NOTABLE NURSING. eye on the clock: specialized nursing skills required to detect signs of brain crisis. in this issue...

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1 A PUBLICATION FOR NURSES BY NURSES FALL 2005 NOTABLE NURSING eye on the clock: specialized nursing skills required to detect signs of brain crisis Time is of the essence in many nursing specialties, but in neuroscience nursing for stroke patients, time is brain. A stroke is caused by interruption of blood flow to the brain when a blood clot occludes an artery, or when a blood vessel in the brain ruptures, leaking blood and thus injuring brain cells. More than 80 percent of strokes are ischemic, resulting from either thrombotic or embolic clots. The thrombolytic agent tissue plasminogen activator (tpa), which works by dissolving the blood clot, is the only treatment currently approved by the U.S. Food and Drug Administration for acute ischemic (sudden onset) stroke. But the window of opportunity is narrow, says Patricia McMahon, RN, BSN, Interventional Neurology, Neurocritical Care and Acute Stroke. Intravenous tpa can significantly reduce long-term disability if given within the first three hours (not three hours and one minute) of symptom onset. Hemorrhagic stroke, which accounts for the remaining 20 percent, has a much higher risk of fatality than ischemic events. The hemorrhage and resulting edema compress the brain within the skull, causing pressure on the brainstem that can result in coma and death. continued on page 3 in this issue... p. 4 Neuroscience Advanced Practice Nursing p. 5 Nurse Fellowship Program p. 6 Nursing Practice in the OR p. 10 Nursing News

2 As the nursing profession struggles with a nationwide shortage, we must become more aware of the issues and concerns that our front-line nurses face everyday and identify ways to enhance career satisfaction. Giving nurses opportunities to be in charge of their practice, championing autonomy and decision making are essential if we are to retain nurses from the new grad to the seasoned professional and also if we are to attract capable, bright individuals to consider a career in nursing. To facilitate an environment of empowerment at The Cleveland Clinic, we assembled teams, facilitated by Nursing Directors and comprised of front-line nurses. These teams are evaluating and developing processes or systems to effect needed improvements in staffing, technology, throughput, our model of care, shared governance, intergenerational nursing and senior nurse retention. We plan to share our findings and solutions with you in future issues of Notable Nursing. As I assess the landscape of our profession, there is probably no better time to be a nurse. Depending on interests or lifestyle needs, nurses can create the kind of practice they want at various stages of their career and life. Career advancement and development opportunities are endless, as evidenced by the articles in this issue of Notable Nursing. We hope you enjoy our publication. Please share it with your colleagues and let us hear from you. Chief Nursing Officer Claire M. Young, RN, MBA, joined the Clinic in 1995 as the Administrator of Preventive Cardiology. From 1997 to her new appointment, she served as Director of Quality Management, where she was involved in performance improvement, patient satisfaction, clinical quality data abstraction, clinical practice guidelines and competency assessment. Young received her BS from Texas A&M University in 1986, her ADN from Houston Baptist University in 1991 and her MBA from Lake Erie College in She was a staff nurse in trauma, cardiac intensive care and cardiothoracic intensive care as well as Manager of Preventive Cardiology at Hermann Hospital in Houston, Texas. comments to youngc@ccf.org. executive editor Michelle Dumpe, Ph.D., RN comments about Notable Nursing to dumpem@ccf.org editorial board Taletha Carter, RN, MS, CCRN, Medical Cardiac Stepdown Mary Beth Modic, MSN, RN, CNS, Diabetes and Patient Education Nancy C. Smith, MSN, RN, CNS, Neurology Claudia Straub, MSN, RN, BC, Nursing Education Robbi Cwynar, BSN, RN.C, Thoracic and Cardiovascular Surgery Nancy Albert, Ph.D., RN, CCNS, Nursing Research Christina Canfield, RN, BSN, Medicine Deborah Solomon, BSN, RNBC, Surgery Rosemary Halun, Editor Mike Viars, Art Director Don Gerda, Photography Deborah Durbin, Marketing Manager If you want to add someone to the mailing list, please durbind@ccf.org. from the chief nursing officer 2

