HCS Alumni Panelists

A group of Health Care Systems alumni returned to Carrington Hall on April 24, 2012 to share their professional experiences with current HCS students. Their message: big changes are happening in health care, and nurses are leading the way.

The alumni panel, organized by the SON Office of Advancement and Associate Professor Cheryl B. Jones, brought in almost two dozen HCS alumni dating back to the graduating class of 2004. Nurse graduates came in from across the country, many with remarkable reports on what they’re doing now.

The SON’s Health Care Systems Program offers master’s and post-master’s training for nurses who want to further their expertise in administration, education, informatics, quality and outcomes management, and clinical leadership. Often these nurses have extensive clinical backgrounds and seek to influence health care on a system-wide level. According to a recent article in The Atlantic Magazine, now is a good moment for nurses to effect change by rising to leadership positions.

“Our current students already have successful careers, but it’s amazing to think of the expanded roles and opportunities that lie ahead,” said Dr. Jones, who referenced the Atlantic article. Proof of this trend was all around the room and shared by former HCS students.

Take HCS ’09 grad Angela Newman, nurse manager at WakeMed Cary, who was asked to help improve the oncology unit at her hospital. After observing oncology staff, Newman had the idea of expanding her unit’s operations by opening an outpatient clinic for blood transfusions.

“I put a proposal together, sent it to my VP, and within minutes he sent it to finance,” Newman said. It was Newman’s story of creating a medical day treatment unit that inspired Jones to bring the HCS students back to share their stories.

Susy Koruth, ’10, the SON’s first Clinical Nurse Leader certified graduate, is having a big impact in a clinical setting.

“As you can see, I’m completely clinical,” Koruth said, wearing scrubs for her position as CNL of the main surgical floor at the VA Medical Center in Durham. Koruth is not only the first SON CNL graduate, but also the first CNL to work at the Durham VA.

“At first the hospital didn’t really know exactly what the CNL role meant,” Koruth said. “But now it’s taking shape.” Koruth’s duties include monitoring performance improvement indicators for all the patients on her floor as well as serving as a support resource and educator. She has found an easy way to explain what she does: “You know the attending doctor? I’m the attending nurse.”

Another nurse whose career speaks directly to the nurse leadership trend outlined in the Atlantic is Lindsay Gaynor, ’04. Gaynor, who pursued the administration track with a focus on health care policy, is now director of clinical services and innovation for a multi-specialty physicians group in Massachusetts. Gaynor’s group is preparing to act as a pioneer Accountable Care Organization with Medicare. As an ACO, the group will work together as a network of hospitals, physicians, and other providers, sharing responsibility for the health of a specific population, in this case, of Medicare recipients. In ACO formations, providers are rewarded with increased pay when their populations show measured signs of good health, like decreased hospital visits.

“This is my first time at the executive level and I feel like we’re really having an impact on national health care reform,” Gaynor said. “It’s the team-based, multi-disciplinary care the U.S. health system has been talking about.”

Trent Praytor, ‘09 and Dustin Williams, ‘09

Dustin Williams, ‘09, spoke about the expanded roles in informatics that are and will become more available to nurses in the future.  These roles include the chief nursing information officer who leads and guides informatics operations; serving on teams to facilitate and coordinate the adoption of electronic health record technologies and the achievement of “meaningful use,” and leading efforts to implement a variety of electronic documentation systems.

Panelist Nancy Gleason, ’08, uses her HCS training in her role as a supervisor in the pre-anesthesia clinic at UNC. “I was learning something that I really needed to know in my current role as nurse manager from the get-go,” Gleason said of the HCS program. Gleason’s subsequent work and research have focused on patient safety, nurse empowerment in decision making, and nurse managers’ job satisfaction. “At this point in my career I’m looking to advance the legacy of nursing,” Gleason said.

“The one thing that I am learning, thanks to this program, is how to be a director,” said Beth Hutchinson, HCS ’10, administration, director of the Duke Birthing Center. Hutchinson spent 25 years as a nurse manager in pediatrics before taking on the role of director at Duke.

