Exceptional. Extraordinary

Exceptional nurses . . . Extraordinary Care 2009 Nursing Annual Report “ As we sustain and enhance our organization’s culture of excellence, we ...
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Exceptional

nurses . . . Extraordinary

Care

2009 Nursing Annual Report

“ As we sustain

and enhance our organization’s culture of excellence, we look to continue to build on our exceptional practices and identify opportunities to reach beyond our high standard of excellence.



—Kathleen S. Jose MSN, RN, CNO

cont ent s 2

From the CNO

4

Transformational Leadership

7

Structural Empowerment

2 2

E xemplar y Professional Practice

2 8

New K nowledge, Innovations and Improvements

3 4

Repor t on 2009 Philanthropic Suppor t for Nursing

From the

CNO

Fiscal year 2009 (October 1, 2008 through September 30, 2009) was very special for Lahey Clinic nurses: Lahey Clinic received recognition as a Magnet organization, the highest acknowledgment for nursing excellence. On August 17, 2009, we received the official news that Lahey Clinic had achieved Magnet recognition by the American Nurses Credentialing Center (ANCC). Less than 6 percent of the nation’s hospitals have earned such recognition, and we joined an elite list of six other Massachusetts hospitals recognized for providing the highest level of patient-focused nursing care. The announcement culminated our seven-year journey of excellence, which involved completing a rigorous application process including an in-depth self-assessment of key clinical and administrative standards set forth by the American Nurses Association (ANA). During Phase I of the process, a 2200-page document was submitted, showcasing supportive evidence as to when we met or exceeded the 64 standards. Because the document was accepted without request for additional information, we proceeded directly to Phase II, the site survey. During the on-site visit, which took place June 1-4, four appraisers visited Lahey’s medical centers in both Burlington and Peabody, inviting comment from nurses, administrators, patients and staff. They quickly recognized our commitment to excellence, our expertise, and the spirit of collaboration we share with one another. The site visit proved to be an uplifting experience for all colleagues, patients and families, community leaders, and academic partners. It was an opportunity to take a moment to reflect and be proud of the outstanding health care delivered to our patients every day. The ANCC agreed, and their executive summary of our submitted documentation and site visit validates the praise received from the four appraisers during their exit conference. Our success in meeting Magnet expectations in all of the 14 Forces of Magnetism was further demonstrated by the following 12 Exemplars identified in the final formal report. • • • • • • • •

Quality of Nursing Leadership (2) Management Style (2) Quality of Care (1) Quality Improvement (1) Consultation and Resources (2) Community and the Health Care Organization (2) Nurses as Teachers (1) Professional Development (1)

This unusually high number of exemplars strengthens our enviable position as a health care organization in which nursing delivers excellent patient outcomes as well as interdisciplinary patient- and family-centered care. Exemplar status means we are an organization that fosters professional autonomy, decision making, and nursing educational and professional development opportunities that lead to the potential for career advancement. I congratulate every member of Lahey’s Nursing staff for having received the highest honor that can be earned by a health care organization, both national and international, for its Nursing Department, which recognizes innovation, teamwork, and evidenced-based, patient-focused care. I also extend my deepest personal thanks to the hundreds of colleagues throughout the organization who contributed time, expertise and extra effort to the Magnet journey and during the review process. Together, their efforts made all the difference. As we sustain and enhance our organization’s culture of excellence, we look to continue to build on our exceptional practices and identify opportunities to reach beyond our high standard of performance. I look forward to what the future will bring.

Kathleen S. Jose, MSN, RN, Chief Nursing Officer

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Kathleen S. Jose, MSN, RN, chief nursing officer, was joined by Magnet champions from various units to accept the phone call from Wolf. Showing their support, (far left) are Tim O’Connor, chief financial officer; David Barrett, MD, former president and chief executive officer; and Sanford Kurtz, MD, former chief operating officer.

magnet Designation Magnet designation is widely accepted as the gold standard of patient care, an accolade that validates our standing as a hospital where nursing delivers excellent patient outcomes and where professionals have high levels of job satisfaction. It means we are actively involved in data collection and decision making in patient care delivery, and we have open communication between nurses and other members of the health care team. As a Magnet facility, we attract the best and brightest nursing professionals and provide a supportive staff work environment.

Alumni Auditorium was a scene of pride and jubilation when Gail Wolf, DSN, FAAN, of the Magnet Recognition Program declared Lahey Clinic a member of “the 5 percent club.”

One proud group of Lahey nurses gathers outside Alumni Auditorium after the big moment.

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Transformational Leadership Transformational leadership is a motivational style of management whereby employees are encouraged to achieve greater performance through inspirational leadership, which develops employee self-confidence and higher achievement of goals. It is a necessary element in an organization to create, build and sustain the culture of excellence in patient care and outcomes. As the leader of the nursing service, the chief nursing officer must be a knowledgeable, transformational leader who articulates a vision and philosophy, communicates expectations, develops leaders, and implements a structure to meet the current and future needs of nursing and the organization. Our nursing leader, Kathleen S. Jose, MSN, RN, sits at and has a voice in the highest levels of the organization as chief nursing officer (CNO). As our leader, her mission and responsibility is to ensure that our patients receive the highest level of patient care and that our nurses are supported, along with the interdisciplinary team, to deliver excellence in care. The American Nurses Credentialing Center (ANCC) recognized Lahey’s dynamic transformational driven culture in our 2009 Magnet submission by way of exemplars. Four of the 12 exemplars on excellence were cited in the area of transformational leadership as seen in the following ANCC feedback: 1. The CNO is very involved in building on strengths within her leadership team and direct care nurses. 2. Staff nurses consistently stated that they felt their voices were heard and could relate examples of decisions made as a result. 3. The CNO and her leadership team are strong advocates on behalf of staff nurses for revision or implementation of systems, new equipment, personnel support, and additional FTEs. 4. The structure well positions nurse-led initiatives for success and support across the institution.

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Chief Nursing Officer and Senior Vice President Kathleen S. Jose, MSN, RN

Associate Chief Nurse Patient Flow and Nursing Resources Ann Killilea, BA, RN

Nursing Float Pool Nursing Resource Team Emergency Department Administrative Supervisors Admitting Nurses Nursing Pool Staffing Office Patient Flow Coordinators

Nursing Administration Office Manager Administrative Asst To Chief Nursing Officer Nursing Administration Administrative Assistants Magnet Program Director Magnet Administrative Assistant

Associate Chief Nurse Medical/Surgical and Finance Jacqueline S. Bergeron, MS, RN

5 WH 6 CH 6 EH 7 EH and IV Therapy Interventional Cardiology Holding Area Hematology/Oncology Infusion Room Lahey Clinic North – 2S/ED/Hem/Onc Clinic

Associate Chief Nurse Nursing Informatics and Quality Cynthia Fiekers, BSN, RN

Informatics Nurse Specialist Performance Improvement Innovator

Associate Chief Nurse Ambulatory Nursing Practice Sheila Cunniff, BS, RN

Associate Chief Nurse Nursing Education, Research and Professional Development Gayle Gravlin, Ed.D, RN, NEA-BC

6 SE and 7 SE H 6 WH 7 WH 7 CH

Nursing Quality Measurement Analyst Nursing Quality Project Specialist

Ambulatory Nursing Practice 2w – Radiation Oncology/Behavioral Med. 3se – Hematology/Oncology 4e, 4c – Gim 4se – Urology/Executive Health 4w – Hepatobiliary/Endocrinology 5c – Otolaryngology, Pulmonary/Ccm/Oral Surgery 5E – Cardiology/Vascular Med./Ct Surgery Central Educators Ambulatory Educators Educational Technology Educator Niche Program Leader

Advanced Pratice Nurses

5W – Rheumatology, Nephrology 6c – Gi/Gs 6w – C/R, Gyn, Plastic Recon./ Vascular Surgery 7c – Orthopedics, Neuro Surgery 7w – Id, Neurology, Pain Center (Ophthalmology) 31 Mall Road – Allergy Wall Street – Dermatology

Grn Coordinator Hem/Onc Clinical Specialist Moodle E-Learning Management System

Nursing Simulation Program Aha Bls/Acls Program Marn Program

Clinical Educators

Associate Chief Nurse Critical Care Nursing Services Tracy A. Malone, MSN, RN

6 West Progressive care Rapid Response Team Critical Care Floats Medical Intensive Care Unit (MICU) Critical Care Unit (CCU) / Intensive Care Unit (ICU) Surgical Intensive Care Unit (SICU)

Associate Chief Nurse Perioperative Services Deborah Zarrella, MSN, RN

Ambulatory Surgery Endoscopy Interventional Radiology PACU Preoperative Center Operating Room Lahey Clinic North

CRNAs

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Demographics

the nurses at Lahey Clinic All numbers reflect Fiscal Year 2009 (October 2008 through September 2009)

Ambulatory n RN n APRN n Leadership n LPN n Unlicensed

The following percentages are based on combined Ambulatory and Hospital RN numbers

Age n Under 25 n 25 - 34 n 35 - 44 n 45 - 54 n 55 - 64 n 65 or older

4.32% 25.22% 21.25% 30.25% 16.31% 2.65%

Gender n Percentage female n Percentage male

94.18% 5.82%

Years of Service

Hospital n RN n CRNA n Leadership n Unlicensed n Other

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n 0 – 3 years n 4 – 9 years n 10 – 19 years n Over 20 years

19.66% 45.95% 15.34% 19.05%

Highest Level of Education n Diploma (LPN): n Diploma (RN): n Associate Degree: n Bachelor’s Degree: n Master’s Degree: n Doctorate:

5.38% 7.11% 24.78% 58.69% 3.94% 0.10%

Structural Empowerment Nursing shared governance The Nursing Shared Governance Model is the central vehicle that guides and drives the operational, professional, educational and research processes for nursing practice at Lahey Clinic. The structure has continued to evolve since the year 2000 to include councils for decision making based upon internal and external forces that impact nursing practice. Under the direction of the chief nursing officer, nurses from all areas of Lahey are encouraged to participate in the governance process to have a voice and a venue to actively participate in nursing practice.

