2022 Nursing Annual Report

NURSING ANNUAL REPORT

• Embracing a New Tomorrow •

20 22 Nursing

Table of Contents

Nursing Annual Report 2022 Embracing a New Tomorrow

9

Transformational Leadership

17

Structural Empowerment

33

Exemplary Professional Practice

43

New Knowledge

55

Empirical Outcomes

56% Eligible Clinical Nurses with Specialty Certifications

Clinical Nurses with Bachelor’s or Higher in Nursing

MSN and Higher Degrees for Leadership

Certification Rates for Leadership

Number of Nurses

Number of APRNs

136

800

A Message from Senior Vice President and Chief Nurse Executive Robin Mutz Dear Friends and Colleagues, Strength and resilience were our mantra this past year as we emerged from the pandemic and began to adjust to our new normal. The pandemic took its toll on the world and on health care, but St. Jude nurses demonstrated their strength and resilience as the campus reopened when COVID-19 transmissions dropped and restrictions began to relax. Seeing smiling faces without masks in non-clinical areas reassured us that our commitment to patients and families lifts our spirits and reminds us all of the critical work we do.

This year’s Nursing Annual Report for St. Jude Children’s Research Hospital: Embracing a New Tomorrow highlights nursing initiatives that ensure excellence and evidence-based outcomes, the foundation of highquality nursing practices.

Many new things began to emerge as the year progressed. As the new St. Jude FY22-27 Strategic Plan advanced, St. Jude Nursing created a new strategic plan to support the organizational direction. We designed a roadmap to keep us focused on the singular vision to Accelerate Progress Globally. During Nurse’s Week, we introduced the global evidence-based practice program designed to partner St. Jude nurses with nurses worldwide to work on shared projects that promote nursing excellence and improve care for children through St. Jude Global.

In February, Russia invaded Ukraine, and once again, St. Jude nurses responded. Our nurses designed “Operation Sunflower” to prepare for Ukrainian families coming to St. Jude to receive care. When I rounded and spoke to different nurses about receiving children on such short notice without information about when or how many, I heard the same response, “Sure, it’s what we do.” My heart swells as I recall your commitment to these vulnerable children. Tammy Teems, MSN, RN, CPN, NEA-BC, director of Outpatient Services, and I were honored to attend the 2022 Magnet Conference. We spoke at the CNO breakfast about Operation Sunflower and received the Daisy Team Award on behalf of St. Jude Ambulatory nurses. The highlight of the event was a video of St. Jude nurses recounting their “why” they are St. Jude nurses. There wasn’t a dry eye in the room, and I was a very proud CNE. Our nurses spent many hours with the architects designing the new ambulatory clinic building slated to open in 2026. Nurses simulated work in mockup rooms, rearranged furniture and equipment, measured spaces and stretched their imaginations on how to work smarter in the new spaces. They embraced the opportunity to optimize the patient experience and create spaces that promote healing and efficiency.

Returning to our new normal, we tried several new ideas to stabilize and grow our nursing workforce.

Dr. Downing and I conducted listening sessions with nurses from every clinical area to hear their concerns and ideas for moving forward. We redesigned our nurse residency program to onboard new residents in cohorts to create community. Our first Match Day of matching residents with their chosen work environment was celebrated. We developed a transition team to onboard nurses and allow them to complete parts of their orientation prior to placing them in their permanent work homes. Our nurses redesigned the career ladder to give nurses more incentive to remain at the bedside. Most of all, we were able to join together for our Annual Nursing Gala. It was a wonderful event where we got to be together and celebrate nursing again.

At the end of the year, I made a tough decision. I announced my plan to retire at the end of FY23 after 44 years as a nurse. It was a bittersweet decision for me, but I am confident my successor will allow St. Jude Nursing to continue to lead the profession. Guiding St. Jude Nursing has been the capstone of my career, and I take many sweet memories with me. I wish you joy, peace and time to share with those you love, especially these precious children.

Sincerely,

Robin Mutz, MPPM, BSN, RNC, NEA-BC Senior Vice President Chief Nurse Executive

Transformational Leadership

Operation Sunflower prepares to accept patients and families from Ukraine’s war zone

In February 2022, Russia invaded parts of Ukraine, which put major distress and instability on the Ukrainian health care system. This caused many pediatric oncology patients, along with their families, to be displaced and in need of medical attention. After the war began, several St. Jude Global physicians went to Poland to assist with triaging these patients and families.

After the war began, Tammy Teems, MSN, RN, CPN, NEA-BC, director of Outpatient Services, received a call from Robin Mutz, MPPM, BSN, RNC, NEA-BC, senior vice president and chief nurse executive, that St. Jude would take in several patients from Ukraine. Teems immediately formed a team and developed a plan to receive these patients within 48 hours since the departure time from Poland was unknown. The multidisciplinary team included staff members from Nursing, Clinical Operations, ALSAC, Global Outreach, Social Work, Child Life, Interpreter Services, Security, Legal, Housing, Food Services and Patient Registration. This team became known as Operation Sunflower in honor of the national flower of Ukraine.

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ST. JUDE NURSING ANNUAL REPORT 2022

In March 2022, Teems learned that St. Jude would receive nine Ukrainian patients along with some family members. Due to the organization and pre-planning of team Operation Sunflower, St. Jude welcomed these individuals in less than 24 hours. The patients and families left Poland, with a layover in Washington, D.C., before arriving at Memphis International Airport. Employees from Interpreter Services and Social Work met the patients and families to make the transition to the St. Jude campus a smooth one. St. Jude Security arranged for transportation to campus. Operation Sunflower team members greeted the families as they arrived on campus. The patients were first consented for treatment at Patient Registration, and then were seen in a nearby clinic by members of their medical care team for clearance to housing. Since the medical team was uncertain of the patients’ medical health and conditions, Nursing house supervisors were on standby for direct patient admissions, if needed. The clinical staff’s goal was to provide a safe and clean space to rest.

Once the patients were cleared for housing, they received a warm Ukrainian meal, prepared by St. Jude Food Services. Patients also received smartphones with a Ukrainian interpreter application. The phones helped the patients and families stay in touch with family members back home. Security arranged for transportation from campus to a St. Jude housing facility where the families lived during their time at St. Jude.

Jill Biden, First Lady of the United States, met privately with the Ukrainian patients and families in late March 2022 during her visit to the St. Jude campus.

In September 2022, Operation Sunflower received the prestigious DAISY Team Award provided by the DAISY Foundation™. The DAISY Team Award is given to a team that provides collaboration in meeting patient and patient family needs by going above and beyond the traditional role of Nursing. The criteria for the award consisted of a nurse-led team of two or more people. In October 2022, members of the Nursing Leadership Team accepted this award during the ANCC National Magnet® Conference in Philadelphia.

Finding cures. Saving children.

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Joint Commission survey: Don’t get ready; stay ready

The Joint Commission (TJC) provides a framework for providing safe care to help improve hospital performance and the patient experience. To maintain accreditation, St. Jude participates in an unannounced, on-site TJC survey every 18 to 39 months. The hospital was scheduled to receive this regular inspection between October and December 2021.

However, there was nothing “regular” about this regulatory process.

To prepare for the survey, St. Jude would have normally brought consultants on-site to help identify areas of risk. Additionally, Infection Control, Environmental Health and Safety, Nursing Excellence, and the Office of Quality and Patient Safety’s Accreditation team would have accelerated surveillance activities closer to the survey window as part of continuous readiness.

However, the restrictions resulting from internal and external COVID-19 protocols limited the opportunities to gather improvement data usually acquired from routine unit rounding and inspections to build corrective action plans. Nonetheless, St. Jude was expected to maintain high levels of patient care and services to meet TJC standards and on-site accreditation requirements.

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ST. JUDE NURSING ANNUAL REPORT 2022

circulate prep tools that provided “dos and don’ts” and survey tips. There was a renewed partnership between Nursing, Accreditation, Facilities, Operations and Maintenance, Environment of Care, Legal and other support services committed to making adjustments to validate standards and compliance with different tools and inventive approaches.

The effectiveness of this partnership was tested June 21, 2022, when TJC arrived on campus.

The surveyors were impressed with the campus, culture and mission of the organization. They complimented St. Jude staffing ratios and appreciated the organization’s commitment throughout the pandemic. The surveyors identified several opportunities to improve processes of care and promote patient safety with practice changes. However, these findings were placed as moderate-limited and lowlimited on the Safer Matrix. There were no findings placed on the matrix as high risk or immediate threat.

In the midst of restrictive pandemic circumstances, a multidisciplinary alliance was formed to promote readiness. In lieu of on-site consultative assessments, Nursing participated in Webex documentation reviews and tracers with mock surveyors. Nursing Leadership launched the Clinical Environment Project where the units used a checklist to standardize follow-up and report issues related to facilities operations and environment care to reduce multiple unit rounding. Clinical Excellence partnered with the Accreditation team to develop rounding forms to highlight problematic areas of compliance as well as

Finding cures. Saving children.

Nursing is building on the findings of the June 2022 TJC survey and will continue to promote continuous readiness with documentation assessments, unit rounds, data analysis, evidenced practice changes, policy review and ongoing communication with the Accreditation team. There is a quote that says, “Someone is sitting in the shade today because someone planted trees long ago.”

Nursing has had the privilege of improving patient care and nursing practice over the years through the roots of Joint Commission requirements and standards. Nursing now looks forward to branching out to survey methods that help ensure we stay ready.

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Clinical Logistics Department expands As St. Jude Nursing continues to grow in capacity and service, our Nursing Administration team has developed innovative strategies to help accommodate and guide this work. In 2019, Nursing rolled out a new service area: Clinical Logistics. In its original form, the service included a house supervisor office to act as a center of hospital operations, managing capacity, staffing, emergency response and transport. In addition, the team rolled out the Patient Care Coordination and Navigation effort to provide seamless service and a direct point of contact for patients throughout their journey.

