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WINTER 2013

Salute to Nurses Nominate your favorite nursing professional

Nurses give back after hours Four compelling stories of selfless commitment to community service

OPTIMISM

Sharing hope and confidence in nursing homes

Q U A R T E R LY


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Cover:

Ruth Kueper, Trinity Free Clinic, Carmel

Cover photo: Marc Lebryk

Inside 4-6

On the Pulse

8-12 Cover story: Nurses give back after hours

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14 Salute to Nurses

Continuing education

16-17

Nursing with heart

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Paths to greatness

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Healint addictions

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Spreading optimism

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Work well with others

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Q&A with Shannon Smith

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On the Pulse

by Julie Young

Nurse can’t say enough about above-and-beyond care John Babista doesn’t remember being transported to Franciscan St. Margaret Health in Hammond shortly after finishing the annual Leon’s World’s Fastest Triathlon last June. But he and his wife, Alma, say they’ll never forget the “above and beyond” treatment they received from physicians, nurses, administrators, chaplains, cleaning people and cafeteria workers. “I cannot say enough about the people who helped and all the people in that hospital,” said John, 40, of Woodridge, Ill. He was treated in the hospital from June 2 to 21 for a heart attack, followed by nine more days in a rehabilitation facility. He had no previous health issues, had been running competitively for three years, participated in an Ironman competition last year and is an avid cyclist. John and his wife, both nurses, have two sons, ages 8 and 15. “I train all year long,” he said. “It was an eye-opener. Even if you’re healthy and in good shape, anything can happen.” The cause of his heart attack hasn’t been determined. John’s first memory of his time in the hospital came on day 13. The couple have returned to the hospital to thank the staff because the quality treatment went beyond mere medical care, said Alma, who witnessed the entire ordeal — from the time her husband of 15 years collapsed near the finish line until now, as he continues to recover. Once John was transferred to intensive care, his wife asked Kathy Thacker, a nurse, about the possibility of flying her mother-in-law in from her home in the Philippines. Thacker contacted patient representative Pat Halfman, who notified Chaplain Nicholas Perkins and Josef Dou, spiritual services director. The Babistas also said Perkins provided immense help and comfort through the experience. Tony Englert, executive director of regional development, and Carol Schuster, regional chief nursing officer, called upon a partnership with Southwest Airlines to fly John’s mother from Los Angeles to Chicago at no charge. Transportation between the Philippines and Los Angeles was made possible through funds from Catholic Charities. The hospital also allowed family members to stay in an apartment there to be closer to John. Today he is working to resume his normal activities and believes the ordeal will help him become an even better nurse. “I want to share that compassion,” he said. ●

Last reunion for Wishard nursing alums More than 30 years ago, the last nursing class walked the halls of Wishard Memorial Hospital. To mark this date — and to allow alumni one last glimpse inside the hospital before it moves to the Sidney & Lois Eskenazi Hospital and Eskenazi Health campus — the Wishard Memorial Hospital Nursing Alumni Association hosted a homecoming event. All Wishard nursing school graduates were invited back to the place their careers began. A custom advertisi

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On Saturday, Sept. 21, the Wishard Memorial Hospital Nursing Alumni Association celebrated past students. Sharon Benefiel, vice president of the association and a 1973 graduate, had a difficult time tracking down nearly 1,000 addresses of nursing school alumni. “Many graduates went on to distinguished careers in nursing throughout the United States and abroad, including military and missionary work,” Benefiel said. “This year,

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Nominate your favorite nursing professional for 2014 at www.indystar.com/nurses. Nominations will be accepted through Feb. 14. (See Page 14 for more details.)


On the Pulse the same year we move to the gorgeous Sidney & Lois Eskenazi Hospital and Eskenazi Health campus, a day of activities (was) planned, including guest speakers, a memorial service and business meeting.” Many alumni have stayed close to each another and to Wishard through the years. A handful support ongoing activities at the Wishard Nursing Museum, which for the past 30 years has displayed hospital artifacts and nursing memorabilia. Members of the public can glimpse life as nurse a half-century ago. Many of these items will be moved to the new campus when it opens in December. The museum’s most visible claim to fame came in the 1980s, when it served as the setting for hospital scenes in “Hoosiers.” The first of its kind in Indiana, the Wishard Memorial Hospital School of Nursing bears an impressive history. From the first class of five in 1885 to the last class of 31 in 1980, the program graduated more than 2,500 nursing students. The school has had many names — opening as the Flower Mission School of Nursing in 1883 and later becoming Indianapolis City Hospital, Indianapolis General Hospital, Marion County General Hospital and then Wishard Memorial Hospital School of Nursing. ●

As part of this evolution, Ascension Health and its health ministries have developed extensive formation programs and processes to integrate the mission, core values and Catholic identity within the organization. Tyrell will continue to serve on the boards of directors for St. Vincent Health and its foundation. Sister Renee Rose, DC, will serve as a member of the St. Vincent Health board. “Since the first four Daughters of Charity arrived in Indianapolis in 1881 to open the St. Vincent’s Infirmary, they have selflessly served the people of Indiana,” said Ian Worden, interim chief executive of St. Vincent Health. “Today the six Daughters — Sister Mary Kay Tyrell, DC; Sister Louise Busby, DC; Sister Rita Joyce DiNardo, DC; Sister Mary Satala, DC; Sister Mary Powers, DC; and Sister Cecilia Ann West, DC — continue that service in a variety of ways, and we celebrate their presence and contributions until the time they receive new mission assignments.” ●

