Vanessa Coronel, BSN, RN

VA Boston Healthcare System

Boston, MA

NOVA Emeritus Member Denise Dulude was one of the first nurses to come out of retirement and olunteer to fight the COVID-19 pandemic. This article will highlight her nursing background at the VA and why she heeded the call to fight this pandemic.

Background

Denise began her VA nursing career in the 1980s. She started as a staff nurse on a neurology floor and later became the Nurse Manager for neurology’s stroke center. Her progression in the clinical and leadership ladder has been impressive- being the nurse manager for several units including Emergency Department, Cardiac Care Unit and Outpatient Specialty Clinics. In her 37-year career in nursing, Denise has been known to be a great mentor to staff, nurse managers and associate chief nurses. 

Reasons for Choosing VA

Back in the 1980s, the VA offered to excuse all federal student loans for nurses who worked for two years. As a new nurse faced with student loan payments, Denise considered this a good deal. After two years, she had grown to really appreciate serving the Veterans. Denise shared that “The Veterans truly appreciate you- they have this authenticity that is very hard to describe. The VA is more than just a hospital for our Veterans- it is a meeting place or more like a second home for them. They look forward to interacting with fellow Veterans and they feel true appreciation as reflected by the quality of care that the VA provides. It is only the VA that truly knows our Veterans and how to provide the specialized care that they deserve.” 

Nursing Platform of Increasing Vaccinations

In early 2000, Denise was the Patient Care Coordinator in the acute care setting. Being on the night tour, she noticed that nurses did not have access for vaccination and other employee health resources. Typically, employee health was only open during weekdays. Denise began to vaccinate nurses during her leadership rounds. She worked closely with Infection Prevention and after three years, had recruited more nurses to join her in vaccinating the frontline staff. Denise added additional services such as tuberculosis testing and personal protective equipment fitting. In 2010, she spearheaded process improvement projects to increase flu vaccination among Veterans. Hence, Denise is well known at the VA Boston as the original flu fighter.

Denise Dulude administering flu shot to the VA Secretary Robert McDonald in October 2014.

As a Halloween treat. Denise Dulude and Sue Shannon are offering flu shots to employees and Veterans via the rolling flu cart in 2015.

Impact of COVID-19 Pandemic in Nursing

In her 37-year career, Denise has been involved with several disaster response initiatives (Post-9/11, Measles Outbreak, TB Exposure, and Boston Marathon Bombing), however Denise has not seen anything like the COVID-19 pandemic. Although, she can totally relate to the pandemic’s impact in nursing. The majority of the frontline staff dealing with this pandemic are nurses and are putting their own safety at risk and they worry for their own families as well. They are juggling their commitment to providing care and other priorities which is a huge burden and can create a lot of stress. 

VA Boston’s Response to the COVID-19 Pandemic

VA Boston has a robust process in ensuring that frontline staff have the appropriate personal protective equipment (PPE). As part of the COVID 19 Incident Management Team’s Personal Protective Equipment Staff, Denise has been spearheading efforts to ensure that frontline staff have the knowledge, competencies and resources to utilize proper PPE appropriately. Her duties include working with the PPE Support Staff to facilitate the proper use of PPE, track inventory and usage levels and visual inspection of VA staff for proper PPE (as shown in the picture below). VA Boston continues to work with other VAs and the private sector to ensure the appropriate PPE par levels. Mitigation strategies are also in place in anticipation of the COVID-19 surge. 

Denise Dulude in PPE rounds with Nicole Condon checking if frontline staff have the appropriate PPE.

Lessons Learned from a Pandemic  

Denise had three words to say: “Communicate, communicate, communicate. Nurse Leaders need to ensure transparency of information.” Denise mentioned that the VA Boston conducts weekly town hall meetings where executive leadership has an open forum with all employees. Employee Assistance Program (EAP), a confidential program helps VA employees work through various life challenges that may adversely affect their job performance, health or personal well-being. Located on all three campuses, EAP is a helpful resource for employees who find themselves overwhelmed by the pandemic. The Holistic Committee offers meditation and relaxation classes. Most importantly, the VA nursing culture of teamwork persists. As Denise has mentioned: “We are all in it together and we shall overcome this.”

Reason for Coming Out of Retirement to Help Fight Covid-19

Denise mentioned that she goes where help is needed. Perhaps it is inherent in nursing to help others. Denise may have retired but one could ever take the nurse out of Denise. Thank you, Denise, for your dedication to our Veterans and Happy Nurses Week!

