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NewYork-Presbyterian Morgan Stanley Children's Hospital

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NewYork-Presbyterian Morgan Stanley Children’s Hospital was founded as Babies Hospital in 1887 by five female physicians with a 30-bed capacity. It was one of the first nurseries for premature infants, caring for infants and children up to age three who, primarily, were economically disadvantaged. Many groundbreaking medical and technical innovations developed at Babies Hospital during its early years are still widely used today. These include the first incubators for premature babies in the United States; the Apgar score, which remains the international standard for assessing newborn health; and the sweat test for diagnosing cystic fibrosis.

In the early 1880s, Babies Hospital established a relationship with Columbia University's College of Physicians and Surgeons. In 1900, the Rockefeller family funded the construction of a new Babies Hospital, a 10-story building located on the hospital’s original site at Lexington Avenue and 55th Street. In 1929, Babies Hospital moved to Upper Manhattan to become part of the then Columbia-Presbyterian Medical Center. It expanded to 190 beds and began treating patients up to 12 years old.

In 2003, a new 269-bed children's hospital opened on the NewYork-Presbyterian/Columbia University Medical Center campus. Babies Hospital was renamed NewYork-Presbyterian Morgan Stanley Children's Hospital in honor of the Morgan Stanley corporation, which donated the lead gift to build the new hospital.

Today, NewYork-Presbyterian Morgan Stanley Children’s is one of the largest providers of children’s health services in the tri-state area. It is a major international referral center serving infants to young adults age 21 in every area of pediatrics, including complex neonatal and critical care, and all pediatric subspecialties. NewYork-Presbyterian Morgan Stanley Children’s also houses the obstetrical service (formerly Sloane Hospital for Women).

2022 Measures of Distinction

45%

National Board Certification Rate

97%

Percent of RNs with BSN and Higher Degrees

64

Newly Obtained National Board Certification

31

Formal Degrees Conferred

3

Nursing Research Studies Completed

6

Nursing Research Studies in Progress

3

Professional Publication(s)

3

Podium Presentation(s)

8

Poster Presentation(s)

Contributions of Nurses

Ensuring the safe delivery of a newborn requires a team approach. Due to the complex and rapidly changing timeline during this phase of care, communication about medicines has been a challenging domain related to improvements in the patient experience. Patients receive pre- and postpartum medications with a myriad of side effects, which make it difficult for patients to focus on education for long periods of time. 
Consequently, the labor and delivery and postpartum teams, led by Esther Schiavello, MSN, RN, C-EFM, and Ugochi Chukwuocha, MPA, RN-CBC, developed medication cards that could be used for short periods of time when team members are with their patients. The medication cards are highlighted regarding any medications administered by our anesthesiology partners prior to going into the delivery and operating rooms. The medication cards are also used during nurse leader rounds to ensure adherence to the practice and serve as a reminder for patients and loved ones to refer to this resource. 
There was a 20 percent increase in patient experience HCAHPS top box score regarding communication about medicines.  Nurse leaders continue to stress this best practice by reading patient comments, sharing feedback, and reviewing patient experience scores at team meetings and huddles. 

The Patient Safety and Quality Council led by Quennie Ramos-Niza, BSN, RN, and Peggy Quinn, MPH, BSN, RN, CPHQ, NEA-BC, Director of Nursing Quality, restructured their council and meetings to improve engagement and accountability for quality and patient safety (QPS) goals. 
NewYork-Presbyterian Morgan Stanley Children’s Hospital Bernadette Khan, DNP, RN, NEA-BC Group Vice President and Chief Nursing Officer Individual unit-based champions were identified for each goal: C. diff, CAUTI, CLABSI, elopement, barcoded medication administration, HAPI reduction, and falls reduction. During the council meetings, breakout rooms for each goal were created with Zoom to facilitate focused discussions. For each goal, the team held brainstorming sessions on how they would meet their quality and patient safety goals while discussing barriers and innovations for improvement. Action plans were created for each of the goals and reported out to the full Patient Safety and Quality Council. 
By utilizing this breakout method, the Patient Safety and Quality Council teams achieved their  QPS goals and increased engagement and participation at council meetings. 