Riley Physicians welcomes new NP Riley Physicians Pediatrics, a partner with IU Health Arnett, is pleased to announce Abby Berg, MSN, RN, CPNP, recently joined the department. Berg received a bachelor’s degree in biology and master’s degree from Indiana University School of Nursing. She began Berg her career at Riley Hospital for Children at IU Health, where she cared for pediatric oncology patients and developed a lifelong passion for young patients. Berg is a continuing lecturer at Purdue University. She is accepting patients at IU Health Arnett Medical Offices, 2600 Greenbush St. in Lafayette. ●

Daughters of Charity to transition out On Oct. 4, the Daughters of Charity St. Louise Province announced a gradual transition from the Archdiocese of Indianapolis and the Diocese of Lafayettein-Indiana. By 2014, the six Daughters of Charity who serve at St. Vincent Indianapolis Health will depart to serve higher-need areas. The decision came after much discernment and is due in part to a decreasing number of women in the vocation. The shift in service is being echoed in health care systems nationwide. “Being able to entrust the ministries of St. Vincent Health to well-prepared lay and community leadership affirms the Daughters’ confidence in the direction and sustainability of the work in Indiana,” said Sister Mary Kay Tyrell, DC, St. Vincent Health Sister Servant. “The work will continue to grow and strengthen, as St. Vincent Health carries out the unwavering mission of serving the sick and poor.”

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On the Pulse

5 reasons to consider travel nursing Travel nursing is becoming a popular pursuit as more nurses discover this always interesting, untraditional option. Instead of working as a full-time staff nurse at one hospital, a travel nurse can work around the country on a temporary contract basis. Hospitals employ travel nurses for several reasons: to fill in for staff members on maternity leave, supplement staff in new units, support expanding units and temporarily manage sudden turnover. Travel nurses typically find work through staffing agencies that partner with hospitals nationwide. “Every day we are basically recruiting for our pipeline of nurses,” said Alison Radcliffe, recruitment manager at Randstad Healthcare. “There are tons of jobs out there. One nurse could have five different options at once.” If you are a nurse looking for a challenging change of pace, consider these five reasons to become a travel nurse:

KC and the Sunshine Band to headline cancer fundraiser Community Health Network Foundation officials announced KC and the Sunshine Band will headline its premier cancer fundraising event, The Giving Gig, on Feb. 15, 2014, at the Indianapolis Marriott downtown. The group behind “Get Down Tonight,” “Shake Your Booty” and “That’s the Way (I Like It),” will perform hits that defined the 1970s. The performance will highlight an evening of giving, and all proceeds will benefit Community’s cancer patients and their families. Joyce Irwin, president and CEO of Community Health Network Foundation, said the fundraiser will bring together 820 donors to raise support. The program also will celebrate survivors and pay Irwin tribute to patients who lost the fight with cancer. “Our second annual event will raise funds needed to help our cancer patients and their families manage everyday needs while fighting the strongest fight possible,” Irwin said. “Our donors and sponsors will fund needs ranging from assistance with meals and transportation to copays and medications. It’s all about helping ordinary people during extraordinary times and having fun along the way.” Tables seat 10 guests at a cost of $2,500. The price includes access to a cocktail reception, silent and live auctions, four-course gourmet dinner and dancing. Make reservations at www.ecommunity. com/givinggig or (317) 355-GIVE. ●

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1. Travel The first reason is obvious: Travel nurses get to explore and discover cities everywhere. “Some people get bored and want to keep things spicy,” Radcliffe said. “With travel nursing, they can be traveling to a different city every three months.” While travel nursing is a permanent career for many, some use it as a way to try out different cities and hospitals before settling on a permanent location to live and work. “Many times you get an assignment for 13 weeks, and there could be the opportunity to extend the contract, from six months to a year,” Radcliffe said.

2. Flexibility Travel nurses can decide if and when they take an assignment and whether they want back-to-back assignments or breaks in between. “They have that luxury of thinking, ‘I’m going to take two weeks off between the next two assignments.’ You can plan when you do work and when you don’t,” Radcliffe said.

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3. Great pay Travel nurses often command higher rates than full-time staff nurses. “The hospitals we partner with typically offer some higher rates because it’s a short-term contract and they’re in a bind,” Radcliffe noted. Some assignments can include opportunities for overtime and certain tax benefits. “If you maintain a home base, you could qualify for some tax benefits — deductions for meals, incidentals,” Radcliffe said. “With that, in addition to hourly wages, they can take home some great pay.” The national average salary for travel nurses today is $66,267.

4. Career growth Travel nurses can work for specific hospitals, and they can step into opportunities they may not have at home or that otherwise could take years to ascend to. “As a travel nurse you can get into some of these well-known facilities and teaching facilities that you might not have a chance to do otherwise,” Radcliffe said.

5. Professional development Working in different hospitals nationwide can yield a tremendous learning experience. “It just makes you a well-rounded nurse and eventually your resume looks great,” Radcliffe said. “You’ve been exposed to so many procedures, so many types of patients.” But travel nurses do need to be experienced to get assignments with an agency like Randstad, which typically requires one or more years of clinical work. “We want [nurses] to feel comfortable from a clinical standpoint, because when you’re a travel nurse, your orientation is pretty minimal. If your contract is 13 weeks, orientation is usually one week,” Radcliffe said. “They expect you to hit the ground running.” ●


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Cover story

By Angela Parker

Nurses give back after hours Compassion, thoughtfulness, selflessness. These terms naturally describe nurses. But do nurses check these characteristics at the door when they clock out each day? Of course not. In the stories that follow, you’ll read about local nurses who live their passion every hour and seek new ways to share their caring.

