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2. nursing

C O M PA S S I O N • E X P E R T C A R E
LEADERSHIP • COMMUNITY SERVICE
Nursing
Annual Report
2010
SM
Children’s Hospital Los Angeles
A 2010 Overview
In This Issue
OUR HOSPITAL
• Licensed patient beds: 286
Letter from Magnet Managers . . . . . . . . . . . . . . . . . . 1
• Average daily census: 239.5
Letter from the Chief Nursing Officer . . . . . . . . . . . . . . 2
• Annual patient admissions: 11,420
Letter from the President and CEO . . . . . . . . . . . . . . . . 2
• Annual outpatient surgery cases: 8,886
Professional Development—Certification . . . . . . . . . . . 3
• Annual inpatient surgery cases: 6,575
Professional Development—Education . . . . . . . . . . . . . 8
• Patient days: 88,980
Professional Engagement . . . . . . . . . . . . . . . . . . . . . . 9
• Emergency and trauma visits: 97,000
Commitment to Community Involvement . . . . . . . . . . . 12
• Average length of stay in the hospital: 7.86 days
Recognition of Nursing . . . . . . . . . . . . . . . . . . . . . . 15
• Annual transport patients: 1,937
Culture of Safety . . . . . . . . . . . . . . . . . . . . . . . . . . 17
• Annual outpatient clinic visits: approximately 406,000
Another year as a Magnet-designated hospital has flown by! • Patient visits at community sites through the Division of Adolescent Medicine: 9,756
And so much has happened in 2010. Our nurses truly
• Patients under the age of 4 years old: approximately 50 percent
walls. Nurses took time out of their daily lives to help those in need
• Outpatient clinics: 48
­demonstrated their excellent work inside and outside the hospital
in Haiti. Nurses contributed their knowledge and expertise to the
decisions made in the Collaborative Governance Structure. They
also ­challenged themselves to achieve certification and advanced
OUR NURSES
• 68 percent of our nurse leaders have a national certification
• 58 percent of our nurse leaders are certified as Advanced Practice Nurses
• We have 79 Nurse Practitioners
degrees. Nurses continue to maintain collegial relationships with all disciplines to ensure the best patient outcomes. These are a few
Professional Practice Model . . . . . . . . . . . . . . . . . . . 19
Innovation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Nurse Week Essay Winner . . . . . . . . . . . . . . . . . . . 23
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . 25
Nursing Mission and Vision . . . . . . . . . . . . . . . . . . . 25
of the many attributes featured in this Annual Nursing Report that
define why WE ARE MAGNET.
Margaux Chan, RN, BSN, CPN
Susan Crandall, RN, BSN
• We have 15 Clinical Nurse Specialists
• We have 7 Nurse Anesthetists
• Average length of tenure for our nurses: 10 years
• Our expert nurses taught approximately 950 nursing students in 2010
Cover: Edgar Ordonez, RN Cardiothoracic Intensive Care Unit Nurse
and Versant™ RN Residency graduate.
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Welcome
Professional Development: Certification
Our certified nurses are the pride of Children’s Hospital Los
­newsletter for the Los Angeles chapter of the Society of Pediatric
Angeles. The journey to certification requires intense discipline.
Nursing, writing for the Nurse Week Essay Contest and
To prepare for the certification exam, some nurses take a
­contributing articles to the hospital’s “RN Remedies” blog series.
preparatory class and participate in study groups. Gloria Verret,
RN, CPN, studied with another nurse using nursing textbooks
and practice test questions. “It was like studying for the boards,
very intense and hard,” she says. Others choose to study alone
for countless hours. No matter the approach, the work pays off
when the nurse passes the exam.
Nurses commonly question the need for certification: “Why get
certified?” The answer is, “Why not?” Verret started at a facility
where there was no motivation to pursue certification or
­professional advancement. So when she arrived at Children’s
Hospital, she was pleased to see that nursing knowledge and
2010 was a year of preparation. We began the year with an The nurses at Children’s Hospital Los Angeles are some of the best
eye toward the transition into the Marion and John E. Anderson
anywhere. As they help us create hope and build healthier futures
However, the journey does not end there. Certified nurses must fulfill
­Children’s Hospital demonstrates its high regard for certified nurses
Pavilion. We spent more than 10 years intimately involved in the
for the children and families we treat, I’m consistently impressed by
certain requirements to maintain their certification, depending on
by offering them an hourly differential, a benefit not offered in many
planning of the beautiful, family-centered healing environment that
their skill, compassion and thoughtfulness.
the certifying body. This creates a commitment to lifelong learning
organizations. This drove her to challenge herself, personally and
by studying for required tests, attending conferences pertinent to
professionally, to accomplish certification and to advance up the
their certification and reading professional literature.
clinical ladder.
would become a trademark of the new building. 2010 took on a
new level of dedication that included all of us.
As we ready ourselves for Magnet re-designation, I’m also grateful
for our nurses’ professionalism and hard work. And we asked a
leadership are valued here. She was especially impressed that
Once complete, the building would be ours to create a state-of-
lot from them this year. Preparing to move into our new 317-bed
For example, to maintain her certification in Neonatal Intensive Care,
Requirements to uphold certification through continuing education
the-art hospital for the children and families we serve. Nurses and
inpatient tower, the Marion and John E. Anderson Pavilion, involves
Nicole Ainsworth, RNC-NIC, has to accumulate 45 Continuing
increase the knowledge base of certified nurses and promote
all members of the health care team at Children’s Hospital stepped
a monumental amount of planning, and in many cases our nurses
Education Units (CEU) instead of the minimum 30 CEUs required
patient safety. Certified nurses are more marketable for professional
up to begin the transition plan that would be fully implemented are leading the charge. These duties come in addition to their work
for licensure renewal. Thus, the expectations of these governing
advancement, internally and externally. They also are empowered in 2011.
caring for our patients, conducting research, achieving professional
bodies create a higher level of expertise, contributing to new
to share their knowledge and expertise in their workplace and
enrichment and advancing nursing as a profession. We cannot
knowledge in nursing practice.
community. Consumers who choose Board-Certified physicians Details were planned, problems were resolved and excellence was achieved over and over again. I was proud every step of the
thank them enough for rising to this challenge.
In 2007, Niebuhr and Biel conducted an American Board of
way. Every member of the Children’s Hospital community was a
Weekly, I hear stories about how great our nurses are—from their
Nurse Specialties (ABNS) survey among certified and non-certified
valuable part of the process.
supervisors, their colleagues and the patient families in our care.
nurses to study their views of nursing certification. The ABNS survey
Our highly-skilled corps of nurses help make this place more than
found that 88 percent of nurses agreed that certification enhanced
just a hospital; it is a welcoming environment of hope and healing.
personal confidence in clinical abilities. More than 90 percent of
2010 also was a year of impressive collaborative governance
work. It was a year of learning and problem-solving as we
developed structure, accountability and broad professional
To all of our nurses: Thank you for the support and ­leadership you
collaboration. Again, I am proud of the success we experience provide at Children’s Hospital Los Angeles.
in our vision to empower direct-care providers.
I know our success is based on our passion to always be better.
We all should feel grateful because we learn from each other every
day. Jobs don’t get any better than that.
I am proud to work with the nurses and Patient Care Services staff
to make Children’s Hospital Los Angeles the best and safest hospital
for kids and families.
Richard D. Cordova, FACHE
President and Chief Executive Officer
Children’s Hospital Los Angeles
as their health care providers will soon be cognizant of BoardCertified nurses and will expect quality care from them.
­Certification is not just mere letters after a name; it identifies
nursing’s highest value of professionalism.
nurses agreed that certification enhances professional credibility
Certified Nurses:
and validates specialized knowledge.
• Have professional pride and achievement
Ainsworth expressed this confidence after passing the certification exam.
• Are identified by patients and families as credible experts in their field
“I felt that I knew the material well, which made me more confident
when I taught or precepted new nurses in the Newborn and Infant
Critical Care Unit,” she explains.
The study also found that 98 percent of nurses agreed that
certification enhances feelings of personal accomplishment. The conclusion of this study indicates that certified nurses are
differentiated in the workplace as adept and proficient leaders.
• Are more likely to get offers for professional opportunities to
contribute their expertise, such as invitations to join committees,
participate in educational activities and serve on special projects
• Are marketable, opening doors for career advancement
• Are committed to continuing their education to uphold their certification
Mary Dee Hacker, MBA, RN, FAAN
Verret felt this sense of achievement after obtaining her certification
Reference:
Vice President of Patient Care Services and Chief Nursing Officer
in 2005. This motivated her to pursue many nursing opportunities.
