President’s Message: Judy Philbrook, MSN, NNP-BC
CANNP celebrates its 25th anniversary this year. I am happy to report that our current “State of the Union” is very good! Our annual conference was attended by 78 participants from 6 different states. This is higher than it has been in years! We had excellent speakers on pertinent, hot topics! We also had 12 vendors. The vendor piece is especially important as it has become increasingly difficult to lure vendors given the current economic climate, other obligations and changing contact hour regulations. We had a net gain of ~ $4000 from this year’s conference! A special thanks to the conference planning committee – it is a lot of hard work, but it is certainly worth it!
Membership is up! CANNP granted both a scholarship award and a research grant this year. We have had our first contact hour offering for members only on our website and we are getting ready to post the second one on “Neonatal CXR Interpretation.” An offering on head ultrasound interpretation will follow… We recognize the importance of continuing education and research in our profession. Our financial status is good. Your Board of Directors is responsible and budget minded! PayPal has been a blessing as it has not only increased convenience for members, but also for vendors. I know that it is summer and our minds are turning toward school breaks, vacation and time-off, but I urge you to remain diligent in your practice and profession as these do not take a break for summer! Consider ways that you can “give back” – new projects, committees, or consider writing an article for this newsletter! I love this quote by Walt Disney: “The way to get started is to quit talking and begin doing.”
Have a great summer! -Judy Philbrook
Conference Highlights/Info-Durham, NC 2016
The 2016 annual CANNP conference, “Shades of Blue: Collaboration in Neonatal Care Across the Carolinas” was held on April 21st and April 22nd at the Hilton Hotel in Durham, NC. A special THANK YOU to the conference planning committee for their hard work and dedication in making this conference such a huge success!
Members of the planning committee included: Cynthia Baker, NNP-BC Dr. Stephanie Blake DNP, NNP-BC Dr. Amy Jnah, DNP, NNP-BC Sherry LeBlanc, NNP-BC Felicia Soza, NNP-BC
Topics and Presenters Included:
- Simulation Training: Establishing and Maintaining Procedural Competency -Dr. Amy Jnah DNP, NNP-BC & Dr. Stephen DeMeo, MD
- Innovative Clinical Research Design in NCCC -Dr. Matt Laughon, MD
- Working with the Courts: What practitioners Need to Know -The Honorable Judge Beverly Scarlet, JD
- Reducing Admissions for Asymptomatic Hypoglycemia -Sherry LeBlanc, NNP-BC
- Pain Management in the Post Operative Neonate –Dr. Tom Young, MD
- Probiotics: Combining Evidence and Practice – Dr. Christine Rowland, DNP, NNP-BC
- Case Study: Wound Vac and Open Abdominal Wounds –Dr. Tracey Bell, DNP, NNP-BC
- Global Health Initiatives –Dr. Carl Bose, MD *SICC & Neurodevelopmental Outcomes –Dr. William Malcolm, MD
- Helping the Big People in our Little People World –Kathy Brigla, CSW
- Audiology & Hearing Screens in the NICU & Beyond –Dr. Jackson Roush, PhD
- Discharge of the Complex Patient – Carol Hubbard, PNP & Jennifer Bowles, PNP, NNP
- ENT Potpourri– Dr. Eileen Raynor, MD
- Evaluating Respiratory Syncytial Virus Burden in At-Risk Infants –Dr. Stephanie Blake, DNP, NNP-BC
Thank you to all practice sites that donated gift baskets for the raffle!
The following participants won:
- Courtney McDaniel, WakeMed
- Debra Nickerson, Levine Children’s
- Jodi Deal, Vidant
- Ginger Rhodes-Ryan, Novant
- Morgan Gibson, Duke
- Janet Woods, Vidant
- Judy Philbrook, Cape Fear Valley
Information for 2017 Conference
The 2017 CANNP Conference will be held in Greenville, NC at the Hilton Hotel on April 20th-21st!!!! The Conference Planning Committee will include practitioners from Vidant Medical Center. There will be a skills lab this year and there is also a CALL FOR ABSTRACTS!!! Watch the CANNP website for additional information and hotel specifics. See pages 14- 15 of this newsletter for submission forms for the poster and podium presentation call for abstracts.
Scholarship and Research Grant Award Recipients:
CANNP Scholarship 2016
CANNP offers a Scholarship Award to recognize an individual who has returned to school to enhance their role as an NNP and provide them with financial assistance. The recipient of the Scholarship Award is announced at the annual meeting. If there are no submissions, the award is given to a nursing school with a NNP program on a rotating basis.
Candidates for the Scholarship Award for Neonatal Nurse Practitioner Education must:
- Be a current member of CANNP
- Be enrolled in an nursing educational program that offers a degree (BSN, MS, Doctorate)
- Be enrolled in an educational program that will enhance their role as an NNP
- Successfully complete a minimum of two courses towards the degree they seek
- Commit to submitting an educational feature for the CANNP newsletter after accepting award or present at the CANNP conference the following year.
This year, the Scholarship was awarded to Kayla Wyrick, NNP-BC. Kayla is attending the DNP program at Grand Canyon University and will graduate in 2017.
CANNP Grant 2016
CANNP offers an annual award to assist members who are involved in clinical research. Candidates for the grant award must:
- Be an active member of CANNP for at least two consecutive years
- Have a masters degree or higher or be currently enrolled in a Masters completion program
- Practice professionally as a neonatal nurse practitioner
- Demonstrate ongoing professional education by completing required number of CEUs by the State Board of Nursing
- Obtain IRB approval prior to applying for the grant
- Agree to present completed research at a CANNP conference and write an educational feature about the research for the CANNP newsletter.
