Magnet® Excellence

The NewYork-Presbyterian Lower Manhattan Hospital Department of Nursing is under the direction of Vice President and Chief Nursing Officer (CNO), Joan Halpern (pictured right: center), MS, RNC, NNP. She is responsible for providing strategic vision, direction, and leadership for the Department of Nursing and other clinical departments. As CNO, Ms. Halpern is responsible and accountable for the provision of nursing services 24 hours a day, 7 days a week, and her functions include fiscal planning, resource allocation, staffing, healthy work environment, and employee relations.

Directors of Nursing direct each clinical service line and work with the CNO to plan and coordinate service line activities. Patient Care Directors manage the daily operations of the unit.

In November 2018, Ms. Halpern led a leader rounding process. Nurse leaders round daily on all patients to conduct interviews and manage issues with the patients’ experience in real time. After implementation of the leader rounds and feedback, there was an improvement in the overall star rating of NewYork-Presbyterian Lower Manhattan Hospital for patient experience.

In October 2017, Annie Lu, MS, RN, ANP-BC, BC-ADM, Diabetes Nurse Practitioner, began leading an initiative, in partnership with the NewYork-Presbyterian Quality University, to standardize diabetic ketoacidosis (DKA) dosing guidelines in the intensive care unit (ICU). The American Diabetes Association (2018) recommends standard dosing guidelines for critical care patients on continuous insulin infusions. Previous DKA policies required the ICU clinical nurse to first consult the ICU medical provider every hour to obtain dose adjustments based on point-of-care glucose results. Ms. Lu saw an opportunity to implement an evidence-based protocol to improve patient care.

Ms. Lu partnered with her counterparts at NewYork-Presbyterian/Weill Cornell Medical Center to develop a standardized, nurse-directed DKA protocol for the ICU. The protocol would allow nurses to titrate continuous insulin infusions independently, based on the standardized dosage algorithm. It also included a transition algorithm from intravenous (IV) to subcutaneous insulin.

During November and December 2017, Ms. Lu educated all ICU clinical nurses and providers on the new protocol, which launched in December. Before and after the implementation of the new protocol, Ms. Lu gathered patient-level metrics, including percentage of low glucose results.

The data indicated a decline in hypoglycemia among patients with DKA. Ms. Lu plans to continue data collection to validate if standardized, nurse-driven protocols for continuous insulin infusions demonstrate a statistically significant clinical impact.

In 2018, members of an NYP-LMH Pain Committee, including William Sinnott, MSN, RN, APRN-C, Pain Management Nurse Practitioner, identified a need to improve patient experience scores in the Ambulatory Surgery Unit (ASU) for the question “Did the doctors and nurses make sure you were as comfortable as possible?” Nurses on the Pain Committee collaborated with Warly Remegio, MS, RN-BC, NEA-BC, CCRN-CSC, Program Director for Nursing Professional Development, Beth Taubkin, MS, RN, CPAN, Nurse Educator, Erroll Balingcongan, MSN, CRNA, Certified Registered Nurse Anesthetist, and Anna Krakowski, MS, RN-BC, AGPCNP-BC, ACHPN, CHPN, Palliative Care Nurse Practitioner, to create a continuing education program targeting ASU nurses with an aim to enhance knowledge, skills, and attitudes regarding consistent and effective pain management. The team created the Pain Resource Nurse (PRN) Program, a comprehensive course taken by clinical nurses that covers content including the nurse’s role in pain management, pharmacologic and non-pharmacologic approaches to pain management, and ethical and cultural issues in pain management. Interactive discussions and innovative strategies are employed as teaching methodologies, such as the use of imagery and diagrams, video demonstrations, and interactive game-based learning platforms, with the intention of arming nurses with the knowledge and skills necessary to become a resource for pain management on their unit.

In March 2019, the team hosted its first PRN Program course, which was attended by four ASU clinical nurses. Post-course surveys showed that the nurses had improved their knowledge, skills, and attitudes regarding pain management, and the nurses were confident that they could serve as a resource to other ASU clinical nurses in the management of pain. Following implementation of the PRN Program, there was substantial improvement for the question “Did the doctors and nurses make sure you were as comfortable as possible?” in ASU for three consecutive months.