Children’s Hospital Los Angeles
“Being a CPN has given me professional confidence and pride,”
Niebuhr, B. & Biel, M. (2007). The value of specialty nursing
certification. Nursing Outlook, 55(4), 176-181
she notes. “I started to volunteer to be on housewide councils,
including the Recruitment and Retention Council and House of
Representatives.” She has even started writing, editing the
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Our Certified Nurses 2010
Critical Care Registered Nurse (CCRN )
Carolyn D e La Cruz Pasiwen
Virginia A. Culla
Elizabeth Suzanne Daley
Sylvia Gomez
Juliet Christine Goss
Kathleen S. McIntyre
Lisa A. Rizzi-Wagner
Sandra X Shepard
Victoria J. Winter
Donna Guadiz Monica Horn
Michelle Anne Costabile
Nhu N. Tran
Josephine O. Ellashek
Nancy Aguirre
Frances Blayney
Alejandra Briseno
Agnes E. Bundac
Rebecca S. Cales
Sherry Cauley
Suzanne Rose Chan
Corinne M. Costley
Gena M. Favero
Heidi D. Geary
Ronda N. Habaradas
Fereshteh Kiani
Catherine D. Klatzker
Sandra Lee
Louis M. Luminarias III
Katherine M. Meyer
Joseph M. Ng
Monica Nuss
Garineh Selina Petrosian
Monica Lee Rice
Pacita M. Sangalang
David Schmidt
Diana Z. Sepulveda
Suzette Dee Sweeney
Linda A. Topper
Linda C. Young
Victoria Joanne Duncombe
Nancy Blake
Nancy Ann Pike
6 North
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic ICU
Cardiothoracic Transplant
Cardiothoracic Transplant
Neonatal ICU
Neonatal ICU
Critical Care Services
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Pediatric ICU
Nursing Director
Cardiothoracic Surgery
Certified Pediatric Nurse (CPN)
Nora A. Delgado
Giuliana V. Fiore
Amy Jean Girguis
Natalie Goldman-Merritt
Michelle M. Karlu
Jolene Marie Knapp
Angela Adriana Madrid
Susan Martinez
Sarah G. Ramirez
Erin Schmidt
Abigail Barbara Shetland
Marcela M. Solorio
Lesley Navea Abcede
Linda B. Allen
Leticia Avram
Arnie B. Banez
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Emma A. Clark
Sarah Duffy
Margaret-Ellen Frankel
Susan L. Gonzalez
Frances H. Guzek
Susan D. Jensen
Justin Albert Markle
Cheryl Ann McCauley
Francis Mombay
Janaya Morgan
Sharlene C. Odhner
Judith A. Tighe
Donna Lee Vanca
Diana H. Vaughn
Polin Yousefzadeh
Elaine Butterworth DeAnn Sabrina Campbell
Anne A. Casale
Eileen R. Duncan
Kristine N. Gawley
Lavonda R. Hoover
Elaine C. Iwamoto
Christine S. Limann
Patricia Mueller
John Rutland Caroline Kelton Sanborne
Afton Nicole Schrimpf
Flora W. Yuen
Lori L. Chan
Yvonne M. Hughes-Ganzon
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Amanda Esther Price
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Vanessa Rios
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Gloria N. Verret
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Olivia Banuelos
Monica M. Ciccarelli
Aileen De Guzman
Darcey Lynn Diaz
Kay M. Gilmore
Tammy Lynne Johnson
Marcia Lachelle Massey-Norfleet
Victoria Ann Miller
Theresa Tostado
Chrystal Uy Elysia M. Weiner
Ashlei M. McCloud
Aileen Yanga De Guzman
William C. Kenny
Annie Yeremian
James Connard
Raulin D. Feria
Elisa D. Barrios
Terece Charme’ Jones
Rica Sharon Prospero Morzov
Beth Christie Clark
Anabel Enriquez Costa
James Tom Cottrell
Mariella Flores
Armstrong Hao
Nicole M. Magni
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CCC
Critical Care Services
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Vanessa B. Martinez
Jon M. Mc Kinnon
Morales Monica
Inge M. Morton
Angela M. Quijada
Lindsay Quirk
Denise M. Sherwood
Amanda Silver
Valerie Tripoli
Stephanie Valenzuela
Robin L. Wood
Jody Leigh Castrillon
George Dennis Cruso
Terri E. Stambaugh
Julissa M. Forte
Julye A. Henley
Kathleen Elizabeth Kelts
Paul A. Ciriacks
Jeanette M. Goggins
Rachel Guinn-Jackson
Kim Hodge
Kerri Hunter
Kathy Kelly
Velma Leon Guerrero
Linda S. Loiselle
Gayle C. Luker
Marisa Martinez
Christopher L. May
Allison McCune
Christina Ng
Nancy O’Gorman
Amy Omuse
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Joan Marie Flom Pritchard
Martha Samuel
Felicia Tremmel
Ana Borde
Laurie F. Newton
Cynthia K. Burrola
Allan J. Cresencia
Jessica Lawson Garcia
Erin L. Lowerhouse
Margaux Chan
Jason Robert Vargas
Sherry Nolan
Jennifer M. Huson
Sheila Kun
Olivia J. Brett
Vanessa Guerrero
Claudia McCullum
Veronica Wallace
Debbie L. Hand
Judith Sherif
Stacey B. Adler
Emergency Department
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PACU
PACU
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PACU (ASC)
PACU (ASC)
5 East
Pediatric ICU
Pulmonary - Clinical
Pulmonary Function Lab
Radiology Nursing
Radiology Nursing
Radiology Nursing
Surgical Admitting
Transport
Cardiothoracic Surgery
Certified Pediatric Hematology -Oncology Nurse
(CPHON) and Certified Pediatric Oncology Nurse (CPON)
Irene V. Aberin
Dania Marisa Bourque
Staci A. Castillo
Renee A. Flores-Garcia
Heather Joy Mehl
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4
4
4
4
East
East
East
East
East
Johanna Navia
Marifel Pagkalinawan
Sacha Lauren Reis
Afshid Roozrokh
Gina Marie Santangelo
Kerry S. Vancura
Sonya L. Williams
Melissa Stewart Aguirre
Diane Rita Altounji
Michelle Castle
Sona Daldumyan
Lizzele J. Dulay
Meghan Meehan
Courtney A. Rogers
Laura J. Vasquez
Willow Voytko
Cara Suzanne Wise
Paula J. Ybarra
Jennifer C. Blaney
Kristina Brown
Vilma L. Evangelista
Dawn P. Landery
Paul D. Liehr
Mary F. Moses
Donna M. Quiroz
Dannielle Seluta
Shinyi Tang
Ngaire F. Wilson
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Ann Eldise Hart
Gwendolyn M. Kimball
Alice Sanchez
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Jamie Tripp Bacani
Stana Bogojevic
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Sherri Lynn Carcich
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Ma Luz Reyes
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Anne Schwartz Nord
Belinda P. Sia
Karen Faith Sidi
Christina Izumi Smith
Anthony Opimo
Maria L. Medina-Velasco
Diane M. Grade
Kellie A. Loera
Rita L. Secola
Peggy L. Townsend
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4 East
4 East
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Care Coordination
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Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
PCS Cancer Center
4 East
Hem-Onc Nursing
Nursing Director
4 West/BMT
A N N U A L
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Our Certified Nurses 2010
Neonatal Intensive Care Nursing (RNC-NIC)
Susan Cline
Nicole C. Ainsworth
Sonja Alli-Casella
Susan V. Bugsch
Carol E. Cadaver
Beverly S. Drummond
Sandra Luz Espinosa Johanna Constance Gaeta
Robert Fred Giesler
Anne B. Gleeson
Dolores M. Greenwood
Heather Ann Hackett
Carrie Leigh Jennewein
Kyong Ran Kim
Laura A. Klee
Lorie J. Pagado
Victoria Pniel
Diane E. Real
Lisa Marie Rosik
Suet Ching Sham
Carolyn S. Waddell
Robin B. White
Elsa M. Yedinak
Maxine Orieji Ogbaa
Denise Navarro Weibel
Cynthia Diane Atkinson
Pamela Lynn Costa
Jennifer Jordan
Karen Elizabeth Helton Rapoport
Emergency Department
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
NICCU
PCS Education Department
Institute for Maternal-Fetal Health
NICCU
Institute for Maternal-Fetal Health
Certification in Nursing (RNC)
Susan R. Benson
