I N D I A N A

FA L L 2 0 1 1

QUA R T E RLY
i n d y s t a r . c o m /n u r s i n g

NURSES TAKE WING TO SAVE LIVES

CAREERS & TRAINING:

FLIGHT NIGHT

Dealing with grief at work

YOUR WORLD Q&A:

Danny Ball

Cover:

Its about relationships

Goodwill Industries of Central Indiana is bringing Nurse-Family Partnership (NFP) to Indiana and seeking baccalaureateprepared registered nurses. NFP helps change the lives of low-income women who are pregnant with their first child. Home visits from caring, registered nurses result in healthier pregnancies, better parenting, and babies getting the best possible start in life. More on this evidence-based model: www.nursefamilypartnership.org Apply today: www.goodwillindy.org/gwjobs or vnowosielski@goodwillindy.org

QUA R T E R LY

Barbara Coffel, RN, MSN, CNS, is a pediatric flight nurse with Indiana University Health LifeLine.

Inside

Photo: Marc Lebryk

4 On the Pulse Guest columnist: Ruby McBride, RN, MSN, CS, Administrative Resource to Practice Alliance, Marion General Hospital 6 Clips & Tips

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Outside sales and events supervisor Inside sales and events executive Health care specialist Carrie Bernhardt (317) 444-7288 carrie.bernhardt@indystar.com Morris Bradley (317) 444-7437 morris.bradley@indystar.com S arah Harmon (317) 444-7113 sarah.harmon@indystar.com M andi Keeney (317) 444-7267 mandi.keeney@indystar.com

Cover Story
10 Angels of mercy: Flight nurses take wing

Education specialist

Careers & Training

15 Dealing with grief 17 Online nursing

Your World
22 Courage at the Indiana State Fair 23 Q&A with Danny Ball

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Nominate someone for Salute to Nurses. Find a new job in nursing. Subscribe for free email alerts. Do it all at indystar.com/nursing.

Providing the best level of comprehensive quality care to our communities takes teamwork.

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Job

Pub
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growth
were sprouting up everywhere
You dont become the fastest growing senior care provider and the 8th largest employer in the state without having the most talented and skilled professionals on your team. With over 51 locations and more to come in 2011, were in your neighborhood oering you the chance to work with the team thats growing while everyone else is standing still. If youre looking for growth in your career, its all happening right here.

Nurses - All Shifts. Opportunities exist throughout Indiana.

We oer competitive compensation and aordable benets, including: Health, Dental, Vision, and Life Insurance Employee Assistance Program 401(k) Tuition Assistance Paid Time O Six Paid Holidays Short-term Disability For more information regarding our current opportunities, please visit our website at: www.AmericanSrCommunities.com Or send your resume to: American Senior Communities, 6900 South Gray Rd., Indianapolis, IN 46237; Call: 317.787.6454 x313; Email: hrjobs@americansrcommunities.com EOE

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Be sure youre in the know. Sign up to receive free email alerts when the each quarterly issue of INQ publishes: indystar.com/nursing.

On the Pulse
Recognition

Promotions, workshops, awards

Content
Indiana Nursing Quarterly is a product of Star Media, 307 N. Pennsylvania St., Indianapolis, Ind. Its distributed electronically to registered nurses throughout central Indiana. Submit news items to pubs@indystar.com. Editor A ngela Parker (317) 444-7039 angela.parker@indystar.com M anda Newlin B rooke Baker, Shari Held, Ashley Petry, Holly Wheeler Joe Soria Marc Lebryk

Contributing editor Contributing writers Graphic designer Photos

Two St. Francis Health nurses were recognized for extraordinary care to patients and families. Becky Teising and Mickey Sullivan are recipients of the hospitals DAISY Awards. The awards are part of The DAISY Foundation, a nationwide program recognizing Teising nurses. The DAISY Award for Extraordinary Nurses is a national program that honors the compassionate care and clinical excellence that our Franciscan St. Francis nurses bring to their patients every day. The DAISY Award was established by the DAISY Foundation in memory of J. Sullivan Patrick Barnes who died at 33 an auto-immune disease. His family was so impressed by the clinical skills, caring and compassion of the nurses who cared for him that they created this national award to say

thank you to nurses everywhere. For more information, go to www.daisyfoundation.org.

Noteworthy

St.Vincent Health officials announced the development of the WellCare Institute at St.Vincent to meet the needs of individuals and corporate clients. Michael Busk, MD, will serve as system executive of the WellCare Institute at St.Vincent. The WellCare Institute at St.Vincent will focus on optimizing patients overall Busk health by assessing their current health risks, and providing disease prevention, education and detection. The wellness institute will strategically align with the faith-based health systems business development efforts to deliver employer-based health offerings including, on-site clinics, critical case management and specialized health benefits plans. These partnerships are intended to aid both large and small employers in controlling healthcare costs and keeping employees healthy.

Send news to

pubs@indystar.com.

Cindy Adams, Chief Nursing Officer, Community Health Network

When opportunity knocks, Were first to open the door.

Nurses are right there on the front lines of care and at Community, they also happen to be right there on the front lines of change. The Institute of Medicine recommends advanced education for nurses and suggests they should be in full partnership with physicians and other professionals in redesigning health care. At Community, we couldnt agree more and are opening doors to help our nurses advance in this direction. By providing more educational opportunities and fostering interdisciplinary partnerships, we strengthen our ability to deliver exceptional care. And thats a pretty strong argument for change.

Make plans to be part of our advanced-practice nursing seminar in mid-January. Learn more at eCommunity.com/nursing.