Unit-Based Practice Councils The Shared Governance Structure includes the Unit-Based Practice Councils (UBPCs), which include the Nurse Practitioner (NP) Committee and Certified Registered Nurse Anesthetists (CRNAs). The UBPCs were integrated into the Shared Governance Structure in 2006. They meet regularly and identify opportunities for improvement in nursing practice in their respective units that enhance excellence in patient care. The UBPC structure is the essential process for staff nurse decision making in operational and professional practice issues at the unit level.

Central Councils There are 11 Shared Governance Central Councils that include staff from all areas of Nursing. The central councils focus on processes for relationship building and mutual collaboration and the development and promotion of policies, guidelines, and standards of practice that enhance professional nursing practice and promote quality in patient care. As shown in the model diagram, the Nursing Practice Coordinating Council receives information from all the UBPCs and the other central councils and coordinates, facilitates, and maintains the integrity of the Shared Governance Structure.

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nursing shared governance

❚ NURSING PRACTICE COORDINATING COUNCIL (NPCC)

❚ AMBULATORY CLINICAL PRACTICE COUNCIL

❚ NURSING QUALITY SAFETY COUNCIL

Co-Chairs: Kathleen S. Jose, MSN, RN, CNO, and Janet Habeshian, BSN, RN, NM

Chair: Sheila Cunniff, RN, Associate Chief

Co-Chairs: Margie Sipe, MSN, RN, Performance Improvement Innovator, and Kelly Higgins, RN, Ambulatory Surgery

The Nursing Practice Coordinating Council provides a forum for shared decision making about nursing practice across the organization.

Significant Accomplishments in 2009 n Initiated

Governance Council and unit-based council bylaws and scopes of service

n Participated

in the Lahey Clinic Magnet Journey presentation, and presented to the Magnet appraisers

n Developed

an effective communication plan for usage on the floors/units

The Ambulatory Clinical Practice Council reviews all policies and nursing practice guidelines related to ambulatory nursing practice within Lahey Clinic and ensures that they conform to current regulatory requirements and standards of care.

Significant Accomplishments in 2009 n

Developed the Ambulatory Skills Fair 2009

n

Reviewed four key job descriptions (RN, LPN, Clinic Assistant, Nurse Navigator)

n

Revised many nursing policies to include: • Allergy documentation • Dermatology policy for administration of local anesthesia • Two otolaryngology nursing policies regarding BAHA implants • Transcription of orders in Ambulatory • Screening patients in Ambulatory • Telephone memorandum form in Ambulatory • TB Skin Testing Policy • Oncology policies for new drug protocols

n Participated

in the leadership development program by Joan Meadows from the Advisory Board who visited Lahey Clinic on August 14, presenting on “Never Events” and “Cultivating Excellence”

n Reviewed

challenges, actions and next steps based on the 2008 NDNQI survey n

Finalized Ambulatory Competencies 2009

n

Completed evaluation tools for RN, LPN, CA

The Nursing Quality Safety Council promotes and maintains a nursing environment that allows colleagues the ability to practice in the safest manner, identifying opportunities to improve patient care. It provides a professional environment for patients that supports the quality and performance improvement.

Significant Accomplishments in 2009 n Reviewed

the 2009 National Patient Safety Goals and the education process to take back to the floors/units

n Followed

up on the RN Satisfaction Value Stream Analysis Steering Committee Report: “Time for Patient Care”

n Participated

in the creation of the Sitter Safety Assessment Algorithm

n Participated

in the creation of Page 4 on the Discharge Summary: “Tips to Help You Recover”

n Assisted

with redesign of the Nursing Dashboards that are now posted on the Lahey Clinic Intranet, MassNet

n Participated

in the improvement/redesign of unit dashboards

n Assisted

with the education on “How to Do a Double Check” on high alert medications

NURSING PEER REVIEW COMMITTEE (Subcommittee of Nursing Quality Safety Council) The Nursing Peer Review Committee is responsible for the review of adverse patient outcomes in order to determine whether such outcomes represent opportunities for quality improvement.

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nursing shared governance

❚ NURSING ETHICS COUNCIL Co-Chairs: Kay Horiuchi, BSN, RN, and Alison Richardson, BSN, RN The Nursing Ethics Council is comprised of nurses from all nursing areas including Lahey Clinic Medical Center, North Shore and the ambulatory clinics.

Significant Accomplishments in 2009

❚ NURSING RESEARCH COUNCIL Co-Chairs: Amy Dooley, BSN, RN, CPAN, Staff Nurse PACU, and Ann Dylis, PhD, RN, Nurse Research Scientist

❚ INTERDISCIPLINARY PATIENT CARE LEADERSHIP COUNCIL Chair: Kathleen S. Jose, MSN, RN, CNO

The Nursing Research Council is dedicated to the support of nursing research and evidencebased practice at Lahey Clinic. Its mission is to encourage participation in all areas of nursing research, believing that research is the scientific foundation for nursing practice. Furthermore, the council members support that nursing research is essential to the improvement of patient care and the development of professional nursing practice.

The Interdisciplinary Patient Care Leadership Council provides a forum for everyone on the patient care delivery team to create, describe, monitor and discuss interventions for all performance improvement initiatives that affect the outcomes of the patients we serve.

Significant Accomplishments in 2009

n Participated

n Council

member participation in providing information for the Magnet report

n Initiation

of individual unit research-based reports at council meetings

n Initiation

of teleconferencing of council meetings to Lahey Clinic Medical Center, North Shore

n Educational

sessions on published research, online journal clubs and nursing database searches

Significant Accomplishments in 2009 changes to the Transfusion Investigation Record

n

n Group n

n Participated

in education events during National Patient Safety Awareness Week

n Took

ongoing updates on medication safety back to the units

n Implementation

phones

of charge nurse designated

reviewed and accepted council bylaws

Magnet • Review of Magnet document • Brief on meeting with Magnet appraisers • Preparation for site visit

n

Updated/discussed topics for the Critical Care Ethics Program, week of June 9, 2009

n

Supported the successful program, “Ethical Issues in Critical Care”; continued with efforts in educating the nursing staff about ethical consults

n

Sent four members to the annual Harvard Bioethics Program

n

Finalized November Grand Rounds: “Got Ethics? We Got the Code”

n

Reviewed and discussed ANA Code of Ethics precepts

n

Supported nursing colleagues and follow-up with ethics consults regarding difficult cases

n Reviewed

in the rollout of CareFusion technology on all units

Council held all day continuing education class on ethical issues in critical care nursing

n Improved

nutritional consult screen was added to Lahey Clinic Medical Center

n Participation

in planning and exhibiting at Nursing Research Day on May 5, 2009

n Research

mentorship provided by the three nurse research scientists

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nursing shared governance

❚ PROFESSIONAL AND EDUCATION COUNCIL

❚ COORDINATION AND REVIEW COUNCIL

❚ PATIENT CARE TECHNOLOGY COUNCIL

Co-Chairs: Alison O’Brien, MSN, RN, Senior Education Coordinator, and Lisa Walsh, RN, Staff Nurse, Float Pool

Chair: Doris Barreiro, MSN, RN, Nurse Manager MICU

Chair: Cynthia Fiekers, RN, BSN, Associate Chief Nurse, Informatics and Quality

The Professional and Educational Council oversees, reviews and approves all nursing education materials and activities. It supports a culture of practice-based improvement as a process essential to the growth and development of all nurses at Lahey Clinic.

Significant Accomplishments in 2009 n The

purpose and goals of the Professional and Education Council were reviewed, updated and approved.

n The

Council appointed a sub-group to work with the MOODLE administrator to set a process for approval of educators’ applications to create educational modules for use on the MOODLE e-learning management system.

n The

Council reviewed 71 proposed educational course materials and/or activities, of which 33 were accepted.

n The

Nursing Education Needs Assessment Annual Survey results for 2008 were reviewed. Topics and titles for the 2009 Continuing Education Calendar were discussed. The Council approved the 2009 Continuing Education Calendar.

n The

Council approved an updated “Matrix Orientation Competencies by Unit.”

n The

Council recommended items for inclusion in the Massachusetts Association of Registered Nurses (MARN) Annual Report that would demonstrate practice-based improvements resulting from staff educational offerings.

n Council

members met with Magnet appraisers during our Magnet survey. They discussed educational projects that had been done on their units and gave examples of how the Council fulfilled its function of overseeing all nursing educational materials and activities at Lahey.