Pictured (L to R) – Amanda Bowling, Manager of House Supervision, Nolan Eason, Director of Clinical Logistics, Sara Barnes, Manager of Central Staffing, Lauren McMurry, Manager of Command Center Logistics, and Katrina Pennington, Manager of Care Coordination. Not Pictured: Rebecca Tafaro, Manager of Vascular Access, Jessica Wade, Manager of Care Coordination, Taryn Donley, Clinical Logistics Coordinator, and Jenny Harp, Senior Administrative Specialist.

The beginning of the COVID-19 pandemic in 2020 brought new challenges around campus safety and staffing shortages. In response, Clinical Logistics implemented the COVID Supplemental Staff team to manage screening of staff, patients and caregivers to keep our campus safe for immunocompromised patients. To mitigate the impact on staffing due to the nationwide staffing shortage, the team developed and implemented the Nursing Transition Team, an innovative pipeline approach to hiring and onboarding new nurses. This approach minimizes the amount of time that any vacancy remains open, and the Float Pool Staff to harness the versatility of experienced nurses who can “float” to multiple areas to provide support.

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In 2022, Clinical Logistics expanded, growing into its own freestanding department that provides a broad menu of new services including blueprints for a Clinical Command Center, a Vascular Access Team, a Central Staffing Office and a Hematology Care Coordination Team.

A relatively new concept in health care, care coordination expands patient care beyond case management, ensuring that both patients and families feel supported, regardless of where they are in their journey.

Together, Jessica Wade, MHA, MSN, FNP-C, NRCME, NE-BC, and Katrina Pennington, BSN, RN, manage the Oncology and Hematology Care Coordination teams. Through their work, Wade and Pennington are defining the needs of various patient populations at St. Jude.

To support this vision, Eason has built a team of strategic leaders that will help shape and guide the growth of Clinical Logistics. Lauren McMurry, DNP, RN, FNP-C, CNML, serves as the new Command Center Operations Manager and is responsible for the strategic planning, development, administration and operations of the St. Jude Clinical Command Center. Sara Barnes, MSN, RN, joined Clinical Logistics as manager of the new Central Staffing Office to manage and oversee the COVID Supplemental, Float Pool, PCIS and Nursing Transition teams.

Rebecca Tafaro Boyer, MSN, RN-CNL, CPHON, leads the Vascular Access team, bringing modern technology and nursing services to all patient care settings, providing a high standard of vascular access care including the prevention and management of intravenous and central venous catheter complications.

In July 2022, Clinical Logistics welcomed an innovative new thought leader, Nolan Eason, MSN, RN, NE-BC, to serve as the director of Clinical Logistics. In this role, Eason is spearheading the development and implementation of a new Clinical Command Center, realizing the St. Jude vision of creating a centralized hub that will continuously elevate the level of care, quality and experience provided to patients and their families while delivering seamless access to coordinated interdisciplinary care across the continuum.

Finding cures. Saving children.

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Structural Empowerment

Finding cures. Saving children.

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Celebrating the profession of nursing Nursing Recognition 2022 The Recognition Committee of Nursing Shared Governance assesses, develops, implements and oversees activities to celebrate and honor the profession of nursing. This includes the DAISY Award, national Certified Nurses Day, Nursing Care Team Week and the annual Nursing Gala.

The DAISY Award for Extraordinary Nurses is an international award created to honor nurses all year long for their extraordinary and compassionate care. A St. Jude parent said, “DAISY Award honorees personify the remarkable patient care experience at St. Jude. These nurses consistently demonstrate excellence through their clinical expertise and extraordinary, compassionate care.

They are recognized as outstanding role models in our nursing community.”

The 2022 DAISY Award recipients included:

Andrew Hardee

Kristen Campbell

Sara Ford

Shelby Wright

BSN, RN

MSN, RN, BMTCN

BSN, RN, CPN, CPHON

BSN, RN

DAISY Team Breakfast

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ST. JUDE NURSING ANNUAL REPORT 2022

In March 2022, Nursing celebrated the accomplishments of specialty certified nurses on national Certified Nurses Day. Certified nurses exemplify professionalism, dedication, expertise and service to nursing and our patients. St. Jude supports certifications by providing reimbursement for exam fees, study materials and a review course.

Celebration activities included sweet treats delivered by Recognition Committee members.

Selfie photo of nurses in their certified nursing T-shirts were featured in The Pulse nursing newsletter and displayed on the Nursing Hub and Nursing Recognition Wall.

In May 2022, St. Jude Nursing partnered with University of Tennessee Health Science Center College of Nursing to promote and sponsor the 2022 Nightingala Hero Awards. This event involved the celebration and recognition of nurses across the community.

St. Jude nurses were nominees of the following awards: • Aubrey Pepper, MSN, RN, CNOR, NE-BC, Executive Leader Nurse Hero • Belinda Mandrell, PhD, RN, CPNP, FAAN, Executive Leader Nurse Hero • Shelby Hodges, BSN, RN, Bedside Nurse Hero • Danielle Eisenman, MSN, FNP, Advanced Practice Nurse Hero • Lynn Rodriquez, MSN, PPCNP-BC, RN, Advanced Practice Nurse Hero St. Jude Nursing also hosted several activities for Nursing Care Team Week, which included Blessing of the Hands, loaded teas, massages, scholarly speakers, sweet treats and gifts. The nurses participated in dress up days such as Disney day, team sports day, superhero day, luau day and pajama day.

In October 2022, members of Nursing leadership accepted the DAISY Team Award at the Annual Magnet® Conference in Philadelphia. The DAISY Team Award honors two or more nurses who identify and meet patient or family needs by going above and beyond. The St. Jude nursing team, along with St. Jude Global, accepted this award for their efforts in unyielding compassion for the Ukrainian children who came to St. Jude for their pediatric oncology treatment. When the children arrived at St. Jude, they were met by a multidisciplinary team who helped make their arrival comfortable. This team included staff members from Nursing, ALSAC, Global Outreach, Social Work, Child Life, Interpreter Services, Patient Registration, Security, Clinical Operations, Legal, Food Services and Housing. With the aid of medical interpreters, Food Services created Ukrainian meals for the families. Each patient received a smartphone with a Ukrainian interpreter app. The goal for the multidisciplinary team was to give the patients and families a safe, clean space to rest.

Finding cures. Saving children.

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To close out 2022, Nursing leadership hosted the annual Nursing Gala at the historic Peabody Hotel in downtown Memphis in December. Nursing celebrated six award recipients for Nurse of the Year, Advanced Practice Provider of the Year, Diversity, Equity and Inclusion Nurse of the Year, Nursing Team Award, Friend of Nursing and the BEE Award.

The recipients were:

Lauren Braskich

Sandra Jones

Kimberly Proctor

BSN, RN, CPN, CPHON

DNP, RN, CPNP-PC

MSN, RN, PPCNP-BC CPHON

Sara Ridenour

Jacklyn Arnold

Child Life Specialist II

Patient Care Associate

• Lauren Braskich, BSN, RN, CPN, CPHON – Nurse of the Year for outstanding achievement for an ambassador for Nursing Excellence • Kimberly Proctor, MSN, RN, PPCNP-BC – Advanced Practice Provider of the Year for outstanding achievement as an ambassador for Nursing Excellence • Sandra Jones, DNP, RN, CPNP-PC – Diversity, Equity, and Inclusion Nurse of the Year for outstanding achievement as an ambassador for Nursing Excellence • Vascular Access - Nursing Team Award for outstanding achievement as a team of ambassadors for Nursing Excellence (Rebecca Tafaro, MSN, RN, CNL, CPHON, Lisa Freeman, BSN, RN, OCN, Teresa Neal, BSN, VA-BC, Nikki Jeter, RN, VA-BC, Roxanna Stuart, BSN, RN, CPHON, Darenda Wright, BSN, RN, CPN, VA-BC, and Stephanie Morgan, RN, CPN, VA-BC) • Sara Ridenour, Child Life Specialist II – Friend of Nursing for outstanding support and empowerment of Nursing Excellence • Jacklyn Arnold, Patient Care Associate – BEE Award for outstanding support and empowerment of Nursing Excellence

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ST. JUDE NURSING ANNUAL REPORT 2022

Additional recognition for 2022 included: • Amos Jacobs Award recipient Liz Harmeier, BSN, RN, BMTCN, Inpatient Services • Patient and Family-Centered Care Champions: Kelsey Carlton, BSN, RN, CPHON, Laura Poteet, BSN, RN, Katie Tomaszczuk, BSN, RN, CPHON, BMTCN, Susan Bock, MSN, RN, NE-BC, and Nicole Ramirez, MSN, NP-C, RN, PED-BC The annual gala was followed by a Friends of Nursing breakfast to honor and celebrate all nursing support staff. This was held in the Marlo Thomas Center on the St. Jude campus.

The 2022 Nursing Gala Award

Finding cures. Saving children.

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Nurse Residency Program Match Day Success: Program revision creates an effective pipeline for securing top nursing talent

St. Jude Nursing is committed to recruiting the best and brightest nursing talent and retaining them at the bedside. However, national nursing trends show that many new graduate nurses leave within their first year of nursing.

To ensure St. Jude would always be able to provide excellent nursing care to its patient populations, Nursing chose to take a proactive approach to mitigate trends in first-year nurse retention and the impending nursing shortage, sparked by aging generations and ignited by the mass exodus seen in health care institutions across the country during the COVID-19 pandemic.

