2013 DH Nursing: A Year in Review

2013
DARTMOUTH-HITCHCOCK NURSING | A YEAR IN REVIEW
Dear Colleagues,
This special edition of Dartmouth-Hitchcock Nursing
serves as our 2013 Nursing Year in Review. This letter
as your chief nursing officer is one of the final items
I am completing as I prepare to leave for retirement.
It gives me a chance to reflect one last time upon the
accomplishments and commitments of DartmouthHitchcock (D-H) nurses. Reading about our 2013
accomplishments will be a great way for our new
leader to learn about our nursing community.
The 2013 Dartmouth-Hitchcock Nursing: A Year
in Review again highlights our accomplishments
as directed by the nursing strategic plan and in
alignment with the components of our Professional
Practice Model (PPM) for Nursing at D-H. As we
have described many times, D-H has a clear vision
and direction for the future: improving the health
of the population, providing value-based care and
moving to new reimbursement models. Our nursing
strategic plan was developed and has been revised to
align with our organizational vision and strategy. The
PPM provides the framework to approach the nursing
strategic plan in a systematic way using the D-H
philosophy and values for nursing as the guideposts.
These documents provide us with focus for the work
ahead of us as a professional nursing community
and supports creating a sustainable health system to
improve the lives of the people and communities we
serve. They also incorporate our nursing mission and
two high-level goals: a healthy care environment and a
healthy work environment.
As I review the list of items included in this review, I
feel great pride and gratitude for our accomplishments.
Aligned with the intention of the D-H Value Institute,
we have educated our nursing leaders and unit-based
council chairs as Yellowbelts, thereby increasing our
capacity to make improvements in the care of our
patients and our work environment. In keeping with
our Shared Governance motto, “Every Nurse a Leader,”
this review highlights the role of direct care staff in the
design of our new inpatient units, the selection of an
evidence-based practice implementation model and the
transformative work of Team Care, an interprofessional
collaborative effort to improve the experience of our
patients. The outcomes and progress of these various
items are astounding and, due to the efforts of so many
of you, focused on making things better.
In reflecting on my career as a nurse, I appreciate most
the countless opportunities I have had to learn and
grow. Many of you know I often make the statement
“If the door opens, walk through it.” This phrase is
meant to convey my own experience that many of the
opportunities I have had through my nursing career
were unexpected and, quite frankly, often out of my
comfort zone. Over this past year, I have observed
many of you reach outside of your comfort zone
and grab unexpected opportunities that came your
way; opportunities to learn and grow and to make
things better for our patients and families—to create
an environment in which our patients and families can
heal, the pinnacle/peak in our PPM schematic and the
ultimate goal for nursing practice at D-H. That is, after
all, our stated mission.
My sincere thanks for everything you have done to
make it a reality,
Linda
Linda J. von Reyn
Chief Nursing Officer (April 2009 to March 2014)
NURSING YEAR IN REVIEW // 2013
Throughout Dartmouth-Hitchcock (D-H), we
advance population health by forging partnerships.
Our D-H Nursing Professional Practice Model,
designed to reflect the landscape of the mountains
in our region, guides us to "Reach the peak by
building relationships."
The features in our 2013 Dartmouth-Hitchcock
Nursing: A Year in Review describe initiatives
that nurture relationships that are fundamental
to achieving the healthiest population possible.
Building relationships with self, relationships with
colleagues and relationships with patients and
families are prerequisites for engaging patients,
families and health professionals as partners in a
sustainable health system.
3
We are building relationships with self by
investing our energy in improving our practice
and our processes. In what must be the largest
Yellowbelt training ever orchestrated by our Value
Institute, more than 70 nursing leaders learned the
improvement science that helps us start taking care
of tomorrow's patients today.
Working with our colleagues from many disciplines
to reduce readmissions from heart failure, we
witness the power of relationships and collaboration
to affect meaningful benefits for patients for whom
enjoying the best care means staying out of the
hospital.
Our Team Care initiative is bringing it all together,
shining the light of our culture of caring on the
complex environment of inpatient care. We look
forward to the future of Team Care with a deep
focus on improving communication and clinical
quality in alignment with the Partnership for
Patients/Hospital Engagement Network program.
The movement toward population health and valuebased care is driving innovation in the community
care setting—after all, most care delivery and selfcare happens right in the home. One of our most
proactive and meaningful initiatives is helping our
senior citizens stay well and independent at home,
while also advancing our expertise and capacity to
deliver accountable care at the regional level.
I am grateful to Linda von Reyn, PhD, RN, for her gracious leadership and legacy of encouraging emerging
leaders to reach for new opportunities. Beginning in
2013, I have been honored to serve on the D-H Board
of Governors, and I look forward to continued opportunities for us to work together to improve the lives
of the people and communities we serve.
Cheryl L. Abbott, MSN, CNRN
Neurosciences/ENT
Staff Nurse Executive Chair
NURSING YEAR IN REVIEW // 2013
4
Paula Johnson, BSN, MPA, DA, RN
Professional Practice Model
In its simplest form, a model is a visual representation
of a set of relationships. A Nursing Professional
Practice Model conveys the values and core
characteristics of nursing in a given organization.
Nursing at Dartmouth-Hitchcock (D-H) has many
elements that normally appear in the Professional
Practice Model (PPM), including our nursing mission,
our commitment to patient- and family-centered
care, our philosophy of nursing, an identified nursing
theorist and strong Shared Governance structures.
What Nursing at D-H lacked was a picture that
reflected all these values and could provide a
common foundation for Nursing at D-H.
As part of the development of the revised nursing
strategic plan in 2012, one of the goals was to
develop and implement an agreed upon PPM. The
Magnet Ambassadors were a key group involved in
this chartered work, as they provide broad nursing
representation from across the organization.
The team began by understanding and defining
professional practice models to develop shared
NURSING YEAR IN REVIEW // 2013
and common terminology. They next reviewed
models from other organizations, and then worked
with Communications and Marketing to develop
a schematic for D-H. This information was shared
along the way with the unit-based councils, nursing
leadership teams and the house-wide Coordinating
Council to provide feedback and facilitate dialogue.
Every nurse in the organization received a brochure
with the new design and a high-level description of
each of the elements. A deeper analysis of aligning
nursing work with each element of the model
began at the annual Shared Governance retreat
in November 2013. This same presentation also
occurred as part of Nursing Professional Practice
Grand Rounds in December 2013.
The Magnet Ambassadors are currently working
with peers at the unit level with large dry erase
posters to begin to align the work at the unit level
with our new PPM. This is meant to be a positive
experience, with nurses reflecting on the work they
have been involved in and are most proud of and
OVERVIEW
5
Left to right: Jill Toth, BSN, RN; Janice Chapman, BSN, RN; and Paula Johnson, BSN, MPA, DA, RN
The stories highlighted in this year in review align
with the different components of the new model,
and I hope will inspire you to reflect with pride on the
work being done to advance nursing at D-H.
create an
environment
in which
PATIENTS & FAMILIES
can HEAL
PR
OF
ES
SIO
NA
LP
AC
RA
CO
CT
UN
ICE
PR
T
AB
OF
ILI
ES
TY
SIO
NA
LD
SH
EV
AR
EL
ED
OP
GO
ME
VE
NT
RN
AN
CA
C
E
SY RE D
ST
EM ELIV
E
S
RY
identifying where it best fits within the model—to
begin to bring the model to life in each individual
practice setting. In addition, the model is being rolled
out on the Intranet and the Internet so that people
both internally and externally can identify what
it means to be a nurse at D-H. As we continue to
develop new relationships and partnerships, having a
common foundation for nursing becomes increasingly
important.
RESPECT
& DIGNITY
INFORMATION
SHARING
PARTICIPATION
COLLABORATION
PATIENT & FAMILY CENTERED CARE
Paula Johnson, BSN, MPA, DA, RN
Clinical Program Coordinator, Magnet and Retention
RELATIONSHIP BASED CARE
D-H Nursing Professional Practice Model
NURSING YEAR IN REVIEW // 2013
M A N A G I N G PA I N , P L E A S I N G PAT I E N T S - A CCO U N TA B I L I T Y
Managing Pain, Pleasing Patients
6
Pain. For many, and perhaps even most
patients, pain plays a major role in how
they define their hospital experience. The
hospital staff’s management of a patient's
pain, then, can also define a patient’s
perception of their care.
to improve, quality and consistency of manufactured
products. Today, the methodology and its hierarchy
of staff expertise—Yellowbelts, Greenbelts, Blackbelts—are used in many business sectors, including
health care. At D-H, the Value Institute has combined Lean techniques with the Six Sigma methodology to establish a standard framework for quality
improvement efforts throughout the organization.
