nursing notes fall qxp by liaoqinmei


									                             U N I T E D                    H O S P I T A L

                                                                                           October 2005, Vol. 2 (Issue 3)

Tracer Pathways — Improving Service
                                                                               Barb Knudtson, RN, Education Services

In 2002 JCAHO started a new initiative called “Shared        Emergency Department, Interventional Radiology, Cath
Visions-New Pathways.” This initiative resulted in sig-      Lab and Blood Bank. Once this review was complete,
nificant changes to the accreditation process that           Hoesing went to those identified areas with a set of
“sharpens the focus of the accreditation process on oper-    questions related to practice in those areas and tied to
ational systems critical to the safety and quality of        the patient she had reviewed on 3400.
patient care.”
                                                             Key areas of focus in the tracer are:
A key part of the changed survey process is the intro-         Patient safety goals
duction of the tracer methodology — an evaluation              Planning patient care
method in which surveyors select a patient and use that        Transitions and communication between areas and
individual’s record as a road map to move through the          caregiver staff
organization to assess and evaluate the organization’s         Pain management
compliance with selected standards.
                                                             To prepare United nursing staff for this change, a num-
In June 2005 United Hospital staff and leaders experi-       ber of strategies have been implemented:
enced the new tracer method during the mock survey              Unit and department tracers will provide individual
visit with Helen Hoesing. Staff and leaders who partici-        nurses with an opportunity to practice the new
pated commented on the in-depth look at patient care,           method. These will be carried out at first by leaders,
the significant involvement of the bedside nurse and            then unit practice councils, and eventually ACMs.
the range of questions that resulted from looking at one        Messages of the Week are being provided to leaders
record.                                                         to review with staff to be ready for the types of ques-
                                                                tions surveyors will ask.
The mock survey started with a patient selected on              Key messages are provided for staff every week in
3400. Hoesing, our surveyor, sat with the patient’s nurse       Update.
and record. The nurse reviewed the patient’s current            Pocket guides and brochures will be released some-
status with Hoesing. Then the nurse and Hoesing                 time in October as a resource to staff.
looked through the charts “tracing” the care of the             A patient safety goals badge has been provided to all
patient through a variety of departments including              staff.

PRACTICE CHANGE: PICC Flush after Blood Draw
                                                                                        The Nursing Research Council