This proactive strategy focused on the St. Jude Nurse Residency Program (NRP), which provides a new graduate nurse the opportunity to become a Pediatric Oncology Nurse (PON) at St. Jude.

NRPs are transitioning to practice programs to bridge the gap between the academic setting and the professional nursing practice environment. The goal is to help new graduate nurses build the critical-thinking skills they need to provide safe, high-quality care to St. Jude patients.

Brooke Jackson

Damaris Ayala

Hunter Haynes

Simone Black

The St. Jude NRP began in 2012 to produce nurse residency graduates who are prepared to lead the advancement of nursing care for children with catastrophic diseases, expand the hospital’s evidence-based practice footprint and participate in the global sharing of knowledge which we have accomplished by gaining accreditation as a transition to practice program. This helps create St. Jude leaders who are currently educators, advanced practice providers and managers throughout our organization.

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In 2022, the NRP underwent revision, resulting in a new model that allows new graduate nurses to experience all areas of nursing at St. Jude prior to beginning orientation in a permanent unit. The new model begins with all new graduates onboarding into a generic graduate nurse role, which mitigates delays in licensure and fosters nurse resident bonding from day one.

Following onboarding, nurse residents participate in a week of National Council Licensure Examination study preparations, which has resulted in pass rates well above state and national benchmarks. This is followed by several weeks of clinical rotations where nurse residents spend time in all nursing areas including inpatient units, outpatient clinics and surgical services units.

During this time, new graduate nurses experience different nursing workflows and patient populations, which helps them establish relationships across the institution. After the clinical rotations, the new graduate nurses are matched to a home unit through use of the National Matching Algorithm, an evidence-based matching process that culminates with a Match Day celebration when the entire Department of Nursing comes together to meet new team members and usher in a new generation of St. Jude nurses. Filled with confetti, music and fun, Match Day signifies that the new graduates will embark on their clinical orientation phase and officially begin their 12-month residency program, which brings the cohort together for monthly sessions focused on building foundational nursing skills as well as St. Jude specific skills needed to care for our vulnerable patient population.

To further enhance this pipeline and ensure achievement of strategic goals, the Nurse Externship Program simultaneously underwent revision, which resulted in many summer externs joining the Nurse Residency Program following graduation. The St. Jude Summer Nurse Externship program brings nursing students from across the country to campus where they spend eight to 10 weeks working alongside nurses in inpatient units, outpatient clinics and surgical services units.

The Nurse Residency Program supports the mission, vision and values of St. Jude and aligns with the strategic goal to create a work environment that encourages employees to contribute maximally toward the mission, rewards their contributions and supports their career development. The revised NRP created a novel model that provides a pipeline for recruiting and introducing new graduate nurses to St. Jude, all while fostering a connection with our patients and love for the institution and the nursing profession.

Finding cures. Saving children.

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Nursing Mentorship Program The Clinical Excellence Department revised and adapted its mentor program to meet the needs of new graduate nurses transitioning to practice and experienced nurses interested in growth opportunities. The goal was to develop a program consisting of mentor/mentee matching, written resources for clinical nurses and sessions for mentors to help mentees set professional growth goals.

The Nursing Mentorship Program is modeled after the Academy of MedicalSurgical Nurses (AMSN) program, which includes role descriptions, timelines and progress reports. This new model, combined with the previous mentoring program, was used to develop a sustainable program to meet clinical nurse needs. The AMSN program is significantly designed for new graduate nurses who are acclimating to new roles. Therefore, the program was adapted to meet the need for the new clinical nurse as well as the experienced clinical nurse seeking growth opportunities.

With approval of the Nurse Executive Team, the program was launched in May 2022. The program uses a “speed dating” approach to assist with matching mentors and mentees. Mentor bios are collected and sent to each of the mentees. Mentees review these prior to the matching session.

During the session, mentees have three to five minutes to talk with each of the mentors to get a better understanding of the mentor’s skills and how they may be useful to the mentee in reaching their goals. The mentees provide their top three mentor choices to the program manager who makes the final match. The mentor and mentee are notified of the match by email and are encouraged to begin their mentoring relationship.

Mentors are asked to read “Now Discover Your Strengths” by Don Clifton and complete the Clifton Strengths Assessment. They are given a list of strengths that are common to strong mentors. This helps mentors identify areas they may like to develop.

Although the program is designed to be informal, mentors and mentees are given tools to help facilitate goal setting, evaluate progress and evaluate the program’s effectiveness. Evaluations are used to make improvements and to offer feedback to mentors. Mentors and mentees are not given a timeline for continuing the mentoring relationship. Although a year is suggested, both can continue to meet and communicate as needed about career goals. Participant feedback, new ideas and best practices can open the door for opportunities to improve and optimize the program.

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Recruiting and retaining the best and brightest through clinical advancement A strategic goal of the Nursing Department is to recruit and retain the highest caliber professional nurses. The Clinical Advancement Plus (CAP) program is designed to create a variety of options to recognize and promote clinical excellence, innovation, leadership and experience demonstrated by registered nurses who choose to advance their career in one of three tracks: clinical, education or leadership. The CAP program allows registered nurses to advance up to CAPs Level 4 based on experience, knowledge, skills and performance standards defined by each level. The goal is to drive better patient outcomes, recognize and promote the clinical expertise of registered nurses, enhance the quality of nursing care and reward and retain senior clinical registered nurses. The program includes a peer mentorship and committee review process.

In May 2022, the Clinical Advancement Committee leaders, Katie Tomaszczuk, BSN, RN, CPHON, BMTCN, and Emily Nichols, BSN, RN, CPHON, CPN, PON IV, met with Margie Kjellin, MSN, RN, CPHON, NE-BC, director of Nursing Clinical Excellence, and Nancy Ballinger, clinical project manager, to discuss national benchmark data for clinical advancement programs that reflected a gap in the St. Jude hiring and promotion practices. Historical hiring practices required 10 years of nursing experience for external registered nurses to be hired at CAP Level 2 with promotion through application at two years of St. Jude experience. This put St. Jude at a significant disadvantage for recruitment in a highly competitive market.

With the support of the Nursing Leadership Team and help from our compensation partners, Tomaszczuk and Nichols updated the CAP Plus policy to change eligibility to 18 months of nursing experience at 0.5 full time equivalent (FTE) and above for hiring and promotion to CAP Level 2. This update will enhance the institution’s ability to recruit and retain the brightest talent.

Pictured (L to R) - Margie Kjellin, Director of Clinical Excellence, and Emily Nichols, Pediatric Oncology Nurse, Outpatient Clinics, Not Pictured: Katie Tomaszczuk, Pediatric Oncology Nurse, Inpatient Units

Tomaszczuk and Nichols worked with speed and diligence to inform staff of the change and to help CAP committee mentors prepare newly eligible staff for successful application. In July 2022, Nursing implemented the new approach. The first round of internal CAP Level 2 promotions of registered nurses with 18 months of experience were reviewed by the CAP peer review committee.

An unprecedented, 30 CAP Level 2 promotions were awarded in July and 19 in October due to this practice change. From July to December, 23 experienced nurses were hired at CAP Level 2. This revised approach advances efforts to recruit and retain the workforce needed to achieve the St. Jude Nursing strategic plan.

Finding cures. Saving children.

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Seeking accreditation for Advanced Practice fellowship In September 2020, the Center of Advanced Practice recognized a need for standardized, consistent and excellent onboarding of new advanced practice providers (APPs) to St. Jude. This was especially true for nurse practitioners, physician assistants and certified nurse anesthetists who had recently graduated from their respective graduate schools.

The transition from school to practice can feel daunting. Often a new graduate experiences imposter syndrome during their first year. To improve the experience of transitioning to their new role, the Center of Advanced Practice developed a year-long transition program for all APPs. The program was designed with best practices for transitions in mind. Components of the program include preceptorship, mentorship, didactic training, personalized learning, hands-on learning, tools for monitoring progression and competency and performing a professional project. The Center for Advanced Practice launched the program and saw wonderful results, such as improved recruitment and retention, reduced time to completion of supervised proctoring and a commitment to both clinical and professional practice. APP fellows were able to create community with other new APPs as they developed knowledge, skills and relationships that would serve as the foundation to their new career.

Just two years later in September 2022, the American Nursing Credentialing Center (ANCC) announced the launch of a brand-new accreditation called Advanced Practice Provider Fellowship Accreditation (APPFA). The first cohort was accepted for application in October 2022. St. Jude applied for APPFA and received notification in October that we had met the submission requirement in the first ever cohort of programs seeking accreditation. It was important to the St. Jude Center of Advanced Practice to be pioneers in setting the standard for new APPs transitioning to practice. The accreditation validates that your APP fellowship program can meet the rigorous standards associated with excellence. The standards require proof of extraordinary performance in program leadership, organizational enculturation, program goals, problem-based learning, development and design.

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Our milestones are many in the journey. The Center of Advanced Practice has had 26 APPs in the program since the launch in 2020. Of the 26 APPs, 16 were new graduate fellows. We met all five program goals by 100%. Additionally, we trained 48 preceptors and 20 mentors to provide program leadership. We were able to hire the first Advanced Practice Professional Practice Operations Manager and first Advanced Practice Professional Development Educator to provide leadership and oversight to the APP Fellowship.

Finding cures. Saving children.

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Center of Advanced Practice Providers hosts affiliates conference

On May 20, 2022, St. Jude Children’s Research Hospital hosted an Affiliate Annual Conference. This conference brought together physicians and advanced practice providers (APPs) from St. Jude and affiliate clinics from across the country. A dedicated APP track was offered to meet the specific educational needs of the APPs. The day prior to the conference, the Center of Advanced Practice hosted affiliate APPs to shadow various clinical departments at St. Jude. The shadowing experiences were arranged based on the requests of the affiliate APPs. This opportunity offered exposure to processes, workflow and clinical knowledge that could enhance their roles at their designated institutions. Most importantly, this experience provided an opportunity for collaboration and relationship-building.

