April 2012

Our Journey to Excellence...

Damita J. Williams, RN, MSN,
MA, CPN, NE-BC

As I reflect on the past few months, I cannot help but be filled with excitement about where we are headed at Children's. Despite the challenges we face, and all that you have shared with me in staff meetings, town halls, and while rounding, I am filled with hope. I believe in each of you and the hard work you do everyday for the children and their families.

Dear Colleagues,

As I reflect on the past few months, I cannot help but be filled with excitement about where we are headed at Children's. Despite the challenges we face, and all that you have shared with me in staff meetings, town halls, and while rounding, I am filled with hope. I believe in each of you and the hard work you do everyday for the children and their families.

My first Town Hall meetings were held during the week of March 20th, on all shifts and on the weekend. We discussed an overview of my first 90 days at Children's. My three priorities were to be highly visible, to meet with key stakeholders and to complete an organizational assessment. All of those things were accomplished and will continue over the next 90 days. You also helped me to identify our strengths and opportunities. All of those contributed to an action plan for each of our four pillars: Experience, People, Community and Fiscal Fitness.

I received a great deal of feedback from nearly 200 staff members that attended the Town Hall meetings. One of the things we discussed was the status of our Magnet® Designation. We have been challenged by the changes in the application process and new expectations for nursing excellence. Our greatest opportunities are with improving our nurse satisfaction and our patient satisfaction. The new focus of Magnet® is on outcomes, and we need to work toward building structures and processes to achieve those outcomes.

One new initiative that began this year was senior leader rounding. This began in an effort to reach out to staff to learn about their quality and safety concerns and to allow them the opportunity to engage with senior leaders. It has been very well received by participating senior leadership and by staff on the units. The experience is providing an opportunity for staff to voice their concerns, and for management to become further engaged with the strengths and challenges of each unit in the hospital. This allows us to actively learn from each other and enhance the rich and dynamic community that has always defined CHM.

Also included in this issue of I & E:

  • How Lean Sigma Six, a nurse driven initiative, has successfully shortened emergency department wait times
  • Replacing the checklist approach with story-telling for Professional Development Ladder (PDL) portfolio submissions
  • Developing a new mentoring culture
  • A salute to Children's Regional Poison Control Center
  • The value of certification

Last but not least, we introduce our Nurse of the Month and DAISY winners, who exemplify the best of nursing at the Children's Hospital of Michigan. Congratulations to you all!

Thank you for all you do each day!

Damita J. Williams RN, MSN, MA, CPN, NE-BC
Vice President Patient Care Services
Children's Hospital of Michigan

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Executive Team Rounding Calendar
(April – July)

April 19

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Clinical Transformation Medical Records Educators Outpatient Pharmacy Valet EVS Nursing Admin Support Registration  

May 3

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Lab Case Management Quality IT Facilities Central Supply Dietary Staff Marketing  

May 10

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Southfield West Bloomfield Westland Rehab Novi Rehab Warren Rehab Dearborn Birmingham Clinton Township  

May 17

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  2nd Floor Carls Holden - Cardiology 3rd Floor Carls 3rd Floor Main Hospital Clinic 4th Floor Carls 4th Floor UHC Novi/ Bloomfield Hills 1st Floor - Ortho Clinic  

June 7

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Registration Human Resources SC-D Rehab Inpatient Pharmacy SC-D - 2nd Floor Radiology SC-D - 1st Floor SC-D - 3rd Floor  

June 14

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Medical Records 5W Dietary NICU/
PANDA 1
Obs OR Dialysis 5E  

June 21

Dr. Gray/ Tonya back-up Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  1st Floor - Ortho Clinic Quality Out of the office 3rd Floor Carls Social Work 2nd Floor Carls RT ED  

July 12

Dr. Gray Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  6 West Dialysis 5E 5W PICU/4SW NICU/
PANDA 1
OR 6 East  

July 19

Dr. Gray Chad Damita Joe Luanne Drs. Rudy/Tonya Lori Linda  
  Inpatient Pharmacy Social Work Radiology ED RT Rehab Volunteers Child Life  

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Revised PDL Coming in May

With the new format, nurses have the opportunity to more accurately describe what they do through the stories they tell about their participation on committees, leadership responsibilities and interactions with patients and families.