Cheryl Estepa Barton
Marlene Beranek
Emi Kotoh
Endocrinology
Cardiology
Institute for Maternal-Fetal Health
Institute for Maternal-Fetal Health
5 East
Pain Management
Certified Clinical Transplant Coordinator (CCTC)
Stephanie Johnson
Donna Guadiz
Monica Horn
Liver Transplant
Cardiothoracic Transplant
Cardiothoracic Transplant
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L O S
Susan L. Cesinger
Martha A. Martinez
Emergency Transport
Emergency Transport
Certified Pediatric Emergency Nurse (CPEN)
Russ Gill
Claire Meyer
Nicole D. Sheppard
Susan D. Jensen
Nicole M. Magni
Nancy O’Gorman
Emergency Transport
Emergency Department
Emergency Department
5 West
Emergency Department
Nursing Resources
Certified Professional in Health Care Risk
Management (CPHRM)
Karen Prommer
Risk Management
Certified Rehabilitation Registered Nurse (CRRN)
Rachel Blackburn
Care Coordination
Certified School Nurse
Medical Genetics
Certified Wound, Ostomy, Continence Nurse (CWOCN)
Beth Harrison
Ambulatory Care
Certified Nurse Administration (NEA-BC)
Nancy Blake
Beverly S. Drummond
Critical Care Services
NICCU
6 East
Pediatric ICU
Orthopaedic Nurses Certification (ONC)
Ann M. Wakulich
Orthopaedics
Certified Nursing Professional Development (RN-BC)
Marilyn Deon Mills
Suzanne Taylor
Sylvia Gomez
Frances Blayney
Urology
H O S P I TA L
Certified Neonatal & Pediatric Transport (C-NPT)
Catherine D. Kissinger
Teresa L. Loera
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Endocrinology
Certified Gastrostomy Nurse
Valerie Gordon
Operating Room
Peri-operative Services
Peri-operative Services
Operating Room
Operating Room
Operating Room
Operating Room
Operating Room
Operating Room
Peri-operative Services
Operating Room
Certified Nurse Administration (NE-BC)
Certified Diabetes Educator (CDE)
Anna Gastelum Bitting
Meredith Mae Bock
Louise A. Brancale
Eulalia Carcelen
Nancy Chang
Barbara Hollen
Mary T. Mc Carthy
Debra Dee Miller
Vanessa Lizzet Mansilla
Kristi M. Brandt
Nancy Bridges
Randall Cook
Melinda R. Dizon
Verzhine Fodolyan
Angela M. Hartley
Meredith Renee Johnson
Janet J. Quigley
Florence E. Rivera
Dawna Lee Willsey
Minako Yasumura
Michele Paige
Certified Clinical Nurse Specialist
Sherry Nolan
Meghan Sullivan Middleton
Certified Nurse Operating Room (CNOR)
A N G E L E S
Radiology Nursing
Nursing Director
Cardiothoracic ICU
Pediatric ICU
Certified in Pain Management
Meghan Sullivan Middleton
Pain Management
Certified Lactation Educator/Counselor (CLE)
Christine S. Limann
6 East
Certified Registered Nurse Infusion (CRNI)
Johanna Navia
Stana Bogojevic
4 East
Hem-Onc Nursing
Certified Adult Nurse Practitioner (CANP)
Roy Villena Tatlonghari
Employee Health Services
Certified Family Nurse Practitioner (CFNP)
Constance C. Gallardo
Marilyn Harris
Anthony Hernandez
Caroline Kwong
Vanessa Lizzet Mansilla
Melanie T. Moya
Carol A. Okuhara
Lillian Vicky Rosu
Nancy Ann Pike
Radiology
Adolescent Medicine
Surgical Admitting
Cardiothoracic Surgery
Endocrinology
Employee Health Services
Cardiothoracic Surgery
Cardiothoracic Surgery
Cardiothoracic Surgery
Primary Care Certified Family Nurse ­P ractitioner
(CFNP-PC)
Yvonne J. Olive
Surgical Admitting
Certified Pediatric Nurse Practitioner (CPNP)
Tizita Amde-Michael
Cheryl Estepa Barton
Susan M. Carson
Kirsti Catton
Margo Coon
Jennifer N. Donkin
Kristen Ethridge
Anna Christine Evans
Karla Aurine Haynes
Helen Lau
Patricia A. McMahon Peterson
Jennifer L. Murray
Kaberi Mozumder
Mary Baron Nelson
Donna Nowicki
Lisa Oda
Maki Okada
Paola I. Pederzoli
Kasey Rangan
Maria D. Reyes
Yael L. Rosenthal
Bianca M. Salvetti Nanora Thompson
Kynna Nichole Wright
Vanessa Rios Jennifer L. Baldwin
David Schmidt
UCEDD – DMH
Cardiology
Hem-Onc Nursing
Cardiothoracic Surgery
Radiology Nursing
Hem-Onc Nursing
Cardiothoracic Surgery
Hem-Onc Nursing
Plastic Surgery/Craniofacial
Plastic Surgery/Craniofacial
Hem-Onc Nursing
Pain Management
Cardiothoracic Surgery
Radiology Nursing/Anesthesia
Pediatric Surgery
5 West
Hem-Onc Nursing
Hem-Onc Nursing
Hem-Onc Nursing
Pulmonary
Hem-Onc Nursing
Pediatric ICU
Adolescent Medicine
Hem-Onc Nursing
6 North – Rehab
6 West
Pediatric ICU
Acute Care Certified Pediatric Nurse ­P ractitioner
(CPNP-AC):
Mary Mc Culley
Andrea Lynne Parker
Gina Zambetti
Carol A. Okuhara
Lillian Vicky Rosu
Nancy Ann Pike
Stacey B. Adler
Leticia R. Boutros
Beatrice L. Chun
Debra A. Rannalli
Mary Virgallito
Marifel Pagkalinawan
Cardiothoracic Surgery
Pediatric Surgery
Pediatric Surgery
Cardiothoracic Surgery
Cardiothoracic Surgery
Cardiothoracic Surgery
Cardiothoracic Surgery
Surgical Admitting
Surgical Admitting
Surgical Admitting
Radiology Nursing
4 East
Primary Care and Acute Care Certified ­P ediatric
Nurse Practitioner (CPNP-PC/AC)
Susanne Matich (Carvajal)
Pamela Michelle Faire
Melanie Green
Deborah G. Harris
Denna Jung
Deborah L. Jury
Meghan Sullivan Middleton
Radiology Nursing
Cardiothoracic Surgery
Cardiothoracic Surgery
Hem-Onc Nursing
Radiology Nursing
Pain Management
Pain Management
Primary Care Neonatal Nurse Practitioner (NNP-PC)
Marlene Beranek
Pamela Lynn Costa
Sharon Fichera
Jennifer Jordan
Emi Kotoh
Bonnie Lee
Karen Elizabeth Helton Rapoport
Johanna Constance Gaeta
Institute for
Institute for
NICCU
NICCU
Institute for
Institute for
Institute for
NICCU
Maternal-Fetal Health
Maternal-Fetal Health
Maternal-Fetal Health
Maternal-Fetal Health
Maternal-Fetal Health
Certified Registered Nurse Anesthetists
Melissa Bailey
Paula Belson
Sara Glasser
Mary Iwaszewski
Judy Koempel
Sarah Polkinghorn
Shinny Thomas
Anesthesiology
Anesthesiology
Anesthesiology
Anesthesiology
Anesthesiology
Anesthesiology
Anesthesiology
Total number of certified nurses:
312
Total number of certified nurse practitioners: 57
Total:369
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Professional Development: Education
Professional Engagement
Advanced Degrees
Collaborative Governance
New Advanced Degrees in 2010
Children’s Hospital Los Angeles values nurses with
advanced degrees, offering a degree differential and
opportunities for professional growth and promotions.
To increase the number of BSN-, MSN- and PhD-prepared
nurses, Children’s Hospital strongly supports and
Bachelor’s Degree
making happens at the staff level and to improve efficiency, coordination
received a BSN
and ­communication among the hospital’s Patient Care Services (PCS)
Teresa Esquivel, RN, (4 West) received a BSN
initiatives. The following are council accomplishments for 2010.
Liberty Garcia, RN, (4 West) received a BSN
leaders allow flexible scheduling to accommodate school
Khadijah Khan, RN, (Rheumatology) received a BSN
education and informs nurses of opportunities for
­advanced degrees at local colleges and universities.
These opportunities include:
Vanessa Rios, RN, (6 North) received a BSN
Tyla Vecchiarelli, RN, (Post Anesthesia Care Unit) received a BSN
Master’s Degree
• Tuition assistance program
Cheryl Franco, RN, (Clinical Care Coordinator) received an • RN to BSN program grant
• Terry Varatta Scholarships for nursing graduate students
• Nursing college and university information sessions at Children’s Hospital Thinking of going back to school? Just do it!
