Joseph Krivoruk, BSN, CCRN

Joseph Krivoruk, BSN, CCRN, is a critical care nurse in the Intensive Care Unit (ICU) at Mount Sinai Brooklyn. During his 10 years at the hospital, he has witnessed the death of patients in his care. He is often the first health care provider a deceased’s family encounters, so he has played an important role consoling family members and offering emotional support. But Joseph long felt he wanted to do more. “I wanted families to know that although it isn’t our family member, we, as staff on the unit, understand the sadness and frustration, and we sympathize with their loss.”

The seed for an idea to do more was actually planted 14 years ago, when Joseph’s grandmother passed away from a brain hemorrhage and he was given a copy of her last CT scan. “Giving families something tangible to remember their loved one by seemed meaningful, it felt right.”

Through the spring and summer of 2023, Joseph and his family had a series of ailments and losses. During this time, he came across another hospital that gave a similar “take home” gift to families of children in the ICU. He shared his thoughts about such a gift with his manager, Jacqueline Callender, MPH, CCRN, and the Director of ICU, Ilse Martinez Espina, MD. In October 2023, the first “Message in the Bottle”—a printout of a patient’s last good heart rhythm, placed in a small bottle with a sympathy note—was given to a family member, and was positively received. The family appreciated being able to hold onto their loved one’s last heartbeat.

Message in a Bottle keepsake

Joseph’s journey into his current role hasn’t been straightforward. He began his career as an emergency medical services professional and eventually entered nursing school. “When my grandmother was ill, it became clear to me that nursing care is about dignity and safety.”  His first nursing job was in home care hospice, where, Joseph says, these lessons of dignity and the values of acknowledging family, were reaffirmed. They are, he says, among the personal life lessons he often shares with nursing students and newly hired nurses at Mount Sinai.

Temi Elegbede, BSN, RN

Najma Jean, Front End Supervisor, Clinical Neurosciences at Mount Sinai-Union Square, was working in her office when she heard a strange sound in the adjoining waiting room, like someone gasping for air.  She ran out, and her instincts proved correct: a patient was choking on something they ate. Najma ran back to the office suite and notified Temi Elegbede, BSN, RN, Manager, Patient Care Services.

“Temi immediately sprang into action, running out to the patient,” Najma recounts. “This was a terrifying situation for most of us, as the patient clearly was having difficulty breathing and speaking, but Temi took over with incredible ease and care, calming our team. He performed a successful Heimlich maneuver, and everything was instantly okay.”

Eumenide Vernet, MSN, RN, Senior Director of Nursing for Ambulatory Services, Mount Sinai-Union Square, is Temi’s supervisor. “Temi is known for doing the right thing, at the right time, right where he is,” she says. “All his training and experience kicked in when he came to this patient’s side. Always cool and collected, he intervened decisively with lifesaving results. We all think it’s a huge deal that he saved a person’s life, but to him, he did what he was supposed to do and is wondering what the fuss is all about.”

Temi, a Mount Sinai nurse since 2019, is indeed humble. “This is what I am trained to do,” he explains, “and I take my education seriously. In situations like these, you have to remind yourself that you have been equipped with the necessary problem-solving skills and be confident you can resolve even the most serious issues facing patients.”

Marsha Sinanan-Vasishta, MBA, MSN, RN, NEA-BC, CPXP

“In challenge there exists possibility” might best describe the leadership pathway and management approach of Marsha Sinanan-Vasishta, MBA, MSN, RN, NEA-BC, CPXP, Vice President and Chief Nursing Officer (CNO) of Mount Sinai Morningside and Mount Sinai West. As a little girl growing up in the Caribbean country of Trinidad and Tobago, Ms. Sinanan-Vasishta dreamed of becoming a veterinarian. It was a serious illness at a very young age that changed her life’s course.

“I got very sick when I was in Trinidad,” she says. “I had a really bad case of rubella—German measles—that required emergency surgery. My infection grew so bad that they had to remove my adenoids, tonsils, and uvula. Care in the Caribbean was completely different than what we know as care in the United States. The wards were all open, and you had to bring in your own sheets and supplies. I was so scared.”

Yet it was this experience that exposed Ms. Sinanan-Vasishta to the world of health care and its various roles, most memorably nursing.