The DMC Professional Development Ladder (PDL) Steering Committee has been working to clarify and re-educate nurses across the system in preparation for the revised PDL, beginning with the May 1, 2012 portfolio submissions.

The revised version uses a story-telling format instead of the current checklist approach. Based on the Magnet Recognition Program® components, the new PDL asks applicants to describe the "who, what, when, where, why and how" of the activity as well as demonstrate the impact or outcome of the activity.

"The PDL encourages nurses to grow beyond their current practice which in turn enhances the quality of care, promotes health and reduces costs," says Steering Committee Member Carrie Gelmini, BSN, CPN. "After reviewing the old PDL model and looking at ways to support the DMC mission to provide service to the community, quality patient care, education, advocacy and research, our committee worked to realign the PDL more closely to the Magnet components."

"We wanted to develop a standardized measurement tool for all DMC nurses to use in advancing up the PDL," says Steering Committee Member Nancy Merkel, BSN, RN. "In the old format one earned points for completing requirements. The more points you could earn, the higher the level you could climb. With the new format, nurses have the opportunity to more accurately describe what they do through the stories they tell about their participation on committees, leadership responsibilities and interactions with patients and families."

Applicants can choose any two activities they wish from those provided but everyone must address the application of the Professional Practice Model in their practice. To assist applicants, the Children's PDL committee has created some tips for developing a successful portfolio. These include information about the Children's Hospital of Michigan Professional Practice Model, a writing guide/template and a "crosswalk" that links activities captured by the current PDL to the new PDL. Children's materials are being shared and used by other DMC hospitals as they make the transition to the new PDL.

The Children's Hospital PDL Steering Committee will hold open workshops that will give staff members an opportunity to review their portfolios and ask questions. Watch your e-mail in-boxes for workshop dates. Staff also can see their unit PDL representatives listed below for help with portfolios. More information can be found at the PDL site on the PDL Intraweb.

Unit PDL Representatives:
Cassandra Chassie, PICU
Dayle Ciurysek, 5 West
Carrie Gelmini, NICU
Jennifer Higgison, PICU
Lynne Hillman, Nursing Administration
Marcia Hooper, Ambulatory
Nancy Kragl, Imaging
Nancy Merkel, 6 East
Lisa Schaecher, 4 SW
Cindy Schmidt, OR
Joanne Shaw, SDS/PACU
Antonia Sobieski, ED
Madelyn Torakis, Nursing Administration
Maureen Valcke, SIDS/PACU
Lauranne Gosses, NICU

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New Professional Nurse Council (PNC) Chair Looks at Year Ahead

Jennie Basirico, BSN, RNC-NIC

Jennie Basirico, BSN, RNC-NIC, is excited about her new responsibilities as Children's PNC Chair. She says each unit in the hospital has provided a "great" representative that has created a team that works together to "get the job done well."

"The PNC is rolling out a new dress code policy for RNs," says Basirico. "We are doing this because evidence suggests that safety increases, and so does patient and nurse satisfaction, when it is easier to identify who the nurse is on the unit. Starting July 1, the dress code in effect will be navy blue scrub pants or skirt with a colorful scrub top. That way we can be identified as nurses, but still wear the fun scrub tops that the kids love."

Basirico also says the PNC is looking forward to Children's Nurses Week celebration in May and is currently reviewing nominations for Nurse of the Year. And for the third year in a row, Children's is partnering with Gleaners Community Food Bank for the cereal drive, which will take place June 1 – 8.

"This is a hospital-wide effort with everyone getting into the act," says Basirico. "There is a team representing each floor and enthusiasm and success have built significantly since we began three years ago. We are looking for the best year yet in 2012."

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KidsHealth

 

Anyone looking for credible health information on a variety of health related topics, written specifically to appeal to curious kids looking for answers, should look no further than www.childrensdmc.org/KidsHealth, part of The Nemours Foundation Center for Children's Health Media. KidsHealth® information speaks directly to both pre-adolescents and teenagers, in their language, and offers perspective, advice and comfort about a wide range of physical, emotional and behavioral issues. All KidsHealth® content goes through a rigorous medical review by pediatricians and other medical experts as well as ongoing medical reviews. Parents might also find the information useful. KidsHealth® is available in both English and Spanish.