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The Coordination and Review Council coordinates and standardizes elements of nursing practice related to organization systems and job performance.

Significant Accomplishments in 2009 n The

job description of the Staff RN, which was revised by the Council, was accepted by the Associate Chiefs

n Reviewed

the job descriptions for the following tertiary care positions (all were accepted with minor revisions):

• Tertiary Care Team Leader • Nursing Assistant • Nurse Associate • Unit Coordinator n Reviewed

and Approved the following policies:

• Shared Governance Structure • Admission of a patient • Documentation: Nursing and, with a few additions, Transcription of Medications • The policy and flow sheet for opioid infusion were also reviewed and approved with minor changes n Approved

job descriptions for the Nursing Supervisor and Critical Care Family Liaison RN as well as reviewed the new template for physical requirements that will be in all job descriptions

n Reviewed

and approved the revised falls documentation and care plan

n Reviewed

and approved the document, “Tips to Help You Recover,” a patient handout to be included with discharge instructions (it will be an educational tool for patients as well as a means to help Lahey attain 100 percent on the Congestive Heart Failure [CHF] core measures)

The Patient Care Technology Council is a multidisciplinary council that facilitates the implementation of departmental and organizational objectives related to technology in order to enhance patient care.

Significant Accomplishments in 2009 n Active

participation in the selection process and installation of the New Patient Station

n Actively

contributed to the CareFusion rollout on all inpatient medical/surgical and critical care units

n Deeply

involved in the research, vendor review and selection of Eclypsis as the electronic health record for the inpatient environment

nursing shared governance

❚ NURSE PHYSICIAN PARTNERSHIP COUNCIL Co-Chairs: Kathleen S. Jose, MSN, RN, CNO, and Fran White, BSN, RN, Nurse Manager, 6 Central Hospital The Nurse Physician Partnership Council creates a partnership between nurses and physicians to jointly manage and problem solve in order to accelerate positive patient outcomes. It also provides a forum to share ideas, discuss issues and disseminate new information.

Significant Accomplishments in 2009 n Council

is working on developing a “walk in my shoes” type of program where the residents get paired up with a nurse for either a shift or a few hours in order for the residents to better understand the role of the nurse (this has been very successful with the Tufts medical students).

n Council

organized a meet-and-greet breakfast for the new surgical residents when they started at Lahey, which took place on August 12, 2009. All the new surgical residents, as well as existing surgical residents, attended. Representatives from Case Management, Social Services, Nutrition and Nursing welcomed the residents.

n The

Council discussed strategies to help bridge the gaps between the Medical Emergency Team (MET) and the attending services. It was recommended that there be some type of debriefing after each MET call. This would give the MET and the attending service the opportunity to discuss what went well and if there were any issues/concerns.

n Tufts

medical students: Nursing put together an hour-long curriculum for the first-year students, which included discussions regarding communication and collaboration. Students overwhelmingly wanted to know more about the role of the nurse.

❚ CLINICAL PRACTICE COUNCIL Co-Chairs: Mary Sutton, RN, CPAN, CAPA, Nurse Manager, PACU, and Maureen McLaughlin, RN, MS, CPAN, CAPA, Clinical Educator, PACU The Clinical Practice Council reviews all policies and nursing practice guidelines related to nursing practice within the Lahey Clinic health care system and ensures that they conform with current evidence-based standards of care and are consistent across all care settings.

Significant Accomplishments in 2009 n The

following critical care policies were revised, presented and approved:

• Endotracheal or Tracheostomy Tube Suction (nm7032) • Endotracheal Intubation, Assisting With (nm7030) n The

following nursing policy was revised, presented, and approved with minor changes/ recommendations:

• Transcription of Orders (nm7207) n Shared

Governance Structure Policy was presented by Tracy Malone and approved with minor edits.

n Nursing

Practice Guideline: Initial Patient Assessment (IPA): Changes were made to address home medications brought to the hospital by inpatients, per Clinic and Administrative Manual Policy, Medication Management, Medications Brought to the Hospital by Inpatients.

n Collaborative

Patient Plan of Care: Reviewed based on recommended changes by the Professional and Education Council.

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Professional Development The Center for Clinical and Professional Development: Nursing Education at Lahey Clinic The Center for Clinical and Professional Development at Lahey Clinic promotes the advancement of clinical excellence through the creation of an environment that actively supports a philosophy and culture of lifelong learning. We boast a robust and vital Nursing Education Department servicing Lahey colleagues, retired Lahey employees and community members. In addition to the 235 class sessions offered in 2009, courses are in development year-round to meet the professional needs of our multiple constituencies. Our offerings provide BLS and ACLS certification and career development opportunities for nurses at all levels of the organization and at all stages of experience, novice to expert. Lahey’s nursing research and evidence-based practice initiatives were recognized as having “an exemplar level of excellence” by the ANCC Magnet Program in their Executive Summary Report. As a newly designated NICHE (Nurses Improving Care for Healthsystem Elders) hospital, we will begin to implement a geriatric resource nurse model, and will offer courses specifically targeting care of the over 65 patient population. Even as we strive to meet the current needs of our organization and the community, we must look to the

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future. On the national front, the report of the Robert Wood Johnson Foundation at the Institute of Medicine “Initiative on the Future of Nursing: Leading Change, Advancing Health” and the Carnegie Foundation Report, “Educating Nurses: A Call for Radical Transformation,” seek to identify the critical knowledge, skills, competencies and strategies that the nurse of the future will need to master. At the state level, government, nursing schools and professional nursing organizations have joined forces to examine these same issues. Several Lahey colleagues serve on sub-committees of the Massachusetts Department of Higher Education Nursing Initiative including the Nurse of the Future Nursing Core Competency Committee and the MONE Academic Practice Integration Committee. The goal for all is the same: to develop effective nursing education that translates into effective practice and optimal patient outcomes. As a Lahey nurse, it is not enough to be receptive to change. Here, we work every day to participate in shaping the future. FY2009 Highlights from the Center for Clinical and Professional Development follow.

1. New Colleague Orientation Program The overall goal of Nursing Orientation is to acquaint new and transferred staff with departmental goals and functions, to establish open communication, and to promote an orientation that reflects the institutional guiding principles and philosophy of the Nursing Department. Nursing orientation provides the new or transferred colleague with information that will serve as a foundation for the delivery of safe, competent and quality care for all patients. All newly hired direct care nursing staff participate in our extensive, competency based orientation. Week one of this program begins with General Nursing Orientation, with an introduction to the organization and its culture, and continues throughout the first week of the colleague’s tenure. During this initial period, all nursing colleagues receive hands-on computer and nursing documentation education and participate in appropriate skills training in our state-of-the-art Skills Lab. Also during week 1, all non-physician Lahey colleagues are required to attend the 4.5 hour New Colleague Mandatory Education Program facilitated by a clinical nurse educator from the Center for Clinical and Professional Development. Offered twice per month, this program provides the new colleague with comprehensive information on patient confidentiality, privacy and patient rights. The curriculum includes videos, guest speakers, PowerPoint presentations, an informational packet for the new colleague and a post-test. Upon completion of the first week of nursing general orientation, the newly hired direct care nurse begins unitspecific orientation. Once the orientee reports to his or her practice area, the unit-based clinical educator, in collaboration with the preceptor, facilitates the completion of the positionspecific Orientation Skills Checklist. Additional support for newly hired Nursing colleagues is the presence of a clinically expert off-shift central educator. A total of 234 Nursing colleagues were hired in 2009 (refer to statistics on page 19).

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nursing education

2. Newly Licensed Nurse Program and Critical Care RN Intern/Residency Program

With a 97 percent retention rate, Lahey Clinic enjoys a solid foundation of experienced nursing staff on which to build a staff of “Exceptional Nurses” delivering “Extraordinary Care,” a goal manifested in our Magnet journey slogan. In FY 2009, we onboarded 111 RNs. Of these, 47 were Newly Licensed Nurses (NLNs) to whom we offer an outstanding orientation program initiated during the first week of nursing general orientation. The program consists of planned mentoring by a preceptor and clinical educator, participation in patient-based case scenarios in the simulation lab, exercises in critical thinking, and observation experiences in a variety of clinical settings. NLNs also participate in the Medical/Surgical Pathway to Expertise, an interactive evidenced-based clinical program structured upon the work of Patricia Benner, PhD, RN, FAAN, FRCN, The Novice to Expert Skills Acquisition Model. The NLN program was designed to meet the unique needs of the NLN by providing unitbased clinical learning opportunities as well as educational programs and support, facilitating the transition of the NLN into the profession and socialization to the Lahey Clinic nursing community, and to promote the development of clinical competency. The orientation program was created utilizing current research, adult learning theory, and evidence for best practice and optimal learning. The goal of the program is to support the NLN in the transition from novice to competent professional nurse. Elements of the NLN program include General Orientation, Nursing Department Orientation, NLN Welcome Luncheon, Unit-Based Orientation, Medical/ Surgical Pathway to Expertise, and the Telemetry Pathway.

