Nurses Making a Difference Julie Gattis, BSN, RN, BA, AHN Mother/Baby days
Julie Gattis, BSN, RN, BA, day shift AHN in Mother/Baby (M/B), joined Salinas Valley Memorial's Labor & Delivery (L&D) unit in 1987 and moved to M/B in 2006. "I graduated from CSU, Sacramento in 1982 with a BA in psychology and realized that I didn't want to work with just people's minds," says Julie. "I wanted to care for the whole person. That's when I applied for nursing school at CSU, Chico. My second semester was focused on L&D and I knew I'd found my niche in nursing."
After graduating with her BSN/RN in 1985, Julie worked at St. Elizabeth's Hospital in Red Bluff. "It was a very small L&D and sometimes I was the only nurse on my shift," recalls Julie. "The experience taught me to be independent and resourceful, and to know when to ask for help."
Until last year, AHNs for each shift in L&D also covered the Mother/Baby unit. Patient volume in L&D often meant that the AHN was not readily available to M/B nurses. In August 2009, Julie, along with Michelle Savala, BSN, RN, evenings and Ludy Lim, MSN, RN, nights, was named AHN for M/B. The Perinatal Unit Practice Council was formed the same year with Julie—a nominee for 2010 Nurse of the Year—as its first chair. Today, she continues her involvement as the AHN representative to the council as well as serves on the hospital's TJC Tracer Team.
"Being nominated for Nurse of the Year meant everything because my fellow nurses suggested me," she says. "I felt like a winner just being nominated. I was honored that the staff thought that much of me to take the time to nominate me. Having an excellent, professional staff and the support of CNS Julie Vasher and Director Pat Valenzano makes my job as an AHN even more enjoyable."
Julie and her two daughters live in Salinas. In her spare time, she loves spending time with her family, knitting and playing with her new Puggle puppy—a beagle and pug mix. "She's 20 pounds of adorable," Julie says with a smile.
Through successful weight loss and a healthier lifestyle, nurses at SVMHS are a shinning example for their patients, family, friends and one another. With 2010 just a few days old, Renee Armenta, RN and Sylvia Lara-Sanchez, RN—nurses who work the night shift in the Comprehensive Cancer Center—joined Weight Watchers. Soon, other nurses and friends followed suit.
"I was 60 pounds overweight, my blood pressure was high and I was tired of being tired all the time," says Renee. "My kids mentioned that I slept through most of my days off. Those comments—along with the fact that I have a family history of high blood pressure and diabetes—inspired me to make big changes."
"When my youngest child turned three and I hadn't yet lost the 'baby weight,' I knew I needed to do something about it," says Sylvia. "Then, Renee invited me to join Weight Watchers with her. The program teaches you to make better choices rather than focusing on a specific diet. It was hard at first, but got easier as we all supported each other and shared ideas."
Within three months, Sylvia had met her goal and has maintained her weight loss. "I lost 30 pounds which is what my three-year-old weighs," Sylvia says. "I lost the equivalent of a whole little person!" After reaching her goal and maintaining it for six weeks, Sylvia became a lifetime member of Weight Watchers and can attend meetings at no charge. "There's no reason not to go," she continues, "especially when I can help motivate others who are still trying. I feel better, am more physically active and, overall, our whole family is eating and living a healthier lifestyle."
When she weighed in on July 15, Renee had lost 42 pounds. "I bought some exercise DVDs and started working out at home in March," says Renee. "At first, I nearly killed myself," she says laughing, "but now it's second nature. I have so much more energy, at work and at home. I played football with one of my nine-year-old twins and it was a shock to both of us that I could do it. My kids didn't want to eat 'diet food,' so I showed them how we could eat 'regular people food' just making better choices. It's a big turnaround."
Renee and Sylvia heartily agree—"If we can do it, anyone can."
The Renal Process Improvement Committee was formed in March to address streamlining processes to improve outcomes for patients with renal failure. The collaborative group—led by Theresa Johnson, BSN, RN, Case Management Operations Manager and facilitated by Laura Mittendorf Zerbe, Organizational PI Specialist, Quality Management Services—also included representatives from case management, the medical staff, MSCV3 nurses, rehabilitation services, diagnostic imaging, social services and the business office.
Case Management works closely with nursing to identify ways to positively impact patient outcomes and reduce length of stay for patients with a specific DRG. In this case, the DRG was renal failure with major morbidities. "In February, our average length of stay (LOS) for these patients was 12.5 days," says Theresa. "That compared to the GMLOS average at other hospitals of 5.1 days. As a group, we uncovered ways to significantly improve outcomes for our patients." Significantly is an apt word for the initial results—March average LOS was 6.7 days, April 4.5 days and May 4 days. "This demonstrates the power of collaboration in enhancing patient safety, quality of care and outcomes," Theresa says.
