Remember The Mission

The myth: telephone triage nurses do not use nursing skills rather only answer the phone. The reality: NurseLink nurses perform nursing assessments, evaluations and interventions just like nurses in any other practice arena. Yes, they sit in a chair and answer the phone one, call right after the other. The nurses must remain cognizant of the different ring tones that alert the nurse of ‘Crisis Hotline’ (Center for Health Care Services) call, urgent or emergent medical caller from ‘Community Medicine Associate’ clinics and the University Health System (UHS) Operator, and/or a ‘Community First Health Plan’ caller. All calls need urgent attention. While the nurse takes urgent calls, he or she must pay attention to the routine calls. These are ‘NurseLink’ calls that have been pre-screened by the support staff.

NurseLink consists of twelve (12) seasoned Registered Nurses and eight support staff members. This fast paced service takes phone calls ranging from a frantic mom of a constipated newborn or a patient that has fallen and obtained injury to the crisis caller that has taken a drug overdose or is ready to jump off of a bridge. A telephone triage nurse must possess astute communication and assessment skills, and must be able to rely on clarity of critical thinking, past experiences and ability to differentiate tone of voice and characteristics of the caller. The nurse has to make quick, accurate decisions, often involving emergent or urgent interventions, He or she must also provide home advice to a patient that is not seen but only heard, often a very difficult task.

An example of a routine triage call is from a mother regarding an eight year old that has nausea, vomiting, diarrhea, fever and complains of abdominal pain. The nurse first speaks with the mother, who presents the symptoms, then speaks with the child to clarify/verify the symptoms (assessment). Then the nurse makes the nursing diagnosis. Decisions must be made quickly. Does this child need to go to the ER, clinic or only home care (plan of care). Next, the nurse provides the advice (implement intervention). Finally, the nurse asks the mother to call back to verify that she made an appointment with clinic or went to the emergency room or called 911 (evaluation). This all has to be done within a reasonable time which is expected to be approximately six minutes. While speaking with the patient, the telephone triage nurse must be able to navigate the University Health System computer system and various programs all at the same time. Finally, documentation is a must for all of our phone calls, and like most unit or floor nurses this charting may have to be placed in various sites.

Other duties of a triage nurse include communicating with physicians, various clinics, laboratories and radiology departments. We are the on call system for Community Medicine Associates, Medicine Clinic, and any department that is closed or after hours. NurseLink nurses coordinate care with other departments such as Care Link and the Ambulatory Connection clinic as well as providing community resource information.

Let us not forget that like all of UHS nurses, triage nurses must continually learn, and attain information to keep abreast with current changes in the healthcare field. One of our nurses recently put together a book including patient preparation for special procedures on everything from dental extraction and colonoscopies to pulmonary function tests. We are also active members of several committees. One example is the policy committees, which has recently implemented the “Career Ladder” and are working on the completion of the “Peer Review” policy. Some of the nurses have returned to school and are pursuing their Masters degree. Several nurses have given in-services to Haven for Hope and Centro Med Clinics to improve community knowledge of University Health System especially knowledge of NurseLink and the Express Med Clinic.

So here we are, nurses to the core. NurseLink Triage nurses use the nursing process without seeing or touching the person. Yet we impact the patients just as much as a bedside nurse does. Where the bedside nurse left off, the NurseLink nurse picks up in other words we bridge the gap to make UHS complete.

We are proud to be UHS.

Susan Gordon RN

NurseLink 358-3000

Oncology Nursing

“We poison people for a living!” my day Charge Nurse says, to the neophyte nurse and the lay person, that would come as a shock. But if you look at it closely that’s the main point in giving patient Chemotherapy. But that is not what we are all about.

Oncology Nursing is evolving, patients have more options unlike before, some cancer can be treated by Surgery, Radiation and then there’s Chemotherapy. That’s where we come in. Unlike other fields or discipline of Nursing, we are there with our patients from the moment the first test results come back, be it with the blood test or the biopsy or even the bone-marrow aspirate result. We are there from day one to D day. You hold their hand, administer the drugs, clean up the mess and in the end wrap what once was a living, vibrant person and pray for their souls.