MSN (Nursing Education)
Jamie Lin, RN, (Pediatric Intensive Care Unit) received an MSN
(Leadership and Management)
Jessica Moller, RN, (Bone Marrow Transplantation) received an
MSN (Nursing Leadership and Management)
Sasha Reis, RN, (4 East) received an MSN/PNP/CNS
Desiree Ritter, RN, (Nursing Resources) received an MSN Nurse Leaders
3%
Associate’s
Degree
42%
Bachelor’s Degree
(Health Administration)
C H I L D R E N ’ S
House of Representatives
(Chairs: Nicole Ainsworth, RNC-NIC, and
Shannon Duffy, MPH, RD, CNSD)
• Proposed that applicants for the Versant™ RN Residency be
­required to have a bachelor’s degree.
• Instituted Unit Huddles within PCS (See page 18 for more
­information on Unit Huddles).
Recruitment and Retention Council
(Chairs: Vanessa Guerrero, RN, BSN, CPN, and
Carola Mendez, Child Life Specialist)
• Conducted a PCS Needs Assessment to understand the
­recruitment and retention needs of staff.
• Improved bilateral communication between Human Resources
and PCS staff.
• Implemented the Electronic Employee Suggestion Box in
­collaboration with Human Resources.
• Collected information from different PCS disciplines regarding
recruitment and retention activities.
• Introduced the Huddles concept and its application for all work
areas to the House of Representatives.
• Recommended the use the PES scale for the 2010 Children’s
Hospital Los Angeles survey.
• Implemented the placement of the communication board at
employee entrance.
• Contributed suggestions for the Employee Time Off Changes.
•Quality
Coordinated
activities
for Nurse
Week 2010
Council
(Chairs:
Jennifer
Baldwin, RN, CPN,
and Kristine Gawley, RN, CPN)
• Developed the NPO (Nil per os, Latin for “nothing by mouth”)
project aimed at improving patient/family satisfaction scores
related to the NPO policy/procedure which involved surveying
parents of children who required NPO status. Provided suggestions
related to policy changes, incorporating changes in KIDS
ordering process and staff/physician education and analysis.
• Developed “Medicus Interruptus,” a multi-unit performance
improvement project, which aims to decrease administrationrelated medication errors by 80 percent by minimizing work
interruptions and standardizing the medication administration
process (See page 17 for more information on Medicus Interruptus).
• Developed Falls Prevention project, with a goal of a reduction in
the number of patient falls while using a multidisciplinary
approach, updating current policy and care plan and making
Kim Tull, RN, (5 West) received an MSN/FNP
1%
Doctorate
Degree
54%
Master’s Degree
The American Nurses Creditialing Center Magnet Recognition Program Guidelines for 2013 state that all nurse managers must have a bachelor’s degree in nursing—a goal that Children’s Hospital Los Angeles already has achieved.
8
Governance structure continues to meet its goals: to ensure decision-
Victoria Duncombe, RN, (Pediatric Intensive Care Unit) ­encourages nurses to pursue advanced degrees. Nurse
and home life. The hospital offers financial support for
After another year and a change in membership, the Collaborative
• Coordinated all PCS discipline recognition weeks and ensuring
recognition and activities are included in staff e-newsletter and calendar.
H O S P I TA L
L O S
A N G E L E S
Members of the House of Representatives.
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Professional Engagement
recommendations for providing non-slip, circumferential footwear
for patients. Also improved signage regarding the risk of patient
falls and developed patient/family teaching information.
(MPCs) for end-of-life care and heart, lung, kidney, liver and
small bowel transplants.
• Emergency Review Form and feedback process after Rapid
Response Team/Code Blue.
• Developed the Intravenous (IV) Infiltrate Reduction plan, a
­multidisciplinary/multi-council collaboration with the goal of
reducing all grade 3 and 4 IV infiltrates to zero. Provided
modification of the IV infiltration Incident Report Form, initiated a
house-wide pilot of a new IV securement device and developed
recommendations for education.
• Developed the Hand Hygiene Project, a system that will require
implementation of the hand hygiene performance improvement
project if any unit/clinic has two consecutive quarters of total
compliance data that are below the benchmark of 90 percent.
Also implemented public display of hand hygiene data for all
inpatient units.
• Provided input regarding the selection of new isolation gowns
related to cost/usage issue of the current gown supply.
• Conducted Unit Tracer Presentations for the council, while
providing input regarding deficient areas, their fishbone analysis
and action plans.
• Reviewed various performance improvement project presentations
for evaluations and follow-up.
• Prepared Contrast Screening Form to be uploaded into KIDS
(computerized charting).
• Worked with hospital policy coordinators to facilitate review and approval process.
• Completed 360 Peer Review for performance evaluation for
implementation in July 2011.
Carola Mendez, Child Life Specialist (left), and Vanessa Guerrero, RN,
with Richard D. Cordova, FACHE, president and chief executive officer, Children’s Hospital Los Angeles.
transfer to a higher level of care. Also developed PEWS audit
form, and unit audits are done for compliance and improvement
of the process. Compliance rates are increasing throughout the hospital.
• Completed Scope of Practice grids for PCS disciplines, including
Unit Assistants, Patient Care Service Aides, Pharmacy, Spiritual
Care Services, Social Work, Speech Pathology, outpatient
medical assistants and Diversity and Language Services.
• Collaborated with Patient Falls Task Force.
Education, Research and Development Council
(Chairs: Edahrline Salas, RN, BSN, MA, and
Sandra Hall, RN, BSN)
• Scheduled and facilitated the PCS Grand Rounds.
• Organized the housewide PCS Education Fair.
• Updated the audit tool for Multidisciplinary Plan of Care (MPC),
Data-Action-Response-Plan (DARP) and education power notes.
• To help resolve communication issues, the “Situation, Background,
Assessment, Recommendation, Questions” (SBARQ) process for
hand-off communication was improved by developing the
Ticket-to-Ride communication tool, utilizing the KIDS electronic
medical records system for real-time information at report, when
communicating with doctors or when calling reports to other units.
• Analyzed unit generic biannual audits to ensure 90 percent compliance.
• Updated Ticket-to-Ride form and worked with SuperKIDS team to
move form into KIDS.
° IV Infiltrate Forms: re-education of staff related to use
° SBARQ: re-education and evaluation
• Implemented a new audit tool for Licensed Vocational Nurse documentation.
• Reviewed all current care plans to aid in the development of the
Electronic Multidisciplinary Plan of Care (eMPC).
• Implemented Pediatric Early Warning Score (PEWS) systems,
based on vital signs and behaviors. PEWS is designed to help
identify kids at risk of getting sicker and prevent the need for a
• Improved the process for generating discharge instructions for
patients and families.
° Medication Error Reduction Plan (MERP) preparedness
° Sterillium/Remedy hand lotion
Clinical Practice Council (Chairs: Nida Oriza, RN,
BSN, and Terrie Ballard, RN, CPN)
Edahrline Salas, RN, enjoys a lighter moment during a presentation.
• Implemented and recommended education plans and
­evaluations on:
° Epidural policy update education
° PEWS Education
Aileen De Guzman, RN, (left) and Kim Kaloustian, PT.
° Positional car seat testing
° Formula powder pointers
° Code evaluation process update
° Nasogastric (NG) and tracheostomy policy update education
• Approved and implemented new Multidisciplinary Plans of Care
° Ultrasorb pads/linen usage: education to work areas
­regarding product change
° Point-of-care testing reagent and supplies update education
° Central venous catheter (CVC) teaching recommendations
° Infection Control policy updates: education to work areas
regarding policy changes
• Selected recipients for the Terry Varatta Scholarship for nursing
graduate students.
• Research Infrastructure: advised and identified needs, including a research class, in coordination with Felicitas dela Cruz, RN, DNSc.
House of Representatives members listen to a presentation.
10
C H I L D R E N ’ S
H O S P I TA L
L O S
A N G E L E S
Gloria Verret, RN, (left) and Joan Clark, RN.
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Commitment to Community Involvement
International Help
More than half of the 1,000 nurses at Children’s Hospital ­
Los Angeles regularly volunteer in the local and global community.
In tandem with physicians, surgeons and other pediatric experts,
nurses from the hospital reach thousands of children a year from
around the world.
Their dedication to providing care for children in underserved areas of the globe—both at home and abroad—is the result of
knowledgeable staff backed by an organization that values and
respects diversity while actively addressing children’s health barriers
and disparities.
During the two-week deployment to Haiti, nurses
tended to wounds, sepsis, severe dehydration
and respiratory distress brought on by the quake.
More than half of the 1,000 nurses
at Children’s Hospital ­Los Angeles
regularly volunteer in the local and
global community.
“I wanted to help through action,” says Anne Vitug, RN, who works
in the Pediatric Intensive Care Unit (PICU) at Children’s Hospital
and traveled to Haiti. “I think that’s why we do what we do as
doctors and nurses. We can use what knowledge we have and
“Culturally sensitive nursing care is business as usual at Children’s
make a difference.”
