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Giving School Nurses Access To Medical Records Improves Care



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School nurses today do a lot more than bandage skinned knees. They administer vaccines and medications, help diabetic students monitor their blood sugar, and prepare teachers to handle a student's seizure or asthma attack, among many other things.

And though school nurses see many students regularly, they don't always have the most up-to-date information about the students' health. School nurses must get permission from parents to communicate with a child's doctor. Once the doctor gives them a care plan for the child, they generally rely on the doctor and/or parents for updates and changes.

"When things change, we don't always get told in a timely manner," says Nina Fekaris, a school nurse in the Beaverton, Ore., school district. "It works, but it takes a lot of coordination."

At the same time, school-based health care is unfamiliar territory to many medical professionals, who operate in a health care universe largely separate from school clinics and other community-based medical services.

In Delaware, "lots of nurses expressed that they had difficulty communicating with providers" at Nemours Health System, which serves children around the state, according to Claudia Kane, program manager of the Student Health Collaboration at Nemours.

In 2011, Nemours got together with the Delaware School Nurses Association and the state Department of Education to develop a program that, with parental approval, gives school nurses read-only access to the electronic health records of more than 1,500 students who have complex medical conditions or special needs. That includes conditions such as diabetes, asthma, attention deficit hyperactivity disorder, seizure disorders or gastrointestinal problems.

Beth Mattey, a school nurse in Wilmington, says that now that she has access to the Nemours system, she can check the recent lab test results of a student who has diabetes. "It's helpful for me to monitor his [blood sugar levels] and work with him to make sure he's in better control," says Mattey, who is president-elect of the National Association of School Nurses.

When a student put a staple through his finger, Mattey was able to check to make sure he went to the doctor and got treatment. "Checking with him directly involves calling him out of class," she says.

Eventually, school nurses will be able to put information into the Nemours electronic records system as well, says Kane.

In the meantime, Nemours doctors, some of whom were initially skeptical about allowing school nurses access to health system medical records, are warming up to the arrangement. Kane says it encourages communication between physicians and school nurses, and eases the burden of routine tasks because Nemours doctors no longer have to fax over care plans or instructions to the school nurse every few months for students who are part of the program.

The Nemours Student Health Collaboration project is operating in all Delaware public school districts as well as half of charter schools and about one-third of private schools. Kane says Nemours plans to extend the program to school-based health centers next.


Do you think they should have access to medical records?

OR Nurses caught in the act of recycling


By Joan Banovic

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Judge's notes: This team made a change for the greater good. The initiative benefits not just the hospital but their community and beyond. They used a scientific, research-based approach and gained support from multidiscipline teams, management and administration.

It started with a single question: "Why can't I recycle this?" In the main operating room, we perform approximately 1,500 cases per month, all requiring sterile instrumentation, sterile water, sterile saline, packaged sterile supplies and implants. All of our supplies are packaged in disposable recyclable material. Operating rooms across the country contribute the largest amount of municipal trash in a hospital, secondary only to food services. If we were able to recycle half of what we used, we could make a major impact not only to our landfills and community, but potentially our small part of the world.

Jennifer Pallotta, BSN, RN, CNOR, inpatient operating room, masterminded the project. She empowered all who chose to become involved. Together, Jennifer and I spearheaded this massive undertaking. We gathered nurses, technicians, anesthesiologists and the Environmental Services Department staff to help assist with our endeavor. Together, we would all make a difference.

Our first step was educating ourselves in the art of recycling. We did it at home; how difficult could it be? We spoke with our managers and gained support and buy-in, for without them this huge practice change would have never been achievable. We joined our hospital-based "Green Team" and educated ourselves on what would be required. We then began to educate the staff, slowly introducing the concept of recycling product from the operating room. Surgery and anesthesia chairmen were informed of our initiative via emails and introductions at committee meetings. It was imperative that we had the surgery and anesthesia staff as involved as the perioperative personnel. An area of concern would be the Environmental Services Department, for without them our study could be in jeopardy. We were amazed at the enthusiasm that they displayed when we began our educational process with them. We informed them that without their support, our study would surely fail. It was a priority for Jennifer and me to ensure that they were comfortable with the process, and truly understood what a driving force their support would be. By empowering the Environmental Service Department, we gained allies that would last much longer than our study.

We initiated a pilot program. Phase I we monitored and measured five operating rooms: ENT/gynecological, laparoscopic, orthopedic, robotic and neurosurgical procedures. We would do this for a period of one month, three times a week. We would base our results on the amount of trash (weight) that we produced, separating only red bag waste from regular trash.

Coincidentally, the end of Phase I coincided with our institution's signing a Memorandum of Understanding with the Environmental Protection Agency. Not only did we have buy-in and support from our managers, but we also received support from our president and chief executive officer, as well as our executive vice president and chief nursing and patient care officer.
Once the one-month period was complete and we had our baseline statistics, the real fun began. We would need to educate staff on recycling of operating room supplies: What could be recycled as opposed to what could not be. What material was acceptable, and what we needed to watch out for. We began an educational program that consisted of in-services, posters, banners and giveaways. Jennifer and I made ourselves available at all times for questions and answers for whoever had concerns.