This year the Grant was awarded to Sherry LeBlanc, NNP-BC. Her research is focused on reducing NICU admissions for hypoglycemia by implementing a care bundle for at –risk infants.
Award Updates: Please check the CANNP website and the upcoming Newsletter for new changes and requirements for the 2017 Peer Recognition, Scholarship, and Grant Awards.
Minutes from the 2016 Annual Business Meeting: Dr. Amy Jnah, DNP, NNP-BC, Secretary
Practice Site Updates:
Cape Fear Valley Medical Center Fayetteville, NC
It has been a slow couple of months here in the NICU, but as most of you all know, good things don’t last forever and we are back to hopping again. During our little lull, it gave some of us a chance for some extracurricular activities you might say. Dr. Thomas Ciszek, founder of the NICU here at CFVHS and longtime director just recently embarked on an opportunity of a lifetime. He departed on May 13 for Nigeria to work with the Helping Babies Breath Program. It is an evidence based educational program that teaches neonatal resuscitation skills to resource limited areas. It is a collaborative effort between a number of organizations such as AAP,WHO, NICHD and more. He was a volunteer for the program over a 10 day period of time, and returned with stories of his eye opening adventure. We also have 2 happy graduates, or better stated, 2 very happy NNPs, both with their last child graduating from college. Susan Nall’s youngest, Stephen graduated from Methodist University with a degree in Business, and Sharon Rush’s youngest graduated from Fayetteville Technical Community College with an Associate’s degree in Nursing and plans to pursue a career in the NICU. Our Neonatologist, Dr. Scott Cameron, recently graduated from Duke Divinity with an MDiv degree, and shares the spotlight with his oldest daughter Wallace as she graduates from High School this month. Finally Dr. Keith Gallaher recently welcomed his 6th grandchild to the family the end of last month. His daughter April blessed the family with her first child, a beautiful baby boy just a few weeks before his anticipated arrival. Grandparents were on scene up in Pennsylvania to help parents and baby settle in. -Sharon Rush
Vidant Medical Center– Greenville, NC
Vidant Medical Center is excited to host the 2017 CANNP Conference in Greenville, NC and appreciate the CANNP Board collaborating with us to make this a wonderful conference for all to attend! While we will be busy planning the conference throughout the year, the NNPs are also hard at work on quality improvement within our unit. We continue to enhance our Neonatal Golden Hour Protocol that standardized the care of all of the infants less than 30 weeks gestation and significantly impacted our IVH and hypothermia on admission rates, as well as work with other hospitals to implement this protocol in their own units. Several of the NNPs are in the beginning stages of implementation for a QI project related to placenta lab draws to decrease the volume of blood needed from a VLBW in the first hours of life and hopefully decrease the need for early PRBC transfusions. We are actively recruiting for openings within our group from retiring NNPs who are moving on to a life of sitting by the beach and watching their grandchildren play. Vidant welcomes Caitlin Morrissey and Christine Monday to the NNP group and are excited to have them as a part of our team. Five of our NNPs will welcome new babies in the 2016 year, so we are staying very busy with baby showers and new baby snuggles. We welcome all of you to come and visit us in Greenville, but I suggest unless baby fever has hit you try NOT to drink the water! We look forward to seeing you all in April of 2017! -Tara Stroud
WakeMed Health Systems– Raleigh, NC
WakeMed continues to grow. We will be adding Ellen Ford NNP from Virginia this summer. Elizabeth Carmac NNP from WakeMed North, was awarded the Good Catch Award for recognizing that the Voalte phone was nonfunctional in the cafeteria and surrounding area at North. Kim Carr is currently serving on the Hospital Anesthesia Committee and the Hospital Compensation Committee for APP’s. She was also instrumental in getting the new TPN program for EPIC functional and all the training involved for the NNP’s & PNP’s in the NICU.
Amy Jnah NNP, DNP, Tracey Robertson Bell NNP, DNP & Desi Newberry NNP, DNP had the following articles published. Amy is the Director of the NNP program at East Carolina University School of Nursing. Tracey and Desi are associate professors.
- -Casey, J., Newberry, D., & Jnah, A. (2016). Early BCPAP: Investigating interprofessional best practices in the NICU. Neonatal Network, 35(3), 125-134.
- -Jnah, A., Newberry, D., Trembath, A., Robertson, T., Downing, A., Greene, M., & Sewell, K. (2016). Neonatal resuscitation training: Implications of course construct and discipline compartmentalization on role confusion and role ambiguity. Advances in Neonatal Care, 16(3), 201- 210.
- -Garcia, K., Jnah, A., & Newberry, D. (2016). Pairing of best practices to reduce length of stay with neonatal abstinence syndrome: The Finnegan scoring tool and cuebased feedings. Journal of Pediatric and Neonatal Nursing: Open Access.
