Nursing Update 2007 - 2008 - Yale-New Haven Hospital

N U R S I N G U P D A T E
THE WORK OF THE NURSE AT YALE-NEW HAVEN HOSPITAL
2007 – 2008

conTEnTs
1 leadership …2
2 Evidence-based practice …6
3 innovation …8
4 community outreach …10
5 research …12
6 growth and development …14
7 recognition …16
Editorial Board: Sue Fitzsimons, R.N., Cathy Stevens, R.N.
Editor: Leah Colihan
Photography: Leah Colihan, Terry Dagradi, Jerry Domian, Ray Paige
Writers: Leah Colihan, Katie Fischer, Kathy Katella
Contributor: Bev DeCato
Design: Jeanne Criscola | Criscola Design
Yale-New Haven Hospital is an EEO/AAP employer
© Spring 2008
www.ynhh.org
Yale-New Haven Hospital
20 York Street
New Haven, CT 06510-3202
Recruitment and Staffing: (203) 688-5083

MAY 2008
Dear Colleagues and Friends of Nursing:
Yale-New Haven Hospital has a long tradition of nursing excellence and
innovation. Our nursing model – founded on the principles espoused by
Florence Nightingale and Virginia Henderson – provides the basis of this
blend of caring and commitment to patient safety.
Each day there is evidence that you – our nurses – find ways to make these
concepts real. You do this through a commitment to research, a dedicated
search for best practices and an appreciation for how innovation can help
you deliver better, safer care to the almost 52,000 inpatients you cared for
last year. You also delivered care to a record 536,500 outpatients.
In this first Nursing Update, you will read about initiatives to improve
how we care for our patients – from hourly rounding through the use
of evidence to guide practice to the important work of the rapid
response teams.
Your work with patients and families is purposeful and aimed to achieve
safe, efficient, effective and equitable care. It is my privilege to share just
a few stories of your remarkable accomplishments with you and others
interested in the work of the nurse at Yale-New Haven Hospital.
I hope we convey our excitement as we continue to institute the changes
that promote and elevate nursing practice in our fine institution.
Sincerely,
Sue Fitzsimons, R.N., Ph.D.
Senior Vice President
Patient Services

1
Leadership
Leadership is key to the success of any organization. In an academic medical center
like Yale-New Haven Hospital, strong, confident nurse leaders impact the excellence of
staff and the quality and safety of patient care. Nurses at all stages of their professional
careers increasingly find opportunities to shape the future of nursing. The hospital’s
embrace of collaborative governance will continue to ensure its reputation as a
national employer of choice and a provider of choice for patients who choose YNHH
for their care.
2 N U R S I N G U P D A T E

Nurses create
collaborative governance
After a tradition of top-down nursing management,
YNHH nursing leaders are implementing a
collaborative governance structure in partnership
with the nursing staff.
Over the past year, a new model that will involve
YNHH’s more than 2,000 clinical nurses has been
initiated. This new professional model places
accountability and authority for practice decisions
at the level of the clinical nurse. It creates
a framework that engages clinical nurses in decision-making
and brings leaders organizationally
closer to the nurses they manage.
ABOVE Members of the Nursing Cabinet meet regularly and work closely with the Staff Nurse Council. Shown in the first row
(l-r) are: Diane Vorio, R.N., vice president, Patient Services; Sue King, R.N., patient service manager, Critical Intervention Unit;
Bertie Chuong, R.N., director of nursing, Temple Recovery Care Center; Sue Fitzsimons, R.N., Ph.D., senior vice president, Patient
Services; Maribeth Hayes, R.N., coordinator, Nursing Performance Management; and Leslie O’Connor, A.P.R.N., administrative
director, Psychiatry Services. In the second row (l-r) are: Francine LoRusso, R.N., director of nursing, Medicine; Stephanie Bilskis,
R.N., practice administrator, Community Health; Catherine Stevens, R.N., director of nursing, Women’s and Infants Services; Cheryl
Hoey, R.N., director of nursing, Pediatrics; Ena Williams, R.N., director of nursing, Perioperative Services; and Tahiry Sanchez, R.N.,
director of nursing, Oncology. Missing from photo are: Mariane Carna, R.N., executive director, Heart and Vascular Center; Carol
Just, R.N., director of nursing, Surgery; and Patricia Span, R.N., director, Professional Practice, Research and Education.
Nursing Cabinet
and Staff Nurse Council
Evolving from “Striving for Excellence,” the
first step in this model was the establishment
of the Nursing Cabinet, whose membership
includes all nursing directors within the
YNHH network.
The second phase was building the 14-member
Staff Nurse Council. In the first year, the members
were selected by managers based on criteria
of leadership. In 2008, nurses will nominate
themselves to serve on this important body and
the Staff Nurse Council will review nominations
and choose their successors.
The Staff Nurse Council is key to collaborative
governance because it assures the nurse at
the bedside a place at the decision-making
table. In the past at Yale-New Haven, decisions
were made by managers, policies and procedures
were written by mid-level nurses, and
staff nurses implemented decisions and processes
that did not necessarily reflect their
best thinking.
Now, with a robust and vibrant Staff Nurse
Council fully responsible for representing all
nurses, ideas, questions, solutions and problems
have a place to go – and that’s up. The goal is
increased and productive communication that
will further strengthen the delivery of safe, high
quality care to Yale-New Haven patients.
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Cluster committees
and standing committees
In anticipation of the questions and issues they
will work through, the Nursing Cabinet and the
Staff Nurse Council have developed cluster committees
in 11 areas, which will serve a valuable
and efficient information-sharing function for
groups of units. To date, the clusters represent
pediatrics, medicine, surgery, heart, ambulatory,
psychiatry, ambulatory services, women’s, adult
ED, perioperative services and oncology.
In addition to the Nursing Cabinet, Staff Nurse
Council and cluster committees, standing committees
deal with work directed from the Staff
Nurse Council. The four standing committees
are: clinical quality, research, education, and
nurse award and recognition.
Succession planning
Collaborative governance places responsibility
on the staff nurse whose first job is caring for patients.
Active participation in governing provides
significant opportunity for nurses to learn about
the working of a complex medical institution,
gain exposure to nurses outside their area of
practice, and improve or strengthen important
communications skills.
Over time, collaborative governance will give
YNHH staff nurses the involvement they need to
become tomorrow’s nurse leaders.
ABOVE The Staff Nurse Council draws nurses from many practices who provide an important voice for the more than 2,000
nurses who work at Yale-New Haven Hospital. Seated in the front row (l-r) are: Mary Weir, R.N., Perioperative Services; cochairs
Rick O’Connor, R.N., Surgical Intensive Care Unit, and Nora O’Keefe, R.N., Diagnostic Radiology; and Jane Buglione,
R.N., Pediatric Emergency Department. Standing (l-r) are: Sybil Shapiro, R.N., Temple Recovery; Kelly Baran, R.N., Gyn/
Oncology; Erin Radocchia, R.N., Maternal Special Care; Melanie D’Amato, R.N., School-age/Adolescent; Mary Kelly O’Shea,
R.N., Infants/Toddlers; and Kelly Poskus, R.N., Neuroscience. Missing from photo are: Shelley Harrigan, R.N., Primary Care
Center; Heather Miska, R.N., Children’s Psychiatric Inpatient Service; and Jeramy Tabuzo, R.N., Hospital Research Unit.
Collaborative governance is a history-altering
departure for staff nurses at Yale-New Haven. The
nurse at the bedside sees what works and what doesn’t,
and we now have a system that examines practice so
patient care is evidence-based.” “— Nora O’Keefe, R.N., Diagnostic Radiology and Staff Nurse Council Co-chair
4 N U R S I N G U P D A T E