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Lean Six Sigma Tackles ER Wait Times

...In the system that was being used previously, the nurse was the fourth person to see the patient. Now, the nurse is the first. And instead of the patient moving from station to station, the patient is placed in a room and services are brought to him or her.

Since the Detroit Medical Center (DMC) initiated its 29-minute emergency department (ED) commitment, Children's emergency department staff has struggled to meet that goal, particularly in times of high volume. In 2009, a Lean Sigma Six team worked on the back end of the process – from the time a patient has finished his or her time in the ED to the time he or she is either admitted or sent home. The latest project seeks to improve triage throughput from the time the patient arrives in the ED to the time he or she is seen by a physician.

Before the Lean Six Sigma team began its work on this project in 2010, Children's had a success rate of 75 percent. The goals were to streamline the ED triage process, achieve the 29-minute commitment 90 percent of the time, and decrease "left without being seen" (LWBS) by 50 percent.

"We knew if we could shorten the triage time, we would shorten the total time patients spent in the ED," says Annette Hartner, RN, MSA, administrative director of continuous process improvement, and this project's Greenbelt process improvement specialist. "We developed a pilot that allowed us to take a step back and separate out all the specific functions of our current system and determine what we could do to improve it. The pilot also provided the data to justify change."

Hartner explains that in the system that was being used previously, the nurse was the fourth person to see the patient. Now, the nurse is the first. And instead of the patient moving from station to station, the patient is placed in a room and services are brought to him or her. This has required reconfiguration of the ED and more staff.

Some of the staff reactions to the pilot were:

"It is reassuring knowing an RN is looking at these patients first."

"I used to hate working triage. If you run it like this all the time I will gladly work out here."

"One stop shop for patients – who do not have to move multiple times."

"The changes have taken the cooperation of finance, human resources and the ED room management," says Hartner. "Physician input and department leadership has been invaluable. We now have two teams consisting of a nurse, patient management clerical associate and a patient care associate, and hope to add another soon. We have significantly reduced the time it takes patients to get from walking into the ED to seeing a physician and we will consistently monitor the process."

"Front line patient care staff in the ED were integral to defining the barriers and improving the process," adds Hartner. "There have been some bumps and hiccups along the way. Once the ED's busy season winds down, the group will reconvene to discuss the issues."

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March 19 was
Certified Nurses Day

 

Margretta "Gretta" Madden Styles, EdD, RN, FAAN (1903-2005), was born on March 19, 1903. Known as the "Mother of Nurse Credentialing," Styles was a visionary scholar with an international impact on the nursing profession. The thousands of certified nurses in the U.S. today and the growing role of certification in contributing to better patient outcomes are a lasting testament to her legacy.

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Magnet Matters

By Madelyn Torakis, MSN, RN
Children's Hospital of Michigan
Magnet Program Coordinator

Madelyn Torakis, MSN, RN

Exemplary practice and public recognition of this through the Magnet Recognition Program® is the result of nurses who strive to make a difference professionally and personally every day for patients, families and colleagues.

Why all the Fuss over Professional Certifications?

Certification as defined by the Magnet Recognition Program® is a process by which a nongovernmental agency or association certifies that an individual licensed to practice a profession has met certain predetermined standards specified by that profession for specialty practice. Its purpose is to ensure various publics that an individual has mastered a body of knowledge and acquired skills in a particular specialty. (2008. Application Manual: Magnet Recognition Program®. Silver Spring, MD: American Nurses Credentialing Center).

Magnet hospitals recognize that nurses who are provided with greater opportunities for professional and personal growth, specifically certification, are more satisfied with their jobs, have a sense of empowerment and competence and, in turn, impact the quality of care provided to patients and families. The focus for Magnet nurses is not just what they do, but the difference what they do has made. It is safe to assume that nurses who have taken the initiative to pursue certification also are more cognizant of the care they provide as they strive to elevate their practice.