Pediatric patients often require multiple intravenous access points to safely and effectively manage their care. Children are vulnerable to skin breakdown due to their fragility and complex care needs in the acute care setting. The vascular access team noticed that patients were experiencing skin breakdown and pressure injuries related to the intravenous access catheter hubs. To address this, wound ostomy care nurses and frontline clinical nurses developed a solution with Mepilex absorbent foam dressings, which are placed under catheter hubs to reduce and relieve pressure on a patient’s skin. 

Following implementation of the new practice by the vascular access team, pressure injuries related to intravenous catheter placement were reduced by 100 percent. Next steps include collaboration with perianesthesia and emergency department teams and expanding the protocol hospital-wide. 

Due to medical complications, a 16-year-old patient became ineligible for a second heart transplant and required an immediate life-saving intervention. This demand for innovation led NewYork-Presbyterian Morgan Stanley Children’s Hospital Perioperative and Critical Care teams to implant the first artificial heart in the Northeastern United States. This groundbreaking procedure involved countless learning initiatives and innovations. Among the innovations, nurses on the Pediatric Cardiac Intensive Care Unit partnered with Nursing Informatics to create an Epic flow sheet to appropriately and safely document the care related to the novel artificial heart provided for this patient. 
 
A young adult’s life was saved, and groundbreaking care modalities were created. New workflows, educational processes, protocols, and inter-team reliabilities have been solidified through this exciting and evolving venture.

Bernadette Khan with nurses at NYP Morgan Stanley Children's Hospital
Bernadette Khan

Bernadette Khan, DNP, RN, NEA-BC, Vice President and Chief Nursing Officer, led a NewYork-Presbyterian Morgan Stanley Children’s Hospital strategic initiative based on a Code Lavender model to change the organization’s approach to supporting employees. Dr. Khan’s transformational leadership on this strategic initiative changed the organization’s structures and processes for supporting the wellbeing of all employees across all departments. It became known as NewYork-Presbyterian Source of Support (NYP SOS).

Dr. Khan formed an interprofessional committee and led them to devise the following workflow for the NYP SOS program:

  1. An employee experiences an event that triggers the need for support. Examples of events that may cause distress or psychological harm include patient death, code, trauma, stress, errors, safety event, patient/family conflict, team conflict, among others.
  2. An employee activates NYP SOS by texting “CHONY SOS” and their location to a designated number from their mobile work device. The information is relayed to a trained first responder.

A trained first responder goes to the employee’s location and has a therapeutic discussion with those involved and connects those in need with resources, depending upon their preferences. Trained responders offer the employee(s) a “menu” of sources of support resources, including Workforce Health and Safety, Occupational Psychiatry, NYPBeHealthy, Healthy Mind NYP, Music Therapy, and Grief Group.

Nurses chatting at cart

The clinical nurses on the 11C Pediatric Intensive Care Unit (PICU) serve as financial stewards. During a January 2019 financial stewardship huddle, PICU clinical nurses Lydia Carson, BSN, RN, CCRN, CPEN, and Emily Williams, BSN, RN, CCRN, believed that standardizing bedside supply carts would prove cost-effective and be a resourceful way improve the nursing environment by ensuring that the necessary supplies that nurses needed would always be available and decrease wasted supplies.

&Ms. Carson and Ms. Williams surveyed the 11 C PICU clinical nurses for suggestions on which supplies were most needed in bedside supply carts. Analysis of the survey results indicated that numerous supplies were deemed nonessential and frequently left unused and then discarded once the patient was transferred or discharged. Ms. Carson and Ms. Williams developed a new supply cart content list of essential supplies based on the survey results. They created a visual aid with pictures of the stocked items, the quantity, and the location of the supplies for nursing assistants stocking the carts. Ms. Carson, Ms. Williams, Mrs. Sobin, and Mrs. Malone educated clinical nurses and nursing assistants on the contents of the new carts, the costs of supplies, and how to properly dispose of supplies after a patient is discharged.

This project was successful in reducing supply expenditures in the months following the project while ensuring adequate supplies were available for nurses when they needed them to improve the nurse practice environment.

NewYork-Presbyterian Morgan Stanley Children’s Hospital fosters a culture of learning, including promoting continuing education and the achievement of higher levels of education in nursing. To maintain a target of 80% of nurses having a Bachelor of Science in Nursing (BSN), two primary strategies were undertaken:

  1. Promoting educational opportunities and encouraging nurses without a BSN to enroll in a BSN program.
  2. Hiring only nurses who have a BSN degree.