The Nursing Research Council was recently asked by the IV Team to review clinical research evidence around
the amount of flush solution to use after a PICC blood draw. Our past policy stated to flush the PICC with 10 cc
of normal saline (NS). Community standards and recommendations from the IV Nurse’s Society are to adequately
flush a PICC with 10-20 cc NS to prevent clot formation. This change is being made to our current
“Intravascular Access and Therapy” policy. Another change you will see on the “Venous Access Device” adden-
dum of this policy is to use a 10 cc syringe (rather than the previously stated 3 cc syringe) when drawing blood to
prevent rupture or fracture of the PICC. When reviewing these practice changes, Nursing Practice Care Delivery
(NPCD) also recommended and will follow-up on working with pharmacy to get these flushes on the MAR to
facilitate documentation. Any questions about this practice change can be directed to any member of the Nursing
Research Council or NPCD.
Policies                                     Being an Excellian® Super-User at ANW
                           Linda Johnson,                                           Lisa Waytulonis, RN, Clinical Documentation
             Patient Care Support Services
                                             Lisa Waytulonis, RN, Clinical               The super-user is essential to a success-
Listed below are those documents in the      Documentation, worked as a super-user       ful Excellian® go-live. Super-users need
United - Patient Care Policy/Procedure       for the Abbott Northwestern (ANW)           to be highly motivated and interested
category on the Allina Knowledge             Excellian® go-live this summer. As a        in supporting their peers, physicians
Network (AKN) that have been updat-          member of United’s Excellian® Core          and others by being out of the count
ed since 6/2/05.                             Team, Waytulonis gained valuable            and working directly with them during
                                             experience she plans to use in helping      implementation. They are involved in
You can view these revised policies on       plan for United’s go-live (scheduled for    reviewing department work flows, act-
the AKN.                                     first quarter 2007).                        ing as a teacher’s assistant during train-
                                                                                         ing and directly communicating with
                                             Prior to the go-live, Waytulonis pre-       staff on the units during go-live.
                                             loaded patient information and med-
    Breast Massage & Hand Expression         ications into Excellian® . After go-live,   Members of United’s Excellian® SWAT
    Breast Milk Collection & Storage         she worked five shifts as a super-user      team participated in the ANW go-live
    Chest Suction, Chest Drainage            nurse across three cardiovascular           and will be going to Mercy and Unity
    System                                   telemetry units at ANW.                     hospitals to assist them. Participating
    Eclipsys SCD: Documentation and                                                      in these go-lives helps us plan for suc-
    Printing                                 In her role, Waytulonis found that          cessful implementation at United. We
    Eclipsys SCD: Downtime                   good communication was important to         also hope to benefit by having super-
    Eclipsys SCD: Routine Hardware           a successful go-live. For instance, she     users from those sites come here to
    Maintenance and Problem Resolution       found that meetings between nursing         support us during our go-live. United
    Eclipsys SCD: User Access                shifts to review outstanding issues,        will need many more super-users from
    Emergency Patient Care                   problems and to hand-off the issues log     all areas for our own go-live. Watch for
    Gastrostomy Tube Replacement             were essential. Each charge nurse had a     more information on super-user
    Hypoglycemia, Treatment of               digital pager so that urgent information    recruitment at United.
    Identification Bands — Patients          could be communicated housewide as
    Identification of Operative Site         necessary for leaders to share with
    Med — Administration —                   employees, super users and Excellian®
    Transdermal Route                        staff.
    Med — Management of
    Extravasation of Peripheral
    Intravenous Solutions & Drugs
    Pain Management                           Celebrations
    Declotting Central Venous Catheters
    Using Alteplase                          Congratulations to the following            Oncology Nursing Certification:
    Apheresis, In-Patient                    nurses who recently achieved                  Leslie Foreman, RN, Breast Center
    Restraint or Seclusion Use:              national nursing certification!               Nurse Clinician
    Behavioral Management
    Food/Drug Interactions                   Medical-Surgical Nursing                    Rehab Nursing Certification:
                                             Certification:                                Maren Nelson, RN, 8940
                                               Brenda Larsen, RN, 2600
Deleted                                        Joyce Grosser, RN, 2600                   Gastrointestinal Nursing
    Autotransfusion                            Monica McClelland, RN, 4400               Certification (CGRN):
    Breast Pump — Medela® Classic              Katie Westman, RN, 4920/40                  Lisa Haviland, RN, Endoscopy
    Breast Pump — Medela® Lactina              Lisa Torres, RN, 4920/40                  Other News
    Breast Pump — Medela® Manual               Shannon McNamara, RN, 4920/40
                                                                                         Margo Halm, RN, CS, PhD, director
                                             Gerontological Nursing                      of Nursing Research/CNS was
                                             Certification:                              recently appointed to the American
                                               Barb Murray, RN, 4400                     Association of Critical-Care Nurses
                                                                                         Research Grant Review Panel.

Diabetes Update
  by Diabetes Resource Staff: Patti Long, RN, CDE; Marti Rud, RN, CDE; Lisa Schipp, RN, ES; and MJ Lee-Vanhoulton, RN, CDE

