SUMMER 2011

N E W S F O R A N D A B O U T FA U L K N E R H O S P I TA L N U R S I N G S TA F F

FAULKNER

NURSE
NURSING PAIN MANAGEMENT COMMITTEE: PAIN AS THE FIFTH VITAL SIGN Jane Shufro, RN, BSN, CPAN

IN
P3:

THIS ISSUE
6 South and patient satisfaction

P4-5: Nursing Awards P6: P8: Are you a culturally competent nurse? Endoscopy prociency workshop

P11: Recommendations for verbal education

Members of Faulkner Hospitals Nursing Pain Management Committee from left, Mary Pat Cunniffe, Kitty Rafferty, Barbara Peary, Helene Bowen Brady, Jane Shufro, Jeanne Hutchins and Lauren Morrisssey.

Faulkner Hospitals Nursing Pain Management Committee is dedicated to meeting the pain management and education needs of our patients and their families. In the past, Faulkner has had an interdisciplinary pain management team that addressed the issues of pain assessment, sedation risks, and identiers for safe medication administration within the hospital.

of the nursing staff in the area of pain assessments, reassessments and protocols, creating an environment that is conducive to excellence in nursing practice and patient care.

The Committee is comprised of registered nurses representing each of the inpatient and specialty areas, staff development, nurse practitioners and nurse directors, as well as an Associate Chief Nurse. The

Over two years ago the need for a specic Nursing Pain Management Committee was identied to look at nursing practices related to pain management. Since then, the committee has continued to further the education and professional development

Committee Co-chairs oversee the planning of monthly meetings and any workshops, one of which was a retreat day where the committee met for an entire workday to rene the QI pain audit tools to more accurately reect the type of pain
continued on P2
Faulkner Nurse SUMMER 2011 1

DEAR NURSING COLLEAGUES

First let me say thank you and congratulations for another successful celebration of our Nursing Profession as we closed out the month of May with Nurses Week, a week that continues to highlight the best of our practices here at Faulkner Hospital. This year we had a Nursing Awards Ceremony attended by not only staff and their families but the families that continue to support our Nursing Awards. It was so enriching to be able to hear of the great practice of all the award winners pictured in this edition of Faulkner Nurse. After reading this edition of Faulkner Nurse you will see exactly what makes our nurses the best! They are often seen as mentors, patient educators, life long learners and nurses that our patients and families have come to count on for their care.
Judy Hayes, RN, MSN, CNO

95th percentile or achieving best practice nationally for care of CHF patient. This high quality care is the expectation of our patients and staff and we need to provide this care in the most affordable fashion to meet the demands on us as a healthcare institution. I know as we work together on this we will reach solutions that not only maintain the excellence in patient care but also assure that the care is accessible for all patients. Enjoy your summer. Sincerely,

The poster session during Nurses Week allowed us to highlight the many diverse areas of practice that we have here at Faulkner Hospital. Our next few months will be challenging ones as we all examine our ability to provide care that continues to meet all the quality and satisfaction metrics that we have attained - whether it is our Press Ganey inpatient satisfaction scores reaching an all time high of the

Judy Hayes RN, MSN, CNO Vice President of Nursing

Nursing Pain Management Committee: pain as the fth vital sign, continued from P1
assessments for their own practice areas. Prior to this, all units used the same tool to assess pain which did not accurately portray the best practice. They also collect and collate the monthly pain QI data that demonstrates how staff document pain assessments and re-assessments. Although many of the staff nurses have been introduced to their unit pain tool, they may not necessarily have information about where that data is used or that its designed to enhance strategies that could improve how nurses document. they are providing, according to Helene Bowen-Brady from staff development. Working with IS to rene Meditech so that RNs can document real time assessments and using the Vocera/ Signet integration to monitor response to patients requests for medication are a few of the accomplishments that the committee has brought to current nursing practice. By reviewing the quality indicators monthly, the committee members are able to identify strong nursing practices that can then be shared with other units in an effort to We feel that nurses do know where their patients pain level is but the challenge is ensuring that nurses are consistently documenting the excellent nursing care improve nursing practices related to pain management. In the near future, we will be conducting a staff Knowledge and Attitude survey which will be used to apply evidencebased interventions for more effective pain management in our nursing practice. Education to meet the learning needs of nursing staff was another focus this past year and a guide to pain reassessment documentation, The Road to Excellence in Pain Management was posted on Nursing Practice Boards for unit discussion. The committee members will be looking at the development of educational programs for patients, family and staff about pain management, as well as collaborate to revise policies and procedures related to pain management.