Phase II of our project began with the same five operating rooms, but the difference is that a recycling trash receptacle was now added. We learned from Phase I of our study that the majority of supplies placed into the red hazardous waste bag did not need to be there. A serendipitous moment came when we were able to remove the red bag receptacle from the operating rooms, and only have it available upon need. We were able to reduce our red bag waste by 50% percent; not only eliminating the financial cost of the bags, but also dramatically decreasing the cost of disposal.

During Phase II of our study we continued positive reinforcement, taking pictures of staff recycling to encourage the team. The staff members enjoyed seeing their photos displayed on the bulletin boards - all caught in the act of recycling. The staff began to take pride and ownership in the project, and began to realize that they were making a difference in something that they had full control over. Acts of positive peer pressure began to emerge. Recycling even caught on with our surgeons being more vigilant on where they disposed of their gowns and gloves; not wanting to contaminate the recyclable items.

The end of Phase II was celebrated amongst the staff. We held a party during our monthly staff in-service decorating the room, serving coffee and breakfast to the staff. We celebrated the fact that we as a team were able to increase our recycling by 34%, hence decreasing 34% of municipal waste that is dumped into our landfills. We cut our hazardous red bag waste by 50%, eliminating the cost of supplies of red bags as well as disposal fees. Our celebration ended with each registered nurse entering the operating suite with a 64-gallon blue recycling bin for each of the 22 operating rooms in the main operating arena. 

This greening initiative was very exciting. The recycling bug caught on. In an age where hospitals need to remain conscious of the earth and be aware of the potential hazards that we can add to the environment, the act of giving back and being green is something that we all can do. By recycling in the operating room, we showed the rest of the medical center that it was certainly possible for them to participate and play a part in this new culture.

This was truly the start of a new era all arising from one simple question, "Why can't I recycle this?"

What is your place of employment doing about recycling? 


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Life in progress: RNs can help baby boomers find funding for promising cancer treatments


By Heather Stringer


When Carrie Bilicki, RN, MSN, ACNS-BC, OCN, met a 60-year-old patient who had been diagnosed with aggressive endometrial cancer, she began to have a persistent — albeit unconventional — idea. 

Bilicki, a cancer nurse navigator in Wisconsin at the time, recently had attended a lecture about a progressive treatment for this type of cancer that involved using a chemotherapy drug traditionally prescribed for ovarian cancer. The patient’s cancer had spread to nearby organs, and she had a poor prognosis. Bilicki convinced the physicians to try the alternative medication. Unfortunately, the patient faced another serious hurdle: The insurance company would not cover the cost of the medication because it was not the standard treatment. At that point, the woman seemed to face the unenviable choice between cancer treatment and financial ruin.

Although patients and providers would like to hope this type of extreme dilemma is the exception, the case may be representative of the near future for two reasons. First, as a 60-year-old, the woman was a baby boomer, and researchers predict the incidence of cancer will increase dramatically as this large segment of the population ages. According to a study published in the Journal of Clinical Oncology in 2009, the U.S. can expect a 67% increase in cancer incidence among older adults between 2010 and 2030. 

Second, statistics suggest cancer treatment is becoming increasingly unaffordable, even for those with insurance who struggle to afford steep copayments. For example, The US Oncology Network — a national group of about 1,000 oncology physicians who treat more than 750,000 cancer patients per year — reported about half of the patients covered by a Medicare Part D plan have required copay assistance for oral chemotherapy for the past several years.

“My message to my peers is to know the financial resources available because there are hundreds of them,” Bilicki, who now is a clinical nurse specialist in breast services at Froedtert Center for Diagnostic Imaging in Milwaukee, Wis., said. “There are foundations, specialty organizations and websites that tell us where to get help. If a patient does not have an advocate to link them to that resource, they will never know it is available.” 

What's new?

For many patients, the desire to find a way to afford medication is driven not only by the fact that they have cancer, but also because the treatment options available today have increased the odds of survival. 

“By far one of the biggest advancements is more personalized medicine that targets cancer cells rather than traditional chemotherapy that did not differentiate between good and bad cells,” Kim George, RN, MSN, ACNS-BC, OCN, a cancer program consultant from Wichita Falls, Texas, said. “For example, now we can test biopsy tissue for specific tumor antigens and biomarkers and then prescribe treatments that target those antigens.” 

The advancements in cancer treatment also are reflected in improved survival rates. According to the Surveillance Epidemiology and End Results Cancer Statistics Review 1975-2009, for example, the 5-year survival rate for breast cancer among women in the U.S. between 1975 and 1977 was 75%. Between 2002 and 2008 that number jumped to 90%. During the same time periods, the 5-year survival rate for both men and women with colon cancer has increased from 50% to 65%. 

“Another major advancement has been the increase in availability of oral chemotherapy and biotherapy,” George said. “It has shifted the care setting. Years ago, the majority of cancer patients received IV infusions, and now more patients can take their medication orally at home. It is wonderful for convenience, and it is also less painful.” 

However, George said, reimbursement is not always a given with oral chemotherapy. “A lot of oncology medications are given off-label, which means that the FDA has not approved a drug for a specific diagnosis, so it may not be covered by some insurance policies,” she said. 

