated<br />
patient unit for hands-on learning and continuing<br />
education, is the latest example of the exceptional<br />
resources available here.<br />
This is a dynamic time for nursing at <strong>Cleveland</strong> <strong>Clinic</strong><br />
as we grow in number, knowledge and opportunities.<br />
Whether you are an experienced nurse or a new<br />
graduate, we invite you to be part of it.<br />
Sincerely,<br />
Claire Young, MSN, MBA, RN<br />
ChiEF NuRSiNg oFFiCER<br />
Table of Contents<br />
p.04 Cover Story: Facing the<br />
<strong>Nursing</strong> Shortage<br />
p.08 Studying Nighttime Noise<br />
in hospitals<br />
p.09 Can We Decrease Length of<br />
Stay after Cardiac Surgery?<br />
p.10 Urology/Gynecology Conference<br />
p. 14 Orthopaedics Conference<br />
p. 18 Cardiac Care Conference<br />
p. 22 <strong>Nursing</strong> News<br />
p. 24 <strong>Nursing</strong> Research Conference<br />
p. 25 Nurse of Note<br />
Executive Editor<br />
Michelle Dumpe, PhD, MS, RN<br />
E-mail comments about <strong>Notable</strong><br />
<strong>Nursing</strong> to dumpem@ccf.org<br />
Editorial Board<br />
Claire Young, MSN, MBA, RN<br />
ChiEF NuRSiNg oFFiCER<br />
Mary Beth Modic, MSN, RN, CNS<br />
DiABETES AND PATiENT EDuCATioN<br />
Claudia Straub, MSN, RN, BC<br />
NuRSiNg EDuCATioN<br />
Robbi Cwynar, BSN, RNC<br />
ThoRACiC & CARDiovASCulAR SuRgERy<br />
Nancy Albert, PhD, RN, CCNS<br />
NuRSiNg RESEARCh<br />
Christina Canfield, MSN, RN, CNS<br />
MEDiCiNE<br />
Deborah Solomon, MSN, RN, CNS<br />
SuRgERy<br />
Barbara Reece, MSN, RN<br />
DiRECToR, MEDiCiNE AND BEhAvioRAl hEAlTh<br />
Christine Harrell<br />
MANAgiNg EDiToR<br />
Michael Viars<br />
ART DiRECToR<br />
Deborah Durbin<br />
MARkETiNg MANAgER<br />
To add yourself or someone else to the mailing list,<br />
change your address or subscribe to the electronic form<br />
of this newsletter, visit clevelandclinic.org/nursing.<br />
<strong>Notable</strong> <strong>Nursing</strong> Fall 2007<br />
Profiles of Success<br />
Four <strong>Cleveland</strong> <strong>Clinic</strong> nurses who cultivated their own paths to career satisfaction<br />
No matter what their level of experience, nurses who join <strong>Cleveland</strong> <strong>Clinic</strong> can expect plenty of opportunities for<br />
advancement early in their careers. Some of those who have prospered in their profession began here as summer<br />
nurse associates or patient care nursing assistants during college. They worked alongside veterans who taught<br />
them about tending to patients’ needs and listening to their stories.<br />
By graduation, many aspiring nurses already know <strong>Cleveland</strong> <strong>Clinic</strong> is where they want to be. And when<br />
graduate school beckons, the hospital encourages nurses to continue working while pursuing their studies.<br />
This reinforces the desire to stay and carve out fulfilling long-term careers. Here are the stories of a few<br />
nurses who have utilized their opportunities at <strong>Cleveland</strong> <strong>Clinic</strong> to cultivate satisfying careers.<br />
Christina Canfield, MSN, CNS | Age 31<br />
<strong>Clinic</strong>al Nurse Specialist, Department of <strong>Nursing</strong> Education<br />
and Professional Practice Development<br />
Education: BSN, kent State university, 2000; MSN/CNS,<br />
Kent State University, 2006; certified by the American<br />
Nurses Credentialing Center as an adult medical-surgical<br />
clinical nurse specialist<br />
When and why did you decide to become a nurse?<br />
I decided to become a nurse after weighing the benefits and<br />
disadvantages of several career options. I had considered<br />
majoring in education, physical therapy and pharmacy, in<br />
addition to nursing. I chose nursing because it was the best<br />
way to combine the best aspects of each profession.<br />
First job/unit assignment at <strong>Cleveland</strong> <strong>Clinic</strong>: My first<br />
position at <strong>Cleveland</strong> <strong>Clinic</strong> was as a patient care nursing<br />
assistant on g81 (internal medicine/otorhinolaryngology/pulmonary).<br />
I was hired into this position before I graduated.<br />
Describe your path from that first job to where you are<br />
now. I moved from PCNA to registered nurse when I<br />
graduated and passed my boards. i spent about 2½ years<br />
as a staff nurse on G81, learning to care for patients with<br />
complex head and neck surgeries and those who had difficulty<br />
weaning from mechanical ventilation. I served as a<br />
preceptor for new nurses, as a unit-based skin care nurse<br />
and a geriatric resource nurse.<br />
I have always been interested in teaching and, in September<br />
2002, I became a clinical instructor responsible for<br />
coordinating orientation, teaching classes and providing<br />
in-service and continuing education.<br />
in July 2004, my supervisor created a position called the<br />
“clinical nurse specialist intern,” in response to a relative<br />
shortage of clinical nurse specialists. I attended graduate<br />
school while continuing to work, assuming more and more<br />
CNS duties. When i graduated in May 2006, i assumed<br />
full CNS responsibilities for two internal medicine units.<br />
One of the units I cover is where I began my career. The<br />
specialized knowledge I gained there has served me well<br />
throughout the years.<br />
Greatest accomplishment as a nurse: Attending graduate<br />
school and becoming licensed as a clinical nurse<br />
specialist. in my current position, i serve as a clinical<br />
expert and resource.<br />
What do you hope to achieve in the next few years?<br />
To successfully complete a nursing research project that<br />
impacts how we provide patient care. I would like to<br />
publish or present the results.<br />
How do you balance work, family and other leisure time?<br />
I have a very supportive family. They were willing to sacrifice<br />
a lot while I was in school, and they went the extra mile to<br />
make sure things ran smoothly while I juggled other responsibilities.<br />
I work with a lot of amazing people, and I’m happy<br />
to say they’re my friends both at work and outside of work.<br />
What helps you manage stress after a hectic day or week<br />
at work? I often take time during my commute home to<br />
reflect on the day’s events. I try to pick at least one thing<br />
that went very well and one thing I learned each day. In an<br />
institution like <strong>Cleveland</strong> <strong>Clinic</strong>, there’s always something.<br />
Focusing on these things keeps me going.<br />
1
2<br />
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
Lauren Mattern RN, BSN | Age: 25<br />
<strong>Clinic</strong>al Instructor, Department of <strong>Nursing</strong> Education and<br />
Professional Practice Development<br />
Education: BSN, Case Western Reserve university, 2004<br />
When and why did you decide to become a nurse?<br />
My mother, a pediatric nurse, told wonderful stories about<br />
caring for children and their families. I never realized how<br />
much a nurse could impact someone’s life until one day, as I<br />
was shopping with my mother, I witnessed a patient’s family<br />
member make a point to stop and thank my mother. it made<br />
me smile and realize that I wanted to have that same feeling<br />
of accomplishment that comes from caring for others.<br />
First job/unit assignment at <strong>Cleveland</strong> <strong>Clinic</strong>: i started as<br />
a nurse associate on G91, cardiology step-down, in 2003.<br />
Describe your path from that job to where you are now.<br />
I worked the summer before my senior year of college and<br />
continued throughout the school year, following a nurse and<br />
developing clinical skills. After graduation, I joined <strong>Cleveland</strong><br />
<strong>Clinic</strong> full time as a registered nurse on the same unit<br />
and provided care to step-down patients at the bedside.<br />
In 2007, after 2½ years as a staff nurse, I became a clinical<br />
instructor in the Department of <strong>Nursing</strong> Education and<br />
Barbara Reece, RN, MSN | Age: 55<br />
Director of <strong>Nursing</strong>, Medicine<br />
and Behavioral Services<br />
Education: AND, Kettering College of Medical Arts, 1975;<br />
BSN, University of San Diego, 1987; MSN, Case Western<br />
Reserve university, 1989<br />
When and why did you decide to become a nurse? in<br />
high school, after working as a candy striper and then as<br />
a nursing assistant. Prior to this, I had always wanted to<br />
be a kindergarten teacher.<br />
First job/unit assignment at <strong>Cleveland</strong> <strong>Clinic</strong>: i started<br />
in 1975 as a staff nurse on a GI unit. After one month,<br />
the nurse manager let me transfer to psychiatry. I had<br />
been assigned to the psychiatric unit when I was a nursing<br />
assistant and became “hooked.”<br />
Describe your path from that job to where you are now.<br />
After two years as a staff nurse, an assistant nurse manager<br />
position opened on the child/adolescent psychiatry unit.<br />
Two years later, the nurse manager position became available.<br />
I was in that position for five years. In 1984, I went<br />
back to school for my BSN. After graduating, I returned to<br />
<strong>Cleveland</strong> and entered graduate school to become a clinical<br />
nurse specialist in adult psychiatric/mental health nursing.<br />
While in graduate school full time, I worked in <strong>Cleveland</strong><br />
<strong>Clinic</strong>’s weekender program.<br />
Professional Practice Development. I teach basic dysrhythmia<br />
and critical care to nurses in orientation and provide<br />
staff members with continuing education.<br />
Greatest accomplishment as a nurse: having a patient ask<br />
for you by name. It is truly amazing how much trust and<br />
faith a patient has in a nurse. When this happened the first<br />
time, I realized how rewarding it is to be a nurse.<br />
What do you hope to achieve in the next few years?<br />
My goal for the coming years is to continue to provide our<br />
caregivers with the best possible education so they, in turn,<br />
provide our patients with the best possible care. To achieve<br />
that goal, i also plan on exploring educational options.<br />
How do you balance work, family and other leisure time?<br />
Carefully. It is often difficult to balance your career and your<br />
life. Planning and setting a schedule has been the best way.<br />
What helps you manage stress after a hectic day or week<br />
at work? i enjoy scrapbooking, baking and spending time<br />
with my family.<br />
(After obtaining her MSN, she held two jobs elsewhere before<br />
“coming home” to <strong>Cleveland</strong> <strong>Clinic</strong> years later as manager<br />
of behavioral services.) Within two years, the nursing<br />
division re-organized, and my position was upgraded. In<br />
2005, I became director of medicine nursing, and I have<br />
managed both areas since then.<br />
What do you hope to achieve in the next few years? i hope<br />
to complete a coaching program and develop formalized<br />
mentoring for nurse managers and assistant nurse managers<br />
in leadership skills, specifically human resource management.<br />
Nurses become clinical experts, but there isn’t as<br />
much emphasis on how to deal with people, especially in<br />
difficult situations.<br />
How do you balance work, family and other leisure time?<br />
My great nieces keep me energized and full of joy. Gardening<br />
is such a grounding activity. My sister and i plant a major<br />
vegetable garden each year. I love to read journals and fiction<br />
and try to leave large blocks of time on weekends to read.<br />
What helps you manage stress after a hectic day or week<br />
at work? i go home, eat a leisurely dinner and read the<br />
paper. i also love to sleep and make sure i get enough sleep<br />
to adequately do my job.<br />
clevelandclinic.org/nursing Fall 2007<br />
quote<br />
Rachael Lynn Taggart, RN, BSN | Age: 25<br />
Registered Nurse, Heart Failure Intensive<br />
Care Unit (H22)<br />
Education: BSN, The University of Toledo/ Medical University<br />
of Ohio (consortium program), 2004; Sigma Theta Tau<br />
(nursing honor society); ACLS-certified<br />
When and why did you decide to become a nurse? My<br />
freshman year of college. It was very spur of the moment. I<br />
had wanted to concentrate on exercise physiology, but then<br />
decided on something more “people-oriented.” Struggling<br />
in chemistry class for that major, I was mortified at my<br />