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2
Evidence-based
practice
As nursing evolves with advances in knowledge and care protocols, nurses seek out
ways to provide the most informed, thoughtful care for their patients. At YNHH,
evidence-based practice is an increasingly important guide for clinical decision
making. As nurses address each patient’s unique situation, they want to deliver the
best practices based on the latest, most conclusive research.
In 2007, nurses at YNHH implemented new evidence-based practices in several areas
as they worked to meet the specific needs of diverse patients and families. Their
efforts have contributed to a carefully focused, assured level of nursing care. Three
examples are nurse rounding, rapid response teams and new safety standards.
6 N U R S I N G U P D A T E

Hourly rounding boosts
satisfaction all around
Last summer, YNHH began hourly rounding by
nurses and patient care associates on pediatric
and medical units.
Marcelle Applewhaite, R.N., patient service manager
for the Infants/Toddlers Unit, and Francine
LoRusso, R.N., director of nursing, Medicine,
spearheaded the effort after a presentation last
summer by a nationally known healthcare consulting
company. The Studer Group had studied
hourly rounding in 14 hospitals across the country,
and found the protocol reduced monthly
call button use by 38 percent, patient falls by 50
percent and skin breakdowns by 14 percent. At
the same time, satisfaction scores soared.
Studer Group staff instructed YNHH nurses in
eight key behaviors, including making an initial
introduction to a patient with a description of
role and experience, and documenting each
visit so patients who are sleeping will know the
caregiver has been in the room. Each hour, nurses
also ask their patients about the four P’s: pain,
positioning, placement and personal needs.
Patient satisfaction scores rose at YNHH last
year, and LoRusso and Applewhaite believe the
new hourly rounding initiative contributed.
In fact, early results of hourly rounding are so
promising that the practice is being implemented
hospital-wide this year.
Rapid response teams
keep patients out of ICUs
When a nurse at YNHH notes a trigger sign in
a patient such as a drop in blood pressure or
simply has a hunch that a patient is deteriorating,
she or he may call in a rapid response
team—essentially an “ICU at the bedside.”
The team will arrive in less than ten minutes
to stabilize the patient.
Rapid response teams were among six evidence-based
safety interventions included in
the Institute of Healthcare Improvement
(IHI)’s campaign to prevent 100,000 in-hospital
deaths. In 2004, IHI recognized Yale-New Haven
Children’s Hospital as one of the first pediatric
hospitals in the country to implement a rapid
response team made up of critical care nurses
and physicians. Use of the teams at YNHCH
resulted in a dramatic decrease in cardio-respiratory
arrests outside of the pediatric ICU.
Adult units at YNHH began using rapid response
teams, which consist of critical care nurses,
physicians and respiratory therapists, to provide
urgent and emergent care in 2006.
For both adults and children, the teams have
been so successful in identifying early warning
signs, avoiding the ICU and saving lives that the
hospital is now planning pilot programs that will
allow families who sense a loved one is deteriorating
to activate the teams directly.
Nurses dedicated to safety
set new standards
YNHH actively protects its patients from preventable
danger through the work of two Yale-New
Haven Health System patient safety registered
nurses—one for obstetrics, one for Perioperative
Services.
Working under the umbrella of Performance
Management, the safety nurses’ primary role is to
educate peers about safety, explains Jean Zimkus,
patient safety nurse for Perioperative Services.
They review literature on safety topics, talk to
physicians and staff about unique challenges
at YNHH, and spearhead improvements. They
collaborate with other healthcare professionals
to promote communication such as briefings and
“hand-off communication,” essentially memos for
new caregivers with pertinent information about
patients who have been transferred from other
units. They installed white boards in surgery suites
for practitioners to make checklists about such
concerns as allergies and fetal heart rates before an
operation begins.
A safety attitude questionnaire conducted among
OB staff in 2004 and 2006, and in Perioperative
Services in 2006 and 2007, showed a statistically
significant improvement in attitude toward safety
and teamwork since their safety nurse was hired.
Patient safety nurses expect to see continued
improvement when they analyze the results of a
2007 survey in both their departments.
Our soon to be hospital-wide hourly rounding
initiative is a perfect example of something we
often find when we seek out the evidence and
take a hard look at how it fits with our needs
at YNHH. Often a simple solution can bring
greater rewards for less effort, and keep the
focus where it matters most – on providing
top-notch care for the patient.”
— Francine LoRusso, R.N., Director of Nursing, Medicine
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3
Innovation
Yale-New Haven Hospital continuously develops new ways to improve patient
care, and nurses are a major factor in steering practice in positive new directions.
Nurses may recommend an investment in a technology such as simulators that
enhance the process of learning new practices, or they may develop a creative
solution to a more organized medication delivery system.
In the past few years, a number of innovations have significantly impacted
patient care and patient safety, and resulted in changes in the way nurses care
for patients.
8 N U R S I N G U P D A T E