Indiana Nursing Adams ad2 indystar.com/nursing 177-3332 Cindy Quarterly 10-14.indd 1

Fall 2011

10/14/11 10:08 AM

Promotions, workshops, awards

On the Pulse

Ophthalmology Coordinator Janae Kegeris, BSN, RN, CNOR, recently was named the Indiana Academy of Ophthalmology Advocate of the Year. Kegeris works in the Riley Outpatient Center Surgery Center at Riley Hospital for Children at IU Health. IU Health Methodist Hospital Clinical Nurse Specialist Michelle Deckard, MSN, CCRN-CMC, has been chosen to receive the Arctic Circle Excellence Award from Medivance. Deckard will receive an educational grant recognizing her work on temperature management (hypothermia post-arrest), including staff/peer education. Byron Atkinson, MHA, RN, has been named interim executive director of throughput services-care management for IU Health Methodist, University and Saxony Hospitals, Riley Hospital for Children at IU Health and Care Alliance. Atkinson previously served in interim nursing leadership roles at IU Health Methodist Hospital, assisting Chief Nursing Officer Linda Chase with critical care services, nursing quality and professional practice, and operations. In his new role, Atkinson will be responsible for

assessing and analyzing the current state of care management and for making structure and process recommendations to enhance care management implementation. Vince Holly, a clinical nurse specialist at IU Health Bloomington Hospital, has been selected to receive a 2012 American Association of Critical Care Nurses Circle of Excellence Award. Holly This national award carries a lifetime of recognition in the AACN Circle of Excellence.Holly was nominated for the award based on his extensive clinical nurse specialist work both from critical care and system-wide perspectives.He leads initiatives that have direct impact on improving patient care and patient outcomes. He will be recognized at the AACN National Teaching Institute next May. The St.Vincent Professional Nurse Recognition Award was presented to Megan Brown, RN, Janmarie Draga, BSN, ONC, RN, Mary Fischer, CNS, CCRN, PCCN, RN, Amy , Julia Reiberg, BSN, CPON, CPN, Gainer, NP

RN, and Judy Ward, RN, for demonstrating the highest standards of nursing practice. The purpose of the PNRA is to advance the interest in promoting professional nursing and excellence in the professional nursing practice, and aims to demonstrate the high value placed on the attributes of clinical competence, role development, clinical leadership and team building. The nurses awarded with the PNRA exhibit a strong commitment to her community, in addition to her place of work. Each recipient offers her expertise and time to numerous community, health and teaching groups to improve her community. Charles Randolph Jr., R.N., has been appointed director of clinical informatics for Franciscan St. Francis Health. Randolph most recently served as project manager for Randolph Jr. the development and implementation of the Epic electronic health records at Franciscan St. Francis three hospitals and affiliated medical offices throughout central Indiana.

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GET YOUR NURSING TRAINING AT A COLLEGE THAT FOCUSES ON CARING.

Are you currently considering an Associate RN program? Or maybe youre looking toward a BSN? Either way, Harrison College is the perfect place to take your nursing career to new heights. Our caring faculty and sta impart real world skills while a ording you hands-on experience. And our low instructor-to-student ratio means youll never get lost in the crowd. Visit Harrison.edu for more information. Or better yet, call 1-800-401-1497 and talk to a program specialist.

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For required program disclosure information, please go to harrison.edu/disclosure

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Clips & Tips

Research, trends, tips

Indiana Center for Nursing brings leaders together to work as one

Forecasts about the future of nursing in Indiana predict a large shortage, and nursing leaders are doing their best to prepare for it. Three organizations Nursing 2000, Nursing 2000 North and the Indiana Nursing Workforce Development Coalition have joined forces to create the Indiana Center for Nursing. The new nonprofit group brings together nursing leaders from hospitals and educational institutions to promote best practices. ICNs executive director, Kimberly Harper, MS, RN, said the center exists to strengthen the states nursing profession. Members include hospitals, long-term care facilities and nursing schools. The centers board is made of chief nursing officers and nursing school deans. This is a group of nurses Harper and nursing executives whose mission is to serve as the voice of nurses in Indiana, Harper said. The main goals of the organization are twofold. One is to ensure an adequate, well-trained supply of nurses to serve the cities of Indiana. The second is to promote Indiana as a magnet state for nursing practice. Preparing for the future The three organizations that created ICN had similar missions, and Harper said it became clear they could accomplish more by combining their efforts. While 35 states have centers for nursing, Indiana wasnt among them, she said. A variety of organizations within Indiana were doing some of the functions that centers for nursing do in other states, but no one was doing all of them, Harper said. The three founding organizations board members decided to join forces and create ICN. Previously, different regions fell under different organizations. Now, INC covers the entire state. The center tracks nursing trends by analyzing work force data. It uses this information to forecast when there will be a need for more nurses. This helps member organizations educational institutions that train nurses and the facilities that hire them to prepare for the future. Theres a concern that we could be looking at a very serious nursing shortage in the near future, Harper said. It will be coming at a time when we actually need more nurses because of health care reform. We want to be prepared. To encourage more interest in registered nursing careers, INC provides scholarships for Indiana nursing students. It also maintains a database of information about Indianas schools so students can compare accredited programs. That information, with the work-force trend data is accessible at www.ic4n.org. Harper said ICN also is striving to create the best working environment for Indianas nurses. The organization also belongs to the Indiana Action Coalitions transforming healthcare committe, which implements recommendations of the National Institute of Medicine Report on the Future of Nursing. By Brooke Baker

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Has a nurse made a difference in your life?

Nominate a nurse for Nurse of the Year today!
Go to Nursing.Indy.com and click on nominate. All Nurse of the Year entries are submitted via the Web site. Nominations must be received by Feb. 5, 2012. Please direct questions to 317-444-7350.

