Tracy Bertiz, DNP, ACNP-BC, CHFN

The Center for Nursing Research and Innovation at Mount Sinai recently interviewed Tracy Bertiz, DNP, ACNP-BC, CHFN, Nurse Practitioner at Mount Sinai Fuster Heart Hospital, about her quality improvement initiative, “Improvement of Nurses’ Ability in Addressing Low Health Literacy to Reduce Hospital Readmission in Adult Heart Failure Patients.” Presented as a poster at Nursing Research Day 2023, the findings were published last month as an abstract in the journal Practical Implementation of Nursing Science. 

What sparked the idea behind your project?

As a Cardiology Nurse Practitioner, I’ve always considered the frequent hospital readmission of our heart failure patients a big challenge. We call them our “frequent flyers.” We have multiple initiatives addressing this issue, but the readmission rate has remained high in spite of our best efforts. Since health literacy can play a large role in the gaps in care experienced by heart failure patients, my project team and I decided to teach nurses and other care team providers how to assess health literacy, and how to use targeted communication strategies to help patients better understand discharge instructions. We chose to work with staff at Mount Sinai’s Transitions of Care Center (TOCC) because of their important connection to patients as they move from one setting to another. Our goal was to decrease the 30-day heart failure readmission rate by training the care team to first assess the health literacy of their patients, and then to offer practical discharge instructions tailored to each individual’s level of understanding. We found that patients benefitted from their care providers using simple language, which helped them develop self-efficacy and better navigate the health care system.

*The above is a sample from the virtual training.

How did teamwork help make the project a success?

The TOCC team was a catalyst for change, and the teamwork we built helped us achieve remarkable results. Additionally, the commitment of the TOCC to close the gaps in care for patients transitioning from hospital to home helped make this project sustainable. I want to acknowledge my Doctor of Nursing Practice (DNP) project team, Tara Cortes, PhD, RN, FAAN, and Chenjuan Ma, PhD, RN, at the NYU Rory Meyers College of Nursing. Their constant mentoring helped me succeed in this endeavor. I also want to recognize the leadership and staff at the TOCC: Esther Pandey, DNP, MS, RN, System Vice President of Care Transitions; Carl Jin, MSN, MPA, RN, Director of Clinical Services; Arzellra Walters, MA, CPNP, RN, Nurse Manager; and the Center’s fantastic nurses. They were instrumental in implementing the initiative. This project would not have materialized without them.

What have you learned from your project?

I have learned that TOCC nurses play a significant role as frontline health care coaches for patients across the Mount Sinai Health System. Effective communication is critical to patients’ adherence to their medications, regular follow-up with health care providers, and self-care of chronic medical conditions.

What new ideas are you hoping to pursue after this experience?

I want to continue to gather and share insights about the importance of assessing health literacy in all patients, regardless of their educational background. Awareness of health literacy can enable care providers to communicate more effectively, but this is only one part of the equation. I think it’s also important to assess patient self-efficacy after receiving instructions targeted to their health literacy level. I would like to investigate whether particular methods of teaching are effective in driving change in patient outcomes.

What advice would you give other Mount Sinai nurses who are thinking of starting a similar project or submitting an abstract?

Mount Sinai nurses who want to start a project must be passionate about their topic to sustain their effort through the intervention period and beyond. Getting other people involved is difficult if your project does not add value for them, so you need to offer something to generate “buy-in” from all the stakeholders involved. In addition, you need to have a clinical mentor who cares about the outcome of your project, and you have to take advantage of the resources available at Mount Sinai, such as the Nursing Project Approval Council at the Center for Nursing Research and Innovation.

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.