According to research, Oncology Nurses can have post traumatic stress syndrome, caregivers fatigue and compassion fatigue. We witness the tragic passing, it can be a fatal Chemo reaction, or just the psychosocial aspect of it all or simply doing the post mortem care of our patient’s ourselves.

It does not really matter how many years you have in your belt as an Oncology Nurse, the experience of death and dying is an unpleasant event it is a part of what we do but doing it routinely and sometimes on a monthly basis can be taxing.

It does take a special nurse to be an Oncology nurse, you just have to care enough and be able to look beyond the cancer and be a healer and sometimes just be a friend.

You have to be a lot of things, you have to play a lot of roles. As the nurse you have to be knowledgeable of the Chemo Regimen and have to educate the patient and the family about the effects and side-effects. As an advocate you have to have the patient’s best interest at heart.

You have to be compassionate and have enough empathy to go through the vomiting, hair loss, anxiety-depression phase, the pain, the family dynamics. Most importantly you have to have the capacity to let go when everything else fails and put in perspective that you did everything you could to make that patient’s stay in this world matter, comfortable, worthwhile if not bearable.

We can be our brother’s keeper, if we are able to put ourselves in their shoes and feel their pain and fight for them and in the end pray for them. Compassion is a Virtue so is hope and caring. If we hear this calling then we’re headed in the right direction.

Click here to view more stories from UHS Nurses.

Radiology nursing has expanded its role in the Radiology department over the past year, and will continue to work closely with all areas in Radiology. We are committed to providing safe and effective care to our patients while they are undergoing diagnostic and therapeutic interventions here in our department.

Radiology

Radiology nurses work in the MRI department here at the hospital 24/7, to provide safe and effective care for all MRI patients, from stable to critical. They promote safety and throughput in the MRI suite, and work together with the MRI technologist to ensure all patients are provided safe and effective care during their visit to the MRI suite. They communicate with the inpatient nurses to discuss and plan the care of all inpatients while in the MRI suite.

Radiology nurses  also staff the 2nd floor CT suite 24/7 with a similar objective; to promote patient safety and throughput in the CT suite, and work with the CT technologist to ensure all CT patients receive safe and effective care during their visit to the CT suite. They communicate with the inpatient nurses to discuss and plan the care of all inpatients while in the CT suite.

They also work with the Radiologist and CT technologist during many special CT studies where the patients need monitoring or may need specific medications and interventions to assure they receive the best possible results from their studies.

Radiology nurses provide procedural sedation to our non-vascular guided intervention patients such as biopsies, drains, and drainages. Working together with the Radiologist, we provide this non-vascular  guided intervention in Sono and CT, to both in and out patients, ensuring they all receive their interventions in a safe, pain free, and comfortable manner, and are recovered appropriately to return home or to their inpatient bed.

Radiology

Radiology nurses have also begun to work in Nuclear Medicine to provide safe and effective care for all patients coming to this area. They communicate with the inpatient nurses to discuss and plan the care of all inpatients while in the Nuclear Medicine area. They monitor and care for cardiac patients having their cardiac studies, and they provide medication to patients as needed during special exams. They contact outpatients to discuss the plans for their upcoming Nuclear Medicine studies, and work with the technologist to promote patient safety and throughput in that area.

Radiology nursing continues to grow toward the goal of providing safe, effective, and compassionate nursing care to all patients visiting the Radiology department. We are ready to monitor and provide care to all complex and special need patients coming to our department, and have asked the inpatient areas to contact us regarding any complex patients. We will soon have an eight bed staging/recovery area, where we can contact inpatient nurses regarding all patients coming to Radiology in order to plan their care while they are in the department.

