magnetismof

2006 NURSING ANNUAL REPORT

Dear Nursing Colleagues,

In my role as Acting Senior Nurse Executive, I frequently have oppor-tunities to learn about and tell sto-ries of nursing excellence. Patients, family members, physicians and

others often relate how simple acts of kindness and caring have made a difference in the life of a patient or their loved ones. When I hear these stories—I know that nurses at DHMC exemplify excellence and strive to bring healing and comfort to our patients and their families. A

nurse’s scope of responsibility may include holding a patient’s hand, giving pain medication, or provid-ing life-saving interventions. At the frontline of care, nurses play a vital role in promoting organizational ef-forts toward keeping patients safe

and achieving excellence regard-less of the patient’s need.

In the past year, members of the healthcare team and nurses have focused on numerous initia-tives to improve the reliability of patient care, safety, and qual-ity. These efforts have addressed

improving patient satisfaction, participating in the Institute for Healthcare Improvement’s 100,000 Lives Campaign, addressing The Joint Commission’s National Patient Safety Goals, and meet-ing expectations of the Center for Medicare/Medicaid Services core measures. Examples of these efforts include activating the Hitchcock Early Response Team, improving the identification of medications on the sterile field, enhancing processes by which in-formation is shared about patients when care is transferred to another caregiver, and decreasing the rate of surgical site and blood stream infections. When nurses provide care, they take important steps to ensure the safety of patients, limit their risks of infection, and prevent complications. Each intervention supports our patients to receive the right care at the right time while meeting their individual needs and preferences.

This year, the Nursing Annual Report presents a series of stories

that illustrate the nursing experi-ence at DHMC. Each of the stories has a theme that corresponds to one of 14 characteristics identified with Magnet hospitals. Not only do these stories exemplify how DHMC earns Magnet status—they also demonstrate how the nursing experience is one of nursing excel-lence at DHMC.

Our initial recognition as a Magnet hospital served as a mile-stone in our pursuit of continuing and expanding efforts to be one of the best nursing organizations in the country. We still have work to do to help us achieve that goal. Please join me in celebrating all that we have achieved, all that each nurse does each day, and our ongoing pursuit of nursing and patient care excellence.

Sincerely,

Linda J. von Reyn, RN, PhDActing Senior Nurse Executive

“A nurse’s scope of

responsibility may include

holding a patient’s hand,

giving pain medication,

or providing life-saving

interventions. At the

frontline of care, nurses play

a vital role in promoting

organizational efforts toward

keeping patients safe and

achieving excellence.”

Autonomy4 Answering an Unmet Need

QuAlity of nursing leAdership5 Supporting Excellent Patient Care

professionAl models of CAre6 The Emerging Concept of Mutuality

QuAlity of CAre

7 Bridging the Gap Between Pediatric and Adult Care

QuAlity improvement8 Creating a “Culture of Mobility”

imAge of nursing9 Improving the Quality of Patient Care and Nursing

professionAl development11 Engaging Staff Nurses as Teachers

personnel poliCies 13 Being Heard, Feeling Valued

orgAnizAtionAl struCture14 When it Comes to Patient Care – Every Detail Counts

nurses As teAChers 15 Helping Smokers Quit

mAnAgement 16 Always Teaching, Always Learning

interdisCiplinAry relAtionships 17 Working Together to Prevent Patient Falls

Community & hospitAl 18 Building Community Awareness About the Risks of Stroke

ConsultAtion19 Advancing the Practice of Nursing

20 DHMCNursing Showcase

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Table of Contents

Autonomy

Answering an Unmet NeedAt DHMC, nurses are fortunate to work in an

environment that nurtures their professional de-

velopment and encourages them to expand their

expertise to continually improve the care of various

patient populations. The following testimonial from

experienced nurse

leader Peter Nolette,

RN, provides an excel-

lent example of this.

“I have now been

in the wound care

nurse role at DHMC for

a year and a half— it

was not something I

would have predicted

doing several years

ago. I identified the

need for a wound

care expert resource within a few months after the

previous part-time resource left the position. In view

of my previous administrative work with the Skin

and Wound Improvement Team, I offered to obtain

further education and training to take on that role

and to obtain national certification.

“As a certified wound care resource for DHMC,

I am attempting to meet the wound care needs of

both ambulatory and inpatient groups. To help edu-

cate staff and manage wound care more proactively,

I am developing a cadre of unit-and-department-

based resource nurses. This group attends quarterly

meetings that include educational programs related

to wound care, and meets in a forum that promotes

group problem-solving and planning to address

wound care issues throughout the organization.

“In addition, many nurses spend a day with me,

doing wound care to become more immersed in

its science and to help promote the application of

this science to everyday skin/wound care of patients.

While teaching these nurses about wound care

science, I also teach the patients and their families.

This helps the nurses to understand the challenges

that patients face after discharge. It also provides

the patient and family with valuable knowledge that

can empower them to become active participants in

their care. This usually results in patient compliance

with wound care therapies.

“The wound care nurse role utilizes the learn-

ing I have achieved from my previous clinical roles

in the OR, Pediatrics, CCU, Outpatient Cardiology,

Renal Dialysis, Radiation Oncology, Discharge Plan-

ning, Case Management, and Nursing Informatics. I

draw on those experiences and knowledge bases

daily in meeting the wound care needs of medically

complex patients and am able to correlate these

complexities with developing plans of care specific

to the individual patient.

“Unfortunately, wound care science is not a

regular part of the curricula of medical or nursing

schools. Currently, there are no physicians at DHMC

who carry this certification. However, there is recog-

nition of the importance of this science and specialty

by a number of physicians who wish their patients

to benefit from this knowledge. This has led to many

collegial relationships in which physicians learn

Peter Nolette

more about the science of wound care and how it

benefits their patients, and seek recommendations

on how patient wound care needs can be best met.

“In my role, I provide continuing education for

nurses at DHMC and across the region. In addition,

DHMC has a relationship with a local long-term care

facility that calls upon my expertise in developing

plans of care for their clients. I have also been a

guest lecturer in several classes of area high schools

and nursing schools, and teach in a variety of edu-

cation programs for RNs, LPNs, and LNAs.”

QuAlity of

nursing leAdership

Supporting Excellent Patient CareAbout a year ago, when Sandra Dickau took over

responsibility as Vice President of Patient Care, one

of her first priorities was to address the leadership

development needs of DHMC’s nursing community,

especially its inpatient nursing directors.

“We drew from the expertise of an external

consultant, internal resources, and the nursing direc-

tors themselves, to assess our needs and to come

up with a work plan that focused on two goals—to

strengthen and further develop individual leader-

ship performance, and to unify and strengthen the

performance of the leadership team,” says Dickau.

With pressures such as an increased de-

mand for inpatient beds and the inability to recruit

enough experienced nurses, the Medical Center’s

priorities were shifting. “In the past, Nursing had

been organized in a more decentralized manner by

specialty,” she explains. “We are now becoming more

unified in our approach and organization. With the

inpatient nursing directors part of a single division,

we were focused on becoming more effective and

efficient in our inpatient care delivery system.”

Personal and Team GrowthMeeting twice a month, the group created a cur-

riculum to improve individual leadership competen-

cies such as how to lead and manage change, how

to build and monitor a budget, and how to commu-

nicate effectively in a complex nursing environment.

To help build an environment that would fos-

ter high-performing teams, the group introduced

more structure to its own meetings. “As we devel-

oped a charter for our team, we got down to the

specifics of things like how we were going to run

our meetings, keep minutes, manage conflict, and

make decisions,” says Dickau. “We brought that same

kind of rigor and discipline to the dynamics of team

management on the units.”

One important exercise involved re-examin-

ing roles and responsibilities of unit staff. “We’ve

tried to be very conscious about providing an

opportunity for people to move into positions of

leadership where it fits for them,” she explains. “To

do that effectively, we’ve needed to create more

clarity about what specific role responsibilities are

so we can help nurture people that have the skill,

aptitude, and desire to grow in leadership. If we

Sandy Dickau

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can be strong leaders, we can make sure we have

a strong foundation not only for Nursing but most

importantly for excellent patient care.”

Throughout the process, Dickau has rein-

forced that core value for every director to keep in

mind as they’re making decisions. “The quality of

patient care has got to be the most important thing

they focus on,” she says. “Whether we’re talking

about a policy, schedules, budget or equipment,

if we keep asking ourselves, ‘What’s best for the

patient?’, then we won’t go wrong.”

professionAl models

of CAre

The Emerging Concept of Mutuality

“Mutuality” is the convergence of two or more people

brought together in a balanced relationship, charac-

terized by understanding and respect for others in

order to achieve a shared goal.

At DHMC, Inpatient Psychiatry nurses Jim

Biernat and Susan Wiitala have been seeking to de-

termine if the concept of mutuality can be infused

into health care.

“Along the way, we’ve found that the idea of

mutuality is more than collaboration and patient

empowerment,” says Biernat. “It transcends the con-

cepts of compliance or adherence. It calls for each of

us, as caregiver and patient, to pay attention to each

other so that we may understand each other.”

“From that meeting place, shared goals can be

developed with caregiver and patient both invested,”

he adds. “There is the acknowledgement that each

needs the other. With mutuality, we shift our focus

from lamenting about not having enough time for

collaborative care to searching for the conditions

that enhance it.”

But according to the American Hospital As-

sociation report, “Eye on Patients,” in both ambula-

tory and acute care settings patients have frequently

reported that they were not involved in decisions

about their care to the extent they desired. Provid-

ers and payers are often seen as “warring tribes.”

Have the variables in healthcare delivery gotten so

complex and so time

pressured, that col-

laboration can only be

an elusive fantasy that is

constantly being dashed

by the pressing need

for expediency and cost

containment?

“As healthcare pro-

viders, we often engage

in an ‘expert’ model of

helping,” says Wiitala. “We

focus more on ‘doing for’

rather than ‘being with’

the patient. In this model,

there is an unequal powerbase between healthcare

provider and patient. Our concept of patient com-

pliance is a symptom of this inequality. As patients

face the complexities of chronic illness and the

increased number and variety of providers that are

needed for health management, we’ve asked our-

selves, ‘Will health care become an embattlement to

survive or can we create an invitation to thrive?’”

Jim Biernat

For several years Wiitala, Biernat, and the

multidisciplinary members of the Psychiatric

Quality Assurance Team have looked at monthly

patient satisfaction scores—scores below 80

would naturally trigger a quality improvement

initiative. With the help of a colleague statistician,

Steven Wiitala, they were recently able to uncover

a phenomenon in the data that was present but

not fully appreciated.

“Within the patient satisfaction scale were

questions that assessed the key components of

mutuality,” Biernat explains. “Upon closer examina-

tion, we found that not only do these components

actually cluster together but they significantly affect

patient satisfaction outcomes and confirm that

mutuality in medicine can work.”