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On the Pulse
During the past several years, there has been a paradigm shift in how nursing policies and procedures are developed.
In the past, we usually followed policies that had been in place for a period of time with an attitude of We have always done it this way. That practice no longer is applicable or acceptable in todays changing patient health care system. Instead, we must adhere to an enormous number of external government regulations, McBride accreditation by governing surveyors, legality issues and other health care stipulations. Internally, the professional nurse is responsible for providing the health care consumer with the best possible care based on best evidence research and sound clinical expertise. While preparing to become certified as a magnet hospital, Marion General Hospital developed an Artistry of Alliances Shared

Paradigm shift in standardizing nursing policies

Governance Model. This model provides a methodology that, with the support of nursing management, results in a different nursing culture. This paradigm shift has resulted in a higher level of quality nursing practice, increased nurse retention and improved patient outcomes and satisfaction. Following this model, Marion General Hospital initiates nursing policies and procedures at the Unit Practice Council level. Bedside nurses are on the frontline of issues they face every day and play a major role in finding solutions to those problems. They know what works and what doesnt work. When nurses recognize that their input is essential and they have the support of managers, they become more involved and take responsibility for their own practices. The Unit Practice Council forwards their recommendations to the Practice Alliance. Practice Alliance is a multi-disciplinary group that offers expertise and recommendations based on the complexity of the clinical process. Policies are written with specific instructions, best practice guidelines and language that is clear and concise. Communicating policies and procedures to nurses is essential and was addressed by the Marion General Hospital Practice Alliance committee. The committee developed an algorithm for improving the communication of policies. These practices were initiated:

Guest columnist Ruby McBride, RN, MSN, CS, Administrative Resource to Practice Alliance, Marion General Hospital

ractice alliance minutes are P distributed to committee members. communication worksheet with A a synopsis of approved policies is distributed to the nursing personnel. olicies are posted on P the hospital webpage.
Regardless of which system hospitals have in place, it is imperative to include bedside practicing nurses in the process of developing nursing policies. The policy process in place now at Marion General Hospital is far superior to the one in place prior to implementing the aforementioned changes. It is hoped that, with continued growth and knowledge, it will continue to develop a higher level of practice.

They chose Witham.

AND WERE SO GLAD THEY DID. AND WERE SO GLAD THEY DID. AND WERE SO GLAD THEY DID.
Why do nurses love Witham? Because great things Why do nurses love Witham? Because great things Why do nurses love Witham? Because feel truer happen in smaller hospitals. Our nursesgreatathings kinship, AND smaller SO GLAD THEY feel happen in WERE hospitals. Our nursesDID.a truer kinship, happendo nurses Witham? Because nurses and truer kinship, a deeper bond love hospitals. Ourgreat thingsfeel awith their Why in smaller both with each other a deeper in smaller hospitals. Our nurses feelother and with their happen bond both with each a truer a deeper bond helps them each something with their patients. aAnd that both with eachother andand remarkable kinship, deeper bond both with do other patients. And that helps helps them do something remarkable with their patients. And that them do something patients. And that helps themkind something remarkable it helps themhelps them become do kind of nurses they always remarkable it become the the of nurses it helps them to be. And tothe kindstarts nurses they always they always wanted become think it all of with one it helps be. And to think it kind of with they always wanted decision. THEY CHOOSE WITHAM. nurses one simple simple to them become the all starts wanted to be. And to think it all starts with one simple wanted to be. And to think it all starts with one simple decision. THEY CHOOSE WITHAM. decision. THEY CHOOSE WITHAM. 8 Indiana Nursing Quarterly indystar.com/nursing Fall 2011 decision. THEY CHOOSE WITHAM.
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Our nurses could work anywhere.

To learn about current job openings To learn about current job openings visit www.witham.org. To learn about current job openings visit www.witham.org. visit www.witham.org.

Promotions, workshops, awards

Response teams help diffuse volatile situations

Hospitals and care centers are places of healing, but theyre also places of high emotion.
Many facilities have workplaceviolence plans in place for times when patients, family members, visitors or even co-workers lose control. Indiana University Health and St. Vincent Health both include workplace-violence training in the core competencies employees must review yearly. Web-based trainings teach employees how to identify potentially violent situations and then provide scenarios to help them practice the skills. We give them tips and ideas and strategies for how to diffuse the situation, how to calm whoever is being aggressive, and get the situation under control, Everett said Linda Q. Everett, PhD, RN, NEA-BC, FAAN, executive vice president and chief nursing executive for IU Health.

On the Pulse

Kimble Richardson, a licensed mental health counselor with the St. Vincent Stress Center of Indianapolis, addresses the issue of stressed-out patients and family members.

MARC LEBRYK / Custom Publications

Recognize the signs

Additional support | At the beginning

of 2011, IU Health formed an aggression prevention team comprised of social workers, chaplains, safety and security officers, behavioral care clinicians and administrative supervisors who have been trained to diffuse potentially violent situations. Most of the time, Everett said, employees on the unit are able to circumvent a problem before it spirals out of control. When they cant, its reassuring to know that the APT is only a call away. The trained health care professionals on staff at IU Health nurses, physicians and others who may be interacting with patients and families are pretty skilled at knowing when something is getting out of hand. When they begin to feel threatened or uncomfortable, they call the team. Kimble Richardson, MS, LMHC, LCSW, LMFT, LCAC, is a licensed mental health counselor with the St. Vincent Stress Center of Indianapolis. He said St. Vincents critical incidence stress management team assists with extreme situations. If a visitor or family member cant

seem to get calmed down, we could eventually get called in for that, he said. We try to use other means first. We try to have an understanding of why people are upset and what we can do to help them.

