Nursing Leading with Care by Enriching Patient Care and Empowering Providers

This month we celebrate nurses who use their skills in networking, adaptability, and continuous quality improvement (QI) to save time and streamline workflows for clinical staff.  We also honor health center nurses who develop rich partnerships with local health departments and other service providers to make a tremendous difference in the lives of at-risk patients and families and highlight the nurses who presented during CHI@Home Year of the Nurse 2020: Leading with Care Into the Future Education Session.

Nurses Leading with Care, Informatics, and Excellence to Prevent Clinician Burn-Out

Cheralyn Johnson, FNP-BC, IA
Director of Quality Improvement
South Boston Community Health Center
Boston, MA

When the COVID-19 pandemic struck, Cheralyn Johnson, Director of Quality Improvement (QI) for South Boston Community Health Center (SBCHC), recognized that her carefully mapped Continuous QI program was too brittle for staff to engage during a time of such flux and uncertainty. Along with the SBCHC Leadership Team, she needed to quickly adapt workflows and protocols to efficiently address both safety and the rapidly changing needs of COVID-19 patients and staff. Everyone felt whiplash caused by the pandemic. After a few months, fatigue set in. Cheralyn realized she had to mentally shift from running a sprint to running a marathon. “Rather than the pre-pandemic structured, time-bound approach to QI, our QI Team knows it’s important to stay flexible and address the areas in need of impactable and value-added improvements during the pandemic.” Cheralyn says.

Cheralyn’s change ideas are shaped by her love for people, and her passion to improve patient lives through the symbiotic relationship between clinical care, quality improvement, and informatics design. She has worked in multiple FQHCs in Boston as a Family Nurse Practitioner for over 6 years, has formal QI training through the Institute of Healthcare Improvement, and has expertise in informatics as an Epic-certified Provider Builder.

With practical knowledge and empathy to notice when clinical staff are struggling with the volume of work, she strives to apply her clinical, QI, and informatics skills to adjust the pace into something more manageable. She wisely acknowledges the need “to always make meaningful decisions about EHR design informed by the workflow and the people who do the work”. Cheralyn collaborates closely with fellow Epic-certified Provider Builder Dr. TJ Schuch, CIO of SBCHC, and together with the Clinical Informatics and QI Teams, they strive to lead data-driven EHR improvements in partnership with impacted leaders and staff.

Cheralyn accelerates her learning by collaborating with others. She, and colleague Allyson Richmond, co-founded a special peer-to-peer Learning Collaborative called the “Boston Health Net QI Learning Collaborative (BHN QI Learning Collaborative)” with a wide range of other community health center QI leaders throughout Boston. This group grew out of a need for QI Directors to have a safe space, free from payor influence, to reframe failure as learning, share wins and best practices, and ways to grow. “I learn something new every time,” Cheralyn says about the monthly calls.

Some of Cheralyn’s innovative EHR efficiencies include:

  • A peer-reviewed COVID-19 test result interpretation tool added to the EHR that consolidates CDC, DPH, and DESE guidelines. It serves as both a practical clinical decision support and documentation tool.
  • A nationally recognized best practice workflow COVID-19 Symptom Tracker Flowsheet which Cheralyn built into the EHR which has helped nurses prioritize COVID-19 Follow Up so they spend less time calling people who are able to self-monitor while identifying patients with severely worsening illness early on who need hospital-level care.
  • EHR tools to identify patients in need of essential routine services with flexibility to meet patients’ needs, while working as a team to prevent nursing and provider burnout.

“I play a role in helping to heal our systems in health care. We have a burnout epidemic in primary care. If I find a one click way to do something rather than 3 clicks, clinicians feel like I’ve saved them time and helped them be more efficient. …. QI brings results and reduces healthcare worker stress, and that brings me joy” Cheralyn said.

No Task is Too Small or Too Large

Lisa Hefner, RN, BSN
Nursing Director
Yakima Neighborhood Health Services
Yakima, WA

One cold day last year, an older woman hobbled from her home to the little-used but elegant front door of a restored Queen Anne home that opens into the office of the CEO of Yakima Neighborhood Health Services (YNHS).

She knocked and Anita Monoian, opened the door slowly since it’s rarely used. “I’ve come to see Lisa,” was all the woman said.

That would be Lisa Hefner, Nursing Director at YNHS. Someone had told her Lisa would fix her bleeding, wounded feet.  And so Lisa dropped whatever she was doing and took care of this patient. No task is too small or too large for Lisa, who started with YNHS in 1994, 26 years ago. From enthusiastic mentor to front-line fighter for infection disease control, she does it all.

Nursing students in Central Washington seek out YNHS for internships because of Lisa’s reputation for providing meaningful primary care clinical experience. They learn to work effectively as an interdisciplinary team member with Physicians, Nurse Practitioners,  Medical Assistants, Behavioral Health Specialists and Pharmacists.

Our mission of “promoting learning opportunities of health professions” is a role Lisa relishes. Every year on spring break, she facilitates a weeklong learning experience for University of Washington students who shadow YNHS providers.  This is not easily accomplished. Students must be thoughtfully matched with providers. They need housing and hosts. And of course, Lisa documents their immunization status before they begin their shadowing experience.