grade despite my best efforts. A young lady in my dorm<br />
talked about how much she loved her nursing classes and<br />
how great her professors were. So, I told the nursing college<br />
counselor that I wanted to be a nurse. That was that.<br />
Looking back, that day was a major turning point. Both my<br />
grandmothers were registered nurses and very influential in<br />
my decision. One of them is still practicing.<br />
First job/unit assignment at <strong>Cleveland</strong> <strong>Clinic</strong>: With one<br />
year left in school, I was accepted into the nurse associate<br />
summer program. For 12 weeks, I worked side by side<br />
with the nurses (on M72/palliative care and pain management).<br />
I had been in a hospital only once before, with my<br />
grandmother on Take your Daughter to Work Day. When<br />
the program ended, management offered me a position for<br />
the rest of the summer as a patient care nursing assistant.<br />
I worked as needed on holiday breaks and long weekends<br />
during my senior year.<br />
Several wonderful, very experienced nurses on that floor<br />
taught me so much about life, death, and everything else<br />
in between. I worked with Dyanne Thomas most often, and<br />
she always exceeded my expectations and patient expectations.<br />
She is one of those nurses who you would think has<br />
“seen it all” and dealt with it gracefully. She made me feel<br />
like I was born to do the job. She was funny, serious, soft<br />
and firm when she needed to be. I also fell in love with the<br />
patients and their stories. My career would not be the same<br />
had I not worked on that floor.<br />
“Several wonderful, very experienced nurses on<br />
that floor taught me so much about life, death,<br />
and everything else in between.”<br />
– Rachael Lynn Taggart, RN, BSN<br />
Describe your path from that job to where you are now.<br />
After I graduated, I wanted to stay on M72. I was told by<br />
management that, while they liked me very much, they<br />
were not hiring new graduates. I was devastated. But I “got<br />
gutsy” and decided i might like the iCu. i had heard about<br />
H22 (heart failure intensive care unit). They were hiring<br />
new grads. I shadowed one day and loved it.<br />
Greatest accomplishment as a nurse: Being selected as<br />
“Nurse of the Year.” Also, I recently went to preceptor class<br />
and oriented my first new grad nurse for H22. Lastly, I took<br />
care of a man for several weeks who was very sick and on<br />
the transplant list. he ended up getting a heart and going<br />
for surgery on one of my night shifts. Just the other day, he<br />
walked back into our unit looking handsome, healthy and<br />
having had great biopsy results. I was so proud!<br />
What do you hope to achieve in the next few years?<br />
To take CCRN classes and get that certification, and maybe<br />
a master’s degree so I can teach nursing someday.<br />
How do you balance work, family and other leisure time?<br />
It is difficult sometimes, working rotating shifts – two<br />
weeks of days and two weeks of nights. Immediate family<br />
and friends have my work schedule, and I keep track of<br />
theirs. We end up doing things whenever I can. Working<br />
three 12-hour shifts each week and two weekends per<br />
month leaves room for mini-vacations and road trips. I<br />
play a lot of phone tag, listen to voice mail and send emails<br />
to keep in touch.<br />
What helps you manage stress after a hectic day or week<br />
at work? I recently bought my first house, so I have been<br />
doing yard work and gardening. I love going to the beach or<br />
a park and walking or rollerblading. I have a YMCA membership<br />
for exercising when the weather is cold or rainy. I<br />
also enjoy massages and fizzing foot scrub.<br />
3
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
Facing the Crisis:<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Takes Practical and Proactive Steps to Tackle the <strong>Nursing</strong> Shortage<br />
The U.S. Bureau of Labor Statistics projects the current nurs-<br />
ing shortage to reach 800,000 by 2020. As a 1,000-bed tertiary<br />
care medical center, <strong>Cleveland</strong> <strong>Clinic</strong> constantly faces the<br />
challenges of recruiting and retaining qualified nurses at all<br />
levels. Add to that staffing requirements for the new 288–bed<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Heart and Vascular Institute facility, scheduled<br />
to open in fall 2008 (see The New Heart of <strong>Cleveland</strong><br />
<strong>Clinic</strong>, Page 7), and you have a nursing shortage issue that has<br />
elevated to top priority for the institution, according to Chief<br />
<strong>Nursing</strong> Officer Claire Young, RN, MSN, MBA.<br />
Retention is a two-fold challenge, Young says. “One element<br />
is attracting and hiring the right people, and the second is<br />
retaining the high-quality people whom we hire.”<br />
To address these needs and develop strategies for more effective<br />
recruitment and retention, the <strong>Cleveland</strong> <strong>Clinic</strong> Division<br />
of <strong>Nursing</strong> held a Retention Summit last fall. As a result of that<br />
meeting, at least 10 new projects related to hiring and retention<br />
are in various stages of implementation.<br />
In the face of a national nursing shortage, <strong>Cleveland</strong> <strong>Clinic</strong> is<br />
addressing nurse hiring and retention from every angle and is constantly<br />
exploring innovative approaches to maintaining the highest<br />
quality nursing staff. The issue has become even more significant<br />
as <strong>Cleveland</strong> <strong>Clinic</strong> prepares for a major expansion next year.<br />
Effectively Recruiting the Best<br />
Attendees at the summit agreed that the key to retaining<br />
nurses is the interviewing and hiring process, says Lois Bock,<br />
RN, BS, Director of Nurse Recruitment. “Our goal is to place<br />
nurses in an environment where they will succeed,” she says.<br />
“We do this by matching their career interests and goals with<br />
the right position for each individual.”<br />
The all-RN nurse recruitment team at <strong>Cleveland</strong> <strong>Clinic</strong> goes<br />
beyond the usual hiring practices and processes to achieve<br />
this perfect match. The team has found that career assessment<br />
and coaching to assist potential hires in determining<br />
their best job fit are essential to successful hiring and contribute<br />
significantly to retention, Bock says.<br />
Job applicants who are undecided as to where their interests<br />
lie are matched with a recruiter who will assist them through<br />
the hiring process, she explained. As part of that process, applicants<br />
are encouraged to job shadow. “By following a nurse<br />
on the floor for an hour or more, the applicant experiences the<br />
work flow and pace and the unit’s environment,” she explains.<br />
clevelandclinic.org/nursing Fall 2007<br />
Shadowing exposes potential hires to the ways in which<br />
<strong>Cleveland</strong> <strong>Clinic</strong> nursing differs from clinical rotations during<br />
nursing school, Young says. “<strong>Cleveland</strong> <strong>Clinic</strong> is a unique<br />
place in its pace and patient acuity, and the better a nurse<br />
understands that going in, the higher the chance that he or<br />
she will be happy here and stay.”<br />
An Innovative Partnership with Area <strong>Nursing</strong> Schools<br />
Recognizing that a shortage of nursing faculty to train new<br />
nurses underlies the nursing shortage, the division started a<br />
Deans’ Roundtable Faculty Initiative in 2005 with the deans of<br />
area nursing schools to discuss this aspect of the problem.<br />
Through the initiative, 275 <strong>Cleveland</strong> <strong>Clinic</strong> nurses were<br />
identified as potential faculty members and a Web site was<br />
developed that matches these nurses with available teaching<br />
opportunities at participating schools. Nurses who are<br />
interested in teaching log on to the Web site and submit a<br />
professional profile, and participating nursing schools post<br />
course profiles for which they are seeking faculty on the Web<br />
site. The Web site compares applicants and positions and<br />
assigns matches.<br />
The Deans’ Roundtable Faculty Initiative also provides<br />
ongoing support through a series of educational offerings,<br />
including one-day faculty development programs, continuing<br />
nursing education programs and quarterly newsletters that<br />
prepare potential faculty to become nurse educators.<br />
The initiative also helps <strong>Cleveland</strong> <strong>Clinic</strong> in its ambitious<br />
efforts to recruit new nursing graduates.<br />
“We now are partnering with area nursing schools to let their<br />
graduates know that our arms are wide open to them and that<br />
we have all the tools to support them throughout their career<br />
at <strong>Cleveland</strong> <strong>Clinic</strong>,” Young says.<br />
<strong>Cleveland</strong> <strong>Clinic</strong>’s student loan assistance is one tool that<br />
new graduates may find very attractive. Through this program,<br />
<strong>Cleveland</strong> <strong>Clinic</strong> will pay up to $10,000 in student loans for<br />
nurses who qualify. In return, the nurse makes an employment<br />
commitment to <strong>Cleveland</strong> <strong>Clinic</strong>.<br />
To woo new graduates from farther away, <strong>Cleveland</strong> <strong>Clinic</strong><br />
offers a weekend visitation option. At these once-monthly<br />
sessions, graduating nursing students who live more than 75<br />
miles away visit <strong>Cleveland</strong> <strong>Clinic</strong> on a Saturday for a question<br />
and answer luncheon, a campus tour, an interview and a shadowing<br />
experience. Participants enjoy complimentary dinner,<br />
parking and an overnight stay in a hotel.<br />
“Although the weekend program represents a major commitment<br />
on our part, it has been highly successful,” Bock says.<br />
“The hiring ratio from these events is about 80 percent, so it is<br />
well worth our while.”<br />
Helping Newly Hired Nurses Adjust<br />
As a result of the Retention Summit, the Division of <strong>Nursing</strong><br />
has enhanced its welcoming and orientation for newly hired<br />
nurses. Once a new hire is on board, every effort is expended<br />
to help him or her feel welcome and part of the team, beyond<br />
the formal orientation that all new <strong>Cleveland</strong> <strong>Clinic</strong> employees<br />
go through.<br />
The focus is on personalizing the experience to meet the<br />
new hire’s needs based on his or her education and experience.<br />
“Every new hire is matched with a Primary Preceptor, an experienced<br />
nurse who serves as a career resource, a listening ear and<br />
a sounding board,” explains Carol Santalucia, MBA, Director of<br />
<strong>Nursing</strong> World-Class Service. Additional unit-based preceptors<br />
also assist the new nurse through clinical orientation, which<br />
focuses on clinical competence, patient care content expertise<br />
and socialization to the unit culture.<br />
On the social and personal side, new hires are invited to<br />
participate in informal support groups and quarterly division<br />
social events.<br />
Special Attention to Retention<br />
Attracting and hiring nurses is only one side of the equation<br />
for meeting staffing requirements, Young emphasizes.<br />
Keeping them is equally or more important, not only from<br />
the financial perspective because of the cost of hiring and<br />
training new employees, but also from a quality perspective,<br />
she says.<br />
“Retaining our nurses is essential to maintaining a consistent<br />
quality of care,” she says. “Retention gives us a constant, high<br />
level of knowledge capital at the bedside.”<br />
Retention is a complex issue, she added, particularly in the<br />
<strong>Cleveland</strong> <strong>Clinic</strong> environment, “where nurses experience<br />
physical, mental and emotional labor all at one time.”<br />
For many nurses, opportunities for professional growth and<br />
career advancement are important to their job satisfaction. By<br />
its structure as a large, multicenter health system, <strong>Cleveland</strong><br />
<strong>Clinic</strong> abounds with career opportunities.<br />
“We encourage nurses to move around if needed to find the<br />
position that is the right fit for them,” Young says. “<strong>Nursing</strong> at<br />
