From Bedside to Bench— And Everywhere In Between
By Christina Hernandez Sherwood
In the early days of the COVID-19 pandemic— as clinicians were determining the best ways to care for sick patients in acute re- spiratory distress—nurses at Penn Medicine
Princeton Health were increasingly moving their patients into the prone position to ease breath- ing and improve mortality. But while lying on the stomach can improve respiration, the position can also break down the skin by causing pressure injuries.
To mitigate these downsides, a certified wound and skin care nurse specialist led the multidisciplinary prone-positioning team at Princeton Health in developing a skin preserva- tion strategy specific to COVID-19 patients. “We started seeing these great results. Our patients didn’t seem to have pressure injuries at the rate others were seeing,” says Kari Mastro PhD RN, Director of Professional Practice, Innovation and Research at Penn Medicine Princeton Health. “We then wrapped a scientific structure around that [to determine] if this happened because of the intervention.”
This bedside intervention-to-bench research scenario is exactly the type of effort that is growing at Penn Medicine Princeton Health with the estab- lishment last June of the new Institute for Nursing Excellence. Comprising three centers—focused on research and innovation, clinical practice, and professional development—the institute unifies dispa- rate efforts into a hub for nurses who want support to advance their careers and education, research new ideas, and improve patient outcomes.
“Having an institute allows you to have a laser focus on these three elements [and] make sure each one gets equal attention,” says Vice President of Patient Care Services and Chief Nursing Officer Karyn Book RN MSN. “Each [center] has its own set of goals and objectives, and its own set of programs.”
The institute gives the 1,200-plus nurses at Penn Medicine Princeton Health the resources they need to turn a clinical innovation into a scientific study, and vice versa, as well as opportunities for profes- sional advancement, says Mastro, who was tapped to serve as the Institute’s Executive Director. Penn Nursing is a partner in these goals, maintaining a close connection with the Institute through Rosemary Polomano PhD RN, Associate Dean for Practice, who serves as the liaison between the School and the Institute, as well as Penn Nursing faculty on the Institute’s governing board. The Princeton Institute for Nursing Excellence leaders will also engage with Penn Nursing faculty through the Penn Nursing and Penn Medicine academic partnership.
“This Institute is highlighting the fine, detailed work that is going on within nursing.”
“The frontline clinical nurses [at Penn Medicine Princeton Health] have a level of expertise and professional practice that you don’t always see everywhere,” Mastro says. “Their interests, their excitement, their desire to grow and to innovate is so alive that developing this institute in this organization just made sense.”
The study of the COVID-19 skin preservation strategy found that patients who received the in- tervention during proning were 97 percent less likely to develop a pressure injury. The American Journal of Critical Care published the results as a continuing education article online ahead of its print release in January 2022. The work was covered in several nursing media outlets, presented at local, regional, and national nursing conferences, and honored by the Journal of Wound Care for its contribution to clinical research.
“In the past, without something like the Institute, that work and those outcomes would have stayed here [at Princeton Health],” says Mastro, a nurse leader and scientist by background. “Now we have the ability to disseminate that work and make a difference, not just here, but truly across the world.” The center’s research and innovation resources include mentorship, statistical support, librarian services, grant writing support, and dissemination strategies.
“With this Institute, we have the ability now to disseminate that work and make a difference, not just here, but truly across the world.”
Another bedside-to-bench—and back again— project making its way through the Institute stemmed from a clinical nurse’s astute observa- tion. The nurse noticed that fewer congestive heart failure patients than usual were being readmitted to the hospital during the COVID-19 pandemic than before. That led the telemetry department’s nursing team to conduct quantitative research to determine why these patients were staying away from the hospital. In an article published in the April 2022 issue of Nursing Management, the team explained that though the congestive heart failure patients used behavioral techniques to avoid hospitalization, they weren’t completely confident in their ability to care for themselves at home.
The results led to a new clinical intervention for congestive heart failure patients at Princeton Health—one that could eventually be replicated elsewhere in the Penn Medicine system. “We’ve cre- ated a heart failure program within the community to help elevate both the caregivers’ and the patients’ knowledge of how to care for themselves with heart failure,” Mastro says. “That’s our next study.”
Up next for the Institute’s research and inno- vation center: Building out a research protocol in preparation for one of the first randomized clin- ical trials to be conducted by a Princeton Health nursing team. Nurses will partner with Physical, Occupational, and Speech Therapists at Princeton’s Acute Rehabilitation Unit to study the use of a virtual reality program in various types of acute physical, speech, and cognitive therapy.
“That’s the kind of [initiative] that, unless you have something like this Institute, you wouldn’t necessarily be able to support,” Mastro says. “We’re seeing this tremendous amount of excitement from the frontline clinical nurses…This Institute is high- lighting the fine, detailed work that is going on within nursing.”
While all three of the Institute’s centers will collaborate with Penn Nursing, perhaps none more so than the Center for Professional Development.
Through the Institute, Princeton Health nurses can tap into the resources of the Penn Nursing Innovation Center. In monthly grand rounds at Princeton Health, nurse managers will learn from leaders such as Marion Leary RN MSN MPH, Director of Innovation at Penn Nursing, about how to innovate in their day-to-day management. “We need managers to learn how to apply innovative design thinking,” Book says, “so when faced with any issue in their unit, they approach the problem differently.”
The professional development center will also host career coaching sessions to give nursing staff members the chance to talk with nurse leaders and educators about how to achieve their career goals, says Book, currently enrolled in Penn Nursing’s Executive Leadership DNP program. Princeton Health nurses who want to advance their careers while remaining at the institution can take ad- vantage of pathways designed to accelerate their trajectories. When the telemetry department needed nursing staff, interested nurses from the medical-surgical unit were given a pathway to get to telemetry. The program was “wildly successful,” Book says, and has led to other new pathways.
“If you want to go to the operating room, or labor and delivery, or critical care, or the emergency department, we will actively help to move you to those places,” she says, “and provide you with the whatever it takes to get you to that unit.”
Dr. Mastro, a core faculty member in Penn Nursing’s Doctor of Nursing Practice in Executive Leadership program, says the Institute will also support evidence-based practice fellowships and, eventually, a research fellowship. The Student Nursing Assistant Fellowship, which started in 2021, brings incoming college seniors to Penn Medicine Princeton Health to work as nursing as- sistants. They get weekly education sessions, plus the opportunity to continue per diem nursing assistant work during the academic year.
The Fellowship complements an initiative with a longer history. Penn Nursing’s George H. and Estelle M. Sands Nursing Scholars Program, an initiative funded in 2002 by the George H. and Estelle M. Sands Foundation, provides undergraduate students with financial resources and dedicated clinical rotations in exchange for post-graduation nursing work at Penn Medicine Princeton Health.
As Sands Scholars become part of the pipeline for the next cohort of Princeton Health nursing residents, so do Student Nursing Assistant Fellows. Mastro says, “We end up with brand new nurses who already know the organization,” she says, “and have really started to learn a bit more than their colleagues about how to be a nurse.”