Planning for the conference started with the completion of an educational needs assessment.

APPs from all affiliate clinics were asked to provide topics for which they wished to receive education. Following the needs assessment, clinical topics were identified that would provide a diverse educational experience for the APPs representing various areas. Content experts were then selected and invited to be speakers at the conference. APPs received education on aplastic anemia, opiate management, integrative medicine, onco-fertility, vaccination procedures, infection prophylaxis, leadership, acute promyelocytic leukemia and chronic myeloid leukemia.

The presentations provided information based on current evidence, reviewed treatment modalities, provided an overview of pertinent St. Jude guidelines and research protocols and discussed the role of the APP. Continuing education credit was offered to attendees.

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A roundtable discussion brought St. Jude and affiliate APPs together for open discussion.

The communication between APPs occurs frequently and is primarily completed via email and phone. Developing relationships and encouraging open discussion was beneficial. It allowed opportunities to recognize strengths and opportunities as we move forward in our work together.

The discussion primarily surrounded opportunities for future collaborations, enhancement in communication and changes in workflow since the implementation of the new electronic medical record.

APPs valued the opportunity to visit St. Jude, meet with team members across the institution and receive education that can be used in their daily work. The Center of Advanced Practice will continue to support the annual affiliate conference and looks forward to leading the APP track.

Future work will focus on additional opportunities for education and collaboration with the knowledge of the benefits of integrating affiliate APPs into educational offerings and projects at St. Jude. Further, identifying opportunities for St. Jude APPs to learn from affiliate APPs will continue to strengthen the collaboration.

Finding cures. Saving children.

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Simulation for emergency management The Center of Advanced Practice acknowledges the significance of emergency management training for Advanced Practice Providers (APPs). Well-defined roles and a clear understanding of workflow are essential to achieving optimal outcomes. The Center of Advanced Practice sought to optimize patient safety, enhance critical thinking and improve provider confidence in managing emergency procedures, policies and equipment. Since hands-on practice promotes the execution of timely and accurate interventions, simulation training was incorporated.

During the Center of Advanced Practice Quarterly Didactic Education Meeting held December 2, 2022, a group of 16 recently hired APPs engaged in an education session centered on their responsibilities during emergencies. A baseline assessment explored content knowledge, provider confidence and perceived barriers to executing emergency management. Following this, Patti Pease, MSN, FNP-BC, Advanced Practice Professional Development educator, led an interactive lecture reviewing essential emergency policies, procedures, phone numbers and basic interventions to perform while awaiting the arrival of the emergency response team.

Immediately following the didactic session, participants were divided into two small groups. Mandi Dodson, MSN, RN, CCRN, CHSE, NPD-BC, professional development specialist, introduced the groups to the simulator and the simulation scenario of a medically unstable 10-year-old patient.

The APPs calculated the St. Jude Advanced Warning Score (SJAWS) and activated an emergency response. The team collaborated to retrieve the code cart and necessary supplies. The APPs obtained intravenous access, ordered critical medications and started cardiopulmonary resuscitation when the simulation patient became pulseless.

They verbalized institutional policies and procedures for early recognition of sepsis and executed interventions in accordance with the guidelines. Following the simulation, the

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groups took part in a formal and thorough debrief. During this time, APPs voiced questions, shared feedback and reflected on the experience.

This emergency management simulation allowed APPs to participate in real-time decision-making, receive hands-on experience and collaborate as a team. A posttest evaluation was repeated immediately following the session and again three months after the education. Sixteen APPs took the baseline evaluation, 15 completed the immediate post-test and 10 submitted the three-month post-test. Using a Likert scale, APPs reported that confidence in their ability to initiate emergency response increased from an average of 3.13 prior to the education to 4 immediately following the education and 4.2 three months posteducation (3-somewhat confident, 4-fairly confident, 5-very confident). APPs reported that factors such as newfound “role clarity” and “practice” contributed to their increase in confidence. Ten knowledge-based questions evaluated the APPs’ understanding of policies, interventions and workflow.

The group average of correctly answered questions improved from a baseline score of 50% to 83% immediately following the session. APPs reported their confidence in managing emergencies while awaiting the emergency response team was an average of 3.38 at baseline (3-somewhat confident and 4-fairly confident).

ST. JUDE NURSING ANNUAL REPORT 2022

Four of the 16 participants reported 1-not at all confident or 2-slightly confident prior to the education. Confidence rose to an average of 3.67 with six APPs reporting a 3-somewhat confident, eight reporting a 4-fairly confident and one reporting a 5-very confident.

New APPs at St. Jude need focused education and hands-on experience to increase their confidence in emergency management. Empowered with knowledge and skills, APPs can be leaders in these situations. Though every emergency scenario is different, having dedicated education, knowledge of policies and opportunities for simulation will help support APPs to act quickly and safely in high-stress, chaotic environments. Frequent reinforcement of emergency management education is vital to all team members, and additional opportunities for simulation will only further enhance understanding and teamwork. Based on this initial experience, emergency management simulations have been added to the APP Fellowship for all learners.

Finding cures. Saving children.

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Exemplary Professional Practice

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Enhancing continuity of care through an interprofessional plan of care

The conversion of the St. Jude electronic medical record to EPIC provided an opportunity to create an interprofessional plan of care that is meaningful, multidisciplinary and evidence based.

Continuity of care across all areas and disciplines helps set the standard for patient care and the experience patients and families have during their treatment journey.

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This need for an interprofessional care plan with the ability to drive care across the continuum at St. Jude provided the opportunity for enhancing communication between clinical areas and disciplines in a consistent and visible way. The team that built the care plan content had to focus on ensuring visibility and interaction with the care plan by all disciplines and areas.

The most important components of the Elsevier plan of care content for St. Jude became the Professional Exchange Report (PER), specifically the Individualization and Summary Sections and the Longitudinal Plan of Care (LPOC). These reports provided visibility and readily available care plan information to all clinical care givers. This allows all disciplines to easily view information about patient concerns and goals as well as see encounter summaries from one screen.

From January to March 2022, Robin Mobley, MSN, RN, NE-BC, program manager, attended staff meetings for each clinical discipline to introduce the care plan, identify staff concerns and generate excitement about the possibilities of improved care with the Elsevier content. Mobley presented a brief overview of how the care plan can be used and documented.

Finding cures. Saving children.

In late August and September 2022, Clinical Immersion meetings were held with all disciplines to supplement the education done in EPIC training. On October 1, 2022, the hospital moved to EPIC from Cerner. All inpatient care plans were entered by Monday, October 3. Ambulatory care plans were entered as patients arrived for visits and initial assessments completed. The Professional Exchange Report (PER), Longitudinal Plan of Care, and encounter summaries were visible to all disciplines. Moving forward, a stand-alone pop-up flow sheet will be available for the individualization section of the PER to provide an easier entry process.

As the care plan documentation is optimized, care plans will be entered consistently for inpatient and outpatient. The care plans will be appropriate for the patient. Interventions will be documented per shift for inpatient and per encounter for other areas, and individual care needs and patient summaries will be documented. Most importantly, all disciplines in all areas across the continuum of care will be able to use the care plan to improve the care provided.

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Adapting and establishing standardized after-hours phone triage process Following a patient event involving after-hours phone triage calls, an apparent cause analysis was completed to identify gaps and challenges in the working environment. The gaps found included the lack of standardized phone triage processes, dedicated nurses or competencies.

Other identified opportunities included the need to improve communication between nurses and providers. This was due to a lack of clarity in responsibilities, roles, handoff procedures, limited documentation of phone triage calls due to electronic health record (EHR) capabilities and lack of policy to guide practice.

A nurse-led multidisciplinary team was formed to develop phone triage protocols and algorithms, to standardize hand-off communication between nurses and providers and to develop a phone triage procedure and documentation template. This team consisted of clinical nurses, physicians, advanced practice providers, nursing leaders, nursing professional development practitioners and team members from the Office of Quality and Patient Safety.

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After reviewing the gaps and challenges, the team initiated a project and implemented actions to improve phone triage practices over several months.

Actions included: • Reviewed the literature and existing phone triage tools • Selected a tool that met our specific population needs (Telephone Triage Toolkit for Children’s Cancer Services developed by the Children’s Cancer and Leukemia Group) • Revised and adapted symptom protocols and action algorithms for patient care • Developed a script and procedure for communication between nurses and providers • Developed patient simulation cases and provided training to nurses and providers at multiple points before and after go-live • Created and completed phone triage nurse competencies based on APHON Communication Principles and Techniques Legal Issues of Phone Triage • Developed phone triage policies and procedures • Completed a Plan-Do-Check-Act small pilot of two protocols and then developed interim paper call-log protocols, algorithms and documentation • Developed and implemented protocols and algorithms for the EHR • Surveyed nurses and providers before and after go-live • Completed data review with team to evaluate opportunities for improvement Eight months since go-live, there have been zero serious patient safety events related to afterhours phone triage calls. A four-month data review after EHR implementation demonstrated 855 documented calls. The most frequently selected protocols were fever (31%), pain (17%), infection (5%) and nausea/vomiting (5%). Hematology Service patients represented the largest volume of phone triage calls (40%), followed by Leukemia (30%), Solid Tumor (14%) and Bone Marrow Transplant (10%). Algorithm recommendations most frequently used were “come to hospital for an urgent review” (36%), followed by advice calls such as “continue care at home and education (17%), “come to clinic appointment within 24 hours” (8%) and “immediately call 911” (3%). Surveys also highlighted the ease of use and enhanced communication with patients and providers.