Pediatrics streamlines
medication delivery
One of the challenges for nurses caring for pediatric
inpatients is to ensure that patients receive
the correct medications they need in a timely
manner. With a pharmacy department that fills
3,800 orders a day, the staff wanted to make the
process of medication dispensing and delivery as
efficient and timely as possible.
Kim Carter, R.N., patient service manager for
the School-age/Adolescent Unit, formed a committee
with Lorraine Lee, Pharmacy Services
manager for medication safety and regulatory
compliance, and members of both staffs. Last
June, the group dedicated one week to pioneering
a new medication delivery system using the
“Lean” process improvement tools, a manufacturing
process Toyota popularized and healthcare
systems—including YNHH—have used to
trim waste and inefficiencies in their processes.
They developed eight interventions and
launched them on the School-age/Adolescent
Unit. They standardized time windows for delivery
of various medications, now posted in the
unit’s medication room, and created a dedicated
area on the unit where all medications must be
delivered. The committee also redesigned the
medication room with a wall-mounted computer
nearby so staff can easily look up information
such as proper dosage and allergies.
Due to the work of this unique collaborative
committee, the School-age staff has seen
significant benefits in accuracy and efficiency
of medication delivery, and the new delivery
system interventions are being implemented in
all of YNHH’s pediatric units with eventual plans
for the adult units as well.
Simulators enhance
nurses’ learning
Since her arrival at the Yale-New Haven
Children’s Hospital last spring, Noelle has given
birth hundreds of times. A life-size mannequin,
Noelle can simulate the normal human birth
process and be programmed to mimic birth
complications. She comes complete with monitors
that display maternal, fetal and newborn
vital signs, and her simulation baby lets staff
know its health status by its color: a healthy
baby will be pink, while a baby experiencing
oxygen deficiency will turn blue.
“For nurses, the simulators are an excellent
training tool,” Cheryl Raab, R.N., perinatal
patient safety nurse, Performance Management,
says. “Simulators give our nurses the
opportunity to learn correct interventions in a
risk-free environment, and provide them with
information and feedback about their individual
performance.”
Raab is currently using Noelle to help train
nurses, physicians, midwives and PCAs from both
the Women’s Center and Labor and Birth, as well
as medical and midwifery students. Meanwhile, in
the Pediatric Emergency Department, SimBaby,
Yale-New Haven’s first interactive infant simulator,
is used to train emergency healthcare professionals
in the care of seriously ill infants.
Simulation has become such an important training
tool for nurses at YNHH that the hospital is
looking at a future simulation center in partnership
with Yale School of Medicine and Yale
School of Nursing.
Wireless phone service
speeds up care delivery
When Yale-New Haven Hospital equipped all
of its nurses and patient care associates with
“SpectraLink” wireless telephone service last
year, telephone tag and noise from front-desk
employees paging nurses became annoyances
of the past, and patient satisfaction scores rose
across the board.
Every nurse and patient care associate (PCA)
has a SpectraLink phone, which can be used
for two-way communication throughout the
hospital without the interference common with
high-powered cellular phones. Patients may
press the call button for assistance, or dial their
nurse or PCA directly. The wireless phones also
allow nurses to quickly connect with other staff
to discuss pertinent information, treatment
protocols, medication orders and time-sensitive
information.
“Equipping nurses and staff with wireless
phones turned out to be a very positive innovation
for caregivers,” said John Sward, R.N., patient
service manager of the General Medicine
Unit on 9-7, who trained nurses throughout
YNHH in the use of the phones. Nurses hear
about their patients’ needs more quickly and are
better able to set priorities and serve them, he
said. “The phones are speeding up the process
of caregiving and make communication easier
and quieter for everyone.”
Innovations can change the way nurses practice
in ways they don’t anticipate. For example,
using wireless phones has made nursing more
efficient in some ways. Now nurses don’t have
to leave the bedside of one patient to take a
phone call about another patient, and they
are able to stay with a patient in crisis while
communicating with the physician.”
— Sue Arbo-Givens, R.N., Patient Service Manager, Orthopedics
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4
Community outreach
Since its founding in 1826, one of YNHH’s most enduring missions has been its
commitment to serving the community. This service takes many forms, including
YNHH’s primary care, women’s and children’s centers and seven school-based clinics.
Educating the public on health and nutrition, exposing high school students to careers
in health care, and performing preventive screenings round out some of YNHH’s
community efforts.
Our nurses provide specialized care to the needy in our community. They are top-notch
educators who are skilled at explaining complex medical conditions and role models for
high school students interested in a nursing career.
1 0 N U R S I N G U P D A T E