A common misconception is that Magnet requires a certain percentage of hospital nurses to be certified. Although Magnet does not mandate a specific number, it does expect that a Magnet hospital has made a commitment to professional development for all of its nurses. One source of evidence (SOE) within the component Structural Empowerment, asks that hospitals describe and demonstrate how their organization sets goals and supports professional development and professional certifications. It then asks for a graphic display showing how the numbers have changed over the past 24 months. The expectation is for a realistic goal that has either met or exceeded the set target. The Children's Hospital of Michigan has over 250 certified nurses.

There are a number of positive outcomes associated with the attainment of professional certification. The most common is a sense of pride, satisfaction and validation of knowledge by nurses. From that positive initial reaction stems a chain of additional benefits including empowerment, greater competence and expertise, and enhanced collaboration with other members of the health care team. Exemplary practice and public recognition of this through the Magnet Recognition Program® is the result of nurses who strive to make a difference professionally and personally every day for patients, families and colleagues.

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January's DAISY
Award Winner also
Nurse of the Month

Brad Phillips, ADN

Brad Phillips, ADN, 4 SW cardiology, has much to show for the first few months of 2012 — two significant honors.

He was chosen Nurse of the Month and DAISY award winner. According to his manager, Marilyn Mowrer, BSN, RN, NE-BC, CPN, Phillips has proven to be an exceptional nurse in the short time he has been out of school.

"His special talent is his ability to relate to families and patients in a way that makes them feel comfortable and special," says Mowrer. "He is not afraid of handling a difficult diagnosis. What shows is that he truly cares about those he works with and those he cares for."

The DAISY Award is presented quarterly to publicly honor nurses who have provided exceptional and compassionate care to patients and families. It is based on information received from the At Your service (AYS) surveys completed by families. The DAISY Foundation was formed in January 2000 by the family of J. Patrick Barnes, who died at age 33 of complications from Idiopathic Thrombocytopenic Purpua. DAISY is an acronym for Diseases Attacking the Immune System.

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Children's Hospital of Michigan's Poison Control Center Going Strong

We handle anything that is poison related. That can mean chemical exposure, medication questions, substance abuse, environmental mishaps such as the Kalamazoo oil spill in 2010, and even animal exposure.

When the Children's Hospital of Michigan Poison Control Center was established in 1958 it was only the third such center in the entire nation. It is now the only such resource in Michigan. The office of the Children's Hospital of Michigan Regional Poison Control Center is located at the old Hutzel Hospital building. Managing Director Susan Smolinske, PharmD, DABAT, is joined by a staff of 36, plus physicians on call, and an office coordinator.

"We handle anything that is poison related," says Smolinske. "That can mean chemical exposure, medication questions, substance abuse, environmental mishaps such as the Kalamazoo oil spill in 2010, and even animal exposure. We are available 24 hours a day, seven days a week, 365 days a year. In 2011, we handled 92,000 calls."

In recognition of Poison Control Week, which was March 18-24, we quote from the Spring 2011 issue of Tox Tips, the Children's Hospital of Michigan Regional Poison Control Center newsletter:

Children's Hospital of Michigan Regional Poison Control Center is the best health care bargain around. Calling Children's Hospital of Michigan Regional Poison Control Center is free and confidential. You can call your poison center for questions such as: Is it safe to take certain medications together? Or: Is the cleaning product my child just touched safe for kids? Most poison exposures can be treated successfully at home, without a costly emergency room visit. Studies indicate that every dollar spent on a poison center saves $7. And patients who do need to be treated in a health care center stay a median of 3.5 days when they call a poison center, compared to 6.5 days when they do not.

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Mentoring Program Picking up Steam

Lynne Hillman, RN, BScN,
BEd, MEd

Beth Voyles, RN, CPN

As a direct result of the interest in a mentoring program voiced by the nursing units at Children's, Lynne Hillman, RN, BScN, BEd, MEd, and Beth Voyles, RN, CPN, brought together mentoring representatives from each unit to work collaboratively in developing a hospital-wide program, which is currently underway. Hillman is Children's Transitions RN Residency Program manager and DMC CE administrator. Voyles is Children's palliative care nurse coordinator.