A little help can mean a lot

Point the way for patients who need assistance financing cancer treatments, by seeking resources such as the following:

• — Provides sources for copay assistance and answers questions about disability and insurance processes

• — Features information on different types of cancer, newsletters and financial and advocacy resources

• — Provides an extensive list of national resources for advocacy, financial and pharmaceutical assistance

• — A nonprofit organization that helps low-income families who cannot afford the medication they need 

• — Chronic Disease Fund — A nonprofit organization that helps patients obtain lifesaving medications

For a list of drug assistance programs from pharmaceutical companies, visit

Point the way

The art of navigating the path to financial assistance for cancer medication is not simple, and organizations such as The US Oncology Network, based in The Woodlands, Texas, have hired professionals to help patients connect with funding resources and launched the OncologyRx Care Advantage pharmacy in 2006. Nurses in the network can refer patients to Care Advantage staff who help them apply for financial assistance. 

“The types of drugs used to treat cancer today are definitely more expensive than when I started working in oncology almost 30 years ago,” said Lori Lindsey, RN, MSN, NP, OCN, a clinical services program manager with The US Oncology Network. “Multidrug regimens, including oral targeted therapies, can sometimes cost $30,000 for a round of treatment, although the use of these drugs has markedly improved outcomes and increased survival for some diseases.” 

For patients who are uninsured, the best option is to apply directly to the drug manufacturer for patient assistance, said Meg Asher, a patient access coordinator/patient advocate lead at the Care Advantage pharmacy. “When we learn that a patient is without insurance, we notify the doctor’s office and send a manufacturer’s application to them for the patient’s use,” Asher said. “Under these circumstances, we will not be the dispensing pharmacy; the manufacturer has their own specified pharmacy that will service the patient.”

Even those who are insured under Medicare Part D often require assistance because the copayments can be thousands of dollars, Asher said. For these patients, the Care Advantage advocate team helps patients connect with various foundations that provide copay assistance in the form of grants. Some of the foundations assist patients who suffer from a specific disease, while others help those who are taking a specific drug for a disease. 

While some facilities have staff trained to help patients find financial assistance, this is not always the case. For these patients, one resource is the Patient Advocate Foundation, a nonprofit organization with case managers who help patients with life-threatening illnesses to maintain financial stability. 

“When I was a hospital nurse, I honestly didn’t know about a lot of the resources available to help patients after they left my care,” Pat Jolley, RN, the clinical director of research and reporting at PAF, said. “Many people have never had to ask for financial help in the past, and they are unaware that there are options. If they are newly diagnosed, we try to educate them about the likely expenses down the road to help identify potential problems. In my experience, when patients contact us saying they cannot afford one thing, it is usually just the tip of the iceberg.” 

For example, PAF assisted a 62-year-old woman with breast cancer who was insured, but she was having difficulty scheduling her needed mastectomy because of outstanding medical bills. She was living on Social Security disability payments, and her insurance did not cover surgeries, scans or tests. The woman received a bill for $50,000 that included the cost of previous care and several office visits. By negotiating with the hospital and the providers, the PAF case manager was able to reduce the bill to a total of $950 and also facilitate the scheduling of her mastectomy. 

Suffering in silence

For Bilicki, one of her personal goals is to encourage patients to consider the financial aspect of their cancer care before they decide to pursue a particular form of treatment. 
“Nobody wants to talk about their financial state, and I think far too often patients suffer in silence rather than saying that they are having trouble with copayments, so what I do is proactively tell them about some of the resources,” Bilicki said. “Just because they have insurance does not mean they will have resources to afford the costs, so I empower all patients right off the bat to proactively seek out assistance if they need it.”

After patients have been diagnosed with cancer, Bilicki encourages them to learn about the resources at the American Cancer Society, which has patient navigators trained to help people connect with financial resources. She also tells them about a group called Patient Resource LLC, which has a website and a patient magazine that includes national, state and local resources available for financial assistance. 
In the case of the woman with endometrial cancer who could not afford a medication that was not covered by her insurance, Bilicki helped her apply for the drug manufacturer’s patient assistance program. Based on her income and medical necessity, she qualified for full assistance. She was on the medication for 15 months, and, despite her initial grim prognosis, the cancer has been in remission for the past five years. 

“I can always remember the tears and fear in their eyes when I first meet patients, and each time it feels like I’ve won the lottery when I help them secure the treatment they need, and they start smiling again,” Bilicki said. “Part of my big mission for my colleagues is to advocate for these patients so they do not miss out on options that can change their lives.” 

A little help can mean a lot

Point the way for patients who need assistance financing cancer treatments, by seeking resources such as the following:

• — Provides sources for copay assistance and answers questions about disability and insurance processes
• — Features information on different types of cancer, newsletters and financial and advocacy resources
• — Provides an extensive list of national resources for advocacy, financial and pharmaceutical assistance
• — A nonprofit organization that helps low-income families who cannot afford the medication they need 
• — Chronic Disease Fund — A nonprofit organization that helps patients obtain lifesaving medications
For a list of drug assistance programs from pharmaceutical companies, visit


Helping first time moms in need: Nurse-Family Partnership


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When Karlina Zambrano was about 13 weeks pregnant, she found a leaflet in her medicaid packet for a program called the Nurse-Family Partnership. The nationwide program would provide a nurse at no charge, who would come to her house weekly or bi-monthly throughout the first two years of her baby’s life. The visits would provide education and resources.