You don’t retire from who you are Ruth Kueper’s nursing career her spanned five decades. While technically retired, she’s still very much a nurse.

“I am a big advocate for nurses to volunteer their time in some way. It’s such a fun atmosphere and it’s not like work.” —Ruth Kueper, RN

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In fact, Kueper has faithfully volunteered at Trinity Free Clinic in Carmel since 2000. “I’m still tired when I come home, but in this situation I feel like I’m making a difference to a population who may not receive health care without me,” she said. Kueper’s work is such an encouragement that her co-volunteers nominated her for an important award, and in 2013 she received the Salute to Nurses Inspiration Award. At Trinity, Kueper puts her

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pediatric nursing skills to work soothing patients and their families. “I don’t have patience with some things, but I don’t lose my patience with children,” she said. “Sometimes I have to work with the parents, too, if they’re upset.” In nominating Kueper, a colleague wrote, “During a time in her life when she could be slowing down and thinking more of herself, Ruth continues to give with a servant’s heart. Her work here at Trinity is an example of nursing at its best.” ●


By Angela Parker

Cover story

Someone by their side No one should be alone or lonely when they pass away — and at Eskenazi Health, no one is. Through a national program called No One Dies Alone, volunteers offer to sit with dying patients who have no one else nearby in their final moments. Rev. Karen Estle, LMHC, spiritual adviser for the hospital’s palliative care program, coordinates more than 70 volunteers. When patients approach the end of life, volunteers stay by their side in three-hour shifts, 24 hours a day. Estle said the process may take a few hours or several days. Some patients are alert enough to appreciate the comfort of a compassionate volunteer, who Estle may offer to read, talk, listen or pray. Volunteers say it’s a privilege to be present for these sacred moments. “When someone is dying, many things fall away as unimportant,” Estle said. “To have someone with

you when you would otherwise be alone, honoring and focusing on you as a person, gives a sense of peace and calmness to the moment.” NODA is a national program implemented at Eskenazi Health last April. Since then, 13 patients have had a hand to hold during their last moments. Volunteers include retired nurses, nursing students and medical students, but no experience is required. “We have a wide variety of volunteers,” Estle said. “From employed professionals to people who own their own business to retirees. Some missed being with a loved one when they died and are paying it forward. Some are afraid of dying and are working through it step by step. Some have experienced that sacred moment of death and find it nurturing.” For more information, contact noda@wishard.edu or (317) 656-4263. ●

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Cover story

By Angela Parker

Boston’s Blessing At age 2, Boston Olvey is a chubby blonde cherub. To look at her, you wouldn’t know she has a life-threatening illness. When she was just a week old, her parents heard the diagnosis: cystic fibrosis.

CF has no known cure. About 30,000 children and adults in the U.S. have it — a number too small to merit federal funding for research.

“When we got that call, I was in complete denial,” said her mother, Ashley Olvey, RN, BSN, Community Health Network. “We had no clue. No one in our family has it. No one even knew what it was.” No one, that is, except Olvey, who studied the disease in nursing school. Given that knowledge, she didn’t want to believe what she was hearing.

Life with CF According to the Cystic Fibrosis Foundation, CF is an inherited condition. When both parents are

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carriers, their children may get the disease. CF causes the body to produce thick, sticky mucus that clogs the lungs, obstructs the pancreas and keeps natural enzymes from breaking down and absorbing food. When CF was recognized as a disease in the 1930s, patients typically didn’t survive childhood. Today, people with CF can expect to live into their 30s and 40s. The lifespan increase is attributable in part to CF screenings of all newborns. Early diagnosis means early treatment and extra precaution for families.


When the Olveys are invited to parties and get-togethers, for example, they know to arrive late. “We’ll call and say, ‘Is everybody healthy? Is anyone coughing?’” Olvey said. “We check out the scene before we arrive. We don’t take Boston around anyone who’s been sick. If we didn’t know to take those precautions, she would have been sick numerous times.” Healthy lungs are pliable and stretch to allow deep breathing. But in people with CF, Olvey said, each cold or cough creates mucous, which causes the lungs to stiffen and harden. As a child like Boston ages, her lungs will become less able to expand. Before her daughter was born, Olvey worked in intensive care. She soon switched to obstetrics to decrease the odds of exposing Boston to serious illnesses. “I love ICU and that’s where my heart was, but it just wasn’t worth the risk,” Olvey said.