Shana (Shakhnoza) Rodriguez. BSN, RN, CNOR

NOVA Chapter 420

Central Virginia Healthcare System

Richmond, VA

When someone mentions OR nurses, the first thing that comes to mind is people covered from head to toe with faces hidden behind masks. A lot of people have no idea of what we do behind the red line that divides restricted and non-restricted areas. Even nurses of different specialties have vague ideas of what OR nursing entails, and I often get questions about what exactly our role in the OR is. We can easily get lost in our own hospital because we rarely get out of the OR is an anecdotal truth.

However, while the COVID-19 pandemic is ravaging through our nation, a lot of units need medically trained professionals to provide adequate care for patients arriving at hospitals at an increasing rate. As an answer to the call for help, OR nurses are stepping out to help and support nurses working on the front lines. For example, at the Central Virginia Health Care System in Richmond, Virginia, a lot of our OR nurses were detailed to screen Veterans for COVID-19 at the stations in our Drive-Through Clinic (DTC). Patients arriving with COVID-19 symptoms are tested before they go to the isolation room in the emergency room (ER) to receive medical attention. DTC reduces exposure of the ER employees and other patients with non-COVID-19 emergencies. 

Picture on left: OR nurses Dena Traylor (Neuro Service) and Adena Mahini (Ortho Service) are screening Veterans at the DTC.

Picture on right: Pamela Liddle (ENT Service Coordinator) trying to warm up during a cold, rainy day while waiting on Veterans arriving at the DTC.

Picture on Left: Kristina Kniceley (Vascular Service) and Dena Traylor (Neuro Service) were photographed before screening Veterans for COVID-19 started.

Picture on Right: Tara Stevens (ENT Service) taking care of Veterans at the DTC.

Due to cancellations of elective cases, our newly opened Post-Anesthesia Care Unit 3-E was transformed into a unit specifically for COVID-19 positive patients. ICU nurses floating there are cross training PACU nurses while OR nurses are helping them to don/doff personal protective equipment (PPE) in proper manner preventing contamination. OR nurses are well versed when it comes to infection control and contamination prevention.  PACU and ICU nurses verbalized how happy they are and feel protected because the OR RNs  are observing and assisting them to put on PPE.  Besides observing and teaching other healthcare providers who are consulting on or assessing COVID positive patients, our OR nurses are providing support by running blood gases, bringing extra supplies, medications, etc. to nurses working inside the COVID rooms, so they don’t have to constantly don/doff PPE if they need additional supplies.

Lauren Walden (GU Service) is working on 3-E, COVID-19 Unit.

OR nurses (from left to right): Lauren Walden (GU Service), Courtney Troy (Neuro Service), and Kathleen Childress (GU Service Coordinator) are working with ICU and PACU nurses on the COVID-19 Unit.

Top left to right and bottom left to right: Darla McKimmie (recently joined our VA family and Ophthalmology Service, Kristina Kniceley (Vascular Service), Laura Baxter (Ortho Service), Terrice Wisbang (Cardiac Service), Melinda Talley (General Service), Tamara Kelejian (Neurosurgery Service Coordinator), and Courtney Troy (Neurosurgery Service) are working as observers and instructors for proper donning/doffing of PPE on those units, as well as “runners” for supplies and doing blood gases at the MICU and 3-E,  COVID-19 Unit.

Another group of nurses are working at the nursing home and hospice care units. They are helping to provide care for the Veterans residing there or working by the entrances of those units checking healthcare providers’ temperatures before they enter. Since our in-house barber shop is closed due to strict quarantine rules, a lot of Veterans residing in the above mentioned units needed haircuts and shaving. Our Podiatry Service Coordinator, Barrett Smith, bought all the necessary supplies and gave haircuts and shaved the patients on the nursing home and hospice units.

Picture on left: Barrett “Barry” Smith is transporting a patient from the nursing home to the Radiology Department for a scheduled test.

Picture in middle and on right:Jeremy Andrion (Ortho Service Coordinator) and Bernadith Abuan (Cardiac Service Coordinator) are working by the entrances to the Nursing Home and Hospice Care Units where they are screening healthcare providers arriving to those units.

At times like this where all hands-on deck is required to serve our Veterans and provide the best possible care to achieve positive outcomes and protect them from Covid-19, our OR nurses did not hesitate to volunteer to be where they are needed. These amazing nurses changed their regular work schedules and are working weekends, evenings, nights, and longer hours to accommodate the needs of the Veterans.