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6 SOUTHS EFFORT TO IMPROVE PATIENT SATISFACTION

Last September, the staff of 6 South was asked to participate in a Lean quality improvement initiative. The Lean program is a philosophy that helps drive efciency through employee empowerment and changes at the grass roots level. Lean principles include gaining respect from individuals for their ideas which fosters the most impact on results.
Sarah Sawyer, left and Kathy Codair.

They educate the patient on their room and how to use the call light. The nurse and the nursing assistant update the patient white board every shift in the room with their name and titles. In-patient satisfaction surveys were completed both before and after this intervention. Below are two graphs of the Press Ganey results showing the improvement in the two questions. The rst graph shows the delay in meeting Data was collected in these two areas over a period of time. The researchers found that call lights were being answered in a timely manner, however the patients need was not always being met, such as when a patient requested pain medication but there may not have been a doctors order for the pain medication. Kathy and Sarah warn that change takes time and having staff input was the key to the success that they have seen. The hardest thing now will be sustaining the success. the patients needs and the second graph shows the staffs attitude toward requests.

After reviewing the Press Ganey report from last summer it was clear that a change needed to be initiated. July of 2010s press Ganey report showed that patients were scoring nursing staff at a lower percentage than previously. Kathy Codair, Nursing Director, solicited Sarah Sawyer, staff nurse, to research the issues and problems.

Together Kathy and Sarah, coached by Cori Loescher, attended a Partners wide Lean training program which met monthly for ve months. Sarah and Kathy met with the staff to dene sources of waste and delays in meeting peoples needs. They analyzed the results of two Press Ganey questions: delay in meeting the patient needs and staffs attitude toward requests.

Sarah and Kathy initiated education to the nursing assistants regarding the importance of quality communication with patients. A script was designed by the nursing assistants to outline key information.

The nursing assistant introduces themselves by name to their patient and family and explains the purpose of their visit.

Published by Marketing and Public Affairs (617) 983-7588 djgoldberg@partners.org We welcome your feedback and suggestions for future issues.

Faulkner Nurse SUMMER 2011 3

NOTES ON NURSES WEEK AWARDS

CONGRATULATIONS TO ALL OF THE 2011 AWARD WINNERS!

THE ELAINE HAZELTON MEMORIAL SCHOLARSHIP

was established by Elaines family and is given to a nurse who demonstrates a dedication to Faulkner Hospital and the practice and advance of nursing along with continuing their education. This years winner was Kimberly Tierney, RN, 6N.

THE ANGELA MCALARNEY AWARD

was presented to Margaret McNulty, RN, Dana-Farber/Brigham and Womens Cancer Center at Faulkner Hospital. The McAlarney Award was established in 2003 to be given to a member of the Nursing Department in recognition of excellence in patient teaching.

Kimberly Tierney, RN

From left, Judy Hayes and Margaret McNulty.

THE MAL AND LOIS LEWIS EXCELLENCE IN NURSING PRACTICE SCHOLARSHIP AWARD
was established in 2010 to be given to a nurse that meets the following criteria 1. a nurse working in cardiology that demonstrates compassion in a family centered context, 2. a nurse that advocates for the patients using evidence-based research and 3. a nurse who is recognized by her/his peers for their unique contribution. The 2011 winner was Tammy McNeil, RN, 6N.
From left, Judy Hayes, Tammy McNeil and Annie Lewis-OConnor, PhD.

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This past May, seven members of Faulkner Hospitals Nursing staff were presented with awards. The nurses were nominated by their peers. Each award has different criteria but all of the awards link to the profession of nursing.

THE MRACHECK AWARD was established in 1995 to be given to three members of the Nursing Department for recognition
of their clinical skills, as well as to support their continuation in the nursing profession. This years winners were Bridgid Stevens, RN, 6S, Jackie Dejean, RN, 7N and Karen Clougher, RN, 6N.

Bridgid Stevens

From left, Judy Hayes and Jackie Dejean.

From left, Judy Hayes and Karen Clougher.

The last award presented was the

MARY DEVANE AWARD.

This award was established in 1999 to be given to any member of the Nursing Department in recognition of their commitment to delivering patient care with compassion, kindness and humor. The award was presented to Diane Corgain Hunt RN, OPOU.
From left, Judy Hayes and Diane Corgain Hunt.

