Jonathan Nover, MBA, RN

In the fast-paced world of health care, Emergency Services may set the pace. In mid-2024, Jonathan Nover, MBA, RN, assumed the role of Vice President of Nursing, Emergency Services, Mount Sinai Health System, in stride and with a running start.

Mr. Nover entered with an impressive track record of supporting nurses to do their best work, and with significant results. His contributions have led to reductions in hospital-acquired pressure injuries, reduced length of stay, nurse vacancy rates of single digit to zero, increased patient experience ratings, reduced workplace violence, and a strong display of quality improvement and health care legislative advocacy on the national stage.

“Jonathan brings an impressive portfolio of innovation and outcomes to the Health System’s nursing leadership team,” says Beth Oliver, DNP, RN, FAAN, Chief Nurse Executive, Senior Vice President, Cardiac Services, Mount Sinai Health System. “A key ingredient driving his success is his steady focus on doing what’s best for the nurse at the bedside.”

Mr. Nover’s philosophy is seemingly simple and yet highly effective: place people and technology at the forefront.

“I approach my work by striving to be both innovative and servant-minded,” Mr. Nover says. “Innovative in the sense of leveraging technology and best practice to help to guide and accelerate change. I want our nurses and nurse leaders to be at the forefront of novel methods and engaged in this rapidly evolving health care landscape.”

“While I am very tech-forward, I am equally people forward,” he says. “I’m in a terrific position to serve others, to help make the work more aligned, efficient, and value based, and to make the best of every situation for the people around me, from the leaders to the clinical nurses and teams taking care of our patients. I am honored to be at the helm, guiding the collective decisions about nursing practice in the Emergency Medicine specialty. By focusing on serving others, I believe that energy is returned many-fold.”

Making Work More Efficient

In his prior role as Senior Director of Nursing at Mount Sinai Queens, this philosophy proved invaluable. “Jonathan’s decision-making—including the projects he chooses to move forward—centers around improving patient outcomes and the notion of giving time back to both the patient and the clinical nurse,” says Jill Goldstein, RN, MA, MS, Deputy Chief Nursing Officer of Mount Sinai Queens.

“We have an extraordinary opportunity to align goals with our data technology partners and artificial intelligence (AI) experts while ensuring our nurse experts are embedded into decision pathways and workflow processes. The nurse in the loop is critical,” Mr. Nover says. “This may open new doors in the ED clinical operational realm, predicting next steps in throughput with nurses re-engineering new workflows, developing models and tools to help guide nurses to seek out patients at higher risk for specific presentations, or removing manual steps for nurses to improve efficiency. The result should be improved outcomes and giving our patients back time, which in turn gives time back to our clinical staff to help them continuously reprioritize clinical demands and perhaps take a breath, absorb a learning moment, and bond with a colleague.”

Examples abound of Mr. Nover’s technology/person-forward approach and advocacy brought to life. Video patient monitoring is helping to decrease falls and improve safety. Pilots of virtual nursing have shown effective ways to offset the documentation burden on nurses. Electronic reminders of regulatory requirements are improving the efficiency of managers and assistant nurse managers. Text messaging applications are improving patient experience and digital engagement.

“We’re also creating new platforms and workflows that are going to make our work more efficient and more electronic and remove what little paper we still have left,” Mr. Nover says. “As we’re doing this work, it’s important that we commit to finding ways to decrease our footprint, waste less, and become more green.”

Once projects are piloted locally, they are then rolled out systemwide in various ways. In the case of the community-acquired pressure injuries, Mr. Nover’s team created a turnkey quality improvement project. This ensured that each Mount Sinai ED site was ready and able to carry out the specific steps or actionable items to move the project forward.

The One Mount Sinai Vision

“I am proud to note, our ED systemwide community-acquired pressure injury (CAPI) discovery project has captured over 800 CAPIs in the three months since the project has been live,” Mr. Nover says. “That translates to improved patient care and potentially a projected $12 million in-hospital cost avoidance. In another systemwide quality improvement project, we are piloting new workflows to use text messaging to reduce admission delays. We are predicting 50,000+ hours of ED boarding saved in the first year from a simple text message.”

He continues, “This methodology of rolling out projects systemwide is part of the bigger vision to align our emergency departments under the One Mount Sinai vision. Essentially, this vision means that whether you walk into an emergency department on the Upper West Side or in Brooklyn or any other site, the experience will be similar and of the same high quality in terms of care, treatment, policies, clinical practice, and even something granular like offering electronic discharge as an alternative to paper.”