As a wife of a Veteran myself, I simply would like to recognize their selfless service and show my appreciation for their work ethic and dedication for our patients that served our country!

Penny Kaye Jensen, DNP, APRN, FNP-C, FAAN, FAANP       

VACO/ONS 

National APRN Program Manager      

Ronald Nardi, MSN, APRN, PMHCNS-BC 

Alaska VA Healthcare System  

Substance Use Disorder, Domiciliary Care, Same Day Access Mental Health APRN    

Great news! Penny Kaye Jensen, DNP, FNP-BC, FAAN, FAANP and Mr. Ronald Nardi MSN, APRN, PMHCNS-BC have agreed to serve as chairpersons of the newly formed NOVA Advanced Practice Registered Nurse (APRN) Committee. 

Penny Kaye Jensen

Dr. Jensen began her career with the Department of Veterans Affairs in 1994 and has practiced for the past 22 years as a nurse practitioner in the Outpatient Primary Care Clinics at the Salt Lake City Veterans Affairs Healthcare System. She is a Fellow of the American Academy of Nursing (AAN), American Academy of Nurse Practitioners (AANP) and a Distinguished Practitioner and Fellow of the National Academies of Practice (NAP). Dr. Jensen served as President of the American Academy of Nurse Practitioners. She received the Towers Health Policy Pinnacle Award as well as the Loretta C. Ford Award in 2017 for her tireless work to further the NP profession at the national level. She is the only NP in the nation to receive both awards.

Dr. Jensen serves as the National APRN Health Policy Liaison for the Department of Veterans Affairs Office of Nursing Services in Washington, D.C. Her primary responsibility has been to lead the Veterans Health Administration’s (VHA) initiative to approve Full Practice Authority (FPA) for all Advanced Practice Registered Nurses (APRNs) throughout the enterprise. She led the VA FPA initiative which resulted in APRN Final Rule (AP44) being approved, granting full practice authority to APRN roles practicing within the VA: Certified Nurse Practitioner (CNP), Certified Clinical Nurse Specialist (CCNS), and Certified Nurse Midwife (CNM). Dr. Jensen shared that, “it has taken over 10 years for this much anticipated day to arrive, ironically falling on Florence Nightingale’s 200th Birthday! I can proudly report that all 140 VA Healthcare Systems (100%) have amended their bylaws to allow FPA for three of the four roles of APRN practice! Congratulations to Puerto Rico for moving forward!”

Ronald Nardi

Mr. Ronald Nardi graduated from Vanderbilt University School of Nursing where he earned his Master of Science degree in Adult Psychiatric Mental Health Nursing and began his VA career at the Nashville, Tennessee Veterans Administration. It is here where he was afforded the opportunity to serve our Nations’ Heroes and recognize the gift of freedom that was paid by those in the armed forces. As a Clinical Nurse Specialist (CNS), he secured his Advanced Practice Registered Nurse licensure in 1994 and was the first APRN at the Institute of Living in Connecticut to prescribe psychotropic medications on an inpatient basis. Mr. Nardi’s career has spanned a variety of psychiatric settings and roles across the full continuum of care. He has served as staff nurse, research, director of inpatient and intensive outpatient care, PTSD Team, Behavioral Health Interdisciplinary Program (BHIP) Team, Substance Use Disorder including Suboxone Treatment, Primary Care Mental Health Integration (PCMHI), Same Day Access, Domiciliary Care, Teacher and Mentor. As of October 2020, Mr. Nardi will reach a milestone of having served 20 years as an APRN in the VA.  

Mr. Nardi is currently working at the Alaska VA, having relocated in 2018. He has joined the Nurse Professional Standards Board and has served in a variety of clinical and leadership roles including Interim Clinical Director for the Alaska VA Mental Health Care Line. APRN Nardi is an inaugural member of the Office of Nursing Services Advanced Practice Registered Nurse Council, Clinical Nurse Specialist Council and APRN Qualification Standards Board.  

Mr. Nardi joined NOVA many years ago and presented at his first annual conference in New Orleans on Posttraumatic Stress Disorder. He then went on to join the NOVA Board or Directors as a National Director and then Executive Director as Membership Secretary. Mr. Nardi has served as Chairperson of NOVA’s Annual Meeting for several years. At the 2018 Annual Conference Nursing Strong: Evidence Based Care for America’s Heroes in Richmond, Virginia, he again presented. This time as speaker, he shared his experience as it related to Disaster Emergency Medical Personnel System (DEMPS) and his deployment to Puerto Rico following Hurricane Maria. Nurse Nardi is passionate about Nursing and strengthening and growing NOVA. Mr. Nardi feels that, “It is all about the nurses, all nurses, and what NOVA can do for them. Nurses need to be recognized in bold ways.”