“I thought ‘Why not? It’s more information, more research,’” said Zambrano, now mom to 4-month-old Anthony, who she says is the “most adorable chunk of awesomeness ever.”

Zambrano soon met nurse Gloria Bugarin, who has worked for the Partnership through the YWCA of Metropolitan Dallas since 2006.

The Partnership is provided to low income women pregnant with their first child. The goal is to improve pregnancy outcomes, child health and increase “economic self-sufficiency.”

“A lot of it, even though we’re all RNs, is social work,” Bugarin said. She sees many clients who are in abusive relationships and tries to help them find resources to be safe. Others need help finding work or transportation to jobs. And on top of that, they rely on Bugarin to help point them to good child care.

Together, Bugarin helped Zambrano, 27, work on getting her blood pressure down. After Anthony was born (healthy and to term), Bugarin helped her with breastfeeding, which Zambrano desperately wanted to do, but found difficult. And when Zambrano, who had a stack of library books about pregnancy on her table when Bugarin first met her, felt like she wasn’t doing enough “attachment parenting,” Bugarin gave her advice [any new mom could use.]ECHO “To calm me down, she said if you think about a day, you feed him often, you’re there when he cries, you change him. You do everything to make him happy. Each thing you do builds trust in you from him.”

Bugarin took this job after 14 years as an elementary school nurse. She saw a need for parenting programs and early interventions, thinking that could help the countless children she saw coming into school with behavioral problems and developmental delays.

She feels like there are success stories for sure.

In one instance recently, she had a mom who was in a violent relationship with the baby’s father. Bugarin provided her with resources and at at some point after, that mom decided it was time to leave. She’s now living with family and has a job watching her cousin’s 6-month-old so she can keep her baby with her during the day. “From our visits and her desire to have a better life for herself and her baby, she’s making better choices,” Bugarin said.

For Zambrano and her husband, the visits have been incredibly helpful as they don’t really have family nearby. “There was somebody there who would talk to me and answer my questions, who might not be in an extreme rush,” she said. “I can really just open up and speak to her.”

Bugarin will be at the organization’s annual Mother’s Day celebration later this week. Previous graduates will be there, and more than 300 have already RSVP’d, she said excitedly. She is also proud to say she has two clients graduating (which happens when their children turn two) soon. “It is exciting, but also a little sad because we develop a relationship,” she said. One is still continuing with her education and is in the 10th grade. The other is going to college to become a social worker.

“I’m hoping she’ll volunteer or apply to work” with us, Bugarin said.

It should be noted: If you buy a Boppy pillow at Babies R Us during the month of May, the Boppy Company will donate 5 percent of its proceeds in the form of pillows to the Nurse-Family Partnership. The company has donated nearly 10,000 pillows over the last five years. You can also donate directly here until May

Leading the Way: Nurses recognized for improving health care



Wherever health care is provided, a nurse is likely to be there.

Nurses_Lizeth_Martinez-DP-1.jpgTuesday marks the start of National Nurses Week, an annual opportunity for communities to recognize the full range of nurses’ contributions. This year’s theme, “Nurses: Leading the Way,” recognizes nurses as leaders in the field.

Nurses are being honored as leaders who improve the quality of health care. Nurses practice in diverse roles, such as clinicians, administrators, researchers, educators and policymakers.

Lizeth Martinez, a registered nurse at Valley Baptist Medical Center in Harlingen, said every nurse is different.

“We each have our scope of practice and me, personally, I always try to be there for my patients,” Martinez said. “From what I have seen I am very fortunate to work with the people that I do.”

Martinez, who was born and raised in Brownsville, is currently working on a graduate degree in nursing at the University of Texas at Brownsville and should be finished by next year.

She said that in the two and half years that she’s been a nurse she has gained a lot of experience.

“I love being a nurse,” Martinez said. “As nurses we care in a different way, in a compassionate and holistic manner promoting health and healing.”

However, being a nurse is not without its challenges, said Martinez, who mainly works with wound care and diabetes patients.

“I think the most challenging thing about being a nurse is the emotional aspect because we see a lot of patients that are chronically ill,” Martinez said.

Garett Byrd, a pediatric registered nurse at Harlingen Medical Center, has worked in the nursing field for nine years.

Byrd, whose parents were nurses, said the profession has changed a lot during that time.

“Over the years I’ve noticed an increase in accountability and technology,” Byrd said. “The nursing profession has moved towards a more evidenced based practice. Were not doing things just to do them, were researching and going by the research.”

He said the community should keep one thing in mind.

“The community needs to remember that we’re human beings too, and we’re here because we care,” Byrd said.

Both Martinez and Byrd said nurses are leaders in the health profession.

“I think we are leaders. The profession is so amazing because there are so many things you can do, so many fields you can go into,” Martinez said.

