Chris Mueller – nurse practitioner in the Outpatient Leukemia Clinic
As a nurse practitioner in Sunnybrook’s Outpatient Leukemia Clinic, Chris Mueller works with patients and families at very difficult times in their lives.
“I get to know patients very well,” says Chris, who notes that close surveillance is critical as patients with acute leukemia and lymphoma can become ill very quickly. “We are always assessing for complications of chemotherapy, particularly infectious signs and symptoms. If a patient who is immunocompromised develops a fever, we provide rapid assessment and start them on antibiotics to help avert serious complications.”
The clinic is nurse practitioner-led, providing chemotherapy and transfusions, as well as diagnosis and care for any complications that may arise from a patient’s illness. Patients range from young adults to seniors and experience a range of outcomes from cure to palliative care.
The model of care places an emphasis on team collaboration and communication. If a patient heads to the Emergency Department and is clinically stable, prompt communication between the two areas allows the patient to move quickly to the clinic. Chris notes the improved access to care helps boost patient satisfaction as well as clinical outcomes.
Chris and her nurse practitioner colleague work closely with the registered nurses on the unit to understand each patient’s personal health journey. For Chris, one of the most impactful parts of her role is seeing the interactions between patients and their families.
“I am so grateful to see incredible acts of love between people that I would not ordinarily get to experience in my everyday life. Patients and their families can be incredibly resilient in the face of great stress,” says Chris. “I aspire to have as much strength, resolve, and courage as our patients and families do.”
Carolyn Lawton – diabetes nurse practitioner
Ask Carolyn Lawton what she loves about her role as a nurse practitioner and she struggles to narrow it down.
Carolyn admits she finds it gratifying using her specialized knowledge to educate patients and families about their diabetes care plan. She also gets very excited about the explosion of technology and medication in the area of diabetes.
“I’ve seen the leaps and bounds that diabetes care has recently made with treatment and technology,” says Carolyn, who has worked in her role as nurse practitioner since 1996. “There’s an ever-expanding toolkit of diabetes medications. It’s exciting but also comes with the responsibility of ensuring you’re providing the right drug and the right technology to the right person.”
One out of every five patients admitted to Sunnybrook has diabetes. People living with diabetes have longer hospital stays and are more likely to be readmitted than those without the condition. On top of this, surgical site infections are linked to blood glucose results that are above the 5-10 mmol/L guidelines.
The role of Diabetes Nurse Practitioner was created to improve outcomes and address these realities. Research has shown that a nurse practitioner with specialized training is associated with patients’ greater use of insulin therapy, meaning lower mean blood glucose levels.
Carolyn spends her days between inpatient units and outpatient diabetes clinics, helping identify and limit factors which may interfere with safe, high quality diabetes care. She’s an active member of the Diabetes Champion Group which drives best practice at the unit level and also works with the Sunnybrook Diabetes Education Program (SUNDEC) and the Rapid Assessment Diabetes and Referral Program (RADAR), which follows highly complex patients in an outpatient setting.
Carolyn recently read hockey player Max Domi’s autobiography; Max lives with diabetes.
“He speaks about “no days off,” the pressure of always making the right choices. I think as health care professionals we understand, and know this is a heavy burden to carry,” says Carolyn, who adds there’s a need to study new diabetes technology to see how it impacts patients’ quality of life.
Aimee Santoro – high risk obstetrics nurse practitioner
Having a high risk pregnancy can be incredibly stressful for women and their families. At Sunnybrook, a nurse practitioner role is helping to reduce emergency department visits by providing personalized care and patient advocacy.
Aimee Santoro spends her days with women who are pregnant and may have kidney disease, a history of preterm birth, a pregnancy complicated by genetic or chromosomal problems, high blood pressure, preterm delivery or be carrying multiples.
Each year, Sunnybrook’s high risk obstetrics clinics have roughly 15,000 patient visits. Aimee’s days are often dotted with difficult conversations.
“I’m at ease spending time with women who have difficult news to process and supporting their decision-making,” says Aimee. “I take the time to help women and their families understand, in layperson’s terms, what they’re facing.”
Aimee has spent 17 years in the field of high risk obstetrics. A critical part of her role is early intervention, before a woman makes the decision to visit an emergency department when concerned about a complication.
“Patients call me with questions and concerns. Many are on the verge of heading to an emergency department; they’re experiencing high blood pressure or having spotting or symptoms of urinary tract infections,” explains Aimee.
She acts quickly by ordering labs and arranging an ultrasound for these women, so women avoid an emergency visit and instead receive care from a clinical team familiar with their health journey. Aimee is also co-leading a research project into early screening for preeclampsia, with the goal of improving detection and subsequent treatment for women.
Aimee is quick to add how much she enjoys working with the entire team, including the maternal fetal medicine specialists, to problem solve.
“My work is incredibly satisfying,” says Aimee. “Not only do I really enjoy caring for women and their families to ensure they have the best outcomes, but I am always learning something new in an exciting field.”
Photography by Kevin Van Paassen