Hospital Los Angeles,” says Noreen Clarke, RN, MSN, who
Nurses’ time and talents also are deployed at home when
directs the International Craniofacial Children’s Fund (ICCF) at the
hospital, which helps provide treatment to international patients.
“We’re used to dealing with children from a variety of cultures and we have the infrastructure to support their special needs.”
When the Haitian earthquake struck in 2010, nurses from Children’s
Hospital were among 20 hospital volunteers who traveled to the devastated country to provide medical support.
other key communications. Together, these tools ensure that the
who came to Children’s Hospital for life-saving surgery through a
hospital is ready and prepared to help.
collaboration between ICCF, Mending Kids International and the
Injured by an improvised explosive device (IED) in Baghdad,
internationally through programs such as Operation Smile, Hashim was brought to the U.S. for treatment for head trauma in
­Mending Kids International and Interplast.
August 2010. He then underwent a series of surgeries at Children’s
traveled to the devastated country to provide medical support. A N G E L E S
recovery. Now healthy, Hashim has returned to Iraq.
organization committed to improving health conditions in Haiti.
it’s a child from Bangladesh, Ethiopia or Christmas Island, we are
by the quake.
L O S
assisted every step of the way during the boy’s months-long
“The bottom line is that we are prepared,” Clarke says. “Whether
sepsis, severe dehydration and respiratory distress brought on Nancy Aguirre, RN, (from left) Alanna Rowley, RN, and Alejandra
Briseno, RN, in Haiti.
Hospital to place a titanium plate over his injured skull. Nurses
The group offered help through Project Medishare, a nonprofit
During the two-week deployment, nurses tended to wounds, H O S P I TA L
Children of War Foundation.
others from the hospital, regularly donate their much-needed skills
­Children’s Hospital were among 20 hospital volunteers who
C H I L D R E N ’ S
countries through ICCF, the privately funded organization Clarke
One special case was Hashim Zareef, a 10-year-old boy from Iraq
When the Haitian earthquake struck in 2010, nurses from
12
In 2010, nurses took part in the care of 34 children from 16
and a Diversity Services Department that aids in interpretation and
Pre- and post-operating room nurses and nurse educators, among
Jace Vargas, RN, (left) and Anne Vitug, RN.
­international patients come to Children’s Hospital for treatment. directs at the hospital.
Those important tools include diverse staff, extensive training in
cultural competency, years of experience with diverse populations
Volunteers offered help through Project Medishare, a nonprofit organization committed to improving
health conditions in Haiti. well-prepared to treat their medical and surgical needs in a
culturally sensitive manner.”
The pediatric ward in Haiti.
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Commitment to Community Involvement
Recognition of Nursing: The 2010 DAISY Awards
Institute for Maternal-Fetal Health
The DAISY Awards, which recognize nurses who
Foundation was established to honor nurses who positively impact
­exemplify excellence in patient care, have become a
the lives of their ill patients and coping families.
When expecting parents discover that their unborn child is
celebrated tradition at Children’s Hospital Los Angeles.
Children’s Hospital is one of more than 50 hospitals in the Bonnie and J. Mark Barnes founded the DAISY (Diseases Attacking
United States that have partnered with the DAISY Foundation.
the Immune System) Foundation in memory of their son, J. Patrick
Recipients of the DAISY Award receive a certificate, a DAISY pin,
Barnes, who died of complications from his autoimmune diseases
Cinnabon® cinnamon rolls and a unique hand-carved statue called
(idiopathic thrombocytopenic purpura) at age 33. In tribute and
“The Healer’s Touch,” created by artisans in Zimbabwe, Africa.
not healthy, the stressors they experience include coping
with their unfortunate reality while simultaneously
figuring out how to get help. It’s not easy to find medical
services that will try to assist in the need of both the
mother and fetus, as well as promote open communication
and collaboration between health care teams.
appreciation of the nurses who cared for their son, the DAISY
Sheila Perez, RN, BSN
Irene Klecha, RN, MSN
To resolve such fragmented care, Children’s Hospital Los Angeles
and the University of Southern California (USC) partnered to
Currently, Perez and Klecha coordinate care for more than establish the CHLA-USC Institute for Maternal-Fetal Health (IMFH).
90 patients at a time. “I talk to the perinatologist, obstetrician,
This program, unique to Southern California with only a few similar
neonatologist, geneticists, surgeons and the unit accepting the
programs nationwide, provides comprehensive care to mothers and
patient,” says Perez. This coordination is vital to the team’s
their unborn children. The program recognizes that it must treat both
communication so that no information is left out. They prepare
the mother and the fetus separately because they require different
packets complete with the mother’s information, the physician’s
therapies. But the program also ensures that specialists collaborate
notes, lab and diagnostic results and deliver them to the accepting
and coordinate care for optimal health and a safe delivery.
units, usually the Newborn and Infant Critical Care Unit or
January
February
March
April
Cardiothoracic Intensive Care Unit. They also notify the team Kerry Moller, RN
Alice Loo, RN, MSN, CPON
Cathy Foster, RN, MSN, PNP
Miguel Aventino, RN
May
June
July
August
Maria Lapinid, RN, BSN, CPON
Maria Dakan, RN, BSN
Margaux Chan, RN, BSN
Lindsay Quirk, RN, BSN
September
October
November
December
Donna Quiroz, RN, BSN,
CPON
Stephanie Brown, RN, BSN
Cheryl Barton, RN, MSN, NP
Christina Smith-Cruso, RN,
BSN, CPON
The IMFH team is made up of an interdisciplinary group of
­obstetricians, specialty physicians, nurses and psychosocial
counselors. The office is located at Hollywood Presbyterian
of the mother’s expected delivery date and coordinate the neonate’s
transfer to Children’s Hospital.
Medical Center, adjacent to Children’s Hospital. The mother In addition, they offer comfort to parents by giving them their comes to receive obstetrical care and meet with the Children’s pager numbers for any questions, concerns or emotional support.
Hospital team of specialized physicians, including neonatologists
They even try to attend the delivery, to provide the parents with
and surgeons. The team and parents discuss the recommended
reassurance and to ensure the continuity of care after birth. plan of care for the unborn child, based on specialized tests and
diagnostics. Once the child is delivered at Hollywood Presbyterian,
the baby is transported to Children’s Hospital via the Children’s
Hospital Transport Team. These nurse care managers truly embrace the spirit of nursing. They are teachers. They are autonomous and critical thinkers. They are patient advocates. They provide psychosocial support.
They are interdisciplinary facilitators. Without their nursing service,
The parents’ journey to the IMFH begins with their obstetrician.
Doctors refer patients to the IMFH if they detect a fetal anomaly.
These referrals generally come from the Los Angeles area, but have
come from as far as Bakersfield and the Inland Empire. Once the
mother arrives, she is further evaluated by one of two nurse care
the continuity of care would be broken.
Perez describes her role in the IMFH with pride. “It is a hard job,
but it is rewarding,” she says. “The IMFH is nurse-driven; we
coordinate the care. We are the patient advocates.”
managers: Sheila Perez, RN, BSN, and Irene Klecha, RN, MSN.
Perez and Klecha have a special and comprehensive role in
coordinating care for both the mother and unborn child. Perez
explains that her initial role, when she meets the families for the first
time, is to “introduce myself and explain what I do. I spend time
with them to best explain the defect and its pathophysiology. Then I listen and support them emotionally.” 14
C H I L D R E N ’ S
H O S P I TA L
L O S
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Recognition of Nursing
Mary Dee Hacker Inducted
as a Fellow into the American
Academy of Nursing
Culture of Safety
The “GEM” (Going the Extra Mile)
Award
The GEM Award recognizes individuals,
Across the country, medication errors account for most
including nurses, who exemplify the mistakes made in hospitals.
values of Children’s Hospital Los Angeles:
At Children’s Hospital Los Angeles, a new program aims to Excellence, Teamwork, Service, Respect and Knowledge. These are the values that make ­Children’s Hospital one of the Nurse Sandra Espinosa,
NNP, was honored with a
GEM award in May 2010.
New Project Aims to Reduce Medication Errors
top hospitals in the nation.
change that norm. Based on the MedRite program created by
Kaiser Permanente, the Medicus Interruptus project seeks to
decrease interruptions that most nurses experience while giving
patients medication.
“The goal is to reduce distractions for nurses and anyone else who
administers medication,” says Sherry Nolan, RN, MSN, CNS,
clinical manager of 5 East. “Lots of research shows that you have to focus. It’s a complex task, and it’s hard when you’re interrupted
all the time.”
