NURSING MATTERS - Miami Children's Hospital

NURSING MATTERSPUBLISHED FOR THE NURSING STAFF OF MIAMI CHILDREN’S HOSPITALVolume 13 • Issue 2 • Spring 2012Leader inthe SpotlightKohl’s Cares is a foundation of Kohl’s departmentstores that provides grants to various community partnersto show its commitment to kid’s health and education.The use of this grant varies based on the health relatedneeds of the community. Miami Children’s Hospital andKohl’s Associates in Action are committed to the healthand well-being of the children in our community andhave joined to provide families with bike-and child-safetyevents at various South Florida locations throughout theyear. The events focus on head injury prevention andinclude bicycle helmet fittings and helmet giveaways.Since 2009, Kohl’s has provided more than $325,000to the Miami Children’s Hospital Foundation to makethese events possible. Miami Children’s was presentedwith the 2011-2012 grant check at an event on October15, 2011. This event featured entertainment, giveawaysand more. The partnership with Kohl’s has provided anew way for Miami Children’s Hospital to give to thecommunity. For more information on the Kohl’s Caresgrant, calendar of future events, and bike and helmetsafety information, please visit us athttp://www.mch.com/KohlsCares.Why I Became a NurseBy Veronica Scott-Fulton, DrNP, MPH, RNAdministrative Director of Nursing Operations andMedical Surgical ServicesDaisy, my mother, who serves as thematriarch of the family, has alwaysbeen my hero. She is an extremelyrobust, religious woman with an abundance ofSouthern qualities, such as grace, mercy, humilityand the courage to endure the toughest storms. Asthe eldest daughter of 12, she easily managed andbecame acclimated to storms. The family historicalrecord is filled with accounts of Daisy cooking fullmeals to feed 50 or more people on short notice.continued on page 6Inthis issueChild Life in Our MCH Emergency DepartmentThe Road to Doctorate in Nursing Practice(DNP)My Philosophy of Nursing3East Uses Lean Tools to Enhance CustomerServiceThe Incredibles- Med Surg’s Very Own SMEsNew Certifications and EducationA New Year’s Trauma Brings Gift of RenewedAppreciationWestern Institutional Review Board Visits theMiami Children’s Hospital Research InstituteCheesecake Recipe

From the Desk of Jackie GonzalezDear Nursing Team:The nursing team at Miami Children’s has much to celebratelooking back and much to anticipate in the year underway.As always, our nursing team was at the forefront of 2011hospital initiatives to advance care practice and experience.For many families, we are the heart, soul and smiling face ofMCH care and our impact is immeasurable.We recently went live with our PEDS electronic medicalrecord system. I want to thank those nurses who serve asSubject Matter Experts last year and in 2012 to supportdevelopment of the new system and as well as theircolleagues. Their hard work and guidance ensures that ournew system will be optimal in its ability to support childrenand families and care here at MCH.Some of our nurses were trained as “super users” who teachothers how to utilize the new system. The go-live in April,marked a huge step forward for the children we serve. Theinterconnectivity of our systems through PEDS optimizescare practice, facilitating access to comprehensive patientrecords and enhancing care.We continue to pursue our Magnet renewal process and areadvancing documentation that demonstrates how the MCHnursing team lives and breathes Magnet components. Thesite visit is expected to follow in late fall. This is a busy timefor us as we prepare to showcase ourselves and “Magnify ourExcellence.” The delivery of care at Miami Children’s Hospitalis guided by the principles of family-centered care. The NursingDepartment is dedicated to the belief that each child is uniqueand an integral part of a family unit. Families are involvedthroughout the course of their child’s care and are consideredvalued partners in care delivery. At all times, the deliveryof care ensures respect for the dignity, values, religious andcultural beliefs of children and families. You will be hearingmore about our new Professional Practice Model in months tocome, developed especially by and for MCH nurses, that willserve to guide us into the future.Thank you one and all for a dynamic 2011 and for embarkingwith me on PEDS and Magnet projects. As always, our nursingteam is truly a force to be reckoned with. It is genuinely aprivilege to serve with all of you.Sincerely,Jackie Gonzalez, ARNP, MSN, NEA-BC, FAANSenior Vice President / Chief Nursing Officer / Patient Safety OfficerState Nursing VisionMiami Children’sHospital’sLeadershipCollaborativeRelationshipsPatients, Families,& GlobalCommunityNursingProfessionalism& ValuesProfessionalPractice ModelCare Delivery& OutcomesRecognition& RewardsState Nursing Mission2