Gifts

Center for Caring is a resource center for the nurses and staff, and has several groups that come to gather to support each other. Several events marked the month of December beginning with the Healing Art Exhibit where art from nurses, Doctors and staff were exhibited in the hospital lobby December 6th.  Then members of the Center for Caring “Caring Connections” a mostly nurse based group put together fruit baskets for the 3rd year. These fruit baskets were delivered to the hospital units and departments on December 24th or 25th in gratitude for the employee’s hard work, especially during the holiday season. To close the month the Center for Caring and all its groups gathered gifts throughout the month of December for their adopted UHS Family thanks to the program from Social Workers at UHD.  These gifts were delivered on December 22nd to the family of seven who were very happy when Center for Caring stopped at their house.

Fruit Baskets

Center for Caring is a power house of resources for health and wellness. 



It also offers the Art of giving ….”For it is in giving that we also receive”. 

The Givers

Inpatient Psychiatry and Psychiatric Emergency Services (PES) staff members put their giving spirit into motion by donating clothing to Clarity Hospital, which serves children and adolescent who need inpatient psychiatric treatment.  Lois Weisinger RN contacted Clarity Hospital to find out what types of donations were needed.   After the Inpatient Psychiatry and PES staff members were notified about what was needed, they donated sweatshirts, socks, pajamas, and underwear.  Lois delivered the donations to Clarity Hospital on December 21, 2010.

Thank You SSgt David Viera

In December of 2009 my son SSgt David Viera was deployed to Iraq. Upon his deployment two members of my UHS family, Pat Robichaud and Beth Lawrence, took it upon themselves to organize a UHS Care package for my son and his fellow soldiers.

Pat and Beth reached out to our fellow NBN nurses for donations to help complete the UHS Care package. The NBN nurses took on the challenge by providing a mass amount of donations in the form of board games, peanuts, gum, mints, crackers, beef jerky, shaving products, soaps, hand sanitizers, magazines, mugs and even monetary donations.

A sense of happiness and pride overwhelmed my son when he received the UHS Care package.

“little things like that really help brighten everyone’s day out here. When I first walked into our barracks carrying that huge package, it felt like Christmas morning. I couldn’t open the package fast enough. It was a really wonderful thing to do. On behalf of  ~~ Charlie Company, 3rd Brigade Support Battalion, 1st Heavy  Brigade  combat team, 3rd Infantry Division thank you from the bottom of all our hearts”.

UHS cares not only about our patients but about each other. It is the little things such as organizing a care package for my deployed son that makes me value, respect and appreciate my fellow coworkers here at UHS. This is an act that was not necessary but done out of love and consideration. On behalf of my son and myself, I want to thank Pat Robichaud and Beth Lawrence as well as all NBN nurses who contributed to the care package. It is the simple things that make a difference in showing that we care.

I was born and raised in the Philippines. My parents were both teachers and I grew up with only enough resources for basic needs like food, shelter and education. I had to walk with rubber slippers to and from school about 2.5km twice a day. When I was in high school and college, I had to walk to the nearest bus stop which is about 5 km from my house. I had to pound the rice for my weekly consumption and bring my own firewood since my parents couldn’t afford to pay for the gas stove. My parents, especially my mom instilled in all of us, my 2 brothers and me, that the most important gift they can give us is our education, since it can never be stolen or taken away from us. I finished my nursing degree with honors despite limited financial resources. My aging parents had to work hard so the three of us could finish college.

      It had been my dream to come to the US to look for “greener pastures” as the cliché goes. I worked hard to pass all the qualifying exams and in 1994, I realized that dream. So in 1994, I flew to the US. It was my first airplane ride ever and my first time to be away from my parents.

    Last July 4th when I saw the fireworks exploding into different brilliant colors illuminating the clear skies, I got goose bumps because I felt so proud to be a citizen of this country, to be a part of this great nation. It seems very unbelievable that I am raising my kids here, that they have more opportunities , that they have a better life  and they have more luxuries and  enjoying life’s comfort which my husband and I did not have when we were kids.