Prom for a cure CF has no known cure. About 30,000 children and adults in the U.S. have it — a number too small to merit

federal funding for research. To raise money for research, Olvey organized an adult prom last year. Based on its initial success, the Second Annual 65 Roses Adult Prom was held Nov. 23. “I planned the first one in three months. It was a little rough, but it all seemed to work out. We were pretty happy with what we raised,” Olvey said. “Everything we make goes to the CF Foundation, which is one of the most efficient foundations; 90 cents of every dollar goes straight to research.” Olvey and her husband, Josh, also founded www.blessboston.com, a nonprofit organization that helps other families affected by CF. How does she

find time to do it all? “Boston’s a good napper,” Olvey laughed. “That’s when I work on the prom.” But while Boston is the reason behind the prom, she probably won’t be able to attend it. “We’re nervous about bringing her out in a big group of people who will want to talk to her, love on her, hug her,” Olvey said. “One cold could mean Boston going into the hospital and having to be put on a ventilator.” ●

Search for nursing jobs on the largest network of healthcare job sites

Continued on Page 12 Indiana Nursing Quarterly

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Cover story

By Angela Parker

Clinical managers set the standard In 2010, clinical managers at Hendricks Regional Health wanted to do something to strengthen their relationships and help integrate newcomers into their circle. Their answer was to volunteer together. “We wanted to do whatever we could to help others. We wanted it to be health-focused, but it didn’t have to be in health care,” said Wendy Deaton, BSN, RN-CNML, clinical manger for the hospital’s childbirth center. To get started, the group rounded up peanut butter donations for a local church. Clinical managers and their units quickly collected 40 jars. The next project was to collect food donations for the Hendricks “It wouldn’t County Humane Society — another success. work if we They’ve since supported Special didn’t all want Olympics, the Lions Club and Wheeler Mission Ministries. But the group’s main to do it,” event is the Kids’ Summer Lunch Bunch. Staff members donate items for sack lunches, which managers then bag and serve to children during summer break. “It wouldn’t work if we didn’t all want to do it,” Deaton said. “It’s rewarding in itself, and we’re modeling behavior we want for our staff. It helps keep us centered in our nursing roots and remember why we went into nursing.” ●

Top: Volunteers from Hendricks Regional Health collected bikes for the American Legion bicycle drive. Middle: The Kids’ Summer Lunch Bunch collects food items for sack lunches. Right: An early project the clinical managers’ units undertook was a pet food drive for Hendricks County Humane Society.

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Careers & Training

Julie Young

Salute to Nurses celebrates those who serve selflessly For more than a decade, Star Media’s Salute to Nurses presented by The Indianapolis Star has celebrated extraordinary people who do extraordinary things. Whether they are on the front lines of patient care in clinical settings, serving the community, inspiring colleagues or educating the next generation of professionals, nurses are the heart of health care -- and they deserve respect and recognition. “The Salute to Nurses is a very special event,” said Amanda Gilman, Star Media marketing coordinator. “It honors these amazing professionals who go above and beyond the call of duty each and every day to provide selfless service in the health care field. The awards luncheon will be held

April 23, 2014, at the Indiana Roof Ballroom, where we will recognize five outstanding individuals and name one of them the overall Nurse of the Year.”

Validating nurses’ impact Now through Feb. 14, anyone can nominate nurses in these five categories: Lifetime of Compassion, Advancement of Nursing, Community Outreach, Inspiration and Nursing Educator of the Year. Gilman said the nominations are received through Star Media’s website and reviewed by members of the State Board of Nursing, who face the challenging task of choosing the winners from hundreds of deserving nominees. Individual winners are notified before the awards luncheon, and the Nurse of the Year is announced at the event. “We really make a big deal out of their accomplishments,” Gilman said. “When we know who the winner is, we usually coordinate something with their HR department and surprise them with the news at a staff meeting. It’s always exciting to see their reaction, and it’s so much fun because their colleagues get to celebrate alongside them.” Janis Watts, MSN, RN, NE-BC, of IU Health North Hospital, was named Nurse Educator of the Year for 2013. Salute to Nurses validates the impact of nurses on patients and colleagues throughout the community, she said. “We don’t expect that recognition, so when it happens it’s a nice feeling,” Watts said. “I may not be on the front lines of daily patient care, but I educate those who are. It is a strong validation that the contribution I make is important.”

Liz O’Neil, BSN, RN, a family nurse practitioner at the Family Health Clinic of Monon, was stunned to learn she’d been named the Community Outreach award winner last year. “It was such an honor,” she said. “You are competing against so many deserving people around the state, who all have moving O’Neil stories. It’s flattering to think that someone nominated me for the work I’ve done. I still can’t believe I won.”

Shared recognition Though the awards are given to individuals, they’re shared by friends, families and colleagues who attend the awards luncheon. Gilman said some 900 guests generally are on hand at the gala, where nurses are given the VIP treatment and are publicly honored for their accomplishments. At the same time, a $3,500 scholarship is awarded to one nursing student to help with tuition and expenses. And the health care facility with the most nursing nominations is acknowledged for recruiting the brightest professionals in Indiana. “The nursing profession is more than a job, it’s a vocation. These individuals deserve to be recognized for the contributions they make,” Gilman said. “Thanks to our partners, the Star Media’s Salute to Nurses is a day when we can give back to the unsung heroes of our community.” ●

Nominate your favorite nurse Do you know a nurse who deserves special recognition? Star Media is proud to host the 12th Annual Salute to Nurses, an event to honor those who provide selfless service and tireless dedication. In a time of staffing shortages and increasing demands, honorees are finding ways to go beyond the call of duty to provide care and comfort to patients and families. Nominate your favorite nursing professional and learn more about the annual event by going to www.indystar.com/nurses or calling (317) 444-7350. Nominations will be accepted through Feb. 14.

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Yummy in my tummy!