Their next step is to see under which condi-

tions the presence of mutuality in health care can be

enhanced. “While this part of our journey is just be-

ginning, we think it is a journey worth the undertak-

ing—indeed, we wonder if it might be the journey

itself that puts us all in a better place,” says Wiitala.

QuAlity of CAre

Bridging the Gap Between Pediatric and Adult CareWhen it comes time for a pediatric patient with

complex medical problems to begin receiving adult

care, making the transition can involve a number of

challenges.

“Parents, who are usually the primary care

givers, have a difficult time seeing their child as

an adult when they reach 19 or 20 years of age

because they have not progressed through the nor-

mal stages of growth and development,” explains

Sharon Markowitz, a Nurse Manager in Pediatrics.

“They know and trust their child’s pediatric care

team. And the pediatric care team—which includes

the pediatrician, specialty nurse coordinators, social

workers, continuing care managers, and school

nurses—knows and trusts their assessments of their

child’s condition.”

A further complicating factor is that, often

times, the diseases or conditions children have are

most common in childhood and are unfamiliar to

adult medical care providers. In turn, as children

become adults, there are adult conditions and

medications that pediatricians are not familiar with.

Hospital admission policies often require

children over the age of 19 years to be admitted

to adult units. “But adult nurses and providers,

especially house staff, are not trained in the care of

these complex children,” says Markowitz. “And since

the pediatrician is not able to be the provider to

patients in the adult units, the parents often feel

abandoned without the support of their regular

care team. It was during these times—when a child

was in crisis and needed to be admitted—that our

own pediatric nursing staff noticed that we really

had no transition, and no preparation time for the

Linda James, Ellen Heuduska, Sharon Markowitz

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parents or the care team to adjust to the changes.”

To address the problem, the nurses recently led

a multidisciplinary effort to develop an effective tran-

sition process at DHMC. This process now includes:

pediatric providers initiating transition discussions for

medically complex children as part of their well child

check at 13 years of age; a new summary form com-

pleted by the parents and pediatric care team before

the child’s 19th birthday; a meeting between the

family, pediatric care team, and the adult care team

who will be taking over the care; and a transition ap-

pointment with the adult provider, with the continu-

ing care manager and pediatric nurse coordinators

staying involved with the family and as resources for

the adult caregivers until the transition is completed.

“This plan will hopefully allow the transition pro-

cess to flow smoothly, so that the patient and family

will feel prepared, their specialty needs will be consid-

ered, and the best care possible will be provided for

the child,” says Markowitz. “Thanks to the efforts of the

nursing staff—who wanted to provide the best care

for their patients who are approaching adulthood—

this transition plan has come into fruition.”

QuAlity

improvement

Creating a “Culture of Mobility”

On DHMC’s 3 West unit, postoperative patients who’ve

had joint replacement surgery are encouraged to get

up for every meal, walk frequently, and exercise more

as part of an interdisciplinary performance improve-

ment project called, “A Culture of Mobility.” By embrac-

ing this change in culture, nurses, surgeons, anesthe-

siologists, and physical and occupational therapists

have positively impacted their patient care practices.

“Demand for total joint replacement surgery

has increased as the baby boomers have aged and

more elderly people remain active and function-

ing,” explains Mary Catherine Rawls, RN, a Clinical

Nurse Specialist in Surgery. “We needed to expand

our access and capacity at DHMC to accommodate

increases in the need for this surgery.”

To ensure that nursing, physical therapy, and

discharge planning processes were “best prac-

tice” and evidence-based, they were reviewed by

an interdisciplinary steering committee. Process

improvements in the following categories provided

a framework for the project: preoperative patient

education and preparation, anesthesia and surgical

preference, commencement and aggressiveness of

therapy, patient mobility and progress, and discharge

planning and community resources.

A 3 West “Ambassador Group” comprised of regis-

tered nurses and licensed nursing assistants was estab-

lished to identify, develop, and champion revised patient

care processes through education and practice changes

to support this increasingly mobile patient population.

“We established a four-hour education session

taught by 3 West nurses, physicians, and physical and

occupational therapists,” says Rawls. “Staff from the

inpatient care unit and Physical and Occupational

Therapy also attended a four-day national conference

in Boston to further update their knowledge and skills.”

Practice changes included a revised kardex,

standardized order sets, updated preoperative

booklets, furniture design changes, subject-focused

monthly bulletin boards, an increased focus on

Polly Campion, Evelyn Schlosser, Kathy LaCoss and Jean Avery

healthy living for healing, competency in femoral

nerve block catheter care and discontinuance, and a

daily orthopaedic team “huddle.”

The group is currently working on a pre-op DVD

for patients, an orthopaedic website and televised edu-

cational offerings in preparation for patient discharge,

and the development of a poster and nursing grand

rounds presentation. In May, the ambassador group

will travel to St. Louis where they have been invited to

present their poster to other orthopaedic nurses at the

National Association of Orthopaedic Nurses’ Conference.

Improvement is ongoing. Outcomes being

measured include patient knowledge and satisfac-

tion, capacity and length of stay, infection and fall

rates, and nurse satisfaction and injury.

“By increasing their knowledge and understand-

ing of patient care processes, orthopaedic nurses

have shifted their paradigms of thinking and changed

the culture of 3 West,” Rawls says. “Relationships with

other disciplines are increasingly collegial and dy-

namic. The Culture of Mobility initiative has resulted in

improved patient care by nurses at the bedside and a

re-energized commitment to quality.”

imAge of nursing

Improving the Quality of Patient Care and NursingWhen you think of a nurse, the first im-

age that comes to mind is one of care-

giver at the bedside. But at DHMC there

is a specialized role for professional

nurses that, while different from care providers, di-

rectly supports the organization’s ability to provide

high quality care—the Clinical Quality Associate.

“The role of the Clinical Quality Associate

requires a diverse set of skills,” explains Polly Campion,

Director of Clinical Improvement at DHMC. “These

include excellent clinical skills and experience, the

ability to communicate well with people at a variety

of levels and across many disciplines, and strong data

analysis capabilities.”

The Medical Center’s three Clinical Quality

Associates—Jean Avery, RN, Kathy LaCoss, RN, and

Evelyn Schlosser, RN—each have an advanced

degree and work with multidisciplinary teams as

well as individual clinicians to help lead and facilitate

DHMC’s major clinical improvement projects.

A Safer System for Pain ControlOne such project began six years ago for Avery,

whose experience includes working with both oncol-

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ogy and dialysis patients. “We had purchased a new

patient-controlled analgesic (PCA) pump, used for

pain control primarily by postoperative and oncology

patients,” she recalls. “But because of a design flaw, it

was easy to misprogram high doses of narcotics. We

went back to the manufacturer, but they couldn’t fix

the flaw at the time. So, we implemented a ‘double-

check’ process of our own to safeguard our patients,

rewrote standing orders, and re-educated staff.”

What was the key to finding a successful reso-

lution? “More than anything, persistence,” says Avery.

“We had to keep evaluating new devices, talking to

vendors, and maintaining an open relationship with

them because it took a while for the marketplace to

catch up to where the need was. When it did catch

up, we included Nursing, Anesthesia, Biomedical

Engineering, IT, Pharmacy, and Purchasing in the

selection process. As organizer of the project, my role

included bringing folks together, offering constant

encouragement, and setting the selection criteria.”

DHMC recently purchased 81 new PCA devices

that are being used throughout adult medicine. “This

pump has a number of safety enhancements includ-

ing bar coding capabilities, the ability to pre-program

dose limits that cannot be exceeded, and a larger key

pad that is more legible and easier to use,” she says.

“As a result, the likelihood of programming errors has

been greatly reduced, and our patients are safer.”

Preventing Surgical ComplicationsLaCoss first got involved in the surgical care

improvement project (SCIP)—one of the evidence-

based interventions promoted by the Centers for

Medicare/Medicaid and the Institute for Healthcare

Improvement (IHI)—in the fall of 2005. “The fun-

damental goal of the project has been to prevent

surgical complications such as infection and deep

vein thrombosis (DVT) by using interventions which

include prophylactic antibiotics and other mea-

sures,” she explains.

“My role has been to facilitate, to provide

administrative support, and to work with different

members of a multidisciplinary team led by Dr. Paul

Kispert, as well as with the different sections and

departments that are affected by this work,” says

LaCoss, whose background includes caring for pedi-

atric patients in the Intensive Care Nursery. “We ini-

tially focused on seven specific surgical procedures,

but have since expanded our efforts to include all

surgical patients.”

Where has she seen the biggest improvements?

“With improving our compliance in both giving pre-

operative antibiotics and discontinuing postoperative

antibiotics at the most optimal times,” she explains. “A

third involves eliminating the use of safety razors for

skin preps (because of risk of infection). I think utilizing

the strengths of the members of the team who’ve had

the most credibility in these areas has been instru-

mental in making our efforts successful.”

Improving “House-wide” PracticesSuccess has come a little more slowly with fully

adopting the Joint Commission’s Universal Protocol

project—a set of procedures developed to help pre-

vent “wrong patient” and “wrong site/side” surgeries

from happening.

“While the work involved in pulling all of the

information together and creating a protocol for

DHMC was challenging in and of itself, the imple-

A Timeline of Milestones in Nursing History (national and international events are in italics)

1860Nightingale Training School for Nurses is es-tablished in England.

1883U.S. has 22 schools of nursing.

189336-bed Mary Hitch-cock Memorial Hospital and MHMH Training School for Nurses open.

1�01-1�22: Ida Frances Shepard, RN, superintendent of Mary Hitchcock Memorial Hospital and its Training School for Nurses. She nurtured the MHMH SON through prosperous and difficult times and oversaw its 1905 transition from a two- to a three-year program.

1905MHMH nursing course increases from two to three years.

1906Graduate Nurses of New Hampshire formed; group lobbies for state registration of nurses.

1907Psychiatric rotations at New Hampshire State Hospital begin (end in 1914). State’s first Nurse Practice Act passes.

1908First formal SON graduation held.caption here in

this area

1910Alumnae association formed. First state board exam given.

1920Billings-Lee opens as a nurses’ dorm.U.S. has 3,000 di-ploma schools.

1923Committee for Study of Nursing and Nurs-ing Education decries exploitation of student nurses as cheap labor.

1924School starts admitting students in classes in-

stead of one at a time.

1927Hitchcock Clinic founded.

1928Word “training” de-leted from SON name; it’s now the MHMH School of Nursing.

1929MHMH is among first to undergo voluntary assessment by Committeeon the Grading of Nursing Schools. First catalogue published.

1937Building 37 opens as a nurses’ dorm.

mentation has proved far more challenging,” says

Schlosser, who helped lead and facilitate the project.

“That is our biggest challenge in every project we

take on as Clinical Quality Associates, because most

of the work doesn’t involve one clinical setting,

department, or service. It involves ‘house-wide’

practices.”