In recognition of their work, four Mount Sinai EDs have received Lantern Awards from the Emergency Nurses Association (ENA) for demonstrating exceptional and innovative leadership, practice, education, advocacy, and research. The ENA is described as the premier professional nursing association dedicated to defining the future of emergency nursing. Mr. Nover says, “I envision all our EDs holding the prestigious Lantern Award by year’s end, because we are hyper-focused on excellence.”

Pathway to Leadership

Mr. Nover brings more than 18 years of progressive and transformational nursing leadership experience in emergency medicine and hospital leadership to his role of Vice President of Nursing, Emergency Services, Mount Sinai Health System. He joined Mount Sinai in 2019 as Senior Director of Nursing, Mount Sinai Queens, where he directed and oversaw the daily operations and performance of the Emergency Department, critical care and medical-surgical services, inpatient dialysis, and evening/night nursing administrator services.

Prior to joining Mount Sinai, he served in several leadership positions at NYC Health + Hospitals from 2010 to 2019, including Associate Executive Director, Emergency Department, and Hospital Patient Experience Officer, South Brooklyn Health; and Associate Director, Nursing Adult and Psychiatric Emergency Department, Lincoln Hospital.

Mr. Nover is the recipient of the New York State 1199 Nurse of Distinction for Leadership Award, and a New York City Proclamation for Community Service from Mayor Eric Adams, a testament to his transformational leadership style and commitment to community health.

He currently serves as Chair of the Government Affairs Committee for the New York State Emergency Nurse Association and is enrolled in the Yale Healthcare Leadership, Systems, and Policy Doctor of Nursing Program at the Yale University School of Nursing.

Kim-Anh-Nhi (Nhi) Nyugen (left) and Maria “Vickee” Sevillano

In 2022, Maria “Vickee” Sevillano, BSN, RN, CWCN, COCN, Wound Care Specialist at The Mount Sinai Hospital, attended a virtual informational discussion on artificial intelligence (AI) that clicked like a light bulb in her mind. “Even before attending that lecture I had been wondering if we could create a machine-learning application for pressure injury prevention. I was aware that big strides had been made using AI to interpret radiologic images. But could we use AI to identify patients at risk for pressure injuries? Most likely.” So Vickee reached out to Robbie Freeman, DNP, RN, Chief Digital Transformation Officer at the Mount Sinai Health System, and asked the question.

Vickee quickly became deeply involved in exploring how AI could be used in wound care as a member of a workgroup with Kim-Anh-Nhi (Nhi) Nyugen, MSc, Senior Clinical Data Scientist, Icahn School of Medicine at Mount Sinai. “Nhi needed to know our workflow, from placing the consult to chart review and completing a consults. Shadowing the nurses at The Mount Sinai Hospital to understand how wound care prevention, assessment, and treatment currently existed, we identified more than 300 clinical data points that would indicate a profile of patients at risk,” Vickee says. “From there, we created a model called the Pressure Injury Prevention Artificial Intelligence (PIPAI) Tool that would align best with our workflow. I validated the model every day for four months on two pilot units, and after some finetuning, we scaled to five additional units. I did unit-to-unit in-service with the staff to increase tool utilization. We deployed the tool to additional units, and currently the PIPAI tool is in use in 15 units.”

The initial results from the pilot units were overwhelmingly positive. There was a nine percent increase in patients discharged without pressure injuries, compared with before the pilot started. And the model was 50 percent more accurate in identifying patients at risk compared to the current risk assessment tool, the Braden Score.

“Pressure injuries are a global issue, and a heavy financial burden for hospitals, in addition to contributing to complications for patients,” Nhi says. “Traditional methods miss more than half of patients who will develop pressure injuries. “We need to create a tool to be more proactive in prevention rather than reactive after a pressure injury happens. The tool runs independently and continuously, thus at-risk patients are identified as soon as they arrive in the unit, even before the nurses see the patients.”

The model will be rolled out to Mount Sinai Morningside later in 2025 and likely to the rest of the Health System over time.

Vickee’s face lights up with a big smile when she speaks about the impact of this AI tool. “I am so excited and happy when a patient goes home with a healed pressure injury or no injury,” she says. “With this tool, maybe we can reduce pressure injuries around the world!”