Clear expectations | Richardson and Everett said the safety of employees and patients is tantamount, and visitors who become violent are asked to leave. Both hospitals permit supervisors to form an agreement with a potentially volatile individual before a situation escalates. The agreement spells out acceptable behavior and the consequences of breaking those rules. Everett said the approach has been successful since its implementation this year. If it looks like theres going to be a social issue [or] a difficult family or patient situation, we devise a care contract with that patient or visitor that really holds them to a certain level of behavior, Everett said. I think its helped. Were trying to introduce strategies that will calm people and remind them that certain behaviors are expected of them even if they are a patient or a visitor.

According to Kimble Richardson, MS, LMHC, LCSW, LMFT, LCAC, a licensed mental health counselor with St. Vincent Stress Center of Indianapolis, people tend to exhibit certain behaviors when theyre about to lose their temper or become violent. You dont have to be a mental health professional to notice those things, but it takes a little bit of sophistication to be attuned to other peoples social cues, he said. Signs of escalating aggression include: Clenched jaw Faster breathing Pressured or louder speech Wringing hands or clenching fists Cursing Pacing Recognizing the signs is the first step, but nurses must know what to do in these tense situations. Richardson said its possible to stop an episode before it really begins just by listening and offering to help. Many times, that helps calm people down pretty quickly, he said. In many cases when people are getting upset like this, they just want information. They want to know that youre attending to them.
indystar.com/nursing Fall 2011

Indiana Nursing Quarterly

Cover Story

By Ashley Petry

Patient care at the highest leve

Samaritan Flight Program, operated by Parkview Health in Fort Wayne, takes off for another emergency rescue flight.
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Autonomy and adrenaline. These

el

qualities appeal to flight nurses, who do their jobs thousands of feet in the air. Some work in helicopters, providing on-site trauma care and short-range hospital-tohospital transfers. Others work in airplanes, which offer longer-range transport for patients heading to rehabilitation or hospice programs. A typical flight team includes a nurse, paramedic and pilot. Regardless of their specialty, flight nurses agree on one thing: Theirs is a tremendously rewarding job a nurse can have.
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Cover Story

Barbara Coffel, a flight nurse for Indiana University Health LifeLine, performs a pre-flight check.

MARC LEBRYK / Custom Publications

A job to love | Before Samantha

McCarty, RN, PHRN, EMT-B, became a flight nurse, she worked for years in the emergency department of a rural hospital. The facility frequently used emergency helicopters to transfer patients. Eight years ago, she jumped at the chance to join Air Evac Lifeteam and now is stationed at the helicopter base in Brazil, Ind. I like the autonomy, McCarty said. I dont have a doctor over my shoulder saying, Give Tylenol. Do this. Do that. My partner and I put our brains together, assess the patient and treat the patient. Barbara Coffel, RN, MSN, CNS, is a pediatric flight nurse with Indiana University Health LifeLine. She pursued the career more than 20 years ago when

her son, then 10, suffered recurrent cerebral aneurysms and needed to be transported to Riley Hospital for Children. You have the ability to really make a difference to make a huge difference especially when were talking about babies, she said. The things you do in the first 5 or 10 minutes can make all the difference in the world in terms of the outcome. That level of responsibility might intimidate some nurses, but not Joe Ruley, RN. A career with the Samaritan Flight Program, a service of Parkview Health in Fort Wayne, is ideal for this former emergency-room nurse, who also is a license as a private pilot. He now splits his time between on-site trauma cases, such as traffic accidents, and hospital-to-hospital transfers.

This year, the one thats been most memorable Barbara Coffel was a little baby, about 3 months old, who was post-op with hypoplastic left heart syndrome, a very serious defect. He was in heart failure and incredibly sick. We spent most of the flight on our knees working with him. It became abundantly clear that we had to get him somewhere they could do something more definitive for him. Riley is the only level-one pediatric trauma center in the state, so we made the phone call and asked to have all the players in place when we arrived. That was going to make a big difference in his survival. He ended up doing pretty well in the long run. 12
Indiana Nursing Quarterly indystar.com/nursing Fall 2011

Indiana University Health LifeLine

Every flight mission is completely different. One patient in Florida was a snowbird who had a house up in northern Indiana. She was one of our hospice transports back home. Her family knew that she was dying, and we were Grace On Wings able to get her back home for a couple weeks. She didnt really talk to us during the flight, but she smiled a lot. That was a fun time, because most often Im taking people to a hospital, so seeing someone get excited about being home is a pretty phenomenal thing. To be able to put someone back in their bed at home and get them tucked in, you know they are where they want to be.

James Matthew Guy

Im always very impressed with how people respond to me, he said. Its amazing to me, the outpouring of support while were working.

Balancing aspects | But the job isnt without challenges. Flight nurses must be able to think critically, make quick assessments and then act on those decisions. Sometimes, they also have to be skilled diplomats. Youre walking into somebody elses ER, Coffel said. You have doctors and nurses who have invested a lot of time and energy into this [patient]. Theyre worried and scared. Youre just a nurse, but you walk in and take over. Sometimes the waters part to help you, but sometimes theyre hesitant to turn a patient over to people they dont know. The best part of the job, McCarty said, is communicating with patients who have good outcomes. She recalled one boy whose prognosis was grave after he was struck by an SUV. Now years later, the boy is healthy. His parents still send McCarty updates about his milestones and good grades. I think its the same as any kind of nursing, Coffel said. The basic principle is still delivering the best care we can and ensuring the best outcomes we can get. You just happen to do it in a helicopter. The logistics | With Air Evac Lifeteam,
McCarty is based at a regional airport, where she works a 24-hour shift and must be prepared to respond to an emergency within five minutes. She generally works five shifts every 14 days usually two shifts one week and three the next. You have to be on your A game not just in the middle of the day, but also at two in the morning, she said. Coffel is based at the heliport in downtown Indianapolis; like McCarty, she works 24-hour shifts. Because of the focus on pediatric patients, the teams include of one nurse and one respiratory therapist.