A key aspect of the role includes developing

tools, techniques, and resources for local leaders,

so they have the information and support they

need to “own” projects and enact change, says

Schlosser, whose background includes critical care

and being an Army nurse. “One of the most power-

ful things we did was to create a Universal Protocol

auditing tool and expectation that has resulted in

full implementation of the protocol in 88 percent

of our clinical settings. We still have some work to

do to get to 100 percent, but that is our goal,” she

says. “Not only do we have the opportunity to im-

prove patient care, but we also have the privilege

of supporting our colleagues while they provide

direct care to our patients. You couldn’t ask for a

better job!”

professionAl

development

Engaging Staff Nurses as TeachersIn June of 2005, the Office of Professional Nursing (OPN)

made the decision to expand its mission to educate fu-

ture nurses. This led to a unique opportunity for DHMC

nurses to explore and maintain a faculty practice.

“DHMC had historically served affiliating

schools of nursing by consistently providing quality

clinical experiences through access to multiple inpa-

tient units with receptive nursing staff who believed

that the teaching of future nurses is an expectation

of professional practice,” explains Ellen Ceppetelli, RN,

MS, Director of Nursing Education in the OPN. “The

faculty practice model was developed to promote

and facilitate Master’s-prepared nurses to teach in

schools of nursing while retaining their DHMC staff

positions, pay, and benefits.”

In this model, nurses can teach within their

current position or as an independent contractor. For

nurses who want to retain the pay and benefits of

their current position, the school of nursing reim-

burses the medical center and the nurse receives their

usual salary and release time to serve as faculty. A

faculty float pool of 31 potential nurse educators was

created after the first recruitment effort and became a

resource for schools of nursing in need of adjunct fac-

ulty. In the first year, 16 DHMC nurses were classroom

or clinical faculty for undergraduate nursing students

in four schools of nursing.

The anticipated benefits of this model to the

Ellen Ceppetelli

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organization and schools of nursing included reten-

tion of nursing staff, low-risk career development op-

portunity for practicing nurses, increased enrollments,

clinical instruction for students by expert nurses,

improved recruitment of new graduate nurses, and

improved integration of students on clinical units.

A “Win-Win”The program has allowed Jillian Miller, RN, to fulfill a

dream—to teach future nurses.

“My job is to help them bridge the gap from

the didactic classroom to clinical practice; being able

to see the students understand the concepts has

been an extraordinary experience,” says Miller, who

has been teaching third-year nursing students how

to care for pediatric patients on the Pediatric/Adoles-

cent Unit since 2005. “Having expert clinicians teach

clinical skills to nursing students is a ‘win-win’ situa-

tion—the students benefit as well as the clinician.”

Professionally, Miller has been enriched by this

teaching experience. “Seeing nursing through the

students’ eyes has reminded me of why I went into

nursing,” she says. “I feel I have recaptured my pas-

sion for nursing. Mentoring and facilitating learning

for the nursing students has been positive. I have

created new relationships and have expanded my

nursing network within and outside the institution.”

Students have commented that the DHMC

faculty have a higher level of credibility since they

are knowledgeable and practicing clinicians. “Col-

laborating with the faculty at Colby-Sawyer College

has expanded my understanding of the education

process,” Miller adds. “I feel I have grown in my profes-

sional practice due to this experience.”

Passing the BatonAs an adjunct faculty member for Colby-Sawyer Col-

lege nursing students, Kathleen Craig, RN, has been

delighted to have the opportunity to “pass the baton”

to the next generation of nurses.

“I hear the voices of my own teachers when

I’m working with students,” says Craig, a nurse in the

Birthing Pavilion Continuing Care Center and Lacta-

tion Clinic. “Sometimes I invoke the ‘old ones,’ including

Florence Nightingale, to let the next generation know

where we came from while we determine, using evi-

dence-based practice models, where we are going.”

The faculty practice model provides direct

student access to the most senior clinical nurses

in a practice environment that the senior nurse is

intimately familiar with. “What better way to practice,

both for the student and the senior nurse?” asks

Craig, who has worked at DHMC in a clinical role

since 1982. “I have appreciated the opportunity to

engender strong theory-based practice for nursing

students as they learn essential technical skills that

require a lot of ‘head-hand’ coordination. The result

is that they are able to bring their hearts into their

practice in a way that serves the population and the

profession, not just the individual.”

By promoting this innovative approach to

engaging staff nurses as teachers, the OPN has raised

the level of awareness throughout the organization

of its expanded commitment to teaching nurses of

the future, and has legitimized the faculty role as a

highly valued one within the nursing community.

“This message has resonated with advanced

practice nurses and nurses enrolled in Master’s

programs that had contemplated teaching but for

Memorial Day 1952, Mary Hitchcock Memorial Hospital

1943MHMH participates in U.S. Cadet Nurse Corps program.

1944Affiliation made with New Hampshire State Hospital in Concord (ends in 1964).

1947First yearbook is published.

1950Building 50 opens as a nurses’ dorm.

1��1-1�60: Mary Louise Fernald, RN, director of nursing ser-vice and nursing education(1951 to 1957); she retained the title of director of nurs-ing education (1957-1960) when the Department of Nursing split.

1952SON temporarily accred-ited by National League for Nursing (NLN).The Journal of Nursing Research, the first such journal, is established.

1955Affiliation made with Boston Lying-In Hospital (ends in 1962). MHMH opens one of the nation’s first ICUs.

a variety of reasons had not pursued the role,” says

Ceppetelli. “If this first year’s outcomes are predictive

of the future, perhaps we can build a waiting list of

faculty float pool members to match the waiting list

of nursing school applicants in our affiliating schools.”

personnel poliCies

Being Heard, Feeling ValuedWhen Dartmouth-Hitchcock decided to restructure

its retirement program a few years ago, it faced some

daunting challenges.

While the organization’s retirement benefits

were top notch, they were complex. Separate

programs had evolved for the Dartmouth-Hitch-

cock Clinic and Mary Hitchcock Memorial Hospital.

Dartmouth-Hitchcock wanted to unify the programs

in a way that would give people choice and also

make sure that they did not lose any benefits. It also

wanted to design a simple and contemporary pro-

gram that would appeal to new hires and continue

to reward longevity.

Then, there was the challenge of effectively

communicating the changes to a large and diverse

group of employees. Retirement can be a compli-

cated and emotional subject and people are often

suspicious of change. “Normally, when a company

restructures its retirement program it results in a

‘takeaway for employees,’” explains Richard Showal-

ter, Chief Financial Officer at Dartmouth-Hitchcock.

“That wasn’t the case with us. We wanted people to

understand that the financial goals that were part

of this process were focused on stabilizing pension

expense and contributions in the future, not reduc-

ing benefits or cutting costs.”

To help it accomplish all of these goals, Dart-

mouth-Hitchcock formed a multidisciplinary Pension

Work Group (PWG) in 2005, co-chaired by Showalter

and Dr. Peter Spiegel. Senior nurse leaders Donna

Brown and Linda von Reyn were key participants in

the group’s five-hour planning sessions.

“We looked at how every proposed change

would impact staff—from the LNA who had just

started to the RN who’d been in practice here for

35 years,” says Brown, who, as Director of Inpatient

Nursing, was managing over 100 medical/surgical

beds with more than 200 nurses at the time. “We

went back and met with the nursing staff on a

regular basis and let them know that their voice was

being heard, their concerns were being brought to

the table, and that we were getting answers to any

issues they had.”

Dartmouth-Hitchcock’s approach was so

thorough, innovative, and well-executed, that after

the organization completed the project late last year

it was awarded the 2006 Best Benefits Practice Award

from the New England Employee Benefits Council.

“I think the end result is, we now have a stronger

retirement program overall,” Brown says. “For the more

senior nurse, who’s been here five years or longer and

is vested in the organization, it was a ‘win-win.’ They

had the choice of staying with the traditional plan or

selecting the opportunities available with the new.

And for the young nurse coming out of school, the

new plan is attractive because it’s very competitive

and it’s portable—they can take it with them if they

1956Affiliation made with Boston Children’s Hos-pital (ends in 1968).

1957Department of Nursing organizes as two entities: service and education.

1958SON gets full NLN accreditation.

1960sTeam nursing, a national trend, is a clinical re-quirement at MHMH.

1964Psychiatric affiliation made with Danvers (Mass.) State Hospital.

1965First male student enters SON (11 graduate by the time it closes). NLN renews accreditation.American Nurses’ Asso-ciation says the minimum preparation for nursing should be a bachelor’s degree.A staff nurse attends to

a patient, circa 1963A nursing class in the basement of Building 37

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1970sMHMH has 420 beds.

1��2-1�88: Marilyn Prouty, MS, RN, senior vice president of nursing (head of theSON in 1974-75) intro-duced the role of clinical nurse specialists to MHMH. She also set the wheels in

motion for phasing out the School of Nursing and over-saw the closing process.

1973MHMH becomes part of DHMC.

1974SON faculty holds a confer-ence on the future of nursing.

1976SON issues a report recommending the school be closed.

1977MHMH Trustees accept closure recommenda-tion. Last class enters.Since 1967, diploma programs have dropped from 840 to

428, baccalaureate programs have grown from 188 to 329.

1980Last class graduates. MHMH trained 1,850 nurses in 87 years.

1981Colby-Sawyer College, in affiliation with MHMH, begins a bachelor’s

program in nursing.

1�84-1��8: Linda Cronenwett, PhD, RN, director of nursing research, education and practice, helped create the nursing practice council, bringing nursing leaders and staff nurses together.

1991DHMC moves from Hanover to new facility in Lebanon, NH.

decide to move on to another organization.”

“When we started this project one of our over-

arching goals was to develop a pension plan that

would help support an environment where people

in general—and nurses in particular—would feel

valued,” says Spiegel. “Thanks to the teamwork which

is such an integral part of our culture here, I think

we’ve done that.”

orgAnizAtionAl

struCture

Every Detail CountsIn May 2006, an activation team was organized to

participate in decision-making for a novel project at

DHMC. The goal? To transform an existing inpatient

psychiatry unit to an inpatient surgical unit. The team

included staff nurses from each of the two existing

surgical units, a unit secretary, and the leadership team.

Weekly meetings were scheduled with the goal of

opening the unit for patient care on October 1, 2006.

Led by Sally Patton, RN, Director of Inpatient

Surgery, the team was charged with making a wide

variety of decisions—ranging from the staffing

model to the type of medication cart to purchase to

the specific locations for the code buttons, print-

ers, and fax machine. “In addition, we discussed the

distribution of surgical services between what would

be three geographic locations,” says Patton. “Service

allocation was made based on an analysis of volume

by service, as well as a plan to try to balance patient

acuity with average length of stay.”

