NursingSUMMER 2007

A Publication for a Community of Exceptional Nurses Engaged in Extraordinary Practice

pRogRESS notES

Continued on page 4

The recent grand rounds included a series of skits in which the Nursing Ethics acting troupe portrayed a patient, her daughter, a clinical nurse, an advanced practice nurse and a physician. In the skits, “windows of

opportunity” for communication were repeatedly opened, then closed:

• The patient asked the physician what would happen if her treatment didn’t work. The physician told her “it will work,” rather than discussing a possible Plan B or Plan C.

• The clinical nurse and then the APN attempted to open a dialogue with the physician on the patient’s behalf, but the physician deflected the discussion.

• The patient expressed a growing fear that she would “end up on a breathing machine,” but the care team refrained from discussing end-of-life issues based on the physician’s directions.

The final vignette portrayed how it might have looked had the patient care team taken advantage of those opportunities for communication, and how early and honest discussion, reflective listening and attention to and respect for the patient’s feelings and desires can best serve our patients, regardless of where they are in their treatment or recovery.

was the theme for the second annual Nursing Ethics Grand Rounds, which took place on May 11 during Nurses’ Week.

Wait a minute—Crime Scene Investigation? Actually, in this case CSI stands for Communicating Sensitive Information, which is at the heart of what the Clinical Ethics Committee (CEC) and its subgroup, the Nursing Ethics Task Force, are all about.

M. D. AnDersonCommunication Wave Hits Hospital Nursing Ethics Task Force Responsible

3Joyce Neumann poses as Horatio Caine from the television show CSI: Miami. Neumann is a nurse member of the Clinical Ethics Committee, and director of the Bone Marrow Transplantation program.

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Nursing Excellencein Advanced Practice Nursing

2NURSING PROGRESS NOTES

Dear colleagues,

You – our nurses – support and contribute to M. D. Anderson’s mission at every level and in myriad roles across the institution. M. D. Anderson could not have achieved, nor could it maintain, its international distinction as a premier cancer hospital were it not for its exceptional nurses.

Just getting the job done is not nearly enough – and nobody knows that better than M. D. Anderson nurses. It’s about the dedication, the passion and the commitment to excellence that you bring to your work every day.

At the 3rd Annual Nursing Excellence Awards, we proudly recognized outstanding nurses in seven categories that represent the breadth and diversity of nursing practice at M. D. Anderson. Nursing professionals from research, advanced practice nursing, education and leadership were honored, along with licensed vocational nurses and clinical nurses from the inpatient and outpatient settings.

Each of you plays a critical role in enhancing the excellence, value, safety and efficiency of our patient care. Whoever you are, no matter what you are doing, you have the power to achieve some kind of excellence.

Thank you for your ongoing commitment to excellence.

Barbara Summers, Ph.D., RN Vice President and Chief Nursing Officer

A Message FroM our

Chief Nursing Officer

Excellence in LeadershipMariamma Babu, clinical nurse, nursing-p5, says she wants to retire knowing she has helped to make M. D. Anderson a better place.

Other finalists:Jandelaria Alim, nursing-p10 nancy tomczak, nursing-g11 Cristina Zita, nursing-p9

The Stephanie perez Award for Excellence in Clinical practice

Stella Dike, clinical nurse, nursing-g10 East, is dedicated to education, and demonstrates that nurses can affect change in others’ lives, even if they have to cross an ocean and a continent to do so.

Other finalistsJandelaria Alim, nursing-p10Julia Sarkar, nursing-p10Valsamma Varghese, nursing-p4

The stars came out

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3SUMMER • 2007

Excellence in Clinical practice - outpatient Setting Loven Panes, clinical nurse, AtC-Bed/Chair Unit, thinks fast on his feet, and his patients love him. A typical phrase heard on his unit is, “I don’t mind waiting, as long as I have him as my nurse.”

Other finalists: Linda Brack-Madison, Internal Medicine Center; teresa Bryant, Melanoma & Skin Center

Excellence in Clinical practice - LVnSandra Stephens, vocational nurse, gynecologic oncology Center, works hard at making the patient experience flow smoothly prior to all procedures and ensures that consents have been signed and the patient has received education.