Nurses have even commented that this is their favorite part of the EHR. Standardization of the phone triage process and communication provided opportunities for enhanced decision-making tailored to the chief complaint and patient/caregiver responses to promote safe and effective symptom evaluation and care advice.

Finding cures. Saving children.

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New Family Rounding program improves patient experience at St. Jude

At St. Jude, patient family-centered care involves recognizing the uniqueness of each child and family, practicing open and honest communication and empowering families to play a valuable role in improving health care quality and safety.

Through a recently launched Family Rounding program, a team of dedicated staff in the Kay Research and Care Center is helping families and patients feel more engaged and comfortable throughout their health care journeys.

Led by Lindsey Reap, MSN, RN, NE-BC, nurse manager, Inpatient Units, and Erin Harper, manager, Advanced Practice Provider, the Family Rounding program personifies the tenants of patient and family-centered care, dignity and respect, collaboration, information sharing and involvement.

Reap explained that family rounding was implemented in the hospital’s Intensive Care Unit many years ago. KAY 3, the intermediate care unit (IMCU), is the first inpatient unit, outside of critical care, to implement this type of rounding.

“Part of the reason that Family Rounding works so well on Kay 3 is that the chemo service line has always been very fluid, with patients coming from all over the institution,” Reap said.

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Harper, along with Jennifer Street, BSN, RN, CPN, NPD-BC, Nursing Education, and all KAY 3 clinical staff leaders, worked together to create a Chemotherapy Service rounding form that allows clinical and family needs to be shared consistently between nurses on day and night shifts.

“The rounding form has done a great job of bringing both nursing shifts together,” Reap said.

Another key to the program’s early success has been consistent times that rounding occurs for each patient, ensuring that everyone on the care team is present. Led by the primary nurse, rounds take place at the bedside to allow the patient, family, nurse and clinical care provider team to receive the same information at the same time. Each family is encouraged to participate, and all families are given notice that rounds will occur. Interpreters are provided when needed.

“Things can get lost in translation, so Family Rounding is a great chance for all to be involved,” Reap said. “Sometimes, the care team and primary nurse will discuss a few brief things from the rounding form outside the room, making changes to the care of the patient in the moment. Next, they will go into the room to receive input and involvement from the caregivers, which ensures everyone is on the same page about the new plan. It’s truly a partnership.”

Clinical staff leaders and relief staff leaders round with each provider team to ensure that each nurse is involved, which promotes continuity of care. Reap said Kay 3 typically has a shorter inpatient stay than some of the hospital’s other inpatient units. Improved communication via the Family Rounding program helps the care team work more efficiently toward a timely discharge for a Kay 3 patient—typically two to three days.

“Staff love being part of the Family Rounding process. They say it’s more organized and coordinated, and they appreciate that the care team and primary nurse are consistently involved and talking firsthand to the families,” Reap said.

“Parents tell us that Family Rounding helps them feel they are an active partner in their child’s care. We strive to continue involving parents and patients in all aspects of care, and we would love to see family-centered rounds in all areas and service lines across the hospital.”

Finding cures. Saving children.

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Reducing risk of harm related to patient falls In the pediatric population, patients are at high risk for developmental falls. In the hospital setting, all patients have some risk of falling due to health conditions, medications or other physiological reasons. Inpatient nurses assess patients for risk at time of admission and each shift. Nurses then assign standard safety precautions. While all patients are assessed for falls risk and safety measures are implemented, the falls precaution standard of care is implemented for any patient screened to be at high risk for physiologic fall.

In early 2022, a higher-than-usual fall rate trend was noted. In May 2022, a spike of nine total falls were noted across multiple inpatient units, one of which resulted in a minor injury that required the application of an ice pack.

While most of these falls did not result in injury, they identified an opportunity to look at common causes of falls and target specific interventions for prevention to ensure a safe patient care environment.

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Common causes included: • Moving without asking for assistance • Teenagers and young adults wanting bathroom privacy • Patients running, playing, tripping Shared governance representatives and unit leadership partnered on a fall prevention and reduction plan.

Actions included: • The clinical staff leader (CSL) or relief staff leader (RSL) conducts a fall huddle with staff immediately after a fall event.

• Nurses provide education to patients and family caregivers on the need for use of non-skid socks, bedrails, not leaving patients without assistance when out of bed and use of the call light when needing help.

• Nurses emphasizing safety over privacy related to bathroom needs to minimize falls risks.

Parent advisors recommended staff give clear and direct expectations to patients and caregivers that assistance to the bathroom is for the patient’s safety and to explain the reason why the patient is at risk.

• Nurses engaging parent caregivers in bedside report on preference of how/who needs to assist the patient for toileting.

• Nurses and patient care assistants provide reinforcement of falls precautions during hourly safety rounds and to provide and encourage assistance moving from bed, chair, bedside commode or bathroom.

• CSLs conducting “falls rounds” to ensure appropriate falls precautions are in place, use of bed alarms, if applicable, and that patient is wearing non-skid socks. CSLs audit charts for appropriate documentation of interventions.

Inpatient and unit-based councils, in partnership with parent advisors, developed criteria for use of bed alarms that would give comfort to both parents who need to step away from the bedside, as well as an alert to staff if a patient is trying to get out of bed unassisted. The November Nursing Education Days provided updates to staff on Falls Precautions Standard of Care and the criteria for use of the bed alarms. Laminated bed alarm guidelines were placed on each unit, and education to patients and caregivers on the use and purpose of bed alarms was provided. The increase in the use of bed alarms for patients that meet criteria resulted in positive feedback from caregivers and staff.

The falls prevention and reduction plan resulted in a significant decrease in total falls, reducing the overall falls rate from 5.84 per 1,000 patient days to 0.64 per 1,000 patient days from May to December.

Finding cures. Saving children.

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New Knowledge

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Nurses use new technology with defibrillator upgrades

In 2022, St. Jude identified a need to upgrade the current defibrillator equipment to align with the American Heart Association’s recommended guidelines for real-time audio-visual feedback during live events. The updated LIFEPAK defibrillator is an all-in-one defibrillator and monitor that delivers fast and efficient care and early detection of changing patient condition in life-threatening situations, resulting in better patient outcomes. The upgraded defibrillators incorporate new monitoring capabilities and eliminate the need for additional equipment at the patient’s bedside.

The new features include noninvasive blood pressure monitoring and capnography. Having all wave forms and measurements on one monitoring screen allows clinical teams to assess the patient, expedite interventions and visualize intervention effectiveness in an organized and systematic approach.

Clinical nurses and nurse professional development practitioners led a multidisciplinary team to stage, deploy and replace 28 defibrillators in designated clinical areas. The team consisted of staff from Nursing, Respiratory Therapy, Biomedical Engineering, Materials Management and Critical Care – Pulmonary Medicine.

The project team developed an educational curriculum to train nursing staff prior to the deployment of the new defibrillators. This involved web-based training and hands-on training.

The new defibrillators were deployed in the designated clinical areas in March 2022.

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Epic Go-Live October 2022 marked the launch of Epic, the electronic health record new to St. Jude. Dubbed Project IGNITE, Epic Go-Live was the culmination of three years of planning and preparation to move away from the health record that had been in use for more than 20 years. While 2021 included the foundation being laid with the establishment of the IGNITE governance structure and key organizational scoping decisions, 2022 was when the project took flight. St. Jude nurses exemplified the organization’s core value of embracing the challenge to create a new tomorrow as key representatives engaged in content creation, hardware deployment and testing, and enduser training.

Dozens of nurses representing multiple clinical and research areas served as subject matter experts and advisers to more than 60 workgroups and councils. Working alongside analysts and project support staff from Epic, these groups evaluated Epic’s recommended workflows and functionality. Feedback from the nurses helped shape future-state workflows and content in use today. These groups also evaluated new hardware including label printers, patient and provider communication devices and electronic display boards that interface with Epic to help facilitate patient care. More than 1,000 devices were deployed and tested during the months before go-live.

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Epic Go-Live continues...

Employee training began in mid-August and continued through the end of September. Nurses took part in a combination of web-based learning modules and in-person classes designed to acquaint them with the Epic landscape as it pertains to their individual focus areas and daily work. The curriculum was developed over the course of several months with feedback and knowledge from nurses as subject matter experts. Each class was built to meet foundational and specific learning needs of nurses working across the many specialty areas of St. Jude. Additionally, several full-time staff nurses temporarily stepped away from direct patient care from July through October to work as principal trainers, providing instruction to their peers in the classroom sessions.

Super users contributed during the pre-implementation and go-live periods. Nearly 400 St. Jude staff members volunteered to serve as super users to assist their colleagues during classroom training and to offer at-the-elbow support through the transition. Epic partners noted that an unprecedented number of volunteer staff supported go-live, highlighting the level of dedication, collaboration and professionalism on display at St. Jude.

Epic officially went live at 4 a.m. Saturday, October 1, 2022. More than 200 IGNITE team members were on-site for the big day. Two command centers were established, one for operational support and one for technical support. These command centers were open 24/7 and staffed by IGNITE project leadership, Epic project leadership, support managers and key project stakeholders. The command centers were instrumental in monitoring and resolving both operational and clinical impacts of go-live, as well as serving as a point of escalation for department leaders when issues occurred.

The Epic launch was a monumental undertaking that required collaboration across every area of St. Jude. It would not have been possible without the expert knowledge, dedication, patience and resilience of St. Jude nurses and those who partner with them. Through the implementation and continued optimization of Epic, Nursing aims to continue setting the standard for patient care and the experience patients and families have during their treatment journey.