Tammy Scarborough applied and was awarded the Grants and Skills Scholarship in February in an effort to be able to attend the AHRQ TeamSTEPPS National Conference in June in Washington, DC. She was very honored to receive this Scholarship among many entrants. The scholarship money will allow her to attend the National Conference for TeamSTEPPS and hopefully gain further knowledge on the TeamSTEPPS process but mostly how to sustain change when it does occur within a unit. The Conference is well attended with 400 people attending and 500 more that were on a waiting list to attend. The AHRQ (Agency for Healthcare Research and Quality) sponsors this conference yearly. Kathy Connelly NNP received the 2016 Clinical Nursing Excellence award from the NICU staff. She is also currently serving as Vice President of the Carolinas Association Neonatal Nurse Practitioners (CANNP) and is on the WakeMed Advanced Practice Provider Leadership Council (APPLC). Ginger Rhodes-Ryan NNP is the Research Coordinator for Neonatology and is responsible for the more than 20 research projects in the NICU. They range from looking at blood transfusion criteria, isolette/temperature regulation in the premature infants to administration of probiotics. -Kathy Connelly
Carolinas Medical Center– Charlotte, NC
Summer Greetings from the NNP Service at Levine Children’s Hospital! As we start this Summer Season, we are very excited to be back at a full complement of staff. In January, Jennifer Smith joined our team! In June, Amy Groce and Susan Randall accepted offers to join our service! Both will become a part of our family in September. Janna Pinckney also joined us as a PRN teammate this July! In addition to a very busy 6 months of recruiting, we are hosting one Duke NNP student and will soon be hosting an additional student from ECU this summer and fall. By the way, NNP Students are not our only students…Dr. Christine Rowland completed her DNP at ECU in December, and Jodi Amador will become Dr. Amador this coming December when she too graduates from ECU! Our team has also been a part of the Antibiotic Stewardship Initiative hosted by the VON. We are also the fortunate recipients of grant monies to start a research proposal with Duke and are partnering with the PQCNC to host a Breaking Bad News Foundation workshop this November! Finally, we are planning more involvement in our Neonatal Developmental Follow Up Clinic as this busy clinic expands its hours this summer. We wish you all many sun soaked, relaxing and memorable days of summer spent with family and friends! -Gail Harris
Novant Health Presbyterian Medical Center– Charlotte, NC
It’s been a fairly busy few months at Presbyterian Medical Center. Three new members are joining our team this summer. Trisha Abernathy, MSN, NNP-BC is a new graduate from Duke University and joined the group in May. Linda Liebler, MSN, NNP-BC is an experienced practitioner coming from Florida. She joined our group this month. Colleen Wells, MSN, NNP-BC is a young practitioner with two years’ experience joining our team from Texas. We anticipate her starting in August. Kayla Wyrick, MSN, NNP-BC is pursuing the DNP degree, and was awarded the CANNP scholarship at this years’ conference. We also have an ECU NNP student, Courtney Wallace, with our group this summer. Our Matthews Medical Center will open a new women’s center in August, including a new special care nursery with private rooms. We look forward to this new, exciting experience. -Kayla Wyri
Educational Feature- Maternal Obesity: Big Consequences for Mom and Baby
By Pam Kasten, NNP-BC (Levine Children’s Hospital, Carolinas Medical Center, Charlotte, NC)
Adult obesity is a pandemic problem, significantly impacting all areas of healthcare across the globe; the situation is no less dire for women of reproductive age in the United States. In 2009, the CDC reported that the prevalence of obesity in this group of women was 30.2%, and the prevalence of overweight women of child-bearing age was 56.7%. Similar population based examination in other developed countries and also in the U.S. report rates for overweight and obesity among women aged 18- 39 at the range of 25-35%. Body mass index (BMI) forms the basis for defining obesity; BMI is an individual’s body weight in kilograms (Kg) divided by their height in meters, squared. The World Health Organization (WHO) and the National Institute of Health (NIH) define a normal BMI as 18.5-24.9, overweight as 25-29.9, and obese as a BMI equal to or greater than 30. According to the CDC, obesity is most common is non-Hispanic Black women followed by Mexican American women, and then non-Hispanic white women.
Maternal obesity is related to a myriad of health concerns for both mother and baby. Additionally, pre-pregnancy obesity contributes to reduced fertility related to oligo-ovulation and anovulation, increased need for Assisted Reproductive Technology (ART), and thus an increased risk of birth defects in resultant fetuses. An infant conceived as a result of ART may have as much as a two-to-fourfold increased risk for many mid-line developmental defects (cardiac septal defects, cleft lip/ palate, esophageal/ anal atresia) compared with an infant conceived without fertility assistance. Neural tube fetal defects occur twice as often. Routine fetal monitoring via ultrasound and even fundal height measurement and external palpation to determine fetal size and lie is hampered and compromised by maternal obesity.
Obesity contributes to serious health concerns for the pregnant woman. Pre-existing diabetes may be present, or gestational diabetes develops in about 17% of obese women versus just 1-3% of non-obese pregnant women. Hypertensive disorders and thromboembolic disorders (aided by venous stasis) are more prevalent in obese pregnant women; chronic or gestational hypertension can predispose to preeclampsia in 14-28% of obese women. Sadly, early fetal loss and stillbirth are strongly correlated with obesity in pregnancy.
Intrapartum and postpartum well-being of the pregnant woman is also detrimentally affected by obesity. There is a higher incidence of preterm birth, labor induction, prolonged labor, failed (or inability to place) epidural anesthesia, Cesarean delivery, prolonged hospitalization, serious postpartum hemorrhage, wound infection, myocardial infarction, nerve injuries and urinary tract infections. Cesarean delivery risk is doubled for the obese woman, and higher rates of maternal death are strongly linked to increasing surgical births, advanced maternal age and maternal obesity. In the United Kingdom and inquiry into maternal death showed that 35% of women who died either directly or indirectly due to pregnancy were obese with a BMI > 30.
