Nurse Is a “Shining Beacon” for Patients Moving From Emergency to Inpatient Care

Zhanna Makoviy, RN, FAACM, is a case manager at Mount Sinai West, guiding patients smoothly from the Emergency Department to inpatient care. Marking her 10-year anniversary with the Mount Sinai Health System, Ms. Makoviy receives high praise from her leadership, colleagues, and patients. “Zhanna exemplifies the very best of our values and mission at Mount Sinai,” says Jose Francisco Morales, BSN, CCM, Assistant Director of Case Management at Mount Sinai West. “She has been a cornerstone of our case management and emergency departments, practicing with clinical expertise, a collaborative approach, and an unwavering commitment to patient-centered care.”

Two patient caregivers expressed gratitude for Ms. Makoviy’s efforts. “I want to praise the actions and kindness of Ms. Makoviy,” one patient’s sister wrote. “She was so helpful as we moved my brother from the ED to a room. She was empathic, working with a fellow nurse to have the forms processed quickly. I owe her a deep debt of gratitude.” Another caregiver wrote, “My experience with Ms. Makoviy was wonderful. She is a shining beacon.”

Ms. Makoviy is committed to patient experience excellence, for all patients. “Every patient we encounter in the emergency room is not just a case, but a unique individual, deserving of compassionate care and meticulous attention,” she says. “As a case management nurse, I believe in the power of collaboration and advocacy, ensuring that each patient receives not only the immediate treatment they need, but also the resources and support necessary for their ongoing recovery. Our role is to bridge the gap between urgent medical needs and comprehensive care, upholding the highest standards of professionalism and empathy in every interaction. It is beautiful and fulfilling to see the positive impact a health provider’s dedication has on a patient’s journey, and I am grateful for the opportunity to contribute to this field.”

“The impact of Zhanna’s work extends beyond her clinical abilities,” says Mr. Morales, “for her humanity and compassion lead to profound impressions. Zhanna is a testament to how one person’s dedication to always go above and beyond can transform care experiences and create lasting positive outcomes for all involved.”

National Leaders on Psychological Safety Speak at Annual Mount Sinai Nursing Conference

In the Your Voice Counts all-staff survey across our system, Mount Sinai nurses identified psychological safety as a common and pressing concern. A packed auditorium was treated to a deep dive into the topic recently at the Health System’s 2024 Annual Nursing Conference, “Empowering Teams: Building a Culture of Safety and Collaboration.” Highlights included a two-pronged keynote approach by nationally recognized experts in the field, a lively panel discussion, and a Q&A session.

The importance of the material was relayed via introductory remarks by senior Mount Sinai Heath System leaders Beth Oliver, DNP, RN, FAAN, Chief Nurse Executive and Senior Vice President, Cardiac Services; Brendan G. Carr, MD, MA, MS, Chief Executive Officer, Professor and Kenneth L. Davis, MD, Distinguished Chair; and David L. Reich, MD, Chief Clinical Officer and President, The Mount Sinai Hospital and Mount Sinai Queens.

Then, the two keynote speakers recognized Mount Sinai’s reputation as a leading health care organization and set their sights on the future: How to leverage that standing to ensure delivery of care that is stronger, better, always.

Amy Edmondson, PhD, Novartis Professor of Leadership and Management, Harvard Business School, began with an engaging, no-nonsense, and at times humorous keynote, “Work Without Fear: Why Psychological Safety Matters for Safe High-Quality Care.” With a focus on work environments, she made the important point that psychological safety involves a healthy friction, creating a place where people feel comfortable pointing out mistakes to further the team’s goals. She went on to discuss key related elements:

  • How high standards and psychological safety go hand in hand
  • How various work environments function
  • How we as individuals deal with them
  • How we band together in teams to respond and excel

Thomas Lee, MD, Chief Medical Officer of Press Ganey, the patient-satisfaction survey firm—which also conducted Your Voice Counts for Mount Sinai—seamlessly picked up where Dr. Edmondson left off with his keynote, “How Do We Hard-Wire What Amy Thinks We Should Do?” He shifted the discussion from the organizational perspective to that of teams and individuals and how staff can work together to prevent errors. Dr. Lee particularly noted the concept of social capital and the importance of empowering team members to speak up if they see something out of place, and to innovate for improvement.