James Matthew Guy, a volunteer flight nurse and paramedic for Grace on Wings, tends to a patient while en route to a hospital.

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Samaritan flight nurses are based at an airport and work three days in 12-hour, alternating day and night shifts with another crew. Between helicopter flights, the nurses restock medical supplies, train new recruits, prepare community educational programs and when they can rest up so theyll be fresh for the next call. The situation is different for James Matthew Guy, RN, BSN, NRETT, a volunteer flight nurse and paramedic for Grace on Wings in Plainfield: He also

works full-time at Kosciusko Community Hospital. A pager notifies him whenever Grace on Wings needs assistance. Teams are assembled based on the availability of volunteer professionals (including pilots) who can meet the patients specific needs. The nonprofit organization is the nations only charity airplane ambulance. Nicknamed Nellie, the plane is used for hospital-to-hospital transports of 150 miles or more, generally from one ICU to another. It also transports hospice

A 3-year-old I went after one time had a lot of neurological trauma and hemodynamic trauma. I didnt have time to miss an IV and start another one Samaritan Flight because I had to go on and do something else. I Program didnt have time to make any mistakes. Thats why I think theres a higher power out there who helps us sometimes. I found out later that he was back in school and active, and that was really great. There are lots of miracle stories out there.
Indiana Nursing Quarterly indystar.com/nursing Fall 2011

Joe Ruley

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Cover Story
require a grade of 100 percent before considering an application. After being hired, nurses get even more training. For McCarty, that included a three-week flight academy and oral board exams. Flight nurses work under the license of their medical directors, who are emergency-department physicians. They must be trained in skills that nurses dont normally perform, such as inserting chest tubes, and often are required to practice those skills during in-service workshops. Airplane nurses also are trained in flight physiology, focusing on the impact of altitude and cabin pressure on patients with certain conditions. Regardless of a nurses trauma experience, flight nursing comes with its own set of challenges. Most companies partner new recruits with seasoned professionals who act as mentors. Although the hurdles to entry are high, flight nurses say the extra effort is worth it. My job satisfaction is amazing because I love what I do, McCarty said. I love taking care of patients and using my knowledge to help someone in their time of need. We need to be the best part of their worst day, and I take pride in that, in helping someone at a difficult time.

Samantha McCarthy, a flight nurse for Air Evac Lifeteam, recently was awarded the National Flight Nurse of the Year by her company.

patients who wish to return home.

Training requirements | Being a flight

nurse requires extensive training and certification. When McCarty applied to Air Evac Lifeteam, she had to have half a dozen specific certifications, such as ACLS and PALS, before her application even would be considered. The company also requires applicants to have at least three years of experience in a busy emergency department or ICU. Many companies require applicants to pass written tests and simulations. Some

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My first flight was a patient who was having a dissecting aneurysm, which means there is blood leaking into the body. The doctor said, Take the Air Evac Lifeteam patient and go. Be fast. I was scared to death and was paralyzed with fear. Once we got the patient safely dropped off in Indianapolis, I got back in the helicopter, and thought, I dont even know if I can do this. It was so much stress. A week later, the patient and his sister came to our base. He told us that the doctors in Indianapolis said he wouldnt be alive if not for us, and his sister made us cookies. That sealed the deal. Thats why I do what I do, because hes here.

Samantha McCarty

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By Holly Wheeler

Careers & Training

Death, grief are the inevitable and human side of nursing

Losing a patient is distressing regardless of the circumstance. But some situations can help nurses prepare better for patient deaths. Those who are called to work in ICU, for example, know theyll face patient deaths in the line of work.
[People] are called to different types of nursing, and that does affect how you think and how you process and how you prepare, said Tony Reynolds, RN, BSN, CCRN, nurse manager of the ICU at Community Hospital South. While ICU patients have a more tenuous hold on life, no unit or field of nursing is immune to patient Reynolds mortality. In long-term care settings, death is the end of each residents care experience. We have the long-term care units where some of the nurses assistants and nurses have worked there for years taking care of that resident, said Martha Herron, RN, director of clinical services for American Senior Communities. Those types of situations are probably the most difficult because youre not only losing a resident, youre losing a family member. Sometimes [youre] the only family member they have had. said. You still go through the grieving process, but I guess you learn to deal with it better. Its a learning experience. Thats just part of life. As nurses become more seasoned, they learn how to manage their own feelings in the face of a familys grief. Herron said American Senior Communities makes sure new nurses dont go through a patients dying process by themselves. I think you can ask any nurse, whether theyre in a hospital or nursing facility, and theyll always remember that first death, she said. ICU nurses often have years of experience on the unit and are inured to death. For less-experienced nurses, coping often comes with extensive support from co-workers. Other nurses, chaplains and managers are sources of consolation and can help colleagues through the grieving process. Sometimes, if we just ask them, it validates how they feel, Reynolds said. For particularly upsetting losses, nurses can access formal services such as employee assistance programs.

Jill RN.
This, the only information provided on her employee badge, identified the woman who was with my father in the last moments of his life. My fathers unidentified illness didnt seem real until five days before he died, when doctors diagnosed him with stage IV esophageal cancer. He spent those five days on a telemetry unit a situation he hated until Jill RN took over the last two days of his hospitalization. Jill was everything my dad needed then funny, easy-going, upbeat, bossy in a good way and approachable. But father coded suddenly as Jill helped him out of bed then died within a few minutes. She was as stunned as we were, crying as she consoled us. At that moment, Jill was more than my dads nurse she was a member of my family. Holly Wheeler

Lessexperienced nurses rely on the support from coworkers when coping with death.