“As nurses were able to provide and coordinate care and think those aspects of leadership position.”

Karen A. Daley, president of the American Nurses Association, agrees.Nurses_Garett_Byrd_DSC05075.jpg

“All nurses are leaders, whether they are in direct patient care, administrative roles or meeting consumers’ needs in new roles such as care coordinators or wellness coaches,” Daley said.

“This week, we acknowledge nurses’ vast contributions and how they are leading the way in improving health care and ultimately, the health of the nation.”

Nurses are leading initiatives to increase access to care and improve outcomes by focusing on primary care, prevention, wellness, chronic disease management and the coordination of care among health care providers and settings.

These are areas in which nurses excel given their education and experience, the ANA said.

According to the ANA, nursing is the nation’s largest health care profession, with nearly 3 million employed professionals and is projected to grow faster than all other occupations.

The federal government projects that more than 1 million new registered nurses will be needed by 2022 to fill new jobs and replace nurses who leave the profession.

Demand for nursing care will grow rapidly as Baby Boomers swell Medicare enrollment by 50 percent by 2025 and millions of individuals obtain new or better access to care under the health care reform law, the ANA said.

Source: Valley Morning Star 

Employment Options for Nurses


Q. I have been a bedside nurse for over 25 years and love my career. Both of my daughters have also gone into nursing. What are the career options for us? I don’t think I’ll be bedside much longer and what do recent grads have to look forward to?

A. The outlook for all health care professionals is very good as long as you are open to working in many environments. Hospitals, nursing homes, home health and insurance companies are among the industries interested in speaking to nursing professionals and other health service providers. The OOH (Occupational Outlook Handbook) projects a 19 percent growth rate for nurses between 2012 and 2022 due to an increase in the interest in preventative care, an increase in chronic conditions and the baby boomers need for health care in the future.

I consulted Kathy Lind, Staffing Manger for Boston Children’s Hospital, to get more information on options for experienced nurses who may not want to stay bedside. “Nurses with significant experience who are ready to leave the bedside and who are not ready to retire have several options. There are roles that focus on care coordination or clinical documentation. These positions require the expertise of a seasoned nurse and can be great options for nurses looking to transition.”

Lind comments, ”For recent graduates, it’s important to remember that you may not land your first choice as your first job. The best thing you can do is keep your options open and maintain a positive attitude. If you have the chance to speak with a recruiter or hiring manager, approach the conversation as an opportunity to build a professional relationship and ask if it’s OK to contact them occasionally for updates via email. You can keep them updated on the status of your boards and if you’ve accepted a position elsewhere.”

Your first job will most likely not be your last job. Many staffing managers would agree with Lind’s comment: “You may need to consider extending your job search beyond your initial clinical specialty and geographic preferences. The best thing you can do as a new graduate RN is to secure a position and gain one to two years of valuable experience. At that point you can begin to think about applying for that dream job!”


New York nurses share how colleagues inspire them every day

In healthcare facilities, it takes a network of teammates to ensure the optimal health of patients who receive care. The most successful teams are those who acknowledge each other’s strengths and work together accordingly where there are weaknesses, inspiring one another along the way. 

In honor of National Nurses Week, we asked nurses in New York and New Jersey to share the many ways in which their colleagues inspire them in their everyday lives to be better nurses, better teammates and better people. On the next few pages, we share their thought-provoking and heartfelt responses with you. 
Benjamin Quinones, RN, coordinator of care, MJHS Home Care, Brooklyn, N.Y.
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My network of team leaders helped me transition into nursing after 16 years as a paramedic. I didn’t get to be part of patients’ follow-up care or journey back to independence while working as a paramedic. 

As part of MJHS Home Care, I see patients one-on-one, but with the support I get from my special colleagues, I’ve never felt alone. Most important, my team leaders have taught me that at the end of the day, it’s all about our patients. 

Stephen R. Marrone, RN-BC, Edd, CTN-A, deputy nursing director, SUNY Downstate Medical Center, Brooklyn, N.Y.

bilde (6) resized 600When I was a high school volunteer in the ICU of a community hospital in Brooklyn, I watched the nurses care for patients and knew I wanted to be a nurse. As a nurse for more than three decades, I continue to be inspired by nurses every day, individually and collectively. 

Individually, I see nurses work tirelessly to provide excellent care during difficult financial times, and I am determined to make sure they have the resources they need to provide safe care. I am inspired when I see younger nurses become leaders on their units and I know I have made a difference. 

Several nurses have mentored and provided a springboard for me to elevate my practice and expand my scope of influence. They did so by recognizing potential in me that was hidden from myself. They helped me gain entry into higher levels of practice and a peer group that role-modeled leadership. 

When I am having one of those days when I ask myself, “Why do I do this?,” I think of those nurses and the patients we care for and remember that I am privileged to be touched by others and to touch others’ lives every day. 

Sylvie Jacobs, RN, BSN, CPAN, postanesthesia care unit, Mount Sinai Hospital, New York City
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The nurse who remains with me as the most inspiring is Patricia Liang. We worked side by side in the postanesthesia care unit for decades. 