To achieve this goal, strategies included:

  • Increased tuition reimbursement and prepayment options
  • Maintaining school affiliations
  • Continuing to partner with schools that offer financial discounts to NewYork-Presbyterian nurses
  • Frequent communication about reimbursement programs and professional development opportunities
  • Maintaining the mentoring program for students with scholarly projects

In 2019, NewYork-Presbyterian Morgan Stanley Children’s Hospital exceeded the goal and continues to encourage and support nurses furthering their education in nursing.

The professional practice model (PPM) describes the role of the NewYork-Presbyterian Morgan Stanley Children’s Hospital professional nurses, and how nursing is practiced in a culture of excellence, safety, and patient- and family-centered care. The components of the PPM include advocacy, autonomy, collaboration, evidence-based practice, and professional development.

In July 2018, Kamila Sahadeo, BSN, RN, CPN, Clinical Nurse, 4N Post-anesthesia Care Unit (PACU), and Mary “Jackie” Yeosock, BSN, RN, Clinical Nurse, 4N PACU, formed a partnership to seek professional development and advancement through the NewYork-Presbyterian Morgan Stanley Children’s Hospital’s Clinical Ladder program. The Clinical Ladder program provides a method for professional registered nurses to advance in clinical practice while maintaining contact with patients. For their project, Ms. Sahadeo and Ms. Yeosock sought opportunities to improve the patient experience in the 4N PACU and reviewed the perceptions of patients on the nursing care they were provided, and committed to personal, clinical, and scholarly growth to optimize the patient experience related to how nurses respond to patient complaints and concerns.

Ms. Sahadeo and Ms. Yeosock conducted a literature search of scholarly articles and reviewed tools used by other healthcare facilities aimed at improving the patient experience. They decided to develop a checklist of evidence-based practices to ensure all nurses and employees provided consistent, patient- and family-centered care. The checklist included:

  • Patient and family greetings from clinical nurses upon arrival to the unit
  • Rounding on patients by the charge nurse and leadership team who provided timely updates and were available to answer any questions
  • Ensuring food and drinks were available to families
  • Involvement of child life specialists as needed
  • Parents being present when the patient received anesthesia as indicated
  • Noise level kept to a minimum on the unit
  • Thank you cards written by the healthcare team, including nurses, and mailed to patients upon discharge
  • Post-operative discharge calls conducted by nurses

Ms. Sahadeo and Ms. Yeosock presented the checklist to the entire 4N PACU healthcare team, gained buy-in, and used audits to review compliance. As a result, patient experience scores improved in the months following the project. The 4N PACU continues to use the checklist to ensure a positive experience for both patients and families who undergo procedures at NewYork-Presbyterian Morgan Stanley Children’s.

Principal Investigator: Lenka Hellerova, MS, RN

Lenka Hellerova

Investigators: Peter Dayan, MD; Maureen George, PhD, RN, AE-C, FAAN

Research Coordinators: Ariana Gonzalez, Julie Ochs, Marc Vindas

NewYork-Presbyterian Morgan Stanley Children’s Hospital Emergency Department (ED) provides care to an ethnically diverse and vulnerable population who seek mental health care during crises. The primary caregivers of young people are conduits to ensuring treatment and follow up care. The emergency department clinicians sought to first understand the perceptions, beliefs, and attitudes about mental health and mental illness of these caregivers. The primary aim was to explore:

  • Caregivers’ perceptions about mental health and mental illness, specifically depression and suicidality
  • Their perceptions of mental illness as it relates to their child
  • The impact their child’s illness has had on them
  • Their perceived barriers and facilitators to treatment for their children

The exploratory aim was to measure the caregivers’ health and mental health literacy to understand the potential relationship between these two constructs. Together, these data would help to identify targets for future intervention development and measurement needs to facilitate caregiver's understanding of and ability to actively participate in the care of their child with mental health needs. A convenience sample of English speaking primary caregivers of youth who: are 6-17 years old, live within the five boroughs of New York City, are medically stable, have no major comorbidities, and live with the primary caregiver at least 60% of the time were included in this study. Semi-structured interviews were coded independently by two coders and audited by a third.