<strong>Cleveland</strong> <strong>Clinic</strong> is very diverse with many different types of opportunities.<br />
We don’t believe that one size fits all when it comes<br />
to nursing positions.” (For examples of nurses who have created<br />
rewarding career paths at <strong>Cleveland</strong> <strong>Clinic</strong>, see Page 1.)<br />
Another option for any registered nurse or licensed practical<br />
nurse who seeks more flexibility is <strong>Cleveland</strong> <strong>Clinic</strong> Agency<br />
Resources. This new <strong>Cleveland</strong> <strong>Clinic</strong> spin-off company is essentially<br />
a nursing temporary agency, except that nurses who sign on<br />
with the agency work exclusively for <strong>Cleveland</strong> <strong>Clinic</strong> hospitals.<br />
5
6<br />
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
Qualified nurses who are registered with the agency go<br />
online to check current temporary staffing needs, select the<br />
ones that fit their personal schedule and sign up to work<br />
those hours. “Nurses must be clinically qualified for the job<br />
and must commit to working at three facilities within the<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Health System,” Bock explains. “The agency<br />
gives nurses the flexibility they want and assures <strong>Cleveland</strong><br />
<strong>Clinic</strong> of a qualified pool of professionals to meet temporary<br />
staffing needs.”<br />
A State-of-the-Art Learning Center<br />
To support clinical learning and professional development,<br />
the Department of <strong>Nursing</strong> Education and Professional Practice<br />
Development recently opened a high-tech learning center<br />
that includes an eight-bed laboratory. The clinical simulation<br />
lab, funded by Hill-Rom Co., includes six patient beds in a<br />
standard patient care unit configuration, two intensive care<br />
beds and an infant intensive care crib.<br />
“Everything in the lab is real, except the patients,” says Michelle<br />
Dumpe, PhD, MS, RN, Associate Chief <strong>Nursing</strong> Officer, <strong>Nursing</strong><br />
Education and Professional Practice Development. “The lab is<br />
equipped with everything that a real patient unit or intensive<br />
care unit would have, including laptop computers for bedside<br />
charting, a crash cart and a supply room. All the equipment<br />
is operational.”<br />
Six of the beds are occupied by interactive simulator models<br />
that can have their vital signs taken realistically and can be<br />
moved and repositioned in the beds. The two models in the<br />
intensive care unit are fully programmable to simulate real-life<br />
critical care situations such as ventilation, cardiac monitoring<br />
or intravenous fluid delivery.<br />
The lab, fully operational by January 2008, will have multiple<br />
uses, Dumpe says. “We will be using it for continuing education<br />
for staff nurses to learn new techniques and technology,<br />
for clinical testing for job advancement and for validating a<br />
new hire’s hands-on skills during orientation. Particularly for<br />
new hires, the lab is one way to help bridge the gap between<br />
nursing school and the reality of clinical practice.” Interventions<br />
occurring in the lab will be videotaped for later review<br />
and discussion by the nurse and a preceptor, she added.<br />
The expanded <strong>Nursing</strong> Education and Professional Practice<br />
Development Department, which recently moved to new,<br />
totally redesigned quarters on the main campus, also includes<br />
a new 40-station computer center for online learning. Nurses<br />
now can enroll online for training, scheduling it at their convenience,<br />
and go to the computer center to take the course.<br />
Online offerings include in-service training as well as courses<br />
for personal development and career advancement, Dumpe<br />
said. “Our staff of more than 30 nurse educators is continually<br />
developing new classes for staff education,” she said. “It’s a<br />
part of <strong>Cleveland</strong> <strong>Clinic</strong>’s commitment to ongoing professional<br />
career education for our nurses.” It’s also a perfect complement<br />
to the new simulation lab, she added, allowing nurses<br />
to take the didactic portion of a course in the computer center<br />
and go through a clinical check-off in the lab.<br />
<strong>Nursing</strong> students in the computer lab of the Learning Center for <strong>Nursing</strong> Practice Excellence. Students receive instruction in the simulation lab.<br />
clevelandclinic.org/nursing Fall 2007<br />
quote<br />
“Our goal is never to turn away a qualified nurse. And once they are here, we<br />
want to support them in their personal and career goals in every way possible.”<br />
– Claire Young, RN, MSN, MBA, Chief <strong>Nursing</strong> Officer<br />
An Emphasis on Health, Wellness and Life Balance<br />
Also the result of the Retention Summit, the division has<br />
implemented a nursing wellness initiative that addresses the<br />
health of the mind, body and spirit through exercise programs,<br />
nutrition education and other wellness-focused opportunities.<br />
“At <strong>Cleveland</strong> <strong>Clinic</strong> we are passionate about patient advocacy<br />
and satisfaction,” Santalucia says. “The best way to achieve<br />
that is by taking care of our employees.”<br />
The Parent Shift Program, an innovative scheduling approach,<br />
is another example of how <strong>Cleveland</strong> <strong>Clinic</strong> is trying to meet<br />
nurses’ personal needs in addition to their professional needs.<br />
Introduced three years ago, this popular scheduling option<br />
is designed for parents or caregivers who need to be home in<br />
the early morning and late afternoon but have several hours<br />
available in the middle of the day to work. The Parent Shift<br />
Program lets nurses work the mid-day hours without requiring<br />
a commitment to a complete shift, making it ideal for nurses<br />
with family responsibilities.<br />
Career Options Abound for Veteran Nurses Too<br />
Some senior nurses want to stay in bedside nursing, but for<br />
those who are seeking other choices, the Division of <strong>Nursing</strong><br />
has created a range of nursing positions that are less stressful<br />
and intense. Positions such as Admitting Nurse give <strong>Cleveland</strong><br />
<strong>Clinic</strong> and its patients the benefit of the experience and knowledge<br />
of senior nurses while satisfying the nurses’ desire for a<br />
less-intensive work situation still within nursing.<br />
Senior nurses also enjoy priority scheduling and opportunities<br />
to become instructors and preceptors. “Senior nurses are<br />
foundational to building a solid nursing organization,” Young<br />
said. “It’s very important that we keep these employees in<br />
whom we have put our faith and trust.”<br />
E-mail comments to youngc@ccf.org, dumpem@ccf.org, bockl@ccf.org and santalc@ccf.org.<br />
The New Heart<br />
of <strong>Cleveland</strong> <strong>Clinic</strong><br />
Construction is under way for a new<br />
Heart and Vascular Institute facility at<br />
<strong>Cleveland</strong> <strong>Clinic</strong>. Scheduled to open in<br />
2008, the new 10-story hospital tower and<br />
technology center will provide a comprehensive<br />
model of care where patient care,<br />
research and education are offered in one<br />
location. Features include:<br />
• Outpatient diagnostic facilities<br />
including 115 exam rooms and 170<br />
physician offices<br />
• Technology building for complex<br />
and highly technical procedures<br />
• Inpatient facilities featuring 288<br />
(mostly private) hospital beds<br />
• Fully-equipped conference center<br />
For more information regarding the new<br />
Heart and Vascular Institute facility, visit<br />
clevelandclinic.org/heartcenter. To learn<br />
more about nursing opportunities, visit<br />
clevelandclinic.org/jobs/nursing.htm.<br />
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8<br />
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
Studying Nighttime Noise and Patient Satisfaction<br />
A bright idea came to mind after many patients at<br />
<strong>Cleveland</strong> <strong>Clinic</strong> had told Terri Murray, RN, BSN,<br />
about nighttime noise disrupting their sleep:<br />
Let’s do a study.<br />
Murray and Jackie Spence, RN, nurse managers in the Heart<br />
and Vascular Institute’s cardiothoracic stepdown units, set out<br />
to explore if a correlation existed. They assessed patients’ perceptions<br />
of noise and impact on sleep and whether perception<br />
of noise is based on demographic or surgery variables (age,<br />
gender, medical history, surgical procedure type, etc.) instead<br />
of unit environment.<br />
It’s the first study of this kind, says Spence. “The literature<br />
search only found other studies that measured noise level<br />
ranges in decibels.”<br />
From January through May, the nurse managers surveyed a<br />
total of 150 randomly selected adult patients on three floors.<br />
The patients’ primary reason for hospital admission was postoperative<br />
recovery after coronary artery bypass graft and/or<br />
valve procedure.<br />
Exclusion criteria consisted of several elements: admission<br />
for a different reason; age less than 18 years; other surgery or<br />
medical condition; unwilling to give written informed consent<br />
to participate; unable to read or write English; mentally<br />
impaired close to discharge (when data are collected); or any<br />
psychiatric or psychological condition.<br />
After three nights in the unit, patients who qualified were<br />
asked to fill out a 24-item survey. This was designed to determine<br />
which factors tend to disrupt sleep and which are likely<br />
to promote relaxation between 11 p.m. and 6 a.m.<br />
The survey measured patients’ perceptions of average nighttime<br />
noise on the floors by showing evidence of 15 different<br />
factors, such as roommate snoring, nurses talking, and equipment<br />
moving in the hallway.<br />
A Likert-type scale first identified that the noise factor did<br />
indeed occur and then measured how often and severe it<br />
seemed. It also evaluated the extent to which it made falling<br />
asleep or staying asleep difficult.<br />
The survey also listed 10 sleep-promotion factors and asked<br />
patients if they benefited from any of them during their last<br />
two nights in trying to relax, sleep better, or block out noise.<br />
This included ear plugs, a CD player, television set, eye shields,<br />
medication, change of roommates, private room, room door<br />
closed, and nurses’ use of soft voices and making less noise.<br />
In addition, data collected in an ongoing registry of all open<br />
heart surgery cases will be used to determine if patient, medical<br />
condition or surgery variables influence patient perceptions<br />
of noise at night.<br />
Data will be analyzed using descriptive statistics, correlation<br />
statistics and differences between groups (high vs. low<br />
perceptions of nighttime noise).<br />
Once the final results are complete, Murray and Spence hope<br />
to publish their research.<br />
“Understanding relationships of variables that we cannot<br />
change (age, gender, ethnicity, medical background, etc),<br />
those we can change and patient’s perception of the environment<br />
as noisy can aid in planning to optimize sleep,”<br />
says Murray, “which may, in turn, improve overall patient<br />
satisfaction with the hospital experience.”<br />
E-mail comments to murrayt@ccf.org or spencej2@ccf.org.<br />
clevelandclinic.org/nursing Fall 2007<br />
Can Nurses Help Decrease a Patient’s<br />
Length of Stay after Cardiac Surgery?<br />
Study findings indicate it’s not likely<br />
Following a study of cardiac surgery patients, nurses at <strong>Cleveland</strong> <strong>Clinic</strong> concluded that bleeding,<br />
respiratory complications and/or the need for red blood cells after surgery delay the initiation of Coumadin, ®<br />
which prompts a longer stay for patients.<br />
Patients taking Coumadin ® after cardiac surgery stay three<br />
days longer in the hospital on average than those who do not,<br />
based on <strong>Cleveland</strong> <strong>Clinic</strong> registry data. But it was unclear<br />
why – and whether something could be done to intervene and<br />
alter hospital processes.<br />
Another unknown was whether nurses should focus attention<br />
on systems that prompt better post-discharge monitoring of<br />