Child Life in Our MCH Emergency DepartmentBy Brittany Brown, Miriam Damvar, Lauren Falduti, Danielle Furio and Kim MoralesFrom a child’s eye view, a hospitalis a blur of white coats, strangevoices and sharp needles. And whenyour medical vocabulary is limitedto “boo-boo” and “ouchy,” it’s hard forcaregivers to figure out what’s going onor why it hurts. This is where a Child LifeSpecialist, such as Miriam Damvar, canhelp. Miriam assists patients and familymembers in understanding what’s going onin an age-appropriate manner. She mightuse bubbles to distract a toddler during anIV Start or use an iPad with a school-agechild during a laceration repair. Miriamis one of five Child Life Specialists whowork in our Emergency Department here atMiami Children’s Hospital.Miami Children’s Hospital employs fiveChild Life Specialists and one Child Lifeassistant in our Emergency Department. Tobecome a Child Life Specialist, you mustearn a minimum bachelor’s or master’sdegree, with an educational emphasison human growth and development,education, psychology, or a related field ofstudy. All of our ED Child Life specialistsare certified, which requires them tocomplete a supervised 480-hour clinicalinternship, pass an examination, and adhereto a minimum standard for continuedprofessional development in order tomaintain certification. Our Certified ChildLife Specialists in the ED help childrenand families cope with stressful situationsby finding out about any misconceptionsor fears they have about the ED and helpthem work through anxieties. Kim Morales,the outpatient Child Life Supervisor, said,“Much of the distress that is associatedwith an emergency room visit is due to thechild’s fear and the parent’s uncertaintyaround how to manage all of that. If we canreduce those fears, what is left over is notso horrible.” The truth is an IV start, blooddraw or laceration repair is going to hurt.And you can’t save a child from all thepain and indignity that comes with a visitto the Emergency Department but there aremany things that a Child Life Specialist cando to help ease the pain and distress of ourpatients and families.Child Life utilizes play to establishquick rapport with a patient in order tocreate a trusting relationship that aids inthe child’s comfort with the healthcareteam. We prepare the patient for upcomingprocedures using visuals and medicalequipment in order to decrease anxietyand fear, and encourage confidence andcontrol by giving them choices, whenpossible, such as allowing a child to choosewhat hand the nurse first looks at for anIV start. Child Life is also present duringthe procedure to facilitate distraction fromanxiety, and to provide emotional supportand coping techniques to help the childmaster the experience. The methods appliedby Child Life help to increase the child’scooperation, which can result in fewermedical staff members needed to “hold” aswell as less time spent during procedures.There is also a significantly lower amountof sedation and pain medication needed,due to the focus Child Life places ondecreasing the child’s anxiety as wellas utilizing non-pharmacological paintechniques such as distraction, guidedimagery and comfort positioning.3The following is an email is from aparent of a patient who was in our ED inDecember. Child Life Specialist BrittanyBrown (BB) was providing support anddistraction with this patient using an iPadand the patient was playing a game calledFruit Ninja, which involves swiping ascreen. “This e-mail is to let you know thatyou guys are..!!!!..AMAZING..!!!..My son(you can’t stop the swipe) the best fruitninja of the emergency room was very sickand you guys helped us to pass througheasily. BB was a very special person tous and Chris. They did a bunch of tests tomy boy. (Blood work, x-ray, etc.)....butwe didn’t feel it because somebody tookthe time to explain to us the whole thingwith detail. That person was BB. .So, toBB and the Child Life Department....a bigTHANK YOU! Thanks for all the thingsyou did for us to make us comfortable atMiami Children’s Hospital. With peoplelike that... (BB)...we just want to be sickall the time. Thanks to Miami Children’sHospital, to the emergency room and theChild Life Department. A big thank you toBB for being there for my son.....thank youso much......and remember.....“You can’tstop the swipe.”