As professionals working in the NICU we are all familiar with the clinical presentation of infants born to diabetic mothers (IDM). We generally know what to expect with these patients. What is not as clear, but perhaps no less significant, is the clinical presentation of the infant born to the obese mother. Perhaps you can recall a clinical situation involving an infant, born to an obese mother (but not diagnosed as gestational diabetic), where you were challenged with many of the same problems that confront the IDM infant: large for gestational age, hypoglycemia or borderline and persistent low blood glucose, poor feeding initiation and stamina, lethargy, etc. Due to their larger-than-expected size, birth trauma may be present. Infants of obese women often have clinical symptoms and presentations much like their IDM counterparts, but these symptoms may be “missed” or overlooked in the absence of a maternal diagnosis. Increased maternal serum glucose concentration less severe than what is “diagnostic” for diabetes is associated with fetal overgrowth, particularly adiposity. It is logical to conclude as well that these newborns experience similar effects related to maternal hyperglycemia and subsequent fetal hyperinsulinemia. Perhaps obstetrical criteria for the diagnosis of gestational diabetes warrants further research and revision? Or perhaps a new diagnosis is more appropriate? Either way these infants must be accurately identified; infants born to obese mothers have an increased risk for resuscitation a birth and subsequent NICU admission. Neonatal morbidity rates are closely linked to maternal obesity. Studies in the U.S. and abroad have demonstrated that these infants are nearly twice as likely to die during the early neonatal period and that this risk extends through the first year after birth.
Maternal obesity and effects on offspring may have lifelong health consequences. It appears that a propensity to develop adolescent obesity and subsequent adult metabolic syndrome (obesity, hypertension, insulin resistance and dyslipidemia) may be related to infants born either LGA or macrosomic. The current epidemic of obesity may therefore be getting its start in the womb via fetal overgrowth. It would seem then that strategies to promote healthy pre-pregnant and pregnant weight in women of childbearing age is imperative to long-term health for global generations to come.
- Feresu, S. A., et. al. (2015). Relationship between maternal obesity and prenatal, metabolic syndrome, obstetrical and perinatal complications of pregnancy in Indiana, 2008- 2010, BMC Pregnancy and Childbirth, 15, 266.
- Jorgensen, A. M. (2010). The impact of maternal obesity on antepartum risk, intrapartum risk and adverse neonatal health outcomes, NICU Currents, 1(1).
- Mamun, A. A., et. al. (2011). Associations of maternal prepregnancy obesity and excess pregnancy weight gains with adverse pregnancy outcomes and length of hospital stay, BMC Pregnancy and Childbirth, 11, 62.
- Marchi, J., et. al. (2015). Risks associated with obesity in pregnancy, for the mother and baby: a systemic review of reviews, World Obesity, 16, 621- 638.
Professional Organization and Legislative Updates:
National Association of Neonatal Nurse Practitioners (NANN)
- *Global Neonatal & Maternal Issues Prevent unnecessary neonatal, newborn, & maternal mortality by ensuring early skin-to-skin contact, exclusive breastfeeding, extra care for small & sick babies, global vaccination targets, and embedding universal health coverage
- *Nursing Workforce and Education Nursing workforce development programs known as Title VIII in Washington D.C. are crucial for development of the current nursing workforce & will be vital to the development of the future nursing workforce, please support Title VIII reauthorization-funding requests at any and every opportunity
- *Neonatal Abstinence Syndrome Follow the recommendations of the Protecting Our Infants Legislation and advocate for implementation of measures and evidence-based recommendations on a state & local level
- *Promoting Life-saving New Therapies for Neonates Act of 2014 (S.2041) This legislation will spur innovation for new neonatal drug therapies, improving outcomes for devastating neonatal condition.
- *Reimbursement for Donor Human Milk for Preterm Infants If your state introduces legislation to provide Medicaid coverage for donor milk, contact your elected officials and ask them to vote for this legislation. If your states Medicaid program does not reimburse donor breast milk, contact your elected officials and educate them on the importance of breast milk for infants with medical need. Include in your communication your concern about lack of access to donor milk and the ultimate cost savings a human milk diet provides
- Join the MyNANN Advocacy Community to share information and insights with like-minded members
- Participate in your NANN chapter’s advocacy initiatives to make an impact and stay up to date on local issues or take part in programs like “Virtual Lobby Week”
- Serve on NANN’s Health Policy and Advocacy committee to help guide NANN’s advocacy focus and educate members on the issues
North Carolina Nurses Association (NCNA): Senate Bill 695– Modernize Nursing Practice Act: (An act to update and modernize the Nursing Practice Act) -The NC Board of Nursing bill to modernize the Nursing Practice Act is not expected to pass this session. Legislative leaders, including Health Committee Chairs, have indicated that scope of practice legislation will be heard next session. All nurses should stand ready to be a resource to help deliver quality health care and be a part of the solution to curb the rising costs as lawmakers look at health care economics.
Happy New Year … and Happy Anniversary to CANNP! CANNP was founded 25 years ago!!
The original mission was to:
- establish an organization to facilitate professional development, education and research for the neonatal nurse practitioner
- to provide a communication network for exchange of ideas regarding practice, education and the professional role of the neonatal nurse practitioners; and
- to participate in the legislative activities regarding nurse practitioner scope of practice specifically in the neonatal care area.
We continue to strive to meet these goals to improve both ourselves and our care. We have come a long way!
A lot has changed in 25 years!