clotting activity, so that patients could be sent home faster.<br />
“With this as our background, we set out to get some answers,”<br />
says Robbi Cwynar, RN, BSN, BC, <strong>Clinic</strong>al Manager of Thoracic<br />
and Cardiovascular Surgery.<br />
Cwynar and two colleagues – Nancy Albert, PhD, RN, CCNS,<br />
CCRN, CNA, Director of <strong>Nursing</strong> Research and Innovation,<br />
and Carol Hall, MSN, CNP, a nurse practitioner in Thoracic<br />
and Cardiovascular Surgery – recently conducted the study<br />
that entailed retrospective chart review of patients who underwent<br />
coronary artery bypass graft surgery or valve surgery at<br />
<strong>Cleveland</strong> <strong>Clinic</strong> in 2004.<br />
“I have been on the committee to look at length of stay and<br />
have been interested in length of stay for many years,” says<br />
Cwynar, a <strong>Cleveland</strong> <strong>Clinic</strong> nurse for 28 years.<br />
The nurses used an Institutional Review Board approved<br />
registry that contains data on all patients undergoing cardiac<br />
surgical procedures. For inclusion in the study, patients had to<br />
be receiving Coumadin® after surgery, but not beforehand, and<br />
their circumstances had to fit other requirements (e.g., a nonemergency<br />
surgical case and being younger than 85 years old).<br />
“Once we had a list of all cases that met inclusion criteria,<br />
we randomly selected cases for review, based on hospital<br />
length of stay,” Albert explains. “Patients were grouped as<br />
‘short length of stay,’ defined as seven days or less for isolated<br />
coronary artery bypass grafting (CABG) and nine days<br />
or less for valve surgery or combination CABG and valve<br />
surgery; or ‘long length of stay,’ defined as more than<br />
seven days after CABG or more than nine days after valve<br />
or combination surgery.”<br />
Of the 82 patients, 33 underwent isolated CABG and 49 had<br />
valve or combination procedures. There were few differences<br />
between the groups in demographics, medical history, common<br />
complications such as atrial fibrillation or adverse events,<br />
and use of angiotensin-converting enzyme (ACE) inhibitors<br />
and beta-blocker therapies.<br />
Patients with longer length of stay had bleeding complications<br />
that extended their days in intensive care and overall time in<br />
the hospital. They also tended to be older (mean age 73.5 years<br />
vs. 68.5 years). Patients with longer length of stay exhibited<br />
more post-operative respiratory insufficiency and were more<br />
likely to receive red blood cells. In addition, they had more<br />
consultations for other services (e.g., pulmonary medicine).<br />
As for Coumadin ® therapy, patients with longer length of stay<br />
had a greater time lapse between the surgery date and start of<br />
the medication. The nurses concluded that bleeding, respiratory<br />
complications and/or need for red blood cells after surgery<br />
delay the initiation of Coumadin ® . This, in turn, prompts<br />
a longer stay, increases costs of care, and postpones recovery<br />
or rehabilitation.<br />
“Ultimately, the factors that were found to lengthen hospital<br />
stay are not factors easily tweaked by nurses to change clinical<br />
outcomes,” Albert says. “We cannot control bleeding or respiratory<br />
complications that occur even with excellent post-operative<br />
management.”<br />
“And since so few patient variables were significant predictors<br />
of long length of stay,” she continued, “we cannot even create<br />
a risk score to determine who is at risk before surgery, and<br />
then try to be more vigilant in assessment and care delivery to<br />
prevent complications.”<br />
However, the findings offer valuable insight. They can help<br />
healthcare providers identify intensive care unit patients<br />
who develop bleeding or respiratory complications, so that<br />
discharge planning could be started sooner. For instance,<br />
clinicians could assess clotting time earlier, possibly initiate<br />
Coumadin® more quickly, and adjust dosing to achieve the<br />
target dose in less time.<br />
E-mail comments to cwynarr@ccf.org and albertn@ccf.org.<br />
9
3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe<br />
<strong>Cleveland</strong> <strong>Clinic</strong>’s 3rd annual urology/gynecology <strong>Nursing</strong> Conference was held April 21 at the<br />
InterContinental Hotel and Bank of America Conference Center on <strong>Cleveland</strong> <strong>Clinic</strong>’s main campus.<br />
The one-day conference was directed to nurses and other allied healthcare professionals. Topics<br />
included methods of prevention for HPV to eradicate cervical cancer; trends in treatment for benign<br />
prostatic hyperplasia; advances in treatment for urinary incontinence; conveying sensitive information<br />
to patients; and robotic surgery in urology.<br />
Course Co-Directors were: Susan Beam, RN, BSN; Brian Klein, RN, BSN, BA, CNOR; Janet ursinyi,<br />
RN; Michelle Suhy, RN, BSN, CuRN; Dorothy A. Calabrese, RN, MSN, CNP; Laurel Stevens, RN, BA;<br />
and Debra O’Connor, LPN.<br />
Breaking Bad News<br />
Kathleen Lupica, RN, MSN, CNP, CCRN<br />
Breaking bad news is part of our<br />
job; a learned skill that is well worth<br />
our time and effort.<br />
There are six key steps to breaking bad<br />
news, and the first is learning how to start.<br />
Setting is vital; you want to do it in person,<br />
in a calm, private place without distractions.<br />
It is up to the patient to determine<br />
who else should be present.<br />
The next step is finding out what the<br />
patient knows. Start with no assumptions,<br />
and let the patient tell you what<br />
he or she knows. Use vocabulary similar<br />
to the patient’s and pay attention to the<br />
patient’s body language.<br />
The third step is finding out what patients want to know. For example, ask if they’d<br />
like details or just main points about the tests that came back. Often your role is just<br />
to confirm what they already suspect.<br />
Fourth is sharing information in a therapeutic manner. It’s best to start by listening<br />
to their concerns and responding in a way that is truthful, positive and realistically<br />
hopeful. Pause often and let them speak. Ask if they understand and be ready to<br />
clarify or repeat facts. When asked for a timeline, use ballpark figures and explain<br />
that statistics provide only a range.<br />
Next, respond to their feelings. Tell them it’s OK to be angry. Offer a tissue if they<br />
cry and use therapeutic touch. Let them know that guilt is useless. Be sure not to<br />
provide premature reassurance; it’s OK to remain silent rather than promise what<br />
you can’t deliver.<br />
Lastly, after explaining the diagnosis, outline some treatment options, help create a<br />
possible plan and talk about what outcomes can be expected. Remind patients of the<br />
things that will help them cope – their family, their faith. Finally, give them a specific<br />
next step, such as the date of their follow-up visit and leave the door open to any<br />
questions they may think of later.<br />
E-mail comments to lupicak@ccf.org.<br />
Kathleen Lupica, RN, MSN, CNP, CCRN<br />
3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe<br />
11
3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe<br />
Robotics for Surgical Specialties<br />
georges-Pascal Haber, M.D. | Section of Laparoscopic and Robotic Surgery, glickman urological and Kidney Institute, <strong>Cleveland</strong> <strong>Clinic</strong><br />
Diana Baker, RN, BSN | <strong>Clinic</strong>al Coordinator, glickman urological and Kidney Institute, <strong>Cleveland</strong> <strong>Clinic</strong><br />
Though robots have had a hand in urological<br />
surgery since the early 1990s, their role continues<br />
to evolve in exciting ways.<br />
Earliest robots, such as the Aesop, were little more than static<br />
holders of laparoscopic cameras. Then newer features were<br />
added, such as infrared sensors that enabled some robots<br />
(endo assist) to move in synchrony with the surgeon’s hand.<br />
These earlier robots helped us see, but were still a limited<br />
preview of the life-like 3-D views we get from today’s devices.<br />
The da Vinci ® surgical robots used widely today first entered<br />
the OR in late 2000. They brought not only better visualization,<br />
but improved dexterity. Unlike older designs, these new<br />
instruments can operate at a 90-degree angle, enabling precise<br />
movements even within a tightly confined surgical field.<br />
The robots in clinical use today don’t provide tactile feedback<br />
to the surgeon, nor do they include various energy devices,<br />
such as laser tools.<br />
We are currently in the final stages of testing a laser tool for<br />
use in robotic prostatectomies and partial nephrectomies.<br />
The advantage of these lasers is that their beams can be<br />
tightly focused, reducing the amount of thermal damage<br />
and risk to nearby nerves.<br />
Diana Baker, RN, BSN<br />
Georges-Pascal Haber, M.D.<br />
However, even with better robots, the surgeon who sits at an<br />
operating console across the room from the patient needs<br />
skilled assistance. An assistant surgeon remains at the<br />
bedside providing manual suction and clipping, and a nurse<br />
performs several key roles, including troubleshooting and<br />
docking the robot.<br />
Aside from making the next generation of robots smaller<br />
and less expensive (current designs are over $1.2 million),<br />
engineers are working to equip them with ‘augmented virtual<br />
reality.’ These are GPS navigational systems that give precise<br />
feedback on the positions of each instrument. They also have a<br />
memory, allowing the surgeon to have an instrument return to<br />
any previous position.<br />
Further in the future are robotic devices that provide a surgeon<br />
with layered visualization and 3-D reconstructions of a tumor<br />
made from CT and MRI scans. Different colored zones are<br />
highlighted around the tumor providing a guide for optimal<br />
tumor removal.<br />
Developing a Personal Formula for Contentment<br />
Scott Bea, Psy.D. | <strong>Clinic</strong>al Psychologist, Department of Psychiatry and Psychology, <strong>Cleveland</strong> <strong>Clinic</strong><br />
Happiness is not a destination, but a journey: not<br />
something you achieve, but rather something you<br />
must continually work at.<br />
Yet, coming to this realization isn’t easy in a consumer-driven<br />
society where we’re indoctrinated into thinking that happiness is<br />
about having ‘stuff.’ We’re busier than ever before, and working<br />
more hours, so it’s hard to give relationships the time they need.<br />
Some of our unhappiness may also be a leftover from the<br />
conditioning of the early human brain. In order to survive,<br />
it had to stay focused on things that could kill us, no matter<br />
how nice the rest of our surroundings were. Anxiety was<br />
good; happiness a luxury. To overcome this history, we have<br />
to recondition how we see our environment.<br />
One step is to be a ‘gift giver’ – not of material things, but of<br />
your time, energy and attention. Another step is to complain<br />
less (70 percent of American conversations are characterized<br />
by complaint) and give compliments and praise more. Studies<br />
show that 16 instances of praise to every instance of criticism is<br />
an ideal ratio to keep people functioning well.<br />
A third is to be happier with who we are and not get caught<br />
up in the frustrating pursuit of trying to be like someone else.<br />
This requires us to be more aware of and take responsibility<br />
for what we really need and to not let others determine what<br />
is important.<br />
Forgiveness is another key step. We must understand that<br />
people come with a wide range of abilities, intelligence and<br />
other behavioral traits. We need to be more forgiving of others<br />
who may have less ability than ourselves.<br />
Like any good habit, learning to be happy takes practice. At<br />
bedtime each night, think of three good things you did that<br />
day. If you go to sleep with positive thoughts, you’ll sleep better<br />
and wake up more refreshed. In the morning, make a list<br />
of the five things you’re best at and during the day commit at<br />
least one random act of kindness.<br />
To reduce the impact of everyday worries, take 15 minutes<br />
each day to make a list of everything that’s worrying you. When<br />