"Mentoring has a direct impact on nursing care, creates high-quality health care and improves patient outcomes," says Hillman. "It provides an extra support layer for new orientees and helps with retention. In the mentoring culture being created on each unit, everyone benefits."

Among the advantages for mentees is greater job satisfaction and an increase in job comfort level and professional growth. For mentors, a mentoring program adds to personal satisfaction, growth and professional success. And for the hospital and unit, it increases customer satisfaction, helps create a positive environment and improves unit cohesiveness.

"We are starting with nursing and hope to expand to other staff to satisfy the needs of each unit," continues Hillman. "Each unit is working hard to recruit mentors and training sessions are in process. Each unit's mentor representative, listed below, is creating a mentor toolkit. The retention and recruitment staff will be evaluating the program on an ongoing basis."

Unit Mentor Representatives
NICU: Carrie Gelmini
5E: Justine Koehler
6E: Sarah Serwatka & Tonya Johnson
ED: Tabitha Dzikowicz & Claire Martin
PICU: Kim Milosevic
5W: Christine Jones
6W: Veronica Kaschalk

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First Annual Michigan
Pediatric Trauma Conference

Tuesday, June 12, 2012

Marriott East Lansing at University Place
7:15am – 4:30pm
Download the brochure to learn more!

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Awards and Announcements

 

Deborah Niedbala has successfully passed the national certification exam as a 'Certified Professional in Healthcare Quality.'

Jennie Basirico, RN in the NICU is the PNC Chair for 2012. Chair elect is Wendi Tague, RN, who works on 5 West.

Shelly Hammond, former Adolescent Medicine Staff Nurse, named Interim Clinical Manager for GPC, Adolescent Medicine, Faculty Practice and the Immunization Station. Shelly has been at the Children's Hospital of Michigan for 22 years and has worked as a staff nurse since earning her BSN in 1994. Her expertise is in caring for children with neurological disorders, endocrine disorders and most recently, adolescents. She became certified as a Pediatric Nurse in 2009.

MaryAnn Lynch's abstract, PUTTING A PROFESSIONAL NURSING PRACTICE MODEL INTO PRACTICE-MAKING IT REAL!, was accepted for presentation at the 2012 Wayne State University College of Nursing Research Day on April 4, 2012.

Nitin Nayak has been with the Detroit Medical Center (DMC) for eight years, and came to Children's Hospital of Michigan in 2004 as a registered nurse. Prior to joining the DMC, he worked as a physician in the United Kingdom and India. Effective March 5, 2012 he began his new position as manager of patient care services. He earned a Bachelor of Science degree in Nursing from the University of Detroit Mercy and is currently working on his Masters Degree in Health Services Administration. He also has a Bachelor of Medicine and Bachelor of Surgery from Kasturba Medical College in India.

Nikkey Lester has been with the Detroit Medical Center since 2010 in the human resources department. Effective March 5, she became Senior Executive Secretary to Damita Williams, vice president, Patient Care Services at Children's Hospital of Michigan. She earned a Bachelor of Science degree in Health Services Administration from the University of Detroit Mercy and is also pursuing a Masters degree in Health Services Administration.

Denay Mershman BA, BSN, RN at Children's Hospital of Michigan has been selected to receive a Nase Practitioner Healthcare Foundation Grant Award for 2011-2012. This study is to promote pain management for ED pediatric patients.

Damita J. Williams MSN, MA, RN, CPN, NE-BC vice president of Patient Care Services at DMC Children's Hospital of Michigan, has received the Outstanding Nursing Alumni Award from Ball State University, Muncie, IN.

For nearly 40 years the university has presented the award in recognition of individuals who have given exceptional service to the nursing profession through education, service, and community involvement.

Williams, who joined DMC Children's Hospital of Michigan in December 2011, received her undergraduate degree in nursing from Ball State University. In addition, she holds advanced degrees in nursing administration from the University of St. Francis in Fort Wayne, IN, and advanced leadership studies from Indiana Wesleyan University in St. Marion, IN where she is completing her doctorate in organizational leadership. Williams is also a certified pediatric nurse and a board certified nurse executive.