“There was one particular nurse who was able to calm me, and my mother had a high degree of confidence in her care,” she says. “She made us feel safe and well cared for, and that changed everything. The nurses at that time would also do rotations out in the community and visit people in their homes, and I was lucky enough to have this same nurse provide my follow-up care at home. This not only exposed me to the field of nursing itself, but also to the diversity of roles within the profession. The competence and compassion it takes to care for patients in different settings, and how adaptable a nurse has to be, is so impressive. It also showed me how one person can have such an impact on someone else’s life.”

Ms. Sinanan-Vasishta knew then and there that she wanted to become a nurse. She wanted to make a difference in the world. In the years to come, her mother and father would move the whole family to New York, where they had no other family but a few friends. Ms. Sinanan-Vasishta began working as a companion in the Jewish Home and Hospital for the Aged in the Bronx and also started her nursing studies.

Creating Excellence Together

Following nursing school, as a new nurse practicing at the bedside, Ms. Sinanan-Vasishta gained a different perspective on the world of care delivery. “I loved caring for patients and their families. It was incredibly fulfilling,” she says, “but I could see so many inefficiencies, so much waste in the system itself. I had a mentor who used to challenge us by asking, ‘What isn’t working?’ and that stuck with me on the unit. Once I started thinking like that, I wanted to help change things on a broader level. That’s when I had my ‘aha’ moment: In a leadership position, I could significantly influence change and make systematic improvements.”

As she rounds in her CNO role today, Ms. Sinanan-Vasishta continues to look at nursing practice through this lens. “What are the barriers to delivering the best possible care, and how do I help remove them?”

To further prepare her for this work, Ms. Sinanan-Vasishta earned a Lean Six Sigma Green Belt. “I am an avid Lean advocate,” she says, “and I was thrilled to join Mount Sinai Morningside, since it is a Lean organization. Lean Six Sigma as a process improvement approach is focused on eliminating inefficiencies by creating solutions to eliminate waste and redundancy. The staff are my eyes and ears in this process, my patient-facing experts, and rounding provides a direct way of working together to advance practice and make things easier for them. I might be holding the wheel, but really, it’s the staff who are driving.”

Examples of this staff-driven partnership are numerous and have shown tremendous results in improving efficiency and, ultimately, care delivery.

Most recently, staff brought forward the issues of managing the workstation on wheels inventory, broken equipment protocol, and the escalation of clean supply rooms and respiratory equipment. “The medical-surgical units began to find themselves lacking specific respiratory supplies,” says Ms. Sinanan-Vasishta. “In recent years, this patient population has become more acutely ill. Certain equipment that might rarely have been needed is now used much more frequently. Staff pointed out this emerging need for a realignment of readily available supplies to support practice.”

Based upon feedback during CNO rounds, Ms. Sinanan-Vasishta invited members of the respiratory team to her nursing leadership team meeting to further examine the issue and its underlying causes. Soon, a plan emerged and is being rolled out to improve the types of respiratory supplies on these “med-surg” units.

Staff also shared that it was often challenging to distinguish between pieces of equipment, such as workstations on wheels, that were fully operational and those that were not. Non-working pieces often remained in place on the unit, pushed aside in a rush to bring working equipment to the bedside. Along with colleagues in the Digital and Technology Partners department, the nursing team created a standard protocol for submitting needed repairs and requests for parts and equipment that have since kept operations and care delivery moving without disruption. “The rollout of the new processes and procedures have gone very well at Mount Sinai Morningside,” says Ms. Sinanan-Vasishta. “We are now going to spread this work to Mount Sinai West and are exploring the feasibility of disseminating this throughout the Health System.”

In another effort to foster two-way communications with patient-facing staff, Ms. Sinanan-Vasishta recognized the important role Unit Practice Councils and a Staff Advisory Council that reported directly to the CNO might play. Unit Practice Councils, once only service-line based at Mount Sinai Morningside, are now meeting throughout the hospital and beginning to emerge throughout Mount Sinai West. “These are a terrific forum for advancing practice and relationship-centered care at the local level and throughout the hospital,” she says. “A Staff Advisory Council brings together representatives from the Unit Practice Councils to meet and communicate directly with me as CNO, and to promote the sharing of best practices, exchange of critical information, and brainstorming. This also facilitates the dissemination of their lived work and improvement experiences hospital-wide and has become a very important structure and process for giving voice to nurses. It’s empowering.”

Pathway to Leadership

Ms. Sinanan-Vashista brings both institutional familiarity and solid nursing leadership experience to her Vice President/CNO positions at Mount Sinai Morningside and Mount Sinai West. She continues to be guided in her work and life by a favorite quotation from Nelson Mandela: “It always seems impossible until it’s done.”