The Road to Doctorate in Nursing Practice (DNP)By Raquel Pasaron, DNP, ARNP, FNP-BC (Raquel is MCH’s first DNP)When I graduated with mybachelor’s degree almost 24years ago, the faculty instilledin my graduating class the prospect ofcontinued education in nursing. One of myprofessors said, “I give you a year, you’llget bored and apply for graduate school.”My father, a blue collar worker, ingrainedin me the drive to study and work towardeducational pursuits. He said to me, aftergraduation, if you want to continue witha graduate degree I will help you. I said,“No, Dad, I want to be the bestnurse that I can possibly be; Iwant to pursue further studies,but only in practice can I be anexpert.”After three years of clinicalpractice, I decided to go backto school and pursue mygraduate degree. (Not sure thatafter three years of practice, Iwas an expert, but….) On mygraduation day, my chairpersonat that time, Dr. Donna Pfeifer,said to my parents, “She needsto pursue doctoral studies.”Almost 15 years later, I did.First, I considered a researchbaseddoctorate degree (PhD),and completed 18 credits.However, research synthesiswas not what I aspired to do.As I was driving back homefrom a national conference with my workcolleague and her husband, a Universityof Florida (UF) alumni, I was convincedto apply for the on-line UF Doctorate ofNursing Practice (DNP) Program. Theapplication was due in five days.The program was ideal for me. The onlinebasis of the program was somewhatdaunting, but the appeal of working withinyour time constraints was aligned to mywork and life schedule. The DNP Programat UF was one of the first in the state. Theuniversity’s College of Nursing has anexcellent reputation and the curriculumwas extremely appealing, innovative andin keeping with the American Associationof Colleges of Nursing’s white paper onpractice-based doctoral education. Thecurriculum, student body and programwas tailored to practice-based practitionersand in keeping with recommendationsregarding the transformational changein education required for professionalnurses to practice at the most advancedprofessional level.The depth and breadth of thecurriculum was comprehensive andcarefully planned for stepwise progression.The courses included: health policy,public health and epidemiology principles,nursing informatics, quality indicatorsin nursing systems, outcome measures,advanced reasoning, ethical considerationsin nursing, applied statistics, advancedpharmacotherapeutics and lastly thesynthesis of research application theadvanced nursing project and residencyprogram. The application, resources,faculty availability, accessibility, seamlessprocesses associated with the program,college and coursework were completelyhardwired. I felt extremely “special” andnot a “cog in a wheel.”However, doctoral education wasone of the most humbling and rewardingendeavors of my professional career.The on-line program helped me be abetter communicator, both in writing andin person because it made me keenlyaware of how important words are andcommunication is,regardless of modality.The program requiredgreat organizationalskills, drive anddedication. The rewardswere immeasurable. Iearned a great respect forpeople, nursing and itsdiversity.Having earned thisdegree is almost a surrealexperience. My curiosityhas been constant, bothprofessionally andpersonally: 1) I am awork in progress. 2) Iwant to be the best nurseI can possibly be.Curiosity, for me,is fueled by directionand purpose for nursingexcellence. I am not surethat I will ever accomplish that goal, butpursuit of self-actualization, whether wereach it or not, is always a good idea. Inmy advanced project acknowledgement, Istated, “I hope that throughout this journeyI have chosen, I have made those aroundme proud by serving those that need methe most.”I pray every day that I give the best ofme in every patient encounter. I hope thatI continue to grow and learn, and that theDNP is only a step further.4