Latent Autoimmune Diabetes in                                                             Reminder
                                                                                          When you admit a patient with an
Adults (LADA)                                                                             insulin pump, you MUST get orders for
A growing number of adults have a form       controlling blood glucose for years are      the basal rates and meal boluses, as
of diabetes that does not seem to fit ini-   those that stimulate pancreatic              well as for the correction boluses.
tially into the broadly accepted cate-       production of insulin, slow digestion of     These MUST be written on the MAR.
gories of type 1 or type 2 diabetes. These   carbohydrates or reduce excess glucose       If the physician orders “per patient,”
patients have a form of diabetes called      production.                                  you must ask the patient what his or
latent autoimmune diabetes in adults                                                      her rate is and clear it with the physi-
(LADA). They are often not over-             Diagnosis of LADA includes measure-          cian. Patients need to bring all supplies
weight and have little or no resistance      ment of C-peptide levels, which would        as we do not have these. Site changes
to insulin. It is not much different from    be low to normal (C-peptide levels in        are to be charted same as any other site
type 1 diabetes that appears in children     type 2s is within normal or elevated).       change. Patient must be completely
but strikes later in life and has a slow     Depending on these results, a measure-       independent in all areas related to the
onset. An estimated 5 percent to 10          ment of antibodies that attack beta cells    pump or it is not safe for that patient
percent of all patients with diabetes may    (especially antiglutamic acid decarboxy-     to wear the pump in the hospital. Run
have it. Because insulin resistance is       lase antibodies) may be performed and in     the insulin pump custom document as
minimal or nonexistent, the standard         the case of LADA would be elevated.          soon as possible as this outlines your
medications designed to reduce insulin       The treatment of choice for these indi-      responsibilities and lists the pump
resistance tend not to be effective.         viduals would be insulin as with type 1s.    manufacturers’ resource numbers. This
Medications that are often effective in                                                   document is found by selecting #5 in
                                                                                          the custom document screen, typing
                                                                                          “insulin” and selecting insulin pump
                                                                                          document. All insulin pump patient
New Product Alert                                                                         admissions REQUIRE a consult with dia-
                                                                                          betes resource as per the admission
   The Opticlick® Lantus® pen is now            stocked in the glucometer kits. There     screening tool.
   available to our patients through the        is now an alternative. The purple
   diabetes resource staff. If you have a       lancets are much kinder to our
   patient who you feel may benefit
   from this product, please initiate a
                                                patients as they have a smaller gauge
                                                needle. You can order these from
                                                                                          DID YOU KNOW?
   diabetes consult.                            materials management — Lawson                About 8.6 million people over 60
                                                number 154665. Lets make our                 have diabetes! That’s 18.3 percent
   We have received many complaints             patients as comfortable as possible.         of that age group, and the numbers
   about pain from the orange lancets           Give them a try!                             are equal among men and women.
                                                                                             We work with two home delivery
                                                                                             companies: Byram Healthcare and
                                                                                             CCS Medical. Both offer home
                                                                                             delivery of diabetes and other sup-
Medication Update                                                                            plies (i.e., stoma supplies). They
A new medication has just been               secretion and regulating gastric empty-         both bill insurance companies,
approved for the treatment of diabetes,      ing. It may even encourage new beta cell        including Medicare, and only charge
called BYETTA™. It will be injected BID      formation, and it has been proven to            what Medicare allows (less co-pay
up to 60 minutes before meal time. It        cause weight loss in many patients. It is       for these patients). CCS also has
does not replace insulin but offers          delivered by a pen in 5 to 10 mcg and           prescription drug delivery, and they
improved glucose control by increasing       must be kept in the refrigerator and dis-       accept Medicaid and all other types
the production of insulin in response to     carded 30 days after the pen is initiated.      of insurance. For more information
food, suppressing postprandial glucagons     LOOK FOR IT SOON!                               about these companies, talk with
                                                                                             one of the Diabetes Resource RNs.
The features of the new PCx
strip include:
    Gold wrap to easily distin-
    guish it from the current
    silver wrapped version
    The test strip requires less
    The target area for the blood
    application on the new strip
    is at the end of the strip
    rather than the middle.
    The strip has a clear plastic
    coating that allows you to see
    blood wicking into the strip

   Look for it this Fall.
   Happy glucose testing.
United Hospital Nursing Shines                                                          Words from staff:

                                                                                        Why I Returned to
during Magnet Mock Survey                                                               United Hospital
                                             by Naomi English, RN, Patient Care Float
                                                                                        Jessie Schwab, RN, is a critical care nurse
Julia Au Coin, PhD, a consultant from        As we accompanied Au Coin around           on 3940. She started at United in 1999
the American Nurses Association              the campus and heard her speak during      as a nurse’s assistant, but left in 2004 to
Credentialing Center (ANCC) and a            the informal wrap-up session, we all       go to a home care agency. She returned
professor at the University of North         realized just how special and valuable     six months later. This is an interview
Carolina’s School of Nursing, conduct-       nursing is at United and how our daily     with her on her perspective of returning
ed a mock survey of the nursing depart-      efforts impact the excellent delivery of   to United.
ment of United Hospital on Aug. 8-9,         patient care. This mock survey gave our
2005. A mock survey is part of the           magnet process a big boost as it served    Q: What were you looking for when you
process to attain ANCC’s Magnet              to build momentum and validate what        left United?
Hospital award for Nursing Excellence.       we as nurses have already accomplished.    JS: I wanted to expand my role as
A committee of United nurses has been                                                   professional registered nurse and increase
working for more than a year to earn         Those of us on the Magnet Steering         my clinical expertise. At the time there
this prestigious award. Currently, only      Committee feel that the designation is     were no open positions at United, so I
3 percent of American hospitals have         well within our grasp. We continue to      looked elsewhere.
met the stringent requirements to be         make progress toward this achievement.
designated a “Magnet Hospital.”              United has submitted an application,       Q: What persuaded you to return?
                                             and work has begun on the extensive        JS: I started at United as an NA and pro-
During her two days at United,               amount of written documentation that       gressed to an RN. I felt very comfortable
Au Coin met with staff nurses, nursing       is part of the process.                    with the environment here and with my
leaders, pharmacists, respiratory thera-                                                nursing colleagues. I came back to
pists, administrators and physicians. She    I am very happy to be a part of this       United in the Float Pool knowing that I
asked probing questions about nurses’        endeavor and represent the staff nurse     would find a good environment in which
accomplishments, perception of nursing       perspective. Feel free to contact me at    to practice and opportunities to expand
by other departments and nursing col-, or you can       my role as an RN. I felt that the educa-
laborate for excellent patient care.         contact Julie Sabo (1-8378) or any of      tional offerings were excellent and want-
                                             the other committee members.               ed to take advantage of them.
Au Coin focused mainly on staff nurses,
touring many of the nursing areas and        Magnet Steering Committee                  Q: What keeps you at United now?
interviewing individual staff nurses. She                                               JS: I feel I am a valuable member of the
asked them why they choose to practice       Ruth Darvell, RN                1-8335     health care team; it is a respectful and
at United, if they were certified in their   Julia Endres-Spray, RN          1-8095     learning environment. I foresee opportu-
nursing specialty and how United helps       Naomi English, RN               1-8030     nities for me in the future as I continue
them attain/maintain certification. She      Kathy Forbes, RN                1-8525     to grow professionally. I took the critical
also was interested in staff nurses’ com-    Margo Halm, RN, PhD             1-8536     care course, and it was great. I also am
munity involvement, including types of       Barb Knudtson, RN               1-8775     supported by my leaders and peers.
volunteer activities, and how we             Susan Loushin, RN               1-8240
achieve balance between our personal         Ginny Oskey, RN                 1-8666     Q: What advice do you have for others seek-
and professional lives.                      Sue Penque, RN                  1-8815     ing nursing opportunities here at United?
                                             Laurie Post, RN                 1-8450     JS: Check everything out; there are so
Au Coin spoke with members of                Pat Ryan, RN                    1-8369     many opportunities for RNs here. You
United’s nursing committees about how        Julie Sabo, RN                  1-8378     may not think one position is what you
information on research and quality ini-     Debbie Sapp                     1-8585     are interested in, but check it out any-
tiatives is communicated to other nurs-      Karla Sohl, RN                  1-2375     how. I networked with lots of people
ing colleagues. Au Coin was impressed        Marie Stuewe, RN                1-6335     here, so they all knew I was looking for
with something that most of us take for      Rose West, RN                   1-8031     more opportunities and kept me informed
granted — the view from and the                                                         when such opportunities arose.
design of many of the patient rooms.