If you are an Advanced Practice Registered Nurse (APRN), please contact NOVA nova@vanurse.org. Several members are APRNs but joined NOVA prior to becoming an APRN. NOVA wants to make sure you are in the appropriate membership category. And, if you are interested in joining the NOVA APRN Committee, please let NOVA know. Email notifications with details for future NOVA APRN Committee Meetings and VA APRN National Town Hall Meetings will be going out soon. Stand by!

Pictured (Right to Left):  APRN Council, Penny Kaye Jensen and Ronald Nardi, VA APRNs in Puerto Rico        

Betty M. Ogren, LPN

VA Northern Indiana Health Care Systems

Fort Wayne, Indiana 

During COVID-19, Betty Ogren purchased 78 little containers of Play-Doh, printed quotes and a fun little saying and attached them to the containers. With the help of the Patient Aligned Care Team (PACT) Unit Practice Council (UPC) members, she passed them out to each Primary Care and Specialty Care Nurses. They absolutely loved them. Small things can add a smile in a stressful time!

Sample Quote: “We rise by lifting others.” - Robert Ingersoll

TJ Wilcox-Olson

VA Portland Healthcare System
Portland, Oregon

April Yantis 

NOVA Chapter 364

Black Hills VA Health Care System
Ft. Meade, South Dakota

April Yantis has been a registered nurse for 10 years, a VA nurse for the last two, working with the Women’s Health program at VA Black Hills. She is the newest member of NOVA Chapter 364. Growing up, April had never thought about becoming a nurse. Her life experiences as a patient initially caused her to venture into it and she says that it has become her passion. In her late teens and early twenties, she had several surgeries and “became keenly aware of what a difference a great nurse could make in the recovery of a patient in the hospital.”   

April decided to begin pursuing higher education when two of her three children were in school. She took classes to become a CNA and then began working at a long-term care facility and then a rehab hospital. This led to her calling of becoming a nurse. She reflects, “I loved knowing the residents and patients. I loved ensuring their privacy and dignity even in the most basic of cares. I enjoyed the days and discussions with long-term care residents. I rejoiced with stroke patients when they walked out of the rehab hospital to go back to their lives.”

When COVID-19 arrived, so did the call for volunteers to hospitals across the country that were heavily inundated with sick patients. When April received the email calling for volunteers for the Disaster Emergency Management Personnel System (DEMPS) program, she says she couldn’t ignore it, “half of the time spent in my position is in the outpatient clinic. We were now unable to see many patients in the clinic, so my workload came to a screeching halt.” April was selected to deploy to the New Orleans VA. She says, “the experience was one that will forever be integrated into my life. Professional men and women, from every corner of our country, answering the call of help from our brethren to care for our country’s heroes.”

Her favorite part of the experience was the staff comradery. She shared that, "nurses from all over the country, MDs, Speech Therapy, OT/PT, Housekeeping, CNAs – everyone truly worked together to give each individual Veteran the best care possible.” The hardest part was the change from working in an outpatient area, as April has for most of her career, to becoming an inpatient floor nurse. She jokingly reports, “I had to reach into the cobwebs in the attic of my brain to remember some things. For example, hanging heparin for the first time was terrifying and I did the calculations half a dozen times before I felt confident. However, the aforementioned comradery of staff helped ease my trepidation. I asked many questions.” She humorously described her orientation as, “something like being thrown in the deep side of a swimming pool – but with floaties on my arms.”

April’s family was very supportive of her decision to go to New Orleans. Overall, she was fearless about walking into the storm. April felt confident the VA would provide all the necessary personal protective equipment (PPE) which was available to protect staff and patients. She admitted that she was most fearful about the virus the day before she left for the deployment and she ensured her husband knew her final wishes. April’s supervisor and coworkers were also supportive prior to and after her return. She made sure to socially distance and wear her mask after returning from New Orleans.  

Her best advice to another nurse who is considering volunteering for DEMPS or some other type of disaster relief deployment is to “pack light but thoughtfully. Put on your brave face – you can do hard things.”

April hopes she will get more opportunities to volunteer for similar experiences in the future. She imparts, “any experience that can stretch us beyond our comfort zone is usually a great choice. We can glean even from negative experiences to become better nurses!”