3 continued from page 1 We cannot see that the brain is bleeding, notes Jane Miller, RN, Nurse Manager, Neuroscience Concentrated Care Unit and the Neuroscience nursing floor. We have to be able to detect the very subtle signs that bleeding is occurring. This is where our assessment skills are pivotal. In the acute phase of stroke, the nurse must monitor for stroke progression by assessing changes in weakness, numbness, aphasia, dysphasia, seizures, vital signs and altered mental status. The Cleveland Clinic s neuroscience nurses provide immediate evaluation of all patients admitted with stroke symptoms. All neuro nurses are certified in use of the National Institutes of Health (NIH) Stroke Scale (NIHSS), the most widely accepted tool for the neurological assessment of stroke severity and stroke prognosis. Detailed assessment skills save lives, says Michelle Dumpe, Ph.D., RN, Director of Nursing Education. The single most effective intervention in stroke treatment is early, definitive recognition of the signs and symptoms. From the time of admission, neuro nurses support the patient s healing by monitoring lab values, vital signs and heart rhythms and promoting the patient s mobility and nutrition. Patients have worse outcomes if they are febrile or spike glucose levels within the first 24 to 48 hours following a stroke, so it is essential to monitor every aspect of the patient s condition during that critical period, McMahon notes. As key members of the multidisciplinary medical team, neuroscience nurses provide continuity of care during the acute phase of hospitalization. They work closely with the physicians, other health care professionals, the patient and the patient s family to develop and implement an individual treatment plan to return the patient to the highest possible level of function and quality of life. Nurses are the only health professionals that have 24-hour contact with patients, giving them the lead role in patient education. This includes educating the patient and the patient s family regarding treatment options, tests, imaging, and interventional or surgical procedures, as well as stroke risk factors and symptoms. Nurses also help patients and their families understand vital signs and lab values, explain medications and dietary restrictions and prepare them for the lengthy recovery process ahead. The nursing staff also implements a prevention plan for each patient for post-stroke complications, such as skin breakdown, deep vein thrombosis, inadequate nutrition, aspiration pneumonia and falls. demonstrated by our nurses was a major factor contributing to this accreditation. Accreditation has not changed the standard of care but has led to greater standardization of care, adds Sharon Ungar, RN, Assistant Nurse Manager, Neuroscience Intensive Care Unit. We now have protocols for the treatment and care of stroke patients that are supported by standardized admission orders. Ungar and her colleagues developed the Clinic s first online comprehensive Competency for Stroke Education, the first diseasespecific educational tool required for all health professionals at The Cleveland Clinic s main campus. As a result, all Clinic staff can articulate the signs and symptoms of stroke and are educated on when to activate the 2CLOT pager system that alerts the Emergency Stroke Team. As stroke treatment continues to advance, The Cleveland Clinic has been in the forefront of a number of significant clinical trials and studies including the Phase II Dose Escalation study of Desmoteplase in Acute Ischemic Stroke (DEDAS) trial to evaluate a new thrombolytic agent that can be administered up to nine hours from symptom onset. THE NEURO NURSE Neuroscience nurses impact both quality of life and cost of care for patients with neurological disorders. Using their specialized assessment skills, they affect the length of stay, reduce pain, discomfort and anxiety. By providing preventive education to the public, they also have the opportunity to reduce the incidence of stroke and associated morbidity and costs. As new nurses are introduced to neuroscience nursing at The Cleveland Clinic, their 10-week orientation focuses on refinement of neuro assessment skills, neuro anatomy, surgeries and disease processes. It can be a difficult time for nursing students, says Sharon Dorsey, RN, MSN, CCRN, Clinical Nurse Specialist. Most nursing instructors on the academic level have not had a lot of exposure to neuro patients. In turn, nursing students are not exposed to the specialty, and, as a result, they tend to be fearful. Miller, who works closely with the neuro nursing students on the floor, attempts to reduce the fear factor. I tell new nurses that they don t have to know why something has changed about a patient - they will learn that eventually, she says. I have them focus first on recognizing that a change has occurred. NEURO comments to mcmahop@ccf.org; millerj4@ccf.org; ACCREDITATION LINKED TO QUALITY NURSING CARE The Cleveland Clinic achieved JCAHO accreditation as a Primary Stroke Center in This recognition is due in part to the quality of nursing care, Dumpe says. The high level of practice Patricia McMahon, RN, BSN Despite or possibly because of the challenges of neuroscience nursing, once a nurse gets hooked on it, there is no going back. There is no more gratifying work, McMahon says. I absolutely know that we make a difference every day in our patients lives. dumpem@ccf.org; ungars@ccf.org. N3