Gerontological Nurse Certification
Becoming a Future Oriented RN
                                                       By Anna Gryczman RN, MSN, PHN, AHN-BC, United Hospital Staff RN

Did you ever wonder what the future            older,” will grow by more than 50 per-     you are considering a career in oncology
will bring regarding your nursing career?      cent in the next fifteen years. The most   nursing, you know that the majority of
                                               rapidly growing demographic group          cancer patients are older adults. Or
The future can be predicted by looking         among age categories is the “oldest eld-   look at how many older patients have
at demographics, technology and other          erly” — the population age 75 and over.    chronic health care needs requiring
societal forces. Demographic trends in                                                    general medical-surgical hospitalization.
the United States clearly point to an          Because of this you may want to consid-    The same is true for emergency nursing.
increasing number of elderly people            er Gerontological Nurse Certification      According to Hutchins (1999) and
needing health care services and not           today . . . invest in your personal and    O’Neill & Barry (2003), older adults
enough nurses prepared in geriatric            professional growth as a registered        make up 60 percent of visits to
nursing to manage their care.                  nurse.                                     cardiologists and 53 percent of visits to
But what does it mean for YOU? Will            The American Nurses Credentialing
you be prepared to provide the best care       Center (ANCC) offers a gerontological      So consider Gerontological Nurse
for your older patients?                       certification exam for entry-level RNs.    Certification today . . . your expert
                                               To prepare for the ANCC                    knowledge will positively impact
To become confident and competent in           Gerontological Nursing Certification       patient outcomes in more than one way.
your ability to care for geriatric patients,   exam, the John A. Hartford Foundation      Be proactive.
you will need specialized knowledge,           Institute for Geriatric Nursing offers a
including an understanding of normal           FREE online review course. Visit           For information about gerontological
aging and familiarity with the different for more informa-      nurse examination, including the eligi-
ways an older patient may present with         tion and          bility requirements, fees, exam content
subtle clinical manifestations.                                                           outline, study references and a sample
                                               Because the majority of patients in most   of practice examination questions, visit
Census Bureau (2000) population pro-           nursing specialties are over age 65, you
jections indicate that the number of           will need geriatric nursing knowledge in
elderly defined as the “age 65 and             almost every specialty. For example, if

Our Journey to Magnet Status: Focus on Force 1
                                                                                            Julie Sabo, RN, MN, CCRN, APRN-BC