The two then joined Mount Sinai experts, including Pam Abner, MPA, CPXP, Senior Vice President, System Health Equity Officer, Chief Diversity Operations Officer, Mount Sinai Health System, Jonathan Nover, MBA, RN, Vice President of Nursing for Emergency Services, Mount Sinai Health System, and Beth Degen, RN, Senior Clinical Nurse, The Mount Sinai Hospital, for an engaging interdisciplinary panel discussion and Q&A session, moderated by Rebecca Anderson, MPH, Vice President of Strategy Operations, Office of the Chief Medical Officer. The overarching themes were about building inclusive, supportive care environments—setting the foundation for a safer, more unified health care future.

The conference was a practical, idea-packed day for clinicians looking to foster stronger teams and safer patient outcomes.

Mount Sinai Nursing Research Day Features Phillips School of Nursing Student Researchers

From left: Alyssa Ramkissoon, Jessica Jurgens, Kathryn Cole, Aliza Ben-Zacharia PhD, DNP, ANP-BC, FAAN

Three aspiring nurses studying at the Mount Sinai Phillips School of Nursing (PSON) were accepted into the 2024 Phillips Evidence-Based Practice/Quality Improvement (EBP/QI) Fellowship Program earlier this year and presented their projects along with nurse researchers at The Mount Sinai Hospital’s annual Nursing Research Day on Friday, November 15.

The Program, also known as the Phillips Fellowship, at PSON was developed in 2017 to increase pre-licensure nursing student experience in evidence-based practice and nursing science. Under the direction of Aliza Ben-Zacharia, PhD, DNP, ANP-BC, FAAN, and supported by lecturing professors, selected fellows undergo the development and implementation of an EBP/QI project. All projects are submitted to the review committee at the Mount Sinai Health System’s Center for Nursing Research and Innovation (CNRI) for ethical approval before implementation. At the end of the fellowship, students present their projects along with nurse researchers at The Mount Sinai Hospital’s Nursing Research Day; this year taking place on Friday, November 15. Alyssa Ramkissoon, Jessica Jurgens, and Kathryn Cole are the 2024 fellows.

The objective of Alyssa Ramkissoon’s project, Enhancing Nursing Communication in Palliative Care by Empowering Nurses Through the COMFORT Model’s Connect Module, is to increase palliative care knowledge by nurses and nursing students. Alyssa, who worked at the Mount Sinai Health System for six years as a Cardiology Research Associate and in the Department of Neuropathology/Manhattan HIV Brain Bank before enrolling in PSON, explains that in palliative care, effective communication is essential to the efficacy of nursing interventions. “Palliative care is frequently a difficult subject for new nurses to understand, and occasionally even for seasoned nurses. In their conversations with patients at the bedside, nurses frequently encounter challenging questions from the patients. Knowing how to adequately answer these questions is crucial since it affects the patient’s course of treatment. Further, hospice and palliative care are sometimes confused. It is critical to bridge this informational gap and promote confidence in nursing communication.”

Jessica Jurgens also focuses on communication for her project, Bridging the Communication Gap Between Nursing Students and Spanish Speaking Patients. She explains, “Effective communication is the cornerstone of patient care. But miscommunication between providers and patients can result in insurmountable problems, and a language barrier can compound these consequences. The Hispanic population in the United States has grown to 65 million, so there is close to a one in five chance a provider will be treating a Spanish speaking patient. While Spanish translators are often provided by hospitals, there are times when knowing simple/common phrases, similar to those that a nurse would use in their daily practice, would benefit the nurse in providing expedited answers or care, without needing to take the time to reach a translator for every interaction. This project aims to teach nursing students basic medical Spanish phrases in hopes of building their confidence and self-reliance, while addressing the language barrier. This will also save time that might be spent locating a translator, at times when only a simple question might be asked.”