     Those fireworks made me ponder on how proud I am to be working for this hospital. UHS has really provided me with boundless opportunities and experiences that make me feel that I made a difference in the life of another human being. Working in the MICU department opens the door to a variety of experiences. My critical thinking, IV skills and communications skills are being honed and I continue to grow everyday. I learned to be a leader, to be a follower, to be a mediator, to be my patient advocate, and I learned how to express myself more effectively. Being part of a Magnet Hospital is an achievement for someone like me who came from a very humble beginning.  I am proud to be a part of this country that gives everyone a chance to have medical help regardless of social status. One of our daughters has a very rare lung condition and she needs IVIG treatment, steroid regimen, antineoplastic treatment and occasional blood transfusion and oxygen therapy. If this has happened back in my home country, her chance of survival would have been very, very limited. With the help of our great pulmonologist, Dr. Mangos and Immunologist Dr. Infante, our daughter is still with us. We may not know what the future holds for her but at least we know that we have the means to help her enjoy a meaningful life.

I am glad that I took my kids to celebrate this 4th of July and I am looking forward for more celebrations as a nurse in this great hospital.

                             Submitted by:

                          Preciosa Lacea Jumamil, BSN RN,CCRN-CMC

                          MCCU

Daisy Award Program

I remember being excited about being a part of bringing the DAISY AWARD PROGRAM to our system two years ago in 2008. It has been a rewarding experience to serve on this committee from its inception and I would like to share a few moments of how it has impacted our nursing staff.

We wanted a way to recognize our exceptional nurses and to create a culture throughout our health care system that valued these role models. One goal was to improve our nurse retention and recruitment. We now realize how much more we have gained by having this recognition program in our hospital.

This award now in over 500 hospitals across the USA, was established by a grieving family who had been touched by the remarkable care, clinical skills and compassion demonstrated by the nurses caring for their son, Patrick Barnes during his illness. They wanted to recognize exceptional nurses across the country thus started the DAISY Foundation in 2000.

Healer's Touch

This recognition award also provides the winner with a hand carved sculpture (pictured) called the “Healer’s Touch” made of serpentine stone from Zimbabwe. Because the Center for Caring pays $100 for each sculpture it allows the artists’ the ability to supplement their income in a very depressed economy. Each sculpture is unique with the signature of the artist imprinted on the base. This reminds me of the imprint that we as nurses have the opportunity to make on each of our patients lives as we provide our healing touch.

The DAISY Foundation also funds research and evidence-based practice projects linking their yearning to impact treatment of patients with auto-immune diseases and cancer and their passion for the compassionate work nurses do in medical facilities all over the country.

This program provides support for nurses who

• Continually evaluate their practice


• Seek answers to clinical questions in an effort to improve their practice


• Change their practice based on evidence and evaluation of that change

The confidence this family recognized in nurses is inspiring and instills within our nurses encouragement to keep on seeking ways to improve their performance and the quality of care delivered to their patients by understanding each patient’s unique experience.

Donna Grieder accepting Daisy Award.

We have had monthly winners since January of 2009.

Our November ’09 winner Donna Grieder wrote:

“The fact that the award was started by a family in recognition of what nurses “do” makes it feel like an Olympic medal to me. I’m humbled and touched that from their grief they reached out to all of us, to thank us and show that what we do matters very much.”

“There’s a ripple effect I now see from the award. I got emails from people in the system that I interact with. Each one is a little gift. Then, too, I feel I have a chance to thank the Barnes family and their foundation by explaining that DAISY refers to Diseases Attacking the Immune System and why the program was developed. I feel like a DAISY ambassador.”

She closes her letter by saying, “Nursing is special. I want to thank the health system for participating in this program, which by honoring one of us at a time, also honors all nurses for what we do everyday.

The March 2009 recipient Virginia shared with me that she felt her entire nursing career had been validated when she received the DAISY Award.  She had many experiences throughout her many years of practice and felt it was such a blessing to be retiring after having received this award. She was recognized for her assessment skills that noted the tiny changes that monitors can not detect which led to a life saving outcome for her patient.

The fact that this presentation also involves serving cinnamon rolls makes it appealing in another way. During one of Patrick’s final days he requested a Cinnabon and also wanted them to be brought in for all of the nurses. We celebrate the winner with all staff members as they are an integral part of making the team successful. The aroma of cinnamon is a reminder of how special these extraordinary nurses are and how important their work is.