Nolan worked on the project with the Patient Safety Subcommittee,
part of the Quality Control Council at Children’s Hospital. As adviser, she and Cheryl McCauley, RN, CPN, committee
chairwoman and a nurse on 5 West, serve as group coordinators.
Mary Dee Hacker receives her certificate from American Academy
of Nursing president-elect Joanne Disch, PhD, RN, FAAN.
Medicus Interruptus works
like this:
Mary Dee Hacker, MBA, RN, FAAN, vice president of Patient Care Services and chief nursing officer at Children’s
Hospital Los Angeles, received the prestigious honor of being
• Nurses preparing and administering medication wear a reflective yellow sash.
­inducted as a Fellow into the American Academy of Nursing.
Hacker was inducted Nov. 13, 2010, during the Academy’s 37th annual Meeting and Conference in Washington, D.C. The
Academy’s ­Fellows represent the nation’s most accomplished nurse
leaders in education, management, practice and research.
“Receiving this recognition is truly an honor for me,” says Hacker,
who began her career at Children’s Hospital in 1975 as a staff
nurse. Her distinguished career includes many achievements and
honors, including leading the hospital to Magnet Recognition in
2008 and being the driving force behind the innovative Versant™
RN Residency in Pediatrics Program, created in 1999 in response
to the national nursing shortage. Hacker also received the Diane
Cooper Lifetime Achievement Award from NurseWeek magazine in 2009, and was recognized in 1997 by California Medicine
magazine as one of “California’s 100 Most Interesting and
Influential Healthcare Leaders.” A frequent speaker at state,
Humanism Award winner Lisa Hatter, RN, BSN, with Richard D. Cordova,
FACHE, president and chief executive officer, Children’s Hospital Los ­Angeles and Eyal Ben-Isaac, MD.
The Morris and Mary Press
CHLA Humanism Award
Since 1973, Children’s Hospital Los Angeles has upheld the
tradition of honoring individuals and a department/work area—
all of whom have been nominated by their peers. other hospital groups and parents to explain the project. “When
began serving as pilot units for the error-reduction program in May.
you’re out in the middle of the hall, people catch you and ask
The goal was to decrease administration-related “Nurses thought this idea was a little hokey at first, but now they’re
while standardizing the process. Medication error rates from
seeing that they can get really focused.”
the participating floors were then calculated by the Quality
job expectations in demonstrating superlative and consistent
Department. The program was rolled out to the entire kindness and thoughtfulness in their interactions with co-workers,
hospital in the fall.
patients and guests. The 2010 Nursing winner was Lisa Hatter,
RN, BSN, and 6 West won the Work Area category.
the nation’s health care system.
Angeles a warmer, friendlier and more compassionate place.
A N G E L E S
In addition to training programs, posters and fliers were made for
for such a program, Nolan says. Both 5 West and 5 East
workers and a work area or division who go beyond their daily
customer relations and care also make Children’s Hospital Los
L O S
Observations throughout the hospital demonstrated the need
medication errors by 80 percent by the end of August, being a strong advocate for the nursing profession and improving
H O S P I TA L
• Signs on carts read, “Meds Being Given, Please Do Not Interrupt.”
questions, whether they’re physicians or parents,” Nolan says.
Their respect, service, excellence, knowledge and teamwork in
C H I L D R E N ’ S
The Medicus Interruptus project seeks to decrease interruptions that
most nurses experience while giving patients medication.
The Morris and Mary Press CHLA Humanism Awards honor
regional and national meetings, Hacker says she is committed to
16
• Yellow and black tape around medication carts indicates that the nurse in the “square of silence” should not be interrupted. The steps of medication administration are posted as well.
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Culture of Safety
6 North Unit Huddles
Professional Practice Model
are caring for patients. The on-coming charge nurse leads the
The Magnet Recognition Program envisions health care as a
Now, as we go through the process of Magnet re-designation, the
Huddles and announces the updates from a Huddle announcement
dynamic entity, continually evolving into a better system of
application request calls for the organization to demonstrate how
sheet that is updated by managers every Monday.
care. This is why the program stresses that hospitals must
nurses have analyzed, evaluated and modified the Professional
The focus is to communicate any updates to staff before they start
“raise the bar” to achieve high-quality patient outcomes.
Practice Model.
their shift. Information on the Huddle announcement sheet includes
how many patients are expected for that particular shift, staffing
situations, any critical patient status changes, events happening in
the hospital, new or updated policies, requirement deadlines like
CHEX and which manager is on call. Huddles also can be used to
In 2006, a group of nurses of all levels created the Professional
Practice Model to illustrate nursing practice at Children’s Hospital
Los Angeles. It was presented house-wide for nurses to embrace
and was included in the Magnet document submitted in 2007. recognize staff for achievements, thank people for working overtime
In fall 2010, a group of nurses called the Magnet Champions
came together to re-evaluate the model and make revisions to fit the
current vision of Children’s Hospital. They also brought the model
to their own units/departments for more nursing input. After all the
nurses’ collaborative efforts, the new Professional Practice Model
was finalized in the spring of 2011.
and introduce new staff.
Overcoming Challenges
There were challenges to implementing Unit Huddles because they
A 6 North night shift Huddle.
represented change. For example, some were concerned that
Merriam Webster’s definition of huddle is “to come
Huddles would cause staff to start reports late, make reports take
together closely in a group.” This definition perfectly
longer, increase overtime or waste staff time. The reality is that they
describes the concept behind Unit Huddles at Children’s
are short—five minutes—and decrease overtime. They also make
Hospital Los Angeles. The Huddles have a simple goal:
reports more efficient because staff already have an idea of how
to increase communication and teamwork.
their shift is going to go.
In 2008, before Unit Huddles were implemented on 6 North, an
internal survey gathered feedback on teamwork and communications.
The results showed room for improvement.
With consistent effort and support from the 6 North managers and leadership committee, huddling is now a positive reality on 6 North.
Phan Dang, RN, brought up the idea of Huddles at the unit
Positive Change
leadership retreat in January 2008; Huddles had been used
Huddles have improved staff awareness. Because changes are
effectively at her previous job and increased teamwork and
constantly communicated to staff via Huddles, compliance with
communication. The leadership team embraced and supported new hospital and unit requirements has improved dramatically.
the concept, and Huddles were officially implemented on 6 North
on Feb. 12, 2008.
Tardiness also has become a very rare issue because everyone is
required to huddle at the beginning of every shift. Huddles set the
Children’s Hospital is a teaching facility with constant change. tone for the beginning of every shift and include every staff
A challenge to any teaching facility is to communicate these
member: RNs, LVNs, patient care service aides, unit assistants changes to staff. It is sometimes difficult for staff members who and even nursing students. This has definitely led to increased staff
do not work daily to keep up with email updates, policy and
satisfaction with teamwork and communication because everyone
­procedure changes and any new events or requirements—­
knows that they are part of the team.
especially ones that affect patient care. This same concern also
was expressed in the Patient Care Services Recruitment and
Retention Survey done in January 2010.
What are Unit Huddles?
SM
The building blocks represent what nurses do at Children’s Hospital Los Angeles.
They capture what is essential in our practice. Teamwork and lifelong learning
are key to providing family-centered care to our patients. The continuous circle
Exactly one year after Unit Huddles were implemented, the same
represents our ongoing efforts to acquire and share knowledge, to provide
internal survey was given to 6 North staff. The results reflected very
­service, to give respect to our patients, families and colleagues and to improve
positive improvements in the staff’s perception of communication
and sustain quality in our practice.
and teamwork. Huddles are an excellent tool that will be used for
A Unit Huddle is a five-minute-or-less “huddle”—a gathering of all
years to come.
on-coming staff. These short meetings occur at every change of
shift, so that all on-coming staff can huddle while the current staff
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Innovation
Research
RN Bloggers Create Dynamic Community
Education Forum
Lectures
Karen Rodriguez, RN, gave an oral presentation, “Nurse
­Practitioner Championed: Pediatric Trauma Continuity Clinic
As a pediatric nurse, Kelli Anderson, RN, BSN, ­(Cardiac
Utilizing the ‘Medical Home’ Concept,” at the American Pediatric
­Catheterization Lab) is accustomed to family members,
Surgical Nurses Association in Orlando, Fla., in May 2010.
neighbors and friends asking her all types of child-related
health and safety questions. As a mom of two teenage
Laura Klee, RN, participated in the panel discussion, “ECMO: boys, the 22-year veteran nurse also has firsthand
the Southern California Experience,” for the first Coastal California
Association of Neonatal Nurses educational conference in
experience with topics that concern parents most. Now,
February 2010.
Anderson and a select group of other ­Children’s Hospital
Edahrline Salas, RN, (left) and Jessica Klaristenfeld, RN, next to their poster
at the Organization of Healthcare Educators Program.