The Incredibles: Med Surg’s VeryOwn SMEsBy Elizabeth Padilla, MSN, RN, CPNcontinued from coverWhy I Became a NurseSo you’ve heard about them -- SMEs(subject matter specialists). In factyou’ve heard the MCH familypronounce their titles differently, “smeez”or “S-M-E.” So, who are they? Why werethey chosen? And just what exactly do theydo? I had the pleasure to interview fourSMEs from the medical-surgical units.I asked ourPEDS electronicmedical recordcrew whatintrigued themabout becomingSMEs. JenniferHager (2NorthSME) statedshe wanted tobe ahead of thegame when itcame to PEDS.Jennifer Shapiro (2E SME) had an interestin clinical systems and was ready for thischallenge. Cindy Ayala (3S SME) saw it asa way to show her pride- by representingher unit. While working on creating thenursing software for MCH, the SMEs haveencountered some enlightening challenges.Cindy said she had to learn to “think ofthings in a broad perspective, like hospitalwide verses unit based.” All SMEs sharedthe challenge of having to figure everythingout on their own, sort of like a policedetective. Only, they weren’t on theirown. They had each other to rely on, askquestions and support one another.They also share proud moments asSMEs. Natalia Lopez’s (3East SME)moment was when she was asked aquestion and she had the right answer. Itwas a small detail, but it made her feelvictorious. Jennifer Shapiro’s proudestmoment came after her hard work ofdeveloping and leading the PEDS updatesand demonstrations to staff, she wasrecognized by Bing and Jackie for herhard work. Cindy’s proudest moment wasovercoming a fear that many share – publicspeaking. She had to do many updatesfor Nursing Leadership and for staff andrealized she conquered her fear.The SMEs had witty answers whenasked about what is the ONE aspect ofthe electronic medical record the nurseswould most benefit from. Jennifer Hagersays that being able to quickly access thephysicians’ orders and notes will lead toimproved patientcare. Natalia sharesher sentimentas well, statingthat physicianorder entry willlead to enhancedtranscription.Jennifer Shapironotes that nowmedication orderswill go directlyfrom the physicianto the pharmacy, increasing efficiencyand speed in medication preparation.Cindy sees the one-stop-shop the EMRwill provide as the greatest benefit. Now,medications and all charting will be doneon the same computer software.I finally asked them to identify tipsfor our MCH nursing family to help themsucceed in welcoming the PEDS system.Cindy Ayala advises teams to stay on thecurious level of the mood elevator and to“keep an open mind.” Jennifer Shapiroechoed Cindy’s opinion by stating thatwe should all maintain a positive attitude,get involved and participate in end usertraining. Jennifer Hager says that “beingopen to change and understanding that thiswill be easier as time passes” should bekept in the back of our minds at all times.The success of PEDS is due largely inpart to the hard work of the SMEs. Theytoo did not know what to expect, but withan optimistic attitude and positive thoughts,not only did they learn this program, butthey were able to mold it to what thenursing team at MCH needs.6It is indeed a rare occasion orevent that surprises her or finds herunprepared. More often than not, shestands ready to manage the worst ofsituations with the requisite strengthto win the battle. Such is life forDaisy as witnessed by a gratefuldaughter. I never understood howshe did it, only that she laughed outloud, sang the praises of God, andallowed life to shine its magnificentglory upon her.She is the reason I became a nurse.My grandmother and two of myaunts were nurses, so maybe itwas in my blood. They are all verycaring and take great pride in gettinglate night phone calls from churchmembers and neighbors asking aboutvarious ailments or medications.For them, this is a life calling; it’sGod’s work on earth. It is this senseof duty and this sense of mission thatcomplete their entire identity. Theywould wear their white uniforms tochurch and be honored with the titleof “mother nurse.” They continue towear their white caps, white dressuniforms, stockings and white shoesto be easily identified as a nurse byall who saw them. What a sight!I am a native South Carolinian. Istarted my nursing career at EmoryUniversity Hospital Mid-Town inAtlanta, Ga. I worked on a 42-bedsurgical unit. The nurse-to-patientratio was six to one and we had onepatient care tech for the entire floor.It was a tough place for a new gradand I wondered many times why Ichose this profession. In the end,nursing has become my life andmy happiness. I am wrapped in thesplendor of its presence and willnever let go. My future plan is tonever retire. When I am too old forhospital work, I want to be a schoolnurse at an elementary school.