Faulkner Nurse SUMMER 2011 5

AN EYE TOWARDS THE FUTURE

By Brenda Cleary, RN

As we enter the second decade of the new millennium, we should take a moment or two to ponder some of the changes that have occurred. Technology continues at a remarkable pace bringing with it tremendous advances to peoples lives. Unfortunately this may also come with a price. Society, more and more has expectations of instant gratication. Whether its high speed internet or fast food, we always want better and quicker. We are hooked to our cell phones, iphones, ipads and computers from the moment we wake until the moment we go to bed. It should come as no surprise that this way of life has crossed over into our practice as nurses. Along with providing expert care to our patients, we also need to remember to take care of our co-workers and ourselves. Stop and think of the last time you told someone on your unit that they did
Brenda Cleary, RN

a great job, or the last time you sincerely thanked a colleague. I encourage senior nurses to remember that they were once new to their chosen eld and worked hard to gain experience and build their skill set. Faced with individual goals and providing expert care in this fast paced world may make it hard to consider mentoring, but remember we were all once new nurses and just as frightened and overwhelmed as some of our colleagues may be right now. So as we reect on the celebration of the recently passed Nurses Week, lets try to remember that skilled and expert nursing practice comes with old-fashioned time and mentoring. We should challenge ourselves and pause long enough to recognize and support our colleagues. Finally, lets keep a special eye open for our newer nurses and welcome them to our team.

ARE YOU A CULTURALLY COMPETENT NURSE?

By Yuka Hazam, RN, MSN, 6 South

The United States is more diverse than ever before and this will continue to be true. American nurses require advanced skills to provide culturally competent care for the patients. Culturally competent care means that nurses and other healthcare professionals are able to work in cross cultural situations effectively. The rst step is to be aware of differences between you and patients. These differences may be about their thoughts and values about health care and their lives. The second step is to provide culturally sensitive care which requires interpersonal and communication skills. A lack of cultural sensitivity may cause conict and unsafe care. A nurse or physician may believe that patients must follow our advice no matter what their culture is because our health care is the best in the world. However, our world class medicine could be useless and meaningless if patients do not understand or refuse it because our healthcare providers are culturally incompetent. Think about this situation. You go to an Asian country and have chest pains. You have limited language prociency in that counYuka Hazam, RN

trys language. The hospital smells different and is a very unfriendly environment. The doctors prescribe some strange medicines and acupuncture therapy and these medicines are traditional and familiar in this Asian country but not to you. They say this is what you must do. Would you be comfortable accepting these strange therapies? What would you want to know if you wanted to be treated by them? Nurses have important roles to play in culturally sensitive care. However, our skills and healthcare systems are not yet advanced enough to provide culturally competent care for patients who are not familiar with US healthcare and practices. Some cultures are very complex. In addition, family dynamics or religion may create conict between healthcare providers and patients. Nurses must understand the patients comfort level and provide them with adequate information. Nurses must improve interpersonal skills and skills that establish a trusting relationship between nurses, patients and their families. This may not solve all cultural problems but it is the most important part of cultural competency. Please share with me any of your cultural care experiences.

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RISK MANAGEMENT CONSIDERATIONS WHEN CARING FOR THE SUICIDAL PATIENT ON 1:1 OBSERVATION
Joanne Locke, RN, JD

The responsibility of the registered nurse for the care of any patient arises from a legal concept known as the standard of care. The standard of care is dened as the degree of skill and learning of the average, qualied member of the profession practicing the specialty, taking into account advances in the profession. While this denition may sound like legalese, the standard of care is an important concept for nurses to understand when assessing his or her risk of liability for adverse events.

learned about suicide risk assessment as part of nursing education, hospital policies and procedures, and nursing practice guidelines, which may be taught as part of Nursing Case Review, seminars, and workshops. The average qualied nurse would be expected to know the basic requirements of suicidal risk assessment, such as asking the patient if he is having thoughts of harming himself, and if so, whether he has a plan. Once the assessment conrms that there appears to be a risk of suicide, the nurse has a non-delegable duty to use reasonable

duties and in essence, leaves the patient in the unsupervised care of a sitter or security guard, the nurse has departed from the standard of care, and is responsible for any injury that may result from such negligence. How can a nurse assure that she has met the standard of care for monitoring a suicidal patient? The nurse must be familiar with hospital policies and procedures for the care of a patient at risk for suicide, and comply with the policy requirements. This policy can be found in Faulkner 411 and the nurse should review it when a suicidal patient is under his or her care. Compliance with the policy can be demonstrated