Some of the issues the group addressed included reducing the time required to find a pay source for new acute renal patients who needed dialysis; working with physical therapy (PT) to help patients sit up for at least three hours, and nurses and PTs partnering to ensure that patients could take meals sitting up. "Our goal is to make sure patients are moving throughout the hospital system efficiently so they're not debilitated during their stay," explains Theresa. "We plan to look at other DRGs on each floor that offer opportunities for improving patient outcomes and satisfaction."
Renal Process Improvement Committee
Brenda Dumpit, Business Services Manager
Maria Fuenzalida, Clinical Social Worker, Manager
Art Gabudao, Clinical Social Worker, MSCV3
Laura Mittendorf Zerbe, Organizational PI Specialist, Quality Management Services
Evelyn Soriano, RN, Case Manager, MSCV3
Mary Stepien, RN, AHN, Diagnostic Imaging
Maria Torres, Physical Therapy Assistant, Rehabilitation Services
Born at Salinas Valley Memorial Hospital, Pam Yates, RN, CLC worked in our Nurse Staffing office while attending nursing school at Hartnell. Since graduating in 1998, she has worked in Pediatrics. "Nursing is a great way to combine my interests in helping people and in science," says Pam. "I considered obstetrics, but after a pediatrics rotation, I was hooked. I love kids and am comfortable taking care of them. And it's very rewarding to be able to care for the whole family."
Pam, a Certified Lactation Consultant since 2002, was recently named Patient Care Champion for the unit. "I went through the interview process and was lucky enough to be selected," she says. She is also a relief charge nurse and serves on the Pediatric Practice Council. "Pediatrics is a cohesive unit where everyone pitches in without having to be asked."
She and her husband have three children and live in Salinas. Most Mondays, Pam's at home in the kitchen baking—one of her favorite leisure activities.
"More than 50 percent of our patients have a high or moderate nutrition acuity level (NAL) when they're admitted to the hospital," says Cynthia Poole, MS, RD, Director of Nutrition Services. "The Nutrition Services Department's clinical dietitians team up with nurses, physicians and other members of the healthcare team to create a nutrition plan based on each patient's risk level. Our goal is to support healing and disease management while they're in the hospital and give them tools to use at home."
"The expertise of our Nutrition Services staff not only aids our patients in recovery, but also helps avoid complications and interactions," says Libby Brice, RN, Float Pool, Progressive Care, Level II and Heart Center. "They participate in rounds and meet with patients who need specialized nutrition care. They're always available when I have questions, this is especially important on foods that might interfere with medications such as anticoagulants."
When a person is admitted to SVMHS, a nurse completes a nutrition screening. The results, along with all other information from the patient's chart, are entered into the system and immediately accessible to Nutrition Services staff. A registered clinical dietitian sees patients with a high Nutrition Acuity Level (NAL) within 24 hours and those with moderate NAL in 48 hours. All new patients are visited by one of the department's diet clerks within 24 hours of admission. "The clerks have a great deal of interaction with our patients and are there to assist with menu selections, answer questions, address special needs, follow up and act as the liaison with Nutrition Services," says Cynthia. Tray passers deliver meals and snacks to patients throughout their stay.
"Much of my work is done with patients who have been newly diagnosed with diabetes, those on dialysis or blood thinners and participants in cardiac rehab," says Sheri Caprara-Hayes, RD whose focus is on educating patients as well as family members. "My goal is to equip them with tools for survival."
Many of our registered dietitians have their MS degrees and specialty certifications in areas such as diabetes, nutrition support and neonatal nutrition.
Jennifer Leduc, RD, CNSC is a clinical dietitian specializing in neonatal intensive care. "I work closely with NICU nurses and other clinicians to come up with a plan of care," she says. "My role is to help the NICU team to develop a feeding plan for the baby while in the hospital as well as for the transition to home."
"I've always liked taking care of people and became a nurse's aide at age 17," says Maria Schade, RN-SNIII, RNC, Labor & Delivery (L&D). Her mother, a CNA at SVMHS for 20 years, suggested that she look into the hospital's UA course. After completing the course in 1989, she worked as a UA on Level II. "My confidence increased and that inspired me to go to nursing school."
Graduating from Hartnell in 1994, she continued to work as a UA in Level II, the Heart Center and ICU/CCU and as a RN at Mee Memorial. Three years later, a position opened up in our L&D unit and she's been there every since.
Maria is the Perinatal Services Performance Improvement representative on the Nurse Quality Council. She serves on the Patient Safety, Life Safety and OB Tech committees. Maria is also co-director of the Basic Life Support program at SVMHS.