4 advanced practice nursing in neuroscience a collaborative link between physicians and nurses Tina Georgievski, MSN, CNP is the first nurse practitioner on The Cleveland Clinic s Neuroscience units. Since 2003, her role has been to enable the throughput process to be a knowledgeable and accessible resource for nurses. Nurses feel comfortable coming to me with questions about patients, Georgievski says. I am their first exposure to what an advanced practice nurse can do in an acute care setting. And the nurses are paying attention. They see the benefits of her advanced training, which include prescriptive authority and practice autonomy. Jane Miller, nurse manager of the neuroscience units, calls Georgievski an inspiration. Since Tina arrived, we have five nurses working toward advanced degrees and another 10 becoming certified in neuroscience nursing. Georgievski says her role in neuro is in contrast to outpatient nurse practitioners who help diagnose common medical disorders and initial treatment strategies. Most of my patients are admitted for surgery, so my role focuses on helping manage their co-morbidities and their postoperative course, she explains. Tina Georgievski, MSN, CNP and Michael Anderson, RN, CCRN providing tremendous opportunities for networking, ongoing education and professional growth. With new AMA restrictions on the number of hours residents can work weekly, Georgievski s role on the unit takes on added impetus. I write prescriptions, fill out paperwork for discharge, educate patients, talk to families, and enable the throughput process to unfold smoothly, she says. She serves as a collaborative link between physicians and nurses. And the patients absolutely love her, Miller adds. Georgievski and Clinic colleague Michael Anderson, RN, CCRN, recently founded the Northeastern Ohio Chapter of the American Association of Neuroscience Nurses. The chapter is a forum for neuroscience nurses to increase knowledge and create a network of support in their highly specialized field. Anderson explains that Clinic nurses are encouraged to become members of professional organizations. The local chapter will bring together neuroscience nurses from all of the local hospitals, says Anderson, providing tremendous opportunities for networking, ongoing education and professional growth. Through CEU-associated lectures and programs, Georgievski and Anderson hope to encourage nurses to become certified registered nurses in neuroscience. Being certified improves patient care, says Georgievski, and reinforces The Cleveland Clinic s status as a Magnet hospital. comments to georgit@ccf.org or andersm6@ccf.org. Neuroscience Nursing Conference November 10 11, 2005 InterContinental Hotel and MBNA Conference Center For more information, Tina Georgievski, MSN, CNP, at georgit@ccf.org. 4

5 nurse fellowship program take your career to the next level Nurses seeking to take their careers to the next level in nursing administration now have the opportunity to learn one-on-one from some of the outstanding leaders in the field. The Cleveland Clinic Division of Nursing has established a oneyear, paid Nurse Executive Fellowship to provide hands-on experience in nursing management under the guidance of Janet Fuchs, RN, MSN, Director of Advanced Practice Nursing, and other Cleveland Clinic nurse executives. FELLOW Fuchs stresses that the right person for the fellowship is someone who is motivated and excited about a career in nursing leadership, rather than a person who meets certain criteria or has specific experience. At the completion of the one-year fellowship, the nurse will be ready to move into a position as a nurse manager with real-life experience to offer. And from there, Who knows? Fuchs says. With a solid foundation in nursing management, there will be no limit to what the nurse can achieve in nursing leadership. HOW TO APPLY The Cleveland Clinic has much to offer in breadth and depth of experience for the nurse who is interested in a management career, Fuchs says. With our size and level and diversity of care, The Cleveland Clinic offers a unique setting where the candidate can develop his or her leadership skills. The first fellowship begins in June 2006 and runs though June To be considered for the position, a nurse must have a master s degree in health care administration, business administration or nursing with an administrative background. He or she also must have broad health care experience, and previous management experience is desirable. The fellow will be exposed to every aspect of nursing management during the course of the year. Accreditation, financial management and budgeting, marketing, team leadership, the