The standard of care is determined by applying nursing actions (or omissions) against what is required by statute and regulation, policies and procedures, and other evidence of accepted nursing practice. When a nurse departs from the standard of care in the treatment of his or her patient, and the patient is injured as a result of this departure, the nurse can be found negligent, and may be subject to damages to compensate the patient for injuries resulting from the negligence. Negligence may occur when a nurse fails to use adequate clinical judgment in patient assessment, or when the nurse fails to implement appropriate nursing intervention. How does this apply to the care of a suicidal patient?

judgment to meet the patients need for safety from self-harm.

A non-delegable duty is one that only the professional nurse can perform under the authority of her professional license; a non-delegable duty cannot be assigned to an unlicensed practitioner. In the case of a patient on 1:1 observation, this means that although a sitter or security ofcer may be the person who is assigned to stay with the patient and perform the actual observation, it remains the sole duty of the nurse to perform ongoing patient assessments, to monitor for a change in condition, to assure that the sitter has received clear and comprehensive instruction about what is expected of him or her, and to perform adequate hand-

through good documentation of nursing assessment, care, and communication of signicant changes. Documentation on a communication tool sheet that contains reminders and an observer care plan assures that both the nurse and the sitter understand what is required to assure that the patient has received adequate monitoring and care during the shift. While no nurse is expected to guarantee the safety of a suicidal patient, the nurse must provide reasonable care. Following these steps can provide the patient with good nursing care and demonstrate that the nurse has met the standard of care.

When caring for a patient at risk of suicide, the nurse is responsible for what the average qualied nurse would have

off communications with the doctor, the sitter, and the next nurse who cares for the patient. If the nurse fails to perform these

Faulkner Nurse SUMMER 2011 7

ENDOSCOPY PROFICIENCY WORKSHOP

Seven thousand patients annually undergo endoscopic procedures at Faulkner Hospitals Gregory Endoscopy Centre. Each of these patients depends upon the nursing staff to be thoroughly skilled in all aspects of endoscopic care. The Joint Commission requires that staff be competent to perform their tasks and that competence be assessed and documented at one to three year intervals.

In the technologically advanced endoscopy setting, new modalities and applications are frequently introduced and endoscopy staff must remain current in this changing environment. As endoscopy has moved beyond diagnostic procedures to the therapeutic and interventional, excellence in patient care and technological prociency are closely linked. nursing staff, as experts in a particular modality provide education To meet this challenge, the nurses of Gregory Endoscopy Centre dedicated an entire February afternoon to participating in a hands-on prociency workshop. The physician staff demonstrated their commitment to this endeavor by freeing the endoscopy schedule for the allotted time period. The workshop familiarized staff with lesser-used endoscopic therapies and reviewed day-today processes to insure quality and safety based on best practice guidelines. The nursing staff identied a need for more hands-on exposure and, with physician input, guided the content of the workshop. Procedural sedation and medication safety in the geriatric population are two required competencies assessed annually by written exam. Endoscopy nurses also maintain current ACLS certication. and support to those less experienced. Stations included endoscopic band ligation, clipping, electrocautery, balloon dilators, argon plasma coagulation, sclerotherapy, and ERCP. The nurses are also required to be thoroughly familiar with endoscope reprocessing. Competence in this area is assessed and documented annually.

A station was prepared for each procedure under review. Nurses analyzed guidelines for safe preparation, operation and disassembly of equipment and conrmed prociency by practice and return demonstration. Individual prociency was documented per Joint Commission requirements. Guidelines were informed by manufacturers instructions, on site in-services provided by manufacturers representatives, journal articles, and standards developed by the Society for Gastrointestinal Nurses and Associates (SGNA). Just in time teaching is always available to endoscopy

Patient safety is ensured by knowledgeable nurses, competent in their elds of practice. Thorough familiarity with diseases of the GI tract, and the mastery of technology essential to excellence in endoscopy practice, enhances self perception and condence. This mastery demonstrates to the practitioner and patient that the skills and knowledge necessary for excellence in patient care have been attained. The furthering of knowledge is a professional responsibility. A commitment to continued nursing education promotes excellence in patient care, safety and satisfaction.