Critical Care RN Intern/Residency Program With generous philanthropic support, Lahey Clinic’s Department of Clinical and Professional Development accepted our third cohort into the Critical Care RN Internship/Residency program. The BSN junior students were selected after a rigorous and highly competitive application process. This cohort’s graduation date was May 2010. The student interns were paired with a nurse ”coach” who facilitated expanding their knowledge of communication, socialization, advanced nursing skills, critical thinking, and collaboration between nursing team and interdisciplinary members of the organization. The program included workshops, simulation, journaling, evidence-based reading materials and guest lecturers. Previous critical care RN interns who are now working in Lahey’s Progressive Care Unit stated: “the experience and the knowledge that I received is invaluable” and the program “provided an excellent foundation, familiarizing us to Lahey’s work environment.” Expansion of the program to include four medical-surgical participants was scheduled for 2010.

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“ We are very proud of the professional growth that has taken place here at Lahey and are honored to have been a part of this transformational process.



— Susan Buthmann RN, CAPA, CPAN, Staff Nurse Ambulatory Surgery Pre-operative Center, Magnet Champion

nursing education

3. Providing Content, Depth and Breadth through Continuing Education Contact Hour Offerings:

Continuing Education Offerings Fiscal Year 2009 (October 2008 through September 2009) Nurses at Lahey Clinic are encouraged and supported in their professional development efforts. Lahey Clinic is approved by the Massachusetts Association of Registered Nurses (MARN) as a provider of continuing education. Nurse educators provide MARN approved contact-hour educational programs to promote recruitment, retention, competence and continuing education of nursing staff members. A department-wide Annual Educational Needs Assessment informs the Education Department regarding the staff’s needs and preferences for timely topics. A unit-based educational needs assessment is carried out by clinical educators. Unit-based councils are consulted, and a slate of all day educational program topics is presented to the Professional and Educational Council for approval. FY2009 topics included:

Title

Date

What’s New in Renal and Hepatobiliary Transplant Care

Attendance Contact Hours

Nov 11, 2008

70

239

March 31, 2009

148

918.75

State-of-the-Art Stroke Care

May 7, 2009

135

523.5

Ethical Issues in Critical Care Nursing

June 9, 2009

107

619

September 22, 2009

130

497.5

Trauma and Critical Care Update 2009

Coming to a Bedside or Clinic Near You! Select Nursing Topics for 2009

These five offerings provided over 2797 contact hours to 590 participants. In addition, during FY2009, other Lahey courses awarded more than 2100 additional MARN contact hours to Lahey and community nurses, for a total of nearly 5000 contact hours awarded through our accreditation as a MARN contact-hour provider. The following are examples of course offerings open to the community:

Basic Life Support Advanced Cardiovascular Life Support Caring for the Patient and Family at the End of Life (ELNEC) ONS Chemotherapy and Biotherapy All Day Continuing Education Re-Entry to the Nursing Profession

Please see “Selected Stats” on page 19.

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nursing education

4. Technology and Innovation: Implementation of a Responsive, Nursing-Managed e-Learning Platform

In FY2009, the Nursing Department implemented MOODLE (Modular Object Oriented Learning Environment), an open source e-learning platform. MOODLE has grown from an initial pilot program to a vibrant part of our educational methodology with over 35 courses in development in the first year. The initiative came about due to the Nursing Department’s need for rapid dissemination of information and evidence-based education for staff nurses. Technology-savvy staff nurses and educators, accustomed to a rich e-learning environment, added to the impetus to shift to an open source learning management system that could be administered independently by the Nursing Education Department. This would enable nurse educators to create and manage targeted, timely educational content designed to meet the specific needs of unit-based staff. The new role of “Technology Educator” was created, and Moodle, an open source e-learning management system, was implemented. Moodle provided nurse educators with an interactive, flexible, user friendly, multi-modal platform. A Moodle Steering Committee comprised of nurse educators was established through the Professional and Educational Council to oversee policy and process as part of the Nursing Shared Governance Structure. Factors contributing to success in overcoming organizational and technology infrastructure barriers included excellent interdepartmental collaboration, expectations of more rapid responsiveness to evolving regulatory compliance demands, and demonstration of ongoing cost effectiveness. After implementation of the new system, increased educator and staff satisfaction has been reported. Outcomes to be evaluated include efficiencies of educator time for interaction with staff, how this innovative pedagogy affects knowledge translation into daily nursing practice, and whether a direct link can be made to improved patient care.

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5. Technology and Innovation: Nursing Simulation Simulation training has evolved at Lahey Clinic since the joint purchase with the Department of Medicine of our first high fidelity human patient simulator (brand name: SimMan) in 2003. With the opening of our new Center for Clinical and Professional Development in the Gordon Building and the purchase of a second manikin in 2006, both with generous philanthropic support, our SimMan had a new home in a nursing skills lab set up as a nursing unit. For the past three years, we have been using simulation as part of our newly licensed nurse program to model situations that occur infrequently but require critical thinking and quick action, such as cardiac arrest or near arrest situations. The response from this program has been overwhelmingly positive with the new graduates commenting that the experience made them feel more confident in their ability to handle these types of situations in their practice. This high fidelity manikin has also been used in ACLS training. Expansion of the simulation program included our critical care skills fair, telemetry program and many interdisciplinary training courses such as Medical Emergency Team (MET) training and the new resident orientation day. Simulation scenarios will continue to be created to immerse the students in situations where they need to use critical thinking as well as technical skills to problem solve and act quickly, in a risk-free environment. Two simulation instructor workshops expanded the use of this teaching methodology while providing training to unit-based clinical educators who partner with the central educator in facilitating the newly licensed nurse simulation program. In 2009, the Massachusetts Department of Higher Education (DHE) awarded Lahey Clinic, in collaboration with Salem State College, an award in the amount of $10,000 for the development of the Care of the Geriatric Multicultural Patient with MRSA simulation scenario. Nursing has also requested philanthropic funding for a wireless human patient simulator in order to provide training at the learners’ practice sites, thus making the manikin and equipment mobile for use in both ambulatory and in-patient areas. Simulation at Lahey has grown into an effective method of education for our nursing and medical staff. We will continue to seek opportunities to bring learners into an environment where they can develop critical thinking, gain confidence in stressful situations, hone their skills and develop team building strategies. In addition, we believe that investment in this methodology will result in enhanced patient safety and excellent patient outcomes.

nursing education

6.

Embarking on the NICHE (Nurses Improving Care for Healthsystem Elders) Journey Nationwide, almost 50 percent of hospital admissions are adults over 65 years old. The inpatient population at Lahey Clinic, like most acute care hospitals, consists of a high percentage of older adults. Older adults tend to experience longer lengths of stay, higher readmission rates, and higher rates of functional decline (Kim et al., 2007; Thornlow, 2009). Nurses are in a prime position to prevent these complications and improve outcomes for older adults by providing evidence-based and age-sensitive care. Nurses Improving Care for Healthsystem Elders (NICHE) is a national, evidence-based program designed to achieve system improvements in the care of older adults by improving geriatric nursing competence and promoting exemplary and age-sensitive care for all patients over 65 years old through education, training and resources. Much like Magnet designation, hospitals must apply for NICHE designation. Recognizing that excellence in nursing care requires patient population knowledge and skills, Lahey’s Nursing Department appointed a steering committee and embarked on the NICHE journey, working throughout 2009 to earn this invaluable designation. NICHE designation was received in January 2010.

7. Targeting Competency Assessment through Area-Specific Skills Fairs

As part of the annual competency verification program for nursing, the successful completion of a skills fair is required of every Lahey nurse. Under the aegis of the Professional and Educational Council, nurse educators develop the content and organize the fairs, offering multiple sessions throughout the year to accommodate all nurses, regardless of shift and unit. At the fairs, stations manned by nurse educators provide an arena wherein over 1000 staff nurses demonstrate skills. Some stations also provide teaching and remediation. There were two significant changes to the skills fair configuration for 2009. Recognizing that the essential competencies required of medical-surgical, critical care, specialty unit and emergency room nurses can differ, educators in 2009 developed area-specific skills fairs. Each area included basic skills that were deemed “all nursing relevant.” Other skills were designated significant to certain areas only. By customizing the skills stations to the area, we were able to ensure that the annual skills fairs continue to be both relevant and reflective of nursing practice. Also in 2009, skills fairs included nursing assistants as well as registered nurses. The inclusion of nursing assistants reflected the recognition that they serve as health care team members as well as the expectation that they demonstrate a level of expertise in the execution of their duties.

The Lahey Clinic NICHE Program Team Members: (Front row, left to right) Gayle Gravlin, EdD, RN, NEA-BC; Susan Bellofatto, RN, 7C; Colette April, RN; Janet Habeshian, MSN, RN; Diane Currier, BSN, RN (Back row, left to right) Ann Dylis, PhD, RN; Susan Gordon, ACNP-BC; Catherine Reardon, BSN, RN, 7C; Alison O’Brien, MSN, RN

For 2010, skills fairs will become totally assessment centered. Skills fair preparation modules will be made available to staff through MOODLE, and it is expected that “transit times” for staff to complete the skills fairs will be reduced.