School-based nurses
keep teens in the care loop
Adolescents aren’t likely to go to the doctor
on their own, and even parents who have
insurance may be too busy to get them there.
As a result, advanced practice nurses at seven
YNHH school-based health centers (SBHC) in
the greater New Haven area provide on-site
services, including primary health assessments
as well as diagnosis and treatment of major and
minor illnesses.
In 2007, the YNHH SBHCs treated nearly 9,000
students in elementary, middle and high schools
in Branford, Hamden and New Haven. Nurses
may treat or advise students on diabetes, obesity,
pregnancy and sexually transmitted diseases.
Lynn Peckham, advanced practice registered
nurse in New Haven’s Sheridan Middle School,
said the most prevalent problem she sees among
students is asthma. She explains that schoolbased
nurses make an impact in helping students
manage asthma so they can stay in school and
out of the hospital. In addition, YNHH social
workers work on-site at the SBHCs and help
students with anger management, anxiety,
depression and phobias.
In addition to providing an important link
between students and additional community
services, school-based nurses establish YNHH as
a medical home for those who don’t have one.
They also provide health education that gives
students a firm understanding of the importance
of taking responsibility for their own
health.
Nurses help detect cancer
early in the community
If success means convincing women to take
responsibility for their health, the Connecticut
Breast and Cervical Cancer Early Detection
Program for medically underserved women is
making its mark. Working out of the YNHH
Department of Community Health, the staff has
always had to make multiple calls to get some
patients in for screenings, but lately more women
have been seeking out the program and making
appointments themselves.
Christine Galla, R.N., case manager, gives credit to
media marketing efforts and vigorous outreach.
YNHH, one of 18 sites in the state to offer cancer
screening through this program, sends outreach
workers to churches, hair salons and housing
projects to educate women. The program provides
Pap smears to women 19 to 64 years of age
who have no insurance coverage or prohibitive
deductibles, and mammograms to medically
underserved women who are 40 and older.
The program especially hopes to reach older
women, who are likely to avoid mammograms;
and African-American and Hispanic women,
who have the highest mortality rate among all
racial and ethnic groups.
In the grant’s fiscal year that ended in June 2007,
the Early Detection Program made outreach visits
to 902 women at 20 locations in the greater New
Haven area, and provided services to 251 women.
Last July, YNHH launched a digital mammography
van, the first in Connecticut, to provide mammograms
to women where they live and work.
Stroke team takes the
offensive against brain attacks
Since YNHH revamped its stroke program,
nurses have played a key role in helping the
hospital earn the distinction as a Joint Commission
Primary Stroke Center, providing acute
and recovery care for the more than 600 stroke
patients the hospital admits each year.
Karin Nyström, A.P.R.N., clinical coordinator,
said the stroke program and neuroscience units
at YNHH offer rich opportunities for nurses interested
in research or clinical nursing. They can
participate on multidisciplinary teams specially
trained to evaluate and treat stroke and other
cerebrovascular diseases. Nurses also collaborate
with the YNHH Emergency Department to
enhance the effective use of the clot-dissolving
agent tPA.
YNHH was the first hospital in southern Connecticut
and the fourth in New England to
become nationally certified as a Primary Stroke
Center by The Joint Commission.
In addition, YNHH nurses are actively involved
with the program’s Stamp Out Stroke (S.O.S.)
team, which educates people in the community
to recognize symptoms of stroke and get to the
hospital by calling 9-1-1 within the three-hour
window when treatment is most successful.
While the program has yet to measure the clinical
outcomes of these efforts, Nystrom believes
outreach, close teamwork and cutting-edge
treatments are making a powerful impact in the
diagnosis and treatment of stroke.
Every woman in New Haven should make appointments for
annual mammograms and cervical screenings. Unfortunately,
needy women have incredibly difficult lives – they have to get
past economic and transportation barriers, not to mention the
fear barrier. At YNHH, we are reaching these women and letting
them know we can help. Their health is important to us.”
— Christine Galla, R.N., Case Manager, Connecticut Breast and Cervical Cancer
Early Detection Program
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5
Research
Nurses do their most important work at the patient’s bedside, and are often in the best
position to question the many ways to care for patients – which approaches are working
and which areas need closer scrutiny.
At YNHH, research projects conducted by nurses have prompted changes that have
raised the bar on patient care and improved patient outcomes. Through their
questioning and analysis, nurses help the hospital develop more effective practices and
procedures, control quality and improve patient satisfaction across the board.
1 2 N U R S I N G U P D A T E

SICU nurses take evidencebased
approach to care
Surgical Intensive Care Unit (SICU) nurses are
taking a fresh look at how they provide patient
care with the help of an evidence-based practice
committee. Quarterly, the committee analyzes
the literature on topics selected by SICU nursing
staff and then assists the staff in applying the
findings to their practice.
The SICU’s innovative approach has been so
successful it earned SICU nurses Rick O’Connor,
B.S.N., R.N., and Zachary Krom, B.S.N., R.N., the
opportunity to present the results of the
committee’s work at Sigma Theta Tau’s 18th
International Conference in Vienna, Austria, last
summer. More locally, they are expanding their
important work into other YNHH intensive care
units.
The committee uses the hospital’s chosen model
of incorporating research into practice, the Iowa
Model, which provides a guide for clinical decision-making
and details regarding implementation.
The model includes both the practitioner
and organizational perspectives.
One significant result of the committee’s research
in the SICU is further reinforcement of encouraging
family visitation during resuscitative and
invasive procedures, such as CPR and chest tube
insertions. In cases where both caregivers and
the family are comfortable, families are invited to
stay in their loved one’s room as a nurse or social
worker talks them through the experience. Krom
and O’Connor’s research found that families who
witness efforts to save a loved one’s life are appreciative
to be part of the process. In addition, this
practice can provide a greater sense of closure for
those who are grieving.
Study examines charge nurse
and decision-making
The personality traits of charge nurses do not
always mix with those of physicians – in fact,
the two can be polar opposites, according to a
study conducted by Victoria Dahl Vickers, R.N.,
M.B.A., who was recently named coordinator of
regulatory readiness, and Eija Faulkner, learning
and development consultant in the hospital’s
Institute for Excellence. They presented their
findings last year at the National Nursing Staff
Development Organization’s annual convention
in Atlanta.
Vickers and Faulkner assessed nurses at Yale-
New Haven Hospital with the help of the
Myers-Briggs personality model, typically used
by career counselors. Out of 149 nurses who
participated, 98 identified “feeling” as their
decision-making preference mode, which is the
opposite of physicians, who tend to use a “thinking”
mode to make decisions, Vickers explained.
The second part of the survey dealt with conflict
resolution, using the Thomas Kilman Conflict
Mode Instrument, a leading instrument used to
assess conflict-handling styles. Asked to describe
their conflict resolution style, most nurses expressed
a preference for avoiding conflict.
Vickers and Faulkner, who are using their findings
in training sessions for nurses, say awareness
of how nurses relate to colleagues is useful
because it can help them make adjustments and
perform more efficiently when working as part
of a team.
Nurses play key role
on successful diabetes team
For patients with diabetes, the evidence is
increasingly clear that aggressive management
of blood glucose can reduce complications
from illness or surgery, lower rates of infection
and shorten hospital stays. At Yale-New Haven,
nurses on Connecticut’s first full-time multidisciplinary
diabetes team play a key role in keeping
glucose levels down.
The team—a joint effort between YNHH and
Yale School of Medicine—includes physicians
and caregivers collaborating with primary care
teams to control blood sugar and educate patients
about their diabetes before discharge.
Last year, the team presented 11 months of data
on its work and earned the top prize in research
for Yale-New Haven Hospital at the annual 2007
Joseph A. Zaccagnino Patient Safety and Clinical
Quality Conference.
Among the team’s findings: Glucose is better
controlled when patients receive either a continuous
insulin infusion with frequent monitoring,
or a basal bolus correction regimen, an
approach that imitates normal physiology by
using a fast-acting (bolus) insulin with each meal
and a long-acting (basal) insulin once or twice a
day. Two nurses, Helen Psarakis, A.P.R.N., and
Gael Ulisse, A.P.R.N., contributed to the project
team’s findings and success.
We developed our evidence-based practice committee because
we want nurses to keep searching for the best ways to care
for patients. Research turns up new information all the time,
and nurses need to have this information available to them.
With more data and research behind their practice, nurses can
make better choices and that improves care overall.”
— Zachary Krom, R.N., Surgical Intensive Care Unit
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6
Growth and
development
Professional development for nurses at Yale-New Haven Hospital begins on the first
day of employment and spans their careers. As part of their orientation, nurses receive
intensive training that continues through their first year of service. Nurses at YNHH
also have opportunities for career development as the hospital introduces the latest
cutting-edge treatments for improved patient care and safety.
As a result, patients who come to YNHH can expect not only the utmost sensitivity and
warmth in their care, but also some of the most knowledgeable nurses in their fields.
1 4 N U R S I N G U P D A T E

