Notable Nursing: Update February 2014

It’s a Small World: Nursing Program Invites International VisitorsIt’s a Small World: Nursing Program Invites International Visitors

Julian Hui Min Lee works as a specialty nurse in geriatrics at Singapore General Hospital. But for three weeks last October, Lee gained invaluable experience and insight shadowing healthcare professionals halfway around the world at Cleveland Clinic as part of the Zielony Nursing Institute’s Visiting Scholars Program.

“It’s a very good program,” says Lee. “I got to rotate through different areas of Cleveland Clinic and see some of the programs offered by the Department of Geriatrics, like the Falls Clinic.” Lee observed several nurses at work on inpatient units and at the hospital’s Brain Health Clinic, Aging Brain Clinic, Falls Clinic and other areas.

Lee was one of 30 nurses from five countries to visit Cleveland Clinic from June through December 2013. She learned about the Visiting Scholars Program online, then earned a scholarship to attend from the Minister of Health at Singapore General Hospital.

The Visiting Scholars Program allows nursing professionals worldwide to gain knowledge and new skills in multiple areas of nursing practice, education and personal clinical interest. The program is tailored for participants to meet their career development objectives and their sponsoring institution’s needs. “Upon successful completion, participants take with them the skills and best practices of the Zielony Nursing Institute and can apply them to patient care at their own institutions,” says Nancy Kanyok, MSN, RN, BC, CNS, education nurse specialist who coordinates the program at Cleveland Clinic.

Lee plans to do just that. She was particularly impressed with Cleveland Clinic’s Geriatric Nurse Resource Program. Through the program, staff nurses are trained to assess, detect, prevent and manage common geriatric nursing care problems that occur across all specialties. These include decreased physical function, incontinence, delirium, skin care and so on. More than 100 nurses have been trained as geriatric resources nurses since 2001. “I will look into [implementing] the Geriatric Resource Nurse Program at my hospital,” says Lee. “It’s a very good way to educate staff nurses on geriatric issues and will improve the care of our patients.”

Anne Vanderbilt, CNS, CNP, spent three days with Lee. Vanderbilt is an advanced practice nurse manager with Cleveland Clinic’s Nursing Education and Professional Development Department as well as a clinical nurse specialist in geriatrics. Lee observed Vanderbilt interview patients, get histories, conduct physical exams, review medications and instruct family members. “She asked a lot of ‘why’ questions: Why did you choose that medication? Why did you recommend that course of treatment?” recalls Vanderbilt. “And then we discussed the decision-making process.”

Vanderbilt says the international nurse was amazed at the level of independence conferred on APNs. Vanderbilt saw 20 patients with Lee at her side, while the nurse from Singapore is not permitted to conduct office visits without a physician follow-up. “Julian was impressed to see nurses here practicing at the full scope of their licenses and with robust support from the hospital and collegiality with other healthcare professionals,” says Vanderbilt.

While Lee gained a lot from her time in Cleveland, so did Vanderbilt. “Deep down, despite our cultural differences, we all face the same issues in nursing. We have so much in common in the day-to-day care of patients” she says. They shared frustrations over the limitations in pharmacology for patients with dementia and discussed interventions for preventing falls.

Ultimately, creating bonds between nurses is the goal of the Visiting Scholars Program. “I look forward to seeing more and more visiting nurses,” says Vanderbilt. “We have a lot to offer each other.”

Nurses Lend a Healing Hand at Community Health CenterNurses Lend a Healing Hand at Community Health Center

Pat Zabala, RN, recently cared for a husband and wife, both of whom are diabetic. She discovered they were sharing syringes and dividing up insulin to save money. Zabala provided the couple free syringes and insulin at North Coast Health Ministry (NCHM), a faith-based charitable health center in Lakewood, Ohio, that provides healthcare to uninsured and underinsured people.

Zabala is one of more than 20 nurses who volunteered at NCHM in 2013, nearly a third of whom are affiliated with the Cleveland Clinic health system. “I have had a blessed life, and I think it’s important to give back,” says Zabala. “North Coast Health Ministry fills a void in our healthcare system.” Zabala, who has been a nurse for 43 years, works in the post-anesthesia care unit at Fairview Hospital. Once a month she volunteers during an evening clinic at NCHM. “The patients are so grateful for anything you can do for them,” she says.

Jeanine Gergel, Assistant Executive Director of NCHM, says volunteer physicians, nurses and clerical staff are essential to the health center. “Volunteers extend the care provided by our paid staff, making it possible to provide care to more individuals in need than our budget would otherwise allow,” she says. “They are also important advocates for the work we do and, in many cases, help get the word out about our services to the people who need them.”

NCHM provides primary healthcare, specialty referrals, prescription assistance, preventive and chronic disease management, medical tests and health education to more than 2,200 low-income individuals. In the first 10 months of 2013, nurses volunteered more than 1,900 hours. These include LPNs, RNs, advanced practice nurses and nursing students completing clinical rotations.

While the nurses provide invaluable care to patients who might not otherwise receive medical attention, they are rewardedtoo. Zabala walks away from each evening clinic knowing she has made a difference. “I encourage any nurse who has some free time to volunteer,” she says. “Give back what you can.”

Training Bolsters Workplace Skills of PCNAsTraining Bolsters Workplace Skills of PCNAs

Last fall, Cleveland Clinic began revamping its orientation and training for patient care nursing assistants (PCNAs) to not only better prepare the caregivers for work, but also improve retention. “Most PCNAs come to us with little to no work experience in healthcare or anywhere,” says Theresa Gouch, BSN, RN, a clinical instructor who oversees orientation and onboarding for unlicensed nursing staff. “We want to give them resources to be successful and hopefully keep them as long-term employees.”

Previously, new full-time PCNAs received one week of clinical skills training prior to joining a unit at Cleveland Clinic’s main campus or one of its community hospitals. In October, the health system added a week of general workforce training prior to the clinical instruction. Cleveland Clinic teamed with OhioGuidestone, a Northeast Ohio nonprofit organization that offers a workforce development program. “We’ve partnered with them to help us with soft skills and life skills to help new hires adapt to the workplace,” says Gouch.

The 40-hour training covers a variety of topics, including how to manage time, communicate effectively and behaveprofessionally. It also features team-building exercises. “It’s so important for our PCNAs to embrace the team model,” says Gouch. “They will join a team on their unit, and every day that team may look a little bit different. PCNAs must adapt to that.”

To reinforce the importance of teamwork, this year Cleveland Clinic also is adding a combined orientation day for all new nursing staff, such as RNs, PCNAs, medics and health unit coordinators. “We want to bring all bedside caregivers together and focus on our nursing professional practice model,” Gouch explains. The Cleveland Clinic Zielony Nursing Institute’s Professional Practice Model encourages nurses to think in action, serve as leaders and provide relationship-based care. PCNAs will learn more hands-on skills “to give them confidence to deliver care independently and feel better prepared,” says Gouch.

So far, OhioGuidestone has facilitated three workforce education programs for the Nursing Institute, with an average of 10 PCNAs in each cohort. Cleveland Clinic hopes to boost that number to 20 per class. Gouch is currently following up with the first cohort, three months after its training, to gauge the program’s effectiveness. While there are no official results yet, feedback has been positive. “We are optimistic that our new training efforts will give PCNAs the right skills to help them thrive,” she says.