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Peri-anesthesia nurses create sister teams The Nursing Surgical Services sedation team provides pre- and post-anesthesia care for patients in the Diagnostic Imaging (DI) and Radiation Oncology (RO) areas. But functioning as one large team covering multiple service lines led to an inefficient workflow.

Nurses on the peri-anesthesia team were covering three different modalities located on different floors, often requiring movement between the areas each day depending on the schedule of patients. It was difficult for schedulers to see which areas may not be able to handle add-on cases due to one scheduling template for all areas. This made it challenging to plan for surges in patient volume and resulted in staff working overtime or being called back to work.

Peri-anesthesia team leaders formed a project team to review their current staffing and scheduling processes. Following that review, the team created two sister teams- one dedicated to DI and the other to RO. The formation of two dedicated teams created a consistent work location for staff and allowed for dedicated clinical staff leader and relief staff leader coverage, which resulted in consistent leadership for staff and stronger service line relationships through continuity of care.

Leaders surveyed peri-anesthesia staff for input on workflow, preference of team assignment, as well as how team assignments should be made in the event of an imbalance between the two areas.

Organizational Development conducted a change management session to identify and address concerns related to the changes. Topics included on-call and holiday scheduling and pull guidelines.

After analyzing staff input related to team selection and other details, the two dedicated teams were formed. With the implementation of EPIC, separate scheduling templates were created for each team, facilitating a more efficient process for schedule changes, surges in patient volume and add-on cases. The new teams gave the staff more autonomy in their regular scheduling, call schedules and holiday coverage.

With the implementation of the dedicated peri-anesthesia teams, a more efficient scheduling process is now in place. This has led to an increase in staff satisfaction and a reduction in overtime and call-backs, as well as better overall relationships with all stakeholders involved, including patients.

Finding cures. Saving children.

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Nurses and Allied Health professionals attend Nursing Research and Psychosocial Services Symposium On May 18, 2022, the Research/Evidence Based Council, the Division of Nursing Research, and Psychosocial Services hosted the Nursing Research and Psychosocial Services Symposium in the Marlo Thomas Center at St. Jude.

Themed “Building the Future of Patient Care,” the symposium was open to all nurses and allied health professionals and provided an opportunity to highlight clinical scholarship and showcase the impact on patient care outcomes. St. Jude is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation. St. Jude is also approved by the American Psychological Association to sponsor continuing education for psychologists. Participants in the symposium were eligible to earn free continuing education credits for both nursing and psychology.

The symposium featured several events including staff presentations, along with a parent panel and poster viewings. Judges trained by the Nursing Research Department evaluated a total of 14 posters.

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Presentations included: • The Basics of Dissemination: Abstracts, Posters, and the DNSA Portal, by Jami Gattuso, MSN, CPON; Donna Hancock, MSN; and Susan Ogg, MS, RN • Creating a Meaningful Study, by Belinda Mandrell, PhD, RN, CPNP, FAAN • Promotion of HPV Vaccination in Childhood Cancer Survivors After Completion of Cancer – Directed Therapy, by Emily Browne, DNP, RN, CPNP, and Julia Neely, MPH, CHES • Global Research/QI Collaboration in Nursing, by Monnie Abraham, PhD, MSN, FISQua, CPHQ • Center for Experimental Neurotherapeutics: A Focus on Childhood Catastrophic Disease, by Victoria Delany, BSN, RN, CPN, CCRC

Following the symposium, participants networked and enjoyed a wine and cheese reception with electronic poster viewing on top of the Inspiration4 Advanced Research Center rooftop.

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Vascular Access Team: PICCing the right lines using 3CG technology Placement of central venous catheters (CVC) and intravenous (IV) insertion is an integral part of care for St. Jude patients. The St. Jude Vascular Access Team (VAT) is made up of highly skilled, board-certified registered nurses who are specially trained in vascular access management.

Three years ago, the VAT established goals to support the mission of developing, standardizing and implementing best practices in both the inpatient and outpatient areas for IV insertion as well as the prevention of IV and CVC complications. There was a phased-in approach to accomplish these goals.

The first phase was the introduction and successful deployment of ultrasound guided IV insertion (USGI) in December 2020 which eliminated multiple access attempts and reduced the risk of complication. This technology was later expanded to include a super user group to help prevent delays and gaps in services for difficult patient sticks, especially on nights and weekends.

The second phase was the implementation of midline/longline in March 2021. Expert placement of midlines/longlines by the VAT nurse was the key driver of the PIVMidline Decision Tree. The Medical Executive Committee approved the Midline standing order. This was developed to support VAT nurse clinical decision making and practice in determining which line is best based on individual patient assessment in May 2021.

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The third and final phase was the VAT nurse insertion of vascular access devices, PICCs, by 2022. The PICC line is more durable than a regular IV and allows repeated and longterm access to the bloodstream for frequent or regular administration of drugs. PICCs can help avoid the pain of frequent needle sticks and reduce the risk of irritation to the smaller veins. Senior vascular nurses Rebecca Tafaro Boyer, MSN, RN - CNL, CPHON, and Stephenie Morgan, RN, CPN, VA-BC, were the first to complete training and obtained special certification in May 2022 to insert PICCs using 3CG technology.

This was an operational improvement in which patient delays were decreased as traditionally PICCs were only inserted by Interventional Radiology’s busy staff. There was also a clinical benefit to the patient as the 3CG technology confirms line location and central placement which eliminates the need for fluoroscopy.

By the end of December 2022, this team had successfully placed 62 PICC lines with a success rate of 82%.

A partnership between IR and the VAT has been established in which criterion guides which patients require consultation, which should be referred to VAT and which patients would be better served in IR based on their clinical history and status. The VAT team has championed the completion of their goal to establish best practices by implementing 3CG technology to PICC the right lines for our patients.

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The VAT Team won the 2022 Nursing Team Award for outstanding achievement as a team of ambassadors for nursing excellence.

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Seroprevalence of Measles (Rubeola) Antibodies in Childhood Cancer Survivors Seroprevalence of Measles (Rubeola) Antibodies in Childhood Cancer Survivors Deborah B. Crom, PhD, RN, CFNP1, Lisa A. Walters, DNP, RN, CFNP1, Yimei Li, PhD2, Jai Liang, PhD2, Diego R. Hijano, MD, MSc3, Daniel A. Mulrooney MD4, Lee Ann Carmichael, DNP, RN, CFNP1, Sarah L. Ford, MS, PA-C1, Shekinah J. Andrews, MSN, RN, CFNP1, Daniel Smith, DNP, RN, CFNP1, Melissa M. Hudson, MD4,5, Belinda N. Mandrell, PhD, RN, PNP-AC, FAAN6 Measles is re-emerging as a public health threat, raising important questions about disease vulnerability among childhood cancer survivors.

Serious complications associated with measles include pneumonia and encephalitis.

Deborah B. Crom, PhD, RN, CFNP1

1. The introduction of vaccination against measles in 1963 dramatically reduced the incidence of the disease and the associated morbidity and mortality. In 2000, the Centers for Disease Control and Prevention (CDC) declared that measles had been eliminated from the United States.

2. However, a November 2022 CDC Newsroom Release cautioned that measles poses a growing threat to nearly 40 million children because of routine immunization programs having been disrupted during the COVID-19 pandemic, resulting in a steady decline in measles vaccination coverage. The dramatic decrease in coverage is attributable not only to pandemic-related disruption but also to the rising culture of vaccine hesitancy, which has resulted in a loss of herd immunity.

3. A recent Children’s Oncology Group review emphasized the importance of measles seroprevalence surveillance in bone marrow transplant recipients; however, the risk of infection in childhood cancer survivors treated with standard-risk therapy has not been fully addressed.

4. This quality improvement project assessed the seroprevalence of anti-measles IgG antibodies as a marker of immune status in survivors of childhood cancer and associated demographic/ treatment variables.

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Sample and Data Collection A convenience sample of survivors attending the St. Jude After Completion of Therapy Clinic from January 2020 to February 2022 was identified. Participants were childhood cancer survivors who were free of active disease, having routine blood studies drawn and who could provide documentation of having received two doses of measles, mumps and rubella (MMR) vaccine before their cancer diagnosis. Patient record review documented demographic and treatment variables. Anti-measles (rubeola) IgG antibody seroprevalence was assessed by enzyme immunoassay for vaccine-specific antibodies.

Results Of 270 survivors evaluated, 110 (42%) were female, 196 (75%) were white and 159 (61%) were leukemia/lymphoma survivors.

Participants were a median of eight years from their cancer diagnosis and a median of 14 years from their last MMR vaccination.

Of these 262, 110 (42%) had negative measles seroprevalence, suggesting loss of immunity. Seroprevalence estimates did not differ by diagnosis, race, age, sex, time since cancer diagnosis, or time since immunization. Univariate modeling failed to identify statistically significant predictors of seroprevalence.

Implication to Practice Our results are a call to action for pediatric oncology nurses to assess survivors’ risk of measles and to encourage repeat vaccination when appropriate. Not acting is no longer an option. Special attention must be given to young adult survivors living in close communities, such as colleges, trade schools, or the military, or working in health care settings where infectious diseases often emerge. Clinicians are in a pivotal position to address vaccine hesitancy both

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in their patients and in their communities.

Interventions designed to address vaccine hesitancy stress the need to affirm patients’ personal values while supplying information regarding the benefit of vaccinations. In addition, nurses can help curb the spread of misinformation by engaging in public forums and social media and encouraging focused surveillance and legislation to counteract erroneous information propagated via the Internet.

References 1. Strebel, P. M., & Orenstein, W. A. (2019).