Early in the process, the team toured the area

that was being transformed, making note of the

most obvious structural issues that would need to be

addressed from their perspective. They also toured a

patient care area that had been renovated one year

prior to this project. “This helped us to learn what was

working well and what could be improved from that

department’s perspective,” says Patton. “Initial deci-

sions included the sequencing of room numbers and

the name of the unit. Our objective was to assure that

visitors and medical center personnel would be able

to easily locate patients in the new area.”

Throughout the activation work, as purchasing

decisions for furniture and equipment were made,

the staff nurses were allowed to review the options

and make the final decisions. “Another key issue

(to focus on) was the need to remember the many

minor details that are critical to effective functioning

in a patient care area,” explains Angela Price, RN, Clini-

cal Coordinator for the new unit. “Our unit secretary

on the team began to keep notes during her work

hours as she thought of things that would need to

be included in the new area.”

The entire team spent one meeting touring the

current inpatient surgical units to generate a list of

the details. They toured their “sister” unit so that they

would more readily notice details than they would if

1994Dartmouth-Hitchcock Air Response Team be-gins operation; team includes flight nurses.

1���-2006: Nancy Formella, MSN, RN, senior nurse executive. She spear-headed the effort to obtain

the prestigious “Magnet” designation from the American Nurses Creden-tialing Center in 2003.

2003DHMC awarded

“Magnet” status in recogni-tion of meeting the highest stan-dards of nursing excellence.

2004DHMC starts a nurse resi-dency program using patient simulators.

2006: Linda (Kobokovich) von Reyn RN, PhD as-sumes role of Acting Senior Nurse Executive when Nancy Formella is named Acting President of MHMH and the DHA.

2006DHMC has 1,188 RNs employed in the hospital and 169 RNs in the clinic. In addi-tion, 128 ARNPs, 71 LPNs and 341 LNAs are part of DHMC’s nursing team.

walking through a familiar location.

As a result of their dedicated attention to the

activation goal, the unit opened on time. “I think

the fact that the entire team was empowered to

make the decisions assured a safe and effective work

environment,” says Patton. “The staff were able to im-

mediately provide effective and efficient patient care

because all of the details had been managed prior

to patients arriving. Those details could never have

been addressed without the assistance and partici-

pation of the staff themselves.”

nurses

As teAChers

Helping Smokers QuitNurses from multiple practice areas within DHMC have

taken on the challenge of expanding their best prac-

tices by promoting one of the national “Healthy People

2010” leading health indicators—reducing tobacco use.

A concerted effort to improve tobacco cessa-

tion resources for inpatients began last year when

Colleen Warren, RN, and her colleagues secured a

grant from the NH Department of Health and Hu-

man Services. The initiative included developing a

standardized process for offering tobacco cessation

advice and assistance to hospitalized patients.

“We educated clinicians about the US Public

Health Service Guidelines (USPHSG) evidence-based

5As Model (Ask, Advise, Assess, Assist, Arrange) and

utilized an electronic flow sheet documentation

process developed by a DHMC physician,” says War-

ren. “We conducted a pilot on 1 East and 3 East and

in six months saw the number of clinicians using the

process go from only 2 percent up to 85 percent.”

Though the grant project ended last summer, the

group has continued its efforts, taking advantage of

the tools and momentum created. It has recruited 50

clinicians to be part of a Tobacco Treatment Team (TTT),

arranging specialized online training for them through

the University of Massachusetts Medical School.

“Many nurses have invested their own time to

complete the online course which is called, ‘Basic

Skills for Working With Smokers’,” says Ellen Prior, RN,

who is leading efforts to extend tobacco cessation

into the outpatient setting. “The role of the TTT

members is to act as unit-based resources, sharing

their knowledge with their colleagues. They also

serve as consultants to assist patients with quit at-

tempts by means of brief counseling interventions

during their hospital stay and by facilitating referrals

to the NH and VT Tobacco Quit Lines.”

There have been a number of outstanding

contributions made by nurses in this effort. “The He-

matology/Oncology unit TTT member implemented

his new knowledge of tobacco use interventions by

organizing a bulletin board/poster display for the staff

to utilize,” says Warren. “He also set up a centralized

process for faxing referrals to the NH/VT Quit Lines.”

[Timeline Reprinted with Permission of Dartmouth Medicine. Photos Courtesy of Dartmouth College Library.]

DHMC Tobacco Treatment Team

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The Medical Specialties staff has championed

documentation of tobacco treatment interventions

in the electronic medical record and consistently

achieved high percentages of patient screening,

advice, and counseling interventions.

The Intermediate Cardiology Unit TTT mem-

bers are exploring ways to optimize their collabo-

ration by coordinating with the Advance Practice

Nurse who currently has a Tobacco Treatment Clinic

for the Cardiothoracic Clinic. Additionally, nurses

on 5 West (Neurosciences) have incorporated the

USPHSG 5As Model for tobacco treatment as their

standard of practice.

“Tobacco use is still the leading preventable

cause of death in this country,” says Prior. “But there

is now very good research that shows that even

though it is an addiction, there are effective treat-

ment methods we can use to help people. In fact, if

the 2.2 million working nurses in the US each helped

one person per year to quit smoking, nurses would

triple the US quit rate.”

mAnAgement

Always Teaching, Always Learning“On our unit, we have nursing leaders whose roles

vary from staff nurse to clinical leader,” explains Bar-

bara Power, RN, describing the management style of

the Neuro Special Care Unit (NSCU). “As a result of this

structure, the attributes of accessibility, visibility, and

communication are available to all nurses at all times.”

While the unit’s nursing leaders are not

always officially designated, through their personal

strengths and their extensive knowledge base they

provide invaluable guidance and information to

staff nurses. Many freely and generously extend their

knowledge while simultaneously providing patient

care, charge nurse responsibilities, and other du-

ties. “To me, this means that we have both a culture

of learning as well as formal and informal modes

of communication and learning—a model which

exemplifies the best that can be offered to nurses in

busy, intensive work environments,” says Power.

This style of leadership, and the environment it

creates, leads to higher quality of care and to overall

quality improvements which serve to continually

elevate standards of patient care.

The NSCU’s nursing leaders strive to embrace

and implement new patient care initiatives and to

create in-service educational opportunities for staff

nurses to be kept up-to-date in their skills. These

range from quality improvement initiatives such as

central line care to prevent infection to real-time ap-

plication of new wound care techniques to directly

enhance quality of patient care. “This management

style is very effective because it seamlessly blends

with day-to-day patient care as it is provided by staff

nurses,” explains Powers.

The unit’s nursing leaders take every opportu-

nity to teach and communicate high-quality patient

care. An activity as simple as repositioning a patient

in bed is used as an opportunity to identify the pos-

sibility of new approaches to care or the application

of new clinical initiatives. “The culture in our hospital,

and on our unit, provides a continuous operating

cycle of the positive effects of strong clinical nursing

leadership and the caring of one another that this

model embodies,” Power adds.

interdisCiplinAry

relAtionships

Working Together to Prevent Patient FallsUnless you’re directly involved in caring for senior

citizens, you may not realize how dangerous and

commonplace falls can be. Falls are, in fact, the num-

ber one cause of death from injury for people age 65

and older. But elderly patients aren’t the only ones at

risk in the inpatient setting—falls among hospital-

ized patients of all ages can be a persistent problem.

To reduce the risk of patient harm resulting

from falls, DHMC formed a multidisciplinary inpatient

Falls Committee in 2004. The committee—which

includes representatives from Nursing, Rehabilitation

Medicine, Pharmacy, Safety, Housekeeping, Engi-

neering, Purchasing, Quality Improvement, and Risk

Management—is co-chaired by Dr. Nancy Bagley

and Peggy Plunkett, Clinical Nurse Specialist.

As part of its goal to implement a falls prevention

program throughout the hospital, the group launched

a comprehensive prevention education campaign in

2006. “What we’re trying to promote is that all patients

admitted to the hospital are at risk to fall, and it’s every

staff person’s responsibility to assist in falls prevention,”

says Plunkett.

The committee’s efforts have included: revising

the patient falls and management policy at DHMC;

promoting increased Rehabilitation Medicine and

Pharmacy evaluations for patients who have fallen

more than once; disseminating a prompt for nurses

to reassess patients on a daily basis who are at risk to

fall; working with Engineering to increase the bright-

ness of bulbs in room nightlights; and implementing

the use of double-sided, non-slip patient slippers.

“We obtained grant funding from the DHMC

Auxiliary for all medical, surgical, and medical-surgical

units to purchase additional gait belts, rolling walkers,

shower chairs, and personal safety alarms (for bed or

chair),” she says. “We’ve also developed magenta-col-

ored bracelets, uniform door signs, and other materi-

als (to educate patients and families), so everyone in

the hospital can easily identify high-risk patients and

come to their aid quickly, if needed.”

As a result of the many initiatives undertaken to

prevent falls and reduce injuries from falls when they

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occur, the committee is seeing some encouraging re-

sults. “Annual fall rates improved in five units from the

same period last year (CCU, ICU, NSCU, 1 West, and

ICCU),” says Plunkett. “In addition, the fall rates for four

different units have shown improvement in the last

quarter (HSCU, 1 East, 3 West, and 5 West). I believe

the collaboration of the many disciplines involved in

our Falls Committee has been the key.”

Community

And hospitAl

Building Community Awareness About the Risks of StrokeThough stroke is very common—it is the third

leading cause of death behind heart disease and

cancer—the public has many misunderstandings

about the condition.

“Many people aren’t familiar with the signs and

symptoms of stroke, so they often ignore them or

think that they’ll go away,” explains Donna Crowley,

Nursing Director for the Neuroscience Unit at DHMC.

“But stroke is actually a 911 emergency, just like a

heart attack. So it’s critical for people to get to a facil-

ity that has access to the new treatments and drugs

that are available as quickly as possible. The most ef-

fective treatments can be administered if it is within

three hours of the onset of stroke symptoms.”

To help educate the public about stroke, Crow-

ley and the nurses from the Neuroscience Unit, in a

joint effort with the local chapter of the American

Association of Neuroscience Nurses, volunteer their

time at two community events each year.

In the spring, the nurses team up to participate

in a bowling event to help raise funds for the Good

Neighbor Clinic in White River Junction, VT. During

the event, the team also performs blood pressure

checks, shares information about stroke signs and

prevention, and also distributes educational materi-

als about traumatic brain injury prevention.

At the Autumn Community Health Fair hosted

by DHMC each fall, the nurses set up a series of

booths, providing blood pressure screenings and

stroke risk assessments. Last year, they screened

more than 150 people.

“We were very busy,” says Crowley. “And it wasn’t

just a matter of taking each person’s blood pressure.

In addition to assessing people’s risk, we talked with

them, answered any questions they had, and offered

guidance and education on important factors such

as staying physically active, having good dietary

habits, and seeing their physician on a regular basis.