Exceptional Nurses... Extraordinary Care | 17

nursing education

8. Nursing Research Nursing research at Lahey Clinic has become so much a part of the culture that specific educational and mentorship aspects of the program were acknowledged by the ANCC Magnet surveyors as exemplars. These aspects included the Research Council, research fellows, the work of the nurse research scientists and the Research Steering Committee, and the volume of Institutional Review Board approved research studies. Fellows numbered 16 with the 2009 class. The Nursing Research Fellows for 2009 were: • Rita Florio, MSN, RN, CNOR, Staff Nurse in the OR • Lisa Jasak, BS, RN, Staff Nurse on 6/7SE • Mary Levesque, MSN, RN, Clinical Educator on 6/7SE • Ann Marie McLaughlin, RN, BSN, CPAN, CAPA, Clinical Educator in Ambulatory Surgery/ Preadmission Testing

Cynthia Ruddock, RN, clinical educator, Lahey Clinic Medical Center, North Shore, displaying her poster presentation during the 6th Annual Nursing Research Day

• Anna Trunfio, BSN, RN, Staff Nurse, Ambulatory Surgery/Preadmission Testing Nurse research scientists worked diligently in 2009 to revise and update the Nursing Research/EBP Online Manual. Additionally, their mentorship activities included assistance provided to the Nursing Research Fellows with the monthly Research Roundtable Journal Club and their visits to the unit-based councils. Projects that resulted from these visits included Appraising the Quality of the Patient Experience in Interventional Cardiology, initiation of an online Moodle journal club on 6/7SE, and an Institutional Review Board approved research study on safety and teamwork in surgical services. In addition, please refer to significant accomplishments on page 9, under the Nursing Research Council, and on page 28, under New Knowledge, Innovations and Improvements.

18 | Exceptional Nurses... Extraordinary Care

Brenda Hill, BSN, RN, OCN, nurse manager; Linda Voner, RN, OCN, staff nurse; and Nellee Fine, MS, RN, AOCN, clinical specialist, with their poster presentation for Research Day

nursing education

Selected Stats for 2009 In FY2009 Nursing Education Staff provided: n Education

for 59 organizational rollouts and initiatives

n

n



Charge Nurse Workshops attended by 71 staff members Preceptor Workshops attended by 85 participants as a prerequisite for service as preceptors to newly hired and newly licensed nurses

Lahey’s Women’s Leadership Council (WLC) has raised funding for the Clinic’s nursing Student Stipend Program, a model philanthropic effort created in response to the nation’s nursing shortage. Through a collaborative partnership with Middlesex Community College, Lahey provides access to a part-time associate of science in nursing program designed to enable qualified Clinic staff members in non-nursing roles to make the transition into nursing. Beginning nursing students are able to reduce work hours to accommodate classroom and clinical training schedules, and Lahey Clinic provides stipends to replace all or part of the salary lost through reduction of hours. For the 2008 to 2009 school year, 16 stipend participants received $124,941 in stipend disbursements.

n Three



re-entry programs which served 39 participants from around the state. A total of 259 individuals have participated since the program’s inception.

Student Stipend Program

n

Five ONS biotherapy/chemotherapy classes leading to ONS Provider Cards for 19 Lahey Clinic colleagues and 12 outside participants from two New England states and nine health care organizations

n

As an American Heart Association Training Center, trained employees and community participants and issued 1700 ACLS and BLS cards to trained providers

n



n

Lahey Clinic’s commitment to supporting students in financing their education includes a Tuition Assistance Program of up to $2000 per academic year, prorated and available to all colleagues working more than 20 hours per week. This program has been in place for many years. The amount of tuition assistance offered is increased periodically to reflect rising education costs. For the 2008 to 2009 school year, 149 nursing employees were reimbursed $223,868 for 282 courses.

all day sessions of “Caring for Patients and Families at the End of Life” (ELNEC), which provided end of life education for 50 RNs

Loan Forgiveness

Nursing Orientation for newly hired Nursing Department colleagues, which included 111 RNs, 14 nursing associates, 59 nursing assistants, 19 unit coordinators and 5 technicians, 5 LPNs and 21 clinic assistants for a total of 234 participants

n ASN – 67%

n Two



Tuition Assistance Program

Mandatory education for 549 nonphysician Lahey hires

Percentage of Participant by Degree Enrollment

n BSN – 24% n MSN – 9%

Since the program’s 2001 inception, more than 662 Lahey Clinic colleagues have benefited from the Nursing Loan Forgiveness Program. During 2009, 112 colleagues participated in the Loan Forgiveness Program.

Exceptional Nurses... Extraordinary Care | 19

nursing education

Lahey Clinic Certification Facts

Certifications Professional specialty certification benefits patients, nurses and employers, signifying a mark of excellence in practice. Specialty certification is a voluntary process, and it points to a nurse’s commitment to both his or her professional development and dedication to patient care and outcomes. According to the American Association of Critical-Care Nurses (AACN), “Nursing certification contributes to improved patient safety and quality of care as well as to the professional satisfaction that nurses seek. Certification is an important indicator that a nurse is qualified and competent in their specialty and that this nurse has also met rigorous requirements to achieve and maintain their expert credential.” Lahey Clinic encourages all nurses to become certified in their specialty area of practice. For those nurses who have gone above and beyond in bettering themselves for their patients by achieving certification, Lahey Clinic rewards them by reimbursement of examination fees and subsequent recertification fees.

13.8 percent of Lahey RNs are certified in their specialty of practice 155 RNs are certified in their specialty of practice 17 new RNs were added in 2009 16 RNs hold more than one certification 31 nursing specialties are represented

Congratulations to the following nurses who received certification in 2009 Eileen Batchelor, RN-BC BC – Medical Surgical Nursing

Pamela Greenwood, RN, CPSN CPSN – Plastic Surgery Nursing

Debralee Quinn, RN-BC BC – Professional Development Nursing

Sheila Baxter, RN, CEN CEN – Emergency Nursing

Kimberly Johnson, RN, CCTN CCTN – Clinical Transplant Nursing

Erin Sanborn, RN, CCTN CCTN – Transplantation Nursing

Debra R. Bourque, RN, DNC DNC – Dermatology Nursing

Pearl Joyce, RN, CEN CEN – Emergency Nursing

Elizabeth Sweeney, RN, CRRN CRRN – Rehabilitation Nursing

Charlotte Bovil, RN, OCN OCN – Oncology Nursing

Christi Kivlehan, RN-BC BC – Medical Surgical Nursing

Bernadette Villalpando, RN, CPAN CPAN – Perianesthesia Nursing

Joan M. Cavanaugh, RN, CNRN CNRN – Neuroscience Nursing

Maureen O’Connell, RN, CEN CEN – Emergency Nursing

Lisa Warner, RN, CCRN CCRN – Critical Care Nursing

Becky Chase, RN, CNRN CNRN – Neuroscience Nursing

George Phelps, RN, RCIS RCIS – Invasive Cardiology Nursing

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Nursing colleagues whose names were added to the Nursing Wall of Honor in May 2009

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E xemplar y Professional Practice Staffing Lahey Clinic nursing colleagues are valued for their contribution to excellence in clinical practice that results in quality patient outcomes. Lahey Clinic continually demonstrates its commitment to retaining our valuable nursing colleagues in multiple ways. The Nursing Shared Governance Structure provides staff nurses the forums to discuss clinical and professional practice ideas and concerns, and encourages staff nurse leadership in the form of chair opportunities on councils and committees. Nursing representation is encouraged and sought after for interdisciplinary committees and performance improvement and innovation initiatives. Staff nurses are nominated monthly by peers, interdisciplinary colleagues, patients or patient families for the DAISY Award for excellence in nursing care. Lahey Clinic is also committed to providing financial assistance for nursing colleagues to pursue certifications, as well as advanced formal education. Lahey Clinic’s nursing colleagues’ commitment to quality patient outcomes is acknowledged by both the nursing and organization leadership and is reflected by the low nurse turnover rate (3.5 percent). Lahey Clinic has participated in the National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey beginning in 2004. Since 2004, Lahey has expanded the areas/units participating in the survey. Additional specialty areas were included in order to glean a wider perspective on RN satisfaction. Currently all of the RNs who comply with standards of eligibility are offered the opportunity to participate in the survey. Lahey Clinic compares the unit data to the National Comparative Teaching Hospital (NCTH) T-scores. When analyzing the data, Lahey reviews and compares the units’ measurements with other units of the same type. Lahey also evaluates how satisfied the nurses are relative to NCTH T-scores.