  • The categories that emerged from content analysis were:
  • Caregivers’ definitions of mental health, depression, and suicidality
  • Perceived causes of mental illness in their child; difficulties in identification of mental illness in their child
  • The impact of the child’s illness on the caregiver
  • A complex network of communication which led to the child’s ED visit; and barriers and facilitators to treatment

Study results highlight that mental health/illness is a complex issue for caregivers and that negative cultural beliefs and stigmatizing terminology such as “crazy” and “slow” were present among many caregivers, reinforcing previous findings that mental illness is often viewed negatively and often not discussed openly. Study findings underscore the need to proactively address the attitudes and knowledge of caregivers that may present obstacles to caring for children with depression and suicidal ideations. Based on these study findings, further studies on culturally-appropriate interventions are recommended to address the mental health knowledge and attitudes of caregivers whose children present to the children’s ED with mental health needs.

Publications

Carson, L. (2019). Stigma associated with opioid use disorders in adolescents limits naloxone prescribing. Journal of Pediatric Nursing, 49, 92-96.

2019 Awards and Recognition

2019 Distinguished CPEN Award
Board of Certification for Emergency Nursing
Cara Szeglin, BSN, RN, CPEN
Emergency Department

Podium Presentations

Lisa Manente, BSN, RN, CPN; Lisa Murray, BSN, RN, CPN; Terri McCluskey, MSN/ED, MS, RN, FNP-BC, CPN.Silence is Golden: Reducing Alarm Fatigue While Using Appropriate Telemetry Monitoring. October 2019: Northeast Pediatric Cardiology Nurses Association Conference: Pediatric Cardiology Nurses – At The Heart of It, Washington, DC.

Terri L. McCluskey, MSN/ED, MS, RN, FNP-BC CPN; Sandra McGill-Lane, MS, RN, FNP, CCRN, CNS.Utilizing Simulation for Maintaining Pediatric Ventricular Assist Devices Competency of the Bedside Nurse: Re-development of an Education Program. October 2019: Northeast Pediatric Cardiology Nurses Association Conference: Pediatric Cardiology Nurses – At The Heart of It, Washington, DC.

Poster Presentations

Philip DeSena, BSN, RN, CPN; Jessica Valla, BSN, RN, CPN.Improving Patient Satisfaction with the Utilization of a Communication Tool. December 2019: NewYork-Presbyterian Morgan Stanley Children’s Hospital Evidence-Based Practice Nursing Poster Symposium, New York, NY.

Glenda Ebron, BSN, RN; Sandra McGill-Lane, MS, RN, FNP, CCRN, CNS; Gloria Gomez, MS, RN, FNP.Go with the Flow: A Nurse Driven Interdisciplinary Initiative to “Demand Exceeds Capacity” Challenges in the PCICU. February 2019: Cardiology 2019: Annual Update on Pediatric and Congenital Cardiovascular Disease, Huntington Beach, CA.

Adriana Koziakova, DNP, RN, CLC.Improving the Knowledge and Skills of Nurses in Car Seat Safety: Comparative Effectiveness of Educational Approaches. December 2019: NewYork-Presbyterian Morgan Stanley Children’s Hospital Evidence-Based Practice Nursing Poster Symposium, New York, NY.

Terri L. McCluskey, MSN/ED, MS, RN, FNP-BC CPN; Sandra McGill-Lane, MS, RN, FNP, CCRN, CNS.Use of Simulation in Maintaining Competency with Pediatric Ventricular Assist Devices for Bedside Nurses. February 2019: Cardiology 2019: Annual Update on Pediatric and Congenital Cardiovascular Disease Conference, Huntington Beach, CA.

Sandra McGill-Lane, MS, RN, FNP, CCRN, CNS; Terri McCluskey, MSN/ED, MS, FNP-BC, RN, CPN.Maintaining Competency with Pediatric Ventricular Assist Devices Utilizing Simulation. February 2019: Cardiology 2019: Annual Update on Pediatric and Congenital Cardiovascular Disease, Huntington Beach, CA.

Astin Sacci, BSN, RN, CCRN; Lilia Coutinho, BSN, RN, CCRN; Antoinette Bernardo, BSN, RN, CCRN; Sandra McGill-Lane, MS, RN, FNP, CCRN, CNS.A Case Review: The Implantation of a BiVAD Impella in a Pediatric Patient with Severe Clinical Heart Transplant Rejection. October 2019: Northeast Pediatric Cardiology Nurses Association (NPCNA) Annual Conference, Washington, DC.