She was the go-to resource because she seemed to know what to do in every situation and could impart the information to staff in a kind and supportive way. 

Liang was tiny in stature but relayed an enormous, quiet power, always in a respectful way. The new residents got away with nothing when Liang was around. She not only had a seemingly bottomless wealth of knowledge, but she also had an unfailing moral compass. When there was an ethical issue that needed to be resolved, we knew to ask Liang. 

She was not a talkative person — she was usually focused on coordinating care — but you somehow felt her support and appreciation for your efforts. I always will remember her for not just being an outstanding nurse, but for also being an outstanding person. 

Janice Wright, RN, BSN, staff nurse, 4C med/surg unit, Lutheran Medical Center, Brooklyn, N.Y.

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I have been working at Lutheran Medical Center on a med/surg unit for the past four years. I have had the pleasure of working with an extraordinary group of nursing colleagues. 

It is hard to single out one particular person because I truly can say my professional life has been enriched and my work ethics validated by each of the nurses with whom I work. I feel empowered and energized in my daily work because of my colleagues. 

Mary Farren, RN, MSN, CWOCN, clinical nurse specialist, acute care, VNSNY, Queens, N.Y.

describe the imageNearly every morning for the past 10 years, I have been fortunate to have a chat with Marilyn Liota, RN, as we start our day around 7 a.m. Nearly every conversation begins with Liota saying: “Tell me what is good.” From there, we have gone off in many directions. What a way to open a conversation, and what a way to start the day. 

I consider myself fortunate to have known Liota, worked under her leadership and guidance, and been a part of the special and historic “Marilyn Liota” years at VNSNY. Liota recently retired and I’m truly happy for her, yet underneath it all, I feel a touch of sadness, too. I will miss her so much. 

So typical of a giving soul like hers, Liota’s next steps involve giving generously of herself to help others as a volunteer working with new immigrants for a nonprofit organization called “Literacy Nassau.” 

Kathleen Lanzo, RN, clinical practice coordinator, ASU/OR holding/ENDO/PACU, Plainview (N.Y.) Hospital

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When I think of the most influential person in nursing who has enriched my life, the answer rolls right off my tongue. Her name is Winnie Mele, RN. I have been blessed to work alongside her for 28 years, and still each new day brings a new experience. 

Her style of leadership motivates and inspires all who know her to be successful in their careers. She gets out and circulates among the troops. No matter how dark the day, I always can count on her to make it a learning experience without being punitive. 

We share the same vision and passion for nursing. There is never a day when she won’t sit and have coffee, share a story, sing a song or just listen. “Every patient, every time” is the mantra she taught me and her staff. I am a better person professionally and spiritually because of this special outstanding woman. 

Compassion, honesty, fairness and loyalty are what I have taken from this extraordinary nurse who, throughout my career, has been my role model. Everyone should have someone like Mele in their life. I thank God for her every day. 

Nydia White, RN, critical care unit, South Nassau Communities Hospital, Oceanside, N.Y.

describe the imageI was 21 years old when I was a new RN on a med/surg floor. On that unit there was no such thing as being alone as a nurse — we worked together as a team. It was scary, overwhelming and exciting at the same time. 

Lisa Williams, my first nurse manager, did more than just her job. If there was a sick call, she would take a section of patients. If we needed some extra hands, she would give bed baths. Williams exemplified confidence, leadership and teamwork with a touch of color and a twist of enthusiasm that would radiate to her staff. 

The quality that amazed me most was her compassion for people. It wasn’t just about your abilities as a nurse; it was about tapping into the kind of person you were and helping you grow. She could sense if something was wrong, take you to the side and support you through the challenge. 

Williams’ specialty was to identify a nurse’s potential and mentor her to be a better nurse and a better person. She encouraged me to be the charge nurse and join committees when I didn’t think I was ready, but she assured me I was. Now I am a critical care RN and even host a CCRN review class. I volunteer for many committees. I am a better person and nurse because of Williams, my first nurse manager, mentor and friend. 

Erica Zippo, RNC-OB, BSN, C-EFM, staff nurse, labor and delivery, White Plains (N.Y.) Hospital

describe the imageI was a new graduate nurse when I started working on the labor and delivery unit at White Plains Hospital. In nursing school, we heard that nurses eat their young, so the support, camaraderie and familylike atmosphere I felt on the unit was something I never expected. 

My colleagues took me under their wings and enthusiastically shared their knowledge and individual experiences, most of which were things I had not learned in school. When observing my colleagues in action, I learned how to make a patient and his or her family feel comfortable, calm and welcome; how to complete an efficient history and physical while admitting a woman in labor; and how to make the delivery of every baby special despite the paperwork and nursing tasks. 

This shared knowledge from my colleagues continues to enrich my professional life and has shaped me into the nurse I am today. My colleagues also have supported me in my personal life through many important moments, such as relationships, break-ups, moves, graduate school, marriage and the birth of my daughter. I am thankful for the positive influences of my strong, intelligent and caring colleagues.

For more responses, visit



Degrees matter

Nurse researcher Linda H. Aiken, RN, PhD, FAAN, FRCN, has published a study that presents the latest in growing body of evidence to suggest a more highly educated nursing workforce saves lives.