“Yet pain, so elemental to the human sense of
wellness, is very difficult to manage,” says Kate
Bryant, BSN, RN, staff nurse in the 3 West inpatient
surgical unit at Dartmouth-Hitchcock Medical Center
(DHMC). “It’s really challenging. Basically, pain is
whatever the patient says it is. And one patient’s ‘2’
can be another patient’s ‘8’,” she adds, referring to the
standard 10-point pain scale, where “0” is no pain at
all and “10” is “excruciating pain.” The problem of pain
management is especially apparent in 3 West, which
issues more narcotic pain medications than any other
unit at DHMC.
As part of the Nursing Strategic Plan to increase
expertise in process improvement, 68 nursing staff and
leaders were trained in Six Sigma methodology at the
Yellowbelt level, including Bryant and her team members. Following the training session during the summer of 2013, the team, which included 2 West Nurse
Manager Angela Price, BSN, RN; staff nurse Courtney
Peterson, MEd, RN; Unit Supervisors Ericka Bergeron,
BSN, RN, and Kimberly Hardin, RN; and 3 West Nurse
Manager Nancy Karon, BSN, RN, ONC, first identified
their goal: an average HCAHPS score of 71 or better
related to how patients perceive their pain management at D-H. After discussion and a staff survey, the
Yellowbelt team decided that focusing on staff nurse
education would yield the best results.
Patients completing the Hospital Consumer
Assessment of Healthcare Providers and Systems
(HCAHPS) upon discharge consistently gave
DHMC scores in the low 60s on average for pain
management—not bad, but not great either. With
the Affordable Care Act placing more emphasis than
ever on HCAHPS scores, Bryant and nurse colleagues
on 3 West as well as 2 and 4 West resolved to develop
and implement a plan to improve our scores.
The goal of any pain management plan, says Bryant,
“is to keep pain always in control.”
B R I N G I N G I N T H E Y E L L O W B E LT
The result was a quality improvement Yellowbelt
project that not only found ways to improve pain
management in all these inpatient units, but also provided new ways for nurses to connect with patients.
The Six Sigma methodology was developed back in
1986 by Motorola, the electronics company, as a way
NURSING YEAR IN REVIEW // 2013
Staff education included distribution of five “Pain
Tips of the Week” during a five-week period, mentoring on the floor by charge nurses and a review
of monthly HCAHPS scores. The scores were also
posted on Quality Boards on the unit.
Perhaps mostly importantly, the team, with input from
staff, developed a Patient Daily Goal Sheet to be used
by patients and nurses to establish pain-management
goals, e.g., "'I want my pain not to exceed 2 today.' The
Goal Sheet became a way for patients and nurses to
connect," says Bryant. “We found that a lot of patients
didn’t understand the pain medication regimen they
were on. Some were on regular pain meds, others on
an as-needed basis. The Goal Sheet gave us a way to
talk about it and clear up any misunderstandings.”
The Goal Sheet proved to be a great success—with
one drawback: “It’s another piece of paper floating
in the patient’s room.” So the Goal Sheet’s informa-
D-H NURSING
PROFESSIONAL
PRACTICE MODEL:
ACCOUNTABILITY
The Professional Practice Model element of
Accountability reflects
the responsibility of the
nurse to provide highquality, evidence-based
care, but also to identify
and implement opportunities for continuous
improvement. The Yellowbelt training provides
a standardized approach
to this improvement process, providing training
and tools to implement
an improvement project
with small tests of
change.
7
Kate Bryant, BSN, RN, center; and Keith Garland, RN, right
tion was transferred to the white board hanging in
each patient’s room. It is updated daily in consultation with physicians, nurses and the patient and
patient’s support group.
O BTA I N I N G A “ PA I N H I S TO R Y ”
The Yellowbelt team also surveyed 15 patients to
learn what was most important to them about
managing their pain. They discovered the importance of obtaining a “pain history” when a patient
is admitted to the unit, which Bryant points out is
different than a medical history. “You find out how
each patient has handled their pain in the past,
what has worked and what hasn’t with medications or other non-pharmacological methods. It’s
an essential tool to help come up with an effective
new pain-management strategy.” The pain history
also helped create a dialogue between patient and
nurse. “It gave us a chance to tell the patient, ‘We
are here as your advocate. We are partners in your
pain management,’” she says.
Team Care—D-H’s interdisciplinary, relationshipbased care initiative that uses rounding interventions to bring the patient and patient’s family into
partnership with providers and hospital staff—“is
a big part of this,” she adds. “Purposeful Rounding,
the Nurse Knowledge Exchange at the bedside,
Interdisciplinary Rounding—they all address pain
in one way or another.” Managing pain moved
to the center of discussions rather than being
regarded as an unavoidable byproduct of medical
treatment.
The Yellowbelt team tried to be realistic about
its goals. “We didn’t want to set the bar too
high, because we didn’t want to fail,” she admits.
But after two months, HCAHPS scores for pain
management for the three inpatients units participating in the Yellowbelt project climbed past
the original goal of 71. Not content to merely
succeed, Bryant says successes indentified by the
project have been integrated into ongoing operations and team members hope to see scores
higher than ever. ●
WHERE DESIGN MEETS NURSING'S MISSION - NURSING MISSION
8
Where Design Meets
Nursing’s Mission: Creating
a Healing Environment
“Patient-centered” at DartmouthHitchcock doesn’t apply only to patient
care. Ultimately, even the design of a
patient room is a key element of the patient
experience and of the D-H Nursing Mission,
which is to create an environment in which
families and patients can heal. Nurses play
an active role in creating this environment,
whether through identifying unique needs
of patients and families or in the creation
of healing spaces. The new Intensive Care
Unit (ICU) and Medical Specialties Unit
at Dartmouth-Hitchcock Medical Center
(DHMC) show how thoughtful, careful
design can meet nursing’s mission and
satisfy multiple needs in the process.
Just like patients and doctors, nurses, too, “want an
efficient design and the latest technology,” says Steve
Thomas, MSN, RN, CCRN, a nurse manager who
was deeply involved in the design of the new units.
“As nurse manager, I attended literally hundreds of
pre-planning meetings with all the stakeholders who
interface with the ICU. We had weekly meetings
with our architectural firm, built a mock-up of a
room and had nurses visit the mock-up and provide
feedback.”
The fundamental problem the new ICU was designed
to solve is a simple enough problem: create more
beds at DHMC. But, in addition, the new unit had to
improve patient care for present and future patients
as well as working conditions for staff.
“The new unit allows patients to receive the best
of what medicine can offer while at the same time
recognizing that some of what patients need can’t be
provided by drugs and devices or even the hospital
staff,” says Jeff Munson, MD, MSCE, one of the ICU
providers who was involved in the project from
the beginning. “D-H recognizes the vital role each
patient's family and friends can play in illness and
health, and every effort has been made to allow our
patients’ loved ones to be more involved in the care."
“We designed the rooms to have a defined nurse
area, patient area and family area,” adds Thomas.
"There is plenty of room for everyone.”
Left to right: Marie Christine, Fahrner, RN; Jen Clark, RN; and Lori Wild, RN
NURSING YEAR IN REVIEW // 2013
"D-H recognizes the vital role each patient's family
and friends can play in illness and health, and every
effort has been made to allow our patients' loved
ones to be more involved in the care."
-Jeff Munson, MD, MSCE
Nursing staff demonstrate new ICU technology.
A DREAM COME TRUE
From a nursing perspective, the new ICU is a dream
come true. Patient rooms, all of which are single
and private, are laid out with a “nursing zone” and
a corresponding family space to separate visitors
from nursing/clinical duties without creating a
physical barrier. Clinicians, nurses and family are out
of each other’s way but not so distant to prevent a
collaborative relationship. Monitoring equipment is
mounted on booms and patient lifts descend from
the ceiling. A clinician’s computer is located beside
every patient bed.
“The orientation of the bed in each room is more
natural and allows patients to see outside. This
is critical to reducing the rate of delirium in our
patients,” says Munson. “Each room also includes
a large family space with a pull-out couch and a
bathroom with a shower." This arrangement allows
visitors to remain with their loved ones throughout
their hospitalization.
Deanna Orfanidis, MS, RN, nursing administrative
director for Inpatient Care in Critical Care and Surgical
Specialties, who was also involved in the design of
the new ICU, notes that “a lot of thought went into
the color scheme and the way the architecture works
to facilitate efficiency in delivering care to patients.
Aesthetically, the new ICU is really pleasing.”
“The rooms are large enough to allow the full
NURSING YEAR IN REVIEW // 2013
WHERE DESIGN MEETS NURSING'S MISSION - NURSING MISSION
spectrum of critical care, which often includes
multiple providers as well as several pieces of
equipment such as dialysis machines and ventilators.
The new rooms also give nurses the ability to
complete their electronic documentation without
leaving the bedside," describes Munson.