Knowledge and understanding | Physiological

training gives nurses an understanding of illness and the life cycle, which helps them mentally cope psychologically with patient deaths. Another part of successful coping is experience. You have to be able to understand the dying process and accept it yourself, Herron

Comforting through your own pain | Nursing isnt

limited to caring for patients it includes caring for the patients familes. Some people just want you there to listen and to answer questions,

Reynolds said. A lot of it is setting up what to expect This is normal. Were going to keep your family member comfortable. And letting them know its OK to grieve. When a family member dies whether expected or unexpectedly a nurse usually is first on the scene. If the nurse has built a relationship with the family theyll look to the nurse as a health care professional, as well as a source of support and understanding. Nurses whove experienced the death of a loved one have a different level of compassion for the grieving family. It is part of the job, Reynolds said. Its almost like a ministry. You get a sense of pride and comfort knowing youre there for them during this time.
indystar.com/nursing Fall 2011

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Careers & Training

By Brooke Baker

Online nursing degree options

As more Indiana hospitals push for magnet status, many registered nurses are going back to school for a bachelors degree.
But thanks to the growing number of online programs, nures dont necessarily have to go back to the classroom. Several universities in the state offer RN-to-BSN and RN-to-MSN online degree programs, and even a PhD in nursing. [An online program] is really a viable option for the working professional, said Dr. Barbara Ihrke, PhD, RN, dean of the Indiana Wesleyan Univeristy School of Nursing. IWU offers RN to BSN and MSN classes Ihrke online, and according to Ihrke, these degrees are every bit as rigorous as their traditional counterparts. Whether its a residential baccalaureate or an online baccalaureate, [students] have to meet the same baccalaureate outcomes and the same accreditation standards, Ihrke said. [Online] is a different curriculum in that its content meets the needs of working adults. In other words, there are assumptions made that working adults understand the nursing programs, so they start at a higher level. The online RN-to-BSN program at WGU Indiana is competency-based. Students are tested on core competency skills throughout the term and move on only when theyve passed that assessment. Peggy Keen, MSN, RN, WGU state nursing director, said students who bring skills from their work experience can move ahead faster because they can quickly pass their competency assessments. Lets say someone in a nursing leadership administration masters program has 20 years of experience as

A different approach to clinicals

WGU Indiana, which offers both pre- and post-licensure online nursing degrees, is taking a new approach to clinicals. It pairs each student with one nurse (a clinical coach) for 12-hour shifts throughout the clinical rotation. [Clinical coaches] work one-on-one with students and develop a mentoring relationship, said Peggy Keen, MSN, RN, state nursing director for WGU Indiana. 16
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This arrangement has advantages for both parties. Students get to choose clinical coaches whose schedules mesh with theirs (maybe nights or weekends) and experience what its like to work full shifts. Mentors have time to observe students abilities as well as areas that need extra instruction. Hancock Regional Health is one of WGU Indianas partner facilities. Marsha Meckel, MA, BSN, RN, team leader of clinical
Fall 2011

excellence, said clinical coaches complete a mentoring course with WGU that provides some valuable mentoring tools. The majority of our staff precept new employees or student nurses anyway, she said. Its really nice to have a formal program we can offer to make sure everyone has the same expectations about what needs to occur when they have a student with them.

Careers & Training

a director, Keen said. They bring competencies theyve already developed. Theyd probably be able to move through a course and their assessments much faster than someone who hasnt had any nursing administration experience. number of times each week. Teachers join discussions and monitor them closely. Ihrke compared nonparticipation to skipping class or trying to remain anonymous in the back row of the classroom. If theyre not responding on the discussion board, its pretty obvious, Ihrke said. If theyre not responding, theyre counted absent and [at IWU] they can only be absent from one class in a five-week session. If theyre not posting, someones out there saying Whats going on? How do we need to help you? Schools with online programs work hard to ensure that students can access the support they need, including faculty and advisers, who make a point to be easily accessible by email. Unlike a traditional university where students might go in and attend a four-hour class one day a week, they have much more access to their faculty members, said Gina Drake, MSN, RN, director of academic affairs and chair of health care programs for the University of Phoenix. Questions get answered in a timely manner because faculty are in the classroom and looking, she said. In addition to the RN to BSN and RN to MSN online degree programs, Phoenix offers an online PhD in nursing.

Whats an online degree program like? | The details differ for each school,
but online and classroom courses share similarities because core competencies are the same for both venues. Most online programs are asynchronous, meaning that students progress through the weeks material at their own pace. They dont meet at scheduled times to watch lectures together or participate in discussions, that doesnt mean discussions dont happen. Discussion boards are an important component of online classrooms and can be an advantage for students who would be hesitant to speak up in an actual classroom. The online forum provides a more controlled environment for debate and inquiry. Students are expected to contribute thought-out comments at certain

What about clinicals? | Because students are registered nurses, they completed most of the clinical work during their previous schooling. The community health clinical requirement usually is all that remains. Each school arranges clinicals differently. Some partners with facilities, where students are placed for clinicals and skill labs. At others, students arrange their own clinicals with help from their advisers, who review the proposed facility and monitor students progress. The University of Phoenix has a virtual clinical environment that allows students to complete required hours by working through scenarios online. We have state-of-the-art simulation labs that students can use if they choose to, Drake said. We also have a virtual health care organization that is actually a hospital [students can use] when they are enrolled in a course that has clinical requirement. They click on the link to that organization and they can do assignments that relate to that clinical through a virtual organization.

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Your World

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Your World

By Shari Held

Outside interests help nurses achieve balance

SHUTTERSTOCK

Amber Mack has been involved in ballet since she saw The Nutcracker as a high school freshman.