Other finalists: Carolina Cua, Lymphoma/Myeloma

Excellence in Advanced practice nursingMary Lou Warren, advanced practice nurse, nursing Service-Critical Care Unit, has been actively involved with the End-of-Life Committee and is developing a plan with the Clinical Safety and Effectiveness group to support our end-of-life patients.

Other finalist: Curtin Kimberly, CCU

Excellence in EducationMary Ann Rapp, clinical nurse, nursing-p10, is fascinated with teaching novice nurses and nursing students until they become independent and can function on their own.

Other finalists: Vlasta Aubrecht, nursing-p4

The stars came out for 3rd Annual Nursing Excellence Awards

Laurie Hughes, advanced practice nurse, Surgical oncology, was the 21st recipient of the Arceneaux

award. the award, considered one of the most prestigious given at the institution, was presented June 19.

Hughes says she “chooses to call M. D. Anderson home because of the patients, the staff and the unparalleled support for

the patients and their families in the healing process associated with this often deadly disease.”

Excellence in Clinical trials - ResearchDonna Branham, senior research nurse, gynecologic oncology, will assist at M. D. Anderson España, teaching our international nurse colleagues the basics of clinical trial management and data collection.

Other finalists: ganene Steinhaus, thoracic/Head & neck; terri Warren, DoCM phase I

Ethel Fleming ArceneauxOutstanding Nurse –Oncologist Award

4NURSING PROGRESS NOTES

Ethics (continued from page 1)

Nurses unaware or fearing retributionthe nursing Ethics task Force formed two years ago to address the problem of steadily declining numbers of nurses calling for and participating in ethics consults. Kathleen Shannon-McAdams, an advanced practice nurse in Lymphoma, co-chairs the committee with Colleen Jernigan, clinical administrative director, Sarcoma Center. When they initially polled nurses about their perceptions and experiences with ethics consults, they found that many of them:

• Did not know how to contact the service

• Feared conflict with physicians, nurse colleagues or nurse managers

• Lacked knowledge of ethical issues• Were unaware that they could call a consult

The action planSeveral interventions were developed to increase awareness of CEC services, educate nurses about ethical principles and empower nurses to advocate for patients:

Education on the unit level nursing CEC members connected with nurses on the units, first through meetings to familiarize the nurses with the service. Focus groups and open door sessions were formed to support nurses and talk about their ethical concerns. “oncology nurses are faced with tough ethical challenges involving patient care,” says Shannon-McAdams. “the nursing Ethics task Force realizes that nurses may need assistance in ethical decision making, and M. D. Anderson supports them through this process.” to maintain the connection, CEC members visit the units monthly to talk with nurses, ask how they’re doing, if they have questions, etc., and serve as resources.

Grand rounds nursing Ethics grand rounds is presented biannually; the inaugural event was in october 2006, the second in May 2007.

Ethics Corner By the end of this year, nurses will be able to anonymously submit questions to the CEC online.

Nursing orientation nurses now receive an hour of ethics instruction as part of nursing orientation. the CEC has suggested this material be presented in an expanded format about a month after initial orientation.

Unit ethics rounds Ethics rounds are given monthly in the Intensive Care Unit and in Stem Cell transplant. nursing ethics rounds started in Lymphoma in July. the CEC hopes to see the practice eventually spread to other areas.

Nurses helping nursesWhen asked if things had changed over the past two years, Shannon-McAdams says she can only comment on what she’s observed in the Lymphoma service. “nurses are very comfortable in the patient advocacy role. they are also more confident in expressing their concerns to the advanced practice nurse, nurse manager or physician. the nurses are talking to physicians about situations, working them out together first. We are moving away from nurses feeling intimidated by a supervisor and are now working together for the good of the patient.”

She says nurses in the CEC are excited about supporting and mentoring new and experienced nurses. “It’s all about nurses helping nurses – what a powerful combination. It is a very exciting and gratifying time to be a nurse at M. D. Anderson.”

Representatives of the Ethics Consultation Service are on call

24 hours a day, seven days a week.

to contact them: telephone (713) 792-8775

page (713) 404-2863

5SUMMER • 2007

“Leading at the bedside and at the point of care is what clinical leadership is all about,” says Jan Keller, director of nursing Workforce Development. Clinical leadership is the core of the Rising Stars program. thirty of our nurses recently completed the year-long program and raved about their experiences.