10
This ability comes into play especially with Team
Care, D-H’s interdisciplinary, relationship-based care
initiative that uses rounding interventions to bring
the patient and patient’s family into partnership
with providers and hospital staff. One of the key
interventions is the Nurse Knowledge Exchange at
the bedside during a shift change. With the ability to
document information electronically at the bedside,
it’s easy for the off-going nurse and the on-coming
nurse to include the patient in the conversation.
DESIGNING FOR RESPONSIVENESS
The new Medical Specialties Unit on 2 East, which
opened last summer, is using a new nurse call system,
called NaviCare®, which enhances staff coordination.
Together with relocated equipment and supplies,
the call system allows staff to work more efficiently,
according to Melissa Golightly, BSN, RN, who serves
as nurse manager for the 60-bed Medical Specialties
Unit on 1 East, 2 East and 3 East.
NaviCare® is an example of how technology can
combine with design and the nursing mission to
improve patient care. “It interacts with our beds
and links to badges that each nursing staff member
wears,” says Golightly. Using graphical touch screens
that are located in each patient room and throughout
the Medical Specialties Unit, nursing staff are able
to quickly locate colleagues and request help when
they need it. Unit support assistants are also able
to answer patient call lights, helping to keep the
workflow efficient. A favorite feature among nursing
staff is auto canceling. “That means that the system
automatically cancels the call lights when a nurse
walks into a room,” she comments. “That seems like
a small detail, but for the nurses it was huge. Before,
staff had to go to the back wall of the room and
reach over equipment to turn it off manually.”
As with the new ICU, the changes introduced in the
new Medical Specialties Unit came about with the
NURSING YEAR IN REVIEW // 2013
"When you think about
any of these projects,
you're planning for the
future. The challenge,
though, is being
visionary. You have
to ask: What will the
patient population be in
the future and how will
health care be delivered
in a hospital setting?"
-Deanna Orfanidis, MS, RN
full engagement of the nursing staff. “They came up
with the idea to feature artwork to promote a healing
environment. Now we have some really nice photos
and paintings, done by our own staff members,
displayed around the unit,” she says.
A CO O R D I N AT E D E F F O RT
“When you think about any of these projects, you’re
planning for the future. The challenge, though, is
being visionary,” comments Orfanidis. “You have to
ask: What will the patient population be in the future
and how will health care be delivered in a hospital
setting?"
“Preparing to open a new unit makes one truly
appreciate how many people are absolutely necessary
to make state-of-the art intensive care possible,”
comments Munson. “These projects have required
the coordinated effort of representatives from
virtually every part of the hospital." ●
Left to right: Jessica Nordman, RN; Melinda
Deneau, LNA; and Melissa Golightly, BSN, RN
S E L E C T I N G A M O D E L F O R E V I D E N C E- B A S E D P R A C T I C E AT D A RT M O U T H - H I TC H CO C K
Selecting a Model for Evidence-Based
Practice at Dartmouth-Hitchcock
12
In the fall of 2013, staff nurses on
Dartmouth-Hitchcock’s (D-H) inpatient
Hematology-Oncology Unit questioned a
proposed change in nursing practice.
The D-H Blood Bank had just changed the
policy that cancer patients would no longer
automatically be given the pre-medications
Tylenol and Benadryl before receiving
blood and platelet transfusions. The nurses
were concerned about changing this
long-held practice, which helps prevent a
reaction with the transfusions.
R E S E A R C H I N G T H E L I T E R AT U R E
A small group of the nurses, together with a clinical
specialist and a nurse practitioner, formed a team
to examine the clinical question using an evidencebased practice framework. Their goal was to conduct
a critical review of the current literature to determine
if the proposed change was the best practice and
best for patients.
After researching the literature and pulling together
a detailed summary of studies done on the topic,
they reconvened to discuss their findings. “I was
there for the meeting,” says Susan DiStasio, DNP,
ANP-C, APRN, AOCNP, administrative director of
Nursing at the Dartmouth-Hitchcock Norris Cotton
Cancer Center. “As they went through each article, it
became clear that the evidence consistently showed
no difference in reactions with the pre-medications.
The group was stunned.”
The group made several recommendations that
resulted in changes in their care process and in the
orientation of new nurses. They did presentations
at their staff meeting and for the ambulatory nurses
in the Infusion Suite. “It was a very empowering
experience for them,” says DiStasio.
EXPANDING EVIDENCE-BASED CARE
The story from 1 West serves as “a great example
of the critical role evidence-based practice plays
in ensuring that patients receive care that is of the
highest safety and quality,” says Mary Jo Slattery, MSN,
RN, clinical program coordinator for Nursing Research.
Susan Distasio, DNP, ANP-C, APRN, AOCNP
NURSING YEAR IN REVIEW // 2013
“Within our Nursing Strategic Plan, and through
a capstone project that Susan did for her doctoral
program, there was clear recognition that we needed
a structure, a framework for expanding the use of
evidence-based practice here,” says Slattery. One way
to expand the framework for evidence-based practice
D-H NURSING
PROFESSIONAL
PRACTICE MODEL:
SHARED
GOVERNANCE
them and narrowed the list to three for more
in-depth review. Kim Maynard, our chair, and I
then made a recommendation to the Coordinating
Council, and they supported it fully.”
A NEW EVIDENCE-BASED
PRACTICE MODEL FOR D-H
The Research Council chose the Iowa Model of
Evidence-Based Practice to Promote Quality as
the best fit for the organization.
“Some of its strengths are that it’s wellestablished, it’s very consistent with our culture of
quality improvement and it’s more practical and
easier to use than the other models we looked at,”
says Slattery. “It also emphasizes the importance
of forming teams and working collaboratively to
solve problems.”
Mary Jo Slattery, MS, RN
is through the implementation of a model. An
evidence-based practice (EBP) model provides
a standardized approach to answering clinical
questions or in developing an evidence-based
practice project.
As members of the Shared Governance Research
Council, Slattery and DiStasio helped lead efforts
over the past year to select and implement an EBP
model—one that melds clinical expertise, research
evidence and patient values and can be integrated
across the D-H system.
Slattery and librarian Heather Blunt pulled
together the majority of the literature for the
Research Council to review. “The group selected
five models to evaluate, so that we had two
reviewers per model,” says Slattery. “We developed
criteria that we took from the literature, ranked
“In addition," says DiStasio, "we liked how, once
you identify your clinical question, it asks how
your project fits into the strategic plan for the
organization. This really helps you to prioritize
what you’re doing,” she says. “And if you evaluate
the literature and you don’t find enough evidence
to make a change in practice, it asks you to
consider conducting your own research.”
Next steps include establishing a team and
timeline for implementation. "We’ll have a
larger group, which will be part of a research
committee, with a wide range of people from
leadership to staff nurses,” says Slattery.
“Our goal is to start slowly and gradually expand
the number of projects as we go along, so we
can build on the new knowledge and excitement
that is generated,” adds DiStasio. “The biggest
part will be getting people to participate in
the projects. We want every nurse to have an
experience like the nurses did on 1 West.” ●
The Nursing Professional
Practice Model (PPM) at
D-H includes an element
focusing on shared governance. Shared governance
provides a structure and
forum for shared dialogue
and shared leadership
to address priorities for
nursing and to develop
and implement the nursing strategic plan. One
of the elements of the
nursing strategic plan
includes a goal to identify and implement an
evidence based practice
(EBP) model for nursing; a
standardized approach to
answering clinical questions or to develop an
evidence based practice
project. In examining the
PPM schematic, it was
identified that the correct
group to lead this initiative was the Research
Council, part of the
shared governance structure at D-H. This story
highlights the benefits of
the use of an EBP model,
as well as the structure
and process used at D-H
for the selection of an
agreed upon EBP model
for full implementation.
13
PROFESSIONAL
DEVELOPMENT
D-H NURSING
PROFESSIONAL
PRACTICE MODEL:
PROFESSIONAL
DEVELOPMENT
Professional development is
one of the key components
of the Nursing Professional
Practice Model (PPM) at
D-H. Professional development is guided in part by the
American Nurses Association (ANA) Code of Ethics
for Nursing, which includes
a commitment to the
advancement of the nursing
profession, promotion of the
nursing profession, accountability and responsibility
for practice, and a commitment to becoming a lifelong
learner. Each individual has
accountability and responsibility for their own professional development, and D-H
provides numerous resources
to support each individual’s
goals. The Professional
Development element also
aligns with the Institute of
Medicine (IOM) Future of
Nursing recommendations,
which include recommendations for nurses to practice
at the fullest extent of their
licensure and training, to increase the number of nurses
with a baccalaureate degree
to 80 percent by 2020, to
double the number of doctorate-prepared nurses by
2020, and to prepare nurses
to become full partners at
decisional tables to influence health care reform and
policy. The framework for
professional development at
D-H and the resulting nursing strategic plan goals provide the best launch pad for
these changes to occur. D-H
nurses are among the very
best in the industry; providing the right framework, tools
and resources will position
D-H nurses to be recognized
leaders in the advancement of
the profession.
