Chris Mueller – nurse practitioner in the Outpatient Leukemia Clinic

Chris Mueller.

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

Carolyn Lawton.

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

Aimee Santoro.

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

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Registered Nurse and nursing preceptor Deborah Capra has some tips to help you get the most out of a practical placement. While her advice focuses on nursing, these reminders are great for all students on placement for health-care disciplines.

1. Don’t forget the basics: Start in general medicine. A lot of students now see the TV shows and want to go straight for the ER or surgical floors. But, it’s good to get a good basic knowledge of bedside nursing first. These are the fundamentals.

2. Outline your learning goals: “It’s important for you to speak up and inform your preceptor of what your learning goals are: if there’s something you want to see or try, let us know,” Deborah says. “We want to make your experience a positive one. If it’s a new treatment or a procedure that isn’t done often, we can keep an eye out and connect you to these opportunities.”

3. Speak up: Be clear about your objectives. If things aren’t going as you expected, or you aren’t getting what you need out of your placement, speak to your preceptor, or the educator on the unit.

4. Who, what, when, where, why: Ask questions. Lots of them. “Don’t feel dumb or intimidated,” Deborah says. “This is how you will learn. Plus, you are helping us! Sometimes we get into our routine and we forget why we do this.” It benefits the staff when students ask questions and are forced to stop to think. “It reminds us why we have a certain policy or procedure,” Deborah adds.

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Coming soon! Advice from Sunnybrook’s top docs, nurses, physios and other allied health professionals.

Looking back on their school days, what insights do they have now that they wish they could have known then? As they say, hindsight is 20-20.

Check back here soon for our first post!

The post Advice from the health-care pros: What I wish I knew back then… appeared first on Your Health Matters.

If you have found your way to this blog, you are probably already aware of the renewed commitment to education that is underway at Sunnybrook.

As an academic health sciences centre, Sunnybrook has a mandate that goes beyond providing the highest standard of clinical care to our patients. We are committed to creating, translating, and integrating new knowledge into patient care, education, and research. We take seriously the idea that everyone is a teacher and everyone is a learner. In fact, it is likely that it was this active learning environment that drew you to Sunnybrook in the first place.

However, in the midst of all of our activities related to patient care, the business of health care, research, and teaching, it is easy to overlook the idea that that practice of education itself is a focus for research and innovation. Part of our renewed mandate as an academic health sciences centre includes a sharper focus on development, implementation, and dissemination of best practices in clinical education.

There are many excellent and innovative education activities going on at Sunnybrook. Some of these have emerged out of necessity, some reflect the natural talents and instincts of our staff and physicians, and some are the result of focused and deliberate scholarly activity. It is important that we profile these activities, not only within Sunnybrook, but in the larger community. Equally important is the need to explore in a systematic way, how and under what circumstances these approaches are effective.

In our day-to-day work, each of us encounters multiple opportunities to be both a teacher and a learner – working with a student, assisting a new staff member to “learn the ropes”, encountering a job situation that is unfamiliar or unique. As committed lifelong learners, we typically approach these situations using our individual tried-and-true approaches. However these situations can also present opportunities to push ourselves to try something a little different.

Perhaps you’ve noticed patterns in the way different patients respond when you explain routines and procedures. You may have found that you and your colleagues have different ideas about the best way to introduce a new procedure, teach new staff, or master a technical task.

Pay attention to your reflections and hunches. Share them with your colleagues. These are the seeds of education scholarship.

Imagine the possibilities…

Marg Blastorah, RN, PhD

Director, Nursing Knowledge, Research and Innovation

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