“It made me think about how I can be a leader and a mentor on a daily basis in my area,” says nicole Luckett, clinical outpatient nurse in the Children’s Cancer Hospital. Luckett also

says it was beneficial to learn and develop professional skills such as putting together poster presentations and abstracts. She says her experience will help her in the years to come as she strives to be a better nurse.

the program includes 12 classes that occur over a year. Each month, Rising Star participants soaked up a different class covering topics such as healing and dying across cultures; systems-thinking simulations; working with powerpoint; publishing professional portfolios; evidence-based practice; giving and receiving feedback; and a field trip to BrainSUItE, our specially designed suite integrating all surgical and diagnostic tools necessary to treat complex neurosurgical cases in one operating room. they also celebrated their new-found network of nurses by participating in social events.

“We tried to cater the classes to the specific needs of the participants through an initial assessment,” says Keller. the first group ended the year wanting more, so a Rising Stars second phase may be in order to fulfill this need.

“It was really awesome to watch the first group dive into the program. We’re excited to see what the new batch of Rising Stars will be like,” says Kelly Meekins, project manager for nursing Workforce Develop-ment. the next group of Rising Stars began in June.

For more information on the Rising Stars program, contact Kelly Meekins, program manager, Nursing Workforce Development, at (713) 792-4280.

Rising staRs pRogRam is developing leadeRship at the bedside

You’ve rifled through your file drawers, leafed through journals, checked

online and even looked through the junk in your car, but you still can’t

quite put your hands on it. Something or someone has prompted you to produce your presentations, publications and accomplishments for the past year. Maybe it was an e-mail from tammy Dawson, program coordinator, asking for information for the next nursing outcomes Report.

Sure, you have the information – you’ve saved every acceptance letter and conference brochure. It’s just not that easy retrieving it.

Well, throw all that paper out the window, kick up your heels and laugh out loud because you are about to witness the end of the I-don’t-have-time-for-excavating-information era.

The Nursing Professional Portfolio will provide an unprecedented means for nurses to tell their stories of development of professional knowledge, skills and competencies, and to record their accomplishments in a format that is easily retrievable.

the portfolio also has important strategic and reporting benefits for nursing. It will provide us – for the first time – with a database to support our need to report the accomplishments of our

learning, then leading—Nancy Tomczak and Debbie Cline practice the skills they learned in the Rising Stars program, which teaches nurses to be leaders.

Portfolio ushers in new (more organized) era

nursing community to the Joint Commission, the American nurses Credentialing Center, and in the annual nursing outcomes Report. It will also assist us in planning for the direction and growth of our nursing team.

It can serve as an import adjunct during the annual performance evaluation, when running for office of a professional organization, when renewing certification and in other professional activities. It will be invaluable to the nurse who is seeking a promotion, a new responsibility in a current position, or a new position.

phase I of the project, in April, was a pilot in Lymphoma. In phase II, later this summer, the portfolio will be rolled out house-wide. the portfolio will be a module in myHR peopleSoft. Initially, there will be two levels of involvement:• Verification that the license, certification and education

information in peopleSoft is complete and accurate• Entry of publications, presentations, professional memberships

and committees – both internal and external

phase III will see new modules go live, including career goals and objectives, employment history, consulting and faculty appointments. Additional functions are planned for Fiscal Year 2008, and may include Web access, the ability to attach documents, an interface with the Education Center and an external continuing education module.

6NURSING PROGRESS NOTES

team player – Rosa Churchwell, clinical nurse, Main OR Nursing, has worked at M. D. Anderson for 25 years, and says the one thing that has never changed is the sense of teamwork in the group.

Carla Willis has a clear vision for the future of nursing within the perioperative Enterprise. “I hope to offer

our nurses a variety of ways to be leaders in our specialized field,” says the director of perioperative Enterprise Services, Main oR nursing.

Her vision is supported by a team of strong nurse managers and staff. the nurses have a long menu of leadership opportunities to choose from including sitting on panels to hire their colleagues and managers, participating in process improvement teams, working on clinical practice teams and educating colleagues.

they’ve formed a leadership council to organize many of their projects, processes and programs. the council extends into five different teams: clinical practice, education, retention and satisfaction, resource management

and regulatory compliance. these teams, comprising nurses from the Main Building and Mays Clinic operat-ing rooms, have sub-groups covering the multitude of issues that come up

in nursing. For example, there are plans for the retention and satisfaction team to look into a mentor program and event planning for the staff, and for the resource management team to look into instrument reduction, product evalua-tions and waste reduction initiatives.