"I have a passion for helping bring new life into the world," Maria says. "It's a gift to be part of the patient's family and help them through this important time in life."
Maria has three grown children, four lively dogs and lives in Salinas. In her spare time, she loves watching baseball, basketball and football—especially when the Giants, Warriors or 49-ers are playing.
Bulletin Boards Showcase accomplishments of SVMHS Nurses
The Evidence Based Practice Council (EBPC) has two bulletin boards in the hospital to showcase the work and accomplishments of our nursing staff. One is located in the main hallway near the lab (around the corner from the ATM) and the second is on the basement level, visible as you exit the triple elevators. "We want staff, patients and visitors to see that our nurses are making significant contributions to quality patient care and to the profession of nursing," says EBPC member Lisa Garcia, MSN, RN, CNS Pediatrics.
Some of the items currently posted on the boards are published articles and presentations by SVMHS nursing staff, information about Chapter Membership for Sigma Theta Tau International Honor Society of Nursing and updates regarding Nursing Grand Rounds. A list of EBPC members is also displayed so that nurses know who to contact if they have an idea for a project. "The bulletin boards are designed to inspire and inform nurses and other staff as well as let visitors and patients know that we're constantly working to improve patient safety and quality of care," says Lourdes Escolta, MSN, RN, CMSRN, ONC, CNN, CNS Med/Surg, and EBPC member.
All suggestions for board postings are welcome for consideration and can be submitted to the EBP Council.
Vanessa Irwin, MSN, RN, CLC, Clinical Nurse Educator, Med/Surg and Peds presented her research entitled, "Patient Care Champions: A Model for Acute Care Hospital Staff Education" at the Sigma Theta Tau International's 21st International Nursing Research Congress in July, held in Orlando, Florida. The focus of this year's congress was Global Diversity Through Research, Education and Evidence Based Practice. More than 740 nurses from 40-plus countries attended. Sigma Theta Tau International (STTI) is the Honor Society of Nursing that Vanessa joined during her MSN program. The mission of STTI is to support the learning, knowledge and professional development of nurses committed to making a difference in health worldwide.
Rachel Failano, MSN, RN, Clinical Nurse Educator, Clinical Simulation/Skills Lab Coordinator presented the results of a pilot study looking at "Primary Language and Rapid Response Team (RRT) Outcomes" during a poster session at the 35th National Association of Hispanic Nurses (NAHN) Annual Conference in July held in Washington, DC. Approximately 400 attendees participated in a wide-variety of presentations and workshops targeting Transforming Policy to Support Healthy Communities for Latinos. Rachel's poster was awarded third place among dozens of posters presented! The NAHN is committed to improving the quality of health and nursing care of Hispanic consumers as well as providing equal access to educational, professional and economic opportunities for Hispanic nurses.
Project Focus—Hypothermia therapy after cardiac arrest
A multi-disciplinary effort was launched in June 2009 to research, develop and implement a Hypothermia Therapy After Cardiac Arrest Protocol for SVMHS.
Karen Bird, RN-SNIII, CCRN, ICU is the researcher and author on the project. "It was a collaborative effort between physicians, nurses and pharmacy," says Karen.
The American Heart Association reports an average of 300,000 out-of-hospital cardiac arrests in the U.S. each year. Only 4.7 percent of these patients typically survive to hospital discharge, and of those survivors, 90 percent have some degree of permanent brain damage. The American Heart Association has issued a recommendation for hypothermia therapy as part of post-resuscitation care.
During arrest, a lack of circulation sets off a variety of destructive processes in the brain. "Studies show that hypothermia is currently the only therapy with a good success rate in preserving brain function for these patients," Karen explains. Cooling the patient for 24 hours stops the destructive processes, slows metabolism and allows the brain to rest, mitigating the damage that's already occurred and preventing additional damage. Cooling may be started in the cath lab or ICU, and the process is completed in the ICU. Re-warming is done slowly. It takes about 72 hours to complete this complex therapy.
Once it's determined that a patient needs the therapy, it must begin quickly to be most effective. Physicians will use a screening tool to quickly assess cardiac arrest survivors and identify candidates for the therapy. If cooling is to be started in the cath lab, a "Code Cool" is announced hospital-wide. "Other units of the hospital do not need to take action, but we want everyone to be aware of the new code," Karen says.
Education is an important element in implementing any new protocol. Karen has presented hypothermia protocol education to the ICU and cath lab staff as well as the cardiology and emergency departments. She has also created bilingual Carenotes for patients and their family. Proud to be involved in bringing this therapy to SVMHS, Karen says, "This therapy may provide a significant improvement in quality of life for these patients."
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