you make the list daily, it trains your brain to under-respond to<br />
the worries, diluting their impact on your state of mind.<br />
3RD ANNuAL uROLOgY/gYNeCOLOgY NuRSINg CONFeReNCe
7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe<br />
Held in February at the InterContinental Hotel and Bank of America Conference Center on <strong>Cleveland</strong><br />
<strong>Clinic</strong>’s main campus, conference attendance skyrocketed with 254 registered participants, according to<br />
Co-Directors Deborah De Mars, RN, RNFA, ONC, Dawn gerz, RN, RNFA, ONC, and William J. Wick,<br />
Coordinator of Orthopaedic Materials in the Department of Orthopaedic Surgery.<br />
The conference opened with broadcast of a live total hip<br />
arthroplasty, performed by <strong>Cleveland</strong> <strong>Clinic</strong> orthopaedic<br />
surgeon Lester S. Borden, M.D.<br />
In a Q&A session following the surgery, Dr. Borden and his<br />
nurse, Sharon Pivonka, RN, RNFA, reflected on the evolution<br />
in total joint surgeries. As a resident in the 1960s, Dr. Borden<br />
saw total hips take up to eight hours with high blood loss and<br />
infection rates of 15 percent.<br />
“Initially, we didn’t have the instrumentation to get these<br />
implants in and to resurface the bone,” Dr. Borden explained.<br />
“Instrumentation has made a huge difference. Today, we have<br />
higher quality implants, better instrumentation, less blood<br />
loss and much lower infection rates.”<br />
Scars are smaller and rehabilitation is faster. Cement is out.<br />
“We want the patient’s bone to grow into the implant,” he said.<br />
Bedside nurses should get patients moving. Hip and knee pa-<br />
tients should sit in a chair the day following surgery, putting 75<br />
percent of their weight on the unoperative leg. Physical therapy<br />
should begin the following day. “There is no science in overpro-<br />
tecting patients,” Dr. Borden said. He added, “The sooner the<br />
patient gets moving, the better for them psychologically.”<br />
Total hip patients use a walker or crutches for four weeks<br />
after surgery, followed by a cane for four more weeks, to give<br />
muscles around the implant time to heal. To avoid dislocating<br />
a new hip, patients avoid bending over to pick up an item or<br />
sitting with their knees above their waistline.<br />
<strong>Nursing</strong> Students Invited<br />
Conference planners invited professors and students from<br />
nursing programs at <strong>Cleveland</strong> State University (CSU) and<br />
Huron School of <strong>Nursing</strong> as guests.<br />
“In academia, we don’t get opportunities to see surgeries,” said<br />
Marilyn Weitzel, Professor of Pediatric <strong>Nursing</strong> at CSU. “I was<br />
glad the surgeon was so kind to the (patient’s) family. Our<br />
nursing program stresses that a patient is more than an individual,<br />
each comes with a family.”<br />
“Seeing a live surgery reminds me of why I became a nurse,”<br />
said Michael McQueen, senior at Huron School of <strong>Nursing</strong>.<br />
“<strong>Nursing</strong> provides a great forum for collaboration, something<br />
is always happening and there is always something to learn.”<br />
Huron School of <strong>Nursing</strong> students. Back row, from left: Bill Wingler, Michael<br />
McQueen, James Tighe. Front row, from left: Jennifer Dolence, Jennifer Tramte,<br />
Heather Pennington, and Huron faculty member Lydia Glaude, MSN, CNP, RN.<br />
Future of the OR: The goal is OPTIMAL<br />
Operating rooms are typically “overcrowded, paper-based and designed for 1970s procedures,” said<br />
Jonathan L. Schaffer, M.D., M.B.A., of the <strong>Cleveland</strong> <strong>Clinic</strong> Advanced Operative Technology group in the<br />
Department of Orthopaedic Surgery and one of the architects of the <strong>Cleveland</strong> <strong>Clinic</strong> project to develop,<br />
design and construct the Orthopaedic OR of the Future. The project was launched six years ago to<br />
improve quality, increase capacity and manage costs more efficiently.<br />
“Most operating rooms run from 7:30 a.m. to 5:30<br />
p.m. at an inefficient 42 percent utilization rate,”<br />
Dr. Schaffer said. Access, quality and value will<br />
characterize optimal use in the future, he said.<br />
His project team came from every department<br />
and from among patients and families. They dis-<br />
covered many inconsistencies that wasted time:<br />
sterile gloves in different places and arthroscopy<br />
tables set up in different ways.<br />
In planning, the team discarded old assumptions<br />
and integrated new design elements from Euro-<br />
pean operating rooms and corporations that had<br />
developed new production facilities. Looking at<br />
opportunities to improve performance, the team<br />
determined the difference if patients were trans-<br />
ferred from the OR table to a bed on the count of<br />
two instead of three – the second of time for each<br />
move could mean a theoretical $1 million savings<br />
in labor costs annually.<br />
OR nurses and technicians helped develop the new look and refine proce-<br />
dures and processes. “We wanted the OR of the future to be easier on the<br />
nurses who spend eight to 12 hours there every day,” Dr. Schaffer said.<br />
Three orthopaedic ORs were redesigned along with support areas and the<br />
sterile core between the rooms. Scheduled surgeries were re-routed and<br />
nurses extended the work day as needed to keep the schedule going and<br />
to avoid delays during construction. “The commitment and efficiency of<br />
OR nurses meant a savings of 189 percent in construction program costs,”<br />
he said.<br />
The new operating rooms are streamlined for optimal use. Supplies such<br />
as gloves are located in the same place in each room; arthroscopy tables<br />
have a consistent setup and the technical and implant rooms are opti-<br />
mally organized. A central documentation and control area in each OR<br />
has three computers. Controls for lights, cameras and pumps are within<br />
easy reach of the circulating nurse. Up to one additional joint procedure<br />
can be accommodated per day per room.<br />
“These ORs are now coherent, properly functioning workspaces,” said<br />
Dr. Schaffer. “The future of the Orthopaedic OR is very bright.”<br />
Metrics used in Developing<br />
Plans and Processes for the<br />
OR of the Future:<br />
• Increase efficiency and productivity<br />
of the surgeons, OR staff and hospital<br />
support personnel<br />
• Improve patient outcomes<br />
• Decrease pain<br />
• Restore function<br />
• Avoid complications<br />
• Increase satisfaction<br />
• Provide greater value to society<br />
7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe
7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe<br />
Risk Management: Staying out of a Courtroom<br />
Vicki Bokar, CPHRM | Director of <strong>Clinic</strong>al Risk Management at <strong>Cleveland</strong> <strong>Clinic</strong><br />
Orthopaedic surgery ranks among the top five specialties in terms of being named most frequently in malpractice<br />
claims. Nationally, some of these claims have resulted in large settlements, including a $7.5 million<br />
settlement for failure to diagnose Compartment Syndrome, and a $16.1 million settlement for failure to diagnose<br />
lower leg thrombosis that resulted in the death of a young patient. Surgeons and physicians aren’t the<br />
sole targets. One claim was targeted toward a nurse who inadvertently used IV tubing that was not sterile.<br />
The most common allegations in orthopaedic claims include:<br />
• Improper performance of surgery<br />
• Improper management or judgment<br />
• Failure or delay in diagnosis or treatment<br />
• Postoperative complications<br />
• Infections<br />
• Complications under casts<br />
• Wrong surgery<br />
Informed consent issues are often tagged onto the primary claim.<br />
Nurses, physicians and other practitioners play a role in every<br />
single situation listed above. Thus, each member of the team can<br />
take steps to avoid malpractice claims. Don’t expect that certain<br />
diagnoses or complications will present with textbook signs and<br />
symptoms because the patient’s presentation may be atypical.<br />
Unless you remember this, you may inadvertently miss important<br />
subtle clues that should be communicated to a physician.<br />
Observe and listen carefully to the patient. Limit distractions in<br />
your clinical practice and you will minimize your risk of making<br />
an error. Internal systems should be adequate and effective,<br />
such as tickler systems to assure that important test results are<br />
reviewed and reported in a timely manner. Ensure that every<br />
patient has one healthcare professional coordinating the plan<br />
of care wherever possible, particularly in the outpatient setting.<br />
This can help prevent things from “falling through the cracks.”<br />
Avoid disagreements with colleagues and/or making inappropriate<br />
comments within hearing of patients or families.<br />
Do not jump to conclusions or speculate when an event<br />
occurs. You may not have the whole story at the time.<br />
Introduce residents as members of the healthcare team to<br />
avoid additional risks to hospitals with teaching programs.<br />
Be aware that diagnostic errors often occur on weekends or<br />
holidays, so communication and handoffs must be thorough<br />
and complete. Don’t rule out a problem without sufficient<br />
evidence to support that decision.<br />
Proper documentation should reference only information<br />
related to patient care. Include every phone call, care-related<br />
activity (including patient response) and any instructions provided<br />
to patients. Date and time each note, avoid late entries<br />
and never, ever alter a medical record. Review the documentation<br />
of others to assure that you know all pertinent information<br />
on your patient. Beware of clicking on the wrong menu item<br />
from electronic medical record’s drop down menu.<br />
Patients sue primarily because their surgical outcomes do<br />
not meet their expectations. Prior to surgery, provide patients<br />
with written educational materials about their procedure and<br />
ensure they have realistic expectations. These materials may<br />
supplement the consent process and help patients to better<br />
understand potential risks and benefits. Inform surgeons if<br />
the patient has unrealistic expectations and/or does not seem<br />
to understand what was discussed during the consent process.<br />
Departure from the standard of care is one of the elements<br />
that must be proven in a malpractice case, so educate<br />
yourself regarding best practices. Nurses on a particular<br />
unit might want to identify their 15 best safety practices and<br />
ensure through ongoing monitoring that everyone follows<br />
them without deviation. Coach one another. Repeat back everything<br />
someone says to you. Know and follow the Universal<br />
Protocol. Wash your hands before and after patient care.<br />
If you remain vigilant and conscientious in your delivery of<br />
patient care at all times, you will have little reason to worry<br />
about a malpractice lawsuit.<br />
E-mail comments to bokarv@ccf.org.<br />
Rekindling the Spirit<br />
Scott Sheperd, Ph.D., a nationally known speaker and<br />
author, invited participants to examine beliefs about stress<br />
and to rekindle their passion.<br />
“Adults whine all the time,” Dr. Sheperd said. “When someone<br />
whines at lunch – don’t you try to top them with your own sad story?”<br />
The audience erupted in laughter.<br />
Through humor and targeted examples, Dr. Sheperd challenged participants<br />
to stop using the word stress. “Words have power,” he said.<br />
“They don’t just describe a situation, they create it.”<br />
Marriage, divorce, job changes and moves are not stressful at all, he<br />
said. Neither are holidays. “We bring the meaning to the events of our<br />
lives. There are no stressful meetings, jobs or days. Stress is not a fact,<br />
but an opinion,” he said.<br />
He wondered aloud why we let other people determine our mood.<br />
“We can choose to be joyful and peaceful. Yet, we give away our personal<br />
power. We avoid responsibility for our lives and pass the buck every<br />
chance we get.”<br />
“I’m a big believer in the power of the human spirit,” he said. “Decide<br />
that as long as you aren’t dead, you will choose to be alive.”<br />
Scott Sheperd, Ph.D.<br />
To Reclaim Personal Power<br />
• Become aware of your attitude.<br />