“Our research shows that each 10% increase in the proportion of nurses in a hospital with a bachelor’s degree is associated with a 7% decline in mortality following common surgery,” said Aiken, professor of nursing and sociology and director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia.
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“More education, and particularly university education, enhances critical thinking. Professional nurses are called upon to quickly synthesize a large amount of clinical information about acutely ill patients, process this information in the context of scientific evidence, reach evidence-based conclusions, communicate salient information and their conclusions to physicians, and act in the absence of a physician at the bedside, which is most of the time.” 

Aiken said the study, published Feb. 26 on the website of The Lancet, was designed to account for other possible explanations for lower mortality, including patient-to-nurse ratios, presence of physicians, availability of high technology and how sick the patients are on admission. 

“After taking into account these other factors, nurses’ education is a very important factor in patient outcomes,” Aiken said.

The researchers combed through more than 420,000 patient records of discharged patients following common surgeries, such as knee replacements, appendectomies and vascular procedures.

This isn’t the first such finding for Aiken. 

“In U.S. research, we have established a causal linkage between better-educated nurses and patient deaths by studying hospitals over time, showing that hospitals that actually increase their hiring of bachelor’s nurses have greater declines in mortality than hospitals that have not increased BSN employment over the same time period,” she said. 

American Association of Colleges of Nursing President Jane Kirschling, RN, PhD, FAAN, said the fact Aiken publishes in such high-end journals as the Journal of the American Medical Association and The Lancet shows her findings stand up to rigorous scientific reviews. 

The message for associate degree-prepared nurses, according to Kirschling, is to continue their education. 

“We’re the largest single group of healthcare providers in the United States, and we’re there 24-7, 365 days a year for the care that’s provided,” Kirschling said. “That’s in hospitals, community settings and long-term care settings. So, we have to make that commitment as a discipline and as professional nurses to continue to expand our knowledge and our critical thinking skills, and we do that through advancing nursing education.”

Donna Meyer, RN, MSN, president, National Organization for Associate Degree Nursing, said that while the N-OADN supports higher-education initiatives in nursing, community colleges are crucial to meet the nursing care needs of the U.S. healthcare system. Community colleges graduate quality nurses representing 60% of the nursing workforce, according to Meyer, who is dean of health sciences at Lewis and Clark Community College in Godfrey, Ill. 

“Community colleges provide entry points for students moving into the nursing profession to practice, [and] provide a pathway to higher education and advanced practice, research and faculty positions,” Meyer said. “Many community colleges are embedded in rural and-or medically underserved communities, and without them and the nursing graduates they produce, healthcare provider shortages would continue to impair access to care.”

Meyer said N-OADN is working with the National League for Nursing, AACN and the American Nurses Association to find ways to encourage students to continue their education. A-OADN also is working with the Robert Wood Johnson Foundation’s Future of Nursing: Campaign for Action to support recommendations in the Institute of Medicine report, “The Future of Nursing: Leading Change, Advancing Health.”
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The study supports the importance of IOM recommendations that 80% of the U.S. nursing workforce be bachelor’s-educated by 2020, Aiken said. Nurses should help their institutions use this strong evidence base to improve nurse staffing adequacy and facilitate the transition to a BSN workforce.

“There are now quite a few large, well-designed studies by different research teams and in different countries documenting the relationship between more BSNs in hospitals and better patient outcomes,” Aiken said. “These studies were mentioned in The Lancet article and include at least multiple studies in the U.S., research in Canada, Belgium, China and now in nine countries in Europe. That is a substantial evidence base, sufficient to guide policy and practice decisions.”

To hospital and other employers, this and other studies show that nursing education really does matter, Kirschling said. 

Healthcare stakeholders need to “make the investment in our associate degree-prepared nurses by providing tuition support for them to go back to school … [and] to provide flexibility in the workplace” to allow them to continue their education, Kirschling said. 

Lancet study abstract:

For further reading, see “An increase in the number of nurses with baccalaureate degrees is linked to lower rates of postsurgery mortality,” by Ann Kutney-Lee, RN, PhD, Douglas M. Sloane, PhD, and Linda H. Aiken, RN, PhD, FRCN, FAAN, Health Affairs, March 2013 (study abstract): 

Engaged in education

This article is part of a series that will periodically examine issues affecting the future of nursing education in the U.S.

Previous articles:

RWJF offers funding for 'Future of Nursing' implementation

Study looks at implementation of recommendations on BSNs

Longer nurse tenure on hospital units leads to higher quality care


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When it comes to the cost and quality of hospital care, nurse tenure and teamwork matters. Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study from researchers at Columbia University School of Nursing and Columbia Business School. The study was published in the current issue of the American Economics Journal: Applied Economics.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is the largest study of its kind to link nurse staffing to . The researchers analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing impacted the length of stay for patients. Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, a shorter length of stay indicates that the hospital provided better treatment. At the same time, a shorter length of stay also makes care more cost-effective. The study found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3 percent decrease in length of stay.

"Reducing length of stay is the holy grail of hospital management because it means patients are getting higher quality, more cost-effective care," says senior study author Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at Columbia Nursing. "When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions – disrupting the balance of a team can make quality go down and costs go up."