Nurses improve practice
through transplant
certification
With the recent appointment of Sukru Emre,
M.D., an internationally known transplant
surgeon, the Yale-New Haven Transplantation
Center has witnessed a growing patient volume,
and cutting-edge surgeries such as the first split
liver and living donor liver transplant performed
in Connecticut. Last year, nurses expanded their
knowledge about transplantation in a study
group for a new Certified Clinical Transplant
Nurse (CCTN) credential exam developed by the
American Board of Transplant Certification.
Rick O’Connor, R.N., SICU, who led the study
group and was the first nurse to take the exam,
said research shows nurse certification improves
outcomes for transplant patients. The CCTN
exam covers heart, liver, kidney and pancreas
transplants, in addition to lung and small bowel
transplants. The certification also covers a
variety of nursing concerns and topics, including
vascular complications, infection control and
drugs that prevent rejection.
This year, three more YNHH nurses are planning
to take the rigorous test. Meanwhile, O’Connor
plans to begin a new study group and is targeting
all surgical ICU nurses to participate to
prepare for next year’s test.
Nurses standardize the
language of fetal monitoring
Families who decide to have babies at Yale-New
Haven Hospital can feel especially confident that
they will have a successful experience thanks to
an emphasis on safety in labor and delivery. A
perinatal patient safety nurse has instituted some
30 new evidence-based clinical guidelines, and
trained all perinatal teams in the proper use and
interpretation of fetal monitoring tests.
Her work has resulted in a 30-40 percent reduction
in adverse events in obstetrics, including
stillbirths, birth injuries and low Apgar scores
for newborns.
Training and certification in the use of fetal
monitoring alone made an especially significant
impact in the department. “Historically, doctors
and nurses trained separately in fetal monitoring,
and learned different terminologies,” said
Cheryl Raab, R.N., the perinatal safety nurse.
In the late ’90s, standard terminology was developed
to provide a common language pertaining
to variability and rates of acceleration and
deceleration of fetal heart rate.
Staff members on units that perform fetal monitoring
have taken and passed the fetal monitoring
training. Raab said the 223 obstetricians,
nurses and midwives who trained at YNHH
and took a national certification test had an
initial 99 percent pass rate, compared with a
national 87 percent pass rate.
Residency provides
support for new nurses
The hospital’s Post-Baccalaureate Nurse Residency
Program provides important support for
new nurses as they make the transition from
nursing students to acute-care professionals.
That support—unique among hospitals in New
England—has also become a draw for nurses
who choose to start their careers at YNHH.
In three years, 137 new nurses have completed
the year-long program developed by the
University Health System Consortium and the
American Association of Colleges of Nursing.
Residents cover such topics as clinical judgment
and leadership development. They meet monthly
in small groups with a resident facilitator
who may be from Southern Connecticut State
University, Yale School of Nursing or Yale-New
Haven Hospital.
In addition, 29 new associate degree and
diploma nurses have completed the New Graduate
Associate and Diploma Nurses First Year
Development Program, a parallel program to
the Nurse Residency Program.
Every new graduate nurse at YNHH is required
to participate in one of the two programs.
Graduates report that the programs gave them
the direction and support they need at a critical
time in their careers, giving them confidence and
introducing them to nurses who address their
questions in an encouraging environment.
“
Critical care nurses are feeling the impact of
the increased volume of transplant patients,
so it is becoming increasingly important for
us to enhance our knowledge as we set up
nursing guidelines and follow these special
patients through their ICU course. Advances
in medicine at YNHH are challenging nurses
to challenge themselves to keep improving
upon the way they provide care.”
— Rick O’Connor, R.N., Surgical Intensive Care Unit
and Staff Nurse Council Co-Chair
Y A L E - N E W H A V E N H O S P I T A L 1 5

7
Recognition
In a busy environment that operates 24 hours a day, seven days a week and
365 days a year, it is sometimes easy to forget to take a step back and recognize the
extraordinary women and men who are direct care givers to the tens of thousands
of patients who choose YNHH for their care.
While its nurses have historically been highly regarded in Connecticut and beyond,
the hospital has intensified its effort to develop opportunities to find and honor its
finest nurses. Below are just a few of the ways in which YNHH nurses have been
honored for their contributions to patient care.
1 6 N U R S I N G U P D A T E

