Traditions Summer 2011

In This Issue:

• Miriam Nursing – After Dark

• The Meaning of Magnet: Conversing with The Miriam’s Nursing Leaders

• Student Athletes Score
  for Cancer Research
  at The Miriam

• Words of Gratitude

Miriam Nursing – After Dark

Exceptional care and teamwork continues every hour of the day and night.

At the end of a long day, while The Miriam’s daytime nurses prepare to head home, Chris Tucci, BSN, RN-BC, arrives at work for the overnight shift of 7 p.m. to 7 a.m.

At 7:15, he gets reports from the outgoing nurse about the patients’ histories and conditions. “When I meet the patients, I can see where they’ve been and where they’re going,” says Tucci, who started at The Miriam in 2006 as a collegiate nurse intern before taking a nursing position in 2008.

Tucci works primarily on a surgical unit that has many postoperative patients who require increased monitoring overnight. After meeting and assessing his patients, he performs procedures such as dressing changes and blood draws, gives any prescribed medications, and monitors lab values before settling patients in bed for the night. Other important duties include monitoring the past 24-hour fluid balance, collaborating with physicians and documenting the patient’s progress in the electronic medical record.

 Tucci’s morning routine starts early in the new day: “A lot of the surgical teams round at about 5 or 5:30 in the morning, so that’s when they start waking up patients, assessing their vital signs and giving early medications. It’s a long night, but it’s enjoyable.”

People sometimes suppose that the night shift is not as involved in the operations or the overall culture of the hospital as the day shift. However, says Maria Ducharme, MS, RN, NE-BC, senior vice president, patient care services, and chief nursing officer, “Chris, like many of his peers, has taken—and excelled at—opportunities offered in many areas. At The Miriam, our nurses give it their all, no matter the time of day or night. They care, and they do whatever it takes.”

“At The Miriam, our nurses give it their all, no matter the time of day or night. They care, and they do whatever it takes.” -- Maria Ducharme, MS, RN, NE-BC, senior vice president, patient care services, and chief nursing officer

For instance, Tucci co-chairs The Miriam’s clinical informatics committee, which meets monthly to discuss ways that nurses can improve patient care and safety through the use of information technology. He helped design, test and implement The Miriam’s new clinical documentation system as well as the electronic medical record system. He has also trained other staff members to use these systems. “Just being involved opens many avenues to represent the bedside nurse in the greater picture, which has benefited me and the rest of the nurses here,” he says. “But, for me, it all comes back to delivering the best patient care I can.”

Recently, Tucci cared for an elderly orthopedic patient who wasn’t eating or sleeping much. Since there are no meals overnight, he relied on the daytime nurses to work to improve her nutrition while they relied on him to help her sleep by decreasing noise and distractions. “Working together, we had a good outcome after a long journey. Collaboration between the two shifts is very common—you can’t have one without the other.”

Maria Ducharme adds, “Chris’s experience highlights how important the individualized care plan—including sleep, rest and pain control at night—is for each patient because, otherwise, they are not going to be able to do all the essential things we want them to do during the day.”

The Meaning of Magnet:

Conversing with The Miriam’s Nursing Leaders

Here Maria Ducharme, MS, RN, NE-BC, senior vice president, patient care services, and chief nursing officer, and Karen Joost, MS, RN, director of inpatient nursing and respiratory care, share their insights on what it means for The Miriam Hospital to have received and maintained since 1998 the Magnet Award for Nursing Excellence, the highest level of recognition that the American Nurses Credentialing Center can accord to organized nursing services. We are the fourth hospital in the world to receive this award four consecutive times.

Ducharme: The standards of nursing excellence are well embedded in The Miriam Hospital. Magnet status puts nurses in a position to be autonomous and gives them the platform as coordinators of care to work collegially and collaboratively with other health care professionals.

Joost: We have so many nurse-driven examples of how we’ve changed practice and improved outcomes. One example is our oral care protocol, which has significantly decreased our ventilatorassociated pneumonias. That protocol, which came from a staff nurse’s recommendation, is now being modeled in other hospitals.

Ducharme: It’s about creating and sustaining an environment that supports inquiry, autonomy and collaboration— where we all make the best decisions for our patients. It’s about being able to take risks to advocate for patients. If nurses think they’re going to be punished if they make an error, or that they don’t work
in a collaborative environment, they’re going to be less apt to take risks for their patients.

Student Athletes Score for Cancer Research at The Miriam

Dear Dr. Timothy J. Babineau,

I would like to thank you and your staff for making a difficult time easier for my husband and me. For more than a month, my husband’s vision had gone gray on numerous occasions.He also had severe headaches and developed a whooshing sensation in his ears.

Dr. Asa at South County Eye Physicians sent us to The Miriam Hospital's emergency department on finding that my husband's optic nerve was swollen and his eyes were hemorrhaging. The emergency department staff was wonderful—from the doctors and nurses to the transporters and the MRI technician. Since it was very late on a Friday night and winter weather caused black ice on the roads, the staff arranged for me to spend the night in my husband’s room.

The next day, one nurse, Cindy, made us feel like family, like we were the most important people to her. She knew I had many questions for Dr. Marcoux, so she got me a pen and paper and made sure he was given my list of questions.

Even the cafeteria staff helped out. I am gluten intolerant, and as soon as I mentioned this, they set me right up with foods I could eat and made nice replacements for me.

On Sunday, my husband had a lumbar puncture, and within an hour Dr. Zayas told us he had idiopathic intracranial hypertension. Another nurse, Kimberly, helped us through the discharge process and made sure my husband’s medication was available at our pharmacy.

As we left The Miriam, I noticed that my husband’s primary care physician’s picture was on the wall for receiving an award of excellence.

Thank you for having so many talented and gifted people in your hospital.

Sincerely,
Linda and Steven Markhart
Richmond, Rhode Island
LSMC