Nurses do amazing things on the job. Between shifts and on weekends, they translate their passion for nursing into other ventures with some incredible results.
Here are the stories of nurses who shine in the limelight away from the job.

En pointe | When Amber Mack, RN, saw a performance of The Nutcracker as a high school freshman, she knew shed found her passion. She started taking classes and playing catch-up. Most ballerinas start when they are 2, she said. Her hard work paid off when she won a Mack talent scholarship to Northern Illinois University. There she earned a bachelor of fine arts degree in dance performance. Before graduating, she landed a job as a company member with the Indiana Ballet Theatre in Crown Point.

Two years later, when the ballet company cut its health insurance benefits, Mack stayed on, but she also returned to school this time to get a nursing degree. After working for five years in pediatrics at Franciscan St. Anthony Hospital, Mack switched from part time to PRN status and took a part-time position at Express Care in Valparaiso. She also spends four days a week at the ballet company practicing and sewing costumes, and dances in most performances. Many of my patients came to my performances with their school groups, she said. I got to go out afterward and speak with them and encourage them to go to college and pursue their dreams. Dual careers are just part of this busy 28-year-olds life. She and her husband have a 15-month-old son and recently found out theyre expecting a second child. Hectic schedule aside, Mack said its all worth it. You definitely need to have a passion and a career outside of nursing. Otherwise youre going to get burned out, she said. You cant just help others all the time. You need to help yourself,
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Your World
and have your own thing to do when you get off work.

Right on target | Stacy Young is a

nursing student at the University of Southern Indiana. She also works full-time at Covance, a pharmaceutical research company. Whats unusual is that shes also an accomplished archer. Though her parents are avid archers, Young didnt take up the sport herself until 10 years ago after a painful breakup with her first love. I was very young, and I was kind of lost, she said. I tried to remember what I had done for fun before meeting him. One day, she came across the bow her ex-boyfriend had given her and decided to give it a try. This year, she finished eighth overall in the National Triple Crown. It was very shocking because it was my first year out, she said. I had only participated in little local shoots where, most of the time, I was the only girl. After her success in the nationals, Young began preparing for the world competition in New York, setting her sights on becoming the No. 5 archer in the world. With 1,500 participants, the

Stacy Young spends her spare time on the archery range.

competition as intimidating, but she prevailed and did, indeed, become the No. 5 ranked archer in the world. At 29, Young still has strong skills and a passion for archery, but she recognizes that she cant compete forever and that the prospects of earning a living as an archer are slim. The way I look at it is, its a fun thing to do, and Im going to make the best of it while I can, she said. But I have to have

something to fall back on. She received her CNA certification in 2003 and has worked in several health care environments since then, including nursing homes, hospitals, doctors offices and a psychiatric unit. I love every minute of it, she said. I couldnt ever see myself not doing nursing.
Do you have an unusual hobby or interest? Tell us about it at pubs@indystar.com.

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With three consecutive honors from both Modern Healthcare Magazines Best Places to Work in Healthcare AND Indiana Chamber of Commerces Best Place to Work, its no secret that Hancock Regional Hospital boasts the best nurses in the business. We want to thank you, our nurses, for our consistent winning streak. We are currently accepting applications from

Its a 3-peat.

Registered Nurses

For more information or to apply online, visit the Careers section of our website:

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REGISTERED NURSE OPPORTUNITIES

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Your World

By Ashley Petry

When tragedy struck August 13, 2011, at the Indiana State Fair, many volunteers came to the aid of injured concertgoers immediately after the stage collapse.

TONY CAMPBELL / SHUTTERSTOCK.COM

Indiana State fair lifesavers:

For 3-year-old Maggie Mullin, the Aug. 13 Sugarland concert at the Indiana State Fair was a chance to see her favorite band and wear a fancy new pink tutu. Instead, bad weather turned the family outing into a nightmare. When the stage collapsed into the VIP area, dubbed the Sugar Pit, Maggie and her mother, Laura Magdziarz, were injured. While some concertgoers fled the scene in panic, many others rushed to the pit to help. Many worked to free people trapped by the rigging, and those with medical training including nurses, doctors and EMTs came to the aid the injured. Maggie alone encountered a care chain of nearly a dozen volunteers, including a doctor and several nurses.

Nurses rushed to help injured concertgoers

hoped I would, Prater said. Instinct just took blew us over, but I thank my husband for over, but everything Ive been taught really saving my life. helped me. Without hesitation, Prater and her In the end, seven people died as a result husband dashed back into the fray to help. of the freak accident, and dozens more were After climbing over rigging, Prater encountered injured. Maggie was one of the lucky ones. Maggie, who was sitting on the lap of her She has made a full recovery, and gained new injured mother. friends along the way several Her mom was yelling neverknewhowI even delivered new pink tutus to I Help us! Prater said. I saw the little girls arm was badly wouldreallyreact her hospital room. broken and bleeding profusely, inthemoment, and I thought she might have a butIreactedhowI Everyone can help if they will severed artery. While Prater and other wouldhavehoped nurses worked amongst the Prater used someones shirt as a tourniquet to wreckage, others set up a Iwould.Instinct stabilize Maggies arm, but justtookover,but makeshift triage area under the she knew immediate medical bleachers. One was OB nurse everythingIve attention was required. She Doreen Norris-Stojak, RN, MS, beentaughtreally director of women and children told Magdziarz, You have to trust me, and then passed services for Methodist Hospitals helpedme. Maggie to open arms on the in Gary and Merrillville. Natalie Prater, RN other side of the rigging. The concert tickets were Riley Hospital for The little girl, her tutu now a Mothers Day present, and Children at IU Health smeared with blood, passed Norris-Stojak been looked through several sets of arms before being forward to reliving childhood traditions at the loaded into an ambulance and rushed to Riley. Indiana State Fair. She and her husband were Meanwhile, Prater turned her attention to sitting in the third row of the bleachers when Magdziarz and others in need. the stage collapsed. I never knew how I would really react in In the aftermath, the couple asked a the moment, but I reacted how I would have police officer how they could help, and he
Fall 2011