YNHH named 12
Nightingales in 2007
Each year, Yale-New Haven nominates nurses
for the Nightingale Award, an award the honors
nurses from greater New Haven area hospitals
and healthcare institutions for commitment to
excellence in their nursing practice. The Visiting
Nurse Association of South Central Connecticut,
the Hospital of St. Raphael, the Community
Foundation for Greater New Haven and
YNHH are founding sponsors of the Nightingales
program which raises awareness of the
contributions nurses make.
The 12 Yale-New Haven nurses honored as
Nightingales in 2007 were:
ABOVE Nine of the Nightingales honored in 2007 met in the Atrium for their “class” photo with Sue Fitzsimons (right). Shown are
(l-r): Gloria Wallace, Elizabeth Miller, Joan Workman, Jill Jolley, Barbara Ackerman, Deirdre Lonergan, Gerri Slowikowski, Millicent
Gershon and Earl Hapgood.
Five nurse leaders honored
At the 2007 Nurse of the Year ceremony,
five nurses were honored with four nurse
leadership awards. Shown (below) in Harkness
Hall, where the ceremony was held, are (l-r):
Surgical Intensive Care Unit nurses Zach Krom
and Rick O’Connor, who received the award for
research; Shelley Harrigan, Adult Primary Care
Center, for practice; Sue Fitzsimons, senior vice
president, Patient Services; Karen Camp,
retired nurse manager for whom the management
award is named; and Marie Devlin, R.N.,
patient service manager, SICU, who received
the Karen L. Camp Award for Management.
Unable to attend the ceremony was Ann Marie
Rausch, R.N., Surgery (6-5), who earned the
education award.
Barbara Ackerman (in memoriam)
Newborn Special Care Unit
Jeannine Bradley
Pediatric Emergency Department
Laurie Finta
Ambulatory Surgery
Millicent Gershon
Diagnostic Radiology
Earl Hapgood
Adult and Pediatric Post-Anesthesia Care Units
Jill Jolley
School-age/Adolescent Unit
Mengqing Lai
Winchester Chest Clinic
Deirdre Lonergan
Orthopedics
Elizabeth Miller
Maternal Special Care
Gerri Slowikowski
Surgical Intensive Care Unit
Gloria Wallace
Acute Care for the Elderly
Joan Workman
Adult Inpatient, Yale-New Haven
Psychiatric Hospital
Y A L E - N E W H A V E N H O S P I T A L 1 7

Nurse of the Year 2007
Each year during National Nurse Week, Yale-
New Haven Hospital takes the opportunity to
recognize its nurses in a variety of ways. Each
unit nominates a nurse for her or his commitment
to patient care. The following nurses were
honored as Nurse of the Year from their units.
Jeff Agli
Diagnostic Radiology
Deanna Arizzi
Medical Oncology/Bone Marrow Transplant
Ann Marie Bautz
Cardiac Medical Units (5-2/3)
Nadine Bruder
School-age/Adolescent
Pat Capone
Acute Care for the Elderly
Pam Cohane
Pediatric Specialty Center
Amanda Coppola
Infant/Toddler
Sherry Coyle
South Pavilion Operating Room
Christine Danilowicz
General Medicine (9-7)
Chris DeFrancesco
Adult Emergency Department
Kate Delossantos
Adult Resource Support Unit
Diane Dirzius
Medical Oncology Clinic
Marcie Durso
Pediatric Primary Care Center
Stacy Farago
General Medicine (5-7)
Allison Febbroriello
Maternal Special Care
Ellen Ferraro
Surgery (6-5)
Tracey Frith
Obstetrics (WP 11)
Toni Frizinia
Cardiac Medical Units (5-2/3)
David Gauley
Adult Diagnostic Radiology
Megan Gnidula
Pediatric Catheter Laboratory
Joanne Gorman
Women’s Primary Care Center
Jill Grillo
Cardiothoracic Intensive Care Unit
Michael Hayes
Surgery (6-7)
Betsy Hine
Cardiac Intensive Care Unit
Deb Hollaway
Shoreline Medical Center ED
Lynn Irons
Adult Primary Care Center
Terri Johnson
Shoreline Medical Center Post-Anesthesia Care Unit
(PACU)
Susanne Koshis
GI Procedure Center
Debbie Krista
Pediatric PACU
Roman Kudrycki
Adolescent Unit YNHPH
Kimberly La Pia
Breast Center
Sandy Lee
Medical Intensive Care Unit
Annelie Lindvall
Dual Diagnosis YNHPH
Li-Ping Liu
Neuroscience Intensive Care Unit
Deirdre Lonergan
Orthopedics
Jennifer Maddern
Surgery (6-4)
Katie Mannochi
PACU
Susan Marchini
General Medicine (10-7)
Marilou Masocol
Adult Unit YNHPH
Allyson McManama
Temple Recovery Care Center
Sherry Molaskey-Jones
Perinatal Maternal-Fetal Medicine
Shanda Nardelli
Gyn/Oncology Unit
Peggie O’Donnell
Apheresis/Transfusion Service
Jillian Orlando
Pediatric Oncology/Respiratory Care Unit
Paula Pastore
Children’s Psychiatric Inpatient Service
Carol Penta
Radiation Therapy
Melissa Rafael
Surgical Intensive Care Unit
Judy Rodriguez
Neuro Medicine and Surgery
Jerrilyn Rosa
Express Admission Service/Pre-Admission Testing
Joyce Russell
General Clinical Research Center
Marjorie Russell
General Medicine (5-5)
Rowena Saga-Abrina
Cardiac Surgery
Aida Santiago
Ambulatory PACU
Jenny Scholl
Pediatric Emergency Department
Jackie Selly
Surgery (7-5)
Diane Smart-Greene
General Medicine (9-5)
Mary Ellen Smith
Newborn Special Care Unit
Nancy Smith
Obstetrics (WP 10)
Joy Southard
Pediatric Resource Support Unit
Wynnett Stewart
Nathan Smith Clinic
Sheila Stranz
Temple Surgical PACU
Christine Suntheimer
Perinatal Maternal-Fetal Medicine
Jaime Swartz
Children’s Research/Oncology
Dennis Uy
Ambulatory OR
Sally Varghese
Pediatric Intensive Care Unit
Lori Vogt
Labor and Birth
ABOVE RIGHT Last year, YNHH president and CEO Marna P. Borgstrom (left) personally
congratulated each of the 16 employees who were named “I am Yale-New Haven”
Service Excellence Heroes. Here she is shown with Anne Summach, R.N.,
Neuroscience Unit.
RIGHT Richard D’Aquila, executive vice president and COO, regularly rounds on patient
care units. Nurses take the opportunity to discuss issues with him when he visits. On
a recent visit to General Surgery (6-7), D’Aquila meets (l-r): Linda Russell, R.N., Terri
Wusterbarth, R.N., and Nancy Hoey, R.N., patient service manager.
1 8 N U R S I N G U P D A T E