Kathryn Cole also worked at Mount Sinai prior to enrolling at PSON; she was a medical scribe for the Department of Urology. The goal of her project, Cloudy Judgment: Addressing Gaps in Awareness of Cannabis Use and Surgical Patients is to enhance nursing students’ and nurses’ understanding of cannabis, particularly regarding perioperative screening and its implications. She discusses the rationale for her initiative: “As more people use cannabis for both recreational and medicinal purposes, there’s a growing need to understand how this impacts pain management during and after surgery. However, current preoperative assessments often do not adequately address cannabis use, which could lead to less effective pain management strategies. Additionally, the opioid crisis remains a significant public health issue, with nearly 75 percent of drug overdose deaths involving an opioid in 2020. This crisis continues to affect communities nationwide and addressing potential interactions between cannabis and opioids is crucial in ensuring safer pain management practices. My project explores whether incorporating simple, standardized marijuana screening tools into the nursing curriculum can lead to better pain management outcomes for patients undergoing surgery, potentially mitigating the risks associated with opioid use.”

Dr. Ben-Zacharia is understandably proud of these student fellows. “We only choose two to three fellows each year, based on numerous highly selective criteria, including GPA, faculty and peer recommendations, and a personal interview. They do most of their work in the span of one semester, including literature searches, survey implementation, and analysis, and, of course, preparing their presentations. All while they are simultaneously doing their final semester requirements and clinical rotations. We are so fortunate to have these and many other students at PSON who are committed to improving the field of nursing.”

Celebrating Excellence: The Mount Sinai Hospital Department of Nursing Earns Nine Exemplars With Fifth Consecutive Magnet Recognition®

The Mount Sinai Hospital Department of Nursing has once again distinguished itself in nursing excellence by earning its fifth consecutive Magnet Recognition®, a prestigious designation achieved by less than 1 percent of hospitals nationwide. However, what makes this achievement truly remarkable is the hospital’s receipt of nine exemplars—additional marks of excellence within the Magnet framework.

The Magnet Recognition® program, administered by the American Nurses Credentialing Center (ANCC), is the ultimate credential for nursing excellence. Earning Magnet status is a rigorous process that reflects a health care organization’s commitment to providing outstanding patient care, fostering an innovative health environment, and supporting dedicated nursing staff. ANCC uses nationwide benchmarks to determine if an organization is meeting these rigorous standards. Our recent Magnet Survey showed that we are exceeding and leading the nation in nine, underscoring Mount Sinai Nursing’s exemplary performance:

  1. Advanced Nursing Education: Mount Sinai maintained a clinical nurse staff in which 97 percent of registered nurses have a baccalaureate or higher degree, significantly surpassing the standard requirement of 80 percent.
  2. Professional Development and Improved Patient Outcomes: Innovative practices like the “Nursing Attending Model” improved patient outcomes by reducing nurse-sensitive indicators, such as falls and infections, and enhanced patient experiences in communication, teamwork, and responsiveness.
  3. Clinical Quality Indicators for Patient Burns: Mount Sinai outcomes data for ambulatory patient burns consistently outperformed national benchmarks comparison cohorts provided by the national database for the majority of eight quarters on 100 percent of the units.in managing patient burns across all units.
  4. Ambulatory Surgical Errors Management: Mount Sinai’s outcomes data on surgical errors consistently exceeded national benchmarks, demonstrating exceptional clinical performance.
  5. Patient Experience Category-Inpatient Care Coordination: The hospital excelled in inpatient care coordination, with outcomes significantly surpassing national benchmarks, showcasing their commitment to integrated and personalized patient care.
  6. Patient Experience Category-Inpatient Pain Management: Mount Sinai enhanced patient experience through exemplary inpatient pain management, outperforming national standards over eight quarters.
  7. Patient Experience Category-Inpatient Patient Education: Mount Sinai demonstrated excellence in inpatient patient education, leading to superior patient experience outcomes against national benchmarks.
  8. Patient Experience Category-Inpatient Patient Engagement and Centered Care: Mount Sinai’s approach to inpatient patient engagement and personalized care consistently led to higher patient satisfaction and exceeded national standards.
  9. Nursing Research Infrastructure: The exemplary support from the Center for Nursing Research and Innovation has led to substantial contributions to nursing knowledge, supported by significant research funding and numerous publications.

With unwavering dedication and innovative practices, the Department of Nursing at The Mount Sinai Hospital has once again established a benchmark for nursing excellence. These nine exemplars not only highlight the remarkable quality of care within our institution but also serve as a model for health care organizations worldwide. As we celebrate this significant achievement, we honor the tireless efforts and pioneering spirit of Mount Sinai’s nursing staff. Their relentless pursuit of excellence creates an environment where nurses aspire to work and patients receive the highest standard of care.