In 2018, clinical nurses on the 6B Mother/Baby unit identified the need to improve patient satisfaction scores for the question, "When I left the hospital, I had a good understanding of the things I was responsible for in managing my health." On this particular unit, there is a short length of stay, and so clinical nurses have limited time to spend educating new mothers and their family in postpartum and newborn care at home. Barbara Alba, PhD, RN, NEA-BC, Director of Nursing for Maternal-Child Health partnered with clinical nurses, including Mei Fong, MSN, RN, CLC, and Claire Megie, BSN, RNC-OB/MNN, CCE, CLC to develop an innovative solution to help supplement discharge education. The nurses suggested the use of virtual discharge classes that could be conducted daily by a clinical nurse in a room adjacent to the unit, which could be accessed by multiple patients through a live stream on an app installed on an electronic tablet. The nurses developed a script to ensure consistent and standardized content was being delivered, and partnered with IT professionals to allocate the electronic tablets, install the live stream application, and install the audio/visual monitors to film the discharge class. All 6B Mother/Baby clinical nurses were educated on how to deliver the class content, as well as how to assist their patients in accessing the app for the daily live stream. The virtual classes were implemented in September 2018, resulting in improved patient satisfaction scores for the question, "When I left the hospital, I had a good understanding of the things I was responsible for in managing my health."

In March 2019, clinical nurses on the Fall Prevention Committee, including 4C clinical nurses Christopher Kayser, BSN, RN, PCCN and Suzanna Slater, BSN, RN-BC, and Medical-Surgical Clinical Nurse Manager Anyely Campbell, MA, BSN, CMSRN, identified that many of the fall events that were occurring involved patients with Limited English Proficiency (LEP). The clinical nurses discussed how fall prevention education and patient engagement in a fall prevention plan was difficult with LEP patients, even when utilizing an over-the-phone interpreter service. They suggested utilization of a Video Remote Interpreter (VRI) to provide education to patients about fall prevention, and to engage the patients in a plan for fall prevention, since the two-way visualization of an interpreter was more effective in explaining fall prevention materials. The nurses also acknowledged that such an intervention was well-aligned with the NYP mission statement of advancing innovative, patient-centered care, and serving the needs of our local community. Lauren Stoerger, MSN, RN, NEA-BC, CCRN, CNRN, Director of Nursing for Medical-Surgical, Critical Care, and Emergency Services, advocated for allocation of funds to purchase VRI machines for two medical-surgical units to trial the process. After developing nursing practice guidelines for utilization of the VRIs in preventing falls, the clinical nurses implemented the intervention in May 2019, and observed a decrease in the number of falls involving LEP patients following implementation.

Publications

Carter, E.J., Greendyke, W.G., Furuya, E.Y., Srinivasan, A., Shelley, A.N., Bothra, A., & Larson, E.L. (2018). Exploring the nurses’ role in antibiotic stewardship: A multisite qualitative study on nurses and infection preventionists. American Journal of Infection Control, 46(5),492-97.

Kenny, P., Kirton, C.A., Krakowski, A., & Sherman, D.W. (2018). Palliative care and HIV/AIDS. In Palliative Care Nursing: Quality Care to the End of Life. (5th ed.) New York: Springer Publishing Company, LLC.

2018 Awards and Recognition

Schwartz Center 2018 Compassionate Caregiver Award Finalist
Emergency Department, NewYork-Presbyterian Lower Manhattan Hospital

Warly Remegio, MS, RN-BC, NEA-BC, CCRN-CSC
2018 Excellence Award in Nursing Education
Philippine Nurses Association of New York, Inc.

Podium Presentations

Ama Mathewos, MPA, BSN, RN, NEA-BC, Alexa Shelley, MS, RN-BC, FNP-BC; Grace Shyh, PharmD, BCPS, BCACP. Interprofessional collaboration to enhance antimicrobial stewardship. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Annie Lu, MS, RN, ANP-BC, BC-ADM. Nurses collaborating to improve patient outcomes. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Christopher Otto, BSN, RN. Transitioning to nursing practice. April 2018: Chi Eta Phi Annual Regional Conference, Pittsburgh, PA.