Force 1 of the 14 forces of Magnetism          board, the Nursing Practice Care                Linda Gfrerer and Susan Loushin
speaks to the quality of nursing leader-       Delivery Board. Together they lead staff        (Education Services) — Members of
ship. Leaders are not defined just as          RN leaders and nurses in other roles            Minnesota Organization of Leaders
those in traditional leadership roles,         from all areas in reviewing and approv-         in Nursing
such as nurse managers, directors or           ing variable staffing plans, nursing poli-      Sue Penque (Administration) —
CNSs, but also the formal and informal         cies, nursing outcomes (patient falls,          Past president of American
nursing leaders we have in direct              pressure ulcers, nursing satisfaction,          Association of Critical Care Nurses
patient care roles. Nurse leaders are          etc.) and a multitude of other issues           Julie Sabo (John Nasseff Heart
described as knowledgeable, strong risk        impacting nursing practice.                     Hospital) — Past president of local
takers. They are the wise nurses who we                                                        National Association of Clinical
go to for nursing consultation when            Our Low Lift Committee is another               Nurse Specialists(NACNS) affiliate
faced with a difficult patient situation,      great example of how nurses have                Kelly Gannon (Neuro Program
ethical dilemma or management issue.           impacted patient care thorough the hos-         Leader) — Member of American
                                               pital. The nurses involved were leaders         Neuroscience Nurses
Magnet Force 1 is exemplified in               in obtaining, training and championing          Margo Halm (CNS) — NACNS
Magnet hospitals by a variety of charac-       safety equipment to move patients.              Nominating Committee member
teristics. First, competency, skill and                                                        and fellow of the American Heart
educational advancement are valued,            How are United RNs taking a lead in             Association’s Council on
role modeled and supported by the              the profession of nursing? Look at the          Cardiovascular Nursing
institution. The mission, vision, values       number of United RNs running for                Linda Christinsen-Rengel (Perinatal
and strategic plan of nursing are con-         MNA office, delegate or board of direc-         Outreach Coordinator) —
gruent with those aspects of the organi-       tors — pretty impressive. Other exam-           Membership coordinator for
zation. The Chief Nurse Officer                ples of leadership are:                         Minnesota section AWHONN and
(CNO) represents all nurses within the            Bunny Engeldorf (Behavioral Health           on Planning Committee for
institution at the highest governing              Service) — Commission for MNA                Minnesota Perinatal Organization
body. The CNO and other nurse                     Economic and General Welfare                 Cheryl Kirchner (Birth Center) —
administrators secure adequate financial          Program                                      Member of the Education
and human resources to support nursing            Linda White (Medicine) and Julia             Committee for Minnesota Section
practice throughout the hospital.                 Endres-Spray (Oncology) — Both               AWHONN.
Nursing input is valued, and decision             directors for MNA
making and nursing satisfaction are               Anna Grcyzman (Float Pool) —              This list is by no means complete and it
measured. Nurses from many roles are              Commission for Education                  could go on and on!
included in decisions and are involved            Larry Himebaugh, Bette Sisler, Dan
in governing bodies. Nurses at all levels         Halbakken, Denise Elling, among           What examples can you think of on
lead and participate in professional              others (ED) — All are members of          your unit or in your life that exemplify
nursing organizations at all levels.              the Emergency Nurses Association          and amplify the leadership that nursing
                                                  Polly Groshens (ED) — Past presi-         takes on at United and in the nursing
Whew! Those are big statements. So                dent of Minnesota Emergency               community each day? It is there every
how do we at United exemplify this                Nurses Association                        day and the results of that leadership
force? Sue Penque RN, MSN, APRN-                  Diane Lemay (3300) — A member             are evident at the patient’s side.
BC, is our CNO; she is part of the                of the MNA Foundation
Senior Management Team, which is                  Rosanne Ferguson (Sister Kenny
the highest governing body at United.             Rehabilitation Institute) — Board          Correction:
Her role is integral to all issues affecting      member for the Minnesota Stroke            In the summer 2005 issue of Nursing
nursing, and she actively advocates for           Association                                Notes, the author of “Staff Nurses
nursing practice. The CNO and our                 Mary Goering (Birth Center) —              Attend Magnet Conference in St.
Minnesota Nursing Association                     Secretary for MN Association of            Cloud,” was listed incorrectly. The
(MNA) leader, Linda Slattengren, co-              Women’s Health, Obstetric and              author is Naomi English, RN, Patient
chair our highest nursing governing               Neonatal Nurses (AWHONN)                   Care Float.