In 2021 she was appointed Chief Nursing Officer of Mount Sinai Morningside, having joined the hospital as Deputy Chief Nursing Officer in 2019. Before joining Mount Sinai, she was a Director of Nursing at NewYork-Presbyterian/Allen Hospital, where she provided oversight to the Emergency Department, Behavioral Health, the Dan and Jane Och Spine Hospital, and the Geriatric/Hospitalist Unit. There she helped lead several systemwide quality, patient safety, and patient experience advances. She also previously held clinical nursing leadership positions at Columbia University Irving Medical Center.

Ms. Sinanan-Vasishta is currently enrolled in the Yale Healthcare Leadership, Systems, and Policy Doctor of Nursing Program at the Yale School of Nursing. She earned her Certificate in Lean Six Sigma and Lean Six Sigma Green Belt from Vanderbilt University, and a Master of Business Administration with a concentration in Health Care Management from the University of Phoenix.

A board certified Nurse Executive, Ms. Sinanan-Vasishta was among the first nurses in the country to earn Certified Patient Experience Professional certification. She currently serves as a voluntary adjunct faculty member of the Mount Sinai Phillips School of Nursing and is a member of the Transcultural Nursing Society, the American Nurses Association, the American College of Healthcare Executives, and the International Honor Society for Nursing, and is a Fellow in the New York Academy of Medicine. She co-chairs the Health System’s Nurses Against Racism Committee to help create and sustain an anti-racist and equitable organization and foster equitable patient care within the communities served by Mount Sinai. Ms. Sinanan-Vasishta is a member of the Board of Directors of the OKB Hope Foundation, which provides health care access to rural populations in Ghana, Africa. She is also the nurse lead for Mount Sinai International Advisory Team’s collaboration with the government of Guyana, South America, to help improve health outcomes within the Guyana Public Hospital Corporation health system.

Stacey A. Conklin, MSN, RN-BC, MHCDS, NE-BC

Each year, Gallup surveys the public opinion of various professions in terms of honesty and ethics. For 21 consecutive years, nurses have come out on top. Nurses are trusted because of their integrity, advocacy, empathy, and compassion. They do whatever it takes to make a difference in the life of another. The work is very rewarding but also fast-paced and demanding, making it critically important for nurses to focus on their personal well-being as well.

“Nurses are dedicated to delivering the best and safest possible care to our patients,” says Stacey Conklin, MSN, RN-BC, MHCDS, NE-BC, Senior Vice President and Chief Nursing Officer (CNO) at Mount Sinai South Nassau. “To deliver this level of care, we have to fully support them, both professionally and as whole people. I see this as one of my top responsibilities as CNO.”

Ms. Conklin, her colleagues, and her leadership team have been conducting focus groups, doing leadership rounds, and working strenuously to better understand the needs of nurses. “My focus is on identifying the most important priorities, bringing these back to our senior leadership team, and fiercely advocating for them,” she says.

As part of this work, they are exploring emerging generational differences in the workforce. “For a new nurse, the workplace can be overwhelming at times,” she says. “There’s so much to learn. Yet, those of us who have been nurses for many years can learn some important work-life balance lessons from them.”

Historically, nurses have been known for doing whatever it takes to care for patients and their loved ones, at times to their own detriment. Ms. Conklin senses a subtle shift emerging within nursing, one that has the potential to shape the future of the profession. “As a newer generation of nurses is coming along, it’s clear they’re highly dedicated to their patients,” she says. “But they also understand better than we did that they can only give their patients their best when they are at their best.”

Creating Excellence Together

To this end, Ms. Conklin and her team have been especially focused on supporting the nursing staff in career advancement and by reducing workload.

Career Paths

“The nurses want to know they have a good career path, so we want to work with them to set goals and advance professionally,” she says. “For example, the hospital is currently expanding to add 40 critical care beds and nine operating rooms and launching a cardiac surgery program in 2025. This is an amazing opportunity for staff as they grow and get grounded. If and when they want to go into cardiac surgery, the opportunity is going to be right here.”

The hospital also offers a robust clinical ladder that gives nurses an opportunity to validate their level of expertise and be compensated accordingly. Nurses can apply to participate in a five-level system that works on a point basis. Staff earn points for different aspects of their practice, including patient experience, exemplary practice, community service, research, and others. As they progress, the requirements change to reflect a higher expected level of professional experience and expertise.