Eileen Carter, PhD, RN; Alexa Shelley, MS, RN-BC, FNP-BC. Lessons learned: Engaging nurses to foster a culture of inquiry through qualitative methods. March 2018: New York Association of Nurse Executives and Leaders (NYONEL) Annual Conference, Westchester, NY.

Warly Remegio, MS, RN-BC, NEA-BC, CCRN-CSC; Diana Alemar, MSN, RN-BC, NEA-BC, CNL. The tale of all this time: The magic of orientation redesign. July 2018: Association of Nursing Professional Development National Convention, Lake Buena Vista, FL.

Warly Remegio, MS, RN-BC, NEA-BC, CCRN-CSC. Clinical nurses level of psychological empowerment and factors that influence their decision to join professional organizations. July 2018: Philippine Nurses Association of America National Convention, Jersey City, NJ.

Poster Presentations

Alexa Shelley, MS, RN-BC, FNP-BC; Jessica O’Brien, MS, RN, AGCNS-BC, PCCN; Lauren Stoerger, MSN, RN, CCRN, CNRN; Kevin Xuereb, MSN, MSEd, RN, CCRN, ACCNS-AG; Ann Marie Lanza-Bisciello, MSN, RN-BC, CWOCN; Anne Cummings, BNS, RN, CAPA; Natasha Kendrioski, BSN, RN, CCRN; Denise King, MSN, RN, CAPA; Carolyn Sun, PhD, RN, ANP-BC. Cultural competency addition to registered nurses’ existing education at NewYork-Presbyterian Lower Manhattan Hospital: A randomized controlled trial. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Anna Krakowski, MS, RN-BC, AGPCNP-BC, ACHPN, CHPN; Warly Remegio, MS, RN-BC, NEA-BC, CCRN-CSC. Addressing the palliative care education needs among clinical nurses at NewYork-Presbyterian. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Annie Lu, MS, RN, ANP-BC, BC-ADM; Warly Remegio, RN,RN-BC, NEA-BC, CCRN-CSC. Improving diabetes care through education and mentorship. July 2018: Association for Nursing Professional Development Annual Convention, Lake Buena Vista, FL.

Eileen J. Carter, PhD, RN; Alexandra Shelley, MS, RN-BC, FNP-BC; Rita Olans, DNP, CPNP, APRN-BC; Joanna Goldberg, MSLIS; David Calfee, MD, MS; Elaine Larson, PhD, RN, CIC. Interventions to enhance clinical nurse partnership in acute care and nursing home (NH) antibiotic stewardship: A scoping review. October 2018: IDWeek, San Francisco, CA.

Esteen Ladson Barnes, DNP, MPA, RN, CCRN, NEA-BC. Moral distress in critical care: Debriefings, does it help? November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Jessica O’Brien, MS, RN, AGCNS-BC, PCCN; Kevin Xuereb, MSN, MSEd, RN, ACCNS-AG, CCRN; Lauren Stoerger, MSN, RN, NEA-BC, CCRN, CNRN; Carolyn Sun, PhD, RN, ANP-BC. Bedside shift report and hourly rounding by nurses. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

Katrina St. Claire, BSN, RN, CLC; Carolyn Sun, PhD, RN, ANP-BC. Neonatal intensive care unit discharge planning. November 2018: Ninth Annual NewYork-Presbyterian Nursing Research, Evidence-Based Practice, and Innovation Symposium, New York, NY.

William Greendyke, MD; Alexandra Shelley, MS, RN-BC, FNP-BC; Philip Zachariah, MD, MS; E. Yoko Furuya, MD, MS; Eileen J. Carter, PhD. Barriers and facilitators to bedside nursing involvement in antibiotic stewardship: Multisite qualitative study of prescribers. October 2018: IDWeek, San Francisco, CA.