The new Nightingales
by Matthew Cyr
Jenifer Sant Elizabeth
Jenifer Sant, RN, BSN
16 years as a nurse; the last 13 on Children’s Neurosurgical
What kind of patients do you take care of?
Children with epilepsy make up the biggest part of the program,
but we deal with seizures of all types. We also care for kids with
hydrocephalus, which is accumulation of cerebrospinal fluid in the
brain, and children with brain tumors, back injuries, closed head
injuries and other neurological disorders.
Do adults and children recover differently from brain
Definitely. An adult with a closed head injury, stroke, aneurysm
or traumatic brain injury is often left neurologically devastated.
But since the brain isn’t fully developed in children for
many years, their brains can reprogram themselves. We’ve seen
children with the same diagnoses as adults come in after extensive
rehab walking and talking. We do a surgery here for kids with severe
seizures called a hemispherectomy where up to half of the brain
may be removed, and it’s amazing to watch them recover. Unless
you’re a neurologist or a neuroscience nurse you may not know
that they had such major surgery.
What have you learned about nursing that you can’t
learn in school?
To highly value and act on what parents say. There have been several
times when a child just doesn’t look right when I walk into
the room and I can’t put my finger on what’s wrong,
so I’ll ask the mother “aside from fact that your child
is in hospital, are you really worried about him right now?”
If she says yes, then I get worried.
Do you worry about getting too emotionally involved
You need to get involved with your patients, but you have to cut
yourself off a little bit when your emotions get involved. If you’re
upset it doesn’t do anyone any good. You need to be an advocate
for that child and present yourself as a professional to the rest
of the care team. If they sense you’re getting too emotional
they may not listen to you as they should.
As a clinical coordinator, what do you miss about bedside
Just walking into the room and saying, “I’m going to
be your nurse today.” I try to pick up extra shifts here and
there when I can be at the bedside, because that’s what I
do best and I would really miss it if I wasn’t able to do
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Staff Nurse III on 8 East, a general medical floor
What do you do on a daily basis?
I function in a variety of roles, including taking care of patients
and families, teaching and training new nurses, and being the charge
I also work on special projects to assess and improve the overall
system, and serve as a mentor and resource to new staff on the unit.
My job is different from when I was a Staff Nurse I because of my
clinical expertise and accountability. I try to improve the unit
and bring new nurses to their own level of expertise.
Have you enjoyed your evolution into a mentorship role?
It’s been a gradual process. Over the years as I’ve
developed as a nurse, I grew slowly from doing strictly patient
care, to improving the unit and eventually to system-wide changes.
As my clinical expertise grew, I was able to seek out and embrace
new challenges and responsibilities both on the unit and in the
What’s the hardest thing for a new nurse to learn?
The organizational component of the job. As a nurse, you need to
be able to juggle competing demands. There might be a crying baby
in one room, a child needing pain medication in another, and a third
who needs to go to a test, and you have to decide in 30 seconds
which is the priority. Over time the clinical expertise will come,
but if you haven’t learned to organize your day, it can be
really difficult to function adequately.
How is nursing different than you thought it would
When I started 13 years ago, I thought of it as just a job. Now
it’s more than that. It’s part of my life. I’m
really glad to be in a profession where I make a difference every
day. Life is too short not to feel like you’ve made a mark
in this world.
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Ellen O'Donnell, MSN,
Has been a nurse for 32 years; got her Pediatric Nurse Practitioner
degree in 1996
What's the difference between a nurse and a nurse practitioner?
I was a nurse for over 24 years, then decided to get a Master's
Degree in Nursing and become a pediatric nurse practitioner. That
has helped me expand my nursing skills to the point where I look
at the entire continuum of care, both outpatient and inpatient.
I do things nurses do like health histories, physical examinations,
diagnosis, and disease management, but I also order lab tests, prescribe
medications, and counsel and educate patients and families on long-term
What do you do in the General Surgery clinic?
I work with the surgeons to evaluate patients before surgery, educate
and teach, and answer questions about things like long-term management
of complex surgical problems. I also help create educational materials
for patients and families, perform research projects and publish
What do you like about working with children?
Children are so honest and open and tell it like it is. They are
so much fun. People ask how I can work with sick kids, but I tell
them that children are the most courageous people I know. They give
anyone they come in contact with an inner strength, a "special"
something of themselves. It's hard to describe, but being able to
connect with them in some small way is really important to me.