A New Year’s Trauma Brings Giftof Renewed AppreciationBy Patty Rowe, RN, CPNOver the past 30 years, many victimsof tragic accidents have passed throughthe doors of our Emergency Department.Time and time again, our team has beencalled to make preparations and anticipatedevastating situations. And of course,weekends and holidays are prime days fortraumatic events.The dawn of 2012 in the ED was noexception. What occurred on that NewYear’s shift was something I could neverhave imagined in all of my years. Initiallythe message that circulated within thedepartment suggested that an incomingpatient was the victim of a stabbing and thata stretcher was needed outside. Anticipatingthe worst was nothing compared to theexperience I was about to face.Several of the staff retrieved the patientfrom a car out front, while others set up thetrauma room, and I proceeded to call forthe necessary blood that was expected tobe delivered for the bleeding patient.The doors opened and the charge nurseordered that I be seated. I never questionedher request, but immediately following, Iheard a very familiar cry. I slowly stoodfrom the chair and looked toward theracing stretcher headed for the traumaroom. I was unable to see the patient thenurses had crowded around the stretcher.There was only one quick glimpse of ared lock of hair, but I was determined notto follow where my mind was beginningto lead me. Nothing was certain untilthe last visual took place, my belovedhusband glancing toward me and followingthe stretcher inside. At that point I wasovercome by nausea as my heart raceduncontrollably, but deep within my soul Iknew “someone” was in control, and that“someone” is the one I talk to every day inmy prayers.The confirmation of this wasoverwhelming when one of the doctors andone of the nurses ran to my side and askedme if I wanted to pray. I knew that I neededto gain the Courage, Patience, ProfoundPeace and Serenity that only comesthrough prayer. Nowhere else in the worldcan you find this when you are faced withthese types of trials. This is what is beyondall human understanding!Time seemed to stand still at this pointand I started to reflect on the staff in thedepartment that day. From the physicians,nurses, secretaries, registration clerks,housekeeping, ED and radiology techs,whether they were at my son’s side orcaring for the other sick children, theywere all given to such a beautiful purpose.I began to realize in fact, I truly was on theother side. I no longer was the caregiverbut the care receiver. Through my eyes,I witnessed like never before, the staff’sdirection, focus, determination and thedepth of their never-ending compassion.I was graced to see them in a whole newlight and have been immensely touchedever since.Life as we know it, is forever changing,and it is those with whom we encounterthat change us. From our loved ones, tothose with whom we work, and those wemeet every day of our life, we learn andgrow, and appreciate all that is offered tous for a greater purpose.This fateful night will be one I willnever forget. This particular night heldmuch promise and hope in the frailty of lifeand I pray it will help us all to realize theimportance of relationships within our ownfamily and at work. We must never forgetthat we are surrounded by “angels” andthose “angels” include you. You are theones that reach out to so many, to heal, tocomfort and give support, and especially intrials such as these.Our family has been so very blessedand it is my desire to recognize each andevery one of you! My thoughts have beenmany, and I wanted something very specialto reward you.In the meantime, all I have to offer isa gracious heart. You all are very dear to7me and words cannot fully express theappreciation that our family has for eachand every one of you!Our son has fully recovered from theinjury, which was not a stabbing, but aninjury caused by carrying bottles on ago-ped and then falling. The injury to theabdomen was long and deep, but did notpenetrate into the vital organs. Anotherblessing from above.May God continue to bless your livesabundantly!Cheesecake RecipeBy Carol Braz, RN,Emergency Department( the recipe makes 2 cheesecakes)• 3 8-ounce blocks of creamcheese (softened----leave itout of the fridge for severalhours)• 1 cup of sugar• 4 eggs• 2 teaspoons of vanilla1. Mix with a mixer untilsmooth.2. Place contents in grahamcracker crusts.3. Bake at 350 for 35 minutes.Let cool for about 2 hours,then place toppings. (I usethe pie filling fruit in thecanned fruit section)4. Refrigerate for severalhours, then serve.5. Enjoy!