Check out 15 restaurants where kids eat free or for little cost. Join other Hoosiers saving money on their family meals at indystar.com/eatfree

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Careers & Training

By Shari Held

heart

Nursingwith Planning a career in cardiac care What area of cardiac care is your calling? Find out by working in the cardiac care unit of a comprehensive hospital, advises Fran Sercer, RN, a nursing informaticist and cardiology system administrator at Eskenazi Health. “You’ll see sick and not-so-sick patients with all different cardiovascular disease processes,” she said. “From there you can see which is most interesting to you.” Sercer’s own path to cardiac care was atypical. A nurse for 27 years, she gained experience in an intensive care unit before working in noninvasive cardiac care. In 2010 Sercer earned a degree in nursing informatics, and shortly thereafter her employer opened a cardiology unit. Always interested in cardiac care, she segued into a position that merged the two: cardiac nursing informatics. “Most of us who work in the field had family members with cardiac issues or some kind of experience with it,” she said. Nurses who work in cardiac care units and cath labs tend to have experience in these areas:

❯ Telemetry

A hospital’s telemetry unit is a stepping stone into intensive care. It bridges the gap between critically ill patients and those who aren’t dangerously ill but require inpatient treatment. “Telemetry patients require closer observation and may be more at risk for having unstable vital signs, but they’re not critical,” Sercer said.

❯ Intensive care

“I see the ICU as the foundation for working in the coronary cath lab,” Sercer said. Seriously ill patients must continuously be monitored for changes, and ICU nurses should be equipped to assess and act quickly.

❯ Emergency departments

The intensity of a fast-paced emergency department and the teamwork required to treat trauma patients combine to prepare nurses for careers in cardiac care. 16

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If you’re working toward a nursing degree — or you have a degree but want to consider a specialty — know that the field of cardiac care has much to offer.

“Cardiac nursing is exciting no matter whether you are working with the acute patient or the chronic patient,” said Rosalyn Brown, MSN, RN, NEA-BC. Brown is the nursing director for Community Heart and Vascular Hospital and is the director of Community Health Network’s cardiac catheterization labs. For acute heart care, the cath lab is the center point of all activity. It’s where patients undergo surgical procedures involving Brown the heart and vessels, peripheral artery disease and electrophysiology, which corrects heart rhythms. The cath lab’s “circulator” is a nurse who maintains a patient’s physical status. RNs also may serve as scrub nurses who provide physicians catheters and other supplies during medical procedures and as monitors charged with documenting all parts of treatment. In the cath lab’s fast-paced environment, where a patient’s condition can change in a second, nurses must have well-developed critical-thinking skills and be able to react quickly to any number of circumstances. Hospital cath labs that staff cardiac nurses generally require their RNs to have a minimum level of experience in acute care nursing in intensive care or emergency departments. “New nurses know the basics, but a critical-care background develops their critical-thinking skills,” Brown said. Fran Sercer, RN, a Sercer nursing informaticist and cardiology system administrator at Eskenazi Health in


Indianapolis, said cath lab nurses need to be able to work autonomously but function well in a team. They also should be able to deliver medications competently. The work can be demanding, requiring on-call RNs to arrive at the facility within 30 minutes of being summoned to treat patients. “Cath lab RNs have a reputation for being assertive and direct,” Sercer said. “But they must be compassionate. Cardiac patients are often frightened and anxious, so good communication skills are important.”

Options abound Cardiac intensive care and progressive care nurses, who work in heart hospitals and within cardiac

units, may specialize in diseases like congestive heart failure and acute coronary syndrome. “They’ve got to be patient enough to recognize what’s going on with their patients,” Brown said. “In the cardiac world, taking time to listen is so important.” She advises cardiac nurses to carefully choose their workplace, too. “It’s important to look at what the hospital has achieved,” Brown said. “If you want to be a cardiac nurse, you want to be at one of the best places.” A hospital environment isn’t the only place to pursue a career in cardiac care. Nurses can work in outpatient stress labs, Coumadin

clinics and heart-failure or rehab clinics. “If you are the kind of nurse who enjoys caring for the same patients day after day and watching them progress, you might want to be a cardiac rehab nurse,” Brown said. Heart disease is the leading cause of death in the U.S., according to the American Heart Association, and it affects males and females of all ages and races. “Heart disease is pervasive in our population,” Sercer said. “You really have the opportunity to make a difference. It is very meaningful work to me.” ●

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Careers & Training

By Deb Buehler

Paths to greatness Johnson Memorial Hospital has created a safe place where new nurses can learn, grow and effectively work in teams. The program is intended to nurture beginners while they adjust to the rigors of their chosen field. “As a young nurse, you learn a lot by trial and error,” said Michelle Bisesi, RNC-OB, MSN, NEA-BC, director of nursing. “The older you get, the more you recognize the importance of what every person brings to the “A good team table. A good recognizes team recognizes who is best who is best at what and at what and then uses that then uses that person’s skills person’s skills and expertise to meet a patient’s and expertise needs.” to meet a Through the Johnson patient’s Memorial needs.” Hospital program, a new nurse works directly with a preceptor, who helps that individual learn and understand the clinical requirements of the job. This training lasts through the nurse’s orientation period. But clinical knowledge is just part of a nurse’s job. Being a good team member is equally important — and that’s where mentors can help. Johnson Memorial Hospital’s yearlong mentor program brings together new and experienced nurses from

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different departments. The mentor is charged with offering encouragement and support, answering basic questions and serving as a confidential resource. The relationship can help mentees learn to function and contribute on staff teams of nurses, specialists and physicians. “This is a personal, one-on-one relationship,” Bisesi said. “In this relationship the mentee can go to their mentor with concerns that aren’t necessarily clinical in nature.” An essential factor in the relationship is confidentiality. If mentees want to discuss a challenge or conflict with someone in their department, they’re assured the mentor won’t be working with or talking to that same individual. Due to the preceptor and mentor program, nursing staff turnover at Johnson Memorial Hospital has decreased significantly. And while the program started among the nursing staff, it has spread to include other key roles.