Ms. Conklin is also trying to establish pathways to leadership for millennial nurses. “There’s been an unofficial rule in nursing that you have to pay your dues before you can become a leader,” she says. “I’d like us to think differently about fostering young nurses to go into leadership roles and tap into their unique talents earlier in their careers.  We have already begun to do this with the nursing leadership team and everyone is benefitting from the connections with staff and leaders.”

Workload Reduction

Another priority involves reducing the workload of nurses. Ms. Conklin and her team are applying evidence-based models of care to remove tasks that can be time-consuming. “Being innovative is really important to me,” she says, “And that includes listening to the ideas the nurses have and looking to technology as a way to ease their burden and enhance practice.”

“The introduction of the virtual nurse on the Medical-Surgical and Telemetry units is a great example,” says Ms. Conklin. Virtual nursing involves incorporating the support of an experienced nurse into the care of a patient via a real-time telehealth or virtual connection. “The virtual nurse can conduct the majority of an admission or provide a second set of eyes for a skin check, something we would otherwise have to pull another nurse away from the bedside to do. We’re encouraging nurses to identify and delegate other tasks these virtual nurses can perform,” she says. “Like patient education, where they are spending time with the patient, and the patient is reassured that they always have someone there for them.”

Mount Sinai South Nassau is using software to assess patient acuity that accounts for not only how sick the patient is, but for the amount of time it takes to provide care. “The patient is here because they require care, but for Patient A that care may not be as time-consuming as the care necessary for Patient B,” says Ms. Conklin. “Patient B may be admitted for something minor, but their care is time-intensive. We want to understand both the complexity and intensity of the care required, so that we can staff the unit appropriately and objectively. This allows us to tailor the staffing to meet the actual needs of the patients.”

“We also want to help nurses better balance their time at work and at home, and we can do this by thinking differently about scheduling,” says Ms. Conklin. “For example, the nurses on the Behavioral Health Unit wanted to go to 10-hour shifts versus eight-hour shifts. I was all for it, and they proposed a schedule with two shifts going to 10 hours, and the overnight shift staying at eight hours. The nurses who opted for the 10-hour shifts would work only four days a week versus five. Everybody was happy, it worked, and we implemented the change at no cost to the organization. It was a huge win for the staff because they created more work-life balance.”

Pathway to Leadership

“I started school as a married mother of one and pregnant with another,” says Ms. Conklin. “Entering my career a little bit later gave me a very different perspective, and once I started my clinical experiences I never looked back.”

Initially on staff at NYU Langone Medical Center, Ms. Conklin ascended to the role of Assistant Nurse Manager. There, she helped launch a new electronic medical record, learning a lot about the topic before it was even a field. She then accepted a position in nursing education at another hospital, helping to roll out their electronic medical record in tandem with a shared governance council to better engage staff in the work. Later, she took her talents to a systemwide information technology position, all while working on her Master of Science in Health Care Delivery at Dartmouth College.

“I learned a lot about technology, workflow, and hospital operations and was able to use my clinical knowledge to really enhance workflows across the organization,” says Ms. Conklin. “But, I was feeling very disconnected from patient care. I wanted to go back into nursing and become a CNO, and I was fortunate to have a great mentor who helped me do just that. And, as a CNO at the height of the pandemic, when we had to open virtual units, my IT background became instrumental in helping operationalize units and technology in non-traditional patient care areas.”

Ms. Conklin has more than 20 years of experience in nursing administration and patient care. She was Director of Patient Care Services at Mount Sinai Beth Israel and Chief Information Officer at North Shore University Hospital in Manhasset, New York. She later served as Senior Director of Patient Care Services at New York Eye and Ear Infirmary of Mount Sinai before being named Vice President of Patient Care Services and Chief Nursing Officer there. Today, Ms. Conklin oversees all nursing activities at Mount Sinai South Nassau, and the more than 900 registered nurses who ensure the delivery of consistent high-quality care to their community. A testimony to the hospital’s Nursing Service, the American Nurses Credentialing Center (ANCC) recently designated Mount Sinai South Nassau a Magnet hospital for the third time, the highest available recognition of excellence in nursing care.

Ms. Conklin served as an adjunct professor of Graduate Nursing at Molloy College, where she received her Bachelor of Science in Nursing. She earned her Master of Science in Nursing from Walden University in Baltimore, and her Master of Science in Health Care Delivery from Dartmouth College. Ms. Conklin is board certified by the ANCC in both Nursing Informatics and as a Nurse Executive. She is a member of the American Nurses Association and a Fellow of The New York Academy of Medicine.