Practice Change: Foley Catheter Care
                                                                                                                The Nursing Research Council

The Nursing Research Council recently         4. Pre-testing of silicone catheter bal-             should be avoided to prevent back-
recommended practice changes related             loons is not recommended since the                flow of urine into bladder.
to Foley catheter management as based            silicone can form a crease at the
on evidence in the current research lit-         balloon area, causing trauma to the            8. Catheters may leak from a variety of
erature. These changes are discussed in          urethra during insertion.                         causes, including kinked catheters or
the fourth quarter self-study packet.                                                              drainage tubing, constipation or fecal
Highlights include:                           5. Secure catheters or tubing to the                 impaction, bladder spasms, infection,
                                                 thigh in both males and females to                occluded lumens or encrustration.
1. Use alternatives whenever possible,           prevent movement and traction. If                 Refer to the self-study packet for an
   such as condom catheters, in men              using tape to secure, remove any                  evidence-based protocol for manag-
   when short-term catheterization is            sticky biofilm that accumulates on                ing each of these problems.
   necessary.                                    the catheter since microbes can
                                                 ascend into the bladder from this              9. Irrigation of catheters should be
2. For insertion, a single-use packet of         residue, setting the patient up for a             avoided unless obstruction is suspect-
   lubricant and/or 2 percent lidocaine          catheter-associated urinary tract                 ed. Remember a physician’s order is
   jelly is recommended for comfort. In          infection (UTI). A nonadhesive                    needed for intermittent irrigation.
   men, the lubricant should be gently           catheter holder, such as the elastic
   injected directly into urethra. If using      Cath-Mate™ or multipurpose tube                10. Cleaning urinary equipment is no
   lidocaine jelly, wait 2-5 minutes             holder, should be considered to                    longer recommended during hospital
   before continuing.                            eliminate the presence of biofilm,                 stays to ensure a closed system is
                                                 especially if longer-term catheteriza-             maintained to prevent catheter-
3. Use the smallest catheter (14-18 Fr)          tion is anticipated.                               associated UTIs. Therefore, leg bags
   and balloon size (5 cc) possible.                                                                should not be changed to night bags
   Inflate the balloon with 5-10 cc           6. Empty collecting bag every 4-6 hours               while patients are hospitalized.
   sterile water. NEVER use more than            to prevent bacteria from migrating
   10 cc.                                        up the catheter lumen.                         11. There remains no definitive guide-
                                                                                                    line on when Foley catheters should
 Nursing Notes Editorial Board                7. Collection bags should always be                   be changed. As a general rule,
                                                 kept below the level of the bladder                catheters should be removed as soon
Margo Halm, RN, CS      Michele G. Scheid
    Newsletter          Communications
                                                 and dependent loops in the tubing                  as possible.
    Coordinator             Specialist

 Sue Penque, RN, CS       Elaine Tuhy
    Vice President       Administrative
                                                The Nursing Research Council:
     Patient Care           Assistant           Miriam Blalock, RN                Barb Jacobs, RN                   Bette Sisler, RN
                          John Nasseff
                                                Becky Braden, RN                  Katie Krisko-Hagel, RN            Patti Soll, RN
  Julie Sabo, RN, CS     Heart Hospital
      John Nasseff                              Minda Demira, RN                  Dave Larson, RN                   Deb Steele, RN
    Heart Hospital     Glenda Cartney, RN       Norbert Erben, RN                 Stephanie Leininger, RN           Linda Strom, RN
                          ACM, 3940             Mary Goering, RN                  Diane Lemay, RN                   Jen Wells, RN
                                                Anna Gryczman, RN                 Anna McFarlane, RN                Molly Zignego, RN
                                                Margo Halm, RN                    Julie Sabo, RN

                                      Nursing Notes is the official newsletter of United Hospital nurses. Nursing Notes is published quarterly by
                                      the United Hospital Nursing Care Delivery Board. The Nursing Notes editorial board reserves the right to
                                      edit material based on content and space and the right to change this policy at any time. If you are inter-
                                      ested in serving voluntarily on the editorial board, please contact Margo Halm at 651-241-8536.

                                      Submissions for Nursing Notes are preferred in writing (electronic) and can be sent to: Margo Halm, RN,
                                      newsletter coordinator, or United Hospital, 333 No. Smith Ave., Mail Route
                                      60231, St. Paul, MN 55102, 651-241-8536. Please include your name, department and phone number.

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