• Forgive.<br />
• Think “Rainbows Happen.”<br />
• Stop talking like a victim.<br />
• Don’t let routines become ruts.<br />
“The only difference between ruts<br />
and graves is the depth.”<br />
• Make small changes and follow through.<br />
• Don’t wish life away. (I wish it was<br />
summer, Friday, vacation . . .)<br />
• Slow down, feel the rhythm of being alive.<br />
• Make every day a good day.<br />
• Be with people you love and care about.<br />
• Watch your words – they have power<br />
to create.<br />
• Do something every day that makes<br />
you feel passionate about life.<br />
• Every night, ask yourself how you handled<br />
the day. If you handled it poorly,<br />
resolve to change your mind, which<br />
takes courage.<br />
7TH ANNuAL ORTHOPAeDICS: exCeLLeNCe THROugH eDuCATION CONFeReNCe
26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe<br />
In its 26th year, the Dimensions in Cardiac Care nursing conference was a unique academic event<br />
designed to provide the latest trends in patient management and technology. The event was held April<br />
15-17 at the InterContinental Hotel and Bank of America Conference Center on <strong>Cleveland</strong> <strong>Clinic</strong>’s<br />
main campus with the purpose of providing the nursing professional with a national forum to share<br />
knowledge and information regarding the care of the cardiac patient. Nurses representing interventional<br />
cardiology, cardiovascular medicine, cardiothoracic surgery and transplantation attended the<br />
event co-chaired by Nancy Albert, PhD, CCNS, CCRN, CNA; Kelly Hancock, BSN, RN and Kathleen<br />
Tripepi-Bova, MSN, RN, CCNS, CCRN.<br />
Rearranging the gI Tract: esophageal Surgeries<br />
Kathleen Tripepi-Bova, MSN, RN, CCNS, CCRN | Thoracic Surgery, Medical Cardiology and Transplant<br />
Though esophageal cancer is not very common, adenocarcinoma of the esophagus is the type most commonly<br />
seen in the united States. For those patients who are candidates for surgical resection of esophageal cancer,<br />
an esophagogastrectomy may be performed. In this procedure, the majority of the esophagus and a portion of<br />
the stomach are removed, and the now tubular stomach is brought up into the chest and is reconnected to the<br />
remnant esophagus in order to sustain function.<br />
Unfortunately, adenocarcinoma has no symptoms and is<br />
rarely diagnosed until the tumor blocks about 75 percent<br />
of the esophagus, causing dysphagia. Such late detection<br />
means a 5-year survival of only five to 20 percent.<br />
One diagnostic strategy occurs with patients who have signs and<br />
symptoms of GERD (gastric esophageal reflux disease). These<br />
people are susceptive to a condition called Barrett’s esophagus,<br />
which may become adenocarcinoma of the esophagus. Regular<br />
GI surveillance identifies the cancer in its earliest stages before<br />
it can spread outward from esophageal lining to lymph nodes.<br />
Esophageal ultrasound plays a key role in the clinical staging of<br />
esophageal cancer. It is an outpatient procedure that looks at tumor<br />
depth and proximal lymph node involvement of esophageal<br />
cancer. This is very helpful in determining treatment strategies.<br />
Just what is involved in the esophagectomy varies with where<br />
the tumor is and what alternate conduits are available for use.<br />
The most commonly used alternate conduit is the stomach,<br />
which is remade into the tube that is connected to the remaining<br />
portion of the esophagus.<br />
If the stomach is not available, the jejunum, (Rous-En-Y) or<br />
midsection of the small intestine, is used. The duodenum<br />
(upper section) is avoided because of its attachments to the<br />
pancreas and biliary sytme. If neither of these options is<br />
available, the colon may be used (colonic interposition).<br />
Risk of complications after esophagectomy are increased by<br />
the fact that the GI tract is not a sterile environment. Risk of<br />
chylothorax is as high as 60 percent, and treatment requires<br />
a no-fat diet. However, a new procedure, a lymphangiogram,<br />
allows for identification of the area of leak so that the leak can<br />
be identified and sealed off.<br />
Despite ongoing advances, esophageal surgeries remain<br />
complex procedures with significant mortality and morbidity.<br />
Best results are obtained in specialized medical centers with<br />
experienced nursing care, as nurses usually identify postoperative<br />
problems first.<br />
E-mail comments to tripepk@ccf.org.<br />
Can We Reverse Coronary Artery Disease?<br />
Steven Nissen, M.D., Chairman of <strong>Cleveland</strong> <strong>Clinic</strong>’s Department of Cardiovascular<br />
Medicine, was one of the keynote speakers at the Dimensions in Cardiac Care<br />
Conference. In his speech, entitled “Can We Reverse Coronary Artery Disease?,”<br />
Dr. Nissen talked about how, despite ongoing good efforts, coronary artery disease<br />
remains a leading cause of death among men and women.<br />
He explained that for many years CAD was believed to be a disease of lumen narrowing, but<br />
recent evidence has shown this to be otherwise. The real problem, as revealed by intravascular<br />
ultrasound, is the accumulation of atherosclerotic plaque in the vessel walls. As the plaque<br />
builds up, it leads to outward displacement of the vessel wall, with the plaque accumulating<br />
for years or even decades before it starts to occlude the vessel and show up on an angiogram.<br />
So plaque is the ‘tip of the iceberg’ of coronary disease, Dr. Nissen said, with the vast majority of it,<br />
some 99 percent, hidden from view. Yet, to effectively treat CAD, all of the hidden plaque needs to<br />
be treated.<br />
Many treatment efforts have been focused on lowering cholesterol, particularly LDL levels, using<br />
statins to get LDL down to 110 mg/dL in order to slow disease progression. But, Dr. Nissen said, the<br />
question remains as to whether disease progression could be halted or reversed if the levels were<br />
pushed even lower.<br />
Evidence from clinical studies (the Reversal Trial and the Prove IT trial) showed this could be done<br />
if LDL was lowered to 70 mg/dL. It also showed that the lower LDL was driven, the more disease<br />
progression was retarded.<br />
These studies had another important finding<br />
– that aggressively lowering LDL also pushes<br />
down levels of C-reactive protein, a marker of<br />
inflammation. Statins appear to play a dual,<br />
helpful role, with each role apparently independent<br />
of the other.<br />
Dr. Nissen said some of the latest studies<br />
are looking at raising HDL, lowering blood<br />
pressure, or using even more potent statins<br />
to reduce plaque volume. In that last regard,<br />
there has been some exciting early evidence.<br />
In a study lasting only 24 months (the Asteroid<br />
trial), investigators were able to reduce plaque<br />
levels by nearly 7 percent by lowering LDL to<br />
60 mg/dL.<br />
Over the next decade methods will be developed<br />
for early diagnosis of CAD, while the<br />
plaque is still developing, Dr. Nissen said.<br />
Better tools for moderating LDL, HDL, inflammation<br />
and high blood pressure also should<br />
be available.<br />
Steven Nissen, M.D.<br />
26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe
26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe<br />
Advances in Cardiac Imaging<br />
Scott D. Flamm, M.D. | Head of Cardiovascular Imaging, Department of Radiology, <strong>Cleveland</strong> <strong>Clinic</strong><br />
The application of MRI and CT cardiac imaging to<br />
clinical practice continues to evolve in exciting ways.<br />
Today, MRI is not only the gold standard for evaluating left<br />
ventricular function, it also is used to assess valve function<br />
and myocardial ischemia and viability. It is a noninvasive,<br />
non-ionizing, nontoxic approach that delivers high-resolution<br />
images with detailed information on both heart morphology<br />
and function. The main restrictions to its use include the presence<br />
of pacemakers, ICDS and intracranial aneurysm clips,<br />
and large body habitus.<br />
Advances in CT technology, particularly the advent of multidetector<br />
CT, has greatly broadened its use in cardiac assessment.<br />
Rapid patient throughput (up to 8 patients per hour)<br />
and improved image resolution (down to 0.5 mm) means it<br />
can now provide functional as well as structural feedback. Ionizing<br />
radiation remains the main limit to wider use; a 64-slice<br />
CT of the coronary arteries can provide the equivalent radiation<br />
dose of 450 to 600 chest X-rays or more.<br />
Diuresis in Heart Failure<br />
Nancy M. Albert, Ph.D, CCNS, CCRN, CNA | Director, <strong>Nursing</strong> Research and Innovation, <strong>Cleveland</strong> <strong>Clinic</strong><br />
We need a better way to measure and monitor hemodynamic<br />
congestion. Some internal monitoring devices that are part<br />
of an implantable cardioverter-defibrillator (ICD) provide<br />
additional information to track patient status. They indicate<br />
if there’s been a new bout of atrial fibrillation, look at AT/AF<br />
ventricular rate during the day and night, provide heart rate<br />
variability data, and track patient activity over time.<br />
One company’s internal monitoring ICD device provides a<br />
trend of internal left chest impedance cardiography. Because<br />
air offers greater resistance to electrical flow than water, a<br />
high reading means the patient is dry and a low reading tells<br />
us the patient is wet. The device is always on, eliminating the<br />
need for patient adherence, and data can be retrieved from any<br />
remote computer. While valuable data is obtained, this still<br />
provides just one part of the picture.<br />
Unlike traditional diuretics, which increase risk of mortality<br />
(by 37 percent) even as they improve symptoms, new drugs may<br />
The newer CTs are now as much a functional as a morphological<br />
tool as they convert two-dimensional scans into 3-D renderings.<br />
Such data allows us to reconstruct the beating of the left<br />
ventricle and yields quantitative data on LV function on par<br />
with echocardiography and MRI. The improved resolution of<br />
CT images makes it an important tool in planning valve procedures,<br />
as well as a postoperative check on placement. Despite<br />
the growing use of CT in cardiac imaging, the role of MRI has not<br />
diminished, but evolved. We are developing new ways to look at<br />
the aorta, both spatially and temporally, creating visualizations of<br />
valve function and turbulence, throughout systole and diastole.<br />
We are now performing stress perfusion protocols, and with<br />
newer contrast materials, that enable us to distinguish between<br />
reversible and irreversible areas of myocardial damage.<br />
A new type of MRI scan known as “delayed-enhancement”<br />
magnetic resonance imaging has a spatial resolution that is<br />
5-10 times better than NMR or SPECT, and allows us to distinguish<br />
between heart muscle that is healthy and muscle that is<br />
dead. This type of study can be performed in less than an hour<br />
and with no ionizing radiation.<br />
Hemodynamic congestion is the No. 1 reason for the rehospitalization of patients with heart failure. Yet such<br />
congestion can be difficult to diagnose, which means that, too often, patients with decompensated heart failure<br />
may be sent home in a sub-clinical congested state, raising the risk of future rehospitalization.<br />
help reduce volume overload in other ways. One is an inhibitor<br />
of the anti-diuretic hormone – arginine vasopressin. Vasopressin<br />
is a potent vasoconstrictor that regulates water and sodium<br />
reabsorption. Studies of this new drug show that those taking<br />
it, compared to placebo, had greater urine ouput and better<br />
normalization of serum sodium from baseline to discharge.<br />
Selective A1 adenosine receptor blockers have a direct impact<br />
on glomerular filtration rate, helping patients shed a bit more<br />
urine, and seem to provide optimal diuresis when used in<br />
combination with furosemide.<br />
Ultrafiltration, while not new, is an area of active research in<br />
patients with heart failure. Most trials are small, but show<br />
that ultrafiltration is a safe procedure and, compared to<br />
those patients receiving standard treatment, it decreased<br />
time to rehospitalization, days of rehospitalization and<br />