With that approach, each session takes a little while,

but people seem to appreciate it greatly, and the

staff really feels good about doing it.”

ConsultAtion

Advancing the Practice of NursingAdvanced practice nurses have been part of the

professional staff at DHMC since the 1970s. Currently

there are 121 advanced practice nurses—providing

expert clinical care in more than 25 sections/divisions

at DHMC—17 of whom have started in the past year.

While the legal title for advanced practice

nurses in New Hampshire is ARNP, they are also cat-

egorized as CRNAs (Certified Registered Nurse Anes-

thetists), CNMs (Certified Nurse Midwives), and NPs

(Nurse Practitioners). They are licensed by the New

Hampshire Board of Nursing and must have passed a

national certifying exam in their specialty area prior to

applying for licensure. In addition, all new ARNPs must

have a Master’s degree. The majority of advanced

practice nurses at DHMC are Master’s prepared.

Advanced practice nurses provide primary care

for patients within their licensed scope of practice. “The

role of the ARNP generally encompasses five aspects—

clinical practice, education, consultation, research and

quality improvement, and professional practice,” says

Dorothy Mullaney, ARNP, who directs the neonatal

nurse practitioners in DHMC’s Intensive Care Nursery

(ICN). “While the majority of what we do is clinical

practice, the other aspects of our role are highly valued,

both individually and by the organization.”

Most of the ARNPs at DHMC are very involved in

education. They participate in preceptoring and men-

toring nurse practitioner students and are active in the

orientation of new RN staff. They provide both formal

and informal education—through nursing grand

rounds; writing manuscripts for professional journals;

speaking at local, regional, and national conferences;

and some are on faculty at schools of nursing.

The ARNPs also share their expertise by con-

sulting at DHMC and through the regional programs.

These consultations are both clinical and educational

in nature. “In the ICN, we provide a lot of support

to new nurses through informal teaching,” explains

Mullaney. “We help increase their basic knowledge

and understanding of disease processes, and how

to apply that to a specific patient’s diagnosis. We

also help them to develop critical thinking skills, and

encourage them to really be part of the team that is

planning the care of the patient.”

Research and quality improvement are high

priorities for the ARNPs at DHMC. Many are involved

in ongoing projects in their sections. Nurse practi-

tioners have participated in the Clinical Evaluative

Science program at Dartmouth College and have

also applied for and received quality improvement

grants from the Hitchcock Foundation.

Professional practice is also very important to

the advanced practices nurses. “We view our practice

as one that expands the nursing role and offers

advanced clinical opportunities,” Mullaney says.

Over the past year, the ARNPs have continued

to meet on at least a quarterly basis to discuss com-

mon issues and identify ways to strengthen their role

within DHMC. They are currently looking at revising

job briefs to make them consistent, improving the

orientation process for new ARNPs, and continuing

to be deeply involved in meeting and maintaining

the mission of DHMC.

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dhmC nursing showCAse

Certifications Awarded & RenewedAACN Certification Corporation:

Certified Critical Care Registered Nurse

tracey l. fabry, RN, CCRN

American Nurses Credentialing Center:

Certified Ambulatory Care Nurse

renee maynes, RN-BC, BSN

Certified Gerontology Nurse

raeann hodgson, RN-BC, BSN, BS-Ed

deborah lindberg, RN-BC, BSN, MBA

Justin montgomery, RN-BC, BSN

Certified Pediatric Nurse

deborah gardner, RN-BC, BSN

faye m. Keat, RN-BC, BSN

lisa lavigne, RN-BC

Kelly A. manson, RN-BC

linda J. nekoroski, RN-BC, BN

patrice g. super, RN-BC, BSN

Certified Medical-Surgical Nurse

Carol m. Bodge, RN-BC, BSN

marsha Call, RN-BC

ruth perrinez, RN-BC, BSN

Colleen warren, RN-BC, MSN Certification in Psychiatric and Men-tal Health Nursing

Kristina m. smith, RN-BC, BSN

American Board of Perianesthesia Nursing Certification:

Certified Ambulatory Perianesthesia Nurse

tina m. drake, RN, CAPA

Carol hall, RN, BSN, CAPA

Jane A. Jackson, RN, CAPA

della lynde, RN, BSN, CAPA

gayle strachan, RN, CAPA

American Society of Perianesthesia Nurses:

Certified Perianesthesia Nurse

Carla sandstrom, RN, BSN, CPAN

Association of Rehabilitation Nurses:

Certified Rehabilitation Registered Nurse

Kathy J. whitcomb, RN, CRRN

Board of Certification for Emergency Nursing:

Certified Emergency Nurse

stephen d. Jameson, RN, CCRN, CFRN, CEN

Brian s. putney, RN, CEN

June stacey, RN, BSN, CEN

Certified Flight Registered Nurse

timothy Bray, RN, BSN, CFRN

Competency & Credentialing Institute:

Certified Nurse Operating Room

patricia A. stockwell, RN, BS, CNOR

linda thompson, RN, BSN, CNOR

Infusion Nurses Certification Corporation:

Certified Registered Nurse Infusion

susan J. Bettis, RN, BSN, CRNI

Brendan hickey, RN, BSN, CRNI

sheila m. Jackson, RN, CRNI

International Lactation Consultant Association:

International Board Certified Lactation Consultant

nanette Bellavance, RN, IBCLC

National Board for Certification of Hospice and Palliative Care:

Certified Advanced Hospice and Palliative Care Nurse

marie Bakitas, ARNP, DNSc, NP-C, AOCN, CHPN, FAAN,

National Certification Corporation:

High Risk Neonatal Nurse

Barbara dunbar, RN, RNC

Oncology Nursing Certification Corporation:

Oncology Certified Nurse

marilyn K. Bedell, RN, MS, OCN

steve Brown, RN, BS, MEd, OCN

michelle Boucher, RN, BS, OCN

Kathleen Carson, RN, BSN, OCN

sarah drury, RN, BS, OCN

susan eichholz, RN, BSN, OCN

leslie grima, RN, OCN

Brain highhouse, RN, BSN, OCN

sharon l. macdonald, RN, BSN, OCN

Cindy Johnson-maclam, RN, BS, OCN

debra nagy, RN, BS, OCN

Kathleen neilsen, RN, OCN

sabrina powers, RN, BSN, OCN

susan m. smith, RN, OCN

sarah usher, RN, MSN, OCN

lisa wesinger, RN, OCN

Kate wilcox, RN, BS, OCN

Certified Pediatric Oncology Nurse

Kimberly A. sleeper, RN, BSN, CPON

Certification Board for Urologic Nurses and Associates:

Certified Urology Registered Nurse

virginia smith, RN, CURN

Education Updatesrhonda Amadon, RN, MBA, OB/GYN, received a Master of Business Admin-istration degree from Franklin Pierce College.

marie Bakitas, ARNP, DNSc, NP-C, AOCN, CHPN, FAAN, Palliative Medicine, received a Doctor of Nurs-ing Science degree from Yale School of Nursing.

louise Carpenter, RN, BSN, OB/GYN, received a Bachelor of Science in Nursing degree from the University of Phoenix.

Andrea davis, LPN, OB/GYN, received an Associates Degree in Nurs-ing from Vermont Technical College.

stephanie duquette, LPN, PCT II, Pedi-atric Support Staff, completed the Practi-cal Nursing Program at New Hampshire Community Technical College.

debra p. hastings, RN, PhD, CNOR, Center for Continuing Education in the Health Sciences (CCEHS), re-ceived a Doctor of Philosophy degree in Nursing from Duquesne University.

Judith l. hakala, RN, ICU, received an Associates Degree in Nursing from the New Hampshire Community Technical College.

Kathleen A. Knudsen, RN, Surgical Specialties, received an Associates Degree in Nursing from Vermont Technical College.

irit librot, RN, BSN, IBCLC, Surgical Specialties, received a Master of Sci-ence degree in Management with a concentration in Health Care Admin-istration from New England College.

timothy newton, RN, ICCU, re-ceived an Associates Degree in Nurs-ing from New Hampshire Community Technical College.

peter nolette, RN, BSN, MBA, CWCN, Wound Care Nurse, Office of Professional Nursing, received a Master of Business Administration degree in Leadership from Franklin Pierce College.

deanna orfanidis, RN, MS, CNOR, Clinical Coordinator, Operating Room, received a Master of Science in Nursing degree from the University of New Hampshire.

denise s. preston, RN, BSN, MS, Clinical Improvement, received a Master of Science degree in Manage-ment with a concentration in Health Care Administration from New Eng-land College.

Jennifer tuohy, RN, Neuroscience/ENT, received an Associates Degree

in Nursing from New Hampshire Community Technical College.

Colleen warren, RN-BC, MSN, re-ceived a Master of Science in Nurs-ing degree from the University of Vermont.

Scholarships Awarded The Levine Nursing Continuing Education Awards

wendy h. Aarnio, RNInterventional Radiology

stephen d. Jameson, RN DHART

Elsa Frank Hintze Nurse Excellence Scholarship

Catherine m. driscoll, RN Intensive Care Nursery

Brian J. highhouse, RNHematology/Oncology Special Care Unit

Office of Professional Nursing Evidence-Based Nursing Practice Conference Award

laurie B. heels, RN, BSN, CPANPerioperative Services

heather A. martin, RN, MSN, CNRN Hematology/Oncology Special Care Unit

Gladys A. Godfrey Scholarship

Alison d. gilliland, Unit Secretary General and Vascular Surgery

Madlyn R. Smith Promise Award in Nursing

ellen m. lavoie smith, ARNP, MS, APRN-BC, AOCNNorris Cotton Cancer Center

Auxiliary Nursing Scholarships

(Pursuing an Associates Degree in Nursing)

Cheryl l. Abbott, PCT I, LNA Neuroscience/ENT

Carol Barraby, LNA/PCT I Medical Hematology/Oncology

todd gardner, PCT II Surgery

pamela tilton, MEd, CHES Research Coordinator, HCWHP

melissa waggoner, LNA, LPN OB/GYN

(Pursuing a Bachelors Degree in Nursing)odalie Bernash, PCT Pediatric Intensive Care Unit

Cindy goewey, RN Intensive Care Unit

Beverly poljacik, RN Intensive Care Unit

Cathryn J. zampiere, RN, CEN Emergency Department

(Pursuing a Masters Degree in Nursing)susan louise Cole, RN, BSN ICCU

Kathleen n. Craig, RN-C, BSN, IBCLC Birthing Pavilion

terrie l. farnham, LNA, BS, MS Medical Specialties

laurie heels, RN, BSN Perioperative Services

darcy Kreis, LNA Medical Specialties

Jodi lee, RN Vascular Surgery-OR

renee maynes, RN-BC, BSN Office of Professional Nursing

Jillian miller, RN, BSN, CPAN PACU

nicole stone, RN, BS Pediatric Hematology/Oncology

Ann wescott, RN, BS PACU

(Pursuing a Masters Degree in Nursing/MBA)Carole l. usher, RN, CNRN NSCU

Dartmouth-Hitchcock Alliance Scholarships

(Pursuing a Practical Nursing Program)

Crista Bean, PCT II Same Day Program

stephanie duquette, PCT II Pediatrics

(Pursuing an Associates Degree in Nursing) shawn Barbour, LNA Medical Hematology/Oncology

Ann Campbell, LPN Clinic Float

Judith hakala, PCT Intensive Care Unit

maureen thompson, LPN DH-Woodstock

Jennifer tuohy, PCT Neurology

Kimberly townsend, LNA Medical Hematology/Oncology

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(Pursuing a Bachelors Degree in Nursing)odalie Bernash, PCT Pediatric Intensive Care Unit

(Pursuing a Masters Degree in Nursing)Judith dixon, RN, BSN Care Management

laurie heels, RN, BSN Perioperative Services

david sanborn, PCT Perioperative Services

Other Scholarships matthew Choate, RN, BSN, CEN, Pediatric and Adolescent Intensive Care Unit, received a scholarship, Nurse in Washington Internship (NIWI), National Emergency Nurses Association.

tamsin J. mulrooney, ARNP, OCN, Comprehensive Breast Program, re-ceived a doctoral scholarship from the American Cancer Society.