Trent Praytor, ‘09, also spoke about leadership opportunities for nurses in non-traditional settings.  After graduating from the HCS program, Trent took a position as a director of critical and progressive care at MedWest Haywood Hospital in Clyde, NC.  This step gave him the opportunity to help the organization achieve critical patient and organizational outcomes.  More recently, he has taken on the role of chief nursing officer at AnMed Health and Rehabilitation Hospital in Anderson, SC.  This position enables him to put his education to work by leading nursing services outside of acute care, and to ensure that patients who need rehabilitation services get high-quality care.   This was the perfect opportunity for Trent to take the next step in his leadership journey.
Before wrapping up, Jones asked the HCS grads what they wish they had more experience in.  The same words kept coming up: finance, marketing, facilities design, law, data analysis, project management. Their remarks reflect the increasing duties being undertaken by nurses who graduate from the HCS program and have opportunities to move above and beyond the jobs they first trained for.

Dean Swanson attended the panel and offered this in her closing remarks: “Never underestimate the lens through which you ask questions as a nurse.”  Our current HCS students and our graduates will do this as they continue to expand the boundaries of health care change, innovation, and leadership.

The group was led by SON’s Jean Davison, clinical assistant professor and family nurse practitioner. Volunteers included SON’s Rhonda Lanning, clinical instructor and nurse midwife, Elizabeth Prata, family nurse practitioner from UNC Center for Latino Health, and Christine Walko, PharmD from the School of Pharmacy.

The group conducted over 100 health screenings on local children before seeing over 150 patients per day at four different clinical sites. In addition, triage staff cared for minor complaints and handed out anti-parasitic treatments and vitamins. All told, the group saw more than 1,000 patients over the course of their trip, and distributed 20 food packets that could feed a family of five for one week.

UNC’s MedWorld helped provide the group with medical supplies to distribute to local hospitals and clinics. One hospital received endotracheal intubation equipment while its pediatric ward received beanie babies and toys.  Other supplies and medications were donated to Dr. Elmor Mejia, who is the only doctor with a hyperbaric chamber for treating injured Miskito lobster divers.

Before leaving Honduras, the group met with US Attorney David Arizmendi, vice consul of the US Embassy, who expressed appreciation for the group’s service.

View photos from their trip here.

Dr. Meg Zomorodi

SON clinical associate professor Meg Zomorodi, RN, CNL, PhD, was chosen to participate in the 2012-13 Nurse Faculty Leadership Academy. By pairing new nurse educators with mentors and NFLA expert faculty members, this 20-month intensive program seeks to develop leadership skills in new nurse faculty. Dr. Zomorodi will work with Dr. Judith Halstead, PhD, RN, ANEF, FAAN, from the Indiana University School of Nursing to enhance her leadership capabilities and SON’s Clinical Nurse Leader curriculum.

Dr. Zomorodi chose Dr. Halstead as her mentor because of her expertise in online education. The two will work together to develop ideas for an innovative, engaging online CNL program and revise two core CNL courses. They will receive additional guidance from Dr. Carol Winters of East Carolina University.

“I was so surprised by the first meeting and the wealth of knowledge that was in the room,” Dr. Zomorodi said. “It was in the first 5 minutes of meeting my mentor that I knew I had made the right decision.”

The Honor Society of Nursing, Sigma Theta Tau International’s Leadership Institute developed the NFLA with a grant from the Elsevier Foundation. The academy promotes faculty retention and high performing, supportive work environments through a challenging learning experience that gives new nurse educators the leadership skills necessary for their transition into the faculty role. The Academy chose 16 fellows from all over the nation to participate in its 2012-13 program.

By participating in the program, Dr. Zomorodi will gain unbiased perspectives from schools that face similar challenges, giving her valuable insight into leadership and course curriculum development. Dr. Zomorodi believes that her participation in the program will benefit not only her but the School as a whole.