Celebrating Nurse Practitioner (NP) Week: NPs at the Heart of Health Care

Nurse Practitioner team, The Mount Sinai Hospital

The Nurse Practitioner (NP) profession originated in the 1960s through the collaborative and collegial efforts of nurse Loretta Ford, MS, EdD, FAAN, FAANP, and physician Henry Silver, MD, with an emphasis on illness prevention and health promotion including patient education.

Today, there are more than 385,000 licensed NPs bringing a comprehensive perspective to health care all across the United States. The NP role is deemed as one of the fastest growing professions, with the U.S. Bureau of Labor Statistics projecting a 46 percent increase by 2031.

In collaboration with physicians and interdisciplinary team members, NPs continue to make valuable contributions in delivering optimal patient care while minimizing duplication of clinical effort and promoting the appropriate and timely use of all health care providers on the team. NPs provide care that is respectful of and responsive to individual patient preferences, needs, and values, and ensure that patient values guide all clinical decisions.

Nurse Practitioner Week, Sunday, November 10, to Saturday, November 16, provides the Mount Sinai community with the opportunity to reflect on the valuable contributions of our approximately 900 NPs in advancing the mission, vision, and values of our organization.

Below are brief personal reflections of a few of our Mount Sinai Health System NPs on the importance of the NP role in health care:

“NPs bring a unique blend of clinical expertise and patient-centered care to health care. With advanced training, we provide comprehensive assessments, diagnose conditions, and develop treatment plans, often with a focus on preventive care and patient education,” says Meghan Costigan Kraus, FNP-BC, CDCES, Director of Diabetes Services/Endocrinology, Mount Sinai South Nassau. “NPs’ holistic approach emphasizes communication and education, fostering strong relationships and empowering the patients they care for.”

Meghan Costigan Kraus, FNP-BC, CDCES

J’Adore Larosa-Mattis, MSN, APRN, FNP-BC

“As a NP, I prioritize patient-centered care and building strong relationships with my patients and their families,” says J’Adore Larosa-Mattis, MSN, APRN, FNP-BC, Department of Surgery, Mount Sinai-Union Square. “A great NP combines clinical expertise with empathy, active listening, and a holistic approach to health. Patients often describe us as approachable and dedicated, highlighting our ability to understand their unique needs and concerns, which fosters trust and enhances their overall experience.”

“NPs bring knowledge and understanding from both nursing and medicine to care for patients and their families, enhancing our ability to collaborate with all care teams and provide the best possible care,” says Francisco Diaz, DNP, RN, NP-BC, GNP-BC, CDCES, Diabetes Care and Education Specialist, Mount Sinai Morningside.

Francisco Diaz, DNP, RN, NP-BC, GNP-BC, CDCES

Helen Wu, NP-BC

“I chose to transition from RN to NP to continue learning and expanding my ability to care for patients,” says Helen Wu, NP-BC, Heart Failure, Mount Sinai Queens. “This journey has been a significant step in my professional development, allowing me to enhance patient care through advanced practice. NPs are important to patient care and provide a blend of clinical expertise, patient-centered care, and compassion.”

“NPs approach the patient with a nursing perspective, which is grounded in being caring and compassionate, really trying to understand our patient from a human perspective,” says Lisette Kimbere, DNP, ANP-BC, Oncology Care Unit, The Mount Sinai Hospital. “We also bring the provider perspective. We understand what may be best for these patients and how to proceed with a specific line of treatment. In a way, we bring the best of both worlds to the patient and their family.”

Lisette Kimbere, DNP, ANP-BC

Holly Morhaim, MSN, NP

“An NP is a clinician who is caring, attentive, establishes trust with their patients, and uses their knowledge, expertise, and experience in bridging gaps in care,” says Holly Morhaim, MSN, NP, Clinical Program Manager, Mount Sinai Stroke Center, Mount Sinai Brooklyn.” An NP differs from a clinical nurse in being able to diagnose and treat medical conditions, order diagnostic tests, and prescribe medical therapies. NPs are nurses at heart, and in addition to diagnosing and treating patients they also focus on patients’ comfort; help bridge patients’ understanding of the disease process, treatments, and expectations; and provide more comprehensive patient education.”