length of stay when hospitalized.<br />
E-mail comments to albertn@ccf.org.<br />
Valvular Heart Disease<br />
Deborah Klein, MSN, RN, CCRN, CS | Cardiac ICu and Heart Failure Special Care unit<br />
Through age and disease, heart valves that once<br />
opened like clockwork can become regurgitant,<br />
incompetent or stenotic, and generally fail to close<br />
completely. The types of possible dysfunction are<br />
several, as are the treatment options.<br />
Sometimes infective endocarditis can cause such valve<br />
problems, with the infection due to IV drug use, staph aureus<br />
migrating along a catheter line or a prosthetic heart valve. It<br />
presents as a rapidly developing high fever, with profound<br />
chills and sweats and requires a blood culture, physical exam<br />
findings and echocardiography to confirm diagnosis. Since<br />
it has such a high mortality rate (25 percent among general<br />
population, and 40-70 percent for those 70 and older), proper<br />
medical management is a must. However, this requires identifying<br />
the source of the infection. Surgery may be indicated if<br />
hemodynamic instability develops, fever persists and there is<br />
evidence of valvular abscess or system emboli.<br />
The gradual buildup of lipid deposits on valve leaflets leads to<br />
calcification, impaired leaflet movement and a narrowing of<br />
the orifice, known as stenosis. Narrowing of the aortic valve<br />
(AV) orifice restricts blood flow and poses a burden on the left<br />
ventricle, leading to increased ventricular wall thickness and<br />
dysfunctional hemodynamics. Aortic stenosis can present as<br />
dizziness, syncope after exercise, chest pain, atrial fibrillation,<br />
ventricular fibrillation or ventricular tachycardia. Diagnostic<br />
scans are likely to show left ventricular (LV) enlargement,<br />
thickened leaflets and a significantly reduced AV area. Medical<br />
management may include diuretics, reduced dietary sodium,<br />
avoidance of vigorous activity as well as beta blockers, statins<br />
and vasodilators.<br />
Sometimes endocarditis, calcification or aortic root dilation<br />
can cause aortic valve leaflets to incompletely close, allowing<br />
backflow into the left ventricle known as aortic regurgitation<br />
(AR). It also puts hemodynamic stress on the LV. In acute cases,<br />
Deborah Klein, MSN, RN, CCRN, CS<br />
it presents as a sharp rise in LV and left atrial (LA) pressures,<br />
pulmonary edema and acute heart failure. With more chronic<br />
AR, there is left-sided heart failure over time. Once confirmed<br />
by echocardiogram, management may include a vasodilator<br />
and nifedipine if asymptomatic. Beta blockers are avoided since<br />
they lengthen diastole. Vasodilators can be given to slow LV dilation.<br />
Valve replacement is an option if management fails.<br />
Stenosis and regurgitation also occurs to the mitral valves. In<br />
mitral stenosis, there is LA hypertrophy, pulmonary hypertension<br />
and development of atrial fibrillation, since hypertrophy<br />
stretches the atrial conduction fibers. The expanded LA can<br />
also cause hoarseness if it compresses the laryngeal nerve. To<br />
manage stenosis and pulmonary congestion, diuretics and<br />
beta blockers are given; to treat atrial fibrillation, digoxin,<br />
calcium channel blockers and anticoagulant may be used. Surgical<br />
options range from a balloon valvuloplasty, to valvotomy,<br />
to MV repair or replacement.<br />
With mitral regurgitation, various drugs help reduce the leakage<br />
of blood (afterload) into the LA, including nipride, ACE-I, nitrates<br />
and hydralazine. Valve repair or replacement is also an option.<br />
E-mail comments to kleind@ccf.org.<br />
26TH ANNuAL DIMeNSIONS IN CARDIAC CARe CONFeReNCe
22<br />
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
<strong>Cleveland</strong> <strong>Clinic</strong> <strong>Nursing</strong> News<br />
PRESENTATIONS<br />
AORN 54th Congress of the Orange<br />
County Convention Center<br />
March 2007 | orlando, Florida<br />
Making a Difference Through Research<br />
Siedlecki SL, PhD, RN<br />
AORN 54th Congress of the Orange<br />
County Convention Center<br />
March 2007 | orlando, Florida<br />
Poster Presentation: Making Research Reality<br />
Siedlecki SL, PhD, RN<br />
Preventative Cardiology Nurses<br />
Association Annual Symposium<br />
April 2007 | Minneapolis, Minnesota<br />
Poster Presentation: Heart Failure<br />
Knowledge: What’s Race Go To Do With It?<br />
Albert NM, PhD, CCNS, CCRN, CAN<br />
Trochelman K, MSN, RN<br />
Howey K, MS<br />
10th Congress of Society<br />
of Chest Pain Centers<br />
April 2007 | Nashville, Tennessee<br />
Case based treatment – Things to do right<br />
and what not to do wrong<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
Cardiac Surgery Symposium<br />
April 2007 | lima, ohio<br />
Advances in Critical Care <strong>Nursing</strong><br />
Hill K, MSN, RN, CCNS-CSC, CNS<br />
33rd Annual Critical Care Update<br />
April 2007 | las vegas, Nevada<br />
Anatomically Correct: How Cardiac Anatomy<br />
Impacts the Postoperative Course<br />
5 Things I Wish I Knew About Chest Pain<br />
Hill K, MSN, RN, CCNS-CSC, CNS<br />
Northeast Ohio Case Management<br />
Network Annual Conference<br />
April 2007 | <strong>Cleveland</strong>, ohio<br />
Ethics, Case Managers, and Planning Ahead<br />
Hill K, MSN, RN, CCNS-CSC, CNS<br />
Dimensions in Cardiac Care 2007<br />
April 2007 | <strong>Cleveland</strong>, ohio<br />
- Case Studies in Heart Failure<br />
- Valvular Heart Disease<br />
- 12 Lead ECG Course<br />
- So You want to be an APN<br />
Klein D, MSN, RN, CCRN, CS, CNS<br />
Ohio Consortium of<br />
<strong>Nursing</strong> Learning Labs<br />
April 2007 | Findlay, ohio<br />
A New Menu for Skills Lab Practicum<br />
Price K, BSN, RN<br />
Midwest Political Science<br />
Association Meeting<br />
April 2007 | Chicago, illinois<br />
Medicaid Tele-Reimbursement Policy:<br />
Explaining State Innovation<br />
Schmeida M, PhD, MSN, RN, CNS<br />
Pediatric Endocrine<br />
Nurses Society Conference<br />
April 2007 | Portland, oregon<br />
APN Case Study: Growth Failure in<br />
Patient with Down’s Syndrome,<br />
Hypothyroidism and Type 1 Diabetes<br />
Switzer C, MSN, RN, CPNP, CDE, NP<br />
Challenges in Cardiology<br />
Dar Al Fouad hospital<br />
May 2007 | 6th october City, Egypt<br />
- <strong>Clinic</strong>al Management of Heart Failure<br />
- Drugs Used for Heart Failure<br />
- The Importance of Self-Care in<br />
Managing Heart Failure<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
Heart Failure State of Science<br />
Conference American Heart<br />
Association Council of<br />
Cardiovascular <strong>Nursing</strong><br />
May 2007 | Washington, D.C.<br />
State of <strong>Clinic</strong>al Practice<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
National Teaching Institute<br />
and Critical Care Exposition<br />
May 2007 | Atlanta, georgia<br />
Beyond the Horizon: Drug and Mechanical<br />
Diuresis in Heart Failure<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
National Teaching Institute and<br />
Critical Care Exposition<br />
May 2007 | Atlanta, georgia<br />
Issues in Heart Failure: Management<br />
Adherence and Polypharmacy<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
American Transplant Congress<br />
May 2007 | San Francisco, California<br />
Cardiovascular Disease in<br />
Solid Organ Transplantation<br />
Hoercher KJ, RN, Director,<br />
Kaufman Center for Heart Failure<br />
American Geriatric<br />
Society Conference<br />
May 2007 | Seattle, Washington<br />
Poster Presentation: Moving Forward by<br />
Looking Back: A Proactive Reminiscence<br />
Program for Depressed Elderly<br />
Simon J, BSN, RN, Rader E, Marrie K, MSN,<br />
RN, Campbell J, M.D.<br />
clevelandclinic.org/nursing Fall 2007<br />
3rd Annual Meeting of the American<br />
Association of Heart Failure Nurses<br />
Developing the Science of Heart<br />
Failure <strong>Nursing</strong><br />
June 2007 | San Diego, California<br />
- Research: Understanding It and Applying<br />
It to Practice<br />
- The Ins and Outs of Publishing<br />
Albert NM, PhD, CCNS, CCRN, CNA<br />
Society for Vascular<br />
Medicine and Biology<br />
June 2007 | Baltimore, Maryland<br />
Sublingual Administration of Warfarin:<br />
A Novel Form of Delivery<br />
Batke-Hastings S, MSN, CNP, MBA<br />
Carman TL, M.D.<br />
Society for Vascular Medicine<br />
and Biology’s 18th Annual<br />
Scientific Sessions<br />
June 2007 | Baltimore, Maryland<br />
Poster Presentation: Sublingual Administration<br />
of Warfarin: A Novel Form of Delivery<br />
Batke-Hastings S, MSN, CNP, MBA<br />
5th Annual Conference of State<br />
<strong>Nursing</strong> Workforce Centers<br />
June 2007 | San Francisco, California<br />
The Other Shortage<br />
Dumpe ML, PhD, MS, RN<br />
Kavanagh J, MSN, RN<br />
Western Thoracic Surgical Association<br />
June 2007 | Santa Ana Pueblo, New Mexico<br />
Prognosis of Patients Removed from a Transplant<br />
Waiting List for Medical Improvement:<br />
Implications for Organ Allocation and<br />
Transplantation in Status 2 Patients<br />
Discussant: Robbins RC, M.D., Chairman,<br />
Cardiovascular Surgery, Stanford University<br />
School of Medicine<br />
Presenter: Hoercher KJ, RN, Director,<br />
Kaufman Center for Heart Failure<br />
Scholarship of Teaching and Learning<br />
(SoTL) in <strong>Nursing</strong> Conference<br />
August 2007 | Cincinnati, ohio<br />
CNS Student Competencies in Outcomes<br />
Planning and Evaluation: Curricular<br />
Considerations and Exemplars<br />
Canfield C, MSN, RN, CNS, Coughlin<br />
R, MSN, RN, CNS, Jacobson A, PhD, RN,<br />
Jacobson K, MSN, RN, CCNS, Ludwick R,<br />
PhD, RN.C, CNS, Rock R, MSN, RN, CCNS,<br />
Soat M, MSN, RN, CCNS, Solomon D, MSN,<br />
RN, CNS<br />
Heart Failure Society of America<br />
September, 2007 | Washington, D.C.<br />
Expert Panel: Case Discussion in Heart Failure<br />
Hoercher KJ, RN, Director, Kaufman<br />
Center for Heart Failure<br />
PuBLICATIONS<br />
Albert NM<br />
Non-ST-Segment Elevation Acute<br />
Coronary Syndromes: Treatment<br />
Guidelines for the Nurse Practitioner.<br />
Journal of the American Association<br />
of Nurse Practitioners.<br />
2007;19:277-289.<br />
Fonarow GC, Yancy CW, Albert NM,<br />
Curtis AB, Stough WG, Gheorghiade<br />
M, Heywood JT, Mehra M, O’Connor<br />
CM, Reynolds D, Walsh MN.<br />
Improving the Use of Evidence-based<br />
heart Failure Therapies in the outpatient<br />
Setting: The IMPROVE HF Performance<br />
improvement Registry.<br />
American Heart Journal.<br />
2007;doi:10.1016/j.ahj.2007.03.030<br />
Albert NM, Fonarow G, Abraham W,<br />
Chiswell K, Stough WG, Gheorghiade<br />
M, Greenberg BH, O’Connor CM,<br />
Sun JL, Yancy CW, Young JB.<br />
Predictors of Delivery of Hospital-based<br />
heart Failure Patient Education: A Report<br />
from OPTIMIZE-HF.<br />
Journal of Cardiac Failure.<br />
2007;13:189-198<br />
Gheorghiade M, Abraham WT,<br />
Albert NM, Stough WG, Greenberg BH,<br />
O’Connor CM, Pieper K, She L,<br />
Yancy C, Young JB, Fonarow GC.<br />
Relationship Between Admission Serum Sodium<br />
Concentration and <strong>Clinic</strong>al outcomes<br />
in Patients Hospitalized for Heart Failure:<br />
An Analysis From OPTIMIZE-HF Registry.<br />
European Journal of Heart Failure.<br />
2007;doi:10.1093/eurheartj/ehl542<br />
Albert NM, Zeller R.<br />
Development and Testing of the Survey<br />
of Illness Beliefs in Heart Failure Tool.<br />
Progress in Cardiovascular <strong>Nursing</strong>.<br />
2007;22:63-71<br />
Coughlin RM<br />
Recognizing ventricular Arrhythmias and<br />
Preventing Sudden Cardiac Death.<br />
American Nurse Today.<br />
2007;2(5):38-44<br />
Dumpe ML, Kanyok N, Hill K<br />
Use of an Automated Learning<br />
Management System to validate<br />
Annual <strong>Nursing</strong> Competencies.<br />
Journal for Nurses in Staff Development.<br />
2007;6<br />
Hill K<br />
Contributor and Consultant.<br />
ECG Strip Ease.<br />
Philadelphia: Lippincott, Williams,<br />
and Wilkins, Inc. 2006.<br />
Hill K<br />
The Ps and Qs (and RSTs) of Assessing<br />
and Differentiating Chest Pain.<br />
Mosby’s <strong>Nursing</strong> Consultant.<br />
St. Louis: Elsevier, Inc. April 2007.<br />
www.nursingconsult.com/das/stat/<br />
view/69433923-2/cup.<br />
Bhudia SK, McCarthy PM, Kumpati<br />
GS, Helou J, Hoercher KJ, Rajeswaran<br />
J, Blackstone EH.<br />
Improved Outcomes After Aortic Valve Surgery<br />
for Chronic Aortic Regurgitation With<br />
Severe Left Ventricular Dysfunction.<br />
Journal of the American College of Cardiology.<br />