“It is an opportunity for us to be seen on the national level and I know I will be provided with many ideas that I will share with the faculty,” she said. “It’s also an opportunity for us to build up the CNL program which will benefit our students, faculty, and the surrounding hospitals who are interested in the role.”

Excerpt:
“I will do anything that’s involved with improving cancer care,” says Deborah Mayer, PhD, RN, AOCN, FAAN, associate professor of nursing and member of UNC Lineberger’s Cancer Prevention and Control program. Her work improves cancer care locally and nationally, and nursing was always her career choice. “I wanted to be a nurse since I was five years old,” she says. “I never wavered.”

A journey into refocusing my nursing specialty

By Katie Shattuck

 “So, what do you want to be when you grow up?” We have all been asked this question at various points during our lifetime, in kindergarten during sharing time, in middle school writing class, and then again in high school as we prepare for our entrance into college. I always knew that I wanted to “help people.”  This idea transformed into a solid career path toward nursing after watching my sister go through nursing school and work as a registered nurse in a nursing home.

I applied to graduate school knowing that I wanted to earn my master’s degree in nursing to pursue a career as a Pediatric Nurse Practitioner. At the time, I would have laughed if you said to me that I would find an interest in children with developmental or behavioral disorders. In the fall of my second year in my master’s of nursing program, I was offered the opportunity to participate in NC Leadership Education in Neurodevelopmental Disabilities Fellowship (NC LEND), a yearlong fellowship sponsored by the Maternal and Child Health Branch of the United States Department of Health and Human Services. The purpose of  NC LEND  is to provide training about the complex issues surrounding children with developmental and behavioral disabilities. 

            I started the LEND fellowship unsure of not only what was expected of me but also how I could or would tailor this opportunity to fit in with the care that I was learning to provide as a Pediatric Nurse Practitioner. I had only a cursory knowledge of developmental and behavioral disorders and very limited experience with the community resources set up for these patients and their families. What I have learned over the past eight months has astounded me and made me realize how truly disadvantaged individuals with developmental and behavioral disorders are in terms of the quality of care that they receive.

            Anne (name has been changed) is a perfect example of how common fragmented and ineffective primary care is for individuals with developmental and behavioral disorders. Anne was ten years old with a diagnosis of severe autism spectrum disorder. Her parents came to the behavioral clinic in which I was participating with the hopes that a developmental behavioral specialist would be able to help them with the extreme tantrum behavior that Anne was exhibiting. They were also looking for ways to deal with her lack of self-toileting skills and her repetitive playing of specific clips of television shows.

Anne was also overweight, had a family history of cardiac disease, and during the visit with the behavioral specialist had symptoms of a cough and runny nose that had been going on for ten days. Her parents had not taken her to her primary care doctor for the cough because they assumed that the specialist could take care of anything that may be wrong with her medically. Unfortunately, the specialist addressed none of Anne’s medical concerns; these would have to be discussed with her primary care provider.

At this point during the exam I realized what is missing in our current system. On the one hand, we have great primary care providers who diagnose childhood illnesses. Top-notch primary care providers acknowledge when a child is overweight and start a discussion with the child and family about how to achieve a normal weight. Excellent primary care providers understand that children with chronic conditions like asthma need to have their seasonal allergies under control to help keep their asthma under better control.

On the other hand, we have specialists that know the ins and outs of developmental and behavioral disorders. These specialists have the education to feel comfortable prescribing psychostimulants, antipsychotics, and antidepressants to children when needed. Specialists know how to navigate the world of community resources that the layperson cannot navigate. What we have are two different sets of providers. While each of them performs a necessary function to treat this special population of children and adolescents with developmental or behavioral disorders, they are doing so separately.

In nursing school we spend a great deal of time talking about how we should treat the whole person – we call this holistic care. After eight months as a LEND fellow, I am dismayed to discover that it is a rare thing indeed to find someone who can or will provide both pieces of the puzzle for this population. Some of the barriers prohibiting primary care providers from adequately treating children with developmental or behavioral disorders include lack of insurance company reimbursements, time constraints in busy practices, and being uncomfortable with using screening tools to help diagnose children with developmental and behavioral disorders.