- First, professionally with consensus models for APRN regulation (LACE), workforce surveys, mandatory certification and specified maintenance, increased continuing education requirements…
- Secondly, a lot has changed in the management of our precious babies. Ventilators and respiratory management techniques, which include highfrequency and NAVA ventilation, surfactant, more rapid weaning leading to less ventilator days, bubble CPAP… We have studied nutrition and have learned how to improve growth. We have implemented new strategies, such as body cooling for HIE, and Laser therapy for ROP. We have looked at old strategies (PDA ligation) and have reshaped care.
- Lastly, communication, random safety audits and new NICU designs have been hot topics.
CANNP offers an annual conference to address changes and “new” things. It is a great opportunity to educate ourselves, but also to see what our neighbors are doing and to network.
We have offered our first web-based contact hour offering this year for members only. A lecture from the 2015 conference on nutrition is available for viewing and credit through Sept 2016. Another offering on x-ray interpretation is underway.
Please help us help you—let us know what is helpful, contribute to our newsletter, or prepare a presentation for the website!
Lastly, tell your colleagues about CANNP and encourage them to join!
See you at the conference!
Conference Highlights 2016
The 2016 conference will be held on April 21 & 22.
The conference is titled “Shades of Blue: Collaboration in Neonatal Care Across the Carolinas.” Please see the event page for the agenda.
Members of the conference planning committee are:
- Cynthia Baker NNP
- Stephanie Blake NNP
- Amy Jnah DNP, NNP
- Sherry LeBlanc NNP
- Felicia Soza NNP
The committee has worked hard to ensure a wonderful conference. Join us in Durham for a great conference, a chance to network with colleagues from North and South Carolina, continuing education credits and perhaps some shopping or sight seeing.
Brochures have been mailed. If you have not received one, please email Kathy Connelly.
It is time for the annual CANNP Peer Recognition Award. The award nomination forms can be found on-line at the CANNP website: cannp.org. Please consider nominating a well deserving colleague for this meaningful award. Can you think of a better way to say “Well done, Great Job, I’m glad you are on our team, I admire you, you are my role model or thanks for being a great mentor”? Recipients of this award have been pleased that colleagues took the time to recognize them for their contribution to the team. All too often we hear complaints or we are the ones voicing complaints about the lack of recognition for our commitment to our profession and our length of service to an organization. Here is your chance to change this and honor a member of your team. Please consider each team member, their dedication to your unit and infants, efforts to improve or maintain personal education and education for other team members, involvement in unit projects or committees and personal commitment to the continued development of the advanced practice role. Applications can be found on the website and should be mailed to Kathy Connelly 6104 Wolverhampton Dr. Raleigh, NC 27603 and must be postmarked by April 1, 2016.
The award will be announced and presented during the business meeting at the annual conference on April 21st.
CANNP Scholarship Award
CANNP Scholarship The purpose of this award is to recognize an individual who has returned to school to enhance their role as an NNP and provide them with a scholarship award for financial assistance. CANNP is seeking applications from NNPs functioning within our organization who are currently in an educational program seeking an undergraduate or graduate degree. The award recipient will receive a $1000.00 monetary award. The award presentation will be made on April 21st at the business meeting held during the conference.
CANNP Scholarship and Grant Application Applications and additional information can be found on the CANNP website. Completed applications should be mailed with current curriculum vitae to: Kathy Connelly 6104 Wolverhampton Dr. Raleigh, NC 27603. Applications must be postmarked by April 1, 2016.
CANNP Grant Application
The purpose of this award is to assist CANNP members who are involved in clinical research with funding for their project. The grant is for $1000.00. NNPs must be CANNP members for at least two years. Applications are due by May of each year and award notification takes place by August 1st. The CANNP Grant Application can also be found at the CANNP website. Completed applications can be mailed to Kathy Connelly 6104 Wolverhampton Dr. Raleigh, NC 27603 . For questions about either of these awards, please check the web site for additional information and/or email Kathy Connelly at firstname.lastname@example.org.
Elections were held for the Board of Directors in the Fall of 2015.
Election results are as follows:
- President: Judy Philbrook
- Vice President: Kathy Connelly
- Secretary: Amy Jnah
- Treasurer: Sharon Rush
- Member at Large: Christine Rowland
CANNP wishes to thank the outgoing Board Members for their dedication, time and service. The organization has continued to grow and develop under their leadership. Congratulations to the new Board members! Thank you for taking on the daunting task of running and growing our organization! Your ideas and energy are vital to maintain and expand our organization and its impact on advanced practice in the Carolinas.
Dr. Amy Jnah is a board certified neonatal nurse practitioner, professor, researcher, Army wife and mother of two. She is the director for the neonatal nurse practitioner concentration (MSN) with East Carolina University. Dr. Jnah has published articles in several peer reviewed nursing journals, several textbook chapters (to be released in 2016) and is a nurse researcher within the clinical and academic setting. Her academic research trajectory includes mentoring and its implications for the neonatal nurse practitioner workforce. Dr. Jnah's clinical research trajectory include non-invasive screening mechanisms for premature neonates, psychomotor skills competency, and simulation -based training. In her "spare" time, she enjoys triathlons, tennis and vacations to the beach with her family!