“My sister has been a patient in the health care system for her whole life,” says Chloe Jones, NP, Mount Sinai West. “It can be a confusing, contradictory, and frustrating system to navigate. She has an NP on her cardiology team who is the ‘go-to person.’ If there’s a problem, she solves it. If there’s a question, she answers it. If she doesn’t know, she finds the answer. That’s the value that an NP can bring to care: being the go-to person to help guide patients and families through this often very frightening and challenging experience.”

Caring for the Community: Jill Goldstein, RN, MA, MS, Deputy Chief Nursing Officer of Mount Sinai Queens

“I love working in a true community-focused environment,” says Jill Goldstein, RN, MA, MS, Deputy Chief Nursing Officer of Mount Sinai Queens.

Jill Goldstein, RN, MA, MS, is all about community. As the nurse leader at Mount Sinai Queens, she oversees a 225-licensed-bed hospital that provides care to the surrounding neighborhoods of western Queens. She directs and supports her team of round-the-clock nursing and support staff. And she is a passionate disruptor of the too-easily-accepted limitations that contribute to the creation of far-reaching social barriers.

“I love working in a true community-focused environment,” says Ms. Goldstein, Deputy Chief Nursing Officer of Mount Sinai Queens. “We operate under one license and share the same policies with The Mount Sinai Hospital, so Mount Sinai Queens is the community complement to their quaternary setting.”

Ms. Goldstein sees this as her hospital’s superpower. “Nearly 70 percent of our hospital staff live and work among the people they see as patients. We have a strong connection to our community that’s palpable. It’s deep, and it’s real,” she says. “We take care of the same people we see in the grocery store and the bank. This, combined with the size of the hospital itself, makes it a place where people know one another’s name. There’s a familiarity here that connects us to our work in a very meaningful and caring way, the ‘Mount Sinai Queens Way.’”

This sense of caring for ourselves and our patients, families, clinical colleagues, care team members, and local and global communities is embedded into the culture of Mount Sinai Queens nursing via the professional practice model of Relationship-Centered Care.

“This is something I’m really proud of,” says Ms. Goldstein, “an example of which I call ‘Rising Stars.’ We have about two dozen-plus nurses who started their careers in non-nursing roles, such as housekeeping, dietary, or unit clerks. Each studied and worked their way through school and subsequently up through various positions to become a registered nurse. They are incredibly inspiring, and it is the gift that keeps on giving with a better than 90 percent retention rate.”

“It’s an understatement when we say that it takes a village to become a nurse,” she says. “The Rising Stars pathway speaks to how our staff assist the different members of our hospital community, how they help them rise. They surround these individuals with encouragement to get through school, to become a better version of themselves, enabling them to improve their livelihood. It’s just amazing. And it’s part of why we see staff enjoying nursing careers here that span 10, 20, 30, and 40 years.”

It is also this sense of teamwork and community that contributes to the hospital being Magnet® designated by the American Nurses Credentialing Center since 2014, the longest continuous designation of any hospital in Queens. Magnet designation is the highest available recognition of nursing excellence, achieved by only 10 percent of hospitals in the United States.

Mount Sinai recently announced that Mount Sinai Queens earned its third consecutive Magnet Recognition®. Click here to read more about the news. “I am so very proud of our nurses for this incredible achievement,” says Ms. Goldstein. “This redesignation is a tribute to our entire nursing staff and support teams, and it perfectly demonstrates their empowerment and commitment to nursing excellence.”

“Magnet® designation represents an interdisciplinary team supporting nurses to do their best work, to have optimum outcomes for patients, and to advance the delivery of care through purposeful process improvements,” says Ms. Goldstein. “The nursing leaders and their teams focus on a journey of continuous progress versus perfection. And our Magnet Champions and their respective unit practice councils bring voice to practice and drive optimum bedside care through their shared decision-making to truly create excellence together.”

Affecting the Broader Community

Among her many responsibilities, Ms. Goldstein is perhaps most passionate about her efforts to advance diversity, equity, inclusion, and belonging, both within and beyond the hospital’s walls. “I firmly believe that everything we do needs to be threaded through this work,” says Ms. Goldstein. “Diversity, equity, inclusion, and belonging are the foundation for everything we are trying to accomplish.”