14
NURSING YEAR IN REVIEW // 2013
Allison McHugh, BSN, MHS, RN, NE-BC;
left, and Sonal Kumar, PhD
P R O F E S S I O N A L D E V E LO P M E N T
Professional Development
NURSING LEADERSHIP DEVELOPMENT
“Strong nursing leadership is needed more than
ever in times of great change,” says Allison McHugh,
BSN, MHS, RN, NE-BC, nursing administrative
director for Medical Specialties, Neurosciences and
Cardiovascular services. That’s why the Nursing
Leadership Development Series was launched in 2013.
McHugh, along with Debra Hastings, PhD, RN-BC,
CNOR, director, Continuing Nursing Education;
and Sonal Kumar, PhD, senior strategic plannning
specialist, developed the program, which uses
experiential learning methods to allow nurses to
learn, practice and apply leadership skills.
During the six-month program, participants spend
time in the Patient Safety Training Center to test
the learning in their day-to-day work. “It will prepare
participants for AONE (American Organization of
Nurse Executives) and Clinical Nurse Manager/
Leader certification, which is great for personal
advancement and important for DartmouthHitchcock (D-H) Magnet designation,” says McHugh.
Believing that leadership is a core competency
for health care professionals, the Geisel School of
Medicine offers a summer course called “The Science
and Practice of Leading Yourself,” directed by the Dean
of the Geisel School of Medicine, Wiley “Chip” Souba,
MD, ScD, MBA. The focus is on effective leadership.
Nurses, physicians, administrators and others take
part in the course, providing what Hastings calls “truly
interprofessional education and learning.”
C E RT I F I C AT I O N S
“Certification is one of the many opportunities for
professional development,” says McHugh. With the
focus of health care shifting to continuum of care,
population heath and disease management, nurses
need to become increasingly certified and specialized
to acquire the set of skills required for their clinical
responsibilities.
15
Debra Hastings, PhD, RN-BC, CNOR
D-H offers a vast array of preparatory courses to help
nurses become certified in a specialty. “We have well
over 200 different certifications,” says McHugh, “from
wound specialist to nurse executive. Most of the
time you have to go someplace else and pay for the
preparatory course, but D-H offers free prep courses
to employees.“
Under an ongoing collaborative, D-H and The
Dartmouth Institute for Health Policy and Clinical
Practice (TDI) are offering a new certificate program
this year: “The Linda von Reyn Value-Based Care
Scholars program.” It’s been named in honor of
D-H’s recently retired chief nursing officer, who
exemplifies the critical skills that are needed as
health care transitions to value-based care. “It is
a team-based, interprofessional program,” says
Hastings. “Six nurses are paired with residents from
their department, and together they work on a
project that benefits that patient population.” The
“von Reyn scholars” will earn a TDI Certificate in the
Fundamentals of Value-Based Care.
NURSING YEAR IN REVIEW // 2013
P R O F E S S I O N A L D E V E LO P M E N T
A D VA N C I N G A C A D E M I C E D U C AT I O N
D-H has a long-standing history of encouraging and
supporting nurses to pursue advanced educational
opportunities, and there are several teams across
D-H working on the achievement of this goal.
16
“We want nurses to practice the highest level of their
profession," says McHugh. “Our goal here, which
is part of the D-H nursing strategic plan, is that 80
percent of our bedside nurses will have a bachelor’s
degree in nursing by 2020. We estimate 50 percent of
D-H nurses currently have a baccalaureate education.”
Nurses enrolled in baccalaureate nursing programs
receive advanced training in quality improvement and
evidence-based practice, preparing them to function
effectively in an increasingly complex environment.
The literature reveals that those patients who are
cared for by a baccalaureate-prepared nurse experience better outcomes. The Iowa Model report also
includes findings that nurses with a BSN degree are
more likely to go on to pursue graduate degrees in
nursing, helping to create the pipeline for nursing faculty and to continue to increase the knowledge base
of nursing through PhD-prepared nursing researchers.
There are many programs available to those interested
in pursuing or advancing a nursing degree. Hastings
and her colleague Paula Johnson, BSN, MPA, DA, RN,
clinical program coordinator of Magnet and retention
in the Office of Professional Nursing, hold monthly
educational forums that often lead to one-on-one sessions. “I feel like I have traveled a long path to advance
my education and progress in my career,” says Hastings, “so if I can help someone in their personal quest,
I’m happy to support them in meeting their goals. In
fact, I very much enjoy this aspect of my work.”
SCHOLARSHIPS AND GRANTS
Tuition reimbursement is available at D-H and there
are scholarship and grant opportunities as well. There
are several scholarships that support nurses to attend a national or international conference in their
specialty, to gain and share the latest knowledge and
to maintain continuing education credits needed to
support certification in a specialty. In addition, the
Varnum Auxiliary Nursing Scholarship is available
NURSING YEAR IN REVIEW // 2013
annually for those enrolled in nursing programs. Beginning in 2001, the Auxiliary has provided an average
of $40,000 each year to support those enrolled in
nursing degree programs
“Each spring we enter ‘scholarship application season’
as we prepare to provide scholarships to D-H nurses
during National Nurses Week. Each year, we aspire
to increase the number of nurses who apply for these
scholarships,” explains McHugh. That’s where Hastings’ team comes in. They look to put nurses in touch
with those opportunities. Hastings says specialty
organizations are often overlooked as a resource. Additional sources of funding include Sigma Theta Tau,
International Honor Society of Nursing, particularly
for degrees beyond the baccalaureate level, and other
nursing-based organizations.
WHY PROFESSIONAL DEVELOPMENT
“You can become a nurse,” says McHugh, “but it’s not
an end when you graduate. There’s so much more
you can do, so much more you can learn about your
profession or that you can learn about your practice.”
“Everything is changing in health care,” says Hastings.
“It is important to build on what we learn in our basic
nursing education programs. Nursing is a profession
that demands life-long learning. We need to keep advancing our education and broadening our knowledge
base in order to provide nursing excellence at the point
of care. We need to continue our education for our
licensure—we need it for our certification. ●
P R O F E S S I O N A L D E V E LO P M E N T
Meghan
Poperowitz
17
Meghan Poperowitz, BSN, RN-BC
credits a freak bike accident for her
second career as a nurse.
“I remember opening my eyes to a car
tire next to my unhelmeted head,” she says. While
suffering only two fractures in her pinkie finger,
her interaction with the health care system proved
life-changing. After volunteering on a medical unit
in a Philadelphia hospital, Poperowitz decided she
wanted to be a nurse. She quit her job and went back
to school for her second bachelor’s degree.
It was Dartmouth-Hitchcock’s robust residency
program that drew her to New Hampshire three
years ago. Now a staff nurse on the Medical
Specialties unit, her interests lie in geriatrics and
palliative care. “In Girl Scouts, we always volunteered
at nursing homes,” says Poperowitz. "I used to adore
hanging out with seniors. I really enjoy working with
that population.”
Through courses offered at D-H, she’s become
certified in geriatric nursing and is preparing to
become certified in palliative care. Last year, she
participated in AgeWISE, a six-month residency
program that focuses on geropalliative care. While
earning contact hours and continuing education
credits, she was able to integrate the new learning
into her clinical setting. “I became an unofficial leader
on the floor,” she says. “Co-workers began to seek
me out as a resource. I was able to support my fellow
nurses by helping them navigate difficult end-of-life
care conversations. That kind of in-depth training just
isn’t given in nursing school.”
She goes to Nursing Grand Rounds, attends geriatric
boot camps—one-hour lunch learning sessions—
and would love to take a leadership course. “The
educational offerings are robust”, says Poperowitz.
“You can pretty much have any opportunity you
want. You just have to put yourself out there and
be aware of what’s happening around you. I read all
the emails, the nursing newsletters and check the
continuing education website regularly.”
Poperowitz is now looking at a Master’s program and,
eventually, to becoming a nurse practitioner.
Just last month, she sat down with Debra Hastings,
PhD, RN, CNOR, director of Continuing Nursing
Education, to discuss future steps. ●
NURSING YEAR IN REVIEW // 2013
E L E VAT E H E A LT H I M P R O V I N G PAT I E N T A N D P O P U L AT I O N H E A LT H
ElevateHealth:
18
D-H’s new Nursing Professional Practice
Model (PPM) provides the framework for
approaching the nursing strategic plan.
The main goal of the strategic plan—to
improve population and patient health—will
be made possible by optimizing the role of
the professional nurse. ElevateHealth, an
innovative provider/insurer collaboration,
is informed, in part, by professional nurses
who also play a critical role in its operation.