Beyond the in-clinic training, Lisa also provides community and home-based supervision (and internships) for public health nurses, working with maternal child health populations.

As the YNHS mission expanded to include ending homelessness, Lisa, over the last ten years, has developed expertise supervising street outreach in the Health Care for the Homeless program. She oversees the outreach RN, problem-solving most recently a Hepatitis A outbreak that had staff going out in the community to vaccinate the most vulnerable. Lisa partnered with the local Health District to immunize countless homeless and other individuals – an effort that is still ongoing.

Leading by example – Lisa is an assiduous handwasher – she monitors our compliance with the rigorous infection control standards required by the Joint Commission and National Center for Quality Assurance. YNHS has excelled in this area.

In sum, Lisa’s energy, expertise and daily dedication to patients and her staff keeps YNHS firing on all cylinders. To us, she is “Nurse of All Time!”

With appreciation to Leah Ward.

Nurses Leading with Care through Valuable Partnerships

Joy Tilley, RN CCM
Manager of Maternal-Child Case Management, Pregnancy Medical Home Nurse Coordinator
Kintegra Health
Gastonia, NC
In the North Carolina communities she serves, Joy Tilley is a powerful advocate for women and children that are high risk for complications and healthcare issues. She oversees the Care Management for High-Risk Pregnancy and Care Management for At-Risk Children programs. The unique thing about these programs is that they are operated as a joint effort by the local Gaston County Department of Health and Human Services, Community Care of North Carolina, and Kintegra Health where Joy is employed. Because of this collaborative arrangement, Joy has become well known for her exceptional work, and nurses from other counties reach out to her for support and guidance. She is always willing to lend her expertise and knowledge.

Joy, along with her diverse staff of 11 Case Managers and the program coordinator are contracted as the only FQHC to provide case management services otherwise provided by the local health department.  “We have a truly symbiotic relationship that best serves the needs of our community… it is the best of both worlds joining our resources.” She recognizes that this gives her team a distinct advantage in meeting the needs of their clients.

”COVID challenged us, and made us better,” she says. She spends more time now on virtual platforms, and much less time in her car. In the virtual setting she‘s gained more time to meet with her team, to more actively participate in collaborative meetings, and to feel more efficient overall. Though she misses in-person contact or time in the community, Joy values how technology has allowed her team to “stretch their reach” while learning to serve the families she cares for where they are. “Being able to provide support and connections for these women and families to help them make positive changes in their life really gives me a sense of purpose.”

Joy’s greatest reward is to witness when the families she works with meet their goals, become self-sufficient, and use their experiences to help others. She also enjoys the “monumental experiences” of seeing growth and development in her staff as they learn to engage with a family, stratify their risks, prioritize their needs, and then effectively intervene in an impactful way.

If she were to give one bit of advice, Joy recommends that nurses should renew their passion for nursing by remembering the impact they can have on each patient. “It’s not an easy job, but the impact on people’s lives is invaluable and rewarding.”

Hope and Support

Tammera Neumann, BSN, RN, PS, CARN
Clinical Coordinator, Alcohol & Drug Recovery Center
Family Health Center of Marshfield, Inc.
Marshfield, WI

“My title is Clinical Coordinator’ but I think of myself as a ‘connector’”, observes Tammy Neumann.

Since 1987 Tammy has worked with people affected by substance abuse, and has been a Certified Addictions Registered Nurse (CARN) since 1992. For the Family Health Center of Marshfield, Inc., a member of the Marshfield Clinic Health System, she ensures quality patient resources are available at the three alcohol and drug treatment centers, and for patients she sees at the Marshfield Medical Center-Marshfield who have alcohol or substance use issues.

Throughout the pandemic, Tammy explains that people have “coped the way they have coped”, and that Wisconsin is ranked as 2nd in the country with the highest levels of binge-drinking. Tammy also explains that each treatment center seems to deal with a primary substance abuse issue unique to their area, such as opioids, alcohol, or methamphetamines. Each area is different based on the accessibility or availability of a substance in the communities, but the reasons behind substance use are often the same– as a response to trauma. With COVID-19, it has been even more difficult for patients to stop using because they are more isolated. “Substance use is a disease of secrecy. With so much isolation, there are fewer barriers for use to continue,” she points out.

Tammy feels that she and her nurse colleague, Karen, are fortunate in the way they deliver care because they can see people face-to-face in the hospital. They engage patients in motivational conversations about their alcohol, nicotine, and substance use based on the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model. “We get to address both prevention AND treatment.” No two visits are ever the same. They may also follow up with patients by phone.

What she hopes to see in the future is that substance use is routinely addressed and discussed as an important part of overall health care, especially as cannabis use becomes more common. “We have to normalize these conversations like anything else so people can make educated decisions and be well,” she points out.  She would like to see the stigma around substance abuse diffused.

Tammy relays a quote from Paul Brodeur that strikes her as important: “Statistics are human beings with the tears wiped away.” That is how Tammy views her work. When she talks with an individual who is using, and having family troubles or job troubles, their problems are much more real and important to address than population statistics can relay. Tammy understands how important her visits may be as a source of hope and support, so she asks each patient “How can I help?”

Read the blog post from the CHI 2020 Year of the Nurse Session: Year of the Nurse 2020: A Conversation with Three Nurse Leaders