application of evidenced-based practice to clinical care, human resources and clinical practice improvement are all part of the curriculum. To ensure the program fulfills the fellow s personal career goals, Fuchs and Cleveland Clinic Chief Nursing Officer Claire M. Young, RN, MBA, have designed it for maximum flexibility. During the interview and selection process, candidates will be asked specifically about their career plans and areas of special interest. When the selected fellow is on board next summer, Fuchs and Young will work closely with her or him to tailor the experience to the individual s interests. We will design the program around the person, Fuchs explains. For example, if he or she has a special interest in oncology, we would make sure that administrative projects in that clinical area are part of the fellowship experience. Projects assigned to the fellow could range from getting involved in a new program rollout, such as the electronic medical record, to evaluating new equipment or technology related to patient safety. Whatever the exact nature of the project, it will be hands-on experience in the real world, accomplishing a goal that is meaningful for the fellow and the institution, Fuchs says. The fellowship is designed strictly for those who want a career in administration, she emphasizes. The fellow may be involved in nursing administration related to a clinical unit, but clinical experience is not part of the program. Nurses interested in applying for the Cleveland Clinic Nurse Executive Fellowship for must submit the following: Written letter of intent A resume Two letters of reference (one from a former supervisor) A written statement of objectives, including career and educational objectives for the program. Information should be submitted via U.S. mail or by November 30, 2005 to: Janet Fuchs, RN, MSN Director of Advanced Practice Nursing The Cleveland Clinic, W Euclid Avenue Cleveland, Ohio fuchsj@ccf.org N 5

6 nursing practice in the OR successfully managing rapid change Technological change brings improvements in surgical patient care but also brings unique challenges to the OR nurse. To help OR nurses thrive in an environment of rapid technological advancement, Barbara Wilson, MSN, RN, CNAA, CNOR, Clinical Director of Surgical Services, and Barbara Fahey, RN, Assistant Clinical Director for Surgical Services, have formed a management team specifically to address changes in nursing practice brought about by new technology. At The Cleveland Clinic, 233 RNs are involved in more than 34,000 surgical cases annually, participating in 150 cases a day. Nursing in the OR is becoming increasingly complex as technology is infiltrating every aspect of the job, says Ginny Manocchio, RN, BSN, Nurse Manager of Neurosurgery, Spine and Pain Management. Technology means not only more training but also learning how to multitask. We need to learn how to operate, clean and sterilize new equipment; how to move it from one OR to another and how to prepare it for surgery, Manocchio says. This is much different from OR nursing in the past when we worried about counting sponges. OR nurses at The Cleveland Clinic often have the additional responsibility of participating in surgical procedures that are teleconferenced live around the world. They recently were involved in a live international teleconference of a new minimally invasive mitral valve replacement procedure pioneered at the Clinic. Although participating in these broadcasts is an honor, it also brings a unique type of stress, Fahey notes. As a circulating or scrub nurse in a teleconferenced surgery, you are very conscious of the fact that it is live and is being watched in cities around the world. Nursing practice must continually adapt to keep pace with technological advancement, Wilson says. OR nurses work daily on the cutting edge, and that can be challenging. 6

7 PROMOTING QUALITY OF WORK LIFE Wilson and Fahey are committed to helping OR and PACU nurses receive adequate training in new processes and procedures to make them comfortable in their jobs, welcoming of new technology, and able to fulfill their traditional role as patient advocate. Since the beginning of 2005, Wilson and Fahey have implemented a number of changes in policies that they anticipate will increase efficiency, promote employee retention and improve the quality of work life for RNs. One of their primary goals is to improve communication among OR nurses. To help accomplish this, they have established a bulletin board system dubbed Dashboard. It provides a snapshot of key information, including patient volumes, turnover rates and the number of ORs in use at any given time, Wilson explains. Dashboard provides the staff with the information they need to better understand the business and their jobs. Nominal group technique is another tool Fahey and Wilson are applying to improve