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INTRAVENOUS INSERTION ANXIETY/NEEDLE PHOBIA

By Kathleen M. Opanasets, RN and Diane M. Pessa, RN

As peri-operative nurses working in the holding area, we see many patients having many different types of surgeries. A common factor in these patients is fear or anxiety relating to intravenous (IV) insertion. No one likes having an intravenous inserted, some are very frightened; and a few patients have a severe needle phobia. It is estimated the incidence of needle phobia among the general population is 3-4 percent (Fernandes, P. 2003). This needle phobia can cause such a high level of anxiety and fear during IV insertion, that patients become pale, diaphoretic and may even have vaso-vagal reactions. This is a real concern to peri-operative nurses working in the pre-operative holding area. Many of our patients have more fear and anxiety over the intravenous insertion than the actual surgical procedure. This is true regardless of whether this is a rst surgery or a more experienced surgical patient. As one of the most common invasive nursing procedures, insertion of an intravenous catheter has a long track record of being painful, stressful and a patient dissatiser (Halm,2008, pp. 265). The anxiety regarding IV insertion can be alleviated in several ways. As with all patients, the nurse must rst assess the patient. The nurse may be able to determine what concerns and fears this particular patient might be experiencing. Some patients are afraid of the needle stick, some are uncomfortable with the idea of seeing any blood, and some are terried of the anticipated or expected pain associated with IV insertion. But its two sticks, instead of one. This is a frequent statement that we hear over and over. Some of our colleagues can be skeptical about the use of buffered Lidocaine before IV insertion. After years of starting IVs in the Emergency Department and in the GI Department, I came to the pre-op holding area. In the pre-op holding area, anesthesia showed me how they use buffered subdermal Lidocaine to insert IVs. Some of our colleagues can be skeptical about the use of buffered Lidocaine before IV insertion. I, too, was a skeptic; after all it was two needle sticks instead of one. But with so many patients lled with fear and anxiety about IV insertion, I was willing to be open minded about the process. After observing anesthesia insert many IVs using buffered Lidocaine, I have observed patients are much more comfortable and have decreased pain and anxiety during IV insertions (Opanasets, K. 2011). Depending on patient needs, a detailed explanation of the IV insertion procedure, use of relaxation techniques, and the use of a local aesthetic can greatly reduce fears and anxiety.
From left, Kathleen Opanasets and Diane Pessa.

One percent Lidocaine is acidic on the pH scale and therefore it causes a burning sensation when it is injected, so Sodium Bicarbonate (Neut) is used to buffer and decrease the pH which results in less burning. A study in the Annals of Emergency Medicine states: Pain and anxiety can be reduced by pre-treating with local anesthetics (McNaughton, Zhou, Robert, Storrow, Kennedy, 2009 pp. 214). This study concluded pain and anxiety were greatly decreased during IV insertion using intra-dermal Lidocaine. IV insertions are a hospital procedure that provokes pain and anxiety. There are ways of alleviating this anxiety by reducing the pain associated with IV insertions. In order to provide patients with the best care based on evidence-based practices, hospitals should develop IV insertion policies to include the use of intra-dermal buffered Lidocaine for every IV start in the adult population. Our goal should be to decrease pains and relieve anxiety whenever possible. Based on the research we have done and the clinical process we have observed it is our intention to work towards an IV insertion policy that permits the use of buffered Lidocaine for the insertion of IVs here at Faulkner Hospital.

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New ICU NUrse DIreCtor NameD

emergeNCy DepartmeNt Names New NUrse DIreCtor

Renia Noel, RN, BSN, was recently named Nurse Director for the Emergency Department. Noel comes to Faulkner Hospital from Cambridge Hospital where she held the same position. Prior to her work at Cambridge Hospital, she worked at Lowell General Hospital for 16 years.