What's the best part of your job?
I love meeting new patients and families, staying connected to the
long-term patients and families and making a difference. Sometimes
you don't even know you're making a difference until they come back
and tell you how something you said or did helped them understand
or get through their procedure, test, or intervention. It's great
to know that I have somehow touched these families, but they have
touched me a whole lot more than they know. There are a lot of special
patients and families who take a little piece of your heart with
them, but then you know there is someone else coming who will fill
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Connie Dinning, RN,
Chemotherapy Order Entry system administrator; was a direct-care
nurse for 20 years
What is COE?
It’s the Pediatric Chemotherapy Order Entry system, which
is a computer system for doctors to prescribe chemotherapy more
safely for oncology patients, and for nurses and pharmacists to
review and work with those orders. It was developed jointly by Children’s
and the Dana-Farber Cancer Institute.
How does it work?
The system identifies the patient’s treatment plan, and includes
a drug dictionary, order prescribing and template building capabilities.
The treatment plans are used for many types of cancer and chemo
regimens, and for pediatric patients of all ages. Patients on the
same treatment plan who are due to get the same chemo regimen will
have a standardized set of orders, which vary only by dosing for
patient size or age, or unique patient needs.
How does COE make chemo delivery safer?
It requires the necessary components of an order, does the math
and standardizes orders. There’s no ambiguity because treatment
plans are reviewed intensively by nursing, pharmacy and medicine
prior to being given to patients. The result is that orders can’t
get through without being complete and well thought out. COE allows
us to track the fact that there are fewer changes to chemotherapy
orders, which often translates into saving potential errors in patient
What do you do as the COE administrator?
I create templates for COE, test the system and troubleshoot clinical
and computer problems related to chemo orders. I also train new
COE users, and help determine the best content for the templates
and COE. I didn’t have a technical background when I took
the job six years ago, but I’ve learned a tremendous amount
about computers and how systems work.
What has surprised you about nursing?
I got into it because I wanted to work with patients and families,
but I’ve been surprised that there are a variety of opportunities
for growth and a lot of satisfaction in other roles. When this job
came around, they needed someone with clinical expertise and it
sounded like the type of work that might be interesting. I just
started a master’s degree program and can see how it’s
helpful to have a broader knowledge of systems and management. Working
with COE has made me much more interested in the broader level of
clinical care. It’s really created a nice career path.
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Josh Bourgeois, RN, BSN
5 years as a nurse in the Cardiac Intensive Care Unit
The CICU is a very intense place. What drew you to
I love the acuity of it. A lot of the babies have heart defects
of varying severity, from holes in the heart to hypoplastic left
heart syndrome, which is a congenital syndrome involving several
abnormalities of the heart and blood vessels. We’re the only
pediatric heart center in New England that deals with HLHS, and
the only pediatric heart transplant center in the northeast. We
do over a thousand open heart surgery cases a year on patients from
around the country and the world.
Is it hard to take care of such sick children?
It’s important to remember that underneath all of the technology
there is someone’s child that you’re caring for and
that makes it easier to deal with. It’s such an exact science
here that it usually goes the way you expect. On the other hand
there are kids who are very complex and I deal with them and their
parents longer. It gets a little harder the more time I’ve
spent with the family, but we have the lowest mortality rate in
the country, so the vast majority do well.
How is your experience taking care of these patients
different than that of a doctor?
I usually have only one or two patients at a time so I’m with
the child constantly. I see nuances that could lead to complications.
There are 22 other patients on this unit who are just as sick as
the one I have so I have to tell the doctors what’s going
on. The physicians rely on the nurses and our experience to assist
them in the care of these patients.
What challenges do you face in your job?
One thing people always ask me about is death and dying. We deal
with that, but not on a daily basis. When it happens, our job goes
from taking care of the baby to taking care of the family. You really
have to take your cues from the parents about what they need. And
that’s not just with the death of a child. People deal with
illness differently so we have to adjust our style to help them
see past all this equipment. A big part of helping them is non-verbal
actions to make them realize everything is going okay.
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Martha Curley, RN PhD,
A nurse researcher on in the Medical/Surgical ICU
How did you end up as a nurse researcher?
When I was a staff nurse and a clinical nurse specialist, I was
constantly challenged with what was the best way to provide nursing
care. I felt it was important to get a PhD in nursing research in
order to systematically answer those questions.