In 2020, Ms. Goldstein experienced an “aha moment” after reading the book White Fragility, assigned reading for a Mount Sinai Health System C-suite meeting. “I was deeply upset by what I read. I had a true awakening. How could I have known so little about this issue? This is when I knew that I had to act. I had to be part of something bigger. I had to throw myself into places where I may have never seen myself and learn, learn, learn, and then take those learnings and pay it forward by doing something.” This was a very personal goal.

And there is plenty of work to be done. According to the National Commission to Address Racism in Nursing, 63 percent of nurses surveyed said they personally experienced an act of racism in the workplace. More than 50 percent said that racism in the workplace has affected their professional well-being. “This is unacceptable, and I’m determined to do be a disruptor in that world,” says Ms. Goldstein.

And disrupt she has.

“I got involved in a space I knew nothing about. I just inserted myself, listened more, read more, joined more, raised my hand more. I don’t always know what I’m talking about, but I do know that I’m very intentional about listening, learning, and leveraging my role to make a difference.”

Two years ago, Ms. Goldstein and colleagues started a systemwide council called Nurses Against Racism (NAR). “Nurses comprise the largest segment of the hospital workforce and are at the bedside 24/7,” she says, “and while we know racist behaviors toward nurses are prevalent, these issues can easily get swept under the rug. We want to create safe space for nurses to share their stories, their pain, their success.” Today, each entity within Mount Sinai Health System sponsors a local branch of NAR—also known as an employee resource group—that offers a safe space to share, listen to one another, and have difficult conversations.

The work of NAR also prompted the formation of a subcommittee to advance equity through quality measurement. “Alongside colleagues from the Office for Diversity and Inclusion, we embarked on a deep analytical data dive, initially looking at systemwide hospital-acquired pressure injuries (HAPI). A detailed review revealed that patients with a preferred language other than Spanish or English were at a 40 percent higher risk for HAPI than English-speaking patients. A team is in the process of confirming that practices related to HAPIs are consistent hospital-wide and engaging front-line clinical nurses to develop tests of change for improvement.

Ms. Goldstein has also been active in promoting the Health System’s Policy 130, which expressly empowers and supports nurses and other staff to speak up and directly address acts of racism and discrimination.

In collaboration with the Office of Patient Experience, Office for Diversity and Inclusion, and NAR, the Health System developed a first-of-its-kind pocket card with tips to guide nursing staff through these challenging encounters. “It’s about immediate escalation to leadership for support, zero tolerance, and de-escalating skills. Nurses agree that seven or eight times out of 10, the approach will be effective,” she says, “and when nurses share a story of when they or a leader used the policy, and it worked, those are our victories. And when it doesn’t work, we talk about it, learn from the experience, and bring that knowledge forward to take action.”

She adds, “I am determined to help make a very real and lasting difference. We have to.”

Pathway to Leadership

Ms. Goldstein moved into a leadership position relatively early in her career, and has not looked back.

A health care veteran with more than 38 years of tertiary hospital and home health care services experience, Ms. Goldstein brings a legacy of leading and delivering innovative, influential, and celebrated programs and clinical services. She has been a catalyst for change with a proven ability to drive quality improvement, fiscal fitness, patient-centered care, and lead teams to achieve positive patient experiences.

As the nurse leader at Mount Sinai Queens, Ms. Goldstein leads a nursing staff of more than 400, overseeing nursing practice, education, quality, and safety of care. She is one of many critical players in maintaining the hospital’s Magnet® designation. She is also a key player in the development and implementation of hospital-wide performance improvement programs.

Prior to joining Mount Sinai Queens, Ms. Goldstein was a vice president of operations at the Visiting Nurse Service. She is a Fellow of the Robert Wood Johnson Foundation Executive Nurse program, and she holds a Master of Science in Health Services Management and a Master of Arts in Nursing Administration from New York University’s Wagner Graduate School of Public Service.

Ms. Goldstein is a member of the American Organization of Nurse Executives and past president of the Greater New York Nassau Suffolk Organization for Nursing Leadership, the American Nurses Association, and a Fellow of the New York Academy of Medicine. In her spare time, you can find her in Aruba—her “happy place” for the last 20+ years—or with a pair of binoculars studying avian life near and far.

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