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Making Connections Between Multiple Data Sources to Improve Nurse Satisfaction and Retention Kathleen S. Jose, MSN, RN, Chief Nursing Officer; Cynthia Fiekers, BSN, RN, Associate Chief Nurse Informatics and Quality; and Nancy Phoenix Bittner, PhD, RN, Per Diem Nurse Research Scientist, recently completed the study: “Making Connections Between Multiple Data Sources to Improve Nurse Satisfaction and Retention.” A brief description of the study follows. Nurses’ satisfaction with their role in the nursing profession is a significant concern for nurse leaders. The nursing shortage has pushed recruitment and retention of qualified nurses to a pivotal point in the delivery of quality care. The purpose of the presentation was to emphasize the multifaceted approach the Lahey Clinic Department of Nursing used to improve nurse job satisfaction. The project spanned over three years utilizing NDNQI data from 2006-2009, along with other data sources. This presentation is relevant for nurse leaders and educators who are interested in exploring initiatives that effectively use multiple data sources for application to their own institutions.

The information highlights how data drove the focus group project to generate more specific findings. Integrating the focus group findings and the quantitative data led to implementing interventions directed toward work environment, communication, job enjoyment and RN job plans. Interventions included changes in communication with colleagues and leadership as well as organizational initiatives.

retention. Participants will learn the steps of developing alternative ways to apply information from trending data. This project has significant implications for nurse leaders to provide a variety of methods to gather, analyze and utilize valuable information to improve quality nursing practice. The following graphs reflect nursing and patient satisfaction trends from 2006-2009.

The outcomes included improved scores in work environment (decision making, autonomy) and job enjoyment scores. There was an increase in nurses reporting plans to stay on the same unit as well. A decrease in nurse turnover occurred, indicating improved work satisfaction and

Exceptional Nurses... Extraordinary Care | 23

nursing satisfaction comparisons

Nursing Work Index Satisfied with CNO

n 2006 n 2009

Career development opportunities

Lahey Clinic NDNQI RN Satisfaction Annual Comparison 2006 to 2009 showing increased nurse satisfaction

Satisfied with my job Nurse manager is a good leader

Satisfaction Annual Comparison < 40 is low satisfaction / 40 – 60 is moderate satisfaction / >60 is high satisfaction

2007

2008

2009

Time for patient care

52.16

51.06

54.45

Teamwork

68.01

67.58

72.30

MD’s appreciate what I do

56.10

55.54

59.95

Participate in decision making

46.12

47.57

51.53

Autonomy in daily practice

48.79

49.67

50.22

Satisfied with status of nursing

47.69

47.75

55.98

Satisfied with salary

46.25

48.12

51.33

Lahey Clinic NDNQI RN Satisfaction Annual Comparison 2006 to 2009 showing increased nurse satisfaction 24 | Exceptional Nurses... Extraordinary Care

patient satisfaction comparisons

Patient Satisfaction –Nursing Dashboard Data n 2006 n 2009

Lahey Clinic Press Ganey Patient Satisfaction Annual Comparison 2006 to 2009 showing increase in patient satisfaction

l s ts re in sy es ID ed ed al e ed c /c rs t es s iv m d pa e r n r e u u e e o n o t c n q k fo to ou rs iti re e al re ec e in /c nu nse d h n v h s e t d i o n u r r c s o s es e yo of co ca er wa on es in f th resp l t l e o p g l s p / r t i p r s l in nd o in ke ia Sk nu rs /re ed de ie c t s r u e u s h e a s F n c se tit tiv sp uc ll hi ne ur si at d a o w r t n e pt N s e o e n se e’ om Ov tt rs io rs e t n u s Pr u n r N te N te Nu Ex At

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DAISY Award What is the Daisy Award? DAISY is an acronym for Diseases Attacking the Immune System. The DAISY Foundation was created in memory of J. Patrick Barnes, who died at age 33 from complications of a rare disease called idiopathic thrombocytopenia purpura. The Foundation supports research along with services for families and patients. During Pat’s eight-week hospitalization, his family was awestruck by the care and compassion his nurses provided not only to Pat, but to everyone in his family. The Foundation recognizes the compassion and clinical skills of nurses with programs like the DAISY Award. The award rewards and celebrates the extraordinary clinical skill and compassionate care given by nurses every day. Lahey Clinic is proud to be a DAISY Award Hospital Partner, recognizing one of our nurses or a team of nurses with this special honor every month or quarter.

2009 DAISY Award Winners January

Diane Geehan, BSN, RN, CAPA, CPAN, Ambulatory Surgery

April

February

Kim Johanson, BS, RN, 7C

May

The Cath Lab Holding Area nurses

Greg Babcock, BSN, RN, CCRN, 6W PCU

august

september

Bonnie Brien, BSN, RN, Case Management

Joanne Sliney, RN, PACU

March

Helen Rogers, LPN, Dermatology at Wall Street

June

Colleen Hammond, BS/BA, BSN, RN, 6C Street

october

Amy Poirier, BSN, RN, 6 East Hospital Telemetry/6E PCU

Mentorship Award 2009 Nursing Spectrum Excellence Award Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development, was the recipient of the 2009 Nursing Spectrum Excellence Award for the Northeast Region in the category of Mentorship after being nominated by her staff.

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november

Marlene Barrett, BSN, RN, CCRN, 6W PCU rapid response nurse

december

Donna (Dee) Benanti, RN, CNOR, RNFA, Lahey Clinic OR

Congratulations to the following 2009 Preceptors of Distinction Linda Comfort, BSN, RN, former staff nurse 5 West, current Nursing Quality Project Coordinator Kathy Erickson, BSN, RN, staff nurse, 6/7 Southeast Andrea Falzano, BSN, RN, staff nurse, 6 East Jeanne Femia, RN, staff nurse, ED Linda Ferranti, BSN, RN, CNOR, staff nurse, OR

Lahey Clinic Department of Nursing Preceptor of Distinction Award Overview A preceptor of distinction creates a safe environment in which trust and wisdom can be discovered by both the preceptor and preceptee. Through example, the preceptor encourages a journey of growth and discovery and is a role model for excellence in patient and family care. Clinical nurses committed to this role help to create a positive learning environment for new nurses who choose to practice at Lahey Clinic. The Lahey Clinic Preceptor of Distinction Award is designed to recognize a clinical staff nurse who consistently demonstrates excellence in educating, precepting, mentoring and coaching nurses.

Jackie Gauthier, BSN, RN, staff nurse, 7 East Therese Louis, BA, ASN, RN, staff nurse, Ambulatory Surgery Joan O’Connell, BSN, RN, staff nurse, PACU Suzanne Quigley, AD, RN, staff nurse, 7 West Janine Raby, AD, RN, staff nurse, Lahey Clinic Medical Center, North Shore Erin Sanborn, RN, CCTN, staff nurse, 6 Central Andrea Silen, BSN, RN, staff nurse, 7 Central Colleen Sousa, RN, staff nurse, 6 West Mindy Strassberg, BSN, RN, CCRN, staff nurse, MICU

Preceptors of Distinction 2009 (from l to r): Andrea Silen, BSN, RN; Suzanne Quigley, AD, RN; Therese Louis, BA, ASN, RN; Colleen Sousa, RN; Kathy Erickson, BSN, RN; Jackie Gauthier, BSN, RN; Joan O’Connell, BSN, RN; Andrea Falzano, BSN, RN; Linda Comfort, BSN, RN; Karen Waisnor, BSN, RN; and Mindy Strassberg, BSN, RN, CCRN. Missing from photo: Jeanne Femia, RN; Linda Ferranti, BSN, RN, CNOR; Janine Raby, AD, RN; and Erin Sanborn, RN, CCTN.

Karen Waisnor, BSN, RN, staff nurse, ICU

Exceptional Nurses... Extraordinary Care | 27

New K nowledge, Innovations and Improvements Nursing Research and Evidence-based Practice Lahey’s nursing research and evidence-based practice initiatives were recognized as having “an exemplar level of excellence” by the ANCC Magnet Program in their Executive Summary Report. Specific educational and mentorship aspects of the program that were acknowledged included: Research Council, Research Fellows, work of the nurse research scientists and the Research Steering Committee, as well as the many Institutional Review Board approved research studies.

Institutional Review Board Approved Nursing Studies with Principal Investigators Needs of Critical Care Families and the Perceptions of the ICU Staff Joan Alosso, RN, BSN, CCRN, Critical Care Family Liaison, 2008 Lahey Nursing Research Grant winner

Social Support and the Continuum of Care for the Cardiovascular Rehabilitation Patient Deborah L. Sullivan, MS, APRN, BC, Cardiovascular Prevention and Rehabilitation Department, 2008 Lahey Nursing Research Grant winner

M-Aqua: Multicenter Aquapheresis User Analysis Nancy Todd, NP

Tufts University School of Medicine Medical Student/Nurse Partnership Program: A Pilot Study of Pre-Clerkship Medical Student/Nurse Interactions on the Wards Debralee Quinn, MS, RN-BC, CNN, Central Educator

The Current State of Preceptorship in Massachusetts Organization of Nurse Executives (MONE) Member Organizations Paula Aufiero, MSN, RN, Nurse Manager, Surgical Intensive Care Unit

Safety and Teamwork in Surgical Services Patrice M. Osgood, BSN, MS, CNOR, Nurse Manager, Operating Room

28 | Exceptional Nurses... Extraordinary Care

Submitted and Accepted Research Abstracts During Fiscal Year 2009 1. Eastern Nursing Research Society: 22nd Annual Scientific Sessions, March 2010, Providence, Rhode Island.