Service Excellence
Heroes for 2007
Sixteen Yale-New Haven Hospital employees
were named “I am Yale-New Haven” Service
Excellence Heroes. Five nurses were among
the first 16 employees to be honored with this
significant hospital award. They are:
Nicole Buxton, R.N.
Post-Partum (WP 11)
Earl Hapgood, R.N.
Nurse Educator, Adult and Pediatric Post-Anesthesia
Care Units
Larry Richardson, R.N.
Coordinator of Transplant Services,
Perioperative Services
Anne Summach, R.N.
Neuroscience/Acute Care Unit
Ena Williams, R.N.
Nursing Director, Perioperative Services
Recognition and Clinical
Advancement Program
In 1991, Yale-New Haven Hospital introduced
an internal clinical ladder called the Recognition
and Clinical Advancement Program (RCAP), and
more than 2,000 nurses have advanced on it.
RCAP has three rungs – Clinical Nurse II, III and
IV – and managers consistently encourage nurses
to climb the ladder through a rigorous program
in which nurses, working with a preceptor, record
their experiences with patients in a portfolio
of exemplars. Nurses who advance are recognized
at a quarterly ceremony. The following
nurses advanced to levels II and III in 2007.
Clinical Nurse III
Evelyn Afriyie
Post-Anesthesia Care Unit
Jill Azzarone
Oncology/Pediatric Respiratory Care Unit
Twila Balint
Occupational Health Services
Melissa Barre
Surgical Intensive Care Unit
Janet Battaglia
Express Admissions
Michelle Bosley
Surgery Unit (7-5)
Nicole Buxton
Maternity (WP 11)
Kathy Caliendo
Surgery Unit (4-7)
Erin Cavanaugh
Labor and Birth
Christopher DeFrancesco
Adult Emergency Department
Laurie Devin
Resource Support Unit
Janina Dziurzynski
GI Procedure Clinic
Tamar Edelkind
Newborn Special Care Unit
Pam Fleming
Surgery Unit (4-7)
Elizabeth Flynn
Temple Recovery Care Center
Cindy Fusco
Surgery Unit (7-5)
Patricia Gray
Oncology/Pediatric Respiratory Care Unit
Daniel Hartmann
Adult Emergency Department
ABOVE Nurses attend the Recognition and Clinical Advancement
Program to celebrate the advancement of their colleagues
on the three-rung clinical ladder. The three nurses who
attained Level III and senior managers are shown (l-r): Chong
Jumarito-Panaguiton, R.N., CTICU; Sue Fitzsimons, senior
vice president, Patient Services; Debbie DiMarco, R.N.,
Perioperative Services; Leslie O’Connor, A.P.R.N., clinical
director, Yale-New Haven Psychiatric Hospital; Kevin Myatt,
senior vice president, Human Resources; and Alison Lucibello,
R.N., CICU.
Theresa Hyland
Labor and Birth
Katherine Mannochi
South Pavilion Post-Anesthesia Care Unit (PACU)
Staci McNeil
Adult Primary Care Center
Phyllis Murphy
Medical Intensive Care Unit
Eleanor Myers-Brown
South Pavilion PACU
Laetitia Nakaar
Gyn/Oncology Unit
Carol Nockunas
GI Procedure Clinic
Megan Nolan
Labor and Birth
Anne H. O’Connor
Hospital Research Unit
Danielle Orfitelli
Adult Emergency Department
Victoria Parker Orkins
Cardiothoracic Intensive Care Unit
Jillian Orlando
Oncology/Pediatric Respiratory Care Unit
Alaire Perazella
Maternal-Fetal Medicine Unit
Stephanie Piscitelli
Oncology/Pediatric Respiratory Care Unit
Annalisa Porter
Surgical Intensive Care Unit
Carey Ranz
Surgery Unit (4-7)
Kelley Reddington
Labor and Birth
Y A L E - N E W H A V E N H O S P I T A L 1 9

Rowena Saga-Abrina
Surgery Unit (4-7)
Cristina Santiago
Diagnostic Radiology
John Strathy
Surgical Intensive Care Unit
Tracy Sturrock
Medicine Unit (6-5)
Jeramy Tabuzo
Hospital Research Unit
Carolyn Thompson
Gyn/Oncology Unit
Clinical Nurse II
Roxanne Amato
Adult Emergency Department
Deanna Arizzi
Medical Oncology
Annette Avallone
Acute Care for the Elderly
Frank Balisciano
Ambulatory Surgery
Samantha Bean
Maternal Special Care Unit
Lisa Berardi
Temple Surgical Recovery
Filjah Bernardo
Acute Care for the Elderly
Deborah Bok
Temple Endoscopy Center
Elizabeth Borges
Acute Care for the Elderly
Peggy Bouchard
Cardiothoracic Intensive Care Unit
Jessica Boughton
School-age/Adolescent Unit
R. Titlope Boyejo
Women’s Center
Donna Brester
Pediatric Intensive Care Unit
Erin Brown
Medicine Unit (5-5)
Maureen Bruce
Surgery Unit (6-7)
Nadine Bruder
School-age/Adolescent Unit
Carly Brueggestrat
Cardiothoracic Intensive Care Unit
Shayleen Brueggestrat
Surgery Unit (6-4)
Starley Buchanan
School-age/Adolescent Unit
Heather Bugay
Medical Intensive Care Unit
Lois Caldrello
Cardiothoracic Intensive Care Unit
Arturo Capiral
Perioperative Services
Tracey Cassese
Pediatric Emergency Department
Tammy Ciuci
Surgery Unit (6-4)
Maria Lourdes Co
Medical Oncology Unit
Sheryl Combs
Pediatric Resource Pool
Daniel Coraluzzi
Temple Surgical
Robin Corcoran
Shoreline Surgery/Endoscopy
Denise Corso
Newborn Special Care Unit
Janice Cossette
Shoreline Surgery/Endoscopy
Valerie Curbow
Adult Emergency Department
Jeffrey Curran
Surgery Unit (7-5)
Amy Cusano
Medical Oncology Unit
Heather Daigle
Newborn Special Care Unit
Melanie D’Amato
School-age/Adolescent Unit
Debbie Debiase
Surgery Unit (6-4)
Amy Degray
Maternal Special Care Unit
Roselyn Desiree
Medicine Unit (9-7)
Donna D’Eugenio
Hospital Research Unit
Kathryn Dias
Surgical Intensive Care Unit
Joan Ecklund
Orthopedics Unit
Tricia Eddy
Perioperative Services
Etsuko Elmammann
Orthopedics Unit
Samantha Emerling
Medicine Unit (9-7)
Dolores Errity
Temple Surgical Recovery
Carlotta Evans
Surgery Unit (6-4)
Martha Ferreira
Surgery Unit (6-4)
M. Michele Flowers
South Pavilion Operating Rooms
Autumn Foshee
Maternity (WP 11)
Jill Franco
Labor and Birth
Tracey Frith
Maternity (WP 11)
Heather Gainer
Medicine Unit (9-5)
Mary Catherine Gannon
Surgery Unit (7-5)
Elizabeth Gernat
Maternity (WP 11)
Cecilyn Glorioso
Medicine Unit (9-7)
Kevin Gonzalez
Medical Intensive Care Unit
Erwille Joy Gurdek
Labor and Birth
Carrie Guttman
Gyn/Oncology Unit
Katarzyna Haley
Orthopedics Unit
Lois Hawken
Resource Support Unit
Stephanie Hays
Neuro Intensive Care Unit
Robyn Hewitt
Adult Emergency Department
Stephanie Hinchliff
Surgical Intensive Care Unit
Deborah Hollaway
Shoreline Emergency Department
Jessica Holmes
Maternity Unit (WP 11)
Megan Homes
Medical Oncology Unit
Chelsea Howell
Medical Oncology Unit
Marie Gael Husmalaga
Medicine Unit (9-7)
Danielle Innis
Medicine Unit (9-5)
Kenneth Jacobs
Shoreline Emergency Department
Nataliya Jatsiv
Surgery Unit (6-5)
Elizabeth Jobbagy
Surgical Intensive Care Unit
Cheryl Jones
South Pavilion Post-Anesthesia Care Unit
Lisa Jones
Medicine Units (10-7/8)
Lida Jureczko-Russell
Urology/General Surgery Unit
Kristine Keller
Adult Emergency Department
20 nursing uPDATE