Nursing Matters isproduced quarterly byand for the nursing staff ofMiami Children’s Hospitalin collaboration with theMarketing departmentJackie Gonzalez, ARNP,MSN, NEA-BC, FAANSenior Vice PresidentChief Nursing OfficerMarcia Diaz de VillegasDirector of Marketing andPublic RelationsMarketing Editor:Rachel PerryNursing Editors:Joy Ortiz, RN, CCRNMonica Brown, RN, MSN,CPNContributing Writers:The nursing staff ofMiami Children’sHospitalLayout: Hortensia CesarPhotography:Edgar Estrada,Steven Llanes,Juan Carlos RabionetTo submit news andinformation to theNursing Mattersnewsletter, please emailjoy.ortiz@mch.com ormonica.brown@mch.com.Articles accepted must bewritten by MCH nurses,previously unpublished anddon’t forget to include yourfull credentials for credit.Western Institutional Review BoardVisits the MCH Research InstituteBy Jenny Cordo, MSN, ARPN, PNP-BCIMiami Children’s Hospital ResearchInstitute this month received a visit from arepresentative of the Western InstitutionalReview Board (WIRB), an entity that providesa review of clinical investigations to assure theprotection of the rights and welfare of the studysubjects.Cynthia Gates, RN, JD, Vice President ofEducation and Consulting Services for WIRB cameto Miami Children’s Hospital Research Institute toreview research processes and provide education.During her visit, she offered informationalseminars for physician and nursing investigatorsas well as research staff. Ms. Gates also met• Sandra Burcet, CPN, 2 East• Rico Trespicio, CPN Cert.,2 East• Maibys Molina, CPN Cert.,2 East• Vera Berry, CPN Cert., 2 North• Michele Moreno, CPN Cert., 2 North• Cristina Meca, CPN Cert., 2 North• Cristina Milian, CPN Cert., 2 North• Ana Lourdes Perez, CPN Cert., 2 North• Jessica Perez, CPN Cert., 2 North• Natalia Lopez, CPN Cert., 3 East• Valeria Riorda, CPN Cert., 3 East• Alejandro Perez, CPN Cert, 3 East• Vladimir Almenares, CA Certs, 3 East• Dalva Ferraz, CA Certs, 3 East• Martha Tanos, CA Certs, 3 East• Mellissa Iglessias, MSN/ FNP-BC, 3 NE• Cristina Suarez, MSN, 3 NE• Audrey Strapp, CA Certs, 3 NE• Guillermo Serrano, CA Certs, 3 NE• Nelly Santos, CPN Cert., 3 NE• Michelle Tai, CPN Cert., 3 North /Infusion• Lina Gaviria, CPN Cert., 3 North /Infusion• Natalie Machado, CPN Cert., 3 North /Infusion• Karina Egues, CPN Cert., 3 North /Infusion• Diana Garcia, CPN Cert., 3 North /Infusion• Annette Caravia, CPN Cert., 3 North /Infusion• Cristina Suarez, CPN Cert., 3 North /Infusion• Anilady Casserino, CPN Cert., 3 North /Infusion• Willyne Lozainder, CPN Cert., 3 North /Infusion• Caroline Mazzitelli, CPN Cert., 3 North /Infusion• Sylvia Mendez, CPN Cert., 3 North /Infusionwith a number of research staff members andadministrative personnel as part of her review ofthe research institute practice.Ms. Gates noted that the MCH researchteam was knowledgeable, worked well with theinvestigators and asked insightful questions. Shewill submit her findings to the WIRB Board fortheir consideration.