communications. In this system, staff members in each specialty area identify issues and concerns they perceive as barriers to optimal job performance. The staff in each group vote to identify their top three concerns, and those will become the process improvement goals for the next year. We hope this method will sensitize us to the staff s frustrations and help us to minimize them, Wilson says. Fahey and Wilson consider communication critical to staff retention. To create a dialogue with employees, they invite 20 recently hired RNs each quarter to an open forum. During this session, the nurses have the opportunity to discuss the issues and challenges of being a new employee in a large medical complex with their peers as well as with Fahey and Wilson. Making employees feel heard and valued helps improve the quality of their work life, Fahey says. Keeping lines of communication open and offering staff various forums for expressing frustrations helps contribute to employee retention, Wilson adds. The team also brought innovations to scheduling. One of their first changes was to make OR nurses with 25 or more years of experience exempt from mandatory overtime. The change pleased both the senior nurses it affected directly and younger nurses who are pleased to see senior nurses rewarded for longterm employment. To improve scheduling on a daily basis, Wilson and Fahey have implemented the Five Member Team concept. On this schedule, four team members start work at 7 a.m., and the fifth team member comes in at 9 a.m. This fifth person can be either a RN or an OR Tech. The five staff members form a small work team in which they decide when each member will take a break, go to lunch, and assist with OR turnover and preparing patients. It gives the nurses more accountability for making their own work day a quality day, Wilson explains. ENHANCING NURSING PRACTICE Nursing practice in the OR today is affected by three main variables: technology, patient acuity and longer lifespans. Wilson and Fahey instituted several new procedures to assist nurses in managing these variables and enhance nursing practice. One of the major advances is the implementation of standardized procedures and policies required by The Association of perioperative Registered Nurses (AORN), a professional organization that supports RNs in achieving optimal outcomes for operative and other invasive procedures. Claire Young, RN, MBA, the Clinic s Chief Nursing Officer, enthusiastically supports this initiative and has enrolled all operating room RNs into AORN. Wilson hopes to have all Nurse Managers achieve certification in perioperative nursing (CNOR) by June Fahey and Wilson also encourage research by OR nurses; a dedicated Ph.D. research nurse is assigned to Surgical Services to assist with research projects related to OR nursing. comments to wilsonb3@ccf.org; faheyb@ccf.org or manoccg@ccf.org. N 7

8 expanding the role of the registered nurse in the OR RN First Assistant program provides another rung on the ever-expanding nursing career ladder In 1994, the Ohio Board of Nursing (OBN) mandated first assistant training for registered nurses who served as surgical assistants in the operating room. In response to the mandate, the Cleveland Clinic Department of Thoracic and Cardiovascular Surgery developed a registered nurse first assistant (RNFA) course for RNs in all surgical specialties. The course was based on the AORN s Core Curriculum. To meet accreditation requirements by the Certification Board of Perioperative Nursing, an affiliation with Lorain County Community College (LCCC) in Lorain, Ohio, was created. Since 1998, The Cleveland Clinic and LCCC, through its continuing education program, have offered a 16-week RNFA course during Spring and Fall semesters. The LCCC course includes 45 hours of clinical practice and awards five semester hours of college credit. The majority of classes are held at The Cleveland Clinic. Twelve Clinic RNFAs from different surgical specialties and two LCCC instructors serve as course instructors. The 45 hours of clinical practice must be completed at the Clinic under the direction of five Clinic RNFA preceptors from the Department of Thoracic and Cardiovascular Surgery. To be eligible to take the RNFA course, an RN must be certified as a nurse in the operating room (CNOR). Upon completing the course successfully, an RN may practice as First Assistant in the OR. Certification, which requires a BSN and a current RN license, may be obtained after completing 2,000 hours of practice as a First Assistant in a surgical specialty. RNFAs are found in every surgical specialty, but the Department of Thoracic and Cardiovascular Surgery at The Cleveland Clinic lays claim to the most. We have 26 RNFAs in Thoracic and Cardiovascular surgery, says Robbie Cwynar, BSN, RN. C, the education coordinator and clinical manager of Nurse