Inge Morton, RN, presented a lecture, “Pediatric Trauma: Los Angeles nurses are sharing their vast knowledge in a
Debbie Jury, RN, gave a guest lecture, “Principles of Pediatric
Late Onset Complications,” at the Emergency Nurses Association/
more global and Internet-savvy way: by blogging.
Pain,” at the UCLA School of Nursing.
Emergency Department Approved for Pediatrics Conference Anderson, Jennifer Buchanan, RN, MSN, (Cardiology) and
Jennifer Murray, RN, lectured on the subject of pediatric palliative
Deborah Braidic, the hospital’s manager of Web content, launched
care and nursing education at the 2010 American Academy of
the innovative RN Remedies blog series in November 2010. Kelli Anderson, RN, (left) and Jennifer Buchanan, RN.
Blog post topics range from common childhood conditions to safety tips for injury prevention and issues regarding teen health.
Since its launch, seven more nurse bloggers have joined the education and cutting-edge research. So it’s not surprising that the
RN Remedies blog series is accumulating a steady core of followers.
at Presbyterian Intercommunity Hospital in Whittier, Calif., in October 2010.
Hospice and Palliative Medicine, and at the Hospice and Palliative
Victoria Winter, RN, presented “Family Making: A Grounded
Nurses Association Annual Assembly in Boston.
Theory Study” at the Sigma Theta Tau Conference, Nursing
Colleene Young, RN, gave lectures on “Hemofiltration Case
Odyssey 2010, in San Diego in October 2010.
Studies” and “ScVO2 Monitoring: Revealing What Traditional Anna Evans, RN, presented a care report, “Pregnancy in a Patient
RN Remedies team, supported by the hospital’s in-house blogger,
Featuring a new post each Monday morning, the series receives
Vital Signs May Not” at the Pediatric Critical Care Nursing
with Anaplastic Oligodendroglioma Taking Temozolomide,” at the
Web Content Coordinator Lisa Timmons. In addition, regular
approximately 1,000 hits each month. Readers are encouraged to
Conference in San Diego in October 2010.
Society of Neuro-Oncology meeting in Montreal, Canada, in
contributors Gloria Verret, RN, CPN, (Surgical and Kidney/
email questions or post comments, creating an intimate connection
Liver Transplant) and Tere Jones, RN, CPN, (Medical/Surgical)
between the nurse bloggers and readers.
Colleene Young, RN, gave a presentation on “Nurse Responsibilities
have joined Anderson and Buchanan as featured bloggers by
consistently contributing blog posts during the program’s crucial first six months of existence.
“A large part of our job is educating the parents of our patients,”
says Buchanan, who has been working at Children’s Hospital for the past four years and also is a certified lactation educator.
Buchanan has been working with children her whole life, enjoying
previous roles as a camp counselor, snowboard instructor and
patient care associate.
“This blog allows us to get the information out to the community
beyond our patients and their families,” adds Buchanan, who
began her nursing career in the Newborn and Infant Critical Care Unit at Children’s Hospital.
As Gallup’s national survey indicates year after year, nurses are among the most trusted professionals in the nation. Meanwhile,
Children’s Hospital nurses are at the forefront of continuing
and Clinical Decision-Making When Caring for Critically Ill
“We’re working on developing the blog and expanding it to reach
Pediatric Patients Requiring Continuous Renal Replacement
a broader community,” explains Braidic. “Our nurses have such
Therapy” at the European Academy of Paediatric Societies in
great passion and dedication, and we’re so proud of them. This
Copenhagen, Denmark, in October 2010.
unique program really allows our nurses’ voices to be heard.”
Fran Blayney, RN, presented a lecture, “Acute Kidney Injury:
As the site grows, Buchanan says she hopes to see more nurses
Investigating an Old Criminal with a New Tool,” at the Pediatric
start blogging. “We have so many experts at this hospital. We Critical Care Nursing Conference in San Diego in October 2010.
can be a great source of information for families everywhere.”
David Schmidt, RN, presented two lectures, “CVVHDF: A Nurse-
Anderson, who also teaches puberty classes at elementary Run Program” and “Busting BSI in the PICU,” at the Pediatric
schools in her community, says she never thought she would be a
Critical Care Nursing Conference in San Diego in October 2010.
“blogger,” but likes the opportunity to reach out to people, educate
Noreen Clarke, RN, and Susan Cline, RN, presented “Maka’s
the community and make a difference.
November 2010.
Story: Bringing International Health Care to our Hometown,” at the
Posters
Karen Rodriguez, RN, had a poster presentation, “Implementation
of a Pediatric Trauma Continuity Clinic Utilizing the ‘Medical
Home’ Concept,” at the Society of Trauma Nurses (STN) in
Orlando, Fla., in April 2010.
Diane Altounji, RN, Monica Grover, RN, and Peggy Townsend,
RN, presented their poster, “Caring for the Caregiver: Supportive
Care for Nurses,” at the Association of Pediatric Hematology/
Oncology Nurses conference in Minneapolis in October 2010.
Jessica Klaristenfeld, RN, and Edahrline Salas, RN, presented
their poster, “Poster Presentation Projects: An Innovative Method
“It’s a whole new world,” she says. “I was walking down the hall
National Magnet Conference in Phoenix in October 2010.
the other day and someone yelled out that they had just read my
Sandra Watcher, RN, presented a lecture, “Making the Complex
Professional Nurse,” at the National Nursing Staff Development
Simple: Teaching our Pediatric Patients,” at the American College
Organization Conference in San Diego in June 2010.
blog … that’s a great feeling.”
Visit Wearechildren’s.org for the RN Remedies blog.
for Dynamically Bridging an RN Resident’s Journey from Student to
of Rheumatology’s (ACR) Scientific Conference in Atlanta in
November 2010. She also was a facilitator for the conference’s
Infusion Therapy Networking Session and served as a moderator.
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Research
Posters
Nurse Week Essay Winner
Publications
(continued)
Laura Vasquez, RN, and Rita Secola, RN, presented their poster,
Meghan Middleton, RN, and Debbie Jury, RN, co-wrote “Developing a Nursing Education Tool for Administration of
an article, “My Aching Back,” for Therapy Times Magazine.
Chimeric Antibody in High Risk Neuroblastoma Patients,” at the
Association of Pediatric Hematology/Oncology Nurses conference
in Minneapolis in October 2010.
Catherine Goodhue, RN, co-published “Disaster and Mass
Casualty Events in the Pediatric Population” in the November 2010
issue of Seminars in Pediatric Surgery. Peggy Townsend, RN, Maria Velasco, RN, Kellie Loera, RN, and
Rita Secola, RN, presented their poster, “Capturing the Educational
Needs and Preferences for Generational Differences in Hematology/
Oncology/BMT Nursing,” at the Association of Pediatric
Catherine Goodhue, RN, co-wrote “Disaster Preparedness Among
Medical Students: A Survey Assessment” in the September/
October 2010 issue of the American Journal of Disaster Medicine.
What About the Nursing Profession
Makes You Passionate?
By Adam Brenneman, RN, BSN
Pediatric Intensive Care Unit
During nursing school, I remember always hearing that
nursing was not a profession, that it was an art, a passion
even. Part of me wrote it off, dismissing it as overzealous
nursing professors obsessed with their profession. Sure, I
enjoyed nursing, but was it a passion? It was not until I started
­Hematology/Oncology Nurses conference in Minneapolis in
Catherine Goodhue, RN, co-published “Disaster Olympix: working in the Pediatric Intensive Care Unit at Children’s
October 2010.
A Unique Nursing Emergency Preparedness Exercise” in the
Hospital Los Angeles that I realized those professors might just
January/February 2010 issue of Journal of Trauma Nursing.
be onto something. During my relatively short career, I have
Jennifer Blaney, RN, Donna Quiroz, RN, Hazel Kolpak, RN,
seen more on my unit than I ever thought I would. My patients
Jasmin Uy, RN, and Kristin Malicse, RN, presented their poster,
Karen Rodriguez, RN, and Catherine Goodhue, RN, published
“Utilizing a Patient-Centered Medication Calendar to Improve the
“Pediatric Nurse Practitioner Implementation of a Pediatric Trauma
Discharge Process in the BMT Population,” at the Association Continuity Clinic Utilizing the ‘Medical Home’ Model” in the
of Pediatric Hematology/Oncology Nurses conference in
Summer 2010 issue of the Journal of Trauma Nursing.
­Minneapolis in October 2010.