But if someone told me when I started nursing 30 years ago that
I would have my PhD and would be a nursing scientist at Children’s,
I would have said you’re totally out of your mind because
that wasn’t in the cards for me at all. The only reason I
went into nursing was because my father told me I couldn’t
marry my husband unless I made something of myself, and I could
finish a nursing program in three years rather than go to a university
for four. We got married a week after I graduated from nursing school
and we’re still together 30 years later. All I wanted to do
was get married, but my father wanted me to be self-sufficient.
It was good advice.
How do you go from helping individual patients to asking
questions that affect all patients?
Once you become proficient in bedside patient care you realize that
there are parents around and they need as much help from nursing
as the patients. They come to the intensive care unit and it’s
a strange environment and a strange experience to see their child
critically ill. The nurse is the singular person with those parents
eight or 12 hours a day who can help them understand what they’re
feeling and show them how best to help their child. As nurses we
help them succeed as “good” parents in that situation.
We may not be able to influence the outcome of every child who comes
here, but we can influence how a family experiences their child’s
Early on, I developed the Nursing Mutual Care Participation Model
of Care, and one of my initial studies was how nurses work with
families on how to parent a critically ill child. We found that
the care model significantly reduced parent stress in regard to
the intensive care environment. And once we started showing that
nursing intervention makes a huge difference to parents, I got hooked
on how to take care of patients better.
How does your research differ from that of physician
The science of nursing is separate from other disciplines. The American
Nurse Association talks about nursing practice as caring relationships
that facilitate healing, so we look at both the subjective and objective
experience of illness. For example, we look at what it’s like
to be the parent of a sick child, but also study how to position
patients with acute respiratory failure so they heal the best. The
best outcomes happen when you have the best medicine, surgery, radiology,
nursing, physical therapy and social work.
What does your current research focus on?
Right now I’m doing a multi-site research study on the effect
of prone positioning in patients with acute lung injury. Many patients
come into the ICU in respiratory failure, and by tradition nurses
have cared for them in the supine position, which is on their backs.
We did a phase one trial and found that about 80 percent of children
had an improved level of oxygenation when placed on their stomachs.
We then asked whether that level of oxygenation improves the clinical
outcome. Is it worth turning someone who is heavily instrumented
on their stomachs for 20 hours a day? To find out I’m enrolling
180 patients in more than 12 sites around the country to determine
whether the clinical outcomes are better when treating children
in the prone position.
In this kind of work, one thing feeds into another. When patients
are kept prone for 20 hours a day they are more likely to get pressure
ulcers. So in order to learn how to best prevent those, I worked
with my colleague Sandy Quigley to predict, manage and prevent them.
On top of all that, in order to assure patient comfort we had to
consistently evaluate and manage their sedation, so we developed
the nurse-implemented sedation algorithm. You ask one question and
it gets bigger.
Do you miss direct patient care?
There’s still a lot of the clinical nurse specialist in me,
and for me being a researcher has everything to do with being a
nurse. Most doctorally prepared nurses work in an academic setting
and don’t have the clinical connection that I do. My office
is here on the ICU and I wouldn’t give that up for anything.
I can walk out of my office, touch a human life, then walk back
in here and crunch the numbers.
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Mimi Bernardin, RN, BSN
Has been a nurse for 8 years; the last 4 in the Emergency Department
What do you do in the ED?
Depending on the day, I may be the charge nurse, the triage nurse,
or a staff nurse. As the triage nurse, I’m the first person
to see patients when they come into the ED. I perform a physical
assessment, which includes taking vital signs, determining level
of acuity for each patient and prioritizing care accordingly. On
an average day we see about 200 kids, and treat everything from
traumas and psychiatric issues to gastrointestinal and respiratory
Have you always worked in the ED?
No, when I started at Children’s about six years ago I worked
on 9 East and 10 East, which are general pediatric units.
What’s different about working in the ED?
Although I take care of patients with a broader range of illnesses
in the ED, the time spent with each patient and family is much shorter.
An ED nurse has to have quick assessment and clinical decision making
skills. Sometimes within minutes of meeting a patient, an IV has
to be placed and medications administered. Prioritizing care quickly
and effectively is essential.
What do you like most about your job?
I really enjoy the patient and family interaction I get as a staff
nurse. Despite the fast pace, I can develop a relationship with
patients and help them through their ED visit. We all want to make
a difference, and in the ED you only have a short time to do it.
So I try to recognize the unique needs of each patient and make
the ED visit as smooth as possible.
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