Grants Awardedsuzanne C. Beyea, RN, PhD, FAAN and linda von reyn, RN, PhD, received a grant from the Bureau of Health Professions (BHPr), Health Resources and Services Administra-tion (HRSA) for a program entitled:

“Competency for Geriatric Nursing in Rural New England.”

sandra Knowlton-soho, RN, MS, received a Breast Cancer Educa-tion Grant from the Vermont/New Hampshire Affiliate of the Susan G. Komen Breast Cancer Foundation.

Other Awardsmarie Bakitas, ARNP, DNSc, NP-C, AOCN, FAAN

Jointly awarded the Anthony Di Guida/Delta Mu Prize from Yale School of Nursing and Delta Mu Chapter of the Sigma Theta Tau International Nursing Honor Society.

Doctoral Scholarship, American Cancer Society.

T32 Research Training Program in Self and Family Management, NIH/NINR, Post-Doctoral Fellow-ship, Yale School of Nursing.

marilyn K. Bedell, RN, MS, OCNDaffodil Day Outstanding Achieve-ment Award 2006, American Cancer Society.

lisa hegel, ARNP, MS, COHNSMedique Leadership Award, North-east Association of Occupational Health Nurses.

sara mcmillan, RN Award for Excellence in Clinical Teaching at the Vermont Organiza-tion of Nurse Leaders Summit in Stowe, VT.

deanna orfanidis, RN, MS, CNORMary Louise Fernald Research Pre-sentation Award from the University of New Hampshire.

Jean A. proehl, RN, MN, CEN, CCRN, FAENPresident’s Award from the Emer-gency Nurses Association.

Julie shocksnider, RNC, APN, C, MS, IBCLC, CCE Inducted into Sigma Theta Tau International Honor Society for Nursing, Epsilon Tau Chapter.

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Joyce truman, RN, terry edson, LPN, Carolyn fitzmaurice, RN, and sandra tisdale, LPNFirst Place for poster presentation

“To Go Bags for Laryngectomy and Tracheostomy In-patients” at the Society of Otorhinolaryngology and Head-Neck Nurses Conference, Toronto, Canada.

Colleen warren, RN-BC, MSN Community Health Leadership Award, DHMC.

Katherine mcfaun williams, RN, BSN Distinguished Service Award, Ver-mont State Nurses Association.

the dhmC nurse midwife service received the “With Women, for a Lifetime Gold Commendation” award from the American College of Nurse Midwives, recognizing and maintaining high standards for more than 20 years.

Arete Awards

wayne f. Barlow, RN Same Day Program

Burke r. Barnett, RN Intensive Care Unit

timothy J. Bray, RN DHART

louise B. Carpenter, RN OB/GYN

ellen J. Chaput, RN Same Day Program

Judith C. dixon, RN Care Management

nicola J. felicetti, RN Medical Specialties

Joan m. goodrich, RN Gastroenterology/Hepatology

Jennifer A. greene, RN Endoscopy

dhmC nursing showCAse

hilary l. s. hawkins, RN Emergency Department

Jackie B. hodge, RN Intensive Care Nursery

patricia d. leBlanc, RN Medical Hematology/Oncology

laurie K. o’rourke, RN General Surgery

lisa m. paquette, RN Gastroenterology/Hepatology

Becky J. passino, RN Operating Room

Angelika A. patterson, RN Medical Specialties

Julie e. pratt, RN Intensive Care Unit

Karen e. richardson, RN PACU

patrice g. super, RN Pediatrics

Cynthia g. tebbetts, RN Neurology Unit

susan wiitala, RN Psychiatric Care

teri r. walsh, RN Vascular Surgery

Professional Activities (Selected)

suzanne C. Beyea, RN, PhD, FAAN

Review Committee Member, Nursing Education, Practice and Research Awards, Health Resourc-es and Services Administration (HRSA).

Research Committee, National Patient Safety Committee.

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Member, Safe Medication Use Committee, United States Pharma-copeia (USP).

Editorial Board, AORN Journal and International Journal of Nursing Terminologies and Classifications.

ellen B. Ceppetelli, RN, MS

Member, Advisory Board, Com-munity College of Vermont, Wilder, VT.

Member, Massachusetts Board of Higher Education Evaluation Team, RN-BSN Proposal Visiting Team.

Writer, Clinical Nurse Leader Na-tional Certification Exam, Ameri-can Nurses Credentialing Center.

Secretary, National Board of Direc-tors, American Lung Association.

matthew Choate, BSN, RN, CEN

President, Upper Valley Chapter, American Association of Critical Care Nurses.

Chair, Government Affairs Com-mittee, Vermont Emergency Nurses Association.

michael A. frace, RN, MSN, RRT

President, Upper Connecticut River Valley Chapter, Academy of Medical-Surgical Nurses.

National Co-Chair, Chapter Devel-opment, Academy of Medical-Sur-gical Nurses.

debra p. hastings, RN, PhD, CNOR

National Chairperson, Periopera-tive Research/Evidence-based Practice Committee, Associa-tion of periOperative Registered Nurses (AORN).

Secretary and Member, Board of

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Directors, AORN, Lakes Region of New Hampshire.

Member, Advisory Board, State of New Hampshire Sexual Assault Nurse Examiner (SANE) Program.

Member, Board of Directors, New Beginnings – A Women’s Crisis Center—Belknap County.

Member, Review Panel, AORN Journal.

lisa hegel, ARNP, MS, COHNS

Vice-President, New Hampshire Association Occupational Health Nurses.

renee maynes, RN-BC, BSN, CAN

Member, Practice and Educa-tion Committee, New Hampshire Board of Nursing.

linda J. patchett, RN, MBA

Member, Board of Directors, Northern New England Clinical Oncology Society.

Member, Board of Directors, and Chairman, Program Committee, Leadership New Hampshire.

Jean A. proehl, RN, MN, CEN, CCRN, FAEN

Chairperson-elect, January – June, 2006; Chairperson, July 2006

– June 2008, Academy of Emer-gency Nursing.

Chairperson, Awards Advisory Committee, Emergency Nurses Association.

President’s Advisory Council, Emergency Nurses Association.

Team Leader, TNCC Dissemination

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to United Arab Emirates, Emer-gency Nurses Association.

Member, Nursing Consult Advi-sory Board, Elsevier.

Editor, Advanced Emergency Nursing Journal.

Content Editor, Emergency Nurs-ing Secrets, (2nd Ed.).

maureen t. Quigley, ARNP, MS, FNP

Member, Allied Health Program Committee, Exam Review Commit-tee, and Contributing Exam Writer, American Society of Bariatric Surgery.

Katie steuer, RN, BSN, CNOR

Chairperson, Operating Room Open House Committee.

sally t. trombly, RN, MPH, JD

Member, Board of Directors, Anes-thesia Patient Safety Foundation.

Member, Scientific Evaluation Committee, Anesthesia Patient Safety Foundation.

Member, Bylaws Committee, Ameri-can Society for Healthcare Risk Mgmt.

Member, Handbook Task Force, American Society for Healthcare Risk Management.

Member, Editorial Board, Health-care Risk Control, ECRI.

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PublicationsArmstrong, K. J., & lasch-inger, h. (2006). Structural Empowerment, Magnet Hos-pital Characteristics, and Pa-tient Safety Culture: Making the Link. Journal of Nursing Care Quality, 21(2), 124-134.

Bakitas, m. (2006). Under-standing Chemotherapy-In-duced Peripheral Neuropathy: The Patients’ Perspective on Symptoms and Everyday Life Effects. Dissertation Abstracts.

Bakitas, m., & daretany, K. (2006). End-Of-Life Care. In D. R. P. Swearingen (Ed.), Manual of Medical-Surgi-cal Nursing Care: Nursing Interventions and Collabora-tive Management (6th ed., pp. 91-105). St. Louis: Mosby.

Bakitas, m., lyons, K. d., dixon, J., & Ahles, t. (2006). Palliative Care Program Effec-tiveness Research: Develop-ing Rigor in Sampling Design, Conduct and Reporting. Journal of Pain and Symptom Management, 31(3), 270-284.

Beyea, s. C. (2006). The Value of Knowing the Patient. AORN Journal, 83(4), 825-826.

Beyea, s. C. (2006). Surgical Care Improvement Project—An Important Initiative. AORN Journal, 83(6), 1371-1374.

Beyea, s. C. (2006). Safe Med-ication Practices in Periopera-tive Settings. Perioperative Nursing Clinics, 1(3), 283-288.

Beyea, s. C. (2006). The National Patient Safety Goals: A Focus for Action. AORN Journal, 84(3), 485, 486, 488.

Beyea, s., Ceppetelli, e., formella, n., & reeves, s. (2006). Meeting the Needs for Nursing Faculty: A Service/Ed-ucation Collaboration. Nurse Leader, 4(5), 34-37.

Beyea, s., & slattery, m. (2006). Evidence-Based Practice in Nursing: A Guide to Successful Implementation. Marblehead: HCPro, Inc.

Brown, K., shaker, m., Jen-kins, p., & verdi, m. (2006). A Cost-Effective Analysis of Venom Desensitization in Children Treated for Cure and Risk-Reduction. Journal of Allergy and Clinical Immunol-ogy, 117(2), S309-S309.