Educate and associate At Hendricks Regional Health, nurses can pursue several pathways to leadership. Yvonne Culpepper, DNP, RN, vice president of nursing, said the hospital’s internal organization is the source of new opportunities. “We have a nursing governance structure, including an education council, practice council and research council,” Culpepper said. Such councils work to improve nursing positions while also improving patient outcomes. Nurses are • Winter 2013

encouraged to represent their unit on councils and advocate for their needs, said Lynn Devich, MSN, MBA, RN, ACNS-BC, director of professional development and nursing excellence. The Institute of Medicine published a study calling on hospitals to ensure that at least 80 percent of nurses on staff held BSN degrees. At Hendricks Regional Health, when two people with equal experience vie for an open position, the candidate with a BSN degree has the edge. Hendricks is now collaborating with the University of Indianapolis to make it easier for staff nurses to complete advanced degrees. Today, just 60 percent of the hospital’s nurses have earned this distinction. Because the average individual today has more chronic conditions than patients of the past, nurses face complex issues that require strong critical-thinking skills. Culpepper believes the BSN is the entry-level standard. She encourages nurses who have an associate’s degrees alone to make the extra effort to earn a BSN. Nurses who want to take on leadership roles should participate in professional organizations and pursue specialty certifications as well. These certifications, awarded to indicate certain expertise, require additional training, studying and examinations. “A board certification really shows a nurse’s expertise in her field,” Devich said. “And it adds to the credentials listed behind the nurse’s name. Once you’ve determined your focus, we consider that certification to reflect an expert level.” ●


Healing

Deb Buehler

Careers & Training

addictions

Nurses play an important role in mental health and psychiatric care, including serving patients who struggle with drug and alcohol abuse and addictive behaviors. Nurses who specialize in healing addictions draw on their clinical expertise to treat patients and their families, but they also work to build supportive relationships, encourage hope and inspire lasting recovery. “A lot of addiction nursing involves education,” said Susan Harmon, RN, AN, BA, outpatient nursing manager at Eskenazi Health’s Midtown Community Mental Health facility. “Nurses work with patients and their families for an extended period of time, seeing them three and four times a week and really getting to know them well to help them learn what they need to do to stay in recovery.” Addictions nurses need to be aboveaverage listeners, keep an open mind and believe that each addiction is a disease, not a person’s choice to be successful. Because nurses administer medications, they Harmon also need excellent clinical skills.

Growing into the job Doreen Shell, RN, gained experience in addictions nursing by working in a prison setting. Today she is a house supervisor for adults and adolescents at Fairbanks Hospital, a not-for-profit alcohol and drug treatment center in Indianapolis. Fairbanks Hospital has provided ongoing training for Shell, enabling her to learn more about addictions, assessment and the medications available to support patients. “Assessment starts with counselors, and then nurses become part of the process,” Shell said. “Assessment is a key responsibility of the nurse.” The process requires practitioners to understand a patient’s physical

health, emotional well being and addictions. During assessment, a nurse may evaluate the patient’s history of drug use to determine the best approach to treatment. Shell’s colleague — Jennifer Hood, RN, CARN, nursing manager at Fairbanks Hospital — works with patients of all ages. Adults tend to be much less healthy, Hood said, with chronic medical conditions like hypertension, diabetes and COPD, and they experience more intense withdrawal symptoms. Adults may have cardiac and renal problems to contend with, as well as mental health issues like bipolar disorder, depression and anxiety. Adolescents tend to self-medicate with drugs or alcohol and exhibit behavioral problems at school and home, Hood said, because they haven’t developed appropriate coping skills. According to Harmon, Eskenazi Health recruits nurses who have addictions experience. For beginners in the profession, she recommends gaining work experience, learning about addictions from medical journals, attending workshops and earning certifications. These methods help addictions nurses become and remain well informed.

Reducing the stigma Medical professionals devoted to addictions treatment say a stigma remains around addictions and substance abuse problems. Yet many patients who are treated for addictions also are battling mental health issues that require attention. “People don’t choose this path for themselves,” said Hillary Cravens, NP, at Community Network’s Gallahue Mental Health Services. “There is a strong genetic link and a biological component. You don’t tell someone with diabetes to stop being diabetic — it’s a lifelong condition, and so is

addiction. Both have to be treated like any other chronic illness.” Cravens gained addictions nursing experience on the job and then became a nurse practitioner to support her work. Many training and education opportunities are available for nurses to gain knowledge of medical and mental health. Working or volunteering for an organization that serves addictions patients is a great place to start, Cravens noted. “Find a health center with this specialty,” she said. “That is probably the best training you can get.” Career paths and possibilities Medical and mental health facilities across central Indiana hire addictions nurses. These include methadone clinics and hospitals equipped with detoxification and addictions programs. But new opportunities don’t come often, Harmon said, because nurses in the field tend to be passionate about and committed to their work, and turnover is therefore low. “People with addictions arrive in such poor shape and blossom into a butterfly by the time they leave,” Shell said. “It makes you feel good to know you made a difference in someone’s life.” ●