Our DAISY winner, James Alexander sums it up by telling me how winning the award has impacted him. “It made me aware that even little things that are done for patients can make a big impression. So even on the toughest of days, I can find some comfort in the thought that what I did, made a difference.” It is this sentiment that exemplifies the work that nurses do every shift, every day. This DAISY recognition that UHS supports has definitely been instrumental in increasing our morale and has rejuvenated the spirit of why we chose a career in nursing.

We would like to invite you to visit our DAISY Winners @


By Peggy Bartholomew RN-BC

As I found my way to morning coffee, I encountered a family member, Anna who was seeking some of the same refreshment. After ensuring that Anna was provided the creamer first, she told me about her daughter having Outpatient Surgery (OPS). She then related how friendly and nice the staff had been and how impressed she was with the cleanliness. She then added that normally people think University Hospital and… (She cringed) but, it’s wonderful here.  I usually go to a private hospital in town; I’m going to start coming here.  I replied, saying, “Well, come on over.  We would be happy to have you”.  She touched my arm and said, “I am, thank you”. 

Celebrating the good news.

I watched her later as I was standing in line to pay and she was interacting with other employees who were all smiling and talking to her.  When we met again at the condiment station, I said hi again.  She said, “Do you work in customer service?”  I told her I didn’t, that I worked in Case Management.  She said, “Will you please share what I have said with the higher up people?  I really want them to know how impressed I am with this hospital”.  I assured her that I would and we said our goodbyes. 

It was a very pleasant interaction and I was so proud of our hospital.  The environment and attitude that we want to convey is working and it’s so great to see the positive outcomes of our plans coming in to focus.   What was also so great is the effect that it had on me.  I felt myself swell with pride and my cheeks flush from all the wonderful things she was saying about us.  That’s a great feeling to experience as an employee and serves as encouragement to continue toward our mission!

We then asked Jeanie Sauerland, BSN, RN Educator for OPS for her to explain how they exceed patient and family expectations each day.

Jeanie explained that OPS has had top patient satisfaction scores throughout this year and with good reason – the entire staff work together as a team and strive for excellence.  Here are some of the things that have been initiated in the department.

1.  At discharge, patients are given a thank you card that has been signed by all the staff members caring for them throughout the perioperative period.


2. The charge nurse goes into the outpatient waiting room at the beginning of the day to introduce herself and give an overview of what will happen in the next few hours.  She returns frequently throughout the day to update the family members of status changes and delays.


3. A poster that shows family members pictures of what to expect as an OPS patient is located for everyone to see as soon as they walk into the department.  We are also developing a handout for family members “What to Expect the Day of Surgery” with simple explanations of complicated processes and locations that are important – like waiting rooms, the chapel, and vending machines!


4. Above the patient assignment board is a large poster celebrating over 400 years of combined experience for the nurses.


5. When the area gets busy, everyone helps.  Patrice Gibson, the PCC, can be found nearly every morning assisting with patient check-ins.  I have also been fortunate to spend time at the bedside during the busy times.  This relationship where everyone helps each other forges a strong bond of respect between staff members.


6. This is not a large department, but praise is freely given and recognized.  Several staff members have received On-the-spot recognitions, Gold and Silver awards, and Daisy nominations.  A bulletin celebrating monthly honorees is posted for the entire surgical services department to see.


7. There are so many examples of “above and beyond”, which are received in thank you letters from patients.  But even if unseen, the nurses reach out.  Yvonne Alexander, RN, transported a patient to the pediatric floor and noticed another child crying and alone.  “This touched my heart”.  Yvonne decided that she would visit the young patient.  Yvonne’s son, a gifted cartoonist and caricature artist, came with his mother.  They met the patient and her family and left her with a wonderful personalized drawing.  And this was on Yvonne’s day off!

I am very proud to be a part of this area!  

Tiffeny Flewellin, RN
Manager, Case Management