Dr. Christine Rowland is also a board certified neonatal nurse practitioner. She currently practices full-time in the NICU at Levine Children’s Hospital at Carolinas Medical Center in Charlotte NC. She also enjoys working PRN at Catawba Valley Medical Center in Hickory. She received her BSN in 2006 from the University of Akron, her MSN in 2011 and DNP in 2015, both from East Carolina University. Her areas of clinical interest and scholarship include delivery room management, advanced neonatal procedures, developmental care, necrotizing enterocolitis prevention, quality improvement, and application for best practices. She is a proud member of American Nurses Association, NC Nurses Association, National Association of Neonatal Nurse Practitioners, and CANNP. She married her husband Steve this past summer in beautiful Charleston, SC, and in her free time she enjoys running, gardening, reading, traveling, and volunteering for the March of Dimes.
Secretary’s Report: Kathy Connelly Minutes from the last annual business meeting will be displayed outside of the conference room at the 2016 Conference. Treasurer’s Report: The CANNP balance is currently: $25,154.77 Member-at-Large: Sharon Rush CANNP currently has 56 members. It is time to renew your membership. A membership application form is enclosed in this newsletter or you may obtain one from our website. Applications must be received by or at the annual conference. Applications will be considered late after the conference and a $5.00 late fee will be assessed to members who have not renewed their membership by this deadline. Please encourage all members of your team to join or rejoin and be active in this worthwhile organization. The address for renewals and correspondence is: CANNP C/o Judy Philbrook 6474 Summerchase Drive Fayetteville, NC 28311
Multidisciplinary Rounding (MDR) Nicole (Nikki) Barrett MSN, NNP-BC Volume 6 Issue 1 Page 5
The event was facilitated by a performance improvement advisor. First, the team identified shared goals for the MDR model that included improving quality and satisfaction as defined by the family, improving continuity of care, and reducing potentially harmful errors. The team spent the entire day creating a model that included geographic bed assignments, a plan for involving and communicating with patients, assigned roles that gave all team members voice and an opportunity to collaborate, a nurse recap of the daily plan of care, and “real-time” electronic order entry. Based on parental feedback regarding privacy concerns, the decision was made to hold rounds at a table at the end of the hallway rather than at each bedside. The daily MDR team, which includes the doctor, nurse, nurse practitioner, nutritionist, pharmacist, respiratory therapist, case manager, and parent(s), started a trial of their newly designed rounding model in October 2014. The Mission Hospital NICU team recently transformed their Multidisciplinary Rounding (MDR) Experience. The purpose of this project was to implement a coordinated, streamlined, family-centered, quality rounding experience for every baby every day. When the MDR committee started their work in early 2014, process and care varied greatly from provider to provider and the overall NICU team’s daily workflows were disconnected, fragmented, and often redundant. Great opportunities existed, particularly surrounding consistency and communication. After several unsuccessful attempts at implementing a new MDR model during the first half of 2014 the NICU team decided to hold a one-day kaizen event in quest of an innovative MDR model for trial. The 20 kaizen attendees included:
- NICU RN’s
- Neonatal Nurse Practitioner’s
- NICU Respiratory Therapists
- Mission Physician
- MDR Champion
- NICU Case Manager
- NICU Pharmacist
- NICU Educator
- NICU Leadership
- NICU Family Member
The event was facilitated by a performance improvement advisor. First, the team identified shared goals for the MDR model that included improving quality and satisfaction as defined by the family, improving continuity of care, and reducing potentially harmful errors. The team spent the entire day creating a model that included geographic bed assignments, a plan for involving and communicating with patients, assigned roles that gave all team members voice and an opportunity to collaborate, a nurse recap of the daily plan of care, and “real-time” electronic order entry. Based on parental feedback regarding privacy concerns, the decision was made to hold rounds at a table at the end of the hallway rather than at each bedside. The daily MDR team, which includes the doctor, nurse, nurse practitioner, nutritionist, pharmacist, respiratory therapist, case manager, and parent(s), started a trial of their newly designed rounding model in October 2014.
While the team continues to meet and make further refinements through PDSA cycles, the process has been largely successful. Most recent enhancements include an MDR invitation for family members and modification of geographic location of patients, concentrating short stay patients in one area and more acute patients in another area. Measurable improvements have been noted. Parents often participate in rounds and patient satisfaction scores have significantly improved, particularly regarding “Doctor’s Communication/Keeping Patient Informed” and “Overall quality of care”, “Overall Quality of Care”, and “Overall Level of Safety”. When asked what was outstanding about the NICU experience, one parent said, “The daily round tables that the doctors and the team do for each baby. I think that’s outstanding… and the fact that the parents can attend that and be a part of it.” The positive changes were not only noticed by the families, but staff too. A survey of the NICU team revealed that 89% of providers and 97% of bedside nurses agreed that MDR has positively impacted patient care. This project was successful and successfully hardwired because it was created and owned by a multidisciplinary team, family feedback was a top priority, and the NICU team debriefed weekly through several PDSA cycles. Feedback from multiple parent and staff surveys continue to drive PDSA trials.
Practice Site Updates
Cape Fear Valley: It’s been a fairly quiet 6 months here at the Valley, however we have just recently welcomed the newest little member to the Coggin family. Congratulations to Dr. Kristin Coggin and husband Myers on the birth of their 3rd child Madelyn “Elliot” Coggin. She made her big entrance on the morning of January 7th, a few weeks early, saving her mother from those last few call shifts before a much needed leave. Big sister Merritt and brother Sullivan are hopefully adjusting well. Another note of congratulations, to Wendy Brock NNP-BC DNP on her poster presentation on “Improving Interdisciplinary Communication in the NICU” at the Vermont Oxford Meeting in Chicago on October 3-4. She has been very busy winding down the completion of her DNP program in December. Again congratulations Wendy and thank you for all your hard work.