Clark, J., & young, m. e. (2006). Cardiovascular Disor-ders: Section Four: Cardiac Surgery. In P. Swearingen (Ed.), Manual of Medical-Sur-gical Nursing Care (6th ed., pp. 195-198). St. Louis: Mosby Elsevier.

dixon, J., Kinney, g. A., Block, C., & daley, v. (2006). Chronic Kidney Disease and Dialysis Management In A Pregnant Woman: Case Report. Dialysis & Transplan-tation, 35(6), 372-374.

Karon, n. m. (2007). Com-plications: Compartment Syndrome. In N. Mooney (Ed.), Orthopaedic Nursing Core Competencies Across the Lifespan (pp. 85-87). Chi-cago: National Association of Orthopaedic Nurses.

Karon, n. m. (2007). Compli-cations: Deep Vein Throm-bosis. In N. Mooney (Ed.), Orthopaedic Nursing Core Competencies Across the

Lifespan (pp. 88-92). Chicago: National Association of Or-thopaedic Nurses.

Karon, n. m. (2007). Compli-cations: Pulmonary Embolism. In N. Mooney (Ed.), Orthopae-dic Nursing Core Competen-cies Across the Lifespan (pp. 93-97). Chicago: National Asso-ciation of Orthopaedic Nurses.

Karon, n. m. (2007). Com-plications: Fat Embolism Syndrome. In N. Mooney (Ed.), Orthopaedic Nursing Core Competencies Across the Lifespan (pp. 98-101). Chi-cago: National Association of Orthopaedic Nurses.

Knoerlein, K., mcKenney, w. m., mullaney, d. m., & Quinn, s. m. (2007). The Sur-gical Neonate. In N.T. Brown, L. M. Flanigan, C. A. Mc-Comiskey & P. Pieper (Eds.), Nursing Care of the Pediatric Surgical Patient (pp. 167-180). Sudbury: Jones and Bartlett.

lafrak, l., Burch, K., Caravantes, r., Knoerlein, K., denolf, n., duncan, J., et al. (2006). Sucrose Analgesia: Identifying Potentially Better Practices. Pediatrics, 118, S197-202.

langille, K., & proehl, J. A. (2006). Pertussis—A Variety of Implications for Emergen-cy Departments. Advanced Emergency Nursing Journal, 28(3), 190-197.

mcneil, B. J., elfrink, v., Beyea, s. C., pierce, s. t., & Bickford, C. J. (2006). Com-puter Literacy Study: Report of Qualitative Findings. Jour-nal of Professional Nursing, 22(1), 52-59.

meehan, K. r., fitzmau-rice, t., root, l., Kimtis, e., patchett, l., & hill, J. (2006). The Financial Requirements and Time Commitments of Caregivers for Autologous Stem Cell Transplant Recipi-ents. The Journal of Support-ive Oncology, 4(4), 187-190.

meehan, K. r., hill, J. m., patchett, l., webber, s. m., wu, J., ely, p., et al. (2006). Implementation of Peripheral Blood CD34 Analyses to Initi-ate Leukapheresis: Marked Re-duction in Resource Utilization. Transfusion, 46(4), 523-529.

proehl, J. A. (2006). Chest Pain. In K. Oman, J. Koziol-McLain & L. Sheetz (Eds.), Emergency Nursing Secrets (2nd ed., pp. 147-154). St. Louis: Elsevier.

rawls, m. C. (2007). Total Knee Arthroplasty. In N. Mooney (Ed.), Orthopaedic Nursing Core Competencies: Across the Lifespan (2 ed., pp. 69-76). Chicago: National Association of Orthopaedic Nurses.

rawls, m. C. (2007). Total Hip Arthroplasty. In N. Mooney (Ed.), Orthopaedic Nursing Core Competencies: Across the Lifespan (2 ed., pp. 77-84). Chicago: National Associa-tion of Orthopaedic Nurses.

rawls, m. C. (2008). “Pre-operative Teaching” in Real World Practice Tips from Magnet Hospitals. In A. Ber-man, S. Snyder, B. Kozier & G. Erb (Eds.), Kozier & Erb’s Fundamentals of Nursing (p. 946). Upper Saddle River: Prentice Hall.

shocksnider, J. (2006). Evidence-Based Practice Becomes a Reality. In Evidence-Based Practice: A Guide to Successful Implementation (pp. 47-64). Marblehead: HCPro.

skalla, K. A., & mcCoy, J. p. (2006). Spiritual Assessment of Patient with Cancer: The Moral Authority, Vocational, Aesthetic, Social, and Tran-cendent Model. Oncology Nursing Forum, 33(4), 745-751.

stanhope, n. (2006). Tem-perature Measurement in the Phase I: PACU. Journal of PeriAnesthesia Nursing, 21(1), 27-36.

thompson, e., harding, A. l., pond, f., hammond, C., & taylor, m. (2006). A Part-nership to Improve Health Care in Kosovo: Dartmouth Medical School and Kosovar Nurses Worked Together on a Two-Year Project to Rebuild Primary Health Care in the Post-Conflict City of Gjilan. American Journal of Nursing (Critical Care Edition), 106(11), 72CC, 72DD.

trombly, s. (2006). The Risk Management Professional and Biomedical Technology. In R. C. S. Brown (Ed.), Risk Management Handbook for Health Care Organizations (5th ed., Vol. 2, pp. 187-200). San Francisco: Jossey-Bass.

trombly, s. (2006). Adverse Events Require Communica-tion and Disclosure. Anesthe-sia Patient Safety Foundation Newsletter, 21(1), 1-3.

dhmC nursing showCAse

PresentationsBakitas, m. Assessment and Management of the Patient with Pain and Cognitive Im-pairment. Crotched Mountain Rehabilitation Center. Green-field, NH. (March).

Bakitas, m. Chemotherapy-Induced Peripheral Neuropa-thy: Interpreting Discrepan-cies Between Symptom Severity and Patient Ap-praisal of Effects on Quality of Life and Family Percep-tions of End-of-Life Care in an NCI-Designated Comprehen-sive Cancer Center. Eastern Nursing Research Society. Philadelphia, PA. (April).

Bakitas, m., Ahles, t.A., Brokaw, f., Byock, i. Fam-ily Perceptions of End-of-Life Care in an NCI-Designated Comprehensive Cancer Center. Eastern Nursing Research So-ciety. Philadelphia, PA. (April).

Bakitas, m. Understand-ing Chemo-induced Neu-ropathy. Schmertz Rounds, Dartmouth Medical School, Lebanon, NH. (May).

Bakitas, m. Keeping Patients at the Center of Care: Nursing Science and Patient and Family Advocacy. Transforming Cancer Care. Manchester, NH. (May).

Bakitas, m. Communication Issues in Palliative Care. Cen-tral Vermont Hospital. Barre, VT. (August).

Bakitas, m. Management of Neuropathic Pain. New Hampshire Neuropathy As-sociation. Wentworth-by the Sea, NH. (August).

Bakitas, m. Principles of Pal-liative and End-of-Life Care. Senior Seminar, Colby-Saw-yer College. New London, NH. (September).

Bakitas, m. Background Noise: The Experience of Che-motherapy-Induced Peripheral Neuropathy. Comprehensive Breast Cancer Conference. Lebanon, NH. (October).

Bakitas, m. Chemotherapy-Induced Peripheral Neuropa-thy: Discrepancies Between Interview Data and Self-Re-port Questionnaires. 9th International Conference on Mechanisms and Treatment of Neuropathic Pain. Ber-muda. (November).

Bedell, m. Like Sand Through an Hourglass…On-cology Nursing Yesterday, Today and Tomorrow. North-east Regional Oncology Nursing Conference. Ports-mouth, NH. (November).

Bedell, m. Successful Meet-ings. Leadership Develop-ment Institute. Oncology Nursing Society. Lansdowne, VA. (December).

Bell, d., Bise, i., Craven, r., demauro, n., desliets, l. & farrah, s. CE 101: Planning and Achieving Best Practices. Pre-Conference Workshop. 33rd Annual Professional Nurse Educator Conference. Burlington, VT. (October).

Brown, K. The SSRI Exposed Infant: What We Know, What We Don’t Know and Where We Are Going. 9th Annual Neonatal Advanced Practice Nursing Forum 2006. Wash-ington, DC. (June).

Ceppetelli, e. Linking Cur-rent Concepts in Competency-based Education and Critical Thinking to the Practice Set-ting. Creativity and Connec-tions: Building a Framework for Future Nursing Education and Practice Conference, Massachusetts Commission on Higher Education. Worces-ter, MA. (March).

Ceppetelli, e. The Journey Back: From Injury to Return to Self. New Hampshire LPN As-sociation Annual Conference. Lebanon, NH. (May).

Ceppetelli, e. & reeves, s. Faculty Shortage Solution: The Faculty Cost-Center Experience at DHMC. 33rd Annual Professional Nurse Educator Conference. Burl-ington, VT. (October).

Ceppetelli, e. & o’donnell, J. Inter-professional Education: The Future Is Now. 33rd An-nual Professional Nurse Edu-cator Conference. Burlington, VT. (October).

Choate, m. The Nurse as a Legislative Activist. Vermont Emergency Nurses Associa-tion. Montpelier, VT. (April) and Nursing Education De-partment Inservice, Northern Vermont Regional Hospital, Montpelier, VT. (September).

Choate, m. Toxins and Terrors. Respiratory Care Conference, DHMC, Lebanon, NH. (October).

frace, m. Understanding ARDS. Leading the Way to Excellence in Nursing Practice. Academy of Medical-Surgical Nurses. Phila-delphia, PA. (September).

godfrey, m., mcCoy, K. s., ten haken, J. Nurses of the 21st Century: Leading, Car-ing and Improving at the Frontline as Full Partners. Pre-Conference Workshop. 33rd Annual Professional Nurse Educator Conference. Burlington, VT. (October).

hodgson, r. Contributing to the Bedside Assessment in the Elderly. Gerontology Up-date 2006. DHMC, Lebanon, NH. (April).

Karon, n. m. Culture of Mobili-ty. Fall 2006 LNA Forum. DHMC, Lebanon, NH. (November).

mudge, B. Assuring Pediat-ric Medication Safety. New Hampshire Nurses Asso-ciation Spring Conference. Nashua, NH. (February).

mudge, B. Pain Manage-ment in Children: A Team Approach. DHMC and VNA/VNH Pediatric Conference. Lebanon, NH. (October).

mudge, B. PEDI-HERT – Rapid Response Team for Pe-diatrics. New Hampshire Pedi-atric Nurse Managers Meeting. Concord, NH. (November).

mullaney, d. Neonatal Pain and Sedation. Neonatal Ad-vanced Practice Nursing Meet-ing. Weymouth, MA. (April).

mullaney, d. Caring for the Extremely Low Birthweight Infant. South Shore Hospital Annual Neonatal Conference. Kingston, MA. (November).