Clinician Services in the Clinic s Department of Thoracic and Cardiovascular Surgery. We are probably the largest group anywhere in the country. Greg Hanson, CRNFA, who has worked in Thoracic and Cardiovascular surgery for 20 years, took the RNFA certification exam seven years ago. Becoming an RNFA has expanded my experience both in and out of the operating room, Hanson says. The surgical tasks of the RNFA in Thoracic and Cardiovascular Surgery, completed under the direct supervision of a surgeon, include helping the surgical resident open and close, harvesting the radial arteries and saphenous veins as conduits for bypass grafts, exposure of femoral artery and vein for cannulation the patient and inserting the intra-aortic bypass pump and managing the IABP during surgery. When he is not in the operating room, Hanson works closely with technology companies that are developing new techniques in his specialty. I am exposed to many innovations such as endoscopic vein harvesting, left ventricular assist devices, robotics and new techniques for treating heart failure. Hanson helps these companies run training labs on new technology for surgeons, RNFAs and PAs. The training is done in the Clinic s cadaver lab. In addition to their surgical roles, RNFAs care for patients both pre- and post-operatively. Because of the Clinic s team concept, patient care is left to a team of primarily critical care nurses leaving RNFAs to focus solely on their role as First Assistants in the operating room. Cwynar says that most of the RNFAs in her department have been at the Clinic for 20 years or longer. It is time to bring in younger RNs, to let them know that there are still places to go in their career, she says. Hanson considers his certification as an RNFA like a feather in his cap. As an RNFA, I am much more versatile and, I think, more beneficial to my department. For information about the Division of Nursing s RNFA program, call 216/ or cwynarr@ccf.org. 8

9 nursing research the link to stronger evidence-based nursing practice The Cleveland Clinic recognizes the value of research as a cornerstone of patient care. Within the past year, Cleveland Clinic nurses have begun an aggressive program to conduct research aimed at refining nursing practice and improving patient outcomes. Nancy Albert, Ph.D., RN, CCNS, CCRN, CNA, Director of the Department of Nursing Research and Innovation, discusses this pioneering effort that involves more than 4,000 Cleveland Clinic nurses at every level of the nursing continuum. Q. Is nursing research new at The Cleveland Clinic? A. For about 20 years we had a Ph.D. nurse researcher in the Division of Nursing assisting nurses who were interested in conducting research projects. In 2004, I was charged with developing the infrastructure for a proactive nursing research program. We now have four Ph.D. nurses in the Department of Nursing Research and 87 projects in various stages of development. Q. What kind of support does nursing research have? A. We have the support of our Chief Nursing Officer Claire Young, who feels strongly that research is a necessary part of evidence-based practice. She is committed to fostering the growth of this program. Q. What do physicians think about your efforts? A. Our physicians understand what research brings to the practice of medicine, and so they have been wonderful in their support. The structure of the Clinic as a group practice, which integrates research and education into the practice model, encourages and supports collaboration among all professionals. Q. How do you get nurses motivated to do research? A. We ask nurses to think about problems that need solutions. To start the wheels turning, some nursing directors have offered one-day retreats for nurse managers and clinical instructors at which we make a presentation. By the end of day, everyone has a research project. In addition, 19 of our nurses recently presented their projects on Research Day. Q. How are you communicating your findings outside The Cleveland Clinic? A. We encourage publishing articles and presentations at meetings. When you make a presentation and are able to answer questions from the audience, you realize how much you are contributing to nursing. CLEVELAND CLINIC NURSES ARE TAKING EVERYDAY ISSUES AND DEVISING RESEARCH STUDIES WITH THE AIM OF IMPROVING PATIENT CARE. HERE ARE SOME EXAMPLES: When a radiology nurse noted that pediatric patients are often afraid of the MRI scanner, she developed a photo diary with simple words and bright pictures to explain the test. Her study will evaluate whether pre-mri education with this diary decreases stress and anxiety. Surveys will be given before and after the intervention (usual care vs. photo diary) to enable her to compare results. A nurse in plastic surgery discovered a lack of information about quality of life following breast reduction surgery. She