Victoria Winter, RN, wrote a chapter, “Excellence in Practice: on caring for our patients but on their families as well. I have
Dawn Landery, RN, Mary Moses, RN, and Shinyi Tang, RN,
A Resident-Centered Care Program in a Long-Term Facility,” in the
seen parents and families at the absolute worst time in their
presented their poster, “Developing an Allergy Protocol Kardex Artinian Intersystem Model: Integrating Theory and Practice.
lives, and it did not take me long to realize that this unit was for the Hematopoietic Stem Cell Patient,” at the Association of
Mary Dee Hacker, MBA, RN, FAAN, published an article,
Pediatric Hematology/Oncology Nurses conference in
“Magnetically Charged,” in ADVANCE for Nurses in ­Minneapolis in October 2010.
October 2010.
Maki Okada, RN, and Kathleen Meeske, RN, presented their
Catherine Goodhue, RN, had an article, “Medical Home poster, “Operationalizing Exercise Guidelines for Anthracycline-
Model,” published in the April/June 2010 issue of Journal of
have ranged from newborns to 25-year-olds. They have had
everything from chronic illnesses that have made it impossible
for them to leave the hospital to an accidental trauma that has
landed them in our care. As pediatric nurses, we focus not only
not for the faint of heart, or those who lacked passion. Maybe I did have a passion for nursing. Maybe I was not giving myself
enough credit.
But there came a moment when it became utterly clear to me
Chair of the Department of Pediatrics, Vice President of Academic Affairs
and Director of The Saban Research Institute D. Brent Polk, MD, with Nurse Week essay winner Adam Brenneman, RN, BSN.
that nursing was my passion. In order for you to understand it, him, and since infant hearts are hard to come by, we waited ... I would need to tell you a story. It is hard to explain the pure and waited. He needed a machine to breathe, and a small
at the Association of Pediatric Hematology/Oncology Nurses
joy that I feel remembering it. It’s a story about a baby boy pharmacy of medications given around the clock to maintain his
conference in Minneapolis in October 2010.
and the night he got a new heart. There is a disease known optimal health. Almost every single nurse on the unit had been
as cardiomyopathy, which literally means heart muscle disease,
his nurse at least once. Many of us had cared for him more
and as you can imagine, it is not very compatible with living.
times than we can remember. All of us had our ups and downs
The only cure is a heart transplant. That is where our story begins.
with him, from rocking out to soft rock all night long with him
Treated Cancer Survivors at Children’s Hospital Los Angeles,” Fran Blayney, RN, Cindy Rowlett, RN, Sue Bugsch, RN, Fran
Guzek, RN, Jessica Klaristenfeld, RN, and Debbie Reid, RN,
presented a poster, “Implementing Preceptors Best Practices:
Teaching and Supporting the Model Preceptor,” at the
­Organization of Healthcare Educators Program in Pasadena, Calif.
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Trauma Nursing.
As pediatric nurses, we focus not
only on caring for our patients but
on their families as well.
(his favorite song being “Careless Whisper” by George
Michael, at least that’s what I like to think), to watching him
extubate himself four times on four separate occasions, with a
mere flick of his head (which was almost cute because you got
to see him without a tube in his mouth, but we were too busy
being scared out of our minds and running around trying to Due to his disease, the baby boy had been calling the Pediatric
get ready for the emergent re-intubation). But no matter what, Intensive Care Unit at Children’s Hospital Los Angeles his home
he always had an endearing quality to him. He was only
since he was born ... nine months before. Our mission for the
months old, being put through more than most of us could ever
nine months was to keep him alive until we found a heart for
imagine, yet he kept on truckin’ along.
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Nurse Week Essay Winner
What About the Nursing Profession Makes You Passionate?
(continued from page 23)
Acknowledgements:
We would like to thank the following people
for contributing to this report:
When I walked onto the unit that night there was a rumor, a
whisper in the air, so soft as though we did not want to jinx him,
Magnet Oath
As a member of this Magnet Hospital, I pledge to uphold the Children’s
Hospital Los Angeles culture of distinction. I will advocate and support the
further advancement of excellence in my practice. As an integral part of the
Richard D. Cordova, FACHE
Children’s Hospital Los Angeles community, I will continue to promote collegial
Mary Dee Hacker, MBA, RN, FAAN
­interdisciplinary teamwork. Utilizing the Forces of Magnetism, I will strive to
Carolyn Kendrick
provide even higher-quality family-centered care. I will constantly endeavor to
It was so strange seeing his mom packing up all his belongings
Doris Lymbertos
advance my expertise through lifelong learning. Lastly, I do swear to do all in
that had accumulated over the past nine months. She was
Robin Moore DeCapua
my power to maintain the highest standards and practices of my profession.
crying tears of joy while constantly being interrupted by hugs
Leslie Neuman
from the many health care providers who were so overjoyed by
Suzanne Taylor, RN-BC, MSN, EMT
Nursing Mission Statement
this moment. His mother was eternally grateful for every one Elaine Verdugo
of us, no matter how small of a part we played in her baby
Adam Brenneman, RN, BSN
boy’s life here at Children’s Hospital, from housekeeping to
Tracy Kumono
attendings. We all were afraid to leave on our breaks for fear
Matthew Pearson
of missing the send-off.
Jim Deeken
Nursing Values
Chandra Broadwater
• At Children’s Hospital Los Angeles we value advancement and innovation
that this little boy was finally getting a heart. You could literally
see every nurse’s and doctor’s face light up as the words sunk in.
In a flurry of good wishes and
tears, he was carted away through
a tunnel of nurses, doctors and
health care providers with such
pomp and circumstance worthy
of royalty.
As the moment arrived and the OR staff prepared for transport,
we all began to gather, overwhelmed, knowing that his time
had come. We nurses comforted his mother, who was crying
Nursing outcomes.
• We provide family-centered care involving multidisciplinary ­collaboration.
• We embrace the cultural diversity of families and staff in our practice of
caring for children.
Nurse Week essay winner Adam Brenneman, RN, BSN.
mother had us to lean on, she had hope and the support she
Margaux Chan, RN, BSN, CPN, and
Susan Crandall, RN, BSN
Magnet Program Managers
needed to be strong for her baby. As I watched that baby Nursing Guiding Principle
Children’s Hospital Los Angeles Nurses embody the principles of integrity,
respect, leadership and advocacy in our daily work.
boy roll away, I finally appreciated the passion that was
Creative Direction:
Nursing Philosophy
nursing. I finally grasped why I was a nurse.
Jim Deeken
We, the Nurses of Children’s Hospital Los Angeles, embody individualized
­children?” It is a simple response: because I am passionate
getting a new heart. In a flurry of good wishes and tears, he
about it. Yes, this job can be intense, and yes, sometimes it
was carted away through a tunnel of nurses, doctors and seems like the bad outweighs the good. But sometimes ... health care providers with such pomp and circumstance worthy
you get to stand in a hallway, an hour after you have already
of royalty.
clocked out, and hear the sounds of a heart monitor getting
ever realized. In that moment, I understood if it had not been for
in a diverse community.
Sheila Perez, RN, BSN
Phan Dang, RN
tears of joy, many of us tearing up as well. Her baby boy was
more important than most realize, more important than I had
innovative and evidence-based Nursing care for children and their families in Nursing practice, professionalism and meaningful recognition for quality
Kelli Anderson, RN, BSN
I get asked all the time, “How can you work with sick
the reason why I am passionate about what I do. Nursing is
creating opportunities which support an environment of excellent, integrated,
Sarah Brown
Jennifer Buchannan, RN, MSN
uncontrollably, her eyes red and face soaked with her own
As the travel monitor faded into the distance, I realized this is
We are committed to advancing the professional practice of Nursing by
closer and closer with a child’s mother you’ve come to know
over the past nine months, and you get to see her face light up
as she sees her baby boy for the first time ... with his brand
new heart.
family-centered care. Research, ­evidence-based practice and lifelong
Design:
learning are the foundations for our practice. Our Nursing decisions integrate
Wendy Byle
sound clinical judgment, ethical responsibility and compassion to optimize
patient outcomes.
Editors:
Sarah Brown
Chandra Broadwater
Matthew Pearson
Nursing Vision
Nursing care at Children’s Hospital Los Angeles is recognized internationally
as a model for Nursing excellence. By utilizing best practice, we provide
outstanding family-centered care in an environment that honors its diverse
community. We strongly promote lifelong learning and collaborative
interdisciplinary ­relationships. In addition, our emphasis on Nursing research,
the effort of all of the PICU nursing staff, that baby boy would
The tin man begged for a heart, and all he got was some
leadership and professional development makes Children’s Hospital Los
not have made it to this moment and would not be getting a
velvet stuffed with sawdust. That night, a baby got a new heart,
Angeles the organization of choice for a career in pediatric nursing.
new heart. I finally comprehended that it was because his
and I have to admit ... the real thing is far more magical.
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SM
CHLA.org