Philanthropy AwardAnnette r. and samuel m. levine, long-standing supporters of nursing at DHMC, received the Ameri-can Journal of Nursing—Beatrice Renfield Caring for Caregiver Award, an honor given annually to a philan-thropist who has benefited nursing.

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patchett, l. Health Care Fi-nances 101. DHMC Hematolo-gy/Oncology Unit Mini-course. Lebanon, NH. (October).

patchett, l., root, l. & meehan, K. Shared Medi-cal Appointments (SMA):

Implementation in the Bone Marrow Transplant Clinic. Northern New England Clinical Oncology Society. Portland, ME. (November).

plunkett, p. Anxiety and Depression in Hematology/

Oncology Patients. Hematol-ogy/Oncology Mini-Course. DHMC. Lebanon, NH. (March and October).

plunkett, p. Care of the Patient with Cognitive Impairment. 2006 Fall LNA Conference.

DHMC, Lebanon, NH. (March).

plunkett, p. Current Issues in Biomedical Ethics. Central Vermont Medical Center, Berlin, VT. (April).

plunkett, p. Evidence-based Falls Risk Reduction—Acute Care Population. 6th Annual NH Conference on Aging. Manchester, NH. (May).

plunkett, p. Anxiety Man-agement. Advances Con-ference. Manchester, NH. (September).

plunkett, p. Patients Behav-ing Badly…What’s a Nurse to Do? Medical-Surgical Update 2006. DHMC. Lebanon, NH. (October).

plunkett, p. Supervisors Caring for Anxious or Angry Patients, Families or Staff. Connections and Renewal II. DHMC. Leba-non, NH. (October).

plunkett, p. Assessment and Care of the Confused/Agitat-ed Patient and Case Studies. Gerontology Update 2006: Confusion, Polypharmacy, Falls and Incontinence. Cen-tral Vermont Medical Center. Berlin, VT. (October).

proehl, J. Tips for Speakers. Emergency Nurse Associa-tion Leadership Symposium. Austin, TX. (February).

proehl, J. Moving into a New ED. Emergency Nurse As-sociation Leadership Sympo-sium. Austin, TX. (February) and Tampa General Hospital. Tampa, FL. (June).

proehl, J. Critical Clinical Thinking & Trivia Bowl. New England Regional Sympo-

sium for Emergency Nursing. North Conway, NH. (April).

proehl, J. From Ivory Tower to Bedside: Evidence-Based Practice in Emergency Nurs-ing—Emergency Nursing Pearls. Emory Crawford Long Emergency Nursing Confer-ence. Atlanta, GA. (October).

proehl, J. & leBlanc, l. Canadian Triage and Acuity System. Canadian Triage and Acuity System. San Antonio, TX. (September).

Quigley, m. How to Manage and Maintain Comprehen-sive Follow-up after Bariatric Surgery. Annual Meeting, Society of the American Gas-trointestinal and Endoscopic Surgeons (SAGES). Dallas, TX. (April).

Quigley, m. Avoiding Mal-practice in Bariatric Surgery. Advanced Practice Bariatric Seminar, Bariatric Best. San Francisco, CA. (June).

Quigley, m. Obesity: Com-plications, Considerations and Care. Medical-Surgical Update 2006. DHMC, Leba-non, NH. (October).

Quinn, s. Prematurity Over-view and Growth, Develop-ment and Nutrition in a Pre-mature Infant. Pediatric Skill Day: Care of the Premature Infant. VNA Health System of Northern New England. Concord, NH. (November).

rawls, m. C. Surgical Site Infections. Medical-Surgical Update 2006. DHMC. Leba-non, NH. (October).

American Association of Critical Care Nurses: Horizons 2006, Manchester, NH. (March)Brochu, C. J., & goewey, C. Improv-ing New Graduate Readiness to Practice Through a Unit Specific Nurse Residency Program.*

9th Annual Magnet Conference, Miami, FL. (March)Beyea, s. C. Competency for Entry into Practice Utilizing Human Patient Simulation.

14th Annual Conference for Nurse Educators, New Castle, NH. (May)Beidler, C., todd, f., von reyn, l.J., & Beyea, s.C. Developing a Scenario for Human Patient Simulation.*

Kertis, J., van loon, d., & nicoll, n. SimBaby® Brings Human Patient Simu-lation to a Neonatal Nurse Residency Program.*

todd, f. Integrating Reflective Practice into Human Patient Simulation Experi-ences.*

todd, f. Reflection: A Strategy for Active Learning with Human Patient Simulation.

Northern New England Perioperative Nursing Trend and Team Work, Lebanon, NH. (September) Beyea, s. C. Team Training and Simulation.

24th Annual International Nursing Computer and Technology Conference, Toronto, Ontario, Canada (May)Beyea, s. C. & von reyn, l. K. The Use of Human Patient Simulation in Develop-ing Recent Graduate Nurse Competencies.

Laerdal Simulation Users’ Group, Foxwoods, CT. (June) grigel, C. & todd, f. Integration of Simulation into Education.

todd, f. Human Patient Simulation and the Nurse Residency Program at Dart-mouth-Hitchcock Medical Center.

10th National Magnet Conference, Denver, CO. (October)todd, f. Using Human Patient Simulation for Graduate Nurses.

33rd Annual Professional Nurse Educators Group Conference, Burlington, VT. (October)Beidler, C., Beyea, s.C., todd, f., & von reyn, l.J. Maximizing the Potential of Human Patient Simulation: Teaching and Learning Along the Novice to Expert Continuum. (Pre-Conference workshop).

sheets, d. o., Kertis, J., & mudge, B. Developing Competency with Pediatric Residents using Patient Simulation.*

* Poster presentation

simulation-related presentations

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rawls, m. C. & Karon, n. A Culture of Mobility. LNA Con-ference. DHMC. Lebanon, NH. (November).

sandberg-Cook, J. Demen-tia/Delerium. Nursing Educa-tion Series, Kendal at Hanover. Hanover, NH. (January).

sandberg-Cook, J. Muscu-loskeletal Disorders. Nursing Education Series, Kendal at Hanover. Hanover, NH. (February).

sandberg-Cook, J. Patient Falls: The Scope of the Prob-lem. Nursing Grand Rounds, DHMC. Lebanon, NH. (May).

sandberg-Cook, J. Connec-tive Tissue Diseases. Senior Nursing Class, Colby-Sawyer College. New London, NH. (September).

sandberg-Cook, J. Com-mon Skin Problems in Long Term Care. Nursing Education Series, Kendal at Hanover. Hanover, NH. (November).

sandberg-Cook, J. Jordan, B., & plunkett, m. Falls: The Scope of the Problem and Urinary Incontinence. Central Vermont Hospital. Randolph, VT. (October) and Best Practices in the Care of Older Adults, DHMC. Lebanon, NH. (December).

von reyn, l. & palumbo, m. Hot Topics in Education and Practice: Here Are The Ques-tions and Challenges. 33rd Annual Professional Nurse Educator Conference. Burlington, VT. (October).

Poster PresentationsBakitas, m., Brokaw, f., Ahles, t. A., Byock, i. Fam-ily Perceptions of End-of-Life Care in an NCI-Designated Comprehensive Cancer Center. American Academy of Hospice and Palliative Medicine and HPNA An-nual Assembly. Nashville, TN. (February).

Bakitas, m. Chemotherapy-Induced Peripheral Neuropa-thy: Patient Perspectives on Whether to Continue Neuro-toxic Treatment. Oncology Nursing Society Congress. Boston, MA. (May).

Bennett, m., & Bedell, m., Decreasing the Morbidity Associated with Central Ve-nous Catheters in the Bone Marrow/Stem Cell Transplant Patient. Oncology Nursing Society Congress. Boston, MA. (May).

Boucher-Concilio, A., Baki-tas, m., & usher, s. Foster-ing Advance Care Planning in a Hospital-based Radiation Oncology Practice, Oncology Nursing Society Congress. Boston, MA. (May).

Key, l., rezendes, m., gemery, J., & onega, t. Improved Outcomes in Management of Malignant Pleural Effusions. Summer Institute on Evidence-based Practice. San Antonio, TX. (June/July).

Knoerlein, K. Ibuprofen versus Indomethacin for the Closure of Patent Ductus Ar-teriorsus: A Critical Appraisal of Randomized Clinical Trials. 9th Annual Neonatal

Advanced Practice Nursing Forum 2006. Washington, DC. (June).

mcKenney, w. Use of C-Reactive Protein Levels to Minimize Antibiotic Expo-sure in Infants <1500 grams in the Intenstive Care Nurs-ery. 9th Annual Neonatal Advanced Practice Nursing Forum 2006. Washington, DC. (June).

mudge, B., Arsenault, l., duhaime, A., mcCarragher, J., mroz, i., proehl, J. Devel-oping and Implementing an Age Appropriate Standard-ized Neurological Assess-ment. 33rd Annual Profes-sional Nurse Educator Group Conference. Burlington, VT. (October).

palac, d., patchett, l., Jensen, C., flanagan, m., & Byock, i. Bone Marrow Procedure-related Pain and Anxiety Improved with Propofol Protocol. Northern New England Clinical Oncol-ogy Society. Portland, ME. (November).

patchett, l., root, l., Kimtis, e., & hill, J. Shared Medical Appointments (SMA): Implementation in the Bone Marrow Transplant Clin-ic. Northern New England Clinical Oncology Society. Portland, ME. (November).

prior, e., warren, C., & liu, s., Implementation of an Evidence-Based Tobacco Treatment Program in the Hospital Setting. 33rd Annual Professional Nurse Educator Conference. Burlington, VT. (October).

rawls, m. C. Pancreatic Transplants: Pathway to Nor-moglycemia. Nursing 2006 Symposium: The Conference for Clinical Excellence. Las Vegas, NV. (April).

truman, s., edson, t., fitzmaurice, C., & tisdale, s. To Go Bags for Laryngectomy and Tracheostomy In-patients. Society of Otorhinolaryngol-ogy and Head-Neck Con-ference. Toronto, Canada. (September).

warren, C., liu, s., & Colburn, K. Establishing a Tobacco Treatment Team at DHMC. 33rd Annual Pro-fessional Nurse Educator Conference. Burlington, VT. (October).

One Medical Center Drive Lebanon, NH, 03756

www.dhmc.org

Executive EditorsSuzanne Beyea & Mary Jo Slattery

Contributing EditorLiz Cooper

WriterTim Dean

PhotographerMark Washburn

Art DirectorDavid Jenne

ContributorsLinda Arsenault, James Biernat, Ellen Ceppetelli, Kathleen Craig, Sharon Markowitz, Jillian Miller, Dorothy

Mullaney, Peter Nolette, Sally Patton, Peggy Plunkett, Barbara Power, Ellen

Prior, Mary Catherine Rawls, Colleen Warren

Published jointly each year by the Office of Professional Nursing and the Department of

Public Affairs & Marketing, Creative Services. All contents © 2007.

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