Measles. New England Journal of Medicine, 381(4), 349-357. doi:10.1056/NEJMcp1905181 2. Katz, S. L., & Hinman, A. R. (2004). Summary and conclusions: Measles elimination meeting, 16-17 March 2000. The Journal of Infectious Disease, 189 Suppl 1, S43-47. doi:10.1086/377696 3. National Center for Immunization and Respiratory Diseases Do VD. (2019). Measles cases and outbreaks. Retrieved 4. Guilcher, G. M. T., Rivard, L., Huang, J. T., Wright, N. A. M., Anderson, L., Eissa, H., Chow, E. J. (2021). Immune function in childhood cancer survivors: A Children’s Oncology Group review. The Lancet. Child & Adolescent Health, 5(4), 284-294. doi:10.1016/S23524642(20)30312-6

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Empirical Outcomes

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Presentations: Brown, K. Introduction to Anesthesia at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

James, M. Introduction to Critical Care Medicine at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

Brown, E. Library Search. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Jones, S.C. Adolescent to Adult Healthcare Transition.

National Association of Pediatric Nurse Practitioners Conference, Virtual, United States, October 2022.

Burgess, R. HIV Management and Research at St. Jude.

APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, August 2022.

Jones, S.C. Embracing Adolescent to Adult Healthcare Transition in Clinical Practice. Pediatric Advanced Practice Provider Conference, Le Bonheur Children’s Medical Center, Memphis, TN, November 2022.

Chapman, L. Introduction to Brain Tumor at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Clark, K. Pediatric Endocrine Management at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, August 2022.

Frieders, J., Stone, S. ORIME Model Utilization. APP Preceptor Course Series, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Gattuso, J, Hancock, D, Ogg S. The Basics of Dissemination: Abstracts, Posters, and the DNSA Portal.

Nursing Research and Psychosocial Services Symposium, Memphis, TN, May 18, 2022.

Gattuso, J. Being involved in your professional nursing organization: What, why, how? APHON Greater Midsouth Chapter, Memphis, TN, March 2022.

Gray, N., Goodings-Harris, C., Lewis, S., Uhrich, J., Sahoo, S., Wlodarski, M. Results of prospective hematologic surveillance with correlative single cell DNA sequencing in children with SAMD9/SAMD9L related bone marrow failure and monosomy 7. 2nd ESH-EBMT Translational Research Conference: Bone Marrow Failure Syndromes, Paris, France, November 2022.

Harper, E. Introduction to Hospitalist Medicine and the Acute Care Clinic at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

Horwitz, D., Tatum, M., Koltnow, P., Tucker, J., Cunningham, M., Sabbatini, G. Transition to Clinical Practice: Financial Planning and Loans Panel [Panel presentation]. The University of Tennessee Health Science Center Physician Assistant Program, Memphis, TN, November 2022.

Humphrey, Y. Introduction to Psychiatry in Pediatric Patients with Catastrophic Diseases. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

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Jones, S.C. Introduction to Transition Programs. APP Quarterly Education Series. St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Kimble, A. Fertility in Oncology Patients. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

Kimble, A. Introduction to Pediatric Surgery at St. Jude.

APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Lavoie, P. Introduction to Hematology at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, August 2022.

Mandrell BN, Pritchard M, Ogg S, Bosi J. Utilization of photobiomodulation in the prevention and treatment of oral mucositis. Association of Pediatric Hematology Oncology Nurses, West Palm, FL, October 2022.

Max, A. Introduction to Infectious Disease at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

McMillan, C., & Culver, J. Introduction to Pediatric Leukemia and Lymphoma at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Michaels, C. Immunizations in the BMTCT Population and COVID-19 Therapeutics. St. Jude Children’s Research Hospital Affiliate Conference, St. Jude Children’s Research Hospital, Memphis, TN, May 2022.

Pease, P. Simulation for Emergency Management at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

ST. JUDE NURSING ANNUAL REPORT 2022

Persaud, Y, Mandrell BN, Sharma A, Carroll Y, Irvine M, Olufadi Y, Kang G, Rai P, Estepp J, Hankins JS, Johnson L-M. COVID-19 vaccine rates among pediatric patients with Sickle Cell Disease: A single institutional experience.

The Foundation for Sickle Cell Disease Research’s 16th Annual Sickle Cell Disease Research and Educational Symposium and 45th National Sickle Cell Disease Scientific Meeting, Fort Lauderdale, FL, June 2022.

Sisam, J., Mackay, V. Overview of Sickle Cell Disease and SJCRH Transplant Protocols. [BMT RN education session].

St. Jude Children’s Research Hospital, Memphis, TN, March 2022.

Pratt, A. Introduction to Pediatric Pain Management at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Stone, S. Advanced Practice Nursing at St Jude. Shanghai International Pediatric Oncology Symposium, Shanghai, China, May 2022.

Proctor, K. Introduction to Pediatric Intervention Radiology at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Rivera, J, Malone S, Puerto-Torres M, Prewitt K, Sakaan F, Zebin A, Arias AV, Bhattacharyya P, Gunasekera S, Johnson S, Kambugu J, Kaye E, Mandrell BN, Mack J, McArthur J, Mendez DO, Morrissey L, Sharara R, Snaman J, Sniderman E, Luke D, Graetz D, Agulnik A. Development of a quantitative measure to assess the quality of interdisciplinary communication around patient deterioration in variable resourced hospitals (CritCom). WFPICCS 2022/11th Congress of the World Federation of Pediatric Intensive & Critical Care Societies, Cape Town, South Africa, July 2022.

Sisam, J. Epic BMT Specialty Training for Inpatient/ Outpatient Providers. St. Jude Children’s Research Hospital, Memphis, TN, September 2022.

Stone, S. Non-Violent Communication. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, June 2022.

Stone, S. Introduction to Advanced Practice Provider clinical efficiency. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Stone, S. Methods for Sharpening Clinical Reasoning Skills.

APP Preceptor Course Series, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Turner, R., & Stone, S. Characteristics of Successful Preceptors. APP Preceptor Course Series, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Rivera, J, Malone S, Puerto-Torres M, Prewitt K, Sakaan F, Al Zebin Z, Arias AV, Bhattacharyya Partha B, Gunasekera S, Johnson S, Kambugu J, Kaye EC, Mandrell BN, Mack J, McArthur J, Mendez A, Morrissey L, Sharara-Chami R, Snaman J, Sniderman E, Luke D, Graetz D, Agulnik A. Assessment of the quality of interdisciplinary communication (CritCom) around patient deterioration in pediatric hematology-oncology centers of variable resource-levels. SIOP, Barcelona, Spain, October 2022.

Tyre, A. Introduction to Solid Tumor at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, December 2022.

Rutt, E. Introduction to Pediatric Quality of Life and Palliative Care at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Ureda, T., Pease, P., Stone, S. Certified preceptor educational lunch. APP Preceptor Education. St. Jude Children’s Research Hospital, Memphis, TN, May 2022.

Sabbatini, G. HIV and PrEP in Pediatric and AYA Medicine: A Rapid Review. 4th Annual Pediatric APP Conference, Le Bonheur Children’s Hospital, Memphis, TN, November 2022.

Sabbatini, G. Case of HCV reactivation v. reinfection in a person with HIV coinfection. Southeast Viral Hepatitis Interactive Case Conference, Southeast Aids Education and Training Center, Virtual, March 2022.

Simmons, A. Pediatric Neurology Management in children with catastrophic diseases at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, August 2022.

Finding cures. Saving children.

Ureda T, Skeens M, Montgomery K, Hooke C. “Abstracts, Posters, Presentations, and More.” Association of Pediatric Hematology Oncology Nurses Annual Conference. West Palm Beach, FL. September 15, 2022. Preconference Workshop.

Ureda, T. Stone, S. The art of giving feedback. APP Preceptor Course Series, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Ureda, T. Stone, S. Mentorship in EVOLVE. APP Mentor Course, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Walters, L., Smith, D. Introduction to Survivorship care at St. Jude. APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Wills, C. W. “Fundamentals of Pediatric Hematology and Oncology Nursing – Palestine.” Memphis, TN: St. Jude Children’s Research Hospital, 2022.

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Wills, C. W. St. Jude Nursing Academy, “Sickle Cell Disease: Acute Clinical Manifestations of Sickle Cell Disease,” St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Wills, C. W. Sickle Cell Boot Camp to Promote Nursing Excellence, “Sickle Cell Disease: Acute Chest Syndrome,” University of Tennessee Health Science Center, June 2022.

Woody, K. Introduction to Stem Cell Transplant at St.Jude.

APP Quarterly Didactic Series at St. Jude Children’s Research Hospital, Memphis, TN, February 2022.

Elliott, A, Johnson’ S, Harman, J. Implementation and early outcomes of the St. Jude Behavioral Emergency Response Team (BERT). Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital.

May 2022.

Woody, K., Stone, S. Leading Different Types of Learners in a Busy Clinical Environment. APP Preceptor Course Series, St. Jude Children’s Research Hospital, Memphis, TN, 2022.

Kamara D, Crabtree VM, Crowley SJ, Semko J, Merchant TE, Mandrell BN. Circadian rhythms among youth with craniopharyngioma. SLEEP Annual Meeting. June 2022.

Posters:

Kjellin M, Pepper A, Mutz R, Ballinger N, Mathieson B. Brave today, stronger tomorrow: Building a sustainable nursing leadership structure. Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital. May 2022.

Afify, Z., Taj, M., Srivatsa, K., Miller, T.P., Edington, H., Dalal, M., Robles, J., Ford, J., Ehrhardt, M.J., Ureda, T., Rubinstein, J., McCormack, S., Rivers, J.M., Shisholm, K.M., Kavanaugh, M., Bukowinski, A.J., Friehling, E., Marks, L., Smith, C.M. Mason C. (June 2022). Pediatric EBV-negative monomorphic post-solid organ transplant lymphoproliferative disorders [EBV(-)M-PTLD]: Characteristics, treatment and outcomes from 11 pediatric academic centers. American Society of Clinical Oncology Annual Meeting. 2022.