2007;49:1465-71<br />
Sharma MS, Hoercher KJ,<br />
Starling RC, Alster JM, Deglurkar I,<br />
Blackstone EH, Smedira NG.<br />
Seeing the Future: Strategic Decision<br />
Support for Heart Transplant.<br />
Journal of Heart and Lung Transplantation.<br />
2007;26(Supplement, February 2007):S209<br />
Magyer D, Smedira NG, Hoercher KJ,<br />
Navia JL, Mihaljevic T, Taylor DO,<br />
Starling RC, Gonzalez-Stawinski.<br />
Outcomes of Female Heart Transplant<br />
Recipients Bridged to Transplantation with<br />
a ventricular Assist Device.<br />
Journal of Heart and Lung Transplantation.<br />
2007;26(Supplement, February 2007):S89<br />
Smedira NG, Hoercher KJ,<br />
Feng J, Klingman L, Starling RC,<br />
Blackstone EH.<br />
Transplant Should Not Be Delayed While<br />
Awaiting Functional Recovery in Patients<br />
on Mechanical Circulatory Support.<br />
Journal of Thoracic and<br />
Cardiovascular Surgery.<br />
2007 (in press)<br />
Klein DG<br />
From Novice to Expert: <strong>Clinic</strong>al Nurse<br />
Specialist Competencies<br />
Acute and Critical Care <strong>Clinic</strong>al Nurse<br />
Specialist: Synergy for Best Practices<br />
Philadelphia, PA: Saunders (Elsevier); 2007.<br />
23
24<br />
<strong>Notable</strong> <strong>Nursing</strong> clevelandclinic.org/nursing<br />
AWARDS<br />
Nancy Albert, PhD, CCNS, CCRN, CNA<br />
Inductee, American College of<br />
Critical Care Medicine<br />
Society of Critical Care Medicine<br />
Nancy Latza, RN<br />
Certification<br />
Certified Registered Nurse Infusion<br />
(CRNI) examination<br />
Cheryl Switzer, MSN, RN, CPNP, CDE<br />
Kathy Bielek, BSN, RN, CPON<br />
Barbara Donaho Distinguished<br />
Leadership in Learning Award<br />
Kent State University<br />
Rose Vamos, ENA<br />
Class of 2007 Valedictorian<br />
<strong>Cleveland</strong> State University<br />
3RD ANNuAL NuRSINg ReSeARCH CONFeReNCe<br />
Nancy Albert, PhD, CCNS, CCRN, CNA<br />
Chair of the Science Sub-Committee for<br />
Advanced Heart Disease Taskforce<br />
Council of Cardiovascular <strong>Nursing</strong> of<br />
the American Heart Association<br />
Betty Ching, MSN, RN<br />
Secretary, Board of Trustees<br />
Heart Rhythm Society<br />
Betty Ching, MS, RN<br />
Invited Chair and Faculty<br />
28th Annual Scientific Session of<br />
the Heart Rhythm Society<br />
May 2007 | Denver, Colorado<br />
Susan Curtis, MSN, RN, CCRP<br />
Chair, Northeast Ohio Local Chapter<br />
The Society of <strong>Clinic</strong>al Research Associates<br />
APPOINTMENTS<br />
Paul Egan, MS, RN<br />
Invited Faculty<br />
28th Annual Scientific Session of<br />
the Heart Rhythm Society<br />
May 2007 | Denver, Colorado<br />
Georgina Rodgers, BSN, RN, OCN<br />
Review Board Appointment<br />
<strong>Clinic</strong>al Journal of Oncology <strong>Nursing</strong><br />
Mary Schmeida, PhD, RN, MSN, CNS<br />
Chair, National Panel on<br />
Implementing Health Policy<br />
Midwest Political Science Association<br />
April 2007<br />
Cheryl Switzer, MSN, RN, CPNP, CDE<br />
Treasurer<br />
Pediatric Endocrinology <strong>Nursing</strong> Society<br />
Making <strong>Nursing</strong> Research a Reality:<br />
Perils and Practical Solutions<br />
Leah Curtin, DSc, RN, clinical professor<br />
of nursing at the university of Cincinnati<br />
College of <strong>Nursing</strong> and Health, set the<br />
tone for the 3rd annual <strong>Nursing</strong> Research<br />
Conference May 10 with her keynote<br />
address, “The Metaphysics of Health<br />
and Disease.”<br />
The purpose of the Department of <strong>Nursing</strong><br />
Innovation and Research’s conference was to<br />
encourage and inspire registered nurses to par-<br />
ticipate in meaningful research. Curtin’s lively<br />
review of recent studies on the relationship of<br />
social, demographic and psychological factors<br />
to health and disease provided fertile ground for<br />
new research.<br />
“Research in this field, dating back to the 1970s,<br />
demonstrates that social conditions determine<br />
an individual’s risk of disease and that an<br />
individual’s early life determines future health<br />
events,” Curtin explained.<br />
She traced the history of this concept by citing<br />
famous studies from each decade of research,<br />
including several recent papers that link early<br />
childhood nutrition and sensory stimulation to<br />
an individual’s ability to cope with stress and,<br />
ultimately, to adult health status.<br />
“Childhood influences determine coping skills,<br />
and early deficits cannot be overcome,” Curtin<br />
stated. “Those who are lacking in nutrition and<br />
social stimulation early in life have a vulnerability<br />
to disease.”<br />
She concluded by challenging nurses to consider<br />
the questions of what creates a healthy population<br />
and where health funding should be spent.<br />
“Knowing the impact of nutrition, low stress and<br />
social support on future health or illness, overlaid<br />
with the need to create a healthier population,<br />
we have to ask these questions,” Curtin<br />
stressed. “The opportunities for further research<br />
in this area are tremendous.”<br />
clevelandclinic.org/nursing Fall 2007<br />
Nurse of Note<br />
Debra Albert, RN, MBA, CNAA, believes in making<br />
the most of the professional opportunities that come<br />
her way. This attitude has been the impetus for her<br />
evolving career at <strong>Cleveland</strong> <strong>Clinic</strong> during the past<br />
20-plus years, and helped her progress from bedside<br />
nursing as a new graduate to her present position as<br />
Associate Chief <strong>Nursing</strong> Officer.<br />
As her own career path exemplifies, “<strong>Cleveland</strong> <strong>Clinic</strong> is a<br />
great organization where you can always count on new op-<br />
portunities,” Albert says. “We are always changing, leading<br />
to new and exciting opportunities for nurses at every level<br />
throughout the organization.”<br />
Mentoring Helped Her Move Forward<br />
Albert began at <strong>Cleveland</strong> <strong>Clinic</strong> as a BSN student from<br />
The University of Akron in 1986. She worked as an aid and<br />
then as a staff nurse on the internal medicine and geriatric<br />
unit for five years. In 1991,<br />
Albert’s nurse manager<br />
quote<br />
encouraged her to consider a<br />
promotion to assistant nurse<br />
manager and then mentored<br />
Albert for two years.<br />
Mentoring relationships like<br />
those she has experienced<br />
in her own career are an important<br />
element of nursing at<br />
<strong>Cleveland</strong> <strong>Clinic</strong>, Albert notes. “I personally owe my success<br />
to good nurse mentors, and we have many of them here. I tell<br />
nurses not to be afraid to reach out for help,” she says. “I stand<br />
on the shoulders of my predecessors, and hopefully, new<br />
nurse leaders will stand on mine.”<br />
After two years as an assistant nurse manager, Albert moved<br />
up to a position as nurse manager for Inpatient Rehabilitation<br />
and the Epilepsy Monitoring Unit. Coinciding with her<br />
promotion, she enrolled in a master’s of business administration<br />
program to expand her knowledge of the business side of<br />
healthcare. She completed her degree in 1997.<br />
A Career-Changing Opportunity<br />
In 1996 Albert was promoted to director of neuroscience and<br />
rehabilitation nursing, adding the neurology and neurosurgery<br />
units to her responsibilities. Without prior experience<br />
in the neurosciences, Albert says she was challenged daily to<br />
learn and expand her skill set.<br />
Debra Albert, RN, MBA, CNAA<br />
“We are always changing, leading to new<br />
and exciting opportunities for nurses at<br />
every level throughout the organization.”<br />
– Debra Albert, RN, MBA, CNAA<br />
“Early on, I had to prove myself to physicians who questioned<br />
my ability but who gradually came to respect me as a peer,”<br />
she comments. “Ultimately, this was probably the position in<br />
which I grew the most, personally and professionally.”<br />
Albert was named Director of Surgical and Post-Acute Care<br />
<strong>Nursing</strong> in 1998, followed by a promotion in 2000 to Vice Presi-<br />
dent for <strong>Nursing</strong>-Chief <strong>Nursing</strong> Executive at Euclid Hospital,<br />
an affiliate within the <strong>Cleveland</strong> <strong>Clinic</strong> Health System.<br />
This was a significant change,<br />
offering a different perspec-<br />
tive on nursing, Albert reflects.<br />
“It was a chance to see another<br />
facet of nursing where patient<br />
acuity and focus was different<br />
than here at main campus.”<br />
An Offer She Couldn’t Refuse<br />
When Chief <strong>Nursing</strong> Officer<br />
Claire Young, RN, MSN, MBA, called in January 2006 to recruit<br />
Albert to her current position, “I couldn’t refuse,” Albert says.<br />
“It was coming home. I grew up here personally and profession-<br />
ally, and I couldn’t turn it down.”<br />
Now pursuing a master’s degree in nursing, Albert balances<br />
her professional career, education and a family that includes a<br />
husband and two young sons. On all fronts, “I’m always thinking<br />
about what’s next, what can I do better,” she says.<br />
The same desire to look to the future also infuses <strong>Cleveland</strong><br />
<strong>Clinic</strong>, Albert says, and is one of the reasons she has found<br />
great satisfaction here. “This is a place where everyone is motivated<br />
to constantly improve and strive to discover how we can<br />
provide better patient care.”<br />
“If an individual wants a place to grow, this is it,” she says. “Anyone<br />
with a passion for nursing can accomplish great things here.”<br />
E-mail comments to albertd@ccf.org.<br />
25
Your Destination for <strong>Nursing</strong> Practice<br />
Save the Date: September 29, 2007<br />
<strong>Nursing</strong> Open House<br />
10 a.m. – 2 p.m.<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Lerner Research Institute<br />
First Floor Commons Area<br />
Find your perfect match at <strong>Cleveland</strong> <strong>Clinic</strong>, and create the<br />
kind of nursing career that best suits your interests and needs.<br />
By attending our open house, you can:<br />
• Meet our leadership team and nursing staff<br />
• Interview with our nurse managers<br />
• Tour our exceptional facilities<br />
• Apply online for available positions<br />
To learn more about nursing opportunities or to register<br />
online, visit clevelandclinic.org/nursing.<br />
10th Annual Innovations in<br />
Neuroscience <strong>Nursing</strong> Conference<br />
October 4-6<br />
Intercontinental Hotel and<br />
Bank of America Conference Center<br />
<strong>Cleveland</strong>, Ohio<br />
For information or to register, visit clevelandclinic.org/nursing<br />
9th Annual Pain Management<br />
Conference for Nurses and Allied<br />
Healthcare Professionals<br />
October 6<br />
Executive Caterers at Landerhaven<br />
Mayfield Heights, Ohio<br />
For more information, visit clevelandclinic.org/painmanagement<br />
The <strong>Cleveland</strong> <strong>Clinic</strong> Foundation<br />
9500 euclid Avenue / W14<br />
<strong>Cleveland</strong>, OH 44195<br />
Weekend Immersion<br />
in <strong>Nursing</strong> Informatics<br />
October 26-27<br />
<strong>Cleveland</strong> <strong>Clinic</strong> Lyndhurst Campus<br />
Lyndhurst, Ohio<br />
To register, contact Stephanie Vargo at 216.445.4010<br />
or vargos2@ccf.org<br />
Dimensions in Cardiac Care<br />
March 9-11, 2008<br />
Intercontinental Hotel and<br />
Bank of America Conference Center<br />
<strong>Cleveland</strong>, Ohio<br />
For more information, contact Kathy Hill at hillk4@ccf.org<br />
Heart and Vascular<br />
Institute <strong>Nursing</strong> Internship<br />
<strong>Cleveland</strong> <strong>Clinic</strong> has created an internship program<br />
specifically designed to develop new graduates into the finest<br />
cardiac nurses in the nation.<br />
As an intern in one of the three areas offered – cardiothoracic,<br />
cardiac or transplant – you will work alongside some of the<br />
best nurses and physicians in the country and will be able to<br />
work with state-of-the-art therapies and treatments for a variety<br />
of severe heart-related conditions.<br />
Don’t miss out on this excellent opportunity to train in the<br />
nation’s leading hospital for cardiac care. Applications are<br />
available online at clevelandclinic.org/nursing and will be accepted<br />
through April 2008. For more information, please call<br />
216.297.7704.