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Nurse of the Month

Kelly Sandridge

 

November

Acute Care
Kelly Sandridge, BSN, RN, CPN, graduated from Eastern Michigan University and came to work on 6 East at Children’s 10 years ago. "I love the kids we work with and watching them get better," she says. "The biggest challenge is when we have a child that we can't make better. I enjoy getting to know the patients and families and working with new staff. We have a great team here."

 

Janet Rapp, RN, CPN

 

December

Alternative Practice
Janet Rapp, RN celebrated her 25th anniversary at Children's, after starting as a student nurse tech from Madonna College. She decided on a career in nursing after discovering that accounting was not for her. "I love nursing and can't think of anything else I would like to be," she says. "Working with the kids is great because you never know what they are going to come up with."

 

Cheri Darichuk, RN

 

Acute Care
Cheri Darichuk, RN, came to Children's five years ago after serving in the United States Air Force. "I spent six years behind a computer, with very little people interaction and decided that I would love to take care of children and became a nurse," she says. "What I love most about this job is helping to make the kids' stay at the hospital the best it can be. I also really do enjoy the people I work with. We are like a little family and it makes it a nice unit to work on."

 

Emily Newman, RN, BSN

 

Critical Care
Emily Newman, RN, BSN, has worked at Children's since June of 2007, beginning in the emergency department and currently in the PICU. A graduate of the University of Michigan, Newman is continuing her education to become a pediatric nurse practitioner. "I am inspired by the teamwork of my co-workers, the strength and bravery of the kids and the diversity of the ICU," she sys. "I love learning so much about so many different things."

 

Brad Phillips, RN

 

January

Brad Phillips, RN, was an SNA at Children's before becoming an RN. A graduate of Monroe County Community College, Phillips has been at Children's for just over six months. Wanting to work with children, he considered elementary education, deciding on a career in nursing. "I love helping kids and their families and I especially love working with cardiac patients," he says. "Among my greatest challenges are trying to stay on my toes at all times, and learning as much as I can as a new nurse."

 

Brett Muran, RN

 

Brett Muran, RN, was an investment advisor and personal financial planner before changing careers to nursing. He came to work at Children's PICU four years ago and recently transitioned into the cardiac cath lab. Muran became a nurse because, he says, "I wanted to be proud of the work I did. Patients and families entrust you with something so sacred – their well being. The responsibility is very real yet an awesome privilege. Our ability to contribute in a meaningful way is unparalleled. Our greatest challenge is taking care of ourselves and our co-workers."

 

Elaine McCarthy, RN, CPN

 

Elaine McCarthy, RN, CPN, came to Children's from St. Clair College in Windsor, Ontario, 20 years ago. She has worked on 6 NE, the PICU, and currently, in the cath lab. "Some very good role models inspired me to seek out this great profession," she says. "No two days are the same in my job. We take care of a diverse group of patients ranging in age and levels of acuity. Our staff is very dedicated and supportive and we are successful because of our teamwork. One of our greatest challenges is keeping up with the ever-changing technology."

 

Alicia Roach, BSN, RN

 

February

Alicia Roach, BSN, RN, came to 6 West at Children's in 2008 after graduating from Oakland University. She knew she had found her professional home after completing her nursing clinical rotation on 6 West. "I work with an amazing group of people who love what they do," she says. "And I feel blessed to work with awesome families and incredible kids that I get to build relationships with."

 

Katie Rohrhoff, MSN, RN

 

Katie Rohrhoff, MSN, RN, is the nurse educator for Children's PICU and 4 SW. She earned her bachelor's degree from University of Detroit-Mercy and a master's degree in nursing education from Oakland University. "My mom was a nurse and I decided that's what I wanted to do when I was in kindergarten," she says. "I like working with new nurses because I was once one of them. My goal is to provide the guidance and support they need."

 

Linda Kopy, RN, AND

 

Linda Kopy, RN, AND, worked in the airline industry before attending the nursing program at Schoolcraft College. "After being in the corporate world, I felt the need to be in a profession that would make a difference in people's lives," she says. "I love working with newborn infants. It is so rewarding to me to be part of their first experience."

 

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Four pillars of excellence