Indiana Nursing Quarterly

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Winter 2013

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Your World

By Julie Young

Spreading optimism:

Sharing hope and confidence in nursing homes Helen Keller once said, “Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence.” The sentiment is encouraging, especially for people who are facing life-altering ailments. For Hoosiers who live in nursing homes, a dedicated group of people are committed to providing them the best care possible. Last year, Indiana launched its OPTIMISTIC study supported by a $13.4 million award from the Centers for Medicare & Medicaid Services. The program is the first of seven nationally funded groups to go live in all partnering facilities. The goal is to prevent unnecessary emergency department visits and hospitalizations for nursing home residents.

What is OPTIMISTIC? The national study is intended to identify ways medical providers can enhance care and communication within and between nursing homes and acute care facilities. “The goal of the project is to reduce unnecessary transfers to the emergency department or hospital by supporting the nursing home staff in caring for residents,” said Kathleen T. Unroe, MD, MHA, project co-director. OPTIMISTIC – which stands for Optimizing Patient Transfers, Impacting Medical Quality and Improving Symptoms: Transforming Institutional Care – aptly describes how project facilitators feel about the potential to improve care among a vulnerable population, Unroe said. “OPTIMISTIC is an academic community–government partnership. We are working together to improve care for long-stay nursing home residents in central Indiana,” she explained. “By working with the IU School of Nursing, the University of Indianapolis and community partners, we are providing education and training in real-world environments to develop a new model of care, putting increased resources into nursing homes.”

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Specially trained RNs have been placed at 19 participating nursing homes in Indiana, where they are supported by nurse practitioners. They work directly with facility staff to implement quality improvements, advance care planning and treat sick residents, Unroe noted. “Using approaches and tools that have been shown to work, we are supporting nursing home staff in identifying sick residents early so they can be treated in the facility. These long-stay nursing home residents have multiple medical problems and need help with basic activities of self-care; many of them have dementia,” she said.

Providing palliative care Another focus of the project, according to Greg Sachs, MD, FACP, is palliative care. This type of care — which focuses on relieving the symptoms, stress and pain of serious illness — is particularly relevant to providers. “The majority of long-stay nursing home residents have dementia, such as Alzheimer’s disease,” Sachs said. “Many are quite frail and have advanced dementia. Research studies show that despite most patients and families wanting care at this stage of life to focus on comfort and company, there are a lot of transfers to emergency rooms and hospitals that end up being burdensome. Sometimes treatments are provided in hospitals, which only adds to suffering without changing the overall course for the patient. “OPTIMISTIC includes training for our staff and the participating nursing facilities’ staff to try to prevent these kinds of transfers by improving advance care planning and conversations about goals of care.” ●

Winter 2013

Local optimism In Indiana, 19 nursing homes are participating in the national OPTIMISTIC study: Allisonville Meadows American Village Brownsburg Meadows Countryside Meadows Forest Creek Village Golden Living Indianapolis Greenwood Meadows Harrison Terrace Hooverwood Kindred Greenwood Kindred Wildwood Miller’s Merry Manor – Castleton Miller’s Merry Manor – Indy East North Capitol Nursing & Rehabilitation Northwest Manor Rosewalk Village Riverwalk Village University Heights Westpark Rehabilitation & Healthcare Center

National optimism In 2011, the Centers for Medicare & Medicaid Services determined that $3 billion was being spent on potentially avoidable hospitalizations for Medicare and Medicaid enrollees. One goal of the OPTIMISTIC study is to avoid unwarranted visits. In addition to Indiana, OPTIMISTIC programs also are underway in Alabama, Missouri, Nebraska, New York, Nevada and Pennsylvania.


By Jen Bingham

Your world

Working well with others? That’s hard work! A new buzzword in health care is “interprofessional practice” – a term that simply means using good communication to provide unified health care for patients. While that may sound like common sense, increasing specialization has created a situation where multiple care providers serve one patient’s varied needs. Getting diverse practitioners to come together is an increasing focus in medical environments. “The ‘continuity of care’ is stressed in class all the time,” said Eve Ricketts, a first-year student nurse at Ivy Tech Community College. “Our teachers talk about the benefits of collaboration of care between caregivers to ensure the best patient outcomes.” Instructors have described cases where patient deaths were attributed to poor communication by the medical team, Ricketts said. This is an extreme scenario, but patients can suffer in many lesser ways when caregivers don’t thoroughly share information.

the situation and understand together how they can get this patient through this situation.” Simulations are meant to be stressful at times, but learners are able to explore effective teamwork without having the extra anxiety of impacting actual patients. When a training session is over, group members talk through their actions and the situation at large. “In a debriefing situation, you talk about that experience for each team member, what they felt about the interaction, whether they had all the information they needed, whether the steps they know as best practices were followed,” Dwyer said. “We ask, ‘Did someone step up and advocate for the patient?’” The simulation and debriefing are recorded on video and audio so that participants can listen for nonverbal cues and visually review the circumstances. “What they remember may be different from what they see,” Dwyer said. This process is a valuable part of the learning experience and helps individuals improve their ability to work in teams. ●