“Sometimes it’s hard to believe all of this is going on while we’re running more than 25 operating rooms. But it’s exciting to see the vision for nursing coming to life as we work on all the

Hustle and Bustle:

Keeping up with leadership opportunities in perioperative nursingprojects,” says Michelle Edelbrock, nurse manager, Main oR nursing. Edelbrock has been with perioperative Enterprise for more than a year, but brings more than 30 years of operating room experience to the nursing management team. She’s involved in a number of teams on the council and other projects such as the Joint Commission ongoing Readiness team.

Longevity and experience are attributes of nurses who work in the

operating rooms. Rosa Churchwell, clinical nurse, Main oR nursing, has been in and around operations here at M. D. Anderson for 25 years and still has an appreciation for her work and colleagues. “I love that I can still ask someone about something I don’t know and get an answer. I can answer a couple of questions too,” she says with a smile. Churchwell advocates her inquisitive side to the less experienced nurses, too. “All you have to do is ask. Asking questions is the best thing you can do to ensure you know what’s going on and learn something new each day,” she says.

new information only becomes knowledge when it’s focused and communicated, so the nursing team is focusing on some of the big picture topics such as standardizing processes. one team works on standardizing the counting process, which will help track all of the sponges and instruments used in a surgical case. Several others are working on standardizing and reducing the number of instruments in instru-ment sets for various types of surgical cases and working toward an agreed upon back table set-up for all cases.

the nurses are also deeply involved in the process improvement teams for perioperative Enterprise. the surgery scheduling and retained foreign objects teams have a strong nursing presence and both have benefited from nurse input and feedback.

“Everyone has a niche, whether it’s in technology, education or social events. I always try to find something that interests the nurses. Who doesn’t want to be a part of something?” says Willis. Between the leadership opportunities and the bustle of the operating rooms, it’s clear that all the perioperative Enterprise nurses are a part of something big.

Everyone has

a niche,

whether it’s

in technology,

education or

social events.

7SUMMER • 2007

Perioperative Nursing ResidencyM. D. Anderson is growing its own “super troop” of nurses to work in its operating rooms. the perioperative nursing Residency program takes nurses without operating room experience through 12-18 months of education in the perioperative nursing roles.

the residency has five phases:1: Basic introduction to the roles of a

perioperative nurse in a surgical team setting2: preparation for the scrub nurse role 3: preparation for the circulating nurse role 4: oR governance structure and the nurse’s role5: Rotation through four advanced surgical services

and emergency situation preparedness

In addition to the five phases, the residents have didactic classes, skills labs, exposure to surgical technology, and direct guidance from a nurse preceptor and a nurse educator. the first five residents began the program in January and the second set of nurses began in April.

“I was waiting for a program just like this to open up,” says Sarah Morana, Rn, one of the new residents. “now I see how many different things there are to learn. I’m excited about all the new opportunities the program has to offer me.”

Carla Willis, director of perioperative Services in M. D. Anderson’s Main Building operating rooms, has high hopes for the program and looks forward to seeing the nurses expand their knowledge base and skills. “I know that any nurse who completes this program will be a good oR nurse; no doubt about it,” says Willis.

instrument identification –

Sarah Morana, clinical nurse, Main OR Nursing, is learning about the different types of instruments used in surgery as part of the Perioperative Nursing Residency program.

Sharon Hawkins and every one of her 13 siblings went to college. She attributes this to her father, whom she calls “a great man.” A product of the Depression, he never had the opportunity to go

to college, but vowed that his children would, and education was paramount in his home. Hawkins remembers growing up in a small, central texas town, and being taught that when you meet with resistance you “just dig in harder.” this spirit and tenacity learned at an early age have served her well in her life and her career.

As a patient access coordinator (pAC) since 2000, Hawkins is no stranger to resistance. Her role is to obtain financial clearance from patients’ insurance companies, for single procedures and for continu-ing treatment. Initially, she says, physicians viewed her more as an obstacle to their patients’ treatment rather than as a partner in it.