             In order to provide the quality, holistic care that we as nurses and advanced practice nurses have set as our standard, we need to make sure that we have the knowledge to treat these patients. We need to make sure that we willingly embark upon lifelong learning in the area of developmental and behavioral disorders to make sure that we are fighting against the norm of fragmented care in order to provide quality care to a most underserved population.

If you asked me today what I want to be when I grow up, I would still say that I want to “help people.” However, I would just be sure to state loud and clear that my goal is to “help provide cohesive, comprehensive care to children and adolescents with developmental and behavioral disorders.” I encourage you to do the same.

Clinical Assistant Professor Megan P. Williams was excited to see her pediatric clinical students pictured in an article from the N.C. Children’s Hospital. From left to right are Adria Gillespie,  Aaron Parsons, Victoria Neff & of course the star of the show Christian! Read the whole story here: http://www.ncchildrenshospital.org/calendarkids/christian.

Mi-Kyung Song, PhD, RN

Associate Professor Mi-Kyung Song has received a grant ($50K) from the Kornfeld Program in Bioethics and Patient Care, which is administered by The Greenwall Foundation. The grant will support Dr. Song’s research project that  examines management of ethical issues in free-standing dialysis facilities. This prestigious award recognizes the significance and potential impact of individual research projects and researchers in bioethics areas. In the 62 years of the Foundation’s history, only two nurse researchers have been awarded grants.

Deborah Mayer, PhD, RN, AOCN, FAAN

When cancer patients experience medical problems, they may visit emergency departments, but how often and for what reasons, there is little data.

A first-ever study of emergency room use by oncology patients in North Carolina was published in the May 23, 2011 online issue of the Journal of Clinical Oncology. Authors hope the study can give them information so that they can target clinical problems to improve delivery of quality cancer care, thus avoiding emergency room visits.

Deborah Mayer, PhD, RN, AOCN, FAAN, associate professor of nursing in the UNC School of Nursing, study lead author, said, “While some cancer patients develop acute problems that do require a visit to the emergency department, some visits might be avoided with better symptom management.” Mayer is a member of UNC Lineberger Comprehensive Cancer Center.

The UNC team used a statewide database to collect information on over 35,000 Emergency department (ED) visits. They learned that the top three problems that brought patients to the ED were related to pain, respiratory distress, and gastrointestinal issues (mostly nausea and vomiting).
Mayer thinks some of these problems, such as nausea and vomiting, could be managed by the patient and cancer doctors and nurses. Reasons for a problem need to be explored: did the patient not get a prescription? Was the patient able to fill the prescription and take the medication? If it wasn’t working, did they call their doctor or nurse? Mayer concludes by saying that ‘While we have made great strides in cancer care, this study shows we still have room for improvement’.
 
Unlike other people visiting the emergency department where about 15 percent were admitted to the hospital, over 63 percent of cancer patients were admitted.

Debbie Travers, PhD, RN, CEN, FAEN, assistant professor in the UNC School of Nursing and study co-author, believes that “the Study validates the need for emergency department nurses to play an active role in the care and management of acute problems faced by cancer patients.” She said that the study identified additional areas for research, including management of acute symptoms for targeted populations, especially patients with lung cancer.

Other UNC authors are: Annah Wyss, MPH of the UNC Gillings School of Global Public Health; Ashley Leak, RN-BC, MSN, OCN, UNC School of Nursing; and Anna Waller, ScD, UNC School of Medicine. This research was funded by the NC TraCS Institute at UNC-Chapel Hill, one of 55 medical research institutions working together as a national consortium to improve the way biomedical research is conducted across the country. The consortium is funded through the NIH Clinical and Translational Science Awards (CTSA).

Read the press release here: http://news.unchealthcare.org/news/2011/may/cancer-ed-visits.