Mimi Emerson, MS, RN, care coordinator
for ElevateHealth and D-H Wellness
Plus, explains nursing’s role in program
development and delivery.
What is ElevateHealth?
ElevateHealth is a new approach to collaboration
between providers and Harvard Pilgrim Health Care
to deliver the best, most efficient health care to
subscribers. It’s an insurance product that is available
to employers with two to 50 employees and includes more than 400 primary care physicians, 2,600
specialists and the inpatient facilities of DartmouthHitchcock Medical Center, Elliott Hospital System,
Cheshire Medical Center, New London Hospital and
Southern New Hampshire Medical Center.
ElevateHealth focuses on a care management
approach that brings clinical and utilization
information together for the benefit of individual
patients and overall population health.
How will information sharing translate
to better health?
By marrying clinical notes and claims information, we
shed new light on individual and population health.
Physicians see where patients are having trouble:
What is sending them to primary care, specialists
NURSING YEAR IN REVIEW // 2013
or the hospital? Are they getting or following preventative care? Population data informs physicians
of important patterns: Are people seeing treatment
outside the local network? Are they seeking care in
the Emergency Department instead of through their
primary care provider?
ElevateHealth is described as being a
“collaborative and innovative partnership.” Why
is it important to deliver care this new way?
There is general recognition that the health care picture has become fragmented. Physicians and insurers
don’t have a complete picture of what’s happening to
the patient.
In addition, as we learn more about the way
health care is being delivered, we understand that
the quantity of resources and the quality of resources
aren’t always aligned. We’re trying to increase quality
by sharing information between the insurer and
providers, then utilizing care coordination to bring
the right resources to patients.
What was your role in ElevateHealth’s
development and planning?
I’ve been a care manager in the D-H Wellness Plus
program for six years. Care coordination is a big part
of ElevateHealth, so I was asked to lend my expertise
to the development of the product.
I and other nurses from Elliot Health System and
Harvard Pilgrim Health Care are on the ground doing
the work of care management and coordination. As a
member of the committee that outlined this feature
of ElevateHealth’s care delivery model, I was able to
share my knowledge and experience.
What does a care coordinator do?
Care coordinators make sure there’s a connection between the patient and primary care provider, specialty care providers and additional resources as needed.
For example, if a patient is hospitalized, I’ll reach
E L E VAT E H E A LT H : I M P R O V I N G PAT I E N T A N D P O P U L AT I O N H E A LT H
Improving Patient
and Population Health
out to see why and what’s happening. If there’s not
a strong connection between the patient and his or
hers physician, I’ll get engaged. It’s especially important to check in with people when they’re discharged
from the hospital.
We also help patients who are dealing with
chronic disease. We might hear from the insurer
that a patient doesn’t seem to be doing well. We can
reach out and understand what’s going on and offer
information or help the patient find the right resources. Most importantly, we can help that patient clarify
what he or she needs and wants and organize his or
her care around that. And we can make sure that the
primary care physician has the information needed to
support the patient.
What have you learned through your
involvement in ElevateHealth?
People often see insurance on one side of health care
and providers on the other. It’s very new to see providers and insurers working together. As I’ve gotten
to know people who work for Harvard Pilgrim Health
Care, I understand that we have the same goals. This
is in part about saving money, but more, importantly,
it’s about using resources to the patient’s and population’s benefit.
19
What are the biggest challenges faced
by this new delivery system?
Figuring out how to share information appropriately
is a big challenge. While adhering strictly to privacy
rules and regulations, we also need to make sure that
providers and care coordinators have the information
necessary to help patients. Most patients are very
receptive to a proactive call that asks how they’re
doing or checks in on an issue. Others wonder how a
care coordinator got their information. It’s an education process.
How is ElevateHealth working?
The program has been operational since December
2013, and the subscriber base is small but growing. We
are encouraged by the wide array of employers who
have made this product available to their employees,
and anticipate that this trend will fuel a strong membership in future years. Our actual measures of success
are still being developed, and it will take some time
to really know how the program is doing from that
vantage point. As a new program, we have the flexibility to adapt as we grow, responding in real time to
our customers’ needs, and providing the most relevant,
helpful “array” of services available.
Mimi Emerson, MS, RN
NURSING YEAR IN REVIEW // 2013
T E A M C A R E A N D R E L AT I O N S H I P - B A S E D C A R E
Team Care and
Relationship-Based Care
20
Team Care, Dartmouth-Hitchcock’s
innovative interdisciplinary care initiative, is
building the future of inpatient care delivery.
A relationship-based care (RBC) model, Team
Care focuses on three key relationships: the
relationship with self, with others and with
patients and families. Team Care’s focus on
integrating key behaviors, or “interventions,”
into daily work reinforces the importance
of these connections and the building
of relationships that result in improved
communication to achieve better outcomes
and experiences for patients and families.
The four key interventions to improve
outcomes for all inpatients at D-H under
the Team Care initiative include:
1. Purposeful Rounding:
To improve patient experience and care
outcomes
2. Interdisciplinary Patient Care Rounds:
Creating a daily plan of care and daily goals
3. Nurse Knowledge Exchange (NKE):
Nurse-to-Nurse report at the bedside
4. Leadership Rounding for Outcomes:
Identified as the single best way to
support implementing needed change
efficiently, but in a manner responsive to
issues identified by patients and staff
Implemented with a launch in the fall of 2013, the
initiative is already beginning to fundamentally and
positively reshape the patient experience and improve outcomes at D-H. To understand the impact of
these interventions, practices and processes are measured and the data are collected on a weekly basis.
From left to right: Members of the Team Care Advisory Team,
Johanna Beliveau, MBA, RN; Diane Andrews, MHCDS, RN;
Steve Surgeoner, MD; and Pam Brown, BSN, MS, RN.
NURSING YEAR IN REVIEW // 2013
“The differences are real and early results can be seen
in the data we’ve collected so far,” says Pam Brown,
BSN, MS, RN, director of Nursing Quality and Safety
and improvement advisor to Team Care’s Advisory
team. “Some of the results are really powerful.”
T E A M C A R E A N D R E L AT I O N S H I P - B A S E D C A R E
21
LEADERSHIP ROUNDING
Safety Rounds are an integral component of Team Care and an essential part in helping to initiate culture change. These rounds provide
an opportunity for leaders to engage with staff and learn about real-life issues of quality and safety. Sam Casella, MD, associate director
for Quality and Safety, at CHaD, left, leads Safety Rounds on the Pediatric Adolescent unit. Joined by Johanna Beliveau, MBA, RN,
administrative director and Team Care Collaborative co-chair, center, Sara Chaffee, MD, medical director, far right; and Buffy Meliment,
BSN, RN, unit nurse manager (not shown); talk with Kim Derryberry, RN, about recent issues with chemotherapy administration, where
communication and hand-off (two elements of the Team Care Collaborative) are emphasized as critical to safe practice.
R E S U LT S T O D A T E
Team Care’s results to date are indeed impressive.
First, a growing majority of inpatient units now have
highly engaged nursing and physician co-leader pairs
who are determining priorities and implementation
of Team Care initiatives within their areas. “These coleader pairings are a linchpin of Team Care. Over time,
we all know that new initiatives will be added to our
priorities. These co-leader pairings across the inpatient
areas are precisely how we will diffuse best practice for
today’s hot topics, and also for future initiatives.” says
Steve Surgenor, MD, associate chief officer for Quality
and Value.
Second, patients are seeing their primary nurse much
more quickly following the implementation of NKE.
The average time until a nurse sees their first patient
following a shift change has dropped in some units
from more than 25 minutes to less than five minutes.
The percentage of patients now experiencing NKE at
their bedside has averaged between 85 percent and
95 percent since the beginning of December. And
the percentage of patients responding “always” to
survey questions regarding effective communications
with nurses, doctors and hospital staff has improved
from a low of 60 percent in September to a high of
83 percent in December, as measured in Hospital
Consumer Assessment of Healthcare Providers and
Systems (HCAHPS) scores. “The interventions that
have been tested are taking hold,” says Brown. “They
are very much becoming the way we do things here.”
NURSING YEAR IN REVIEW // 2013
T E A M C A R E A N D R E L AT I O N S H I P - B A S E D C A R E
THE NURSING PERSPECTIVE
22
From a nursing perspective, Team Care emphasizes
and values communication, especially with the
patient and the patient’s support network. Team
Care’s patient-centered approach can be seen in the
Purposeful Rounding posters on display in several of
the inpatient units at Dartmouth-Hitchcock Medical
Center (DHMC). These posters remind nurses what
ROUNDS stands for: (R) ARe you comfortable? (O)
Do you need to be moved to the Other side of the
bed? (U) Do you need to Use the bathroom? (N) Do
you Need anything? (D) Would you like the Door
open or closed? And (S) Make a Safety check of lines
and cords in the room.