WakeMed: Well, where to begin! This has been a busy year for WakeMed. We opened up a new birthing center, WakeMed North, in May and although it has had many growing pains, they have become the place to deliver! The rooms are the size of a small apartment (well maybe not that big) but very spacious. The Special Care Nursery has 6 private rooms and of course 24/7 coverage by our NNP’s. Our Raleigh location is getting ready to open new Labor & Delivery rooms, OR and Neonatal resuscitation room this month. They are just as beautiful as North! Our Cary location has been so busy that we had to hire a part time PNP to help see all the newborns! On a more personal note, Desi Newberry NNP gave birth to a beautiful baby boy, William, in August. Tracey Robertson NNP married Victor Bell in October. Both continue to be professors at ECU’s NNP program in which Amy Jnah is the director. Amy also joined the CANNP Board as the new secretary starting this month. Amy will be a wonderful addition to the board. She has also been very busy working with the 2016 CANNP conference committee. Many thanks to Amy for that also. Dr. Ross Vaughan also retired this summer. Ross was the oldest practicing Neonatologist in NC at the time of his retirement. We continue to grow our Neonatology family! This month, we will add a new Neonatologist, Claudia Cadet MD, who joins us from Rex Hospital. We are excited to have her with us, but sad for Rex. Ginger Rhodes-Ryan NNP has been extremely busy in her role as research coordinator for the NICU. We have added so many new studies; we are having a hard time keeping up with them. Good thing Ginger can keep them all straight! If you are ever in the Raleigh area, please feel free to come by for a tour! We love to show off our new renovations!
Womack Army Medical Center: It has been a busy summer and fall for our practice. We officially dropped down to keeping 28 weeks gestation infants in our NICU! Our ongoing collaboration with ECU and placing student NNPs continues. We bid a fond farewell to Paula Roach, MSN, NNP-BC as she joined the new practice at Southeastern Regional Medical Center that is expanding their Special Care Nursery to care for more preterm infants. Also moving on in her Air Force military career, LTC. Sherreen Batts, one of our Neonatologists is now working at Portsmouth Naval Center in their NICU. We welcomed MAJ Eleana Beadle from Hawaii as our new Neonatologist replacing Dr. Batts. Dr. AJ Grein has spread his business wings and became one of the partners (besides continuing to be our Medical Director) in an established B&B known as the Applewood Manor in Asheville, NC. Liz Lawrence, NNP-BC became a grandmother for the second time in July. Grandson Maximilian joined his big sister Lana and his family in Charlotte. Liz also became a first time owner/breeder/handler of a National Champion Arabian Yearling Colt, Sport Horse in Hand– Psylent Rockstar at Sport Horse Nationals last fall in Raleigh. She also garnered a National Top Ten placing in the 2 year old Filly Sport Horse in Hand with Sweet Psylence, Psylent Rockstar’s big sister! Very exciting times for Legacy Farms. We welcome Jenny Porter, MSN, NNPBC to our Neonatology team! Jenny was one of our staff nurses that actually did some of her clinical time with us as she was going through her NNP classes. She has been working at Cape Fear Valley Medical Center since completing school and we are excited to be welcoming her back.
Remember: It is time to renew membership. This form is attached or may be downloaded from the CANNP website. We would like to encourage you to consider nominating a member of your group for the annual peer award. Also note information about the scholarship award. If you are a member in good standing and are working on a degree, please consider applying for this award. The Research Grant Application Form is also discussed. Please go to the web site and take a look at this form. If you are considering or are currently involved in a research project, please consider applying for this monetary award. We would like to again encourage all members to consider writing an educational feature for this newsletter. Sharing information and practice initiatives is rewarding and important to our membership. The newsletter is an important communication tool. This tool however may be limited if only a few NNP’s contribute to it. CANNP needs you, your ideas, experiences and energy to continue the growth we have experienced over the past several years. Please email comments, suggestions, articles or practice site up-dates to : Christine Rowland at email@example.com
President's Message- Judy Philbrook
“We cannot live for ourselves alone. Our lives are connected by a thousand invisible threads, and along these sympathetic fibers, our actions run as causes and return to us as results.” Herman Melville
Ever wonder why you do what you do day after day? Or ask yourself if anything that you have done has made a difference?
Our NICU has a reunion each year—the first Saturday of June. What an awesome and humbling experience! I heard many stories, and experienced laughter, gratitude, and tears. Parents and/or grandparents came up to me and asked if I remembered them, told me about their child and thanked me. One mother said that her son had a Grade 3 IVH and that this caused great worries, but happily reported that he is now 3 and knows his ABCs and how to count! Another father said his baby was in our unit for 12 weeks and was showing her off! Yet another family told me that because of their son, they have gone back to church and he is attending a Christian school. Parents talked about coming to visit their babies in the NICU, answering calls in the middle of the night, and how it feels to come back.
Don’t ever sell yourself short. People are watching what we do—and how we do it—all of the time. Sometimes the most insignificant things to you may mean the most to the family. Also remember that being there counts too—sometimes the emotional connection speaks louder than words.
Belonging to a professional organization, like CANNP, can produce similar questions and feelings. Again, is what I am doing making a difference? It seems like this is a lot of work for the number of members that we have.
I appreciate your continued support of this organization! In this newsletter, I am pleased to announce fantastic budgetary news. I am grateful to the 2015 conference planning committee for all of their hard work in planning an excellent conference.
