Advanced education is helping nurses expand their horizons – and mentor the colleagues who follow in their footsteps.
It was a stressful situation for a new nurse in Sunnybrook’s Neonatal Intensive Care Unit (NICU): A father, upset over a change in the care plan for his premature baby, was becoming increasingly emotional and the nurse – who had been on the job for about six months – was struggling over how to handle the situation.
Enter registered nurse Jo-Ann Alfred, a nurse educator whose advanced education and clinical training gave her the tools she needed to calm the nurse down and help her deal with a potentially confrontational situation.
“The father was emotional, and at the time the nurse wasn’t sure how to properly explain the change in the plan without getting the father more upset,” says Alfred, an 18-year veteran nurse who has been working in the NICU since 2014. “I told her the biggest thing to do in this situation is to use kindness and understanding, and listen, because [for the most part] they just want to be heard.”
The work of Alfred and other nursing mentors is part of Sunnybrook’s emphasis on continuing education, which is proving to be more important as health-care workers adapt to new challenges of increasingly complex hospital settings, an aging population, complex medical conditions and technological advances such as mobile devices and electronic medical records.
“This is about ensuring that we are providing the best care we can for patients and families in a constantly evolving world,” says Elizabeth McLaney, Sunnybrook’s director of Interprofessional Education. “And at the same time, ensuring we can continue to provide that care for future generations.”
In the nursing education department, improving the patient experience comes in many forms – but it all starts with making sure newly hired nurses are comfortable and confident in their roles. Critical to this is mentoring. Following an orientation period, each new nurse is teamed with an experienced colleague, says Beverly Waite, a nursing education leader at Sunnybrook.
As well as benefiting from mentoring initiatives, many of Sunnybrook’s registered nurses pursue a master’s degree and even a PhD, qualifying them for advanced-practice nursing positions (such as nurse practitioner and clinical nurse specialist) and other clinical roles, as well as research, teaching and leadership positions.
So who are these Sunnybrook nurses embracing the never-stop-learning culture? Below are just a few.
Part-time registered nurse (RN) in the trauma unit and clinical instructor for University of Toronto (U of T) nursing students.
Lauren Cosolo knows through her own experience the value of having a mentor.
“When starting out as a new nurse, you’re not confident in yourself or your skills, but having somebody there to help you through that is so valuable,” says Cosolo, 27. “In the trauma unit, we get people who’ve been seriously hurt from motor vehicle collisions to gunshots and have traumatic brain injuries – they’re complex traumas that involve lots of different systems.”
For the past couple of years, while working part time in the unit, Cosolo has pursued a master’s degree in nursing. By doing so she hopes to become a nurse educator, to teach other nurses in “evidence-based practice” – that is, caring for patients using the best knowledge possible, based on both scientific findings and what has been shown to work in practice.
“I really enjoy nursing education and being that support system: helping new nurses and nursing students develop skills and confidence.”
When patients arrive in the trauma unit, she says, “usually they’re from the Intensive Care Unit (ICU) and they’re acutely ill. A newly hired nurse in the ICU may struggle at first with addressing the concerns and fears of distraught families of these patients. But the mentor helps by giving valuable advice and recommending resources to help the new nurse deal with the needs of the patients’ loved ones.”
Under the early guidance of her mentor Melanie Santos at Sunnybrook, Cosolo learned to hone her nursing skills. “Melanie was very much the one who would give me confidence. She was always there for support when I needed her, but also pushed me to be independent, which is important,” Cosolo says.
After taking a nurse preceptor workshop (which educates nurses on how to guide and work with students), Cosolo mentored her first student last year and takes pride in seeing her now working in the trauma unit.
“I really enjoy nursing education and being that support system: helping new nurses and nursing students develop skills and confidence, handle a full patient load and practise confidently, ethically and safely,” Cosolo adds.
Advanced-practice nurse (APN) in the ICU and assistant professor at the Lawrence S. Bloomberg Faculty of Nursing at U of T
Craig Dale has seen his career as a nurse go through quite an evolution over his 22-year tenure at Sunnybrook; through it all, he’s constantly reminded of the importance of learning from the patient experience.
Dale, 51, has been an APN in the ICU for the past decade, with specialties in qualitative health research and critical-care nursing. He has been an assistant professor at the University of Toronto since January 2015, two years after earning his PhD in nursing.
“A lot of people entering the profession don’t realize that you can have a rich career that advances patient care from more than one vantage.”
“One thing I didn’t realize at the start of my career,” he says, “is, you can become a scientist at the same time as being a nurse clinician. A lot of people entering the profession don’t realize that you can have a rich career that advances patient care from more than one vantage. In my case, I’ve done this through my clinical role, my academic work, my research and as a mentor to other nurses at Sunnybrook.”
Dale’s research focuses on improving hygiene practices for intubated and mechanically ventilated adult patients. For his doctorate, he studied the practical challenges of providing oral care and how to improve it. It’s an essential life-saving skill; for instance, he discovered that pneumonia starts with bacteria in the mouth.
He believes nurses play a crucial role in the health-care system internationally, including in leadership positions, “because they understand what’s happening at the point of care: they know how things work and how they break down. They’ve also been trained to communicate with people in distress which is one of the most important skills clinicians can bring to the patient-family encounter.”
One young trauma patient, who suffered extensive orthopaedic and facial fractures in addition to a life-threatening pneumonia, was particularly memorable for Dale.
“He couldn’t speak while on the ventilator and his eyes wouldn’t open because of his facial swelling,” he says. “Assuming he was able to hear and understand me, I guided him during his care and offered encouraging details about his recovery. Many months later he walked into the ICU to thank me. He didn’t know what I looked like but said he could recognize my voice.
“Despite the high-tech focus of ICU life-support, I have learned how patient survival is undeniably conditioned by empathetic support and communication.”
Desiree and Drew Lewis
Staff RNs, Neonatal Intensive Care Unit (NICU)
Born several weeks early, it seemed fraternal twins Desiree and Drew Lewis’s destiny that they would end up working with other premature babies. They have been doing just that in Sunnybrook’s NICU since September 2015.
The sisters, who turned 26 in May, say their experiences in the NICU after getting nursing degrees have been “amazing,” in large part because they weren’t just thrown into the nursing pool to sink or swim.
Drew, the older twin by five minutes, always wanted to be a nurse. Desiree earned an accounting diploma before realizing she, too, would rather work in health care.
After graduating last year, they joined the NICU staff and entered an orientation program with in-class learning for two weeks, then received one-on-one training by nurse preceptors over a three-month period.
“I am lucky that I can come to work every day and feel inspired by all those around me.”
Their own background as premature twins helps fire their enthusiasm for their work in the NICU. “I am inspired by [preterm babies’] strength, resilience and fight, and by how strong and hopeful their families are,” says Desiree, who says these young patients motivate her every day to want to learn as much as possible about her profession.
“I am lucky that I can come to work every day and feel inspired by all those around me,” she says, adding she wants to further her education and inspire future nurses “the way I was inspired by many throughout my journey.”
Desiree says she and her sister continually experience what it means to be part of a teaching hospital. They’re grateful they can collaborate with other nurses, doctors, pharmacists, dietitians, social workers and other professionals who are passionate about their jobs and enthused to teach and “clarify their piece of the patient puzzle,” while trying to return that to their colleagues at Sunnybrook.
Although she’s not certain what her career future holds, Drew says she, too, will one day pursue additional education, and her experience at Sunnybrook will prepare her.
“I will be ready for the journey.”
All photography by Doug Nicholson