conducted a qualitative study to learn what women experience postoperatively the study results will become the baseline by which to develop interventions as needed. Patients recovering from bone marrow transplantation are prone to infection and require frequent temperature monitoring. Nurses will study the reliability of the newer temporal artery digital thermometer compared to standard of practice to determine if reliability is assured and if comfort is enhanced with the newer device. Q. Is your goal to publish or present? A. The last step is actually translating the results back into practice. If the study results prove to be important and valid in improving patient care or outcomes, then it is important to take steps that integrate the research intervention into nursing practice. Q. Do nurses work independently on research projects? A. Some nurses are able to work rather independently; others need writing support or guidance learning how to think in a research style. One s nursing background doesn t seem to make a difference in research abilities, and at first the process can be overwhelming. Nurses who are working on a higher education degree have the easiest time when research is part of their curriculum. Q. What does research mean to the nursing profession as a whole? A. Nursing is a rather new profession, so there are gaps in its foundation that relate to the most effective and safest ways to take care of patients. Conducting nursing research to fill these gaps will help us have a stronger evidence-based practice. When we (nurses) are involved in research, we go beyond what is known today to enhance the foundation of nursing, advance the knowledge of nurses and ensure its status as a profession. comments to albertn@ccf.org. N 9

10 CLEVELAND CLINIC DIVISION OF NURSING nursing news PRESENTATIONS Strategies for Succeeding in Nursing School Cleveland Council on Black Nurses August 27, 2005 Sheryle R. Bailey, BSN, RN, M.Ed. Renew Nursing Through Scholarship 16th International Nursing Research Congress July 14, 2005, Waikoloa, Hawaii Kathy Tripepi-Bova, MSN, RN, CNS & Lisa Salamon MSN RN, CNS People to People Delegation Use of Levalbuterol (Xopenex) for the Treatment of Acute Exacerbation of Asthma. The Critical Care Society of the Western Cape March 2005, Cape Town, South Africa Rebecca L. Meredith, BS, RRT, RCP Use of an Online Learning Management System to Validate Annual Nursing Competencies National Nursing Staff Development Organization July 21-24th, 2005, New Orleans Nancy A. Kanyok MSN RN, BC Heart of the Gut: Management of End-Stage Liver Disease American Association of Critical-Care Nurses National Teaching Institute May 12, 2005, New Orleans Renee McHugh, MSN, RN AWARDS Ellen Dooling, MSN, RN, CNP Excellence in Writing Award, Honorable Mention Journal for Neuroscience Nursing American Association of Neuroscience Nurses Annual Conference, Washington DC, April 2005 PUBLICATIONS Thoracic Aortic Aneurysms Journal of Cardiovascular Nursing. 20(4), 2005, Deborah Klein, MSN, CCRN, CNS Oncology Nurse Certification Lynn Rush, RN, NM Patti Akins, RN, NM UPCOMING CONFERENCES 25th Annual Dimensions in Cardiac Care Sunday, March 19 - March 21, 2006 InterContinental Hotel and MBNA Conference Center For 25 years, Cleveland Clinic cardiac nurses have hosted an annual symposium attracting nurses from around the country to learn about the latest innovations in treatments and patient management. Don t miss this event. For more information Debbie Klein at kleind@ccf.org. Cleveland Clinic Is Among Top Companies for Working Moms The October 2005 issue of Working Mother magazine includes The Cleveland Clinic in its annual listing of the Top 100 Best Companies for Working Mothers. We are honored to be included on this prestigious list, says Chief Nursing Officer Claire Young, RN, MBA. Here at The Cleveland Clinic, we believe in balancing home and work life for an optimal lifestyle, and we do our best to provide a variety of opportunities for working mothers. Some of the family-friendly initiatives at the Clinic include an on-site childcare center (KinderCare), a variety of wellness programs, a mentorship program, competitive benefits packages and flexible scheduling opportunities that include our popular Parent Shift. The Parent Shift program allows nurses to practice nursing without committing to shifts of 8 hours or more. Nurses can work from as few as 2 hours daily to as many as 6 hours daily. The minimum monthly commitment is four, 2-hour shifts or 8 hours. The program also includes flexible start and end times for days, nights and/or weekends. In tallying the top 100, Working Mother judged companies on five areas: advancing women, quality of work/life, childcare options, time off for new parents and flexibility of scheduling. The detailed application examines 500 points of information on a company, including company culture, family-friendly policies and compensation. 10