Mans B, Kjellin M, Craig D. Nurses transform clinical environment. Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital.

May 2022.

Arnold, J, Moran-Wasklewicz, A, Melancon, M. Utilizing a System to Develop the Nursing Professional Development Practitioner in Project Management. Association for Nursing Professional Development. March 2022.

McNeil MJ, Kiefer A, Woods C, Barnett B, Berry-Carter K, Clark L, Mandrell BN, Snaman J, Kaye EC, Baker JN. Grief Challenges for parents participating in a mentor program after a child died of cancer. The American Society of Pediatric Hematology/Oncology. May 2022.

Boggs J, Uhrich J, Lewis S, Hale M, Boals M, Takemoto C, Wlodarski M. Leaving no child behind: Gaining insight on rare hematological diseases. Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital. May 2022.

Ogg S, Bosi J, Pritchard M, Mandrell BN. Let there be light: Photobiomodulation in treatment of oral mucositis.

Nursing Research and Psychosocial Services Symposium.

St. Jude Children’s Research Hospital. May 2022.

Boggs, J., Uhrich, J., Lewis, S., Gray, N., Hale, M., Boals, M., Takemoto, C., Wlodarski, M. Leaving no child behind: gaining INSIGHT on rare hematological diseases. 2nd ESHEBMT Translational Research Conference: Bone Marrow Failure Syndromes. November 2022.

Chahin, S, Choquette AE, Crabtree VA, Mandrell BN, Jones AM, Potter BS, Tillery R. Correlates of sleep and sleep disturbance among adolescents transitioning off cancer therapy. Society of Pediatric Psychology Annual Conference. April 2022.

Chahin, SAE, Crabtree VA, Mandrell BN, Jones AM, Potter BS, Tillery R. Correlates of sleep and sleep disturbance among adolescents transitioning off cancer therapy.

Nursing Research and Psychosocial Services Symposium, St. Jude Children’s Research Hospital. May 2022.

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Choquette, A.E., Jones, A.M., Potter, B.S., Barnwell, E., Browne, E.K., Jones, S., Feibelman, S., Tillery Webster, R. Mindfulness and internalizing symptoms as predictors of fear of recurrence in caregivers of pediatric cancer survivors. 54th Congress of the International Society of Pediatric Oncology. September 2022.

Pardue, A. Developing and Implementing a Novel Operating Room Nurse Residency. Association for Nursing Professional Development Conference. March 2022.

Pardue, A. Operating Room Nurse Residency: Program Development and Implementation to Improve Retention and Satisfaction. Association of PeriOperative Nurses Global Surgical Conference and Expo. March 2022.

Pepper A, Marston A, Kjellin M, Mutz R. Utilization of cascading goals to improve nursing certification rates.

Nursing Research and Psychosocial Services Symposium.

St. Jude Children’s Research Hospital. May 2022.

Ring S, Edwards M, Kuehner T, Davies P, Duncan K, Crews KR, Kornegay NM, Hudson MV, Haidar CE. Integration of patient education by research nurses into a preemptive pharmacogenomics model. Department of Pharmacy and Pharmaceutical Sciences and Oncology, Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital. May 2022.

ST. JUDE NURSING ANNUAL REPORT 2022

Song R, Hwang SN, Goode C, Storment D, Scroggins M, Abramson Z, Hillenbrand CM, Mandrell BN, Krull K, Reddick WE. Assessment of fat fractions of tongues, pharyngeal walls and soft palates by GOOSE and DIXON methods.

International Society for Magnetic Resonance in Medicine.

31st Scientific Meeting. May 2022.

Wynja K, McHenry JM, Alexandrov AW, A novel conceptual model of rehabilitation and reintegrating adolescents following neurological injury or disease. University of Tennessee Health Science Center, Atlantic Brain and Spine Associates, Semmes Murphey Clinic, Nursing Research and Psychosocial Services Symposium. St. Jude Children’s Research Hospital. May 2022.

Publications: Afify, Z, Taj, M., Orjuela-Grimm, M., Srivatsa, K., Miller TP., Edington, HJ., Dalal, M., Robles, J., Ford JB., Ehrhardt MJ., Ureda, T., Rubinstein JD., McCormack, S., Rivers, JM., Chisholm, KM., Kavanaugh, MK., Bukowinski AJ., Friehling ED., Ford MC., Reddy SN., Marks LJ., Smith CM., Mason, CC. “Multicenter study of pediatric Epstein-Barr virusnegative monomorphic post solid organ transplant lymphoproliferative disorders.” Cancer. 2022, 1-10.

Allmon, P, Delaney A, Bourque MA, Canale M, Chiang J, Sabin ND, Upadhyaya SA. Management of refractory hyperandrogenism with BRAF V600E inhibition in a patient with ganglioglioma. Pediatric Blood Cancer.

2022;69(S2): e29735 Goodings-Harris, C., Sahoo, S. S., Lewis, S., Kozyra, E., Arribas-Layton, M., Ramamoorthy, S., Jesudas, R., Gray, N., Erlacher, M., Niemeyer, C., Wlodarski, M. (2022).

Germline SAMD9/9L MDS predisposition syndromes are characterized by complex clonal architecture and lineagespecific escape mechanisms including somatic genetic rescue in T and B lymphocytes. Blood, 140(Supplement 1), 1195–1196. https://doi.org/10.1182/blood-2022-163337 Johnson, LM, Mandrell BN, Li C, Lu Z, Gattuso J, Harrison LW, Mori M, Ouma AA, Pritchard M, HowardSharp K, Nichols KE. Managing pandora’s box: Familial expectations around the return of (future) germline results. AJOB Empir Bioeth. 2022 Jul-Sept; 13(3):152-165. doi: 10.1080/23294515.2022.2063994. PMID: 35471132.

Klages K, Berlin KS, Cook JL, Merchant TE, Wise M, Mandrell BN, Conklin HM, Crabtree VMc. Healthrelated quality of life, obesity, fragmented sleep, fatigue and psychosocial problems among youth with craniopharyngioma. Psychooncology 2022 May; 31(5):779787.doi:10.1002/pon.5862. PMID: 34859518.

Lipsitt, A, Arnold, P, Chi, L, et al. Outcomes of patients who underwent treatment for anti-HLA donorspecific antibodies before receiving a haploidentical hematopoietic cell transplant. Pediatric Blood Cancer.

2022; 69:e29993. https://doi.org/10.1002/pbc.29993 Finding cures. Saving children.

Mandrell BN, Johnson LM, Caples M, Gattuso J, Maciaszek JL, Mostafavi R, Sharpe-Howard K, Nichols KE. Parental preferences surrounding timing and content of consent conversations for clinical germline genetic testing following a child’s new cancer diagnosis. JCO Precis Oncol, 2022, Oct;6:e2200323. doi: 10.1200/PO.22.00323. PMID: 36265116.

McNeil MJ, Kiefer A, Woods C, Barnett B, Berry-Carter K, Clark L, Mandrell BN, Snaman J, Kay EC, Baker JN. You are not alone: Connecting through a bereaved parent mentor program for parents whose child died of cancer. Cancer Med 11(17):3332-3341, 2022. doi: 10.1002/cam4.4696.

PMID: 35362669.

McRorie, C. Derouin, A. (2022). Standardizing Handoff Communication: Evaluation of a standardized communication tool to improve handoff among the pediatric infectious disease team. International Journal of Nursing and Health Care Sciences, 02(11), 157. Okumura, L., Fry, J., Yetman, R., Beach, L., Kristovich, K.M., Boyd, K., Smith, J.A., Stone, S., Shah, A.J., Pinner, L. (2022). Evaluation of Impact of Enteral Nutrition Pathway at a Pediatric Stem Cell Transplant Institution. Transplantation and Cellular Therapy.

Salek M, Woods C, Gattas M, Gattuso J, Mandrell BN, Baker JN, Kaye EC. Multidisciplinary clinical perspectives on embedded palliative oncology models in pediatric cancer.

J Pain Symptom Manage, 2022 Sept; 64(3):222-233. doi: 10.1016/j.jpainsymman.2022.05.019. PMID: 35649459.

Song R, Hwang SN, Goode C, Storment D, Scoggins M, Abramson Z, Hillenbrand CM, Mandrell BN, Krull K, and Reddick WE. Assessment of fat fractions in the tongue, soft palate, pharyngeal wall, and parapharyngeal fat pad by the GOOSE and DIXON methods. Investigative Radiology, Investigative Radiology: 2022 Dec 1:57(12):802809. doi:10.1097/RLI.0000000000000899.

Stone, S. (2022). Advanced Practitioner Society for Hematology and Oncology Cancer Therapy Prescribing Course: “Pediatric Cancer Therapy Prescribing. [Author and Speaker]. Retrieved from: https://apacademy.apsho. org/products/19-pediatric-cancer-therapyprescribing? packages%5B%5D=134226&in_package=134226&sort_ by=package_order&ref=package&ref_id=134226 Tomaszczuk K, Nichols E, Mandrell BN. Redesigning a clinical advancement program to promote and strengthen competencies of clinical nurses. J Nursing Admin, 52(9):462-468, 2022. doi: 10.1097/ NNA.0000000000001183; PMID: 35973194.

Yusuf, S., Hagan, J. L., Stone, S. (2022). A curriculum to improve knowledge and skills of nurse practitioners and physician assistants in the pediatric emergency department. Journal of the American Association of Nurse Practitioners, 34(10), 1116–1125. https://doi.org/10.1097/ JXX.0000000000000771

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