Pat Marinelli, RN

Renia Noel, RN

Pat Marinelli, RN, MSN, was recently named Nurse Director of Faulkner Hospitals ICU. Marinelli has served as the acting director for the past six months and brings over 30 years of critical care nursing and leadership to her new position. Previous to this position, she had been the clinical leader in the ICU since 1998. Pat has been a well respected member of the ICU team, has been recognized by her physician colleagues for her skill and collegiality and is a key member of numerous nursing and hospital committees, says Judy Hayes, Chief Nursing Officer. Marinelli received her Bachelor of Science in Nursing, along with a Masters of Science in Nursing and certification as an Adult Nurse Practitioner from the University of Massachusetts Boston. I am thrilled to have the opportunity to work at Faulkner Hospital as it has a great reputation for creating strong quality care that is patient centered, Noel said. In her spare time, Noel enjoys the outdoors, a good book and cheering on the sidelines at her childrens sports games. She is currently pursuing a Masters in Science degree in Health Informatics and Management at the University of Massachusetts at Lowell. She holds a Bachelor of Science in nursing as well as a certificate in Health Management and Policy, both from UMASS- Lowell. Dedicated to her family; husband, Paul son Lukas and daughters Zoe, Sidney and Nina, she worked weekends and attended classes during the day in order to further her nursing education.

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PATIENT AND FAMILY EDUCATION COMMITTEE PROVIDES RECOMMENDATIONS FOR VERBAL EDUCATION
Faulkner Hospitals Patient and Family Education Committee identied verbal education as our initial priority project. The committee conducted a literature review of articles from 1990-2010. The need for patient education is widely recognized in the medical community. The Joint Commission standard PC.02.03.01 states: The hospital provides patient education and training based on each patients needs and abilities. Communication is effective when patients comprehend accurate, timely, complete, and unambiguous messages from providers in a way that enables them to participate responsibly in their care. However, the reality is that communication is often partially understood, misunderstood or misinterpreted. Even with the best of intentions, patient education that fails to educate can result in adverse events or poor outcomes. The Joint Commission studied patient/provider communication as root causes of sentinel Faulkner Hospitals Patient and Family Education Committee recommends the following practices for effective verbal education: Our literature review enabled us to dene barriers to good verbal education and provide recommendations for best practices in verbal education. events and found that oral communication caused 10 percent of sentinel events from 2006-2008.

Find out what the patient already knows before providing information Ask patients specic questions like, What brought you to the hospital? Realize that patients may not even be aware that they do not understand Use easy to understand language free from technical jargon Talk to NOT AT people Be empathetic, pay attention to the patients fears and try to address them Ask patients about their life experiences and use in teaching Be aware of patients non-verbal messages Emphasize one to three key points Present the most important information rst and repeat it Provide information in several different ways Supplement verbal education with simple visual materials Use a question list Use a teach back method and ask patients to repeat information in their own words Dont just ask the patient, Do you understand? Family members may also need to be educated Use an interpreter if a patient requires one due to language or disability Patients must be given an opportunity to ask questions

Patient and Family Education Committee Members: Christi Barney, Rebecca Blair, Maureen Fischer, Ellen Fusfeld, Carolyn Geoghegan, Dave Hill, Georgette Hurrell, Paula Knotts, Cara

Marcus, Bruce Mattus, Megan McAlpine, Kenneth Pariser, Drew Sanita, Kelly Schoppee, Kathleen Shaughnessey, Billie Starks, Peggy Tomasini, Shannon Vukosa and John Wright.

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WHAT IS A MENTOR?
By Latonya Guice

What is a mentor? My denition of a mentor is a person who offers their knowledge and/ or expertise and support to a person who is new to an area of mutual interest. For instance, a mentor can be a person who provides guidance and encouragement to the mentee, the person that is new and
Lotonya Guice, RN, BSN

It was the most wonderful experience for me. It made me feel special and secure in the fact that I had someone in my corner that I could go to when things became a little hectic and out of control. She would be there to offer me words of encouragement and support and it gave me the condence that a new nurse needs to succeed in this very demanding occupation. As a mentor I am not only there for issues that occur in the nursing profession but I am also there for any personal issues or concerns that the mentee might have outside of the practice. Essentially, I am a condant and friend that is there for any concerns or issues that the mentee might have during this phase in their life. I am very fortunate that I have the opportunity to mentor. It makes me feel proud to know that I am able to give of myself to someone in the way that my mentor gave of herself to me. It has come back around full circle. Like Oprah Winfrey says, we must pay it forward and I am proud to say I am doing just that!

unfamiliar to the area of mutual interest.

I am a mentor because I think that it is very rewarding to be able to offer the skills and knowledge that I have gained over the years in my nursing practice to a newly licensed nurse. I also mentor because I think it is important to give back to someone else. When I was a novice nurse I was approached by a veteran nurse who wanted to take me under her wing to help guide me in my new role as a nurse.

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