According to Nancy Karon, BSN, RN, nurse manager
on 3 West, the NKE, especially, makes patients more
engaged with their recovery; family and support system members feel informed and included; and there’s
been a noticeable improvement in staff morale.
“We see ourselves as a team,” she says. “Everybody
has a responsibility for a patient.” This sense of
responsibility encourages nurses to sharpen their observations, to notice even slight changes in a patient’s
appearance or behavior. “We’re paying attention to
the patient’s condition earlier and earlier,” she adds.
“That’s going to improve their care.”
Other Team Care data show improvements in nurse
communications, doctor communications and in
the amount of time that patients receive help after
asking for it. Last summer, the percentage of patients
who said they would recommend D-H to others—a
key indicator of patient experience and satisfaction—
was in the high 70s; the percentage is now in the
high 80s. When surveyed, patients were asked, “Is the
staff doing everything they could to help you with
your pain?” More than 80 percent answered "yes."
AN EVOLUTION
Team Care evolved from the work of 10 frontline
improvement teams who participated in the national
Partnership for Patients initiative last year. This
national initiative aims to improve quality, safety and
health outcomes across the U.S. by reducing 10 common sources of preventable harm in the hospital setting. While the RBC model has proven successful in
several large health care organizations, Eric Lansigan,
MD, the medical director on the Medical Hematology/Oncology inpatient unit, who has been working
closely with Nurse Manager Virginia Bayliss, still calls
Team Care “a huge cultural shift.”
In January 2013, after months of work to share and
learn from the best hospitals in the nation, the
frontline improvement teams presented their recommendations for practice changes that would make
D-H safer and improve the patient experience. Team
Care began to take shape following those presentations. Based on previous experience with the model,
Team Care co-chair Johanna Beliveau, MBA, RN,
approached the sponsors, Linda von Reyn, PhD, RN,
chief nursing officer; and George Blike, MD, chief
quality and value officer; with a proposal for the
Team Care Collaborative. "I have seen this model
produce truly fantastic results and that is what we
need now, for our patients and our staff," she says.
Team Care is being implemented through an “all
teach, all learn” methodology known as a breakthrough series collaborative. Learning sessions are
conducted every two to three months where nurses,
physicians and allied health providers share experiences and compare notes, while also learning from
experts in the field. Learning Session I, held in October 2013, introduced the concept of relationship-
Left to right: Lynn McRae, MA, RN; Sarah Paige BSN, RN;
Cheryl Abbott, MSN, CNRN; and Deborah King, LNA
NURSING YEAR IN REVIEW // 2013
TEAM CARE AND RELATIONSHIP-BASED CARE
D-H NURSING
PROFESSIONAL
PRACTICE MODEL:
CARE DELIVERY
The Care Delivery
component of the D-H
Nursing Professional
Practice Model (PPM)
highlights the roles,
systems and approach
in the delivery of care
to our patients, families
and community. The
care delivery system at
D-H is interdisciplinary in
nature, with the nurse at
the center, providing care
coordination as part of
their role.
23
Left to right: Matt Truland, RN; Kate Bryant, BSN, RN; Aurora Gleason, LNA; and Rhonda Tracey, RN
Self
based care and presented the experiences of some
early Team Care adopters. Learning Session II, in
February 2014, focused on building teams and using teamwork to conduct effective interdisciplinary rounding. A third Learning Session was held
in May of 2014.
The learning sessions provide an opportunity for
teams to talk about issues and work out kinks in
a non-judgmental, non-hierarchical environment.
At Learning Session II, it was soon clear that the
“ideal state” of interdisciplinary rounding is a moving target and is different for each unit. But that is
the nature of Team Care: it’s a dynamic initiative
that thrives on adaptability.
LIVING UP TO A MISSION
“Team Care is about improving quality in a number
of ways through team work and thoughtful collaboration,” says Surgenor. “We have learned that
one of the best ways to reduce unwanted complications and, at the same time, to improve the
patient experience is to engage the expertise of a
variety of relevant caregivers who come together
as a patient care team, including the attending
physician, nurses, physical therapists and everyone in between. A unique challenge for academic
medical centers like DHMC is that many learners
join the team, which most of us find very rewarding, but also makes Team Care more complicated.
And the patient and his or her family is the most
critical member of the team. While the work is
challenging, it is also enormously rewarding, he
emphasizes. Team Care is at the very heart of a
patient-centered culture of caring, he says. “Team
Care’s defining quality and value is greater collaboration by clear roles and responsibilities for the
benefit of the patient as well as communication
and teamwork among staff.”
Nancy Karon agrees. “What it’s really all about” for
nursing, she says, “is living up to D-H’s mission of
being patient-centered. This is where it happens.
You get in the room with the patient, you talk to
them and include them in the treatment plan of
the day, you write the information on the white
board in the room, you go back to check on them
and they know when to expect you, you talk to
family members who are in the room—you can
really assess what’s going on with a patient.” ●
TEAM
CARE
Colleagues
Patient/
Family
THE TEAM CARE
GRAPHIC:
A Venn diagram-style
visual aid depicting the
interconnection of Self,
Colleagues and Patient/
Family is showing up
throughout DHMC on
posters and flyers. “The
graphic is the program
in a nutshell—it’s all
about collaboration
and relationships,” says
Surgenor. “It’s a great
reminder that Team Care
is, in fact, DartmouthHitchcock Care.”
C E RT I F I C AT I O N S
24
AMERICAN
ASSOCIATION OF
HEART FAILURE
NURSES
Certified Heart Failure
Nurse
Sherry Duveneck, MSN, RN,
CHFN
AMERICAN
ASSOCIATION OF
NEUROSCIENCE
NURSING
Certified Neuroscience
Nurse
Wanda Handel, MSN, RN,
CNRN
AMERICAN
ASSOCIATION OF
PERIOPERATIVE
REGISTERED NURSES
Certified Operating Room
Nurse
Celine Crete, RN, CNOR
AMERICAN
HOLISTIC NURSES
CREDENTIALING
CORPORATION
Certified Health and
Wellness Nurse Coach
Rita Severinghaus, BSN, MA,
HWNC-BC
AMERICAN NURSES
CREDENTIALING
CENTER
Certified Medical-Surgical
Nurse
Jennifer Berry, BSN, RN-BC
Certified Family Nurse
Practitioner
Brianna Seaver, APRN,
FNP-BC
Certification in
Gerontological Nursing
Meghan Poperowitz, BSN,
RN-BC
COMMISSION FOR
CASE MANAGER
CERTIFICATION
Teryl Zimmermann
Desrochers, RN, CCM
Carol McShane, RN, CCM
NURSING YEAR IN REVIEW // 2013
INTERNATIONAL
BOARD OF
LACTATION
CONSULTANT
EXAMINERS
Certified Lactation
Counselor
Adrienne Domenicucci, RN,
CLC
MEDICALSURGICAL NURSING
CERTIFICATION
BOARD
Certified Medical Surgical
Nurse
Susan Loskutoff, RN-BC
NATIONAL
ASSOCIATION OF
HEALTH COACHES
Certified Health Coach
Denise Biron, MS, RN,
COHN, CHC
NATIONAL BOARD
FOR CERTIFICATION
OF HOSPICE AND
PALLIATIVE NURSES
Certified Hospice and
Palliative Nurse
Charlene Forcier, RN, CHPN
NATIONAL
CERTIFICATION
CORPORATION
Neonatal Intensive Care
Nursing
Jenny Morrow, BSN, RNCNIC
WOUND, OSTOMY
AND CONTINENCE
NURSING
CERTIFICATION BOARD
Certified Wound Care
Nurse
Kate Roche, RN, CWCN
EDUCATION UPDATES
Sydney Allen, BSN, RN,
OR, completed a Bachelor’s
Degree of Science in
Nursing from Franklin Pierce
University.
Theresa Banks, MSN, RN,
OPN, completed a Master’s
Degree of Science in
Nursing Education from the
University of Phoenix.
Wanda Handel, MSN, RN,
CNRN, Neurosciences/
ENT, completed a Master’s
Degree of Science in
Nursing from the University
of Alabama at Birmingham.
Catherine Holub-Smith,
DNP, RN, Pediatrics,
completed a Doctorate in
Nursing Practice Degree
from Northeastern
University.
Rachelle Kleber, BSN,
RNC-NIC, ICN, completed a
Bachelor’s Degree of Science
in Nursing from Excelsior
College.
Theresa Murray, MSN,
RN, OPN, completed a
Master’s Degree of Science
in Nursing from Norwich
University.