Finding focus Some providers focus so intently on their specialty area that they fail to see the whole patient. And because today’s medical system involves multiple phases and handoffs, professionals are challenged to create and follow a singular treatment plan. To alleviate these difficulties, new communication methods are being emphasized. “The way they design charts today helps,” Ricketts said. “They’re all electronic, and any team member can easily access other people’s notes. Anybody on the care team can access any part of the chart.” The Simulation Center at Fairbanks Hall — a joint project of the Indiana University School of Medicine, Indiana University School of Nursing and Indiana University Health — offers a great practice space for interprofessional training. Jennifer Dwyer, MSN, RN-BC, FNPBC, said the center can bring together teams to work through complicated scenarios. In some situations they work with dummies; in others they interact in a clinical setting, where actors stage health care dilemmas. “Teamwork and communication Dwyer are what we build things around,” Dwyer said. “The simulations provide challenges. We build in stress and adversity to see how providers reach out and use one another to effect change in

Where’s your team spirit? Teamwork is important in nearly every situation, so why do some professional shy away from open communication and active follow-up? ■ Time is a limited commodity in the medical world. Meetings take time. Learning to work better with others takes time. But good teamwork and strong communication among group members can save lives — making it worth the time and effort. ■ Professionals may assume they know each others’ roles in patient care, which can lead to miscommunication and mistakes. By learning the true nature of colleague’s roles, background and experience, medical staff members can show the best characteristics of interprofessional practice. Indiana Nursing Quarterly

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Your World

By Angela Parker

Position: Manager, Riverview Hospital Advanced Wound Care Center Education: RN, BSN, Olivet Nazarene University, Kankakee, Ill.; CWOCN, Metropolitan University, Minneapolis, Minn.; NP, Ball State University

with

Shannon Smith

Experience: Worked at Riverview Hospital since high school. Began as a phlebotomist, moved to med/surg in 2001, worked in wound care for 11 years and has managed the Advanced Wound Care Center since August 2013.

MBA, BSA, RN

Q: Why are you pursuing a degree as a nurse practitioner? A: “I’ve always wanted to be a nurse practitioner. To really work in the wound-care field, you have to have a master-level degree. And Riverview was looking for nurse practitioners to work in specialty groups. Since I was already in wound care, it seemed natural for me to do it. I could step right into the job.” Q: What prompted your decision to become a nurse practitioner? A: “I was married and had a 2 1/2-year-old and a newborn, but I went ahead and enrolled and said if God wants me to do this, it will happen. About a year later, I got a letter from Ball State asking if I still wanted to be in the program. They had lost my letter saying I’d been invited. I took that to mean I was supposed to do this.

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Winter 2013


Your World

“My family and Riverview have been very supportive. If it weren’t for those two factors, I could not have gone back to school and work and take care of my family. It has all worked out very well. I graduate May 3. I’m glad it’s at the end, but it’s been a good process.”

management. Every adult going back into a master’s program has to deal with the time-management issue of family, work and school. My first year was the most difficult. Now people say, ‘I don’t know how you do everything,’ and I don’t either. It just happens. You learn not to sleep a lot and you drink a lot of caffeine and you get everything done.”

Q: How will this degree benefit your career and employer? A: “I will be able to step into a provider role in the wound care center, which helps in many ways. I can still be the manager, but I can also cover patient slots, help make plans of care, write the orders, do the debridement.

“It also gives me verification that I’m doing what I’m supposed to do. It gives me that little dot at the end of the sentence to say this is what I want to do for the rest of my life. My other goal in being a nurse practitioner is to do some mission work — to go overseas and use my medical background.”

Q: What’s the most difficult aspect of this transition? A: “So far the most difficult part has been time

Q: What advice would you give to someone who wants to become a nurse practitioner? A: “Even though it looks daunting in the beginning, it’s well worthwhile. If an advanced degree is going to make that push in your career to help you help others and get satisfaction from your job, it’s worth the hassle of going back to school and all the hard work.

“Make sure you have your life in place so you can juggle things at one time, because it will never be perfect. If I could’ve gone back for my nurse practitioner before having children, that would’ve been easier, but I don’t know that I would have been ready in my career for that. Know where you are in your life. If it’s really important to you, you’ll find a way to make it happen.” ●

Indiana’s nurse practitioners In Indiana, a nurse practitioner must be a licensed registered nurse and have a master’s degree. A collaborative agreement with a state physician is required for an NP to diagnose and treat illness and prescribe medication. NPs also should be certified through their specialty’s national certifying body. They may choose to be certified in areas where they worked as RNs. NPs treat acute and chronic conditions and prescribe medications and therapy. They may see patients of all ages and serve as a primary health care provider. NPs practice in such settings as physician offices, hospitals, community health clinics, home health services and nursing homes — making a priority of prevention, wellness and patient education. A master of science degree in nursing is the minimum education requirement. The American Association of Colleges of Nursing promotes the DNP as the minimum education needed for nurse practitioners to be implemented by 2015. According to the Bureau of Labor Statistics, Indiana’s 2,650 nurse practitioners earn a mean annual salary of $85,590.

State schools offering advanced nursing degrees include: • Ball State University • Goshen College • Indiana State University • Indiana Wesleyan University • IUPUI • Purdue University • University of Indianapolis • University of Saint Francis • University of Southern Indiana • Valparaiso University

Indiana Nursing Quarterly

indystar.com/nursing

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Indiana Nursing Quarterly winter 2013