While many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the study found that it's more cost-effective for hospitals to pay staff RNs overtime to work more hours on their unit. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies, the study found.

Nursing skill also mattered, the study found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

"This rigorous econometric analysis of  shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units," says the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School.

The researchers used the VA's Personnel and Accounting Integrated Data for information on each nurse's age, education, prior experience, VA hire date, start date at the current VA facility, and start date for the current unit at that facility. To assess patient outcomes, the researchers used the VA's Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90 percent of all acute care stays in the VA system for the fiscal years 2003 to 2006.

Provided by Columbia University Medical Center

Nurses on the run


For nearly a year, the Boston Marathon bombings and their aftermath have haunted Chelsey McGinn, RN, of the Blake 12 Intensive Care Unit (ICU). In December the MGH gave McGinn an opportunity to honor the victims – and begin her own healing process – by running this year’s marathon as part of its Emergency Response Fund team.

“I feel like it’s been almost a year now, and I haven’t really done anything therapeutic sinceBlake12Marathoners resized 600 it happened,” McGinn says. “I felt like other people who I worked with found ways to kind of cope with it, but I hadn’t really found that. When this came up, I thought this was a perfect way to celebrate how far the victims have come and recognize my co-workers.” 

McGinn is one of six nurses on her unit who are planning to run the 2014 Boston Marathon – five for charity teams and one as a qualified runner. Most are first-time runners, and all say they are running in honor of the three bombing victims who were treated on the unit.

“I had a really hard time afterward, and it lasted longer than I expected,” says Laura Lux, RN, who is running for the American Red Cross. “I’m running because I don’t want to be defeated. I know if he could, my patient would be running just to prove a point. Because he can’t, I feel like I need to do this for him. After watching what he and his family went through, I feel like it’s the least I could do for them.”

Lux says she felt an immediate connection with her patient and his family. “Despite everything they were just so determined and so strong,” she says. “Everyone was angry, but there was good coming from it too. We got to know each other because of it. I felt like he was a family member. It’s the most personal experience of my career.”

Lux’s experience is similar to that of the other nurses who are running, including Emily Erhardt, RN, a trauma ICU nurse and member of the MGH Emergency Response Fund Team, who has stayed in touch with her patient and his family since they left the hospital. “This event affected everyone, so it was one of the few times in my career that I felt like all I could do with the family was cry with them. It’s such a terrible thing that happened that there aren’t words to comfort them. You just have to be there for them,” she says. “A year ago they were strangers to me, but now they’re the most inspiring people in my life. I’m not much of an athlete, but I was really affected by the whole thing, and I wanted to do something more.”

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Blake 12 runners receive a boost of support from the Harvard University Employees Credit Union. Included in the photo with members of the ICU are Paul Conners, MGH branch manager; Eugene Foley, president and CEO; and Guillermo Banchiere, MGH director of Environmental Services, who serves as a member of the credit union's board of directors.

Allyson Mendonza, RN, who is running for the Mass General Marathon Team “Fighting Kids Cancer … One Step At a Time,” recalls the moment she knew she too wanted to do something more. Mendonza says her patient had just returned from surgery when she was told President Barack Obama was coming to visit. The woman was excited but was distraught about her appearance, so Mendonza and her colleague soaked her nails and helped shampoo and condition her hair to wash out the cement and clumps of dried blood.

“We just tried our best to make her feel better about herself and feel good for the day ahead. She actually fell asleep. When she awoke, she said, ‘This is the most relaxed I have felt in days.’ It was just so emotional for us and for her,” Mendonza says.

Caring for the marathon victims brought the unit closer together, and staff once again have come together to support and encourage their fellow colleagues.

“The teamwork and the camaraderie were amazing,” saysKatherine Pyrek, RN, who was the charge nurse during the week of the bombing. “Every one of the nurses was affected by what was going on, but they stayed strong and carried on. The bonds the nurses made with the patients and their families were incredible and really went above and beyond.”

Pyrek, who is running for the Mass General Marathon Team, says the Blake 12 runners offer each other advice and encouragement to help in the training process. “We remind why we’re doing this – for our patients and their families,” she says. “I think about the patients when they were in pain and how scared they were. I think that if they get through it then I can get through however many miles I need to run.”


The runners all say they look to Meredith Salony, RN, a veteran marathoner who qualified for the marathon, for guidance. “I’m so proud to be in this unit where there’s so much enthusiasm. Even the people who aren’t running are trying to help out and organize events and find ways for people to contribute,” Salony says.

Each of the nurses says they are overwhelmed when they imagine how they will feel on Marathon Monday.

“I think it’ll be really therapeutic and empowering,” McGinn says. “I’m honored to be a part of it. If I’m ever going to run a marathon, this is the one I want to run. I’ll always remember the way I felt at work that night, and it’s going to be a really nice thing to be able to remember this feeling for the rest of my life too.”

For more information or to support the teams visit

This is the first in a series of articles that MGH Hotline will publish about staff running in this year’s Boston Marathon.

Source: Massachusetts General Hospital

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