She joined the Brain and Spine Center in February 2006. “In this center, we have a generally young patient population,” she explains. “the staff and physicians want to be aggressive in their treatment plans. When an insurance company denies a treatment, the pACs are the unfortunate messengers of this news.” For this reason, Hawkins doubted the role was one she would want to stay in. But, true to her nature, she “dug in harder” and began the arduous work that was necessary to transform the system – not only in the Brain and Spine Center, but in other M. D. Anderson centers as well.

When a physician or research nurse identifies a patient for a clinical trial or off-label, off-protocol treatment, Hawkins believes in having a standardized process for contacting the insurance company and obtaining authorization to proceed. She has developed what she calls her “recipes,” which are standard request-for-approval letters for different situations. “I believe in sharing what I’ve learned,” she says. Hawkins has shared her recipes, and other tidbits of knowledge (“My contacts give me contacts”), with pACs in other centers.

Much of the work she has done is in educating the business providers. She says that in the process, she has built trusting relationships. “For M. D. Anderson, a lot of the resistance has fallen away,” she observes. “our reputation precedes us.”

What about the resistance from physicians? “It’s gone,” she declares with a smile. “they’re willing to work with me, write letters of medical necessity, and give me journal articles that I can show to the insurance companies to support requests for the patients.”

Hawkins says she still has work to do. “My goal is for all texans to have the ability to participate in or have access to clinical trials,” she says. “Whether at M. D. Anderson or elsewhere in texas.” She’ll do it, too. She doesn’t take no for an answer.

To find out more about M. D. Anderson’s Perioperative Nursing Residency Program, contact Elizabeth Lottinger, senior recruiter, Human Resources, (713) 792-4627.

Sharon Hawkins clears patient access hurdles

P r o f i l e s i n n u r s i n g

Vice President and Chief Nursing Officer ........................Barbara Summers, Ph.D., RN

Director, Workforce Planning & Development .................Jan L. Keller, M.S., RN

Communications Program Manager, Clinical Operations ....Megan Maisel

Editor .......................................................................Wendy Lynn

Contributing Writer .....................................................Stacy Swanson

Graphic Design & Photography .....................................Medical Graphics & Photography

NursiNg Progress Notesis published quarterly for M. D. Anderson’s Community of

Exceptional nurses Engaged in Extraordinary practice.

Requests and submissions should be directed to: Wendy p. Lynn at wplynn@mdanderson.org, or (713) 563-8832

Nursing pRogRESS notES

“I felt intimidated being there, because I was only a clinical

nurse. It seemed like the majority of the others were advanced

practice nurses, managers, etc.”

this is how Debbie Cline described her initial impression of the

Fall 2006 Oncology Nursing Society Leadership Development

Institute conference in Lansdowne, Virginia. “But after we started

talking to each other,” she goes on to explain. “I found out that

they were intimidated by me because I was from M. D. Anderson! once

the ice was broken we had a good time.” the four-day, interactive

conference was the first of three phases in the year-long LDI fellowship.

During the conference, fellows constructed their plans for personal

leadership development and for implementation of leadership projects.

Cline, a clinical nurse on inpatient unit green 11, was accepted for

the fellowship in Fall 2006, along with M. D. Anderson colleague

geline tamayo, advanced practice nurse, thoracic/Head & neck

Medical oncology. “Every nurse has leadership potential,” says tamayo.

“An M. D. Anderson nursing strategic goal is development of clinical

nurse leaders. the onS LDI helps the nurse discover this potential and

prepare for career advancement.”

the second fellowship phase is the implementation of their plans and

projects; the third is disseminating knowledge gained through their

projects and serving as role models and mentors to others.

Cline is now four months into her year-long project, which is to

evaluate the nursing practice Congress. She hopes to be finished with

phase 1 by the end of 2007. possible topics of evaluation include nursing

autonomy and shared governance. When she selects the topic, she must

also choose an appropriate research tool or method with which to

evaluate it. Cline will then submit her proposal to the nursing Research

Steering Committee and the Institutional Review Board for approval.

onS fellowship helps nurses develop their “inner leaders”

Fellowship Friends— Nurses Cline and Tamayo became fast friends when they met at the ONS LDI Conference last fall.