Instinct takes over

The first to reach her was Natalie Prater, RN, a nurse with Riley Hospital for Children at IU Health. Prater had been standing about five people away from the stage, but when the weather worsened, her husband suggested that they leave. We started walking away, and thats when we heard the snaps and pops and [the stage] started coming down, Prater said. We ran, and the stage collapsed about 5 feet from us. We were covered in dust, and the wind about
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Your World

By Holly Wheeler

MARC LEBRYK / Custom Publications

Natalie Prater of Riley Hospital in Indianapolis, takes time to play with three-year-old Aayla from Gary.

with
About me
Position: Staff nurse, palliative care and oncology, Richard L. Roudebush VAMC

directed them to the triage area. Norris-Stojak tended to patients lacerations and broken bones. Her husband, who also works for Methodist Hospitals, but as a plant operations manager and has no medical training, carried patients to ambulances on boards and folding tables. Norris-Stojak said her experience with hospital disaster drills helped her get through the evening and handle the emotional challenges that followed. Any time there is a disaster drill Ill participate, because its good experience, she said. I know now that I would never hesitate.

Danny Ball
in surgery the first year then went over to a new unit called palliative care and oncology. I absolutely love it.

Education: Ivy Tech Community College

How do you cope with caring for patients who are near death?
Im acclimated to it, but it can be difficult at times because you do get attached to the patients and their families. Thats part of the job I like, part of what makes it worth it. Palliative care and oncology are two different sides of the same coin. In oncology, every once in a while a success story will walk through the door just to thank us. That really makes you feel like youre making a difference.

What did you do before enrolling in nursing school?

I used to be in a band. I played guitar and was a singer. We did a lot of rock and a little bit of funk and a little bit of improv. We played all over the place The Patio in Broad Ripple, we played in Terre Haute a lot, the college towns, Bloomington and St. Louis. We did it full time. We all had our little side jobs, but what we did was music.

Training + adrenaline

Lori Postma, RN, medical care branch director for Franciscan Physicians Hospital in Munster, said disaster drills are a good way for all nurses to prepare for situations like the one that occurred at the Indiana State Fair. She regularly organizes such drills, which she described as teaching people things she hopes theyll never have to use. Knowledge is always the key when it comes to things like that, she said. The more you learn and know how to handle situations, it makes it a lot less scary. Postma also recommends a nursing certification called Pre-hospital Trauma Life Support. The class addresses practical skills as well as the emotional challenges faced by first responders. Postma said even nurses who never encounter large-scale disasters likely will use the training at some point whether they happen upon a car accident or encounter an emergency situation in their community, theyll be prepared. That adrenaline kicks in, and you do what you have to do to help people survive, she said. Youre not a nurse if you dont have that sort of thing in your mind.

Why did you become a nurse?

One night toward the end of 2003, it hit me all at once: I think it might be time to move onto something else. Then, on New Years Eve, I stopped what I was doing and said, I am going to become a nurse. The next day [Ivy Tech] was open, I drove up and enrolled. It also came about because I converted to Catholicism and I wanted to do something completely different. I had considered nursing before, but I wasnt ready.

What challenges do you face as a man in a femaledominated profession?

The male nurses on the floor usually get the more combative patients, because they will respond differently to a male nurse. [But] it seems to me that people are accepting.

Whats the most important thing in your life right now?

I have a 3-year-old daughter whos really the main focus of my life right now. Shes pretty much why I do everything I do. I was fortunate enough to be able to switch from 12-hour shifts to 8-hour shifts so I can be there every evening for her.

Why did you choose to work at the VAMC?

I felt very at-home there immediately I pretty much knew that was where I wanted to work. I worked

Tell us about your world

Send an email to pubs@indystar.com

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Join our mission.

Work alongside the greatest healer of all time

At St. Francis Health, we believe delivering healthcare is more than a job. Its a calling. If you have an angels touch and a servants heart, we invite you to join our mission.

The people, the faith-based ministry, professionalism and compassionate care are what make St. Francis Health a great place to have a rewarding career in health care. We are currently seeking candidates for the following positions:

Beech Grove Campus RNs Intensive Care all shifts

Current Indiana RN license is required. We will consider new graduates who have passed the RN boards.

RNs Nursing Resource Pool

New, temporary contract positions available for short term needs: D/E/N with 13 week contracts and guaranteed hours Offering premium pay rates with completion bonuses Med/Surg and Critical Care needs Also hiring for permanent openings in the Resource Pool! Options to work 12-36 hours per week, D/E/N; 4, 8 and 12 hour shifts available 8 different commitment options with competitive rates Currently we are in need of Med/Surg and Critical Care Nurses to work on a temporary basis at our Beech Grove, Indianapolis and Mooresville facilities. Must have 1 year experience in Med/Surg and 2 years experience in Critical Care required. Indiana RN license is required.

Indianapolis Campus Unit Manager Labor & Delivery

The qualified candidate must possess a BSN from an accredited school of nursing and a valid Indiana RN license. MSN is preferred. Previous management experience is required. A background in business is ideal.

Unit Manager Medical Progressive Care

The qualified candidate must possess a BSN from an accredited school of nursing and valid IN licensure. Masters preferred. A minimum of 3-5 years management experience and experience in project management, budgets & productivity; cardiac experience is required.

RNs Post Surgical Inpatient Unit days, nights and weekends

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