Carol Kennedy
Oncology/Pediatric Respiratory Care Unit
Shawn King
Cardiothoracic Intensive Care Unit
Linda Koch
Radiation Therapy
Maria Koursaris
Neuro Intensive Care Unit
Hope Lamberson
Surgery Unit (7-5)
Jay Lano
Medicine Unit (5-7)
Sara Lantowski
Gyn/Oncology Unit
Liliana Lara
Maternity (WP 11)
Elpidio Latorilla
Temple Surgical
Tracy Lee
Medicine Unit (5-7)
Carolyn Levy
Labor and Birth
Tawnia Lewis
Newborn Special Care Unit
Alison Linske
Surgery Unit (6-4)
Virach Lotharakphong
Cardiothoracic Intensive Care Unit
Robyn Lussier
Temple Surgical Recovery
Dawn Lyder
Labor and Birth
Brittany Lyhus
Pediatric Intensive Care Unit
Jennifer Maddern
Surgery Unit (6-4)
Jena Malchiodi
Apheresis
Mary Manseau
Surgery Unit (6-7)
Destiny Massaro
Adult Emergency Department
Stella Mateo
Maternity (WP 11)
Tracy Mazzella
Surgery Unit (6-4)
Christina McCann
Acute Care for the Elderly
Diane McQueeney
Temple Surgical
Stacy Mehmet
Medicine Unit (5-5)
Alexandra Mena Hertado
Medical Oncology Unit
Felice Mennone
Maternal Special Care Unit
Sami Merit
Neuro Intensive Care Unit
Shandi Montiel
Pediatric Emergency Department
Diana Moore
Maternity (WP 11)
Jennifer Morgan
Surgical Intensive Care Unit
Sandra Morgan
Temple Recovery Care
Deann Morin
School-age/Adolescent Unit
Krystal Mozny
Pediatric Emergency Department
Catherine Mulvey
Shoreline Emergency Department
Kathleen Murphy
Temple Endoscopy Center
Lindsay Neptune
Infants and Toddlers Unit
Melane Ninonuevo
Labor and Birth
Vicki Ogbejesi
Resource Support Unit
Mary Okwusosu-Osakwe
Medical Oncology Unit
Elaine Ovecka
Medical Intensive Care Unit
Maria Paterno
South Pavilion Operating Rooms
Erin Patton
Pediatric Intensive Care Unit
Alisha Pearson
Adult Emergency Department
Jennifer Pelletier
Oncology/Pediatric Respiratory Care Unit
Melanie Pipping
South Pavilion Operating Rooms
Doreen Prentise
Perioperative Services
Marian Quitain
Adolescent/Geriatric Unit YNHPH
Cathy Rafalowski
Acute Care for the Elderly
Meighann Recile
Medicine Unit (9-5)
Wayne Rollins
Medical Oncology Unit
Jasmine Rosales-Anchetta
Medicine Unit (9-7)
Heather Rosario
Ambulatory Surgicenter
Lorien Sargolini
Hospital Research Unit
Jaime Sawyer
Medicine Unit (5-5)
Susan Shaw
Labor and Birth
Rachael Soyka
Adult Emergency Department
Kathryn Standish
Medicine Unit (5-5)
Marina Syrax
Medicine Unit (9-7)
Cindy Taylor
South Pavilion PACU
Alyssa Wanat
Medicine Unit (5-5)
Louise Ward
Labor and Birth
Ilene (Dee) Zimmerman
Radiation Therapy
Daniel Zweeres
Medicine Unit (5-5)
AONE taps three nurses
for its prestigious fellowship
In 2007, the American Organization of Nurse
Executives (AONE) chose three Yale-New Haven
nurse leaders for its prestigious 2008 nurse manager
fellowship. They are (below): Denine Baxter,
R.N., patient service manager, Pediatric ED;
Marie Devlin, R.N., patient service manager, SICU
and Stepdown and General Trauma Unit; and
Sandra Watcke, R.N., patient service manager,
Medical Oncology Treatment Center.
The AONE Nurse Manager Fellowship is a yearlong
professional development program designed
to provide in-depth education and development
through four fellowship retreats, by applying
classroom learning in the workplace and through
electronic communications with expert faculty
and other fellows. The goal of the program is to
ensure the vitality of strong nursing leadership
within American healthcare organizations.
a b o v e The three YNHH nurse managers chosen for AONE
fellowships meet with Sue Fitzsimons. Shown (l-r) are: Denine
Baxter; Sandra Watcke; Sue Fitzsimons, R.N., Ph.D., senior vice
president, Patient Services; and Marie Devlin.
YAlE-nEw hAvEn hosPiTAl 21

N U R S I N G
U P D A T E