Nurses’ and Nursing Assistants’ Reports of Missed Care and Delegation Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development, and Nancy Phoenix Bittner, PhD, RN, CCRN, Nurse Research Scientist

The Lived Experience of the Living Liver Donor: A Phenomenological Study Frances White, MS, RN, Nurse Manager, 6 Central

Social Support and the Continuum of Care for the Cardiovascular Rehabilitation Patient Claire MacDonald, MSN, RN, Clinical Educator, and Deborah Sullivan, MS, APRN, BC, Cardiovascular Prevention and Rehabilitation Department

A Multidisciplinary Effort to Improve Safety and Teamwork in Surgical Services Patrice M. Osgood, BSN, MS, RN, CNOR, Nurse Manager, Operating Room; Ann M. Dylis, PhD, RN, Nurse Research Scientist; Kimberly K. Wheeler, MSN, RN, CNOR, Clinical Educator, Operating Room; and Deborah Zarrella, MSN, RN, Associate Chief Nurse Surgical Services 2. Association of Operating Room Nurses (AORN) 57th Annual Congress, March 2010, Denver, Colorado

Multidisciplinary Approach to Surgical Safety and Teamwork Patrice M. Osgood, BSN, MS, RN, CNOR, Nurse Manager, Operating Room; Ann M. Dylis, PhD, RN, Nurse Research Scientist; Kimberly K. Wheeler, MSN, RN, CNOR, Clinical Educator, Operating Room; and Deborah Zarrella, MSN, RN, Associate Chief Nurse Surgical Services 3. American Heart Association Joint Conference 50th Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity and Metabolism 2010, March 2010, San Francisco, CA

Social Support and the Continuum of Care for the Cardiovascular Rehabilitation Patient

2009 American Organization of Nurse Executives (AONE) National Award for Research Poster Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development, and Nancy PhoenixBittner, PhD, RN, CCRN, Nurse Research Scientist, co-authored the article, “Critical Thinking, Delegation and Missed Care in Nursing Practice,” which appeared in the March 2009 issue (Vol 39:3) of The Journal of Nursing Administration. At the annual AONE national conference in San Antonio, Texas in April 2009, their poster was awarded third place.

2009 Lahey Nursing Research Grant Recipients Does the Use of Remote Robotic Assisted Patient Care Rounds on the Off-Shift Influence Nurse-Physician Collaboration in the Surgical Intensive Care Unit? Principal Investigator: Michele Bettinelli, BSN, RN, CCRN, Clinical Educator, Surgical Intensive Care Unit (SICU), 2008 Nursing Research Fellow

Nurse’s Perceptions of the Existence of Horizontal Violence in the Workplace and Its Impact on Patient Care Principal Investigator: Alison M. O’Brien, MSN, RN, Senior Nursing Education Coordinator, 2008 Nursing Research Fellow; Co-Investigator: Arlene D. Stoller, BSN, RN, 2008 Nursing Research Fellow

Deborah Sullivan, MS, APRN, BC, Cardiovascular Prevention and Rehabilitation Department, and Claire MacDonald, MSN, RN, Clinical Educator

Exceptional Nurses... Extraordinary Care | 29

2009 Research Day The Sixth Annual Research Day was held on May 5, 2009. There were six nursing research/evidence-based practice podium presentations, along with 20 posters, the most ever exhibited.

2009 Research Day Podium Presentations Keynote Address: Past Successes & Future Advances: Nursing Research and

Evidence-Based Practice at Lahey Ann M. Dylis, PhD, RN, Nurse Research Scientist

Evaluation of Implementation of the Association of Perioperative Registered Nurses (AORN) Correct Site Surgery Tool Kit Deborah Farina Mulloy, PhD, RN, CNOR, Director, Risk Management & Patient Safety

2009 Research Day Poster Presentations Needs of Critical Care Families and the Perceptions of ICU Staff Joan Alosso, BSN, RN, CCRN, Critical Care Family Liaison Registered Nurse Sally J. Cadman, MS, RN, CCRN, Critical Care Nurse Specialist, 2007 Research Fellow

Evidence-Based Practice in Action: Exceptional Nursing…Extraordinary Care in the Surgical Intensive Care (SICU) Michele Bettinelli, BS, RN, CCRN, Clinical Educator, SICU, 2008 Research Fellow

Work of the 7 East Unit-Based Council: Nasogastric Tube Protocol Debbie Halliday-Wilson, ASN, RN; Marcelle Saurman, BSN, RN

Exploring Critical Thinking and Delegation in Nursing Practice Nancy Phoenix Bittner, PhD, RN, CCRN, Assistant Dean, School of Nursing and Health Professions, Regis College Nurse Research Scientist

Nurses’ and Nursing Assistants’ Reports of Missed Care and Delegation

Exploring Critical Thinking and Delegation in Nursing Practice Nancy Phoenix Bittner, PhD, RN, CCRN, Assistant Dean, School of Nursing and Health Professions, Regis College, Nurse Research Scientist Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development

Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development; Nancy Phoenix Bittner, PhD, RN, CCRN, Assistant Dean, School of Nursing and Health Professions, Regis College Nurse Research Scientist

A Falls Risk Assessment to Determine the Effectiveness of a Multi-Disciplinary Falls Prevention Program

A Phenomenological Study of the Living Liver Donor

Nursing “Hand-Off” Communication from the Operating Room (OR) to Post Anesthesia Care Unit (PACU): Implications for Patient Safety

Frances White, MSN, RN, Nurse Manager, 6 Central

Darlene Bourgeois, MSN, RN, CCRN, Injury Prevention Coordinator Trauma Service, 2007 Research Fellow

Amy Dooley, BSN, RN, CPAN, Staff Nurse-PACU, 2008 Research Fellow

Nursing Research and Evidence-Based Practice Initiatives at Lahey Clinic Ann M. Dylis, PhD, RN, Nurse Research Scientist

The Complexity of Measuring Teamwork in the Operating Room: A Journey to Safety Rita T. Florio, MSN, RN, CNOR, Staff Nurse, Operating Room, 2009 Research Fellow

30 | Exceptional Nurses... Extraordinary Care

research day poster presentations

Hermine Getzoyan, MSN, RN, Critical Care Educator, 2008 Research Fellow

An Evidence-Based Review: Temporal Artery Thermometer: How Do They Measure Up to Existing Methods?

Nurses’ Reports of Missed Care Following Delegation

Cynthia S. Ruddock, RN, Clinical Educator, PACU/Endoscopy, Lahey Clinic Medical Center, North Shore

Weight-Based Heparin Dosing: Implementing Evidence-Based Practice

Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development Nancy Phoenix Bittner, PhD, RN, CCRN, Assistant Dean, School of Nursing and Health Professions, Regis College, Nurse Research Scientist

The MICU Butterfly Project: An Evidenced-Based Practice Change Mindy J. Strassberg, BSN, RN, CCRN, Staff Nurse, MICU Lynda J. Walsh, MSN, RN, Clinical Educator, MICU

Lisa Jasak, BSN, RN, Staff Nurse, 6/7 SouthEast, 2009 Research Fellow

Social Support and the Continuum of Care for the Cardiovascular Rehabilitation Patient

Drug Utilization Review of Pregabalin and Concomitant Medications

Deborah Sullivan, MS, APRN, BC, Cardiac Rehabilitation Nurse Claire MacDonald, MSN, RN, Clinical Educator, 2007 Research Fellow

Developing a Workload Measurement Tool to Achieve Staffing Effectiveness

Andrew Kowal, MD, and Virgie Zajac, RN-BC, CRRN, Lahey Interventional Pain Management Center C. Moffitt, PharmD, Medical Outcomes Specialist, Global Research/Development, Pfizer Inc.

