D-H Nurse Manages Flow in the ED and also CREST Program
To be a good Emergency Department (ED) nurse you have to be able to multitask. In the span of five minutes the following scenarios may all unfold in the ED, explains Julia Barry, RN, BSN, CEN, who works the overnight shift in Dartmouth-Hitchcock Medical Center’s (DHMC) ED.
“You’re placing an IV in a patient with veins that are difficult to access, while the pager is going off with the DHART helicopter being dispatched to a scene trauma,” says Barry, who sits in the middle of the ED, managing the unit’s flow during her shifts as the charge nurse. “A local ambulance is patching and arriving with someone who is in cardiac arrest. A patient walks in the front door of the ED covered in blood after being assaulted. And a psychiatric patient is crying out and escalating. Despite all of these situations, the need to assure patient safety has to be the number one objective for the ED nurse.”
From candy striper to ED nurse
How did this New Hampshire Seacoast native, who got her start in health care as a high school candy striper and initially worked in the pediatric ICU at New York City’s Mount Sinai Hospital, end up in the ED? “I’m an adrenaline junkie and a multitasker. The fact that as an ED nurse you’re being pulled in so many different directions is one of my strong suits,” says Barry, who has worked in the emergency departments at Yale-New Haven Hospital in Connecticut, Mt. Ascutney Hospital and Health Center in Windsor, Vermont, and at DHMC since March 2014.
With a demanding job, a 10-month-old daughter and a 6-year-old stepson at home, Barry clearly excels at multitasking. In addition to managing two nursing clinical shifts a week at DHMC, she became program manager for the Center for Rural Emergency Service and Trauma (CREST) in June, a job to which she devotes 12 hours a week. CREST is a DHMC-based collaborative program of 17 critical access and community hospitals across New Hampshire and Vermont.
She also occasionally works per diem at two rural critical access hospitals, serves on DHMC’s STEMI Committee and is a member of Leadership Saves Lives (LSL), which is a partnership of 10 Mayo Clinic Care Network hospitals and part of a research study spearheaded by the Yale Global Health Leadership Institute. The goal of the LSL study is to reduce mortality in patients with acute myocardial infarction (AMI) by implementing specific strategies, while the STEMI Committee team hopes to improve AMI care regionally by reviewing every STEMI that is treated at DHMC and identifying and addressing systems issues.
Improving rural patient care
Since assuming her new role with CREST, Barry has visited several of the CREST member hospitals, and met with ED and nursing leaders, as well as a few hospital leaders. As one of the Center for Telehealth’s primary educational and outreach partners, CREST is designed to strengthen the emergency care of patients across rural New England through the sharing of education, comparative data, best practices, and twice-monthly case reviews (trauma case reviews are presented the first Wednesday of every month, and emergency case reviews on the third Wednesday).
“The mission of CREST is to improve the care of rural patients through efficient access to specialty care. My goal is to increase visibility and awareness of CREST and to see what obstacles the local hospitals are facing so that we can help them better serve and care for their patients,” says Barry, who plans to visit four more CREST hospitals in September: Dartmouth-Hitchcock Brattleboro (VT) Medical Center, Upper Connecticut Valley Hospital in Colebrook, NH, Grace Cottage Hospital in Townshend, VT, and Northeastern Vermont Regional Hospital in St. Johnsbury, VT.
Increasing emergency care educational opportunities
One of the challenges facing the region’s small rural hospitals is accessing beds and the specialty care they need from D-H providers, an issue that is increasingly being addressed by the D-H Center for Telehealth. Barry says rural nurses and physicians also want to have greater access to education and training. “Many of the nursing staff at rural hospitals are home-grown,” Barry explains. “They’ve gone to a nearby community college and have often not been exposed to higher acuity, level one trauma care. So how can we broaden their vision of emergency nursing?”
Barry is working with Debra Pilling Hastings, PhD, RN-BC, CNOR(E), the director of D-H’s Continuing Nursing Education, “so that some of rural nurses can shadow DHMC nurses and see what we do.” Barry says that D-H’s mobile simulation unit will also enable health care providers at rural hospitals to practice their acute care skills, giving them the “know-how plus the confidence to execute. This can also only help give additional tools to provide excellent patient care and improve the transfer process, when necessary.”
Another prime educational opportunity is CREST’s upcoming eighth annual Northern New England Rural Emergency Services and Trauma Symposium, which is at DHMC on October 15. Two CREST-sponsored events will also be held at DHMC the day before and the day after the symposium. An Airways Management Workshop for Emergency and Trauma Providers is on October 14, and a free Nonviolent Crisis Intervention course CREST members is October 16.
“How can Dartmouth-Hitchcock help?”
As she continues her CREST hospital visits, Barry looks forward to building stronger relationships and partnerships with the region’s hospitals. “When you’re in the trenches at these smaller hospitals, you get it loud and clear—the obstacles they’re facing are real,” she says. “When you can’t get an ambulance to transfer a patient that’s acutely ill you’ve got to figure out the best way to care for that patient with the resources you have at your fingertips. So how do we empower these people to feel safe and comfortable to care for that very, very sick patient that they may not be able to get to us for four hours? Or help them understand what patients truly need to come here and what patients they can safely manage there, and what resources they need in order to do that.
“I wake up in the morning and I ask myself, ‘How can Dartmouth-Hitchcock help patients and providers in the region?’ And I think we can be that hospital, that health system, that is really a resource.”
As she continues her CREST hospital visits, Barry looks forward to building stronger relationships and partnerships with the region’s hospitals. She says, “I wake up in the morning and I ask myself, ‘How can Dartmouth-Hitchcock help patients and providers in the region?’ And I think we can be that hospital, that health system, that is really a resource.
“When you’re in the trenches at these smaller hospitals, you get it loud and clear—the obstacles they’re facing are real. When you can’t get an ambulance to transfer a patient that’s acutely ill you’ve got to figure out the best way to care for that patient with the resources you have at your fingertips. So how do we empower these people to feel safe and comfortable to care for that very, very sick patient that they may not be able to get to us for four hours? Or help them understand what patients truly need to come here and what patients they can safely manage there, and what resources they need in order to do that. I’m passionate about helping to make sure they’re prepared for these situations.”