ONCOLOGY NURSING
CERTIFICATION
CORPORATION
Oncology Certified Nurse
Linda Kirouac, RN, OCN
Christi-Lynn Martin, BSN,
RN, OCN
Kathleen Pieroni, RN, OCN
Carley Starr, RN, OCN
Timothy Wheaton, RN, Day
Surgery Center, completed
an Associate Degree in
Nursing from St. Joseph’s
School of Nursing, Nashua,
NH.
ADULT ONCOLOGY
CERTIFIED NURSE
PRACTITIONER
Melissa Davis, APRN,
AOCNP
SCHOLARSHIPS
AWARDED
Heather Worster, RN, Day
Surgery Center, completed
an Associate Degree in
Nursing from Manchester
Community College.
Elsa Frank Hintze Magnet
Scholarship for Nursing
Excellence
Karen Downing, RN
Pediatrics Clinic
Susan Gaston, RN
Infectious Disease, Manchester
Kimberly Derryberry, BSN, RN
Inpatient Pediatrics
Aurora Gleason, LNA
3 West
Lynne Chase, MPH, RN,
CEN
Emergency Department
Chad Harrington, LNA
Neurosciences
The Levine Nursing
Continuing Education
Award
Jillian Rafter, RN, CEN
Emergency Department
Courtney Peterson, RN
4 West Inpatient Surgery
Margaret Provost, BSN, RN
Pediatric Intensive Care Unit
Gladys A. Godfrey
Scholarship
Ayla Priestley, LNA
ICU
Evidence-Based Nursing
Practice Award
Stacia Ghafoori, RN, CPON
Pediatric Intensive Care Unit
Patient Safety Training
Center Innovation in
Nursing Education Award
Lisa Davenport, RN, CCRN
CVCC
James W. Varnum Auxiliary
Scholarship Awards
Kathryn Abraham, BSN, RN
Norris Cotton Cancer
Center, Office of Clinical
Research
Stephanie Berman, RN
General Internal Medicine
Teresa Brubaker, BSN, RN
Perioperative Services
Maddie Dalgliesh, BSN, RN
NSCU
Stephanie Donahue, RN
Pulmonary, Manchester
Katherine Doton, MSN, RN
Pediatrics Clinic
Colleen Harrington, BSN,
MEd, RN, CNOR
OSC
Veronica Januszewski, RN
Primary Care
Claire Ketteler, RN-BC
Psychiatry
April Kingsbury, LPN
Primary Care
Katrina Masure, BSN, RN
ICN
Nichole Moorhead, RN
Perioperative Services
Lisa Moulton, RN
Pediatric Pulmonary, Cystic
Fibrosis Research
Ruth Anne Neborsky, RN
Patient Placement
Jennifer Norris, RN, CFRN
DHART
Sarah Nugent, RN
Operating Room
Ayla Priestley, LNA
ICU
Kristen Rhodes, RN
Primary Care, Concord
Tracie Ruggles, RN-BC
3 West
Kathleen Schumann, CMA
Plymouth Pediatrics
Rachael Smith, BSN, RN
4 West
Jordan Swartout, RN
Neurosciences
Sarah Thompson, BSN, RN
PICU
Lisa von Braun, MSN, RN,
CNL
Psychiatry
Nicola Felicetti, RN
Care Management
Melissa Waggoner, RN
CHaD Pediatric
Gastroenterology
Lise Fex, BSN, RN-BC
2 West
Theresa Ward, RN, CCRN
Emergency Department
Robyn Galvin, RN
Endoscopy, Nashua
Jennifer Wasilauskas, RN
Perioperative Services
C E RT I F I C AT I O N S
CERTIFICATIONS
Kerry Wulpern, BSN, RN
ICCU
Rachael Smith, BSN, RN
4 West
OTHER AWARDS
Jocelyn Verrill, LPN
Rheumatology
Areté Awards
Doug Alizio, BSN, RN
Life Safety
The Sandra Dickau Award
for Patient and Family
Centered Care
Sydney Allen, BSN, RN
Operating Room
Deb Cofell, BSN, RN
Care Management
Beth Beauchain, BSN, RN
2 West
The Deirdre Sheets Patient
and Family Centered Care
Award
Molly Bondurant, RN, CFRN
DHART
Tina Bowers, RN
HSCU
Leslie Burke, BSN, RN
ICU
Barbara Carr, BSN, RN
PACU
Linda Coutermarsh, RN,
CNRN
NSCU
Ellen Gilbert, RN
Care Management
Laura Heath, BSN, RN
PICU
Michelle Isner, BSN, RN
ICCU
Nancy Kennedy, RN
Radiation Oncology
Brandi LaCroix, LPN
Primary Care
Douglas Laidlaw, RN
CVCC
Sara McMillan, RN
ISCU
Dawn Malinowski, LPN
Pediatrics Clinic
Tracy Mauck, BSN
Pediatrics
Jacquelyn McDowell, RN
1 West
Jennifer Mellish, BSN, RN,
CNOR
OSC
Cynthia Morris, BSN, RN,
CAPA
Same Day Surgery
Mary Lou Judas, BSN, RN
ICN
The Deborah Miller ARNP,
CNM, MPH Award for
Advanced Practice in Nursing
Danielle Basta, APRN
Primary Care
The Barbara Agnew
RN Magnet Award for
Mentorship
Mildred Sattler, BSN, RN,
CCRN
Emergency Department
The Marianne Markwell
RN Commitment Award
for Neuroscience Nursing
Becky Murdough, RN
Neurology Clinic
The Rolf Olsen Partnership
in Nursing Award
Joanna Celenza
ICN
The Donna Crowley
Excellence in Nursing
Leadership Award
Bridget Mudge, MSN, RN,
CNS
Pediatrics
The Bakitas Award
for New Knowledge,
Innovations and
Improvements
Ellen Prior, BSN, MS, CCM
Care Management
Sue Von Iderstine, RN
Vascular Access
DAISY Awards
Renee Ratte, BSN, RN
ICN
Dorothy Heinrich, BSN, RN
4 West
Tracie Ruggles, RN-BC
3 West
Chris Apel-Cram, RN, CCRN
ICU
Denise Johnson, LPN
Urology
Lauren Clause, RN
ICN
Jane Kenyon, RN
Birthing Pavilion
Robin Williams, RN
PICU Float
Maureen Gardella, RN
Psychiatry
Margaret Georgia, RN
Care Management
Stacia Ghafoori, RN, CPON
PICU
Pamela Goodale, RN
Flex Unit
Elizabeth McGrath, APRN
NCCC
Michelle Adamyk, RN
Nashua Day Surgery
Yellowbelt Training
Kerstin Alderson, BSN, RN
ICU
Virginia Bayliss, BSN, RN
MHO
Emily Beaudoin, RN
BP
Ericka Bergeron, BSN, RN
3 West
Lise Bernardi, RN
Medical Specialties
Tina Bowers, RN
HSCU
Kathleen Brochu, BSN, RN
OB-GYN
Pamela Brown, BSN, MS, RN
OPN
Teresa Brubaker, BSN, RN
OR
Kate Bryant, BSN, RN
3 West
Michelle Buck, RN
Patient Placement
Deborah Cantlin, BSN, RN
GIM
Holly Converse, BSN, RN
Same Day Surgery
Mary Coutermarsh, BSN,
RN, VA-BC
Vascular Access
Amy Curley, MSN, RN, CEN
ED
Kimberly Derryberry, BSN, RN
Pediatrics
Susan DiStasio, DNP, RN
NCCC
Miriam Dowling, MSN, RN,
CCRN
ICU
Susan Eichholz, BSN, RN,
OCN
MHO
Melinda Goodwin, RN
Live Well Work Well
Gregory DeMatteo, BSN,
RN
MHO
Wanda Handel, MSN, RN,
CNRN
5 West
Kimberly Hardin, RN
2 West
Jessica Harrington, Nursing
Student, INBRE Program
Pediatrics
Justin Harris, BSN, RN
ICCU
Debra Hastings, PhD, RN-BC
OPN
Megan Howe, BSN, RN
MHO
Stephen Jameson, RN,
CFRN
DHART
Christine Judd, RN
Flex Unit
Nancy Karon, BSN, RN-BC
3 West
Sarah Lou King, RN, CAPA
OSC
Rachelle Kleber, BSN, RNCNIC
ICN
Caron (Heidi) LaCasse, BSN,
RN, CNRN
5 West
Cynthia LaClair, RN
Wellness Plus
Janet Levasseur, BSN, RN
Medical Specialties
Carol Majewski, BSN, MS, RN
Perioperative Services
Teresa Malec, RN
Flex Unit
Caryn McCoy, MSN, RNCNIC
ICN
Janice Narey, MSN, RN
ICU
Lynn McRae, RN
5 West
25
Michael Mehegan, RN, TNCC
ED
Tina Mongillo, MSN, RN
ISCU
Alyssa Olson, BSN, RN
MHO
Courtney Peterson, RN
4 West
Jean Picconi, MSN, RN-BC
OPN
Barbara Power, RN, CNRN
5 West
Angela Price, BSN, RN-BC
2 West
Ellen Prior, BSN, RN, CCM
Care Management
Lori Profota, DNP, RN
OPN
Margaret Provost, BSN, RN
PICU
Mildred Sattler, BSN, RN,
CCRN
ED
Jacqueline Stout, BSN, RN
ICCU
Jane Taylor, BSN, RN
ICU
Cynthia Tebbetts, BSN, RN
5 West
Sarah Thompson, BSN, RN
PICU
Moriah Tidwell, BSN, RN,
TNCC
ED
Jennifer Wasilauskas, RN
OR
Lisa Wesinger, RN
MHO
Sharon Wiley, RN
CGP-Manchester
Lori Wood, RNC-NIC
ICN
Mary Wood, MSN, RN, CDE
OPN
NURSING YEAR IN REVIEW // 2013
C E RT I F I C AT I O N S
Certifications
Green Belt Training
26
Karen Pushee, MA, RN
CVCC and ICCU
Kyle Madigan, MSN, RN,
CEN, CFRN
DHART
Pam Brown, BSN, MS, RN
OPN
Kerry Mogan, RN
Family Medicine, Keene
Susan M. Smith, BSN, RN
OR
Black belt Training
Johanna Beliveau, MBA, RN
Administrative Director,
Maternal Child Health and
Psychiatry
Other Awards
Wanda Handel, MSN,
RN, CNRN, received the
Outstanding Clinical Nurse
Specialist Graduate Student
Award from the University
of Alabama at Birmingham.