“I would like to thank all of our ResearchTeam and the investigators who participated in theWIRB visit,” said Jose Perdomo, Director of theResearch Institute and Associate General Counsel.“This was a great display of team work.”New Certifications and Education• Stephanie Soto, CPN Cert., 3 North /Infusion• Kristen Rojas, CPN Cert., 3 North /Infusion• Anamaria Jaurequi, CPN Cert., 3 South• Beatriz Milian, CPN Cert., 3 South• Oldine Pierre, CPN Cert., 3 South• Elizabeth Forrest, CPN Cert., 3 South• Patricia Tavio, CPN Cert., 3 South• Damaris Sanchez, CPN Cert., 3 South• Karen Rickets, CPN Cert. 3 South• Jeannie Perez, CPN Cert., 3 South• Carolina Ferraz, CPN Cert., 3 South• Mercedes Pons, LPN-RN, Dialysis• Odalys Correa, RN, LPN-RN, ED• Idania Leon, RN, LPN-RN, ED• Simone Carter, RN LPN-RN, ED• Joan Cornell, RN, LPN-RN, ED• Erika Colston, LPN-RN, ED• Lizette Rivera, CPN Cert., ED• Lilia Alonzo, CPN Cert., ED• Gabrielle Lugo, CPN Cert., Float Pool• Emmanuel Ramirez, CPN Cert., Float Pool• Janyne Solomon, CPN Cert., Float Pool• Jeanette Rawls, CPN Cert., Float Pool• Katy Cabanillas, CPN Cert., Float Pool• Alicia Lue, Vascular Access Cert., IV Team• Ansley Bienvenu, Vascular Access Cert.,IV Team• Marissa Subido, CPN Cert., NICU• Priscilla Armas, CPN Cert., NICU• Marina Fabian, CPN Cert., NICU• Sarah Iverson, CPN Cert., NICU• Angela Ow, CPN Cert., NICU• Florence Smith, CPN Cert., NICU• Nadine Goelz, CNOR Cert., OR• Odalys Bancroft, CNOR Cert., OR• Andres A. Andres, CST, OR• Patricia Bowen, CPN Cert., PCC• Maria Mejia Rincon, CA Certs, PCC• Julia Badia, CA Cert, PCC• Erica Pardo, PNP-BC, PICU• Angelina Apolis, CPN Cert., PICU• Gina Jimenez, CPN Cert., PICU• Vanessa Lengyel, CPN Cert., PICU• Alison Scheflow, CPN Cert., PICU• Michelle Rodriguez, CPN Cert., PICU• Francesca Otero, CPN Cert, PICU• Vanessa Escobar, CPN Cert., PICU• Jason Shull, CPN Cert., PICU• Alejandra Guermes, CPN Cert., PICU• Vivette Dobbins, CPN Cert., PICU• Victoria Perez, CPN Cert., PICU• Alison Scheflow, CPN Cert., PICU• Mariel Marin, CPN Cert., PICU• Julie Smith, CA Certs, PICU• Bobbie Robinson, CPN Cert., PICU• Jannette Martinez, CPN Cert., SameDay Surgery• Jeannette Giraldo, CPN Cert., SameDay Surgery• Rebeca Pastor, CPN Cert., CV• Lourdes Selbio, CPN Cert., CV• Jen Vasserman, CPN Cert., CV• Jessica Miller, CPN Cert., CV• Dafenie Fernandez, CPN Cert., CV• Maria Caridad-Cortina, CPN Cert., CV• Jackie Rodriguez, CPN Cert., CV• Danielle Emerrick, CPN Cert., CV• Andrea Downs, RN, CPN Cert., CV• Joy Garcia, RN, CPN Cert., CV• Esther Wooten, RN, CPN Cert., CV• Ana Liza Marasigan, CPN Cert., CVMCH-HC201206_2271