11 destination YOUR FOR nursing PRACTICE THE CLEVELAND CLINIC Located in Cleveland, Ohio A not-for-profit multispecialty academic medical center Founded in 1921 Consistently ranked one of the 10 best hospitals in the nation by U.S.News & World Report; Heart Center ranked #1 for 10 consecutive years 956 beds More than 1,700 physicians and scientists representing 120 specialties and subpspecialties Two million outpatient visits annually 65,000 surgical procedures annually DISCOVER ENDLESS CAREER OPPORTUNITIES The Cleveland Clinic Division of Nursing offers career paths in nursing that provide diversification and specialization. Join our elite team of nursing professionals, and make The Cleveland Clinic your destination for nursing practice. Nursing specialties include: Advanced Practice Nursing Behavioral Health Cancer Center The Children s Hospital Nursing Education Emergency Department The Heart Center Nursing Information Systems Medicine/Women s Health Nursing Quality Nursing Research Surgery/Post Acute Care/Radiology Surgical Services/OR Call today about exciting new openings in Neuroscience Nursing and in our Post Anesthesia Care Unit. Call 216/ SEE FOR YOURSELF The Division of Nursing Web site reflects the strength and diversity of nursing practice at The Cleveland Clinic, where nurses have achieved Magnet status the highest national ranking for nursing excellence. Log on to and while you re there be sure to read the overviews of our departments, peruse the comments of Cleveland Clinic nurses and review job openings. Then decide if this is the right career choice for you. Still have questions? We ve got answers. Call us at 216/ N 11

12 nurse of note CLEVELAND CLINIC NURSE RECOGNIZED FOR DEDICATION, INNOVATION AND QUALITY CARE Debbie Klein, MSN, CCRN, CNS, smiles, thinks As a nurse, consultant, teacher and for a moment, and responds to an interviewer s leader in critical care Klein has had question about her awe-inspiring list of accomplishments by saying, I have endless profes- both locally and nationally. She opportunities to publish and present sional opportunities and challenges as a Clinical recently presented Aortic Valve Disease: Stenosis and Regurgitation at Nurse Specialist (CNS). the American Association of Critical- Debbie s career as a CNS spans over 25 Care Nursing annual meeting in New years. Just being around for this length of Orleans. It was only the latest in a time is not a sufficient explanation for the series of educational presentations accomplishments of a career still far from she has made to national nursing over. It takes effort and talent. During this audiences. She has amassed an extensive curriculum vitae of articles in time she has served patients, families, nurses, physicians, students and colleagues to build juried journals through the years and a remarkable edifice of accomplishment. has given, by her estimate, more than Klein began her nursing career in the Debbie Klein, MSN, CCRN, CNS 100 lectures on subjects as diverse as Cleveland Clinic s Cardiothoracic Intensive metabolic syndrome, Marfan Syndrome, sepsis, and the art of getting medical knowledge, Care Unit, where she worked from 1979 to 1982, while starting on her Master s Degree in Nursing. experience and practice into print. She has published 35 She left the Clinic, worked at another hospital and then book chapters and articles on critical care topics, is a returned to the Clinic as a CNS in the 16-bed Cardiac ICU reviewer for noted peer-reviewed nursing journals, and is and the 8-bed Heart Failure Special Care Unit. the editor of Introduction to Critical Care Nursing, a new The crux of what it means to be a Clinical Nurse Specialist is to improve patient outcomes through nursing Debbie Klein is active in leading professional nursing organiza- textbook that rolled off the press this year (Elsevier, 2005). practice, Klein says. Critical care nurses manage tions, including the American Association of Critical-Care Nurses, patients based on evidence. What strategies can the nurse Society of Critical Care Medicine and the National Association of implement to promote hemodynamic stability? What are Clinical Nurse Specialists. She holds clinical faculty appointments at several nursing schools. As she contemplates her career, potential complications of this therapy? How can the nurse ensure that this patient understands the medications Klein sums up her formula for success: Recognize when opportunities arise, seize them and run with them. he is taking? The nurse must know the evidence and the rationale for therapies and be able to think critically about comments to kleind@ccf.org. the data obtained, she explains. NOTABLE NURSING Non-Profit Org. U.S. Postage PAID Cleveland, Ohio Permit No Nursing Education and Research / P Euclid Avenue Cleveland, OH 44195