Heidi Hayes, RN, received
an Advanced Nursing
Leadership Certificate from
St. Anselm College.
Linda Kirouac, RN, OCN
and Kimberly Sleeper,
BSN, RN, CPON,
received a Certificate in
Chemotherapy/Biotherapy
from the Oncology Nursing
Society.
GRANTS AWARDED
Patricia Borden, BSN, MBA,
RN, and Judith Dixon, MSN,
RN received an EvidenceBased Research Grant from
the American Nephrology
Nurses’ Association for
the research proposal,
“Multidisciplinary CKD Clinic.”
Paula Johnson, BSN, MPA,
DA, RN
•Member, New Hampshire
Nurses Association
Commission on Continuing
Nursing Education
Sheila Johnson, MBA, RN
•Member, Board of
Directors, National Alliance
on Mental Illness, New
Hampshire
•Member, Board of
Directors, Riverbend
Community Mental Health
Center, Concord, NH
•AAACN Care Coordination
Transition Management
Competencies Phase IV
Expert Panel, American
Academy of Ambulatory
Care Nurses
Ellen Parker, RN
•Member at Large, Board
of Directors, New England
Nursing Informatics
Consortium
Paul O’Kane, MSN, RN
•President, Vermont
Nursing Informatics
Association, first chapter
organization of the
American Nursing
Informatics Association
Ellen Prior, RN, C-TTS
•Primary Prevention
Tobacco Work Group, New
Hampshire Comprehensive
Cancer Collaborative
•Member, Upper Valley
Public Health Advisory
Council Executive
Committee
Tammy Lambert, MSN, RN
•Member, March of Dimes
Board of Governors, New
Hampshire Division
PROFESSIONAL
ACTIVITIES
Susan M. Smith, BSN, RN,
CNOR
•Secretary, Association of
Perioperative Registered
Nurses, Chapter 3001
Teryl Zimmermann
Desrochers, RN, CCM
•Dartmouth-Hitchcock
Representative,
Manchester Collaborative
for Healthy Living
Linda Thompson, BSN, RN,
CNOR
•Treasurer, Board of
Directors, Association of
Perioperative Registered
Nurses, Chapter 3001
NURSING YEAR IN REVIEW // 2013
Patricia Tobin, LPN
•Director, National
Federation of Licensed
Practical Nurses
•Member, American
Association of Ambulatory
Care Nurses
Maureen Quigley, APRN
•Co-Chair, Integrated
Health Education
Committee, American
Society for Metabolic and
Bariatric Surgery
•Member, American Society
for Metabolic and Bariatric
Surgery Integrated Health
Executive Council
PUBLICATIONS
Duveneck, S., Matchem,
L., Kaminski, K., Beggs, V.,
D’anna, S. (2013). Reducing
heart failure readmissions
continuing care manager.
Heart and Lung: The Journal
of Acute and Critical Care,
42(6), 6.
Martin, C.L.,
Szczepiorkowski, Z.M.,
Dunbar, N. (2013). Complete
recovery of neurologic
function in a patient with
Marburg’s variant of multiple
sclerosis who received high
dose cyclophosphamide
and therapeutic plasma
exchange. Journal of Clinical
Apheresis, 28(2), 127-128.
McCabe, E. (2013). Breast
Disorders. In T.M. Buttaro et
al (Ed), 4th Ed. Primary Care:
A Collaborative Practice. St.
Louis, MO: Elsevier Mosby.
Rosenkranz, K.M., Tsui,
E. McCabe, E., Gui, J.,
Underhill, K., Barth, R. (2013).
Increased rates of long
term complications after
MammoSite brachytherapy
compared to whole breast
radiation therapy. Journal
of the American College of
Surgeons, 217(3), 497-502.
Severinghaus, R. (2013).
Caring about community,
ecology and the lives of
women. AHNA Beginnings,
33(5), 14-16.
PRESENTATIONS
Caller, T., Secore, K.,
Ferguson, R., Jobst, B.
Design and Feasibility of a
Memory Intervention with
Focus on Self-Management
for Cognitive Impairment in
Epilepsy. American Epilepsy
Society. Washington, D.C.
(December)
Chase, L. A Qualitative Study
to Explore the Role of Nurses
in Health Policy Development
in the Middle East. Sigma
Theta Tau International 24th
Nursing Research Congress.
Prague, Czech Republic. (July)
Cochrane, E., LaClair,
C. Putting Patients in
the Driver’s Seat: How
Care Coordinators Help
COPD Patients Manage
their Chronic Illness. Case
Management Society of
New England. Worcester,
MA. (October)
Collette, A. Improved Nurseto-Nurse Communication
and Patient Safety with a
Standardized Reporting Tool.
Nursing 2014 Symposium.
Las Vegas, NV. (March)
Crean, N. Are You Ready for
a Site Visit? New Hampshire
Immunization Conference.
Manchester, NH. (March)
Duveneck, S. Reducing
Heart Failure Readmissions
at Dartmouth Hitchcock
Medical Center. American
Association of Heart
Failure Nurses 9th Annual
Conference. Montreal,
Quebec Canada. (June)
Johnson, S. IT/Analytics.
Medicare Shared Savings
Program Boot Camp, American
Medical Group Association.
Philadelphia, PA. (May)
Johnson, S. Effective
collaboration between
hospitals and health plans
to enhance quality of care
and health outcomes to
reduce readmission rates.
2013 Congress on Reducing
Hospital Readmissions/
World Congress. Las Vegas,
NV. (April)
Martin, C.L.,
Szczepiorkowski, Z.M.,
Dunbar, N. Complete
Recovery of Neurologic
Function in a Patient with
Marburg’s Variant of Multiple
Sclerosis who Received High
Dose Cyclophosphamide
and Therapeutic Plasma
Exchange. American Society
for Apheresis Annual
Meeting. Denver, CO. (May)
Mudge, B., Skinner, C.,
McGrath, S., Kasten, D.,
Jenzen, L., McCarthy, J.
SSHHH…It’s Quiet: Reducing
Monitor Alarms While
Enhancing Patient Safety.
National Patient Safety
Foundation. New Orleans,
LA. (May)
Parker, E. Creating the Role
of the Nursing Informatics
Preceptor. American Nursing
Informatics Association
Conference. San Antonio,
TX. (April)
Parker, E., O’Kane, P.
Creating the Role of the
Nursing Preceptor in
Informatics. Epic User
Group Meeting. Verona, WI.
(September)
Secore, K., Caller, T.,
Rosenbaum, R., Kleen, J.,
Kaspar, J., Harrington, J.,
Jobst, B. Transitions in Care:
Improving the Hospital
Discharge Process for Epilepsy
Patients. American Epilepsy
Society. Washington, D.C.
(December)
Editor
Anne Clemens
Design:
Erin Higgins
Writers:
Steve Bjerklie
Beth Carroll
Tim Dean
Karen Kaliski
Photography:
Mark Washburn
Cover: From left, Moriah Tidwell, RN; Amy Curley, CNs; and Jill Toth, BSN, RN
Inside back cover: Hillary Hudson, RN