I heard many positive comments about our conference—it is professional and well done, it provides networking experiences and the vendors loved the opportunity to share their wares. But, there are a lot of nurse practitioners who are not taking advantage of our regional expertise. Please share the value of CANNP with them as we are making a difference—one day at a time, one admission or discharge at a time and one conference at a time…
Have a great summer! Judy
2015 Conference Highlights
The 2015 annual CANNP conference, “Babies are our Business” was held on April 16 and 17 at the Great Wolf Lodge in Concord, NC.
The conference planning committee did a great job and their hard work is appreciated. Members of this committee included: Joanna Fletcher NNP-BC Paula Issinghoff NNP-BC Reagan Oglesbee NNP-BC Carol Snyder NNP-BC Cheryl Smith NNP-BC Renee Starcevich NNP-BC
Topics and presenters included:
- Update in Neonatal Neurology Carolyn Hart, MD Antibiotic Stewardship John “Brock” Harris, Pharm D
- The Premature Infant: A Nutritional Emergency Suzanne Smith MSRD, LDN, IBCLC
- The Golden Hour Phyllis Waddell, RN, BSN
- Competency Maintenance: What You Don't Know Can Hurt You Lee Shirland, MS, NNP-BC
- HFOV with the Neonate Chris Surike, RRT-NPS
- NNP Mentoring Program Amy Jnah (ECU) DNP, NNP-BC
- Nursing Research in the NICU Desi Newberry DNP, NNP-BC
- Putting Together Prenatal and Neonatal Genetic Testing Erin Steed, MS, CGC
- Gut Microbiome and Its Effect on Disease Chris Magryta, MD
- Newborn Screening for Complex Congenital Heart Disease Matthew B. Brothers, MD
Practice sites traditionally donate gift baskets.The following participants won a basket: UNC - Debra Nickerson, Duke - Beth Connelly, CMC, Levine Childrens - Deana Grogan, Charlotte Novant - Kristen Ruby, WakeMed - Kathy Connelly, CFVHS - Tneshia Sweat, Forsythe - Oksana Kasko, CMC Pineville - Courtney McDaniel, Vendors - Jennifer Wetherby
CANNP offered a Skills Lab at the conference. The following skills were demonstrated and practiced: umbilical catheterization, lumbar puncture, intraosseous insertion, intubation and chest tubes. Mannequins were donated previously by PETA.
Educational Feature: Spirituality in Our NICU
By Judy Philbrook, NNP-BC
Spirituality in our NICU is currently a three-pronged process.
It consists of 1) debriefings 2) a monthly worship service and 3) spiritual retreats.
I wrote about our debriefings and efforts in palliative care in the July 2014 issue of this Newsletter, so will address the other areas in this article.
Monthly Worship Service:
We started to offer a worship service for our staff in Sept 2014. We call this the Saturday Evening Worship Service and hold it on the first Sat of the month. It is offered at 6 pm to accommodate oncoming staff, and at 7:30 for those who are leaving. Each service is 30 minutes. It took several months to obtain approval for this offering. First, we sought and received approval from the NICU Medical Team, the Patient Care Manager, the Service Line Director and from our hospital’s Chaplain Services. We sought community pastoral support and were fortunate that Judith Foster Reese, an Episcopal priest who was serving as an interim at a local church, was interested. Judith had some previous experience in biostatistics and research in a NICU at the University of Alabama (Birmingham). We also sought musicians and were able to secure the help of the Second Mile Praise Band at a local Presbyterian church. We have our worship services in our NICU Classroom. It is “remodeled” - the tables are folded and chairs are arranged in a semi-circle. The counter top serves as our altar and has featured flowers, battery operated candles and a cross that I bring from my Sunday School classroom!
Our service opens with soft music. We then have a variety of offerings, but these have always included a reading from the Bible, a meditation and music. Meditations are often adapted to the health care worker. Attendance varies—we have had 15 people, or 4 people attend. Regardless, we worship and have an increased sense of God and community when we leave.
Judith left in January for her next assignment. We have been fortunate to find another pastor, Eva Ruth, who moved back to Lumberton last Nov. Eva is a hospital chaplain and is also working on life coach certification. She is employed part time at a Presbyterian church in Lumberton in pastoral care.
We have tried to open our service to other disciplines—we have invited our maternal-child colleagues and NICU parents.
This winter, I sought funding through our Employee Directed Funds Grant Program. We were granted money to pay Eva for her travel and work with the stipulation that we include an announcement in our bimonthly employee newsletter, that an overhead announcement be made prior to the service and that I work with marketing to develop a professional flier. It’s all win-win! Spiritual Retreats The last prong is attendance at a spiritual retreat.
One of our physicians, Scott Cameron, asked me and another NNP to attend this retreat several years ago. We did and saw how we could work to make things better and have asked and sponsored 13 more staff members (NNP, RN, RT and unit secretary staff). The retreat is through the North Carolina Presbyterian Pilgrimage group. (Others may liken this
to Cursillo or the Walk to Emmaus). After the retreat, we meet as a large, or in smaller, groups and continue to try to maintain our focus. The neat thing about this is that staff members are now asking us if they can go, rather than us asking them! It is telling and is hopefully making a difference.
We are all faced with challenges and are finding that being able to openly talk about issues we face, both work-related and personal, in this environment is good for all of us. On the bottom of the worship invite, there is a statement that reads:
Let us lift up our needs to you, O Lord, as we bring our personal and professional needs to You in community with our friends and co-workers.
We praise You and know that only You can restore peace within us.
We feel fortunate to have these opportunities in our workplace.