Staffing by Acuity to Improve Patient Outcomes Mary Levesque, MSN, RN, Clinical Educator, 6/7Southeast, 2009 Research Fellow

Oncology Nurses’ Comfort Levels: Discussing Death and Dying with Terminally Ill Patients Anne Palazzolo Lyons, MSN, RN, FNP-C, Staff Nurse, 7 West

“I Passed my Certification Exam!” Perceived Benefits of Professional Certification Ann Marie McLaughlin, MA, BSN, RN, CPAN, CAPA, Clinical Educator, Ambulatory Surgery/Pre Operative Center, 2009 Research Fellow

Catheter-Associated Urinary Tract Infections: What Preventative Measures Work? Eileen E Tarr, BSN, RN, 6/7 SouthEast Staff Nurse

Evidence-Based Nursing Practice Implementation Success: Supporting Skill Acquisition/Integration at the Bedside Anna Trunfio, BSN, RN, CAPA, Staff Nurse, Ambulatory Surgery/Pre Operative Center, 2009 Research Fellow

Preventing Extravasation: Going the “EXTRA-STEP” Linda Voner, RN, OCN, Clinic Nurse, Sophia Gordon Cancer Center Brenda Hill, BSN, RN, OCN, Nurse Manager, Sophia Gordon Cancer Center Nellee Fine, MA, RN, AOCN, Clinical Nurse Specialist Hematology/ Oncology, 2007 Nursing Research Fellow

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Implementation of Bar Code Medication Administration (BCMA) By Margie Sipe, MS, RN, Nursing Performance Improvement Innovator The implementation of a hospital-wide BCMA is one example of an innovative project that continues to improve nursing practice and ensure that patients receive the correct medications. Tracking and analyzing medication errors has always been an important way to understand interventions needed to improve the safety of the medication management processes. Transcription errors had the highest volume of errors, particularly errors that caused doses to be omitted. This occurred when all the required administration times were not written on the manually transcribed medication administration records (MAR). This metric was looked at most closely during the implementation project. The rate for these types of errors dropped to zero just six months after implementing BCMA on the pilot unit. A unique feature of the BCMA project plan was the model chosen to ensure user competency. Typically, new technology implementations provide some online and classroom learning and a chance to practice with test scripts. Given the complex nature of medication orders and the wide variety of different types of orders on different specialty units, the typical model would be insufficient. It was decided to do a form of simulation in a live learning environment. After class, nurses and those respiratory therapists who would be administering medications went back to their assigned units and “practiced” administering medications using the new handheld electronic technology. The “practice” scenarios were, in reality, actual orders on their assigned patients. They continued to administer and document medications using the manual process, but additionally paralleled

the new process using scanning technology to verify the five rights of medication administration to safely give the medications. The benefits of this model were that any issues with order setup or the ability to scan and document complicated order sets were identified early in the process and corrected with end-user input. To facilitate a smooth transition, pharmacists were placed on the units preparing to “go live” with BCMA, and interdisciplinary collaboration was fostered. Continuing learning in a live environment also enabled observation methods to be used to ensure correct processes were followed when using this new technology. When an issue arose, the teams worked together to come up with a viable solution. By the time of a unit’s “go live” date, the switch over from paper to electronic documentation was anticlimactic. Implementations were smooth, and, using a daily debriefing format, needs for ongoing performance improvements were identified as well as resolved. Completing such a project without computerized provider order entry and a totally manual process will be a major accomplishment. Even the typically more difficult implementations, such as oncology and critical care, will be accomplished by using the unique process and daily staff nurse input. Medication transcription errors have been reduced with regard to missing administration times, and correct medications get to the correct patients when the process is appropriately followed as shown in the following graph.

Transcription errors: incorrect times on the Pilot Unit pre- and post-implementation of bar code medication administration

Number of timing errors dropped to zero post-implementation

Pre-implementation January 2008 – May 2008 32 | Exceptional Nurses... Extraordinary Care

Post-implementation May 2008 – November 2008

MARN

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Accreditations, Commendations and Awards ❚ Lahey Clinic has achieved Magnet

❚ Lahey Clinic has again been awarded

❚ The Intersocietal Commission for

❚ Urologists at Lahey Clinic

status in recognition of excellence in nursing care. The Magnet Recognition Program, administered by the American Nurses Credentialing Center (ANCC), recognizes health care organizations worldwide that are dedicated to nursing excellence, professionalism and patient-focused care.

the Gold Seal of Approval by The Joint Commission. We received only one “requirement for improvement,” or RFI, in the more than 250 standards that were applied in our November review. We have already provided evidence of compliance with that RFI following the survey. In all, The Joint Commission surveys about 4200 hospitals of the 15,000 health care organizations in the nation it evaluates. According to The Joint Commission, the average number of final RFIs for hospitals surveyed in 2008 was 10.

the Accreditation of Echocardiography Laboratories granted accreditation to Lahey’s Echo Lab, which conducts ultrasound studies of the heart.

successfully removed a diseased kidney from a patient through her navel. The procedure, known as laparoendoscopic single site (LESS) surgery, was believed to be the first urologic application of its kind in New England.

❚ The Continuing Education Committee of Massachusetts has reviewed Lahey Clinic’s provider application and has determined that, once again, we have met the criteria set forth by the ANCC’s Commission on Accreditation. Lahey Clinic first achieved MARN provider status in 2003 and, with this renewal, will remain a MARN provider of continuing education for a three-year period, until 2012.

❚ In 2009, Lahey’s Stroke Service once again received the American Stroke Association’s Get With the Guidelines—Stroke, Gold Performance Achievement Award. The award recognizes 85 percent or better adherence to quality performance measures for 24 or more consecutive months. Lahey was among only 13 hospitals in Massachusetts to receive this distinction.

❚ The Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services, awarded Lahey Clinic the Silver 1 Medal of Honor for Organ Donation. The award recognizes Lahey for achieving a 75 percent conversion rate (the rate of actual donations occurring as compared to the number of eligible donors) and for reaching the milestone of 10 percent of donors following cardiac death.

❚ Lahey Clinic’s Infection Control

❚ Lahey was named one of the top 100 integrated health networks by SDI, a leading provider of health care analytics. The 2009 edition of the SDI IHN 100 identifies the top integrated health networks among 570 specialty, local and regional networks in the United States that meet critical success factors. Lahey’s scores surpassed the national average in seven of eight categories.

Program was awarded a certificate of merit by the Betsy Lehman Center as part of the center’s annual patient safety award initiative. The 2009 awards honor organizations that demonstrate a safety culture with specific respect to health-care associated infections.

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Repor t on 2009 Philanthropic Suppor t for Nursing During 2009, Lahey Clinic raised close to $458,000 to advance nursing education, nursing workforce development and other areas of need. We are grateful for your support. In 2009, Lahey received a multi-year grant from the Citizens Bank Foundation to support the Clinic’s nursing workforce development activities: the Nursing Internship/Residency Program and the Lahey Clinic-Middlesex Community College Nursing Education Partnership. “At Citizens Bank, we care deeply about our communities. We are proud to demonstrate that commitment by making this grant to Lahey in recognition of the exceptional level of nursing expertise and staff training that benefits patients every day and addresses the nation’s need for more nurses,” said Jerry Sargent, President of Citizens Bank, Massachusetts. Lahey former CEO and president David M. Barrett, MD, applauded Citizens Bank’s recognition of the Clinic’s ability to attract and retain skilled nurses, who are committed to ongoing professional development to stay at the forefront of nursing. Donors also help us move forward on key initiatives to improve and enhance patient care. In 2009, an important gift from Dr. Christopher G. Connolly and Ms. Marjorie L. Liner allowed Lahey to advance towards NICHE (Nurses Improving Care for Healthsystem Elders) accreditation, signaling the Clinic’s commitment to outstanding geriatric nursing care. Their gift allowed members of our NICHE steering committee to participate in initial leadership training as well as the NICHE national conference, where Lahey was officially recognized

34 | Exceptional Nurses... Extraordinary Care

as a newly designated NICHE hospital. We thank Dr. Connolly and Ms. Liner for their vision and gift to our nursing program. In addition, we recognize the significant fundraising efforts of the Women’s Health Forum, Lahey’s foremost volunteer group. Founded in 2006, the Lahey Clinic Women’s Health Forum is dedicated to creating a greater awareness of women’s health issues, and generating increased donations for Nursing and Clinic initiatives. During 2009, Salter HealthCare’s lead sponsorship of the Women’s Health Forum supported activities that raised funds for nursing stipends, benefiting our nurses through increased access to training and tuition reimbursement. Our donor report would not be complete without mention of our most valued Nursing supporters, John and Letitia Carter. Over the years, the Carters’ generosity and dedication to our nursing program has helped us educate and train nursing staff—from entry-level nurses to seasoned professionals—in nursing simulation and other important programs and services. The Carters’ support for Nursing allows the Clinic to be a nursing leader, helping our staff achieve their personal career goals, keep pace with technology, and continually improve the quality of care that we provide to our patients. Lahey Clinic thanks our many wonderful donors. You are important members of the team of nurses, doctors and others who are committed to delivering the best possible patient care every day. Thank you!

From Left: Gayle Gravlin, EdD, RN, NEA-BC, Associate Chief Nurse, Nursing Education, Research & Professional Development; Patricia Tyler, Director Workforce Development; Joan Robbio, Senior Vice President, Human Resources Officer; Robert Driscoll, COO, Salter HealthCare; Tom Salter, Vice President of Business Development, Salter HealthCare; Robert Salter, Principal/owner, Salter HealthCare; Beverly Stoebel, Director of marketing, Salter HealthCare; and Kathleen S. Jose, MSN, RN, Chief Nursing Officer, Lahey Clinic

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“ Lahey has now joined

an elite group of organizations recognized for excellence in nursing practice. As such, others who aspire to reach a similar level of excellence will seek our input and advice. Involvement in education, professional development and personal growth are hallmarks of a Magnet organization. Continue to take pride in your accomplishments and strive to mentor others on the journey of excellence.



—Kathleen S. Jose MSN, RN, CNO

Nursing colleagues in the Medical Intensive Care Unit (MICU)

Lahey Clinic 41 Mall Road Burlington, MA 01805

Exceptional

NURSES Extraordinary

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at Lahey Clinic

2009 Nursing Annual Report